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Appendix 1
7/16/13 1
Response to Intervention Handbook Reynolds School District
RTI is a framework for identifying students who are struggling to learn basic academic and social-‐behavioral skills. It is not a program, curriculum or model. The goal of RTI is to prevent learning difficulties by providing early, effective supports at a necessary level of intensity to maximize student potential and proficiency within the general education setting. Essential understandings embedded in Response to Intervention are:
• All students have potential to be benchmark students.
• The Academic Core is defined through the Common Core State Standards.
• Instructors must know where each child is on a continuum of learning.
• Instructors must plan for successful learning trajectories using any and all resources. • Positive Behavior Interventions and Supports must be in place in all schools.
RTI K-‐12 RTI is a systems approach to identifying students who are struggling to learn basic academic and social-‐behavioral skills and providing them with appropriate, targeted instruction/interventions. Reynolds School District has identified and implemented system components to support student learning. This system includes commitments around assessments, instructional and behavioral response, and collaborative decision-‐making. Assessment Assessments are in place to ensure student needs are identified and instruction is appropriately designed and delivered. Students at grades K-‐8 are given a universal screener to identify those needing additional diagnostic testing for appropriate instructional placement. To continue analyzing student placement and progress, students identified as intensive will have their progress monitored at least every two weeks and those identified as strategic will have their progress monitored at least once per month.
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Formative assessments, written collaboratively, provide teachers with information regarding student understanding on stated lesson outcomes. Summative assessments are used to analyze and compare both student and system outcomes. Instructional Response Reading and Mathematics instruction are directed by the Common Core State Standards (CCSS), sequenced by district teams. Instruction is grounded in the SIOP Model. Scientifically research-‐based strategies and materials are used as designated by PLC teams and the data gathered through assessments. Where plans are made and/or programs are chosen, instruction is to be delivered with fidelity; within the purpose for which it was designed in the manner in which it is designed to be delivered. All instructional interventions are to be monitored and documented. Collaborative Decision-‐Making Reynolds School District has made a commitment to collaboration through the provision of PLC time during at least one early release each month. To analyze the effectiveness of student placement, PLCs by grade level or department meet to review current student data and to review system effectiveness. The RTI system involves:
• universal screening • implementation of research/evidence-‐based interventions • progress monitoring and adjusting interventions when student performance does not
improve • referral for special education evaluation when student performance shows prolonged
“non-‐responsiveness” to intervention in the general education setting. The information from an RTI process is just one component of an evaluation to determine special education eligibility.
School-‐Wide PBIS (Behavior) School-‐wide PBIS places emphasis on school-‐wide systems of support including proactive strategies for defining, teaching, and supporting appropriate student behaviors to create positive school environments. Instead of using a patchwork of individual behavioral management plans, a continuum of positive behavior support for all students within a school is implemented in classroom and non-‐classroom settings (such as hallways, restrooms, etc.). PBIS is an application of a behaviorally-‐based systems approach to enhance the capacity of schools, families, and communities to design effective environments that improve the link between research-‐validated practices and the environments in which teaching and learning occurs. Attention is focused on creating and sustaining primary (school-‐wide), secondary (classroom), and tertiary (individual) systems of support. As a result, within school systems, good
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instructional practices have their best chance of increasing student academic achievement.1 Features of School-‐wide PBIS include seven basic systems strategies: 1. Establish a PBIS Team representative of key school constituents that will review discipline data regularly and ensure the establishment of the “green zone” of the triangle on prevention activities for all students. The Team will also regularly participate in professional development activities on behavior management.
2. Establish 3-‐5 basic school rules agreed upon by the majority of the staff (e.g., Be Safe, Be Responsible, Be Respectful).
3. Achieve staff consensus on the expectations for behavior in following the above rules within different settings (e.g., classrooms, hallways, bathrooms, playground, assemblies, bus-‐loading).
4. Create lesson plans to teach the expectations
5. Create a schedule for instruction during the year and indications for responsibilities.
6. Recognize students for following expectations on a 5 to 1 ratio against the administration of consequences for not following them.
7. Establish a clear procedure for the administration of discipline management (e.g., procedures for writing referrals, determining which are classroom managed and which are office managed) as well as a continuum of consequences. Keep track of all discipline referrals in a data-‐based format (e.g., School Wide Information System (SWIS). All schools in the RSD system will operate within Response to Intervention. The frame includes an assessment battery, instructional components and a meeting structure. Forms are included to provide continuity and documentation.
1 The OrRTI Technical Assistance Guidelines are also available at http://www.ode.state.or.us/search/page/?=2244
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Academic Assessment Battery Re
ading
Screening Should we worry?
Independent Reading Level Assessment (IRLA) Easy CBM 6-‐8
Fall: Sept 4 – Sept 27 Winter: Jan 6 – Jan 31
Diagnostic Why are we worried?
IRLA (at instructional level) In-‐Program/Placement Tests Etc.
As suggested by screening information in order to identify appropriate intervention/course of instruction
Progress Monitoring Is there growth against a set, normed benchmark?
IRLA Easy CBM 6-‐8 In-‐Program Mastery Tests
Standardized, quantifies growth against a pre-‐set bar. Team determines frequency no less than once per 6 weeks.
Formative Are learning targets set in class being met?
IRLA Teacher/Team-‐Designed Formative Assessments
Classroom based, measures growth toward and/or mastery of learning targets
Summative Has the set, normed benchmark been achieved?
IRLA Easy CBM 6-‐8 OAKS
Spring: May 19 – Jun 6
Math
Screening Should we worry? Easy CBM K-‐8 Fall: Sept 4 – Oct 4
Winter: Jan 6 – Jan 31 Diagnostic Why are we worried?
Computation Assessments Skills Inventory Etc.
As suggested by screening information in order to identify appropriate intervention/course of instruction
Progress Monitoring Is there growth against a set, normed benchmark?
Easy CBM K-‐8 In-‐Program Mastery Tests
Standardized, quantifies growth against a pre-‐set bar. Team determines frequency no less than once per 6 weeks.
Formative Are learning targets set in class being met?
Team-‐Designed Formative Assessments
Classroom based, measures growth toward and/or mastery of toward learning targets
Summative Has the set, normed benchmark been achieved?
Easy CBM K-‐8 OAKS Spring: May 19 – Jun 6
Writing
Screening Should we worry? Fall Prompt Sept 4 – Oct 4
Diagnostic Why are we worried?
Progress Monitoring Is there growth against a set, normed benchmark?
Formative Are learning targets set in class being met?
Team-‐Designed Formative Assessments No less than once per 6 weeks
Summative Has the set, normed benchmark been achieved?
Spring Prompt May 19 – Jun 6
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Behavioral Assessment Battery Screening File review, referrals, teacher data, observation notes, contact former
teachers Diagnostic Thinking Skills inventory, observation notes, out of class time, referrals,
suspensions, tracking sheets, Student Intervention Profile (Behavior) etc.
Progress Monitoring Teaching identified lagging skill(s) (Intervention) and tracking progress
(observations, data sheets, intervention plans, etc.).
Formative Intervention data (RSD Data systems) teacher anecdotal data and
observations Summative Referrals, suspensions, out of class time, work completion, attendance, etc
Instructional Components Intensity Curriculum Instruction
Tier I Benchmark Green Zone
RSD-‐sequenced Common Core State Standards
Instruction must be focused, rigorous and engaging with explicitly stated learning targets. Effective strategies for differentiation and individualization must be present to meet individual student need.
Tier II Strategic
Yellow Zone
Supplemental – research based – addressing deficit skills that hinder access to CCSS
Instructional strategies used with fidelity to shore up assessed deficits. Programs must be carefully chosen to target and accelerate learning. Intervention effectiveness tracked through progress monitoring assessments and documented with the Student Intervention Profile.
Tier III Intensive Red Zone
Replacement – research based – addressing deficit skills that prevent access to CCSS
Instructional materials and strategies used with fidelity to accelerate learning, providing access to CCSS.
Behavioral Components Intensity Curriculum Instruction (not an exhaustive list)
Tier I Benchmark Green Zone
School wide PBIS programs and social skills instruction (Second Steps, etc.)
Classroom based instruction regarding appropriate social skills, modification of assignments, change in seating assignments, decreased work time, more frequent teacher check-‐ins, increased verbal/non-‐verbal praise etc.
Tier II Strategic
Yellow Zone
Check In/Check Out, small group social skills lessons
Skills groups, Attendance groups, Homework/After school group, Check-‐in/Check-‐out, family outreach, collaboration around identifying trigger events, basic positive behavior support program (weekly), contracts, Plan B conversations, Safety Plan, etc.
Tier III Intensive Red Zone
Check In/Check Out, Individual social skills instruction
Student Intervention Profile – Behavior Form, Safety Plan, family meetings, positive behavioral support program (Daily), increase skills deficit support through individualized skill building and social groups, referral to outside agencies, etc.
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Protocols for Meetings Data Team PLC Child Study Team
Embedded in these teams are adjustments to instruction and attention to student growth -‐ focused on Tiers I and II
Team: specialists, classroom teacher bringing forth concern, parent invited, but not requisite Purpose: Engage in Data-‐Based Problem Solving for an individual student after data confirms that solid core instruction and Tier II interventions have not yielded sufficient gains. Frequency: As needed Teacher Required to Bring: • Intervention Profile, documenting two appropriately chosen, but unsuccessful interventions • Other applicable data Process: • Classroom teacher explains: -‐ student strengths -‐ instructional history -‐ adjustments made & results -‐ problem statement • Conversation opens to problem solving with specialist input • Action plan developed
Outcome: Action plan focused on instructional next steps formed with timeline for checking back in with the team
Team: Teachers who work with the same group of students (ex. Grade level teachers, department…) Purpose: Engage in Data-‐Based Problem Solving using standardized measures (DIBELS, OAKS, in-‐program assessments...) Frequency: Every 6-‐8 weeks Team Members Required to Bring: • Standardized data for all students, organized for ease of collaborative problem solving Process: • Review Data What is happening and for what groups? • Identify the Problem What is the problem? (class-‐wide assessment results, system, groupings, pacing, time…) • Analyze the Problem Why is the problem occurring? • Intervene How will we solve the problem? • Evaluate Did the intervention work to solve the problem? Outcome: System adjustment to address large scale issues
Team: Teachers who work with the same group of students (ex. Grade level teachers, department…) Purpose: Engage in Data-‐Based Problem Solving using defined learning targets and formative assessments Frequency: Every week Team Members Required to Bring: • Formative data for all students, organized for ease of collaborative problem solving Process: • Review Data Did student(s) learn what was taught? • Identify learning targets What do students need to know? • Determine formative assessments How will I know they’ve learned it? • Deepen rigor What will I do if they have?
-‐or-‐
• Remediate to accelerate What will I do if they haven’t?
Outcome: Instructional adjustments to accommodate individual student needs
Each meeting must:
Have a designated facilitator Have a designated note taker Include student data (proof of struggle or success) Focus on finding solutions Yield actions with timelines
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RTI Process Flow Chart
Classroom Teachers use data to identify students needing intervention
Classroom Teachers bring student data to their PLC meeting
PLC teams
Determine interventions to be
used
Determine progress monitor to be used and at what frequency
Determine length of time intervention
will occur
Cycle through data analysis and intervention application 2 times. Classroom Teacher to keep track of interventions and data. If after 2 interventions the student is still not making gains…
Classroom Teacher will bring Intervention Profile (academic, behavioral or both) with a File Review to CST for further, more targeted interventions and action planning.
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Explanation of aspects of flow chart: Examples of data: Academic Data Behavioral Data IRLA Tardies Easy CBM Absences Formative Assessments Referrals Unit Tests Observational Notes Placement Tests Work Samples
Examples of data to bring to PLC: Assessment reports from on-‐line systems
IRLA, Easy CBM, Synergy, ELPA, OAKS, SWIS, Study Island… Actual student work Work samples, progress monitoring booklets… Home Language Survey Comparisons
Student to student, student to standard, student to self over time…
Match intervention with assessed need. Be mindful. You are hypothesizing about what will bring a student to proficiency on the deficit skill. The Menu of Intervention Options can be a good guide at this stage. Guide decisions with the following questions: Will an adjustment of time for instruction make an impact? Why? Will an adjustment of materials make an impact? Why? Will the design of instructional delivery make an impact? Why? Progress monitor the skill you are attempting to impact. You need to have three or more data points below an aimline before determining an intervention is not effective.
Classroom Teachers collect data to identify students needing intervention
Classroom Teachers bring student data to their PLC meeting
Determine interventions to be used
Determine progress monitor to be used and at what frequency
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It is true that learning takes time. It is also true that if something isn’t working, something else needs to be tried soon. Students don’t have time to waste. Be careful to pair interventions and students with progress monitoring in ways that are likely to accelerate learning, not halt it.
The Student Intervention Profile (both the academic and behavioral version) is for the classroom teacher to use to document interventions and to guide the problem-‐solving that will occur as part of the CST. The numbers in parentheses in the benchmark score chart are the benchmarks expected for each of the required assessment measures. This form should be maintained from year to year so interventions begun in the late spring are not lost for the early fall.
A File Review is necessary to bring to CST to help ensure that the whole child has been considered in the design and implementation of interventions.
Follow through with action planning that occurred in the CST.
Forms referenced in explanations: Menu of Intervention Options -‐ Academic Menu of Intervention Options -‐ Behavioral Student Intervention Profile -‐ Academic -‐ Elementary Student Intervention Profile -‐ Academic -‐ Secondary Student Intervention Profile -‐ Behavioral File Review
Determine length of time intervention will occur
Cycle through 2 times. Classroom Teacher to keep track of interventions and data. If, after 2 interventions the student is still not making gains…
Classroom Teacher will bring Intervention Profile (academic, behavioral or both) with a File Review to CST for further, more targeted interventions and action planning.
Apply third intervention according to the planning of the CST. Monitor progress.
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Menu of Intervention Options -‐ Academic When Planning for a possible intervention, explore the following questions to guide the decision making process: Will an adjustment of time for instruction make an impact? Why? Will an adjustment of materials make an impact? Why? Will the design of instructional delivery make an impact? Why? Make sure to record intervention selected in intervention profile.
Options for Curriculum/Program
____ Check fidelity of program implementation ____ Provide additional training ____ Add a coaching component
____ Add another component using ____ Existing program ____ Another part of a program to reinforce a skill ____ The computer
____ Move to a more structured intervention program (check one) ☐ Phonics for Reading ☐ Read Well ☐ Reading Mastery ☐ Reading Mastery Plus ☐ Soar to Success ☐ Corrective Reading ☐ Rewards ☐ Horizons Level ____ ☐ Read Naturally ☐ GATE .8 ☐ Early Reading Intervention ☐ ______________________
____ Change the core program
Options for the Student
____ Increase motivation ____ Add incentives ____ Change incentives ____ Adjust behavior plan ____ Increase success level
____ Increase active engagement ____ Number of responses per session ____ Teach, review and post standards of behavior
____ Increase regular attendance ____ Parent contact
____ Ensure student level matches instructional level ____ Skill grouping ____ Differentiated instruction
____ Increase types of cueing approaches ____ Visual ____ Auditory ____ Tactile
Options for Instructional Practices
____ Change pace of instruction (↑ or ↓)
____ Employ standard cueing correction procedures
____ Pre-‐teach concepts outside the group
____ Build/activate prior knowledge
____ Increase types of cueing approaches ____ Visual ____ Auditory ____ Tactile
____ Other _________________________________
Options for Instructional Logistics
____ Reduce size of instructional group
____ Add additional instructional time ____ Double Dosing ____ Different Materials
____ Change instructor ____ Change seating within group
____ Provide instruction in small units throughout the day
____ Change physical environment
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Menu of Intervention Options -‐ Behavioral When Planning for a possible intervention, explore the following questions to guide the decision making process: Will an adjustment of time for instruction make an impact? Why? Will an adjustment of materials make an impact? Why? Will the design of instructional delivery make an impact? Why? Make sure to record intervention selected in intervention profile.
Options for Curriculum/Program
____ Second Steps (TIER I) ____ Building PBIS (TIER I) ____ Antibullying (TIER I) ____ Family Outreach (TIER II TIER III) ____ Small group with counselor (social skills group,
attendance group) (TIER II-‐TIER III ____ Individualized support from counselor (TIER III) ____ Check in – Check out (TIER II-‐TIER III) ____ Safety Plan (TIER II-‐TIER III) ____ Incentive Program (TIER I, II, III) ____ Break cards (TIER I-‐TIER II) ____ Increased Individualized social skills building
(TIER III) ____ Student Intervention Profile – Behavioral (TIER II-‐
TIER III) ____ Positive Behavior Support Program (TIER II-‐TIER
III)
Options for the Student
____ Increase motivation ____ Add incentives (TIER I, II, III) ____ Change incentives (TIER I, II, III) ____ Adjust Positive Behavior Support Program (TIER II-‐TIER III) ____ Increase success level (TIER I, II, III)
____ Increase active engagement ____ Number of responses per session (TIER I) ____ Teach, review and post standards (TIER I) of behavior
____ Increase regular attendance ____ Parent contact (TIER II,-‐TIER III)
____ Ensure student level matches instructional level ____ Skill grouping (TIER I, TIER II TIER III) ____ Differentiated instruction (TIER I, II, III)
____ Increase types of cueing approaches ____ Visual (TIER II, TIER III) ____ Auditory (TIER II) ____ Tactile (TIER II, TIER III )
Options for Instructional Practices
____ Change pace of instruction (↑ or ↓)
____ Employ standard cueing correction procedures
____ Pre-‐teach concepts outside the group
____ Increase types of cueing approaches ____ Visual ____ Auditory ____ Tactile
____ Other _________________________________
Options for Logistics
____ Reduce size of instructional group (TIER I-‐TIER II)
____ Add additional instructional time ____ Double Dosing ____ Different Materials
____ Change instructor (TIER II) ____ Change seating within group (TIER I)
____ Provide individual(Safety/Respect/Responsibility) instruction small units throughout the day(TIER III)
____ Change physical environment (TIER I, II, III)
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Student Intervention Profile – Academic – Elementary To be completed by classroom teacher when interventions are determined to be needed.
Student Name: ________________ SSID Number: ________ Date: _______
School: ______________ Initial Grade Level: _______ Program (circle): ELL / Title I / None Ethnicity: ____________ Gender: ___________ Native Language: ___________
Language of Instruction and Time per Day: ________________________________________________ Areas of Academic Strength: ______________________________________________________________________ _____________________________________________________________________________________________ Benchmark Scores (indicate fall, winter, or spring)
Attendance Issues: ☐ Excessive ☐ Minor ☐ Mostly Tardy ☐ Other _________________________ Behavioral Issues: ______________________________________________________________________ Note Additional Concerns/Issues: __________________________________________________________ ______________________________________________________________________________________
K 1st 2nd 3rd 4th 5th IRLA Level OAKS (Rdg) (211) (216)
(221) Writing Scores
Easy CBM (Math) (41) (41) (40) (41) (41) (43) OAKS (Math) (212) (219) (225) ELPA
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Intervention #1 Current Grade Level ________ Curriculum: __________________________ Starting Lesson #: ______ Start Date: _____________ Instructor: ☐ Licensed Regular Ed. ☐ Licensed Specialist ☐ Instructional Assistant ☐ ___________ Group Size: __________ Frequency: ☐1x/week ☐2x/week ☐3x/week ☐4x/week ☐5x/week ☐Other _____________ Duration: ☐15 min. ☐20 min ☐30 min ☐45 min ☐60 min ☐Other ____________________ Progress Data: Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Accommodation Notes: ________________________________________________________________ ____________________________________________________________________________________ Intervention End Date: ________ Ending Lesson #: ________ Reason for Ending & Next Steps: _______________________________________________________ ____________________________________________________________________________________
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Intervention #2 Current Grade Level ________ Curriculum: __________________________ Starting Lesson #: ______ Start Date: _____________ Instructor: ☐ Licensed Regular Ed. ☐ Licensed Specialist ☐ Instructional Assistant ☐ ___________ Group Size: __________ Frequency: ☐1x/week ☐2x/week ☐3x/week ☐4x/week ☐5x/week ☐Other _____________ Duration: ☐15 min. ☐20 min ☐30 min ☐45 min ☐60 min ☐Other ____________________ Progress Data: Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Accommodation Notes: ________________________________________________________________ ____________________________________________________________________________________ Intervention End Date: ________ Ending Lesson #: ________ Reason for Ending & Next Steps: _______________________________________________________ ____________________________________________________________________________________
Intervention #3 Current Grade Level ________ Curriculum: __________________________ Starting Lesson #: ______ Start Date: _____________ Instructor: ☐ Licensed Regular Ed. ☐ Licensed Specialist ☐ Instructional Assistant ☐ ___________ Group Size: __________ Frequency: ☐1x/week ☐2x/week ☐3x/week ☐4x/week ☐5x/week ☐Other _____________ Duration: ☐15 min. ☐20 min ☐30 min ☐45 min ☐60 min ☐Other ____________________ Progress Data: Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Accommodation Notes: ________________________________________________________________ ____________________________________________________________________________________ Intervention End Date: ________ Ending Lesson #: ________ Reason for Ending & Next Steps: _______________________________________________________ ____________________________________________________________________________________
Intervention #4 Current Grade Level ________ Curriculum: __________________________ Starting Lesson #: ______ Start Date: _____________ Instructor: ☐ Licensed Regular Ed. ☐ Licensed Specialist ☐ Instructional Assistant ☐ ___________ Group Size: __________ Frequency: ☐1x/week ☐2x/week ☐3x/week ☐4x/week ☐5x/week ☐Other _____________ Duration: ☐15 min. ☐20 min ☐30 min ☐45 min ☐60 min ☐Other ____________________ Progress Data: Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Accommodation Notes: ________________________________________________________________ ____________________________________________________________________________________ Intervention End Date: ________ Ending Lesson #: ________ Reason for Ending & Next Steps: _______________________________________________________ ____________________________________________________________________________________
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Student Intervention Profile – Academic – Secondary To be completed by teacher when interventions are determined to be needed.
Student Name: _____________________ Student Number: _______ Date: ______
School: __________ Initial Grade Level: _______ Program (circle): ELL / Title I / None Ethnicity: __________ Gender: __________ Native Language: ___________
Language of Instruction and Time per Day: ___________________________________________ Areas of Academic Strength: ______________________________________________________________________ _____________________________________________________________________________________________ Benchmark Scores (indicate fall, winter, or spring) EasyCBM scores based on ‘12-‐‘13 norms.
6th 7th 8th 9th 10th 11th Easy CBM (PRF) (163) (157) (163) Easy CBM (Comp) (16) (13) (14) Easy CBM (Voc) (19) (18) (19) DRA Level OAKS (Rdg) (226) (229) (232) (236) Writing Scores Easy CBM (Math) (37) (34) (33) OAKS (Math) (227) (232) (234) (236) ELPA Li
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Attendance Issues: ☐ Excessive ☐ Minor ☐ Mostly Tardy ☐ Other ______________________________________ Behavioral Issues: ______________________________________________________________________________
Note Additional Concerns/Issues: _________________________________________________________________
_____________________________________________________________________________________________
Intervention #1 Current Grade Level ________ Curriculum: __________________________ Starting Lesson #: ______ Start Date: _____________ Instructor: ☐ Licensed Regular Ed. ☐ Licensed Specialist ☐ Instructional Assistant ☐ ___________ Group Size: __________ Frequency: ☐1x/week ☐2x/week ☐3x/week ☐4x/week ☐5x/week ☐Other _____________ Duration: ☐15 min. ☐20 min ☐30 min ☐45 min ☐60 min ☐Other ____________________ Progress Data: Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Accommodation Notes: ________________________________________________________________ ____________________________________________________________________________________ Intervention End Date: ________ Ending Lesson #: ________ Reason for Ending & Next Steps: _______________________________________________________ ____________________________________________________________________________________
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Intervention #2 Current Grade Level ________ Curriculum: __________________________ Starting Lesson #: ______ Start Date: _____________ Instructor: ☐ Licensed Regular Ed. ☐ Licensed Specialist ☐ Instructional Assistant ☐ ___________ Group Size: __________ Frequency: ☐1x/week ☐2x/week ☐3x/week ☐4x/week ☐5x/week ☐Other _____________ Duration: ☐15 min. ☐20 min ☐30 min ☐45 min ☐60 min ☐Other ____________________ Progress Data: Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Accommodation Notes: ________________________________________________________________ ____________________________________________________________________________________ Intervention End Date: ________ Ending Lesson #: ________ Reason for Ending & Next Steps: _______________________________________________________ ____________________________________________________________________________________
Intervention #3 Current Grade Level ________ Curriculum: __________________________ Starting Lesson #: ______ Start Date: _____________ Instructor: ☐ Licensed Regular Ed. ☐ Licensed Specialist ☐ Instructional Assistant ☐ ___________ Group Size: __________ Frequency: ☐1x/week ☐2x/week ☐3x/week ☐4x/week ☐5x/week ☐Other _____________ Duration: ☐15 min. ☐20 min ☐30 min ☐45 min ☐60 min ☐Other ____________________ Progress Data: Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Accommodation Notes: ________________________________________________________________ ____________________________________________________________________________________ Intervention End Date: ________ Ending Lesson #: ________ Reason for Ending & Next Steps: _______________________________________________________ ____________________________________________________________________________________
Intervention #4 Current Grade Level ________ Curriculum: __________________________ Starting Lesson #: ______ Start Date: _____________ Instructor: ☐ Licensed Regular Ed. ☐ Licensed Specialist ☐ Instructional Assistant ☐ ___________ Group Size: __________ Frequency: ☐1x/week ☐2x/week ☐3x/week ☐4x/week ☐5x/week ☐Other _____________ Duration: ☐15 min. ☐20 min ☐30 min ☐45 min ☐60 min ☐Other ____________________ Progress Data: Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Date _____ Test ____________ Score _______ Accommodation Notes: ________________________________________________________________ ____________________________________________________________________________________ Intervention End Date: ________ Ending Lesson #: ________ Reason for Ending & Next Steps: _______________________________________________________ ____________________________________________________________________________________
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Student Intervention Profile – Behavioral To be completed by classroom teacher when interventions are determined to be needed.
Student Name: ________________ SSID Number: ________ Date: _______
School: __________ Initial Grade Level: _______ Program (circle): ELL /Title I / None Native Language: __________ Behavioral strengths: ____________________________________________________________________________________________________________________________________________________________ Special interests: ____________________________________________________________________________________________________________________________________________________________ Begin this chart in box #1. Work sequentially by number. (Because of these circumstances…
When these events happen…
This behavior is occurring…
For these reasons…)
3. Set Up (“slow trigger”)
2. Set Off (“fast trigger”)
1. Target Behavior 4. Reinforces (gain/avoid)
Document interventions attempted and outcomes prior to initiating the CST process.
Intervention #1 Intervention #2
Outcome Outcome
Appendix 1
7/16/13 17
To be developed at CST Meeting with input from team.
Intervention #3 Intervention #4
Outcome Outcome
Next steps/action plan:
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File Review and Problem Identification Worksheet To be completed by classroom teacher and brought to CST Meeting
Student Name: _______________ SSID Number: ________ Date: _______
School: _____________________ Classroom Teacher ____________________
Attendance Record K 1st 2nd 3rd 4th 5th School Year School Attended
Days Absent Days Tardy
Progress Rates K 1st 2nd 3rd 4th 5th Provide evidence of progress causing concern
Review of Report Cards, Progress Reports and Teacher Comments
Reading
Math
Writing
Language Skills
Behavior and Attendance
Other
Includes completed:
⃞ Intervention Profile
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Summary of Teacher Concerns
Hypothesis Development Evidence supports that primary problems are due to: ⃞ Attention ⃞ Motivation ⃞ Lack of English Proficiency ⃞ Behavioral Issues
If evidence supports that primary problems are due to: ⃞ Attendance ⃞ Mobility ⃞ School Interruptions Indicate reasons for absences and/or interruptions:
Evidence supports that primary problems are due to other concerns: ⃞ Trauma ⃞ Family Concerns ⃞ Other Disabilities (Documented Medical Diagnosis) Describe issue(s) – be sure to note when these issues occurred and their correlation with academic concern. Indicate Next Steps: