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Purpose
Purpose
This module is an introduction to the second tier of the three-tiered school mental health approach. The module will cover who falls in tier 2 and as well as how to start identifying kids who would benefit from tier 2 intervention.
Retrieved from: TOT 2: Moving to Tier 2 (2019)
What’s the difference between Tier 1 and Tier 2?
What’s the difference between Tier 1 and Tier 2?
Tier 1 services and supports are designed to meet the needs of ALL of students. These are the supports and services that, generally speaking, apply to the entire student body. Examples of Tier 1 supports include many of the programs and initiatives that you learned about in the last course, such as anti-bullying campaigns, character counts programs, and inclusivity initiatives.
For our purposes, Tier 2 supports are designed for students who are at risk of social, emotional, or behavioral concerns. In reality, Tier 2 supports are also provided under Response to Intervention (RtI) frameworks for students at risk for learning or academic concerns.
When we look back at the multi-tiered levels of support triangle (below), we see that the overwhelming majority of students should have their needs met through Tier 1 endeavors. In theory, only about 15% of the students in any given school would require the next level of support, or Tier 2 services. Even fewer students should need Tier 3 supports.
Anderson & Borgmeier (2010) in the article Tier II Interventions within the Framework of School-Wide Positive Behavior Support: Essential Features for Design, Implementation, and maintenance provide an overview of how schools can successfully implement a Tier II program. According to the authors the effort, by the team, to develop a program with clear guidelines, determining how to identify kids who need services, how to implement evidence based practices and how to determine when to fade kids out of services will assure the fidelity needed to ensure success of the program. Take time to read through this article before moving on to the discussion of school wide screening for Tier II as it will inform your thoughts.
Retrieved from: TOT 2: Moving to Tier 2 (2019)
Tier 2: Screenings
Tier 2: Screenings
Based on each school’s policies and procedures, students can be identified as in need of Tier 2 mental health supports and services in several ways. The two most common mechanisms are 1) identification through class-wide screenings and 2) referral by administrator, teacher (or other educators) or parent.
For more information about identification through class-wide screenings, refer to the following webpage from RTI Network: http://www.rtinetwork.org/learn/research/universal-screening-within-a-rti-model
Although it seems logical that schools would screen and identify kids through universal screening, anyone who has worked in a school knows that once kids are identified as needing additional help they are treated differently, by teachers, administrators, and other kids. We touched on the challenges of school-wide screening in TOT 1. The Anderson & Borgmeier article offers another option for school-wide screening that might address some of the challenges.
Retrieved from: TOT 2: Moving to Tier 2 (2019)
General Discussion Post:
General Discussion Post:
Use the information from the RTI Network article on Universal Screening and the Anderson & Borgmeier article as a guide to your answers. How can the school mental health teams mitigate the risk of children feeling abnormal or being labeled by peers as abnormal when schools implement school-wide screening and programs for Tier 2 needs? Could there be a school-wide education program that might make getting additional help an “okay” option for kids, and for parents? Could this be tied to the Tier one programs?
I think students would be more susceptible to receiving tier-II help if the schools could find a way to decrease the stigma behind mental health. There are fewer stigmas about students who need to leave class in order to receive speech therapy or learning help compared to students who are leaving class for mental health purposes. Within the school context, I think the most important thing is that the students are aware of the issues because rumors are more likely to be spread when there is a lack of information. The Response-to-Intervention (RTI) model looks at universal screenings and suggests that screenings should be quick and short. They are looking for students who are lagging behind their peers. I don’t necessarily believe this is the best way to approach mental health. There are some kids who just do not like or succeed at school. The fact that their falling behind might be contributing to something else. I think that the screening process need to be more in depth and focus more on questions that looks at reasons behind the lack of effort put into school and if it is a cognitive issue, a mental health issue, or just a lack of interest in sitting in a classroom all day. There has to be a better way to approach the screening process and help identify the students who would benefit from the tier II programs that the schools offer.
Assignment:
Assignment:
After reviewing the Tier 2 responsibilities write up a job description for an OT practitioner that is specific to working on a multi-tiered system of support problem solving team to address the mental health needs of students.
In your description include: What is the scope of work that the OT would do? Include key job responsibilities. What are the key qualities and attributes such a practitioner should possess? What specific knowledge and skills should such an individual possess? Here are some sample job descriptions for you to review and potentially use a model. Try to keep your job description down to 1-2 pages.
https://resources.workable.com/occupational-therapist-job-description
Occupational Therapy Job Description
Overview:
Occupational Therapy (OT) is a career that looks beyond the medical diagnosis and dives deep into the individual’s motivation do participate in everyday occupations by using skills and techniques that focus on body mechanics, sensory integration, and occupations to better the mental and physical capabilities of the individual. The occupational therapist examines all types of possible issues that may arise when dealing with a pre-existing or newly acquired diagnosis.
Job Description:
The occupational therapist will administer a three-tiered program to student within the school system and use a screening mechanism to observe, find, and treat student’s that are susceptible to any type of mental health condition. The occupational therapist will utilize school-wide (tier I) prevention programs that can target the greater school population, as well as find educational and evaluative methods to incorporate individualized treatment plans and strategies to improve the lives of the students who need further services (tier II and tier III).
Responsibilities:
The occupational therapist is responsible for administering assessments that evaluate the level of functional mobility and cognitive function that is required in order to participate in everyday activities. The OT is responsible for observing, evaluating, and treating individuals with many types of impairments that are impacting a person’s ability to perform tasks within their everyday lives.
Key Qualities of an Occupational Therapist:
Occupational therapists demonstrate compassion, empathy, and understanding towards their clients and the caregivers of their clients. Occupational therapists are open-minded, kind, and passionate about their clients and their ability to help others. They need to be observant, trusting, and approachable by exhibiting a plethora of knowledge within the field and be able to incorporate client-centered evidence-based practice into their sessions. The OT should be able to remain on task, complete assessments within the required time frames, and interpret the results and educate the client’s and their caregivers on the important information.
General Discussion Post:
General Discussion Post:
Reply to the introduction post and answer the questions posed above.
After reading through the reports, the students I believe that would most benefit from the involvement of OT on their problem-solving team would be students with Attention-deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD). I think that student who these two diagnoses would benefit the most is because the students appear to have issues remaining on task and focusing on the activity they are assigned to complete. Some of the students are distracting to others, while some just get up and wander around the room or lose focus on what they are supposed to be doing. Looking at the intervention plans that have been written up, I as an OT with an OT lens would look for ways to motivate the child rather than avoid a behavior. Avoiding a behavior works sometimes, however, sometime children act out in order to gain the attention of an adult. Avoiding behaviors can lead to more serious disruptions and can in fact cause more issues later on. I would observe and learn more about the student to understand what the student likes and find ways to interact with the student and aim to focus on his or her positive attributes and slowly integrate strategies in that would benefit their concertation and focus by incorporating the activities they enjoy to see if it truly is an attention issue or just a lack on interest on a topic. Using my OT lens, I would want to assess the child within their contextual environment before I began my intervention plan. I do believe a lot of the intervention strategies that were recommended are valid and very useful strategies, but it would be on a case by case decision after assessing the child.
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