WASHINGTON RTI SITE VISIT INTERVIEW FORM
School:
Name of School: ______________________________________
District: ___________________________________
Grades of Student Population: K 1 2 3 4 5 6 7 8 9 10 11 12
Focus Area(s)
Persons Interviewed: _________________________________________
Subject(s):
Grades:
Interviewer: ________________________________________________
Date: _________________
The RTI Essential Components Integrity Rubric and the Washington RTI Integrity Site Interview Form are for use by individuals responsible for
monitoring the school-level fidelity of Response to Intervention (RTI) implementation. These forms are not designed for compliance monitoring and
therefore should not be used for this purpose. NEWESD and the Office of Superintendent of Public Instruction for Washington State modified the
original document developed the interview form with the assistance of the National Center for Response to Intervention (NCRTI). The interview
questions are similar in content to the NCRTI Essential Components Integrity Worksheet which is intended be used by schools for self-appraisal.
The format of the RTI Integrity Site Interview Form is semi-structured and thus requires a trained evaluator for administration.
**Schools wishing to complete a self-appraisal should not use this interview form and may obtain the Essential Components Worksheet from the
NCRTI website, www.rti4success.org.
The Integrity Rubric accompanies either assessment tool (Site Interview Form or Essential Components Worksheet) for scoring purposes. The
Rubric provides descriptions of ratings for each item. Information about school-level implementation should be collected through interviews with
school personnel (sample interview questions are provided below) and through observations and document review. After all of the information has
been collected, evaluators use their notes and the RTI Essential Components Integrity Rubric to rate the school on each item. The Rubric provides
a five-point rating scale and descriptions of practices that would score a 1, 3, and 5. If you judge a school’s practice to fall between the described
ratings, assign the school a rating of 2 or 4. For example, if you judge a school to be performing at a level higher than the Rubric describes for a 3
rating but not quite at the level described for a 5, rate the school as performing at a 4.
Introductory Script for Interviews:
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
Interview Questions
Comments/Remarks
Ratings (1-5)
Screening—The RTI system accurately identifies students at risk of poor learning outcomes or challenging behaviors.
1. Screening Tools
What tools do you use for screening?
Notes:
Reading:
Math:
What evidence do you have that
supports the reliability of your
screening tools?
What evidence do you have that
supports the validity of your screening
tools?
Recommendation(s):
What do you think about the accuracy
of your screening tools in predict
students’ risk status?
(Provide evidence, if available; i.e.
technical manuals, information from
NCRTI Tools Charts, data from the
publisher.)
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
2. Universal
Screening
Interview Questions
Comments/Remarks
Which students participate in screening
(grade levels and groups)?
Notes:
Ratings (1-5)
Reading:
Math:
How often is screening conducted?
What procedures do you use to ensure
implementation accuracy (i.e.
universal, accurate administration,
scoring, and accurate use of cut points
to identify students)?
Recommendation(s):
(Provide evidence, if available. i.e.,
sample administration scripts, sample
data, description of training and/or
procedures for checking or retraining
as needed.)
Multi-Level Prevention/Intervention System—The framework includes a school-wide, multi-level system for preventing school failure.
Primary Level Prevention/Core Curriculum
3. Research-Based
Curriculum
Materials
What curriculum materials do you use
in your core program?
Notes:
Reading:
Math:
How do you know whether these
materials are research-based for your
population of learners?
(Provide evidence, if available; i.e.
information from IES Practice Guides,
NCRTI tools charts, WWC, or other
relevant sources)
Recommendation(s):
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
4. Fidelity
Interview Questions
Comments/Remarks
How do you ensure that your
curriculum materials are delivered with
fidelity?
Notes:
Ratings (1-5)
Reading:
Math:
What procedures do you use to monitor
the fidelity of implementation of your
core curriculum?
5. Articulation of
Teaching and
Learning
(Provide evidence, if available; i.e.
fidelity checklists, observation
protocols, processes for re-training)
Recommendation(s):
How is teaching and learning
articulated (aligned) from one grade to
another?
Notes:
How do you ensure that teaching and
learning is well articulated (aligned)
within grade levels so that students
have similar experiences, regardless of
their assigned teacher?
6. Instruction
In what ways do teachers in your
building differentiate instruction?
Reading:
Math:
Recommendation(s):
Notes:
Reading:
Math:
What information do teachers use to
determine the needs of students for the
purpose of differentiation?
(Provide evidence, if available; i.e.
sources of data used to identify student
needs, grouping strategies)
Recommendation(s):
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
7. School-Based
Professional
Development
Interview Questions
Comments/Remarks
Please describe the structure for
professional development in your
school.
Notes:
Ratings (1-5)
Reading:
Math:
Recommendation(s):
Secondary (Strategic) Prevention
8. Evidence-Based
Intervention
What intervention materials do you use
in secondary prevention?
Notes:
Reading:
Math:
What evidence have you reviewed
regarding the program’s effectiveness?
(Provide evidence, if available; i.e.
information from IES Practice Guides,
NCRTI tools charts, WWC, or other
relevant sources)
9. Complements
Core Instruction
In what ways do secondary intervention
materials align or support foundational
skills relevant to core instruction?
Recommendation(s):
Notes:
Reading:
Math:
Recommendation(s):
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
10. Fidelity
Interview Questions
Comments/Remarks
What evidence do you have that
secondary interventions are
implemented with fidelity (according to
the standard protocol)?
Notes:
Ratings (1-5)
Reading:
Math:
What procedures do you use to monitor
fidelity?
11. Instruction
(Provide evidence, if available; i.e.
fidelity checklists, observation
protocols, processes for re-training)
Recommendation(s):
Who delivers secondary interventions?
Notes:
Reading:
Math:
How are staff trained to deliver
interventions?
What is the typical group size for
secondary interventions?
(Provide evidence, if available; i.e.
sample schedules, group rosters)
Recommendation(s):
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
12. Determining
Responsiveness
to Secondary
Prevention
Interview Questions
Comments/Remarks
What data are used to decide whether
or not a student is responding to
intervention?
Notes:
Ratings (1-5)
Reading:
Math:
What procedures are in place to help
support the team in making these
decisions accurately and consistently?
13. Addition to
Primary
(Provide evidence, if available; i.e.
meeting protocol or procedures
manual)
Recommendation(s):
Are the secondary level interventions
always implemented as a supplement
to the core curriculum?
If no, please explain.
Notes:
(Provide evidence if available; i.e. a
sample schedule)
Reading:
Math:
Recommendation(s):
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
Interview Questions
Comments/Remarks
Ratings (1-5)
Tertiary (Intensive) Prevention
14. Evidence-Based
Intervention
Describe the interventions used at the
tertiary level?
What information do you have to
indicate that interventions are
supported by evidence (i.e. that
interventions are either an evidencebased standard treatment protocol, or
based on validated progress monitoring
methods for individualizing instruction)?
Notes:
Reading:
Math:
Recommendation(s):
In what way are your tertiary
interventions more intensive than
secondary interventions?
(Provide evidence, if available; i.e.
intervention information, student
progress monitoring data showing
evidence of effectiveness)
15. Fidelity
What evidence do you have that
tertiary interventions are implemented
with fidelity (according to the standard
protocol)?
Notes:
Reading:
Math:
What procedures do you use to monitor
fidelity?
(Provide evidence, if available; i.e.
fidelity checklists, observation
protocols; processes for re-training )
Recommendation(s):
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
16. Instruction
Interview Questions
Comments/Remarks
Who delivers tertiary interventions?
Notes:
Ratings (1-5)
Reading:
Math:
How are staff trained to deliver these
interventions?
What is the typical group size for
tertiary interventions?
(Provide evidence, if available; i.e.
sample schedules, group rosters)
17. Determining
Responsiveness
to Tertiary
Prevention
What data are used to decide whether
or not a student is responding to
tertiary intervention/prevention?
Recommendation(s):
Notes:
Reading:
Math:
What procedures are in place to help
support the team in making these
decisions accurately and consistently?
18. Addition to
Primary
(Provide evidence, if available; i.e.
meeting protocol or procedures
manual)
Recommendation(s):
Are the tertiary level interventions
always implemented as a supplement
to the core curriculum?
If no, please explain.
Notes:
(Provide evidence if available; i.e. a
sample schedule)
Recommendation(s):
Reading:
Math:
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
Interview Questions
Comments/Remarks
Ratings (1-5)
Progress Monitoring—Ongoing and frequent monitoring of progress that quantifies rates of improvement and, informs instructional practice and
the development of individualized programs.
19. Progress
Monitoring Tools
What tools do you use to monitor
student progress?
Notes:
Reading:
Math:
How many alternate forms (of equal
and controlled difficulty) are available?
How do you determine minimum
acceptable growth?
Recommendation(s):
How do you determine acceptable end
of the year performance?
What evidence do you have to suggest
that performance level data are
reliable?
(Provide evidence, if available; i.e. a
technical manual from the publisher,
sample probes, information from the
NCRTI Tools Chart)
20. Frequency of
Monitoring
How often are students at the primary
level progress monitored?
Notes:
Reading:
Math:
How often are students at the
secondary level progress monitored?
How often are students at the tertiary
level progress monitored?
Recommendation(s):
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
21. Administration
Process
Interview Questions
Comments/Remarks
Describe the process used for
administering progress monitoring.
Notes:
Ratings (1-5)
Reading:
Math:
How do you ensure that progress
monitoring probes are administered
using a standard procedure?
(Provide evidence, if available. i.e.,
sample administration scripts, sample
data, description of training and/or
procedures for checking or retraining
as needed.)
Recommendation(s):
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
Interview Questions
Comments/Remarks
Ratings (1-5)
Data-Based Decision Making — Data-based decision making processes are used to inform instruction, movement within the multi-level system,
and disability identification (in accordance with state law).
22. Decision-Making
Process
What process do you use to make
decisions about placement of students
in secondary or tertiary
intervention/prevention levels?
Notes:
Reading:
Math:
Who participates in this decisionmaking process?
Are there procedures in place that
include objective decision-making
criteria to support teams in making
placement or movement
determinations?
Recommendation(s):
(Provide evidence, if available. i.e.,
meeting protocol, composition of
decision-making team(s), sample data
reviewed, identification of desired cutpoints or growth rates for determining
movement and/or response to
instruction)
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
Interview Questions
Comments/Remarks
Ratings (1-5)
Overarching Factors—Factors that relate to the entire RTI system.
23. Prevention
Focuses
To what extent do you believe the
teaching staff views the purpose of RTI
as primarily to prevent students from
having academic and/or behavioral
problems?
What portion of the teaching staff view
RTI as primarily a means for special
education identification?
24. Leadership
How do leaders/administrators
perceive and support RTI at the school
level?
Notes:
Reading:
Math:
Recommendation(s):
Notes:
Reading:
Math:
How do leaders/administrators
perceive and support RTI at the
district level?
Recommendation(s):
25. Staff
Qualifications
What ongoing RTI training (or training
on relevant components) available to
all school staff? Please describe.
Notes:
If not, who receives training?
Recommendation(s):

See notes from 11 a,b and 16 a,b
Reading:
Math:
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Item
26. Culturally and
Linguistically
Responsive
Interview Questions
Comments/Remarks
What efforts are made to ensure that
core instruction, secondary, and tertiary
interventions consider the cultural,
linguistic, and socioeconomic factors
present in your school?
(Provide evidence, if available. i.e.,
sample materials, information from
school handbook, description of
relevant professional development.)
27. Communications
with Parent
What information is available to
parents/guardians describing the
school’s (or district’s) essential
components of RTI?
How are parents/guardians updated
regarding progress if their students are
receiving secondary or tertiary
interventions?
Notes:
Ratings (1-5)
Reading:
Math:
Recommendation(s):
Notes:
Reading:
Math:
Recommendation(s):
(Provide evidence, if available. i.e.,
parent brochures, sample letters home,
progress reports, conference
information)
28. Other
How are RTI data used in your special
education eligibility process?
Notes:
Is there anything else you would like for
us to know?
Recommendation(s):
Not scored
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.
WASHINGTON RTI SITE VISIT INTERVIEW FORM
Average Scores Across Components
Component
Reading Average
Math Average
Behavior Average
Screening
Core Instruction
Secondary Intervention
Intensive Intervention
Progress Monitoring
Data-based decision-making
Overarching Factors
Overall Score
*Component scores were averaged across subcomponents within the topics listed above. The overall score is the average of the average component scores for each subject area
(reading or math). If something was scored as “NA” due to lack of information, it was not included in the calculations. Please see the NCRTI Integrity Rubric for more information about
what constitutes scores of 1-5 across subcomponents.
Thanks to NCRTI & RMC Research Corporation for their assistance in the development of this tool.