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Duval County Public SchoolsParentally Placed Private School Student OfficeRTI PacketAttached here are the “RTI Forms” to help guide the information necessary to determine eligibility for Specific Learning Disabilities according to I.D.E.A. (The Individuals With Disabilities in Education Act). Keep in mind there are no federal/state specific “forms,” but these forms were designed to help capture what is necessary in the RTI process and ultimately for SLD Eligibility Determination. Included here is:?The Response To Intervention (RTI) Checklist of Documentation needed for SLD eligibilityOn this form, we need to show 3 Tiers of intervention (Tier 1 just being the grade-level curriculum that everyone gets, while Tier 2 and Tier 3 are more individualized/prescriptive), how frequently they are happening (no set number, but typically Tier 2 is about an hour per week, and Tier 3 is about another hour per week, give or take), and showing that the interventions are aligned (for eligibility, we're determining a SPECIFIC disability. More importantly...if you focus Tier 2 and Tier 3 on the same Foundational Skill Deficit?Area (sight words or phonics or fluency or comprehension), you'll get more bang for your buck - ?RTI?will be more successful and it's more straightforward. Typically, RTI should focus on the most foundational skill deficit area, and the paperwork should reflect this focus.?2) DCPS Observation forms (2) - These don't have to be on these forms, but we do need 2 observations from 2 different professionals at the school (helps to show the state that various educational professionals have noted the problem).?Ideally, we should have 1 observation PRE-interventions, and one POST-interventions, but certainly we would want one earlier in the process and one later in the process.We also need Progress Monitoring Data. Progress Monitoring is required but requires no specific “form.” Usually it is in the form of a graph. There is no specific "form" for progress monitoring, but it does typically need to be graphed showing the expectation and how the child is growing week to week. For instance: if the focus in sight-word?recognition for a 1st grader, and the # of Dolch words at the end of 1st grade is 100 Dolch words, then week to week you could measure how that student is growing (23 words one week, 26 the next week, 30 the next week....), which is easy to graph. The idea is that progress monitoring should be a?quick and easy measure of the skill set you're addressing in intervention. ?For questions or concerns, please contact our office at 904-348-7889, or email our DCPS School Psychologist, Robert Poole, M.S. Ed., P.D, at pooler@Thank you,Rhonda Giffin, M.Ed.PPPSS Admissions SpecialistParentally Placed Private School Student OfficeExceptional Student Education Services(904) 348-7889Response To Intervention (RTI) Checklist of Documentation needed for SLD eligibilityStudent name/number: ________________________________________ Grade: ___________Area of concern that RtI has focused on (CHOOSE ONE, Mark with “X,” and stay focused in that area):Reading: FORMCHECKBOX Sound/Letter Correspondence FORMCHECKBOX Sight Word Recognition FORMCHECKBOX Phonics FORMCHECKBOX Fluency FORMCHECKBOX ComprehensionMath: FORMCHECKBOX Math Calculation FORMCHECKBOX Applied Math/Math Problem Solving Writing: FORMCHECKBOX Written ExpressionLanguage: FORMCHECKBOX Phonological Processing FORMCHECKBOX Social Interaction FORMCHECKBOX Oral Expression FORMCHECKBOX Listening Comprehension Tier 1 (Core): Core Curriculum core curriculum in area of concern (reading block, math block, etc.)Whole-Group Core Curriculum (reading or math)Teacher in area of concernMinutes per day in Tier 1 in area of concernDate Student Enrolled this current yearDescribe Progress in Tier 1:Tier 2 (Targeted)-small group instruction/interventions beyond the core (on-going)Tier 2 Instruction: Materials &/or ProgramImplemented ByDuration &Frequency # of minutes & # of days/wkStart DateEnd DateBrief Description ofProgress ResultsTier 3 (Intensive) - individualized instruction/interventions beyond core (on-going)Tier 3 Instruction: Materials &/or ProgramImplemented ByDuration &Frequency Minutes &# of SessionsStart DateEnd DateBrief Description ofProgress ResultsStudent’s Progress/Response to Interventions: FORMCHECKBOX Not making consistent or adequate progress FORMCHECKBOX Making progress, but is still below grade level and needs intensive interventions FORMCHECKBOX Made excellent progress/on or near grade level/interventions can be implemented in the gen ed classroomAttach: FORMCHECKBOX Observation #1 (from teacher or school administrator, pre-intervention) FORMCHECKBOX Observation #2 (from teacher or school administrator, post-intervention) FORMCHECKBOX PROGRESS MONITORING Graph: Showing student’s response/weekly progress monitoring (copy/copies) in the SPECIFIC area of concern.1st Student Observation (Pre-Observation)Observations must be conducted during the time of the student’s learning or behavioral concern.)Observation Date: FORMTEXT ?????Student NameStudent NumberGradeDOBSchool Name and Number FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????OBSERVATION SUMMARY: FORMCHECKBOX Pre-intervention FORMCHECKBOX Post-intervention Observer Name/Position: FORMTEXT ?????Subject area: FORMTEXT ?????Start Time: FORMTEXT ?????End Time: FORMTEXT ?????Class Activity FORMCHECKBOX Teacher directed whole class FORMCHECKBOX Teacher directed small group FORMCHECKBOX Independent work session FORMCHECKBOX Other: Directions: Place a (√) beside the problem behaviors that were observed during this observation. ACADEMIC ENGAGEMENTATTENTION/ORGANIZATIONSOCIAL/BEHAVIORAL FORMCHECKBOX Difficulty beginning/completing tasks FORMCHECKBOX Does not follow classroom rules FORMCHECKBOX Needs constant reassurance FORMCHECKBOX Gives up easily FORMCHECKBOX Does not comply to teacher direction FORMCHECKBOX Cries/pouts/sulks FORMCHECKBOX Reverses/confuses letters, words, numbers FORMCHECKBOX Talks out excessively FORMCHECKBOX Acts frightened timid/shy FORMCHECKBOX Does not participate in discussion/activity FORMCHECKBOX Disorganized desk and work materials FORMCHECKBOX Withdrawn FORMCHECKBOX Does not turn in assignments FORMCHECKBOX Difficulty transitioning between tasks FORMCHECKBOX Avoided or rejected by peers FORMCHECKBOX Requires teacher prompting to work FORMCHECKBOX Short attention span FORMCHECKBOX Clings to teachers or others FORMCHECKBOX Excessively seeks others’ assistance FORMCHECKBOX Fidgets with objects FORMCHECKBOX Nervous/excitable FORMCHECKBOX Does not ask for assistance FORMCHECKBOX Stares blankly/seemingly daydreams FORMCHECKBOX Argumentative FORMCHECKBOX Out of seat or assigned work area FORMCHECKBOX Acts impulsively FORMCHECKBOX Loses temper FORMCHECKBOX Picks on othersLANGUAGE/ARTICULATIONPHYSICAL CONCERNS FORMCHECKBOX Physically aggressive toward others FORMCHECKBOX Difficulty understanding written direction FORMCHECKBOX Seems tired/lethargic FORMCHECKBOX Swears/uses profanity FORMCHECKBOX Difficulty understanding oral direction FORMCHECKBOX Makes physical complaints FORMCHECKBOX Changes moods rapidly FORMCHECKBOX Difficulty understanding student’s speech FORMCHECKBOX Poor fine motor coordination FORMCHECKBOX Talks disrespectfully to others FORMCHECKBOX Difficulty answering questions verbally FORMCHECKBOX Poor gross motor coordination FORMCHECKBOX Damages property FORMCHECKBOX Poor use of grammar/vocabulary FORMCHECKBOX Fidgets/squirms FORMCHECKBOX Disrupts activities/learning environmentNARRATIVE OF OBSERVATION: FORMTEXT ?????2nd Student Observation (Post-Observation)Observations must be conducted during the time of the student’s learning or behavioral concern.)Observation Date: FORMTEXT ?????Student NameStudent NumberGradeDOBSchool Name and Number FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????OBSERVATION SUMMARY: FORMCHECKBOX Pre-intervention FORMCHECKBOX Post-intervention Observer Name/Position: FORMTEXT ?????Subject area: FORMTEXT ?????Start Time: FORMTEXT ?????End Time: FORMTEXT ?????Class Activity FORMCHECKBOX Teacher directed whole class FORMCHECKBOX Teacher directed small group FORMCHECKBOX Independent work session FORMCHECKBOX Other: Directions: Place a (√) beside the problem behaviors that were observed during this observation. ACADEMIC ENGAGEMENTATTENTION/ORGANIZATIONSOCIAL/BEHAVIORAL FORMCHECKBOX Difficulty beginning/completing tasks FORMCHECKBOX Does not follow classroom rules FORMCHECKBOX Needs constant reassurance FORMCHECKBOX Gives up easily FORMCHECKBOX Does not comply to teacher direction FORMCHECKBOX Cries/pouts/sulks FORMCHECKBOX Reverses/confuses letters, words, numbers FORMCHECKBOX Talks out excessively FORMCHECKBOX Acts frightened timid/shy FORMCHECKBOX Does not participate in discussion/activity FORMCHECKBOX Disorganized desk and work materials FORMCHECKBOX Withdrawn FORMCHECKBOX Does not turn in assignments FORMCHECKBOX Difficulty transitioning between tasks FORMCHECKBOX Avoided or rejected by peers FORMCHECKBOX Requires teacher prompting to work FORMCHECKBOX Short attention span FORMCHECKBOX Clings to teachers or others FORMCHECKBOX Excessively seeks others’ assistance FORMCHECKBOX Fidgets with objects FORMCHECKBOX Nervous/excitable FORMCHECKBOX Does not ask for assistance FORMCHECKBOX Stares blankly/seemingly daydreams FORMCHECKBOX Argumentative FORMCHECKBOX Out of seat or assigned work area FORMCHECKBOX Acts impulsively FORMCHECKBOX Loses temper FORMCHECKBOX Picks on othersLANGUAGE/ARTICULATIONPHYSICAL CONCERNS FORMCHECKBOX Physically aggressive toward others FORMCHECKBOX Difficulty understanding written direction FORMCHECKBOX Seems tired/lethargic FORMCHECKBOX Swears/uses profanity FORMCHECKBOX Difficulty understanding oral direction FORMCHECKBOX Makes physical complaints FORMCHECKBOX Changes moods rapidly FORMCHECKBOX Difficulty understanding student’s speech FORMCHECKBOX Poor fine motor coordination FORMCHECKBOX Talks disrespectfully to others FORMCHECKBOX Difficulty answering questions verbally FORMCHECKBOX Poor gross motor coordination FORMCHECKBOX Damages property FORMCHECKBOX Poor use of grammar/vocabulary FORMCHECKBOX Fidgets/squirms FORMCHECKBOX Disrupts activities/learning environmentNARRATIVE OF OBSERVATION: FORMTEXT ????? ................
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