We consider an emerging challenge in special education that involves the interplay between an emphasis on evidence-based practices (EBPs) and the need to provide individualized intensive interventions for students with significant emotional and behavioral problems. With the use of Multi-Tiered Systems of Support (MTSS), teachers are expected to implement standardized EBPs with fidelity. Yet, students with significant difficulties tend to have problems that reflect a complex set of changing factors that require carefully tailored and coordinated interventions that are adapted to students' ongoing dynamic needs. To address this issue, we discuss the concept of practice elements (PEs) as a foundation for identifying intervention strategies, and we consider how the concepts of adaptive expertise (AE) can help guide the selection of PEs and implementation and modification of multistrategy approaches to increase responsiveness to students with emotional and behavioral problems. Implications for service delivery and future research are considered.