Intervention Intensity Rating Form
New London School District
Teacher name:
Date:
Intervention Title/Description:
Check or circle the appropriate column, if hesitant, choose the higher of the two columns.
PREPARATION
1. Preparation for the
Intervention: certification or
other formal credentials
required to qualify person to
implement the intervention
2. On a per-pupil basis, the
cost to purchase or effort
needed to create the
intervention materials
3. Initial Training required to
use the intervention
IMPLEMENTATION
4. Amount of preparation
required for each session of the
intervention
5. Average time needed each
session to implement the
intervention
6. Degree to which the
intervention is tailored to the
unique needs of the target
student
7. Degree to which the
intervention can be carried out
by the educator as part of his or
her ‘typical’ instructional
routine
Column 1
No certification or
specialized credentials
required
Column 2
Certification or
specialized credentials
required, but commonly
available at school
Column 3
Certification or
specialized credentials
required
Intervention materials not
needed or do not entail
significant expense or effort
Intervention materials
required, at a modest cost or
with reasonable effort
Intervention materials per
pupil are costly or require
substantial effort to create
Little or no training
needed
Modest training needed(12 sessions)
Significant training
required (more than 2
sessions)
Little or no preparation is
needed
Some preparation needed
(15 minutes per session)
Little or no extra time is
needed
Some time is needed (up
to 30 minutes per session)
Intervention is likely to be
effective with a wide range
of students (e.g. use praise
statements)
Intervention is tailored to
the target students but could
also be applied to other
students who show similar,
somewhat common problems
Intervention requires that
the educator expend
moderate amount of
additional effort or time
beyond the usual instructional
routine
Substantial preparation
is needed (more than 15
minutes per session)
Substantial preparation
needed (more than 30 minutes
per session)
Intervention is highly
individualized to the needs of
the target student and unlikely
to be applicable to many other
students in the class or school
Intervention requires that
the educator expend
significant additional effort
or time beyond the usual
instructional routine
Intervention can be fully
integrated into the teacher’s
instructional routine.
8. Size of the developmental
gap between the stated
intervention outcome goal(s) of
the target student and the
‘typical’ academic or
behavioral levels of the
classroom or grade level
9. Potential of the intervention
to distract other students or
disrupt the learning of others
MONITORING OF THE
INTERVENTION
10. Effort required to monitor
the success of the intervention
TOTALS
Count the number of responses
in each column.
Intervention goal
approaches or matches the
academic or behavioral levels
of most students in the
classroom or grade level
Intervention goal falls
below the academic or
behavioral levels of most
students in the classroom or
grade level
Intervention goal falls
significantly below the
academic or behavioral levels
of most students in the
classroom or grade level
Intervention can be
implemented with little or no
disruption to students or
learning
Intervention is likely to
result in mild distraction of
students or mild disruption to
student learning
Intervention is likely to
result in significant
distraction of students or
significant disruption to
student learning
Monitoring requires little
additional effort (e.g. a
teacher who rates a student on
a Daily Behavior Report
Card)
Column Total
Monitoring requires
moderate additional effort
Monitoring requires
significant additional effort
(e.g. a psychologist who
carries out twice-weekly
direct observations)
Column Total
Column Total
How to use:
o If 7 or more of the 10 fall under any single tier it is likely that is the tier
o If you have a mixed pattern of ratings, the intervention should be considered the intensity of the highest column
containing at least 3 checks.
Tier intensity determined to be _____________________________________________________________________