Response to Intervention: Paradigm shift in assessment practices Kevin L. Buehler, Ph.D., NCSP Response to Intervention Consultant Knox County Schools Activity Write your biggest frustration about the definition of a learning disability. Generate a solution to that frustration. Frequently Mentioned Frustrations regarding LD 1. Students who don’t meet the LD criteria but continue to struggle academically 2. Students who do meet the LD criteria are not identified early enough 3. Students who struggle have to be labeled to receive classroom assistance Solutions 1. Use different criteria 2. Identify students earlier 3. Provide effective interventions for all students who need classroom assistance Easier said than done! However, these premises are the basis of the response to intervention model. Identify Early Different LD Criteria Effective Interventions What’s wrong with the discrepancy model? For students with word reading deficits, there are few meaningful differences between IQachievement discrepant poor readers and IQachievement consistent poor readers Under the discrepancy model, one student qualifies for special education assistance, and the other does not, despite having similar reading achievement The importance of early intervention National Institutes of Health (1999) study: If students are not reading at grade level by the third grade, the odds that they will ever read at grade level are only 1 in 17 By the 4th grade, 2 hours of specialized daily instruction is required to make the same gain that would be obtained from only 30 minutes of specialized daily instruction in kindergarten Impact of Effective Interventions LD Students and RTI/Intervention Students R-CBM Growth Rate of Increase 1 0.8 0.6 0.84 0.81 0.78 0.78 0.62 0.61 0.58 0.57 0.53 RTI/Intervention Students 0.4 0.3 0.2 0 1 LD Students 2 3 Grade 4 5 RTI Model LD Criteria do NOT include a discrepancy requirement Students get help early within the regular education setting At-risk students are provided with research-based interventions Presentation Objectives 1. Discuss the foundations of RTI 2. Review RTI model 3. Discuss the primary assessment component of the RTI process: Curriculum-Based Measurement 4. Review general implementation suggestions 5. Describe specific KCS procedures 6. Review KCS implementation data 7. Review available resources 8. Answer questions Foundations of RTI Theoretical Foundation Academic Systems Behavioral Systems Intensive, Individual Interventions •Individual Students •Assessment-based •High Intensity 1-5% Targeted Group Interventions •Some students (at-risk) •High efficiency •Rapid response Universal Interventions •All students •Preventive, proactive 5-10% 80-90% 1-5% Intensive, Individual Interventions •Individual Students •Assessment-based •Intense, durable procedures Targeted Group Interventions •Some students (at-risk) •High efficiency •Rapid response 5-10% 80-90% Universal Interventions •All settings, all students •Preventive, proactive Legal Foundation RTI was proposed in IDEA 2004 as an alternative method for identifying LD students because of the following: Over-identification of LD students Problems with discrepancy model of identification A lack of specific scientific, research-based instruction/intervention prior to referral A disproportional number of minority placements Special education regulations (IDEA) Determination of Eligibility: “a child must not be determined to be a child with a disability … if the determinant factor for that determination is … lack of appropriate instruction in reading [or] math.” 34 CFR § 300.306 LD procedures: “State … must not require the use of a severe discrepancy between intellectual ability and achievement for determining whether a child has a specific learning disability” 34 CFR § 300.307 The discrepancy model for identifying LD is considered “potentially harmful” to students Implication States cannot mandate the use of the discrepancy formula for identification of LD AND they must permit the use of RTI models. IDEA regulations … underachievement in a child suspected of having a specific learning disability is not due to a lack of appropriate instruction in reading or math by considering: 1) Data that demonstrates that prior to, or as a part of, the referral process, the child was provided appropriate instruction in regular education settings, delivered by qualified personnel; and 2) Data-based documentation of repeated assessments of achievement at reasonable intervals, reflecting formal assessment of student progress during instruction, which was provided to the child’s parents. 34 CFR § 300.309 Implication Students cannot be identified with a learning disability without documenting numerous attempts in regular education to meet their needs using scientific research-based strategies Student progress must be monitored Progress data must be provided to parents * Note: Regardless of the method of identification for LD (discrepancy or RTI), a response-tointervention-like process is required prior to certification. Issues Not Addressed in IDEA The federal regulations do not offer specific guidelines regarding how to implement RTI. How long should the interventions last? How many tiers, or levels, of interventions should be done? Who conducts the interventions? How is progress defined and measured? Specific Texas regulations (i) data that demonstrates the child was provided appropriate instruction in reading (as described in 20 USC, §6368(3)), and/or mathematics within general education settings delivered by qualified personnel; and Specific Texas regulations (ii) data-based documentation of repeated assessments of achievement at reasonable intervals, reflecting formal evaluation of student progress during instruction. Data-based documentation of repeated assessments may include, but is not limited to, response to intervention progress monitoring results, inclass tests on grade-level curriculum, or other regularly administered assessments. Intervals are considered reasonable if consistent with the assessment requirements of a student's specific instructional program. Specific Texas regulations I) does not make sufficient progress when provided a process based on the child's response to scientific, research-based intervention (as defined in 20 USC, §7801(37)), as indicated by the child's performance relative to the performance of the child's peers on repeated, curriculum-based assessments of achievement at reasonable intervals, reflecting student progress during classroom instruction; or Specific Texas regulations (II) exhibits a pattern of strengths and weaknesses in performance, achievement, or both relative to age, grade-level standards, or intellectual ability, as indicated by significant variance among specific areas of cognitive function, such as working memory and verbal comprehension, or between specific areas of cognitive function and academic achievement. Research Foundation Reading Research When students get behind in first grade it is hard for them to catch up Intensive scientific research-based interventions are needed for struggling readers to catch-up Growth in reading fluency requires a lot of accurate practice Struggling readers do not get enough accurate practice Research Foundation Reading Research A student at the 10th percentile reads about 60,000 words a year in 5th grade A student at the 50th percentile reads about 900,000 words a year in 5th grade Average students receive about 15 times as much practice in a year Research Foundation Effectiveness of LD programs for students identified using the discrepancy model has been low: Special education placements tend to stabilize the reading growth of students with reading disabilities rather than accelerate it. (Vaughn, 1998, Moody, 2000) Acceleration rates about .04 SD/year. It will take 8 years to move from 5th to 9th percentile (Torgeson, in press; Hanushek, 1998) Students who enter special education 2+ years below age mates can be expected to maintain disparity or fall farther behind. Effect size for LD programs is .29 (Reschly) It’s the nature of the program more than the label that makes the difference. Research Foundation Using the discrepancy model: Children must fail before they can be identified as LD, with identification typically occurring in grades 3-5 IQ and academic achievement are not independent; so difference scores are unreliable (which results in poor reliability and validity of classification) Is not supported in research in terms of prognosis or cognitive profiles Research Foundation Traditional Assessment Medical model (diagnostic purpose) Deficit oriented Child centered (one at a time) “Wait to fail” Refer-test-place Focuses on diagnosis rather than prevention Alternative to IQ-Achievement Discrepancy Model Defining LD as severe deficit in: Achievement Level AND Rate of Academic Progress Defining LD in terms of a dual deficit LD is defined as non-responders (low achievement and poor progress) to validated scientific research-based instruction RTI eliminates poor instructional quality as a viable explanation for a learning disability Assumption: If a child does not respond to instruction that is effective for the vast majority of students, then there is something different about the student causing the nonresponse Assessment paradigm shifts Move from refer-test-place to assessmentintervention-evaluation practice Move from high inference measures to low inference measures Move from static (one shot) testing to dynamic (continuous) progress monitoring of response to intervention RTI model RTI Model A process where at-risk students are provided increasing levels of intervention prior to consideration for LD Seeks to determine what instructional supports are needed to solve student achievement problems Eliminates a “wait to fail” model because at-risk students get help promptly within the regular education setting Intended to address problems with the discrepancy model of identifying students with LD Essential Components of RTI 1. Universal screening 2. Multiple tiers of intervention 3. Progress monitoring 4. Problem-solving or standard protocol approach 5. Integrated data collection/assessment system 6. Scientific research-based interventions Universal Screening Curriculum-Based Measurement (CBM) is the recommended tool to identify students who are at-risk (have low academic skills) and require interventions CBM is a technically sound and thoroughly researched progress monitoring system Universal Screening CBM: Is a standardized test Is given to everyone Measures critical skills Is brief Can be repeated frequently Is inexpensive and easy to administer and score Provides data to assist with decision making at the individual student, class, school or district level Tells us what students are “at-risk” and need supplemental instruction/intervention Multiple Tiers of Intervention Levels of intervention with increasing frequency &/or intensity from one tier to the next. Some recommend 2 tiers and some recommend 3. 3 Tier Model Special Education Consideration Intensity of Intervention HIGH LOW Tier III Increased Interventions Tier II Supplementary Interventions Tier I Core Curriculum Monitoring Frequency & Degree of Unresponsiveness HIGH Tier guidelines Each tier of intervention builds on the next. In other words, supplemental intervention in each tier adds to the student’s core curriculum instruction. Progress Monitoring Curriculum-Based Measurement (CBM) is the recommended tool for measuring student response to the intervention. Progress Monitoring The purpose of progress monitoring is to take frequent measures of a student’s performance to determine whether he or she is making progress in response to the intervention. Why Not Pre and Post Test? Pre-Test (10 Weeks) ? Post-Test Problem Solving or Standard Protocol Approach Problem Solving A process that uses the skills of professionals from different disciplines to develop and evaluate intervention plans that improve significantly the school performance of students Problem Solving or Standard Protocol Approach Standard Protocol A standard set of interventions available to students when they enter the RTI process Problem Solving or Standard Protocol Approach Combined Using a standard set of interventions, but using a problem-solving team to individualize those interventions Integrated Data Collection / Assessment System AIMSweb, DIBELS, etc. Benchmark Data Collection Progress Monitoring Scientific, Research-Based Interventions Interventions that address academic deficits must be available in general education settings Progress monitoring methods must be incorporated into general education Scientific, Research-Based Interventions Employs systematic, empirical methods Involves rigorous data analyses Relies on methods that provide reliable data across settings, subjects, and evaluators Uses experimental or quasi-experimental designs Allows for replication of the study Has been accepted by a peer-reviewed journal or panel of independent experts 34 C.F.R. 300.35 What Are Interventions Targeted assistance based on progress monitoring Administered by classroom teacher, specialized teacher, or external interventionist Provides additional instruction Individual, Small group, and/or technology assisted Interventions are NOT Preferential seating Shortened assignments Parent contacts Classroom observations Suspension Doing MORE of the same / general classroom assignments Retention Peer-tutoring Scientific, Research-Based Interventions Example of computerbased intervention: Destination Reading/Math Example of teacher directed small-group intervention: Scott Foresman Early Reading Intervention The primary assessment component of RTI: Curriculum-Based Measurement What is CBM? Curriculum-based measurement, or CBM, is a method of monitoring educational progress through direct assessment of academic skills. CBM can be used to measure basic skills in reading, mathematics and written expression, as well as readiness skills. CBM History CBM was developed more than 20 years ago to assist in assessing students’ achievement CBM was originally used to assess growth and development in students’ specific curricula (these measures lacked validity and reliability) Research has shown CBM can be used across varied curricula, schools, teachers, and school districts in a standardized fashion History, cont. CBM has evolved to measure achievement and assist teachers in the following ways: Providing immediate feedback regarding where students are functioning within the class Providing appropriate standards of growth and development across varied curricula What is a probe? When using CBM, the examiner gives the student brief, timed samples, or "probes," made up of academic material taken from the expected skills for the particular grade level. How are probes given and scored? CBM probes are given individually or in groups (depending on the probe), under standardized conditions, are timed and typically last from 1 to 6 minutes, depending on the skills being measured. The child's performance on a CBM probe is scored for speed, or fluency, and for accuracy of performance. Video example What do probes look like? Reading R-CBM This student read 72 WRC/8 Errors Reading Comprehension Maze 15 correct with 1 error Universal screening Given to everyone Tells us which students are “at-risk” and need supplemental instruction/intervention (becomes a referral source in addition to teachers and parents) Crucial to the RTI process (Provides data to assist with decision making at the individual student, class, school or district level) Tool should be a general outcome measure What CBM is and is Not CBM is considered a General Outcome Measure CBM is designed to function as an “indicator” of academic skills (academic thermometer) It is NOT intended to represent all skills associated with a particular domain such as reading CBM probes are considered formative assessment tools that can be used to inform instruction Summative vs. Formative Assessment Summative assessment occurs after instruction Example: “High Stakes” testing Conducted infrequently Does not provide teachers with ongoing assessment data Answers the question, “Did the students learn?” Summative vs. Formative Assessment Formative assessment occurs during instruction Example: CBM probes Conducted frequently Provides teachers with immediate feedback on student performance Answers the question, “Are the students learning?” CBM-Formative Assessment Dynamic—measures are designed to be sensitive to short-term effects of instructional interventions Measure fluency, which is more sensitive to change than accuracy As a result, CBM probes are useful for progress monitoring Advantages of CBM Provides frequent “checks” of achievement over time Indicates student growth over time and across academic years Assists teachers in making decisions about instruction or grouping Can be used to document need for special education consideration How CBM is used in KCS In order to collect local norms, CBM probes are administered three times per year (fall, winter, and spring) for grades K-5 in all elementary schools CBM probes include the areas of early literacy, early numeracy, word identification, reading, and math computation skills Data are available immediately after testing Classroom teachers help administer CBM probes School operates under a “testing mode” which changes the school schedule to provides a quiet testing environment for students How CBM is used in KCS Intervention Mentors & School Psychologists review data with school staff after testing Individual student profiles provide teachers and parents frequent updates on academic growth This allows us to judge how any individual student in KCS compares to other students at that grade level This also allows for continuous monitoring of student progress in special education and regular education In addition, class, school, and district comparisons can be made Screening for RTI Students below the 10th percentile are identified as “at-risk” using CBM benchmark data. Once a student begins the RTI process, CBM data are used to monitor progress weekly to gauge student response to the intervention. Growth rates from progress monitoring are compared to the minimally average (25th percentile) growth rate for a student at that grade level using district norms At some point, “at-risk” could be defined as the percentile that predicts non-proficient status on high-stakes tests Interpreting CBM scores Box and Whisker Charts 90th 75th 25th 10th Interpreting CBM What is an appropriate achievement level? at-risk range may be defined differently in different districts What is appropriate growth? Adequate improvement may be defined differently in different districts Interpreting Progress Monitoring Data 4-Point Rule - If 3 weeks of instruction have occurred and student has at least 6 data points, examine the most recent 4 consecutive scores. If all 4 scores fall below the goal line, a change in instruction is recommended. If all 4 scores fall above the goal line, a goal increase is recommended. Interpreting Progress Monitoring Data Trend analysis - If 3 weeks of instruction have occurred and student has at least 6 data points, examine the trend of the scores. If the trend line is below the goal line, a change in instruction is recommended. If the trend line is above the goal line, a goal increase is recommended. What is a good response to an intervention? GOOD RESPONSE Gap is closing (Can extrapolate a point at which student will “catchup” to peers—even if this is a long range target) QUESTIONABLE RESPONSE Rate at which gap is widening slows considerably, but gap is still widening Gap stops widening but closure does not occur POOR RESPONSE Gap continues to widen with no change in rate RTI Implementation Suggestions Start with Basic Components Universal Screening – Develop local norms Tiers – Determine how many tiers of intervention will be used and length of each tier Interventions – Determine which interventions (scientific, research-based) will be used Progress Monitoring – Determine method of assessing response to intervention Personnel – Determine who will complete the interventions and assessments Define Procedures CBM normative criterion – define at-risk ROI criterion – define poor improvement Intervention(s) to be used Progress monitoring tool and frequency Intensity of intervention Frequency of intervention Duration of intervention Fidelity requirement Remember Full implementation of RTI will likely take 3-5 years, depending on the size of the school district. It is best to implement RTI in stages. Progression of KCS Implementation May, 2003 - brought in Gary Germann from AIMSweb to train a core group of regular education and special education personnel on the CBM Benchmark process 2003-2004 6 elementary schools conduct CBM benchmarking 2004-2005 14 elementary schools conduct CBM benchmarking and use interventions 2 additional elementary schools conduct CBM benchmarking only 2005-2006 7 elementary schools use RTI process in grades K-2 26 elementary schools conduct CBM benchmarking and use interventions 6 additional elementary schools conduct CBM benchmarking only 2006-2007 12 elementary schools use RTI process in grades K-5 24 elementary schools conduct CBM benchmarking and use interventions 12 additional elementary schools conduct CBM benchmarking only 2007-2008 43 elementary schools use RTI process in grades K-5 7 additional elementary schools conduct CBM benchmarking only Specific Knox County Procedures Knox County’s RTI Model 1. Local norms collected three times per year 2. At-Risk students identified using CBM Benchmark measures 3. Computer software programs and scripted reading program interventions available 4. Intervention intensity progressively increases through 3 tiers and student progress is monitored frequently 5. Response to intervention is reviewed by school staff to make appropriate decisions Knox County’s RTI Model Intensity of Intervention HIGH Student CBM above at-risk range Positive response – exit process LOW Special Education Consideration Tier III At least 4 - 60 minute sessions/week Tier II At least 4 - 30 minute sessions/week Tier I Core Curriculum + Classroom Interventions Monitoring Frequency & Degree of Unresponsiveness Student CBM within the at-risk range AND below average ROI HIGH What is Student Compared To? District Norms Individual School Norms (for specific schools) Class Norms/Ranking In other words, the lowest 2 or 3 in the class would be considered for suspected LD Parent Consent The process is based on general education instructional procedures Parent consent is NOT needed to participate in the RTI process An evaluation for special education consideration has NOT been initiated during RTI, so evaluation timelines do not apply A learning disability is NOT suspected until after the intervention process has been completed Fidelity of Interventions In order to say a child has not responded to an intervention, the intervention MUST be conducted EXACTLY as prescribed. Another way to look at this issue is to imagine the intervention process as standardized testing. We would want to know that children were tested in accordance with standardized procedures. It is the same with using response or non-response to interventions. Tier I Criterion: CBM score within the at-risk range (using district or school norms) with record review and teacher validation Intervention: core curriculum + classroom interventions Progress Monitoring: 1 time/week Intensity: determined by Intervention Team (15 minutes/session recommended) Frequency: determined by Intervention Team (3 sessions/week recommended) Duration: 6-8 weeks Parent Notification: every 4 weeks Tier II CBM Criterion: CBM score within the at-risk range (using district or school norms) ROI Criterion: Rate of improvement is below average Intervention: supplemental to the core curriculum Progress Monitoring: 2 times/week Intensity: 30 minutes/session Frequency: At least 4 sessions/week Duration: At least 8-10 weeks Fidelity: 40 sessions within 60 school days Parent Notification: every 4 weeks Tier III CBM Criterion: CBM score within the at-risk range (using district or school norms) ROI Criterion: Rate of improvement is below average Intervention: supplemental to the core curriculum Progress Monitoring: 2 times/week Intensity: 60 minutes/session (can be provided in two 30 minute blocks) Frequency: At least 4 sessions/week Duration: At least 9-12 weeks Fidelity: 45 sessions within 60 school days Parent Notification: every 4 weeks Tier II vs. Tier III The only difference between Tier II and Tier III is the intensity of the intervention treatment. Important Points If a student does not make progress at Tier III, we can feel confident the suspect the student has a learning disability if exclusionary factors are ruled out. Because this process has the potential to be the basis for LD certification, it is imperative that the interventions be carried out with fidelity. Documentation of intervention sessions is required. Frequency of Tier III While scheduling two 30-minute blocks of intervention a day may be difficult, remember that until a child can read, he or she will be unable to do most academic tasks. Thus, remediation of reading difficulties should be the focus. What about Written Expression and Math Reasoning? Classroom intervention of 6-8 weeks in area of concern must be done with weekly progress monitoring Discrepancy testing is used at all schools and data is used in conjunction with response to interventions Special Education Evaluation In the RTI process, LD is not suspected until after all three tiers have been completed with poor response. Once LD is suspected, an evaluation is done to rule out MR and other exclusionary factors. Informed consent is obtained for the evaluation and timelines (40 school days) now apply. The IEP Team reconvenes after the evaluation to write the IEP if all exclusionary factors are ruled out. Special Education Evaluation The eligibility determination team may find that a child has LD if: (1) Child does not achieve adequately for his/her age or to meet State-approved grade-level standards, when provided with appropriate instruction; and (2) Child does not make sufficient academic progress when using RTI (or other alternative method using research-based interventions) or exhibits a pattern of strengths and weaknesses (discrepancy formula); and Special Education Evaluation (3) The eligibility determination team rules out exclusionary factors. (4) LEA must ensure that the child is observed in the regular classroom setting (or other appropriate learning environment). This observation can be done prior to the referral (if “routine”), or after the referral (with parent informed consent). 34 C.F.R. 300.310 Exclusionary Factors The eligibility determination team may not identify a child as having a specific learning disability if the low achievement is primarily the result of: (1) A visual, hearing, or motor disability (2) Mental retardation (3) Emotional disturbance (4) Cultural factors (5) Environmental or economic disadvantage (6) Limited English proficiency (7) Lack of appropriate instruction in reading or math Evaluation Evaluation will be done that includes: (1) Measure of cognitive ability (Possible use of brief measure) (2) Measure of achievement in area(s) of concern (3) Other components agreed upon by IEP team Procedures for Below Average Students Below Average Students Students within the 10th to 24th percentile range on CBM benchmarks or progress monitoring probes Can receive interventions if Intervention Team decides it is necessary Strategic Monitoring Provides a way to monitor the progress of students within the below average range Results are shown on the individual benchmark chart Provides a rate of improvement after each monthly assessment The Benefits Teachers have feedback on student progress available to them on their AIMSweb accounts Intervention Team receives input on how the student is responding and can make decisions accordingly Student does not have to repeat a Tier Reevaluations at RTI Schools How does the RTI process impact kids already eligible? What happens to students who exit the RTI process? Is the gap closing between the student’s performance and typical grade level performance? If the student’s response is poor, should we keep the student in the program? If the student’s response is good, can we transition to a Tier 3, 2, or 1? LD Reevaluations Student who continues to fall within the at-risk range in area of eligibility: No need to re-test unless other disability is suspected Students within the below average range on grade level: Place on special education consultation only for 912 weeks to determine if performance can be maintained at or above 10th percentile Interventions at the RTI level of Tier II or Tier III may be provided Student maintains performance within the below average range: Decertify because needs can be met within general education Student drops to the at-risk range: Maintain eligibility because student continues to need special education services for success Student scores within the average range: No need to re-test Student should be decertified because student no longer has an academic deficit KCS Implementation Data Data Analysis Do we identify same type of students? How many of the students in Tier 1 progress to Tier 2, Tier 2 to Tier 3, etc? Does the percentage of LD students increase/decrease? Knox County Schools Response to Intervention Data Analysis 2006-2007 school year RTI Piloted in 12 elementary schools in grades kindergarten through 5th grade (6324 total student population). 464 students were provided services through the program Each student’s progression through a tier during the school year generated a separate student record. For example, if a student completed three tiers there would be three records on that individual student. 683 intervention records were developed Numer of Records Number of Records per Grade Level 180 160 140 120 100 80 60 40 20 0 163 160 126 94 72 68 K 1 2 3 4 5 Grade 562 records in reading (82%) and 121 records in math (18%) 13 of the records (2%) were for students that exited the tiers and then needed to be re-entered 53% of the students in which a decision was reached successfully exited Tier I 2006-2007 RTI Schools Tier I (12 schools) 47% 53% Successful Exit Higher Tier 46% of the students successfully exited Tier II 2006-2007 RTI Schools Tier II (12 schools) 54% 46% Successful Exit Higher Tier 27% of the students successfully exited Tier III 2006-2007 RTI Schools Tier III (12 schools) 27% 73% Successful Exit Higher Tier 82% of “at-risk” students successfully exited the RTI process 2006-2007 RTI Schools Total 18% Successful Exit 82% Referred for Evaluation Through this RTI Model, 31 students were found to be eligible for a learning disability (29 in basic reading skills, 11 in reading comprehension, and 1 in math computation). Seventeen of the 31 students (55%) would have been eligible under the previous discrepancy model. The average “Best Measure of Ability” score was 94.8 with a standard deviation of 8.3 (Minimum Score, 80; Maximum Score, 114) RTI Eligible Compared to Discrepancy Eligible Eligible by Discrepancy 45% 55% Not Eligible by Discrepancy Online Resources What Works Clearinghouse http://ies.ed.gov/ncee/wwc/ Learning Disabilities Summit http://ldsummit.air.org/ National Center on Student Progress Monitoring http://www.studentprogress.org/default.asp Vaughn Gross Center for Reading and Language Arts http://www.texasreading.org/utcrla/ Florida Problem Solving & Response to Intervention Project http://floridarti.usf.edu/ Florida Center for Reading Research http://www.fcrr.org/ RTI Wire http://www.jimwrightonline.com/php/rti/rti_wire.php Intervention Central http://www.interventioncentral.com/ Audience Questions