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.

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!

A few years ago I was doing a PD session for a group of first-grade teachers and I taught them the “Alligator Chop” — a grip cue song where children snap their fingers like an alligator’s jaws before picking up their pencil (The TV Teacher, 2011).

One teacher in the back raised her hand. “Is that actually evidence-based,” she asked, “or is it just cute?”

It’s a fair question. A lot of what circulates in early childhood education under the label of “best practice” is really just “this felt good and kids seemed to enjoy it.” I’ve been in this field long enough to have seen plenty of trends come and go. So let me answer her directly: yes, the use of songs, posters, and visual and auditory cues in teaching motor skills is evidence-based. Not marginally, not tentatively — genuinely supported by research in both motor learning and handwriting specifically.

Here’s what the research says, and why it matters for every classroom and every child you work with.

First: Why Motor Skill Learning Is Different from Academic Learning  

Motor skills (learning how to do something with your body) are learned through repetition, feedback, and what motor learning researchers call guided practice. The learner needs to receive information about what the correct movement feels like, looks like, and sounds like; and they need that information during practice, not just before it. External cues (things in the environment that prompt the correct movement) are particularly powerful in the early stages of motor skill acquisition, before the skill has become automatic.

This is exactly why a child can understand, intellectually, that they’re supposed to hold the pencil with their thumb and two fingers, but still default to a fisted grip the moment they start writing. The cognitive understanding of what to do is stored separately from the motor program for doing it. You need both, and they’re built through different processes.

Songs, chants, posters, and visual prompts are, in motor learning terms, forms of external cueing. They provide real-time or near-real-time reminders of the target movement pattern during the activity itself. That’s where their power comes from.

What the Research Says About Visual Cues  

Berninger et al. (1997) studied the treatment of handwriting problems in beginning writers and found that interventions including visual prompts and explicit models produced greater improvement than instruction without them. The visual cue created a reference point children could consult during practice — not just a memory of what was shown before practice began.

Weintraub et al. (2009) examined sensorimotor and task-oriented handwriting interventions and found that approaches combining visual feedback with practice were more effective than practice alone in elementary school students with handwriting difficulties. Seeing the correct form — whether on a poster, a teacher model, or a visual prompt card — helps children self-monitor and self-correct during the activity.

Graham and Harris (2013) documented the importance of explicit instruction with visual models in early writing skill development, noting that children in the early stages of learning handwriting benefit significantly from having something to look at while they practice. The visual cue isn’t a crutch — it’s scaffolding that gets removed as the motor program becomes automatic.

What this means practically: the grip poster on your classroom wall isn’t decoration. If it shows the correct finger placement clearly at a height children can reference while seated, it is functioning as an external cue that supports motor learning every single time a child glances at it during writing.

What the Research Says About Auditory Cues and Songs  

This is where it gets especially interesting, because the evidence for auditory cueing in motor learning is robust and often underappreciated in school settings.

Longcamp, Zerbato-Poudou, and Velay (2005) studied the role of practice modality in letter recognition and found that physical practice with concurrent verbal labeling produced stronger learning than visual practice alone. The auditory component — naming, describing, or chanting the movement as it’s performed — strengthens the motor memory being formed.

James and Engelhardt (2012) looked at the effects of handwriting on functional brain development in pre-literate children and found that physically forming a letter while receiving simultaneous multisensory feedback activates more neural networks than either activity in isolation. The brain builds a richer, more redundant motor memory when multiple channels are engaged at once.

This is the neuroscience behind why the chants and songs in Gripipedia work — and why every experienced school OT has some version of a grip cue they’ve been using for years. When a child chants “pinch it, flip it, let it go” while positioning their pencil, they’re not just saying words. They’re activating an auditory motor program that reinforces the physical sequence they’re simultaneously performing.

The real-world evidence for this is also compelling. GriffinOT’s “Crocodile Snap Write Rules” song (2022) and The TV Teacher’s “Alligator Chop Song for Tripod Grasp” (2011) have been used by occupational therapists and teachers worldwide precisely because they work at the classroom level. Children remember them. More importantly, children use them spontaneously — without being prompted — when they pick up a pencil. That’s the definition of a successful external cue: one the learner internalizes and eventually self-applies.

Learning Without Tears has built an entire instructional approach around this principle, embedding verbal cues and chants into every component of their curriculum (Learning Without Tears, 2020). Their widespread adoption across school districts is, in part, an endorsement of the cueing approach itself.

The Cognitive Approach: When Cues Plus Strategy Beats Practice Alone  

Weintraub et al. (2009) and Piller and Torrez (2019) both found support for what’s called a cognitive approach to handwriting intervention — one in which children are taught to use self-talk, problem-solving, and explicit strategies rather than simply repeating movements. The research on the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach, described by Polatajko (2017), shows that children who learn to identify problems and apply strategies outperform children who receive only direct practice with correction.

Songs and visual cues fit naturally into a cognitive approach. They give children a strategy to apply, not just a movement to imitate. When a child hears the song prompt and consciously adjusts their grip, they’re practicing the exact self-monitoring behavior that underlies long-term skill retention.

What This Means for Tier 1 Practice   

The practical translation for school OTs, classroom teachers, and anyone working with young writers at the classroom level:

Posters should be functional, not decorative. A grip poster showing correct positioning in clear, child-facing illustrations — at a height children can reference while seated — is an active intervention tool. Review it before writing time. Reference it when you see a child struggling. Make it part of the classroom routine.

Songs and chants should be taught until they’re automatic. The goal isn’t for children to recite the song when asked. The goal is for them to hear the beginning of it and automatically initiate correct grip positioning. That level of automaticity takes repetition — weeks of consistent use, not a one-time lesson.

Visual cue cards at the desk work differently from wall posters. Desk-level prompts function as immediate, proximal cues during writing. For children who need more intensive support, a small grip cue card at the corner of the desk — visible without looking away from the paper — provides a different level of support than a classroom poster across the room.

Pair the auditory cue with the physical movement every time. The research on multisensory learning supports simultaneous engagement: say it while you do it, until you don’t need to say it anymore because the physical program is established. Don’t teach the song separately from the grip positioning. Teach them together as one unit.

Why This Is What Gripipedia Is Built Around  

I want to be direct about something, because I think it matters clinically.

The resource-pages half of Gripipedia — the visual cue posters, the grip chants, the reward charts, the classroom-ready handouts — isn’t a bonus add-on to the clinical content. It’s the point.

The research I’ve described above is exactly why those tools are in the book. Every song, every poster, every visual prompt in Gripipedia is there because the evidence says that when children are learning motor skills, external cues embedded in the learning activity produce better and more durable outcomes than instruction and practice alone.

School OTs have known this from clinical experience for a long time. The research backs it up. The tools should be in every classroom.

More on Gripipedia — including how to get your hands on it before anyone else — coming soon.

References  

Berninger, V. W., Vaughan, K. B., Abbott, R. D., Abbott, S. P., Rogan, L. W., Brooks, A., & Graham, S. (1997). Treatment of handwriting problems in beginning writers: Transfer from handwriting to composition. Journal of Educational Psychology, 89(4), 652–666.

Graham, S., & Harris, K. R. (2013). How do you write? Writing for young children. In Handbook of Research-Based Practice in Early Education (pp. 380–394). Guilford Press.

GriffinOT. (2022, July 23). Crocodile snap write rules tripod pencil grasp song for children [Video]. YouTube. https://www.youtube.com/watch?v=1j0rPflY8-k

James, K. H., & Engelhardt, L. (2012). The effects of handwriting on functional brain development in pre-literate children. Trends in Neuroscience and Education, 1(1), 32–42.

Learning Without Tears. (2020, August 12). Teaching grip in Pre-K with Get Set for School [Video]. YouTube. https://www.youtube.com/watch?v=u_hsWkrZ1zI

Longcamp, M., Zerbato-Poudou, M. T., & Velay, J. L. (2005). The influence of writing practice on letter recognition in preschool children: A comparison between handwriting and typing. Acta Psychologica, 119(1), 67–79.

Piller, A., & Torrez, E. (2019). Defining occupational therapy interventions for children with fine motor and handwriting difficulties. Journal of Occupational Therapy, Schools, & Early Intervention, 12(2), 210–224.

Polatajko, H. (2017). History of the CO-OP approach. In D. Dawson, S. McEwen, & H. Polatajko (Eds.), Cognitive orientation to daily occupational performance in occupational therapy (pp. 5–10). American Occupational Therapy Association.

The TV Teacher. (2011, November 29). Alligator chop song for tripod grasp [Video]. YouTube. https://www.youtube.com/watch?v=01496z23PIs

Weintraub, N., Yinon, M., Hirsch, I. B., & Parush, S. (2009). Effectiveness of sensorimotor and task-oriented handwriting intervention in elementary school-aged students with handwriting difficulties. OTJR: Occupation, Participation and Health, 29(3), 125–134.

Walk into most elementary classrooms and you’ll see children writing flat on their desks. Worksheets flat. Drawing flat. Coloring flat. Everything flat.

Walk into my OT class push-in session and the first thing I do is prop something up.

I’ve been recommending vertical surface work to teachers for over 25 years, and I still have to explain it at nearly every IEP meeting and professional development session I run. Not because it’s complicated — the reasoning is actually pretty clear — but because it looks different from what teachers expect, and “different from expected” tends to require a conversation.

So here’s the conversation. Let’s talk about why vertical surfaces work, what the research supports, and what this has to do with pencil grasp.

 What Counts as a “Vertical Surface”?   

Before anything else: vertical surfaces aren’t complicated or expensive. We’re talking about:

• A whiteboard or chalkboard (the original)

• A piece of paper taped to the wall

• An easel

• A three-ring binder standing upright on a desk

• A slant board propped at an angle

• A window with washable markers

• A full length mirror or sliding glass door

The defining feature is that the writing surface is positioned at roughly 90 degrees — or at least at a significant incline — rather than flat on the desk. The exact angle matters less than the shift away from horizontal.  Technically, a slant board or three-ring binder is in between, but it still counts for this conversation.

What Happens to the Hand and Wrist on a Vertical Surface  

Here are the biomechanics, as simply as I can put it.

When a child writes on a flat surface, the wrist tends to rest in a neutral or slightly flexed (bent downward) position. For many children — especially those still developing wrist stability or a mature grasp — a flat or flexed wrist puts the hand at a mechanical disadvantage. The web space collapses, the fingers can’t move efficiently, and the large muscles of the forearm and arm end up doing work that should belong to the small muscles of the hand. That’s why we see whole-arm coloring and static grasps at the tabletop.

When the surface is vertical, the wrist naturally moves into extension (bent slightly back). That position:

1. Promotes wrist extension, which is one of the foundational prerequisites for a mature pencil grasp. Benbow (1998) specifically identifies wrist stabilization in extension as the first motor milestone the hand must develop in preparation for functional handwriting. A vertical surface promotes this without any explicit instruction.
2. Encourages the open web space. When writing upright, the thumb and index finger naturally form the circular open web space that supports a functional grasp. On a flat surface, children with immature grasps often collapse this space, tucking the thumb or wrapping fingers around the pencil. The vertical position makes the correct position mechanically easier to achieve.
3. Supports shoulder stability. Working above eye level on a vertical surface requires holding the arms up against gravity, strengthening the muscles, and encouraging shoulder stability.
4. Promotes distal control. Writing on a wall or easel requires the shoulder to work isometrically to hold the arm in place. That co-contraction builds the proximal stability that underlies distal (finger) control. You cannot have precise finger movements without a stable shoulder — fine motor development proceeds from the center of the body outward, and the shoulder is the foundation.

The “Why” Behind Vertical Surfaces  

This isn’t a new idea. Occupational therapy practitioners have recommended vertical surface work for decades — not because it’s trendy, but because the mechanics make sense and clinicians keep watching it work.

The wrist extension piece is the best-documented part. Strickland (1995) noted that positioning the wrist in extension supports the thumb abduction and opposition required for a tripod grasp, and Benbow (1990) found that wrist extension promotes balanced use of the small muscles of the hand. A vertical surface is one of the most efficient ways to encourage this position because it’s embedded in a functional activity. The child is drawing or playing, not doing a rote exercise.

The benefits go beyond handwriting. Myers (1992) pointed out that this same principle applies to fine motor play: toys positioned vertically encourage finger isolation, manipulation, and separation of the two sides of the hand (the foundational skills that underlie mature grasp patterns for writing, play, and self-care).

There’s also a strength and stability component. Working on a vertical surface means holding the arm up against gravity, which builds shoulder stability and arm strength. That proximal stability matters because controlled finger movements depend on a stable base — fine motor development proceeds from the center of the body outward.

Practical Classroom Applications  

This doesn’t have to be elaborate. Here’s what I actually recommend when I consult with teachers:

For the whole class (Tier 1):

• Use the whiteboard or chalkboard for letter formation practice instead of worksheets whenever possible

• Have children complete morning work or spelling practice on paper taped to the wall at least two or three times per week

• Keep an easel in the classroom writing center

• Allow children to lay on the rug, writing on a clipboard. Although the surface isn’t vertical, the child’s positioning encourages the same benefits.

For small groups (Tier 2):

• Vertical surface drawing and writing as part of a fine motor station

• Using a three-ring binder propped upright on the desk as an inexpensive slant board substitute

• Coloring books propped against the wall — yes, coloring on a vertical surface counts

• Fine motor centers and activity stations with vertical toys (pegboards, lite brite, etc.)

For individual students (Tier 3 / direct OT):

• Specific slant boards prescribed by angle based on assessment

• Vertical surface activities explicitly included in the home program

• Monitoring wrist position and grasp quality in the vertical versus horizontal position to identify what the child actually needs

The Grasp Connection  

Here’s why this matters specifically for pencil grasp, and why it’s in a book about grip and grasps.

One of the most common patterns I see in referrals is a child who “knows” the correct finger placement but can’t sustain it. They start with a tripod (fingers in the right spots). But within minutes, they’ve migrated back to a fisted grasp or a wrapped thumb. Teachers sometimes interpret this as carelessness or lack of effort. It’s usually neither.

What’s happening is that the underlying prerequisites for that mature grasp aren’t stable yet. The wrist isn’t strong enough in extension. The shoulder isn’t providing enough proximal support. The proprioceptive feedback isn’t clear enough to help the child self-monitor.

Vertical surface work builds those prerequisites. It doesn’t replace explicit grasp instruction — but it creates the foundation that makes grasp instruction stick.

I tell teachers: if you want the pencil grasp lesson to last longer than the day you taught it, add vertical surfaces and visual reminders (such as a poster of correct grasp) to your classroom routine. It’s not a replacement for anything. It’s the support structure underneath everything else.

A Note on Slant Boards  

Slant boards (angled writing surfaces that sit on the desk) are a middle ground between flat and fully vertical. They’re commonly recommended by school OTPs for children who need more wrist extension than a flat desk provides, or for situations where full vertical work isn’t practical (like a classroom desk during writing instruction).

The rationale is the same as with vertical surfaces: angle the surface, encourage wrist extension, and make it mechanically easier for the small muscles of the hand to do their job. Slant boards are covered in depth in Gripipedia, where we walk through the specific angles, the populations they tend to help most, and how to trial them with students before committing to purchasing them for a classroom.

The Bottom Line  

Vertical surfaces are not a trend. They are not occupational therapy magic. They are a straightforward application of what we know about hand development: that the wrist must be stable in extension, that proprioceptive input builds motor awareness, and that proximal stability precedes distal control.

If you’re working with a child who struggles to maintain a functional grasp, or a classroom full of kindergartners who are still working through the transitional stages, adding vertical surface opportunities to the day is one of the highest-leverage, lowest-cost interventions you have available.

Tape some paper to the wall. You’ll see the difference.

References  

Benbow, M. (1990). Loops and other groups: A kinesthetic writing system. Instructor’s manual. Therapy Skill Builders.

Case-Smith, J. (1991). The effects of tactile defensiveness and tactile discrimination on in-hand manipulation. American Journal of Occupational Therapy, 45(9), 811–818.

Cornhill, H., & Case-Smith, J. (1996). Factors that relate to good and poor handwriting. American Journal of Occupational Therapy, 50(9), 732–739.

Henderson, A., & Pehoski, C. (2006). Hand function in the child: Foundations for remediation. Mosby.

A Visual Guide to Pencil Grip Development That Actually Makes Sense

Last week, a kindergarten teacher showed me her classroom pencil grasp poster and asked, “Why doesn’t this match what I’m seeing with my kids?” She pointed to five different children, each holding their pencils in completely different ways, and honestly looked a bit defeated.

This happens all the time because most developmental charts show you the end goal without explaining the amazing journey children take to get there. Today, I’m sharing the visual progression I use every single day in my practice – one that shows you what normal development actually looks like, not just what we hope it becomes.

Stage 1: Early Immature Grasps (Under 3 Years)  

The “Whole Body Writer” Phase  

Children with immature grasps use their full arm, hand, and fingers as one unit to control the movement of the pencil. These grasps are typically seen in children under three years old, but don’t panic if you see them in slightly older kids who haven’t had much crayon or pencil exposure!

Radial Cross Palmar Grasp & Palmar Supinate Grasp  

These are your classic “fisted” grasps. I watch toddlers use these patterns and they’re absolutely perfect for this stage! The radial cross palmar has the thumb wrapping around to meet the fingers, while the palmar supinate looks like they’re holding a hammer with the thumb pointing up. Both give children the stability they need when their small finger muscles aren’t ready for precise control yet.

Digital Pronate, Brush Grasp & Grasp with Extended Fingers  

These patterns show children starting to use their fingertips more, but still with that whole-arm control. The digital pronate has the wrist turned down, the brush grasp looks exactly like holding a paintbrush, and the extended fingers pattern shows all fingers involved but not quite flexed properly. I love seeing these because they tell me a child is experimenting and building strength!

Stage 2: Transitional Grasps (Ages 3-6) 

Where Development Gets Interesting   

These grasps develop as the child gains stability in their shoulder and elbow. The movement of the pencil is controlled by extrinsic hand and arm muscles, and finger movements are beginning to develop. Schneck & Henderson (1990) identified these as transitional because they continue until six years of age – and that timeline is completely normal!

Cross Thumb/Lateral Pinch, Quadrupod & Static Tripod Grasps  

Here’s where things get really interesting! The cross thumb pattern has the thumb crossing over the pencil – looks “wrong” to many adults but often provides amazing stability for kids. The quadrupod involves four fingers with movement coming from the wrist. The static tripod looks mature but the fingers move as one unit instead of independently. All three are perfectly appropriate for this developmental stage!

Stage 3: Mature Grasps (Ages 4-6 and Beyond)  

Dynamic Movement Takes Center Stage  

Mature pencil grasps are characterized by dynamic finger movements and ulnar stabilization (pinky and fourth finger are “tucked into” the palm). The wrist and forearm are positioned on the table for stability. Here’s the game-changer: there are four equally mature and functional patterns!

All Four Mature Patterns: Equally Functional!  

• Dynamic Tripod: The classic three-finger grasp everyone recognizes
  
• Lateral Tripod: Three fingers with thumb crossing over – still dynamic and efficient
  
• Dynamic Quadrupod: Four fingers with movement from finger joints, not the wrist
  
• Lateral Quadrupod: Four fingers with thumb crossing over but maintaining finger mobility

(Gripipedia, © 2026; Donica et al., 2013)

What Really Matters in Development  

After seeing hundreds of children progress through these stages, I’ve learned that development is beautifully individual. Some kids show mature patterns by age 4, others develop them closer to 7 or 8. Hand size, joint mobility, muscle tone, sensory preferences, and even personality influence this timing.

When to Actually Be Concerned:

• Consistent complaints of hand or finger pain during writing activities

• Complete avoidance of fine motor tasks that peers enjoy

• Significant fatigue after age-appropriate amounts of writing

• Grip patterns that consistently interfere with letter legibility

• No progression in grip development over 6-12 months with regular exposure

• Regression to earlier patterns after mastering more mature ones

Supporting the Natural Progression  

Understanding this visual progression changes how we support children’s development. Instead of forcing specific grip patterns, we can build the foundational skills that allow natural progression to unfold.

References  

Donica, D. K., Goins, A., & Wagner, L. (2013). Effectiveness of handwriting readiness programs on postural control, hand control, and letter and number formation in Head Start classrooms. Journal of Occupational Therapy, Schools, & Early Intervention, 6(2), 81–93. https://doi.org/10.1080/19411243.2013.810938

Gripipedia. (© 2026). Developmental progression of pencil grasp—right hand [Developmental progression chart]. Gripipedia Publications.

Schneck, C. M., & Henderson, A. (1990). Descriptive analysis of the developmental progression of grip position for pencil and crayon control in nondysfunctional children. American Journal of Occupational Therapy, 44(10), 893-900.

Schwellnus, H., Carnahan, H., Kushki, A., Polatajko, H., Missiuna, C., & Chau, T. (2012). Effect of pencil grasp on the speed and legibility of handwriting after a 10-minute copy task in Grade 4 children. Australian Occupational Therapy Journal, 59(3), 180-187.

If you’ve been in the school-based therapy world for more than a minute, you know the feeling of looking at the teachers’ salary schedule, looking at your master’s or doctoral degree, looking at your mountains of specialized continuing education… and feeling completely invisible.

I felt that exact frustration for more than two decades. But today, I’m writing to tell you that the ceiling has officially cracked.

My home district just ratified a historic CSEA contract. We didn’t make a few minor tweaks—we rewrote the blueprint for how NYS school-based therapists under Civil Service are valued in our schools.

Here is exactly what we secured for OT and PT:

• A $10,886 Master’s stipend
• Brand-new Master’s +30 stipend of ($16,424) and Master’s +60 stipend ($21,926)  — earned through specialized professional continuing education (CEUs) and graduate courses converted into salary credits
• A dedicated Doctoral stipend ($24,894) recognizing our highest-level degrees
• A $5,000 specialized stipend for holding an Assistive Technology Professional (ATP) certification

In all of my research into NYS school district contracts so far, I have not found another CSEA Civil Service contract that has successfully built educational lanes like this for OTs and PTs. So how did we pull off the “impossible”? And more importantly, how can you do it in your district? Let’s dive in.

The Root of the Problem: Why OTs and PTs Get Left Behind in NYS

To fight a system, you have to understand how it’s wired. In New York State, the wage gap between teachers and therapists isn’t usually personal — it’s structural.

Under the New York State Education Department (NYSED), professions like speech-language pathology, school psychology, and social work are housed under Pupil Personnel Services (PPS) within the Office of Teaching Initiatives. Because they’re classified as instructional, they automatically land on the teacher salary schedule, complete with built-in lanes for professional growth (those coveted +30 and +60 columns).

Occupational and Physical Therapists are missing from that PPS list. Instead, we’re classified under Civil Service.

Because of that classification, administrators and union reps have historically thrown up their hands and said, “Civil Service contracts don’t have educational lanes. There’s nothing we can do.” For decades, we’ve been boxed into a medical mold, fighting a constant battle to prove we are educators and vital Specialized Instructional Support Personnel (SISP).

But “we’ve always done it this way” is no longer an acceptable excuse.

The Advocacy Blueprint: Data, Presentation, and Persistence

Our peer-reviewed research (published in JOTSEI) found that 96% of school-based OTPs are calling for systemic change to how we’re classified and compensated. This isn’t one frustrated therapist’s problem — it’s a profession-wide structural gap.

When it came time to advocate in my own district, I didn’t just go to administration and complain that things weren’t fair (this time). I treated advocacy like a professional presentation. If you want to change the minds of a Superintendent, an HR Director, or a Union Board, you have to speak their language.

Here is the three-step framework I used:

1. Present the Data Professionally

I built a side-by-side comparison the district couldn’t ignore:

• The salary schedules. In my district, the Master’s stipend for OTs and PTs had been frozen at $2,500 since 2001 — while the same degree earned other related service providers a differential of $10,672 to $21,593 on the teacher schedule.
• The duties. A comparison table showing that OTs and PTs perform the same IEP-mandated, legal responsibilities — standardized testing for eligibility, parent communication, aligning goals with curriculum, superintendent conference days — as the providers being paid on the teacher schedule.
• The cost avoidance. Our district’s assistive technology caseload had grown 460% in four years. Contracted AT services in New York run $110–$150 per hour, with formal evaluations costing up to $3,200 per case. Certified in-house expertise saves the district real money.
• The regional picture. Neighboring districts with similar tax bases already compensate OTs and PTs on the teacher salary schedule — proof that parity is fiscally achievable in our region.

I handed over data that proved a stable, well-compensated therapy department directly protects the district’s special education infrastructure.

2. Offer a Creative Solution

Administrators are busy. If you bring them a problem, you must bring the solution on a silver platter. I proposed a clean, realistic framework showing exactly how clinical CEUs could be mathematically converted into salary credits to mimic the teachers’ +30 and +60 columns — without violating Civil Service rules, and without creating an administrative headache for HR.

3. Relentless, Gracious Follow-Up

Change doesn’t happen in a single meeting. I met with administration, submitted the data, and followed up with unwavering consistency and professional grace. I didn’t let the paperwork gather dust on a desk.

When my union board saw the data and realized we had a viable framework, they stepped up and advocated fiercely for us at the table. When administration reviewed the numbers, they opened their minds to a brand-new way of doing things.

Don’t Give Up: Your District Could Be Next

If you’ve been told by your union or your district that educational columns “can’t be done” for Civil Service OTs and PTs, I’m living proof that they’re wrong. The mold has been broken right here in New York. When you present the right data to the right leaders, structural change is entirely possible.

You are a vital piece of the instructional team. Your advanced training directly impacts student success, safety, and classroom independence every single day. It’s time our contracts reflected that.

Grab My Free District Advocacy Template

You don’t have to reinvent the wheel or spend years staring at a blank page. To help you kickstart the conversation in your own district, I’ve put together a Free District Advocacy Template.

It’s completely customizable — plug in your own district’s salary schedules, caseload data, and regional comparisons. It’s the exact proposal framework that unlocked an $10,000+ raise and historic educational columns for my department.

Present the data.

Play the long game.

And go get what you’re worth.

Here’s something that should make every school-based PT and OT practitioner sit up and pay attention: we completed groundbreaking research showing that 94.9% of New York school physical therapy providers believe they should have the opportunity to pursue educational administrative positions. And yet, state policy continues to block this path entirely. Our data proves that physical therapy providers deserve equal access to these pathways.

Let me explain why this matters—and what we can do about it.

The Classification Problem

Within the New York State Education Department Office of Teaching Initiatives framework, both Occupational Therapy and Physical Therapy services are currently not classified under Pupil Personnel Services.

Pupil Personnel Services include school counselors, school psychologists, and school social workers. Notice who’s missing? OTs and PTs. This classification exclusion means we cannot obtain an educational credential, which renders us ineligible to pursue the coursework required for educational administrative certificates—the gateway to positions like principal, director of special education, or superintendent.

This isn’t just about career advancement. This classification inequity affects recognition, hiring practices, pay equity, tenure opportunities, and ultimately, the quality of care our students receive.

Spencer, J., MEd, OTR/L, Zeidler, S., OTD, OTR/L, & Wiggins, K., OTR/L. (2024). Perceptions of Occupational Therapy Practitioners as Leaders within the New York State Education System. Journal of Occupational Therapy, Schools, & Early Intervention, 17(3), 569–584. https://doi.org/10.1080/19411243.2024.2315579

What the Research Shows

Dr. Serena Zeidler, Kim Wiggins, and I conducted research examining school-based physical therapy providers’ perceptions of leadership within the New York State Education Department. Our PT-specific study, “Perceptions of School-Based Physical Therapy Providers as Leaders Within the New York State Education System,” surveyed 86 physical therapy providers (84 PTs and 2 PTAs) currently working or formerly working in New York schools.

The findings are striking:

Most respondents (94.9%) agree that New York school physical therapy providers should advocate for policies that would provide them the opportunity to pursue educational administrative coursework. Nearly half (49.3%) would actively consider pursuing this coursework if it became available. Another 24% were unsure, and only 26.7% said they wouldn’t consider it.

Think about that. We’re not talking about a small group of disgruntled practitioners. We’re talking about an overwhelming majority who recognize that something is fundamentally broken in how our profession is positioned within the educational system.

Our parallel research on occupational therapy practitioners—published in the Journal of Occupational Therapy, Schools, & Early Intervention—found nearly identical results among OTs, with 94.7% supporting advocacy for change and 94.6% agreeing we should pursue policies allowing access to administrative coursework.

Why This Matters Beyond Career Ladders

I’ve spent over 25 years in school-based practice, and here’s what I know: this isn’t just about who gets to be a principal. The lack of inclusion in Pupil Personnel creates real obstacles to best practices in service delivery for students who need our support.

When OTs and PTs are systematically excluded from the opportunity for formal leadership roles, it affects team collaboration, decision-making processes, and service quality. We’re the only Specialized Instructional Support Personnel (SISPs, or what some still call “related service providers”) who cannot pursue the coursework to become school administrators. We’re left out of critical conversations about programming, scheduling, and resource allocation—conversations where our clinical expertise could directly improve student outcomes.

APTA’s Vision talks about “building a community that advances the profession of physical therapy,” but that vision hits a wall in the school setting when state policy prevents us from accessing leadership pathways. In fact, Dr. Serena Zeidler and I were accepted to present this critical data at the New York State APTA Conference in 2025. While we ultimately did not attend the event, we made sure that APTA leadership received this groundbreaking research firsthand. The federal Every Student Succeeds Act (ESSA) encourages greater involvement for therapy practitioners, yet state policy restricts our advancement. This misalignment between federal intent and state regulation needs to be addressed.

Current Legislative Opportunities

Right now—not someday, but right now—there are concrete opportunities to change this situation. Two bills and a NYSUT resolution are currently pending that directly address these barriers for OTs and PTs in New York schools. Senate Bill S6581 would align PT/OT pay with the state career ladder framework, and S5612 addresses OT roles in school districts and BOCES, our lack of opportunities to be leaders, and the pay disparity.

These legislative initiatives represent years of advocacy work by practitioners who refused to accept that our exclusion from leadership is inevitable or justified.

NY State Senate

NY State Senate Bill S5612

Authorizes OT services to be
provided in school to certain students

Download, Support,
Sign up for Status
Updates on this Bill at
the link above.

Status: All three (3) bills as of Dec 15, 2025 in they are in Assembly (or Committe Senate), which is Step 2 in a 6-step process.

The Bigger Picture

This research represents the first comprehensive look in New York at how classification barriers affect physical therapy providers’ ability to lead and advocate within educational settings. But it’s not just a New York problem—in most states, OTPs and PTs face restrictions on advancing to formal school leadership positions.

As occupational therapy practitioners who led this research, we’re committed to building cross-disciplinary solutions. Dr. Zeidler, Kim Wiggins, and I conducted this work because we believe that when PTs and OTs work together to address systemic barriers, everyone wins—especially the students we serve.

The data is clear. The will is there. Now we need the policy to catch up with what 95% of us already know: physical therapy and occupational therapy providers deserve equal access to school leadership positions, and our students deserve to benefit from our expertise at every level of the education system.

See Why This Matters

• Why do Occupational Therapists want Educational Credentialing?
• I Want the Red Shirt.

As OTs conducting this research, we’re committed to cross-disciplinary solutions. When therapeutic professionals address systemic barriers together, students receive better, more integrated care.

Join the conversation about improving PT services in educational settings!

#PhysicalTherapy #OccupationalTherapy #EducationalServices #InterdisciplinaryResearch #ProfessionalAdvocacy #PublishedResearch #NYSED #TherapyServices

In most states, OTPs and PTs are restricted from advancing to formal school leadership positions. The absence of pathways to leadership may limit the ability to fulfill AOTA’s Vision 2025 and Every Student Succeeds Act (ESSA). This study investigated how limited opportunities for career advancement affect school practice trends. We explore the perceptions of school practitioners in New York State concerning leadership, advocacy, and state policies. Seven hundred and fourteen current and former occupational therapy practitioners in New York schools completed a researcher-developed online survey. Notably, almost all respondents (94.7%) agreed that practitioners should be able to pursue educational administrative coursework.

 

Most (94.6%) agreed that practitioners in New York should advocate for policies that would allow them to pursue such coursework. 

 

Many respondents reported that they would consider pursuing the coursework if available. This research emphasizes the misalignment between federal and state policies. Federal policy (ESSA) and Vision 2025 encourage greater involvement for occupational therapy practitioners, but state policy restricts their advancement. The findings demonstrate the pressing need for reform and the creation of pathways that enable occupational therapy practitioners to assume formal leadership positions in school settings, thus enhancing their contribution to the school community.

The Truth About Pencil Grip Research That Every OTP, Teacher, and Parent Needs to Know

I cannot tell you how many times I’ve heard it in IEP meetings, teacher lounges, and even OT conferences: “Well, research shows that grasp doesn’t really matter for handwriting.” 

Every time I hear this, my heart sinks a little. Because here’s the thing – that statement isn’t wrong, but it’s dangerously incomplete. And it’s leaving struggling kids without the support they desperately need.

What the Research Actually Shows  

Let me break down what multiple studies from 1993-2018 have actually discovered, because the full picture tells a completely different story.

The Four Functional Grasps   

Current research recognizes these four grasp patterns as equally mature and functional:

• Dynamic Tripod – The “classic” three-finger grasp

• Dynamic Quadrupod – Four fingers with dynamic movement

• Lateral Tripod – Three fingers with thumb crossing over

• Lateral Quadrupod – Four fingers with thumb crossing over

(Donica et al., 2018; Schwellnus et al., 2012)

So yes, if your child uses any of these four patterns, grasp truly doesn’t impact their handwriting speed or legibility. The dynamic tripod isn’t the “gold standard” anymore – it’s just one of four equally good options!

But Here’s Where Grasp ABSOLUTELY Matters  

The Missing Piece: Studies consistently show that immature or static pencil grasps lead to increased fatigue and decreased legibility (de Almeida et al., 2013; Dennis & Swinth, 2001; Schwellnus et al., 2012).

I see this every single day in my school. The second-grader whose hand cramps after writing three sentences. The kindergartener who holds their pencil in a fisted grasp and can barely form recognizable letters. The fourth-grader who avoids writing assignments because “it hurts.”

In Schwellnus et al.’s 2012 study of 120 students, guess what happened to the three children with immature grasp patterns? They were classified as “dysgraphic writers.” Every. Single. One.

The Problem with the Research  

Here’s why that “grasp doesn’t matter” statement is so misleading. The studies have significant limitations:

• Exclusion bias: They excluded children with immature or “atypical” grasps

• Sample size: Many studies had very small samples (i.e., 46 children) with only 1-3 children using atypical grasps

• Writing duration: Most only analyzed 1-4 sentences, not real classroom demands

• Limited scope: They omitted children receiving OT services

(Donica et al., 2018; Schwellnus et al., 2013)

The Hidden Cost: Missing Out on Daily Fine Motor Strengthening  

Here’s something that keeps me up at night as an OT; and it’s something most people never consider when they dismiss grasp concerns.

Think about a typical school day for a moment. Kids use pencils during morning work, math worksheets, spelling practice, journal writing, note-taking, homework, art projects, and about a dozen other activities. We’re talking about hours of pencil use every single day!

But here’s what breaks my heart: when kids use immature or compensatory grasps, they’re essentially doing bicep curls when they should be doing finger exercises. Instead of strengthening the small, intricate muscles needed for button fastening, shoelace tying, and precise manipulation, they’re reinforcing inefficient movement patterns hour after hour, day after day.

I had one third-grader whose teacher said, “He writes so much better in the morning, but by afternoon, his letters fall apart.” That’s not a motivation problem – that’s a child whose forearm muscles are exhausted from doing a job they were never meant to do!

The research on grasp strength and functional independence backs this up beautifully. Alaniz et al. (2015) found that grasp strength correlates directly with pencil control AND independence with daily activities. When children develop strong, coordinated hand muscles through proper pencil use, those benefits extend far beyond the classroom.

What This Means for Your Practice  

Stop feeling guilty about addressing grasp patterns! If a child is struggling with handwriting endurance, complaining of pain, or showing decreased legibility over time, their grasp absolutely could be the culprit.

The research supports us when we say: Functional grasp matters. Mature patterns matter. And children with immature patterns may deserve our intervention.

References  

Alaniz, M. L., Galit, E., Necesito, C. I., & Rosario, E. R. (2015). Hand strength, handwriting, and functional skills in children with autism. American Journal of Occupational Therapy, 69(4), 6904220030.

de Almeida, P. H. T. Q., da Cruz, D. M. C., Magna, L. A., & Ferrigno, I. S. V. (2013). An electromyographic analysis of two handwriting grasp patterns. Journal of Electromyography and Kinesiology, 23(4), 838–843. https://doi.org/10.1016/j.jelekin.2013.04.004

Dennis, J. L., & Swinth, Y. (2001). Pencil grasp and children’s handwriting legibility during different-length writing tasks. American Journal of Occupational Therapy, 55(2), 175-183.

Donica, D. K., Goins, A., & Wagner, L. (2018). Effectiveness of handwriting readiness programs on printing performance in kindergarten students. Journal of Occupational Therapy, Schools, & Early Intervention, 11(4), 484-496.

Koziatek, S. M., & Powell, N. J. (2003). Pencil grips, legibility, and speed of fourth-graders’ writing in cursive. American Journal of Occupational Therapy, 57(3), 284-288.

Schwellnus, H., Carnahan, H., Kushki, A., Polatajko, H., Missiuna, C., & Chau, T. (2012). Effect of pencil grasp on the speed and legibility of handwriting after a 10-minute copy task in Grade 4 children. Australian Occupational Therapy Journal, 59(3), 180-187.

Schwellnus, H., Carnahan, H., Kushki, A., Polatajko, H., Missiuna, C., & Chau, T. (2013). Effect of pencil grasp on the speed and legibility of handwriting in children. American Journal of Occupational Therapy, 67(6), 718-726.

Wallen, M., Duff, S., Goyen, T.-A., & Froude, E. (2013). Respecting the evidence: Responsible assessment and effective intervention for children with handwriting difficulties. Australian Occupational Therapy Journal, 60(5), 366–369. https://doi.org/10.1111/1440-1630.12045

I’ll be honest: I was a little nervous to share these results. Not because they were bad — but because they were really good, and I didn’t want anyone to think I was overclaiming.

But the final data from our new ocular motor group proved just how impactful this work can be. Even the principal said it herself: these numbers are impressive. So here we go.

A Little Backstory

If you’ve been following me for a while, you know I teach a vision course with Robert Constantine for school OTPs. Vision is one of those areas I get genuinely fired up about — because undiagnosed vision issues are constantly getting misread as ADHD, dyslexia, behavior problems, or just a kid who doesn’t care.

Last fall, one of the principals in my district heard I wanted to start an Ocular Motor Group as a multi-tiered support for kids struggling with reading. We got the green light from Special Ed. And then things moved fast.

I had a few days to create the program outline and design all the activities. We ran two groups of four students, seen every other day, rotating through stations every two weeks. Total of about 12 weeks of services (not counting winter break).

I called it the O.M.G. — Ocular Motor Group. You’re welcome.

Here are a couple of videos so that you can get a glimpse of the types of activities I used.

To be clear on what those numbers mean: I asked the school psychologist to walk me through the data because I’d never looked at diagnostic reading or math scores like this before. A score of 183% means that student hit her winter i-Ready goal and then surpassed it by 83%. It’s not just passing — it’s blowing past the expected target.

Here’s the summary:

• 3 students went up 1 grade level in reading
• 1 student went up 2 grade levels in reading
• 3 students went up 1 grade level in math
• 1 student went up 2 grade levels in math

Now — I want to be transparent. I can’t attribute all of this progress to the O.M.G. alone. These kids also had teachers, other support staff, and a lot of other variables in their lives. But I also know what I saw in those sessions. These kids were engaged, they were building skills, and something was working.

What Were We Actually Doing?

The number one question I’ve gotten: What activities did you use?

I pulled from everything I know — ocular motor exercises, brain gym, rhythmic movement, and reflex integration — and built it into playful, engaging stations. Nothing felt like “therapy” to the kids. It felt like games.

That’s intentional. When kids are having fun, you get buy-in. When you get buy-in, you get effort. When you get effort, you get results.

Keep it FUN. That’s not a throwaway tip — it’s the whole strategy.

If you want to learn more about vision and how it connects to learning, behavior, and OT practice, check out the Eyes First course I teach with Robert Constantine. The link is below.

And if you’re thinking about starting something like this in your own district — you absolutely can. You don’t need a perfect program. You need a good reason, a willing administrator, and a solid foundation of knowledge to back up your clinical decisions.

Start there.

Want to learn more about vision and school-based OT? Check out Eyes First → Eyes First Vision