Getting “SMART” about implementing multi-tiered systems of support to promote school mental health

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14 Scopus citations


With the growing adoption and implementation of multi-tiered systems of support (MTSS) in school settings, there is increasing need for rigorous evaluations of adaptive-sequential interventions. That is, MTSS specify universal, selected, and indicated interventions to be delivered at each tier of support, yet few investigations have empirically examined the continuum of supports that are provided to students both within and across tiers. This need is compounded by a variety of prevention approaches that have been developed with distinct theoretical foundations (e.g., Positive Behavioral Interventions and Supports, Social-Emotional Learning) that are available within and across tiers. As evidence-based interventions continue to flourish, school-based practitioners greatly need evaluations regarding optimal treatment sequencing. To this end, we describe adaptive treatment strategies as a natural fit within the MTSS framework. Specifically, sequential multiple assignment randomized trials (SMART) offer a promising empirical approach to rigorously develop and compare adaptive treatment regimens within this framework.

Original languageEnglish (US)
Pages (from-to)85-96
Number of pages12
JournalJournal of school psychology
StatePublished - Feb 2018

Bibliographical note

Funding Information:
NIMH grants P20 MH085987 and R34 MH097832 awarded to Gerald J. August provided funding for the content described in this article. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.


  • Adaptive treatment strategies
  • Behavioral support
  • Multi-tiered Systems of Support

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