Silver Sage RTI/PBIS Handbook - Idaho Training Clearinghouse

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Silver Sage RTI/PBIS Handbook

This handbook can be used as a template for creating a RTI/PBIS handbook specific to your school. Silver Sage Elementary uses this handbook as a guide for a combined RTI and PBIS process. Forms, team meeting agendas, and progress monitoring documents are provided on a shared drive so that all faculty and staff have access. This school has also included a data file on the shared drive so that teachers can input student data and it is available to everyone and instantly accessible at team meetings.

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Table of Contents Section 1: Overview …………………………………………………………… 3

Section 2: Practices …………………………………………………………… 5

Section 3: Systems …………………………………………………………….. 9

Section 4: Data ………………………………………………………………… 13

Appendix A: Staff Resources

Appendix A1: Resources for Instructional and Behavioral Supports …….. 24

Appendix B: Systems Forms

Appendix B1: Tier 1 Team Meeting Agenda ………………………………... 26

Appendix B2: Tier 2 Intervention Support Team Agenda …………………. 28 with Data Summary Form

Appendix B3: Individual Student Summary Form …………………………. 30

Figures, Data Tables, and Forms Figure 1. Silver Sage Elementary School RTI Model ………………………. 4

Data Table ……………………………………………………………………... 14

Data Calendar …………………………………………………………………. 22

Data Summary Form …………………………………………………………. 28

Individual Student Summary Form …………………………………………. 30

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Section One: Overview

Response to Intervention (RTI) is an assessment and intervention process for systematically monitoring student progress and making decisions about the need for instructional modifications or increasingly intensified services using progress-monitoring data.

RTI includes both the academic and behavioral aspects of student performance, and in Silver Sage, is based on a three-tiered model, as pictured on page 4. RTI consists of the following integrated components, each of which will be described in this handbook:

1. Evidence-based practices to support student behavior a. High quality core instruction b. Research-based interventions that are supportive of student progress in Tier 1. c. Specially designed instruction for students who require the most intense

supports 2. Systems to support staff implementation

a. Defined team structures b. Defined roles and responsibilities c. Defined processes

3. Data to support decision making a. Universal screening for academics and behavior b. Decision rules for identifying when students need to move through the tiered

system c. Progress monitoring of students in intervention

The primary purpose for implementing RTI is to improve the academic achievement and social competence of all students. RTI also provides a system by which data informs instructional decision-making at the individual, class, grade and school level. Finally, RTI allows for the early identification and intervention for students who do not meet grade level performance benchmarks.

Personalize the handbook for your school by using your school’s name throughout, and including specifics to your school such as curriculums, assessments, and interventions used.

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Figure 1. Silver Sage Elementary School RTI Model

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Section 2: Practices

An RTI approach incorporates a multi-tiered model of educational service delivery in which each tier represents increasingly intense services that are associated with increasing levels of learner needs. The various tiered interventions are designed to provide a set of curricular/instructional processes aimed at improving student response to instruction and student outcomes. The various tiered interventions are briefly described here. An important part of a RTI approach is monitoring the fidelity with which these interventions are implemented (whether interventions are being implemented as intended). Since a RTI model is built upon identifying students who are not responding to interventions at various levels, we need to know that we are actually implementing those interventions before we can say that students are not responding. Tools and procedures for monitoring fidelity of implementation are described in further detail in Section 4: Data. Tier 1. In this system, primary supports and interventions, commonly known as Tier 1 interventions, represent the least-intensive level of service delivery. Tier 1 is designed to serve all students in the school with well-supported instructional programs. Tier 1 interventions are intended to be proactive and preventive. This means that the core foundation of curriculum, instruction, and school organization increases the likelihood of improved student achievement and success for all students and may reduce the number of students who are referred for special education services and supports. The Tier 1 program at Silver Sage consists of the following programs.

Reading. The core curriculum for reading at Silver Sage is Harcourt Trophies. Reading instruction is provided for 90 minutes each day, five times per week. Math. The core curriculum for math at Silver Sage consists of either Scott Foresman or Addison Wesley. Math instruction is provided for 90 minutes each day, five times per week. Language arts. Language arts instruction is integrated with reading and the content areas. The school uses the Step Up to Writing program in the content areas. Behavior. The key components of the core curriculum/evidence-based practice for behavior support are:

• Define and teach school-wide expectations

• Systematically acknowledge appropriate behavior

• Respond consistently to positive behavior

List and describe the core reading, math, language arts, and behavior programs used at your school.

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For specific information for behavior support see the shared file for ‘School Behavior.’

Tier 2. When a student’s school-wide screening or progress monitoring results indicate a deficit in a specific area, an appropriate instructional intervention is implemented and progress within that intervention is monitored. This is Tier 2. The Tier 2 intervention is for those students for whom Tier 1 instruction is insufficient, who are falling behind on benchmark skills, and who require additional instruction to achieve grade-level expectations. A. Tier 2 consists of general education instruction plus specialized intervention that has the following features:

Size of instructional group. Tier 2 interventions are targeted group interventions. The term group may refer to a small number of students receiving instruction (e.g. academic instruction groups and social skills training groups). In the case of behavioral interventions, the term group may also refer to groups of student participating individually in the same program. Frequency of progress monitoring. Although recommendations vary, 1-2 times per week monitoring of progress is typical. Duration of the intervention. Tier 2 interventions typically last for nine to twelve weeks and can be repeated as needed. The duration will be determined based on individual student progress monitoring data. Frequency with which the intervention is delivered. Tier 2 provides for 3-4 academic intervention sessions per week, each lasting 30-60 minutes. Behavioral interventions may be delivered 1-3 times per week or daily within typical routines. Instructor qualifications. Small group academic and social skills instruction is conducted by trained and supervised personnel (not the classroom teacher). Check-in/check-out (CICO) for behavior is delivered by classroom teachers and one staff member outside of the classroom for morning and afternoon check-ins.

Placement in and completion of Tier 2 interventions can result in one of three possible outcomes (Vaughn, 2003):

1. Successful progress is made in the area of deficit and the student exits Tier 2 instruction to return to only Tier 1 instruction.

2. Although progress is being made, the student has not progressed enough to warrant removing support and remains in Tier 2.

3. The rate and amount of progress or the level of support required for the student warrants adaptations to standard Tier 2 interventions, assessment for intensive individualized interventions and/or referral for special education eligibility determination.

B. Tier 2 programs and interventions for the various areas include:

Silver Sage keeps frequently accessed documents on a shared drive.

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Reading. Read Naturally; Rewards; Harcourt Intervention Materials; Mondo; Reading Mastery; PALS; Fry’s Phrases, Fluency practice; Soar to Success; SIPPS.

Math. Math Navigator, V-Math, SFAW Intervention Kit

Language Arts. Self-regulated strategy development in writing, Vocabulary instruction; Mondo oral-instruction

Behavior. Check-in/Check-out (CICO) is a targeted intervention that provides daily support and monitoring in the form of immediate feedback on student behavior and increased adult attention (Crone, Horner & Hawken, 2004). For specific information on CICO see the shared file for ‘School Behavior.’

Tier 3. Tier 3 interventions take an individualized approach to instruction and intervention. Intensive, individualized interventions must be designed to meet the specific learning and behavioral needs of the student, be implemented on a timely basis, be provided by a highly qualified teacher or specialist, and be monitored to determine progress and achievement of desired outcomes. In summary the following are critical features of individualized, tertiary intervention in an RTI model:

Size of instructional group. Instruction and intervention is provided to individual students or small groups. Mastery requirements of content. Tier 3 programs, strategies, and procedures are designed and employed to supplement, enhance, and support Tier 1 and 2 instruction by remediation of the relevant area and development of compensatory strategies. Mastery is relative to the student’s functioning and determined by the individualized education program (IEP) or behavior support plan (BSP) goal setting and through results of progress monitoring and comprehensive evaluation. Frequency of progress monitoring. Continuous progress monitoring informs the teaching process. Duration of the intervention. Individualized instruction continues until progress-monitoring data suggests that the student may be ready to receive instruction in a less intensive tier. Frequency with which the intervention is delivered. The frequency of individualized instruction depends upon student need and will be defined by the IEP or BSP. Most behavior interventions will occur within typical routines on a daily basis and will be supplemented by specific skills training as needed, generally 30 min/ 4 x per week/ per subject

List and describe the reading, math, language arts, and behavior programs used for Tier 2 at your school.

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Instructor qualifications. Special education teachers deliver the academic instruction and may support classroom teachers in implementation of behavior support strategies. Exit criteria. Exit criteria are specified and monitored so that placement is flexible.

Tier 3 supports are the most intensive and individualized to target each student’s area(s) of need.

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Section 3: Systems

In order to implement the RTI/PBS process, the school will create three functional teams: 1) Tier 1 RTI Team (school-wide team), 2) Tier 2 Intervention Support Team (progress monitoring team), and 3) Tier 3 Student-Focused Team. The structure, function, and responsibilities of each team are listed below. 1. Tier 1 RTI Team A. Structure and functions. In order to effectively implement RTI for academics and behavior, a

leadership team has been designated. The RTI team consists of individuals with two primary purposes:

1. To systematically review screening, school and classroom performance data to

determine overall areas of need for school improvement. 2. To guide action planning and implementation of school-wide, universal practices and

systems.

At Silver Sage, the composition of the RTI team includes:

1. Principal 2. School Psychologist 3. Special Education Teacher 4. General Education Teacher(s) 5. Title I Program Teacher

B. Roles and responsibilities. In order for the team to function effectively, the following roles

and responsibilities will need to be fulfilled by members of the team: 1. Meeting recorder –takes notes during meetings and sends minutes within 24 hours. 2. Data coordinator, academics – brings benchmark data ready to review, teacher

observation data, fidelity data and information about professional development needs 3. Data coordinator, behavior – brings ODR data, SWIS data, fidelity data and

information about professional development needs 4. Team leader – creates and distributes the agenda, runs the meeting, ensures all agenda

items are addressed. Responsible for communicating information to school staff. 5. Team 2 Intervention Support Team liaison – communicates to Tier 2 team the

students who will receive Tier 2 interventions based on screening/benchmark data/progress-monitoring of student performance in Tier 1.

C. RTI Meetings. Tier 1 meetings are held every other week on Tuesdays from 8:05 – 9:05 am.

See the school calendar for the specific dates of meetings. The general agenda for Tier 1 meetings is included in the appendix. The team leader ensures that this agenda is followed.

D. Communication. Communication with the rest of the school staff is critical in order for the

school to understand the process and to be active participants in implementing the

At Silver Sage, the following team structure was implemented. Determine what will work best for your school.

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schoolwide system. Communication about the Tier 1 process will be conducted through the following channels:

a. The meeting recorder will distribute minutes to the school staff within 24 hours. b. The appropriate representative from the RTI team will provide updates at

grade/department level team meetings. c. The Team Leader will provide updates at whole-staff meetings. d. Following screening benchmarks, the Tier 2 Liaison will provide information about

the results to the Tier 2 team. 2. Tier 2 Intervention Support Team A. Structure and functions. The Tier 2 intervention support team consists of a team of

individuals with two primary purposes: 1. To select appropriate interventions for students who require Tier 2 supports. 2. To review progress monitoring data for students receiving Tier 2 supports and make

decisions about program modifications.

At Silver Sage, the composition of the Tier 2 Intervention Support team includes:

1. Principal 2. School Psychologist 3. Special Education Teacher 4. General Education Teacher(s) 5. Title I Program Teacher

B. Roles and responsibilities. In order for the team to function effectively, the following roles

and responsibilities will need to be fulfilled by members of the team: • Meeting recorder –takes notes during meetings and sends minutes within 24 hours. • Data coordinator, academics – a) review graphs before meeting and bring to meeting,

b) completes data summary prior to meetings (see Appendix B3), c) brings PM data ready to review and d) informs teachers of progress of students receiving interventions

• Data coordinator, behavior – a) review graphs before meeting and bring to meeting, b) completes data summary prior to meetings (see Appendix B3), c) brings PM data ready to review and d) informs teachers of progress of students receiving interventions

• Team leader – creates and distributes the agenda, runs the meeting, ensures all agenda items are addressed. Responsible for communicating information to school staff.

• Tier 2 coordinator – coordinates programming and scheduling C. RTI Meetings. Tier 2 meetings are held every other week on Tuesdays from 8 – 9 am. See the

school calendar for the specific dates of meetings. The general agenda for Tier 2 meetings is included in the appendix. The team leader ensures that this agenda is followed.

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D. Communication. Communication with the rest of the school staff is critical in order for the

school to understand the process and to be active participants in implementing the schoolwide system. Communication about the Tier 2 Intervention Supports will be conducted through the following channels:

• The meeting recorder will send minutes to the school staff. • Relevant representative will discuss information at grade/department level team

meetings • Team leader will provide updates at whole staff meetings • Tier 1 and Tier 2 liaison will communicate across team meetings

3. Tier 3 Student-Focused Teams A. Structure and functions. The Tier 3 student-focused team consists of a team of individuals

with the following purposes: 1. To assess for intensive individualized interventions and/or referral for special

education eligibility determination. 2. To write an individualized education plan, including goals, objectives, and

accommodations. 3. To review progress monitoring data for individual students receiving Tier 3 supports

and make decisions about program modifications.

At Silver Sage, the composition of the Tier 3 Intervention Support team includes:

4. Principal 5. Parent/guardian 6. School Psychologist 7. Special Education Teacher 8. General Education Teacher(s) 9. Title I Program Teacher, as needed 10. Counselor, as needed 11. Nurse, as needed 12. OT/PT, as needed

B. Roles and responsibilities. Team members will meet together to address students’ strengths,

needs, and individualized education plans. Each member will be responsible for sharing observations, evaluation results, progress monitoring, and goals for the individual student. Administrator or administrative designee will lead the meeting. Notes will be taken and distributed to all team members.

C. MDT Meetings. Occur on Tuesday mornings as needed to complete eligibility, annual

reviews, three year reevaluations, and amendments in accordance with the law.

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D. Communication. Communication with the rest of the team is critical in order for the school to understand the process and to be active participants in implementing the schoolwide system.

• Notes and IEPs will be kept in the students’ confidential file.

4. The process for moving a student through the tiers and the types of forms/data required can be found in the Appendix

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Section 4: Data

RTI is a data-driven process. Data are collected at each tier to inform both the impact on student outcomes and the fidelity with which RTI is being implemented. At each tier, a variety of data is collected for different purposes. At the student level, the focus is on collecting data that will inform decision making for the individual student. At the class/grade/school level, data is systematically reviewed to provide an indication of the fidelity with which the system is being implemented. In the following tables, the data collected at each tier is summarized to include the major area, the name of the measure used, the frequency with which it is implemented, who is responsible for administering the measure, the associated decision rule and related action if the score meets the decision rule. Tier 1. Decision-making at Tier 1 focuses on identifying students who may benefit from additional intervention. Additionally, data are aggregated to inform the class, grade and school level fidelity of the process. In the following two tables, the data collected within tier 1 are summarized.

The following charts show the measures chosen by Silver Sage to be used at Tier 1, along with the decision rules, frequency of administration, and actions to be taken.

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Tier 1 Student Level Data. Measurement Area

Measure Name How Often? Who Administers

Decision Rule Action

Reading TOSREC 3 times/year Teachers Student SS < 90 Further diagnostic testing

QRI, fluency, CBM, CORE

If TOSREC screen is positive

Title 1 Below benchmark Place in Tier 2 intervention

Math EasyCBM 3 times/year Teachers TBD Further diagnostic testing

Math Navigator 3 times/year Teachers

Key Math If EasyCBM screen is positive

Title 1 Place in Tier 2 intervention

Writing TWW CBM 3 times/year Teachers Below benchmark Confirm w/ other data sources – Tier 2 intervention

TOWL If TWW is positive

SS < 90

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Behavior SRSS October Teachers Moderate risk (4 to 8)

Ask teacher: (a) monitor, (b) additional screening, (c) start on intervention

High risk (9 or higher)

Gather additional data (RfA & ODRs) & review at Tier 2 meeting

SWIS Monthly Teachers >3 ODR cumulative or 2 ODR within one month

Gather additional data (RfA & screening data) & review at Tier 2 meeting

Note. TOSREC = Test of Silent Reading Efficiency and Comprehension; QRI = Qualitative Reading Inventory; CBM = curriculum based measure; CORE = core curriculum; TWW = Total Words Written; TOWL = Test of Written Language; SRSS = Student Risk Screening Scale; SWIS = School-wide Information System

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Tier 1 Class/School Level Data. Measurement Area

Measure Name How Often? Who Administers


Reading TOSREC 3 times/year Teachers < 80% of students w/ SS > 85 or 90

Consider class observation, teacher interview, fidelity check

MAP 3 times/year Teachers < 80% of students above 40th percentile


ISAT Once Teachers < 80% of students proficient or greater (also include disaggregated by subpopulation?)


Math EasyCBM 3times/year Teachers < 80% of students above xx?


MAP 3 times/year Teachers < 80% of students above 40th percentile


ISAT Spring Teachers < 80% of students proficient or greater (also include disaggregated by subpopulation)


Writing TWW CBM 3 times/year Teachers < 80% of students above benchmark


ISAT Spring Teachers < 80% of students proficient or greater (also include


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disaggregated by subpopulation)

Behavior Team Implementation Checklist (TIC)

3-4 times/year RTI Team < 2 on any item Review TIC, Action planning to address problems of concern

EBS Self Assessment Survey (EBS SAS)

Spring Staff Sections and Items identified as ‘Not in Place’ or ‘Partially in Place’ and/or identified as ‘High Priority’

Action planning to address problems of concern

School-wide Evaluation Tool (SET) or Benchmarks of Quality (BoQ)

Spring External Reviewer (SET) RTI Team & Coach (BoQ)

<80% on ‘Expectations Taught’ or Overall (SET) <70% (BoQ)

Action planning to address problems of concern

SWIS/ODR data: (a) average referrals/day/month, (b) referrals by location, (c) by type of problem behavior, (d) by time of day, (e) by student

Monthly RTI Team Increasing trend, high rates of problem behavior from specific settings, students, time of day or specific types of PB Less than 80% with 0-1 ODR

Action planning to address problem areas

Note. TOSREC = Test of Silent Reading Efficiency and Comprehension; MAP = Measures of Academic Progress; ISAT = Idaho Standards Achievement Test; CBM = curriculum based measure; TWW = Total Words Written; ODR = Office discipline referrals

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Tier 2. Decision making at Tier 2 addresses 2 primary questions – is the student benefiting from the intervention? And does the intervention seem to support student performance? Students who receive Tier 2 intervention have their progress monitored weekly (or in accordance with best practices for the measure used) and reviewed by the Tier 2 team as well as the intervention provider. Data should also be reviewed by intervention group to check for fidelity. Tier 2 Student Level Data.

Measurement Area

Measure Name How Often?

Who Administers


Reading ORF (AIMSWEB) weekly Intervention teacher First review -Student slope & performance level < targeted

Make an Instructional Change

Second review – after intervention changes slope & perf level < targeted

Student discussed at individual student team meetings for possible referral

Math Easy CBM? Or other?

weekly Intervention teacher First review -Student slope & performance level < targeted




Writing TWW CBM weekly Intervention teacher First review -Student slope & performance level < targeted




The following charts show the measures chosen by Silver Sage to be used at Tier 2.

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Note. ORF = Oral reading fluency; TWW CBM = Total Words Written, curriculum based measure; CICO = Check in/Check out

Behavior CICO daily behavior report card

Daily CICO coordinator & teacher

4 weeks with average above 80%

Implement self-monitoring & systematic fading

2 weeks with average below 80%

(a) remediate system issues (check fidelity), (b) remediate minor student problems, (c) implement adapted CICO – consider brief FBA

After intervention changes, 2 weeks with average below 80%


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Tier 2 Intervention Group Level Data. Measurement Area

Measure Name

How Often? Who Administers


Reading ORF (AIMSWEB)

weekly Intervention teacher

< 65-70%? Of students make progress

Fidelity check - observation

Math Easy CBM? Or other?

weekly Intervention teacher



Writing TWW CBM weekly Intervention teacher



Behavior CICO daily behavior report card

Daily Intervention teacher

< 65-70% Of students make progress


Benchmarks for Advanced Tiers (BAT)

Annually (may be used more frequently for action planning)

Tier 2 Team > 70% Action planning to address problem areas

Note. ORF = Oral reading fluency; TWW CBM = Total Words Written, curriculum based measure; CICO = Check in/Check out

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Tier 3. Decision-making at Tier 3 will be specific to each individual. Interventions must be designed to meet the specific learning and behavioral needs of the student, be implemented on a timely basis, be provided by a highly qualified teacher or specialist, and be monitored frequently to determine progress and achievement of desired outcomes.

This handbook only focuses on Tier 1 and Tier 2 because Silver Sage is still working on getting Tier 3 into place. If you have Tier 3 data charts, place them here.

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Data Calendar

Month Measurement Focus Measure Aug. Sept Oct Nov Dec Jan Feb Mar Apr May

Universal Screening for Behavior

Student Risk Screening Scale (SRSS)

X

X

Fidelity of Implementation for Behavior

Team Implementation Checklist (TIC)

X X X X EBS Self-Assessment Survey (EBS)

X School-wide Evaluation Tool (SET) or Benchmarks of Quality (BoQ)

X Benchmarks for Advanced Tiers

X Student Outcomes School-wide Information System (SWIS)

X X X X X X X X X X School Climate School Safety Survey (SSS)

X X Screening for RTI TOSREC

X X Easy CBM

X X Measures of Academic Progress (MAP)

X X Total Words Written (TWW)

X X RTI Outcomes ISAT

x

This chart indicates the measures to be used (and it’s focus) and a timeline for administration.

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Appendices

Appendix A: Staff Resources

Appendix A1: Resources for Instructional and Behavioral Supports ………... 24


Appendix B1: Tier 1 Team Meeting Agenda …………………………………… 26

Appendix B2: Tier 2 Intervention Support Team Agenda ……………………. 28 with Data Summary Form

Appendix B3: Individual Student Summary Form ……………………………. 30

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Appendix A1: Resources for Instructional and Behavioral Supports

www.pbis.org www.swis.org www.pbisassessment.org http://www.rtictrl.org/ http://rti4success.org/progressMonitoringTools http://www.rti4success.org/instructionTools

These are websites frequently used as resources. Add references and websites as needed.

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B1: Tier 1 Team Meeting Agenda………………………………………………………. 26 B2: Tier 2 Intervention Support Team Agenda………………………………………… 28 B3: Individual Student Summary Form………………………………………………… 30

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B1: Tier 1 Team Meeting Agenda

Tier 1 Team Meeting Agenda

Team Leader: Recorder: Date: Present: ______________________________________________________________________

I. Review agenda (2 minutes) II. Review task list from previous meeting, document status of tasks (10 minutes)

Who What When Status Not In Done Not

started progress Needed Not In Done Not



started progress Needed

III. Review existing data (20 minutes) a. Academic outcomes & referral data (if new data collected since prior meeting) b. Behavior outcomes & referral data (avg referrals/day/month, referrals by

location, time, PB and student) c. Fidelity data

i. Team Implementation Checklist (TIC) (update) ii. School-wide Evaluation Tool (SET)

iii. Self-assessment Survey (SAS) iv. School Safety Survey (SSS)

IV. Problem-solving based on data (10 minutes)

Problem Decision Who is in charge and

what is the target date?

*Note: Add rows to this table as required

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V. Action planning and task list (10 minutes)

Who What When

VI. Confirm next meeting date/time/location (3 minutes)

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B2: Tier 2 Intervention Support Team Agenda with Data Summary Form

Tier 2 Intervention Support Team Agenda

Team Leader: Recorder: Date: Present: ______________________________________________________________________

III. Review agenda (2 minutes) IV. Review task list from previous meeting, document status of tasks (10 minutes)

Who What When Status Not In Done Not




started progress Needed

V. Targeted intervention summary (20 minutes) Intervention # of students by grade in

intervention 1 2 3 4 5

# of students by grade meeting goals 1 2 3 4 5

Behavior Reading Math Lang Arts

For students who are not meeting goals, determine problem and next steps (recorder take notes):

1. Possible problems: fidelity, intervention/function mismatch, intervention needs to be modified

2. Possible decisions: Meet with teacher, change intervention, conduct efficient FBA

*Student Problem Decision Who is in charge and

what is the target date?

*Note: Add rows to this table as required

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VI. New referrals to Tier 2 Supports (Tier 1 Liaison brings this info) -10 minutes

Student Data Referral source

Decision Person Responsible to carry-out decision

Target Date

Continue Monitoring

Begin CICO

Begin Academic Support

R M LA

FBA Academic Assessment

R M LA

Continue Monitoring

Begin CICO


R M LA


R M LA

Continue Monitoring

Begin CICO


R M LA


R M LA

Continue Monitoring

Begin CICO


R M LA


R M LA

Continue Monitoring

Begin CICO


R M LA


R M LA

Continue Monitoring

Begin CICO


R M LA


R M LA

V. Wrap-up (schedule next meeting, review assigned tasks) - 3 minutes

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B3: Individual Student Summary Form

The following form was adapted from the Tigard-Tualatin Elementary RTI handbook (http://www.ode.state.or.us/search/page/?=2225).

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Individual Student Summary Form File Review and Problem Identification

Attendance Review

Grade K 1st 2nd 3rd 4th 5th

School Year School(s) Attended

Days Total Days Present Days Absent

Student Total (all years)

Review of report cards, progress reports, and teacher remarks by grade level significant for: Reading achievement:

Math achievement:

Behavior (including attending skills)

Language Skills: Significant difficulty in writing, speaking skills, organization, social skills, or difficulty across subject areas which cannot be explained by other factors.

Hearing screening results:

English language development:

Other:

Date: School: Grade: Teacher: Person completing this form:

Student Name: Case Manager: Current Services (circle): Sp.Ed ELL Title1 504 other:__________

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Individual Student Summary Form (continued) Student Name: _________________ Date: __________

Achievement Review: Reading


Benchmarks

Expected Gains

Student Score

Other information: teacher concerns, referral questions, comments, summary, etc.

Achievement Review: Math


Benchmarks

Expected Gains

Student Score


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Achievement Review: Writing


Benchmarks

Expected Gains

Student Score


Additional Space for Benchmarks

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Team Members: _____________________________________

Hypothesis Development

Summarizing evidence above, address questions below: 1. Does evidence support that the student’s problems may be primarily due to problems with attention, motivation, or other behavioral difficulty? Include data along with progress monitoring of behavioral supports.

2. Does evidence support that the student’s problems may be primarily due to attendance problems, or frequent school interruptions? If so, indicate reasons for absences and interruptions. What interventions have been put in place to address this issue?

3. Does evidence support that the student’s problems may be primarily due to other concerns like trauma, economic or cultural disadvantage, or other disabilities? Describe. Be sure to note when these issues occurred and their correlations with any academic concerns. What will be done to help the student be more successful?

4. Does the evidence support that the child’s difficulties may be the result of language difficulties in areas such as language processing, social language, or articulation? Indicate next steps

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Individual Student Summary Form (continued)

Student Name: _________________ Date: __________ Team Members: _____________________________________

Hypothesis Development (cont.)

5. Does the evidence support the hypothesis that the difficulty is due to limited English proficiency? Indicate next steps.

6. Does the evidence suggest that the student has low skills and slow progress despite intensive interventions?

Documents

Silver Sage RTI/PBIS Handbook - Idaho Training Clearinghouse