Appendix F: Sample Response-To-Intervention (RTI) Materials (page 2)

By — John Wiley & Sons, Inc.
Updated on Jan 19, 2011

Important Terms:

Response to Intervention (RTI)—addressed through federal and state law and refers to a tiered approach to instruction. Students who do not make adequate academic progress and who are at risk for reading and other learning difficulties receive increasingly intensive instructional and behavioral interventions.

Differentiation of Instruction—instruction tailored to meet the needs of diverse learners in the general education classroom.

ProgressMonitoring—is a scientifically based practice of assessing students' performance on a regular basis. Progress monitoring helps school teams make decisions about instruction.

Universal Screening—is a step taken by school personnel early in the school year to determine which students are at risk for not meeting gradelevel standards. Universal screenings can be accomplished by reviewing recent results of state tests, or by administering an academic screening test to all children in a given grade level. Students whose test scores fall below a certain cutoff are identified as needing more specialized academic interventions.

Scientific, Research-Based Instruction—specific curriculum, educational, and behavioral interventions that have been proven to be effective through scientific peer-reviewed journals.

Parent's Role in RTI:

  • Be involved and proactive in the education of your child.
  • Feel free to request to visit your child's classroom and ask for ways to assist your child to improve his or her performance.
  • Work with your child at home on particular skills identified through screenings.
  • If concerns arise, request a parent conference with your child's teacher or the administration.

Tier 2 Intervention Form

Exhibit F.2 shows a form that is used to gather information about students who are having academic or behavioral difficulties and then to plan and monitor interventions to help them. The form is based on Georgia's four-tier RTI model. In states that use a three-tier model, this intervention plan might be used at Tier 1 or Tier 2.

Research-Based Intervention:

Standard Protocol: Choose one


  • Read 180
  • Partner Reading
  • Six Minute Solution
  • Reader's Theater
  • Click or Clunk
  • Writing Destinations
  • RAP (Paraphrasing)
  • Story Mapping
  • Word Building
  • Other (be specific) _____


  • Study Island
  • Cover/Copy/Compare (Flue)
  • CRA (Concrete, Rep/Abs)
  • Peer-Assisted Learning Strategies (PALS)
  • Schema-based Instruction
  • Incremental Rehearsal
  • FAST Draw (mnemonic)
  • QAR (Quest/Ans/Relat)
  • CAI–Computer-Assisted Instruction


  • Check in/Check out
  • Good Behavior Game
  • Mystery Motivator
  • Visual Cues
  • Self-Monitoring
  • Rubber Band Plan
  • Points for Grumpy
  • Talk Ticket
  • Response/Cost
  • Group Control
  • Positive Peer Reporting
  • Counselor Groups (name of group)
  • Other (be specific) _____


  • Language for Learning
  • Earobics
  • Speedy Speech
  • Articu Check
  • Bridge of Vocabulary
  • Story Schedules

On the first page of this form, the student support team (SST) identifies a specific area of concern: reading, math, written expression, speech/language, or behavior. (More than one of these pages can be used if there is more than one area of concern.) The team also indicates which research-based interventions have been attempted. Teachers may have used some of the standard research-based interventions listed on the form, or they may have used interventions from other sources. The plan for implementation includes information such as the start date of the intervention, the student's current performance (baseline data), who will be implementing the intervention, how frequently and for how long the intervention will be implemented, the ways in which progress will be monitored, the criteria that will be used to make a determination about whether progress has been demonstrated, and when the intervention will end.

The second page of the form allows schools to document the results of their conference meeting. The student's strengths, talents, and interests are identified, the data collected are specified, recommendations are made, and the parent's concerns are listed. More than one conference may occur at Tier 2.

Tier 3 Intervention Form

If a student needs more specialized interventions, he will be moved to Tier 3 in Georgia's four-tier RTI model (or Tier 2 intervention in a three-tier model) (see Exhibit F.3).

On the first page of this form, the student support team (SST) comes up with a specific plan to address academic or behavioral problems. The team lists the date when the interventions are to be implemented, the strategy or strategies to be used, who will be responsible for the implementation of the intervention, how progress will be evaluated (refer to the bottom of the form for possible methods), and the date when the specific intervention was ended.

On the second page of the form, the team graphs the progress of the student. Baseline data will be listed first, to facilitate comparison with future performance. Each time data are collected, they will be mapped on the graph and the date will be included at the bottom. The numbers will vary depending on what is being measured. It may be words read in a sixty-second period, the number of words written within a three-minute period, and so on. The numbers are simply included as a guide. This process allows the SST to see whether a student is making progress and over what period of time the progress has occurred. The two rows in the "Data Points" table are given if the team wants to track different types of data.

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