Barriers to Tier 1 in MTSS are one of the biggest challenges school-based occupational therapists, physical therapists, and speech-language pathologists face when trying to move beyond traditional pull-out models of support. While Therapy in Tier 1 of the MTSS offers tremendous potential for improving participation, access, and inclusion across classrooms, implementation is not always straightforward.
Many therapists encounter challenges such as role confusion, limited teacher buy-in, time constraints, staffing shortages, unclear policies, and difficulty sustaining collaborative systems within busy school environments.
During the 2026 Inclusive Classroom Summit, school-based occupational therapist Amanda Gibbs discussed some of the most common barriers therapists encounter when implementing Tier 1 services – and, importantly, the practical strategies schools and therapy teams can use to overcome these barriers and build more sustainable, collaborative Tier 1 support systems.
Role Confusion Around Therapy in Tier 1 of the MTSS
Role confusion is perhaps one of the biggest barriers in Therapy in Tier 1 of the MTSS. Teachers, administrators, and even families may still associate school-based therapy primarily with pull-out intervention, making it difficult for them to fully understand the purpose of Tier 1 support.
In order to overcome this, it is important to create a clear written role statement aligned with MTSS and IDEA frameworks. Amanda explains that OTP, PT, and SLP teams should work together to define what Tier 1 support looks like within their district so there is consistent understanding across schools. Providing brief staff in-services, sharing success stories, and presenting classroom data can also help school teams better understand how Tier 1 consultation and collaboration differs from Tier 2 and Tier 3 services.
Limited Teacher Buy-In
Another common challenge is gaining teacher buy-in. Amanda stresses that strong therapist-teacher relationships are essential for Therapy in Tier 1 of the MTSS to work effectively.
Rather than approaching classrooms with criticism or overwhelming recommendations, therapists should use a collaborative and consultative approach. Noticing concerns in real time and offering practical, actionable suggestions often leads to stronger collaboration. Simple environmental adaptations, such as adjusting seating arrangements or improving visual access to instruction, can make a meaningful difference while also helping teachers see the value of Tier 1 support.
Time Constraints and Scheduling Challenges
School-based therapists are often balancing large workloads, making it difficult to consistently provide Tier 1 support.
One strategy Amanda recommends is intentionally blocking time within schedules for consultation and classroom coaching. Even short 15–30 minute check-ins during transitions, morning routines, or classroom activities can help therapists maintain regular collaboration and provide support where it is most needed.
Staffing Shortages and High Caseloads
High turnover and staffing shortages can also make consistency difficult. This may result in therapists spending significant time implementing supports, only for systems to fall apart when new staff members enter the classroom.
To address this, Amanda encourages therapists to focus on high-impact universal strategies and ongoing staff training. Providing support to teachers and paraprofessionals, maintaining consistent documentation, and completing periodic follow-ups can help sustain strategies even when staffing changes occur.
Therapist reflection is also very important here. If a strategy is not being carried over consistently, it may be valuable to consider whether the recommendation itself was realistic, practical, or clearly taught.
Lack of Training in Consultative Coaching Models
Another possible barrier is limited training in coaching and consultative service delivery models.
Therapists may feel confident providing direct intervention but less prepared to coach teachers, aides, and paraprofessionals within classroom environments. Amanda encourages therapists to pursue professional development related to MTSS, instructional coaching, and evidence-based consultation practices.
She also highlights the importance of modeling strategies, providing feedback, and gradually fading support. This is particularly important for paraprofessionals, who are often doing their best to support students but may not have received formal training in areas such as prompting, independence, or sensory and motor supports.
Limited Administrative Support
Insufficient administrative support or unclear district policies can significantly impact Tier 1 implementation.
To help overcome this barrier, therapists can align their proposals and recommendations with broader school priorities such as attendance, participation, behavior, and academic outcomes. Providing simple implementation plans and evidence-based rationale can help administrators better understand the value of Tier 1 services and how they support school-wide goals.
Difficulty Collecting Data
Collecting and using universal data can also feel overwhelming for therapists and teachers.
Data systems do not need to be complicated. Simple one-page data sheets, digital forms, or brief progress monitoring systems can help therapists quickly measure whether classroom supports are effective. Having a consistent system in place is essential so information does not “fall through the cracks.”
Confidentiality and Consent Concerns
Providing classroom-wide support can sometimes raise concerns around confidentiality and consent.
Tier 1 interventions should remain universal and non-identifying whenever possible. When discussing individual students, therapists should follow district procedures, use secure communication channels, and document consultation notes appropriately within school systems rather than as medical records.
Equipment and Resource Limitations
Amanda also acknowledged that schools often face limitations around equipment and resources, particularly when costly supports are needed.
While some students may require specialized equipment, therapists can still recommend lower-cost, high-impact alternatives that support participation within the classroom. Examples of supports such as visual schedules, timers, wobble cushions, movement corners, and shared classroom kits can be rotated between classrooms when resources are limited.
Unclear Tier 1 to Tier 2 Referral Processes
Finally, there is the importance of having clear systems in place for determining when students may need additional support beyond Tier 1.
Without a defined referral and decision-making process, teachers may feel unsure about next steps when universal supports are not enough. Amanda recommends creating referral forms, checklists, and clear procedures that guide teams through the transition from Tier 1 to more targeted Tier 2 or Tier 3 intervention when needed.
Why Therapy in Tier 1 of the MTSS matters
Building sustainable Tier 1 systems often starts with small, practical steps – creating collaborative relationships, protecting time for consultation, using simple data collection systems, and embedding supports naturally into classroom routines.
Therapy in Tier 1 of the MTSS is not about doing everything perfectly all at once. It is about creating consistent, meaningful supports that improve access and participation for students across the school environment.
As more schools move toward collaborative MTSS models, therapists have an important opportunity to help shape classrooms that are more proactive, inclusive, and supportive for all learners.
Need a clearer understanding of what Therapy in Tier 1 of the MTSS actually looks like? Click here for Part 1, where we explore what Tier 1 is and what it is not.
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/