Occupational therapists can play an important role in MTSS and RTI in schools, especially when students are experiencing challenges with handwriting, fine motor skills, visual motor skills, sensory processing, self-regulation, organization, or participation in classroom routines.
Rather than waiting until a student is referred for an occupational therapy evaluation, a school-based OT can collaborate with teachers and other school professionals to identify barriers, implement classroom supports, monitor progress, and problem-solve when students need additional help.
For school-based occupational therapists, Multi-Tiered System of Supports (MTSS) and Response to Intervention (RTI) can provide opportunities to support students earlier while also helping educational teams make data-informed decisions.
The goal is not simply to provide “more OT.” Instead, occupational therapy within MTSS should focus on helping students access and participate in meaningful school activities.
This may include supporting:
- Fine motor skills
- Handwriting and written work
- Visual motor integration
- Visual perceptual skills
- Scissor skills
- Classroom tool use
- Sensory processing
- Self-regulation
- Organization
- Classroom routines
- Self-care and school independence
- Participation across the school day
If you are developing an OT RTI or MTSS program, the following framework can help you determine where occupational therapy fits.
What Is MTSS?
MTSS, or Multi-Tiered System of Supports, is a school-wide framework designed to provide increasingly individualized levels of support based on student needs and response to intervention.
Although individual school districts may organize MTSS differently, supports are commonly described across three tiers.
Tier 1: Universal Supports
Tier 1 focuses on strategies, instruction, environmental supports, and routines that are available to all students.
From an occupational therapy perspective, Tier 1 may include collaborating with teachers to improve classroom access and participation.
Examples may include:
- Teaching efficient use of classroom tools
- Providing handwriting strategies
- Supporting developmentally appropriate fine motor opportunities
- Reviewing classroom seating and positioning
- Incorporating movement opportunities into classroom routines
- Providing visual supports
- Supporting classroom organization
- Teaching strategies for managing materials
- Helping teachers recognize barriers to participation
- Providing staff education about sensory processing and regulation
The benefit of Tier 1 occupational therapy supports is that they can reach many students without requiring every child who is struggling to receive individualized OT intervention.
For example, if several kindergarten students are struggling with cutting, the OT might collaborate with the teacher to examine the scissors being used, positioning, task demands, opportunities for practice, and prerequisite skills.
This moves the conversation from:
“Which students need OT?”
to:
“What can we change or teach to help students participate more successfully?”
That is an important distinction.
Tier 2: Targeted OT Supports
Some students will continue to experience difficulty even when strong universal supports are available.
Tier 2 provides more targeted intervention.
Depending on your district’s MTSS structure, this might involve a small group of students working on a specific skill, additional classroom strategies, structured practice opportunities, consultation, or short-term progress monitoring.
An OT might help develop targeted supports for students experiencing difficulty with:
- Pencil control
- Letter formation
- Handwriting legibility
- Fine motor coordination
- Cutting
- Visual motor skills
- Classroom organization
- Managing materials
- Sensory regulation
- Motor planning
- Classroom independence
The intervention should connect directly to the student’s educational participation.
For example, instead of identifying “poor hand strength” as the primary problem, the team might identify that a student has difficulty opening classroom containers, manipulating school tools, completing written work, or managing fasteners during school routines.
The OT can then help the team determine strategies that address the actual participation challenge.
Tier 3: Individualized and Intensive Support
Tier 3 typically involves more individualized and intensive problem-solving.
A student receiving Tier 3 support may require:
- Individualized strategies
- More frequent progress monitoring
- Environmental accommodations
- Task adaptations
- Direct instruction
- Increased consultation
- Individual intervention within the school’s MTSS framework
Importantly, MTSS should not be used simply as a way to delay an evaluation when a disability is suspected.
Instead, information gathered through MTSS can help teams understand:
- What the student is having difficulty doing
- What strategies have already been attempted
- How consistently interventions were implemented
- How the student responded
- Whether the difficulty occurs across settings
- Which supports improve participation
- Whether additional assessment may be appropriate
This is where occupational therapy data collection and progress monitoring become especially valuable.
Start With Participation, Not Just Isolated Skills
One of the most important principles for occupational therapists supporting RTI or MTSS is to begin with the student’s participation.
A student may have messy handwriting, an inefficient pencil grasp, sensory differences, or difficulty with fine motor tasks.
But the more important question is:
How is this affecting the student’s ability to participate in school?
Consider questions such as:
- Can the student communicate their ideas in writing?
- Can they complete classroom work within reasonable expectations?
- Can they independently use classroom materials?
- Can they participate in art and cutting activities?
- Can they manage their belongings?
- Can they transition between classroom routines?
- Can they access learning activities?
- Are environmental or task demands creating unnecessary barriers?
This keeps occupational therapy intervention functional and educationally relevant.
Use OT Screening to Identify the Actual Barrier
Before choosing an intervention, determine what may be contributing to the student’s difficulty.
For handwriting concerns, for example, the problem could involve:
- Letter formation
- Letter size
- Spacing
- Line placement
- Visual motor integration
- Motor planning
- Fine motor coordination
- Writing endurance
- Visual attention
- Difficulty remembering letter forms
- Environmental demands
- The amount of writing required
- Limited opportunities for instruction or practice
Two students with “messy handwriting” may need completely different supports.
This is why occupational therapy screening within MTSS can be so helpful.
Screening does not need to mean conducting a full occupational therapy evaluation on every struggling student. It may involve classroom observation, work sample review, teacher consultation, structured screening activities, and data collection.
For therapists who want an organized way to gather this information, my Occupational Therapy Evaluation, Screening and Data Collection Bundle for RTI/MTSS includes resources designed to support screening, data collection, progress monitoring, problem-solving, and consultation.
Collect Baseline Data Before Starting an OT Intervention
A strong RTI or MTSS occupational therapy intervention should begin with a baseline.
Instead of documenting:
“Student struggles with handwriting.”
Try collecting measurable information.
For example:
Baseline: During a five-sentence classroom writing sample, the student independently placed 42% of letters on the writing line.
Now the team has something specific to monitor.
Other data points might include:
- Percentage of recognizable letters
- Correct letter formation
- Appropriate spacing
- Number of prompts required
- Time required to complete a task
- Percentage of a cutting path maintained
- Number of classroom materials managed independently
- Frequency of adult assistance
- Independence with a classroom routine
- Number of steps completed independently
Data collection does not need to become so complicated that no one has time to complete it.
Simple, repeatable data is often much more useful than an elaborate system that cannot realistically be maintained.
My Occupational Therapy Fine Motor and Visual Motor Data Tracking Resource was designed for tracking multiple students and includes areas such as pre-writing, letters, scissor skills, manipulation, sensory processing, clothing management, and school routines.
Choose One or Two Meaningful Targets
When a student is struggling, it can be tempting to address everything at once.
That can make it difficult to determine whether an intervention is actually working.
Instead, identify one or two functional priorities.
For example:
Concern: Written work is difficult to read.
Target: Improve spacing between words.
Intervention: Provide a consistent visual spacing strategy during classroom writing.
Data: Percentage of words with appropriate spacing during a weekly classroom writing sample.
This makes the MTSS process easier for the OT, teacher, student, and family to understand.
Make OT Interventions Easy for Teachers to Implement
One of the biggest challenges with school-based OT consultation is implementation.
A strategy may be clinically appropriate but still fail if it requires the classroom teacher to remember a complicated routine throughout an already busy school day.
Whenever possible, OT recommendations should be:
- Simple
- Functional
- Easy to explain
- Embedded into existing routines
- Realistic for the classroom
- Easy to monitor
- Flexible enough to adjust
Instead of providing a teacher with a long list of recommendations, consider identifying the two or three strategies most likely to make a meaningful difference.
Then follow up.
Did the strategy help?
Was it realistic?
Did the student use it?
Does it need to be changed?
OT consultation should be an ongoing problem-solving process rather than simply handing someone a list of strategies.
For therapists who want a more structured consultation process, my Occupational Therapy Guided Consultation and Data Forms can help organize consultation and documentation for preschool through middle-school settings.
MTSS Support for Fine Motor Skills
Fine motor concerns are one of the most common reasons teachers seek occupational therapy support.
Students may have difficulty with:
- Manipulating pencils
- Coloring
- Cutting
- Opening containers
- Managing fasteners
- Using glue
- Manipulating classroom materials
- Completing construction activities
- Handling small learning manipulatives
Within MTSS, consider whether the student has had sufficient opportunities to learn and practice the skill before immediately increasing intervention.
Tier 1 support might involve incorporating more meaningful fine motor experiences into classroom routines.
Tier 2 might provide targeted practice for a smaller group of students who require additional instruction or opportunities.
Tier 3 may involve individualized analysis and intervention based on the student’s specific barriers.
MTSS Support for Handwriting
Handwriting is another common area for occupational therapy RTI intervention.
However, handwriting support should be specific.
Instead of saying that a student needs to “work on handwriting,” determine what aspect of handwriting is affecting performance.
Possible areas include:
- Letter formation
- Letter size
- Spacing
- Line orientation
- Alignment
- Writing speed
- Endurance
- Pencil control
- Visual memory for letters
- Overall legibility
A targeted handwriting intervention makes progress monitoring significantly easier.
For students working specifically on letter size, my Year-Long Letter Size Handwriting Practice Bundle provides differentiated practice with visual supports, starting dots, and different writing-space sizes.
For students who need broader handwriting practice, the Ultimate Handwriting Practice Bundle includes a large collection of handwriting and writing activities that can be incorporated across the school year.
MTSS Support for Sensory Processing and Regulation
Sensory processing is another area where occupational therapists can provide valuable classroom consultation.
However, sensory strategies should not be treated as a one-size-fits-all “sensory diet.”
Instead, start by asking:
What is the student trying to do, and what is making participation difficult?
A student who covers their ears during assemblies may need something very different from a student who frequently seeks movement during seated instruction.
Consider:
- Environmental demands
- Noise
- Visual stimulation
- Seating
- Movement opportunities
- Predictability
- Transitions
- Task length
- Sensory preferences
- Access to regulation tools
- Student communication and self-advocacy
Universal sensory supports can also benefit an entire classroom.
My Sensory Strategies and Heavy Work for the Classroom Resource includes classroom strategies addressing areas such as environment, seating, sound, touch, lighting, routines, movement, and proprioceptive input.
For a much larger collection, my Sensory Processing and RTI/MTSS Bundle includes resources designed around sensory processing, self-regulation, classroom problem-solving, and school-based supports.
Movement Can Be a Universal Support
Movement does not have to be reserved for students receiving occupational therapy.
Movement opportunities can be incorporated into the school environment as part of Tier 1 support.
This might include:
- Movement breaks
- Classroom movement routines
- Motor stations
- Transition activities
- Whole-class movement opportunities
- Heavy-work activities
- Flexible opportunities to change position
The goal should not be to make students sit still afterward.
Instead, movement can provide another way for students to access participation, engage their bodies during the school day, and meet individual regulation needs.
My Year-Long Motor Stations and Sensory Path Bundle provides motor stations and movement activities that can be used throughout the school year.
Don’t Forget Visual Supports and Environmental Accommodations
Sometimes the most effective occupational therapy intervention is not remediation.
It is changing the environment.
A student may benefit from:
- A visual schedule
- A visual model
- Fewer materials presented at once
- Alternative paper
- Different writing tools
- Adjusted seating
- Additional workspace
- A predictable routine
- Visual directions
- A checklist
- Increased processing time
- Reduced copying demands
- Access to movement
- Alternative ways to demonstrate knowledge
These supports can reduce unnecessary barriers while allowing the student to participate more independently.
Progress Monitor the Intervention
After implementing an intervention, collect the same type of data used for the baseline whenever possible.
For example:
Week 1: 42% of letters placed appropriately on the line
Week 3: 58%
Week 5: 71%
Week 7: 76%
Now the team can ask:
- Is the student making progress?
- Is the intervention helping?
- Should we continue it?
- Should we change the strategy?
- Does the student still require this level of support?
- Is additional problem-solving needed?
Progress monitoring helps MTSS move beyond subjective statements such as “I think it’s helping.”
Consider Student Voice During the MTSS Process
Whenever developmentally appropriate, include the student in occupational therapy problem-solving.
Ask questions such as:
What part feels hard?
What makes this easier?
Is there something you wish your teacher knew?
Which tool helps you most?
Would you rather try this strategy or that one?
A strategy is much more meaningful when it supports the student’s actual experience rather than simply making their performance look more typical.
This is especially important when addressing sensory processing, regulation, handwriting, seating, movement, and classroom accommodations.
Check out my Student Self-evaluation of Sensory Processing for a checklist for student’s to assess their own sensory needs.
OT and Teacher Collaboration Is Essential
Successful school-based occupational therapy MTSS services depend heavily on collaboration.
Teachers see students functioning within authentic classroom routines every day. Occupational therapists bring expertise in activity analysis, environmental demands, motor development, sensory processing, functional participation, and accommodations.
Combining those perspectives can create much more meaningful interventions.
OTs can support teachers by helping answer questions such as:
- Why might this task be difficult?
- Can we change the environment?
- Can we change the materials?
- Does the student need explicit instruction?
- Is the task developmentally appropriate?
- What prerequisite skills are involved?
- How can we make this easier without removing meaningful participation?
- What data should we collect?
- How will we know whether our strategy is working?
This collaborative problem-solving role is one of the greatest strengths occupational therapy can bring to an MTSS team.
Build an OT RTI/MTSS Toolkit
Having frequently used screening tools, intervention resources, consultation forms, classroom strategies, and progress-monitoring materials organized in one place can make MTSS much easier to manage.
Helpful categories for an occupational therapy MTSS toolkit might include:
Screening and Data Collection
- Fine motor screening
- Visual motor screening
- Handwriting screening
- Classroom observations
- Work sample review
- Progress monitoring forms
Fine Motor and Handwriting
- Pencil control activities
- Scissor activities
- Letter formation practice
- Spacing supports
- Letter-size supports
- Visual motor activities
Sensory and Regulation
- Classroom sensory strategies
- Movement options
- Environmental accommodations
- Regulation supports
- Student self-reflection tools
Consultation
- Teacher questionnaires
- Classroom observation forms
- Strategy documentation
- Follow-up forms
- Progress-monitoring data
If you want many of these materials already organized, check out my Occupational Therapy RTI/MTSS Problem Solving Bundle. It includes 14 resources targeting areas such as fine motor skills, visual motor skills, handwriting, sensory processing, organization, and school-based problem-solving.
Final Thoughts: OT Has an Important Role in MTSS
Occupational therapy can contribute much more to schools than direct services provided after an IEP is established.
Within an RTI or MTSS framework, occupational therapists can help schools identify barriers earlier, strengthen classroom supports, collaborate with educators, implement targeted interventions, monitor progress, and determine when students may need additional support.
The key is keeping intervention connected to meaningful school participation.
Start with the activity the student needs or wants to do.
Identify the barrier.
Implement a realistic support.
Collect data.
Collaborate.
Adjust.
And most importantly, remember that the purpose of school-based occupational therapy is not to make every student’s performance look the same. It is to help students access, participate in, and engage with their educational environment as successfully and independently as possible.
Looking for OT RTI and MTSS Resources?
Browse my Empowering OT by Dr R Teachers Pay Teachers Store for school-based occupational therapy resources supporting RTI, MTSS, fine motor skills, handwriting, visual motor skills, sensory processing, data collection, progress monitoring, consultation, and classroom participation.
You can also start with my Occupational Therapy RTI/MTSS Problem Solving Bundle if you want a larger collection specifically designed for school-based problem-solving and intervention.
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