Responsiveness to Intervention in Reading

2012 ◽  
Vol 36 (1) ◽  
pp. 36-46 ◽  
Author(s):  
Joseph R. Jenkins ◽  
Ellen Schiller ◽  
Jose Blackorby ◽  
Sara Kalb Thayer ◽  
W. David Tilly
Keyword(s):  
Differentiated Instruction ◽  
Progress Monitoring ◽  
Educational Programs ◽  
Tier 2 ◽  
Model Schools ◽  
Tier 2 Interventions ◽  
Tier 1 ◽  
Individualized Educational Programs ◽  
Rti Model ◽  
Tier 3

This article describes how a purposeful sample of 62 elementary schools from 17 states implemented a Response to Intervention (RtI) framework for reading. School informants answered surveys and were interviewed about differentiated instruction in Tier 1, screening/benchmarking, where Tier 2 interventions were located, typical group size and the minutes/day of intervention in Tiers 2 and 3 groups, and how students with individualized educational programs (IEPs) in reading were served in the school’s RtI model. Schools reported using differentiated instruction in Tier 1, favored curriculum-based measures for screening/benchmarking and progress monitoring, reported more intensive interventions and more progress monitoring in Tier 3, and used a wide variety of models for serving students with IEPs within the schools’ RtI models.

scholarly journals Helping Children with Emotional Difficulties

2018 ◽  
Vol 30 (2) ◽  
Author(s):  
Lee R. Pearce
Keyword(s):  
Behavioral Interventions ◽  
Skills Training ◽  
Fifth Grade ◽  
Future Research ◽  
Tier 2 ◽  
Prosocial Skills ◽  
Tier 1 ◽  
Rti Model ◽  
Tier 3 ◽  
Rural Elementary School

This article describes a Response to Intervention (RTI) model of service delivery implemented within a rural elementary school for students in kindergarten through fifth grade experiencing significant emotional and behavioral difficulties. A multi-tiered model is presented that includes school wide interventions in Tier 1, as well as a six separate interventions applied within Tier 2 and Tier 3. These included applied behavioral analysis, social skills training, counseling,  differentiated instruction, cognitive behavioral interventions and parent involvement designed to assist identified students with improving prosocial skills. Nine children were treated within this program model over a two year period, resulting in two students being placed in special education under the category of emotional disturbance by the project’s termination. Positive and negative aspects of the project’s implementation are reviewed, along with directions for future research.  

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.

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 Initial Experience in Predicting the Risk of Hospitalization of 496 Outpatients with COVID-19 Using a Telemedicine Risk Assessment Tool

2020 ◽  
Author(s):  
James B O'Keefe ◽  
Elizabeth J Tong ◽  
Thomas H Taylor ◽  
Ghazala D Datoo O'Keefe ◽  
David C Tong
Keyword(s):  
Risk Assessment ◽  
Assessment Tool ◽  
Cox Regression ◽  
Risk Assessment Tool ◽  
Individual Risk ◽  
Tier 2 ◽  
Tier 1 ◽  
Risk Patients ◽  
Tier 3

Objective: To determine whether a risk prediction tool developed and implemented in March 2020 accurately predicts subsequent hospitalizations. Design: Retrospective cohort study, enrollment from March 24 to May 26, 2020 with follow-up calls until hospitalization or clinical improvement (final calls until June 19, 2020) Setting: Single center telemedicine program managing outpatients from a large medical system in Atlanta, Georgia Participants: 496 patients with laboratory-confirmed COVID-19 in isolation at home. Exclusion criteria included: (1) hospitalization prior to telemedicine program enrollment, (2) immediate discharge with no follow-up calls due to resolution. Exposure: Acute COVID-19 illness Main Outcome and Measures: Hospitalization was the outcome. Days to hospitalization was the metric. Survival analysis using Cox regression was used to determine factors associated with hospitalization. Results: The risk-assessment rubric assigned 496 outpatients to risk tiers as follows: Tier 1, 237 (47.8%); Tier 2, 185 (37.3%); Tier 3, 74 (14.9%). Subsequent hospitalizations numbered 3 (1%), 15 (7%), and 17 (23%) and for Tiers 1-3, respectively. From a Cox regression model with age ≥ 60, gender, and self-reported obesity as covariates, the adjusted hazard ratios using Tier 1 as reference were: Tier 2 HR=3.74 (95% CI, 1.06-13.27; P=0.041); Tier 3 HR=10.87 (95% CI, 3.09-38.27; P<0.001). Tier was the strongest predictor of time to hospitalization. Conclusions and Relevance: A telemedicine risk assessment tool prospectively applied to an outpatient population with COVID-19 identified both low-risk and high-risk patients with better performance than individual risk factors alone. This approach may be appropriate for optimum allocation of resources.

A Step-By-Step Guide to Tier 2 Behavioral Progress Monitoring

2018 ◽  
Vol 27 (1) ◽  
pp. 15-27 ◽  
Author(s):  
Allison L. Bruhn ◽  
Sara C. McDaniel ◽  
Ashley Rila ◽  
Sara Estrapala
Keyword(s):  
Data Collection ◽  
Behavioral Problems ◽  
Systematic Approach ◽  
Progress Monitoring ◽  
Tier 2 ◽  
Low Intensity ◽  
Tier 2 Interventions ◽  
Data Collection And Analysis ◽  
Method Of Measurement ◽  
Problem Solving Teams

Students who are at risk for or show low-intensity behavioral problems may need targeted, Tier 2 interventions. Often, Tier 2 problem-solving teams are charged with monitoring student responsiveness to intervention. This process may be difficult for those who are not trained in data collection and analysis procedures. To aid practitioners in these worthwhile tasks, we offer a step-by-step guide to collecting and evaluating Tier 2 behavioral progress monitoring data. This systematic approach includes (a) selecting an appropriate method of measurement, (b) planning for data collection and evaluation, (c) collecting and analyzing data, (d) considering treatment fidelity, and (e) adjusting intervention based on student responsiveness. Each step is described in detail with specific examples and additional resources are provided.

SFBT Within the Tier 2 Framework

2017 ◽  
Author(s):  
Michael S. Kelly ◽  
Johnny S. Kim ◽  
Cynthia Franklin
Keyword(s):  
Classroom Climate ◽  
Tier 2 ◽  
Social Emotional ◽  
Prevention Services ◽  
Coaching Intervention ◽  
Tier 1 ◽  
American Schools ◽  
Tier 2 Intervention ◽  
Tier 3 ◽  
Teacher Coaching

The educational policy changes of the past 20 years have increased the focus on the provision of prevention services within schools, both for individual students and for social-emotional programming delivered in their classroom. Whether characterized as Response to Intervention (RTI), Positive Behavior Intervention and Supports (PBIS), or Multi-Tiered Systems of Supports (MTSS), the focus on a 3-tier framework of universal (Tier 1), selective (Tier 2) and indicated (Tier 3) has become one of the largest evidence-based framework ever scaled up within American schools, with over 19,000 schools across all 50 states having implemented PBIS by this writing. This chapter focuses on an example of a SFBT Tier 2 intervention, the Working on What Works (WOWW) teacher coaching intervention, that strives to create a better classroom climate for teachers and their students.

Response to Intervention

2020 ◽  
Author(s):  
Evelyn S. Johnson
Keyword(s):  
Response To Intervention ◽  
General Education ◽  
Progress Monitoring ◽  
Instructional Program ◽  
Evidence Based ◽  
Tier 2 ◽  
Academic Challenges ◽  
Essential Components ◽  
Tier 1 ◽  
Tier 2 Intervention

Response to intervention (RTI) is a framework that can help ensure the academic strengths and needs of students are met effectively and efficiently. Patterned on a public health model of prevention, the focus of RTI is on preventing and intervening for academic challenges through a system of increasingly intensive supports, where the least intensive but most effective option is the most desirable. RTI models consist of the key essential components of effective inclusive instruction, universal screening, progress monitoring, data-based instructional decision-making, tiered levels of evidence-based and culturally responsive interventions, and fidelity of implementation. When the RTI framework is well implemented, most students are successful in the general education environment. In the general education classroom, teachers provide quality core, or Tier 1, instruction for all students. Even with high-quality instruction, however, not all students will be successful. Between 10 and 15% of the student population will likely need more intensive academic support at some point during their schooling, typically referred to as Tier 2 intervention. Tier 2 provides a system of evidence-based intervention, designed to meet the needs of most students at risk for poor academic outcomes. Tier 2 interventions are meant to be short in duration, focused on improving skill deficits that interfere with students’ success, and comprised of systematic approaches to providing student support. For some students whose needs cannot be met through Tier 1 or 2 instruction, an even more intensive level of intervention will be required. Tier 3 consists of specially designed interventions to support the needs of students who require a more individualized, intensive instructional program. Through this multi-leveled prevention system, the RTI framework provides supports to students that are appropriate to their needs within an environment of equity, efficiency, and accountability. With a well-structured, rigorous implementation of RTI, schooling becomes much more fluid and responsive to meet student needs.

scholarly journals Combining Tier 2 and Tier 3 Supports for Students with Disabilities in General Education Settings

2016 ◽  
Vol 2 (2) ◽  
pp. 331 ◽  
Author(s):  
K. Sandra MacLeod ◽  
Leanne S. Hawken ◽  
Robert E. O'Neill ◽  
Kaitlin Bundock
Keyword(s):  
General Education ◽  
Problem Behavior ◽  
Students With Disabilities ◽  
Problem Behaviors ◽  
Secondary Level ◽  
Tier 2 ◽  
Research And Practice ◽  
Tier 2 Interventions ◽  
Teachers And Students ◽  
Tier 3

<p>Secondary level or Tier 2 interventions such as the Check-in Check-out (CICO) intervention effectively reduce problem behaviors of students who are non-responsive to school-wide interventions. However, some students will not be successful with Tier 2 interventions. This study investigated the effects of adding individualized function-based support for four students with disabilities who were not successful in general education settings while receiving only a secondary level intervention. Results indicated that the combination of secondary and individualized function-based interventions effectively decreased problem behavior for all participants. Teachers and students rated the interventions as acceptable and effective. Research and practice implications are discussed.</p>

A Review of the Pyramidal Training Approach for Practitioners Working With Individuals With Disabilities

2017 ◽  
Vol 41 (4) ◽  
pp. 558-580 ◽  
Author(s):  
Natalie Andzik ◽  
Helen Irene Cannella-Malone
Keyword(s):  
Progress Monitoring ◽  
Tier 2 ◽  
Pyramidal Training ◽  
Individuals With Disabilities ◽  
Training Approach ◽  
Tier 1

Pyramidal training has been used for many years to expedite training for those who work with individuals with disabilities and utilizes an expert who provides training to a practitioner who then trains another practitioner to implement practices with clients. Fourteen articles were analyzed to investigate the viability of this training approach for practitioners of all types who support individuals with disabilities. Research does support the effectiveness of pyramidal training within the parameters with which it has been evaluated in this review. All Tier 1 participants made improvement; 83% of Tier 2 participants and 43% of individuals with disabilities showed improvement. Future researchers are encouraged to analyze not only the fidelity of the implementation of these practices but also the changes among the individuals with disabilities. To that end, progress monitoring is necessary to determine whether the implementation was the cause for the meaningful gains for the population being served.

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