CSE Referral: Minimum RtI Requirements Checklist
Student Name:Click here to enter text.
Date:Click here to enter a date.
Interventions: Evidence-Based & Implemented with Integrity
Tier 1: Classroom Interventions. The classroom teacher is the “first responder” for students with academic
delays and behavioral difficulties. Classroom efforts to instruct and individually support the student should be
documented.
Adequately
RtI Element
If this element is incomplete,
Documented?
missing, or undocumented…
Tier 1: High-Quality Core Instruction - The student has
Inadequate or incorrectly
received high quality core instruction in the area of concern.
focused core instruction may
☐ YES
“High
quality”
is
defined
as
at
least
80%
of
students
in
the
be an explanation for students’
☐ NO
classroom or grade level performing at or above grade level
academic and behavioral
expectations, through classroom instructional support alone
delays. This does not validate a
(Christ, 2008). Data sources including AIMSweb, NWEA,
referral to special education.
referral data and/or student data sheets should be reviewed to
determine if classrooms are either at 80% or making progress
towards 80% of students meeting grade level expectations.
☐ If no, a tier 1 (core) instructional support plan has
been developed for the classroom and a review date of
Click here to enter a date. has been set.
☐ YES
☐ NO
Tier 1: Classroom/Core Instruction and Support- The
classroom teacher has delivered appropriate and consistent
academic and behavioral instruction to the student.
 Differentiation and/or supplemental instruction
identified as “evidence-based” has been provided to
support learning within the target skill area. [Possible
Tier 1, evidence-based reading supports can be found
within the Standard Reading Protocol chart.] For
students initially identified as at-risk, Tier 1 reading
supports have been provided at a minimum of 3xweek,
for 30 minutes and supplement core instruction.
 For initial Tier 1 students academic baseline and goals
were calculated, and progress-monitoring data was
collected (minimum of 2xmonth for reading) to
measure the impact of differentiation and support.
Daily behavior data sheets have been maintained
through the school day.
 The classroom reading supports and/or teaching of
additional behavioral strategies was provided for a
period sufficiently long (e.g., 6-10 instructional weeks
for reading; 2 weeks for behavior) to fully assess its
effectiveness.
 The student was in attendance for core instruction
90% of the time.
An absence of individualized
classroom support or a poorly
focused classroom instruction
may contribute to the
student’s academic and/or
behavioral delays and does not
validate a referral to special
education.
CSE Referral: Minimum RtI Requirements Checklist
Student Name:Click here to enter text.
Date:Click here to enter a date.
Tiers 2 & 3: Supplemental Interventions. Interventions at Tiers 2 & 3 supplement core instruction and
specifically target the student’s academic and/or behavioral deficits.
Adequately
RtI Element
If this element is incomplete,
Documented?
missing, or undocumented…
A foundation assumption of
Tier 2 & 3 Interventions: Minimum Number & Length The
student’s
cumulative
RtI
information
indicates
that
an
RtI is that a struggling general☐ YES
adequate effort in the general-education setting was made to
education student is typical
☐ NO
provide supplemental interventions at Tiers 2 & 3. The term
and simply needs targeted
“sufficient effort” includes the expectation that within the
instructional support to be
student’s general education setting:
successful. Therefore, strong
 A minimum number of two separate, Tier 2 and Tier 3 evidence (i.e., several
documented, “good faith”
intervention trials have been attempted. Reading
intervention attempts) are
interventions and changes have been consistently
needed before the school can
documented in AIMSweb.
move beyond the assumption
 Each intervention trial lasted the minimum period of
that the student is typical to
time (e.g., 6-10 instructional weeks for reading; 2
weeks for behavior). Reading intervention information consider whether there are
possible “within-child” factors,
and progress monitoring has been documented in
such as a learning disability
AIMSweb.
that best explain the student’s
 Interventions and progress monitoring was
difficulties.
implemented with fidelity and consistency. Fidelity
documentation is available upon request (for reading)
if the student’s classroom has not shown progress
towards 80% on grade level.
 Any changes in intervention were based on data.
Reading guidelines state a change for more intensive
tiered support should occur when there are 4 out of 6
consecutive data points below a student’s aimline.
Tier 2 & 3 Interventions: Essential Elements - Each Tier
Supplemental intervention
2/3
intervention
plan
shows
evidence
that:
programs are compromised if
☐ YES
they are not based on research,
 Instructional programs or practices used in the
☐ NO
are too large, or include
intervention met the criteria of an “evidence-based”
students with very discrepant
intervention and/or are provided within the Standard
intervention needs. Schools
Reading Protocol chart.
cannot have confidence in the
 The intervention was selected because it logically
impact of such potentially
addressed the area(s) of academic or behavioral need
for the student (e.g., an intervention to address phonics compromised supplemental
was chosen for a student whose primary deficit was in intervention programs.
this area based on data).
 The student-teacher ratio in the group-based
intervention provided adequate student support.
NOTE: For Tier 2, group sizes should be 4-6 students.
Tier 3 interventions for reading may be delivered in
smaller groups (e.g., 3 students or fewer) or
individually. Tier 3 for behavior should be delivered
in an individual setting.
 The intervention provided contact time adequate to the
CSE Referral: Minimum RtI Requirements Checklist
Student Name:Click here to enter text.
☐ YES
☐ NO
Date:Click here to enter a date.
student deficit. NOTE: Tier 2 interventions for reading
should take place a minimum of 5 times per week in
sessions of 30 minutes; Tier 3 interventions for
reading should take place daily in sessions of 45
minutes or more (Burns & Gibbons, 2008)
Tier 1, 2, & 3 Interventions: Intervention Integrity Data has been collected to verify that the intervention is
carried out with integrity and fidelity (Gansle & Noell, 2007;
Roach & Elliott, 2008). Relevant fidelity data includes
information about at least 3 of the 5 requirements:
☐ Tier 1 core instruction (to be completed by
building principal)
☐ Attendance
☐ Tier 2 & 3 interventions (including frequency and
length of intervention sessions; rate of improvement;
comparisons to peer performance within the
classroom or students responding to core instruction).
☐ Progress monitoring
☐ Benchmark assessments for reading
Without intervention-integrity
and fidelity data, it is
impossible to discern whether
underperformance is due to the
student’s ‘non-response’ to
intervention or due to an
intervention that was poorly or
inconsistently carried out.
Academic Screenings: General Outcome Measures and Skill-Based Measures
Peer Norms: The school selects efficient measures with good technical adequacy to be used to screen all
students at a grade level in targeted academic areas.
Adequately
RtI Element
If this element is
Documented?
incomplete, missing, or
undocumented…
Selection of Academic Screening Measures - The school has
Academic screening
selected appropriate grade-level screening measures for the
measures provide a shared
☐ YES
academic skill area(s) in which the student struggles (Hosp &
standard for assessing
☐ NO
Howell,
2007).
The
selected
screening
measure(s):
student academic risk. If
☐ N/A
appropriate grade level
 Have “technical adequacy” as grade-level screeners and
(behavioral
screening measure(s) are
have
been
researched
and
shown
to
predict
future
success
referral only)
not in place, the school
in the academic skill(s) targeted (AIMSweb, NWEA)
 Are general enough to give useful information for at least cannot efficiently identify
struggling students who
a full school year of the developing academic skill (e.g.,
need additional
General Outcome Measure or Skill-Based Mastery
intervention support or
Measure such as AIMSweb).
calculate the relative
 Include research norms or benchmarks to guide the
probability of academic
school in evaluating the risk level for each student
success for each student.
screened.
National Norms are utilized at Least 3 Times Per Year. All
In the absence local
☐ YES
students
at
each
grade
level
are
administered
the
relevant
screening norms, the
☐ NO
academic screenings at least three times per year. The results are school cannot easily judge
☐ N/A
compared to national and local norms, which are also referenced whether a student’s skills
(behavioral
are substantially delayed
referral only) when making educational decisions regarding a referral for
intensive or restrictive services/supports.
from those of peers in the
same educational setting.
CSE Referral: Minimum RtI Requirements Checklist
Student Name:Click here to enter text.
Date:Click here to enter a date.
Dual Discrepancy Cut-Offs: Academic Skill Level and Student Rate of Improvement
Establishment of Guidelines for Determining Student ‘Non-Response’ to Intervention as a Dual Discrepancy:
The school has developed definitions for ‘severely discrepant’ academic or behavioral performance and
student growth.
Adequately
RtI Element
If this element is
Documented?
incomplete, missing, or
undocumented…
The RtI model uses a dual
Cut-point Established to Define ‘Severely Discrepant’
Academic or Behavioral Performance - Using local or
discrepancy approach to
☐ YES
national norms, the school sets “cut-points” below which a
identify a student as a
☐ NO
student’s academic performance is defined as “severely
“nonresponder” to academic
discrepant” from that of peers in the enrolled grade.
and behavioral intervention
(Fuchs, 2003) to include: (1)
Students referred to the Committee on Special Education are
a severe discrepancy in
th
performing below the 10 percentile as compared to same
academic or behavioral
aged peers AND often two or more years below their enrolled performance and (2) a
grade level. AIMSweb progress monitoring data should be
discrepancy in rate of student
consistent with benchmark data, within a standard error of
growth during intervention
measurement. Additional data used by the district (NWEA,
(e.g. rate of improvement or
Fountas & Pinnell) should also indicate consistent deficits and ROI). Demonstration that the
validate student achievement levels.
student continues to lag
severely behind peers in
Progress monitoring data for behavior has an individually
academic or behavioral
established goal, developed using baseline data. Progress
skills, despite intensive
monitoring data indicates behavior which is significantly
intervention, is a key
discrepant from same aged peers and below that expected as
requirement in certifying RtI
compared to building and classroom behavioral expectations. “nonresponder” status.
☐ YES
☐ NO
☐ N/A
(behavioral
referral only)
Cut-Off Criterion Selected to Define Discrepant Slope The school has selected a formula for determining when a
student’s rate of improvement (ROI) is severely discrepant
from that of peers.
 AIMSweb benchmark data indicates that a student’s
rate of improvement is less than that of 50% of
students in a national sample who started at a similar
level. This ROI can be obtained from AIMSweb once
at least 2 benchmarks have been obtained on a student.
 AIMSweb progress monitoring data indicates that the
student’s individual ROI is significantly below their
goal ROI, which was calculated for their goal or
instructional level.
A clear formula is needed for
determining whether a
student slope reaches the
threshold of “discrepancy” to
ensure consistency across all
student cases.
Data Collection
Intervention Outcome Data: Student baseline level and goals are calculated for each intervention, and a
sufficient number of data points are collected during progress-monitoring to judge accurately whether the
intervention is successful.
CSE Referral: Minimum RtI Requirements Checklist
Student Name:Click here to enter text.
Date:Click here to enter a date.
Adequately
RtI Element
Documented?
☐ YES
☐ NO
☐ YES
☐ NO
If this element is
incomplete, missing, or
undocumented…
If an off-level student is
Use of Both “Off-Level” and Enrolled Grade-Level
tracked using only
Benchmarks & Progress-Monitoring Measures to Assess
Student Skills and Growth - For students with substantial
unrealistically difficult
skill deficits (e.g., a 2-year delay in reading) or behavioral
progress monitoring
difficulties, any Tier 2/3 intervention is likely to be off level
measures from his or her
or differentiated to match the student’s actual skills. Here are enrolled-grade level, any
data-collection guidelines for off-level interventions (Shapiro, actual evidence of student
2008):
progress may be masked by
the challenging nature of the
 Reading: Survey level assessments (SLAs) were
completed when the student was initially identified as assessment materials. This
below the 10th percentile on grade level text. SLAs are intervention assessment
mismatch could lead the
used to determine the student’s progress monitoring
school to erroneously judge
level.
 Reading: Progress-monitoring should generally match the student as a nonresponder
to an off-level intervention,
the intervention level. So, if a 5th-grade student
when in fact the student is
receives a supplemental reading fluency intervention
actually making substantial
using grade 2 texts, the school would use grade 2
reading fluency progress-monitoring measures to track academic or behavioral
student growth and to determine when the student has progress.
reached mastery at this off-level intervention point.
 Behavior: Interventions and progress monitoring for
behavior should take into account general student
ability (i.e. cognitive, academic). For example a 6th
grade student with impaired cognitive ability should
have a visual schedule instead of a written schedule
and progress monitoring data should reflect this
differentiation.
Student Baseline Calculated - For each Tier 2/3 intervention
being reviewed, the school calculates the student’s baseline
level, or starting point, in the academic or behavioral skill
before starting the intervention (Witt, VanDerHeyden, &
Gilbertson, 2004). Baseline is calculated in one of the
following ways:
 Reading: Using benchmark data, which is consistent
with progress monitoring. Benchmark assessments
should be periodically assessed for fidelity.
 Reading: If benchmark data was obtained more than 4
weeks prior AND a tiered intervention has been
recently attempted, baseline can be assessed by taking
the three final (that is, most recent) data points from
that progress monitoring data series and selecting the
median value from the three points as a calculation of
baseline. This is also used for students who are being
Without information about
baseline student performance
prior to an intervention, it is
difficult to estimate the
actual progress that the
student made during the
intervention. Lack of
baseline data therefore
comprises a “fatal flaw”
(Witt, VanDerHeyden, &
Gilbertson, 2004) that
invalidates any RTI
intervention.
CSE Referral: Minimum RtI Requirements Checklist
Student Name:Click here to enter text.
☐ YES
☐ NO
☐ YES
☐ NO
Date:Click here to enter a date.
progress monitored below their current enrolled grade
level, where SLAs were completed following a prior
benchmark period.
 Behavioral: a preliminary decision by the RtI team
should be made regarding length of time for baseline
data collection and may be dependent on target
behavior. For example: a high frequency behavior
such as yelling-out might result in data collection over
a few days; whereas a low frequency behavior might
be collected over a 2-week period.
Student Goal Calculated - For each intervention being
reviewed, the school calculates a predicted goal for student
progress to be attained by the end of the intervention period.
The goal:
 Is based on acceptable norms for student growth (i.e.,
research-based growth norms). Reading only.
 Is periodically reviewed and updated when a student
meets or exceeds their goal for three consecutive data
points.
 Represents a realistic prediction of student growth that
is sufficiently ambitious - assuming that the
intervention is successful - to eventually close the gap
between the student and grade-level peers.
If no clear goal for student
progress is established prior
to the start of a tiered
intervention, the school
cannot know at the
conclusion whether the
intervention was successful.
Lack of a specific criterion
or goal for student
improvement, therefore
comprises a “fatal flaw”
(Witt, VanDerHeyden, &
Gilbertson, 2004) that
invalidates any RTI
intervention.
Regular Progress-Monitoring Conducted - Each tiered
A student’s rate of
intervention is monitored on a regular basis.
improvement, or slope,
Reading:
during an intervention is
 If Tier 1 (at-risk), the intervention is monitored at least calculated from the total
progress monitoring data
2xmonth.
points collected. The greater
 If Tier 2, the intervention is monitored at least
the number of data points,
1xweek.
the greater the confidence
 If Tier 3, the intervention is monitored following
rd
that the slope is a good
every 3 intervention session.
 Students who are of relative concern (e.g. average but approximation of actual
progress. If, however, the
performing below their grade level target score) can
data is too sparse, the school
also be monitored 1xmonth.
cannot have confidence that
Behavior:
the data points collected are
 Frequency of progress monitoring will be based on
baseline data, as well as frequency and severity of the an accurate representation of
actual student progress.
behavior.
CSE Referral: Minimum RtI Requirements Checklist
Student Name:Click here to enter text.
Date:Click here to enter a date.
Application of RTI Decision Rules to a Particular Student Case
RTI Data Analysis. The student’s individual RtI data is analyzed to determine if that student is a “nonresponder” despite the best efforts to provide evidence-based interventions in the general-education setting.
Adequately
RtI Element
If this element is
Documented?
incomplete, missing, or
undocumented…
A discrepant student
Despite the Tier 2/3 Interventions Attempted, the
performance level is the first
Student’s Skills Continue to Fall Below the Boundary of
☐ YES
Severely
Discrepant
Academic
Performance
Using
the
element of a dual
☐ NO
school’s definition for calculating “severely discrepant
discrepancy needed under
performance”, it is determined that the student’s current
RtI to define a student as a
academic or behavioral performance is discrepant from that of non-responder to general
peers.
education interventions.
A discrepant student slope is
Despite the Tier 2/3 Interventions Attempted, the
the second element of a dual
Student’s
Rate
of
Improvement
(Slope)
Continues
to
Be
☐ YES
Discrepant - Applying the school’s methods for calculating
discrepancy needed under
☐ NO
discrepant slope (above), it is determined that the student’s
RtI to define a student as a
slope (growth during the intervention) is discrepant from that non-responder to generalof peers.
education interventions.
Adapted from Jim Wright’s RtI Toolkit: A Practical Guide for Schools