Aug 15 / Guest blogger and occupational therapy student, Kristine Avendano, OTA, OTD-S

How OT Fits into MTSS: A Practical Guide for Schools

Welcome to guest blogger and occupational therapist Dr. Moira P. Bushell, OTD, MEd, OTR/L, BCP, FAOTA


As a school-based occupational therapy (OT) practitioner, my career has always been rooted in the education system. Coming from a family of educators, I knew I wanted to work in schools — but I also wanted to serve students in a different way. Occupational therapy gave me that opportunity and over the years, I’ve worked across high school, middle school, elementary, self-contained, general education, and private therapeutic placements.

One of the biggest shifts in my career has been watching schools move from RTI (Response to Intervention) to MTSS (Multi-Tiered System of Supports). RTI focused mostly on academics. MTSS still includes that, but it’s bigger — it’s about looking at the whole child: academics, behavior, and social-emotional skills all which impact participation.

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Once you have read this blog you will learn:
  • The three tiers of a Multi-Tiered System of Supports (MTSS) and how they differ from RTI.
  • The unique role occupational therapy can play within the MTSS framework.
  • Practical ways to build relationships, use data, and expand your role on the MTSS team.

The MTSS Triangle (and Why It Matters)


Think of MTSS as a triangle:

Tier 1 – Universal supports for most students. This is where UDL (Universal Design for Learning) shines — creating environments and lessons that work for almost everyone.

Tier 2 – Targeted, small-group supports for specific skills. Still in the general education classroom when possible.

Tier 3 – Intensive, often individual support for students with significant needs. Higher frequency and intensity, that sometimes occurs outside the classroom — but not necessarily special education.
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Getting a Seat at the Table and Where OT Fits In

Sometimes, OTPs have to invite themselves into MTSS conversations. Build relationships. Offer quick wins. Show how your perspective can help the whole team. The more you connect MTSS to what teachers need right now, the faster you’ll get buy-in.

The Data Piece (and Boundaries)

In MTSS, we’re team members first — not providing individualized, “skilled OT” unless a full evaluation is done. That means using data from the team to guide interventions, and being clear with families about what MTSS support is (and isn’t).

Bottom Line

MTSS works best when it’s truly a team effort — and OT’s whole-child perspective is a huge asset. Start with one need you can meet, build relationships, and you’ll find your role in the process grows naturally. MTSS teams need us and we need to be ready to serve.
Author Bio
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Dr. Moira P. Bushell, OTD, MEd, OTR/L, BCP, FAOTAAOTA Board Certification in Pediatrics Certified Reinvention Associate AOTA Volunteer Leadership Development Committee Chairperson

Dr. Moira P. Bushell has made a profound and lasting impact on school-based occupational therapy through over a decade of dedicated clinical practice and influential leadership. She has served in key roles on both state and national committees focused on advancing best practices in school-based OT. Her areas of focus include education law, Multi-Tiered Systems of Support (MTSS), and developing school leadership among occupational therapy practitioners. Dr. Bushell is also the founder of Growth Greenhouse, a company dedicated to providing continuing education, mentorship, and family advocacy to support thriving school communities. A recognized expert in systems change, advocacy, and leadership development, she led the transformation of AOTA’s volunteer nomination process to align with strategic goals and promote inclusive, equity-driven governance. Her unwavering commitment to diversity, inclusion, and student-centered practice has empowered thousands of practitioners and improved outcomes for students nationwide. She was recognized in 2025 by the American Occupational Therapy Association with the Recognition of Achievement Award and the Roster of Fellows. Her work continues to elevate the profession and strengthen the communities she serves. 
check out Moira's upcoming webinar
Leveling Up School Success: OT’s Role in Multi-Tiered Systems of Support
Tuesday, August 19,  2025
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