The Fourth Tier

Armand Pires, PhD, has served as Superintendent of Schools in Medway, Massachusetts since 2015. Prior to this role he served as assistant superintendent, director of curriculum, principal and assistant principal at the middle and high school level, as well as a teacher at the middle and high school level. Armand was also recognized as the 2025 Massachusetts Superintendent of the Year.Ryan Sherman, DBH, has been the director of wellness for a Massachusetts school district since 2016, bridging school and mental health services. He previously worked as a behavioral health provider at Massachusetts General Hospital and is a senior professor in social and emotional learning at Bay Path University . Dr. Sherman has received multiple awards, including the MIAA Wellness Coordinator of the Year. For more, visit www.SELTier4.com.

• Chapter 1: Introducing a New Approach to an Escalating ProblemPart 1: Defining the ChallengeChapter 2 - Unraveling the Crisis: The Rise of Youth Mental Health ChallengesChapter 3 - The Limitation of the Pediatric Mental Health SystemChapter 4 - The Impact of the Youth Mental Health Crisis in SchoolsPart 2: An Expanded Planning FrameworkChapter 5: The Multi-Tiered Systems of Support Framework and Tier 4Chapter 6: What is MTSS Tier 4 and Why Do Schools Need it?Chapter 7: Advantages of a MTSS Tier 4 ModelChapter 8: Planning for SuccessPart 3: Putting the Plan into ActionChapter 9: Building a MTSS Tier 4 ModelChapter 10: Planning for Financial SustainabilityChapter 11: MTSS Tier 4 Model ExamplesChapter 12: A Call to ActionPart 1: Defining the ChallengeChapter 2: Unraveling the Crisis: The Rise of Youth Mental Health ChallengesThe Good News First The Benefits of Socializing Online Helicopter Parenting Has Its PerksThe Youth Mental Health Crisis In America The Pre-Pandemic Rise In PrevalenceThe Post-Pandemic Youth Mental Health Crisis A Product of Their Environment: What’s Fueling the Mental Health CrisisDigital Media and Youth Mental HealthYouth Social Media Use and Mental Health Concerns Perfecting Your Online ImageThe Fear of Missing Out (FOMO)Mobile Devices and Sleep The Assault on Family Protective Factors Key TakeawaysWhat’s Next?Chapter 3: The Limitations of the Pediatric Mental Health System Where Have All the Mental Health Providers Gone?The Plight Of the PediatricianReferring To The AbyssShow Me The Money…Wait, What Money?The Ultimate BottleneckThe Search For Pediatric Mental Health AppointmentsKey TakeawaysWhat’s Next?Chapter 4: The Impact of the Youth Mental Health Crisis on Schools The ImpactThe StudentImpact on the Staff and School ClimateSchool Leaders’ PerspectiveAccepting Our ResponsibilityKey TakeawaysWhat’s Next?Part 2: An Expanded Planning FrameworkChapter 5: The MTSS Framework and Tier 4A Brief HistoryThe MTSS Tiers - An OverviewTime for an Expanded MTSS ModelA Revised ModelWhat does a Tier 4 MTSS Model look like?Key TakeawaysWhat’s Next?Chapter 6: What is MTSS Tier-4, and Why Do Schools Need It?Limitations of MTSS Tier 3A Reactionary Approach to SupportA Sloth-Like Approach to Receiving SupportsChallenges with the Outpatient Referral Model MTSS SEL Tier-4Essential Components of an MTSS Tier-4 Model Key TakeawaysWhat’s Next?Chapter 7: Advantages of the Tier-4 Model Student Benefits Associated With the Tier 4 Model An Ounce of Mental Health Screening is Worth a Pound of CureIncreased Mental Health Access = Better EducationWraparound Care Improves Student Outcomes School and District Benefits Associated With the Tier 4 Model Key TakeawaysNext Steps?Chapter 8: SEL Tier 4 Components Proactive Mental Health Screening And Identification Practices Before You StartApproaches To Universal Mental Health Screening Social And Emotional Learning Competency ScreeningSocial, Emotional, And Behavioral Functioning ScreeningMental Health Disorder Screening Gatekeeper Training Selecting A Universal Screening Tool Or Gatekeeper Training Dedicated Care Coordination The Need For Care Coordination? Defining Care Coordination Benefits Of Care CoordinationStudents and Families School CounselorsCommunity Partner Spotlight: Care SolaceIn-School Outpatient Therapy Benefits Identifying Partners TeletherapyWrap-Around Mental Health ServicesModel ComponentsBenefits School-Based Wrap-Around Mental Health ModelsKey TakeawaysWhat’s Next?Part 3: Putting the Plan into ActionChapter 9: Planning for SuccessConducting an Environmental ScanThe Needs AssessmentCommunity Partner Spotlight: The JED FoundationBuilding Support and MomentumLaunching the Steering CommitteeDeveloping a Communication PlanCommunity Partner Spotlight: kartoonEDUKey TakeawaysNext Steps?Chapter 10: Planning for Financial SustainabilityStaffing for Sustainability Searching for ResourcesDeveloping and Nurturing RelationshipsExisting ResourcesOperating BudgetsCommunity Partner Spotlight: Effective School SolutionsLocal and City/Town ResourcesTown/City SupportsLocal Health AgenciesNational Organizations and Governmental AgenciesFederal AgenciesPrivate FoundationsSeed GrantsKey TakeawaysWhat’s Next?Chapter 11: MTSS Tier-4 Model ExamplesCase Example # 1 Lakeside Public Schools Community Partner Spotlight: CartwheelCase Example # 2 Riverbend Area School District Case Example # 3 Cedar Ridge Local School District What would your district’s Tier-4 program example look like?Key TakeawaysWhat’s Next?Chapter 12: A Call to ActionA Farewell to Traditional MTSS What Lies Ahead for School Mental Health? Chapter 13: Resources