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pdfB-1. Draft Protocol—School-Level Survey
(Treatment Contrast and Data-Informed Allocation of Dropout Prevention
Interventions for Students)
Paperwork Burden Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless such collection displays a valid Office of Management and Budget (OMB) control
number. The valid OMB control number for this information collection is XXXX-XXXX. The time required
to complete this information collection is estimated to average 60 minutes per response. This information
collection is voluntary. 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, DC 20202–
4651. If you have comments or concerns regarding the status of your individual submission of this form,
write directly to: Christopher Boccanfuso, U.S. Department of Education, Institute of Education Sciences,
Room 506D, 555 New Jersey Ave. NW, Washington, DC 20208-5500.
Per the policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E,
Section 183, responses to this data collection will be used only for statistical purposes. The reports
prepared for this study will summarize findings across the sample and will not associate responses with a
specific district or individual. Any willful disclosure of such information for nonstatistical purposes,
except as required by law, is a class E felony.
**This survey will be administered to both treatment and control schools to estimate the impact
of EWIMS on school-level outcomes
The purpose of this draft school-level survey is twofold: the first section documents current
usage of an early warning system tool or the use of data to identify students who are at risk of
academic failure, disengagement, and/or dropping out of high school, and will be used to
measure the treatment contrast in the EWIMS impact study. We will use this information to
document the treatment contrast. Measures are adapted from the REL Appalachia survey in an
attempt to coordinate data collection across RELs on similar EWS implementation studies.
These second section collects consistent information from treatment and control schools about
the types of dropout interventions they are implementing and whether and how they use student
data to allocate those dropout interventions. This section will be used to answer school-level
research question 2a: What is the impact of EWIMS on data-informed allocation of dropout
prevention interventions for students? Items are based on up-to-date input from the Dropout
Prevention Research Alliance members’ input, as well as a collaboration between REL
Appalachia and REL Midwest to develop similar tools for EWS implementation studies. The
study team plans to continue to review and populate these response options prior to
administration and in collaboration with alliance members to reflect the most up-to-date local.
These items are still in draft form and will be finalized with input from REL Midwest’s Dropout
Prevention Alliance.
REL Midwest
Data Collection Instruments—1
Section I: Treatment Contrast—Use of an Early Warning System
1. Is your high school using an early warning system (EWS) to identify students who may be at
risk of not graduating from high school on time?
o
Yes, we are implementing EWS in my high school
If yes, what is the name of your early warning system? ________________________.
o
No, my high school is not currently implementing EWS in any high schools (IF NO,
SKIP TO QUESTION 5)
2. Please tell us when you began implementing an early warning system in your school, and the
degree of implementation in each school year.
Time Period
Degree of Implementation
Before the 2010–11 school year
Drop down menua
2010–11 school year
Drop down menua
2011–12 school year
Drop down menua
2012–13 school year
Drop down menua
2013–14 school year
Drop down menua
Other (Please specify)
Drop down menua
a
Drop down menu: Beginning stages, In progress, Mastered the tool and
process
3. How do you use the early warning system? (Please check all that apply)
o
o
o
o
o
o
o
o
To identify students at risk based on attendance
To identify students at risk based on course failure
To identify students at risk based on behavior
To target resources to support off-track students before they drop out
To assign students to intervention(s)
To monitor student progress or students’ response to intervention(s)
To examine patterns and identify school climate issues
Other (please specify) _____________________________________________________
4. What kinds of reports does your early warning system generate? (Please check all that apply)
o
Student-level reports that show lists of students and risk status
REL Midwest
Data Collection Instruments—2
o
o
o
o
School-level, or graphical, reports that show trends in student risk status across the school
or time
Reports (student or school level) for key subgroups (e.g., students with disabilities) of
students
Intervention-level reports that allow us to monitor the effectiveness of our interventions
Other (please specify) _____________________________________________________
~~~~~~~~~~~~~~~~~~~~~~Skip Pattern from Question 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~
The following questions ask about how your school uses data to identify students who may
be at risk for not graduating on time.
5. Do teachers in your school have access to student data that identifies students at risk of not
graduating?
o Yes, and all teachers access it regularly
o
o
o
o
o
o
Yes, and some teachers access it regularly
Yes, and some teachers access it occasionally
Yes, but very few teachers actually access it
Yes, but no teachers actually access it
No, teachers do not have access to this type of data
Other (please specify) _____________________
6. Does your school review student attendance data to determine which students may be at risk
(i.e., missing more than # days per year)?
o Yes
o
No (IF NO, SKIP TO QUESTION 9)
REL Midwest
Data Collection Instruments—3
7. For which grades do you examine student attendance data? (Please check all that apply.)
o Grade 9
o
o
o
Grade 10
Grade 11
Grade 12
8. How often do you review these data?
o Daily
o
o
o
o
o
o
Weekly
Monthly
4 times per year (once per quarter)
3 times per year
2 times per year
1 time per year
9. How often do you use attendance data to assign students to specific interventions or support
services?
o Never
o
o
o
Rarely
Sometimes
Always
10. Tell us a little bit about how you use attendance data in your school:
11. Does your school review student course performance data (including course failures, credit
deficiencies) to determine which students may be at risk?
o Yes
o
No (IF NO, SKIP TO QUESTION 15)
REL Midwest
Data Collection Instruments—4
12. For which grades do you examine course performance data (including course failures, credit
deficiencies)? (Please check all that apply).
o Grade 9
o
o
o
Grade 10
Grade 11
Grade 12
13. How often do you review these data?
o Daily
o
o
o
o
o
o
Weekly
Monthly
4 times per year (once per quarter)
3 times per year
2 times per year
1 time per year
14. Tell us a little bit about how you use course performance data (including course failures,
credit deficiencies) data in your school:
REL Midwest
Data Collection Instruments—5
15. What other kinds of student data do you look at, and for which grades? (Please check all that
apply.)
We use in these grades
Grade 10 Grade 11 Grade 12
We do
not use
Grade 9
Behavior referrals
Behavior suspensions
Grade point average (GPA)
State assessment results
Other:
Other:
Other:
Other:
The following questions ask about the structure of data review in your high school,
focusing on the group of individuals who use student data to identify students who may be
at risk of not graduating from high school on time. These individuals may be part of a
distinct early warning system team or part of another team that is responsible for
examining these data.
16. Does your school have a team or group of individuals that reviews student data to support
students who are identified as at risk of not graduating from high school? (e.g., building- or
teacher-level teams, Student Success Teams, Data Review Teams)
o Yes, we have a dedicated school-based team.
If yes, what is the goal or purpose of this team? ___________________________
_________________________________________________________________
o
o
No, we do not have a dedicated school-based team.
Other (please specify)
REL Midwest
Data Collection Instruments—6
17. How often does your team meet to review student data?
o Weekly
o
o
o
o
o
Monthly
4 times per year (once per quarter)
3 times per year
2 times per year
1 time per year
18. How often does your team meet to assign students at risk to support and/or interventions?
o
o
o
o
o
o
Weekly
Monthly
4 times per year (once per quarter)
3 times per year
2 times per year
1 time per year
19. Describe the members of the team at the high school level (if applicable). (Please check all
that apply.)
o
o
o
o
o
o
o
o
o
o
o
School principal
Assistant principal
Representative from feeder middle schools
Guidance counselors
Content area teachers
Special education teachers
English language learner instructors
District office representative
Community service providers
Community members
Other (please specify) _____________________________________________________
REL Midwest
Data Collection Instruments—7
20. To what extent do you agree with the following statement: “Implementing an early warning
system will lead to improved graduation rates.”
o
o
o
o
Strongly disagree
Disagree
Agree
Strongly agree
21. How often does your school reflect on the process of identifying and assigning students at
risk to interventions?
o
o
o
o
More than twice a year
Twice a year
Once a year
We do not have this opportunity
REL Midwest
Data Collection Instruments—8
Section II: Data-Informed Allocation of Dropout Prevention Interventions for Students
1. Does your school offer targeted academic interventions (e.g., tutoring, reading remediation,
study skills) for students?
o
o
Yes
No (IF NO, SKIP TO QUESTION 3)
REL Midwest
Data Collection Instruments—9
2.
Please name the targeted academic interventions that the school offers. In the table below, indicate which programs are available,
the number of students who participated during the school year, and the grade level of students who participated.
Program
name
Write in
Focus of the
intervention
Drop down
menu (reading,
mathematics,
science,
tutoring,
remediation,
study skills,
other please
specify)
REL Midwest
How is this
program
delivered?
Drop down
menu
(individually
to students, via
small group,
via large
group,
schoolwide,
other please
specify)
Who delivers
this program?
Drop down
menu (teachers,
administrators,
guidance
department,
community
members,
parents, peers
[other students],
other please
specify)
# of
participating
students
Drop down
menu
(from 1 to 999)
Grade
level(s) of
students
Who refers
students for
this program?
Drop down
menu
(from
grade 9 to
grade 12)
Drop down menu
allowing
checking all that
apply
(administrator,
counselor, parent,
teacher, data
team, student,
[self], other
please specify)
What criteria are
used to select
students for
participation in
targeted academic
interventions?
What data do you
use to determine
whether an
intervention/
support is
working?
Drop down menu
allowing checking all
that apply (course
failure [e.g., failing
Algebra], grade point
average [GPA], number
of credits, student
attendance [e.g.,
missing a number of
days of school or
class], student behavior
[e.g., office referrals,
suspensions], no
criteria, other please
specify)
Drop down menu
allowing checking all
that apply (attendance,
behavior, course
performance, core
course performance,
GPA, credits earned,
behavior referrals,
behavior suspensions,
no criteria, other
please specify)
Data Collection Instruments—10
3. Does your school offer targeted behavior interventions (e.g., social skill training, character education) for students?
o
o
Yes
No (IF NO, SKIP TO QUESTION 4)
a. Please name the targeted behavior interventions at the school. In the table below, indicate which programs are available, the
number of students who participated during the school year, and the grade level of students who participated.
Program
name
Write in
Focus of the
intervention
Drop down
menu (social
skill training,
character
education,
other please
specify)
REL Midwest
How is this
program
delivered?
Drop down
menu
(individually
to students,
via small
group, via
large group,
schoolwide,
other please
specify)
Who delivers
this
program?
Drop down
menu (teachers,
administrators,
guidance
department,
community
members,
parents, peers
[other students],
other please
specify)
# of
participating
students
Drop down
menu
(from 1 to 999)
Grade
level(s) of
students
Drop down
menu (from
grade 9 to
grade 12)
Who refers
students for
this program?
Drop down menu
allowing
checking all that
apply
(administrator,
counselor, parent,
teacher, data
team, student,
[self], other
please specify)
What criteria are used
to select students for
participation in
targeted behavior
interventions?
Drop down menu
allowing checking all that
apply (course failure [e.g.,
failing Algebra], grade
point average [GPA],
number of credits, student
attendance [e.g., missing a
number of days of school
or class], student behavior
[e.g., office referrals,
suspensions], no criteria,
other please specify)
What data do you
use to determine
whether an
intervention/
support is
working?
Drop down menu
allowing checking all
that apply (attendance,
behavior, course
performance, core
course performance,
GPA, credits earned,
behavior referrals,
behavior suspensions,
no criteria, other
please specify)
Data Collection Instruments—11
4. Does your school offer targeted attendance/truancy interventions (e.g., attendance monitor) for students?
o
o
Yes
No (IF NO, SKIP TO QUESTION 5)
a. Please name the targeted attendance/truancy interventions that the school offers. In the table below, indicate which programs
are available, the number of students who participated during the school year, and the grade level of students who participated.
Program
name
Focus of the
intervention
Write in
Drop down
menu
(attendance
monitoring,
contacting
truancy
officers,
automated
contact with
families,
conferences
with families
and students,
other please
specify)
REL Midwest
How is this
program
delivered?
Drop down
menu
(individually
to students, via
small group,
via large
group,
schoolwide,
other please
specify)
Who delivers
this program?
Drop down
menu (teachers,
administrators,
guidance
department,
community
members,
parents, peers
[other students],
other please
specify)
# of
participating
students
Drop down
menu
(from 1 to 999)
Grade
level(s) of
students
Who refers
students for
this program?
Drop down
menu
(from
grade 9 to
grade 12)
Drop down menu
allowing
checking all that
apply
(administrator,
counselor, parent,
teacher, data
team, student,
[self], other
please specify)
What criteria are
used to select
students for
participation in
targeted behavior
interventions?
What data do you
use to determine
whether an
intervention/
support is
working?
Drop down menu
allowing checking all
that apply (course failure
[e.g., failing Algebra],
grade point average
[GPA], number of
credits, student
attendance [e.g., missing
a number of days of
school or class], student
behavior [e.g., office
referrals, suspensions],
no criteria, other please
specify)
Drop down menu
allowing checking all
that apply
(attendance,
behavior, course
performance, core
course performance,
GPA, credits earned,
behavior referrals,
behavior
suspensions, no
criteria, other please
specify)
Data Collection Instruments—12
5. Does your school offer credit or content recovery (e.g., online programs such as Apex, K12, Plato, or another district program)?
o
o
Yes
No (IF NO, SKIP TO QUESTION 6)
a. Please name the credit recovery programs that your school offers. In the table below, indicate which programs are available,
the number of student who participated during the school year, and the grade level of students who participated.
Program
name
Write in
Focus of the
intervention
Drop down
menu (reading,
mathematics,
science,
tutoring,
remediation,
study skills,
other please
specify)
REL Midwest
How is this
program
delivered?
Who
delivers this
program?
Drop down
menu
(individually
to students,
via small
group, via
large group,
schoolwide,
other please
specify)
Drop down
menu
(teachers,
administrators,
guidance
department,
community
members,
parents, peers
[other
students], other
please specify)
# of
participating
students
Drop down
menu
(from 1 to 999)
Grade
level(s)
of
students
Drop
down
menu
(from
grade 9 to
grade 12)
Who refers
students for
this
program?
What criteria are used to
select students for
participation in targeted
behavior interventions?
Drop down
menu allowing
checking all that
apply
(administrator,
counselor,
parent, teacher,
data team,
student, [self],
other please
specify)
Drop down menu allowing
checking all that apply (course
failure [e.g., failing Algebra],
grade point average [GPA],
number of credits, student
attendance [e.g., missing a
number of days of school or
class], student behavior [e.g.,
office referrals, suspensions],
no criteria, other please
specify)
What data do you
use to determine
whether an
intervention/ support
is working?
Drop down menu
allowing checking all
that apply (attendance,
behavior, course
performance, core course
performance, GPA,
credits earned, behavior
referrals, behavior
suspensions, no criteria,
other please specify)
Data Collection Instruments—13
6. Does your school offer student mentoring programs (e.g., Check & Connect, Check In/Check Out)?
o
o
Yes
No (IF NO, SKIP TO QUESTION 7)
a. Which of the following mentoring programs does the school offer or do students have access to in the community? In the table
below, indicate which programs are available, the number of students who participated during the school year, and the grade
level of students who participated.
Program
name
Write in
Focus of the
intervention
Drop down menu
(academic mentoring,
school adjustment
mentoring [e.g., 9th grade
transition program, reentry
from adjudication], career
mentoring, project-based
and community-based
mentoring, group-specific
mentoring, peer mentoring,
other please specify)
What criteria are used
to select students for
How is this Who delivers
# of
Grade
Who refers
participation in
program
this
participating level(s) of students for
targeted behavior
delivered?
program?
students
students this program?
interventions?
Drop down
menu
(individually
to students,
via small
group, via
large group,
schoolwide,
other please
specify)
Drop down
menu (teachers,
administrators,
guidance
Drop down
department,
menu
community
members,
(from 1 to 999)
parents, peers
[other students],
other please
specify)
Drop down menu
allowing
checking all that
apply
Drop down (administrator,
menu (from counselor,
grade 9 to
parent, teacher,
grade 12)
data team,
student, [self],
other please
specify)
Drop down menu allowing
checking all that apply
(course failure [e.g., failing
Algebra], grade point
average [GPA], number of
credits, student attendance
[e.g., missing a number of
days of school or class],
student behavior [e.g., office
referrals, suspensions], no
criteria, other please
specify)
What data do you
use to determine
whether an
intervention/
support is working?
Drop down menu
allowing checking all
that apply (attendance,
behavior, course
performance, core
course performance,
GPA, credits earned,
behavior referrals,
behavior suspensions,
no criteria, other please
specify)
Check &
Connect
Check In
Check Out
Gear Up
REL Midwest
Data Collection Instruments—14
7. Does your school offer a student internship or school-related work-preparation program (such as Job Corp, MACC Project, or
career and technical education classes or programs)?
o
o
Yes
No (IF NO, SKIP TO QUESTION 8)
a. Which of the following student internship or school-related work-preparation programs does the school offer? In the table
below, indicate which programs are available, number of student who participated during the school year, and the grade level
of students who participated.
Program name
Write in
What data do you
What criteria are used to use to determine
select students for
whether an
How is this Who delivers
# of
Grade
Who refers
this
participating level(s) of students for participation in targeted
intervention/
Focus of the program
intervention delivered?
program?
students
students this program? behavior interventions? support is working?
Drop down
menu
(internship,
work-prep,
other please
specify)
Drop down
menu
(individually
to students,
via small
group, via
large group,
schoolwide,
other please
specify)
Drop down
menu (teachers,
administrators,
guidance
Drop down
department,
menu
community
members,
(from 1 to 999)
parents, peers
[other students],
other please
specify)
Drop down menu
allowing
checking all that
Drop down apply
menu
(administrator,
(from
counselor, parent,
grade 9 to teacher, data
grade 12) team, student,
[self], other
please specify)
Drop down menu allowing
checking all that apply (course
failure [e.g., failing Algebra],
grade point average [GPA],
number of credits, student
attendance [e.g., missing a
number of days of school or
class], student behavior [e.g.,
office referrals, suspensions],
no criteria, other please
specify)
Drop down menu
allowing checking all
that apply (attendance,
behavior, course
performance, core
course performance,
GPA, credits earned,
behavior referrals,
behavior suspensions,
no criteria, other please
specify)
Job Corps
AmeriCorps
Post-Secondary Enrollment
Options program at Kent State
University
Career and technical
education program(s) (e.g.,
culinary arts)
Career and technical
education class(es) that are not
part of a program
Other—please describe:
REL Midwest
Data Collection Instruments—15
8. Does your school offer student college preparation programs (such as AVID or Gear Up)?
o
o
Yes
No (IF NO, SKIP TO QUESTION 9)
a. Which of the following college preparation programs does the school offer? In the table below, indicate which programs are
available, the number of students who participated during the school year, and the grade level of students who participated.
Program
name
Write in
Focus of the
intervention
What criteria are used
to select students for
How is this Who delivers
# of
Grade
Who refers
participation in
program
this
participating level(s) of students for
targeted behavior
delivered?
program?
students
students this program?
interventions?
Drop down
menu
Drop down menu (general
(individually
college prep, financial aid
to students,
assistance, application
via small
process assistance, support
group, via
for college entrance exams,
large group,
academics, other please
schoolwide,
specify)
other please
specify)
Drop down
menu (teachers,
administrators,
guidance
Drop down
department,
menu
community
members,
(from 1 to 999)
parents, peers
[other students],
other please
specify)
Drop down menu
allowing
checking all that
apply
Drop down
(administrator,
menu (from
counselor,
grade 9 to
parent, teacher,
grade 12)
data team,
student, [self],
other please
specify)
Drop down menu allowing
checking all that apply
(course failure [e.g., failing
Algebra], grade point
average [GPA], number of
credits, student attendance
[e.g., missing a number of
days of school or class],
student behavior [e.g., office
referrals, suspensions], no
criteria, other please
specify)
What data do you
use to determine
whether an
intervention/
support is working?
Drop down menu
allowing checking all
that apply (attendance,
behavior, course
performance, core
course performance,
GPA, credits earned,
behavior referrals,
behavior suspensions,
no criteria, other please
specify)
Early College
High School
AVID
Gear Up
Talent
Development
REL Midwest
Data Collection Instruments—16
9. In what other ways do you assign students to intervention, or support programming?
o
o
o
Demographics (such as free or reduced-price lunch)
We use teacher recommendations or referrals
Other types of data (please specify)
REL Midwest
Data Collection Instruments—17
| File Type | application/pdf |
| Author | afaria |
| File Modified | 2013-10-29 |
| File Created | 2013-10-29 |