Why Traditional Student Support Models Are Breaking and What Districts Are Doing Instead

May 4, 2026
Vanessa Howe

Table of Contents

Overview

School-based mental health systems are under increasing strain as student needs outpace traditional support models. This recap explores why the Multi-Tiered System of Supports is breaking down and how the emerging “Fourth Tier” approach, combined with teletherapy, is helping districts respond more effectively.

District leaders share how rising student needs, staff burnout, and gaps in access to care are reshaping MTSS, and why a more coordinated approach is gaining momentum.

If you work in a school building right now, this may resonate: school support teams have become extremely stretched in their ability to manage the behavioral health needs of their students.

As a licensed clinical social worker and Director of K12 Therapy at TimelyCare, I talk to district leaders every single day. The consensus? Districts are trying to empty the ocean with a leaky bucket.

I recently had the absolute pleasure of sitting down with Dr. Armand Pires, the 2025 Massachusetts Superintendent of the Year, and Ryan Sherman, Director of Wellness for Medway Public Schools. They co-authored The Fourth Tier, a brilliant guide for district leaders that looks at why traditional mental health frameworks are crumbling and what we can actually do about it.

If you missed our webinar, Beyond Tier 3: What the Fourth Tier Means for Student Mental Health, I’ve compiled the most important takeaways right here.

Why the Traditional Three-Tier Model is Breaking

The traditional Multi-Tiered System of Supports (MTSS) was designed for a different era. It works great when only one to five percent of your students have intense, clinical mental health needs. But what happens when that number jumps to ten or twenty percent?

The system breaks.

This is a topic that's super important for me as a school leader. In two thousand fifteen, when I took over as superintendent and finally had the sort of the keys to the district, one of the first things that I started to do was add staff. Right? We had this staffing challenge around student mental health, what seemed to be a staffing challenge around student mental health, and really thought that adding staff was the logical solution. And soon after I started in the role, Ryan joined the district, and we started really seeing that we weren't having the impact. What we were seeing was, regardless of the staffing levels being increased, we weren't seeing substantive changes with regard to outcomes for students, the number of students who are in crisis. In fact, we can we continue to see an acceleration of both intensity and the number of students that needed more, levels of higher levels of support. So we were dealing with a supply and demand imbalance, but when we added supply, it didn't really have the impact anticipated on demand. And as a result, what we saw in schools, and what we often see in schools is a lot of reaction to those students who have highest level of needs, both an increasing number of students overall with higher needs, but also an increasing level of intensity. And, you know, we recognized pretty early on that we just were not designed for that. Most of our staff at the time hadn't dealt with students who were traditionally not seen in public schools. We then pretty quickly get into pandemic times when we see a further acceleration of this, and you realize that the system is really broken. And because our staff was spending so much of their time dealing with the, very intensive need students and trying to manage and coordinate care for them, they were in fact not able to get to what we traditionally think of as the other tiers of MTSS.

Adding staff sounds like the solution, but demand continues to outpace capacity. This clip shows why traditional approaches fall short.

Dr. Pires shared a story that probably sounds familiar. When he became superintendent, his first instinct was to hire more staff. It seems logical, right? More students with needs equals more counselors. But what he found was that adding supply didn’t actually curb the demand.

Instead of doing proactive, Tier 1 and Tier 2 prevention work – like dropping into classrooms to teach social-emotional skills – counselors were spending their effort navigating the complexities of the current behavioral health system, attempting to locate providers with availability and those who accepted the student’s insurance.

The Toll on Staff and Students

When school staff are constantly swimming against the tide, it creates a system and environment for burnout. Meanwhile, the students who could have been served in Tier 1 or 2 supports end up requiring more intensive interventions when schools are unable to dedicate the time and resources to universal and/or earlier supports.

We end up with a massive bottleneck, exhausted educators, and kids who are slipping through the cracks.

And I adding on to what Armen mentioned, we did add resources to tier three, but there was just never going to be enough addition that worked with the prevalence and intensity that student mental health needs were increasing at. The rate was just going too fast for anyone to keep up, let alone in today's budget. What we're seeing in that three tier model, which worked well when it was designed for about one to five percent of students with that intensity and mental health needs, that those could be met through an IEP, in some in school counseling, and perhaps a referral to the pediatrician who had a a relatively average size prevalence of need and could work with outside clinicians to get them the care they need, but when this, and this isn't a new thing, it certainly accelerated in the pandemic, but even prior, just with the rates of increases in in need, what we're seeing at the tier three level was ten to twenty percent of students. And what that looked like in school was, as Armen mentioned, our counselors spending all their time reaction in reactionary mode, trying to help students with behavior and manage the school day and having them in their office on the phone with adults, whether that was parents trying to get in home supports or navigate insurance or on the phones with providers trying to find openings for their students.

When Tier 3 expands, counselors are pulled into constant crisis response—leaving little room for prevention.

Introducing a Fourth Tier and New Mindset

So, how do we fix this? According to Pires and Sherman, we have to stop waiting for the broader pediatric mental health system to save us. It is heavily backlogged. If we want our kids to get help, schools have to take the reins.

The “Fourth Tier” is both a mindset shift and a programmatic approach. It means acknowledging that coordinating and providing direct care is now part of the school’s job.

For all my building and and district leader colleagues who are out there, we have to get past the old model and understand that it it has become our responsibility as building and district leaders to make sure that we're providing the coordination of or direct care for students. No one else is going to do it. There's not a system. This system isn't going to fix itself. We're in a space where if we're not doing it for our students, then it's simply not happening. And the the lengthy wait times and the lack of persistence in care that we've seen in the traditional model results in more intense needs, staff being burned out, and you're kind of in this cycle of ineffectiveness largely. So conceptually, the shift really for tier four is like, it's our responsibility. Very clearly, it's our responsibility. Should it be as an argument we can have at some point, whether or not this funding is an argument we can have, but it very clearly is. And if we don't do something to act now, then we're gonna continue to impact the potential trajectories of the students for whom we are responsible.

If schools don’t build the bridge to care, it often doesn’t happen.

Core Pieces of the Fourth Tier

Building a responsive system requires a few critical elements:

- Universal screening
- Care coordination
- In-school outpatient therapy
- Wraparound support

Removing Barriers to Student Mental Health Support

If there’s one thing that can shift access to student mental health support, it’s removing the barriers that prevent students and families from following through on care.

As Medway’s Director of Wellness, Dr. Ryan Sherman explained: “In the United States as a whole, if we look at a hundred students who… have mental health concerns… We know that about twenty of those will have their concerns identified and referred. And of that twenty, four of those on average will get to a clinical level of care. Meaning that they’ll get referred to care, they’ll go to enough sessions for a significant change in their clinical disposition.”

Why? Because access doesn’t fail in one place. It breaks down across transportation, scheduling, provider availability, and family capacity.

In this short clip, district leaders explain how reducing real-world barriers helps more students actually follow through on care.

More flexible approaches to care help address these gaps. Students can access support without missing school or activities, and families no longer have to navigate long drives or complex logistics. At the same time, access expands to a broader network of providers, including those who reflect the languages and backgrounds of the students being served.

Supporting Younger Students and Their Families

Accessible care is just as important for younger students. Traditional talk therapy often doesn’t resonate at early ages, but more engaging, developmentally appropriate approaches can.

Just as importantly, these models bring caregivers into the process. Instead of treating the child in isolation, families gain practical tools.

Engaging Families to Break Down Stigma

Although progress has been made around mental health stigma, it still exists. Schools are well-positioned to normalize talking about mental health, building social and emotional resiliency, and asking for help when it’s needed. You are already a trusted community hub. Parents look to you for education, meals, and safety. When mental health support is offered through the school, it normalizes the entire concept.

Most families struggling with their kids' mental health never actually get help. Not because care doesn't exist, but because the system is just too complicated to navigate alone. Schools already help families access food and social services. Mental health care should be no different. Schools have become an access point for so many things, for access to food, to social services, and now, know, certainly our approach is mental health care. And so schools can be a place to normalize this, not only with our students, but our families. For some reason, it's just more acceptable when it's coming through the school or if it's happening during the school day than it would be for them to try to navigate an incredibly complicated system on their own. There's a significant drop off in traditional care pathway where very few students make it to meaningful sustained treatment. In contrast, school based models that remove barriers see dramatically higher follow through and completion rates. When we talk about barriers to care, know, I talked about earlier about four percent of those students make it through the care they need. Our virtual care model, we see those numbers high as high as in the 70s, seventy percent with students. And for younger students especially, the parent is the intervention. Forty percent of their referrals go straight to parent guidance. About forty percent of our referrals go to this parent guidance piece because it is such a crucial component. When schools normalize mental health and treat families as partners, they become the trusted access point that actually changes outcomes.

Schools can make mental health support more approachable and reduce stigma for families

It tells families, “This is just a normal part of how we support your child’s education.” Taking the burden off parents to navigate a complex medical system makes them far more likely to engage. We want to make saying “yes” to therapy the easiest decision a parent makes all week.

Where Do We Go From Here?

You don’t have to overhaul your entire district overnight.

Start small:

Listen to your counselors
Reduce care coordination burden
Explore community and virtual care partnerships

When you remove friction for both staff and families, you create a system where students can actually get the support they need.

We can lead through this moment—but not with outdated models or mindsets.

If you want to replay the full webinar, check it out here

The ROI of Student Mental Health

We all know this work is the right thing to do for kids. But when you have to pitch this to a school board or a town council, you need data.

Here’s the reality: investing in mental health drives meaningful outcomes.

Most schools know students are struggling. The real question is whether investing actually moves the needle on attendance, grades, and the budget. On average, over nine out of ten students who have a mental health concern aren't having those needs met by the outpatient traditional referral system. Those unmet needs overflow into schools as something districts track closely, chronic absenteeism. Rates of chronic absenteeism are going up. Certainly that correlates with the prevalence of depression and anxiety. It's almost an exact correlation in some cases in our high school students. So I think that's how schools are really feeling it, whether they're just not coming to school or they are and they're really disruptive, not because they want to be, it's because they don't have the skills they need from these unmet needs. Over seventy percent of our chronically absent students came to school more often post intervention, regardless whether it was teletherapy, care coordination, in school outpatient therapy, wraparound, whatever it might be. And then academics actually GPA, increased at even higher rate around seventy seven percent for those engaged in those services. And that same investment pays off on the budget side by keeping students out of costlier interventions later. If we invest this amount of money, we can anticipate over this this amount of time of avoiding these costs. And then, of course, it's better for kids, and kids will have improved outcomes, which is the argument. But it's interesting because at the end of the day, is a bottom line kind of issue and a decision that we have to make about where our fiscal priorities are. And we found that, to Ryan's point, that spending some energy and resources in this space has really paid dividends. And not just the idealistic dividends that educators hope for of improved outcomes, but really dividends with regard to financial impact. Better attendance, higher GPAs, real cost avoidance. Student mental health isn't a feel good budget line. It's one of the smartest investments a district can make.

Mental health support is linked to improved attendance and academic performance.

When Medway Public Schools rolled out these supports:

Over 70% of chronically absent students improved attendance
GPAs went up
Students were in-class, learning again

Beyond academics, this is also a cost avoidance strategy. Supporting students earlier prevents more intensive—and more expensive—interventions later.

Key Takeaways

Traditional MTSS frameworks were not designed for today’s level of student mental health need and are now under significant strain.
Hiring more staff alone does not solve the problem, as demand continues to outpace available resources.
The Fourth Tier introduces a new approach that includes care coordination, in-school therapy, and proactive screening.
Teletherapy significantly improves access and engagement, with much higher rates of clinical follow-through compared to traditional referrals.
Investing in student mental health leads to measurable improvements in attendance, academic performance, and long-term cost savings.

FAQs

What is the Fourth Tier in student mental health?

The Fourth Tier is an expansion of traditional MTSS that includes direct care coordination and service delivery within schools. It shifts responsibility toward schools to actively connect students with mental health support rather than relying solely on external systems.

Why is the traditional MTSS model no longer sufficient?

The model was designed for a smaller percentage of students needing intensive support. As that number has grown significantly, schools are overwhelmed, and the system can no longer meet demand effectively.

How does teletherapy improve student access to care?

Teletherapy removes common barriers like transportation, scheduling conflicts, and provider shortages. This makes it easier for students and families to consistently engage in care, leading to better outcomes.

Is teletherapy effective for younger students?

Yes. Teletherapy can incorporate interactive, play-based strategies that engage younger students while also involving parents directly in the care process.

What outcomes can schools expect from investing in mental health support?

Schools can see improved attendance, higher GPAs, reduced staff burnout, and lower long-term costs by preventing the need for more intensive interventions later.

Vanessa Howe

Director, Therapy K-12

Vanessa leads TimelyCare's K-12 therapy team. She is a licensed therapist and clinical supervisor and also holds a school social work certification. Vanessa is a graduate of Grand Valley State University with eighteen years of experience in the social work field. Vanessa began her career as a school social worker in K–12 districts in Michigan. Vanessa brings extensive expertise in delivering behavioral health care to children, adolescents, and families, as well as in building and leading integrated behavioral health programs. She is deeply passionate about expanding access to care, utilizing evidence-based practices, and ensuring high-quality service delivery.

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