Tiered Models: A Dental Analogy

I often hear people confuse Tier 3 of a tiered support model exclusively as “direct services” to students with disabilities. As educators, we often put students into buckets. I want to offer an alternative narrative, one that best aligns to the true nature of a multi-tiered system of supports. In this version of the framework, we must understand that:

  • some students, irregardless of disability, may need support across multiple tiers at different times during their educational journey, 
  • not all students who are identified as having a disability are “tier 3 students”, 
  • tier 2 is not simply a placeholder that occurs before students are moved to tier 3, and 
  • ALL students are “tier one students”.

To understand the fluid nature of a tiered support model, I share a simple analogy that most of us can relate to. Let’s consider dental care and think about the following two “profiles” of students/dental patients. In the first student profile, you will see that a student without a defined disability may benefit from support at all three tiers. In addition, you are offered a student profile where additional tiered support does not preclude a child from receiving strong, authentic tier one or tier two support.

Profile 1: Child born with little to no indication of dental concerns.

  • This child attend regular check ups and cleanings. This may be done by a dental assistant or dentist. Occasionally, the child needs to have cavity filled by a dentist. At one point in their life, they may need braces through an Orthodontist.  Through an accident, they may need to work with a surgeon. At points in their life, this child may need to receive support from all three tiers.

Profile 2: A child born with a cleft lip/palate.

  • A child with a cleft lip/palate requires the same regular preventive and restorative care as the child without a cleft. However, since children with clefts may have special problems related to missing, malformed, or malpositioned teeth, they require early evaluation by a dentist who is familiar with the needs of the child with a cleft. In addition, they may need to see an Orthodontist since their upper teeth do not fit together (occlude) properly with the lower teeth. The orthodontist may suggest an early period of treatment to correct the relationship of the upper jaw to the lower jaw. Coordination between a surgeon and the orthodontist becomes most important in the management of the bony defect in the upper jaw that may result from the cleft. Reconstruction of the cleft defect may be accomplished with a bone graft performed by the surgeon. The orthodontist may place an appliance on the teeth of the upper jaw to prepare for the bone graft & a retainer is usually placed after the bone graft until full braces are applied.


As evidenced by this analogy, we see how students can receive the support they need across multiple tiers without needing to be “identified” and just by a child having a disability diagnosis, they are not automatically placed into “tier 3 supports” without access to high quality tier one models.  

I invite the readers of this blog to consider the implications of the current version of tiered supports in their schools. In existing systems, are there barriers to students receiving tier 3 supports as a product of a process needed for “identification”? Take the case of a student who may need individual counseling support, not as a product of a social/emotional disability, but because of circumstances happening in their home (a difficult divorce for example). Do we offer those services or limit them to students who have been “tested”? How about students missing out on essential tier one instruction as a product of pull out services to receive tier two or tier three support?  What are the implication of this practice? These kinds of circumstances often exist as a product of our placing students in aforementioned buckets and providing resources accordingly. If this is the case in your school, if there are systems in place that create walls to students receiving the services they need, what can you as an educator do to affect change?

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