ENHANCING STUDENT OUTCOMES

Leveraging MTSS and IDEA in School-Based Occupational Therapy

Dr. Moira P. Bushell OTD, MEd, OTR/L, BCP, FAOTA

July 30, 2025

ABOUT ME

Disclosures

LEARNING OBJECTIVES

1. Learners will identify how OTPs can support all students as defined by the Every Student Succeeds Act��2. Learners will select at least two methods for building capacity through collaboration with educator colleagues within an MTSS structure��3. Learners will describe how to operationalize knowledge translation within school practice to improve outcomes for all students

AGENDA

BEFORE WE GET STARTED….

Image from Microsoft Powerpoint

INFLUENCING FACTORS WITHIN SCHOOL PRACTICE

State laws & policies

Federal laws & policies

Other duties as assigned

Practice Guidelines & EBP

(American Occupational Therapy Association, 2017)

WHAT IS THE EVERY STUDENT SUCCEEDS ACT?

ROLE OF SISP IN ESSA

(National Alliance of Specialized Instructional Support Personnel, 2016)

• Six themes in ESSA within Occupational Therapy Scope of Practice
• School Culture and Climate
• Mental Health
• Universal Design for Learning
• Literacy
• Family Engagement
• Life skills and Work Preparedness

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Outcome Based Outcomes within ESSA

(National Alliance of Specialized Instructional Support Personnel, 2024)

This Photo by Unknown Author is licensed under CC BY

OCCUPATIONAL THERAPY WITHIN ESSA

• Every student
• Population health
• Inter-professional Focus
• Evaluate Outcomes

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(American Occupational Therapy Association, 2020)

(National Alliance of Specialized Instructional Support Personnel, 2024)

ESSA IMPLEMENTATION

• OTPs must share our distinct value
• Consider actions and language to demonstrate contributions
• Use resources and examples as launching point
• Cite education research and language within advocacy efforts
• Participate in MTSS

Laverdure, VanCamp & LeCompte, 2023

WHAT IS YOUR INVOLVEMENT IN MTSS?�

INTERACTIVE ACTIVITY #1

• Join assigned Zoom Room
• Share current MTSS practices
• Discuss existing methods
• Identify common practices
• List implementation challenges
• Highlight obstacles
• Discuss successful strategies
• Share effective approaches

MTSS FOUNDATIONS

• Integration of Services
• Combining resources to address student needs
• Data-Driven Decisions
• Using data to guide interventions
• Universal Screening
• Assessing all students to identify those needing support
• Progress Monitoring
• Tracking student progress to adjust interventions

MTSS TEAM COMPOSITION

• The MTSS team includes diverse educational professionals.
• Key members are teachers, support staff, and specialists.
• Collaboration ensures effective student support and intervention.
• Parents or guardians can play a crucial role in the team.
• Regular meetings help to assess student progress and strategies.

ROLE DEFINITION

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• Role understanding critical before collaboration and coaching can begin
• Targeted training can improve this knowledge

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• OTPs must spend time increasing knowledge about role definition

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• Some research supports this being doing through collaborative relationship building

FRAMEWORK IN ARKANSAS

THREE-TIER FRAMEWORK

• Tier 3: Intensive Support
• Less than 5% of students
• Tier 2: Targeted Support
• 10-15% of students
• Tier 1: Universal Support
• 80-85% of students

Tier 1

Tier 2

Tier 3

INTERVENTION STRATEGIES

• Academic Support
• Providing additional resources and tutoring
• Behavioral Interventions
• Implementing strategies to improve behavior
• Motor Skill Development
• Enhancing physical coordination and skills
• Social-Emotional Learning
• Fostering emotional intelligence and social skills

MTSS CYCLE

TIER 1 OT STRATEGIES

What are your best Go-Tos?

EFFECTIVE TIER 1 INTERVENTIONS IN OCCUPATIONAL THERAPY

• Tier 1 interventions are universal and benefit all students.
• Focus on enhancing classroom environments for learning.
• Implement strategies like sensory breaks and ergonomic seating.
• Promote skills such as fine motor and social interactions.
• Collaboration with teachers is essential for success.

3. Universal Design for Learning (UDL)

• Definition: “UDL provides a blueprint for creating instructional goals, methods, materials, and assessments that work for everyone--not a single, one-size-fits-all solution but rather flexible approaches that can be customized and adjusted for individual needs.” ⁸

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• What does the supporting evidence tell us?
• UDL Principles support the learning of students with special needs. ⁹
• Classrooms using UDL principles were able to give students skills to self-regulate and peer monitor, rather than relying on the teacher. ¹⁰

WHAT IS OCCUPATIONAL THERAPY’S DISTINCT VALUE IN UDL?

• Analyzing and grading learning activities

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• Focusing on inclusion while supporting engagement in learning activities

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• Contributing to curriculum teams to meet demands of range of learning styles

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• Supporting differentiated instruction to enhance all learners

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• Modifying environments and activities for greater participation

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UNIVERSAL DESIGN FOR LEARNING IN PRACTICE

• Providing teachers with a range of apps to improve student work completion

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• Surveying the room and providing recommendations about desk heights

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• Providing teachers insight into classroom setup to optimize student participation

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• Encouraging teachers to structure activities with breaks to improve student engagement

SMALL GROUP ACTIVITY

• UDL in Practice
• Classroom Scenario
• Strategy Development
• Implementation Steps

TIER 2 SUPPORT FRAMEWORK

Identification and Assessment

The first step involves identifying students who require additional support and assessing their specific needs.

Implementation of Interventions

Implementing small group interventions to provide targeted support for 10-15% of students who benefit from such measures.

Monitoring Progress

Regular tracking of student progress is essential to ensure the effectiveness of the interventions.

Data-Driven Decisions

Using data collected from progress tracking to make informed decisions about adjusting and guiding support strategies.

OT ROLE IN TIER 2

• Small Group Sessions
• Skill-Specific Interventions
• Teacher Coaching
• Monitoring and Adjustment

IMPLEMENTING TIER 2 SUPPORT

Detailed Student Profile

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Identifying Current Challenges

What do you think the team would identify as the area for growth for the student? What should the goal be?

Exploring Intervention Options

What intervention type, frequency and duration would you recommend? Who could implement the intervention?

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TIER 3

Tailored Individual Support

Tier 3 support focuses on individualized plans to meet the unique needs of each student, ensuring personalized interventions.

Frequent Progress Monitoring

Regular monitoring of student progress is essential for adjusting interventions and ensuring the effectiveness of support.

Team-Based Decisions

Decisions are made collaboratively by a team of educators, specialists, and sometimes family members, ensuring comprehensive support.

Family Collaboration

Collaborating with the family is crucial to provide consistent support across different environments, enhancing the effectiveness of interventions.

DATA COLLECTION SYSTEMS

• Screening Tools
• Initial assessment methods for identifying student needs
• Progress Monitoring
• Ongoing tracking of student performance
• Documentation Methods
• Recording and maintaining student data
• Analysis Techniques
• Evaluating data to inform instruction

QUALITY INDICATORS FOR PROGRAM EVALUATION

• Student Outcomes
• Assessing academic achievements
• Evaluating personal growth
• Program Effectiveness
• Determining impact on target goals
• Analyzing overall performance
• Implementation Fidelity
• Ensuring adherence to planned procedures
• Monitoring consistency in execution
• Team Collaboration
• Evaluating teamwork and communication
• Assessing collaborative efforts

TEAM COLLABORATION

• Communication Protocols
• Establish clear guidelines for team communication
• Ensure all members are aware of communication channels
• Role Definition
• Clearly define each team member's role
• Assign responsibilities based on skills and expertise
• Decision-Making Processes
• Develop a structured approach to decision making
• Encourage collaborative input from all team members
• Resource Sharing
• Facilitate easy access to shared resources
• Promote transparency in resource allocation

IMPLEMENTATION CHALLENGES

• Challenges
• Time Constraints
• Resource Limitations
• Staff Coordination
• Solutions
• Efficient Scheduling
• Resource Optimization
• Team Approaches

QUESTIONS & BREAK

OCCUPATIONAL THERAPY AND IDEA

IDEA – INDIVIDUALS WITH DISABILITIES IN EDUCATION ACT

• “Type and purpose:
• An education act to provide federal financial assistance to State and local education agencies to guarantee special education and related services to eligible children with disabilities.”
• Written as a funding mechanism
• Remedial in nature - provides more supports and services than to non-disabled persons
• Covers all public school students

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(DREDF, 2021)

IDEA PART B - 6 MAIN ELEMENTS/PRINCIPLES

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- IDEA is a funding mechanism for states/districts that have the following: (Center for Parent Resources and Information, 2017)

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1. Free and Appropriate Public Education (FAPE);
2. Appropriate Evaluation;
3. Individualized Education Program (IEP);
4. Least Restrictive Environment (LRE);
5. Parent, and Student Participation and Input, and
6. Procedural Safeguards. (Utah Parent Center, 2022)

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IDEA PART B - SERVICES FOR SCHOOL-AGED CHILDREN

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• Free Appropriate Public Education;
• “The right to FAPE means special education and related services are available to eligible children with disabilities age 3 to 22 and are to be provided at no cost to the parents.
• The specially designed educational programs and services reflect the child’s individual educational needs, and are to be provided in conformity with the Individualized Educational Program (IEP).
• FAPE applies to all qualifying children with disabilities, including those who have been suspended or expelled from school.”

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(Center for Parent Resources, 2017) & (Utah Parent Center, 2022)

IDEA PART B - SERVICES FOR SCHOOL-AGED CHILDREN

2. Appropriate Evaluation

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Child Find

When a school professional believes a student between 3 and 21 may have a disability that has a substantial impact on the student’s learning or behavior, the student is entitled to an evaluation in all areas related to the suspected disability.

(Center for Parent Resources, 2017) & (Utah Parent Center, 2022)

IDEA PART B - SERVICES FOR SCHOOL-AGED CHILDREN

3. Individualized Education Program (IEP):

• Document that outlines specific actions and steps through which educators, parents, and the student themselves may reach the child's stated goals.
• “The IEP is a legally binding, written document that outlines the special education program, services and related services based on the child’s educational needs.”

(Utah Parent Center, 2022)

IDEA PART B - SERVICES FOR SCHOOL-AGED CHILDREN

4. Least Restrictive Environment (LRE)

• The LRE is the environment where the student can receive an appropriate education designed to meet his or her special education needs, while being integrated with nondisabled peers to the maximum extent appropriate.
• Education & services should be provided in the LRE

(Center for Parent Resources, 2017) & (Utah Parent Center, 2022)

IDEA PART B - SERVICES FOR SCHOOL-AGED CHILDREN

5. Parent and Student Participation in Decision-Making

• Input of the child and the child’s parents must be included in the education/IEP process.
• IDEA requires parents be given the opportunity to play a central role in planning and decision-making regarding their child’s education.
• The student’s rights and participation are strongly encouraged, especially when addressing transition planning.

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(APA, 2022) & (Utah Parent Center, 2022)

IDEA PART B - SERVICES FOR SCHOOL-AGED CHILDREN

6. Procedural Due Process

• When a parent feels an IEP is inappropriate for their child, or their child is not receiving needed services, under IDEA the parents have the right to challenge their child's treatment.
• Safeguards are designed to protect the rights of the parents and their children with disabilities, and to give families and schools a mechanism for resolving disputes.

(APA, 2022) & (Utah Parent Center, 2022)

OT WITHIN IDEA & ESSA

• Individual-based
• Evaluate
• Determine Eligibility
• Create outcomes
• Interventions
• Evaluate outcomes

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IDEA

• Every student
• Broad outcomes
• Evaluate context and environment for all
• Inter-professional focus
• Evaluate outcomes

ESSA

(AOTA, 2020 & Schneider & Chandler, 2019)

WHERE IS IDEA IMPLEMENTATION NOW?

• IDEA as a law has not changed that much in the past few decades with each reauthorization
• However, caselaw does impact its implementation which further impacts our school districts and occupational therapy as a whole

ENDREW F. V. DOUGLAS COUNTY SCHOOL DISTRICT RE-1

• Endrew F.’s, IEP failed to show any progress.
• family challenged the public school, had not met FAPE
• enrolled him in a private school.
• His parents sought reimbursement for private school
• The private school created a behavioral intervention plan and strengthened his academic goals, resulting in improvements in his behavior and academic progress.

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Endrew F. 137 S.Ct. at 997 (2017)

ENDREW F. V. DOUGLAS COUNTY SCHOOL DISTRICT RE-1

• In Endrew F. ruling, the U.S Supreme Court created a new standard for what constitutes FAPE

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• Must schools provide meaningful education with significant progress or is minimal progress sufficient?

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• The Supreme Court ruled that minimal or “de minimis” progress was not acceptable.

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U. S. Department of Education, 2022

NEW CASE?

IDEA IMPLEMENTATION BEST PRACTICES FOR OCCUPATIONAL THERAPY

• Occupation Based Evaluations
• Collaborative Goal Writing
• Service Delivery in LRE

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OTPF-4 AND SCHOOL BASED PRACTICE

• Occupations
• ADLs
• IADLs
• Education
• Work
• Play
• Leisure
• Social Participation

(American Occupational Therapy Association, 2020)

• Performance Skills
• Motor Skills
• Process Skills
• Social Interaction Skills

OCCUPATIONAL THERAPY EVALUATION

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RESULTS = Incomplete Evaluation

DOWNSTREAM EFFECTS:

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Incomplete Evaluation

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Incomplete (or Missing) Intervention Plan

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Potentially misaligned student outcomes

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Team confusion about the role and value of school OTPs

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INCONSISTENT OT PRACTICES

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Critical Factors

• The OTPF-4 provides the process (including uniform language) and the vehicle to more consistent practices across the US

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• The Occupational Profile, Analysis of Occupational Performance and Synthesis of Evaluation Process generates the Intervention Plan and Outcomes

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• A complete evaluation is how we define, detail and demonstrate the unique value that school-based practitioners bring to schools and student clients

ADAPTING AN OCCUPATIONAL PROFILE TEMPLATE INTO THE OCCUPATIONAL THERAPY EVALUATION

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• Expand the profile into a narrative form

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• Add the analysis and synthesis components
• these components are critical pieces that reflect student-centered practice while demonstrating our distinct value and contribution in schools

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• The Result: A comprehensive, student-centered evaluation report

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OT EVALUATION PROCESS TO INFORM GOAL SETTING

• Combine Occupational Profile with information gathered from assessments

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• Summarize student’s occupational performance using occupation-based language

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• Strengths-based language when writing about students supports and challenges

(Clark & Handley-More, 2017)

OT EVALUATION PROCESS TO INFORM GOAL SETTING

• You did the evaluation, so now what?

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• Adverse effects and educational needs
• Refer to these statements within IEP paperwork when beginning goal writing
• What areas listed can be support by Occupational Therapy Practitioners?
• Are there ways to target more than one area at a time?
• Disability does not determine need but it impacts goals, supports and services

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• Present Level of Performance
• How does evaluation data translate to educational performance?

SCHOOL-BASED OT GOALS VS. OTHER PEDIATRIC SETTINGS

GOAL WRITING CONSIDERATIONS

• Focus on interprofessional collaborative practice

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• Federal guidance and case law

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• District and/or state guidelines

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• Formatting based on documentation system

(Interprofessional Education Collaborative, n.d. & Hanft & Shepherd, 2016)

INTERPROFESSIONAL COLLABORATIVE GOAL WRITING

• AOTA, APTA, ASHA joined together to highlight interprofessional collaborative goals in school-based practice

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• Process outlined to work as a team to write goals and create data collection methods based on identified educational impacts

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• Differentiates each providers scope of practice within a collaborative goal

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• Reiterates that goals and needs are not specific to one provider.

(American Occupational Therapy Association, et. al., 2022)

PRESENT LEVEL OF PERFORMANCE AND FUNCTIONAL GOAL SETTING

• How a student’s identified disability impacts educational participation and performance

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• Individualize the student’s performance - highlight strengths as well as challenge areas

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• Make sure to highlight all relevant areas of OT scope of practice using occupation-based language

(Illinois State Board of Education, 2021)

THE INTERVENTION PLAN

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Developed after review and synthesis of information from the occupational profile and analysis of the client's occupational performance.

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In our experience, many practitioners incorrectly think that the IEP is the intervention plan.

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Although IEP does include some components (ie. goal, freq, duration of service), it does not often outline intervention approaches.

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Consists of three phases: Intervention, Implementation and Review

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INTERVENTION PLAN

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• Includes:
• Goals
• OT Intervention Approaches
• Method(s) of Service Delivery
• Who, what, when, where, how
• Timelines for review

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THE INTERVENTION PLAN - IMPLEMENTATION

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• Address specific occupations, contexts, and performance patterns and skills affecting performance

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• Utilizes the best available evidence for school setting

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• Includes team collaboration

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• Upholds least restrictive environment guidelines as feasible for student

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• Individualized based on needs and goals

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

OCCUPATION AS INTERVENTION

Body Structures & Function

Activity

Participation

Bottom- Up Approach

Top-Down Approach

OCCUPATIONAL THERAPY PRACTICE GUIDELINES FOR CHILDREN AND YOUTH AGES 5-21 YEARS

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“Activity and occupation-based interventions

are effective in promoting participation and

enhancing performance in valued occupations

of children and youth.”

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• Provide services in the natural context of

desired occupation.

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• Skills-based training/practice in the

context of valued occupations recommended

over isolated sensorimotor approaches.

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The American Journal of Occupational Therapy, 2020, Vol. 74(4), 7404397010p1–7404397010p48.

https://doi.org/10.5014/ajot.2020.744001

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Downloaded from http://research.aota.org/ajot/article-pdf/74/4/7404397010p1/70321/74043970

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INTERVENTION REVIEW

Continuously monitor, review, and reevaluate the client's progress towards goals/outcomes.

Modify the intervention plan as needed.

*Consider the need for continued occupational therapy as a related service and for referral to other services.

*Collaborate and communicate with team to determine necessity for and provision of occupational therapy services

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

KEYS TO IEP CREATION & IMPLEMENTATION FOR GREATEST STUDENT SUCCESS

• Highlight occupation to keep our distinct value at forefront
• Write collaborative goals that support state standards
• Provide services in the LRE and make these decisions as a team
• Be creative! Sometimes less is more
• We cannot do it alone!

QUESTIONS & BREAK

APPLICATION TIME!

WRAP UP & THANK YOU!

KEY TAKEAWAYS

• OTPs SHOULD be involved in MTSS both as consultants and implementors
• Take a seat at the table
• Occupational Therapy supports participation under IDEA.
• Maximizing impact does not mean more time.
• There are so many ways that we can support student success.
• It can be a bit more work on the front end, but building capacity has so many positive downstream effects.

REFERENCES