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This paper presents findings from a two-phase study of state-level variability in policies and supports for district implementation of MTSS. Of particular interest is the way states position MTSS in relationship to all children, including those with significant cognitive disabilities. The first phase of the study involved narrative analysis of MTSS material on state education agency (SEA) websites. It resulted in the identification of 33 states with potential to support an inclusive version of MTSS. The second phase involved interviews with officials from 19 of the 33 states, that is, all the states willing to participate. Findings from coding and thematic analysis of data revealed a continuum of engagement with MTSS and with inclusive approaches to its conception and implementation. Whereas the phrase, “all means all” was repeated across all the states, its realization in practice varied considerably across states signaling empty rhetoric in some and deep commitment in others.