There’s a shift happening in school-based therapy right now, and if you’ve been in any room where MTSS came up lately, you’ve probably felt it too.
I got a front-row seat to just how big that shift is when I presented on MTSS at AOTA INSPIRE 2026 in Anaheim. The room filled up fast, people standing along the walls, sitting on the floor, craning to see the slides, and the conversation kept going well after the session ended, spilling into the hallway.
That kind of turnout tells you something. School-based therapists aren’t just curious about MTSS, they’re hungry for it. And it makes sense: MTSS is the framework that finally gives us a seat at the table, a shared language with administrators, and a way to work upstream, preventing referrals instead of only responding to them once a student is already struggling.
If you’re reading this and thinking, honestly, “What even IS MTSS?”, you’re in exactly the right place. This is the framework shaping what school-based therapy looks like right now. Administrators know it. Teachers know it. It’s time we speak it fluently too.
Something to Help You Get There
To help make this framework easier to hold onto, I put together the MTSS Tier Breakdown for School-Based Therapists, a free one-page reference guide.
It puts OT, PT, and SLP roles across all three tiers on one single page, the kind of thing worth printing, laminating, and sliding across a table at your next team meeting.
What’s On It
The guide breaks down all three tiers, discipline by discipline, so you can see at a glance what OT, PT, and SLP each bring to Tier 1, Tier 2, and Tier 3.
Tier 1 — Universal (All Students, ~80–85%) covers the everyday, skilled work that supports every student. Think classroom consultation, embedded sensory or movement breaks, screenings, and teacher coaching, tailored to what each discipline does best.
Tier 2 — Targeted (Some Students, ~10–15%) is where small groups live. Fine motor, gross motor, and language/social communication groups, along with the data collection that helps determine if a student needs to move to Tier 3.
Tier 3 — Intensive (Few Students, ~1–5%) is our most familiar territory: individualized, IEP-driven services like direct 1:1 therapy, assistive technology, and specialized equipment.
And running underneath all three tiers, the guide also highlights the work we all share: team meetings, documentation, family communication, co-planning with teachers, and advocacy.
A Few Key Reminders Built Into the Guide
- Tier ≠ intensity alone. Tier placement reflects the system of support a student is getting, not just how much direct service they receive. Tier 1 work is still skilled practice.
- IEP students can be at any tier. A student can have an IEP and still benefit from Tier 1 and Tier 2 supports. MTSS and special education aren’t separate tracks, they overlap.
- Data drives movement. Students move between tiers based on data, not intuition. Therapists play a key role in collecting and interpreting that data at every level.
- Document everything. Your Tier 1 and Tier 2 work counts, but only if it’s documented. Capture your consultation, coaching, and group time the same way you document direct service.
Pop your name and email in the form below, and your MTSS Tier Breakdown will land straight in your inbox, ready to save and print. Sharing is caring, so send it along to a colleague, friend, or fellow school-based therapist who’d love it too!