You would have to have been hiding under a rock if you work in the schools and have not heard about Response to Intervention (RtI).

"If your state and school district are using this model, you need to understand your role in it. If we can work with children earlier, in the general education curriculum, using an intervention that is supported by evidence, we can help reduce the number of children being referred to special education... reduce the cost to society... [and have a positive] effect on kids' self esteem," says AOTA's FAQ on Response to Intervention.

The main objective of RtI is to "help all students achieve at a proficient level" (Nebraska Department of Education, 2005. An overview of Response to Intervention). RtI addresses both academic and behavioral needs, and recognizes that the school environment plays a vitally important role in the socialization of children. Based on the familiar three-tier public health model,
RtI uses three levels of intervention or instruction to meet students' different levels of needs. The third tier is the most intensive level of service provision, and it is where occupational therapists work-
ing in the schools have traditionally provided our services to students who have been identified as having a disability and who require specialized instruction and related services.

Active participation in RtI initiatives requires occupational therapists to look beyond (perhaps before is the more accurate term) this third tier to the first tier of universal intervention/core instruction.

The first tier of intervention is often described as preventive or proactive. In public health, prevention is aimed at preventing disease and disability via efforts such as immunizations, developmental screenings and clean-water initiatives. In education, universal interventions also are designed to promote achievement and success, both academically and behaviorally.

The first tier can be conceptualized into three broad areas: universal screenings in general health and well-being, core instruction in all subjects for all students (appropriate to grade level) and school-wide behavioral interventions and positive supports. Occupational therapists may parti-
cipate in the universal screenings related to health and well-being (vision, kinder-
garten readiness, etc.), but we also can identify other areas that could benefit from
an OT perspective.

For example, an OT could collaborate with janitors or other staff (including someone with tools!) for a "Does Your Desk Match You?" campaign. Done at the start of the school year, this effort can prevent dangling legs, knees to the chins and other mismatches between a child and his seating. Good posture at the computer is essential as well. Hang posters that show proper postural alignment for computer use near each work station.

Handwriting is another area where we can contribute. Create a "Handwriting Hints" notebook for each grade level. You could prevent some referrals to OT for "wrapping the thumb" around the pencil shaft by providing the teacher with the tools to address this in the classroom.

Professional development to enhance the abilities of all staff to meet student needs is an important aspect of RtI. In this vein, providing in-services can be a universal intervention. Show teachers ways to modify teaching materials, how to minimize distractions in the classroom, or daily strategies to enhance students' readiness for an intensive learning activity.

For those teaching kindergarten and primary grades, teach instructional practices that match and take advantage of students' developmental abilities at each grade level in order to reduce behavioral problems which arise from student frustration.

It is important that occupational therapists bring to the forefront their know-ledge of and perspectives on those things that facilitate or present obstacles to age-appropriate behavior and the ability to engage in the occupations of school. We should participate in the development and implementation of school-wide behavioral expectations or rules as well as social-skills programs.

Our services are valuable and can find an even larger voice and effect through the universal interventions of Response
to Intervention. n