Internship Assignment Guide
Assignment Planning: Intern Assignments and Due Dates
A1
A2
A3
A4
A5
A6
A7
A8
A9
A10
A11
Assignments
Academic RtI- Tier 1
Academic RtI- Tier 2
Academic RtI- Tier 3
Positive Behavior Support RtI- Tier 1
Positive Behavior Support RtI- Tier 2
Positive Behavior Support RtI- Tier 3
Individual Counseling
Small-Group Counseling
In-service Presentation
Evaluation Team Reports
By-Domain summary description and
evaluation of internship, including a
summary of ratings on Outline of
Objectives and ratings on two Intern
Evaluations of Internship. Reference D3,
D4, and three domain documents
Components
Address target audience (5 W + H)
Use report format for 1 – 6
Due Dates
March or May site visit or earlier
March or May site visit or earlier
March or May site visit or earlier
March or May site visit or earlier
March or May site visit or earlier
March or May site visit or earlier
March site visit or earlier
May site visit or earlier
March site visitor or earlier
March site visit or earlier
Portfolio presentation in June
Grading Term
Winter or Summer-1
Winter or Summer-1
Winter or Summer-1
Winter or Summer-1
Winter or Summer-1
Winter or Summer-1
Winter or Summer-1
Winter or Summer-1
Winter
Winter
Summer-1
ASSIGNMENT WRITTEN REPORT COMPONENTS
A1 A2 A3 A4 A5
12
12
12
12
12
15
15
15
15
15
Use supervisor likert scale for 1, 2, 4, 5, 7-10
16
16
Assess intervention/ treatment acceptability/validity
27
27
Assess treatment integrity/social validity
29
Include graph/progress-monitoring chart
Include evidence-based references
A6
12
15
16
16
27
28
28
28
29
29
30
30
30
8,9
8,9
8,9
8,9
8,9
8,9
14
14
14
14
14
14
Describe results of visual inspection of graph
9
9
9
9
9
9
Show and interpret Goal Attainment Scaling (GAS) (1-6)
7
7
7
7
7
7
Show and interpret % of non-overlapping data points (PND) (1-6)
8
8
8
8
8
8
Show and interpret effect size (ES) calculation (1-6)
9
9
9
9
9
9
Use supervisor rubric for 3 & 6 (Tier III)
Documents
D1
D2
D3
D4
Portfolio Guide
D5
D6
Daily Log
Case Log
17
Intern Evaluations of Internship
General
Specific
A8
12
A9
12
17
INTERNSHIP DOCUMENTS AND DUE DATES
Due Dates
Internship Training Timeline
Outline of Objectives
A7
12
Grading Term
June
August-Sept site visit
September, December, June
June, as part of portfolio
Summer-1
Fall
Fall, Winter, Summer-1
Summer-1
December, March & May site visits
December, March & May site visits
Fall, Winter, Summer-1
Fall, Winter, Summer-1
A10
12
A11
12
D7
End-of-Year Ohio Intern Impact
Intern Informed Consent
Demographic Report
Form for reporting GAS, ES & PND on
Six RtI Assignments
Ratings on Six Objectives from Outline
of Objectives
June, as part of Portfolio
Summer-1
SPECIFIC GUIDELINES FOR ASSIGNMENTS
Assignments A – F (RtI)
(Impact Data for the end-of-year Ohio Internship Evaluation Report for ODE)
Overview of the Guidelines for Gathering Impact Data
These guidelines are designed to enable the reliable and valid collection of impact data
across all nine Ohio university training programs. The following six pages detail the types of
summary statistics that are being sought and provide a step-by-step guideline for calculating each
step. Decision rules are also provided for assisting Intern School Psychologists in gathering data
that most accurately represent their impact on school-age students during their Internship year.
These data will be summarized state-wide for the evaluation, but may also be used by training
programs for NASP and other accreditation functions. Interns should also be encouraged to
gather and summarize these types of data in the future as measures of their professional
accountability.
Which Intervention Cases Should Be Included?
All Ohio Intern School Psychologists will complete at least one intervention in each of
five categories of Ohio’s Integrated Systems Model (OISM) for which they will submit outcome
data (see diagram below). Interns should select intervention cases that (a) show evidence of
instructional objectives of learningRtIfor eventual leadership roles, and (b) demonstrate discrete
skills across the RtI/OISM model. In order to be included in the statewide impact evaluation,
intervention cases should include (a) a discernible evidence-based instructional program or
intervention, (b) progress monitoring data, and (c) intervention integrity data. That is, if an Intern
implemented a small group intervention but progress was not monitored, there were no
adherence checks, and/or the program was not evidence-based, impact data should not be
reported.
Academic
Intervention
Positive Behavioral
Supports
Tier III
(intensive)
Required
(A3)
Required
(A6)
Tier II
(targeted)
Required
(A2)
Required
(A5)
Tier I
(universal)
Required
(A1)
Required
(A4)
Description of Interventions for Each Required OISM Category
1. Academic RtI - Tier I: (a) prevention or positive instructional managerial interventions that are classwide; or (b) defined as typical managerial, that is, what a master teacher might do within his or her role
that has a research base (e.g., more productive practice time, differential attention, contracts to increase
academic performance, etc.) to help one or more students in a classroom. Past interns have assisted a
teacher in conducting an academic needs assessment, co-taught a skill shown to be weak in the preassessment, and monitored progress.
2. Academic RtI– Tier II: (a) small group or (b) embedded and scripted instruction to increase productive
practice time (e.g., reciprocal teaching). If you have multiple groups, select ONE group with parent
permissions for portfolio use, or the group having the most permissions returned. All data paths in a
group would be summarized. For example, if you have 10 children in a group, and 6 parents return
permission, you would report a 60% return rate & summing up (GAS, ES, PND) for the 6 students only.
3. Academic RtI– Tier III: intensive & individualized (e.g., an academic case study using cover-copycompare to learn sight words or number facts). Interventions would meet all of the data requirements for
technical adequacy (i.e., measurement & progress monitoring, decision rule use, evidence-based
intervention, Inter-Observer Agreement (IOA) checks, adherence checks, etc). If entry includes eligibility
decision making, legal checks would also be evident.
4. Positive Behavior Support RtI- Tier I: (a) prevention or positive instructional managerial interventions
that are class-wide; or (b) defined as typical managerial, that is, what a master teacher might do within his
or her role that has a research base (e.g., more productive practice time, differential attention, behavioral
contract, mystery motivator, etc.) to help one or more students in a class.
5. Positive Behavior Support RtI– Tier II: (a) small group (e.g., social behaviors) or (b) embedded
instruction to increase positive practice time (e.g., scripted incidental teaching of social behaviors). If you
have multiple groups, select ONE group with parent permission for portfolio use, or the group having the
most permissions returned. All data paths in a group would be summarized. For example, if you have 10
children in a group, and 6 parents return permission, you would report a 60% return rate & summing up
(GAS, ES, PND) for the 6 students only.
6. Positive Behavior Support RtI– Tier III: intensive & individualized (e.g., a behavioral case study using
a behavioral contract and response cost lottery to increase time on task). Interventions would meet all of
the data requirements for technical adequacy (i.e., measurement & progress monitoring, decision rule use,
evidence-based intervention, (IOA) checks, adherence checks, etc). If entry includes eligibility
considerations, legal checks would also be evident.
Outcome Measures for Demonstrating Impact
All Ohio Interns will submit Goal Attainment Scaling (GAS) data. A step-by-step guide and a form for
GAS are provided on the next page. In addition to reporting GAS data, interns are also asked to provide
either Percentage of Non-overlapping data (PND) and/or Effect Size (ES) data for each intervention entry.
Step-by-step guidelines for PND and ES are also provided in this document.
Step-by-Step Guide to Developing Goals and Using Goal Attainment Scaling
Ohio School Psychology Internship Program
STEP 1
Specify the Expected Level of Outcome for the Goal
As part of the problem-solving process, you will develop a goal statement that that is
observable, measurable, and specific.
 Goals should be based on baseline data.
 Goals should be realistically ambitious, based upon what the student will likely
achieve by the end of the intervention.
 Goals should take into consideration the usual outcomes of this intervention, the
resources of the student, the amount of time planned for intervention, and the skills
of the intervention specialist/change agent.
 Goals should be socially valid (i.e., acceptable to teachers, parents, and the student).
 Goals should be stated in the positive (i.e., promoting replacement behaviors)
STEP 2
Review the Expected Level of Outcome given the following considerations
 Relevance: Is the goal relevant to the student’s present situation?
 Availability of Services: Are the intervention services necessary to attain this goal
available?
 Scale Realism: Is the expected level of outcome realistic for this student at this time
with this intervention?
STEP 3
Specify the Somewhat More and Somewhat Less Than Expected Levels of Outcome for the Goal
 Provide observable, measurable descriptions of outcomes that are more or less
favorable than the expected outcomes in the boxes immediately below and
immediately above, respectively.
 These descriptions are less likely to occur for this student, but still represent
reasonably attainable outcomes.
STEP 4
Specify the Much More and Much Less Than Expected Levels of Outcome
 Complete the extreme levels of the scale with descriptions of the indicators that are
“much more” and “much less” favorable outcomes that can be realistically envisioned
for the student.
 Each extreme level represents the outcome that might be expected to occur in 5% to
10% of similar at-risk students.
OHIO INTERNSHIP EVALUATION
GOAL ATTAINMENT SCALING FORM, 2008-09
UNIVERSITY OF DAYTON
Intern: ________________________
LEVEL OF
ATTAINMENT
Much worse
Than
expected
-2*
Slightly
worse than
expected
-1
No change
0
School Disstrict: ___________________________
(A1)
Academic
Intervention
(A2)
Academic
Intervention
(A3)
Academic
Intervention
Tier I
Tier II
Tier III
(A4)
Positive
Behavioral
Support
Tier I
(A5)
Positive
Behavioral
Support
Tier II
(A6)
Positive
Behavioral
Support
Tier III
Slightly
improved
Over
expectation
+1
Much
Improved
Over
expectation
+2*
*Each extreme level (-2, +2) represents the outcome that might be expected to occur in 5% to 10% of similar at-risk students.
Use a separate form for each assignment.
Use bold font to identify the content of the cell that corresponds to the level actually attained.
In the cell that corresponds to the level actually attained, also enter ES and/or PND.
Step-by-Step Guide for Calculating Percentage of Non-overlapping Data
Ohio School Psychology Internship Program
For an intervention designed to increase the target behavior, determine the percentage of the intervention
data points that fall above the highest baseline data point. In the example that follows, all but the first
intervention data point are above the highest baseline data point. Therefore 9 of the 10 intervention data
points do not overlap the baseline. The PND = 90%.
Baseline
Intervention
For an intervention designed to decrease the target behavior, determine the percentage of the intervention
data points that below above the lowest baseline data point. In the example that follows, the first four
intervention data points are above the lowest baseline data point. Therefore, 6 of the 10 intervention data
points do not overlap the baseline. The PND = 60%.
Baseline
Intervention
Considerations When Using PD
 PND should not be used if there are extreme scores, such as a 0 in the baseline for a target behavior you
want to decrease or an extremely high value in the baseline for a target behavior you want to increase.

PND scores above 85% indicate the intervention is highly effective; scores between 65% and
85% show moderate intervention effects. PND scores between 50% and 65%, or below, would be
considered of questionable effectiveness.
Step-by-Step Guide for Calculating Effect Sizes
Ohio School Psychology Internship Program
STEP 1
Calculate the mean of the baseline data points. In the example below, the mean of the three baseline data
points (18, 4, 12) is 11.3.
STEP 2
Calculate the mean of the intervention data points. In the example below, the mean of the ten intervention
data points (10, 5, 9, 11, 5, 5, 1, 4, 3, 2) is 5.5.
STEP 3
Calculate the standard deviation of the baseline data points. In the example below, the standard deviation
of the three baseline data points (18, 4, 12) is 7.0.
STEP 4
Calculate the difference between the mean of the intervention data and the mean of the baseline data and
divide that by the standard deviation of the baseline data.
ES = mean of the intervention data – mean of the baseline data
standard deviation of baseline data
In the example below,
ES = 5.5 – 11.3 = -0.83
7.0
Baseline
Intervention
Considerations When Using ES



ES should not be used if the baseline data are limited (one or two points only).
ES should not be used if there is no variability in the baseline data (SD = 0)
An ES of +.80 or greater is considered large; an ES of +.50-.79 is considered moderate; an ES of
+.20-.49 is considered small.
Assignment A7 (Individual Counseling)
Submit a description of your implementation of individual counseling, using either the problemsolving model taught in your counseling lab course, the solution-focused counseling model
taught during your intern seminars, or an approach you develop. See field-supervisor evaluation
tool on page 23.
Assignment A8 (Small-Group Counseling)
Submit a description of your implementation of small-group counseling or co-counseling, using
a curriculum designed to deal with a specific pupil problem, such as divorce, social skills, anger
management, study skills, or self-esteem. See field-supervisor evaluation tool on page 24.
Assignment A9 (In-service Presentation)
Submit a description of an in-service presentation for which you were a primary developer and
presenter. Include copies of PowerPoint slides and handouts, and the results of an evaluation of
the in-service by the audience members. Ideally, the in-service planning should include a needs
assessment. See field-supervisor evaluation tool on page 25.
Assignment A10 (Evaluation Team Reports)
Submit blinded copies of two ETRs for initial MFEs for which you were the primary evaluator
and report preparer. See field-supervisor evaluation tool on page 26.
Assignment A11 (Written Internship Summary Description and Evaluation)
Submit a by-Domain summary description and evaluation of internship, including a summary of
ratings on Outline of Objectives and ratings on two Intern Evaluations of Internship. Reference
D3, D4, and three domain documents.
Insuring/Assessing Treatment/Intervention Acceptability/Social Validity





include implementers and other stake holders
should not be limited to including these persons in intervention planning
include something more formal than simply orally asking paRtIcipants their opinions
rating scale is preferred
ratings methods could include the following techniques:
1. ratings of ease of implementation,
2. ratings of the degree to which intervention is perceived as positive (e.g., modeling,
coaching) versus punitive or aversive,
3. ratings of perceived effectiveness of intervention (degree to which the interventionist
believes that the treatment is likely to address the identified concern), and/or
4. ratings or considerations of the match between intervention and its setting (e.g.,
minimally disruptive to classroom ecology, minimally punishing to teachers’ efforts
to maintain the treatment, availability of interventions in setting, training required of
interventionist, degree of effort required given the severity of child’s problem).
Insuring/Assessing Treatment Integrity/Validity












choose interventions that focus on keystone behaviors
choose interventions that have empirical support
choose interventions that are easy to implement
choose interventions that are positive
choose interventions that match the treatment setting
employ an intervention script or treatment manual
provide guided practice and feedback
employ treatment integrity checks (intervention monitoring)
employ a written treatment integrity plan
employ a plan that involves at least one other person/colleague/team member beside the
intervention implementer
employ a plan that gathers objective intervention integrity data
methods could include the following techniques:
1. direct observation (A person observes the intervention while it is being
implemented. The observer records for each step of the intervention plan if the
step occurred or did not occur. At the end of the observation, it is possible to
calculate a treatment integrity percentage, the more the intervention was
implemented with integrity. Direct observation is the most reliable and valid
method for assessing treatment integrity.)
2. rating scale (A person observes the intervention while the teacher is implementing
it. At the end of the observation period, the person rates each step of the
intervention in terms of whether he or she perceives that it was implemented by
the teacher with a high level of integrity or as intended, or with low level of
integrity, meaning it was not implemented as all.)
3. self-report (The teacher implementing the intervention is asked to complete a selfreport form after the period when the intervention was implemented. Each step of
the intervention is listed, and the teacher indicates for each step if he or she
believes the step was implemented with a high or low level of integrity.)
4. interview (A person interviews the teacher responsible for implementing the
intervention. For each step of the intervention plan, the interviewer asks if the
steps were implemented as intended and records the teacher’s answers.)
Insuring/Assessing Treatment Effectiveness



regular and frequent monitoring and chaRtIng of progress compared to baseline,
apply decision rules for changing interventions as needed, based on analysis of progressmonitoring data
Could include
teacher tallies,
self-monitoring tallies,
teacher or parent tallies,
behavioral ratings for target behaviors,
review of work products,
CBM measures of academic fluency,
progress monitored toward achievement of PPOs, skills, rubric, etc.,
evidence of increase in correct answers or decrease of errors in fixed time period
evidence of frequency of desired behavior (increase or decrease), or of
replacement behaviors
where progress-monitoring data are available, should include visual analysis of
charted data, plus calculations of effect size, percentage of non-overlapping data
points, and Goal Attainment Scaling
Intended Audience for Written Reports of Assignments
You should assume that you are preparing your assignments in response to an inquiry by a board
of education member or a newspaper reporter. (Be sure to protect the confidentiality of any
personally-identifiable content.) Imagine that these persons have asked you for a description of
each assignment, including its results and their interpretation. Assume that the content to be
addressed for each assignment is, “Describe your __________ assignment, including the results.”
As you know, such descriptions should address “who, what, why, where, when, and how”
elements, as appropriate.
Selected Helpful Chapters in Interventions Text
Shinn, M. R., Walker, H. M, & Stoner, G. (2002). Interventions for academic and behavior
problems II: Preventive and remedial approaches. Bethesda, MD: NASP.
6.
Using Curriculum-Based Measurement in General Education Classrooms to Promote
Reading Success
9.
Evaluation Strategies for Preventing and Remediating Basic Skill Deficits
10.
Selecting and Evaluating Classroom Interventions
12.
Behaviorally Effective School Environments
16.
Self-Monitoring Procedures for Children and Adolescents
20.
Building, Implementing, and Sustaining a Beginning Reading Improvement Model:
Lessons Learned School by School
21.
Promoting Mathematics Achievement
23.
Classwide Peer Tutoring Programs
24.
Interventions for Improving Study Skills
26.
Remedial Interventions for Students With Reading Decoding Problems
27.
Interventions for Students With Reading Comprehension Problems
28.
Adapting Challenging Textbooks to Improve Content Area Learning
33.
Interventions for Attention Problems
Criteria for Classification of Interventions as Evidence-Based
A. At least two between-group design studies, with a minimum of 30 subjects across studies
receiving the same treatment for the same target problem, and with prospective design and
random assignment of subjects to conditions. Findings must show the treatment to be (a) better
than the control or comparison groups or (b) equivalent to an already-established evidence-based
treatment (EBT).
OR
B. At least two within-group or single-case design studies, with a minimum of 30 subjects
across studies receiving the same treatment for the same target problem, and with prospective
design and random assignment of subjects to conditions. Findings must show the treatment to be
better than the control or comparison conditions, following establishment of a reliable baseline.
OR
C. A combination of one or more between-group and one or more within-group or single-subject
studies, with a minimum of 30 subjects across studies receiving the same treatment for the same
target problem. Studies must meet the appropriate criteria notes in A and B.
AND
D. The majority of applicable studies must support the treatment.
E. The treatment procedures must show acceptable adherence to the treatment program.
Adapted from Elliott, S. H., Kratochwill, T. R., & Callan-Stoiber, K. (2002) Selecting and
evaluating classroom interventions. In M. A. Shinn, M. R., Walker, H. M, & G. Stoner (Eds.)
Interventions for academic and behavior problems II: Preventive and remedial approaches, (p.
251), Bethesda, MD: NASP.
Format for RtI Assignment Write-ups
(Assignments A1 - A6)
Context Definition
Problem Analysis
Norm
Baseline
Hypothesis Testing
Intervention
Design/description/progress
Social validity/treatment acceptability
Treatment/implementation integrity/validity
Alterations in interventions as indicated by progress-monitoring data
Evaluation
Progress monitoring chart
Visual inspection of chart
Effect Size
Percent of non-overlapping data points (PND)
GAS
Case study rubric or rating tool (where indicated)
References
GENERIC EVALUATION FORM FOR RtI INTERVENTION
(for use with assignments A1, A2, A4, A5)
ASSIGNMENT (A1, A2, a4 or A5): _________
Teacher __________________ School ___________Grade _____ Date Completed _________
(Pseudonym)
Context defined
Problem analysis included
classroom norms
Problem analysis included
baseline data gathered (at
least three data points)
Hypotheses formulated
and tested
Intervention design and
intervention progress
described
Social validity/treatment
acceptability assessed
Treatment/implementation
integrity/validity assessed
Alternate intervention
implemented (if needed),
based on progressmonitoring data
Progress monitoring chart
completed
Evaluation of visual
inspection of chart
described
Effect size calculated and
described
PND calculated and
described
GAS form completed
Very
Inappropriate
1
Inappropriate
Adequate
Appropriate
2
3
4
Very
Appropriate
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Supervisor Signature _______________________________
Date of Rating ______________
Tier III Assignment Evaluation Rubric
Tier 3 Academic (A3) & Positive Behavior Support Assignments (A6)
Section 1.0
Local Norms: Local norms and outcome goals were established for class.
Outstanding
Competent
Needs Development
1.1
Teacher consultation provided both
classwide behavioral and/or academic
goals and a target date to accomplish the
classwide goals
Teacher consultation provided only
classwide behavioral and/or academic
goals or a target date to accomplish the
classwide goals
Teacher consultation did not
provide classwide behavioral
and/or academic goals and a
target date to accomplish the
classwide goals
1.2
The class goal statement(s) was
written in observable, measurable terms,
and was based on the all of the following:
Review of curriculum for
academic goals, AND
Task analysis for academic
and/or behavioral target
goals, AND
Description of class-wide
instructional methods to
address the academic and/or
behavioral target goals
The class goal statement(s) was
written in observable, measurable terms
The class goal statement(s)
was NOT written in observable,
measurable terms
Local norms were established
through direct observation, criteria-based
instrument(s), or curriculum-based
measurement (Classes that do not have
established local norms will need to have
at least 3 administrations of each measure
conducted over a several week period to
determine average rate of change per
week or stability for class.)
Local norms were established
through direct observation, criteria-based
instrument(s), or curriculum-based
measurement
Local norms and/or goals
were underdeveloped
Technology was used in the
gathering and synthesis of data
Technology was not used in
the gathering and synthesis of
data
1.3
1.4
Rating for 1.0
Outstanding:
All components in the
Competent and
Outstanding categories
are checked
Substantially
Developed: All
components in the
Competent category
plus some
components in the
Competent: All
components in the
competent category are
checked
Threshold
Development: Some
components in the
competent category are
checked
Needs
Development: Only
components in the
Needs Development
category are checked
Outstanding category
are checked
Section 2. Problem Identification & Analysis: The at-risk student and academic/behavioral concern(s) are identified and
clarified.
Outstanding
Competent
Needs Development
2.1
One at-risk student is identified
One at-risk student was not
clearly identified
2.2
The at-risk student's academic and/or
behavioral concern(s) is identified and
operationally defined using class goals
and local norms
The at-risk student's
academic and/or behavioral
concern(s) is identified but NOT
operationally defined using class
goals and local norms
2.3
The problem was identified and
defined collaboratively
The problem was NOT
identified and defined
collaboratively
A baseline for the at-risk student is
established for the concern(s)
A baseline for the at-risk
student is NOT established or is
inappropriate
2.4
2.5
Skill analysis was conducted and
included all of the following:
Error analysis,
Direct observation of skill,
Criteria-based assessment, OR
curriculum-based assessment
Skill analysis was conducted and
included one or more of the following:
Error analysis,
Direct observation of skill,
Criteria-based assessment, OR
curriculum-based assessment
No skill analysis was
conducted, or analysis was
inappropriate for the identified
concern(s)
2.6
Performance analysis was conducted
and included all of the following:
Record review for historical
documentation of peRtInent
information,
Student interview,
Ecological or situational
analysis of concern (e.g.,
routines, expectation-skill
match, relationships,
classroom environment,
adult/teacher support, cultural
issues)
Direct observation (e.g., ontask)
Parent interview
Performance analysis was conducted
and included one or more of the
following:
Record review for historical
documentation of peRtInent
information,
Student interview,
Ecological or situational
analysis of concern (e.g.,
routines, expectation-skill
match, relationships,
classroom environment,
adult/teacher support, cultural
issues)
Direct observation (e.g., ontask)
Parent interview
No performance analysis was
conducted, or analysis was
inappropriate for the identified
concern(s)
Rating for 2.0
Outstanding:
All components in the
Competent and
Outstanding categories
are checked
Section 3.0
Substantially
Developed: All
components in the
Competent category
plus some components
in the Outstanding
category are checked
Threshold
Development: Some
components in the
competent category are
checked
Needs
Development: Only
components in the
Needs Development
category are checked
Hypothesis Testing: Hypotheses were developed and tested
Outstanding
Competent
Needs Development
Hypotheses were generated through
collaboration with teacher and/or parent
Hypotheses were generated
without collaboration with teacher
and/or parent
Multiple hypotheses were developed
to identify the cause or source of each
problem
A hypothesis was developed to
identify the cause or source of each
problem
No hypotheses were
developed
Each of the multiple hypotheses was
tested to confirm the cause or source of
the problem using one or more of the
following methods:
Direct observation,
Analogue assessment,
Functional assessment,
Self-monitoring assessment,
Other
One hypothesis was tested to confirm
the cause or source of the problem using
one or more of the following methods:
Direct observation,
Analogue assessment,
Functional assessment,
Self-monitoring assessment,
Other
Hypothesis testing did not
occur
The hypothesis reflected awareness of
individual differences (e.g., biological,
social, linguistic, cultural)
The hypothesis did NOT
reflect awareness of individual
differences (e.g., biological,
social, linguistic, cultural)
Hypothesis testing linked the
academic and/or behavioral problem(s)
with the intervention
Hypothesis testing did NOT
link the academic and/or
behavioral problem(s) with the
intervention
3.1
3.2
Competent: All
components in the
competent category are
checked
3.3
3.4
3.5
Rating for 3.0
Outstanding:
All components in the
Competent and
Outstanding categories
are checked
Substantially
Developed: All
components in the
Competent category
plus some
components in the
Outstanding category
are checked
Competent: All
components in the
competent category are
checked
Threshold
Development: Some
components in the
competent category are
checked
Needs
Development: Only
components in the
Needs Development
category are checked
Section 4.
Intervention: Intervention was implemented and monitored
Outstanding
Competent
Needs Development
4.1
Goal statement(s) was written in
observable, measurable terms
Goal statement was NOT written
in observable, measurable terms
4.2
Goal statement(s) emerged from the
problem analyses and hypothesis testing
Goal statement(s) did NOT
emerge from the problem analyses
and hypothesis testing
4.3
Intervention(s) was developed
collaboratively
Intervention(s) was NOT
developed collaboratively
4.4
Intervention(s) logically linked to the
referral question
Intervention was NOT linked to
referral question
4.5
Intervention(s) logically linked to the
hypothesis
Intervention(s) did NOT logically
link to the hypothesis
4.6
Intervention(s) logically linked to the
goal statement
Intervention(s) did NOT logically
link to the goal statement
Intervention(s) was described including
procedures for one or more of the following:
Promoting new or replacement
behaviors/skills
Increasing existing
behaviors/skills
Reducing interfering problem
behaviors
Facilitating generalization
Intervention(s) was NOT
described in enough detail to ensure
appropriate implementation
4.7
Logistics of setting, time, resources and
personnel required for intervention and data
gathering were defined and implemented
4.8
Support was provided to justify the use of
the intervention as evidence-based practice
(e.g., research literature, functional analysis)
Intervention(s) was implemented
4.9
Acceptability of intervention by teacher,
parent and child was verified
Intervention reflected sensitivity to
individual differences, resources, classroom
practices, and other system issues
4.10
Treatment/intervention integrity was
monitored to assure appropriate
Intervention(s) was monitored
Intervention(s) was limited to
determination of eligibility for special
education services or referral for
services external to the school and/or
the home
Intervention did NOT reflect
sensitivity to individual differences,
resources, classroom practices, and
other system issues
Intervention(s) was NOT
monitored
implementation
Rating for 4.0
Outstanding:
All components in the
Competent and
Outstanding categories
are checked
Section 5.0
intervention.
Substantially
Developed: All
components in the
Competent category
plus some components
in the Outstanding
category are checked
Competent: All
components in the
competent category are
checked
Threshold
Development: Some
components in the
competent category are
checked
Needs
Development: Only
components in the
Needs Development
category are checked
Evaluation and Recommendations: Data were gathered and documented to demonstrate efficacy of
Outstanding
Competent
Needs Development
5.1
Goal attainment was plotted at the
end point and compared to baseline
Progress monitoring data were
plotted on a graph or chart
Progress monitoring data
were NOT plotted on a graph or
chart
5.2
Goal attainment was plotted at the
end point and compared to the desired
goal
Data were provided as evidence of
measurable, positive impact toward
stated goal
Data were NOT provided to
document student progress
5.3
Single-case design was specified
(e.g., changing criterion, withdrawal,
multiple baseline, alternating treatments)
to prove efficacy of intervention
Single-case design was not
specified (e.g., changing criterion,
withdrawal, multiple baseline,
alternating treatments) to prove
efficacy of intervention
5.4
Current technologies were used to
present data
Current technologies were
not used to present data
5.5
Data were obtained through multiple
methods and were presented in support
of student's progress from two or more of
the following:
Direct observation
Rating scale
Peer comparison
Self-monitoring
CBM
Other
Evidence in support of student's
progress from one of the following:
Direct observation
Rating scale
Peer comparison
Self-monitoring
CBM
Other
No evidence was provided in
support of student's progress
5.6
Intervention quality and integrity
were monitored with a formal measure
Intervention quality and integrity
were monitored but the formal measure
was not clearly specified
Intervention quality and
integrity were not monitored
5.7
Effectiveness of intervention was
examined collaboratively
Effectiveness of intervention was
examined, but evidence of collaboration
in the examination was not included
Effectiveness of intervention
was not examined
5.8
Intervention limitations and side
effects were described
Intervention limitations or side
effects were described
Intervention limitations and
side effects were not described
5.9
Strategies for follow-up were
developed collaboratively
Suggestions for follow-up were
provided
Suggestions for follow-up
were NOT provided
5.10
Goal Attainment Follow-up Guide
was developed prior to initiation of
intervention.
Level of goal attainment was
determined
Changes in intervention and/or
follow-up recommendations were made,
as indicated by Follow-up Guide.
Level of goal attainment was
determined
Changes in intervention and/or
follow-up recommendations were made.
Level of goal attainment was
not determined.
5.11
Effect size was calculated and
demonstrated a positive, measurable
outcome.
5.12
Percent of Non-overlapping data
points was calculated and demonstrated a
positive, measurable outcome.
Effect size was calculated.
Percent of Non-overlapping data
points was calculated
Effect size was not
calculated.
Percent of Non-overlapping
data points was not calculated
Rating for 5.0
Outstanding:
All components in the
Competent and
Outstanding categories
are checked
Substantially
Developed: All
components in the
Competent category
plus some components
in the Outstanding
category are checked
Competent: All
components in the
competent category are
checked
Threshold
Development: Some
components in the
competent category are
checked
Needs
Development: Only
components in the
Needs Development
category are checked
Overall Rating for Case Study (A rating of Competent or higher is required to pass)
Outstanding:
Case study is rated
Outstanding in all five
Sections
Substantially
Developed: Case
study is rated
Competent or higher
for all Sections and
Substantially
Developed or higher
in one or more
sections
Competent: All
five Sections of the
Case Study are rated
competent
Threshold
Development: Some but
not all Sections are
rated Competent
Needs
Development: Sections
are only rated Needs
Development
Case study submitted by:
Date:
Case study reviewed by:
Date:
SAMPLE* EVALUATION OF INDIVIDUAL COUNSELING
Assignment A7
(Intern ___________________________)
Pupil __________________ School ___________ Age ___ Grade ___ Date Completed _________
(Pseudonym)
Very
Inappropriate Adequate Appropriate
Very
Inappropriate
Appropriate
Obtains permission for
1
2
3
4
5
counseling following
receiving referral
Builds rapport
1
2
3
4
5
Leads pupil in exploration
of problem
1
2
3
4
5
Confirms identification of
problem with pupil
1
2
3
4
5
Establishes baseline,
where appropriate
1
2
3
4
5
Leads pupil in exploration
of possible solutions
1
2
3
4
5
Leads pupil in evaluating
pros and cons of each
possible solution
Assists pupil in selection
of solution to try
1
2
3
4
5
1
2
3
4
5
Assists pupil in designing
solution plan
1
2
3
4
5
Obtains pupil commitment
to plan
1
2
3
4
5
Assists pupil in
monitoring plan
implementation
1
2
3
4
5
Assists pupil in evaluating
plan effectiveness
1
2
3
4
5
Conducts follow-up
evaluation
1
2
3
4
5
* Interns may develop a different evaluation tool for this assignment, depending on what counseling approach they
adopt.
Supervisor Signature _______________________________
Date of Rating ______________
EVALUATION OF SMALL-GROUP COUNSELING
Assignment A8
(Intern ___________________________)
School __________________ Ages ___ Grades ___ Date Completed _________
Very
Inappropriate
1
Inappropriate
Adequate
Appropriate
2
3
4
Very
Appropriate
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Convenes group
1
2
3
4
5
Establishes baseline
1
2
3
4
5
Implements counseling
sessions
Monitors progress
1
2
3
4
5
1
2
3
4
5
Evaluates counseling
effectiveness
Conducts follow-up
evaluation
1
2
3
4
5
1
2
3
4
5
Participates in needs
assessment
Establishes purpose/goal
of counseling
Obtains permission for
counseling
PaRtIcipates in pupil
selection
Plans counseling
Supervisor Signature _______________________________
Date of Rating ______________
EVALUATION OF INSERVICE PRESENTATION
Assignment A9
(Intern ___________________________)
School __________________ Topic__________________ Date Completed _________
Very
Inappropriate
1
Inappropriate
Adequate
Appropriate
2
3
4
Very
Appropriate
5
1
2
3
4
5
Conducts needs
assessment
1
2
3
4
5
Plans inservice
1
2
3
4
5
Prepares inservice
1
2
3
4
5
Prepares evaluation tool
1
2
3
4
5
Delivers inservice
1
2
3
4
5
Conducts evaluation of
inservice
1
2
3
4
5
Summarizes results of
evaluation
1
2
3
4
5
Collaborates in
brainstorming possible
needs for inservice
Designs needs assessment
Supervisor Signature _______________________________
Date of Rating ______________
EVALUATION OF EVALUATION TEAM REPORT
Assignment A10
Very
Inappropriate
1
Inappropriate
Adequate
Appropriate
2
3
4
Very
Appropriate
5
Selects assessment procedures
for given eligibility
determination and student
characteristics.
Describes each assessment
procedures (area).
1
2
3
4
5
1
2
3
4
5
Provides summary
interpretation for each
assessment procedure.
1
2
3
4
5
Includes instructional
implications in the assessment
summaries for each procedure.
1
2
3
4
5
Provides integrated summary
of multifactored assessment.
1
2
3
4
5
Provides instructional
implications drawn from
integrated multifactored
assessment results.
Use clear and concise language
throughout the report.
1
2
3
4
5
1
2
3
4
5
Plans assessments for referred
eligibility determination.
Supervisor Signature _______________________________
Date of Rating ______________
Sample Treatment Acceptability Questionnaire – for Academic Interventions (A1-A3)*
Respondent _________________ Date ____________
Please circle the numbers to indicate your opinion about the intervention that we have prepared.
Strongly Disagree
Slightly
Agree
Disagree
Disagree
1
This is an acceptable intervention for the child’s
1
2
3
4
achievement behavior.
2
Most teachers would find this intervention appropriate for 1
2
3
4
the child’s achievement problem.
3
The intervention should prove effective in changing the
1
2
3
4
child’s problem behavior.
4
I would suggest the use of this intervention to other
1
2
3
4
teachers.
5
The child’s behavior problem is severe enough to warrant 1
2
3
4
use of this intervention.
6
I would be willing to use this intervention in the
1
2
3
4
classroom setting.
7
I believe I have sufficient understanding of the
1
2
3
4
intervention.
8
The intervention would not result in negative side-effects 1
2
3
4
for the child.
9
The intervention would not result in negative effects for
1
2
3
4
other children in the child’s classroom.
10 The intervention would be appropriate for a variety of
1
2
3
4
children.
11 The intervention is consistent with those I have used in
1
2
3
4
classroom settings.
12 I am confident in my ability to use this intervention
1
2
3
4
13
14
15
16
17
The intervention is a fair way to handle the child’s
achievement problem.
The intervention is reasonable for the achievement
problem described.
The intervention would improve the child’s achievement
to the point that it would not noticeably deviate from
other classmates’ behavior.
Soon after using the intervention, the teacher would
notice a positive change in the achievement problem.
The child’s achievement will remain at an improved level
even after the intervention is discontinued.
Strongly
Agree
5
5
5
5
5
5
5
5
5
5
5
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
18
Using the intervention should not only improve the
1
2
3
4
5
child’s achievement in the classroom, but also elsewhere
(e.g., other classrooms, home).
19 The intervention should produce enough improvement in
1
2
3
4
5
the child’s achievement so that it no longer is a problem
in the classroom.
20 Other skills related to the achievement problem also are
1
2
3
4
5
likely to be improved by the intervention.
* Adapted from Kratochwill, T. R., Elliott, S. N., & Callan-Stoiber, K. (2002). Best practices in school-based
problem-solving consultation. In A. Thomas & J. Grimes (Eds.) Best practice in School Psychology IV, (pp. 603604), Bethesda, MD: NASP.
Sample Treatment Acceptability Questionnaire – for Behavior Interventions (A4 – A6)*
Respondent ________________ Date _________
Please circle the numbers to indicate your opinion about the intervention that we have prepared.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
This is an acceptable intervention for the child’s problem
behavior.
Most teachers would find this intervention appropriate for
the child’s behavior problem.
The intervention should prove effective in changing the
child’s problem behavior.
I would suggest the use of this intervention to other
teachers.
The child’s behavior problem is severe enough to warrant
use of this intervention.
I would be willing to use this intervention in the
classroom setting.
I believe I have sufficient understanding of the
intervention.
The intervention would not result in negative side-effects
for the child.
The intervention would not result in negative effects for
other children in the child’s classroom.
The intervention would be appropriate for a variety of
children.
The intervention is consistent with those I have used in
classroom settings.
I am confident in my ability to use this intervention
The intervention is a fair way to handle the child’s
behavior problem.
The intervention is reasonable for the behavior problem
described.
The intervention would improve the child’s behavior to
the point that it would not noticeably deviate from other
classmates’ behavior.
Soon after using the intervention, the teacher would
Strongly
Disagree
1
Disagree
Agree
2
Slightly
Disagree
3
4
Strongly
Agree
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
notice a positive change in the problem behavior.
The child’s behavior will remain at an improved level
1
2
3
4
5
even after the intervention is discontinued.
18 Using the intervention should not only improve the
1
2
3
4
5
child’s behavior in the classroom, but also elsewhere
(e.g., other classrooms, home).
19 The intervention should produce enough improvement in
1
2
3
4
5
the child’s behavior so the behavior no longer is a
problem in the classroom.
20 Other behaviors related to the problem behavior also are
1
2
3
4
5
likely to be improved by the intervention.
*Adapted from Kratochwill, T. R., Elliott, S. N., & Callan-Stoiber, K. (2002). Best practices in school-based
problem-solving consultation. In A. Thomas & J. Grimes (Eds.) Best practice in School Psychology IV, (pp. 603604), Bethesda, MD: NASP.
17
Sample Treatment Integrity Checklist – for Academic Intervention (Paired Reading)
Peer Tutoring Observation Form
Tutor ______________________ Tutee ___________Observer ________________
Date _________ Location ____________ Start Time _______ End Time ________
1. Use of praise. The tutor praised the student _______ times during the observation.
2. Strategies to Build Reading Fluency: Use the rating items below that match the reading fluency
strategy used by your peer tutors (i.e., Paired Reading or ‘Listening While Reading’).
Paired-reading skills. When using paired reading, the tutor:
· Y N Read in unison with the tutee for at least part of the observation.
· Y N Stopped reading aloud when given signal by tutee.
· Y N Responded to reading errors/hesitations by supplying the correct word and having the student
repeat the word before continuing with reading.
· Y N Waited at least 5 seconds before supplying the correct word to a hesitant or struggling reader.
‘Listening While Reading’ skills. When using ‘listening while reading’, the tutor:
· Y N Read aloud from the book for 2 minutes at a time while the tutee silently followed along in the
text.
· Y N Had the tutee read the same passage aloud independently while the tutor silently followed along in
the text.
· Y N Responded to reading errors/hesitations by supplying the correct word and having the student
repeat the word before continuing with reading.
3. Amount of reading. During the observation, about what percentage of time do you estimate that the
tutee was actively reading aloud? Circle that percentage:
Less than 50%……..51-60%……..61-70%……..71-80%……..81-90%……..91-100%
4. Tutor behaviors. Did the tutor behave appropriately during the observed session? Y N
If not, what problem behavior(s) did you observe?
________________________________________________________________________
________________________________________________________________________
5. Tutee behaviors. Did the tutee behave appropriately during the observed session?
YN
If not, what problem behavior(s) did you observe?
________________________________________________________________________
________________________________________________________________________
6. Additional observations. Please note other noteworthy details about the observation (e.g., noise level
of the tutoring location, degree of student motivation, unexpected interruptions).
________________________________________________________________________
________________________________________________________________________
Kids As Reading Helpers: A Peer Tutor Training Manual 2002 by Jim Wright
www.interventioncentral.org
Sample Treatment Integrity Checklist – for Behavioral Intervention
Consultee ______________________ Date __________ Consultant ____________________
Response Cost Lottery
Strongly
Strongly
Disagree
Agree
__________________________
1.
Described system to students.
1
2
3
4
5
2.
Displayed and described reinforcers.
1
2
3
4
5
3.
Placed 3 x 5 card on students’ desks.
1
2
3
4
5
4.
Card taped on 3 sides.
1
2
3
4
5
5.
4 slips of colored paper inserted (different colors
for each student).
1
2
3
4
5
6.
Lottery in effect for ___ hour.
1
2
3
4
5
7.
Slips removed contingent on rule violations.
1
2
3
4
5
8.
Teacher restates rule contingent on violation.
1
2
3
4
5
9.
Remaining slips placed in box.
1
2
3
4
5
10.
Drawing occurs on Friday.
1
2
3
4
5
11.
Winner selects reinforcer on Friday.
1
2
3
4
5
____________________________________________________________________________
From “Assessment of Treatment Integrity in School Consultation and Prereferral Intervention” by F. M. Gresham,
1989, School Psychology Review, 18. Copyright 1989 by School Psychology Review.