Pediatric Therapeutic Services

How Tier 2 Interventions Help Students By Keeping Them Off Caseload

A teacher sends a frantic email or urgently flags you down in the hallway to say, “So-and-so can’t”—write their letters, stay at their desk, keep their hands to themselves… the list goes on—“and I think they need therapy. How do I make a referral?”

Male school-based occupational therapist kneels in front of small group of children sitting on floor, giving “high five” to boy.Hopefully, you don’t find yourself in this situation too often! While you’re eager to help as many students as you can, having to make a formal assessment every time a teacher requests a referral can actually take time away from doing so. Tier 2 interventions offer a far better way to get more students the targeted interventions they need without adding them to your at-capacity caseload.

The middle level in a Multi-Tiered Systems of Support (MTSS) approach to related services, Tier 2 intervention strategies reduce unnecessary one-on-one therapy referrals, but still power significant progress for students with identified educational needs.

At Pediatric Therapeutic Services (PTS), we’ve seen Tier 2 supports help students make measurable and lasting gains in multiple areas. We frequently use resources our own clinicians have developed and refined.

We’d like to share some examples of Tier 2 interventions we’ve found especially effective at accelerating students’ success without increasing pressure on busy therapists like you!

Reviewing the Multi-Tiered Systems of Support Model

In the special education field, you hear much about MTSS, “RtI” (Response to Intervention), and “RtII” (Response to Intervention and Instruction). We at PTS tend to use these terms synonymously. They all refer to, in our co-founders Pam Hackett and Diana Fongheiser’s words, “a tiered approach in which each step represents a more significant investment of time and resources based on the child’s ability to make progress with various levels of support.”

Here’s the overview of how it works:

  • Tier 1
    Supplemental services proactively delivered to all students in the general education classroom environment help 80-90% of them successfully develop educationally necessary skills.
  • Tier 2
    More intensive, short-term services efficiently delivered to small groups of students facing similar challenges who haven’t responded to Tier 1 interventions. They help 5-10% of students.
  • Tier 3
    The most individualized and direct services help the 1-5% of students assessed with the most serious disabilities and disorders—the students who truly should be on a caseload.

Some schools skip Tier 2 interventions for therapeutic support. “Each time we review new therapy caseloads,” Diana and Pam write, “it becomes quickly apparent that some intervention—far less intensive—would have been adequate for many of the students” who end up on a caseload.

While the MTSS approach is no magic cure-all, it does help clarify which students face significant deficits and which could benefit from the temporary, targeted support Tier 2 affords.

Female school-based occupational therapist helps group of middle-schoolers practice handwriting during a Tier 2 intervention.Examples of Tier 2 Intervention Strategies in Action

When can Tier 2 interventions prove particularly useful? 

Handwriting concerns drive many referrals to school-based occupational therapists in schools. But instead of adding every child with “sloppy writing” to an OT’s caseload, why not form a small-group “handwriting club” that any trained teacher or staff member can lead to focus on pencil grip and letter formation in fun ways?

That’s the goal of PTS’ Pencil Power™ small group intervention. Meeting for only half an hour once per week for six weeks, students strengthen their fine motor, visual motor, and handwriting skills, playing games and turning their pencils into superheroic “sidekicks” along the way!

Tier 2 supports can also help students who face social skills challenges. Over the course of just eight weeks, our Super Self™ program equips students with key self-monitoring strategies to help them focus as fully as possible on learning in the classroom. 

Click here to download a sample of the Super Self workbook. You’ll see how it encourages students to choose and use practical strategies—everything from “silent silly faces” and shoulder shrugs to palm presses and chair pull-ups—for staying attentive and productive in school. Teachers and staff members can also lead these small groups after minimal training from trained clinicians.

Resist the rush to referral! Educate teachers and staff about the power of Tier 2 interventions to deliver “therapy without the therapist,” as we like to say.

By helping the schools you work with implement an MTSS model in related services and working directly with fewer students yourself, you’ll actually be helping more students succeed—and that’s why we’re in this line of work!

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