The Fourth Tier
Modernizing MTSS for Student Mental Health
Will be published approx. on 19. March 2026
Book
Hardback
176 pages
978-1-4758-7504-1 (ISBN)
Description
Providing an overview of the student mental health crisis, The Fourth Tier shares a framework to support the development of support that schools and districts can enact to better meet the needs of all students. By leveraging the existing Multi-Tiered Systems of Support (MTSS) model as a starting point and adding a critical fourth tier, this book provides a framework for educators and decision-makers to review, plan, and implement an enhanced level of support for their students.
More details
Series
Language
English
Place of publication
United States
Publishing group
Bloomsbury Publishing Plc
Target group
Professional and scholarly
Illustrations
13 b/w figures, 5 tables, 10 textboxes
Dimensions
Height: 235 mm
Width: 157 mm
Thickness: 14 mm
Weight
412 gr
ISBN-13
978-1-4758-7504-1 (9781475875041)
Copyright in bibliographic data and cover images is held by Nielsen Book Services Limited or by the publishers or by their respective licensors: all rights reserved.
Schweitzer Classification
Persons
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.
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.
Content
Chapter 1: Introducing a New Approach to an Escalating Problem
Part 1: Defining the Challenge
Chapter 2 - Unraveling the Crisis: The Rise of Youth Mental Health Challenges
Chapter 3 - The Limitation of the Pediatric Mental Health System
Chapter 4 - The Impact of the Youth Mental Health Crisis in Schools
Part 2: An Expanded Planning Framework
Chapter 5: The Multi-Tiered Systems of Support Framework and Tier 4
Chapter 6: What is MTSS Tier 4 and Why Do Schools Need it?
Chapter 7: Advantages of a MTSS Tier 4 Model
Chapter 8: Planning for Success
Part 3: Putting the Plan into Action
Chapter 9: Building a MTSS Tier 4 Model
Chapter 10: Planning for Financial Sustainability
Chapter 11: MTSS Tier 4 Model Examples
Chapter 12: A Call to Action
Part 1: Defining the Challenge
Chapter 2: Unraveling the Crisis: The Rise of Youth Mental Health Challenges
The Good News First
The Benefits of Socializing Online
Helicopter Parenting Has Its Perks
The Youth Mental Health Crisis In America
The Pre-Pandemic Rise In Prevalence
The Post-Pandemic Youth Mental Health Crisis
A Product of Their Environment: What's Fueling the Mental Health Crisis
Digital Media and Youth Mental Health
Youth Social Media Use and Mental Health Concerns
Perfecting Your Online Image
The Fear of Missing Out (FOMO)
Mobile Devices and Sleep
The Assault on Family Protective Factors
Key Takeaways
What's Next?
Chapter 3: The Limitations of the Pediatric Mental Health System
Where Have All the Mental Health Providers Gone?
The Plight Of the Pediatrician
Referring To The Abyss
Show Me The Money...Wait, What Money?
The Ultimate Bottleneck
The Search For Pediatric Mental Health Appointments
Key Takeaways
What's Next?
Chapter 4: The Impact of the Youth Mental Health Crisis on Schools
The Impact
The Student
Impact on the Staff and School Climate
School Leaders' Perspective
Accepting Our Responsibility
Key Takeaways
What's Next?
Part 2: An Expanded Planning Framework
Chapter 5: The MTSS Framework and Tier 4
A Brief History
The MTSS Tiers - An Overview
Time for an Expanded MTSS Model
A Revised Model
What does a Tier 4 MTSS Model look like?
Key Takeaways
What's Next?
Chapter 6: What is MTSS Tier-4, and Why Do Schools Need It?
Limitations of MTSS Tier 3
A Reactionary Approach to Support
A Sloth-Like Approach to Receiving Supports
Challenges with the Outpatient Referral Model
MTSS SEL Tier-4
Essential Components of an MTSS Tier-4 Model
Key Takeaways
What'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 Cure
Increased Mental Health Access = Better Education
Wraparound Care Improves Student Outcomes
School and District Benefits Associated With the Tier 4 Model
Key Takeaways
Next Steps?
Chapter 8: SEL Tier 4 Components
Proactive Mental Health Screening And Identification Practices
Before You Start
Approaches To Universal Mental Health Screening
Social And Emotional Learning Competency Screening
Social, Emotional, And Behavioral Functioning Screening
Mental 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 Coordination
Students and Families
School Counselors
Community Partner Spotlight: Care Solace
In-School Outpatient Therapy
Benefits
Identifying Partners
Teletherapy
Wrap-Around Mental Health Services
Model Components
Benefits
School-Based Wrap-Around Mental Health Models
Key Takeaways
What's Next?
Part 3: Putting the Plan into Action
Chapter 9: Planning for Success
Conducting an Environmental Scan
The Needs Assessment
Community Partner Spotlight: The JED Foundation
Building Support and Momentum
Launching the Steering Committee
Developing a Communication Plan
Community Partner Spotlight: kartoonEDU
Key Takeaways
Next Steps?
Chapter 10: Planning for Financial Sustainability
Staffing for Sustainability
Searching for Resources
Developing and Nurturing Relationships
Existing Resources
Operating Budgets
Community Partner Spotlight: Effective School Solutions
Local and City/Town Resources
Town/City Supports
Local Health Agencies
National Organizations and Governmental Agencies
Federal Agencies
Private Foundations
Seed Grants
Key Takeaways
What's Next?
Chapter 11: MTSS Tier-4 Model Examples
Case Example # 1 Lakeside Public Schools
Community Partner Spotlight: Cartwheel
Case 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 Takeaways
What's Next?
Chapter 12: A Call to Action
A Farewell to Traditional MTSS
What Lies Ahead for School Mental Health?
Chapter 13: Resources
Part 1: Defining the Challenge
Chapter 2 - Unraveling the Crisis: The Rise of Youth Mental Health Challenges
Chapter 3 - The Limitation of the Pediatric Mental Health System
Chapter 4 - The Impact of the Youth Mental Health Crisis in Schools
Part 2: An Expanded Planning Framework
Chapter 5: The Multi-Tiered Systems of Support Framework and Tier 4
Chapter 6: What is MTSS Tier 4 and Why Do Schools Need it?
Chapter 7: Advantages of a MTSS Tier 4 Model
Chapter 8: Planning for Success
Part 3: Putting the Plan into Action
Chapter 9: Building a MTSS Tier 4 Model
Chapter 10: Planning for Financial Sustainability
Chapter 11: MTSS Tier 4 Model Examples
Chapter 12: A Call to Action
Part 1: Defining the Challenge
Chapter 2: Unraveling the Crisis: The Rise of Youth Mental Health Challenges
The Good News First
The Benefits of Socializing Online
Helicopter Parenting Has Its Perks
The Youth Mental Health Crisis In America
The Pre-Pandemic Rise In Prevalence
The Post-Pandemic Youth Mental Health Crisis
A Product of Their Environment: What's Fueling the Mental Health Crisis
Digital Media and Youth Mental Health
Youth Social Media Use and Mental Health Concerns
Perfecting Your Online Image
The Fear of Missing Out (FOMO)
Mobile Devices and Sleep
The Assault on Family Protective Factors
Key Takeaways
What's Next?
Chapter 3: The Limitations of the Pediatric Mental Health System
Where Have All the Mental Health Providers Gone?
The Plight Of the Pediatrician
Referring To The Abyss
Show Me The Money...Wait, What Money?
The Ultimate Bottleneck
The Search For Pediatric Mental Health Appointments
Key Takeaways
What's Next?
Chapter 4: The Impact of the Youth Mental Health Crisis on Schools
The Impact
The Student
Impact on the Staff and School Climate
School Leaders' Perspective
Accepting Our Responsibility
Key Takeaways
What's Next?
Part 2: An Expanded Planning Framework
Chapter 5: The MTSS Framework and Tier 4
A Brief History
The MTSS Tiers - An Overview
Time for an Expanded MTSS Model
A Revised Model
What does a Tier 4 MTSS Model look like?
Key Takeaways
What's Next?
Chapter 6: What is MTSS Tier-4, and Why Do Schools Need It?
Limitations of MTSS Tier 3
A Reactionary Approach to Support
A Sloth-Like Approach to Receiving Supports
Challenges with the Outpatient Referral Model
MTSS SEL Tier-4
Essential Components of an MTSS Tier-4 Model
Key Takeaways
What'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 Cure
Increased Mental Health Access = Better Education
Wraparound Care Improves Student Outcomes
School and District Benefits Associated With the Tier 4 Model
Key Takeaways
Next Steps?
Chapter 8: SEL Tier 4 Components
Proactive Mental Health Screening And Identification Practices
Before You Start
Approaches To Universal Mental Health Screening
Social And Emotional Learning Competency Screening
Social, Emotional, And Behavioral Functioning Screening
Mental 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 Coordination
Students and Families
School Counselors
Community Partner Spotlight: Care Solace
In-School Outpatient Therapy
Benefits
Identifying Partners
Teletherapy
Wrap-Around Mental Health Services
Model Components
Benefits
School-Based Wrap-Around Mental Health Models
Key Takeaways
What's Next?
Part 3: Putting the Plan into Action
Chapter 9: Planning for Success
Conducting an Environmental Scan
The Needs Assessment
Community Partner Spotlight: The JED Foundation
Building Support and Momentum
Launching the Steering Committee
Developing a Communication Plan
Community Partner Spotlight: kartoonEDU
Key Takeaways
Next Steps?
Chapter 10: Planning for Financial Sustainability
Staffing for Sustainability
Searching for Resources
Developing and Nurturing Relationships
Existing Resources
Operating Budgets
Community Partner Spotlight: Effective School Solutions
Local and City/Town Resources
Town/City Supports
Local Health Agencies
National Organizations and Governmental Agencies
Federal Agencies
Private Foundations
Seed Grants
Key Takeaways
What's Next?
Chapter 11: MTSS Tier-4 Model Examples
Case Example # 1 Lakeside Public Schools
Community Partner Spotlight: Cartwheel
Case 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 Takeaways
What's Next?
Chapter 12: A Call to Action
A Farewell to Traditional MTSS
What Lies Ahead for School Mental Health?
Chapter 13: Resources