Caddo Parish SBLC Procedures:
RtI and Referral Teams
2015-2016
Acknowledgements
This manual was developed through a collaborative effort to produce a step-by-step guide for school
personnel to implement Response to Intervention (RtI). In the spring of 2014, Keith Burton, Chief
Academic Officer, welcomed Billy Snow and a group of over one hundred educators to initiate this
process. Various directors, principals, supervisors, coordinators, counselors, and pupil appraisal
personnel gathered to review current RtI practices and recommend changes to develop a new RtI
framework for the district. The importance of quality instructional support for ALL students was the
goal.
Under the leadership of Billy Snow, District Transformation and Innovation Officer, and Erin Harp,
Director of Accountability and Instructional Support, a smaller group of professionals were selected
from the original group to form the RtI Committee. Gratitude is expressed to the RtI Committee for
remaining focused on the recommendations of the original group in designing, composing and
editing this final project. The inspiration, support, and guidance of all educators who either directly
or indirectly have been instrumental in making this project a success is also greatly appreciated.
Caddo Parish RtI Committee
Billy Snow, Chair
Erin Harp, Co-Chair
Walter Brown
Lauren Escudé
Cassie Harwell
Brandy Holcomb
Melody Jones
Nell Lamendola
Julie Scruggs
Karen Bush
Patrick Greer
Cheryl Jones-Hart
Dr. Phyllis Leone
Dr. Sheila Lockett
Kasie Mainiero
Michelle Miller
Denise Richmond
Dr. Carla Mitchell
Angela McCoy
Roger Vance
Ginger Gustavson
Table of Contents
Defining “Response to Intervention” ....................................................... 1
District RtI Contacts ................................................................................. 2
Structure for the SBLC Committee ........................................................... 3
SBLC Teams and Responsibilities ........................................................... 4-6
Assessment Overview ............................................................................... 7
Universal Screeners .................................................................................. 8
Progress Monitoring ................................................................................. 9
RtI Timeline Overview ............................................................................ 10
Caddo’s Response to Intervention (RtI) Pyramid .................................... 11
Tier Definitions .................................................................................. 12-13
Caddo Non-Negotiable Programs/Assessments/Interventions .............. 14
Caddo RtI Academic Decision-making Flowchart ............................... 15-18
Parent-Initiated Request Flowchart ........................................................ 19
RtI Clarifications ..................................................................................... 20
Academic/Behavioral/Sensory Screeners……............................................21
RtI and Communication Concerns ..................................................... 22-23
RtI Meeting Agendas and Forms………………………………………….... ......... 24-31
Chekclist for initial referrals .................................................................... 32
RtI Lesson Plans/Student Data Form.................................................. 33-36
Table of Contents (cont.)
Overview for Deep Dive .......................................................................... 38
Deep Dive Forms………………………………………….... ................................ 39-47
Deep Dive Overview ............................................................................... 48
Deep Dive Instructional Forms........................................................... 49-51
Response to Intervention (RtI)
Both the No Child Left Behind Act (NCLB 2001) and the Individuals with Disabilities Education
Improvement Act (IDEA 2004) focus on the quality of instruction that students receive in the
general education setting. NCLB and IDEA require the use of research-based instruction and
interventions. Response to Intervention (RtI) is the practice of meeting the academic and behavioral
needs of all students through a problem-solving process with three key elements:
 High-quality instruction and research-based tiered interventions aligned with individual student
need
 Frequent monitoring of student progress to enable results-based academic and/or behavioral decisions
 Use of student response data in making important educational decisions (such as those regarding
placement, interventions, curriculum, and instructional goals and methodologies)
Using data-based interventions and interventions based on scientific research to determine eligibility
for learning disabilities is stressed in IDEA 2004. With an RtI approach, general education teachers
assume increased responsibility for delivering high-quality instruction to early-indentified
struggling students.
504 Referrals and 504 Students
1. A 504 referral can occur at any point in the RtI process for students with medical impairments that
substantially limit a major life activity/bodily function.
2. A 504 or Dyslexia referral can occur at any point in the RtI process. The RtI team may decide how
long interventions are conducted based on student needs before a referral is made. When a referral is
warranted the SBLC/Referral team should be notified and appropriate documentation, including school
based data must support the need for a referral. A student identified as a 504 or dyslexic student is not
automatically a Tier 3 student.
3. A student who is eligible for 504 may or may not require accommodations on his/her IAP.
Services for Exceptional Children
The most intensive tier of instruction is for students identified as eligible for special education.
Students at this level receive specially designed instruction as determined by the IEP committee.
Instructional Services for Students with Dyslexia
Per Bulletin 1903, students identified as having “Characteristics of Dyslexia” MUST receive the required
150 minutes of multisensory instruction in the whole class setting referred to as Tier 1 or any combination
of instruction in Tiers 1, 2, and/or 3.
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For Assistance . . .
District RtI Contacts
(K-3)
 Professional Development
Dr. Carolyn Gore
cgore@caddoschools.org
286-8405
Angela McCoy
ammcoy@caddoschools.net
675-0444
Melody Jones
mjjones@caddoschools.org
603-5736
 Purchasing
Erin Harp
eaharp@caddoschools.org
603-6515
ILLUMINATE
 Professional Development
Roger Vance (Math K-6)
rvance@caddoschools.orgs
603-6326
Ginger Gustavson
gcgustavson@caddoschool.org
603-6371
 Distribution & Training
Roger Vance (Math K-6)
rvance@caddoschools.org
603-6326
Walter Brown (ELA 6-12)
wbrown@caddoschools.org
603-6361
 Distribution
 Professional Development
Dennie Eason
season@caddoschools.org
603-6866
 Purchasing
Erin Harp
eaharp@caddoschools.org
603-6515
 Distribution
Roger Vance (Math K-6)
rvance@caddoschools.org
603-6326
Ginger Gustavson (Math 7-8)
gcgustavson@caddoschools.org
603-6371
Janice Swicegood
jkswicegood@caddoschools.net
294-5585
JCAMPUS
 Technology
 Professional Development
 Professional Development
Website
www.mobymax.com
 Purchasing
Erin Harp
eaharp@caddoschools.org
603-6515
 Diagnostic Contacts
Brandy Holcomb
baholcomb@caddoschools.org
686-1783
Erin Harp
eaharp@caddoschools.org
603-6515
RtI/Referral Manual
Website for Targeted
Campuses Only
www.classworks.com
 Purchasing
Erin Harp
eaharp@caddoschools.org
603-6515
 Diagnostic Contacts
Julie Scruggs
jscruggs@caddoschools.org
603-6504
Erin Harp
eaharp@caddoschools.org
603-6515
2
Saundra Roberson
shroberson@caddoschools.org
603-5603
 RtI Contact
Michelle Miller
mmiller@caddoschools.org
603-6714
 Purchasing
Erin Harp
eaharp@caddoschools.org
603-6515
2015-2016
School Building
Level Committee
(SBLC)
RtI Team
Referral Team
*Members ~ Principal
Assistant Principal
Instructional Coordinator
Counselor
Reading/Math Interventionist
Classroom Teacher
PBIS member/representative
Behavior Intervention Specialist
Speech/Language Pathologist
*Function ~ Meet every 9 week period
~ Make educational decisions
about students based on data
~ Monitor implementation of
effective instruction and RtI
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*Members ~ RtI Team Members (see left)
Pupil Appraisal Members
Parent/Guardian of Student
May Include: Content Coach
Dyslexia Teacher/Assessor
Speech/Language
Pathologist
Behavior Intervention
Specialist
School Nurse
504 Designee
Community Agency
Motor Specialists
*Function ~ Meet to discuss students
receiving SPED and/ or 504
referral to determine next
course of action
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School Building Level Committee (SBLC)
The SBLC is a general education, data driven, decision-making committee. Decisions are made by individuals
who are qualified to make important educational decisions and to determine the allocation of resources. The
School Building Level Committee is comprised of two separate teams: Response to Intervention (RtI) Team and
Referral Team.
RtI Team Members & Responsibilities
Instructional
Coordinators
or API
Referral Team Members & Responsibilities
*Team Leader
*Assist teachers with retrieving data for
the meetings
*Attend team meetings
*Assist with developing student goals
*Assist with developing appropriate
instructional/RtI strategies
*Review progress monitoring and
diagnositics with teachers every 3 weeks
and document.
Instructional
Coordinators
or API
*Team Leader
*Attend all meetings
*Identify the student and the areas
of concern based on the data
discussed at the RtI Team
meetings
* May delegate other responsibilities
as needed to other RtI Team members
* May delegate other responsibilities as
needed to other RtI Team members
Principal &
AP
*Attend team meetings
*Assist with developing student goals
*Assist with developing appropriate
instructional/RtI strategies
*Review progress monitoring and
diagnositics with teachers every 3 weeks
and document.
Pupil Appraisal
*Attend all meetings
*Assist with analyzing screeners
* Interpret progress monitoring
data
Counselors
*Attend team meetings
*Time keeper (approximately 10 minutes
per student)
*Document team decisions
*Disseminate information to all
stakeholders when necessary (screeners,
parent letters, mandated communication
forms, etc.)
*Attend team meetings
*Bring appropriate data to discuss
identified students to the RtI Team
meeting
*Discuss instructional strategies that
address students’ needs
*Document implemented RtI strategies
*Progress monitor students weekly using
appropriate diagnostic tools and document
data points
Counselors
*Attend all meetings
*Collect screeners and assist with
analysis
*Disseminate information to all
stakeholders
*Document meeting outcomes
*Collaborate with team to
determine next course of action
*Identify the instructional
strategies that have been
implemented
*Bring all data associated with the
student to the meeting, including
RtI plans and data folders
Classroom
Teacher
Classroom
Teacher
Principal and/or
API
*Attend all meetings
*Mediate discussions and solve
problems that may arise
*Monitor the fidelity of the
implementation of the RtI process
and validate the results presented
by the teacher
*Team Leader in the event of a ICs
absence
Special education teachers MAY NOT serve on the SBLC. They may, however, serve as a consultant for other
staff members. Likewise, the SBLC chairperson and the 504 designee may not be the same person.
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Response to Intervention (RtI) Team:
It is the responsibility of the RtI team to review and analyze student progress as depicted in universal screening
assessments, district benchmarks, and formative assessments each 9 week period. The team members will
identify students who need to be discussed at each team meeting. Once the students are identified, team
members will assist the classroom teacher with developing a goal for each student as well as developing
instructional strategies that will enable students to reach the established goal.
Referral Team:
The referral team will conduct meetings after students receive Tier 3 instruction. The parent of the student will be
notified and will be invited to attend the meeting. The meeting is designed to provide information about the
student’s areas of deficit and the instructional strategies that are being implemented by teachers and/or
interventionists that address the areas of concern. Furthermore, appropriate screeners will be analyzed to
determine if the student needs additional services based on the documented outcomes of the screeners.
Additionally, at the end of each team meeting, the following decisions may be made:

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Conduct no further action at this time
Continue current tier of intervention and progress monitoring through the RtI process
Move students to the next tier of intervention and progress monitor through the RtI process
Refer the student to the appropriate committee to conduct a section 504 Evaluation
Refer to Pupil Appraisal (PA) for support services (PA Representative must be present)
Refer to Pupil Appraisal for an individual evaluation (PA Representative must be present)
Consideration of grade retention/Promotion with retention
NOTE; IT IS ALWAYS BEST PRACTICE TO MEET WITH A PARENT ANY TIME THEY
HAVE CONCERNS AND DOCUMENT THESE MEETINGS.
Additional SBLC Support:
Student Concern
Assigned Personnel
Responsibilities
Students whose progress reflects 2 or
more failing grades, as indicated on
progress reports & report cards
School Counselor
Students who demonstrate behavioral
concerns as documented of 4 or more
major referrals
PBIS Committee Members
School Counselor
Behavior Intervention
Specialist
*Weekly meetings with students
individually or in a group setting outlining
behaviors that promote positive actions
towards earning acceptable grades
*Identify personal concerns of students that
may be negatively affecting their grades
and provide counseling services
*Document meetings with students
*PBIS Committee will discuss behavior
concerns and provide teachers with
strategies that may deter inappropriate
behavior
*Counselor will meet with students and
identify events that may inadvertently
contribute to students misbehaviors
Each school’s attendance clerk shall make
daily phone calls to the parents of absent
students; send letters to parents, notifying
them of the number of days of their child’s
accumulated absences; refer the child to the
Counselor for FINS; refer the child to the
CPSB Attendance Department for a home
visit
Students who exhibit excessive
unexcused absences (4 or more)
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Exceptions for Referrals may include the following:
Any student may be discussed at SBLC/Referral team meeting if he or she meets the following criteria:
 Enrolled in an educational program operated by the Caddo Public School District (CPSD) including
those who are receiving homebound services
(or)
 Enrolled in a private school, or public or private preschool or daycare program within the geographical
jurisdiction of CPSD
Schools should identify and discuss the following students at SBLC meetings when needs are not being met in the
general education program including:
 Students who excel in academics and/or the arts
 Students with severe social, emotional, and/or behavioral difficulties whose needs cannot be met by the
PBIS Committee or services provided by the School Counselor
 Students who have communication difficulties
 Students with severe gross or fine motor difficulties
 Students with medical conditions which are documented by a current written medical diagnosis (within
the last 12 months). The condition must significantly impact educational performance.
 Students who may have severe or low incidence impairments (consult with Pupil Appraisal staff for
possible immediate referral). Low incidence impairments are defined as:
Intellectual Disability (Moderate or Severe)
Visual Impairment
Traumatic Brain Injury
Severe Orthopedic Impairments
Multiple Disabilities
Autism Spectrum Disorder (Severe)
Hearing Impairment
Deaf-Blindness
Other serious medical condition(s)
Parental Notification and Participation
Participation by parents is crucial in all referral team meetings in which decisions are being made regarding their
child. The SBLC 1 (meeting notification) invites parents to participate in the SBLC Referral Team meeting and
should be sent prior to each meeting thereafter.
If a parent requests an SBLC referral team meeting, the team should convene and discuss the concerns in a timely
manner; within 10 business days is best practice. If a referral is made by school personnel, efforts should be made
to give the parent “reasonable” notice. Every effort should be made to accommodate parental participation in
SBLC referral team meetings. A meeting may be conducted without a parent present, if all reasonable efforts
have been made to notify the parent that they should attend. The SBLC referral team should keep a record of all
attempts to arrange a mutually convenient time. If a meeting is conducted without a parent, the SBLC referral
team chair should send home a copy of the SBLC Determination (SBLC 3).
Parents may invite other participants or advocates to attend a SBLC referral team meeting with them. If this
occurs, complete a consent form to allow the individual to participate in the meeting. This consent is in
compliance with the Family Educational Rights and Privacy Act (FERPA).
According to Louisiana’s Bulletin 1508: “Parents must be provided a report or summary by the SBLC on the
status of the student’s response to scientifically research-based interventions… including [progress
monitoring] at reasonable intervals. This report or summary must be provided to parents at least once each
grading period until a decision is reached.” The interventions status letter will be mailed out at the end of every
nine week decision point.
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Assessment Overview
Universal Screeners/Progress Monitoring
ELA/Reading – DIBELS Next (K-3) AIMSweb(4-8) Classworks Summative Benchmark (6-8) Beginning, Middle, and End of the Year
Writing – AIMSWEB (This is NOT to be used as a Student Learning Target) (2-8)
Math – AIMSWEB (K-8) or Classworks Summative Benchmark (6-8) -Beginning, Middle, and End
of the Year
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Universal screeners are assessments administered to all students to determine as early as possible which
students are at risk of not meeting academic goals.
Universal screeners are norm referenced measures of automaticity or fluency in the short term memory.
Universal screeners are not diagnostic in nature or standards based.
No accommodation or modifications are allowed for universal screening.
Progress monitoring is a brief assessment to determine if students are making adequate progress..
Progress monitoring is measuring rate of improvement.
If a student’s IEPs allows him/her to have accommodations during testing, they are to be provided for all
progress monitoring assessments.
NOTE: universal screening tools do not place a student in a tier. These tools help us place students in
intervention groups and not in a specific tier.
It is the responsibility of the classroom teacher to administer, score and analyze the data for the
classes they teach. Teachers must have enough information to know how best to use their instructional
time or which students need specific instructional interventions.
Diagnostic Assessments:



Diagnostic assessments are designed to provide the teacher with an understanding of the prior knowledge
and skills, as well as the strengths and specific learning needs of their students.
Diagnostic assessments are generally conducted before instruction is given or changed.
Diagnostic assessments used in Caddo are MobyMax and Classworks.
Formative Assessments:


Formative assessments provide ongoing feedback to improve learning and occur during the learning
process. Formative assessments are a planned process that can involve many different activities.
Examples of Formative assessments used in Caddo are:
o Informal teacher questions/observations
o Conversation with student
o Working portfolio
o Journal writing
o Anecdotal records
o Exit tickets
o Unit assessment questions used during the unit to guide instruction
o Curriculum Based Measurements (CBMs), short cycle assessments
Summative Assessments
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Summative assessments occur when teachers evaluate a final product.
Summative assessments are the last opportunity for students to demonstrate standards after a specified
learning period.
Examples of Summative assessments are:
o State assessments
o Mid-term and Finals
o District benchmarks (Interim Assessments)
o Unit assessments when used at the end of a unit/s
o hort cycle assessments/CBM’s/Quizzes
o
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Universal Screeners
The Universal screening assessments are the f i r s t indicator in identifying students who are at risk for
learning difficulties. Its main purpose is to evaluate academic skills and identify students whose
performance is not consistent with that of their peers. Universal screening assessments are administered to
all students three times per year, at the beginning (BOY), middle (MOY), and end (EOY).
The campus RtI team is responsible for overseeing the universal screening process. Universal assessments
in Caddo will be conducted on every student in grades K-8. Careful documentation of screening results is
important for accurate identification of students’ needs.
o If the results of universal screening assessments suggest that an individual student is performing a t
o r below the 25%tile, interventions should be designed for each student based on their individual
strengths and weaknesses.
o These students will move through the tiers as determined by the RTI team at the end of the nine
week quarterly period.
o These students will be continuously monitored through progress monitoring.
o The goal of district-approved interventions is to fill in foundational skill gaps to help prevent students
from failing to meet academic expectations.
o Confidentiality must be safeguarded, although district-approved screening records should be accessible
to teachers and staff who work with the student.
K-3 Screeners
K-3 Screener Name
Developmental Skills
Checklist
Grade
K
ADHD Screening
*Second
DIBELS Next
*Second
At-Risk Checklist for
Emotional/Social &
Behavioral
*Second
Brief Description
As required by the state
The classroom teacher will
complete the ADHD Screening
checklist.
Fall DIBELS Next - Students who
fall below Benchmark may be
considered for a second dyslexia
screener.
Checklists for social and/or
emotional at-risk behaviors are
completed for third graders.
Failed Screener
Procedures
Follow Best Practices for
Teaching – Tier I
instruction
Refer students who fail
screener and need further
support to the RtI Team.
Use the results from
previously administered
universal and diagnostic
screeners in an RtI Team
meeting to complete the
second dyslexia screener.
Refer students who fail the
screener to the RtI Team
for further screener.
*Any screener can be completed as warranted K-3 at any time.
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Goal of Progress Monitoring (PM):
 Estimate Rates of student Improvement (ROI)
 Identify students who are not demonstrating adequate progress
 Compare the efficacy of different forms of instruction and design more effective,
individualized instructional programs for struggling learners
o PM is a brief assessment; usually 1-3 minutes for reading and 5-8 minutes for math to
determine if students are making adequate progress (automaticity). Think… QUICK and
SIMPLE !!
o PM data should be collected, analyzed and used on an ongoing basis; data must be
charted.
o PM assessments should be given at evenly spaced intervals (at least once every 3 weeks)
for a reasonable amount of time. (typically 9 weeks, but allowances are made based on
specific instructional programs). Best practices would include weekly fluency checks on
the weeks where AIMSweb, DIBELS, and Classworks materials are not being used to
progress monitor. The current curriculum can also provide these assessments.
Universal screening assessments and Tier 1 progress monitoring occur at the student’s grade level.
When students are moved into Tier 2 or Tier 3 progress monitoring will be conducted one grade level
above the student’s instructional level. To determine instructional level, administer the progress
monitoring tool moving down by grade level until the student scores at approximately the 50th
percentile. Our diagnostic tools can also provide information on a student’s instructional level.
Schools may assess student progress periodically on grade level and/or adjust the instructional level
as goals are being met.
Determining Student’s Baseline:
 Reading: Before the first RtI meeting, administer 3 one-minute reading fluency probes in one
sitting. Determine the median score and use it as your baseline when setting the student’s goal.
 Math: Before the first RtI meeting, administer 2 math probes during two different sittings and average
the scores. Use this average as the student’s baseline.
Fidelity of Implementation in Progress Monitoring
o Consistency of test administration
 Progress monitors must be given according to directions outlined in the guide.
o General education
 Do not alter the test in any way.
 Do not use manipulatives for any grade level.
o Special Education and 504
 Follow the prescribed IEP or IAP including all accommodations and modifications.
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Concerning Screeners, Student Groups, and Tiers
Timeline
Colors (from our screeners/diagnostics) Do NOT determine TIERS
Data from NORMS is the best overall indicator to determine GROUPS and level of intensity for filling in gaps – Movement in groups is FLUID
TIERS are determined once a quarter (9wks) AFTER students are given interventions with changes and data indicates sufficient and/or insufficient growth
Create Intervention Instructional Plan: Using the END of the YEAR Screeners and/or other data determine the
Groups for the BEGINNING of Year
FIRST 9 WEEKS:
**DEEP DIVE the Fall Universal Screening/Assessment
End of FIRST 9 WEEKS:
Analyze the current progress monitoring 3 week Check-Up, any other data (formal or informal), and REVIEW the DEEP DIVE
from the Fall Universal Screening/Assessment to determine TIER placement and enter results into JCampus (The Quarterly RTI
Meeting)
SECOND 9 WEEKS:
Create New Intervention Instructional Plan: Use the FALL Universal Screening/Assessment to assist in determining the new
group formations for intensity of skill gaps
End of SECOND 9 WEEKS:
Analyze the current progress monitoring 3 week Check-Ups and any other data (formal/informal) to determine TIER
placement and enter results into JCampus
Because of Christmas Holidays—You may determine TIER movement after holidays
**DEEP DIVE the WINTER Universal Screening/Assessment
THIRD 9 WEEKS:
Create New Intervention Instructional Plan: Use the WINTER Universal Screening/Assessment to assist in determining the
new group formations for intensity of skill gaps
End of THIRD 9 WEEKS:
Analyze the current progress monitoring 3 week Check-Ups and any other data (formal/informal) to determine TIER
placement and enter results into JCampus
FOURTH 9 WEEKS:
Create New Intervention Instructional Plan: Using the current progress monitoring 3 week Check-Ups and any other data
(formal/informal) to assist in determining the new group formations for intensity of skill gaps
End of the FOURTH 9 WEEKS: The SPRING Universal Screening/Assessment is given. DEEP DIVE ! Analyzing ALL data determine student groups
to begin the following school term. Enter any student TIER changes into JCampus.
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CADDO’S RESPONSE TO INTERVENTION PYRAMID
504 INFORMATION
A 504 or Dyslexia referral can
occur at any point in the RtI
process. The RtI team may
decide how long interventions
are conducted based on student
needs before a referral is made.
When a referral is warranted the
SBLC/Referral team should be
notified and appropriate
documentation, including school
based data must support the
need for a referral. A student
identified as a 504 or dyslexic
student is not automatically a
Tier3 student.
Services
for
Exceptional Children:
Special Education
IEP-Specialized
Instructions
Tier 1-3 interventions
with progress monitoring
according to the IEP
Tier 3:
Minimum 120 minutes weekly
above Core Instruction
3-6:1 grouping with targeted,
scaffoldeld interventions
Progress monitoring should be continuous
and entered once every 3 weeks
Decision point for Tier placement is after 9 weeks
Tier 3 instruction should ideally be conducted by an
interventionist
Tier 2:
Minimum 90 minutes weekly above the Core Instruction
Minimum 9 weeks
6:1 grouping with targeted, scaffolded interventions
Progress monitoring should be at one grade level above the student’s
instructional level, be frequent and entered once every 3 weeks
Decision point for Tier placement is after 9 weeks
Tier 2 instruction should be conducted by the classroom teacher or interventionist
CORE Instruction
Progress Monitoring and Small Groups are working ON Grade Level
Tier 1 – Intervention(s) are provided to:
Students who score at or below the 25 %tile on Universal Screeners, District
Benchmarks, Formative Assessments, Anecdotal Records, Teacher Observation, etc.
Students who have no progress monitoring data must first be provided with opportunities for
small group instruction with the teacher before placed into more intensive Tiers
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TIER DEFINITIONS
Tier 1:
Tier 1 is the foundation of the RtI instructional model. In this tier, all students receive high-quality,
research-based instruction in the general education setting. Teachers deliver high-quality core class instruction
that is aligned with state standards. Teachers will differentiate instruction in grade-level classes for 9 weeks
and will monitor the progress of all students via documentation of universal screening and individual student
results on state assessments, curriculum-based assessments, district benchmark assessments, daily
assignments, and teacher-made assessments.
What critical areas need to be addressed in Tier 1?
Short Answer: Classroom Instruction
Long Answer:
The Individuals with Disabilities Improvement Act of 2004 (IDEA) and the No Child Left Behind Act of 2001
(NCLB) advocate the use of interventions and instruction based on scientific research. Both acts require
effective reading and mathematics instruction that results in improved student performance and a reduction in
the number of students needing special education services. Essential components for reading are phonemic
awareness, phonics instruction, fluency, vocabulary development, reading comprehension, and those for
mathematics are mathematics calculation and problem solving.
Tier 1:
Characteristics of powerful Tier 1 instruction include:
- A focus on relationship building and establishment of risk-free environment
- Well-designed lessons using research-based models of lesson design – includes a 90-120 minute block
comprising fluency, working with words, guided reading, objective lesson and performance tasks,
writing, and self-selected reading, inquiry based models, gradual release model, compass learning,
Kagan, benchmark testing, as well as project or problem-based learning.
- Highly engaging lessons that motivate and engage all students
- Rigorous lessons at various cognitive levels (differentiation)
- Lesson delivery in a variety of instructional formats. There should be a balance of effective direct
instruction in whole groups and small groups featuring station teaching, learning stations, and
independent practice.
- Use of a variety of perceptual modes and learning styles to reach all students
- Connecting learning to real life
- Lessons that move from concrete to representational to abstract transfer
- Various methods of grouping to meet needs
- Technology is used in ways that engage students and leads them to research to produce their own
products
- Opportunities to show mastery and engagement in instruction through small group purposeful talk
- Multiple quick formative assessments are used throughout lessons
- Data from quick formative assessments, multiple forms of classroom data such as anecdotal records
curriculum-based measures, and district benchmarks, etc. are used to guide instruction
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Tier 2: (90 minutes weekly above the CORE for a minimum of 9 weeks)
The RtI campus team may increase support to Tier 2 for students who are not making progress at Tier 1.
Students are identified for individualized small-group instruction delivered by teachers and/or interventionists,
in addition to Tier 1 instruction. This intensified level of intervention includes research-based programs,
strategies, and procedures designed to supplement and enhance Tier 1 activities. Tier 2 interventions are
typically provided by the classroom teacher and are data-driven.
Tier 3: (120 minutes weekly above the CORE instruction)
Students who have not responded adequately to interventions in Tiers 1 and 2 and are performing significantly
below grade level will move to Tier 3 and receive intensive, comprehensive intervention in addition to their
grade-level instruction.Tier 3 intervention is designed to be 9 weeks.
*** Tier 1 Lesson Plan MUST Include the Following:
ELA/Reading
Math
1. Fluency
1. Fluency
Examples: Letter Naming, Vowel Patterns, Sight Words,
etc.
2. Word Work
Examples: Simple Addition, Subtraction,
Multiplication, or Division Problems – Quick
2. Spiral Review/Problem of the Day
3. Concrete – Representational –
Abstract
Examples: Phonics, Multisyllabic Words, etc.
3. Guided Reading
4. Objective Lesson and Performance
Task
5. Writing
Examples: Manipulatives (Concrete), Pictorial Models
and Journaling (Representational), Contextually
Aligned Problem Solving (Abstract)
4. Application and Problem Solving
Examples: Writing Prompts with Correct Writing
Sequences, Journaling, Text Dependent Writing, etc.
6. Self-Selected Reading
***Tier 2/Tier 3 Intervention Lessons MUST be Scaffolded and Include the Following:
Example of Scaffolding ~ A 4th grader exhibiting skill gaps in 1st and 2nd grade would receive intervention that starts on the
instructional level where the gaps exist and builds towards grade level mastery. Progress Monitoring should be one
grade level above the student’s instructional level.
ELA/Reading
Math
1. Fluency
1. Fluency
Examples: Letter Naming, Vowel Patterns, Sight Words,
etc.
2. Word Work
2. Computation
Examples: Phonics, Multisyllabic Words, etc.
Examples: More complex problems that require
students to think about the process of solving the
problem
3. Content
Examples: Retell, Making Inferences, Story Elements,
Writing, Graphic Organizers, Grammar Skills,
Punctuation, Semantics, etc.
RtI/Referral Manual
Examples: Simple Addition, Subtraction,
Multiplication, or Division Problems – Quick
3. Problem Solving
Examples: Word Problems that make students
think critically and solve multi-step problems
13
2015-2016
CADDO NON-NEGOTIABLE PROGRAMS/ASSESSMENTS AND
INTERVENTION LIST**
Tier 1
Math
Reading/ELA
Tier 2
Math
Tier 3
Reading/ELA
Math
Reading/ELA
MUST DO:
~Aimsweb
~ * (CRA) Lessons
~MobyMax/
Classworks
~ GO Math
Curriculum
MUST DO:
~DIBELS Next
~Aimsweb
~ *(CRA) Lessons
~MobyMax/
Classworks
~Wonders Curriculum
~Caddo Guidebook
Modules
MUST DO:
~ *(CRA) Lessons
~Aimsweb
~MobyMax/
Classworks
MUST DO:
~ *(CRA) Lessons
~DIBELS Next
~Aimsweb
~MobyMax/
Classworks
MUST DO:
~ *(CRA) Lessons
~Aimsweb
~MobyMax/Classworks
MUST DO:
~ *(CRA) Lessons
~DIBELS Next
~Aimsweb
~MobyMax/
Classworks
MAY USE
MAY USE (Supplemental):
(In addition to the above)
~LDOE state guidebook
~Edmodo (BAP/RAP)
MAY USE (Supplemental):
(In addition to the above)
~ FASST Math (Fluency)
~ TransMath
~ Envision (K-2)
~Eureka Math
~Go Math
MAY USE (Supplemental):
(In addition to the above)
~ LANGUAGE!
~ Read Well
~ Project Read
~ Wonder Works
MAY USE (Supplemental):
(In addition to the above)
~ FASST Math (Fluency)
~ TransMath
~ Envision (K-2)
~Eureka Math
~Go Math
MAY USE (Supplemental):
(In addition to the above)
~ ***LANGUAGE!
~ ****Read Well
~ Project Read
~ Wonder Works
(Supplemental):
~ Envision (K-2)
~Eureka Math
*WRITING-Must be universally screened/assessed and progress monitored for grade 2-8
Interventions are embedded within the ELA/Reading curriculum
**Concrete – Representational – Abstract Lessons
*** Refer to the Best Practices Addendums
****LANGUAGE! - Tier 3-Alternate Core Instruction for students in grades 4-8 elementary campuses
*****Read Well -Tier 3 – Alternate Core Instruction for students in grades K-3
Additional information on intervention strategies can be found in Recommendations for Best Practices.
RtI/Referral Manual
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2015-2016
Caddo RtI Academic Flowchart (K through 8th grade)
Administer universal screeners/assessments at the beginning, middle, and end of the year. Refer to
District Assessment Calendar for specific dates. This includes all students unless otherwise specified in
their IEP’s. No accommodations or modifications are allowed for universal screening except for those
students with sensory impairments( i.e. enlarged print for visual impairments


Principal/RtI Instructional chairperson meets with teachers in grade/department levels to
conduct a DEEP DIVE analysis of the Universal Screeners/Assessments. A cutoff score of the 25th
percentile is used as an indicator of academic risk.
Campus RtI team meets with teachers regarding curriculum and instructional practice.
Tier 1
Universal Screening DECISION POINT
Student at or below the 25th percentile
Student is above the 25th percentile
Students are designated Tier 1 students when they are
at or below the 25th percentile on the universal screener
Progress monitoring is continuous throughout good
classroom teaching. However, once every 3 weeks,
formal progress monitoring data is entered within our
monitoring systems. Progress monitoring occurs on
grade level at this point. Students determined to be at
Tier 1 must be entered into Jcampus.
A parent intervention status letter must be sent home.
Continue working with the student in the general
education classroom using the CORE
instruction(whole group or small group).
After EVERY 3 week progress monitoring point,
teachers with instructional leaders review (have a
“Check-Up”) of student progress based on the data
collected. All documentation, including progress
monitoring data, will be presented at the
QUARTERLY RtI meeting for consideration of changes
to the Tier placement.
Tier 1 is at grade level.
9 Week (Quarterly) RTI DECISION POINT Meeting:
Review all student data
Student’s data shows lack of sufficient progress
The student is placed at the Tier 2 level. All changes
in interventions and progress monitoring must be
documented in JCampus. A parent intervention
status letter must be sent home.
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Student data shows progress:
Determination:
Discontinue progress monitoring.
Continue Tier 1 differentiated instruction. A parent
intervention status letter must be sent home.
2015-2016
Tier 2
Minimum of 90 minutes supplemental instruction weekly above the CORE instruction
Student’s instruction must be scaffolded to fill in gaps
Progress monitoring must be conducted at one grade level above the instructional level
for 9 weeks with 6:1 grouping.
RtI Instructional Team Leaders Responsibilities:
• Every 3 weeks meet with teachers to document and review intervention effectiveness and
problem solve as needed. (Review instructional plan and groups)
• Select appropriate interventions from the Caddo tier 2/3 intervention list.
• Assign intervention and assessment support.
• Complete Administrator/Case Manager observation form
Teacher Responsibilities:
Tier 2
• Progress monitor once every 3 weeks
• Follow the schedule for entering data of once every 3 weeks.
• Complete teacher and parent interview forms
9 Week DECISION POINT (Quarterly meeting)
Growth rate is flat, OR growth
rate has been less than average
for 18 weeks:
At the RtI meeting, plan
interventions and consider moving to
Tier 3. Enter into JCampus.
A parent intervention status letter
must be sent home
Growth rate is less than
average.
At the RtI meeting continue Tier
2 interventions with
modifications and enter into
JCampus.
A parent intervention status
letter must be sent home
Growth rate is average or
above average.
At the RtI meeting make decision
to leave in Tier 2 or move back
to Tier 1 and enter into
JCampus.
A parent intervention status
letter must be sent home
Note: TIER 2 and 3 are
at student instructional
level.
Target or aim line is
one grade level above
the instructional level.
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2015-2016
Tier 3
Minimum 120 minutes supplemental instruction (K-6) at student’s instructional level per week
for 9 weeks, 3-6:1 grouping. Parent letter sent home.
Counselors will disseminate applicable screeners at this point.
RtI Team Responsibilities:
• Discuss intervention effectiveness and problem solve as needed.
• Select appropriate interventions from the Caddo Tier 2/3 intervention list.
• Assign intervention and assessment support.
Teacher Responsibilities:
• Progress monitor once every 3 weeks.
 Follow the schedule of entering data once every 3 weeks.
Tier 3
9 Week DECISION POINT
Meeting
Student is above the 25th
percentile on the most recent
universal screener, OR
growth rate is average or
above average.
Move to Tier 2 and see Tier 2
directions and enter into
Student is at or below the 25th
percentile on the most recent
universal screener, growth
rate is flat, OR growth rate
has been less than
average.
Consider proceeding to referral
for further evaluation and enter
into JCampus. Complete “Initial
Referral for Special Education or
504 Checklist.”
RtI/Referral Manual
JCampus.
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2015-2016
Course of Action/Post Referral
Services for
Exceptional Children
Section 504
Services
Student meets criteria for
a referral for a special
education evaluation
Student meets criteria for
a referral for a 504
evaluation
*Follow the special
education process.
*Follow the 504/SBLC
process.
Student does not meet
eligibility for Special
Education or 504.
In collaboration with the evaluator(s), the RtI/SBLC team will design
appropriate interventions based upon the results of the Pupil
Appraisal/504 evaluation report. The team will determine if the
student will continue in Tier 2 or Tier 3.
Note: Per Bulletin 1903, a student who qualifies for Characteristics of
Dyslexia but does not meet the substantial limitation requirement
under Section 504 shall receive 150 minutes of remediation using
either LANGUAGE! or Project Read.
RtI/Referral Manual
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2015-2016
PARENT-INITIATED REQUEST FLOWCHART
If a parent/legal guardian makes a verbal/written request to a school district’s administrative employee for a full and individual
evaluation of a student, the district shall, not later than the 10th school day of receipt of request:
1) Provide an opportunity for the parent or legal guardian to give written consent for evaluation; or
2) Refuse to provide the evaluation and provide the parent or legal guardian with notice of procedural safeguards under 20
U.S.C. Section 1415 (b)/Louisiana Educational Rights of Children with Disabilities
Refer to the following procedures for a parent initiated request for an evaluation:
The school contacts the parent to verify receipt of request and to get request in writing and immediately notifies the Director of Exceptional
Children, and/or the Pupil Appraisal (PA) coordinator and/or SLP. A SPEECH referral is a referral to SPECIAL ED and follows all the same
processes. Note date request received on the written request.
FOR ALL WRITTEN REQUESTS
RtI representative MUST schedule an EXPEDITED RtI meeting within 5 days of written request- The RtI
team will meet to review ALL current DATA and determine - is there evidence of a possible disability?
(include Pupil Appraisal (PA) coordinator)
An analysis of the presenting data will include a review of the parent(s) written concerns;
the RtI file; student files including grades, progress reports, teacher information, and any
previous evaluations.
If ESL, LPAC referral procedures must be followed.
IF NO, prior to the 10th school day, the
Director of Special Education will
complete a Prior Written Notice of
Decision to refuse the evaluation to be
given to the parent along with a copy of
the Procedural Safeguards.
IF YES, follow the RtI
Initial Assessment
Guidelines for completion.
Intervention at the Tier
Levels (1, 2 & 3) may be
minimal; however ALL RtI
referral forms must be
complete.
Continue the RtI process and
collection of RtI data as
appropriate.
Prior to the 10th school day, Prior
Written Notice/ Notice of Decision
to evaluate and Consent will be
obtained by the appropriate
assessment personnel (PA
staff/SLP). Federal and state initial
evaluation timelines will apply.
Parent may
access
resolution
options.
RtI documentation is REQUIRED!
In order to ensure that
underachievement in a child is not
due to lack of appropriate
instruction in reading or math,
data-based documentation from
the RtI interventions must be
considered. 34 Code of Fed
Reg § 300.309
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2015-2016
Here’s the RtI Scoop Concerning Screeners, Student Groups, and Tiers
Tier placement reflects the amount of time a student has spent in the RtI process. The instructional
intensity and grouping of the classroom interventions are determined by the data. Remember that
what TIER a student is in does not dictate which intervention group they are placed in. Students
should be placed in intervention groups based on the “intensity” of intervention needed. Example:
you may have a TIER 1 student in the most intensive intervention group with a TIER 2 or 3 student
because the TIER 1 student is a newly identified struggling student and the testing data indicates that
he needs intensive interventions (below 10 %tile). The other students may be at a different point of
the TIERED process but the level of intervention needed for all the students are the same.
EVERYONE in Tier 1 receives CORE instruction and interventions whether it is accelerated or
scaffolded. Example of Core time: Teach the lesson, do guided and independent practice, re-
teach to the ones who need it. Use RTI time to do targeted, scaffolded instruction to fill in
gaps.
The RtI committee will use universal screeners and/or other data to determine a student’s placement
in the RtI process. This placement is fluid based on student data. Students may move in and out
Tiers.
Every 9 weeks the determination of Tier placement is documented in JCAMPUS.
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2015-2016
Academic, Behavioral, and Sensory Screenings
When an academic, behavioral or communication deficit exists, the following screenings must be
conducted prior to an evaluation determination (Tier 3):
Type of Screening
Vision /Hearing
Completed By
School Nurse
Notes
Current within 24 months for enrolled students and
12 months for non-enrolled students
Speech-Language Pre-Screen
Classroom Teacher
Current within 12 months
Speech-Language Pathologist
Conducted if Communication Skills Teacher
Communication Skills Teacher
Checklist (CSTC)
Speech and Language Screening
Checklist (CSTC) is at-risk
Health Services Screening Form /
SBLC Chairperson with
If concerns exist, medical records should be
Medical Release Form if needed)
Parent
requested from the student’s doctor.
Motor (Gross and Fine)
Physical Education Teacher
PE Teacher may consult with the classroom teacher
(Gross Motor) and Classroom
if necessary
Teacher (Fine Motor)
Assistive Technology
Classroom Teacher
Conducted through observation of skills and
environment.
Must provide intervention strategies if (8) or
more behaviors in the “Almost Always” category
OR (11) or more behaviors in the “Frequently”
and “Almost Always” categories combined.
Review at minimum incident reports/discipline
records; teacher reports; parent reports and
information provided by the parent; developmental
profiles; previous behavior intervention plans; and
anecdotal records. Record on SBLC 2
Sensory Processing
Classroom Teacher
Social, Emotional, Behavioral
SBLC Chairperson
Developmental (Pre-Kindergarten
Classroom Teacher
Pupil Appraisal conducts assessment for nonenrolled student.
Educational
Review of Data
Review educational history, universal screening
results, statewide/district test results, evidence based
interventions, home-school communication.
Orientation and Mobility
Teacher
Conduct only if visual impairment is suspected.
Only)
Screening results should be entered into the JCampus system.
RtI/SBLC Manual
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2015-2016
RTI and Communication Concerns
According to Louisiana Bulletin 1508, if a student’s communication skills are “at-risk,” evidencebased interventions shall be implemented if he or she is enrolled in grades K or above and for
those ages three to five when appropriate. Areas of concern related to communication are
articulation, fluency, voice quality, and language (receptive and/or expressive).
Tier 1: Teacher Consultation/Education
The SLP can consult and/or collaborate with school-based staff regarding students who are
not demonstrating adequate progress with Tier I instruction, due to possible communication
difficulties. Further staff training regarding communication deficits may also be provided by the
SLP during grade level meetings and/or faculty meetings. SLP may also provide teacher with
recommendations regarding classroom based communication strategies.
Tier 2: Communication Skills Teacher Checklist
1.
When a concern about communication skills arises, the teacher should contact the RtI
Chairperson.
2.
The RtI Chairperson will provide the teacher with the Communication Skills Teacher
Checklist (CSTC).
3.
Teacher completes CSTC. The teacher must indicate the date the communication
concern was discussed with the parent(s). If concerns are noted on the CSTC, the
SLP should be provided with the CSTC for reference.
4.
SLP may also participate and/or collaborate with the RtI team re: Tier 2 academic
interventions.
5.
The general education teacher may also provide small group support to students who
demonstrate weaknesses in communication skills, in conjunction with Tier 2 academic
interventions. The SLP may provide ideas for instruction, materials, and advice on
creating activities to provide the appropriate Tier 2 interventions to these students.
Tier 3: Screening & Possible Direct Intervention Support
1.
The screening process is initiated; the Caddo Communication Screening will be
completed by the SLP to determine if direct communication intervention support is
necessary.
2. Following the screening, the SLP will discuss results with the RtI team. If the student
PASSES the communication screening, the SLP may provide further recommendations
to the teacher. If the student DOES NOT PASS the communication screener, direct
communication interventions will be recommended in the area(s) of concern (articulation,
voice, fluency, and/or language). An SLP-1 form will need to be sent home to acquire
permission from the parent for the SLP to provide interventions. Once permission is
received, communication interventions will be initiated.
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2015-2016
3. The SLP initiates interventions to work with small groups of students with communication
concerns. Progress monitoring will be completed once every three weeks.
4. At the end of the 9 week intervention period, a 1508 referral can be made to the SBLC
committee for communication concerns, if no other concerns are present.
FAQs (Frequently asked Questions re: RtI and Communication Concerns)
 Does a student who is suspected of having communication deficits have to go
through the RtI process?
Yes. A student with suspected communication deficits must be provided with
interventions prior to the completion of the 1508 evaluation.
 Is there any way in which RtI for Communication deficits is different from the
process for other handicapping conditions?
The time period at each tier may be shorter for communication interventions. IF
communication is the student’s ONLY area of need then a 1508 evaluation may be
expedited.
 What are the circumstances in which a referral for a 1508 evaluation can be
expedited?
If the student demonstrates SEVERE articulation, voice, or fluency deficits, he/she may
be referred for an evaluation immediately unless there are academic concerns as well.
Such conditions would include articulation so poor that the child is unintelligible, unusual
quality of voice, or stuttering. This option should be reserved for only the most
significantly impaired students. The decision to refer for evaluation should be presented
by the SLP at an SBLC meeting.
 Why can’t an evaluation for a student with language concerns be expedited?
In most cases, students with language concerns are also demonstrating academic
concerns. Due to the extent that language and academic intertwine, these concerns
usually coexist. Language interventions are curriculum based and should be provided in
concert with academic interventions.
RtI/Referral Manual
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2015-2016
RtI Meeting
Agendas and
Forms
RtI/Referral Manual
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2015-2016
RtI Initial Request Form
Student Name
ID #
Date of Birth
Date
School
About the Student
Student Strengths (Select
all that apply)
Positive attitude.
High expectations for
Handles conflict well.
self.
Hard Worker.
Works well
Athletic.
independently.
Trustworthy.
Good sense of humor.
Takes pride in
appearance.
Works well in groups.
Cooperates.
Musically inclined.
Respectful of authority.
Responsible.
Artistically inclined.
Motivated.
Transitions easily.
Other:
Focused/goal directed.
Creative.
Organized.
Possesses leadership
qualities.
Academic/Communication/Motor Concerns (Select
all that apply)
Grades declining.
Below Grade level
Does not work well
writing skills.
independently.
Incomplete assignments.
Below Grade level reading
Does not work well with
skills.
others.
Below Grade level test
Below Grade level math
Articulation concerns
grades.
skills.
Slow rate of work.
Fails to pass major tests.
Voice
Fluency
concerns
Does not follow
Gives up easily.
Language concerns
directions.
Low rate of retention.
Disorganized.
Fine
Gross motor
concerns
Behavioral Concerns (Select
all that apply)
Verbally disruptive.
Bullies others.
Attention seeking
behavior.
Physically disruptive.
Destroys property.
Steals/cheats/lies.
Physically aggressive.
Easily distracted.
Avoided by peers.
Verbally aggressive.
Argumentative/defiant.
Easily frustrated.
Sexually aggressive.
Shy/withdrawn.
Truant/tardy.
Victim of bullying.
Hostile when criticized.
Other:
Personal Concerns (Select
all that apply)
Body odor.
Difficulty
Burn marks.
moving/uncoordinated.
Poor hygiene.
Complains of
Evidence of selfnausea/vomiting.
mutilation.
overweight/underweight.
Sleeps in class/lethargic.
Bloodshot eyes.
Appears sickly.
Agitated/nervous.
Smells of smoke.
Other:
RtI/Referral Manual
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2015-2016
RtI Meeting Agenda
Prior to the meeting, a moderator and record-keeper should be appointed
I.
Introductions
II.
End-time of meeting determined
(Meeting can be continued another day if not completed on time)
III.
Purpose of meeting discussed
a. Review academic/behavior concerns (initial or concern previously documented in Tier I RtI Mtg.)
b. Present baseline data for each new concern identified (ex. academic progress report, DIBELS, AIMSweb,
standardized test results, etc.)
c. Review supporting documentation for initial concerns or documented concerns in Tier I.
Examples:
1. Administrator/Case Manager observation form (Tier 2/3 only)
2. Classroom teacher interview form
3. Progress monitoring
d. Discuss appropriate learning/behavior expectations for the student’s grade/age
IV.
Develop strategies and begin intervention (for initial RtI meeting or new concern) or
Determine the student’s progress /lack of progress in Tier I, 2, or 3 and decide appropriate action to take. Refer
to the District RtI Manual for decision-making guidance.
V.
Schedule a follow-up meeting date and time
VI.
Send status intervention letters to parents
VII.
Have everyone present sign meeting attendance form
VIII.
Dismiss
RtI/Referral Manual
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2015-2016
Suggested Format for Documenting RtI in JCAMPUS
Enter in the TOP Box
TIER 1 At-Risk meeting date: ________________
Decision: Based on ______universal screening data [student] will be placed in Tier 1 At-Risk intervention support. According to the
data,
he/she scored at or below the 20%tile in the following: (subject area(s) with scores)*.
[Add additional comments regarding any other data and/or concerns (i.e., speech, behavior, sensory/motor); Progress Monitoring begins]
NOTE: If a Tier 1 At-risk meeting was not documented state the following: [Student] has been receiving Tier 1 at risk
interventions/supports based on Fall universal screener in [enter subject(s)] since August 2014.
Follow-up Meeting:
Tier 1 At-Risk Follow-up/Tier 2 meeting date: _______________
After a Review of [enter data reviewed] the RtI team has made the following recommendation:
Enter one of the following statements for each area of concern:
-met progress monitoring goals in (enter subject).
[Student] has
-made some progress in (enter subject) but needs to continue intervention supports.
-made little/no progress in (enter subject) and needs to move to Tier 2
[Add additional comments/concerns- Complete appropriate RTI forms before next meeting; i.e screeners, interviews, observations]
At next follow-up RtI meeting and any other subsequent meeting:
Meeting date: ________________
After a Review of (enter data reviewed) the RtI team has made the following recommendation:
Enter one of the following statements for each area of concern:
-met progress monitoring goals in (enter subject).
[Student] has
-made some progress in (enter subject) but needs to continue intervention supports.
-made little/no progress in (enter subject) and needs to move to Tier (enter tier)
[Record any additional comments/concerns that are relevant to this decision]
******PLEASE BE SURE TO SEND PARENT LETTER AFTER EACH MEETING. LOOK IN THE RtI FORMS SECTION OF MANUAL******
**************************************************************************************************************************************
To be documented in the bottom half of the referral tab:
Intervention/Programs Provided
Meeting date: (enter date)
 Subject: (enter subject) Tier: (enter tier)
 Beginning Date for interventions: _____________
 Intervention will be/is provided 4 days a week (M – Th) for (enter minutes) weekly above the core instruction.
 Intervention will be provided by (enter name)
 Progress monitoring with (enter progress monitoring tool/area) every 2 weeks on (enter grade level/instructional level)
 Intervention Strategies/Programs to be used:
NOTE: As a student moves through the tiers, the intervention strategies/programs being utilized need to change. Also, progress
monitoring MUST be adjusted at TIER 2/3. HOW? Instructional level must be determined and then progress monitoring is conducted
ONE grade level above.
RtI/Referral Manual
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2015-2016
Caddo Parish Public Schools
INTERVENTION STATUS PARENT LETTER
School Name:
Student Name:
Date:
Our school mission is to make sure that every student succeeds. Our school Response to Intervention (RtI) Team met to
discuss your child’s progress in
READING
MATH
WRITTEN EXPRESSION.
As a result of this meeting, it is determined that we will:
________
Begin Tier 1 interventions. These interventions could include the following:
Small group support
Teacher led interventions
Cooperative learning strategies
Other: _________________________________________________________
_________________________________________________________
________
Discontinue the use of any interventions.
________
Continue with the current Tier ______ interventions as previously described and continue to monitor
your child’s progress.
________
Modify the current Tier _____ intervention(s).
________
Request more data and move to Tier ______ interventions by increasing the level of
intensity and frequency of interventions.
________
Move to referral to a special education, 504, or other district option. You should be
contacted shortly to meet with the School Building Level Committee (SBLC) to discuss
this referral.
________
Attached is a parent interview, please complete and return ASAP.
Thank you for working with us to ensure success for your child and please feel free to call with any questions or concerns
that you might have.
RtI/Referral Manual
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2015-2016
Administrator/Case Manager Observation Form
Required for TIER 2
Student: __________________________ Grade_____
Date _____/_____/_____
Teacher___________________________ School____________________
Observer/Position________________________________________________________
Time on Task: (Circle on task [+] or off task [–] at 1-min intervals.)
+ –
+ –
+ –
+ –
+ –
+ –
+ –
+ –
+ –
+ –
+ –
+ –
+ –
+ –
+ –
Class/Subject Observed: (Observation should be in the area of suspected disability.)
English/LA
Reading
Math:
Other:
Student-Teacher Ratio during Observation Period:
Fewer than 10
10–15
16–20
Students:
Classroom Arrangement:
Grouped desks
Tables
Rows of desks
Interaction with Teacher:
Demands teacher attention
discussion
Responds appropriately to praise
redirection
Out of seat without permission
Organizational/Learning Behavior
Makes transitions:
Work Habits
easily
prompting to continue
alone Asks for help:
when called upon
readily
excessively high activity level
did not transition
Works slowly
small group
volunteers information
poor attention and concentration
difficulty following directions
difficulty working with peers
disturbs others
RtI/Referral Manual
never
Needs
large group
answers
demonstrates difficulty in taking turns
extreme mood swings
appropriately
Requires frequent
rarely
Works at appropriate rate
never Participation:
Behavioral Observations (check all that apply)
teacher directives
with teacher assistance
Does not finish assignments Works effectively in:
once
Participates in class
Appears prepared and organized for
with clarification/repetition
Material organized
frequently
Other:
Responds appropriately to correction
with some difficulty
Finishes tasks
Centers
is attentive to instruction
Is easily distracted
activity,Follows individual instructions:
More than 20
difficulty staying on task
noncompliance with
is easily frustrated
interacts with peers
other:__________________________________________________
29
2015-2016
RtI Parent Interview
Required for Tier 2
Student Name:
ID#:
Date:
School:
Teacher:
Grade :
Parent Name(s):
Current Address:
Phone number where you can
be reached:
About your Child: Developmental History/Health Factors (Select
all that apply) Are there any health/medical issues
(past or present) that have affected or are currently affecting your child’s educational performance? (Ex. ADHD, asthma,
diabetes, surgery, etc.)
Medications
Other Relevant Health Information:
Speech services
Wears glasses/contacts
Family history of learning difficulties
Hearing aids/tubes in ears
Other:____________________________________
Were there any delays noted in mastering skills at the appropriate age? (Select
Complications during pregnancy/delivery
Dressing self
all that apply)
Works well by himself/herself
Qualities
Talking
Toilet training
Positive attitude
Respectful
Good sense of humor
Handles conflict well
Artistically inclined
Motivated
Cooperates
Athletic
Hard Worker
Poor grades
himself/herself
Responsible
Disorganized
lies
Poor study skills.
Poor reading skills
Does not work well by
Poor attitude toward school
Does not finish
Does not follow
Poor school attendance
Is bullied
Is late and/or skips school
RtI/Referral Manual
Musically inclined
Does not work well with others
all that apply)
Says mean things (e.g., makes threats, swears)
Argues
Possesses leadership
all that apply)
Difficulty putting thoughts in writing.
Poor math skills
to others, is sexually active)
easily
Creative
Takes pride in appearance
Observations About Your Child’s Behavior (Select
things).
Works well in groups
Other:_____________________________________________________________
Poor handwriting
classwork/homework.
Trustworthy
Finishes what he/she starts
Observations About Your Child’s Academic Performance (Select
directions
Feeding self
Social skills
Child Strengths (Select
Organized
Walking
all that apply)
Avoided by peers
Physically hurts people (e.g., hits, throws
Is sexually inappropriate (e.g., shows private body parts
Shy/withdrawn
Destroys property
Gives up easily
Annoys people
Bullies others
Poor self-concept
Gets mad
Steals/cheats/
Easily distracted
30
2015-2016
RTI TEACHER INTERVIEW
Required for Tier 2
STUDENT_______________________________________ SDT#________________ DATE ____/_____/_____
TEACHER _______________________________SCHOOL___________________________ GRADE______
Please carefully consider this student's ability and provide as much information as possible regarding this
student's typical daily performance in your classroom. His or her behavior and academic performance should be
evaluated in comparison to a typically functioning student of the same age and in terms of appropriate
developmental stages and expectations.
WHAT INSTRUCTIONAL CONCERNS DO YOU HAVE ABOUT THIS STUDENT (Check all areas that apply.):
Academic performance
Fine motor
Gross motor
Social/emotional/behavioral functioning
Organization
Health
Communication
None
Other: ______________________________________
RECEPTIVE /EXPRESSIVE LANGUAGE SKILLS (Check all areas that apply.): Does NOT
comprehend
classroom discussion
follow oral instructions
remember information just heard
display adequate vocabulary
use adequate grammar for general understanding
expresse self fluently when called upon to speak
relate a
sequence of events in order (telling a story)
initiate/engage in appropriate conversation
READING SKILLS (Check all areas that apply.): Does NOT
exhibit satisfactory phonological awareness
exhibit adequate sound/symbol correspondence
recognizes word patterns
recognize sight words
comprehend word meanings
exhibit satisfactory reading rate
use context clues to decode
comprehend what
is read STUDENT
reverses letters
other______________________________________
MATHEMATICS SKILLS (Check all areas that apply.): Does NOT
compute accurately
compute in a timely
manner
makes careless error
align problem
problem solve
solves word/story problems
apply concepts
use mental math
recall math concepts/sequences
understand time/direction STUDENT
Reverses numbers
Other: _______________________________________________________________
WRITTEN LANGUAGE SKILLS (Check all areas that apply.):
Forms letters correctly
Recognizes letter
sequence
Writes dictation accurately
Copies accurately
Reverses letters
Spells accurately
Demonstrates
grammatical correctness
Uses appropriate punctuation
Demonstrates organization/mechanics
Expresses ideas in
written academic/creative tasks
Other:________________________________________
BEHAVIORAL PERFORMANCE (Check all areas that apply.): Does NOT
stay in seat
attend to tasks
respond to reinforcement
follow classroom rules
finish assignments to best of ability
tolerate frustration
Have a positive attitude
Use appropriate verbal expressions respect authority
demonstrate a lack of ageappropriate concern for his/her behavior and its effect on others STUDENT
Engages in frequent physical fighting
appears anxious/nervous
appears withdrawn Other:_____________________________
PEER INTERACTIONS (Check all areas that apply.): Does NOT
appear accepted by majority of peers
work
well independently work well in a group
work well with a peer
appear polite/friendly with peers
have
friends
have positive peer relationships
get along with other students STUDENT
Blames others
Bothers
other students (e.g. poking, tripping, grabbing)
Is always picked on
lacks social skills
Other: ____________
INSTRUCTIONAL MODIFICATIONS ATTEMPTED IN RESPONSE TO STUDENT’S CONCERN(S) IN
(Check all areas that apply.)
Individual tutoring Alternate materials
Ability grouping
Changed seating
Changed class
Behavior management
Grading based individual growth
Grading based on oral tests
Peer
tutoring
Modified/shortened assignments Extra time for completion of work
Taping written materials
Word
processor Spell checker Tracker for reading
Calculator
Audio books/textbooks
English as a second
language strategies Multisensory strategies
Hands-on activities Others (specify) _________________________
RtI/Referral Manual
31
2015-2016
Checklist for Initial Referral for Special Education or Section 504
ALL FORMS MUST BE ACCURATE, COMPLETED WITH NO AREAS LEFT BLANK, AND CHECKED BY THE RESPONSE TO INTERVENTION
CHAIRPERSON .
Documentation to be collected from the RtI team:
1. Copy of the original Home Language Survey from the cumulative record. If the HLS indicates a language other
than English, a member, an interpreter used (if necessary) to communicate with the parent, and the LEP
Coordinator’s signature for approval to refer.
2. Copy of cumulative records containing grades, current and previous report cards (1 year prior), attendance records,
discipline records, discipline incident reports, etc…)
3. Copy of relevant assessments including statewide and local
4. Current Health Services screening. Does the student have a current diagnosis? Yes / No
Medical Release signed and sent for records
Please provide copies of any outside/private assessments or medical information such as information from
psychiatric hospitals, private psychological evaluations, private counseling evaluations, physician’s diagnosis, etc…
5. Current Hearing /Vision screening by the nurse (within 24 mon. for enrolled students / 12 mon for non-enrolled
students (a referral should be completed prior to a request for a Full and Individual Evaluation for failed screener)
6. Current copy of special education evaluation (if applicable)
7. Current dyslexia assessment (if applicable)
8. Current copy of 504 plan (if applicable)
9. Copies of current work samples relevant to the area(s) of academic weakness. JCampus data collection
for RtI, copies of current Behavior Intervention Plan (BIP) and related data collection,
information/progress notes related to services provided by the school counselor.
10. Copies of appropriate documents from the RtI Manual including:
RtI Initial Request Form (if Applicable)
RtI Parent Intervention Status Letters
All information from JCAMPUS including all Tier 1, 2, & 3 data and graphs
RtI Counselor/ Administrator Observation Forms
RtI Teacher Observation Form
Appropriate SCREENINGS (See page___for explanations)
Communication Skill-teacher (CSTC) Did CSTC indicate risk? Yes / No
Speech and Language Screening conducted by Pathologist
Motor Screenings (Classroom Teacher and PE Teacher)
Assistive Technology
Sensory Processing
Developmental Screener (Pre-K)
Educational Screeners
Social/Emotional/Behavioral
Parent, Teacher Interviews
Student Learning Profile for LEP students and all assessment data (if applicable)
Signatures indicate completion of checklist:
_______________________________________
Signature – Response to Intervention Chairperson
_________________
Date
_________________________________________
Signature – Principal
_________________
Date
RtI/Referral Manual
32
2015-2016
RTI Lesson Plans – MATH
Can be front/back
Teacher:______________________________________ Week:_____________________________________________
Student Group:
MONDAY
Fluency (3-5 Min)
TUESDAY
Fluency
WEDNESDAY
Fluency
THURSDAY
Fluency
C-R-A(10-15 Min)
C-R-A
C-R-A
C-R-A
Problem Solving(5-10 Min)
Problem Solving
Problem Solving
Problem Solving
Student Group:
MONDAY
Fluency (3-5 Min)
TUESDAY
Fluency
WEDNESDAY
Fluency
THURSDAY
Fluency
C-R-A(10-15 Min)
C-R-A
C-R-A
C-R-A
Problem Solving(5-10 Min)
Problem Solving
Problem Solving
Problem Solving
Student Group:
MONDAY
Fluency (3-5 Min)
TUESDAY
Fluency
WEDNESDAY
Fluency
THURSDAY
Fluency
C-R-A(10-15 Min)
C-R-A
C-R-A
C-R-A
Problem Solving(5-10 Min)
Problem Solving
Problem Solving
Problem Solving
RtI/Referral Manual
33
FRI
Progress Monitoring:
Weekly formal/ informal
Standard:
FRI
Progress Monitoring:
Weekly formal/ informal
Standard:
FRI
Progress Monitoring:
Weekly formal/ informal
Standard:
2015-2016
RTI Lesson Plans –ELA/Reading
Can be front/back
Teacher:__________________________________ Week:_________________________________________
Student Group:
MONDAY
Fluency (3-5 Min)
TUESDAY
Fluency
WEDNESDAY
Fluency
THURSDAY
Fluency
Word Work(10 Min)
Word Work
Word Work
Word Work
Guided Rdg/
Content/Writing(10 Min)
Guided Rdg/
Content/Writing(10 Min)
Guided Rdg/
Content/Writing(10 Min)
Guided Rdg/
Content/Writing(10 Min)
Student Group:
MONDAY
Fluency (3-5 Min)
TUESDAY
Fluency
WEDNESDAY
Fluency
THURSDAY
Fluency
Word Work(10 Min)
Word Work
Word Work
Word Work
Guided Rdg/
Content/Writing(10 Min)
Guided Rdg/
Content/Writing(10 Min)
Guided Rdg/
Content/Writing(10 Min)
Guided Rdg/
Content/Writing(10 Min)
Student Group:
MONDAY
Fluency (3-5 Min)
TUESDAY
Fluency
WEDNESDAY
Fluency
THURSDAY
Fluency
Word Work(10 Min)
Word Work
Word Work
Word Work
Guided Rdg/
Content/Writing(10 Min)
Guided Rdg/
Content/Writing(10 Min)
Guided Rdg/
Content/Writing(10 Min)
Guided Rdg/
Content/Writing(10 Min)
RtI/Referral Manual
34
FRI
Progress Monitoring:
Weekly formal/ informal
Standard:
FRI
Progress Monitoring:
Weekly formal/ informal
Standard:
FRI
Progress Monitoring:
Weekly formal/ informal
Standard:
2015-2016
STUDENT DATA FORM/Notes
Week Of:
Name:
M
T
W
TH
F
Name:
M
W
TH
F
Name:
M
F
Name:
M
Name:
M
T
T
RtI/Referral Manual
GRADE:
W
TH
INTERVENTIONIST:
Name:
M
T
35
Can be front/back
W
TH
F
T
W
TH
F
T
W
TH
F
2015-2016
Intervention Log (Weekly Plan)
Teacher: ___________________ Week: _____________________
Group Information
Names of Students in Group: _________________________________________
Intervention Provided: Monday, Tuesday, Wednesday, Thursday
Times Met: 25 minutes Reading/ 25 minutes Math
Intervention Provider: ______________________
Curriculum/Materials
Reading
Circle all activities used this week and fill out specific information where necessary
Math
FCRR:________________________________
TPRI Int. Guide:_______________________
Math Fluency:________________________________
Operation:___________________________
FASST Math:________________________________
Decoding Skills:________________________
Manipulatives: _______________________________
Fluency Rate:__________________________
Place Value:_________________________________
Sight Words:___________________________
Part to Whole: _______________________________
Vocabulary:____________________________
_______________________________________
Operations to Solve Problems:__________________
Rounding:___________________________________
Comprehension: Must Circle Skill
Main Idea
Patterns:____________________________________
Summary
Sequencing
Geometry:___________________________________
Cause and Effect
Author’s Purpose/Perspective
Measurement:________________________________
Fact and Opinion
Drawing Conclusions/Inference
Data Sets (graphs, pictures, etc.):________________
Compare and Contrast
Character Changes
Problem Solving (be specific): __________________
Plot Structure
____________________________________________
____________________________________________
Genres: Must Circle Genre
Literary Nonfiction
Other: _____________________________________
Fiction
___________________________________________
Expository
Procedural
Theme/Lesson
Poetry Structure
Drama Elements
Media Literacy
(affixes, roots, context clues and dictionary skills)
Other: ______________________________
_____________________________________
RtI/Referral Manual
36
2015-2016
UNIVERSAL SCREENERS DEEP DIVE FORMS
AND
INSTRUCTIONAL/GROUPING FORMS
RtI/Referral Manual
37
2015-2016
OVERVIEW for Conducting a DEEP DIVE after Universal Screening/Assessment
Purpose: To look closer at the DATA from the universal screener/assessments in order to
assist in creating RTI groups based on intensity of need
DIBELS:
1. Locate the 25%tile based on the National Percentiles for DIBELS
2. Record the composite score in the subtitle BOX
=========================
3. Using the composite score list ALL students who fall at the 25%tile and below –
record their score
=========================
4. Circle all student scores who fall at the 10th%tile and below:
MOST INTENSIVE –Group 3
5. Highlight in green the students who fall from the 25%-21%tile:
Bubble Kids – Group 1
6. Those that remain fall within the 11-20%tile:
INTENSIVE – Group 2
AIMSWEB:
1. Locate the score at the 25%tile (based on national percentiles or use our cheat sheet)and record
in the subtitle BOX
2. List ALL students who fall at the 25%tile and below – record their score
3. **If students names are already listed – DO NOT list again – Just record score
**If their name is not listed – Then add
=============================
Follow steps 4-6 from above
RtI/Referral Manual
38
2015-2016
KINDER - Deep Dive ANALYSIS OF FALL UNIVERSAL SCREENERS & DIAGNOSTIC
DATE:
TEACHER:
Denise Richmond-2015
Purpose: Identifying Intensity of Skill Gaps, Tier Movement and JCampus Data entry
ONLY Students AT or BELOW Target Score (25%tile) On Form: Put Student Scores in Boxes // IF students hit average or above in another area WRITE “B” for Benchmarked
OCM
STUDENT:
NIM
Write Average
Score Below:
____
SBLC Manual
____
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group1
PM on
gr.level
Group
2
Group
3
Place “N” in Box for Needs
39
Write Dibels
Composite
Average
Score Below:
_______
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group 1
PM on
gr.level
Group
2
Group
3
Place “N” in Box for Needs
2015-2016
Diagnostic:
Indicate Grade
Level Plan:
Below / On /
Above
KINDER - Deep Dive ANALYSIS OF WINTER UNIVERSAL SCREENERS & DIAGNOSTIC
DATE:
TEACHER:
Denise Richmond-2015
Purpose: Identifying Intensity of Skill Gaps, Tier Movement and JCampus Data entry
ONLY Students AT or BELOW Target Score (25%tile) On Form: Put Student Scores in Boxes // IF students hit average or above in another area WRITE “B” for Benchmarked
STUDENT:
OCM
NIM
QCM
MNM
Notes:
____
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Write Average Score Below:
____
____
____
Group1
PM on
gr.level
Group
2
Group
3
Place “N” in Box for Needs
Write
Dibels
Composite
Average
Score
Below:
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group1
PM on
gr.level
40
Group
3
Place “N” in Box for Needs
_____
RtI/Referral Manual
Group
2
2015-2016
Diagnostic
Indicate
+/Progress
KINDER - Deep Dive ANALYSIS OF SPRING UNIVERSAL SCREENERS & DIAGN0STIC
DATE:
TEACHER:
Denise Richmond-2015
Purpose: Identifying Intensity of Skill Gaps, Tier Movement and JCampus Data entry
ONLY Students AT or BELOW Target Score (25%tile) On Form: Put Student Scores in Boxes // IF students hit average or above in another area WRITE “B” for Benchmarked
STUDENT:
OCM
NIM
These Only
if Needed
____
____
RtI/Referral Manual
QCM
MNM
Write the
Average Score
Below:
____
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group 1
PM on
gr.level
Group
Group
2
3
Place “N” in box for Needs
____
41
Write
Dibels
Composite
Average
Score
Below:
_______
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group1
PM on
gr.level
Group
2
Group
3
Place “N” in box for Needs
2015-2016
Diagnostic
Indicate
+/Progress
FIRST GRADE- Deep Dive ANALYSIS OF FALL UNIVERSAL SCREENERS & DIAGNOSTIC
DATE:
TEACHER:
Denise Richmond-2015
Purpose: Identifying Intensity of Skill Gaps, Tier Movement and JCampus Data entry
ONLY Students AT or BELOW Target Score (25%tile) On Form: Put Student Scores in Boxes // IF students hit average or above in another area WRITE “B” for Benchmarked
STUDENT:
OCM
NIM
QCM
MNM
Write Average Score Below:
____
____
RtI/Referral Manual
____
____
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group1
PM on
gr.level
Group
Group
2
3
Place “N” in Box for Needs
42
DIBELS
Write
Composite
Average
Score Below:
________
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group 1
Group
Group
2
3
PM on
gr.level
Place “N” in Box for Needs
2015-2016
Diagnostic:
Indicate
Grade Level
Plan:
Below/On/
Above
FIRST GRADE - Deep Dive ANALYSIS OF WINTER UNIVERSAL SCREENERS & DIAGNOSTIC
DATE:
TEACHER:
Denise Richmond 2015
Purpose: Identifying Intensity of Skill Gaps, Tier Movement and JCampus Data entry
ONLY Students AT or BELOW Target Score (25%tile) On Form: Put Student Scores in Boxes // IF students hit average or above in another area WRITE “B” for Benchmarked
Student:
QDM
MNM
Still Needs: Write
Average Score Below
_____
_____
RtI/Referral Manual
MCOMP
Notes:
Write
Average
Score
Below:
_______
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group
1 PM on
gr.level
Group
2
Group
3
Write DIBELS
Composite
Average
Score Below:
__________
Place “N” in box for NEED
43
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group1
PM on
gr.level
Group
2
Group
3
Place “N” in box for NEED
2015-2016
Diagnostics
Indicate
+/Progress
FIRST GRADE - Deep Dive ANALYSIS OF SPRING UNIVERSAL SCREENERS & DIAGNOSTIC
DATE:
TEACHER:
Denise Richmond 2015
Purpose: Identifying Intensity of Skill Gaps, Tier Movement and JCampus Data entry
ONLY Students AT or BELOW Target Score (25%tile) On Form: Put Student Scores in Boxes // IF students hit average or above in another area WRITE “B” for Benchmarked
Student:
MCOMP
Write
Average
Score
Below:
______
RtI/Referral Manual
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group 1
PM on
gr.level
Group
2
Group
3
Place “N” in box for NEED
44
Write
DIBELS
Composite
Average
Score
Below:
_______
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group1
PM on
gr.level
Group
2
Group
3
Place “N” in box for NEED
2015-2016
Diagnostic
Indicate
+/Progress
GRADES 2-6 DEEP DIVE ANALYSIS OF FALL UNIVERSAL SCREENERS & DIAGNOSTIC
DATE:
TEACHER:
Denise Richmond 2015
Purpose: Identifying Intensity of Skill Gaps, Tier Movement and JCampus Data entry
ONLY Students AT or BELOW Target Score (25%tile) On Form: Put Student Scores in Boxes // IF students hit average or above in another area WRITE “B” for Benchmarked
STUDENT
MCAP
MCOMP
Notes:
Write
Average
Score
Below:
Write
Average
Score
Below:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
---------------
-------------
RtI/Referral Manual
Group 1
PM on
gr. level
Group
2
Group
3
Place “N” in box for NEED
45
Write Dibels
Composite
or AIMS
Average Score
Below:
_________
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group 1
PM on
gr.level
Group
2
Group
3
Place “N” in box for NEED
2015-2016
Writing
Write
Average
Score
Below:
________
Diagnostic:
Indicate
Grade Level
Plan:
Below / On /
Above
GRADES 2-6 DEEP DIVE ANALYSIS OF WINTER UNIVERSAL SCREENERS & DIAGNOSTIC
DATE:
TEACHER:
Denise Richmond 2015
Purpose: Identifying Intensity of Skill Gaps, Tier Movement and JCampus Data entry
ONLY Students AT or BELOW Target Score (25%tile) On Form: Put Student Scores in Boxes // IF students hit average or above in another area WRITE “B” for Benchmarked
STUDENT
MCAP
MCOMP
Notes:
Write
Average
Score
Below:
Write
Average
Score
Below:
_____
______
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
RtI/Referral Manual
Group
1
PM on
gr.level
Group
2
Group
3
Place “N” in box for NEED
46
Write Dibels
Composite
or AIMS
Average
Score Below:
________
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group
1
PM on
gr.level
Group
2
Group
3
Place “N” in box for NEED
2015-2016
Writing
Write
Average
Score
Below:
_______
Diagnostic
Indicate
+/Progress
GRADES 2-6 DEEP DIVE ANALYSIS OF SPRING UNIVERSAL SCREENERS & DIAGNOSTIC
DATE:
TEACHER:
Denise Richmond 2015
Purpose: Identifying Intensity of Skill Gaps, Tier Movement and JCampus Data entry
ONLY Students AT or BELOW Target Score (25%tile) On Form: Put Student Scores in Boxes // IF students hit average or above in another area WRITE “B” for Benchmarked
STUDENT
MCAP
MCOMP
Notes:
Write
Average
Score
Below:
Write
Average
Score
Below:
_______
_______
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
RtI/Referral Manual
Group 1
PM on
gr.level
Group
2
Group
3
Place “N” in box for NEED
47
Write Dibels
Composite
or AIMS
Average Score
Below:
________
Notes:
Move to Benchmark-No PM
Continue with current plan (CCP)
Was assessment valid
?What changes are needed
Group 1
PM on
gr.level
Group
2
Group
3
Place “N” in box for NEED
2015-2016
Writing
Write
Average
Score
Below:
________
Diagnostic
Indicate
+/Progress
QUICK SNAP-SHOT
INCLUDING INTERVENTION(S) AND MONITORING
The following plan becomes a working document that will be referred to throughout the 9 weeks

The Core time: Teach the lesson, do guided and independent practice, re-teach to the ones who need it. Use intervention time to do
targeted, scaffolded instruction to fill in gaps.

Some students may begin the school year in TIER 2 or 3 based on previous year’s data and documentation. However, changes to
interventions must be documented as well as the grade level at which a student is progress monitored (please refer to the RTI manual-It is
your guide)

Students should not change TIERS until the end of the 9 weeks; however, moving from one intervention group to another may be done
based on student need and documentation.
Example 1: A student may start in the INTENSIVE Group (Group 2), but after a few weeks the teacher may determine that the
student needs to be with the MOST INTENSIVE group (Group 3) based on data (formal/informal assessments, progress monitoring,
grades, etc.). This movement of intervention DOES NOT EQUAL moving from “Tier 2” to “Tier 3.”
Example 2: You may temporarily place a Tier 1 student in the MOST INTENSIVE intervention group (Group 3), because new data has
indicated a significant skill gap. However, the other students in group 3 may be at a different point of the TIERED process.
Example 3: A student has been newly identified as struggling (Tier 1) based on data and would benefit from the instruction being
given to the most intensive intervention group. After collecting and reviewing progress monitoring, the student may move to the
less intensive or the bubble group based on the student’s progress.

Every three weeks the grade level team, with instructional leader, must review student graphs for progress monitoring, review the
diagnostic individual learning path, record data and make any adjustments
RtI/Referral Manual
48
2015-2016
CORE Time
ITEM ANALYSIS AND INSTRUCTIONAL PLAN
Analysis of why students did
Instructional Plan- What techniques will you use to address
not learn it /common student these standards: Mini Lessons; spiral review; Small Group;
mistakes
Classworks
CORE INSTRUCTION:
Whole Group
-STANDARDS ANALYSISUSE: Current Material
taught; Observations; Exit
Tickets, etc.
WHOLE CLASS
INSTRUCTION:
What standards warrant
more time for whole-class
instruction, re-teaching
and review?




SMALL GROUP CORE INSTRUCTION: What standards
warrant more time for small-group instruction and
review?




RtI/Referral Manual
Instructional Plan : How or when will you structure small
group INSTRUCTION
49
2015-2016
NOT CORE
INTERVENTION TIME (RTI) – FIRST 9 WEEK INSTRUCTIONAL PLAN
INSTRUCTIONAL PLAN FOR BENCHMARK STUDENTS: WHAT ACTIVITES WILL ENHANCE THE LEARNING?
BENCHMARK
R
M
BENCHMARK
R
M
Bubble Kids (Right @ Average) Small Group 1 (2 groups if needed) (Target Score: 25%tile and just below (21-24))
Group 1 Students
Tier 1@Risk
Re-Teach Standard: What
standard(s) needs to be retaught to this group.
SBLC Manual
Analysis: Why didn’t the
students learn it? (Possible
root cause)
50
Instructional Plan: What strategies will you use to
address this standard?
Timeline: When will
this be accomplished
and re-assessed?
2015-2016
Intensive - Small Group 2 (2 if needed) seen by Teacher and/or Interventionist (Roughly from 11-20th%tile)
What skill(s) and
what level is the
student progress
monitored?
Group 2 Students
Example: Jane Doe 3
grade student
rd
2nd-Rdg/Writing
1st MComp
How is the Student Progressing? Review – 3 Week Check Up Graph
Write Measure, Score and indicate: G=Gain / D=Dropped / F=Flat Lined
Classworks: +gain/-loss
PM 1
Classworks
DORF=13 G
+12 Rdg
MComp=5 G
+6 M
PM 2
Note: Changes to Current Plan; Additional
Actions; Progress Monitoring Level adjusted
Classworks
Check 1=Continue
Most Intensive –Small Group 3 ( smaller group) seen by Teacher and/or Interventionist (Roughly at or below 10%tile)
Group 3 Students
What skill(s) and
what level is the
student progress
monitored?
SBLC Manual
How is the Student Progressing? Review – 3 Week Check Up Graph
Write Measure, Score and indicate: G=Gain / D=Dropped / F=Flat Lined
Classworks: +gain / - loss
PM 1
Classworks
PM 2
Classworks
51
Note: Changes to Current Plan; Additional
Actions; Progress Monitoring Level adjusted
2015-2016