1. Smart SRBI: Primary, Secondary and Tertiary Prevention
Doug Fuchs
Vanderbilt University
2011 CREC Leadership Network
East Windsor, CT

2. I. Two Perspectives on RTI

3. Two Perspectives: An Overview
IDEA and NCLB perspectives with implications for assessment, instruction, and disability identification
IDEA: instruction is evidence-based, standardized, and top-down. LD/BD exist. SE should have a distinctive role in RTI.
NCLB: instruction is bottom-up, driven by problem-solving, and recursive as necessary. LD/BD do not exist. Blur SE.

4. Touchstone of the IDEA View
“In determining whether a child has a specific learning disability, a local ed agency may use a process that determines if [he or she] responds to scientific, research-based intervention as part of the evaluation process” (P.L (b) (6) (A and B).

5. IDEA: RTI’s Purpose
RTI should promote both early intervention and more valid methods of disability identification. These two aims are inextricably connected.

6. IDEA: GE Instruction Evidence-based, explicit, and top-down.
Primary prevention: “research principled” core curricula and evidence-based class-wide instructional programs (e.g., DI, PALS, CIRC).
Secondary prevention: Small-group tutoring with validated standard protocols.

7. IDEA Secondary Prevention: Instruction is the “Test”
Secondary prevention (like primary prevention) should (a) accelerate the progress of at-risk students and (b) identify NRs who are candidates for multi-disciplinary team evaluation for special education.
Small-group tutoring is a test. Like all tests, the tutoring protocol should be standard, replicable, and implemented with fidelity.
Without such standardization comparing students to each other in a school is impossible.

8. Advantages and Disadvantages of the Standard Protocol
Advantages: Standard, tutoring protocols can be research-based and relatively easy to scale up.
Disadvantages: A limited number of them. Spelling? Writing? Algebra?
They can insult teachers’ and specialists’ sense of professionalism because they suggest others know more than they do about instruction.
2% to 6% of the general population do not respond to evidence-based tutoring in researcher-conducted studies.

9. NCLB View Uniformally challenging standards for all.
Assessments are aligned with standards.
Virtually all (including most SWD) participate in the assessments.
Student performance is the basis of accountability.
Standards will close the achievement gap and eliminate nearly all high-incidence SWD.
GE and SE need to merge (“blurring” SE).

10. NCLB: Problem Solving
Problem solving is the engine of instruction at the various tiers.
Multiple meanings of problem solving:
Differentiated instruction
Team collaboration (e.g. Teacher Assistance Teams, Instructional Support Teams)
Behavioral Consultation

11. Achilles Heel: Absence of Intensive Instruction
IDEA: Relies on the traditional continuum of SE placements and services; ignores the weakening of SE instruction in schools.
NCLB: SE is blurred in GE and places too much confidence in unvalidated problem solving for children with severe learning problems. I will return to this point.

12. My Bias Is An IDEA Perspective
RTI should stand for both prevention and a more valid method of disability identification.
Fewer tiers of instruction.
Standard protocols over problem solving (except at the most intensive level).
High-incidence disabilities exist
Intensive instruction (SE?) must be part of RTI.

13. II. RTI Framework: Typical Practice

14. Levels of Prevention Tiers vs. levels of prevention.
Primary, secondary, and tertiary levels.

15. Typical RTI: Primary Prevention
Instruction based on research principles
All children receive the universal, core instruction in the mainstream classroom.
Use of classwide instructional programs.
All children are screened once in early fall.
Students falling below a cut-point are identified as “at-risk” for academic failure and move to secondary prevention.

16. Typical RTI: Secondary Prevention
Secondary prevention: Research-validated standard treatment (tutoring) protocol.
Students’ progress is monitored during tutoring.
“Dual-discrepancy” criteria, or other criteria, help identify non-responders.
Responders return to classroom instruction with ongoing monitoring.

17. Example of Secondary Prevention in Nashville
~ In 42 First-Grade Classes in 10 Metro-Nashville Schools ~

18. Tutoring Overview Small groups (groups of two to four students)
4 times per week outside classrooms
Each session:
45 min of tutor-led scripted instruction
10 minutes of sight words practice
5 minutes of letter sounds practice
15 minutes of decoding practice
15 minutes of reading fluency practice

19. Tutoring Lesson
Steps included in the Sounds, Sight Words, and Decodable Words activities:
Introducing new sound or word
Choral practice
Individual practice
2 opportunities to produce correct sounds or words
Writing practice
Reading activities
Choral reading of previous story
Echoing the tutor, one line at a time
Choral reading of story
Choral reading of new story
Choral reading of story
Individual speed reading
Each student reads new story 3 times, for 30 seconds
Opportunity to earn incentives for increasing reading fluency

20. Topic Mastery/Review Mastery of the topic was assessed each day.
If every student in the group achieved mastery of sight words on the first day of that set, the group moved to the next set on the following day.
Each student had two trials to master sight words during the session.
The group progressed to the next set regardless of mastery status after two sessions on the same set.
To ensure that the group would be able to cover more words and sounds

21. Sequence of Sounds and Words

22. Sequence of Sounds and Words

23. Sequence of Sounds and Words

24. Tutoring Fidelity Checklist

25. Typical RTI: Tertiary Prevention
NRs to secondary prevention either stay there despite poor progress, or they move to tertiary (SE), which often means back to GE with accomodations/modifications.
NLTS: 40% of teachers of LD students do not know students’ instructional needs; 11% of these students get modifications.
NLTS: Majority of high school LD students 3 or more grade levels behind.

26. III. Challenges to Typical RTI Practice

27. Challenges for Primary Prevention
Curricula are based on principles from research; not research-validated.
Quality control at district level in choice of curricula.
Professional development.
One-stage screening for “at-risk” produces too many false positives.

28. Challenges for Secondary Prevention
Too many children.
Quality control of choice of tutoring protocols.
Professional development for tutors.
Duration of secondary prevention.
Must all students with severe learning problems pass thru secondary or should they proceed directly to tertiary prevention?

29. Challenges for Tertiary Prevention
The “blurring” of special education.
Modifications and accommodations are not intensive enough for children with severe learning problems.
Millions of SWD are not learning. (NLTS-1 and NLTS-2.)

30. IV. A Primer on CBM
Teachers assess students’ academic performance, using brief measures.
Each alternate form of the CBM test assesses performance on a measure of what is expected by end of year.
The CBM score is viewed as an indicator of overall performance.
Major RTI purposes
To designate risk (measured on 1 occasion near beginning of the year)
To describe rate of response to instruction (measured weekly on alternate forms, with a slope of improvement calculated)

31. What We Look For in CBM INCREASING SCORES:
Student is responding to the instructional program.
FLAT SCORES:
Student is not responding to the instruction program.

32. Sarah’s Progress on Words Read Correctly
Sarah Smith
Reading 2
Words Read Correctly
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May

33. Jessica’s Progress on Words Read Correctly
Jessica Jones
Reading 2
Words Read Correctly
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May

34. CBM Indicators of Reading Competence
Kindergarten: Letter-Sound Fluency
Grade 1: Word-Identification Fluency
Grades 2-3: Passage Reading Fluency
Grades 4-6: Maze Fluency

35. Kindergarten Letter-Sound Fluency
Teacher: Say the sound that goes with each letter.
Time: 1 minute
p U z u y
i t R e w
O a s d f
v g j S h
k m n b V
Y E i c x …

36. Grade 1 Word-Identification Fluency
Teacher: Read these words.
Time: 1 minute.
two
for
come
because
last
from
...

37. Grades 2-3 Passage Reading Fluency
Number of words read aloud correctly in 1 minute on end-of-year passages

38. CBM passage for Correct Words Per Minute
Jason Fry ran home from school. He had to pack his
clothes. He was going to the beach. He packed a swimsuit and
shorts. He packed tennis shoes and his toys. The Fry family was
going to the beach in Florida.
The next morning Jason woke up early. He helped Mom
and Dad pack the car, and his sister, Lonnie, helped too. Mom and
Dad sat in the front seat. They had maps of the beach. Jason sat in
the middle seat with his dog, Ruffie. Lonnie sat in the back and
played with her toys.
They had to drive for a long time. Jason looked out the
window. He saw farms with animals. Many farms had cows and
pigs but some farms had horses. He saw a boy riding a horse.
Jason wanted to ride a horse, too. He saw rows of corn growing in
the fields. Then Jason saw rows of trees. They were orange trees.
He sniffed their yummy smell. Lonnie said she could not wait to
taste one. Dad stopped at a fruit market by the side of the road.
He bought them each an orange.
CBM passage for Correct Words Per Minute

39. CBM Passage Reading Fluency
Not interested in making kids read faster
Interested in kids becoming better readers
The CBM score is an overall indicator of reading competence
Students who score high on CBM
Are better decoders
Are better at sight vocabulary
Are better comprehenders
Correlates highly with high-stakes tests

40. Grades 4-6 Maze Fluency
Number of words replaced correctly in 2.5 minutes on end-of-year passages from which every 7th word has been deleted and replaced with 3 choices

41. Computer Maze

42. CBM Indicators of Math Competence
At each grade level, the items on the test systematically sample the skills expected for mastery at the end of the year.

49. V. Smart Primary and Secondary Prevention

50. Smart Primary Prevention: Identifying At-Risk Students
All students are tested once in the fall.
Students scoring below a cut-score are designated at risk.
For these at-risk students, response to GE is monitored using CBM.

51. Smart Primary Prevention: Finding At-Risk Students
Administer weekly CBM to all at-risk students for 5 weeks.
At end of 5 weeks, identify children whose slope (rate of improvement) is inadequate.
These students enter Tier 2.

52. Smart Secondary Prevention: The Non-Responders
Dual Discrepancy: Slope and Level
Administer weekly CBM to tutored students each week during Tier 2 tutoring.
At end of tutoring, identify children whose slope (rate of improvement) and final level are inadequate.
These students receive the multi-disciplinary evaluation.

53. VI. Smart Tertiary Prevention

54. “Preventing” What?
In health care, what is your internist trying to prevent?
What are we trying to prevent by using RTI?
SE referrals and placements?
Or, dropping out of school, unemployment, incarceration, poor health…?
We need a “unified” approach to RTI, that includes a reformed GE and SE, to increase all children’s quality of life.

55. Smart Tertiary Prevention
Tertiary Prevention: Individualized, Data-based, Recursive
Non-responders to secondary prevention are evaluated by a multidisciplinary team and are identified for SE.
Tertiary prevention:
Student goals are individualized and ambitious.
Progress monitoring is used to “formatively” (or “recursively”) develop effective programs.
Progress monitoring is used to determine whether and when students meet benchmarks and should re-enter secondary or primary prevention

56. Smart Tertiary Prevention
Comprehensive service delivery like Gawande’s “full spectrum” health care.
Schools implementing RTI need specialists with expertise, not generalists, to make it work.

57. Determine Whether Grade-Level Material is Appropriate for PM at Tertiary Prevention
1. Administer three passages at grade level:
Fewer than 10 correct words, use Word Identification Fluency
Between 10 and 50 words, but less than 85–90% correct, move to next lower level of test and administer three passages at this level
2. Maintain appropriate level for entire year.
For Passage Reading Fluency (PRF) and Maze Fluency, teachers should use CBM passages written at the student’s current grade level. However, if a student is well below grade-level expectations, he or she may need to read from a lower grade- level passage. (Lower grade-level passages are often used during secondary and tertiary prevention.) To find the appropriate CBM reading level, follow these steps:
Determine the grade level text at which you expect the student to read competently by year’s end.
Administer three passages at this level. Use generic CBM PRF passages, not passages that teachers use for instruction. If the student reads fewer than 10 correct words in 1 minute, use the CBM Word Identification Fluency measure instead of CBM PRF or CBM Maze Fluency for progress monitoring. If the student reads between 10 and 50 correct words in 1 minute but less than 85–90% correct, move to the next lower level of text and try three passages. If the student reads more than 50 correct words in 1 minute, move to the highest level of text where he/she reads between 10 and 50 words correct in 1 minute (but not higher than the student’s grade-appropriate text).
Maintain the student on this level of text for the purpose of progress monitoring for the entire school year.

58. Format of CBM Goal Setting
Set An Ambitious Goal
Format of CBM Goal Setting
Current Performance Level
Given passages representing 3rd-grade material, Kelsey reads 43 words correct in 1 minute.
Goal
Given passages representing 3rd-grade material, students will read 100 words correct in 1 minute.
Objective
Each week, given passages representing 3rd-grade material, students will read 2 additional words correct in 1 minute.

60. CBM Goal Setting: Three Options
Norms for end-of-year performance
Norms for weekly rate of improvement (slope)
Intra-individual framework
There are three options for setting IEP goals. The first option uses end-of-year benchmarking. The second option uses an intra-individual framework. The third option uses national norms for weekly rate of improvement. Let’s look at these three options in more detail now.

61. Setting IEP Goals: Norms for End-of-Year Performance
Identify appropriate end-of-year grade-level norm.
Mark end-of-year norm on student graph with an X.
Find median of first 3 CBM scores.
To draw goal line, connect median with X.
The first option is end-of-year benchmarking. For typically developing students at the grade level where the student is being monitored, identify the end-of-year CBM benchmark. This is the end-of-year performance goal. The benchmark is represented on the graph by an X at the date marking the end of the year. A goal-line is then drawn between the median of at least the first three CBM graphed scores and the end-of-year performance goal.

62. Setting IEP Goals: Norms for End-of-Year Performance
Grade
Reading
Computation
Concepts and
Applications
Kindergarten
40 sounds/minute (LSF)
---
Grade 1
60 words/minute (WIF)
20 digits
20 points
Grade 2
75 words/minute (PRF)
Grade 3
100 words/minute (PRF)
30 digits
30 points
Grade 4
20 replacements/2.5 minutes
(Maze)
40 digits
Grade 5
25 replacements/2.5 minutes
15 points
Grade 6
30 replacements/2.5 minutes
35 digits
Here are the end-of-year benchmarks.
Note: These figures may change pending additional research.

63. Sam’s Case Study
Sam developed sizeable reading deficits in by the end of 2nd grade. In 3rd grade, he was identified as having a reading disability.
His tutor, Mrs. Hayes, implemented the Orton program but with limited success. His weekly CBM performance demonstrated inadequate slope and inadequate final level.
Mrs. Hayes concluded that Sam’s response to the validated, standard tutoring protocol was inadequate and that he required an individualized program.
Given his large reading deficits, Mrs. Hayes set his IEP goal as competent 2nd-grade performance at the end of 3rd grade.
Rationale: The 2nd-grade curriculum is similar to the 3rd-grade reading curriculum, but includes less challenging reading skills that create a basis for learning harder, third-grade reading skills.

64. Sam’s Case Study
Mrs. Hayes used CBM to slowly build an effective individualized reading program.
She began with Orton, but conducted sessions twice daily, each time for 30 minutes, on a 1:1 basis.
She also implemented CBM. Each weekly test of passage reading fluency assessed overall competence in the 2nd-grade reading curriculum.
Each weekly score was an overall indicator of reading competence at 2nd grade.

65. Passage Reading Fluency
Number of words read correctly in 1 minute

67. CBM Decision-Making Framework
Trend-Line Rule
If 4 weeks of instruction have occurred AND at least 8 data points have been collected, draw a trend line through most recent 8 scores. Compare this trend line against the goal line.
If trend line is steeper than goal line, raise goal.
If trend line is less steep than goal line, make a teaching change.

68. What Is the Data-Based Decision Rule?G T
Make an instructional change.

70. Most important aspect of CBM:
Use Goal to Monitoring Progress and Formatively Evaluating the Instructional Program: Enhancing Student Outcomes
Most important aspect of CBM:
USE THE DATA!!!
We don’t throw out the base program but we build upon it.
The following instructional elements may be altered to enhance student performance:
Instructional components
Size of instructional group
Time allocated for instruction
Materials used
Reinforcement

72. Sam: Time to Make A Change
Change baseline to 30, 34, 28
Initial instruction phase to 30, 35, 28, 32, 40, 35, 31
Goal of 90

73. Sam
To determine the nature of the instructional change for Sam, Mrs. Hayes conducts a Quick Miscue Analysis during Sam’s next CBM testing.
The Quick Miscue Analysis represents one strategy for conducting a diagnostic analysis of Sam’s reading strategies and gaining insight into productive directions for supplementing the Orton program and for building Sam’s individualized program.
Jonah is in 2nd grade. His CBM oral reading fluency data are lower than his classmates’ with scores of 30, 35, 28, 32, 40, 35 and 31 during initial instruction (teacher-directed, whole-class instruction with smaller reading groups two days weekly).
Last reading probe: score of 31
Analyze miscues:

74. Larry was very excited! His father 6
had just brought home a new puppy. Larry’s 14
brother and sister were going to be very
surprised, too
The little puppy was black and brown 31
with a few white patches. Her ears were long 40
and floppy. Her tummy nearly touched the 47
ground. Dad said this dog was a beagle
Larry thought their new dog was cute. 62
He couldn’t decide what he wanted to name 70
saw him (T provided)
our b
mother was much
sorpray
pup blue
for much His hair was
funny teeth were torn
growl our puppy boy

75. was saw no yes very him excited ----- just our brought b minimal
Word Written
Word Spoken
Grapho-phonemic
Syntax
Semantics
was
saw no
yes
very
him
excited
-----
just
our
brought b
minimal
brother
mother
were
much
surprised
sorpray
puppy
pup
Quick Miscue Analysis
30%
50%

76. Sam’s Instructional Change
Given Sam’s inadequate reliance on the semantics of the passage, Mrs. Hayes decides to introduce a tape recorder activity, whereby Sam will monitor semantic miscues in his own reading.
Given Sam’s poor use of grapho-phonemic strategies during his reading of the passage, Mrs. Hayes decides to conduct a diagnostic assessment of Sam’s decoding skills.

77. Decoding Battery 60 nonsense words Ordered from easiest
Basals and ceilings
6 words for each of 10 decoding skills
Mastery criterion for each skill, at each grade
Student reads from paper
Teacher marks on computer, which prompts teacher re. basals/ceilings
Computer
Codes each word as right/wrong
Sorts words into 10 skills
Applies mastery criteria
Identifies 2 nonmastered skills at lowest point in developmental sequence

79. Sam’s Instructional Change
With the results of the diagnostic decoding assessment in hand, Mrs. Hayes decides to target vowel teams for intensive review in and out of contextualized reading.
This emphasis along with the tape recorder activity are added to the Orton program.

81. Sam’s Next Instructional Change
After 7 additional weeks with this instructional modification, Sam increases his rate of improvement but his trend line remains less steep than his goal line.
Mrs. Hayes decides to introduce a systematic reinforcement program to reward on-task behavior and accurate work during tutoring.

82. In This Way …,
Mrs. Hayes continues this iterative process over time, using the data to formatively design an individualized program that works for Sam.
Experimental studies show that when teachers use CBM in this way, they plan more differentiated and effective instruction for students with severe learning problems.

83. Effect Sizes for CBM
Effect Size
Reading
Math
Spelling
Domain

84. Websites Worth Visiting
RTI4success.org
Progressmonitoring.org

85. Contact Information or