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Appendix F: Sample Response-To-Intervention (RTI) Materials (page 4)

By Linda Wilmshurst and Alan W. Brue
John Wiley & Sons, Inc.
Updated on Jan 19, 2011

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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