Problem Solving
Team Process
Elementary Handbook
Table of Contents
1. Introduction
2. Section 1: Overview of the Problem Solving Team Process
a. The 14 Step Problem Solving Team Process
b. The Problem Solving Team Process Flowchart
3. Section 2: Request for Parent/Guardian Information Form
4. Section 3: Peer Consultant Checklist
5. Section 4: Student Data Form
6. Section 5: Developing an Intervention Plan
a. Student Intervention Planning Form
b. Intervention Intensity Rating Form
7. Section 6: Implementing an Intervention
a. Intervention Fidelity Evaluation and Reflection
b. Progress Monitoring
8. Appendices
a. Administrator Cheat Sheet
b. RtI Glossary of Terms
c. Scantron Placement Indicators
Introduction:
Ongoing Problem Solving with Academic and Behavioral Concerns:
Assistance to all Students
Problem Solving is a way of examining all issues with all students, whether the concerns are
behavioral or academic. The focus of Problem Solving should be on developing meaningful,
measurable, and monitorable interventions for all students with needs, which are significantly
discrepant from their average peers.
Problem Solving essentially occurs on three levels. At the first level involves the teacher having a
concern about a student. The focus at the first level is on the teacher gathering data, which would
help define the student’s problem in a measurable, focused manner. This may involve: examining
available information from the school cumulative file, talking to parents, consulting with other
teachers, documenting any other interventions used with the student, under what conditions, and any
results, observing the student, permanent products (along with average peer comparisons), short
observations of the students behaviors as compared to peers, and the student’s performance on
assessments such as District Wide Assessments, end of the chapter/unit tests, DIBELS, Curriculum
Based Measurement reading, math, and written language probes, Individual Reading Inventories (if
available), any measurable products from Title One Reading (if appropriate). These are only a few
examples of measurable data.
Behavioral Data could consist of noting how many times over a given week is the student talking out
of turn, out of seat, using inappropriate language, fighting on the playground, is noncompliant with
teacher directions, etc. Observations over short (20-30) minutes could help provide this information
as well. Another adult such as the school psychologist could do the observations, with parent
consent.
***** It is important to keep in mind at this first level; being able to define the student’s
concern/problem is the key. The teachers need to be able to provide a BASELINE of what the
student is doing that is the main issue to focus on. For example if the student is having difficulties
learning to read, how so? Is the student significantly lower than average peers’ oral reading fluency?
Or, is the student a good oral reader but unable to adequately complete assignments, and performs
lower than peers on classroom and district wide assessments? Two different reading concerns, which
would require different means of examining the available data and defining the problem in a
measurable way.
This is why the data a teacher gathers is so important. Often as educators we all have good
intentions, but these intentions get lost if we cannot figure out as a team what it is we should all be
focusing on with a student. In order to get to this point a teacher needs to bring enough quality data
to a Problem Solving meeting so everyone involved understands the student’s problem/concern. This
level of “enough quality data” is the BASELINE.
It is important educators understand the differences between an Intervention, Accommodations, and
Modifications.
An Intervention involves teaching a new skill or strategy to a student on a short-term basis,
monitoring frequently, with data collected to see if the intervention is successful. For example, if the
student was having difficulty understanding simple math functions as compared to the average peers
in the class, the teacher may, after gathering Baseline data, teach the student Touch Math, and then
monitor the student’s progress over the next several weeks. If the student is not improving after a
couple of weeks the teacher could change the strategy but still keep the focus or goal on increasing
the student’s skills in completing simple addition and subtraction facts. If the student starts out with
a Baseline of 6 addition facts in two minutes, and 2 subtraction facts in two minutes, and peer
averages for the class is 15 addition facts and 12 subtraction facts in two minutes, a goal for an
Intervention Plan could be as simple as “In six weeks, Johnny will solve simple addition problems at
a rate of 10 problems correct in two minutes”.
Accommodations involve making adaptations based on the student’s needs. For example, if the
student is highly distractible and it is difficult for the student to focus during a test or a content area
reading time, a study carrel in the general education setting would be an Accommodation. Reading
tests to students with reading comprehension needs, and allowing a student to dictate written
assignments are other classic examples of Accommodations.
Modifications are simply adjustments in the curriculum, made for individual students based on the
individual’s strengths and weaknesses as a learner as compared to the average of the class.
Modifications allow students to participate in their Least Restrictive Environment. How are
modifications different than Accommodations? For instance, the above example of allowing tests to
be read aloud to a student with reading comprehension needs is an Accommodation because the
student’s ability to read and understand information is within at least the average range of the class if
he/she is given the Accommodation of having the test read to him/her.
A Modification on the otherhand, involves modifying assignments for those students who
demonstrate significant discrepancies (as compared to average classroom peers) in a skill area. For
example, a student with significant skill discrepancies in written language may be allowed to write a
one-sentence response rather than a paragraph, on a daily assignment. If the disability is in reading,
using materials at the student’s Instructional reading level may help the student participate in Science
and Social Studies classes within the General Education setting. Teamwork between both General
and Special education teachers is a must. Students with disabilities have a legal and ethical right to
accommodations and modifications. The main idea is to examine as a team of educators what are the
main concepts the student needs to learn in Social Studies, for example? What are the standards to be
met? Meeting the standards does not necessarily mean the student must use the same textbook, write
the same reports, and complete the assignments as everyone else. If the student has a disability,
which entitles him/her eligible to receive Special Education assistance in the area of need, or if a
student has a disability that falls under Section 504, Accommodations and Modifications in the
General Education setting are guaranteed to these students by law.
Section 1: Overview of the Problem Solving Team Process
Problems Solving Teams:
 Are a function of regular education.
 Use a systematic problem solving approach to assist students who are not progressing at a
satisfactory rate.
 Clarify problems and concerns.
 Develop strategies and organize resources.
 Provide a system for accountability.
Purpose: The problem solving team intervention model attempts to implement interventions before
an initial referral is made to try to modify either the classroom setting or the child’s behaviors, or in
some cases both. It includes setting a performance goal, selecting an intervention, monitoring student
progress, and evaluating outcomes. The problem solving team model also provides educators with
additional information about the child’s learning style, learning environment and classroom behaviors
(Bahr & Kovaleski, 2006).
The purpose of the Problem Solving Team process is to:
 Assist students who are not experiencing success in the classroom.
 Promote divergent thinking and problem-solving.
 Find solutions for children that are least restrictive.
 Provide support to teachers dealing with hard-to-teach students.
The steps in the process (The 14 Step Problem Solving Team Process) and a flowchart (The Problem
Solving Team Process Flowchart) are provided on two separate documents to organize the structure
of the Problem Solving Team Process. (1 page each)
The 14 Step Problem Solving Team Process
1. Parent/Guardian Involvement: (How and when will parents be involved)
 Documented phone call or in person contact notifying parent/guardian that there is a concern
prior to initiating the PST process.
 Gather parent/guardian planning information using Request for Parent/Guardian Information
form sent home or phone call
2. Sign-up with the building administrator to initiate the PST process and a Peer Consultant(s) is
assigned.
3. Teacher completes Elementary Student Data Form and review the returned Request for
Parent/Guardian Information form with peer consultant, as needed.
4. Peer consultant and teacher(s) meet to develop an intervention plan using Student Intervention
Planning Form.
5. Provide a copy of the Student Intervention Planning Form to the student’s parent/guardian and the
school administrator as well as any other school personnel responsible for implementing the plan.
6. Implement intervention plan and student progress monitoring for a minimum of 4 to 6 weeks.
7. Continuous collaborative meeting between teacher and peer consultant to review data and fidelity
checks bi-weekly (Intervention Fidelity Evaluation and Reflection is completed a minimum of 1 time
per week by teacher).
8. After 4 to 6 weeks of implementation, follow up with collaborative meeting including the teacher,
peer consultant, administrator and parent/guardian to:
 Review data gathered
 Discuss progress, if any
 Determine if additional intervention is needed
9. If additional collaboration is needed, the team will determine additional team members and notify
them of the Problem Solving Team meeting.
10. Tier 2 intervention plan will be developed with the team using the Student Intervention Planning
Form and a copy of Student Intervention Planning Form is given to parent/guardian, teacher,
administrator and any other teachers who need to be aware of the intervention plan.
11. Implement intervention plan and student progress monitoring for a minimum of 4 to 6 weeks.
12. Continuous collaborative meeting between teacher and peer consultant to review data and fidelity
checks bi-weekly (Intervention Fidelity Evaluation and Reflection is completed a minimum of 1 time
per week by teacher).
13. After 4 to 6 weeks of implementation, follow up with collaborative meeting including the teacher,
peer consultant, administrator and parent/guardian to:
 Review data gathered
 Discuss progress, if any
 Determine if additional intervention is needed
14. Reconvene and review data. Determine if data that the student is regressing or not making progress,
consider the need for a comprehensive evaluation.
All forms are available at http://www.newlondon.k12.wi.us/pst.cfm
The Problem Solving Team Process Flowchart
Universal Screening for all students
Rigby Running Records
DRA
Scantron
Review data and identify students who meet grade level benchmarks.
Tier 1
Students who meet benchmarks will remain at Tier 1.
Performance will be reviewed at the next benchmark assessment.
Tier 2
Students who do NOT meet benchmark standards
will be considered for Tier 2 intervention.
1. Parent contact made by teacher regarding student concern(s). (Teacher can mean classroom teacher, specialist,
counselor, school psychologist, nurse, principal, etc.)
2. Parent/guardian data collected using the Request for Parent/Guardian Information Form via phone call or mailing
home.
Teacher contacts administrator to initiate the Problem Solving Team process and a Peer Consultant(s) is assigned.
Initial collaborative meeting (teacher and peer consultant(s))
 Complete Student Data Form by reviewing previous data (including progress and behavior files, and Request for
Parent/Guardian Information Form)
 Create academic intervention or behavior modification plan using Student Intervention Planning Form & Intervention
Intensity Rating Form)
A copy of the Student Intervention Plan is provided to the student’s parent/guardian and the school administrator, as well as
any other school personnel responsible for implementing the plan.
Intervention implemented (minimum of 4-6 weeks)
 Intervention Fidelity Evaluation and Reflection is completed a minimum of 1 time per week by teacher
 Continuous collaboration with peer consultant(s) bi-weekly
 Continue to provide updates to parents (***keep parent involved)
Bi-weekly collaborative meetings (teacher and peer consultant(s))
 Review data gathered & discuss progress, if any
 Determine if additional intervention is needed
 Determine need for additional team members & notify them of a follow-up meeting, as appropriate
 After 4-6 weeks of implementation, meet as a team with teacher, peer consultant(s), administrator and parent/guardian.
Goal Met:
Return to Tier 1


Making progress:
Continue with intervention
Insufficient progress:
Develop a Tier 2 or Tier 3 intervention plan as appropriate
Tier 3
Once the Tier 3 goal is met, return to Tier 1 or Tier 2 intervention, as determined by the team.
If data shows that the student is regressing or not making progress, consider the need for a comprehensive evaluation.
Note: SLD eligibility requirements include:
 Documentation of 12 weeks of intervention
 A minimum of 4 progress monitoring data points
 Documentation showing progress monitoring results were shared with parent/guardian
Section 2: Request for Parent/Guardian Information Form:
Purpose: The Request for Parent/Guardian Information Form is used to gather information
from parents/guardians and involve them in the process. The form can be used as a discussion
guide when parents attend a meeting with you to discuss concerns. (3 pages)
Who completes: The form can be completed (1) by mailing home, (2) over the phone, or (3) in
person with the parent/guardian. It is sent or completed with parent/guardian by the teacher or
other school personnel and then reviewed during the initial collaborative meeting.
Where is it kept: Upon completion it is kept in the yellow folder with the classroom teacher.
Request for Parent/Guardian Information
Problem Solving Team
Parent/Guardian:
Date:
Student:
Dear Parent/Guardian,
Concerns with your child’s academic and/or behavior progress have been noted by
. To address
the academic/behavior needs of our students, our school has a designated Problem Solving Team.
The purpose of the Problem Solving Team is to design effective interventions to help students learn and
develop successfully in school. Since you know your child better than anyone else does, please take some
time to think about what you know about your child and how that information may help the Problem Solving
Team determine what may be done to help him or her. The Problem Solving Team respects confidentiality
and is requesting that you only share information that will contribute to developing an effective Student
Intervention Plan for your child.
Please complete this form and return to
by
.
1. What do you see as your child’s strengths? _______________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2. In what area(s) could your child use the most improvement? What things does he/she seem to
struggle with most? __________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3. If we only targeted one area for improvement at a time, what do you see as the priority for your
child? _____________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
4. When you think about things your child needs to improve, what could be possible causes that we
could change in order to make things better? Think about the following areas:
a. Curriculum (Ex: Reading materials are too difficult or too easy to read; homework practice is
inadequate for understanding or is based on material your child already knows.) _____________________
_________________________________________________________________________________
b. Instruction (Ex: Your child doesn’t understand what the teacher is teaching especially during whole
class instruction.) ______________________________________________________________________
_________________________________________________________________________________
c. Environment (Ex: Noise distracts your child’s attention. A recent family event has been difficult for
your child.) ___________________________________________________________________________
_________________________________________________________________________________
d. Learner (Ex: Your child lacks organization or study skills. Your child has not yet mastered behavioral
skills.) _______________________________________________________________________________
_________________________________________________________________________________
5. What can be done to address the areas of difficulty for you child? ____________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
6. Additional information you feel is important for school staff to know about your child:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
What is the best way to contact you to follow up?
Phone: ___________________________________________________________________
E-mail address: ____________________________________________________________
Times/days to reach you: _____________________________________________________
Times/days you are available to meet: ____________________________________________
Thank you for your input.
If you have questions or would like to meet with someone prior to the scheduled Problem Solving Team
meeting, please contact
at
.
Section 3: The Peer Consultant Checklist
Purpose: The peer consultant is defined as the primary colleague and support throughout the
problem solving process. The peer consultant is assigned by the school administrator and is
documented on the yellow folder. The yellow folder is given to the peer consultant with
paperwork for the process, including the Peer Consultant Checklist.
The Peer Consultant Checklist is used by the peer consultant at the initial meeting and each
subsequent meeting to guide discussion at each meeting. It provides a simple reminder of the role
of the peer consultant when working with the classroom teacher (1 page)
Who completes: This form is completed by the peer consultant during the bi-weekly meetings.
Where is it kept: This form is retained by the peer consultant.
Peer Consultant Checklist
Student’s Name: _____________________
Teacher’s Name: ____________________ Grade: ______
As soon as you are assigned as the Peer Consultant to a student’s case, you are the primary colleague and
support throughout the process. This includes the responsibilities outlined in this checklist.
Receive a yellow folder from your building’s administrator. Date of Assignment: _______________
Initial Meeting:
Meet with the student’s teacher as soon as possible (plan on meeting for approximately 30 min. - 1 hour).
Date of Meeting: ______________
Review the information from the Request for Parent/Guardian Information form.
Complete or review the Student Data Form.
Develop an intervention plan and document using the Student Intervention Planning Form. (Use the
Intervention Intensity Rating Form to assist with determining the Tier Intensity).
Important things to remember:
a. How and when will baseline data be collected (if not already available)?
b. When will the intervention begin?
c. Once the intervention has started, how will process be monitored and how often?
d. What resources are needed in order to apply this intervention?
e. Who will finalize Student Intervention Planning Form and distribute to the student’s
parent/guardian, school administrator and all other school personnel who will be
involved with the intervention process?
Schedule follow-up meeting with the teacher for approximately two weeks after the intervention has
been started. Date of next meeting: ___________________
Follow-up Meetings:
(plan for about 30 minutes every other week, record meeting dates on the Intervention Planning form)
Date: _____ _____ _____
Review Intervention Fidelity Evaluation and Reflection form.
Review progress monitoring data and document progress and any changes on the
Student Intervention Planning Form.
Adjust intervention as needed. (A consistent intervention must be implemented
for 4-6 weeks. If the intervention is modified or changed at this point, the intervention timeline
starts over).
Date of next meeting: _______________, _______________, ______________
Final Steps:
After 4-6 weeks of intervention implementation, meet with the teacher, school administrator and
parent/guardian to:
Review data
Discuss progress
Determine the effectiveness of the intervention
Determine next steps:
continue current intervention
choose a different intervention (consider your brainstormed list on the Student
Intervention Planning Form)
schedule a meeting with other school personnel for further planning.
Section 4: Student Data Form
Purpose: The Student Data Form is used to collect the preexisting data on a student. It includes
background, academic, and behavioral information. It is documentation of what has previously
been tried with a student and the outcome. It also provides a space for desired outcomes, which
will assist with writing appropriate goals and the intervention plan for the student. (5 pages)
Who completes:
Option 1-The form is completed by the classroom teacher prior to the initial meeting with
the peer consultant.
Option 2 – The form is completed with the peer consultant during the initial meeting.
During the initial meeting you will need the following information or access to the
following information:
 Information from the student’s progress file
 Information from the student’s behavior file
 Data from district and statewide testing
 Data from classroom assessments
 Teacher observations
 Previous interventions and results of the interventions
 Baseline data for problem behavior(s), if available
Where is it kept: Upon completion, the Student Data Form is kept in the yellow folder with the
classroom teacher.
School District of New London
Student Data Form
CONFIDENTIAL
Staff Name:
Date:
STUDENT INFORMATION
Student Name:
Grade:
Teacher:
Date of Birth:
Parent/Guardian:
Home Phone:
Cell Phone:
Address:
Work Phone:
Strengths:
Concerns: (prioritize your concerns)
Attendance: (if applicable)
Medical Information:
Medical information is currently impacting student learning.
Medical information is not impacting student learning.
Other Pertinent Information:
Age:
COMMUNICATION
Contacts
Information Obtained/ Results/ Outcomes
Review the student’s progress file and behavior file,
including standardized testing, assessments, programming,
and interventions
Consult with student’s former teacher (s)
Consult with other teachers (special education, Title I,
music, art, physical education, school counselor)
Discussion with student regarding specific concerns
(behavior, attendance, achievement)
Contact parents regarding concerns
Method
Date
Method
Date
CURRENT ACADEMIC INFORMATION (completed by the classroom teacher)
Academics
Performance
RIGBY
Level
Date:
Level
Date:
Level
Date:
Level
Date:
Level
Date:
Level
Date:
Level
Date:
Level
Date:
DRA
Dolch Sight Words
(K-3)
List
Support Needed (i.e., 1:1, modified curriculum)
A
B
D
C
E
Scantron Range
Grade 2
Winter
Spring
Reading
Grade 3
Fall
Winter
Spring
Grade 4
Fall
Winter
Spring
Grade 5
Fall
Winter
Spring
Grade 6
Fall
Winter
Spring
Academics
WKCE 3rd grade
M=minimal
performance
B=basic
P=proficient
A=advanced
WKCE 4th grade
Performance
Reading
Math
Support Needed (i.e., 1:1, modified curriculum)
M
M
B
B
P
P
A
A
Reading
Math
Language
Social Studies
Science
M
M
M
M
M
B
B
B
B
B
P
P
P
P
P
Reading
Math
M
M
B
B
P
P
A
A
Reading
Math
M
M
B
B
P
P
A
A
WKCE 5th grade
WKCE 6th grade
Theme Test
Theme 1
/
Theme 2
/
Theme 3
/
Theme 4
/
Theme 5
/
Theme 6
/
Literacy Screener
Writing
Emergent Writing Rubric
Score
Fine Motor
Ideas and Content
Organization
Voice
Word Choice
Sentence Fluency
Conventions
Math
A
A
A
A
A
Scantron Range
Grade 2
Winter
Spring
Math
Grade 3
Fall
Winter
Spring
Grade 4
Fall
Winter
Spring
Grade 5
Fall
Winter
Spring
Grade 6
Fall
Winter
Spring
STRENGTHS AND CONCERNS
Behaviors
Strength
Concern
Prioritize
Concerns
Comments/Explanation
Shows courtesy and respect to
teachers
Shows self-discipline (impulsive /
restless)
Accepts responsibility for own
actions
Stays on task (distractible/short
attention span)
Respects rights / property of others.
Follows directions
Works independently
Completes assignments on time
Comes to class prepared
Uses good organizational habits
Completes work neatly
Frustration tolerance
Social relationships
Other:
Attach the following documents:
Office Referral Forms
Behavior Intervention Plan
Behavior Related Concerns
(Complete this section only if behavior is the main area of concern)
List Primary Behavior Concern:
When have you observed the behavior occurring the most?
Are there specific settings or situations in which the behavior is less severe or minimized? If so, when?
What generally occurs as a result, following the behavior (consequences)?
Are there social consequences / concerns as a result of this behavior? If so, please describe.
Describe any interventions used within the classroom/school setting to address the student’s
needs and the results of interventions (include data).
1.
2.
3.
State as a measurable goal your desired outcome for the student.
1.
2.
3.
Identify your primary goal for this student and transfer that goal to the Student Intervention
Planning Form.
Section 5: Developing an Intervention Plan
Purpose: To develop an intervention plan using the Student Intervention Planning Form. (Use the
Intervention Intensity Rating Form to assist with determining the tier intensity).
Student Intervention Planning Form: This is the form used to outline the intervention that will be
done with the student. Intervention resources should be available to complete this form such as the
Intervention binder, books or access to a computer to use intervention websites. Details of the
intervention and how progress will be monitored are outlined. This form is also used for follow-up
consultation meetings to review the data that has been collected. (3 pages)
Intervention Intensity Rating Form: This is a checklist to help teachers determine the Tier the
intervention plan they are creating for a specific student or a specific group of students is at. (3
pages)
Who completes: These forms are completed during the initial meeting with the peer consultant and
teacher, provided that baseline data on the targeted area has been collected. If additional data is
needed to create the baseline, a second meeting should be scheduled to complete the Student
Intervention Planning Form.
Where is it kept: Upon completion, these forms are kept in the yellow folder with the classroom
teacher. The Student Intervention Planning Form is used to document data at the bi-weekly
meetings.
Student Intervention Planning Form
Student Name:
Tier Intensity:
Date:
Tier 1
Tier 2
Tier 3
Teacher:
(Complete Intervention Intensity Rating Form to determine)
Explore Options
Desired Goal
Write a measurable goal (use desired outcomes identified on Student Data Form). Include behavior, time
frame and criterion.
Example: Tommy will increase his RIGBY reading level from level 12 to level 22 by May. Susie will master Dolch Sight
Word Lists C, D, and E by June.
Brainstorm intervention methods (refer to intervention binder, interventioncentral.org, etc)
Brainstorm to generate intervention methods. Evaluate each one and record the top five. Place an
asterisk (*) by the intervention method selected to implement and attach copy, as appropriate.
1.
2.
3.
4.
5.
Design the Plan
Identify the setting where implementation will occur:
general education setting
combination of settings:
other:
Intervention Considerations:
Record details of the intervention plan.
When will the intervention start?
When will the intervention take place? (Specify days and times)
Who will be responsible for carrying out this intervention plan?
What (if any) special instructional or behavioral program materials/resources or training is needed for
this intervention? (Please specify)
Intervention Fidelity Evaluation and Reflection form to be completed at least weekly.
How acceptable is the intervention to the classroom teacher? Low 1 2 3 4 5 High
(circle)
Monitoring the Intervention:
Progress Monitoring:
Beginning date:
Direction of Change:
Measurement Strategy:
Increase
Review date:
Decrease
Maintain
Who is responsible for doing the actual data collection?
Method of data collection:
Frequency of data collection:
Baseline data:
Copy of planning form is given to
parent and
administrator.
Review the Data
Week 2
Date:
Is the intervention being implemented as designed at the initial meeting?
If not, why?
Yes
No
Are there additional supports/resources that are needed?
Is the frequency of the intervention implementation being recorded?
Do you feel the intervention is effective?
Progress:
Yes
Yes
No
No
Has there been progress?
Baseline data:
Current data:
Notes:
Next meeting date:
If there are unresolved issues, please follow-up with administrator.
Week 4
Date:
Is the intervention being implemented as designed at the initial meeting?
If not, why?
Yes
Are there additional supports/resources that are needed?
Is the frequency of the intervention implementation being recorded?
Do you feel the intervention is effective?
Progress:
Yes
Yes
No
Has there been progress?
Baseline data:
Current data:
Notes:
Next meeting date:
If there are unresolved issues, please follow-up with administrator.
No
No
Week 6
Date:
Is the intervention being implemented as designed at the initial meeting?
If not, why?
Yes
No
Are there additional supports/resources that are needed?
Is the frequency of the intervention implementation being recorded?
Do you feel the intervention is effective?
Progress:
Yes
Yes
No
No
Has there been progress?
Baseline data:
Current data:
Notes:
Next meeting date:
If there are unresolved issues, please follow-up with administrator.
Final Meeting
Date:
Goal met or exceeded
Goal not met but performance improved
Goal not met and performance did not improve or got worse
*Attach data sheets and graphs.
Determine next steps:
continue current intervention
choose a different intervention (consider your brainstormed list on the Student Intervention Planning
Form)
schedule a meeting with other school personnel for further planning
Additional Information, Comments or Concerns:
Intervention Intensity Rating Form
New London School District
Teacher name:
Date:
Intervention Title/Description:
Check or circle the appropriate column, if hesitant, choose the higher of the two columns.
PREPARATION
1. Preparation for the
Intervention: certification or
other formal credentials
required to qualify person to
implement the intervention
2. On a per-pupil basis, the
cost to purchase or effort
needed to create the
intervention materials
3. Initial Training required to
use the intervention
IMPLEMENTATION
4. Amount of preparation
required for each session of the
intervention
5. Average time needed each
session to implement the
intervention
6. Degree to which the
intervention is tailored to the
unique needs of the target
student
7. Degree to which the
intervention can be carried out
by the educator as part of his or
her ‘typical’ instructional
routine
Column 1
No certification or
specialized credentials
required
Column 2
Certification or
specialized credentials
required, but commonly
available at school
Column 3
Certification or
specialized credentials
required
Intervention materials not
needed or do not entail
significant expense or effort
Intervention materials
required, at a modest cost or
with reasonable effort
Intervention materials per
pupil are costly or require
substantial effort to create
Little or no training
needed
Modest training needed(12 sessions)
Significant training
required (more than 2
sessions)
Little or no preparation is
needed
Some preparation needed
(15 minutes per session)
Little or no extra time is
needed
Some time is needed (up
to 30 minutes per session)
Intervention is likely to be
effective with a wide range
of students (e.g. use praise
statements)
Intervention is tailored to
the target students but could
also be applied to other
students who show similar,
somewhat common problems
Intervention requires that
the educator expend
moderate amount of
additional effort or time
beyond the usual instructional
routine
Substantial preparation
is needed (more than 15
minutes per session)
Substantial preparation
needed (more than 30 minutes
per session)
Intervention is highly
individualized to the needs of
the target student and unlikely
to be applicable to many other
students in the class or school
Intervention requires that
the educator expend
significant additional effort
or time beyond the usual
instructional routine
Intervention can be fully
integrated into the teacher’s
instructional routine.
8. Size of the developmental
gap between the stated
intervention outcome goal(s) of
the target student and the
‘typical’ academic or
behavioral levels of the
classroom or grade level
9. Potential of the intervention
to distract other students or
disrupt the learning of others
MONITORING OF THE
INTERVENTION
10. Effort required to monitor
the success of the intervention
TOTALS
Count the number of responses
in each column.
Intervention goal
approaches or matches the
academic or behavioral levels
of most students in the
classroom or grade level
Intervention goal falls
below the academic or
behavioral levels of most
students in the classroom or
grade level
Intervention goal falls
significantly below the
academic or behavioral levels
of most students in the
classroom or grade level
Intervention can be
implemented with little or no
disruption to students or
learning
Intervention is likely to
result in mild distraction of
students or mild disruption to
student learning
Intervention is likely to
result in significant
distraction of students or
significant disruption to
student learning
Monitoring requires little
additional effort (e.g. a
teacher who rates a student on
a Daily Behavior Report
Card)
Column Total
Monitoring requires
moderate additional effort
Monitoring requires
significant additional effort
(e.g. a psychologist who
carries out twice-weekly
direct observations)
Column Total
Column Total
How to use:
o If 7 or more of the 10 fall under any single tier it is likely that is the tier
o If you have a mixed pattern of ratings, the intervention should be considered the intensity of the highest column
containing at least 3 checks.
Tier intensity determined to be _____________________________________________________________________
Section 6: Implementing an Intervention
Purpose: Implement intervention plan and student progress monitoring for a minimum of 4 to 6
weeks. Be sure to document the student’s progress and complete the Intervention Fidelity
Evaluation and Reflection form.
Intervention Fidelity Evaluation and Reflection: The fidelity in which an intervention is carried
out can impact the intervention results. (Fidelity of implementation is defined as “how closely
the prescribed procedures are followed.” (Mellard & Johnson, p.117, Chapter 8).) To ensure
good intervention fidelity this form has been created for teachers to use on a weekly basis to
reflect how closely they have adhered to the treatment protocol. This can then be reviewed with
the peer consultant during bi-weekly meetings. (3 pages)
Who completes: Completed by teacher(s) who are responsible for implementing the
intervention.
Where is it kept: Upon completion, this form is kept in the yellow folder with the classroom
teacher.
Intervention Fidelity Evaluation and Reflection
Student _______________________
Date of Initial Plan Development:______________
Staff Member(s) Implementing Intervention: _______________________________________
Location: _______________________________
Intervention Description: _______________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Complete the following below, rating ‘1’ as Not At All, ‘9’ as Fully.
Date:_____________
Comments:____________________________________________
To what degree were you able to carry out the intervention as it was intended?
1 2 3
not at all
4 5 6
somewhat
7 8 9
fully
If rating fell below a 7, describe reasons it could not be carried out as planned.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Date:_____________
Comments:____________________________________________
To what degree were you able to carry out the intervention as it was intended?
1 2 3
not at all
4 5 6
somewhat
7 8 9
fully
If rating fell below a 7, describe reasons it could not be carried out as planned.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Date:_____________ Comments:____________________________________________
To what degree were you able to carry out the intervention as it was intended?
1 2 3
not at all
4 5 6
somewhat
7 8 9
fully
If rating fell below a 7, describe reasons it could not be carried out as planned.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Date:_____________
Comments:____________________________________________
To what degree were you able to carry out the intervention as it was intended?
1 2 3
not at all
4 5 6
somewhat
7 8 9
fully
If rating fell below a 7, describe reasons it could not be carried out as planned.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Date:_____________
Comments:____________________________________________
To what degree were you able to carry out the intervention as it was intended?
1 2 3
not at all
4 5 6
somewhat
7 8 9
fully
If rating fell below a 7, describe reasons it could not be carried out as planned.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Appendix A: Administrator Cheat Sheet
Administrator Cheat Sheet
1st Yellow Folder
Forms for the referring teacher:
1. Request for Parent/Guardian Information Form
2. Student Data Form
2nd Yellow Folder
Forms for the assigned peer consultant
1. Peer Consultant Checklist
Forms to be completed together during consultation meetings
1. Student Intervention Planning Form
2. Intervention Intensity Rating Form
Appendix B: RtI Glossary of Terms
Glossary of Terms for RtI
Accommodation
Change made to instruction and/or assessment that does not change the expectations
for performance or change the construct that is being measured. Accommodations
provide access to buildings, curriculum, and assessments.
Adaptation
An adjustment to the instructional content or performance expectations of students
with disabilities from what is expected or taught to students in general education.
Adaptations can include decreasing the number of exercises the student is expected
to complete, assigning different reading materials, or allowing use of a calculator.
Core Curriculum
A course of study deemed critical and usually made mandatory for all students of a
school or school system. Core curricula are often instituted at the primary and
secondary levels by school boards, Departments of Education, or other administrative
agencies charged with overseeing education. Core curricula must be scientific and
research-based.
Curriculum-Based Measurement (CBM)
Tools for measuring student competency and progress in the basic skill areas of
reading fluency, spelling, mathematics, and written language.
Data Points
Points on a graph that represent student achievement or behavior relative to a specific
assessment at a specific time.
Differentiated Instruction
Process of designing lesson plans that meet the needs of the range of learners; such
planning includes learning objectives, grouping practices, teaching methods, varied
assignments, and varied materials chosen based on student skill levels, interest levels,
and learning preferences; differentiated instruction focuses on instructional strategies,
instructional groupings, and an array of materials.
Early Intervening Services (EIS)
Early intervening services are the preventive components of No Child Left Behind and
the Individuals with Disabilities Education Act of 2004.
From NCLB:
An LEA will provide training to enable teachers to teach and address the needs of students with
different learning styles, particularly students with disabilities, students with special learning needs
(including students who are gifted and talented), and students with limited English proficiency; and to
improve student behavior in the classroom and identify early and appropriate interventions to help these
students.
From IDEA:
An LEA may use up to 15% of its IDEA Part B funds in any fiscal year, less any funds reduced from its
local fiscal effort, to develop and implement coordinated, early intervening services. Coordinated early
intervening services may include interagency financing structures (for students in K-12 with a particular
emphasis on students in K-3) who have not been identified as needing special education or related
services but who need additional academic and behavioral support to succeed in a general education
environment. When it has been determined that there is significant disproportionality with respect to the
identification of children as children with disabilities, or the placement in particular educational settings
of such children, the SEA shall require the LEA to reserve the maximum 15% of IDEA Part B funds to
provide comprehensive coordinated early intervening services to serve children in the LEA, particularly
children in those groups that were significantly over-identified.
EIS Activities could include:
Professional development for teachers and other school staff to deliver scientificallybased academic instruction and behavioral interventions, including scientifically-based
literacy instruction, and, where appropriate, instruction on the use of adaptive and
instructional software; and providing educational and behavioral evaluations, services
and supports, including scientifically-based literacy instruction.
Fidelity of Implementation & Instruction
Implementation of an intervention, program, or curriculum according to research
findings and/or on developers’ specifications.
GIST: General Intervention Support Team
MISD RtI program
Intensive Interventions
Academic and/or behavioral interventions characterized by increased length,
frequency, and duration of implementation for students who struggle significantly; often
associated with narrowest tier of an RTI tiered model; also referred to as tertiary
interventions.
Learning Disability
IDEA 2004 defines a Learning Disability/Specific Learning Disability in the following
manner: The child does not achieve adequately for the child’s age or to meet Stateapproved grade-level standards in one or more of the following areas, when provided
with learning experiences and instruction appropriate for the child’s age or stateapproved, grade-level standards.
(i) Oral expression.
(ii) Listening comprehension.
(iii) Written expression.
(iv) Basic reading skill.
(v) Reading fluency skills.
(vi) Reading comprehension.
(vii) Mathematics calculation.
(viii) Mathematics problem solving
Over-Identification
Refers to the over representation of students in special education programs/services
that is above state and national averages; identification of more students for services
through special education than the proportion of that population in the general
population.
Positive Behavior Support
A tiered intervention system based on school-wide practices that encourage and
reward positive student and adult behavior.
Positive Behavior Supports
Evidence-based practices embedded in the school curriculum/culture/expectations that
have a prevention focus; teaching, practice, and demonstration of pro-social
behaviors.
Problem-Solving Team
Group of education professionals coming together to consider student-specific data,
brainstorm possible strategies/interventions, and develop a plan of action to address a
student-specific need.
Progress Monitoring
A scientifically based practice used to assess students’ academic performance and
evaluate the effectiveness of instruction. Progress monitoring can be implemented with
individual students or an entire class. Also, the process used to monitor
implementation of specific interventions.
Response to Intervention (RTI)
Practice of providing high-quality instruction and interventions matched to
student need, monitoring progress frequently to make changes in
instruction or goals, and applying child response data to important
educational decisions.
Scaffolding
An instructional technique in which the teacher breaks a complex task into smaller
tasks, models the desired learning strategy or task, provides support as students learn
to do the task, and then gradually shifts responsibility to the students. In this manner, a
teacher enables students to accomplish as much of a task as possible without adult
assistance.
Scientific, Research-Based instruction
Curriculum and educational interventions that have been proven to be
effective for most students based on scientific study.
Scientifically Research Based Interventions
Scientifically based research has the meaning given the term in section 9101(37) of
the Elementary and Secondary Education Act (ESEA) of 1965. Section 9101(37) of
ESEA, as amended by the NCLB, defines scientifically based research as “research
that involves the application of rigorous, systematic, and objective procedures to
obtain reliable and valid knowledge relevant to education activities and programs.” The
statute then explains that this kind of research:
(1) Employs systematic, empirical methods that draw on observation or experiment;
(2) Involves rigorous data analyses that are adequate to test the stated hypotheses
and justify the general conclusions drawn;
(3) Relies on measurements or observational methods that provide reliable and valid
data across evaluators and observers, across multiple measurements and
observations, and across studies by the same or different investigators;
(4) Is evaluated using experimental or quasi-experimental designs in which individuals,
entities, programs, or activities are assigned to different conditions and with
appropriate controls to evaluate the effects of the condition of interest, with a
preference for random-assignment experiments, or other designs to the extent
that those designs contain within-condition or across-condition controls;
(5) Ensures that experimental studies are presented in sufficient detail and clarity to
allow for replication or, at a minimum, offer the opportunity to build systematically
on their findings; and
(6) Has been accepted by a peer-reviewed journal or approved by a panel of
independent experts through a comparably rigorous, objective, and scientific
review.
Tiered Instruction
Levels of instructional intensity within a tiered model of service delivery.
Tiered Model
Common model of three or more tiers that delineate levels of instructional
interventions based on student skill need.
Universal Screening
A process of reviewing student performance through formal and/or informal
assessment measures to determine progress in relation to student benchmarks;
related directly to student learning standards
Taken from the
RtI Action Network
http://www.rtinetwork.org/
Appendix C: Scantron Placement Indicators