RtI Forms

Fidelity The following are procedures which may be used to assess the integrity or fidelity of an intervention (Lane &
Beebe-Frankenberger, 2004): Direct Observation Direct observations are conducted by a trained observer who watches the intervention in the classroom or watches a video of the intervention and then codes behavior. Direct observation is a three step process. First, the tasks of the intervention are analyzed. Next, the observer records the parts of the task analysis which are completed. Finally, the level of integrity is computed. Percentage (%) = number of parts present divided by total number of components times 100 Behavior Rating Scales In this method the entire intervention is observed. A checklist using a likert scale can provide ratings of low to high integrity. Self-Report This is an indirect method in which the teacher can rate the degree of implementation based on a series of questions tied to a likert scale. Permanent Products In this procedure, components of the intervention are saved. For example, notes of a meeting, target behaviors defined, note cards created, weekly report notes, point system, lists of reinforcers, and collected reports. These products illustrate steps of the intervention of a home-school report card. Manualized or scripted interventions In this approach there are step by step directions which can be used by the interventionist. The manuals or scripts can also be used. It is recommended that this approach be combined with direct observation. Interview Post Intervention the teacher or interventionist is interviewed using a series of questions which will suggest whether the intervention was implemented as planned.
OBSERVATION FIDELITY CHECKLIST

Date ________________ Teacher Observer ________________________________ _________________________
Most of the Time 3 Some of the Time 2 Rarely 1 Not at all 0
_______________________ Resources Teacher Behavior
Intervention (specify)
Teacher follows script/directions sufficiently to ensure fidelity of implementation. Teacher implements each step of the intervention to ensure fidelity of implementation. Instruction (Script/Materials) Teacher maintains brisk pace. Teacher provides corrective feedback immediately as needed. Teacher talk is kept to a minimum and is characterized with short requests What answer? How many?
Adapted from Shores, C. and Chester, K. (2007). Improving Schools Through Instructional Pyramids: Utilizing Response to Intervention to Raise Student Achievement. Cartersville, GA: Wesley Educational Services. 2
Self Report Integrity Check

Date________________________ Teacher____________________________________
Intervention:__________________________________________________________________________ Directions: Please complete this form each day after the period in which the intervention has been implemented in your classroom. Strongly Disagree 1 1. 2. 3. 4. 5. Agree 5 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
I described the intervention. I showed the rewards which the child could earn. I described consequences for inappropriate behaviors. I rewarded the child each time the behavior occurred. I delivered the consequence each time the inappropriate behavior occurred. 6. I reviewed daily performance and sent DRC home. 7. 8. 9. 10. 11. I described the intervention. I showed the rewards which the child could earn. I described consequences for inappropriate behaviors. I rewarded the child each time the behavior occurred. I delivered the consequence each time the inappropriate behavior occurred. 12. I reviewed daily performance and sent DRC home. 13. 14. 15. 16. 17. I described the intervention. I showed the rewards which the child could earn. I described consequences for inappropriate behaviors. I rewarded the child each time the behavior occurred. I delivered the consequence each time the inappropriate behavior occurred. 18. I reviewed daily performance and sent DRC home. 19. 20. 21. 22. 23. I described the intervention. I showed the rewards which the child could earn. I described consequences for inappropriate behaviors. I rewarded the child each time the behavior occurred. I delivered the consequence each time the inappropriate behavior occurred. 24. I reviewed daily performance and sent DRC home. 25. 26. 27. 28. 29. I described the intervention. I showed the rewards which the child could earn. I described consequences for inappropriate behaviors. I rewarded the child each time the behavior occurred. I delivered the consequence each time the inappropriate behavior occurred. 30. I reviewed daily performance and sent DRC home.
___________________________________________________________________________________________
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
___________________________________________________________________________________________
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
___________________________________________________________________________________________
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
___________________________________________________________________________________________
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
___________________________________________________________________________________________
RIOT Matrix Best practices for conducting problem solving are to use multiple methods of assessment, assessment across multiple domains, and multiple sources of information. The RIOT Matrix identifies the common procedures used to assess a problem. It is ideal to first review the information that is currently available before additional time is allotted to collecting more data (Hosp, 2006; Christ, 2008). Often, relevant data may already be present. Next, one should interview individuals who have relevant knowledge of the student including his/her skills, abilities, and behavior. It may also be helpful to interview the student. Observations are then conducted in the situations in which the difficulties are most and least likely to occur (Christ, 2008). Conditions should not be altered for the observation. Finally, tests should be used to gather specific types of information which can not be obtained through other means. Christ (2008) states that Tests are a form of observation, but with rules to evaluate correctness or quality. Beyond the basic characteristics which define the learner, there are other factors, or sources, which might impact a students performance. These sources include instruction, curriculum, environment and learner (ICEL; Heartland Area Education Agency 11, 2006).
Review Permanent products of students work, records of prior strategies and their effects, lesson Interview Teachers, parents, paraprofessionals, administrators, and peers to describe experiences and perceptions of pace, opportunities to respond, engagement, contingencies, and activities Teachers, parents, paraprofessionals, administrators, and peers to describe content organization, difficulty and level Teachers, parents, paraprofessionals, administrators, and peers to describe organization, rules, and set up Observe When and where the problem is most likely and least likely to occur Test Systematic manipulations of procedures that include opportunities to respond, repeated practice, durations, contingencies, or activities Systematic manipulations of difficulty, stimulus presentation, interspersed materials, and content Systematic manipulation of praise, contingencies, escape, work completion, criteria for success and failure, seating, and distractions
Instruction
Curriculum
Books, worksheets, software, scope, and sequence
When and where the problem is most likely and least likely to occur When and where the problem is most likely and least likely to occur
Environment
Seating charts, rules, school layout
Learner
Educational records, health records, prior tests and reports
Teachers, parents, paraprofessionals, administrators, and peers to describe observations and experiences with a specific student or group
When and where the problem is most likely and least likely to occur
Taken from: Christ, T.J. (2008). Best Practices in problem analysis. In A. Thomas & J. Grimes (Eds.) Best Practices in school psychology-V (pp.159-176).
Problem-Solving Assessment and Intervention Worksheet Student___________________________________ Grade_________ Teacher_______________ Date of Referral__________________ Date of Problem Analysis Meeting__________________ Collaborators ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
Step 1. Behavioral description of problem (including baseline data) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Step 2. Behavioral statement of desired goal or outcome ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Step 3. Analyze the problem by generating and testing hypotheses about why the behavior is occurring: _____________________________________ occurs because____________________________ (Problem Behavior) (Hypothesis) Step 4. Hypothesize a reason for the problem and brainstorm possible interventions. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Step 5. Evaluate alternatives and select intervention. Step 6. Clarify the intervention and develop action plan, goal, monitoring procedure, and review date. By ___________________, the student will ______________________________________ (Review Date) (Behavioral Goal) 6
as demonstrated by _____________________________________________________________ (Monitoring Procedure) As a result of this intervention:_____________________________________________________ (What and how much) to be implemented by ________________________________, ___________________________ (Who) (When) and insured by__________________________________________________________________ (Treatment integrity procedure) Step 7. Implement the intervention and provide for long term carryover as necessary. Step 8. Evaluate the effectiveness of the intervention, compare results to baseline or target goal, and continue or revise plan as necessary. Summary of Intervention Effectiveness (Attached graphed data comparing results to baseline and target goal) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
From: Telzrow, C.F. (1985). Best Practices in facilitating intervention adherence. In A. Thomas & J. Grimes (Eds.), Best Practices in School Psychology ( pp. 504-506) National Association of School Psychology: Washington, D.C 7
Student Data Sheet

Student Name: __________________________ DOB: ___ /___ /____ Age: _____ Ethnicity/Sex: _________ School: _____________________________ Grade: ________ Retained: N / Y If Yes, when: _______ Referring Teacher: _________________________________________ Date: _____________ Georgia Criterion Referenced Competency Tests (CRCT): Date: Date: Reading English/LA Mathematics Science Social Studies Otis Lennon School Abilities Test: Date: __________ Total ______________ Verbal ______________ Nonverbal ______________ Current Grades: Reading/Language Arts ___________ Mathematics ___________ Benchmarks: Score Reading Math Writing State Writing Assessment: ______________ Attach any additional testing data available on the student Behavior: Attendance pattern: ___________ Date:
Cognitive Abilities Test (CogAT): Date: __________ Verbal ______________ Quantitative ______________ Nonverbal ______________ Composite ______________ Social Studies ___________ Science ___________ Health _____________ P.E./Music___________
Baseline Level Goal Date
Score
Current Level Goal Date
Assessment
Discipline referrals: ___________ Conduct Grade: _________ (attach) Medical history (significant health concerns, major childhood illness/disease, diagnosed syndrome, adaptive, motor, medication): ___________________________________________________________ ____________________________________________________________________________________ Previously Evaluated? Yes or No If yes, by: _______ school ________ private evaluator
Other agency contacts involved with the student: _________________________________________ Is the student currently receiving the following services? (check all that apply) Speech Special Education 504 Plan EIP Hearing and vision exam conducted this school year? 8 No Yes Date: __________
Pre-Referral Intervention Form

Student Name: _______________________________ School: _____________________________________ DOB: ___/___/____ Age: _______ Grade: ___________ Date: _______________
Referring Teacher: ___________________________________
Please list the interventions that you have used with this student and describe the outcomes. Attach all data collected during this process. Intervention (be specific) Person Responsible Start Date End Date Results
Dates of Parent Contact: Phone ______________________ Conference__________________ Letter/Note __________________
Team Meeting: Initial meeting held on: ______/______/______ Initial meeting held with: ______ Grade level team ______ Student Support Team/ RtI Team ______ Other: _______________________________________
Problem Identification Form

Student Name: __________________________ DOB: ___ /___ /____ School: _____________________________ Grade: ________ Age: _____ Ethnicity/Sex: _________ If Yes, when: _______ Retained: N / Y
Parent Name: _______________________________________________ Phone (h): __________________ Address: ___________________________________________________ Phone (w): __________________ Check the presenting problems, including what makes it difficult to teach this student and what factors may be impeding his/her learning. Reading Letter Identification Sounds/phonics Comprehension Fluency Math Basic facts Time/Money Regrouping Geometry Decimals/Fractions Measurement Tables/graphs Word Problems Multi-step Written Language Sentence structure Vocabulary Organization Spelling Punctuation Grammar Oral Language Oral expression Peer communication Adult communication Following directions
Learning Behaviors Working in a group Working independently Distractibility/Hyperactivity Impulsivity Organization skills Lack of persistence Problem solving skills Adaptive Skills Socially immature Immature language Delayed self-help skills
Processing Fine motor skills Gross motor skills/clumsiness Reversals/transpositions Copying from board Copying from book/paper Right/Left confusion Visual memory Auditory memory Sequencing Handwriting
Social Peer relations Adult relations Emotional outbursts Withdrawal Lying/stealing/cheating Bullies others Low self-esteem Anxious Difficulties at home Unusual behaviors (specify): __________________________ __________________________
Other difficulty not listed above (please describe): _________________________________________________ __________________________________________________________________________________________ When is the problem most apparent? _______________________________________ Students strengths and interests: ______________________________________ ______________________________________ ______________________________________ When is the problem least apparent? ________________________________________
______________________________________ ______________________________________ ______________________________________ Date: ________________
Referring Teacher: ___________________________________________ 10
TIER 2: Interventions and Results

Student Name: ______________________________ Meeting # _____ Date: ____________
1. Intervention: ____________________________________________________________________________ GOAL: __________________________________________________________________________________ Days/Times to be implemented: _______________________________________________________________ Duration of Intervention: _____________________________________________________________________ Who will implement the intervention?________________________ monitor? ___________________________ How Progress Monitoring Data will be collected: __________________________________________________ Results: __________________________________________________________________________________________ __________________________________________________________________________________________ (Attach progress monitoring) 2. Intervention: ____________________________________________________________________________ GOAL: __________________________________________________________________________________ Days/Times to be implemented: _______________________________________________________________ Duration of Intervention: _____________________________________________________________________ Who will implement the intervention?________________________ monitor? ___________________________ How Progress Monitoring Data will be collected: __________________________________________________ Results: __________________________________________________________________________________________ __________________________________________________________________________________________ (Attach progress monitoring) 3. Intervention: ____________________________________________________________________________ GOAL: __________________________________________________________________________________ Days/Times to be implemented: _______________________________________________________________ Duration of Intervention: _____________________________________________________________________ Who will implement the intervention?________________________ monitor? ___________________________ How Progress Monitoring Data will be collected: __________________________________________________ Results: __________________________________________________________________________________________ __________________________________________________________________________________________ (Attach progress monitoring) 11
TIER 3: Interventions and Results

Student Name: ________________________________ Meeting # _________ Date: ____________
Intervention 1:__________________________________________________________________________ GOAL: _______________________________________________________________________________ Date goal should be achieved: ____/_____/_______ How will progress monitoring data be collected? _______________________________________________ How frequently will the student be monitored? _________________________________________________ Person(s) responsible for implementation? ______________________Monitoring?____________________
RESULTS:____________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ (Attach progress monitoring data) Should the goal be altered? If yes, how so: ____________________________________________________ If no, continue or develop new intervention
Intervention 2:__________________________________________________________________________ GOAL: _______________________________________________________________________________ Date goal should be achieved: ____/_____/_______ How will progress monitoring data be collected? _______________________________________________ How frequently will the student be monitored? _________________________________________________ Person(s) responsible for implementation? ______________________Monitoring?____________________ RESULTS:___________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ (Attach progress monitoring data) Should the goal be altered? If yes, how so:____________________________________________________ If no, continue or develop new intervention
12
Summary of Meeting
Student Name: ________________________________________ Meeting for: Tier 1 Tier 2 Tier 3 Date: _____________
Notes/Summary of meeting: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Meeting Decision(s): Follow-up Date: ________________ Problem resolved, exit Tier 2 Progress made but problem not resolved, remain at Tier 2 Additional data needed; remain at Tier 2 Additional data needed; move to Tier 3 Inadequate progress made, move to Tier 3 Adequate progress made, move to Tier 2 Progress made but problem not resolved, remain at Tier 3 Additional data needed; remain at Tier 3 Request screening Refer for a 504 Plan Inadequate progress; refer to Special Education The childs disability requires immediate consideration of special education. (requires psychologist) Specify reason: ______________________________________________________ Team members present: Name ______________________ ______________________ ______________________ ______________________
Title Name _________________ _____________________ __________________ _____________________ __________________ _____________________ __________________ _____________________
Title _________________ _________________ _________________ _________________
13
Supplemental Supportive Interventions

Student Name: ____________________________________ DOB: _____/_____/________
School: __________________________________________ Implementing Teacher: ______________________________
Grade: ____________ Date: ___________
Please list the additional strategies, accommodations, and modifications that you have used with this student and describe the outcomes. Intervention (be specific) Person Start Date Responsible End Date Results
14
Parent RtI/SST Meeting Notification Student: _______________________________ School: ________________________________ Dear Parent or Guardian, __________________________________ is to educate students to become lifelong learners and productive citizens, and our mission is to help your child become a successful student. At this time, your child is having difficulties, and a Response to Intervention team/Student Support Team meeting has been scheduled. The meeting will be conducted using a team approach to problem solving, and you are an important member of this team. At this meeting we will create home/school interventions that will help improve academic and behavioral outcomes. The members at this meeting may be a variety of educators and/or specialists, who may include teachers, administrators, the school psychologist, a speech pathologist, and other supportive staff. Please come and share your concerns and views with us. The meeting has been scheduled for ________________________ at _________________________________. If you cannot attend, please contact _______________________@____________________ before the meeting so that we can send you a copy of your childs intervention plan. Sincerely, ________________________ ----------------------------------------Detach and return to school---------------------------------Students name: ______________________________________ ___________________ Yes, I will be able to attend. ___________________ No, I will not be able to attend. Please reschedule my childs meeting for: ______________________________________ Date: __________________ Tier Level: ______________
Signed: ________________________________ (Parent or Legal Guardian)
Date:_________________
15
Data Teams Process & Forms 1. Data team meets and identifies bottom 10th- 25th percentile at each grade level. 2. Data team completes Data/RtI Team Referral form & Summary sheet. a. Group students according to skill area deficits. b. Identify intervention and progress monitoring tools to be used, set goals, and expected growth rates. c. Identify case manager and interventionist for each group of students. d. Principal will sign and accept responsibility for monitoring fidelity of intervention. e. Case manager takes to interventionist and has interventionist sign to acknowledge prescribed intervention and progress monitoring plan. f. Parents of all students' receiving Tier 2 interventions are notified. 3. At 4 weeks & 8 weeks, a Check Point meeting is held a. The team will gather progress monitoring data and determine if the intervention is being successful based on the expected growth rates identified previously. b. Team will complete the Tier 2 Progress Monitoring Check Point Data form for each intervention group identified. c. If No Progress is selected, change the specific student's intervention and document using the Tier 2 Intervention & Results sheets from the RtI Manual. 4. Data team will meet at 12 weeks to review the progress of all students and determine whether or not to continue or change interventions and/or move students to Tier 3. a. The Data/RtI team will identify any students requiring Tier 3 interventions and provide the facilitator with a list of students and all Tier 2 documentation. b. The facilitator will provide the appropriate teachers with RtI paperwork (Student Data Sheet, Pre-Referral Interventions and Problem Identification sheet) to be completed. c. Tier 3 meetings are to be held with the SST team (student's teacher, principal, parents, school psychologist, and any additional members requested) and continue as necessary. - Parents MUST be invited to all Tier 3 meetings and provided with written notice. - A written summary of the meeting and documentation of student progress must be sent home whether or not the parent/guardian attends the meeting. 5. Conduct Check Point meetings as required until results of Benchmark 2 or 3 are available. 6. Repeat process. 16
RtI/Data Team Referral Tier 2 Intervention & Documentation Subject: _____________________________________ Intervention Tool: Start-Up/Build-Up/Spiral-Up Voyager Destination Readers Theater SRA Soar to Success Harcourt Math mClass activities Navigator Phonological Awareness for Children Road to the Code Computer-based instruction Cover-Copy-Compare Writers Workshop Behavior Contract Token Economy/Contingency Plan Small Group Counseling Other: ____________________________ Start Date: _____________ Check Point Date 1: __________ Student Names 1. 2. 3. 4. 5. 6. Interventionist Name: ______________________________ Case Manager Name: ______________________________ Title: ___________________ Title: ___________________ Grade: __________
Progress Monitoring Tool: DIBELS: Measure _______________ mClass/AIMSweb: Measure____________ STAR Dolch Word List CBM Measures: _____________________ Daily Behavior Report Cards Office Discipline Referrals (SWIS) Behavior Charts (scatterplot, interval sampling, event recording, ABC) Other: _____________________________
End Date: _____________ Check Point Date 2: _____________ Teacher Baseline Score Goal Expected Growth Per Week
Validity Statement: I certify that the above noted intervention will be conducted as described for the group of students identified and letters of notification were sent to parents/guardians regarding the intervention plan. ____________________________________ ____________________________________ Principal Date Interventionist Date RtI/Data Team Referral 17
Tier 2 Intervention & Documentation Subject: _____________________________________ Intervention Tool: Passport Reading Journeys v-Math Destination Readers Theater SRA Soar to Success Holt Math Computer-based instruction Navigator Cover-Copy-Compare Writers Workshop Behavior Contract Token Economy/Contingency Plan Small Group Counseling Other: _____________________________ Start Date: _____________ Check Point Date 1: __________ Student Names 1. 2. 3. 4. 5. 6. Interventionist Name: ______________________________ Case Manager Name: ______________________________ Title: ___________________ Title: ___________________ Grade: __________
Progress Monitoring Tool: Passport Reading Journeys STAR AIMSweb: Measure __________________ v-Math CBM Measures: _____________________ Daily Behavior Report Cards Behavior Charts (scatterplot, interval sampling, event recording, ABC) Office Discipline Referrals (SWIS) Other: _____________________________
End Date: ____________ Check Point Date 2: _____________ Teacher Baseline Score Goal Expected Growth Per Week
Validity Statement: I certify that the above noted intervention will be conducted as described for the group of students identified and letters of notification were sent to parents/guardians regarding the intervention plan. ____________________________________ Principal Date ____________________________________ Interventionist Date
18
RtI/Data Team Referral Tier 2 Intervention & Documentation Subject: _____________________________________ Intervention Tool: Support Class/Study Skills Passport Reading Journeys Carnegie Learning Destination Computer-based instruction Navigator Cover-Copy-Compare Behavior Contract Token Economy/Contingency Plan Small Group Counseling Other: _____________________________ Start Date: _________ Check Point 1: __________ Group 1 Target Skill(s): Student Names 1. 2. 3. 4. 5. Group 2 Target Skill(s): Student Names 1. 2. 3. 4. 5. Group 3Target Skill(s): Student Names 1. 2. 3. 4. 5. Teacher Baseline Score
ChkPt 1 ChkPt 2
Grade: __________
Progress Monitoring Tool: Passport Reading Journeys AIMSweb: Measure __________________ STAR CBM Measures: _____________________ Daily Behavior Report Cards Behavior Charts (scatterplot, interval sampling, event recording, ABC) Office Discipline Referrals (SWIS) Other: _____________________________
Check Point 2: _________
End Date: _________
Teacher
Baseline Score
ChkPt 1
ChkPt 2
Goal
Teacher
Baseline Score
ChkPt 1
ChkPt 2
Goal
Goal
19
Group 4Target Skill(s): Student Names 1. 2. 3. 4. 5. Group 5Target Skill(s): Student Names 1. 2. 3. 4. 5. Group 6Target Skill(s): Student Names 1. 2. 3. 4. 5. Teacher Baseline Score
ChkPt 1 ChkPt 2
Teacher
Baseline Score
ChkPt 1
ChkPt 2
Goal
Teacher
Baseline Score
ChkPt 1
ChkPt 2
Goal
Goal
Interventionist Name: ______________________________ Case Manager Name: ______________________________
Title: ___________________ Title: ___________________
Validity Statement: I certify that the above noted intervention will be conducted as described for the group of students identified.
______________________________________________________ ______________________________________________________
RtI Facilitator/Administrator
Date
Interventionist
Date
20
Decision Points
The following decision points are to be used to determine movement of students between the Tiers of intervention. Decision points are based on the results of Universal Screeners conducted throughout the county. School norms are best to use. However, if they are not available county norms may be used. If the county norms have not yet been established (ex. STAR, AIMSweb), the national norms provided by the program may be used.
--------------------------------------------------------------------------------------Decision Point for Tier 2

Student: Is at or below 10th Percentile & Growth rate is less than expected Proceed to Tier 3 Achieves 25th percentile or above Exit Tier 2 Makes some progress and is above 10th percentile Continue Tier 2
---------------------------------------------------------------------------------------------------------------------
Decision Point for Tier 3

Student: Continues to be at or below 10th percentile & Growth rate less than expected Proceed to Tier 4 (evaluation requested) Student making progress and above 10th percentile Continue Tier 3 or Return to Tier 2 Student achieves 25th percentile Exit Tiers
21
Tier 2 Progress Monitoring

Check Point Data Intervention Start Date: ___________________ Grade: ___________ Student Intervention Tool: ________________________ PM Dates & Scores Baseline Score Progress/Decision Significant progress; Exit Intervention/Change Intervention Some progress; Continue Intervention No progress; Below 10th percentile; Change Intervention Significant progress; Exit Intervention/Change Intervention Some progress; Continue Intervention No progress; Below 10th percentile; Change Intervention Significant progress; Exit Intervention/Change Intervention Some progress; Continue Intervention No progress; Below 10th percentile; Change Intervention Significant progress; Exit Intervention/Change Intervention Some progress; Continue Intervention No progress; Below 10th percentile; Change Intervention Significant progress; Exit Intervention/Change Intervention Some progress; Continue Intervention No progress; Below 10th percentile; Change Intervention Significant progress; Exit Intervention/Change Intervention Some progress; Continue Intervention No progress; Below 10th percentile; Change Intervention School Psychologist: _____________________________________________ Instructional Coach: _____________________________________________ Case Manager: _________________________________________________ Interventionist: _________________________________________________ 22 Date: ____________________ Date: ____________________ Date: ____________________ Date: ____________________ Check Point 1 2 Date: __________________
Progress Monitoring Measure: _______________
Parent Information Letter Tier 2 Date: __________________ Dear Parent or Guardian, The Mission of the Richmond County School System is to educate students to become lifelong learners and productive citizens. Our mission is to help your child become a successful student. At Tier 1, ________________, your childs teacher, used different strategies and/or materials with
___________________and collected data to determine if this differentiated instruction was assisting with his/her success in the classroom. Based on the results of data collected at the school, the Data/Response to Intervention Team has recommended additional interventions for your child. We will begin the Tier 2 intervention on ___________________. At Tier 2, we will provide an additional 30 minutes of focused instruction at least three times per week for a minimum of 8 12 weeks. The intervention that will be used is ______________________________________________ Current Score(s): _____________________ Goal(s) to be reached: ____________________ Person(s) who will provide the intervention: ________________________________________ If you have any questions about the Data Team/Response to Intervention process, or questions regarding your childs skill area(s) that we will address through this intervention plan, please contact_______________________________________ at ______________________________. Please sign below to acknowledge that you have been informed about your childs intervention plan. Cut on the line and send the bottom part back to the school. Keep this letter for your record
---------------------------------------cut here and return the bottom part--------------------------------
I have read this letter and understand that the school has identified my child as needing Tier 2 intervention. Parent/Guardian: ________________________________ Date: _____________
23
Decision Making Along the Continuum of the Pyramid of Intervention Tier 1 1. Universal screening or benchmarking conducted at school level 2. Evidence-based curricula and strategies in place for all students 3. Differentiation is documented by general education teachers through the general education environment 4. At risk students identified in an area of instructional delay (language, academics, behavior) 5. A student identified as at risk is monitored for at least a grading period with progress monitoring tool or curriculum-based measures (CBM) in order to determine instructional effectiveness 6. Data included and analyzed by classroom general education teacher for decision-making indicate if Tier 1 universal interventions should be continued or if there is a need to proceed to the increased intensity of Tier 2 interventions Tier 2 1. Parent notified that additional small group instruction may be needed for student 2. Contact parent through a conference or call and written documentation is sent home with strategies that will be attempted 3. Small group instruction in addition to core curriculum provided to student for at least one grading period 4. Progress monitoring administered at least every 2-3 weeks to determine if a change in delivery or strategy is required 5. If data after 3 progress monitoring checks indicate regression or no progress, the problem solving team of general education should meet to determine if more intensity in delivery time or instruction is required Tier 3 1. Hearing and vision screenings completed for students requiring Tier 2 interventions 2. Student remains at lowest 25% of performance in area of deficit and additional interventions deemed necessary by teachers, parent, or others are initiated with a referral to Student Support Team (SST) 3. Baseline and progress monitoring data from Tier 2 are analyzed to create specific goal(s) for student improvement 4. SST may determine the need for additional information on student including the use or administration of informal or formal measures to gather individual data on the area of concern 5. Members of SST collaborate to identify no more than 2 specific interventions to utilize with student, a timeline detailing how long the intervention will be implemented and dates for progress monitoring 24
6. If the student is making progress using the SST interventions, the interventions are continued for a minimum of 12 weeks or if progress toward goal is minimal, SST members will revise or change the intervention. The intervention plan should be implemented for at least 4 weeks before changes are made If the intervention plan is successful, the SST will create a plan for reducing the level of support needed by the student to the Tier 2 level which includes a realistic timeframe for accomplishing this goal. 7. The SST may make a referral to special education (Tier 4) if the intervention plan and its revisions are not successful in helping the student meet the goals identified by the SST
25
Appendix H Basic Reading Skills Work Sample Analysis

Name:______________________________________________________Age:_____________Grade:_________ Teacher:____________________________School:______________________________Date:_______________ Directions: Choose a work sample(s) that best represents the area of concern and demonstrates the deficits in the area. Please attach the work sample(s). Objective of Lesson: __________________________________________________________________________________________ __________________________________________________________________________________________ Grade Level of Assignment Instruction Task Presentation Response Expected Below Grade Level Grade Level Above Grade Level Individual Small Group Whole Group Visual Auditory Tactile Oral Written Other:_______________________________
Is the student lacking prerequisite skills? No Yes, specify:___________________________________________________________________ Is there a pattern in the errors made? No Yes, specify:___________________________________________________________________ Are there factors which hinder progress? No Yes, specify:___________________________________________________________________ Check the descriptors that apply to the specific work sample(s). Does not know all the letters of the alphabet Does not accurately recognize letters and letter order (reverses and/or transposes letters) Has difficulty with sound-symbol relationships Does not discriminate between similar letters and words when reading Cannot accurately sound out unfamiliar words; does not smoothly blend sounds when attacking new words. Fails to demonstrate word attack skills (e.g., phonics, context clues, picture clues, etc.) Omits, adds, substitutes, or reverses letters, words, or sounds when reading. Has not mastered sight words Fails to recognize words on grade level Does not read independently Does not accurately read new words in context after they have been introduced by the teacher Has difficulty with phonic skills when reading (i.e., fails to sound out words correctly or blend sounds into words) Can read words correctly in one context but not in another Cannot read fluently; overly relies on pointing with a finger, holding the book close, etc. Has not mastered reading silently without inappropriate sub-vocalizing Does not read orally and silently at about the same rate as peers Does not read and scan fluently; has excessive omissions and substitutions, or loses his/her place Has not mastered frequently used, irregular words (especially th- and wh- words)
Adapted from McCartney, S. & Wendling, A. (1987), Learning disability intervention manual. Columbia, MO: Hawthorne Educational Services
26
Reading Comprehension Work Sample Analysis

Name:______________________________________________________Age:_____________Grade:_________ Teacher:____________________________School:______________________________Date:_______________ Directions: Choose a work sample(s) that best represents the area of concern and demonstrates the deficits in the area. Please attach the work sample(s). Objective of Lesson: __________________________________________________________________________________________ __________________________________________________________________________________________
Grade Level of Assignment Instruction Task Presentation Response Expected
Below Grade Level Grade Level Above Grade Level Individual Small Group Whole Group Visual Auditory Tactile Oral Written Other:_____________________________________
Is the student lacking prerequisite skills? No Yes, specify:___________________________________________________________________ Is there a pattern in the errors made? No Yes, specify:___________________________________________________________________ Are there factors which hinder progress? No Yes, specify:___________________________________________________________________ Check the descriptors that apply to the specific work sample(s). Does not self-correct. Misuses such that meaning is distorted Does not observe punctuation when reading Loses place when reading (i.e., leaves out words, lines, or sentences when reading) Fails to finish assignments because of reading difficulties (i.e., reads too slowly to finish on time) Does not follow written instruction as well as peers Fails to comprehend the meaning of words in the reading vocabulary Understands what is read to him/her, but not what he/she reads silently Does not recall facts after reading orally Does not accurately comprehend statements with conditional words such as only, never, always, either or, etc. Fails to correctly answer comprehension questions from reading activities Cannot find a main idea statement accurately Cannot infer meaning beyond the text. Does not correctly use textural elements such as headings, subheadings, introductions, summaries, graphic presentations, indexes, etc.
27
Mathematics Calculation Work Sample Analysis

Name:______________________________________________________Age:_____________Grade:_________ Teacher:____________________________School:______________________________Date:_______________ Directions: Choose a work sample(s) that best represents the area of concern and demonstrates the deficits in the area. Please attach the work sample(s). Objective of Lesson: __________________________________________________________________________________________ __________________________________________________________________________________________ Grade Level of Assignment Instruction Task Presentation Response Expected Below Grade Level Grade Level Above Grade Level Individual Small Group Whole Group Visual Auditory Tactile Oral Written Other:_____________________________________
Is the student lacking prerequisite skills? No Yes, specify:___________________________________________________________________ Is there a pattern in the errors made? No Yes, specify:___________________________________________________________________ Are there factors which hinder progress? No Yes, specify:___________________________________________________________________ Check the descriptors that apply to the specific work sample(s). Has not mastered the elements of numerals (i.e., rote counting, recognizing and/or writing numbers in order) Does not comprehend place value Has not mastered basic mathematical facts for grade level Does not remember math facts Does not work math problems as quickly as classmates Confuses operational signs when working math problems Fails to change from one math operation to another Works math problems left to right instead of right to left Does not make use of columns when working math problems (e.g., puts numbers in wrong columns, adds across columns, etc.) Fails to follow necessary steps in math problems (e.g., does steps in the wrong order, omits a step, etc.) Cannot correctly complete operations that require multiple steps for the solution (e.g., long division or subtraction with regrouping) Cannot estimate and evaluate an answer that is approximately correct Fails to correctly solve math problems requiring addition Fails to correctly solve math problems requiring subtraction Fails to correctly solve math problems requiring regrouping Fails to correctly solve math problems requiring multiplication Fails to correctly solve math problems requiring division Fails to correctly solve math problems involving fractions or decimals
28
Mathematical Reasoning Work Sample Analysis

Is the student lacking prerequisite skills? No Yes, specify:___________________________________________________________________ Is there a pattern in the errors made? No Yes, specify:___________________________________________________________________ Are there factors which hinder progress? No Yes, specify:___________________________________________________________________ Check the descriptors that apply to the specific work sample(s). Cannot recognize and comprehend key words that identify the operation used in a word problem Cannot identify the numerical elements to be used in solving a word problem Cannot express the equivalent parts of fractions, percentages, and decimals Cannot solve life-related problems involving time, money, and measurement Cannot accurately estimate response to everyday problems in time, money, and measurement Cannot state the function and use of measurement terms to solve problems Cannot solve basic problems involving geometry Has difficulty solving math word problems Does not understand abstract math concepts without concrete examples (i.e., must have manipulatives in order to work math problems) Falls to correctly solve problems involving money Fails to correctly solve problems using measurement Does not understand the concept of time
29
Listening Comprehension Work Sample Analysis

Is the student lacking prerequisite skills? No Yes, specify:___________________________________________________________________ Is there a pattern in the errors made? No Yes, specify:___________________________________________________________________ Are there factors which hinder progress? No Yes, specify:___________________________________________________________________ Check the descriptors that apply to the specific work sample(s). Requires eye contact in order to listen successfully Attends more successfully when close to source of sound Has difficulty attending to peers/adults when they are talking Unable to follow appropriate verbal directions (requiring a single response) Does not hear all of what is said (e.g., misses word endings, misses key words such as "do not," etc.) Fails to direct attention or fails to maintain attention to important sounds in the immediate environment Unsuccessful in activities requiring listening (e.g., games, following oral directions, etc.) Needs oral questions and directions frequently repeated (e.g., student says, "I don't understand," needs constant reminders, etc.) Has trouble detecting humor or sarcasm in the verbal expression of others Cannot identify age appropriate vocabulary through picture cues Has difficulty differentiating speech sounds heard (e.g., cannot tell the difference between /ch/ and /sh/ sounds, similar vowel sounds, similar consonant sounds, rhyming words etc.) Demonstrates poor comprehension of sentences when presented with picture stimuli Unable to sequence pictures to demonstrate an understanding of orally presented material Unable to respond appropriately to wh- questions following oral presentation of a story Unable to verbally paraphrase sentences or stories presented orally
30
Written Expression Work Sample Analysis

Name:______________________________________________________Age:_____________Grade:_________ Teacher:____________________________School:______________________________Date:_______________ Directions: Choose a work sample(s) that best represents the area of concern and demonstrates the deficits in the area. Please attach the work sample(s). Objective of Lesson: __________________________________________________________________________________________ __________________________________________________________________________________________ Grade Level of Assignment Instruction Task Presentation Response Expected Below Grade Level Grade Level Above Grade Level
Individual Small Group Whole Group Visual Auditory Tactile Oral Written Other:_____________________________________
Is the student lacking prerequisite skills? No Yes, specify:___________________________________________________________________ Is there a pattern in the errors made? No Yes, specify:___________________________________________________________________ Are there factors which hinder progress? No Yes, specify:___________________________________________________________________ Check the descriptors that apply to the specific work sample(s). Demonstrates poor motor coordination and motor fluency Reverses letters and numbers when writing Fails to form letters correctly when printing or writing Uses inappropriate letter size when writing Uses inappropriate spacing between words or sentences when writing Fails to write within a given space (e.g., writes off of the page, does not write on a line, etc.) Is unable to copy letters, words, sentences, and numbers from a model at close distance (e.g., cannot copy from a textbook) Fails to use spelling rules (e.g., "i" before "e" except after "c" rules for changing words to plural form, etc.) Has difficulty with phonetic approaches to spelling Has difficulty spelling words that do not follow the spelling rules Does not use word-endings correctly when spelling or omits them (e.g., -ed, -ing, -ly, etc.) Spells words correctly in one context, but not in another (e.g., can spell the word on a quiz but not in a sentence, cannot spell the word from dictation but. can spell it correctly in. a sentence, etc.) Requires continued drill and practice in order to learn spelling words Unable to generate ideas orally Does not compose complete sentences or express complete thoughts when writing Page 1 of 2
31
Written Expression, continued

Omits, adds, or substitutes words when writing Fails to correctly organize writing activities (e.g., cannot sequence events, cannot develop a paragraph, uses incorrect word order, etc.) Cannot write a single sentence from a sentence starter Cannot write a single sentence from a visual stimulus Cannot write a single sentence from a word Cannot write a single sentence from a topic Cannot write a paragraph from a visual stimulus Cannot write a paragraph following a verbal rehearsal of content with the teacher Cannot write a paragraph from a topic sentence Cannot write a paragraph from a topic Does not use descriptive words (adjectives, adverbs) in writing Fails to use capitalization correctly in writing Fails to use punctuation correctly in writing Demonstrates poor sentence structure in writing Does not use appropriate subject-verb agreement in writing Fails to use verb tenses correctly in writing
Page 2 of 2
32
Oral Expression Work Sample Analysis

Is the student lacking prerequisite skills? No Yes, specify:___________________________________________________________________ Is there a pattern in the errors made? No Yes, specify:___________________________________________________________________ Are there factors which hinder progress? No Yes, specify:___________________________________________________________________ Check the descriptors that apply to the specific work sample(s). Demonstrates a limited speaking vocabulary Has poor age-appropriate vocabulary development Does not respond in complete sentences Unable to carry on conversation with peers and adults Unable to communicate ideas adequately with verbal statements (is dependent on gestures) Does not formulate sentences or stories related to stimuli Unable to relate experiences or stories in sequential order when visual stimuli or word cues are provided Cannot provide verbal labels for common objects in school or home environment Has difficulty with word retrieval (has difficulty "finding" words to describe intent) Speaks dysfluently (e.g., runs words/sentences together, speaks too fast/slow, pauses at incorrect places, etc.) Does not complete statements or thoughts when speaking (e.g., speaks in incomplete sentences, fails to think of correct words to express ideas, etc.) Has difficulty imitating speech sounds Omits, adds, substitutes or rearranges sounds or words when speaking Distorts or mispronounces words or sounds when speaking (not attributed to dialect or accent) Fails to use inflection in speech to communicate meaning (consider volume, pitch, and rate of speech) Speaks with poor age-appropriate grammatical structure (considering cultural and family communication style) Does not use appropriate subject-verb agreement when speaking Fails to use verb tenses correctly when speaking
33
Appendix I Behavior Documentation Antecedent Behavior Consequence Chart Student Name: ___________________________ Date Time Place Antecedent Teacher: ______________________________ Behavior Consequence
34
Daily Behavior Report Card Student Name: _____________________ Dear Parent, This daily report card indicates how positive your child's behavior was today in the classroom. Ratings of 4 to 5 indicate good classroom behavior, 3 suggests fair behavior, and ratings of 1 to 2 indicate inappropriate classroom behaviors. Please discuss this report card with your child and return a signed copy to me at school. Thank you. ____________________________________________________ Compared with other students of the same gender in the classroom, your child: A. ______________________________________________________________________ 1 2 3 4 5 Never Occasionally Sometimes Often Always B. ______________________________________________________________________ 1 2 3 4 5 Never Occasionally Sometimes Often Always C. ______________________________________________________________________ 1 2 3 4 5 Never Occasionally Sometimes Often Always D. ______________________________________________________________________ 1 2 3 4 5 Never Occasionally Sometimes Often Always E. _______________________________________________________________________ 1 2 3 4 5 Never Occasionally Sometimes Often Always
Additional Comments:
Teacher: _________________
Date: ________
Parent Signature: _______________________________
Date: __________
35
Teacher Behavior Log Student Name: ________________________ Date: ____________ Time: _________ am/pm Teacher: ___________________ Setting: _____________________
Description of incident: (what happened, who was involved, during what activity, what triggered it, what was the outcome). _____________________________________________________________ _________________________________________________________________________________ ________________________________________________________________________________ _________________________________________________________________________________ Duration: _______ # of minutes. Intensity: low med. high
Was Time-out required: Yes No; If so how long _________ Comments: ===================================================================== Date: _____________ Time: _______ am/pm Setting: ________________
Description of incident: (what happened, who was involved, during what activity, what triggered it, what was the outcome). ______________________________________________________________ _________________________________________________________________________________ __ _______________________________________________________________________________ _________________________________________________________________________________ Duration: _______ # of minutes. Intensity: low med. high
Was Time-out required: Yes No; If so how long _________ Comments: ===================================================================== Date: ____________ Time: _______ am/pm Setting:_________________
Description of incident: (what happened, who was involved, during what activity, what triggered it, what was the outcome). ________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Duration: _______ # of minutes. Intensity: low med. high
Was Time-out required: Yes No; If so how long _________ Comments:

================================================================================== Copyright 2001, J.L. McDougal
36
Behavioral Scatterplot Directions: Place an "X" in the space that corresponds to the time and date of each observed behavioral incident. Superimpose the student's daily schedule on the scatter plot and look for clusters of behavioral incidents suggesting meaningful patterns. Attempt to match behaviors to possible influences related to time of day, settings, academic tasks, level of adult supervision, and other instructional or environmental variables. Student: Date/Time: Dates: Comments 8:00 8:15 8:30 8:45 9:00 9:15 9:30 9:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00 3:15 3:30 Copyright 2001, J.L. McDougal, Psy.D. 37 ______ Monday _______ Tuesday _________ Wednesday _______ Thursday ______ Friday Setting:
Student: ______________________________________ OS = Out of Seat Student leaves assigned seat MA = Motor Activity Student plays with objects or displays repetitive motor movement CO/V = Calling out/Verbalization Student calls out without using procedures or makes noises that fall outside of accepted academic discourse OT-P = Off-task Passive Student is off task but does not engage in motor behaviors Dates: TIME OS Monday MA CO/V OT-P OS Tuesday MA CO/V OT-P OS MA CO/V OT-P OS Thursday MA CO/V OT-P OS Friday MA CO/V OT-P Wednesday 38 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30
Teacher: ______________________
Behavior Scatterplot
Student: ____________________________________ Behavior 1: ___________________________________________________________________ Behavior 2: ___________________________________________________________________ Dates: TIME 1 Monday 2 1 Tuesday 2 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30 :45 :00 :15 :30 39 1 2 1 Thursday 2 1 Friday 2 Wednesday
Teacher: ____________________
Behavior Scatterplot
Interval Sampling Recording Form Student: Teacher: _______________________ ______________________ Date/Time: _____________________ Observer: ______________________
Observation Activity:___________________________________________________________ DIRECTIONS: White Boxes - Momentary time sampling procedures will be used to code on-task (+) or off-task (-) behavior. Using a stopwatch, observe target student and a same-sex peer and record the observed behavior at the beginning of each 20 second interval. (Record target student observation data first.) Compute the percentage of time on task by adding the number of +s divided by 30 and multiplying by 100 (+s/30x100). Shaded Boxes Partial or Whole interval recording will be used to code additional specific behaviors of interest. It is recommended that the observer develop a coding system prior to beginning the observation (e.g., Non-compliance C, Negative Peer Interaction P), and that the number of behaviors (codes) be limited to those of greatest interest. If using whole interval recording, the code is marked in the interval if the behavior occurs throughout the entire 20 second interval. If using partial interval recording, the code is entered if that behavior occurs at any point during the interval. Indicate the behavior codes at the bottom as well as the number of times each occurred for the target and peer. Interval Target Peer 1 2 3 4 5 6 7 8
Interval Target Peer
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Summary:_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
http://www.oswego.edu/~mcdougal/web_site_4_11_2005/interval_sampling.htm 40
Behavior Observation Event Recording Student: ___________________________ Observer:_________________________________
Date:_________ Time of Day __________ Class/Activity: ____________________________ Directions: Make a slash through the corresponding number each time the target behavior is observed. Target behavior(s): _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Target Student 1 2 3 16 17 18
4 19
5 20
6 21
7 22
8 23
9 24
10 25
11 26
12 27
13 28
14 29
15 30
Total number of occurrences: _______ Peer Comparison 1 2 3 16 17 18
4 19
5 20
6 21
7 22
8 23
9 24
10 25
11 26
12 27
13 28
14 29
15 30
Total number of occurrences: _______ --------------------------------------------------------------------------------------------------------------------Teacher-Student Interactions Directions: Make a slash through the corresponding number each time the teacher interacts with the student positively or negatively. Target Student Positive Interaction when student is behaving (praise, greeting, compliment, positive reinforcement, etc.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Negative Interaction when student is misbehaving (reminder, reprimand, corrections, warning, etc.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Ratio of teacher-student interactions: ______ positive vs. ______ negative Peer Comparison Positive Interaction when student is behaving (praise, greeting, compliment, positive reinforcement, etc.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Negative Interaction when student is misbehaving (reminder, reprimand, corrections, warning, etc.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Ratio of teacher-student interactions: ______ positive vs. ______ negative 41
Appendix J Functional Behavioral Assessment Student: __________________________ DOB: _____________ School: _____________________ Grade: _____ Case Manager: _____________________ Data Source: Observation
Parent Interview
Student Interview Rating Scales
Teacher Interview Testing
Description of Behavior (Antecedent):
Function of Behavior (What does the student get or escape from as a result of the behaviors?):
Frequency:
Intensity (Consequences of problem behavior on student, peers, instructional environment):
Duration:
Describe Previous Interventions:
Educational Impact:
42
Response to Intervention Readiness Checklist Is your school ready to adopt a Response to Intervention (RTI) model ? This checklist is provided to assist in answering that question. Designed to guide a group of school leaders through an appraisal of RtI requirements and best practices Key systemic areas addressed through the checklist are: Leadership Teaming Curriculum Screening School Name: ___________________________________ Date: _______________ Primary RtI/SST Contact ____________________________________ __________ Name/Title Phone
____________________ E-mail
Staff Completing the Checklist: ____________________________________ ________________________________ Name/Title Name/Title ____________________________________ ________________________________ Name/Title Name/Title ____________________________________ ________________________________ Name/Title Name/Title
Leadership School level support at the highest levels, including agreement to adopt an RtI model and allocate required resources Scheduling of frequent RtI meetings and/or grade level meetings at all tiers Long term commitment of resources (staff, time and materials) for screening, assessment, and interventions Leadership team with basic knowledge of the research relative to RtI and the desire to learn more Expertise collaboration utilizing district resources (i.e. school psychologist, counselor, speech therapist) with respect to research based practices for academics and behavior 43
Established
Willing to Implement
No
Teaming Commitment to collaborative teaming (general and special education) at both the district and school levels Principal leadership and staff (general and special education) willing to participate at each school Willingness for general education, special education, and compensatory programs to work together at the district and school levels
Established
No
Curriculum Use of a research validated core reading program at each elementary school Use of or ability to acquire supplemental intervention materials Capacity to provide ongoing training and support to ensure fidelity of implementation Screening School-wide structures in place to facilitate systematic review of and programming to enhance student performance (examples: PBS, or EBIS) Established student level data collection and management system that is tied to the content (e.g. SWIS for the EBIS program, DIBELS, etc.) Capacity to implement progress monitoring
Established
No
Established
No
Having reviewed the above information, our school has formulated the following plan to improve areas needed for RtI implementation: This plan was modified from the 2005 Oregon Department of Education RtI Readiness Plan
44
Definition of Terms
Accommodation: any change made to instruction and/or assessment that does not change the expectations for performance or change the construct that is being measured respectively. Accommodations provide access to buildings, curriculum, and assessments. Baseline: data, collected prior to the initiation of an intervention that is utilized for comparison with data collected during and/or after an intervention has been implemented. Behavioral Logs: are data collected on specific targeted behaviors over time. These logs can be easily charted to show trend lines. Content Area: Academic areas of study for which the Richmond County School System has developed content standards and benchmarks Curriculum Based Measures (CBMs): curriculum based measures are direct assessments of student skills administered in standardized manner that are aligned to state content standards and benchmarks. They are typically discrete probes, which are brief, timed samples. CBMs can measure both fluency and accuracy of student responses. They can be teacher-developed, purchased, or found online, though reliability and validity of the CBMs must be attended to if developing CBMs independently. They can be administered quickly and frequently. Student level results are typically graphed and compared to classroom peers to determine the students level of progress. Differentiation: is a method of delivering instruction to meet the needs and learning styles of diverse learners in the classroom. Differentiation instruction does not include accommodations and modifications, but rather consideration of the adjustment to the content, process, product, and environment so that all students can learn. Evaluation: procedures used to determine whether a child has a disability and the nature and extent of the special education and related services that a child needs. This may include a comprehensive psycho-educational evaluation. Fidelity: refers to the intensity and accuracy with which instruction and intervention is implemented. Research studies follow an implementation protocol to ensure standardization. Teachers must follow this research design, as elaborated in the teachers guide available from publishers, in order to attend to fidelity. Formative Assessment: is a form of assessment intended to give students immediate feedback on their learning progress and to provide teachers with data regarding both what skills students have mastered and what skills are their areas of difficulty. Formative assessment is a system of classroom level assessments that may be teacher developed, such as unit tests and CBMs. Formative assessment is not used to assign marks or grades toward determining whether the student gains credit. It is used exclusively to drive appropriate instructional changes to meet individual student needs. Intervention: a designed change in the manner and/ or degree in which a student is being instructed. An intervention can address academic and/or behavioral needs. Changes can be made in the areas of Program, Time, or Grouping. Progress Monitoring: a scientifically-based practice to access ongoing student progress, as well as the effectiveness of the instruction/intervention plan. Research-Based Instruction: instruction and intervention validated as effective through scientific studies. Response to Intervention: (RtI) is an array of procedures that can be used to determine if and how students respond to specific changes in instruction. RtI provides an improved process and structure for school teams in designing, implementing, and evaluating educational interventions.
45
Screening: provides general information on student skills, behaviors and abilities. Its purpose is to identify potential at-risk students and/or to identify specific skill/behavior deficits to inform interventions. This may include brief measures/assessments given by a school psychologist or other specialized personnel. Scientific, Research-based: the term defined by NCLB is scientifically based research. You may also see some literature refer to this notion as evidence based. We will use the NCLB definition for all of these terms: Section 9101(37) The term scientifically based research-(A) means research that involves the application of rigorous, systematic, and objective procedures to obtain reliable and valid knowledge relevant to education activities and programs; and (B) includes research that: (i) employs systematic, empirical methods that draw on observation or experiment; (ii) involves rigorous data analyses that are adequate to test the stated hypotheses and justify the general conclusions drawn; (iii) relies on measurements or observational methods that provide reliable and valid data across evaluators and observers, across multiple measurements and observations, and across studies by the same or different investigators; (iv) is evaluated using experimental or quasi-experimental designs in which individuals, entities, programs, or activities are assigned to different conditions and with appropriate controls to evaluate the effects of the condition of interest, with a preference for random assignment experiments, or other designs to the extent that those designs contain within-condition or across-condition controls; (v) ensures that experimental studies are presented in sufficient detail and clarity to allow for replication, or at a minimum, offer the opportunity to build systematically on their findings; and (vi) has been approved by a peer-reviewed journal or approved by a panel of independent experts through a comparably rigorous, objective, and scientific review. (NCLB Section 9101(37), 20 USC 7707 (b)(37)) (P.L.107-110, The No Child Left Behind Act of 2001 (2002, Jan. 8), 115 Stat. 1425) Standardized Test Results: provide valuable comparative data on either a state-wide or national level. Some tests measure achievement, while others are more diagnostic. Universal Screening: a means to access students who are at risk for falling below state or grade level sta ndards. The screening can be accomplished through formal and/or informal methods. Work Samples: are actual samples of students work such as writing assignments, projects, homework, etc. Samples can provide great insight.
46
Appendix M
47
AIMSweb Growth Table Richmond County BOE Mathematics Concepts and Applications 2012-2013 School Year
Fall Grade %ile 90 75 50 25 10 Mean StdDev 90 75 50 25 10 Mean StdDev 90 75 50 Num TS 13 / 13 10 / 10 7/7 4/4 3/3 7/7 4/5 21 / 21 16 / 16 12 / 12 9/9 6/6 12 / 13 6/6 14 / 15 11 / 11 8/8 2300 / 11070 6/6 4/4 8/8 4/5 19 / 24 14 / 18 10 / 13 1936 / 3163 7/9 4/6 11 / 14 6/8 15 / 19 11 / 14 2012 / 3762 8 / 10 5/7 3/4 8 / 10 5/6 13 / 19 10 / 14 1788 / 2746 6 / 10 4/6 2/4 7 / 10 5/6 1165 / 2746 1275 / 3762 1443 / 3163 1889 / 11070 Winter Num TS 17 / 19 13 / 15 9 / 11 6/7 3/5 9 / 11 6/6 24 / 27 19 / 21 14 / 16 11 / 12 7/9 15 / 17 7/7 18 / 20 13 / 15 9 / 11 7/8 5/6 10 / 12 5/6 22 / 31 17 / 24 13 / 17 9 / 12 7/9 13 / 18 7/9 19 / 26 15 / 20 11 / 15 7 / 11 4/7 11 / 16 6/8 16 / 23 11 / 17 7 / 12 4/7 3/4 8 / 12 6/7 0 / 2746 0 / 3762 0 / 3163 0 / 11070 Spring Num TS - / 28 - / 21 - / 15 - / 11 -/8 - / 16 -/8 - / 33 - / 24 - / 18 - / 13 -/9 - / 19 -/9 - / 21 - / 15 - / 11 -/7 -/5 - / 12 -/7 - / 35 - / 27 - / 19 - / 13 -/9 - / 20 - / 10 - / 30 - / 24 - / 18 - / 13 -/9 - / 18 -/8 - / 26 - / 20 - / 13 -/9 -/5 - / 14 -/8 Group ROI 0.22 / 0.42 0.17 / 0.31 0.11 / 0.22 0.11 / 0.19 0.00 / 0.14 0.11 / 0.25 0.11 / 0.08 0.17 / 0.33 0.17 / 0.22 0.11 / 0.17 0.11 / 0.11 0.06 / 0.08 0.17 / 0.17 0.06 / 0.08 0.22 / 0.17 0.11 / 0.11 0.06 / 0.08 0.06 / 0.03 0.06 / 0.03 0.11 / 0.11 0.06 / 0.06 0.17 / 0.31 0.17 / 0.25 0.17 / 0.17 0.11 / 0.11 0.17 / 0.08 0.11 / 0.17 0.06 / 0.06 0.22 / 0.31 0.22 / 0.28 0.17 / 0.22 0.11 / 0.17 0.06 / 0.14 0.17 / 0.22 0.06 / 0.06 0.17 / 0.19 0.06 / 0.17 0.06 / 0.08 0.00 / 0.08 0.06 / 0.03 0.06 / 0.11 0.06 / 0.06
2306 / 14033
1849 / 14033
0 / 14033
2334 / 11335
2023 / 11335
0 / 11335
25 10 Mean StdDev 90 75 50
25 10 Mean StdDev 90 75
50 25 10 Mean StdDev 90 75
50 25 10 Mean StdDev
Num = Number of Students TS = Points ROI = Rate Of Improvement ROI is Spring Score minus Fall Score (or Winter minus Fall) divided by 36 weeks (or 18 weeks). Numbers are ( Richmond County BOE / AIMSweb National Norms )
48
AIMSweb Growth Table Richmond County BOE Math Computation 2012-2013 School Year
Fall Grade %ile 90 75 Num pts 52 / 46 41 / 33 2305 / 15269 26 / 22 17 / 14 10 / 8 29 / 24 16 / 14 62 / 49 52 / 36 38 / 24 24 / 17 14 / 10 37 / 27 18 / 15 43 / 33 34 / 22 22 / 14 2296 / 18532 13 / 8 7/5 24 / 16 14 / 12 38 / 37 30 / 27 20 / 18 1935 / 4477 12 / 11 7/6 21 / 20 13 / 12 45 / 40 31 / 29 20 / 19 2013 / 805 11 / 12 5/7 22 / 22 15 / 13 32 / 38 22 / 28 1769 / 1921 14 / 19 7 / 10 4/6 16 / 20 12 / 13 1164 / 1921 1273 / 805 1442 / 4477 1881 / 18532 1849 / 15269 Winter Num Spring Num pts - / 68 - / 64 0 / 15269 - / 56 - / 40 - / 26 - / 50 - / 16 - / 70 - / 66 - / 57 - / 43 - / 29 - / 53 - / 16 - / 61 - / 47 - / 32 0 / 18532 - / 21 - / 12 - / 34 - / 18 - / 57 - / 45 - / 33 0 / 4477 - / 22 - / 13 - / 34 - / 16 - / 56 - / 46 - / 32 0 / 805 - / 19 - / 11 - / 32 - / 17 - / 50 - / 39 0 / 1921 - / 28 - / 17 - / 10 - / 29 - / 15
pts 64 / 63 57 / 55 46 / 42 33 / 29 22 / 19 44 / 41 16 / 16 67 / 65 61 / 56 50 / 44 37 / 32 25 / 22 48 / 43 16 / 16 46 / 47 34 / 34 22 / 23 13 / 14 8/8 24 / 25 15 / 15 43 / 49 32 / 38 23 / 26 15 / 18 8 / 11 24 / 28 13 / 14 45 / 50 32 / 38 22 / 27 12 / 17 6 / 10 23 / 28 15 / 15 35 / 42 26 / 32 17 / 23 9 / 15 5/9 18 / 24 12 / 13
Group ROI 0.67 / 0.61 0.89 / 0.86 1.11 / 0.94 0.89 / 0.72 0.67 / 0.50 0.83 / 0.72 0.00 / 0.06 0.28 / 0.58 0.50 / 0.83 0.67 / 0.92 0.72 / 0.72 0.61 / 0.53 0.61 / 0.72 -0.11 / 0.03 0.17 / 0.78 0.00 / 0.69 0.00 / 0.50 0.00 / 0.36 0.06 / 0.19 0.00 / 0.50 0.06 / 0.17 0.28 / 0.56 0.11 / 0.50 0.17 / 0.42 0.17 / 0.31 0.06 / 0.19 0.17 / 0.39 0.00 / 0.11 0.00 / 0.44 0.06 / 0.47 0.11 / 0.36 0.06 / 0.19 0.06 / 0.11 0.06 / 0.28 0.00 / 0.11 0.17 / 0.33 0.22 / 0.31 0.17 / 0.25 0.11 / 0.19 0.06 / 0.11 0.11 / 0.25 0.00 / 0.06
50 25 10 Mean StdDev 90 75 50 25 10 Mean StdDev 90 75 50
2317 / 18953
2023 / 18953
0 / 18953
25 10 Mean StdDev 90 75 50
25 10 Mean StdDev 90 75 50
25 10 Mean StdDev 90 75
50 25 10 Mean StdDev
Num = Number of Students pts = Points ROI = Rate Of Improvement ROI is Spring Score minus Fall Score (or Winter minus Fall) divided by 36 weeks (or 18 weeks). Numbers are ( Richmond County BOE / AIMSweb National Norms )
49
50
51
Appendix N Speech/Language Referrals Student: ________________________________ Grade: __________ DOB: ____/____/_____
Gather baseline data using one of the following for 1 2 weeks based on the problems you are noticing in the classroom. (Data sheets are available for each selection.) After 1 2 weeks of data is collected, provide a copy of all data to your RtI Facilitator for a Tier 2 meeting to be scheduled with the Speech & Language Pathologist. Language _____ 1. Ask simple WH questions with simple predictable answers 3 times a day for two weeks. (L1) _____ 2. Have student retell a short story or event in the correct sequence. (L2) _____ 3. Have student construct oral sentences using correct grammar/syntax (ex. subject-verb agreement, plurals, pronouns, etc.). Document response and model correct grammar if needed. (L2) _____ 4. Using picture cards teach pictures/vocabulary and have student name the pictures once a day for a week. Document their response. Begin to integrate new pictures/vocabulary with mastered pictures/vocabulary. (L3) _____ 5. Provide student with a 1-step command and a 2-step command once a day for a week. Document the directions given and whether the student correctly followed directions. (L4) Articulation _____ 1. If a child is having difficulties with articulation, complete the target sound chart daily for 1 week. ***Check the developmental sound production sheet to determine if it is an appropriate sound for the childs age before referring the child for a Tier 2 meeting. (A1) _____ 2. Have student produce target sounds in isolation and in words. Document the number correct out of 10 opportunities. (A2) _____ 3. Use auditory discrimination skills to enhance speech sound awareness by providing the student with a set of similar words with different sounds (ex. Listen, pill/bill, are they the same?). (A3) Stuttering _____ 1. Tally the number of stuttered words produced by the student in a brief period of time during spontaneous conversation or a selected reading. (S1)
Baseline Data
WH Questions Student: __________________________________ Date 8/26/10 WH Question Ex. What are you doing? Grade: __________ Teacher: __________________________ Outcome Correct Incorrect X
Student Response Ex. Play. [Model correct response: I am playing ball.]
L1
Retell/Sequencing & Syntax Documentation Student: __________________________________ Grade: __________ Teacher: __________________________ Ask student to retell a story or event using correct sequence and syntax and record their response. Mark the box with a + if correct and a if incorrect. Date Student Response Sequence Outcome Syntax
L2
Vocabulary Student: __________________________________ Grade: __________ Teacher: __________________________
Write in picture names or vocabulary words along the top row. Have the student identify the picture or orally define the word. Write in the date the students response and indicate the number of items correct out of 10 in the last box. Date # Correct
L3
Following Directions Student: __________________________________ Grade: __________ Teacher: __________________________
Provide student with a 1-step command and a 2-step command once a day for a week. Document the directions given and whether the student correctly followed directions. Date Directions Provided Outcome Correct Incorrect
L4
Modeling Student: __________________________________ Grade: __________ Teacher: __________________________
Write in the students sound errors and the modeled response by the teacher. Have the student repeat the modeled response and indicate if it was correct or incorrect. Date Student Error Teacher Model Student Response Outcome Correct Incorrect
L5
Target Sound Chart

Student: __________________________________ Grade: __________ Teacher: __________________________
Show the student a picture beginning with the target sound. Have the student produce the picture name. Place a + if the sound was produced correctly and a if produced incorrectly.
Date M
Sh
R Ch
Z TH
A1
Target Sounds in Words Student: __________________________________ Grade: __________ Teacher: __________________________
Based on the target sound chart, have the student produce the identified sound in 10 words. Place a plus (+) in the box if the child produced the sound correctly, and place a minus () if the child produced it incorrectly. Date # Correct / 10 / 10 / 10 / 10 / 10
Word Lists M = mad, mail, man, mat, milk, mitt, moon, mop, mud, money F = fan, fat, feet, fin, fire, fish, five, fox, fun, four G = game, gas, gate, go, goat, goose, gum, geese, goal, guy T = tag, tall, tap, tape, ten, tie, top, tub, tug, tin K/C = key, kick, king, kiss, kite, car, cape, cap, can, cake D = dice, dig, dime, dirt, dog, doll, dot, duck, dish, down SH = shave, self, shoe, shower, shade, shop, sheep, short, shark, shirt R = rain, rat, rib, row, rub, rug, run, read, rap, rich CH = champ, chat, chain, cheese, chick, chip, child, chew, check, cheap S = sack, sad, sea, sick, sip, sit, sun, seal, six, saw L = lamb, lap, leg, lid, light, lip, lock, log, line, laugh TH = thank, thief, thick, thin, think, thigh, third, thumb, thorn, thirst S-blends = scale, snail, skunk, spoon, straw, slip, snore, skate, slide, stove A2
Sound Awareness Student: __________________________________ Grade: __________ Teacher: __________________________
Provide the student 5 word pairs 3 days a week. Have the student indicate whether the words are the same or different. Date Target Words Same Different Outcome Correct Incorrect
A3
Stuttering Student: __________________________________ __________________________ Grade: __________ Teacher:
Document the date, activity, and amount of time the observation of the students speech took place. Indicate the number of stuttered words that occurred in that time period. Provide a few examples of words the student was unable to produce fluently. Date Monday Activity Elapsed Time Number of stuttered words Example of stuttered words Log of Social Emotional Effects Please date and write in any social-emotional effects the students speech has on his/her participation in class discussions/activities and interactions with peers or adults. Date Participation Tuesday Wednesday Thursday Friday
Peer Interaction
A4
112
Resources
Differentiated Instruction Differentiation through Learning Styles and Memory The Differentiated Classroom: Responding to the Needs of All Learners Differentiating Instruction in the Regular Classroom Fulfilling the Promise of the Differentiated Classroom: Strategies and Tools for Responsive Teaching Data Driven Differentiation in the Standards-Based Classroom Differentiated Instructional Strategies: One Size Doesnt Fit All Differentiating Instruction for Students with Learning Disabilities The Teachers Toolbox for Differentiating Instruction Applying Differentiation Strategies: Teachers Handbook for Secondary Demystifying Differentiation in Middle School: Tools, Strategies, and Activities to Use NOW Instructional Strategies & Interventions Ive DIBELd, Now What? What Successful Math Teachers Do, Grades 6-12 Classroom Instruction That Works: Research-Based Strategies for Increasing Student Achievement Catching Kids Up How to Reach and Teach Children with ADD/ADHD The Pre-Referral Intervention Manual The Tough Kid Series Whatever It Takes: How Professional Learning Communities Respond When Kids Dont Learn School Based Interventions: The Tools You Need to Succeed Interventions for Reading Success Resilient Classrooms: Creating healthy environments for learning 90 Instructional Strategies for the Classroom Behavior Discipline in the Secondary Classroom: A Positive Approach to Behavior Management CHAMPS: A Proactive and Positive Approach to Classroom Management Relational Discipline: Strategies for In-Your Face Kids The Teachers Encyclopedia of Behavior Management: 100 problems/500 plans A Handbook for Classroom Management that Works Coaching Classroom Management Practical Charts for Managing Behavior Practical Ideas that Really Work for Students with Disruptive, Defiant, or Difficult behaviors Disorders Practical Ideas that Really Work for Students with Asperger Syndrome Practical Ideas that Really Work for Students with Autism Spectrum Disorders Practical Ideas that Really Work for Students with ADHD Assessment Qualitative Reading Inventory The ABCs of CBM Response to Intervention Improving Schools through Instructional Pyramids: Utilizing Response to Intervention to Raise Student Achievement Response to Intervention: A Practical Guide for Every Teacher The RTI Guide: Developing and Implementing a Model in Your Schools RTI Toolkit: A Practical Guide for Schools
113
Web-Based Resources
For Parents:
Topic/Title
Discussing RTI with Parents and Students RTI A Primer for Parents IDEA Reauthorization Update Wrightslaw
Content
Questions and Answers Useful information for parents on RTI Articles & Resources
Website/Link
http://www.nrcld.org/resource_kit/general/Q&AEdu cators2007.pdf http://www.kupsplace.org/Parents/rtiprimer.html http://www.bridges4kids.org/SSI.html
Family Education
Middle School Students and School Life Parentpedia: Preteens and Teens 101 Comebacks! Hoagies Kids Hub School Psychologists Corner/For Parents TeacherVision
Offers information about special education law and advocacy for children with disabilities Find school solutions, homework help, parenting, tips, and expert advice Discipline resources
http://www.wrightslaw.com/
http://www.familyeducation.com/home/
www.middleweb.com/
Educational information on parenting pre-teens and teens Bullying help and information website Gifted Resources Free online learning activities for k-12 students information on effective parenting techniques and child management practices Teacher-Parent Collaboration Getting Involved in Your Child's Education
http://family.go.com/parentpedia/preteen-teen/
http://www.bullystoppers.com/ http://www.hoagiesgifted.org/ and http://www.hoagiesgifted.org/parents.htm http://www.quizhub.com/quiz/quizhub.cfm http://www.kupsplace.org/index.html
http://www.teachervision.fen.com/education-andparents/resource/3730.html http://www.nea.org/parents/index.html
National Education Association
114 Listed below are additional websites from the U.S. Department of Education for parents: Topic Especially for Parents Homework Tips for Parents Consejos prcticos para los padres sobre la tarea escolar A Guide to the Tool Kit for Hispanic Families Gua de recursos para las familias hispanas Tips and Resources -- The Partnership Key Things Parents Can Do Reading Tips for Parents Resources for Parents and Families Website/Link http://www.ed.gov/parents/landing.jhtml?src=fp http://www.ed.gov/parents/academic/involve/homework/index.html
http://www.ed.gov/espanol/parents/academic/involve/tareaescolar/index.html
http://www.ed.gov/parents/academic/involve/toolkit/index.html http://www.ed.gov/espanol/parents/academic/involve/toolkit/index.html http://www.ed.gov/parents/academic/help/partnership-tips.html http://www.ed.gov/parents/academic/involve/prepared.pdf http://www.ed.gov/parents/read/resources/guide/reading-parents.ppt http://www.cdc.gov/ncbddd/child/links.htm
Additional websites for educators and parents can be found on our RCBOE /Psychological Services department website (www.rcboe.org). A resource book for parents: 401 Ways to get Your Kids to Work at Home
115
For Students:
www.apples4theteacher.com A site for teachers and kids with learning games, quizzes, worksheets by subjects including arts, foreign language, language arts, math, science and social studies. It also contains articles and research for teachers. www.honorpoint.com Multiplication Madness! This site has a multiplication table, review, study, and drill activities, as well as tests. It will also print a personalized report card with the results of the tests. www.aaamath.com This site is for students K-8th grade. It has basic skills study material, interactive practice, explanations and examples, and challenge games. It also can print results. www.maththatcounts.com The math that counts website contains applets, games that teach, problem solving information, geometry, and rational numbers. There are also teacher resources including information on special education and power point presentations. www.aplusmath.com This website contains games, flashcards, a flashcard maker, a homework helper and worksheets. www.starfall.com This is a website for phonics and reading. It contains games and ABC printouts. It includes 4 areas: ABCs, Learn to Read, Its Fun to Read, and Im Reading. The site is interactive and kid friendly. www.abcya.com K through 5th grade activities on the alphabet and numbers (multiples, counting, connect the dots). There are also mind speed games, which keep the brain working. www.funbrain.com Students can work on math or reading, go to the arcade or the playground on this site. www.4kids.org This site includes games, safe internet links related to academic activities, and other information. There are Ask Amy and Kids Quest. www.nationalgeographic.com The kids section of National Geographic provides information, stories, videos, games, and activities for children. www.pppst.com Petes Powerpoint Station provides children with powerpoints on multiple topics. www.multiplication.com There are games, activities, resources, and teaching tools for the multiplication tables on this website.
116
For Teachers:
Reading http://www.literacy.uconn.edu/compre.htm http://www.fcrr.org/Interventions/index.htm http://www.readingquest.org/strat/ http://www.readingrockets.org/articles/c82 http://www.greece.k12.ny.us/instruction/ela/612/reading/Reading%20Strategies/reading%20strategies%20index.htm http://www.greece.k12.ny.us/instruction/ela/6-12/Tools/Index.htm The Savvy Teachers Guide to Reading Interventions that Work @ www.interventioncentral.org www.ldonline.org Writing http://www.unc.edu/depts/wcweb/handouts/ http://www.k8accesscenter.org/training_resources/languagearts.asp#Wbrief http://www.specialeducation.ilstu.edu/csss/solutions/documents/writingfluency.html Writing Skills Checklist @ www.interventioncentral.org Math www.k8accesscenter.org http://www.kn.pacbell.com/wired/bluewebn/ http://maththatcounts.com http://ies.ed.gov/ncee/wwc/reports/ http://www.ldonline.org/indepth/math Hyperactivity http://www.nimh.nih.gov/health/publications/adhd/complete-publication.shtml (intro to disorder) http://www.ed.gov/teachers/needs/speced/adhd/adhd-resource-pt1.pdf (info & impact on children) http://maxweber.hunter.cuny.edu/pub/eres/EDSPC715_MCINTYRE/AddStrats.html (strategies) http://www.pb5th.com/selfmoni.shtml Off-task/Inattention http://www.chadd.org/AM/CustomPages/home/CHADD_Home.htm?CFID=5382746&CFTOKE N=32283138&jsessionid=f2301720951191519941500 (FAQs) http://www.aap.org/healthtopics/adhd.cfm (links to info) http://www.ed.gov/rschstat/research/pubs/adhd/adhd-teaching_pg3.html Organization/Study Skills http://www.dartmouth.edu/~acskills/success/ http://www.prenhall.com/success/StudySkl/ http://www.studygs.net/ http://www.ucc.vt.edu/stdysk/stdyhlp.html
117 Other Web-Based Resources Agency/Publication Council for Exceptional Children What Works Clearinghouse Georgia Reading First Peer-Assisted Learning Strategies Learning Focused Schools Everything ESL Learning Disabilities Online Learning Disabilities Association of America Intervention Central National Study of the Effectiveness of Reading Comprehension Interventions National Center on Student Progress Monitoring Access Center International Reading Association The National Center for Culturally Responsive Education Systems Scientifically-Based Research The Literacy Web at the University of Connecticut The Iris Center National Center on Response to Intervention Research Institute on Progress Monitoring Kansas University Center for research learning IDEA Partnership Center for Applied Special Technology U.S. Department of Education Website www.cec.sped.org www.w-w-c.org http://curry.edschool.virginia.edu/reading/pr ojects/garf http://kc.vanderbilt.edu/pals www.learningfocused.com www.wverythingesl.net www.ldonline.org www.ldanatl.org www.interventioncentral.org http://readingcomp.mathematical??r.com Area/Topic Special Education All subjects Reading
Reading & Math All subjects English Language Learners Learning Disabilities Learning Disabilities Academics & Behavior Reading
www.studentprogress.org www.k8accesscenter.org www.reading.org www.nccrest.org www.gosbr.net http://www.literacy.uconn.edu/compre.htm http://iris.peabody.vanderbilt.edu www.rti4success.org
Progress monitoring All subjects Reading English Language Learners All subjects Literacy RtI and academic resources RtI information, tools/interventions, events and discussion Research, resources, and products for progress monitoring Reading programs for High School Information and links to other organizations Universal Design Learning Research Based Intervention
www.progressmonitoring.org http://www.kucrl.org http://www.ideapartnership.org http://www.cast.org http://www.ed.gov/rschstat/research/pubs/rig orousevid/index.html
118 Florida Center for Reading Research Agency/Publication Reading Rockets www.fcrr.org Website www.readingrockets.org Reading Area/Topic Reading resources for teachers, parents and professionals Scientifically based research and information on K-12 instruction Resource for teachers and school professionals with printable worksheets Activities and printable worksheets for kids PBS Information on the EBIS program Information available for teachers, parents, and professionals on a variety of topics Research and tools for teachers and professionals Information about Autism Information, resources, and supports for individuals w/ ADHD Information and resources on TS Information and networking for RTI
Center on Instruction
www.centeroninstruction.org
Edhelper.com
www.edhelper.com
Kidzone
www.kidzone.ws/
Positive Behavioral www.pbis.org Interventions and Supports Effective Behavioral & http://ebis.valdosta.edu/ Instructional Supports National Association of School www.nasponline.org Psychologists
National Center for Educational Statistics Center for Disease Control and Prevention Children and Adults with Attention Deficit/ Hyperactivity Disorder Tourette Syndrome Association, Inc. RTI Action Network
http://www.nces.ed.gov
http://www.cdc.gov/ncbddd/autism/ http://www.chadd.org
http://www.tsa-usa.org http://www.rtinetwork.org

RtI Forms

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

RtI Forms

Uploaded by

Copyright:

Available Formats

Fidelity The following are procedures which may be used to assess the integrity or fidelity of an intervention (Lane &

OBSERVATION FIDELITY CHECKLIST

_______________________ Resources Teacher Behavior

Self Report Integrity Check

Books, worksheets, software, scope, and sequence

Seating charts, rules, school layout

Educational records, health records, prior tests and reports

Student Data Sheet

Baseline Level Goal Date

Current Level Goal Date

Pre-Referral Intervention Form

Referring Teacher: ___________________________________

Dates of Parent Contact: Phone ______________________ Conference__________________ Letter/Note __________________

Problem Identification Form

______________________________________ ______________________________________ ______________________________________ Date: ________________

Referring Teacher: ___________________________________________ 10

TIER 2: Interventions and Results

TIER 3: Interventions and Results

Title _________________ _________________ _________________ _________________

Supplemental Supportive Interventions

School: __________________________________________ Implementing Teacher: ______________________________

Grade: ____________ Date: ___________

Signed: ________________________________ (Parent or Legal Guardian)

Check Point 2: _________

End Date: _________

Interventionist Name: ______________________________ Case Manager Name: ______________________________

Title: ___________________ Title: ___________________

--------------------------------------------------------------------------------------Decision Point for Tier 2

Decision Point for Tier 3

Tier 2 Progress Monitoring

Progress Monitoring Measure: _______________

---------------------------------------cut here and return the bottom part--------------------------------

Appendix H Basic Reading Skills Work Sample Analysis

Reading Comprehension Work Sample Analysis

Grade Level of Assignment Instruction Task Presentation Response Expected

Mathematics Calculation Work Sample Analysis

Mathematical Reasoning Work Sample Analysis

Listening Comprehension Work Sample Analysis

Written Expression Work Sample Analysis

Written Expression, continued

Oral Expression Work Sample Analysis

Parent Signature: _______________________________

Was Time-out required: Yes No; If so how long _________ Comments:

Interval Target Peer

Interval Target Peer

Interval Target Peer

Behavior Observation Event Recording Student: ___________________________ Observer:_________________________________

Total number of occurrences: _______ Peer Comparison 1 2 3 16 17 18

Student Interview Rating Scales

Teacher Interview Testing

Description of Behavior (Antecedent):

Intensity (Consequences of problem behavior on student, peers, instructional environment):

Describe Previous Interventions:

50 25 10 Mean StdDev 90 75 50 25 10 Mean StdDev 90 75 50

Appendix N Speech/Language Referrals Student: ________________________________ Grade: __________ DOB: ____/____/_____

Student Response Ex. Play. [Model correct response: I am playing ball.]

Vocabulary Student: __________________________________ Grade: __________ Teacher: __________________________

Following Directions Student: __________________________________ Grade: __________ Teacher: __________________________

Modeling Student: __________________________________ Grade: __________ Teacher: __________________________

Target Sound Chart

Target Sounds in Words Student: __________________________________ Grade: __________ Teacher: __________________________

Sound Awareness Student: __________________________________ Grade: __________ Teacher: __________________________

Stuttering Student: __________________________________ __________________________ Grade: __________ Teacher:

http://www.bullystoppers.com/ http://www.hoagiesgifted.org/ and http://www.hoagiesgifted.org/parents.htm http://www.quizhub.com/quiz/quizhub.cfm http://www.kupsplace.org/index.html

Dates of Parent Contact: Phone __ Conference Letter/Note

______________ Date:

Title _________ _ _ _________

School: ____________ Implementing Teacher:

Grade: __ Date: _

Interventionist Name: Case Manager Name:

Title: _ Title: _

Behavior Observation Event Recording Student: _ Observer:_______

Appendix N Speech/Language Referrals Student: __________________________ Grade: DOB: //_

Vocabulary Student: ______ Grade: Teacher:

Following Directions Student: ______ Grade: Teacher:

Modeling Student: ______ Grade: Teacher:

Target Sounds in Words Student: ______ Grade: Teacher:

Sound Awareness Student: ______ Grade: Teacher:

Stuttering Student: __________________ Grade: Teacher: