Tiers to Communication Success How can SLPs join in the MTSS framework many schools are adopting to catch students’ special education needs earlier and provide levels of intervention? Features
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Features  |   August 01, 2018
Tiers to Communication Success
Author Notes
  • Lesley Sylvan, EdD, CCC-SLP, is an assistant professor in the Department of Communication Sciences & Disorders at Montclair State University in Montclair, New Jersey. She has provided speech-language services in New York City and San Francisco public school districts and is an affiliate of ASHA Special Interest Group 16, School-Based Issues. sylvanl@montclair.edu
    Lesley Sylvan, EdD, CCC-SLP, is an assistant professor in the Department of Communication Sciences & Disorders at Montclair State University in Montclair, New Jersey. She has provided speech-language services in New York City and San Francisco public school districts and is an affiliate of ASHA Special Interest Group 16, School-Based Issues. sylvanl@montclair.edu×
  • Erica Cappellini, MS, CCC-SLP, of Centennial School of Lehigh University, also contributed to this article. erc211@lehigh.edu
    Erica Cappellini, MS, CCC-SLP, of Centennial School of Lehigh University, also contributed to this article. erc211@lehigh.edu×
Article Information
School-Based Settings / Features
Features   |   August 01, 2018
Tiers to Communication Success
The ASHA Leader, August 2018, Vol. 23, 44-53. doi:10.1044/leader.FTR1.23082018.44
The ASHA Leader, August 2018, Vol. 23, 44-53. doi:10.1044/leader.FTR1.23082018.44
It’s a typical work day, and Erica Cappellini sits among a group of students during a teacher-planned cooperative learning activity. As students share their ideas, the speech-language pathologist notices a student (not on her caseload) struggling to express his thoughts coherently. Cappellini asks the teacher if she has noticed the same issue, and she has. They quickly schedule a time to further discuss the extent of the student’s issues, the effects on his education, and some strategies that the teacher could use to help. Only if the student does not respond to Cappellini’s suggested interventions after a set timeframe will he be considered for the special education speech-evaluation process.
This example illustrates the workings of the multi-tiered system of supports (MTSS) framework that Cappellini uses at Centennial School of Lehigh University, a private school in Pennsylvania that serves students (ages 6–21) with severe emotional/behavioral disorders. MTSS allots support services based on students’ specific needs—and how they respond to collaborative interventions—rather than using only the special education evaluation process to determine services.
The MTSS approach has gained steam across all sectors of the U.S. education system, propelled by such federal policies as the Every Student Succeeds Act (ESSA) and the Individuals With Disabilities Education Act (IDEA). As part of the school system, some SLPs may be more involved in MTSS than others. Although high caseloads are sometimes cited as limiting SLPs’ participation in MTSS, some large, urban school districts with limited resources are using the approach in creative ways to assist with those caseloads.
The model’s adaptability in giving students the services they need—as efficiently as possible—is what many educators embrace about it. In ASHA’s 2016 Schools Survey, only 27 percent of school-based SLPs said they did not have a role in MTSS, response-to-intervention (RTI) and/or pre-referral services.
Before MTSS, students had two options: either receive direct speech-language services through special education or access no SLP support at all. With MTSS, struggling students have the chance to receive increased support in speech and language, as well as in other areas such as academics and behavioral/social-emotional realms.
Depending on setting and caseload, SLPs may participate in MTSS in myriad ways, including speech-language screenings, articulation support and social-communication instruction. Of course, SLPs may also face obstacles to implementing MTSS. Some of these could include gaining administrative and parental support to use MTSS to address speech sound disorders and finding time to work at additional tiers while managing an already-full caseload. Arranging mutually convenient times for collaboration with other educators can also be difficult.
Nevertheless, Cappellini and some other SLPs are finding ways to surmount challenges and use MTSS for speech services at their schools. We’ll take a closer look at how she and two others are doing this after clarifying some key concepts.

MTSS’ adaptability in giving students the services they need—as efficiently as possible—is what many educators embrace about it.

How MTSS works
The central element of MTSS is giving students increasingly intense levels of intervention and support, as needed, to be successful. Think of the model as a triangle, with Tier 1 services on the bottom (targeting all students) and Tier 3 services on the top (most individualized). The originator of this triangle of support concept is University of Oregon special education professor Hill Walker, who sought to shift educators’ focus from remediation to prevention.
Tier 1 generally involves instruction or prevention at the whole-class level, with all students receiving research-based instruction. Teachers and specialists monitor how students respond and determine which students are still struggling. Those flagged as struggling may need Tier 2 services, usually involving small-group interventions or more formalized consultation. Students unresponsive to Tier 2 support then would receive services at the Tier 3 level, which provides intensive, individualized support.
It can be confusing to differentiate MTSS from response to intervention (RTI). Yet another acronym in the mix is positive behavioral interventions and supports (PBIS). Though all are associated with meeting student needs through multiple tiers, these terms are not synonymous. Here are the differences:
  • RTI. This concept involves looking at data on how students respond to interventions. School teams use the data to make eligibility and service-delivery decisions to ensure students are successful, even if that means moving up tiers.

  • PBIS. This multi-tiered framework seeks to address behavioral challenges by proactively creating a safe school climate and integrating policies that encourage prosocial behaviors. It also establishes strategies for effective classroom management, with more individualized behavioral interventions as needed.

  • MTSS. This larger-encompassing framework includes RTI for determining services and could include PBIS or any other multiple-level intervention system.

Before MTSS, students had two options: either receive direct speech-language services through special education or access no SLP support at all.

Evidence supporting MTSS
Substantial research in the field of special education reveals benefits of providing multiple tiers of support to students in the areas of literacy and behavior, among others. On a small scale, many trained educators incorporate scaffolded teaching into their lessons, providing enough background information and support for their students to learn. Additionally, a 2005 study by University of Minnesota educational psychology researchers Matthew Burns and James Ysseldyke investigated four large-scale, multi-tiered models and found an association with improved student learning outcomes and fewer students classified for special education.
Research shows that many students respond positively to embedded or short-term support without necessarily being labeled as disabled. For example, although 18 percent of children experience early reading difficulties, multiple studies on multi-tiered intervention models show that most students respond to short-term interventions such as supplemental reading instruction (including a 2003 study led by University of Washington educational psychology researcher Virginia Berninger and published in Language, Speech, and Hearing Services in Schools).
Only a small percent—2 to 5 percent of students, depending on the study—are not successful at that level of support and truly require ongoing specialized services, such as those provided under an IEP.
In addition, the most recent iteration of IDEA allots up to 15 percent of special education funds to provide prevention-oriented (Tier 1 or Tier 2) services for students with academic and/or behavioral difficulties, demonstrating faith in the effectiveness of providing support through a tiered framework. MTSS is also consistent with the IDEA stipulation that children receive special education services in the least restrictive environment (LRE). The idea of LRE is that students be educated with typical peers, following the general education curriculum to the greatest extent possible.
Meanwhile, ESSA, the federal policy governing general education, cites MTSS as a way to support student achievement and teacher effectiveness. It allots funding that states can use for professional development regarding this framework.

SLPs may participate in MTSS in myriad ways, including speech-language screenings, articulation support and social-communication instruction.

MTSS in action
So how are SLPs involved with MTSS? Their involvement in all activities outside the traditional caseload varies greatly. Conducting screenings was the most common MTSS-related activity SLPs reported (60 percent of them) in ASHA’s 2016 Schools Survey. Similarly, a high proportion reported providing consultation as a member of a pre-referral team and collaborating with classroom teachers (55 percent for each activity).
Also notable: SLPs indicated spending an average of only one hour a week on MTSS-consistent activities. This single hour pales in comparison to the 19 hours they reported spending on pull-out services for direct intervention. The limited amount of time typically spent on MTSS indicates that although SLPs value services at lower levels of MTSS, most speech-language services are still provided at the Tier 3 level. It could also speak to the efficiency of meeting needs at lower tiers.
Here, we take a closer look at how three SLPs incorporate MTSS into their various school settings.
Kimberly Barnes
Where: Suburban elementary school, Emmaus, Pennsylvania
What: MTSS focused on language and literacy
Barnes’ school district has adopted extensive RTI/MTSS procedures for academic interventions, but not for speech-language treatment. However, Barnes realizes that she does use MTSS elements in her practice. First, she participates in universal speech-language screenings for entering kindergarten students, corresponding to MTSS Tier 1 services. Barnes also gives the students’ parents information about typical speech and language development and activities to foster language growth. She further assesses students flagged for potential communication needs.
Interventions corresponding to Tier 2 involve a formal speech-language screening initiated by the classroom teacher, instructional support staff, school psychologist or parent. It may include observation of the student in the classroom, consultation with the classroom teacher, strategies for the classroom teacher to try, and/or information sent home to the parent. Depending on the concern, Barnes may schedule a follow-up screening to see if strategies have effectively improved student performance (per RTI). She may also recommend a follow-up formal screening if she determines a child’s errors are not developmentally appropriate.
Barnes spends most of her time providing direct, intensive, individualized support to students with IEPs, corresponding to MTSS Tier 3. Barnes says a heightened focus on MTSS for speech-language in her district would benefit students. “I like the idea of intervening early and providing small-group interventions using research-based interventions before initiating the multidisciplinary evaluation and placing the child in special education,” says Barnes.
Francine DeMarco
Where: Urban elementary school, San Francisco
What: MTSS focused on articulation
DeMarco devotes most of her time to alternative and augmentative communication for students with moderate to severe language disorders, which limits her participation in MTSS. However, she does apply a tiered approach when working with students on articulation goals. As part of her regular caseload, she serves students with severe articulation errors that clearly interfere with their academic progress (Tier 3), but she also works with students with single-sound errors outside of the special education process (Tiers 1 and 2).
DeMarco’s inspiration was the San Diego Unified School District (SDUSD), which provides a special speech class—outside the special education/IEP framework—to students with mild articulation errors. SLPs in the SDUSD noticed that students with mild articulation disorders made up a significant portion of their caseloads and often lingered on caseloads too long. In response to this concern, the district developed the “Speech Improvement Class”—a short-term intervention (one hour per week) to address articulation needs without designating students as having a disability.
Although DeMarco doesn’t follow the Speech Improvement Class model exactly, she does provide articulation therapy to students outside of the special education system. After receiving signed parent permission, she includes these “RTI” students in existing groups of two to four students who have IEPs with articulation goals. The approach allows her to address students’ needs without much paperwork. “Parents really appreciate the support and quick turnaround,” DeMarco says. If the situation changes and the student’s speech errors increasingly thwart educational performance, DeMarco may initiate additional assessment and special education referral.
Erica Cappellini
Where: Centennial School of Lehigh University, an approved private school for students with severe emotional/behavioral disorders, Bethlehem, Pennsylvania
What: MTSS focused on social communication
Centennial School students are placed at the school typically because they rely on their behaviors rather than appropriate words to communicate their wants and needs (for example, they may run out of classrooms, spit, scream, curse and/or flip desks rather than say that the work is too hard). As a result, all Centennial students can theoretically benefit from pragmatic/social communication support.
Instead of having all students on the official speech-language caseload, however, Cappellini meets their needs through a tiered model and related services. For Tier 1, Cappellini trains educators on speech-language topics, warning signs for underlying speech issues, and how to facilitate and cue more appropriate communication. She also participates in students’ classes (including social skills, lunch and recess) to see how they communicate in their natural environments and to encourage prosocial interactions schoolwide, intervening and modeling appropriate skills as needed.
Teachers and the SLP identify some students as needing more help and being at risk for all types of speech-language issues (for example, articulation, fluency, auditory comprehension, expressive language, specific and pervasive pragmatic deficits), indicating a need for Tier 2 services. At this tier, Cappellini collects additional data via teacher meetings and usually a quick one- to two-minute collaborative completion of an assessment tool she created. After learning of interventions already tried, Cappellini recommends additional strategies. She follows up with student observations and teacher check-ins to discuss intervention effects and the need for any additional support.
Tier 2 also includes consultation services for students who don’t have a true speech-language impairment but still require more support than other students. These students may have speech-language treatment listed as a related service in their IEPs. At the Tier 3 level, Cappellini provides the most intensive intervention to students with more specific or severe speech-language needs (approximately 40 percent of the students at this small, specialized school).
Cappellini actively applies the MTSS model to her services today, but this was not the case when she started at Centennial. With encouragement from Centennial’s administration, however, she evolved speech-language services there from an entirely pull-out (Tier 3) model to one that incorporates all tiers. Because of the strong link between communication and behavior, collaboration with teachers is essential to monitoring and facilitating social-language progress.
“Being more a part of the school and seeing students across different environments and tiers allows me to help more children, model interventions and cues, keep an eye out for subtly struggling students, and provide support any way I can,” Cappellini says. “It’s great for generalization, and it’s fun!”

Special education research reveals benefits of providing multiple tiers of support to students in literacy and behavior, among other areas.

Overcoming obstacles, reaping benefits
Although not all administrators, staff and parents will immediately jump to adopt a full MTSS-based speech approach (especially if Tier 3 caseloads are already high), Cappellini’s example shows it’s possible to transform school-based speech services. Clearly, MTSS implementation can look considerably different depending on the setting, and SLPs may need to educate colleagues and parents on how adapting the model could make sense in their respective districts.
SLPs can point out that, as daunting as some MTSS challenges may seem, research indicates that its benefits to students likely outweigh perceived obstacles. Some key MTSS benefits to SLPs include opportunities for increased collaboration, improved generalization and dissemination of strategies, a greater sense of community and purpose within the school, reduced labeling of students with speech-language impairments, and the ability to meet student needs more productively without associated special education paperwork.
How can you join the MTSS movement? The bottom line is to use whatever version of MTSS works most efficiently and effectively in your district. Matching communication needs with appropriate levels of support will help students succeed, a hallmark of a truly successful SLP.
MTSS Lingo Cheat Sheet

MTSS=Multi-tiered system of supports.

RTI=Response to intervention; looking at how students respond to interventions and the need to move up or down the system; sometimes used to refer to academic MTSS.

PBIS=Positive behavioral interventions and supports; MTSS aimed at prevention of behavior issues.

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August 2018
Volume 23, Issue 8