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If you are starting a business, you need an elevator pitch. That two sentence routine statement that states what your business is and why it is going to be successful. If you are a school-based OT... You need a staff room response. This staff room response is a way to ward off the unnecessary and misinformed staff room referrals. You know, when a teacher you barely know sees you in the staff room and asks if you can assess a child in his/her class. The teacher states the student cannot stay in their chair and absolutely hates writing. So what do you do? Give the teacher a referral packet to fill out with an assessment plan. Give the teacher a strategy that make help the student and ask them to get back to you in a week. Tell the teacher to schedule an IEP for the student to discuss the concerns. I have used each of these strategies at one time or another. And in this particular case, I propose that option 2 is your best solution. I’m not going to get into what your strategy might be in this post, but if you can give the teacher a strategy that has a positive effect in this student’s ability to stay seated and write at their desk, then you may have just saved yourself however many hours an assessment, IEP, and treatment would have taken. If it doesn’t work, well then you have options. Try another strategy for a week or two, or you can propose as assessment. Options 1 and 3 are both viable solutions, but may result in the same recommendation from you, but only after several hours of evaluating and weeks of the child continuing to have difficulty in the classroom. So to get back to your staff room response. It may look something like this: “Oh, hello Mrs. Appleseed. Thank you for bringing this concern to me. Have you tried using some theraband around the legs of his chair so that he can fidget in his seat appropriately? No? Would you like me to provide you with some theraband so you may try it? Also, here is a simple data sheet you can use to track how many times he is up and out of his seat in a day.” This plays directly into the RTI/MTSS model and would be considered a level 2 strategy. It also allows something to be put into place immediately rather than in 60 days after you have assessed. Click here for more information related to OT and RTI/MTSS Whether the this is a general education or special education student, this still applies. One disclaimer, I guess you could call it… You want to try and prevent the teacher from identifying who the child is. Under RTI/MTSS level 2 strategies, OTs are not to provide strategies for specific students. Rather, it is meant to be used for general concerns. The concern being a student having difficulty with completing work due to being out of his/her seat in this case. So I hope this helps you save some time this school year and allows you to help more students at your schools. As always, we’d love to hear your feedback and would like to help in anyway we can. Comment below and don’t forget to subscribe so we can let you know as soon as the next post in this series is available. Until next time, -Jayson

Multi-Tiered System of Supports (MTSS) & Response to Intervention and Instruction (RTI2) If you have never heard of these two terms, prepare to have your mind blown because they are designed to help all students, no matter what level they are at or what type of class they are in. They even incorporate Universal Design, which I find amazing. They just call it UDL (Universal Design for Learning). In this post, I am going to give you a brief description of these models and show how you can insert yourself into the system to help more students while completing less assessments. Already familiar with RTI & MTSS , check out this post for specific Tier 1 strategies you can use. Getting to know RTI and MTSS So a little background on RTI2 and MTSS. Originally RTI2 was just RTI, or Response to Intervention. They then added the second “I” (Instruction) and made it look really cool with the 2 superscript (that I don't know how to do) and RTI2 was born. RTI2, as is sounds, is directly related to academic instruction and establishes a 3 tier system. Multi-Tiered System of Supports was then developed and basically said RTI2 is cool and all, but you forgot the non-academic side of things such as the social well-being of a student, UDL, and the non-teaching staff at the school, like us OTs. Thus, MTSS inherently incorporates RTI2. Also, both models relate to students in both general education as well as in special education. Thus, this system should help to keep students with an IEP in the least restrictive educational placement, that we all know is super important. The 3 Tiers RTI2 and MTSS both use a 3 tier system that is best depicted as a pyramid. OTs are uniquely positioned to be a part of all 3 tiers as you will see. Not only to we have the strategies that students can benefit from, but we also have the knowledge of how to research strategies and to use data to track if a particular strategy is working. So let’s break it down as it relates to us OTs! Tier 1: General Strategies Designed to Assist ALL Students & Staff The title says is all! Tier 1 is about researching and educating all parties so that we can best support every student under the watch of every school employee. This post, in fact, is a Tier 1 approach. Everyone reading it is learning about how to better the outcomes of their students. Likewise, trainings, conferences, inservices, webinars, staff meetings and collaborations are all tier 1 strategies. One example of how you as an OT can participate and lead in a tier 1 strategy at your school site(s) is to lead an inservice at your sites about proper posture and ergonomics in the classroom. This way you are teaching 10-to-20 teachers how to walk into their classroom the next morning and adjust their seating arrangements to help 30 students each. Or you could attend an administrators meeting and introduce them to a handwriting curriculum for the primary classrooms. You could then collaborate with teachers to co-teach a few lessons of the program in the classroom. That way they feel more comfortable and can ask any questions they might have for you. Both of these types of inservices are a great investment in your time and could save you plenty of referrals over the years. For 3 specific and targeted Tier 1 strategies, check out this post! Tier 2: Targeted Group Collaboration For the students who don’t respond to the general strategies in tier 1, they may need a more targeted approach. This may look like a small group instruction, classroom observation, or a specified collaboration with a teacher or administrator. For instance, you may have a 2nd grade teacher approach you and say I have a group of students who are just not understanding how to space their words. They use a handwriting program daily, but these 3 students just are not getting it. As a tier 2 intervention, you could observe this 2nd grade class and provide targeted strategies to use with students who appear to be struggling with spacing. You could also provide co-teach a lesson within the class regarding spacing. You could also check with the administrator and teacher to see if they would be open to you doing a small group center in the classroom for a few weeks. For those who are still not responding (hopefully not many), there is tier 3. Tier 3: Targeted Individual Collaboration When I think of Tier 3, I think SST, or Student Study Team. For a student who is not learning through general strategies or targeted group collaboration, an SST is the next option, if not an evaluation for an IEP. As part of a tier 3 strategy or SST, you as the OT may complete a classroom observation with parent permission in order to watch the student. *With an SST you must have gotten parent permission to do this.* After the observation, you should meet with the Student Study Team and put into place a goal and strategy that can be carried out by the team. You may recommend a goal or goals and instruct the staff on what can be done to help the student meet his/her goal, but without a formal assessment, it is my opinion that, skilled OT services should not be implemented. Click here to see how you can respond to a teacher asking you in the staff room to assess a student A few Things to Remember RTI2 and MTSS are relatively new models that are still being worked out in their relationship to IDEA. Thus, make sure that you are checking this source with your state OT guidelines and your district policies. A lawyer once told me, “When in doubt, assess!” While I do use this motto in my decision making, the 3-Tier system has helped me to reduce my referrals and spend more time treating students and collaborating with teachers. The process outlined here is a powerful and beneficial tool to help understand and leverage the system in order to improve your school based practice. I hope this article helps you make some clinical decisions in your OT department and maybe even help to structure your district's referral policies. You can continue on to the next post in the Reducing Referrals, Staff Room Referrals and Your Staff Room Response! Let me know your thoughts in the comments below. For more information about how to improve your school-based OT practice Subscribe now below! Until next time, -Jayson

I don’t know about you, but I’ve never met a school-based OT who isn’t inundated with initial referrals and triennial evaluations. If it’s not one, then it’s the other that has you burnt out looking like this -----------------> Last year, the ‘16-’17 School year, I completed 61 assessments with 25 of those being initial assessments. The year before that, I was closing in on 70 evals with 38 of those being initials. When I look at those numbers, I see two things. I see a nice decrease in the number of initials. But More Importantly, I see the hours wasted assessing kids when I could have been providing effective & proactive treatment. From the file review and interviews to the observations to standardized testing, they all take up time. Then you have to score the testing, synthesize the results, and write it all up! Don’t forget the IEP you now must attend. You are easily looking at several hours worth of time put in for each assessment. Time to make the Change! What would it look like like if we were to back some of that time assessing and replaced it with occupations that could be helping far more kids while preventing new referrals? As I like to put it, I can help a single kid, or maybe even a small group of kids, once a week for 30 minutes after completing an assessment. Or, I can assist a teacher for one hour a week and help who knows how many students. 30, 60? It really only depends on how long that teacher teaches for. My Proposition: Help Your Teachers! You have got to help the teacher, your principal, or whoever it is who is thinking about referring student to you. You can’t wait for them to come to you with the name of a student. You are too late at that point. A Special Education Lawyer will tell you, once an educator has approached you with a concern about a specific student, you are required to do an assessment. Even though you feel the student obviously doesn’t need skilled OT, you are obligated to completing that eval simply because a teacher has asked you for a child-specific solution rather than a general strategy. With that being said, over the next few weeks we are going to share specific actions you can take to reduce the amount of referrals you receive while helping more kids than ever. This will not, and is not meant to, get rid of all referrals, but it should help to prevent a few unnecessary ones. It helped me to reduce my referral count by 13 or about 30%. Isn’t that what we all want in life? Less evals and more fun therapy time? So, why wait? Let’s get started! Click Here to read the first installment of the Reducing Referrals series. The first article in the series in about full classroom RTI2 /MTSS groups and how you can get started reducing your referrals today! Also, please do share below what you are doing in attempt to reduce the amount of referrals you receive. Share us on Social too!