Rti Surveys and forms

Appendix 1. School Survey for the Evaluation of Response to Intervention Practices
for Elementary School Reading

What is the purpose of this study?

This study is part of the congressionally-mandated national evaluation of the Individuals with Disabilities Education Improvement Act (IDEA, Public Law 108-446) and will address the following questions:

• What are the effects on academic achievement of providing intensive reading interventions to elementary school children who have been identified as at risk for reading difficulties compared with children just above the cut point for providing intervention?

• How do academic outcomes, including reading achievement and special education identification, vary with elementary schools' adoption of Response to Intervention practices for early grade reading?

• How do Response to Intervention practices for early grade reading vary across schools?

How is the study team defining Response to Intervention?

Response to Intervention (RtI) is a multi-step approach to providing early and more intensive intervention and monitoring within the general education setting.

In principle, RtI begins with research-based instruction and behavioral support provided to students in the general education classroom, followed by screening of all students to identify those who may need systematic progress monitoring, intervention, or support. Students who are not responding to the general education curriculum and instruction are provided with increasingly intense interventions through a "tiered" system, and they are frequently monitored to assess their progress and inform the choice of future interventions, including possibly special education for students determined to have a disability.

IDEA permits some federal special education funds to be used for "early intervening services" such as RtI, and also permit districts to use RtI to inform decisions regarding a child's eligibility for special education.

Who is administering this study?

This study is being supported by the Institute of Education Sciences (IES) at the U. S. Department of Education as authorized by the U. S. Congress under Section 664 of IDEA. MDRC, SRI International, and RG Research Group developed plans for the study under contract ED-04-CO-0111/0003 with IES, and Survey Research Management is administering the school survey.

What is the purpose of this survey?

This survey seeks information on your school’s core reading program, reading interventions, and system of teacher supports. Core reading instruction refers to instructional time focusing on major components of reading: phonemic awareness, phonics, fluency, reading comprehension, and vocabulary. Core reading instruction may occur in a variety of scheduling arrangements (for example, whole and small group instruction, partner and group work, independent work).

Who should complete this survey?

This survey should be completed by the school principal in consultation with the person or persons who are most knowledgeable about your school’s overall program of reading instruction and about the intervention services provided to children who are performing below grade-level expectations in reading. Only one school survey should be submitted for each school.

Will the information provided through this survey be kept confidential?

All information gathered for this study will be kept confidential and will only be used for research purposes. The information collected about schools and students for this study will be used only for statistical purposes and may not be disclosed or used, in identifiable form, for any other purpose except as required by law (Public Law 107-279, Section 183).

What are the instructions for this survey?

Please answer the questions based on school guidelines and practices. There are no expected answers, so please be thoughtful and honest as you respond. Your participation is important and appreciated. The information you provide will be combined with the information provided by others in statistical reports.

The survey is broken into five short sections:

1. Core Reading Program and Practices

2. Data and Decision Making

3. Special Education Eligibility Policy and Practices

4. Supports and Services to Schools

5. Background Information on Schools

THANK YOU IN ADVANCE FOR COMPLETING THIS SURVEY!

According to the Paperwork Reduction Act of 1995, no persons are required to respond to this voluntary collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1850-New. The time required to complete this information collection is estimated to average one hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Jonathan Jacobson, U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, Suite 500J, Washington, D.C. 20208, or email jonathan.jacobson@ed.gov.

A. CORE READING PROGRAM AND PRACTICES

The core reading block is that part of the schedule when teachers provide a comprehensive program of instruction that focuses on the five reading components: phonemic awareness, phonics, fluency, reading comprehension, and vocabulary; but does not include spelling, grammar, or writing.

A1. During your core reading block, does your school use a commercial reading program to teach reading to all students in kindergarten?

 Yes (skip to question A1b)  No

A1a. What commercial reading program does your school currently use? _________________________

A1b. Please indicate the publisher and title and add the publication year for the program used in each grade. If your school’s reading program is not listed, please add it.

Publisher	Title of Reading Program MARK ALL THAT APPLY	Grade(s) (circle all that apply)
Cambium/Voyager	Read Well	K 1 2 3 4 5
	Universal Literacy	K 1 2 3 4 5
Harcourt	Trophies	K 1 2 3 4 5
	Story Town	K 1 2 3 4 5
Heinemann	Fountas & Pinnell	K 1 2 3 4 5
Houghton Mifflin Harcourt	Journeys	K 1 2 3 4 5
	Rigby: Literacy by Design	K 1 2 3 4 5
Houghton Mifflin	Leveled Readers	K 1 2 3 4 5
	Houghton Mifflin Reading	K 1 2 3 4 5
MacMillan/McGraw-Hill	MacMillan/McGraw-Hill Reading	K 1 2 3 4 5
	Treasures	K 1 2 3 4 5
McGraw-Hill	Horizons	K 1 2 3 4 5
SRA/McGraw-Hill	Journeys	K 1 2 3 4 5
	Horizon	K 1 2 3 4 5
	Reading Mastery	K 1 2 3 4 5
	Open Court Reading	K 1 2 3 4 5
	Imagine It!	K 1 2 3 4 5
Pearson	Scott Foresman Reading Street	K 1 2 3 4 5
	Words Their Way	K 1 2 3 4 5
Reading A to Z	Reading A to Z	K 1 2 3 4 5
Other (please specify publisher and title: _________________)		K 1 2 3 4 5

A2. In what school year did your school implement the reading program that is currently used during the core reading block in the following grades (check one year for each grade)?

	Prior to 2006	2006-07	2007-08	2008-09	2009-10	2010-11	2011-12
Kindergarten							
Grade 1							
Grade 2							
Grade 3							
Grade 4							
Grade 5							

A3. In the last three years, has the reading program used during the core reading block changed in grade 1, 2, or 3?

 Yes  No (skip to question A5)

A4. Why did your school change the reading program? MARK ONE RESPONSE ON EACH ROW.

	Not a factor	Somewhat important factor	Very important factor
a. Too many students in our school were at risk of not reaching state proficiency standards in reading			
b. The core reading curriculum needed to be better aligned with state reading standards			
c. Our school was identified for improvement for not making adequate yearly progress (AYP)			
d. Our school implemented a Response to Intervention (RtI) model and the new curriculum was intended to strengthen the core reading program for more students to reach proficiency			
e. Our district adopted a new reading curriculum and required our school to adopt the new curriculum			

A5. Does your school allocate 5 days a week to the core reading block for students in grades K-5?

 Yes (skip to question A7)  No

A6. How many days per week are allocated to reading instruction?

 4  3  2  Fewer

A7. How many total minutes during the school day are allocated to the core reading block (for example, phonemic awareness, phonics, fluency, vocabulary, and reading comprehension, but excluding spelling, grammar, and writing) for students in grades K-5?

MARK ONE RESPONSE ON EACH ROW.

Grade	Number of Allocated Minutes for Core Reading Block
	Up to 45	46- 60	61- 75	76- 90	91-105	106-120	121-135	136-150	Over 150
Kindergarten									
Grade 1									
Grade 2									
Grade 3									
Grade 4									
Grade 5									

A8. In which grades, if any, does your school schedule core reading instruction to group students in different classes according to their overall reading level? MARK ALL THAT APPLY.

 Kindergarten

 Grade 1

 Grade 2

 Grade 3

 Grade 4

 Grade 5

A9. Are there students from different grades taught reading in the same class?

 Yes  No

A10. In the 2011-12 school year, indicate the methods and frequency that the school leadership has evaluated fidelity of implementation of the reading curriculum or assessment measures as defined by the publisher. MARK ONE RESPONSE ON EACH ROW.

Fidelity of implementation is the delivery of instruction or collection of assessment data in the way in which it was designed to be delivered or collected.

	Once a week or more	Once a month	4-6 times this school year	1-3 times this school year		Not at all
a. Observed classroom reading instruction using an evaluation checklist or form						
b. Observed staff administering universal screening or benchmarking assessments						
c. Observed teachers administering progress monitoring assessments						
d. Other [______________]						

B. DATA AND DECISION MAKING

Questions B1 and B2 ask about the electronic system (including excel spreadsheets) that could be maintained by the state, district, school or reading program/ benchmark vendor.

B1. Does your school have an electronic student data system for systematic monitoring student’s progress in reading?

 Yes  No (skip to question B3)

B2. What type of student-level data is maintained in an electronic student data system or another kind of system (for example, paper and pencil records) for monitoring student’s progress in reading? MARK ALL THAT APPLY.

	Data available electronically	Longitudinal data available for 3 or more years	Data available, but not electronically	No data available
a. Student universal screening or benchmark assessment scores				
b. Student curriculum embedded tests (end of unit tests, weekly tests)				
c. Progress monitoring data to determine whether sufficient progress is being made in a timely manner				
d. State standardized reading achievement test used for accountability purposes				
e. Other standardized reading tests to determine student’s reading level				
f. Reading diagnostic tests to pinpoint specific reading problems				
g. Student grades				
h. Attendance				
i. Behavior referrals or discipline information				
				

Question B3 asks about entering information into the student data system.

B3. Which school staff, if any, are responsible for entering student performance data into the student data system?

	No Data Entered	Teachers	Other School Staff	District, State, or Contractor Staff
a. Student universal screening or benchmark assessment scores				
b. Student curriculum embedded tests (end of unit tests, weekly tests)				
c. Progress monitoring data to determine whether sufficient progress is being made in a timely manner				
d. State standardized reading achievement test used for accountability purposes				
e. Other standardized reading tests to determine student’s reading level				
f. Reading diagnostic tests to pinpoint specific reading problems				
g. Student grades				
h. Special education information				
i. Attendance				
j. Behavior referrals or discipline information				

B4. Does your school use universal screening or benchmarking assessment of all students to identify those who may need systematic progress monitoring, intervention, or support in reading?

 Yes  No (skip to question B9)

B4a. Which of the following benchmarking systems are used at your school? MARK ALL THAT APPLY.

 4Sight

 AIMSweb

 CBM

 CORE Phonics

 DIBELS

 DIBELS Next

 DRA

 DRA2

 EasyCBM

 FAIR

 Fountas and Pinnell

 MAP-NWEA

 Scantron Performance Series

 PALS

 Other (please specify:
__________________)

B5. In what year did implementation of universal screening or benchmark assessments in reading begin for grade 1, grade 3 and grade 5?

Implementation Year	Grade 1	Grade 3	Grade 5
Prior to 2006			
2006-07			
2007-08			
2008-09			
2009-10			
2010-11			
2011-12			

B6. In what month does school start?

 August  September

B7. How often and in what month are screening or benchmarking measures administered to students in each grade?

Month of Screening or Benchmarking Assessment

Grade

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

June

Kindergarten























Grade 1























Grade 2























Grade 3























Grade 4























Grade 5























Questions B8 through B12 ask about the persons who have the primary responsibility in your school for administering student-level assessments. MARK ALL THAT APPLY.

In your school, who has the primary responsibility for administering the following student assessments:	Principal	School psychologist	Classroom teachers	Specialist (for example, interventionist, reading, special education, ELL)		Coach (for example, reading, instructionaletc.)		Other	Not used at our school
B8. Universal screening or benchmark reading tests?									
B9. Curriculum- embedded reading tests?									
B10. Student progress monitoring in reading?									
B11. State accountability tests in reading?									
B12. Diagnostic tests to pinpoint specific problems?									

Questions B13 through B17 ask about the individuals who have the primary responsibility in your school for analyzing student-level assessment data. MARK ALL THAT APPLY.

In your school, which individuals have the primary responsibility for analyzing data from the following student assessments:

	Principal	School psychologist	Classroom teachers	Specialist (for example, interventionist, reading, special education, ELL)		Coach (for example, reading, instructionaletc.)		Other	Not used at our school
B13. Universal screening or benchmark reading tests?									
B14. Curriculum- embedded reading tests?									
B15. Student progress monitoring in reading?									
B16. State accountability tests in reading?									
B17. Diagnostic tests to pinpoint specific problems?									

B18. In your school, which of the following kinds of data and criteria are used for determining whether a student will reach grade level reading benchmarks by the end of the school year?

	Very Important	Somewhat Important	Not Important
a. Use publisher’s recommendations (often color-coded) for universal screening or benchmark scores several times a year			
b. Student curriculum embedded tests (for example, end of unit tests, weekly tests)			
c. Use progress monitoring measures for determining whether sufficient progress is being made in a timely manner			
d. Standardized reading scores to determine student’s reading level			
e. Reading diagnostic tests to pinpoint specific reading problems			
f. Teacher observation of students			

Questions B19 through B22 ask about your school’s guidelines for making decisions when a student is not making satisfactory progress learning to read.

B19. Does your school follow a prescribed sequence of steps for responding to students who are below benchmark in reading?

 Yes  No (skip to question B22)

B20. What is the first step your school encourages classroom teachers to follow when a student scores somewhat below grade level benchmarks in reading? MARK ONE RESPONSE.

 Assign student to a reading intervention group focused on targeted reading skills, in addition to providing core instruction

 Continue offering instruction in the general education classroom and collect additional progress monitoring data

 Consult with peers to find approaches to address the needs of the student before considering an assignment to a reading intervention group Refer for diagnostic testing

 Refer to special education

 Other [_______________________]

B21. What is the first step that your school encourages interventionist or specialist teachers to follow when a student is not making adequate progress in an intervention? MARK ONE RESPONSE.

 Assign student to a different or more intensive reading intervention group focused on targeted reading skills

 Continue offering the intervention and collect additional progress monitoring data

 Consult with peers to find approaches to address the needs of the student before considering an assignment to a different or more intensive intervention

 Refer student for diagnostic testing

 Refer student to special education

 Other [_______________________]

B22. At the fall benchmark, a 1^st grade student is identified as somewhat below in reading. In addition to receiving core reading instruction, he is assigned to receive a reading intervention. How many weeks pass before your school reviews the student’s performance to decide if the student needs a change in this reading intervention?

 1-2 weeks  4 weeks  6 weeks  8-10 weeks
 Wait until the next benchmark period

B23. Following the fall screening/benchmark process, are some first grade students assigned directly to a more intensive intervention (sometimes called Tier 3 or Level 3) without having previously received a targeted reading intervention (sometimes called Tier 2 or Level 2)?

 Yes  No

C. SPECIAL EDUCATION ELIGIBILITY POLICY AND PRACTICES

Questions C1 and C2 ask about policies and practices related to special education eligibility determination at the school.

C1. In your school, are data from a Response to Intervention process used to inform the determination of special education eligibility for students suspected of having a specific learning disability.

 Yes  No (skip to question C3)

C2. In what year did your school begin to use RtI data to help determine eligibility for special education under the category of specific learning disability (SLD)?

 Prior to 2006  2009-10

 2006-07  2010-11

 2007-08  2011-12

 2008-09

C3. In your school, which of the following kinds of data are used for informing special education eligibility determinations for students suspected of having a specific learning disability ? MARK ONE RESPONSE ON EACH ROW.

	Always Used	Sometimes Used	Never Used
a. Data from universal screening or a benchmark assessment in reading			
b. Data and other information from systematic monitoring of student progress following implementation of reading interventions			
c. Data based on cognitive and reading assessments that demonstrate a discrepancy between expected and actual performance (such as an IQ-achievement discrepancy model)			
d. Data from a standardized reading test (for example, state assessments in reading)			
e. Data from other procedures (for example, teacher observations, student work products, parent reports)			
f. Other [_____________________________]			

D. SUPPORTS AND SERVICES TO SCHOOLS

Questions D1 through D12 ask about supports and services provided to the school.

D1. For how many years has your district used the following strategies to support your school in improving reading instruction for students somewhat below or very below grade level benchmarks in reading?

	Never Supported	Planning but not started	1 or 2 years of Support	3 or more years of Support
a. Written policies and guidelines for using data to improve reading instruction				
b. Electronic universal screening or benchmarking system for measuring student general reading outcomes				
c. Reading intervention materials				
d. Reading or instructional coach assigned to your school				
e. Professional development for teachers for implementing the core reading program				
f. Professional development for teachers for differentiation of instruction for children below grade level benchmark in reading				
g. Professional development for teachers for using data to improve reading instruction				
h. Substitute teachers for classroom teachers to be released from teaching responsibilities to review student data				
i. Assistance in scheduling additional time for reading interventions				
j. Additional funding to hire staff				

Response to Intervention (RtI) is a multi-step approach to providing early and progressively intensive intervention and monitoring within the general education setting.

In principle, RtI begins with research-based instruction and behavioral support provided to students in the general education classroom, followed by screening of all students to identify those who may need systematic progress monitoring, intervention, or support.

Students who are not responding to the general education curriculum and instruction are provided with increasingly intense interventions through a “tiered” system, and they are frequently monitored to assess their progress and inform the choice of future interventions, including possibly special education for students determined to have a disability.

D2. Is Response to Intervention (RtI), as defined above, currently used in at least one grade at your school, either partially or fully implemented? MARK ONE RESPONSE.

 Yes  No (skip to question E1)

D3. Is RtI currently implemented at your school in READING in the following grades? MARK ONE RESPONSE ON EACH ROW.

	Yes, fully implemented	Yes, partially implemented		No, not implemented
Kindergarten				
Grade 1				
Grade 2				
Grade 3				
Grade 4				
Grade 5				

D4. Is RtI currently implemented at your school in FIRST GRADE in the following other areas? MARK ONE RESPONSE ON EACH ROW.

	Yes, fully implemented	Yes, partially implemented		No, not implemented
a. Math				
b. Writing				
c. Behavior/Social Skills				

D5. Approximately how many years ago did your school begin implementing RtI in first grade in ANY subject? MARK ONE RESPONSE.

• Less than 1 year ago

• 1 year ago

• 2 years ago

• More than 2 years ago

D6. Think about special education students in grades 1 through 3 who are classified as having a specific learning disability and have an IEP with reading goals . Indicate below the tier(s) of instruction these students typically receive in your school. MARK ALL THAT APPLY. Students with Specific Learning Disabilities in
		Grade 1	Grade 2	Grade 3
	Tier 1 (or Level 1): Core reading instruction--for example, whole and small group instruction, or independent work--regularly given to an entire class			
	Tier 2 (or Level 2): targeted reading intervention provided to small groups of struggling readers			
	Tier 3 (or Level 3): more intensive interventions provided to very small groups or individual students who struggle in reading			
	Other (please specify: ____________________________________)			

D7. How many days per week do most students receive Tier 2 (or Level 2) intervention(s)?

 1  2  3  4  5

D8. How many minutes per day are allocated for most students receiving Tier 2 (or Level 2) intervention(s)?

• Up to 30 minutes

• 31-46 minutes

• 46-60 minutes

• 61-75 minutes

• 76-90 minutes

• 91-105 minutes

• 106-120 minutes

• More than 120 minutes

D9. How many days per week do most students receive Tier 3 (or Level 3) intervention(s)?

 1  2  3  4  5

D10. How many minutes per day are allocated for most students receiving Tier 3 (or Level 3) intervention(s)?

• Up to 30 minutes

• 31-46 minutes

• 46-60 minutes

• 61-75 minutes

• 76-90 minutes

• 91-105 minutes

• 106-120 minutes

• More than 120 minutes

D11. Listed below are a series of possible barriers to implementation of Response to Intervention. To what extent is each a barrier to expanding use of data for improving reading instruction interventions at your school? MARK ONE RESPONSE ON EACH ROW.

	Not a Barrier	Minor Barrier	Major Barrier
a. Inadequate access by school staff to data systems or individual student data			
b. Inadequate resources to train school staff on how to use data to improve reading instruction for students below grade level benchmark in reading (for example, providing data specialists, reading coaches, or professional development funds)			
c. Inadequate criteria for determining whether students in some grades are below grade level benchmarks in reading			
d. Inadequate measures to monitor reading progress of students in some grades			
e. Inadequate research-based interventions for students very below grade level benchmarks in reading			
f. Inadequate resources/supports to increase classroom teacher knowledge of how to differentiate instruction for students experiencing reading difficulty or reading failure during core reading block			
g. Inadequate resources to increase classroom teacher knowledge of how to teach reading to ELL students			
h. Inadequate resources/supports to increase specialist knowledge of how to differentiate instruction for students with reading difficulties or reading failure			
i. Inadequate support for scheduling additional reading time for students somewhat below or very below grade level benchmarks in reading			
j. Inadequate time for teachers to review data			
k. Inadequate district leadership support for using data to improve reading instruction for students experiencing reading difficulties or reading failure			
l. More students in need of reading interventions than there are available teachers/specialists			

D12. For the 2011-12 school year, how has your school made information available to parents/guardians to help them understand how RtI is being implemented in your school? MARK ALL THAT APPLY.

• Communication through written materials such as letters, email, school website, or newsletters

• Communication through written materials translated into home language such as letters, email, school website, or newsletters

• Communication through workshops, discussion groups, or other meetings such as PTA meetings

• Communication through individual meetings with parents or phone calls

• Information is not distributed on this topic

E. BACKGROUND INFORMATION ON SCHOOL

Questions E1 through E6a ask about staffing at the school and historical information.

E1. How many classroom teachers are assigned to grades K-3 this year (2011-12)?

Grade	Enter Number of classroom teachers below
Kindergarten	# ___________
Grade 1	# ___________
Grade 2	# ___________
Grade 3	# ___________
Other K-3 teachers (for example, combination classrooms):	# ___________

E2. How many special education teachers, reading specialists, and paraprofessionals are assigned to students in grades K-3 this year (2011-12)?

Grade	Enter # of FTEs of special education teachers who provide reading intervention and are assigned to students in grades K-3 below…	Enter # of FTEs of reading specialists who provide reading intervention and are assigned to students in grades K-3 below…	Enter # of FTEs of paraprofessionals and/or instructional aides who provide reading intervention and are assigned to students in grades K-3 below…
Kindergarten	# _______	# _______	# _______
Grade 1	# _______	# _______	# _______
Grade 2	# _______	# _______	# _______
Grade 3	# _______	# _______	# _______

E3. In the 2011-12 school year, is there someone in the building whose role is to assist teachers in using and interpreting assessment data on reading?

 Yes  No

E4. Is there someone in the school to provide coaching to classroom teachers on teaching reading?

 Yes  No (skip to question E5)

E4a. What percent of the coach’s time is devoted to the responsibilities below?

	Percent of Time
	Less than 20%	20-40%	41-60%	61-75%	76%-100%
Using and interpreting reading assessment data					
Coaching on teaching reading					

E5. What percent of time is a school psychologist assigned to your school this year (2011-12)?

	No School Psych	1-20%	20-40%	41-60%	61-75%	76%-100%
Percent of time						

E6. Is a school-wide positive behavioral intervention and support program (for example, Positive Behavioral Support, Positive Behavioral Intervention System) implemented at your school? MARK ONE RESPONSE.

 Yes  No (survey complete)

E6a. In what year was the program first implemented? MARK ONE RESPONSE.

 Prior to 2006  2009-10

 2006-07  2010-11

 2007-08  2011-12

 2008-09

Questions from this survey were adapted from the following sources:

ECLS-K 2011 Teacher and School Surveys

ED Study of Education Data Systems and Decision Making Surveys (2007-08)

IDEA National Assessment Implementation Study Surveys

National Education Technology Trends Survey

Reading First Implementation Evaluation Surveys

TASSIE (2002-03), Teacher’s Survey

Washington RTI Evaluation Survey

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April 3, 2012 Revised School Survey