In 2016, the New Hampshire Legislature enacted a system of care model for children’s
behavioral health services, recognizing a critical gap: children exposed to adverse childhood experiences and those with severe emotional disturbances were falling
through the cracks of fragmented services. Educational, developmental, and health care
systems were operating in silos, leaving families to navigate complex needs alone.

This system of care framework was built on a fundamental principle: collaboration. No
single entity – not schools alone, not healthcare providers alone, not families in isolation can address the complex mental health needs of children. One key component of this
framework is the Multi-Tiered System of Support for Behavioral Health and Wellness
(MTSS-B), which exemplifies this collaborative approach by creating structured
partnerships between schools and mental health providers to ensure children receive
coordinated support where they spend most of their time – in their schools and
communities.

The MTSS-B policy emerged from a multiyear effort by the Children’s Behavioral Health
Collaborative, bringing together state agencies, providers, school districts, and child
advocates. With bipartisan support and no testimony in opposition, the legislature
passed SB 534 in 2016, establishing MTSS-B in statute to provide the organizational
framework necessary for early identification and coordinated mental health care. Both
the Department of Education and the Department of Health and Human Services
supported the legislation, as did hospitals, community mental health centers, teachers,
special educators, nurses, social workers, and other advocates. In 2020, Governor Sununu signed and applauded subsequent legislation directing the Department of Education to support MTSS-B development in school districts across the state.

Yet, as the 2026 legislative session approaches, a bill has been proposed to repeal
MTSS-B altogether.

For almost a decade, MTSS-B has successfully helped identify children early and
connect them to appropriate supports. Community Mental Health Centers (CMHCs)
serve as anchors in this system of care, providing clinical expertise and therapeutic
services that schools cannot offer alone. These school-CMHC partnerships operate in
districts across New Hampshire, demonstrating the statewide reach of this collaborative
model. As Jodie Lubarsky, Vice President of Youth and Family Services at Seacoast
Mental Health Center notes, “Schools in our region have seen the overwhelming benefit
of MTSS-B. We have worked collaboratively to support the development and facilitation
of tier 1, 2, and 3 supports in academic communities to have a meaningful impact on the
social, emotional, and behavioral needs of students. ”

Early intervention through MTSS-B changes developmental trajectories. When children
receive timely support, they build resilience, develop coping skills, and maintain
connection to their education—preventing the downstream consequences of untreated
mental health challenges. The MTSS-B framework recognizes what research
consistently demonstrates: children have remarkable capacity for growth when provided
appropriate support within their natural environments. Without this coordinated
approach, children face longer waits for services, more severe symptoms requiring
crisis intervention, and disrupted education that compounds their struggles.

The bipartisan bill that established MTSS-B in 2016 included a compelling finding that
remains urgent today: “Mental health disorders are the most expensive health
conditions in childhood, straining public and private resources.” Repealing MTSS-B
would dismantle the collaborative infrastructure that prevents costly crises and
emergency interventions. The short-sighted savings from eliminating this program will
be dwarfed by the long-term costs: increased hospitalizations, involvement with juvenile
justice and child welfare systems, interrupted education, costly out-of-district school
placements, stress on overwhelmed systems, and most importantly, preventable
suffering for children and families.

At a time when the prevalence and severity of children’s mental health needs have only
increased in our state, we cannot afford to go backward. We cannot return to
fragmented services where families navigate complex systems alone and children wait
until crisis point to receive help. We have a collective responsibility to invest in the well-
being of children, and we need to reassert the simple truth that children’s mental health
is a public health priority.

The legislature acted wisely in 2016 to create a system of care with MTSS-B as one of
its cornerstones. Now is the time to strengthen this foundation, not tear it down. I urge
legislators to reject efforts to repeal MTSS-B and instead recommit to the collaborative,
evidence-based approach that has served New Hampshire’s children and families for
nearly a decade.

Dr. Cynthia Whitaker is President and CEO of Greater Nashua Mental Health. She lives
in Weare.