Therapy in Tier 1 of the MTSS is becoming one of the most important areas of school-based practice for occupational therapists, physical therapists, and speech-language pathologists. However, for many therapists, Tier 1 still feels vague. It is often discussed in theory, but not always clearly defined in day-to-day school practice. Therapy in Tier 1 of the MTSS is not about providing individualized intervention to a few students – it is about supporting access, participation, and inclusion across entire classrooms and school systems.
During the 2026 Inclusive Classroom Summit, school-based occupational therapist Amanda Gibbs shared practical insights into what Tier 1 support actually looks like in schools, where therapists fit within general education, and what does – and does not – fall within the role of school-based therapists at the Tier 1 level.
What is Therapy in Tier 1 of the MTSS?
At its core, therapy in Tier 1 of the MTSS focuses on universal supports that benefit all students within the general education environment.
Rather than targeting one individual student, therapists work collaboratively with teachers, administrators, and school teams to create classroom-wide strategies that improve participation, accessibility, and engagement for everyone.
The goal is to reduce barriers before students struggle significantly enough to require more intensive intervention.
1. Consultation and Collaboration
Amanda emphasizes that strong relationships with teachers, support staff, and administrators are essential. Therapy in Tier 1 of the MTSS relies on collaboration, where therapists partner with school teams to design classroom-level supports that improve participation and access for all students.
This may include regular classroom check-ins, discussing concerns with teachers, recommending strategies, and documenting support provided throughout the school year. Amanda shared that having a simple documentation system, such as an Excel spreadsheet or shared tracking document, can help therapists monitor how often they collaborate, what strategies were recommended, and what classroom needs continue to emerge over time.
2. Universal Screening and Observation
Another major part of therapy in Tier 1 of the MTSS is classroom observation and universal screening. Amanda explains that this often happens most frequently in preschool and kindergarten settings where early intervention is especially important.
For example, occupational therapists may complete simple handwriting or fine motor screeners with an entire kindergarten class to identify developmental trends and determine whether classroom-wide supports are needed. Rather than focusing immediately on individual referrals, universal screening helps therapists gather data about the overall needs of the classroom and identify patterns that may otherwise be missed.
3. Co-Teaching and Coaching
Once therapists build trust within classrooms, Tier 1 support may also involve co-teaching and coaching alongside educators.
Therapists can work directly within classroom routines to support participation. This could include helping teachers implement flexible seating, embedding movement opportunities into instruction, supporting fine motor warm-ups before writing tasks, or coaching staff around sensory, motor, executive functioning, and self-regulation strategies.
The goal is not to remove students from instruction, but to build teacher capacity and support students within their natural learning environment.
4. Tier 1 Strategies and Classroom Modifications
Amanda also discusses the importance of classroom-wide strategies and environmental adaptations. Therapists may recommend changes that improve participation for many students at once, such as ergonomic seating, sensory supports, visual cueing systems, or self-regulation spaces within the classroom.
She also highlights the importance of coaching teachers and paraprofessionals on how to fade support appropriately. Rather than relying heavily on physical prompting or hand-over-hand assistance, therapists can help staff use strategies that encourage greater independence and participation over time.
5. Professional Development
Therapists have valuable expertise to share with teachers and school staff, particularly around developmentally appropriate expectations, movement breaks, sensory strategies, handwriting instruction, task analysis, and inclusive participation supports.
However, it is important to remember that strategies must be realistic and practical for busy classrooms. Looking back on her own experience, Amanda reflected that some supports she initially recommended were difficult for teachers to implement consistently. Effective Tier 1 support means providing strategies that fit naturally into classroom routines rather than adding more demands onto teachers’ already full schedules.
6. Data-Informed Prevention
One thing Amanda stresses on is the importance of data within therapy in Tier 1 of the MTSS. Progress monitoring helps therapists determine whether classroom strategies are effective and whether students are making progress with universal supports.
This does not need to be complicated. It can be as simple as collecting handwriting samples every few weeks, tracking the effectiveness of flexible seating, or observing whether students are able to sustain attention for longer periods during instruction.
The purpose of this data is to guide decision-making. If students are not progressing despite Tier 1 supports, therapists can then begin considering whether Tier 2 or Tier 3 intervention may be necessary.
7. Student Skill-Building Within Classroom Routines
Then there is the importance of embedding skill-building directly into classroom activities. Rather than pulling students away from instruction, therapists can support brief, curriculum-based activities that benefit the whole class.
This may include fine motor warm-ups before handwriting tasks, using Play-Doh to form letters in kindergarten classrooms, or embedding movement breaks into daily instruction. Amanda notes that research supports the use of motor-based, hands-on learning opportunities because they often increase engagement, carryover, and motivation for students.
Therapy in Tier 1 of the MTSS is ultimately about being present within classrooms, collaborating with educators, and creating supports that improve access and participation for all students.
What Therapy in Tier 1 of the MTSS Is Not
Understanding what falls outside the scope of Tier 1 is just as important as understanding what belongs within it.
Therapy in Tier 1 of the MTSS Is Not Individualized Pull-Out Intervention
Individualized pull-out therapy or intensive one-on-one intervention belong within Tier 2, Tier 3, or special education services determined through the IEP, 504, or MTSS process.
At the Tier 1 level, therapists are looking at classroom-wide participation and access. Rather than immediately identifying individual students for separate intervention, the focus should first be on strengthening classroom instruction, environmental supports, and universal strategies.
Therapists should first provide whole-class supports and then use data to determine whether some students may require more targeted intervention over time.
Therapy in Tier 1 of the MTSS Is Not Making Eligibility Decisions Alone
In Tier 1, therapists cannot independently determine whether a student qualifies for special education services.
Even if a therapist notices that a student may require additional support, decisions around eligibility and placement must be made collaboratively through multidisciplinary teams such as the IEP team, MTSS team, or child study team.
Therapists play an important role in identifying concerns and sharing observations, but they should not act in isolation when determining services or supports.
Therapy in Tier 1 of the MTSS Is Not Changing Curriculum or Grading Policies
Another important distinction is that therapists are not responsible for changing curriculum requirements or grading policies.
Teachers are often required to follow state or district-mandated curriculum, even when therapists may feel that parts of the curriculum are not developmentally appropriate or ideal for certain students.
Instead of changing curriculum expectations, therapists can recommend accommodations and classroom supports that help students access the curriculum more successfully. It is important for therapists to remain flexible and work within the educational framework already in place.
Therapy in Tier 1 of the MTSS Is Not Delivering Intensive Clinical Services
Amanda also clarifies that therapy in Tier 1 of MTSS is not medically-based or rehabilitation-focused intervention.
School-based therapists are supporting educational access and participation within the classroom environment, rather than providing intensive clinical services, long-term rehabilitation, or medically-focused therapy.
The purpose of Tier 1 support is to help students engage meaningfully in their school day and access the general education environment.
Therapy in Tier 1 of the MTSS Is Not Implementing Supports Without Teacher Buy-In
Collaboration is essential within Tier 1 services. Therapists should not impose classroom routines, equipment, or interventions without teacher and administrative collaboration.
If teachers do not understand or support the strategy being recommended, carryover is unlikely to happen consistently. Universal classroom supports require shared decision-making and realistic implementation plans that fit within the classroom routine.
Amanda repeatedly highlights the importance of building trust with teachers first, rather than working against classroom systems already in place.
Therapy in Tier 1 of the MTSS Is Not Directing Paraprofessionals Independently
While therapists may support paraprofessionals and classroom aides through coaching and modeling, they should not bypass the classroom teacher when providing direction. Amanda explains that going directly to support staff without teacher collaboration can sometimes create tension within the classroom team.
Instead, therapists should work through the classroom teacher to ensure everyone remains aligned and consistent in how supports are implemented.
Therapy in Tier 1 of the MTSS Is Not Separate From Educational Impact
Finally, Amanda reinforces that all school-based therapy services must remain connected to educational participation and access.
Tier 1 support exists within MTSS and RTI frameworks, where the focus is on helping students participate successfully within the general education environment. Therapists should continually connect interventions back to classroom participation, curriculum access, and student engagement rather than isolated clinical goals.
Why Therapy in Tier 1 of the MTSS matters
When occupational therapists, physical therapists, and speech-language pathologists collaborate within classrooms, support teachers, and embed strategies into everyday routines, they create opportunities to support students earlier and more proactively.
Therapy in Tier 1 of the MTSS helps strengthen classroom participation, improve access for all learners, and reduce unnecessary referrals by addressing barriers before students require more intensive support.
Most importantly, Tier 1 support does not have to begin with a perfect system. The most important step is simply getting started.
Want to explore the real-world challenges therapists face when implementing Tier 1 support? Click here for Part 2, where we unpack common barriers to Therapiy in Tier 1 of MTSS and practical ways to overcome them.
This is just a glimpse: get the full interview plus 11 other expert-led talks on mastering MTSS in schools.
About Amanda Gibbs
Amanda Gibbs is a School-based Occupational Therapist with 5 years of experience serving students 2-22 years of age. Amanda has a certification as a Tier 1 Specialist through the Size Matters Handwriting Program. When she is not working in the school system, she supports and provides resources for other school-based therapists, parents, and teachers online.
Website: https://otenlightenment.com/