The purpose of the Multi-Tiered System of Supports (MTSS) outlined in the resources of the Georgia Department of Education (GADOE) is to provide procedures and processes for school leaders to address gaps in student learning. School leadership teams tasked with MTSS implementation have access to various resources, ranging from step-by-step guides to fidelity checks. However, challenges and successes specific to this endeavor have not been thoroughly documented within the extensive research or guidance documents available. This qualitative case study used purposive sampling and invited six elementary MTSS school leaders with experience implementing MTSS to participate in interviews and a focus group to answer the following research questions: What are educational leaders' perceptions of implementation of the Multi-Tiered System of Supports (MTSS) framework in elementary schools? What are the educational leaders’ challenges and success with MTSS implementation in elementary schools? A thematic analysis of the data was conducted using the conceptual framework of sensemaking and the Structural Frame of organizations. The MTSS leaders proudly shared detailed accounts of their schools’ MTSS implementation, accentuating their concern for staff well-being and expressing optimism for the upcoming year. The study revealed that each leader relied on a well-established structure of routines, procedures, and processes to support students through a cycle of identification, interventions, assessments, and data analysis. A connection to sensemaking emerged in the discussions surrounding the challenges and successes of MTSS, as leaders sought to reach school goals of problem-solving to enhance student behavior and academic outcomes. Utilizing the sensemaking approach alongside Bolman and Deal’s Structural Frame, this study implies that MTSS leadership centers on the ability to comprehend and manage complicated organizational frameworks, while simultaneously interpreting and responding to the barriers to student success.