Join Group

FIRST: Course, KIT and FAQs

The FIRST Course, FIRST KIT, and FAQs provide speech-language pathologists, occupational therapists, and physiotherapists with evidence-based information and tools to support the implementation of a needs-based, tiered model of service in schools.

How to Obtain Positive Outcomes when Using Tiered Models of School Based Rehabilitation Services

teaacher in classroomTiered models of school-based rehabilitation services offer an innovative approach to advancing the United Nations’ global mandate of inclusion and participation of children and youth with diverse needs.

A recently published open access realist review in the International Journal of Disability, Development and Education1 described a qualitative analysis of 52 peer-reviewed papers that determined: What are the outcomes of successful tiered approaches to rehabilitation services for children and youth in education settings, in what circumstances do these services best occur, and how and why?

Results indicated that tiered models led to positive student, family, therapist, and system outcomes. For example, tiered models facilitated children and youth’s skill development, achievement of academic and rehabilitation goals, increased participation and sense of inclusion. Families and therapists also were able to gain knowledge and skills as well as increased confidence applying these skills in other contexts. Additionally, families and professionals developed greater insight and appreciation of each others’ roles. System outcomes included earlier and more timely intervention irrespective of formal identification of student need, resource efficiencies, and advancement of knowledge and resources regarding tiered approaches and curriculum development.

To attain positive outcomes, tiered models must support interprofessional collaboration, capacity building, and be authentic, which means that services are provided in familiar or typical settings, with activities relevant to the child’s curriculum. Many environmental conditions help support successful delivery of tiered services, including adequate time, funding, and material support for therapists to deliver services collaboratively and consistently across all three tiers within a workload orientation. These findings advance understanding of the essential components of successful school-based tiered models and can be used to inform practice.

If you have not done so already, take a moment to explore our latest resources including the FIRST Knowledge Implementation Toolkit (FIRST KIT) and 25 Frequently Asked Questions and Responses about Tiered Services (FIRST FAQs).

The FIRST KIT and FAQs will provide you with:

  • downloadable, printable resources that can be shared with families and educators to explain the outcomes of tiered services and how those can be achieved.
  • examples of classroom-based activities that can be used at each tier to support children’s participation.
  • strategies to guide implementation and to help OTs, PTs, and SLPs to manage their workload in a tiered model.

1 VanderKaay, S., Dix, L., Rivard, L., Missiuna, C., Ng, S., Pollock, N., Sahagian Whalen, S., Eisen, I., Kyte, C., Phoenix, M., Bennett, S., Specht, J., Kennedy, J., McCauley, D., & Campbell, W. (2021). Tiered approaches to rehabilitation services in education settings: Towards developing an explanatory program theory. International Journal of Disability, Development and Education. doi: