OTS 203: What MTSS Interventions Produce the Best Results for Sensory Processing?
- 7 hours ago
- 38 min read
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Welcome to the show notes for Episode 203 of the OT Schoolhouse Podcast.
Struggling to figure out how occupational therapy fits within your school's MTSS framework?
In this episode, Dr. Courtney Boitano shares findings from two groundbreaking studies on sensory processing interventions for kindergarten and fifth-grade students. As a faculty member at San Jose State University and a school-based OT with over 15 years of experience, Courtney provides practical insights into implementing tiered sensory supports that actually work. You'll learn how to use free screening tools like the Strengths and Difficulties Questionnaire (SDQ) to identify students who need additional support, why teacher consultation may be more impactful than you think, and how to implement Zones of Regulation strategies across different tiers.
Whether you're new to MTSS or looking to refine your approach, this episode offers evidence-based strategies you can start using tomorrow to support students and empower teachers with sensory processing challenges in your schools.
Listen now to learn the following objectives:
Learners will identify the research findings from tier 1 and tier 2 sensory interventions with kindergarten and fifth-grade students
Learners will implement evidence based teacher consult strategies as a high- impact MTSS intervention.
Learners will Identify the Strength and Difficulties Questionnaire as a screening tool to identify students who may benefit from sensory processing interventions and determine appropriate tier- level supports.
Guest(s) Bio
Courtney Boitano OTD, OTR/L, BCBA-D
Courtney Boitano is a faculty member at San Jose State University teaching in the occupational therapy masters and doctorate (OTD) program. Courtney also teaches the Pediatric Clinic course at SJSU. Recent research has focused on the role of school-based occupational therapy practitioners in MTSS to affect students’ sensory processing.
As an occupational therapist, she has over 15 years experience working in a variety of pediatric settings and school-based practice. Her clinical practice, OT OuTside focuses on children with developmental disorders and parent support.
Quotes
"The consultation piece was huge. It was like a different person filling out the post-test of the SPM because they didn't just see the tip of the iceberg—they understood what was beneath it."
— Courtney Boitano OTD, OTR/L, BCBA-D
“MTSS can, can work beautifully when it there's alignment at, administrator level”
— Courtney Boitano OTD, OTR/L, BCBA-D
“MTSS isn't just the OT doing MTSS. It's not just the reading specialist doing RTI. It's not just the behaviorist doing PBIS, but it's all of us like really working together to see how can we support the student in across these domains and how can we like bridge it together.”
— Courtney Boitano OTD, OTR/L, BCBA-D
Try to get your foundation under you with everything else, I think, before really diving into MTSS.”
— Jayson Davies,M.A.,OTR/L
Resources
Episode Transcript
Expand to view episode transcript
Jayson Davies
Jayson, hello, and welcome to the OT School House podcast. If you are a school-based OT practitioner, or maybe you're thinking about becoming one in the future, I want you to know that you are in the right place. I'm your host, Jayson Davies, an OT practitioner just like yourself. Today, I'm thrilled to welcome Dr. Courtney Boitano to the OT School House podcast. Courtney is a faculty member at San Jose State University with over 15 years of school-based OT experience, and today she's here to share with you research on sensory processing interventions within the MTSS multi-tiered system of support framework. If you've been wondering how to actually implement MTSS in your school, beyond just talking about how tier one is for 80% tier two is for 15, and tier three is for the final 5% of your students. This is the episode for you. We're diving into Courtney's research with kindergarten, as well as with fifth-grade students, to uncover what really works when it comes to sensory supports, primarily at tiers one and two, by the end of this episode, you're going to learn how to implement free screening tools to identify students who may need sensory supports, understand the practical difference between tier one, two, and three interventions, and also discover why teacher consultation might be your most powerful MTSS strategy, even though it may be the hardest to prioritize. Stay tuned to learn how Dr. Boitano implemented this 10 week MTSS program, and how you can too. Stay tuned.
Amazing Narrator
Hello, and welcome to the OT School House Podcast, your source for school-based occupational therapy tips, interviews, and professional development. Now, to get the conversation started. Here is your host, Jayson Davies. Class is officially in session.
Jayson Davies
Courtney, welcome to the OT School House podcast. It is such a pleasure having you here today. How are you doing?
Courtney Boitano
Good, thanks for having me. I'm so excited to be here.
Jayson Davies
Absolutely. Well, I have to start with something here. I was just on the California Foundation for Occupational Therapy, and looking at the awardees, and I happened to type part of your name in, and it just came up like nine different times. You apparently have figured out how to get some support with your research, and what it looks like some of your students' research through the CFOT. That's awesome.
Courtney Boitano
Yes, yeah, I'm so grateful for the work they're doing to support research and getting our work out there.
Jayson Davies
Yeah, and for those of you who are not in California, the California Federation Foundation, sorry for occupational therapy. It's kind of this: they are not associated with our state association, but they are closely aligned in their goals and furthering the aspect of occupational therapy. And they do have several different grants that they offer every single year. And Courtney has apparently used it for herself as well as really enabled her students to use it, which is just fantastic. What has that process been like? You know, helping your students understand that they can get support that way.
Courtney Boitano
Yeah, it's been so helpful to, for not only their learning, but also that kind of sense of empowerment, of like we're, you know, doing great work, and there is support out there for it, and to get even that, you know, practice of writing a grant proposal, and the some of the research I've done that we're going to talk about today was funded through a CFOT grant, and it just also makes, you know, getting those different protocols, you know, it's costly, or having a little incentive to give to participants just helps all of that research come together as well.
Jayson Davies
Yeah, yeah, absolutely. Well, really quickly, thank you, CFOT, for, you know, making that possible for many of the OT professionals out there that want to find some research, because in some cases, like today, that eventually leads to several published articles and information for us to talk about on the OT School House podcast. So, thank you, CFOT, not sponsored, just a nice little shout out. All right, Courtney, you have a lot of experience within the world of occupational therapy. You are on staff at San Jose State University, you have been a school-based occupational therapist. You also have some of your own clinical experience with OT outside in that platform. How have these experiences really led you into these articles that you ultimately published about with MTSS?
Courtney Boitano
Yeah, and I've gosh, when I graduated from USC with my master's, I knew I wanted to be a school-based OT. They had an opportunity, it was a training grant that we could, a small cohort of us could complete our level two field work in. In schools, and you know, concurrently, while we were doing our coursework, and I loved the experience so much. I was at Long Beach Unified, and just had an amazing mentor, and it was great to, you know, have that clinical practicum experience, and be able to talk about it in our coursework with, you know, our instructor, and I then did the OTD at USC, and was working at LA Unified, and just went straight into schools. So, now, for like, gosh, almost 20 years, I've been working in schools, and, you know, still do a little consulting here and there, supporting students and schools, teachers, administrators. I just love that aspect of
Jayson Davies
it. Yeah, yeah. Wow. Fun note, I also had access to that school-based OT special program at USC. That correct me if I'm wrong, but when you came out, you also got like a little, not a stipend, but they helped with your student loans, right?
Courtney Boitano
Exactly. Yeah, it was amazing. It was an amazing training grant.
Jayson Davies
Yeah, yeah, I did not do that. I did not think I'd end up in the schools, and that's kind of funny now, right? So, yeah, kind of wish I would have done that program, you know, given where I am today. But that's awesome. I'm glad, you know, that's really cool, because it's not many people get to come out of school with the foundational understanding of school-based OT. USC had that program in place for, for so many years, I don't think they have it now, because it was a grant, right? So it's really awesome that that you're able to get that. You said you landed at LAUSD after that, right?
Courtney Boitano
Yeah, yeah, so I was at LA USD, and then I worked for the Southwest Selpa down there in Southern California. Ended up working with a smaller school district down in Southern California, but just have always been so drawn to that energy that schools provide, and that that collaborative piece.
Jayson Davies
Yeah, How long would you say it took you to a learn about MTSS, or did you already know about it from the USC program? And then, how long did it actually take you to, you know, what? Say, I can see students beyond the IEP, and let me actually figure this out.
Courtney Boitano
Yeah, you know, it's really funny. Recently, I was going through some of my, you know, old like school materials, like, yeah, it's you know, when it was just like paper, you know, printed with that plastic comb, and so I had this booklet on RTI in public schools, and I remember, I think LAUSD, you know, they would do different like in services for the rehab professionals, OT, PT, and so it was like an in-service on that, and it's really interesting to look back at that, and then to look at where we are now with RTI and MTSS, and to see that we've been doing it now, you know, for a very long time, but just that evolution of how it's become so encompassing in so many different realms and domains where students and teachers need that support, so it's been especially, I think, helpful for us as OTs, as we've had these conversations about case load versus workload, and these different models, and to to look at how we can make that happen, because we can reach so many more students when we are implementing RTI MTSS frameworks.
Jayson Davies
Yeah, at LA USD, were you at that time, were you able to get into MTSS at all, or did it take you a little bit further down in your career to actually figure out how to make it actually work a little bit?
Courtney Boitano
Yeah, I'm definitely kind of with that. That evolution of what it's been has been how I've also evolved in my own practice of how to do it, and it's so it is. It's hard when you're a new grad and working in the schools and managing the caseload and the different school sites and and just building those relationships and knowing how to do it, so I think there were little like glimmers of being able to do it. I remember my first, you know, first year collaborating with the adapted PE specialist, and there was a great team, you know, APE Speech and myself, and we worked really closely together, and would be at the same site on the same days, so we could do some like really cool groups and kind of bring in those tiered interventions, and I would say that's almost more unique, right, to have that kind of like magical team chemistry come together, where it's like we all were like, oh yeah, we could be doing this and have these different groups, and so it was, you know, long story to say, you know, it's been easier at, you know, some schools versus other schools and. And also, just as I mentioned, kind of having that relationship and rapport building, so it's become easier as I've been able to establish a rapport with the teachers, with the administrators, with the school site.
Jayson Davies
Absolutely, part of the reason I asked you that question is because I wanted to hear that answer. I kind of assumed that that was going to be the answer, because that's my answer too. Like, MTSS is not something that you can jump into most school sites and start doing on day one. Most schools don't have MTSS built within the confines of OT, or OTs built within the confines of MTSS, to probably say it more correctly. And so it is something that you, as OT, kind of has to, you have to take that on, and maybe you do find a really awesome SLP and an AP teacher or a PT that, that will do that with you, but I often, you know, get asked, and I'm sure you have too, from, you know, newer students, like, what to focus on in your first year as a school-based OT, and, like, MTSS was the last thing I'm telling people to focus on, not because it's not great, like it is great, but it's so difficult, and try to get your foundation under you with everything else, I think, before really diving into MTSS 10 years from now, that might be different,
Courtney Boitano
yeah, for sure,
Jayson Davies
but that's how I kind of view it right now, so awesome, I think that is helpful for everyone listening in their first year, maybe even first few years of school-based OT.
Courtney Boitano
Yeah, all
Jayson Davies
right. Well, let's go ahead and dive into kind of explaining MTSS from the from the way that you actually perceive MTSS. Everyone has a slightly different understanding of MTSS and RTI, but I would love to hear kind of how you explain MTSS, whether it be to a fellow OT, a teacher, or a parent, even.
Courtney Boitano
Yeah, and kind of building off of what we were just talking about, how it's evolved. It's been interesting to really see how the terminology has even changed with these frameworks, and how you know, and in kind of doing this work with students, and we've looked at the literature, you know, you go back and it's like it was called early intervening services initially, and then you started to see RTI creeping into the literature a little bit more, and now that more prevalent term that's being used both in the literature and then at school districts is that MTSS term, and so I really, you know, see it as being kind of MTSS as that broader umbrella, and then response to intervention that RTI is kind of that that part underneath the umbrella, those tiered interventions across domains, whether it's for reading, behavioral support, OT being in there, and you know, with MTSS, it's really governing those multiple processes that are supporting students, and so it's, you know, RTI is under that PBIS, the positive behavioral interventions and supports, also falls under that umbrella, and that biggest piece, kind of tying it all together, is that collaborative piece, right? That it's multiple professionals working together, it's not just OT doing MTSS, it's not just the reading specialist doing RTI, it's not just the behaviorist doing PBIS, but it's all of us like really working together to see how can we support the student in across these domains and how can we like bridge it together. So I love that that umbrella image to see how it all, it all falls under that, and it all has to be covered under that umbrella,
Jayson Davies
yeah, yeah, absolutely. I mean, it takes a village, right, to raise any human being and to support any human being on campus. Definitely takes a village. So, yeah, along the lines of that, I think most of us understand that there are three tiers of MTSS and RTI. There was three tiers too, as well. How do you overarchingly describe the three tiers of MTSS?
Courtney Boitano
Right, you know, I always go back to those percentages because it, it makes sense to me when, when we're looking at that, you know, tier one being that the 80% of students, tier two being that 15% of students who need just a little bit more support, and then that, you know, tier three being that 5% that smaller percentage of the students who need that more one on one focused intervention, and so I can really, you know, see how when the team approach comes together to meet the students and the teachers, I include the teachers in there of how, how are we doing those tiered interventions for the teacher, not just for the student, but you know, there are those those teachers, I think we can even kind of align some percentage. Is to teachers, there's some teachers, you know, where we can, we'll kind of get into this, you know, where it is like maybe we're doing an in-service, or maybe there's a teacher who needs more of that one on one consult with the OT, and so, how can we meet both the needs of the students and the teachers within those tiered levels?
Jayson Davies
Yeah, it's so interesting how MTSS can look very different, like two OTs can implement MTSS even at the same particular school, but it's going to look so different. I do feel that the teachers are one part of the dynamic, of course, we are part of the dynamic at play, all the other team members are part of that, and it all influences what your program can actually look like, right? Like, we have to, to a degree, play to our strengths, and some teachers we collaborate really well with, and other teachers maybe we don't have that same connection, but that doesn't mean we can't get creative in a different way to continue to support that teacher at various levels, and of course, their students. So, yeah, absolutely. How do you find that MTSS and special education work together or integrate together? Does that question make sense without additional context?
Courtney Boitano
I think so, and I mean the way that that I conceptualize that is, you know, MTSS can certainly be and is used for the general ed population, right, but where we bring in that that special ed piece is, you know, where we are seeing, and let me back up a little bit, of like I think the classroom dynamic has changed so much from 20 years ago, 10 years ago, to even five years ago, right? The classroom looks so different, so even in a, you know, quote unquote general education classroom, like we are seeing kids with significant needs whose needs aren't being met, and so I think, you know, just keeping that kind of binary separation of general ed and special ed, of course, you know, we have our, you know, frameworks and laws to really define that, but we're seeing it kind of intertwined so much now, and so MTSS really provides a great way to meet the needs of kids, whether they are in general ed or, you know, are in a special day class, you know, in special education, getting an IEP, or have a 504 plan, or have nothing, right? And so I think MTSS really helps to kind of bridge that gap, because you know, like I said, the classroom is looking so different, and teachers are needing so much support, and we really can provide that support to them, because that, that support they're needing is, you know, behavior management, you know, kids having decreased attention spans and a need for more movement, more differentiation, and how they're being taught, and so, and how their needs are being met, and so we can really help teachers understand that. I think we have a really unique perspective for that, so going back to your, you know, question of like MTSS, I think really is that perfect bridge between special ed and general ed, and then just what the classroom is looking like these days.
Jayson Davies
Yeah, yeah, one something that's come up a few times is about I think people forget that even if a student is in a classroom, a more contained classroom, a special education classroom, per se, that, and maybe they have direct OT one time a week for 30 minutes or less, consult, or whatever it might be, that they fall outside of this realm of MTSS, but I don't think that's true. I mean, we can absolutely still be supporting that teacher at tier one that's going to support that student. We can potentially have that student involved in a group inside the classroom at tier two, whether or not that is on the IEP or not on the IEP, because we just happen to have a tier two program in that classroom, and I think that sometimes goes forgotten a little bit.
Courtney Boitano
Absolutely, I agree 100% And yeah, I don't think they can be separated, of like, oh, MTSS is just for that general ed, and yeah, it has to be embedded across, you know, general ed, the, you know, essay sai classrooms for all levels of kids, like we, we really need that,
Jayson Davies
yeah, yeah, all right, I want to start diving into your research a little bit, you did two different, you have two different published research, one, the effects of sensory processing at tier. One and tier two among kindergarten students, and the other is tier one and tier two for sensory processing with fifth grade students. So, you've done this kind of twice with two different populations. My question here is, before we dive into that, this is a question that I go back and forth with all the time as an occupational therapy practitioner going down the MTSS route, are we providing occupational therapy as MTSS, or are we providing a specific support, such as handwriting, fine motor skills, sensory processing, social skills, emotional regulation, as part of that MTSS, and I ask this because I feel like sometimes if we just try and say OT is MTSS, it's just too broad, it doesn't allow us to go into one specific area. Obviously, you kind of have well defined this as sensory processing, and I'm wondering if that was, I mean, for research it has to be on purpose. But yeah, trying to collect your thoughts on that.
Courtney Boitano
Yeah, I think you raise a really good point, and I think it's one of the things that I often come to, just as an OT, of like what we're doing as occupational therapists is is going to look different based on the unique needs of the individual, or in this case of the classroom, and so this was defined, you know, as okay, we're doing, you know, the OT was specifically, you know, defined as sensory processing, because that was the unique need in both the classrooms, and you know what, I continue to emphasize is the unique need, really across classrooms. Now that's what I'm constantly hearing teachers really struggle with, is like really that, and when I say sensory processing, that you know self regulation, you know, kids being able to do that modulation to, you know, bring that arousal level, you know, we have to be able to match that arousal level to different activities, settings, environments, and that's a big challenge right now, and so this was, you know, sensory processing was chosen because that was the need, and how this all came about, so I can dive into a little like context. Let's
Jayson Davies
go in. Yeah, let's go for it.
Courtney Boitano
So, so at San Jose State, we have these really unique clinics on campus, and I lead our pediatric clinic, and so one day we're on campus, and then as a school-based OT, you know, when I started teaching our clinic course, I was like, well, you know, so many grads go into school-based OT, can we have one day be at a school? And so we got this contract with a local, it's a parochial school, so a local school nearby, and one day a week, the student, a small cohort of students, usually around like 10 to 12 students, we go to this school, and this was all, you know, we don't have the manpower, there's just, you know, a few of us, so it's not individual services, so we're doing RTI, this was, you know, okay, How can we expose students to those tiered interventions, so we're doing tier one whole class and tier two small group interventions, and so in response to the needs, you know, following the pandemic, the school administrators, you know, noticed that the fifth grade students, and so that was the first study that came about, also because at San Jose State, master's students do a group research project together that is led by a faculty mentor, and so I, you know, had this kind of need from the school with administrators, kind of saying, like, these fifth graders don't have tools for self-regulation, you know, following the pandemic, we're just seeing a, you know, huge shift in how they're showing up in the classroom, so I thought, okay, this could be a great research study, so it, you know, really was this great opportunity, not only for education of, you know, the clinic students, the research students, and then just to kind of satisfy my own curiosity, but to really meet this, this unique need that we're seeing across schools. So, so we did that first with the fifth graders, and then there were a few shifts I wanted to make, so then we did it with the kindergartners, so I could talk about a little, a little bit more about the fifth graders, but if you have a question, Joe,
Jayson Davies
I, that's exactly what I want to dive into, is that that first article that you have, you were looking at specifically tier one and tier two for sensory processing for fifth grade children, so I mean, let's. Just dive into, I think, a little bit of the methodology, like what did it actually look like.
Courtney Boitano
Yeah, so because you know that was kind of the problem that was brought to us, of like, here we have this fifth grade class and they need tools for self-regulation, so we did, we use the SPM, the sensory processing measure, as a screening tool, and what that really turned out, and it was at two different schools, so the one school where we have the clinic, and then we did another nearby parochial school, so same kind of makeup of students, so we can get some comparison, and the difference was that at one school they had us, this, you know, OT students coming in and doing, you know, the tier one and tier two interventions, and then at the other school, the fifth grade teacher got a workshop, like a in-service that I led one one day, you know, after school, and so what we found with using the SPM as a screening tool was that in reality, you know, there was just a small handful which aligned with what we know about RTI, right, that there's going to be about 15% of students who really, you know, are showing that they need that, you know, tier two intervention, and so this is, you know, wrapping everything into a nutshell, real briefly. But after looking at that, it was like, oh, you know, that using the SPM as a screener for the whole class is just not feasible. It's time consuming for the teacher. It's really cool.
Jayson Davies
So the teacher had to do it. Oh
Courtney Boitano
yeah, so the teacher filled out the SPM, and the, you know, it was costly too, because the, you know, cost of each SPM. So, what we found, you know, from doing that with the fifth graders was that there were some results with the in-service, you know, teachers were understanding the zones of regulation more, and we chose the zones of regulation because it was already kind of being used in the school, so there was some kind of base knowledge of what the zones of regulation is, and it aligned with their social emotional curriculum, and we also, in terms of what that intervention looked like it also brought in some like mindfulness-based strategies, so things like, you know, helping the kids with, like, okay, what are some coping strategies when you are, you know, getting into the yellow and red zone, you know, breathing techniques, taking a break, and it was great to see that the teacher's understanding of what these terms were was, you know, really changing, so because you know I saw that the SPM was not a great screening tool, and we were then hearing, like, you know, our kindergarteners are coming in, and I was like, that would be a great class to do it with, because they don't have the knowledge of the zones of regulation. So, what could this look like with a group of young kids who are coming in? Some have had preschool, some haven't had preschool, some have had, you know, a junior kindergarten program, TK program, some haven't, so we're really, you know, kind of getting a broad, broader mix of background coming in, and one of the things that we then changed with this, instead of using the SPM as a screener, is that we did the Strengths and Difficulties Questionnaire as a screening tool, and this was one the I don't know if you're familiar with the SDQ, but it's a free tool, and it really kind of can tease out some of that behavior, and the like kind of more sensory like components of, you know, like being fidgety, decreased attention, and I have a BCBA also, and I have a BCBA because when I was working at the SELPA, they had a small cohort of students, they offered, or not students, of people working in the Selpa. Yeah, they said, you know, if you're interested, we're going to have a cohort, and I was like, "Gosh, I'm constantly getting asked the question, is it sensory or is it behaviors? It's like, "Sure, I'll do it
Jayson Davies
if you're gonna let me go for it. Yeah, sure.
Courtney Boitano
So that's always been interesting to me to look at kind of that behavioral piece, and that's what teachers really identify, right? They identify the behaviors. Yes, I often use that, like iceberg, you know, analogy of like what you see above the iceberg, at the tip of the iceberg are the behaviors, right? The, you know, kids blurting out, the kids out of their seat, you know, they can't focus, but then we, you know, with our OT perspective, we understand what's underneath that I. Iceberg, so all that to say, I thought, okay, the SDQ really kind of helps to tease out, like, okay, what is that behavior, and what we can then look at, like, what are these sensory components underneath that iceberg? So we replicated it with the kindergartner students, but this time instead of just doing the RTI interventions, the tier one and tier two, and the in-service, we added a consultation piece, so we had three kindergarten classrooms, instead of just like before, we had 2/5-grade classrooms, we had these three different groups, and what we before I jump into what we found, the interventions that were being done for the RTI group, the same idea of following the zones of regulation, because the teacher used the zones in the classroom, but also including, you know, some real like hands-on kindergarten age, you know, different artwork. They are doing sensory activities to, you know, understand, kind of bring in that interoception piece about, like, when we're feeling this way, when our body is feeling this way. Like, what does that tell us, and what can we do with those kind of, you know, mindfulness-based strategies, of, you know, the breath work, asking for help, being able to, you know, advocate for yourself and take a break when you need to take a break, and then one teacher got, you know, consultation, and then another got just that in service, so what was interesting about this, and jump in if you have a question too. Well, I was gonna
Jayson Davies
ask, so just to clarify, so three different classrooms, one just got one in service up front, I'm assuming that was, or did all the teachers get that in service, or did you literally just sit down with one teacher.
Courtney Boitano
No, that's a good question. So the teachers that this was at another school, so two schools again. So two teachers at this one school got the in service. All the teachers, you know, grades K through eight got the in service, and then at the other school it wasn't the in-service, it was RTI intervention. So then the other school, the third teacher got both the in-service and the consultation piece.
Jayson Davies
Okay, so in service, and then what? How often was the consultation?
Courtney Boitano
That was about every two weeks, I want to say,
Jayson Davies
okay, over the course of how long? 1010, weeks, okay. And then course or classroom number three, then was the one who actually had the RTI intervention itself, and kind of just really briefly, what did that look like? I know you talked about zones of regulation a little bit and interception, but as far as like frequency and whatnot, what did that look like?
Courtney Boitano
Great question. So it was once a week, and it was broken into that tier one whole class, so going in and doing like a whole class, you know, activity on, say, you know, understanding our internal cues one week, and then next week about, you know scenarios and role playing different zones of regulation, and then there was also a tier two small group component, so then breaking into small groups with the different activities for zones regulation.
Jayson Davies
okay, so I'm assuming the classroom itself, the tier one was like a 30 minute collaboration lesson with the teacher, and then some students got an additional 15 to 30 minutes for the tier two part of it. Okay, gotcha. And again, over the course of 10 weeks, right?
Courtney Boitano
Yeah,
Jayson Davies
awesome. Okay, was the SDQ is that what was used to determine Tier One and Tier Two in that case, or how? How do did that determine who was Tier Two?
Courtney Boitano
Great question. So we use the SDQ as a screener for then who would we would have administered the who we would administer the SPM to, so then we use the SPM again, but instead of just using it for the whole class, we were then able to administer the SPM. The teacher filled out the SPM for the students who the SDQ total difficulty score was elevated.
Jayson Davies
Interesting, how big or so were these classrooms, just in general? I'm assuming 15-ish kids,
Courtney Boitano
right? Yes, we had 11 who consented to participate for the RTI group, and so not all 11 had, you know, had these elevated scores on the SDQ. So I want to say it was about
Jayson Davies
like five.
Courtney Boitano
Yep, I was just gonna say five. Who, then we administered the SPM four.
Jayson Davies
okay? And then were those five, if they got the SPM, did that basically mean that because they had the elevated score, or whatever score on the SDQ, those five were in tier two, and you use the SPM to help with the data for only the kids who were at tier two. Is that summarized correctly?
Courtney Boitano
Right. Yes. Yes.
Jayson Davies
Okay. Got it.
Courtney Boitano
Lot of things going on with the study, because we had the teachers completing the zones implementation surveys, you know, the zones of regulation came out with some data collection tools, which wasn't in existence when we did the fifth grade study, so it was really, it was interesting to bring that in, to use that as a survey to, to have to be able to measure then how the teachers were implementing and understanding the zone, so we used those measures as well for the teachers. They were completing different surveys, and and we were able to kind of look at that for both the students and the teachers.
Jayson Davies
Yeah, I really wanted to break that down a little bit, because school-based OT practitioners are always trying to figure out, like, well, how do I know when a kid needs tier two intervention, and so you know you're kind of providing that, and of course this was research, so you probably did more than you really might need to do in a clinical setting, maybe you don't need to do the SPM, you just use the SDQ, which is already free for anyone to access, and of course the SPM does get expensive. And then could you have used the, I mean, if you didn't have the SPM, would you have just used the SDQ again later, or maybe you already did that?
Courtney Boitano
You know, that's a.. that's an interesting question. I do like using the SPM for that follow-up piece, because I really think that is the great bridge between, okay, here are these behaviors that the teachers are seeing and are reporting, and then we can bring in the SPM to really back that up and give some concrete examples of, you know, well, here are these different areas where we're seeing, like, oh, you know, actually, you know, their auditory scores are really hearing on the SPM are really high here, or we can really kind of tease it out a bit more, so I think the SDQ serves as a great screener for that, and what was interesting, I mean, our results were not as, as great as I would have loved to see, like, oh, all the SPM scores, you know, really changed, but what we did find was a positive correlation between the results of the SDQ on the total difficulty score, so it gives you a total difficulty score on the SDQ with elevated scores on the SPM, so it did show, like, oh, this really can be a good screening tool if you didn't have the time, you know, didn't have the resources to, you know, I mean, it's mainly time, it's really time consuming for the teacher to do an SPM on, say, 20 kids, but the SDQ shorter, faster, so you could use it as that screening tool, and we did see this positive correlation. I mean, granted, it was a small sample size, so we want to be careful with general generalization, but, but then what we saw too is, so because the SDQ is more kind of behavior-oriented, and it gives you some pro social scores. We saw that there was a negative significant correlation between the pro social scores on the SDQ and the social participation subscale on the SPM. So, what that means, yeah.
Jayson Davies
Explain.
Courtney Boitano
as the pro social behavior scores went up on the SDQ, the social participation difficulties went down, and vice versa. So that's what we would want to see. So we would want to, you know, we don't want to have these elevated scores, and then seeing that, you know, if they're having more social participation difficulties, we would want to see that. Then you know their scores are kind of.
Jayson Davies
Yeah.
Courtney Boitano
opening out, leveling out.
Jayson Davies
It wouldn't make sense if both scores were elevated for good social and difficulty with social skills. So, okay, we're going to take a quick break, getting closer to the end of the episode, but I do want to follow up with you more about the results, and also ask you one more question about using that SPM. So, we'll be right back. All right, Courtney, I do want to move on more to the results, but first, going back to the SPM, this was in a parochial school, you know, not your typical school setting. Mean, or not, your typical public school setting, I should say. In the public school setting, you've worked in LAUSD, a few other school districts, you know the whole referral process and the assessment plan to use standardized tools and whatnot. Can you picture what that would look like when we're using it in this process, whether it's the SPM, the SDQ, or any other tool, when we're using it as this like screener versus an assessment tool on an IEP. Do you think that, and maybe you have more insights on this? Do you feel like we have to let parents know that we're using the SDQ or the SPM if we are giving it to the entire classroom or a group of kids as opposed to an individual student used for the purpose of an IEP.
Courtney Boitano
I think that's a conversation that is often had about, like, okay. Where is this kind of gray area of, is it? Are we able to do this, you know, just as kind of practitioners in a classroom, or.. and I think just the broader, because there are, you know, nuances and different have different rules for that, but I think just as a broader kind of lens to look at MTSS, I think when we can have these really intentional systems in place at the administrator level, so really looking at kind of that macro level of like having this in place of like we're doing a screening tool, using a screening tool, doing a screening for all, maybe it's at the start of the year, for every grade, you know, K through fifth, parents are, you know, asked to complete the STQ, or we're asking, you know, teachers to do it, and it doesn't need to then come from the OT per se, we can help advocate for this, but if there's a real intentional system put in place, and this is where I think MTSS can can work beautifully when it there's alignment at that administrator level of we're going to be using these screening tools, and then OT can come in and say, oh, you know, I'd really like to look at those SDQs that had elevated scores. I know that that might be indicative of sensory processing challenges, and I'm going to, you know, then when I'm in the classroom, I'm going to just do an observation, and we can certainly be doing an observation, and then say we notice, oh yeah, gosh, that here's three kids who I'm really seeing some red flags. Then we could go that step further, of maybe we need to, you know, start some data collection, get some, you know, consent in place to maybe, you know, whatever the school's policy is for that data collection period to then you know maybe have an SST and and go you know further down the line but I think when it really is done intentionally and across again that collaborative piece of it's part of the PBIS so the behavior support team is involved it's this, you know, hopefully, gosh, you know, the school counselor, if a school can have a counselor, you know, they're involved too, because it has metrics that can be really indicative of needing additional mental health support, we can really then create that wraparound support we, we strive for.
Jayson Davies
yeah, yeah, I like to often like kind of compare a really like if we were to put a screening process in place as occupational therapy practitioners, it needs to be a system like what you're talking about, and I often kind of just compare it to the way that a lot of schools do like vision screening every so many years, every student gets screened for vision, and you know it's every kid doing it, it's not being singled out who's getting it. I notice might go home a week or two before saying, "Hey, your kid's going to be screened, please let us know if you don't want this to happen. Like, that is something that can happen, but yeah, it has to happen at a systems level, and you could probably start with just the three kindergarten classes on campus first year, and maybe work up from there, but yeah, I do think it needs to be part of a system. I would not advise an OT just to go ahead and start this screening process without reaching out to the principal and saying, hey, I found this new SDQ that I've heard about on a podcast, and it'd be really great if we could just give it to every kindergartner, and you know, look at the data and see if there's something we can do. There you go. Yeah, a template to use.
Courtney Boitano
A little like anecdotal story of my own children's school, you know, public school. They, as I. Was, you know, doing this study, and kind of came across the SDQ. I was like, oh, I've done this before, and so my kids' school, they did that, they did that, they sent it out, kind of same thing, just like you said. We're, and it came from the counselor, we're going to send out the SDQ, totally optional to complete it, and they did it two times a year.
Jayson Davies
Oh, wow.
Courtney Boitano
And it was so great, and this school also has a really strong PBIS program and systems set up, and it is where I have seen I often go back to it, just, you know, mentally, of like this is where RTI was done so beautifully, because I was also providing some OT services there too, and so I was able to go in and, like, co-treat with the teacher, I would lead a center while she was doing her writing workshop, and while I only had, you know, two kids on my caseload in that classroom, I was able to touch all 20 by having them come through my center, and you know, just kind of give that OT lens of like, oh, you know, those little pencil grip adjustments, or like, oh, I'm kind of noticing that this one, you know, their writing is all over the place, let's try it, you know, slant board, or whatever, those little, those little weeks we can provide.
Jayson Davies
Yeah, I love the idea of MTSS, but I will admit it is hard to put into place, and that's why we're seeing a lot of professional development around it. Dr. Jan Hollenbeck, Jamie Spencer, and Mahler Bushel just presented about it at AOTA Inspire in Anaheim, and it was a full packed room, like everyone wants to do this, but it's not easy, and it's great, like we have the ideas now, we just got to put it into place, and we got to put the systems in place with support from other people, which is like where this entire conversation started by you talking about your amazing APE teacher and speech therapist that you got to work with, so all right. Before we do wrap up, though, I know that you kind of teased a little bit ago that the findings weren't exactly what you'd hoped for, but this is also a small study, and kind of a, you know, pilot per se. What were some of the results that kind of, you know, were not what you hope for, and also just, you know, how you feel that it can move forward.
Courtney Boitano
Yeah, for sure. Yeah, I mentioned, you know, of course, I wanted to see that we would really see big changes on the severe difficulties and moderate difficulties on the SPM, and that wasn't the case, but what we did find, you know, as we kind of sat with the results, and like, okay, what does this tell us? You know, one of the things we thought of, the students and myself, is like, I think, you know, it really shows how the teacher's understanding of sensory processing changed, and we, we know that, because we also had this qualitative component where we interviewed them, and we were able to, like, really hear what, what this was like for them to be a part of this, and they had a totally different lens on doing the, you know, pre and post of the sensory processing measure, they had a totally different lens after even just the in service, so we saw that, you know, the in service was really helpful, both for the fifth grade study and then the kindergarten study, that the teachers gained so much, but the consultation piece was huge, so in doing the post test of the SPM, it was a, it was like a different person filling it out, right, because they didn't just see the tip of the iceberg, right, they didn't just see the behaviors, they understood what was a little bit beneath it, which was just so cool to the testament of OT and what we can provide from these different modalities, right, whether we are working with the students or we are doing an in-service for K through eight teachers, or we are doing that consultation piece a couple times a month, and again, like really tailoring it, that's the nice thing about that consultation, really tailoring it to the unique needs of that teacher of that classroom of the students in her classroom.
Jayson Davies
so you had a total of three different tier one interventions, you had the upfront workshop, you had the consult with the teacher, would you call that still tier one?
Courtney Boitano
Well, no, I kind of think of it different.
Jayson Davies
tier two.
Courtney Boitano
Yeah, I would say, like, yeah, that's more.. I mean, maybe even tier three for the teacher, because it was that one on one time.
Jayson Davies
Interesting. Yeah, I like to think of the personally, I like to think of tier one as being like beyond the classroom, so multiple teachers. First, I like to think of tier two as being classroom specific, because I think that just kind of puts it in a nice shell, and then maybe small group, which then it confuses - it gets confusing because now you're saying wait as a classroom or small group, and then tier three being more the individual. Either way, the point of my question was to kind of go back, would be of the three different models you used, if you were talking, you know, to a school-based OT and said, 'Hey, I want to get involved with MTSS. Would you, would you advise one versus the other?
Courtney Boitano
I would highly advise that consultation piece, and I often talk to colleagues, you know, working in schools, and really, you know, as they share the, like, the consultation piece is the hardest, because it's what it's where we kind of can feel like, oh, we have wiggle room, right? Like, oh, I have an IEP, like I'm not going to make that consultation time, like I could push it off, right? Or, you know, just to the teacher isn't available when you're available, and.
Jayson Davies
Yeah, it's hard.
Courtney Boitano
It's very hard to really figure out how to do that, but kind of going back to where we started with, like, how does this work well? And I think it works well when we have that rapport built, where we, we build that community at our school sites, and I've, it's why I love school-based OT. It's, you know, I've some of my best friends are teachers that I've worked with, right. And it's just the hanging out for 15 minutes over lunch in their room, and that's the consultation piece, right? Or it's, you know, they're doing car line in the morning, and I'm out there with them, chatting, and you know, having it's also great to get to know that, you know, the family side, yeah. work with, but you know, finding these ways where we can build that community, so that that consultation starts to happen more seamlessly, where we, you know, can become kind of more top of mind for the teachers to be like I'm going to run that by Courtney, I'm going to run that by my OT, so it doesn't seem like such a big ask or a big kind of to-do item on our on our list of things to do, and so I think, like, that is one of my big takeaways. It's so impactful for the teacher to get that opportunity to problem solve, to troubleshoot. We can offer a few, you know, suggestions and strategies. They can try it and tell us whether or not that worked. They're with the student five days a week, where we might only be with them once a week, maybe twice a month, and so it can really help with that carry over and empower them, like the teacher at the school who got the consultation piece. She was a veteran teacher, you know, 20 plus years, and she said at one point she was like, I just feel like all of my tools in my toolbox are not working anymore, and you know such a sense of defeat, right? Of like, I know what I'm doing, I'm a good teacher, but nothing is working. But then there was a sense of empowerment, right, where we can offer those tools, and she's doing it, not the OT coming in and leading the group, it's not the OT coming in and making environmental adjustments, but she's doing it for what works for her and her class. And then she felt the sense of empowerment and could speak to the parents too, and actually bring up some of her concerns. That was a big piece too, of sometimes feeling like I don't know if it's my place to bring up some of these concerns, but where we can help with that explanation of what's going on, not just from a behavioral but from a nervous system perspective, and increase their knowledge of what to do, build that toolbox up again can be really empowering for for teachers who are feeling like this is a different classroom than I stepped into 30 years ago.
Jayson Davies
Yeah, one on one can be so impactful. I'm wondering if you think that if you had met with, assuming that there are other kindergarten classrooms at that school, do you think you could have had similar impact if you met with all two or three of the kindergarten teachers at the same time?
Courtney Boitano
Absolutely, because I think that also builds a sense of comradery. I mean, hopefully they already have that sense of camaraderie amongst themselves, but really gives that opportunity for them to to use each other to to build off each other strengths, you know, they know the school system, they know the administrators, so to really get some of those conversations going about, you know, how they could even advocate as the kindergarten team, right, or the first grade team, or whatever it might be,
Jayson Davies
yeah. Yeah, I just think that's a way that you can, it can be difficult to talk to three, four, or five different teachers, time consuming, but yeah, if you can meet with all the kindergarten teachers at once, maybe even K and one, if they're having similar concerns, or at least maybe TK and K, like that can save you some time and help more people all at the same time, so for sure, very cool.
Courtney Boitano
Yeah, I love trying to go to their team level meetings, like a number of, you know, will get out early one day a week for collaboration, and then they'll break into, like, they'll have maybe a faculty meeting, and then break into their team level meetings, and so I'll try to go to, like, whatever is kind of top of mind that I know they're needing some support, and even just listen, you know, maybe some weeks I'm not saying anything, and I can, you know, get some charting done, but, but just hearing what's going on, right, and it just also builds that that sense of community, and being being someone who's on their team too.
Jayson Davies
Yeah, yeah, that's important, having someone on your team. So, all right, Courtney, I think that is going to wrap us up. We talked a lot, and we did not get to dive into every single detail of your articles, but that's okay. They are available, they're out there on the JOT C to read, and you can access them there. So, thank you all. Thank you, Courtney, so much for your time. I really appreciate it. And thank you all for listening to this episode. Really quickly, Courtney, where is the best place for people to potentially find you if they just want to learn a little bit more about you, about the research you've done, your, you've done, and are doing?
Courtney Boitano
Yeah, I have a website for my small private practice, OT outside.com and then also, you know, at San Jose State on our website, and it can easily be reached there as well.
Jayson Davies
Fantastic. And if you are potentially a student listening, San Jose State, you could go there and learn with Courtney and the rest of the staff that they have up there, which are some amazing people. I always enjoy when we get to AOTA and get to see some of my San Jose State friends, it's always fun. So, Courtney, thank you so much. Really appreciate it. And we'll definitely have to stay in touch, especially when you have new research coming up, perhaps soon. All right. Well, thank you so much. We appreciate it.
Courtney Boitano
Thank you.
Jayson Davies
Well, Courtney, I want to say thank you one more time for joining us today and sharing your research on MTSS, as well as how you actually implement these sensory interventions in practice. Your work at San Jose State, as well as in the schools, is helping us to understand how to make MTSS more sustainable and impactful, especially through teacher consultation, which, as you shared, can sometimes be a little difficult to prioritize, as well as implementing, so thank you for that. Really helpful. Now, I don't think I've mentioned this quite yet. I usually do, but be sure to find all the links that we referred to in this episode in the show notes, like the SDQ and the zones of regulation at ots.com/episode 203203 203203 and if you want to dive even further into implementing MTSS within your schools, building consultation skills, and getting support from a community of school-based OT practitioners like us, who are doing this work right alongside you, I'd love to have you join us inside the OT School houses school-based OT collaborative. There you'll get access to courses, monthly mentorship calls with myself and a supportive community of practitioners navigating the same challenges that you are every single day. Head on over to OT School house.com/collab to learn more about all the resources, mentorship, and CEUs that we have available, and join us in the community. Thanks again, Courtney. Really appreciate you being here, and also thank you for listening. Until next time, keep making a difference in the lives of your students, and yeah, we'll catch you in episode 204
Amazing Narrator
Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now. Head on over to OT School house.com Until next time, class is dismissed.
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