Response to Intervention Falls Short

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Last year we wrote about how RTI (Response to Intervention) was being used by some schools to delay, or even prevent, students from being evaluated for special education services (Gatekeeping 101: Response to Intervention). Now it appears that even when used as intended, RTI isn’t achieving the goals that educators promised.

In this followup article, we highlight a recent study sponsored by the U.S. Department of Education that details how students receiving RTI instruction are actually falling further behind grade level rather than catching up. We also have some suggestions about how to proceed if your child is offered RTI instead of special education services.

The Background

RTI was written into the reauthorization of IDEA (the Individuals with Disabilities Education Act) in 2004 as part of an attempt to make the goals of IDEA, which address the unique needs of individual students, more closely conform to the No Child Left Behind Act, which attempts to raise standards for all students uniformly.

Our earlier article explains how the intent of RTI was to screen every student at the elementary school level (ideally in kindergarten or first grade) to identify those who were struggling and, through a standardized series of increasingly more supportive services called “tiers,” bring them up to grade level in basic skills like reading and math. Rather than use the program as it was intended, however, we documented how some schools were using RTI to divert students away from becoming eligible for individualized (and more expensive) special education services.

“Practice Falls Short of Promise”

Adding to our concern about the misuse of RTI as a substitute for special education has come even more discouraging news from a 2015 study sponsored by the U.S. Department of Education that evaluated RTI practices as they are applied to elementary school reading instruction. As described in an article in Education Week magazine, this study examined over 20,000 students in 13 states and found that first grade students who received RTI actually performed worse than a similar peer group that did not. Instead of catching up to grade level, the students receiving RTI lost the equivalent of one-tenth of a school year. To quote one of the study’s authors: “[T]his turns out to be what RTI looks like when it plays out in daily life.”

Why is it Failing?

The Education Week article offers a few insights into what is going wrong:

  • Schools are using RTI “as a kind of general education substitution for special education.” This was the concern we highlighted in our earlier article on special education gatekeeping.
  • Schools are not adequately evaluating students for learning disabilities before initiating an RTI program. Many schools don’t perform any evaluations prior to RTI and therefore don’t know if the interventions they are using are even suitable for the students they are attempting to help.
  • Schools implementing RTI are not clearly separating the broader goals of general education instruction and the more narrowly focused goals of RTI instruction, implying a confusion as to what the program is actually trying to achieve.
  • The RTI instruction in the study was found to be rigid and standardized for all students. In looking at RTI for reading, for example, the study found that the instruction focused on phonics and not reading comprehension, regardless of the individual student’s needs.

In short, RTI, for all its good intentions, is a only a theory without empirical validation. It remains to be seen if this is because the program is inappropriately designed, or if schools are unable or unwilling to implement it appropriately.

What Can You Do?

Like the school we wrote about in our previous article on RTI and gatekeeping, if you are told that your child must first try RTI before the school will consider an evaluation for learning disabilities and special education, consider the following:

  • Very few states have defined any criteria for moving from RTI into special education. If you want to try RTI first, get a written statement from your school describing the criteria for transitioning from RTI to special education. This should include a timeline of how long RTI will be attempted, a definition of the progress expected, and what objective and measurable standards will be used to measure that progress.
  • If you do not feel that RTI is appropriate for your child, it is your right to request an evaluation for eligibility for special education in all areas in which you suspect a disability. The regulation is 34 CFR § 300.309(c), the authorizing statute is 20 USC § 1412(a)(3). The only requirement is that your request must be in writing. The Office of Special Education Programs (OSEP) has warned schools that they must not use RTI to delay or deny “a full and individual evaluation” for special education eligibility.
  • RTI is not a way to diagnose a specific learning disability. You may learn important information about your child through the RTI process, but only an appropriate evaluation performed by a qualified professional can determine the presence of a qualifying disability.
  • RTI and special education are not mutually exclusive. The school can evaluate your child for a learning disability at the same time that your child is receiving RTI instruction. There is an excellent guide for parents on the Wrightslaw website that explains the RTI process in more detail.

As with every other aspect of special education, you need accurate and objective information about your child’s strengths and weaknesses provided by an evaluation. Even though RTI instruction may be high quality and research-based, can it meet your child’s unique needs? Meeting these needs through an individualized education program is your child’s right under IDEA.

Judith Canty Graves and Carson Graves

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157 thoughts on “Response to Intervention Falls Short

  1. Pingback: Response to Intervention Falls Short | Dyslexia...

    1. Carson Graves Post author

      Thanks to everyone for your interest and comments. As a general reply, we would like to point out that we are reporting on a US Department of Education sponsored study and an interpretation of that study in Education Week magazine, a publication geared toward education professionals. We encourage everyone to follow the links provided in our post to both the study and the Education Week article. Any answers to questions about methodology and conclusions can be found in these links as well as comments by the study’s authors and other professionals.

      We are happy to hear that there are schools successfully implementing RTI, but as the study points out these are in the minority. And, as we make clear, RTI is not a substitute for special education evaluations and services, as the OSEP advisory we link to emphasizes. This reinforces our belief in the importance of educating parents so that they can be more effective advocates for their children with learning disabilities, both in our book, “Parents Have the Power to Make Special Education Work” and our blog.

      1. A.M.

        One of the problems is that there are not enough school psychologists, speech/ language pathologist, occupational therapists, etc. to evaluate students. In many states, there is a shortage of these staff to evaluate. The districts can’t find qualified people to evaluate these students and provide services. Many districts also do not see these as necessary positions. The people working in these positions are burning out and going to hospitals to work. The amount of paperwork and legal practices that are required by law to identify a student also makes the process longer. Many lawsuits have also lead to increased paperwork. If you want to make a change, start with changing laws to make it easier to identify students and provide more funding to districts to complete these evaluations. It might also be helpful to encourage college students to go into these professions to help with the shortage. Districts should support people in these positions better so they do not leave. Parents can request an evaluation, but there might be no one qualified in the district to complete it or do the interventions.

        1. Sondra Terry

          Excellent point. Thank you.

          As a school psychologist I am perceived as a testing machine and gatekeeper. There is a lack of respect shown when a child does not qualify. We can make more money outside of the school setting. The same is true with Speech Language Pathologist and Occupational and Physical Therapist. A great deal of our time is spent typing reports and attending meetings before and after we are on the clock. During my work hours I am a testing machine. Who would want to do this job? Every child needs to be tested ASAP. This one is an emergency I am often told. But when i have a meeting a say Johnny does not qualify because there is no discrepancy between his IQ and achievement people are angry at me. 77 IQ is low and his achievement scores in all areas is in the 75 to 82 range they question my tests. Yet all want to keep the old discrepancy model and not provide Johnny with interventions.

          1. Nory

            I could not agree with you more! But to take this one step further, there seems to be a notion that the child with the 77 IQ and achievement scores in the 75 to 82 range will somehow “magically” become a child with a 135 IQ with enough time and intervention, and that just aint so! No Child Left Behind has created a monster for schools and certain segments of “underachieving” students who, frankly, will NEVER be able to show AYP on a consistent basis. And I think it is a SIN to test them to brink, and then punish the district for things that are largely beyond anyone’s control.

          2. Ladonna

            It is my understanding that a child can have a high IQ AND be dyslexic. Dyslexic children need services. If a high IQ is the basis for turning down services to a dyslexic child, then I understand a parents resentment and frustration at not only the tester (you are the “face” of the denial) and the school district/law makers. Dyslexic students need services to reach their full potential. They deserve and should be entitled to programs that teach them to read. And yes, I mean at the tax payers expense.

        2. Anne

          However, even if you have the necessary personnel, there may be other obstacles. I’m a substitute teacher and had several long term assignments this year where I could identify some learning disabilities just from experience and was told that a student could not be tested until they were 2 years behind grade level! That was utterly shocking! One of the students I’m positive was dyslexic and in first grade. To have to wait until he would be in third or fourth grade before identification was frustrating to me. He will be so very far behind by then and the psychological damage is done. Something needs to change.

          1. Jane Strauss,BSEd, MAPA, JD

            This is, unfortunately, not a new problem. When I was a student teacher back in the early 80s, I was told there were no funds to evaluate students by midyear. And some of the students I was quite sure were dyslexic and FAR behind grade level (10th and 11th grade reading at best, at 3rd grade level) had not been evaluated yet and probably never were.

        3. Nichole Yoch

          I concur with this comment about not enough staff to meet the demands of the evaluation process. In addition, the professionals that are used to screen these students also have a caseload of students to treat and are not able to serve these students as required because they are in meetings for IEPS and screening results. I would like to add that as a teacher, I have never been properly trained on how to implement the RTI process. I know that I am not the only teacher in this situation. I would love to see the data of the schools included in this article and compare the amount of professional development those teachers received on the RTI process.

          1. Sondra Terry

            You are correct in training. It is not meant to be hard or a process or more time. The evaluation actually happens faster if implemented correctly. I have been in two A schools that had ongoing training each year and easy and all staff on board with implementing. It was amazing. I actually never evaluated a child that did not qualify and was not swamped. Interventions work!

      2. Michelle Porter

        My gifted daughter is in RTI. An an involved parent I had her evaluated at my own expense and she was identified as being dyslexic just like her father. I requested a meeting and presented my information. At the meeting I was told she is benchmarking even though I was previously told she was below grade level. There was no regard to the evaluation stating she is dyslexic. For a gifted student to not read at grade level I would expect educators to see the red flag here. Nothing is being done so my poor girl will spend her summer with a private tutor to bring her to grade level.

        1. Sondra Terry

          Unfortunately few states recognize dyslexia as a disability or properly treat it. Dyslexics need to be taught using specific curriculum that teaches reading using all five senses and repetition. Most schools purchase or adopt one reading curriculum and all students must learn using one curriculum. If they need something special or different well…..something is wrong with the child. If dyslexics are taught reading by a staff member trained in a researched dyslexic program they progress and catch up therefore never in special education. Special education teachers do not have the programs or training either. Thus, the label or being in Special Education for years does not help. The correct curriculum is needed. The child is not reading disabled until a dyslexic curriculum is introduced to teach reading. Nonreaders and dyslexics soar if taught using a dyslexic curriculum. This is so rewarding. Please research dyslexia curriculum.

          Sondra Terry
          29 years experience
          Reading Specialist
          and School Psycholigist

        2. Veronica Myers

          I had similar issues with our school because dyslexia isn’t something the schools screen for. She struggled for two years before I went and had her privately evaluated. We had IEPs in place at school and had her in speech but she still struggled. Since her evaluation and diagnosis we do therapy twice a week for an hour and a half, both speech for reading and OT for handwriting. She is now straight A’s and it has been so much more amazing. I am in the schools and see kids every day struggling with similar issues and hear nothing is being done and I always suggest seeking outside help, especially if your insurance will pay for it. The school is just understaffed and doesn’t have the funding for more private Therapist. We need a new overhaul in the schools common core is not working nor is no child left behind.

        3. Susan

          In order to not lose ground, Help during the Sumer is a must. summer should rest time with a child with disabilities. As a parent, you must remain vigilant in educating her. Other countries in the world do not take a summer break.

          1. Sondra Terry

            Amen! School calendars were arranged around farming centuries ago. I sure do not see students hauling hay, working cattle, picking crops, running tractors today in the summer. I am sure there are some but not the majority. I often wonder why we still keep centuries old school calendar.

        4. Katres

          My son was held back 2 years in first grade. For reading.we came from the bahamas. His reading and everything was good. I don’t know what’s went wrong during transition. He was placed in kindergarden because of his age, which was 5 a the time. But if he was at home he would have been going into fourth instead of now going into 6. I believe he suffers from dyslexia because he would be fine reading and spelling site words but put a book in front of him and he just doesn’t remember some of the words. And he shuts completely down. I’ve became frustrated. They have now just started him on Rti starting from January past. I don’t know what else to do. Can you email me some help information.keamiller3@hotmail.com

      3. Barb Thompson

        I have found that many RTI strategies are not individualized and are not implemented and/or monitored was th any sort of fidelity. It’s more of a haphazard, poorly planned attempt to have students work on basic skills.

      4. Chris Sousa

        Judith Canty Graves and Carson Graves. While I understand your points and find validity in some of them, I would like to invite you to visit my school in Nottingham New Hampshire, to show you what a quality RTI program does and how it can help students achieve greatness and ensure learning. I think it may alter your point of view.
        Chris Sousa

        1. Sondra Terry

          Yes! That is what I have witnessed. If done correctly and all staff trained it is what is wonderful.

      5. Tai

        RTI has been totally misused in our district. Every child 1-11th grade is progress monitored 3 times a year. Can you imagine a 10th great completing a 3rd grade curriculum assignment? I’m saddened that we cannot utilize anything that comes down the pipeline properly. It is educational malpractice!

      6. Megan

        When implemented correctly, MTSS (RtI and PBIS) work well. The key is that these practices have to be implemented with FIDELITY (the way they were intended). If we were provided with the staff and prep time in my state, RtI would probably show higher levels of effectiveness.

        Also, as a school psychologist, I looked into the research studies that were used. Many of the districts in the study were not implementing RtI with fidelity. One of many examples is that kids were being pulled out of core instruction for intervention, which defeats the whole purpose. They need all of core PLUS intervention. Also, RtI is about giving every child what they need to be successful. This means that you have to find the right intervention for each student and there isn’t a standard protocol approach to solve students’ unique problems.

        Essentially, all this study tells us is that we don’t have the staff and resources to adequately implement MTSS, which impacts the fidelity. Of course the studies will show it “doesn’t work” if it’s not being done correctly.

      7. Susan missman

        RTI has been implemented in our school district as a means to avoid special education determinations for the first three years (K-2) of a student’s educational career. I have witnessed first hand evaluations recommended by Intervention Specialists being denied or avoided because of the underlying policy of RTI first. Students I’ve identified in K-2 for evaluation notoriously qualify at the END of their 2nd grade year leaving them so far behind their age-mates, it will take years to catch up IF they ever catch up. The latter being the most likely to occur, the district has undeserved the precious gems and relegated them to a life of special education. So mad!

  2. Sarah

    It is a COMPLETE WASTE OF TIME! My children’s school has RTI every day in every single class. Everyone has to waste 30-45 minutes a day with this total nonsense all because some someone that has never been in the classroom but has 5 degrees decided that they know best and decided to put every child in the RTI need category. This is exactly why people are homeschooling or taking their children out of public schools because the government once again touched something and it turned to crap.

    1. Sondra Terry

      Intervening at the first sign a child is struggling is what great and effective teachers have done for centuries. They just give it a name now. Not every child learns the same or at the same rate. Many need a different curriculum, style, or approach. This is helping and intervening and not blaming the student. Kids are not all average and above or cookie cutter kids. Labeling a child as disabled is not intervening. So, what happens after they enter special education? Do you think they miraculously get to grade level due to a label? No! Interventions, time, and practice while still exposed to grade level material is what works. Good teachers have done this for centuries. They just make all teachers do it now and gave it a name.

      Sondra Terry
      School Psychologist and Reading Specialist

      1. Will Kasten

        If only every classroom teacher was equipped to do that well…If only there was enough variance in or educational system to recognize that the most successful education model;s are individualized with or without the label and sped compulsions
        .

  3. SUZANNE ARENA

    We have called response to intervention should really be labeled as Response to Intentionally Delay. I’m so glad the study came out Kama I wonder how long it will be before things change as children will continue to fail, and these children are the biggest group of our LD learners , why wouldn’t we give the evidence-based remediation that is proven to work? If you look at a group like decoding dyslexia, which is in 50 states, and has thousands of children that have experimented and found a common remediation that works, why oh why oh why oh why wouldn’t we use this known mediation?

    The Department of Education needs to take their blindfolds off and do it quickly, children are harmed daily with RTI

    1. Kelly

      Maybe that’s exactly what the government wants. It turns my stomach what we do to kids…
      I was an educator in the public school system for 24 years and I finally escaped! I’m now a private reading specialist and most of my students are dyslexic but the schools aren’t addressing this”gift” which it is… and accommodating these kids!

    2. Sondra Terry

      Yes. I agree with you on dyslexia programs. It amazes me that teachers and special education teachers have no training in dyslexia in the majority of states. Please research special education or look at the progress of the bottom quartile or “SWD” students with disabilities progress or gains on your states school testing. Students with disabilities or bottom quartile do not make gains. So placing a child in Special Education is not helping. It does not fix or help a learning disability. Interventions using a variety of researched material moves a child faster and to age or grade level in math or reading while they are still being exposed to grade level curriculum. If all a teacher or school has to offer a struggling student is a disability label, then every child that struggles will look disabled. Schools must offer more curriculum and approaches to all students by trained staff. Students are not the same so why do they all have to learn from one adopted curriculum usually delivered with no training? I think what parents want is successful kids. The ticket to success is multiple curriculums by trained staff and interventions regardless whether it is in general or special education.

      Sondra Terry
      School Psychologist
      Reading Specialist

  4. Gregory Sampson

    Teacher here. It is difficult to implement RtI in the classroom on the secondary level. The Common Core standards cram so much content into the course that to have RtI inevitably means following behind on the current content. What do we do with the children who don’t need RtI? They get enrichment, which to a child means: I have to do extra work that the others don’t. That’s not fair. I don’t need remediation. That can introduce another negative dynamic into the classroom as children may resent the students in intervention. Especially at the younger ages, where children gauge fairness by conformity. Is everyone getting the same. These people need to read Piaget and other developmental experts.

    1. Tracey Parks

      Teacher here….I see this to be true in many aspects … The one area I see hurting the kids the most is that those who do need intervention/special education services are delayed about a year from receiving because you have to document 50 sessions… This in itself takes about 3/4 of a year … That’s a year the child could be receiving more intense services thru spec Ed

      1. sped teacher

        RTI was not designed to be a means to an end to get students tested for special education services. It should be viewed as a problem solving process. Many schools using the RTI process are using it only as a means to an end. Students receive intervention from several different educators and many times they are not working on the same or the correct deficit skill the child needs to improve

        We have educators putting bandaids on elbows when the student has a broken leg. What is the point of working on reading comprehension if the true deficit is reading fluency? Teachers have too much on their plates and in my opinion are not open to RTI because they feel it’s not their job to remediate.

        Teachers are forced to spend all of their time teaching standards and if a kid doesn’t get it, then they must need to go to special education for help. There are way too many students who have been labeled as learning disabled when in fact, they are instructional casualties. RTI if implemented correctly should stop this.

        Why are we as educators ok calling a student learning disabled when they aren’t? RTI isn’t hurting those who need intervention or special education services because the teacher has to document 50 sessions. They are delayed because many schools are not using the system the way it was intended. It was intended to be used as an intervention, a problem solving process. If students are not progressing in skills deficit instruction while also being educated in TIER 1 (general education / grade level standards) then it is possible they do have a learning disability and should be referred for testing. They should be referred based on DATA, not just the teacher saying, “Well, he can’t do anything.” We have to stop pushing these kids off as someone else’s problem because they are hurting test scores.

        Meet them where they are, figure out what their deficit is, and work on it! It’s like the story from Sunday School about the wise man building his house upon the rock. Providing intervention in the wrong area or even the right area without fidelity, is like building your house upon sand. Many students are missing foundational skills that must be taught for them to proceed successfully.

        We all need to take responsibility for these students. General education teachers need to realize that they DO have the ability to help these kids who are struggling.

        However, I do think more teachers would be open to this process if they didn’t feel so threatened by all of this testing nonsense. The people making the laws should come teach for a day. I’m not sure the majority of them, if any, would last only for a day.

        1. Connie

          I have to disagree with your first sentence. RTI was indeed designed as a process that can lead to an evaluation to see if a student qualifies for Learning Disabilities services. The theory is that students who are not performing according to grade level expectations receive interventions. Students who go through the RTI process and do not respond to the interventions can then be evaluated for special education services. This way of identifying LD students took the place of the discrepancy model. Under that model, a teacher could refer a student for evaluation by presenting evidence to a committee. If the student was found to have a discrepancy between his ability to learn (IQ) and what he had actually learned (achievement), he would qualify for LD services.

          1. Tim

            I’m guessing that many districts are not implementing RtI correctly. However, as an RtI specialist I can tell you that the discrepancy model has not been replaced in our district. Many times the discrepancy model has shown to have some grey areas. Students who are suspected of having a learning disability have been kicked back by the child study team because the discrepancy model is showing that there is know skill-IQ discrepancy. With the data collected from RtI we have been able to clear up grey areas by looking at the whole picture. So no…not all RtI programs are used for gate keeping. We use the RtI model as a means to figure out where the root problem is: instruction, environment, deficit, learning disability, etc.

        2. Lacye

          My concern is for the students are passed on who should not move ahead a grade level and in turn are far behind their peers. It really baffles me…there should a be strict criteria in each grade level that students should meet before moving on. And maybe, eventually, there wouldn’t be the need for so much RTI and testing nonsense because kids would, for the most part, be on grade level. But that’s just my opinion!!

          1. Bmarshall

            Grade level standards create a system where we require every child to meet the same bench marks at the exact same time, otherwise we label them as failing and in need of intervention. The research on the way children learn does not support a system of strict standardization. Leaving children back a grade is generally not a viable solution. There have been studies upon studies that verify that retention usually does not benefit the child. Children held back one grade in primary school might benefit, but the older the child is when detained, the less likely retention will help and it more often than not leads to children who drop out before finishing high school.

          2. Sondra Terry

            Retention is not intervention. There should be a law that no child should be retained twice.

          3. Kristin

            Some kids will never be at grade level. So what do we do with those kids then? Keep a 14 year old in 3rd grade until he/she can finally pass the required standards? They don’t qualify for special education because their IQ and performance level are both tapped out as best as they can, yet it’s far below proficiency. This is what I see more and more of each year. How can we help these specific kids??

        3. Tracy Hall

          I don’t disagree with what you say, but, the demands have become so great, and the consequences so severe, it isnt a matter of figuring out what is needed and doing it…it’s a question of how to maximize gains for the majority of the group, rather than individual children. I don’t think it’s right, and it is heartbreaking to be on the front end seeing it happen each day, much less, participating in it, but I didn’t decide that this is how it should be, and neither did any other teacher. Every teacher I know is making reactionary decisions based on the demands of a broken system!

          1. Debra Kelly

            Recently resigned teacher here- Tracy Hall’s comments are precisely accurate!

            I also took part in an RtI process that went on for two years…even after testing! Parental involvement is crucial~ and it is very evident when lacking or non-existent….Maybe we could set up a Parent RTI and help them reach their parenting goals!!!!

      2. Sondra Terry

        Special Education is not an intervention. If implemented and funded correctly interventions in the General Education is successful.

        Response to Intervention is for all children even special education students should be receiving interventions in regular education. Response to intervention has nothing to do with special education. If that is your thinking then your school has implemented or designed it incorrectly.

        Intervening at the first sign of struggle is what educators are paid to do. For centuries we have been programmed to say test it is a disability. The bottom quartile or SWD on your state test tell the story of why there is education reform.

        The bottom quartile and students with disabilities or SWD never progress, yet we continue to do what is not working for the student by putting them in special education and hoping for a different outcome….. Do some research and find our what school demographic have the highest dropout rate…..learning disabled students.

      3. Devin

        This is exactly what i feel!!!! Well said and to the point! You are spot on and so glad to hear people are writing what i feel!

    2. Cheryl Stephens

      The whole mess that has been made is precisely because someone thought they knew more than Piaget! Guess what? They were wrong and countless children have been harmed. It’s almost criminal.

      1. Sondra Terry

        You need to research Special Education and the history behind Specific Learning Disability.

        Labels do not help children.

    3. Stacy

      Amen! I’m an elementary school teacher and RTI does not work for my kids. I taught sped before general ed and I was able to customize everything so much more. I have a really hard time fitting in the RTI consistently as the content is so meaty with our Texas TEKs which are just like the common core standards. If I do fit RTI in, the kids fall behind in content where they need more support. My school will not even consider a sped evaluation unless I have 25 documented RTIs. This means the kiddo fails most of the school year and doesn’t get help. We have to do better.

      1. Sondra Terry

        Good teaching has always meant intervening when a child struggles and having small groups. I was taught this way in first grade in 1966 and did this as a teacher. The only difference is documentation.

        I do not understand why all the fuss. It is good teaching to intervene and have small groups. Try different and presctiptive interventions for skill defits. Practice, practice, practice…..

        RTI just means not jumping to a disability label when a child struggles or you suspect a learning disability. If Autistic or Intellectually Disabled you still refer those.

        If all I can offer a struggling student is special education, then every child that struggles in my room will look disabled. That is not good teaching.

      2. Sondra Terry

        You do not intervene when a student struggles with math or reading? You do not have any small group instruction or learning centers? Do you teach whole group all day and just expect all kids to “get it”?

        The kids will fail because they are not getting any help. Do you help struggling readers? Is special education the only thing you offer kids that struggle?

        Wow.

    4. Amy

      ESE Teacher here with a psychology degree in Child Development. YES!!! The content as well as the amount required to teach – not to mention assess – leaves little time for remediation of specific skills. But what bugs me the most, is how the accommodations are not being provided due to the lack of resources provided because tgere is not enough funding, which is a whole other conversation. Piaget! I had to respond once I read your response to the article. Thank you =)

  5. Karen

    You need to explain what you mean when you say that these first grade students did worse and lost skills. That statement is completely vague and doesn’t explain anything. How did they get worse? By what measures and standards? Additionally, if you claim that RTI is a theory without any empirical valdiation, you clearly are missing the point. The premise of RTI and NCLB, while they are not perfect frameworks, is to deliver research-based instruction and holding educators responsible for accommodating the diverse learning needs of all students instead of assuming a student has a disability when they aren’t initially meeting grade level standards. If a school replaces general education instruction with an intervention, as you mentioned in the article, that is an implementation problem, and not a problem with a framework. Students are supposed to be getting supplemental interventions in addition to general ed instruction.

    1. Anonymous

      I can assume you are not a teacher. What is a teacher supposed to do when 5 out of the 18 students require RTI, often for different concepts, with the other 13 students in the classroom. The students needing the support are lost during whole group instruction, therefore gaining nothing, and the rest of the class is losing what could be used as instructional time. We want our students to perform better, but our hands are tied by these situations. I have seen a student who very obviously needed special education services, but because of RTI and the snail pace of the evaluation process, it was determined on THE LAST DAY OF SCHOOL that the child had an IQ in the low 40’s!! That entire school year, the teacher had to implement interventions to teach concepts the poor child didn’t have the capacity to understand! And the rest of the class would have “enrichment” activities while she tried in vain to bring him to grade level. I’ve seen too many students not receiving the services they so desperately need because the so-called experts observe for 15 minutes and decide that the teacher, who is with the child all day every day, is wrong. It’s come to the point that the “experts” are basically saying that if we put in enough time and effort, students who are intellectually disabled can be cured. That’s not true. They can learn and, depending on the individual child’s degree of cognitive delay, many can be successful in academics. But, many need life skills training and aren’t getting it because the “experts” say that a student with a 50 IQ should learn about the life cycle of a butterfly! Let teachers teach and give students the services they need as soon as possible!

      1. sped teacher

        RTI, at least in Tennessee, is only used to test for a specific learning disability. If you believe a child is intellectually disabled, and have valid data to support this, they should not be put through the RTI process.

      2. Sondra Terry

        Response to Intervention or Instruction is for those that struggle with reading, math, and behavior or appear to have a learning disability or might be SLD/ LD or ADHD or Language Impaired. It is not for suspected other categories.

        Intellectually Disabled and Autistic students and other categories evaluations should not be delayed.

      3. Sondra Terry

        You have an implementation problem. You could have a core curriculum problem. 80% of ALL students in your room should be on grade level. You should statistically only have 3 students needing Tier 2 supports and 1 child right on the cusp of grade level. Check with other grade level teachers to determine if Tier I core curriculum problem.

      4. Nory

        I could NOT agree with you more!!! Having spent 10 years in the elementary educational system, I have seen first-hand exactly what you describe. To assume that a child, with an IQ that is 2, 3, or more standard deviations below norm, can possibly EVER learn what a child with a normative IQ can learn is asinine! Further, to make these children take standardized tests with the rest of the student body when they so clearly cannot, is a sin. And to determine school funding from said test scores is insane! Like the Army slogan says — Be all you CAN be. But not everyone is gonna be a brain surgeon! Play to their strengths, address the weaknesses, and make the classroom an appropriate setting. I am sorry, but a child with a 50 IQ is NOT the intellectual peer of a child with a 135 IQ. We need to go back to leveled classrooms with more intellectual alignment. Teach to the lowest common denominator and everyone loses!

    2. Elaine

      Mic drop. Yes. This. So many instructors do not understand how to implement RTI appropriately.

    3. Kandy

      Problem is that it ends up replacing gen ed, because there are only so many hours in the day. Teachers struggle with time to get it all in as it is, now, schedule two additional intervention times per day. That time takes away from instruction. They can’t cut lunch. Recess is either non-existent or very short. I’ve seen MANY ways of implementation and all of them had negative effects. I’m curious…are you a classroom teacher?

      1. Sondra Terry

        Co teaching is a must if your master schedule does not give you a designated RTI block.

        1. Lisa

          At my district, this is the crux of the issue. The bureaucratic administrators design a master schedule based on convenience and cost-savings without regard for actual student needs and the work that needs to be done. For example, students entering the High School with Lexile scores below grade level are mandated to receive reading intervention. The program selected by the district is supposed to be scheduled daily for at least an hour per session. However, this did not fit into the master schedule, so the intervention is provided only every other day for 40 minutes, severely limiting its efficacy. Another one (not RTI, but still): there was one section of co-taught World History in the high school this year. There are 14 students whose IEPs require ICT. State law requires that any ICT class have no more than 50% IEP students. As a result, the ICT class has more students than desks, and is by far the biggest section in the subject. In addition, all new students with IEPs arriving at the school were placed in ICT even if their IEPs did not specify such. My (untenured) co-teacher and I have been bringing this up all year to the Guidance and SPED departments, as well as the HS administrators. Their response is that it’s unfortunate but necessary because we can’t afford additional staff – so we’re not only overcrowded and handcuffed in trying to address individual needs and goals, but we’ve also been out of compliance with state regs.

    4. D.

      Thank you! I feel like the problem is a misunderstanding of how RTI should be implemented. Children all learn differently, and if teachers are using a “one size fits all” intervention with their struggling students, then they are missing the point! If a child truly has,a learning disability then by all means they are entitled to and should receive sped. But sometimes all a child needs is a different approach and the gift of time to catch up.

    5. Sondra Terry

      Well stated. You are right on.

      Sondra Terry
      School Psychologist
      Reading Specialist
      Former Teacher

  6. Andrea

    I don’t find this true at the school I work and I analyze the rti data. For us, it does not cause a delay in testing. All students should be in special education as the last resort. finally, we have pull-out services with a research based program that target missing learning skills. They are not pulled from core instructional time either. I would like to read this study and feel “averages” do not show a fair look. Median numbers would make more sense. I guess I will look at the article because there are plenty of schools out there that don’t make every minute count. My daughter went from failing 1st grade to me bringing her to my school where she received appropriate interventions and was reading on grade level by the following year. Now she is on grade level with her peers and in 8th grade. I wanted her tested for special education, but I’m glad the interventions worked for her.

    1. Glynda Walker

      Andrea what is your position at your school? What grades do you cover when analyzing rti data? Also how does your county fund the teacher that does the pull-out service?

    2. Teresa

      You stated that your child did not get pulled during core instruction time. I’m curious to know what instruction your child was pulled from to receive his/her RTI time.

      1. JT

        Our school moved to a block schedule. Each grade level has a block for IV Time (Intervention Time) and students that need it go Tier 2 Intervention during that time. Other students receive enrichment or other group instruction during this time. The Special Ed department does use RTI as an excuse for not performing testing for children that may have a LD or other issues. Teachers are told that the students cannot be tested until they have gone through the Tiers. We have teachers that have made requests for testing all year and finally students are being tested now that it is April…nine months into the school year…with less than 40 days of school remaining. If only those students had been receiving the appropriate and much needed help since the beginning of August! In any situation regarding students who are having difficulty learning, imagine what it would be like if everyone involved in the process asked themselves one question, “What is best for this child?”!

        I am not a teacher. I have been a student. I do work in a school system. I daily observe what is happening within education. It does appear that some schools are using the RTI program as an avenue to divert students from the Special Education program (a way to prevent spending money on students that need these services) while banking on the fact that most of the parents are not educated regarding the services that they may request for their child.

        1. Sondra Terry

          The services a struggling student needs is interventions. I still cannot believe after so much research that the public, teachers, and even administrators still think special education has pixie dust and somehow is this great avenue for struggling learners.

          Good teaching is intervening when a student struggles and trying a different approach, strategy, etc. That is what effective teaching is. Dividing class into smaller groups and intervening. Check to see if kids are mastering the skill or concept by some means. Thus, Response to Instruction or Intervention is the name. How can you say that is not what children need? So, the moment a teacher sees a child struggle they need to jump to the term disabled or SLD? I hope not.

          Good teaching is intervening and having small groups. What is wrong about that? It just has a name now and needs to be documented.

        2. Bill

          The question is then..how do we identify students who just had a lack of instruction (i.e. they moved to 10 different schools in the past 3 years) or if they have a learning disability. Discrepancy Models have been known to give grey area readings. Any suggestions?

    3. Sondra Terry

      The key to success is intervention time in the master schedule, hiring interventionists, and simple forms for documenting and software for measuring each skill.

  7. Randy Ewart

    This article offers only a cursory, even superficial review of RTI.

    “theory without empirical validation.” – RTI is a process of assessing student ability, identifying weaknesses, addressing weaknesses with targeted instruction then assessing progress. If the student does not respond to intervention other, more concentrated means of intervention are provided. What aspect of this is faulty?

    Many if not most students receiving special education are falling further behind their peers. Makes sense. My son is severely impacted by autism. As his peers learn to read and do math he is learning to talk and toilet himself. Is special ed holding him back?

    Just like special ed, RTI can be used effectively or ineffectively. Ineffective use does not indicate the process is faulty.

    1. Debbie

      How much progress is considered progress? The elephant in the room ….my sons school does provide EVADENCE based reading intervention (note EVADENCE based verses researched based) but I know it’s not done with Fidelity . The school OG tutor told my son she doesn’t teach “schwa” . Bottom line is children should be screened for dyslexia beginning in K (especially now that we’ve got head start/ great start) and given a EVADENCE based reading intervention and stop wasting valuable time with what failed the first time in smaller groups. Use the proper “label” dyslexia because their isn’t shame in being dyslexic and drives the appropriate interventions needed . These tests need to stop and the millions of dollars districts are forced to pay for and give should go into classrooms as well as teachers pockets. Expecting one size fits all is ridiculous and so is a dyslexic student throwen into a gen Ed, and even sped room with other LD’s or differences. My daughter was stopped with the RTI process from getting the services she needed in math. It was until her younger brother with more profound dyslexia that I began my research into these laws. No parent should have to know what I know in order to get their child help. And MOST teachers , reading specialists, sped teachers,are oblivious is to what dyslexia really is or how to help. Class sizes are insane . One teacher can not meet the needs of 25 young children even if they were “typical” learners. While my son is as every bit deserving to FAPE as his non dyslexic peers I’m forced to advocate for him in his “least restrictive environment ” ( which is more restrictive than anything). He doesn’t have a learning disability , he has a reading disabling . If you tell a child 100 times and they still don’t get it…..who’s the slow learner? Thankx to all of the teachers that loose sleep over other people’s children in the broken system. We all deserve better

      1. Sondra Terry

        You are so correct. I bought my own kit and paid for my own training to tutor dyslexic children. I still use it today. States and schools hate the “d” word.

        Payne Institute in Oklahoma City offers a wonderful 75.00 training that includes the kit for parents and tutors.

        We need more advocates like you.

        Sondra Terry
        School Psychologist
        Reading Specialist
        Former Teacher

  8. Kay Janon

    Don’t worry, we’ll replace it with some other initials that sound scientific and helpful, all the while ignoring class sizes and teacher morale and autonomy. It’s what we do. And the more expensive, the better.

    As for some schools trying RTI before evaluating for special ed, that’s part of the process so students are not over identified. The problem is the interventions end up tracking kids, AND the kids who are in them are in regular ed classes too, creating an opportunity gap because they cannot take electives. The kids end up hating school because it’s all core, all the time. Other unintentional consequences are higher absenteeism and more classroom management issues from kids acting out.

    1. Debbie

      Kay Janon…”Don’t worrie, we’ll replace it with some other initials that sound scientific and helpful” ??? Are you serious? Look into Orton Gillingham approach . It’s been around for over 50 yrs and dyslexia has science proving it that’s the difference with EVADENCE based vers research based. While you may be a teacher I AM dyslexic with dyslexic children. Your lack of knowledge about dyslexia is one I encounter often while advocating for my dyslexic children. Tell me what training in dyslexia do you have? This is exactly what parents encounter, push back for doing their research about a condition their child has. Isn’t that what a “good parent”does? This IS personal to me, it’s my life, my children’s lives. While they show up to school daily in a place that not MENT for them. It’s MENT for one type of student. 70% of the juvenile justice system reads at a third-grade or below level . 80% of the prison population read and the third grade or below level . Some states use 3rd grade reading levels to determine how many prison cells will be needed….. So yes I don’t think that literacy is a place to cut the budget . And balancing budgets on the backs of your most Vulnerable Students is sick. While dyslexia stats are 1 in 5. 20% of the population so YES replace it with a scientific EVADENCE based DYSLEXIA reading intervention. Screen for dyslexia, SAY DYSLEXIA and teach them in a way THEY learn..no don’t bother teaching dyslexic students to read. Continue doing what’s been done. IDEA is 40 yrs old and in 2017 the every child will succeed act will kick in….NOTHING has changed for Dyslexia and education. I think 40 yrs is long enough and this discrimation must end. Look into your states decoding dyslexia. We are moms advocating for the right interventions for our Dyslexic children. (Note I do not call them learning disabled they are dyslexic)

      1. LaKesha

        I am the mother to a dyslexic child. I first notice her struggles in first grade. When I mentioned it to the teacher I was told they had to collect data for a year before an evaluation could be done. RTI was being implemented for her. After not seeing any improvements for three months, I sought an outside tutor. By spring, I was told my daughter would need to repeat the first grade because she was failing reading. I was furious that the same intervention was being done by the school with improvement for my daughter. I did my researched and learned that I needed to request and evaluation in writing. During out ETR meeting the psychologist noted the red flag in high IQ and low reading abilities but the team said she did not qualify. I paid for an outside evaluation and learned she was dyslexic. Fast forward….I hired a parent advocate to help me understand what should be happening. My daughter now has an IEP in place, she is receiving OG tutoring at the schools expense. She also has a private OG tutor as well. We have now faced a new challenge, math. The school’s answer is to retain her for the entire 5th grade year for math. Problem right? My daughter now reads at the 7th grade level. If a researched based with strong evidence specialized curriculum for reading has improved her reading ability, why wouldn’t the school implement a researched based specialized curriculum for math? I have done my homework and her OG private tutor has begun implementing multi-sensory math with her.

    2. Sondra Terry

      As an RtI trainer I admit I have not understood how this can be implemented in high school, unless there are interventionist for math and reading and can be “push in” . That takes funding and NCLB did not fund it.

      The long term theory is very few students should need interventions if it is implemented correctly at lower grades. For it to be implemented correctly there must be intervention time in the master schedule and funding for interventionists and different curriculums and trainings.

  9. Kym H

    When done correctly RTI does delay students. It has to be implemented successfully. I don’t think any effort to help students become successful is a waste of time. More training may be required.

  10. Frustratedtchr

    As a teacher who facilites RTI groups for a living, I find the whole process expremely frustrating. I have documented hundreds of hours to be told, try another stratgy first, try another group, maybe you are doing something wrong. This happens because it is to delay an overworked psych who has to service not one school, but two or three. Each test can take several hours for one child, then the paperwork. The man power is not understood in our society. Everyone is really good at pointing fingers, but in reality learning is very complex and determining a learning Disabilty and the eligibility is even more complex. I speak as a elementary school reading teacher and parent of a Special Ed student.

    1. Sondra Terry

      I agree. This is a wonderful researched and needed part of Education Reform. It needs to be funded to where there are several interventionist and a framework for simple data taking. Without the funding it is perceived to be a headache.

      Monday – Thursday should be interventions with interventionists. Friday simple short measure taken to see if child is responding to the interventions on computer for less than 10 minutes and automatically prints score and graphs.

    2. Sondra Terry

      It is not meant to be frustrating or laborous.

      Research the different models. It is not difficult if implemented correctly.

  11. Jennifer

    As a teacher, my biggest problem with RTI is that it is not special education, but it IS being used as such. Districts are forcing teachers to put students through intervention after giving only ONE test. Our classroom tests, observations, and other data points are NOT even considered. If a child does poorly on the state benchmark test (which, by the way, is administered on a computer with no validation by the teacher), they are automatically on the RTI list. This subjects the child to 30-45 minutes a day of intervention. That 30-45 minutes must be taken from non-core classes. It is usually done during a special class like music or art. Parents are sent home a letter but are not required to actually sign anything giving the school permission. This means many parents do not actually know or understand that their child is being pulled out of classes with their peers during the day.

    RTI is a way for the state to get around classifying children as special education. Don’t believe me? Look at Shelby County Schools right now while they negotiate next year’s budget. The VERY first thing on the chopping block in terms of teacher positions is the special education department. My school went from having about 10% of the school population receiving services to less than 5% since RTI was implemented and, yet, many children’s scores have dropped and our number of students being retained has increased.

    The RTI “approved interventions” are chosen by the district with no input from the teacher. Often these programs are inappropriate for the child’s needs. Teachers are having to occupy a classroom of 25 children while they provide intervention to 1 student for 45 minutes a day! This completely negates the idea of differentiated instruction because no students’ needs are being met, especially the child receiving the intervention.

    As teachers, we must always advocate for the best interest of the child. I have had parent conferences with every parent of a child labeled as RTI. They must be told (because it certainly doesn’t tell them in the letter) that they have the right to refuse services. When I had my first parent conference, the first thing the parent asked me after I explained the intervention process is “how is this not special education?” I replied, “It doesn’t come with a legally binding IEP to protect your child’s rights.”

    1. Carson Graves Post author

      Dear Jennifer,
      Thank you so much for the insights into your experience with RTI. This is why we wrote our article, so that parents can make informed decisions about the RTI process when it is offered to them.
      Judith and Carson

    2. Lynn

      I have seen RTI being heaped on teachers with a subsequent pile of documentation to delay and waitlist students for services. Teachers have naturally try more than one approach with children anyway. Just another way of try to regulate education, cut costs, and take all the creativity and joy out of teaching and learning. Most RTI is from scripted programs that a monkey could deliver reading text that is not fun. I promise 95% of the time a skilled professional can tell you if a child needs special education interventions or if they can be remediate do in the regular setting.

      1. Sondra Terry

        What does special education interventions look like?

        Special education is not an intervention.

        How long did you deliver the interventions? Was it in a small group in your room focused on one skill in an order?

        Which interventions?

        Phonics, phonemic awareness, vocabulary/sight words, fluency, comprehension….

        Did the child master each of the above skills in order before you moved to the next skill?

    3. Sondra Terry

      That is not Response to Intervention being implemented correctly. It is team work. Special Education teachers and Speech Language Pathologists can deliver interventions. Reading Specialists deliver interventions. Intervention time is in the master schedule and students go to their designated interventionist. Those not needing interventions have enrichment. Even the coach, music, and art teachers can be trained to deliver interventions or take the ones not in need of an intervention and do a year long project on a book.

      So many ways to implement RTI.

      If a school has a core curriculum problem at Tier I, which might be the case at your school the no child should be tested for Specific Learning Disability. If 80% of the school population is not on grade level then there is a core curriculum problem. Tier I or core curriculum is the problem no child is to be tested for learning disability. You cannot say it is the child if 80% of the school site population is not on grade level. It is a school problem.

  12. Brittney

    “RTI is not a way to diagnose a Specific Learning Disability.”

    Actually, in the state of Colorado, this is the ONLY way we are allowed to diagnose a learning disability within the school system.

    1. Sondra Terry

      Do you prefer discrepancy model? What about a child that has an 82 IQ and academics are in the 70s. No discrepancy, no special education, no interventions. Hhhmmmm. Child Left Behind

  13. Emily Cadman

    It worked with my son. The teachers and I came up with specific interventions to use and they were implemented correctly. I did significant work at home with him also.

    1. LovesTeaching

      “I did significant work at home with him also.” That’s a strong statement to support parent involvment. As a 1st grade teacher (and educator for 27 years), it has been my experience that many (many not all) of the students in RTI lack parental support from home. They are delayed in language development, experiences and in many cases social interactions. We then push these children into a situation demanding that they read by 6 years old (a whole new statement on the American edcuational system). Holding educators accountable for a childs progress is appropriate but so should holding parents accountable. Until we find a way to do that, those students, no matter how much/many interventions are implemented are going to be or fall behind.

      1. Judy B

        Agreed! It may also be that lack of parental support at home is a big part of the REASON RTI is needed in the first place. As I was reading the article I wondered how many parents would actually read and understand it. So many problems and no perfect answer!

      2. Sondra Terry

        Not with interventions they will move forward because good teaching is intervening.

        Those children are at risk of dropping out and putting them in special education increases the odds. Research it.

    2. Belen

      That’s why it worked, because you seem to be an involved parent. Not the same when you have 120 students and many need to be provided RTI. Only to put the teacher to work even more that they already do.

  14. Scott

    When it mentions students in RTI fall behind their peers who are not in RTI. That of course makes sense. Students placed into RTI because they are performing behind their peers. How much farther behind would they have fallen without RTI interventions?

    And yes, RTI can delay us from getting help for students for up 18 weeks prior to the federally mandated 45 day for a special Ed assessment and an additional 30 days to hold an ARD.

  15. Brenda Force

    As a special education teacher, I like the fact that students are given interventions instead of just being referred for special education. When I started teaching in 1982, many children who couldn’t “get it ” were just referred without using different techniques and had to wait to fail before they could get any help. Many teachers were not willing to give extra help to those students who learn differently. I feel RTI changed that and made general education teAchers try different methods rather than expect all students to learn the same way. Before RTI many children were not getting differentiated instruction.

    1. Sondra Terry

      You are correct and why we have education reform and are behind other countries and our future national defense is at risk.

      Good teaching is intervening and having small groups. At some point teachers, myself included, started teaching out of one curriculum to whole group. Then, if a student struggled our professional opinion was the child had a disability.

      What about little Suzy that did not qualify for specific learning disability cause her IQ was too low and no gap or discrepancy between academics and IQ? Well she was LEFT BEHIND. No special education and no interventions……

      Yet, so many people like that model! Seriously. It was great and easy for the teacher. Do we really want to keep doing what was not working for kids?

  16. Brandi Noll

    An article of mine was published in Kappan magazine (march 2013) called “Seven Ways to Kill RTI.” After having served on an “RTI Team” in a k-12 school district for five years, while working on my Masters of Reading and later a PhD in Literacy, I had a vested interest in really making a difference for struggling readers I served. Looking back we had spent a lot of time checking off things that the literature identified as crucial parts of the RTI process. However, after five years we had gotten nowhere as far as achievement for students. As I work with other school districts I have seen similar things occurring….schools interpreting what must occur with rigid guidelines, over-purchasing of one-size-fits-all programs, poor assessments, school psychologists making educational decisions having never taught before, and too many meetings and paperwork that did nothing for students. It’s sad that RTI is likely going to “die off” now because of this new data being released……. the concept sounded like something we desperately needed at the time: to question whether the issues that students were facing were actually rooted in the student or rooted in the teaching they had been exposed to.

    1. Lisa

      Yes. This. I too have been on a K-12 RTI committee for 8 years and have watched the exact same process unfold – except that it was also undermined by unfaithful implementation and poor or nonexistent follow-up.

  17. Sue

    Retired administrator here. During my tenure, implementing RTI into our reading moved my campus in Texas from acceptable rating to recognized ,and then exemplary three years in a row. When properly implemented RTI reduces the number of special education referrals and students are successfully reading. Implementation correctly is the key to success, and it is the campus administrator’s responsibility to ensure this happens.

  18. Margie Buchanan

    RTI if done right is absolutely effective. It’s just a matter of creative scheduling at the secondary level. I agree it does delay the testing for SPED, but at the secondary level that should be rare anyway. I teach Tier 2 Reading at a secondary level and I can tell you firsthand that many kids’ lives have been changed for the better because now they are more fluent readers whose comprehension has greatly improved.
    It is an absolute necessity when done correctly.

  19. June Ann Stallings

    I have requested a full evaluation of my granddaughter for the last 3 years when we were at her 504 meetings for ADHD and was told she did not meet the criteria for testing. Now, she is finishing 6th grade and finally had testing done for dyslexia and found that she is dyslexic. I knew this was her problem ( I have a masters in special education with 38 years experience teaching in west Tennessee). She has been receiving RTI in math for awhile but language arts is her main trouble. Now they are going to put her on a computer for phonic training and set her up for summer tutoring on 2nd grade phonetics skills 1 on 1. Evaluator thinks she will catch up in a couple of weeks. I have some serious questions and concerns and am not sure where we are going with this. Law suit comes to mind. BUT I will give them the summer to “catch her up”.

    1. Sondra Terry

      Dyslexics needs to be taught using all the senses. The cadillac is Orton-Gillingham.

      Please check out Payne Institute in Oklahoma City training and kit is 75.00. I use it and it is great. Reading Recovery uses the same Orton-Gillingham approach too. Barton is my fourth choice. Linda Mood Bell (lips) would be my fifth choice.

      Sondra Terry
      Reading Specialist
      School Psychologist
      former teacher and RtI trainer

  20. MizB

    I retired after 40 years in elem ed, then returned for a few years in the new intervention program. In our program, students having trouble left class for no more than 30 min. Their teachers gave us specific information and work papers to examine before meeting with them after parents gave permission. In our first meetings with the students, we explained that we were meeting to help, asking what they felt they needed, going forward from there. Most were ready to look into how they could do better right away. For those who were reluctant, we encouraged them to give it a try and see how soon we could help them be on their way. Classes were specific as to what those students needed, so size varied from 1 to 5 with no more than that at one time. We also never pulled them from specials, such as P.E., etc, whole classroom functions/events, or recess. Usually, meeting at 2 or 3 times a week, they were back on classroom level and dismissed/ records filed. One 5th grader I worked with began having failing grades in division, otherwise, her math grades were A’s, including multiplication. Right off, she said she didn’t even like the word “division”… hated it… couldn’t ever get it!! I said, “ok, let’s do some multiplication for fun”! After zipping through a number of “fun” problems, all correct, I said, ” That’s great – now check this out..” quickly putting out a simple division form of 25 ÷ 5. Her eyes widened, but before she said I can’t, I asked her… look here, what “times” this (the 5) = THIS? (the 25)… she immediately said…well, 5, of course, but this is DIVISION!! Bingo, I answered, that’s all “division” IS…. “backwards multiplication”… A huge smile blossomed! (my reward)… we practiced several more, all correct, to her delight… and that’s all it took. One session. Sometimes that’s all “intervention” needs… and a regular classroom teacher these days isn’t usually able to take the time away from the other 24 students – or privately and not in front of everyone. We saw all of our students as unique individuals, each with their own gifts – either waiting to be discovered, or just beginning to bloom… each in their own time, and nothing….n o t h I n g “common” about any one of them.

    1. Jacqueline

      This is what I call proper instruction for changing the perception of what a student has determined he is she is not capable of doing. It is that rigidity of instruction that slows some students. Learning needs to be about each student not all students.

  21. Michelle Wilkins

    If RTI is on average not succeeding, the question to ask is why. You pointed out a possible cause (intervention not matched to need), but there may be other causes out there. One that I suspect is that RTI is left to be implemented by the classroom teacher in many cases (which is why it is less expensive – no added personnel costs). But RTI interventions can be quite 1:1 and the classroom teacher has 17-24 other students to provide learning opportunities for. So how often is the child getting served in their moment of need? How effective is any intervention provided in 2 minute spurts as the teacher makes the rounds to all of his or her students?

    1. tongorad

      Michelle, I think you’ve identified the crux of the matter – overburdened teachers. Adding more obligations and expectations to teacher’s workload is THE one-size-fits-all solution to every problem according to the educational reformers and the administrative class. One has to ask the question, who does RTI truly benefit?

    2. Sondra Terry

      Response to Intervention should never be left to the teacher. It is meant to be a team approach. Special education teachers, speech pathologists, reading interventionists are all suppose to be delivering diagnostics, and then interventions along with teachers. Some successful schools call it “fluid walls”. Meaning students belong to all of us and we are all responsible for their growth. Everyone in the building can help deliver interventions.

      Team, team, team…..

      Good teaching is intervening when a child struggles and having small group instruction. RtI is about all staff members being able to intervene.

  22. Mindy

    Rti is doing nothing to help my child. It is the way for the schools to say let’s gather more data. Um no sorry test my child because this rti only takes away recess and pe Whole not even servicing her needs. Waste of time in my eyes….

    1. Sondra Terry

      Response to interventions is just a name given to what good teachers have done for centuries. The intervene when a student struggles. Good teachers have small groups in the classroom they work with in hopes of moving them closer to grade level and having other strategies to help them learn outside of the adopted curriculum. That is the services struggling students need and should receive.

      Now it is the law and teachers document a weekly score to gauge if that strategy is working (did the child respond, hence Response to Intervention). That is good teaching and has been the norm for effective and good teaching for centuries. It is now the law.

      Testing and special education should always be a last resort. If all a school or teacher can offer a student that struggles is special education, then every child that struggles will look disabled. We can do better than that and sadly it had to be made law cause many teachers did not intervene or have small group instruction.

  23. Heather

    Well this is interesting! I’m a SLP in the schools. You have one comment ALL wrong. RTI is BEFORE an evaluation for SPED services. The point being- there are small groups and other ways to try Gen Ed ideas to help kids catch up before slapping a SPED label on them. Teachers have to get to know their kids and find ways to differentiate teaching to teach each learner. (Visual, auditory…) however these days when there are 25 elementary kids with all kinds of labels in their room, it’s nearly impossible to reach everyone. Sad

    1. Sondra Terry

      Well said. The biggest problem is the federal and many states do not fund RtI. With funding it could be very successful and I have seen it be a success.

      Interventionists, different curriculums, training, software to make quick weekly measures on the skill being taught simple and easy documentation, diagnostics, etc make the difference. This takes funding and personnel. When you have all this in place it is successful.

  24. Angela Awonaike

    Teacher here…PARENTS hit the brakes on being against RTI. Does the RTI process need help? YES. Will it help your child? YES. As a Special Education teacher, there were some students who I observed early on that had symptoms that were characteristic of disabilities that would qualify them for an IEP. But what happens once you sign permission to test? Your child gets an IEP within 90 days and then what? During those 3 months of the IEP process, who builds on the foundational skills your child is struggling with? Don’t be mistaken that during the IEP process your child is getting some special help, outside of what they have already been getting. Additionally, while an IEP states the student’s present levels, and sets goals based on where they are functioning, an IEP is a document…and documents don’t teach children. Ultimately the same professionals that are determining and implementing RTI are the same people who will support your child with an IEP.

    I have had several students who RTI was implemented with fidelity. Some of them continued to rise and in a few years, you would never had known they were having challenges before. Some of them, after the allotted period did not make the expected growth to meet grade level proficiency and moved forward to the IEP process, but even those student benefited from the targeted instruction and continued with RTI during the IEP identification process.

    The best way to advocate for your child is to understand the process and ask questions like:
    1. At what level is my scholar supposed to be performing and what level are they performing at now?
    2. What is the expected amount of growth my child should make during this intervention period to make grade level proficiency?
    3. How and how frequently is my scholar’s progress being monitored?
    4 . What can I do to support?

    1. Sondra Terry

      Amen. Tier II in the classroom should continue after the IEP.

      RtI is law of general education. If child is general education and at the bottom in classroom then Tier II continues. Teachers Tier II is for the bottom performers in his or her classroom. So the sp ed student should not be missing Tier II group in the general edclassroom.

  25. Kaller

    With all that teachers are expected to handle, we need co-teachers and an aid in every classroom, at all times.

    1. Sondra Terry

      Who says you cannot co teach in your grade level? This has been a successful way to deliver interventions in many schools. “Fluid walls” means that the grade level teachers are responsible for all kids growth. Divide up to do tier II to lowest kids in the grade. Get parent volunteers for kids not on tier II.

      Work smarter not harder is what we call it. Good teaching is intervening and have small group instruction for strugglers using a different approach or strategy.

      Why not co teach?

  26. June

    Retired teacher here > Shouldn’t we be looking at other causes outside of the school setting? Some causes that may be due to changes in societal attitudes, behaviors and values? Some (and I emphasize some) parents who are working, and trying to climb the vocational ladder think that if their child is getting the special help at school, they get to have a pass on working with them at home? Maybe, some parents who are trying to continue to have a full, adult social life spend so much time on their cell phone and social media they don’t give their children the time, values and instruction needed for their children to achieve? Some parents find it easier to let their kiddos spend their time with game-boys, on their own cells phones and social media than to have meaningful family time? Or the family is spending so much time traveling from one activity to another? Perhaps the fact that some parents may not want their children to succeed in school because they may have their child’s social security disability funds cut? Superintendents and administrators/state and local board of educations/ state and local department of educations need to stop with being so politically correct and admit that society has a blame in this. I applaud all you teachers who are working harder than ever to get kids to learn. But face it, some REAL problems with RTI children not progressing are not being addressed. You teachers and school employees see it clearly every single day. I am sure that if this article was written by a teacher, the causes of the RTI failure would look a lot different. Carry on Education Warriors. I truly believe that you are the last and best hope for our country to get back on stable ground and be great again.

    1. Sondra Terry

      Agree. Schools can only control what happens in its walls or building. Many barriers to success.

  27. Melissa

    RtI is about delivering strong core instruction at tier 1 (although students) and then modifying what you do at tier 2 and 3 in terms of duration and frequency. At no time have teachers been told to focus on only phonics or only comprehension. The instruction that happens within tier 2 and 3 should be tailored to the group of children being served. It means being creative as a grade level or school. RTI fits into a process called Multi Tiered School Support, RtI is not a predetermined number of sessions, it was developed to help students close gaps in their learning. I have seen many positive effects when RTI is implemented the right way but there are so many factors that if the process is not understood or if there are misconceptions I’m sure it could be detrimental.

    1. Sondra Terry

      Like deficit grouping focusing on certain skills is what I meant. If children struggle with fluency we work strictly on fluency strategies in Tier II and Tier III with weekly monitoring. When mastery is met only then do we work on Comprehension skills next. Tier I addresses all skills n the core curriculum.

      Precriptive skill deficit and monitoring that skill only for Tier II and Tier III .

  28. Sonja

    In LAUSD, we’ve seen RTI abused by charters as a “black hole” to keep students from receiving proper assessments for IEP services. Charters take public funds with a % allotted to special education needs, but never really provide what they should for the few students with disabilities they do enroll. Languishing for years in RTI hell allows schools to appear compliant while completely failing to help a student with disabilities. It was a bad idea from the get-go.

    1. Sondra Terry

      Intervening when a child struggles is good teaching and that is RTI.

      I have never heard of what you are discussing but so sorry to hear about it. That is not a failure of RTI though.

  29. Concerned

    I am a kindergarten teacher and I agree with the findings of this article. Our school has been doing a pull-out RtI program for several years now. (We used to call it Title 1. Now it’s referred to as Tier 2 support.) Our RtI reading program uses a “one size fits all”, specific phonics program to address the early reading needs of all struggling students. However, not all of the students have phonetic deficits. Classroom teachers (myself included) have asked for more guided reading support aimed at comprehension, vocabulary, sight word and fluency development, but have been met with resistance from the RtI staff and administration. We are told that the phonics program needs to be used “to fidelity” in order to be successful, but the success stories just aren’t happening. The gap between the struggling readers (even at a kindergarten level) and the mainstream students is only getting wider.

    1. Sondra Terry

      Someone does not understand RtI at the upper levels.

      Diagnostics and need of the individual child drives the intervention.

      Do you have problem solving meetings?

      This is an example of implentation gone wrong and administration needs training. Title I interventions at Tier II should be less than 6. Tier II is 3 or less students. The interventions should be on deficit areas documented by a diagnostic measure like dibels, star, DAR, etc.

  30. HS teacher

    As a high school teacher we HAVE to RTI every student who does not complete every assignment. It is not being used as a stepping stone for struggling learners. We have to document we have provided repeated opportunities for TEACHERS to intervene for students who will not write a single note in class. They are capable simply will not do it. Anything will fail when not used to benefit the student, when it is used to enable helplessness. Before schools really improve and do not just manipulate numbers there has to be student accountability factored in, there has to be parental accountanility, teacher accountability, and administrative accountability. Our students do not have to bring pencils, pen, paper, calculators or.anything to class but themselves. We can not require anything. We are raising a generation where the student isn’t accountable for anything.

  31. F.

    Educational administrators don’t look at “other causes” of deficient reading skills (societal, cultural) because there is no money to be had in that. As a teacher of high schoolers, I can tell you that the biggest problem is motivation on the part of each student. Students tell me, ” I’m not doing that. I don’t read,” as if they were saying, “I’m not wearing white socks. I don’t do that”. Most who are not identified with a learning difference refuse to read because either it IS difficult for them, or because it requires critical thinking (e.g., effort). These students have CHOSEN not to improve their skills because that choice is more palliative than improving their skills.

  32. Pingback: Delaware’s Special Education Plan To Prevent IEPs & Improve Smarter Balanced Scores – Exceptional Delaware

  33. John

    It took 1 1/2 years to get my son tested with the grand children I told them I wanted them tested and did not want to wait for R T I one child qualified the other did not for an IEP. Parents do have the right for testing and not wait on RTI I decided RTI was just a waste of time and the school people thought they had to do RTI but I told them I had the right to ask for testing and not wait for RTI they thought they were being rushed but I got it done!

    1. Sondra Terry

      Interesting. Federal law mandates interventions must be completed and documented. Yes, evaluation is a parental right, however, interventions must be documented before anyone can label a child has a learning disability. Not so for intellectually Disabled, Language Disorder, Other Health Impaired, or Autism.

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  35. Pam

    I was told that RTI was a must before the school would consider testing for special ed eligibilty. That was 5th grade. When she advanced to 6th grade, that middle school said she had to go through their RTI even though it was the same school district. Needless to say, half way through she had severe coping issues and was going to be expelled… FROM MIDDLE SCHOOL!! The principal of an alternative school setting took her in without an IEP and insisted the middle school test her. Liw and behold, she has ASD and is attending her 4th year in a residential setting out of the area. She will be just shy if her 20th birthday when she finally finishes acquiring her Senior credits. 2 years wasted due to thIs RTI/no child left behind nonesense. Instead, schools should be forthcoming with educating parents if their rights and the steps one HAS to take for a school to test a child. I finally had a teacher take me aside in private and told me my daughter needed to be tested. If it were not for her caring nature, I may never had known. By law a school cannot refuse a request to test…. But they are not required by law to inform a parent of the need. I’m sorry…. Isn’t that why you are in the schools??? To HELP???

    1. Sondra Terry

      Interventions are for reading, math, and behavior in most states. If Autism, intellectually Disabled, Other Health Impaired, are suspected evaluations take place right away.

      Parents can make a request for an evaluatuon in writing.

    2. Sondra Terry

      Interventions is what helps struggling students whether they are special education or general education.

      Ask your child’s teacher if she is continuing Tier II interventions in a small group while in her room. I just bet she or he says, “Well no they are in special education now”. That label does not help your child. Direct teacher interventions help ALL children. If that is her or his answer, your child is receiving less help when they need more help. RtI implemented incorrectly.

      Teachers should deliver Ter II interventions to the lowest students in the room general and special ed. Some believe if in special education they are excused from helping them and those are the ones that need it the most. Unless they are no longer the lowest 4 or 5 in that classroom Tier II continues.

      Everyone has an agenda. Special education is often thought to be a teacher’s ticket out of being responsible for that child. Not true. Tier II should continue with the teacher after placement in Special Education. Tier III is now special education.

      Be sure and ask about Tier II and see if you still believe that teacher was so caring to tell you that. You may have just got her out of helping your child and your child less help. Hhhhmmmm.

  36. Tom McDonald

    Another example of traditional educations and traditional educators inability to change paradigms from 20th century, factory based, one size fits all, teaching to 21st Century, truly personalized, individually facilitated, deep learning FOR ALL STUDENTS
    They continue to jam that square peg in that round hole with ongoing dismal student success outcomes FOR ALL STUDENTS
    When will they understand, embrace and implement the proven research to advance ALL STUDENTS success outcomes that result in individual student, performance improvement outcomes?
    One size fits all doesn’t work for any student. Why continue with this approach, when we know better?

    http://mcdonaldsalesandmarketing.biz/38228/forgetting-curve-3/

    http://www2.ed.gov/about/offices/list/osers/index.html

  37. Teri Pedersen

    My Daughter was really having a hard time in the first grade so I put in writting that I had concerns and that I would like her to be tested however instead of them testing her the did the RTI which never helped her it just seemed worse!! So I swiched school districts and right away I went to the principl and put it in writing again that I wanted her tested!! Well when they finally did the testing we found out that indeed she learning disabilities such as an auditory processing problem and a memorization problem on top of now having mental health issues due to them taking so long to get her the right help she needs!! It is still an everyday struggle for her and myself because no parent wants to see their child have to go thru struggle after struggle everyday being bullied and picked on cuz she is not like the other children!!!

  38. Lyn Yates

    The main problem I see with RtI as a speech language pathologist is that often it’s not only reading the student is struggling with. Underlying foundational language competency is necessary for reading comprehension to occur. If the intervention does not target what the student’s challenges are the intervention will not make a difference.

    1. Sondra Terry

      Yes. Sadly the correct curriculum or strategies needed as well as training others and hiring interventionist is not in school budets. No one funds RtI.

  39. Pauline Maynard

    Yes That’s right! What would be the point of providing intervention, when reading is not the only struggle.

    1. Sondra Terry

      Seriously. Always intervene when a child struggles and have small groups. That has been what effective teachers have or should be doing for centuries. Interventions are part of teaching long before we called it RtI !!!!

      Always intervene before you say learning disabled.

  40. Pingback: Is RTI Working? | Spears Strategy

  41. Misty P

    Well I can only comment on our own experience with RTI, but our experience was a blessing. My son was struggling in the traditional school system so we were able to transfer him to Plato Academy (a charter school) for the 2015/2016, his 4th grade year. He was immediately evaluated before school started and determined to need RTI. He skipped Greek (language) three days a week to attend RTI from the beginning of of the school year till early February when we were notified he “graduated” from it. He has been on honor roll all year and most recently made principal’s list for the first time. His RTI teacher was awesome and my son loved going and didn’t want it to end. We’re very thankful for our short time with RTI. I’m sorry it’s not working for everyone.

  42. sfr

    people think special education fixes problems but it really doesn’t. kids in sped, as far as SLD goes, perform more poorly in the end than those kids with SLD not put in sped. all kids who don’t meet benchmark expectations cannot be put in sped, there are just too many of them. sped doesn’t really provide individualized instruction because there aren’t enough hours in the day or enough personnel to truly individualize it, it’s just smaller group with lower, slower instruction. RTI model vs. discrepancy model of SLD identification will result in more kids in sped because the bar is higher. in my school, low SES, half the kids don’t meet benchmark expectations. parents demand their kids are labeled as disabled yet they don’t bother to make sure their kids wears their glasses to school or do their homework or eat breakfast or take their meds. but they do make sure they fill out the forms to get disability benefits.

    1. Carson Graves Post author

      Special education works as well as parents are willing to make the effort to learn about the laws and their rights. It is true that many schools take advantage of a parent’s ignorance of their child’s right to an appropriate education to minimize or withhold needed services or individualized instruction in order to preserve the school’s budget. It is, of course, against the law for schools to do this, yet we find that many parents aren’t aware of this fact and don’t hold their schools accountable for not providing their children the education that it is the school’s obligation to provide.

      That is why we wrote our book (and our blog articles), to empower parents by explaining the special education process and how to navigate the many entrenched barriers that can prevent their child from getting an appropriate education. We encourage you and any others to take some time to study the many articles we have posted here, and also to read our book, to better understand what special education promises, how it too often fails, and what parents can do about it. Blaming the parents for this failure, as you do in your comment, is incorrect, and does a disservice to the over 6 million families in the US that have children on IEPs.

  43. Tim

    I think it would be beneficial to actually read the 300 page research project that was funded by the U.S. Department of education. I think everyone should read the research before reading any biased opinion. For example the research highlights: successes with RtI, the role ELL’s have in the study. And there’s an interesting disclaimer that warns against using the data to “Generalize” the negative impacts for all students who receive RtI. At least read the first 30 pages and you would see that this article clearly misleads people to believe that the U.S. Department of Education research fully supports the authors position on the effectiveness of RtI. Read before assuming.

    1. Carson Graves Post author

      It is very instructive to read both the article in Education Week (“Study: RTI Practice Falls Short of Promise”) and the 26 page executive summary provided with the 308 page study (all linked to in our post). The Education Week article relies not just on examining the study data, but quotes extensively from the study’s authors and other experts in the field. It would have made our post too long to have included all of these quotes, but none of them change the conclusion of the Education Week article that “First Graders Who Were Identified for More Help Fell Further Behind.”

      Fred Doolittle, a study co-author is quoted as saying “We weren’t expecting to see this pattern,” and “We don’t want to have people say that these findings say these schools aren’t doing RTI right; this turns out to be what RTI looks like when it plays out in daily life,” referring to the study’s finding that first graders who received RTI actually did worse than virtually identical peers.

      Karen K. Wixson, identified as “a reading and literacy professor and a dean emeritus of education at the University of North Carolina Greensboro,” is quoted as saying “Students are missing a lot of broader things that are going to make a difference in their ability to put it all together in functional reading,” if the tier I instruction is too narrowly focused, one of the concerns expressed by the study. The article also says that Professor Wixson “…wasn’t surprised by the negative findings, which she suggests point instead to problems both in the screening tools used to identify students for Tier 2 interventions and in the array of interventions available for them.”

      Another study co-author, Rekha Balu, says that the research “…raises the question then, what is the extent of the contrast and differences in services provided to students below grade levels?” and points out that for students receiving RTI instruction “It was the equivalent of losing one-tenth of a year of learning.”

      Douglas Fuchs, identified as “a professor and chair of special education and human development at Vanderbilt University” and who “is a longtime proponent of RTI,” states “…what’s happened is RTI has been deliberately used as a kind of general education substitution for special education.” (Note that was our concern about RTI to begin with and what the US Department of Education has warned schools not to do.) He is also quoted as saying “I think these data also reflect the gap between research and practice, because for so many schools to have such negative effects at [1st grade], it’s pretty surprising,” And: “For all the schools together, we get a statistically significant negative effect for RTI interventions.”

      Lets look at the study itself. On page 13 of the executive summary, under “Impacts on Reading Outcomes of Students” is the conclusion: “Assignment to Tier 2 or Tier 3 intervention services in impact sample schools had a negative effect on performance on a comprehensive reading measure for first-graders just below the Tier 1 cut point on a screening test.” The accompanying figure ES.4 “shows that the estimate for the effect of assignment to Tier 2 or Tier 3 intervention on the ECLS-K Reading Assessment measure is -0.17 standard deviation and is statistically significant (p-value = 0.002).” This is a slightly condensed restatement from page 79 of the full report.

      Another thing that the data reveals on pages 92 and 93, is that while the 2nd and 3rd graders in the study (the study examined the outcomes of 1st through 3rd graders) did not experience the same negative effect that the 1st graders did, there was no statistically significant difference between their progress and the progress of similar 2nd and 3rd graders who did not receive RTI instruction. The logical inference is that even at its best, the study did not show a positive outcome for RTI relative to general education for any of the students it examined.

      Finally, the study’s authors do point out that the study only examined the effect of RTI on reading instruction for grades 1 through 3, and did not examine RTI instruction in other areas or for other grades. The authors also point out that there has not been any other study that examines the effectiveness of RTI in these other areas and age groups. So, while it is fair to say that this study does not invalidate RTI instruction in other contexts, it doesn’t support it either. In other words, the only known data point for RTI effectiveness is negative. Readers can draw their own conclusions from this.

      In closing, we apologize for such a long-winded reply. However, we hope it is clear that for anyone to imply that one has to read all 308 pages of this study in order to understand its “real” significance, especially without providing any specific citations or supporting quotations, is disingenuous. And, for all the parents who have written us comments describing their frustration with RTI, many of which are attached to our article, we can only observe that they didn’t have to read hundreds of pages of a research study to know that RTI wasn’t fulfilling the promises made to them and their children. In summary, we feel comfortable that both the Education Week article and our report of it are accurate and fair to the study’s conclusions.

      Judith Canty Graves and Carson Graves

  44. Tricia Ball

    My daughter has been in and out of RTI since 2nd grade unfortunately I had to have her held back in 2nd grade because I knew she wasn’t ready for 3rd grade this year they have placed her into 4th grade and she still has the reading level of a 1st grader if RTI is supposed to be helping why is it she is still on such a low reading level? I asked the teachers the principal and the special education teacher if taking her from her classes would hurt her their response “Oh no it won’t she will be fine” guess what she started dropping in grades and they decide to finally place her back in RTI about 6wks before school ended said she had tested out of it at the end of last school yr if she has a history of learning disabilities in her school record why haven’t they taken this to the next step! What do you suggest I do going into this next school yr 2016-17?
    Thank you,
    Tricia Ball

    1. Carson Graves Post author

      Hi Tricia,

      Has your daughter been in special education, or is the school telling you that she is just eligible for RTI? You have the right to request (in writing) that the school test your daughter in all areas of suspected disability to determine if she is eligible for special education. This is not the same as RTI, and RTI cannot be used as a substitute for special education services or to delay evaluations for special education eligibility. We have more information on evaluations and referrals for special education in Chapter 1 of our book.

      Good luck, we hope this helps.
      Judith and Carson

  45. Michelle Skigen

    This is because people were going through a systemic rote practice instead of professionally applying the information – in part because of admin making it an “in addition to” instead of a truly supportive, integrative activity. Also, people confused “RtI” with a pre-packaged program instead of a scaffold/structure on which to hang existing practice. No surprise – but once again studies are not looking at real causes, just that things got screwed up.

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