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.

This book provides a concise, applied research approach to support mental health in schools. It outlines a proactive approach for school leaders to address mental health. The authors' expansion of MTSS to include a fourth tier is an essential shift to effectively respond to the ongoing student mental health crisis. This book is an essential guide for school leaders to work within their sphere of control to address it.

• 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 ActionChapter 13: Resources