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Getting Ahead of Your OT Evals Using Tier 1 Interventions

RTI2 Pyramid

You likely recognize the graph above as the RTI2 Pyramid and understand that OTs typically work with students who fall into the smallest point of the pyramid; those who require an IEP.

Well, lets flip that upside down!

Today I want to put aside that tiny purple section at the top and the slightly larger pink section to focus on strategies that can help the 80% of students; also known and your "typically developing" students in general education. For many of them could easily move up a tier and require much more assistance.

If you are not yet familiar with these programs, I suggest you first read our post titled Reducing OT Referrals: Using MTSS and RTI-2 to Better Assist You! Then head back this way to learn about a few specific tier 1 strategies you can get started with ASAP!

I want to share with you three specific ways that Abby and I are providing Tier 1 RTI interventions in our schools to help our entire student body, while also helping the kids on our direct caseload. That way, you too can help more than just the 5% of students at the top of the pyramid.

These interventions do take some time to put into place. They take some planning that may eat into your assessment writing time or other areas. However, in the long run they will help to cut down some of that assessment time and help to build a rapport with the teachers and the administrators at your site.

Also, make sure you speak with your supervisors to make sure that in your department, district, and state that this is all legal and appropriate. When writing these posts, we consult the IDEA website and the California Practice Act website which does have some of the more strict guidelines. Be sure to check your state's guidelines using this interactive map.

So let’s dive into the three tier 1 strategies you can use to help replace some assessment time with intervention time.

3 Steps to Getting Ahead of Future Evals!

1. Email your teachers and let them know you are available for classroom observations

If you are a district employee, this one can typically be implemented pretty quickly. As a contract therapist, there may be a few more hoops to jump through, but it can be done.

About 2 years ago, I put together a screening form that a teacher could fill out to essentially ask me to come in and make simple recommendations for a specific student; general or special education students. The outcomes of these screenings ranged from me recommending some Theraband around the student’s chair, to a teacher/OT collaborative handwriting lesson for the entire class Sometimes they even led to a full blown OT assessment for a specific student.

That screening process lasted for about 3 or 4 months before I realized through attending conferences that other OTs doing similar screenings were being told that these screenings were essentially “very poor assessment” and not defensible when it came to due processes.

So... we simply ceased doing these individual screenings.

Now, some of you may be saying “well...duh!” And to be fair, we were skeptical of the idea, but were trying to prevent ourselves from becoming exhausted.

That being said, this “failure” led to a more legal screening concept, that I can now share with you.

While screening an individual child may not be the best idea, observing an entire class is very possible and logical. After all, you are an employee/contractor at the school and should collaborate with your colleagues.

So, we put together a classroom OT observation request form. On this form, we laid out exactly what this form was for and what is was not for (individual screens of a child - no student names allowed on this form). We made sure to explain what school-based OTs could look at (routines, chair/desk fit and layout, a variety of barriers to handwriting, sensory stimuli, etc) and how an OT observation could benefit the teacher and their students.

Likewise, some of the possible outcomes of this observation are defined on the form. Ranging from a short collaboration with the teacher, to co-teaching a lesson with the teacher, to starting the SST process or calling and IEP for a specific student may result from this observation.

In most cases, the observation leads to a collaboration meeting between the OT and teacher. Occasionally, it will lead to a collaborative handwriting or self-regulation session. On rare occasions, it leads to an occupational therapy evaluation of a student already identified as having a qualifying disability. We have not yet come across a situation where we recommended a Psycho-educational evaluation for a student.

So download this form now for free!

Check out the form and see if it might work for you. Here are a few pointers as to rolling this process out.

  1. Start with familiar teacher at a school with a supportive administrator. You may not even need the form at this point, but make sure the teacher and administrator know what to expect. If it goes well, the admin help you with materials and spreading your idea.

  2. Expand to the rest of that school before moving on to others. You don’t want to spread yourself too thin before knowing how much time this is going to take. At some schools you may only get one teacher interested in an observation while at others you have the entire k-3 team wanting you to come in.

  3. At other schools, you can start the process through an in-service (which we are about to talk about). Talk to your admin about scheduling a day that you can have 30 minutes or so to present to the teachers how you can help them.

2. In-Services

Like I said earlier, OTs have a unique knowledge and skill set that can benefit teachers and students alike. Unfortunately though, we often forget how beneficial collaborating with teachers can be in facilitating a student’s access to education.

Instead, we sometimes think we can see a student once a week and make significant changes in this student. But imagine the impact you could have if you give an in-service to not only that student’s teacher, but all of the school’s teachers. You could have helped that child and maybe several others.

Here’s an example:

After 5 weeks Johnny begins using a tripod grasp in OT sessions, but the teacher says he is still using a fisted grasp in class. So you do and in-service for the kinder and 1st grade teachers about how to facilitate a tripod grasp and in-hand manipulation skills. Now all of the teachers start their morning writing routine with a 5 minute pre-writing warm up, complete with a quick, cute, and effective pencil grasping story. Now Johnny and his peers are all using a functional grasp in their natural environment.

The great thing about in-services from an OT, is that it can typically benefit both general and special education teachers. It also gives you a chance to introduce your classroom observation idea and the forms we are going to talk about next.


5 easy to do in-services that can have a big impact on all students!

  1. Cheap tools to help calm your fidgety students

  2. GoNoodle and how it’s more than just indoor PE

  3. Why recess should never be taken away. Especially from the kid who loses his recess every day

  4. How complex writing really is and how to make it easier for struggling students.

  5. Gray-space paper can help with this one.

  6. The importance of ergonomics for the students and teacher

I also want to encourage special education teachers and other related service providers to do in-services as well. As a teacher of children with special needs, you have had to learn many behavioral and developmental strategies that I am sure many general education teachers could benefit from.


3. Provide forms to help teachers know when they can expect a student to complete skills.

Simple, yet effective, these reproducible documents are worth creating because you can easily send them out when you get an email about a general concern. Or if a teacher approaches you on campus, you can respond with you “Staff Room Response”

My guess is you probably have some sort of document you either created or have found that shows when a student should have met many fine motor developmental skills. Use this to your advantage by sharing it with your teachers. I have found that many teacher referrals come from simply not knowing what skills a child should have developed by the time they have gotten into their class.

Along with this info sheet, I attach copies of adapted paper (Gray-space paper) and a list of simple tricks to help out with commonly seen difficulties. Actually, I have a packet of these all put together for any SST or IEP I attend. Parents also appreciate the reference.

These forms in conjunction with an in-service are optimal. That way you can quickly review them and answer any questions the teachers have in the moment. These documents will also play a big role when it comes to the OT referral because we can ask the teacher if they have referred and tried any of the strategies and tools outlined in these documents. More on that in a future post and podcast (yep, the podcast is coming soon!)


So those are my 3 most frequently used Tier 1 strategies to help prevent future OT evaluations.

What are yours? Do you use these same strategies, or do you employ completely different strategies in your district(s)? We would love to hear your take on RTI and MTSS in the comments below!

Also, do you know someone who could benefit from this post or others on our page? We would be so grateful if you could share us with them; verbally, in an email, or with the social links below.

Thank you for reading and keep a look out for some more specific tier 2 strategies coming soon.

See you next time at the School House!



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