Vol. 28 • Issue 19
• Page 16
Response to Intervention (RtI) targets all students who may be at risk for academic or behavioral difficulties to help them achieve curriculum standards without requiring special education services.1 The purpose of RtI is to identify struggling learners early in their education and provide instruction based on the student's areas of weakness.2
RtI uses a multi-tiered method to meet goals. Tier 1 focuses on universal, whole-classroom intervention. Tier 2 may target small groups within a classroom. Tier 3 is intensive and more individualized, addressing students who do not respond to previous tier 1 or tier 2 interventions. Within the RtI process, progress is monitored to ensure rates of student improvement match classroom benchmarks; this fits with AOTA's Centennial Vision of occupational therapy as a "science-driven and evidence-based profession."3
A Broader Role in Schools
RtI is a preventative approach, expanding opportunities for occupational therapists beyond traditional school-based programming. Within this service delivery model, OTs collaborate with clients within the general education population,4 thereby meeting the Centennial Vision's call to promote greater visibility of the profession.3
According to the Occupational Therapy Practice Framework, "the client" may not only be the student or students seeking to gain greater independence in daily meaningful occupations, but may also include caregivers, the teachers and support staff, and school administration.5 For example, within this model, occupational therapists may participate in screening procedures, curriculum development, and school- or district-wide RtI teams, as well as development/presentation of in-service education to a larger client base.2 Consultation becomes crucial when considering the students' ability to generalize skills learned across contexts and settings.6 Facility initiatives that already include an RtI model make it easier for the OT to become a valued member of the team.
This collaborative approach also requires OTs to have a working knowledge of regulations and guidelines governing school practice when identifying the direction of program focus. This includes parameters set by federal and state laws, OT scope and standards of practice, as well as facility and administrative guidelines.7
In one elementary school where I work (grades 1-6), OTs are becoming more involved with RtI teams (called Scientific Research Based Intervention, or SRBI, in Connecticut) focused on handwriting. Current instruction in handwriting may benefit from additional data collection procedures such as whole-class screening to identify struggling learners before they fall too far behind.
Facility guidelines require teachers to first identify struggling students within the SRBI program, documenting problem areas and potential solutions, before referring to occupational therapy. At the tier 1 level, members of the SRBI team, led by facility administrators, may recommend strategies that include multi-sensory approaches or additional practice time and homework. The OT may consult with the teacher "client" and provide suggestions to modify activity demands, such as: ways to promote optimal position for handwriting; writing aids to enhance grasp patterns, or adaptive papers when demands require adjustment for successful participation.
The physical environment may also be adjusted to encourage additional fine-motor opportunities. Some examples include: fastening a bathroom pass with buttons versus Velcro when turning it over indicating "in use" or "open"; using clothespins to secure papers for classroom display, or maintaining crayons or markers in Ziploc-style bags. Another example of a successful tier-1 intervention is bi-weekly visits in first-grade classrooms where the therapist may monitor positioning and offer technology suggestions for continued effectiveness or adjustments as needed.
Administration as the "client" may ask OT staff to provide facility-wide in-service education regularly during the school year.
Consultation to the caregiver "client" may involve education using virtual contexts such as an "Occupational Therapy Corner" within a school-based website. Website topics currently in progress include fine-motor home activities, fine-motor strengthening programs, and visuals supporting handwriting practice.
All strategies and interventions are documented and maintained in the student's SRBI file. If struggling students are not making adequate progress, the SRBI team recommends tier 2 placement.
Within tier 2, further data collection indicates targeted areas of weakness the individual students may be exhibiting in handwriting. While other academics such as reading and math incorporate science-driven and evidence-based assessments, handwriting interventions in our school traditionally include subjective information with objective measures attempted.
With increasing demand for evidence-based assessments, OTs and first and second grade teachers in our school are exploring the use of the Screener of Handwriting Proficiency from Handwriting Without Tears (HWT). Results of whole-classroom screening provide valuable information about expected levels of performance at each grade level within a tier 1 and tier 2 program. The data strengthens occupational therapy efforts to support context and environment as well as assist with curriculum strategies intended to progress the students to meet expected handwriting standards. Results will be shared at upcoming mid-year parent/teacher conferences. Progress monitoring and data collection will be taken at the end of the school year. Moving forward, all first and second grade classrooms will complete this screening process at the beginning, middle, and end of the school year as recommended by HWT.
A small number of students receiving tier 2 intervention may not respond to small-group instruction within the classroom. Recently, a third grader receiving tier 2 instruction for writing was exhibiting limited progress and still performing below class expectations.
Tier 3 recommendations included individualized instruction with a resource teacher in addition to small-group instruction designed by the teacher utilizing the school's writing curriculum. Additionally, further evaluation using the Print Tool from HWT allowed the OT to measure changes in handwriting performance. Consultation occurred at regular intervals with teachers and parents.
Occupational therapists are being held accountable for educational progress within students' daily occupations. Assessment tools and interventions need to match intended outcomes. They must be science-driven and evidence-based whenever possible; data collection and documentation are essential and expected features of intervention in special and regular education.5
The high volume of handwriting referrals make this a promising area for OTs to explore within general education. While early-intervening services increase OT visibility, it is essential to monitor daily responsibilities. This is helpful, for example, in determining how to best allocate time. An effective approach is to examine and categorize daily responsibilities and make adjustments to better manage all direct and indirect service.8 For example, when consulting with classroom teachers on a weekly basis, attend grade-level planning meetings where all teachers may be addressed at one time.
While increasing involvement in RtI programs has added to existing workloads, the expected outcome is a reduction in special education referrals, at least in the area of handwriting. This method of service delivery also meets the needs of the many occupational therapy clients within the school setting.
References available at www.advanceweb.com/OT or upon request.
Valerie Strange, OTR/L, is an occupational therapist working for Children's Therapy Services and is contracted with the Cheshire Public School system in Cheshire, CT. She has worked with children for more than 12 years, with a focus on school-based therapy for 10 years. She is currently pursuing her master's degree at Quinnipiac University.