Pediatric Therapeutic Services

Integrated Systems of Support—The Next Evolution of MTSS

By Pamela Hackett, MPT

Managing Partner and Co-Founder of Pediatric Therapeutic Services, Inc. (PTS)

For more than five years now, an evolution has been going in education. What was previously known as Response to Intervention (RTI) and Positive Behavior Interventions and Supports (PBIS) became Multi-Tiered Systems of Support (MTSS). MTSS eliminated some of the “jump through hoops to qualify for services” problems with RTI and even incorporated a lot of the behavioral supports of PBIS, becoming a more comprehensive and proactive approach. For nearly ten years, our related services teams have been delivering therapy using this kind of a tiered model, as we worked to strike a balance between helping more students and limiting the impact on the budget. By putting some tried and true classroom-based strategies and targeted teacher trainings in place, we created a functional safety net for all students. For those who needed a little more, we created short-term, small group interventions to supplement their instruction. It was, and is, a great model. It triages students into the right level of support and builds capacity, not dependency, while those supports are titrated as they progress. Each of the therapies had their own Tier 1, Tier 2 and Tier 3 “plans,” and loads of students progressed so well that they never needed any kind of formal therapy. 

Where the model didn’t work so well was with students who needed supports across multiple disciplines–such as a student with a history of trauma and hyper-activity disorder whose inability to sit still made it hard to participate in a group mental health session. Or the student who had a pragmatic language issue and was not grasping the concepts in the Zones of Regulation group for self-calming. They often got the right supports from each of the professionals involved, but they continued to struggle because the interventions were delivered in isolation from each other. The magic is in integrating those systems of support, so that children with multiple areas of concern can access what they truly need, not just concurrently but simultaneously. This doesn’t mean that students get more direct service from more providers, it means that strategies are integrated across disciplines and treatment sessions using a consultative model. The budgetary impact would be minimal, but the results in terms of meaningful progress would be huge.

Integrated Systems of Support—The Next Evolution of MTSSI personally experienced this “magic” when I worked as a senior physical therapist at the Children’s Hospital of Philadelphia years ago. I completed several rotations at their rehabilitation center, where the children were often involved in multiple therapies. It was common to have a speech therapist attend my PT session because a child would vocalize more when they were working with me on a therapy ball. My OT colleagues would do some vestibular and proprioceptive stimulation prior to my working on balance or walking, and the results were dramatic. The kids weren’t the only ones doing better. As I listened to the speech therapist, I learned how to provide the child with better verbal cues. I picked up some powerful insight into the sensory systems that transformed the way I treat movement disorders to this day. I would not be the clinician I am without having the opportunity to see these talented therapists in action and learning to see through their eyes.

I have also had the privilege of seeing the impact of multi-disciplinary teacher training in hundreds of schools throughout the developing world. For many years, PTS has been delivering free teacher trainings and classroom-based therapy strategies to schools throughout Africa, India, and Latin America.  In countries where there are no therapists, we provide trainings that integrate developmental, behavioral, mental health, and self-regulation strategies. Empowered with knowledge and practical “how to” tools, these teachers are making dramatic progress toward creating inclusive classrooms for students with special needs. Just as exciting is how basic concepts like kinesthetic learning and positive reinforcement are impacting ALL students, not just those who are struggling. It has shown me the power of knowledge and the potential of learning the perspective of other professionals.

I believe it’s time to bring the magic of Integrated Systems of Support into our schools. We have all the pieces in place already–we just need to combine them correctly to multiply their effectiveness. An Integrated Systems of Support model will also help further blur the lines between regular and special education by making the interventions themselves more inclusive. Students who were once thought to be too “complex” for their home school will make exponential progress when the right supports are delivered simultaneously and collaboratively. And other students whose emotional and/or social wellness is impacting academic performance can be taught, not enabled, with the requisite skills to participate fully as students and as members of the community. The fallout from the pandemic has added a whole new level of challenges for our students, emotionally, socially, and academically. It is going to take a lot of listening and learning from one another and the space and time to get them back on track. As educators and therapists, we will grow stronger, valuing the expertise and insight of everyone on the team as we make some “magic” together. 

If you have any questions, please contact us today!

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