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Multitiered Model of Education

Effective instruction differentiation for all students is accomplished via a multi-tiered strategy.

This model features interventions and offers increasingly intensive levels of training

tailored to the student's needs.

Multi-tiered System of Support (MTSS)

Occupational therapy practitioners provide service as a collaborative member of the team to students and on behalf of students through individual, group, whole classroom, and/or school-wide initiatives.

For more details related to MTSS, visit: 

Response to Intervention (RTI)

“a framework in education that may be used to identify students who are at risk in academic or behavior areas; intervene with these students; and identify students with specific learning disabilities.”

Clark, G. F., & Polichino, J. E. (2013). Best practices in Early Intervening Services and Response to Intervention. In G. F. Clark & B. E. Chandler (Eds.), Best practices for occupational therapy in schools, p.173 . Bethesda, MD: AOTA Press.


To learn more details related to RTI, visit:



Early Intervening Services


Response to Intervention


Multi-tiered System of Support

EIS is provided with OTs supporting students in general education prior to a special education referral

Multitiered Model of Education
Reflected in IDEA 2004

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Occupational therapists can provide EIS to students in general education as a related service under IDEA

and under ESSA as specialized instructional support personnel.

*Make sure to review your state licensure laws to ensure the extent to which OT may participate in each MTSS tier

Tier 1

Early Identification Screening


Tier 2

Targeted Interventions

Tier 3




  • School or classroom-wide interventions

  • Core instructional interventions

  • Preventative, proactive

  • Whole class screening to identify age/grade appropriate academic/behavioral support

  • e.g., leading in-service/training to teachers, implementing handwriting curriculum

  • Address specific needs of struggling students

  • Small group interventions

  • Rapid response

  • e.g., implementing multisensory handwriting strategies for some/targeted students


  • Individual student

  • Assessment based

  • Individualized interventions

OT within the RTI Model

Response to intervention is an approach, that requires "collaboration from all school personnel, involves universal screenings; high-quality, evidence-based instructional methods and interventions; data collection and data-based decision-making; and progress monitoring."

AOTA Practice Advisory on Occupational Therapy in Response to Intervention.


Offer strategies along the tiered continuum

OT offer strategies/intervention/education while following the multi-tiered continuum of progress

(see MTSS above)

Business meeting


progress data

OT collect and analyze data related to interventions to make recommendations as needed when students would benefit from receiving more intensive intervention in a different RtI tier

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Practice considerations

Not all states have adopted a RtI approach. The requirements for delivering RtI services vary between states.

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