Pediatric Therapeutic Services

How Occupational Therapy Tier 1 Interventions Benefit Students and Therapists

In any given school day, students must manage a multitude of specific tasks: unlocking and locking lockers, sitting and paying attention to instructions, holding a pencil correctly to write on a worksheet, as examples.

Female school-based occupational therapist kneels next to girl with Down syndrome using tablet computer.As a school-based Occupational Therapist (OT) you help students perform all these daily “occupations” and more. But you can’t exclusively work one-on-one with every student who needs services. The need is too great and your time is too short.

In special education programs using Multi-Tiered Systems of Support (MTSS), Tier 1 Interventions can both ease your load and maximize your interventions’ effectiveness.

At Pediatric Therapeutic Services (PTS), we are big believers in MTSS’ power to do more good for more students without stretching clinicians to the breaking point. This model reserves intensive, one-on-one interventions for students who need them most, while extending related services’ benefits to those who aren’t on a caseload. 

Reviewing the Occupational Therapist’s Role in MTSS

The language of MTSS is relatively new. Only in the last few years have more states started talking about MTSS than RtI (Response to Intervention) on their education websites. But the concept of using tiered systems to support student outcomes isn’t new. MTSS is “what we should have called it from the start,” Dr. Adena Miller writes online. 

At PTS we use the terms synonymously, but we always have this three-level framework in mind:

  • Tier 1
    Supports and services proactively delivered to all students via the general education classroom help 80-90% of them successfully develop educationally necessary skills.
  • Tier 2
    More specialized supports and services, efficiently delivered to small groups of students who don’t respond to Tier 1 interventions, help 5-10% of students.
  • Tier 3
    The most targeted, individualized supports and services help 1-5% of students, those assessed with the most serious disabilities and disorders.

School-based OTs play a critical role in making MTSS work, as the American Occupational Therapy Association (AOTA) explains:

  • Tier 1
    OTs educate teachers about and train them to provide universal interventions and assist in screening all students to identify those who may need more intensive support.
  • Tier 2
    OTs review the data teachers collect and recommend general education adaptations that can benefit small groups of students.
  • Tier 3
    OTs review collected data and help determine which individual students need individualized therapy.

Examples of Tier 1 Interventions in Occupational Therapy

Although you’ll be most directly involved with students in Tiers 2 and 3, your work implementing Tier 1 Interventions with general education teachers and staff is the basis on which the MTSS model’s success rests.

Female school-based occupational therapist sits next to boy sitting at table with other children, playing with rubber shapes.Case in point: Problems with handwriting commonly drive OT referrals. But OTs can train teachers to address these frequent concerns. Among other strategies, teachers can help students:

  • Check and adjust their writing posture
  • Improve paper position and stability
  • Exercise their fingers and hands with pencils, putty, and more
  • Experiment with different pencil grasps
  • Create decorative “sidekicks” to improve letter spacing

Using these and similar activities, teachers can eliminate unnecessary OT referrals for handwriting issues, instead, only referring students who don’t satisfactorily respond to these interventions.

Teachers also frequently ask school-based OTs to help students who have trouble regulating their emotions and behaviors. Here also, OTs can equip teachers with Tier 1 Interventions designed to promote students’ self-regulation—and, by extension, a calm and quiet environment conducive to learning. Such interventions include:

  • Practicing deep belly-breathing exercises
  • Leading guided visualizations as students relax with eyes closed
  • Encouraging students to massage their hands’ and ears’ pressure points
  • Incorporating quick movement breaks into the classroom routine
  • Giving kids thera-putty to roll and squish

When you consult and collaborate with teachers and get them using Tier 1 Interventions in their classrooms, you’ll not only be indirectly helping more students, but also ensuring you have time and energy to deliver more intensive interventions to the students who really need them.

For more examples of OT Tier 1 Interventions for handwriting and self-regulation you can introduce to teachers right away, click here to download detailed and illustrated Consult Cards from PTS

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