Questions about RtI

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Questions about RtI And, hopefully, some answers, too!

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Questions about RtI. And, hopefully, some answers, too!. RtI Tier I. Q: How do I know if I need to enter a student into RtI Level I?. If a student is struggling in the general curriculum. If a child transfers in from a non-RtI school with a current PEP. - PowerPoint PPT Presentation

Transcript of Questions about RtI

Questions about RtI

Questions about RtIAnd, hopefully, some answers, too!RtITier I

Q: How do I know if I need to enter a student into RtI Level I?If a student is struggling in the general curriculum.If a child transfers in from a non-RtI school with a current PEP.If a student failed either EOG test last spring.If a student meets the following grade-level criteria.

Kindergarten

If student does not receive a passing score on the Brigance and scores at or below the 25th percentile on AIMSweb Letter Naming Fluency suggests entry for reading.

If student does not receive a passing score on the Brigance and scores at or below the 25th percentile on AIMSweb Number Identification and Quantity Discrimination suggests entry for math.1st 5th Grades

If a student scores 25% or below on MAP Reading (most recent assessment) and 25% or below on AIMSweb Reading CBM suggests entry for reading.

If a student scores 25% or below on MAP Math (most recent assessment) and 25% or below on AIMSweb Math Computation CBM suggests entry for math.

MAP used as screener for all students; AIMSweb CBMs will only be done with students who score at or below 25% on MAP.

Q: So, now what do I do?Inform the parent by sending home the PSM 1-a parent notification form and RtI information brochure, or even better, schedule a meeting to discuss the RtI Tier I plan with the parent(s) and give these documents to them in person. Either way, KEEP A COPY OF THE NOTIFICATION IN THE CHILDS RtI FOLDER.Complete the PEP / RtI Level 1 / RtI Level 2 Form to develop an intervention plan, using research-based practices. If you need help, contact Emily Norville, LouAnne Morrow, or Michelle Campbell.Complete CBM progress monitoring every three weeks and record data.Now the Paperwork Begins !Helpful Hints for Page 1Unless the child has a current PEP, the date requested on the upper right-hand side of page 1 of the form should be the date of the original RtI I plan development and should match the date that you and the parent sign the lower left box on page 2 and the date that is entered at the top of page 2.

9If the student is being moved from a PEP to RtI 1, the date of the PEP plan development should be in the upper right section of page 1. You document a move to RtI Level 1 by checking in the box on the upper left side of page 1 and writing in the date.Also document the change to RtI I in a contact box on Page 3.

If you receive an ongoing plan from another teacher or grade level, make changes on page 1 so that teacher name, grade, retention, and attendance information is always current.

Check all areas where the child is having significant difficulties on page 1.Boxes highlighted in green are for current MAP, DIBELS, Number Knowledge, STAR reading or math, Running Record, Aimsweb, or other benchmark scores.

The box highlighted in red is for Brigance scores and current progress on the K-2 assessments.

NEW STATE REQUIREMENTS 2010 All Tier I students must now have:A current hearing screening (within one year) this can be arranged with the schools speech pathologist if not in the cumulative folder.A current vision screening (within one year)that assesses both near and far acuity this can be arranged with the school nurse if not in the cumulative folder.Documentation of parent and teacher assessment of the effectiveness of the intervention. (I would do this in a contact box on page 3.)

See area highlighted in blue

Helpful Hints for Page 2Fill out the students name, their date of birth, and the plan date in the event that the pages become separated.

Fill in parental concerns as they are stated in the meeting or as they have been previously expressed to you.Fill out parental involvement to reflect what parent has agreed to do to help the student at home (check homework, use flashcards, create a quiet homework space, read with the student, etc.).The box highlighted with red is for any baseline data that you may have from classroom assessments that you are using as a starting point for progress monitoring or any other assessment information that you feel is relevant to the intervention plan.

20Your intervention plan is what you plan to do in terms of instruction that is different for this child in order to address the apparent skill deficits. Your classroom differentiated instruction may take care of this, but document what will be done, in what size group, with what materials, how often, and the length of the sessions. Be as specific as possible phonics activities doesnt give enough information. A good example would be: guided reading with leveled readers from Reading Streets and multi-sensory word building activities in a group of 6 or fewer for 20 minutes, twice per week with Ms. Jones. This goes in the green highlighted box,

22Helpful Hints for Page 2Decide how to measure the skill(s) that you will be addressing during the instructional intervention. If you need help, see Emily Norville, LouAnne Morrow, or Michelle Campbell. Your measure (progress monitoring) is some form of assessment that you will use to keep track of how the student is responding to the intervention. Record data at least once every three weeks.Have those involved in the development of the plan sign and date page 2. If the parent is not available, note how you have shared the plan information with and gotten input from the parent(s) and sign and date the form yourself.

24Dont get carried away at Level I with intervention plans that are complicated or progress monitoring that is burdensome. Keep it simple. Using small-group guided, leveled, reading and monitoring with STAR or Running Record would be okay at this level. Use the green highlighted areas for documenting the intervention and assessment specifics, even if you choose to use a chart for your data.Do consider setting a goal for where you want the student to be at a certain point in the future. This gives you and the parent a clear time frame and standard for deciding when to consider moving the student to Level II, if necessary. Helpful Hints for Page 3Each time you have contact with the parent, use one of the blocks on page three to document what was discussed and what decision was made. If the contact was not a face-to-face meeting inside of the school, indicate the nature of the contact (phone call, conversation at car duty, e-mail, etc.). One of these contacts should be an actual sit down meeting with the parent, however. Therefore, there should be at least one of these contact blocks that contains a parent signature. Always sign and date the form yourself.You may attach as many copies of page 3 as necessary to document all of your parent contacts.

At each contact or meeting, check in the top left-hand side to indicate what was the outcome of the contact. If nothing changes or the contact was just to update the parent, check Continue Intervention; if the child makes progress and no longer needs intervention, check Discontinue Intervention (drop the student back to a PEP and monitor every six weeks for the remainder of the school year); if the intervention or progress monitoring is changed, check Modify Intervention and specify the changes to be made; if you and the parent feel that the child needs to be moved to Level II, check Move to PSM Level II.Explain all intervention changes in the space provided.

What if my student is still struggling,even with RtI I interventions?If a student is enrolled in RtI Level I the teacher and parent may choose to move the student into RtI Level II when they determine that the students progress monitoring data indicates that:The student has not make progress during the RtI Level I intervention period.The student has made some progress during the RtI Level I intervention period, but not enough to prevent significant difficulties within the regular classroom. This assessment of the interventions (in)effectiveness must be documented on the plan (in a contact box.)RtILevel II

What do I do when my student needs to be moved to RtI II?Invite the parent to a meeting using the psm-2a form and keep a copy for your records.Document the move by checking RtI II in the box in the upper left-hand corner on page one of the plan. Enter the date that the decision was made in the blank beside the check box.This change is also documented in a contact box on page 3 of the students RtI I plan and RtI II is checked in the box in the upper left-hand corner on page one of the plan. Enter the date that the decision was made in the blank beside the check box.(see yellow highlighted portions of page 1 & 3)

What do I do when my student needs to be moved to RtI II?Summarize the students performance at the end to Tier I on the Tier II intervention plan page.See red highlighted portionsDocument the new plan and progress-monitoring procedures on the Tier II intervention plan page. Remember to be specific.Put date that the new intervention begins in the date box at the top of the page.New team members (parent, teacher, grade-level consultant) sign and date the bottom of the Tier II intervention plan page when the plan is developed.See yellow highlighted portions

Student Name:DOB:Date Level II intervention began:NCWISE#Describe Parental Concerns:Parent Involvement in Plan:Current Skill Level/Assessment Data: Specific Skills/Areas Targeted for Intervention:What is your instructional goal?Intervention/Instructional Plan:Persons Completing Initial Plan Date:_____________Teacher:__________________________________________Parent : __________________________________________Other: ___________________________________________Duration of Intervention/Dates:Person(s) Responsible:Documentation Method: (If Charting, please attach): What do I do when my student needs to be moved to RtI II?Modify the current intervention plan OR develop a new, research-based, intervention plan in consultation with the parent and another grade-level staff member, using the RtI II form.The intervention should increase in intensity in some way; either more time per session, more sessions per week, or entirely different materials that are considered to address the students deficit area either more directly or more intensively. Record new plan in green boxes.

Student Name:DOB:Date Level II intervention began:NCWISE#Describe Parental Concerns:Parent Involvement in Plan:Current Skill Level/Assessment Data: Specific Skills/Areas Targeted for Intervention:What is your instructional goal?Intervention/Instructional Plan:Persons Completing Initial Plan Date:_____________Teacher:__________________________________________Parent : __________________________________________Other: ___________________________________________Duration of Intervention/Dates:Person(s) Responsible:Documentation Method: (If Charting, please attach): Helpful Hints for RtI IIEach time you have contact with the parent, use one of the blocks on the second page of the RtI II plan to document what was discussed and what decision was made. If the contact was not a face-to-face meeting inside of the school, indicate the nature of the contact (phone call, conversation at car duty, e-mail, etc.). One of these contacts should be an actual sit down meeting with the parent, however. Therefore, there should be at least one of these contact blocks that contains a parent signature. Always sign and date the form yourself and have the grade-level consultant sign as well.Use Aimsweb to progress-monitor you student. Contact Emily Norville, LouAnne Morrow, or Michelle Campbell to get your child entered into Aimsweb. You will then be able to enter the childs data yourself. (Aimsweb training to come.) Collect data every two weeks.If your student does not meet the goal that you set in Aimsweb, the Tier II team may meet after a reasonable amount of time has passed, the Tier II team may request a move to Tier III.The team (parent, teacher, grade-level representative) will need to meet and evaluate the effectiveness of the intervention on page 2 of the RtI II plan, check Move to Tier III in the box at the top left of the contact box, and sign and date the form where indicated.See yellow highlighted areasMeeting Date (Select Decision)Continue InterventionModify Intervention Discontinue InterventionMove to PSM Level IIIDescribe ActionTeacher signature Parent signatureOther signature (title)When this is complete, bring this paperwork, your data, and a copy of the students most recent MAP scores, to Emily Norville for review. If approved, your child will be taken to the Tier III team for more intensive, prescriptive intervention. Questions?

Rutherford County SchoolsProblem-Solving Model Data Collection

Student Name:NCWISE#Date:

Teacher:DOB:Grade:Retention(s) - Specify Grade Level(s):

Attendance

Enrolled/PresentGrade KGrade 1Grade 2Grade 3Grade 4Grade 5

Area(s) of Concern

Language Arts

___ Phonemic Awareness

___ Letter Identification

___ Decoding

___ Sight Word Vocabulary

___ Reading Comprehension

___ Reading Fluency

___ Written Expression

___ Writing Mechanics

___ Writing Conventions

___ Other (_________________)Mathematics

___ Basic Math Facts

___ Computation

___ Problem-Solving

___ Word Problems

___ Geometry

___ Measurement

___ Probability/Data

___ Analysis

___ Other (___________________)Behavior

___ Noncompliance

___ Social Skills

___ Motivation

___ Attention Span

___ Peer Relationships

___ Withdrawn / Moody

___ Anxiety

___ Overactive

___ Verbally Aggressive

___ Physically Aggressive

___ Other (___________________)

Other

___ Medical (___________________)

___ Motor Skills

___ Speech

___Articulation

___Voice

___Fluency

___ Language

___ Vision

___ Hearing

Reading:Math:Writing:Date of Vision Screening:

Results:

Far: Near:

EOG 3rdEOG 4thEOG 5thDate of Hearing Screening:

Results:

K-2 Assessments

Name and Address of Parent/Guardian

Past Services _____ Small Group Instruction _____ Individual Instruction _____ Counseling

Received: _____ 504 Accommodations _____ Community Services _____ ESL/LEP/ELL _____ Occupational Therapy

_____ Speech/Language Therapy _____ Physical Therapy _____ Tutoring _____ Other (please specify:

Additional Comments/Information/Teacher Observations

Rutherford County Schools

Problem-Solving Model Level I Intervention Plan/PEP and Results

Student Name:DOB:Date:NCWISE#

Describe Parental Concerns:

Parent Involvement in Plan:

Current Skill Level/Assessment Data:

Intervention/Instructional Plan:

Persons Completing Initial Plan Date:_____________

Teacher:__________________________________________

Parent : __________________________________________

Other: ___________________________________________

Duration of Intervention/Dates:

Person(s) Responsible:

Documentation Method: (If Charting, please attach):

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

PEP ____________

RtI Level 1 ____________

RtI Level 2 ____________

Revised 4/19/09

Revised 4/23/09

Rutherford County Schools

Problem-Solving Model Level I Intervention Plan/PEP and Results

Student Name:DOB:Date:NCWISE#

Describe Parental Concerns:

Parent Involvement in Plan:

Current Skill Level/Assessment Data:

Intervention/Instructional Plan:

Persons Completing Initial Plan Date:_____________

Teacher:__________________________________________

Parent : __________________________________________Other: ___________________________________________

Duration of Intervention/Dates:

Person(s) Responsible:

Documentation Method: (If Charting, please attach):

Revised 4/19/09

Revised 4/23/09

Rutherford County SchoolsProblem-Solving Model Data Collection

Student Name:NCWISE#Date:

Teacher:DOB:Grade:Retention(s) - Specify Grade Level(s):

Attendance

Enrolled/PresentGrade KGrade 1Grade 2Grade 3Grade 4Grade 5

Area(s) of Concern

Language Arts

___ Phonemic Awareness

___ Letter Identification

___ Decoding

___ Sight Word Vocabulary

___ Reading Comprehension

___ Reading Fluency

___ Written Expression

___ Writing Mechanics

___ Writing Conventions

___ Other (_________________)Mathematics

___ Basic Math Facts

___ Computation

___ Problem-Solving

___ Word Problems

___ Geometry

___ Measurement

___ Probability/Data

___ Analysis

___ Other (___________________)Behavior

___ Noncompliance

___ Social Skills

___ Motivation

___ Attention Span

___ Peer Relationships

___ Withdrawn / Moody

___ Anxiety

___ Overactive

___ Verbally Aggressive

___ Physically Aggressive

___ Other (___________________)

Other

___ Medical (___________________)

___ Motor Skills

___ Speech

___Articulation

___Voice

___Fluency

___ Language

___ Vision

___ Hearing

Reading:Math:Writing:Date of Vision Screening:

Results:

Far: Near:

EOG 3rdEOG 4thEOG 5thDate of Hearing Screening:

Results:

K-2 Assessments

Name and Address of Parent/Guardian

Past Services _____ Small Group Instruction _____ Individual Instruction _____ Counseling

Received: _____ 504 Accommodations _____ Community Services _____ ESL/LEP/ELL _____ Occupational Therapy

_____ Speech/Language Therapy _____ Physical Therapy _____ Tutoring _____ Other (please specify:

Additional Comments/Information/Teacher Observations

Rutherford County Schools

Problem-Solving Model Level I Intervention Plan/PEP and Results

Student Name:DOB:Date:NCWISE#

Describe Parental Concerns:

Parent Involvement in Plan:

Current Skill Level/Assessment Data:

Intervention/Instructional Plan:

Persons Completing Initial Plan Date:_____________

Teacher:__________________________________________

Parent : __________________________________________

Other: ___________________________________________

Duration of Intervention/Dates:

Person(s) Responsible:

Documentation Method: (If Charting, please attach):

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

PEP ____________

RtI Level 1 ____________

RtI Level 2 ____________

Revised 4/19/09

Revised 4/23/09

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe ActionMoved to RtI I . . .

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Revised 4/19/09

Revised 4/23/09

Rutherford County SchoolsProblem-Solving Model Data Collection

Student Name:NCWISE#Date:

Teacher:DOB:Grade:Retention(s) - Specify Grade Level(s):

Attendance

Enrolled/PresentGrade KGrade 1Grade 2Grade 3Grade 4Grade 5

Area(s) of Concern

Language Arts

___ Phonemic Awareness

___ Letter Identification

___ Decoding

___ Sight Word Vocabulary

___ Reading Comprehension

___ Reading Fluency

___ Written Expression

___ Writing Mechanics

___ Writing Conventions

___ Other (_________________)Mathematics

___ Basic Math Facts

___ Computation

___ Problem-Solving

___ Word Problems

___ Geometry

___ Measurement

___ Probability/Data

___ Analysis

___ Other (___________________)Behavior

___ Noncompliance

___ Social Skills

___ Motivation

___ Attention Span

___ Peer Relationships

___ Withdrawn / Moody

___ Anxiety

___ Overactive

___ Verbally Aggressive

___ Physically Aggressive

___ Other (___________________)

Other

___ Medical (___________________)

___ Motor Skills

___ Speech

___Articulation

___Voice

___Fluency

___ Language

___ Vision

___ Hearing

Reading:Math:Writing:Date of Vision Screening:

Results:

Far: Near:

EOG 3rdEOG 4thEOG 5thDate of Hearing Screening:

Results:

K-2 Assessments

Name and Address of Parent/Guardian

Past Services _____ Small Group Instruction _____ Individual Instruction _____ Counseling

Received: _____ 504 Accommodations _____ Community Services _____ ESL/LEP/ELL _____ Occupational Therapy

_____ Speech/Language Therapy _____ Physical Therapy _____ Tutoring _____ Other (please specify:

Additional Comments/Information/Teacher Observations

Rutherford County Schools

Problem-Solving Model Level I Intervention Plan/PEP and Results

Student Name:DOB:Date:NCWISE#

Describe Parental Concerns:

Parent Involvement in Plan:

Current Skill Level/Assessment Data:

Intervention/Instructional Plan:

Persons Completing Initial Plan Date:_____________

Teacher:__________________________________________

Parent : __________________________________________

Other: ___________________________________________

Duration of Intervention/Dates:

Person(s) Responsible:

Documentation Method: (If Charting, please attach):

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

PEP ____________

RtI Level 1 ____________

RtI Level 2 ____________

Revised 4/19/09

Revised 4/23/09

Rutherford County SchoolsProblem-Solving Model Data Collection

Student Name:NCWISE#Date:

Teacher:DOB:Grade:Retention(s) - Specify Grade Level(s):

Attendance

Enrolled/PresentGrade KGrade 1Grade 2Grade 3Grade 4Grade 5

Area(s) of Concern

Language Arts

___ Phonemic Awareness

___ Letter Identification

___ Decoding

___ Sight Word Vocabulary

___ Reading Comprehension

___ Reading Fluency

___ Written Expression

___ Writing Mechanics

___ Writing Conventions

___ Other (_________________)Mathematics

___ Basic Math Facts

___ Computation

___ Problem-Solving

___ Word Problems

___ Geometry

___ Measurement

___ Probability/Data

___ Analysis

___ Other (___________________)Behavior

___ Noncompliance

___ Social Skills

___ Motivation

___ Attention Span

___ Peer Relationships

___ Withdrawn / Moody

___ Anxiety

___ Overactive

___ Verbally Aggressive

___ Physically Aggressive

___ Other (___________________)

Other

___ Medical (___________________)

___ Motor Skills

___ Speech

___Articulation

___Voice

___Fluency

___ Language

___ Vision

___ Hearing

Reading:Math:Writing:Date of Vision Screening:

Results:

Far: Near:

EOG 3rdEOG 4thEOG 5thDate of Hearing Screening:

Results:

K-2 Assessments

Name and Address of Parent/Guardian

Past Services _____ Small Group Instruction _____ Individual Instruction _____ Counseling

Received: _____ 504 Accommodations _____ Community Services _____ ESL/LEP/ELL _____ Occupational Therapy

_____ Speech/Language Therapy _____ Physical Therapy _____ Tutoring _____ Other (please specify:

Additional Comments/Information/Teacher Observations

Rutherford County Schools

Problem-Solving Model Level I Intervention Plan/PEP and Results

Student Name:DOB:Date:NCWISE#

Describe Parental Concerns:

Parent Involvement in Plan:

Current Skill Level/Assessment Data:

Intervention/Instructional Plan:

Persons Completing Initial Plan Date:_____________

Teacher:__________________________________________

Parent : __________________________________________

Other: ___________________________________________

Duration of Intervention/Dates:

Person(s) Responsible:

Documentation Method: (If Charting, please attach):

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

PEP ____________

RtI Level 1 ____________

RtI Level 2 ____________

Revised 4/19/09

Revised 4/23/09

Rutherford County Schools

Problem-Solving Model Level I Intervention Plan/PEP and Results

Student Name:DOB:Date:NCWISE#

Describe Parental Concerns:Parent Involvement in Plan:

Current Skill Level/Assessment Data:

Intervention/Instructional Plan:

Persons Completing Initial Plan Date:_____________

Teacher:__________________________________________

Parent : __________________________________________

Other: ___________________________________________

Duration of Intervention/Dates:

Person(s) Responsible:

Documentation Method: (If Charting, please attach):

Revised 4/19/09

Revised 4/23/09

Rutherford County Schools

Problem-Solving Model Level I Intervention Plan/PEP and Results

Student Name:DOB:Date:NCWISE#

Describe Parental Concerns:

Parent Involvement in Plan:

Current Skill Level/Assessment Data:

Intervention/Instructional Plan:

Persons Completing Initial Plan Date:_____________

Teacher:__________________________________________

Parent : __________________________________________

Other: ___________________________________________

Duration of Intervention/Dates:

Person(s) Responsible:

Documentation Method: (If Charting, please attach):

Revised 4/19/09

Revised 4/23/09

Rutherford County Schools

Problem-Solving Model Level I Intervention Plan/PEP and Results

Student Name:DOB:Date:NCWISE#

Describe Parental Concerns:

Parent Involvement in Plan:

Current Skill Level/Assessment Data:

Intervention/Instructional Plan:

Persons Completing Initial Plan Date:_____________

Teacher:__________________________________________

Parent : __________________________________________Other: ___________________________________________

Duration of Intervention/Dates:

Person(s) Responsible:

Documentation Method: (If Charting, please attach):

Revised 4/19/09

Revised 4/23/09

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Revised 4/19/09

Revised 4/23/09

Rutherford County SchoolsProblem-Solving Model Data Collection

Student Name:NCWISE#Date:

Teacher:DOB:Grade:Retention(s) - Specify Grade Level(s):

Attendance

Enrolled/PresentGrade KGrade 1Grade 2Grade 3Grade 4Grade 5

Area(s) of Concern

Language Arts

___ Phonemic Awareness

___ Letter Identification

___ Decoding

___ Sight Word Vocabulary

___ Reading Comprehension

___ Reading Fluency

___ Written Expression

___ Writing Mechanics

___ Writing Conventions

___ Other (_________________)Mathematics

___ Basic Math Facts

___ Computation

___ Problem-Solving

___ Word Problems

___ Geometry

___ Measurement

___ Probability/Data

___ Analysis

___ Other (___________________)Behavior

___ Noncompliance

___ Social Skills

___ Motivation

___ Attention Span

___ Peer Relationships

___ Withdrawn / Moody

___ Anxiety

___ Overactive

___ Verbally Aggressive

___ Physically Aggressive

___ Other (___________________)

Other

___ Medical (___________________)

___ Motor Skills

___ Speech

___Articulation

___Voice

___Fluency

___ Language

___ Vision

___ Hearing

Reading:Math:Writing:Date of Vision Screening:

Results:

Far: Near:

EOG 3rdEOG 4thEOG 5thDate of Hearing Screening:

Results:

K-2 Assessments

Name and Address of Parent/Guardian

Past Services _____ Small Group Instruction _____ Individual Instruction _____ Counseling

Received: _____ 504 Accommodations _____ Community Services _____ ESL/LEP/ELL _____ Occupational Therapy

_____ Speech/Language Therapy _____ Physical Therapy _____ Tutoring _____ Other (please specify:

Additional Comments/Information/Teacher Observations

Rutherford County Schools

Problem-Solving Model Level I Intervention Plan/PEP and Results

Student Name:DOB:Date:NCWISE#

Describe Parental Concerns:

Parent Involvement in Plan:

Current Skill Level/Assessment Data:

Intervention/Instructional Plan:

Persons Completing Initial Plan Date:_____________

Teacher:__________________________________________

Parent : __________________________________________

Other: ___________________________________________

Duration of Intervention/Dates:

Person(s) Responsible:

Documentation Method: (If Charting, please attach):

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

PEP ____________

RtI Level 1 ____________

RtI Level 2 ____________

Revised 4/19/09

Revised 4/23/09

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Meeting Date (Select Decision)

Meeting Date

Continue Intervention

Modify Intervention

Discontinue Intervention

Move to PSM Level II

(Describe Action continued)

Continue InterventionModify Intervention

Discontinue InterventionMove to PSM Level II

Describe Action

Teacher signature

Parent signature

Other signature (title)

Revised 4/19/09

Revised 4/23/09