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What is RtI/MTSS?

Response to Intervention (RtI) is an approach to meet every student’s educational needs in the general education environment through a deliberate process of assessment and intervention including planned, regular monitoring of student progress. RtI relies on data based decisions about the need for and provision of instructional modifications, research-based intervention or increasingly intensified services in order to address a need of a struggling student (Johnson, Mellard, Fuchs & McKnight 2006). RtI includes “a multi-tier approach to the early identification and support of students with learning and behavior needs” (RtI Action Network) or a multi-tiered system of support (MTSS). This is why in some states RtI may be called MTSS, especially if general education has become involved.

RtI/MTSS assessments are not deficit based.  The RtI/MTSS approach is focused on:

  • selection of intervention from all options rather than identifying “what is wrong” with the student
  • addressing needs of every students, not just those with educational labels
  • the responsibility of the entire school community for all students
  • positive outcomes for all students
  • multi-tiered service delivery model with differentiated instruction to meet individual need

This approach is built upon some basic fundamental principles:

  • school-wide screening for critical skills,
  • high quality instruction,
  • frequent assessment,
  • systematic collection of student performance data
  • a team approach and
  • data-based decision making.  

In RtI/MTSS, the team does not wait for a student to “fail” before interventions or modifications are implemented to address his/her need.

RtI/MTSS May Have 3 or 4 Tiers

Most states have implemented the 3 tier framework described below. However, it should be noted that in any tier, IDEA 2004 allows parents to request a formal evaluation to determine eligibility for special education. An RTI process cannot be used to deny or delay a formal evaluation for special education.

  • Tier 1: 80-85% of all students are successful in the core curriculum. Students receive high-quality, scientifically-based instruction provided by qualified personnel.
  • Tier 2: Approximately 15% of students are not making adequate progress in Tier 1. These students are provided with interventions matched to their needs on the basis of levels of performance and rates of progress.
  • Tier 3: Approximately 5% of students receive 1:1 interventions that target the individual students’ skill deficits. Students who do not achieve the desired level of progress in response to these targeted interventions are then referred for a comprehensive evaluation and considered for eligibility for special education services under IDEA 2004. Data collected during Tiers 1, 2, and 3 are used to make the eligibility decision.

(Sources: RtI Action Network and RtI NASDSE & CASE White Paper on RtI)

Can students that already have an IEP receive RtI services?

Yes. “There is nothing in IDEA that prohibits children with disabilities who are receiving special education and related services under IDEA from receiving instruction using RTI strategies unless the use of such strategies is inconsistent with their individualized education programs (IEPs).” (IDEA)

How can federally-funded physical therapists provide services to students without an IEP?

There are different funds (federal, state, local, Medicaid reimbursement, etc.) that administrators use to pay the salaries of staff, including physical therapists. Often, their salaries are comprised of a variety of these funding sources. Because federal special education funds only pay for work with students with an IEP, other funding is what allows physical therapists to collaborate or consult in RtI and other general education initiatives. In this way, a physical therapist can work with a team or teacher to meet student needs prior to establishing eligibility for special education and related services. We can assist the team with our expertise for modifying classrooms, suggesting learning strategies or approaching challenges faced by teachers in the general education classroom.

Another way related service providers, including physical therapists can be funded to work in RtI is through use of early intervening services (EIS). EIS are special education funds earmarked for preventative efforts; some districts are required to use EIS, all districts can choose to use EIS.

Additionally, some schools and school districts have found related service providers so valuable to the RtI process that building principals/general education administrators ‘buy back’ time of these providers to spend on RtI initiatives.  

In all cases, PTs should remember that in RtI, our client is the teacher, not the student.

So, SeekFreaks, you are probably asking how does RtI work in real life. Read RtI Part 2 for sample applications and RtI references.

Examples of PT participation in RtI/MTSS

We hope you find the following examples of how PTs can support teachers and students in general education at the various tiers helpful:

Tier 1: Universal Intervention

  • Provide in-services to teachers on typical development, appropriate expectations for age/development
  • Assist with environmental design, provide ergonomic assessments and other suggestions to enhance engagement and performance
  • Provide administration, teachers, and other staff members information about:
    • current research regarding movement
    • the influence of movement on learning
    • learning by incorporating movement activities into instruction
    • teach strategies to promote engagement- allow changes in posture (standing, swaying, sitting/bouncing on cushion or disc, kneeling, laying), movement breaks, scheduling challenging content immediately after PE or recess, and so on.
  • Provide in-service to school administration on benefits of including PE and recess into the school day
  • In-service staff on PTs role in RtI/MTSS and provide resources & guides

Tier 2: Targeted Intervention

For students who continue to struggle after Tier I, Universal Interventions, the therapist may:

  • Participate in school grade-level teacher meetings to problem solve addressing classroom challenges
  • Suggest alternative approaches to promote participation and engage all students
  • Explore environmental barriers, potential accommodations or supports for desired behaviors and engagement in school routines (e.g. bathroom adaptation, extra set of textbooks, preferential seating, movement breaks, adaptive seating/work space, early release or extra transition time, peer partners, etc.)
  • Consult with the teacher to differentiate routines, activities and expectations (e.g., providing breaks during extended writing tasks, providing more time for responses, using written in addition to verbal directions, breaking down tasks)
  • Lead a small group or station during classroom instruction (note: review your local and state policies to ensure that this is permissible)

Tier 3: Intensive Interventions

For students who continue to struggle after Tier II, Targeted Interventions, the therapist may:

  • Participate in the problem-solving process at the individual student level
  • Provide suggestions that can improve an individual student’s performance (see suggestions under Tier 2 and apply on an individual basis)
  • Conduct a PT assessment as part of the comprehensive special education evaluation under IDEA

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Suggested Resources:

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Freakishly Fast Poll

Have you participated in RtI/MTSS?

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Seeking Your Views

I know what you are thinking, RtI is trickier for PTs than for OTs or SLPs. This is where our creativity should shine!

How do you implement or participate in RtI in your schools?

Some therapists are concerned about liability issues of teaching non-therapists (i.e., teachers and teacher aides) to implement PT suggestions. Are you concerned about this? Why or Why not?

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Readers of this article also read these:

The 4 Pillars of School-based PT Assessment

Role of School-based Physical Therapy

IEP 4.0 – Using Data and Collaboration to Develop a Clear PLEP

Article Review: Do Teachers Know the Impact of Preterm Birth?

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