Response to Intervention Planning Tool
Secondary Version (7th-12th)
Purpose: This document is to be used by District and/or Building Leadership Teams (DLTs, BLTs) to guide the implementation of Response to Intervention
through a school-wide three-tier model for academic and behavioral supports.
School Year:
Date plan was started:
District:
Building:
District CCIP Goals:
1.
2.
3.
District Leadership Team Liaison:
District or Building Leadership Team Meeting Dates for the Year:
Coach:
District or Building Leadership Team Members (Name and Title)
Integrated Systems Model Team
OH SST13, March, 2008 -- Revised 2/2009
Page __ of __
Step 1: Problem Definition
Current Disaggregated READING Data: Percentage of students meeting READING benchmarks/proficiency:
In ( ) write the number of students in that subgroup.
Date of Data Reports Used to Complete the Table:
G = Grade level
A = Assessment
(e.g. Spring 07-08 school year)
G
A
All
African American
American Indian or Nat.
Alaskan
Asian or Pacific Islander
Hispanic
Multiracial
White
Male
Female
Economically Disadvantaged
Non-economically
disadvantaged
Students with disabilities
Non-disabled
LEP
Non-LEP
Establishment of Need for the Three-Tier Model
Problem Definition/Need Statement: We need to establish a prevention and intervention model within our school because:
We do not have a full continuum of supports in place to ensure 95-100% of our students meet benchmarks in all grade levels
We have the following achievement gaps (please list below):
Integrated Systems Model Team
OH SST13, March, 2008 -- Revised 2/2009
Page __ of __
Current Disaggregated MATH Data: Percentage of students meeting MATH benchmarks/proficiency
In ( ) write the number of students in that subgroup.
Date of Data Reports Used to Complete the Table:
G = Grade level
A = Assessment
(e.g. Spring 07-08 school year)
G
A
All
African American
American Indian or Nat.
Alaskan
Asian or Pacific Islander
Hispanic
Multiracial
White
Male
Female
Economically Disadvantaged
Non-economically
disadvantaged
Students with disabilities
Non-disabled
LEP
Non-LEP
Establishment of Need for the Three-Tier Model
Problem Definition/Need Statement: We need to establish a prevention and intervention model within our school because:
We do not have a full continuum of supports in place to ensure 95-100% of our students meet benchmarks in all grade levels
We have the following achievement gaps (please list below):
Integrated Systems Model Team
OH SST13, March, 2008 -- Revised 2/2009
Page __ of __
Current Disaggregated Behavior Data:
Date of Data Reports Used to Complete the Table:
(e.g. Spring 07-08 school year)
Average Office Referrals:
Average Office Referrals Per Day Per
Month Per 100 Students*:
(across all months)
* Steps to get the Average Referrals Per Day Per Month per 100 students:
1. Total Enrollment divided by 100
2. Divide average ODR per day per month by above number
Disaggregated Behavior Data:
% of population
% of ODR
% of suspensions
% of expulsions
All
African American
American Indian or Nat.
Alaskan
Asian or Pacific Islander
Hispanic
Multiracial
White
Male
Female
Economically Disadvantaged
Non-economically
disadvantaged
Students with disabilities
Non-disabled
LEP
Non-LEP
Establishment of Need for the Three-Tier Model
Problem Definition/Need Statement: We need to establish a prevention and intervention model within our school because:
We do not have a full continuum of supports in place to meet the system standard (see PBS Analysis Guide for relevant standard).
We have instances of disproportionality (please list below):
Integrated Systems Model Team
OH SST13, March, 2008 -- Revised 2/2009
Page __ of __
Step 2: Analysis of System
Problem Analysis Information: Based on the area(s) that you prioritized on the previous pages, please conduct an analysis of your current structures
and programming. Teams are encouraged to begin with analyzing their Leadership and Teaming structures and then may choose to work on either
literacy, math, and/or behavior. Ultimately, all analyses will be completed at all grade levels.
Leadership & Teaming Analysis (completed first)
Completed: __________
Literacy Analysis
What grade level(s) will be analyzed __________
Completed: __________
Math Analysis
What grade level(s) will be analyzed __________
Completed: __________
PBS Analysis
Completed: __________
Hypothesis: We do not have a fully implemented Three-Tier Model in place in our school because we are missing the following key components.
Summarize Areas of Need from the Analysis (items from the analysis that need to be examined)
Leadership & Teaming Analysis
Leadership
Collaborative Strategic Planning






Administrative Leadership
Building Leadership Team
Literacy Components
Teaming Practices
Data-based Decision Making
Problem Solving
Systems for Implementing Tiers of Instructional/Intervention Supports
Math Components
Behavior Components
Tier 1








Program/Strategies-Core
Program/Strat.-Supplemental
Differentiated Instruction
Effective Implementation of Tier 1
Adherence to Tier 1
Professional Development
Assessment
Decision Rules








Program/Strategies-Core
Program/Strat.-Supplemental
Differentiated Instruction
Effective Implementation of Tier 1
Adherence to Tier 1
Professional Development
Assessment
Decision Rules







Clear Expectations
Explicit Instruction
System for Acknowledgement
System for Managing Disruptions
Data System and Collection
Data Analysis and Sharing
Adherence Data
Tier 2






Program & Strategies
Effective Implementation
Adherence to Tier 2
Professional Development
Assessment
Decision Rules






Program & Strategies
Effective Implementation
Adherence to Tier 2
Professional Development
Assessment
Decision Rules





Team Formation
Entry Decision Rules
Implementation of Program & Strat.
Assessment
Exit Decision Rules
Tier 3






Designing Supports
Effective Implementation
Adherence to Tier 3
Professional Development
Assessment
Decision Rules






Designing Supports
Effective Implementation
Adherence to Tier 3
Professional Development
Assessment
Decision Rules






Team Formation
Entry Decision Rules
Process for Designing Supports
Implementation of Program & Strat.
Assessment
Exit Decision Rules
Integrated Systems Model Team
OH SST13, March, 2008 -- Revised 2/2009
Page __ of __
Step 3: Set Goal(s)
(Goals are measurable and linked to analysis of current structures that need to be enhanced in order to build a tiered model in your school)
The ultimate goal for ALL schools engaging in the Response to Intervention is to have a fully implemented tiered model, where all 3 tiers of support
are strongly in place at each grade level in the school, resulting in 95%-100% of students' reaching key benchmarks.
Goals:
Target Area
Leadership & Teaming
- Links to CCIP Goal(s) #
and
- Strategy(ies) #
Literacy
- Links to CCIP Goal(s) #
and
- Strategy(ies) #
Math
- Links to CCIP Goal(s) #
and
- Strategy(ies) #
Beh
1155Expected change toward building a tiered model in our school that supports ALL students
5%
5%
avio
10
10
Int
Inte
8
8Completion Date
ral
%
%
Goals—Check or state which goal(s) you will work on this school year.
ens
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
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Int
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uali
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
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oc
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ent
Int
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 Put Tier 1 Literacy Supports in place so that 80% - 90% of students reach key readingE benchmarks
ol
ol
P
ion
nswith ONLY Tier 1 supports.
Eff s
W
e Wreading
 Put Tier 2 Literacy Supports in place so that an additional 5%-10% of students reach key
c
id
id
benchmarks with Tier 1 and Tier 2 supports.
ti
v e
e
e reading
 Put Tier 3 Literacy Supports in place so that an additional 1%-5% of students reach key
S In
In
benchmarks with Tier 1, 2 and 3 supports. ALL students making strong progress towards
reading
c
te
h te
goals, with 95%-100% of students reaching key reading benchmarks.
o
rv
rv
o
 Put Tier 1 Math Supports in place so that 80% - 90% of students reach key benchmarks
l- e with ONLY e
W
Tier 1 supports.
nt
i nt
d
io
io
 Put Tier 2 Math Supports in place so that an additional 5%-10% of students reach keye benchmarks
I n
with Tier 1 and Tier 2 supports.
n
n
t s
s
 Put Tier 3 Math Supports in place so that an additional 1%-5% of students reach key benchmarks
e
r
with Tier 1, 2 and 3 supports. ALL students making strong progress towards reading goals,
with
v
95%-100% of students reaching key math benchmarks.
e
n
PBS

ti
Put Tier 1 PBS in place so that 80% - 90% of students reach key behavioral benchmarks
with
o
ONLY Tier 1 supports.
n

Put Tier 2 Behavioral Supports in place so that an additional 5%-10% of students reach key
behavioral benchmarks with Tier 1 and Tier 2 supports.

Put Tier 3 Behavioral Supports in place so that an additional 1%-5% of students reach key
behavioral benchmarks with Tier 1, 2 and 3 supports. ALL students making strong progress
towards behavioral goals, with 95%-100% of students reaching key behavioral benchmarks.
- Links to CCIP Goal(s) #
and
- Strategy(ies) #
s

Integrated Systems Model Team
OH SST13, March, 2008 -- Revised 2/2009
Page __ of __
 Leadership & Teaming
Step 4: Action Steps to Address:
 Literacy
 Math
 PBS
What steps need to be taken during the current school year to build a three-tier model of academic and behavior supports in our school?
What needs to be done?
Is Problem
Solving Needed?
 Yes (use
What are the steps to get this done?
Who?
By
When?
problem-solving sheet)

No

Yes ((use
problem-solving sheet)

No

Yes (use
problem-solving sheet)

No

Yes (use
problem-solving sheet)

No

Yes (use
problem-solving sheet)

No

Yes (use
problem-solving sheet)

No

Yes (use
problem-solving sheet)

Integrated Systems Model Team
OH SST13, March, 2008 -- Revised 2/2009
No
Page __ of __
Step 5: Evaluate the Plan: Refer to the action steps listed in Step 4. For each action step determine if it has been Achieved (A), is
In Progress (I) or is Not Started (N). List any modifications needed in the space provided. Be sure to review building-wide data
each month as part of your review (i.e. DIBELS reports, Big 5 reports from SWIS)
October
Status
Modification
 A
November
Status
Modification
December
Status
Modification
January
Status
 I
 N
 A
 I
 N
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Integrated Systems Model Team
OH SST13, March, 2008 -- Revised 2/2009
Modification
Page __ of __
Step 5: Evaluate the Plan: Continued
February
Status
.
Modification
March
Status
Modification
April
Status
Modification
May
Status
 A
 I
 N
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Integrated Systems Model Team
OH SST13, March, 2008 -- Revised 2/2009
Modification
Page __ of __