Lincoln County Intervention Plan

Lincoln County Intervention Plan

Lincoln County Intervention Plan

Initial RTI Meeting

School Year:

Target Area:

Student Profile

Student: / Teacher: / Date:
Student ID: / School: Choose OneCrab Orchard ElementaryHighland ElementaryHustonville ElementaryMcKinney ElementaryStanford ElementaryWaynesburg ElementarySixth Grade CenterLincoln County Middle SchoolFort Logan High SchoolLincoln County High SchoolChoose One: / Grade: Choose OneKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeFreshmanSophomoreJuniorSenior

Background Information

Area(s) Of Concern (Choose all that apply):
  • Reading- Basic Skills Phonemic Awareness; PhonicsReading- Vocabulary/ComprehensionReading- Fluency (rate, accuracy, expression)Reading- OtherMath- Basic CalculationMath- Reasoning (Problem Solving/Application)Math- OtherWriting- Spelling &/or MechanicsWritten Expression- Sentence/Paragraph CompositionWriting- OtherBehavior
  • Reading- Basic Skills Phonemic Awareness; PhonicsReading- Vocabulary/ComprehensionReading- Fluency (rate, accuracy, expression)Reading- OtherMath- Basic CalculationMath- Reasoning (Problem Solving/Application)Math- OtherWriting- Spelling &/or MechanicsWritten Expression- Sentence/Paragraph CompositionWriting- OtherBehavior
  • Reading- Basic Skills Phonemic Awareness; PhonicsReading- Vocabulary/ComprehensionReading- Fluency (rate, accuracy, expression)Reading- OtherMath- Basic CalculationMath- Reasoning (Problem Solving/Application)Math- OtherWriting- Spelling &/or MechanicsWritten Expression- Sentence/Paragraph CompositionWriting- OtherBehavior
  • Reading- Basic Skills Phonemic Awareness; PhonicsReading- Vocabulary/ComprehensionReading- Fluency (rate, accuracy, expression)Reading- OtherMath- Basic CalculationMath- Reasoning (Problem Solving/Application)Math- OtherWriting- Spelling &/or MechanicsWritten Expression- Sentence/Paragraph CompositionWriting- OtherBehavior
  • Reading- Basic Skills Phonemic Awareness; PhonicsReading- Vocabulary/ComprehensionReading- Fluency (rate, accuracy, expression)Reading- OtherMath- Basic CalculationMath- Reasoning (Problem Solving/Application)Math- OtherWriting- Spelling &/or MechanicsWritten Expression- Sentence/Paragraph CompositionWriting- OtherBehavior
Additional Information:
What data supports the existence of the problem? (include data from PAS, NRT, CBM, T-PRO, common assessments etc)
What is the goal?
Classroom Intervention Start Date: / Attendance Prior to Interventions:
Poor/Infrequent
Truant
Tardy
Frequent Moves
Good/Excellent / Attendance During Intervention Period:
Poor/Infrequent
Truant
Tardy
Frequent Moves
Good/Excellent

Check all that apply:

Vision – Date of Screener:
Poor Corrected Good Excellent
Hearing – Date of Screener:
Poor Amplified/Aided Good Excellent
Speech/Language
Normal/Adequate Rapid/Rambling Slow/Slurred
Somewhat Unintelligible Unintelligible
General Physical Health
Fragile or Impairment Chronic Illness Good Excellent
Mental/Behavioral Health Concerns
None Conduct Anxiety Depression Phobia Substance Abuse Other:
Attitude Toward Self
Poor Normal/Positive Confident Overconfident Unrealistic
Cultural Background
Describe:
Languages Spoken
None English only Bilingual: and Other:
English Language Proficiency
Little/None Basic Social Language Mastered Social Language
Emerging Cognitive Academic Language Fluent/Proficient
Socioeconomic Status
Low Middle Upper Changing- Up: Down:
Attention and Interest in School
Poor/Indifferent Distracted/Bored Alert/Engaged Over-Responsive
Impulse Control
Poor Fair Good Excellent
School Social Relationships
No Friends Few/Adequate Friends Many Friends Too Many Friends
Relationship with Teacher
Distant/Reluctant Normal Needs Closeness/Frequent Contact

Student Strengths:

RTI Meeting Summary

Tier I Review Meeting

(Meeting to review student’s program)

Date of Meeting:

Measurable Objectives- What do you plan to accomplish?
Research Based Strategies/Program:
Frequency/Duration:
Intervention Provided By:
Progress Monitoring Tool:
Resources Needed:
Provide documentation of progress check meeting with resource team:
Status: Using the assessment data collected, describe the impact of the intervention plan on this student’s learning and identify next steps:

Fidelity Statement: The above interventions were delivered with an accurate and consistent application of the three-tier district adopted Response to Intervention (RTI) system, using research-based practices, applied in a documented method over time.

Parent letter sent or parent contact has been made and information about RTI has been shared.

Date:

Meeting Notes:

Meeting Summary
Choose One:Student Met Benchmark - Interventions DiscontinuedStudent is Making Progress - Continue Tier ILack of Progress - Begin Tier II Interventions

Committee Members in Attendance

Name / Signature

***Any applicable reports, data, and or documentation are attached