When therapists understand how to work within multi-tiered systems of support, their impact in schools expands dramatically. Beyond traditional pull-out sessions, school-based therapists can play a critical role in inclusive classrooms, schoolwide support systems, and early intervention. By integrating therapy services across Tier 1, Tier 2, and Tier 3 supports, therapists collaborate effectively with educators, advocate for their role, and improve outcomes for all students – not just those with Individualized Education Programs (IEPs).
During our Inclusive Classrooms Summit, we spoke with Jaime Spencer, MS, OTR/L, a school-based Occupational Therapist whose work is redefining meaningful, systemwide support in schools. Our conversation explored how therapists can move beyond traditional models and become integral contributors within multi-tiered systems of support, reaching entire classrooms and school communities.
Understanding Multi-Tiered Systems of Support: Where Therapists Fit
Multi-tiered systems of support are designed to provide varying levels of intervention based on student need. While these frameworks are often discussed in relation to academics and behavior, they are equally relevant to therapy services. When therapists are fully integrated into this model, their role shifts from being reactive to preventative and system-wide.
Jaime emphasizes that therapists no longer need to be confined to pull-out services. Bringing therapy into the classroom allows them to reach more students, model strategies for teachers, and reduce the need for intensive intervention later. However, this shift requires advocacy. Administrators may not always recognize a therapist’s schoolwide contribution, making it essential for clinicians to clearly communicate their skills, propose practical solutions, and adapt to diverse teaching styles.
The more time therapists spend in classrooms, the more opportunities there are for shared learning: teachers gain insights into developmental skills and accommodations, while therapists deepen their understanding of classroom demands and routines.
Re-Defining the Three Tiers of Support in Multi-Tiered Systems
Tier 1: Universal Support for All Students
Tier 1 is where school-based therapists can have the broadest and most preventative impact, yet it is often where they are least utilized. At this level, therapists support the entire school community – not only students in special education.
This may include pushing into general education classrooms, leading whole-class lessons, providing professional development for staff, offering parent workshops, or participating in school problem-solving teams. These universal supports align closely with universal design for learning principles and allow therapists to address skill development before challenges escalate.
When therapists are visible and involved at Tier 1, they become valued members of the school community rather than specialists who are only consulted when something goes wrong.
Tier 2: Targeted Support for Emerging Needs
Tier 2 focuses on students who have been identified as experiencing challenges and may benefit from additional interventions without individualized services. Referrals often emerge through teacher observations, parent concerns, or problem-solving meetings.
In many cases, small changes can make a meaningful difference. Adjusting classroom furniture, identifying visual or motor challenges, or providing teachers with targeted strategies can significantly improve student participation. Jaime often shares checklists, classroom strategies, and parent handouts that allow teachers and families to implement support consistently across environments.
This tier highlights the importance of collaboration. Teachers are often the first to notice concerns, and therapists can help translate those observations into practical, effective interventions.
Tier 3: Intensive and Individualized Support
Tier 3 remains essential for students who require individualized and intensive intervention. However, when Tier 1 and Tier 2 supports are implemented effectively, Tier 3 services can become more targeted and impactful. Rather than addressing preventable gaps, therapists are able to focus on specific, well-defined needs on a one-on-one basis or in very small groups.
When Push-In Works – and When It Doesn’t
After exploring how Tier 1, Tier 2, and Tier 3 supports operate, the next question is how these strategies play out in real school settings. Jaime shared an example from her district that highlights both the promise and the challenges of classroom-based therapy when systems are not fully aligned.
In one building, Jaime piloted a push-in and modeling approach across all self-contained classrooms from kindergarten through fifth grade. With only one therapist on site, careful scheduling was essential: two full days each week were dedicated to classroom sessions, rotating through multiple classes for 45 minutes each, while the remaining time was reserved for traditional occupational therapy responsibilities.
The results were overwhelmingly positive. Five teachers, representing different grades, classroom structures, and student populations, reported that the model was highly effective. Teachers and therapists learned from each other, students were engaged, and the work felt meaningful for everyone involved.
When a similar approach was attempted in other buildings, the outcomes were very different. This contrast underscores key lessons:
- Timing, planning, and collaboration matter: a push-in approach requires clear roles and shared goals.
- Strong relationships are essential: therapists, teachers, and administrators must trust and communicate.
- Sustained presence demonstrates value: regular classroom engagement allows therapists to model strategies while helping teachers address challenges proactively.
Jaime has seen similar success when pushing into full kindergarten programs. In one year, all 26 kindergarten teachers reported the approach as invaluable. Yet as leadership and priorities shifted, the following year brought changes, highlighting a key reality: school systems evolve, and sustained impact often depends on ongoing advocacy.
Consistent classroom presence allows therapists to reach more students efficiently while equipping teachers to recognize, prevent, and respond to challenges proactively.
Supporting Tier 1 and Tier 2 Students When Therapists Are Contract-Based
In districts where therapy services are primarily contract-based, students identified as needing support may not receive individualized services.
In Jaime’s district, teachers or administrators reach out for consultation when occupational therapy concerns arise. Jaime observes students during naturally occurring classroom routines and provides practical, immediately applicable strategies – such as fine motor supports, seating adjustments, or movement accommodations.
When simple strategies aren’t enough, teachers are guided through structured checklists to identify specific challenges and determine which supports have been tried. Parents are engaged through targeted handouts and resources for carryover at home. Over time, Jaime has built a comprehensive library of tools, enabling her to support more teachers and families efficiently – vital when one clinician is responsible for many students.
Not all contract therapists provide this level of consultation, highlighting the importance of system-level understanding, clear role definition, and proactive collaboration within multi-tiered systems of support
Universal Design in Action: Reaching More Students with Fewer Barriers
Jaime is a strong advocate for universal design strategies that allow school-based therapists to support entire classrooms with minimal time investment, while also creating consistent, accessible supports that benefit a wide range of learners. By designing interventions that can be embedded into daily classroom routines, therapists are able to extend their impact well beyond individual sessions.
Some of Jaime’s most effective universal design approaches include:
- Parent handouts at the start of the year: Guidance on organization, pencil grasp, handwriting, and fine motor skills
- Classroom visuals: Posters and desk cues reinforce skills consistently throughout the day
- Short instructional videos for teachers: Demonstrating warm-ups and movement breaks for repeated use
- Chants and handwriting routines: Engaging verbal cues increase participation and carryover
- Class-wide self-regulation lessons: Teach emotional awareness, coping, and regulation strategies
- Modeled movement routines: Support core strength, regulation, and body awareness, allowing teachers to independently continue routines
Collaboration as a Force Multiplier
One of the most impactful examples Jaime shared involved co-teaching in a self-contained kindergarten classroom alongside a Speech-Language Pathologist. By planning and delivering lessons together, both clinicians gained insight into each other’s strategies and were able to support shared goals throughout the child’s day.
This type of multidisciplinary collaboration strengthens outcomes for students and reinforces the idea that therapy goals do not exist in isolation. Jaime also highlights how physical therapists are often underutilized in school settings, particularly with younger students whose motor skills have been impacted in recent years. Addressing motor foundations early can have a direct influence on academic success.
Case Study: Vision, Reading, and a Tier 2 Breakthrough
One of Jaime’s most compelling examples of Tier 2 intervention emerged from a recurring observation: many students being referred for dyslexia or significant reading difficulties were also showing clear signs of ocular motor dysfunction. Vision, she noted, is often overlooked – both in educational teams and within therapy practice – despite its foundational role in reading and learning.
After advocating with a school psychologist and principal, she implemented a 15-week oculomotor intervention for eight fourth-grade students, some with IEPs and some without. Functional screening, classroom observation, and existing academic data guided the intervention, avoiding standardized testing while remaining measurable.
The Intervention Included:
- Ocular motor and visual tracking activities
- Eye–hand coordination and midline crossing tasks
- Timed “Minute to Win It” stations
- Teacher and parent collaboration
- Functional vision checklists
- Academic progress monitoring using existing school assessments
Students rotated through short, focused stations designed to strengthen visual-motor integration, coordination, and attention – all critical for reading fluency. Progress was measured through both performance data and observable changes in confidence and classroom engagement.
Results:
- 2 students reached grade-level reading
- 2 students gained two grade levels in math
- 4 students gained one grade level in reading or math
- Teachers observed increased confidence, participation, and willingness to engage
One student, in particular, demonstrated severe visual tracking challenges that were not apparent during casual conversation but became clear during structured screening. Following the intervention, she made substantial gains in reading – a powerful reminder that when vision-related needs are addressed, academic barriers can shift dramatically.
Supporting the Whole Child – Including Self-Esteem
Beyond academic progress, Jaime intentionally embedded social-emotional learning into the group. Drawing inspiration from The High Five Habit by Mel Robbins, students ended each session by high-fiving a mirror and stating a positive affirmation.
Initially, many students felt uncomfortable or embarrassed. Over time, however, this ritual became a meaningful part of the group. Students began to internalize positive self-talk and take greater ownership of their learning.
Teachers later shared that they noticed:
- Increased confidence
- Greater classroom participation
- A willingness to read aloud and take academic risks
These shifts mattered deeply, because reading challenges are never just academic. They are closely tied to self-worth, mental health, and long-term educational outcomes.
In Conclusion
Multi-tiered systems of support offer therapists a framework for broad impact – but systems alone do not create change. Advocacy, collaboration, and visibility are essential.
Therapy may no longer be limited to pull-out sessions. Embedded in classrooms, hallways, staff meetings, and schoolwide initiatives, therapists using universal design can remove barriers and build systems where all learners thrive.
That is where lasting change begins.
This is just a glimpse: get the full interview plus 13 other expert-led talks on mastering push-in therapy in schools.
About Jaime Spencer
Jaime is a dedicated school-based Occupational Therapist in Long Island, NY. She’s the driving force behind “Miss Jaime, O.T.,” a global platform empowering educators and parents to make learning fun and accessible for kids. As an entrepreneur, author, and advocate, Jaime is also a vital member of New York’s Occupational Therapy State Board. With a Master’s in Special Education and a Bachelor’s in Occupational Therapy, Jaime is a true leader in her field.
Website: https://missjaimeot.com/