MTSS-Based Interventions

Evidence-Based Interventions to Supporting Students Who Have Experienced Trauma

Tier 3: Intensive (individualized support) 

1. Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

Individual intervention to help students cope with trauma/post-traumatic stress disorder symptoms, delivered by school social workers and other school-based mental health professionals for students who have experienced trauma

Reference: Crosby, S. D. (2015). An ecological perspective on emerging trauma-informed teaching practices. Children & Schools, 37(4), 223-230.

2. As this level requires intensive supports and requires the most intensive support for students impaired by trauma. These kinds of interventions are designed for students or individuals who have had little or no success with any of the interventions implemented in Tier 1 and Tier2. Tier 3 Interventions include:

   1. Functional Behavior Assessment:

   2. Counselor Referral

   3. Seclusion and restraint                                                                                               

   4. Behavior intervention plan

   5. Structured breaks

   6. Collaboration with student's physician

Reference: NASP (2024). Tier 3 Mental and Behavioral Health Interventions and Special Education.  National Association of School Psychologists (NASP) 

3. Tier 3 School-Level Systems Guide
   This guide helps school teams build the foundational systems needed to support students with intensive needs. It shows how to establish a multidisciplinary Tier 3 team, define roles and responsibilities, and set up data collection processes for ongoing decision making. The guide also covers how to design and implement function-based behavior support plans, coordinate with mental health partners, and involve families in planning. By laying out clear procedures for teaming, data use, and coaching, this resource ensures that Tier 3 supports are systematic rather than ad hoc. That structure is essential for students whose behavior is driven by complex factors such as trauma, mental health needs, or chronic stress. When schools use these systems faithfully, they see fewer suspensions and better long-term outcomes for their highest-need students.

Reference: Center on PBIS. (2022). Tier 3 school-level systems guide. University of Oregon, Center on PBIS. Retrieved from https://www.pbis.org/resource/tier-3-school-level-systems-guide

Tier 2: Targeted (small group or individualized)

1. Small group self-regulation skills training  

Small group interventions providing extra support to students identifying difficult emotions or triggers, identifying their responses to triggers, and developing and practicing skills to self-regulate effectively. 

Reference:  Williams, J. S. & Sherrer, K. (2017) Trauma Toolkit for Educator. First Book. https://www.nea.org/sites/default/files/2020-07/MSEA-Trauma-Toolkit-for-Educators.pdf 

2. Tier 2 interventions are geared towards students who are not making sufficient progress with core instruction in the classroom. These interventions include:

1. Modified assignments

2. Targeted small-group instruction

3. Testing accommodations such as small groups, word banks, extended time, and

4. Mentoring or tutoring.  

Reference: The PBIS World Book (2025). pbisworld.com

3. Check-In/Check-Out (CICO)
   This video from the 2023 PBIS Forum shows how to adapt Check-In/Check-Out for every grade level, from kindergarten through high school. Presenters share examples of adjusting daily goal scales, scripting morning and afternoon check-ins, and using simple data tools to track progress. They also explain coaching routines and team review processes that keep CICO on track and meaningful over time. Check-In/Check-Out gives students emerging from trauma extra structure, adult connection, and timely feedback before minor behaviors spiral into office referrals or suspensions. The session emphasizes matching the intervention to student needs rather than applying a one-size-fits-all model.

Reference: Center on PBIS. (2023, April). Session 5i PBIS Forum 2023: One Size Does Not Fit All – Effectively Implementing Check-In/Check-Out from Kindergarten through High School [Video]. PBIS. https://www.pbis.org/video/session-5i-pbis-forum-2023-one-size-does-not-fit-all-effectively-implementing-check-in-check-out-from-kindergarten-through-high-school

Tier 1: Universal (school-wide) 

1. Predictable and structured classroom routines

Allows students to perceive their environment as safe and reliable, decreasing activation of the flight, fight, or freeze response.

Reference: Crosby, S. D. (2015). An ecological perspective on emerging trauma-informed teaching practices. Children & Schools, 37(4), 223-230.

2. Tier 1 intervention strategies in trauma-informed schools are what are described as "universal strategies" that are designed to create a supportive and safe learning environment for students. This is the case for all students, whether or not they have had any trauma-related experience. Tier 1 interventions are intended to promote a positive learning environment, foster social-emotional skills, and prevent or interrupt any behavioral concerns. Some examples of Tier 1 trauma-informed interventions include:

A. Taking a 5-minute break

B. Preferred seating

C. Reduce assignment

D. Daily planner. 

Reference: The PBIS World Book (2025). pbisworld.com

3. Integrating Trauma-Informed Approaches into PBIS
   This guide shows how schools can build trauma-informed strategies directly into their existing PBIS systems. It emphasizes universal supports like schoolwide expectations, staff training on trauma awareness, and adjustments to discipline policies. The goal is to make sure all students, not just those already identified for extra help, benefit from emotionally safe, predictable environments. The guide also explains how these trauma-informed strategies connect across MTSS tiers, with practical tools for expanding to more targeted or intensive supports.

Reference: Eber, L., Barrett, S., Scheel, N., Flammini, A., & Pohlman, K. (2020, May). Integrating a trauma-informed approach within a PBIS framework. Center on PBIS, University of Oregon. https://www.pbis.org/resource/integrating-a-trauma-informed-approach-within-a-pbis-framework