Critique of the National Evaluation of Response to Intervention: A Case for Simpler Frameworks

2017 ◽  
Vol 83 (3) ◽  
pp. 255-268 ◽  
Author(s):  
Douglas Fuchs ◽  
Lynn S. Fuchs
Keyword(s):  
Response To Intervention ◽  
Universal Screening ◽  
Regression Discontinuity ◽  
First Grade ◽  
Tier 2 ◽  
Intensive Intervention ◽  
Rti Implementation ◽  
Tier 3 ◽  
Implementation Data ◽  
Research And Policy

In 2010, the Institute of Education Sciences commissioned a much-needed national evaluation of response to intervention (RTI). The evaluators defined their task very narrowly, asking “Does the use of universal screening, including a cut-point for designating students for more intensive Tier 2 and Tier 3 interventions, increase children’s performance on a comprehensive reading measure?” Their regression-discontinuity analysis showed that first-grade children designated for (but not necessarily receiving) more intensive intervention in the 146 study schools performed significantly worse than children not designated for it. There were no reliable differences between designated and nondesignated students in Grades 2 or 3. The provocativeness of these findings notwithstanding, the evaluation’s focus and design weakens its importance. RTI implementation data were also collected in the 146 study schools. These data suggest many of them were not conducting RTI in a manner supported by research and policy. Such findings and others’ evaluations of RTI advance the idea that simpler frameworks may encourage more educators to implement RTI’s most important components with fidelity.

The Effects of Response to Intervention on Literacy Development in Multiple-Language Settings

2007 ◽  
Vol 30 (3) ◽  
pp. 197-212 ◽  
Author(s):  
Angela Stephens McIntosh ◽  
Anne Graves ◽  
Russell Gersten
Keyword(s):  
Response To Intervention ◽  
Reading Fluency ◽  
Oral Reading ◽  
English Learners ◽  
Oral Reading Fluency ◽  
Literacy Practices ◽  
First Grade ◽  
Future Research ◽  
Tier 2 ◽  
Tier 1

This descriptive study documents the effects of response-to-intervention type practices in four first-grade classrooms of English learners (ELs) from 11 native languages in three schools in a large urban school district in southern California. Observations and interviews in four classrooms across two consecutive years were compared to first-grade gains in oral reading fluency ( N = 111). Reading fluency data were examined in relation to ratings of literacy practices, including the degree to which Tier 1 alone or Tier 1 plus Tier 2-type instruction was implemented. The correlation between classroom ratings on the English Learners Classroom Observation Instrument (ELCOI) and gain from pre- to posttest in first grade on oral reading fluency was moderately strong in both Year 1 ( r = .61) and Year 2 ( r = .57). The correlation between Cluster II teacher ratings and ORF gains was strong in both Year 1 ( r = .75) and Year 2 ( r = .70), suggesting a strong relationship between Tier 2-type literacy practices and end-of-first-grade oral reading fluency. Results indicated a strong correlation ( r = -.81) between the number of students below DIBELS benchmark thresholds at the end of first grade and the teacher rating on the amount of instruction provided for low performers. Followup data at the end of third grade in oral reading fluency and comprehension indicate moderate correlations to first-grade scores ( N = 51). Patterns of practice among first-grade teachers and patterns among ELs who were ultimately labeled as having learning disabilities are discussed. Educational implications and recommendations for future research are also presented.

Multitiered Systems of Supports, Response to Intervention, and Positive Behavioral Interventions and Supports

2021 ◽  
pp. 107-117
Author(s):  
Samantha Bates ◽  
LaShonda Linnen ◽  
Stephanie Columbia ◽  
Dawn Anderson-Butcher
Keyword(s):  
Response To Intervention ◽  
Social Workers ◽  
Behavioral Interventions ◽  
Evidence Based ◽  
Tier 2 ◽  
Students At Risk ◽  
Positive Behavioral Interventions ◽  
School Based ◽  
Tier 1 ◽  
Tier 3

This chapter covers the Response to Intervention framework, Positive Behavioral Interventions and Supports, and multitiered systems of supports (MTSS). The Response to Intervention framework is a central step in implementing a successful MTSS framework. MTSS delivers school-based supports across three tiers: tier 1 (universal), tier 2 (targeted), and tier 3 (individualized). The MTSS framework is a resource that enables schools to use data not only to identify students at risk for poor learning outcomes but also to monitor student progress and deliver evidence-based interventions. The chapter provides examples of ways social workers can maximize the utility of these models and school teams to improve student outcomes.

Using Regression Discontinuity to Test the Impact of a Tier 2 Reading Intervention in First Grade

2014 ◽  
Vol 8 (2) ◽  
pp. 218-244 ◽  
Author(s):  
Scott K. Baker ◽  
Keith Smolkowski ◽  
Erin A. Chaparro ◽  
Jean L. M. Smith ◽  
Hank Fien
Keyword(s):  
Reading Intervention ◽  
Regression Discontinuity ◽  
First Grade ◽  
Tier 2 ◽  
The Impact

Response to Intervention and Current Implementation

2008 ◽  
Vol 9 (3) ◽  
pp. 116-121
Author(s):  
Janet L. Proly
Keyword(s):  
Response To Intervention ◽  
Federal Regulations ◽  
Speech Language Pathologist ◽  
Current Implementation ◽  
Rti Implementation ◽  
Level Of Understanding

Abstract Response to Intervention (RTI) implementation is becoming more widespread due to the references of RTI components in the Federal Regulations. But everyone is not at the same level of understanding about RTI and its implementation. This article will answer several questions. What is RTI? Why are we hearing more and more about RTI? How are states implementing RTI components? How can the speech-language pathologist help in RTI implementation in the presence or absence of a specific RTI infrastructure? How is Florida Proceeding with RTI implementation? Are there any new resources available for principals and other educators who might want to learn more about RTI?

Optimal Timing for Launching Installation of Tier 2 and 3 Systems of School-Wide Positive Behavioral Interventions and Supports

2021 ◽  
pp. 109830072199608
Author(s):  
Angus Kittelman ◽  
Sterett H. Mercer ◽  
Kent McIntosh ◽  
Robert Hoselton
Keyword(s):  
Longitudinal Study ◽  
Behavioral Interventions ◽  
Structural Equation ◽  
Equation Modeling ◽  
Optimal Timing ◽  
First Year ◽  
Tier 2 ◽  
Positive Behavioral Interventions ◽  
Tier 1 ◽  
Tier 3

The purpose of this longitudinal study was to examine patterns in implementation of Tier 2 and 3 school-wide positive behavioral interventions and supports (SWPBIS) systems to identify timings of installation that led to higher implementation of advanced tiers. Extant data from 776 schools in 27 states reporting on the first 3 years of Tier 2 implementation and 359 schools in 23 states reporting on the first year of Tier 3 implementation were analyzed. Using structural equation modeling, we found that higher Tier 1 implementation predicted subsequent Tier 2 and Tier 3 implementation. In addition, waiting 2 or 3 years after initial Tier 1 implementation to launch Tier 2 systems predicted higher initial Tier 2 implementation (compared with implementing the next year). Finally, we found that launching Tier 3 systems after Tier 2 systems, compared with launching both tiers simultaneously, predicted higher Tier 2 implementation in the second and third year, so long as Tier 3 systems were launched within 3 years of Tier 2 systems. These findings provide empirical guidance for when to launch Tier 2 and 3 systems; however, we emphasize that delays in launching advanced systems should not equate to delays in more intensive supports for students.

scholarly journals Global Inland Capture and Culture Finfisheries Follow Different Trends When Evaluated by the Human Development Index

2021 ◽  
Vol 13 (15) ◽  
pp. 8420
Author(s):  
Peter W. Sorensen ◽  
Maria Lourdes D. Palomares
Keyword(s):  
Socioeconomic Factors ◽  
Human Development ◽  
Human Development Index ◽  
Developed Countries ◽  
Global Scale ◽  
Tier 2 ◽  
Development Index ◽  
Tier 1 ◽  
Catch Reconstruction ◽  
Tier 3

To assess whether and how socioeconomic factors might be influencing global freshwater finfisheries, inland fishery data reported to the FAO between 1950 and 2015 were grouped by capture and culture, country human development index, plotted, and compared. We found that while capture inland finfishes have greatly increased on a global scale, this trend is being driven almost entirely by poorly developed (Tier-3) countries which also identify only 17% of their catch. In contrast, capture finfisheries have recently plateaued in moderately-developed (Tier-2) countries which are also identifying 16% of their catch but are dominated by a single country, China. In contrast, reported capture finfisheries are declining in well-developed (Tier-1) countries which identify nearly all (78%) of their fishes. Simultaneously, aquacultural activity has been increasing rapidly in both Tier-2 and Tier-3 countries, but only slowly in Tier-1 countries; remarkably, nearly all cultured species are being identified by all tier groups. These distinctly different trends suggest that socioeconomic factors influence how countries report and conduct capture finfisheries. Reported rapid increases in capture fisheries are worrisome in poorly developed countries because they cannot be explained and thus these fisheries cannot be managed meaningfully even though they depend on them for food. Our descriptive, proof-of-concept study suggests that socioeconomic factors should be considered in future, more sophisticated efforts to understand global freshwater fisheries which might include catch reconstruction.

scholarly journals 23. Regional Variation in Outpatient Antibiotic Prescribing in a Commercially-insured Population, United States, 2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S12-S12
Author(s):  
Destani J Bizune ◽  
Danielle Palms ◽  
Laura M King ◽  
Monina Bartoces ◽  
Ruth Link-Gelles ◽  
...  
Keyword(s):  
United States ◽  
Otitis Media ◽  
Acute Otitis Media ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Tier 2 ◽  
Regional Variability ◽  
Patient Age ◽  
Patient Âgé ◽  
Tier 3

Abstract Background Studies have shown that the Southern United States has higher rates of outpatient antibiotic prescribing compared to other regions in the country, but reasons for this variation are unclear. We aimed to determine whether the regional variability in outpatient antibiotic prescribing for respiratory diagnoses can be explained by differences in patient age, care setting, comorbidities, and diagnosis in a commercially-insured population. Methods We analyzed the 2017 IBM® MarketScan® Commercial Database of commercially-insured individuals aged < 65 years. We included visits with acute respiratory tract infection (ARTI) diagnoses from retail clinics, urgent care centers, emergency departments, and physician offices. ARTI diagnoses were categorized as: Tier 1, antibiotics are almost always indicated (pneumonia); Tier 2, antibiotics are sometimes indicated (sinusitis, acute otitis media, pharyngitis); and Tier 3, antibiotics are not indicated (asthma, allergy, bronchitis, bronchiolitis, influenza, nonsuppurative otitis media, viral upper respiratory infections, viral pneumonia). We calculated risk ratios and 95% confidence intervals (CI) stratified by US Census region and ARTI tier using log-binomial models controlling for patient age, comorbidities (Elixhauser and Complex Chronic Conditions for Children), and setting of care, with Tier 3 visits in the West, the strata with the lowest antibiotic prescription rate, as the reference for all strata. Results A total of 100,104,860 visits were analyzed. In multivariable modeling, ARTI visits in the South and Midwest were highly associated with receiving an antibiotic for Tier 2 conditions vs. patients in other regions (Figure 1). Figure 1. Multivariable model comparing risk of receiving an antibiotic for an ARTI by region and diagnostic tier in urgent care, retail health, emergency department, and office visits, MarketScan® 2017, United States Conclusion Regional variability in outpatient antibiotic prescribing for Tier 2 and 3 ARTIs remained even after controlling for patient age, comorbidities, and setting of care. It is likely that this variability is in part due to non-clinical factors such as regional differences in clinicians’ prescribing habits and patient expectations. Targeted and enhanced public health stewardship interventions are needed to address cultural factors that affect antibiotic prescribing in outpatient settings. Disclosures All Authors: No reported disclosures

Incorporation of plasma-based next-generation sequencing to improve guideline-concordant molecular testing in patients with newly diagnosed metastatic nonsquamous non-small cell lung cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 14-14
Author(s):  
Charu Aggarwal ◽  
Melina Elpi Marmarelis ◽  
Wei-Ting Hwang ◽  
Dylan G. Scholes ◽  
Aditi Puri Singh ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Practice Change ◽  
Molecular Testing ◽  
Tier 2 ◽  
Newly Diagnosed ◽  
Next Generation ◽  
First Line ◽  
Tier 1 ◽  
Tier 3 ◽  
The Impact

14 Background: Current NCCN guidelines recommend comprehensive molecular profiling for all newly diagnosed patients with metastatic non-squamous NSCLC to enable the delivery of personalized medicine. We have previously demonstrated that incorporation of plasma based next-generation gene sequencing (NGS) improves detection of clinically actionable mutations in patients with advanced NSCLC (Aggarwal et al, JAMA Oncology, 2018). To increase rates of comprehensive molecular testing at our institution, we adapted our clinical practice to include concurrent use of plasma (P) and tissue (T) based NGS upon initial diagnosis. P NGS testing was performed using a commercial 74 gene assay. We analyzed the impact of this practice change on guideline concordant molecular testing at our institution. Methods: A retrospective cohort study of patients with newly diagnosed metastatic non-squamous NSCLC following the implementation of this practice change in 12/2018 was performed. Tiers of NCCN guideline concordant testing were defined, Tier 1: complete EGFR, ALK, BRAF, ROS1, MET, RET, NTRK testing, Tier 2: included above, but with incomplete NTRK testing, Tier 3: > 2 genes tested, Tier 4: single gene testing, Tier 5: no testing. Proportion of patients with comprehensive molecular testing by modality (T NGS vs. T+P NGS) were compared using one-sided Fisher’s exact test. Results: Between 01/2019, and 12/2019, 170 patients with newly diagnosed metastatic non-Sq NSCLC were treated at our institution. Overall, 98.2% (167/170) patients underwent molecular testing, Tier 1: n = 100 (59%), Tier 2: n = 39 (23%), Tier 3/4: n = 28 (16.5%), Tier 5: n = 3 (2%). Amongst these patients, 43.1% (72/167) were tested with T NGS alone, 8% (15/167) with P NGS alone, and 47.9% (80/167) with T+P NGS. A higher proportion of patients underwent comprehensive molecular testing (Tiers 1+2) using T+P NGS: 95.7% (79/80) compared to T alone: 62.5% (45/72), p < 0.0005. Prior to the initiation of first line treatment, 72.4% (123/170) patients underwent molecular testing, Tier 1: n = 73 (59%), Tier 2: n = 27 (22%) and Tier 3/4: n = 23 (18%). Amongst these, 39% (48/123) were tested with T NGS alone, 7% (9/123) with P NGS alone and 53.6% (66/123) with T+P NGS. A higher proportion of patients underwent comprehensive molecular testing (Tiers 1+2) using T+P NGS, 100% (66/66) compared to 52% (25/48) with T NGS alone (p < 0.0005). Conclusions: Incorporation of concurrent T+P NGS testing in treatment naïve metastatic non-Sq NSCLC significantly increased the proportion of patients undergoing guideline concordant molecular testing, including prior to initiation of first-line therapy at our institution. Concurrent T+P NGS should be adopted into institutional pathways and routine clinical practice.

scholarly journals Simultaneous Monitoring of the Middle Cerebral and Basilar Arteries to Detect Right-to-Left Shunts Using Transcranial Doppler by Agitated Saline Administration

2021 ◽  
Author(s):  
Min Kim ◽  
So Young Park ◽  
Ji Man Hong
Keyword(s):  
Transcranial Doppler ◽  
Valsalva Maneuver ◽  
Weighted Kappa ◽  
Tier 2 ◽  
Kappa Index ◽  
Evaluation Tool ◽  
Saline Administration ◽  
Basilar Arteries ◽  
Ischemic Attack ◽  
Tier 3

Abstract Transcranial Doppler (TCD) is an easy, non-invasive, and real-time monitoring device for detecting right-to-left shunts (RLS). Nonetheless, it has limited benefits in patients with poor temporal windows. Therefore, we aimed to investigate whether the basilar artery (BA) window was as effective as the middle cerebral artery (MCA) in detecting RLS during TCD monitoring. Overall, we enrolled 344 patients with stroke, transient ischemic attack, headache, or dizziness. MCA and BA were monitored using a modified headset. To investigate the feasibility of the suboccipital window in detecting RLS, we instituted an evaluation tool with three tiers to evaluate microembolic signals (MESs) during TCD monitoring. Tier 1: TCD monitoring of the MCA (bilaterally) in the resting state, tier 2: TCD monitoring of the MCA (bilaterally) while performing the Valsalva maneuver, and tier 3: TCD monitoring of the index MCA and BA while performing the Valsalva maneuver. In tiers 2 and 3, a high agreement rate of 0.8076 and 0.8068 (p<0.001), respectively, on the weighted kappa index, and a high intra-class correlation coefficient of 0.9822 and 0.9860 (p<0.001), respectively, were observed on detecting MESs. Our data suggests that the BA window is as effective as the MCA window for detecting RLS on TCD.

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