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Reducing OT Referrals: Using MTSS and RTI-2 to Better Assist You!

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.

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!

Photo by Sweet Ice Cream Photography

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.

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.

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

Until next time,


1 Comment

Jul 17, 2022

Thanks for writting this

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