Intervention Action Plan
Student Name:
Teacher Name:
Benchmark Topic:
Baseline Data
Measure &
Student
Performance
Score
Potentially Challenging
Components
List of Signs that
Indicate a Student
Needs an
Intervention
List of Actions to Take
Before Deciding on an
Intervention
List of Required
Interventions
PostIntervention
Data Measure
& Student
Performance
Score
Did Student
Meet Goal?
(if no, complete
back side of
sheet)
Intervention Action Plan (Complete for Student Who Did Not Meet Benchmark)
PostAssessment
Data Measure
& Student
Performance
Score
Skill Deficits from PostAssessment
List of Required Interventions
Re- Assessment
Data Measure &
Student
Performance
Score
Did Student
Meet Goal?
(if no, bottom
of sheet)
Interventions
Date(s)
Initiated
General Interventions
Conference with parent/guardian
Conference with previous teachers
Conference with student
Have student work with small group
Work with peer tutor
Student attends after school help
Daily/weekly progress reports implemented
Preferential seating in the classroom
Classroom structure increased
Assignment checklist implemented
Academic Interventions:
Modified or shortened assignments (when
appropriate—ex. IEP)
Alternative assignments
Homework Contract between teacher, student, and
parent
Directions given in another mode
(visual, verbal, or written)
One-on –one additional instruction
Results
Provide “skeletal notes” during lectures
Alternate highly or less preferred tasks
Visual Material Used (charts, films, slides, maps,
sight words, flashcards, experience stories, cue
cards, guides, calculators, etc.)
Reduced or modified written work (when
appropriate-ex. IEP)
Long term assignments divided into chunks with
several check in dates.
Computers used for assignments when applicable.
Page number given for answers in text (when
appropriate—ex.IEP)
Text highlighted
Auditory materials used (audiobook, text reader)
Texts/books on CD/MP3
Assignments read to student
Have student repeat directions
Kinesthetic materials used
(manipuliatives, concrete materials, whiteboard,
templates, games)
Alternate seatwork with physical activities
Tiered/chunked lessons and projects
Use of varied supplementary materials
Assigned “study buddy”
Provide Graphic Organizers
Provide alternative assessments
Flexible grouping
Learning Contract (signed by both student and
teacher)
Alternate assignments for tests
Allow use of notes or text on test (when
appropriate—ex. IEP)
Consult with student’s case manager, if he has an
IEP.
Provide corrective feedback
Have student self-monitor progress and graph
results.
Behavioral Interventions:
Conference with parents
Conference with previous teachers
Conference with student
Consult with colleagues/case manager if student
has an IEP.
Notify counselor when behavior changes.
Complete a Discipline Report for inappropriate
behavior.
Keep documentation of behaviors and logical
consequences.
Provide choices.
Preferential or strategic seating in classroom
Daily/weekly behavior progress reports
Short (1-2 minute) weekly “check in” with teacher
to praise or discuss classroom actions.
Removal to another place to work
Rule restatement and verbal feedback
Strategic removal (errand for teacher, cool down
break)
Distraction and redirection
Positive reinforcement for appropriate behavior
Time-out or removal from classroom
Proximity control (close to teacher)
Allow time and space to cool down
Immediate response to behavior
Change or reduce assignments due to frustration
level (Zone of Proximal Development)
Special roles (erase board, hand out papers, etc.)
Have student self-monitor and graph his own data
(with guidance)
Language Arts Interventions:
Provide phonemic awareness skill remediation
Vocabulary Development/ remediation (See
Reading Apprenticeship materials)
Reading Comprehension remediation activities
(See Reading Apprenticeship materials)
Practice Specific Reading Strategies (Refer to
Reading Apprenticeship materials)
Provide individual instruction (during class/after
school)
Contact Alanna Davis for additional remediation
materials.
Provide graphic organizers for writing
assignments.
Activate Prior Knowledge first when teaching
new material.
Provide anticipation guides and study guides
Provide and teach mnemonic devices for
vocabulary/ retention
Math Instructional Interventions:
Provide manipulatives/hands on activities
Use of computer/relevant technology
Allow calculator use (when appropriate)
Provide visual aides
One-on-one individual help
Pair struggling learner with a higher performing
student.
Contact Alanna Davis for additional remediation
materials.
Have student self-monitor and graph his own
scores
Provide mnemonic devices for memorizing
formulas/ specific steps
Additional Interventions:
Sources:
Blair, Regina B. Intervention Model. Retrieved from:
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CDAQF
jAD&url=http%3A%2F%2Fwesprincipal.wikispaces.com%2Ffile%2Fview%2FACADE
MIC%2BINTERVENTION%2BCHECKLIST%255B1%255D%2B(1).doc&ei=cviHUJC
CCuSn0AG4_IDYDw&usg=AFQjCNFzIcsF-zmyGjGKAoSsXEWvByPlwQ
Technical Assistance Document, Student Academic Intervention Checklist. Retrieved from
http://www.doe.virginia.gov/special_ed/tech_asst_prof_dev/self_assessment/disproportionality/student_intervention_checklist
pdf
Wright, Jim. Academic & Behavioral Evidence-Based Interventions.
Retrieved from: www.interventioncentral.org