Implementing RtI for School-Based OTs and PTs: Supporting Struggling Learners

Jean: Today's presentation is designed to arm each of you with the knowledge you need to work collaboratively with instructional personnel and with other members of the campus team to help struggling learners in general education and help prevent unnecessary referrals to special education.

Definitions

Early Intervening Services (EIS)

Early intervening services is a sometimes confusing topic. It sometimes interchanged or confused with early intervention services, but these actually are very different. They are preventive components of federal education statutes, and this term first showed up in IDEA in 2004. This is about services implemented to benefit students who manifest a risk for poor learning outcomes, but they have not been identified as needing special ed or related services. These students are in a category that is typically referred to as struggling learners in general ed. in the literature. Early intervening services or EIS applies to students K-12 in the law, with an emphasis on K through third-grade students, who need additional academic and behavioral support to succeed in a general education environment.

Response to Intervention (RtI)

Response to intervention, or RtI, is a term you are probably more familiar. It is an example of an early intervening service. It is a multi-tiered approach within general education, not special education, that provides early services to struggling learners to facilitate school success. Sometimes it is referred to as a response to intervention framework. This particular framework addresses both academic and behavioral health needs of all students, particularly those who are at risk.

Positive Behavioral Interventions and Supports (PBIS)

Here is another term that may be more familiar to you. This term first showed up in IDEA in its 1997 authorization. It is not anything that is new as it has been around for about 20 years. It is an evidence-based, data-driven framework proven to reduce disciplinary incidents and increases the school's sense of safety and supports improved academic outcomes. The intervention strategies, that are typically associated with positive behavior, interventions, and supports, address school climate in a comprehensive way as well as the individual needs of students. Again, this is not specific to special ed, but rather it is all-encompassing of public education.

It is not just about what is wrong with the child, but it may also have to do with what is going on between the child and the people or the particular features of the environment that they are learning in.

Multi-Tiered System of Supports (MTSS)

This is a term that has become in use more frequently in the last five to seven years. Multi-tiered system of supports, or MTSS, is an umbrella framework that includes response to intervention and positive behavioral interventions and supports. Both of these frameworks are considered under multi-tiered systems of supports.

Now that we are speaking the same language, let's talk a little bit about a response to intervention and review what it is and what the framework looks like in action.

Review of RtI

The Basic Premise of RtI

Despite the lack of evidence, public health systems historically assumed that when there was a problem with student progress for any student in public education, the problem was within the student. In other words, it was something that was wrong with the student, some sort of an impairment or flaw. And the student was typically referred to special education.

In contrast to that, response to intervention grew out of the published evidence that was gathered primarily in the 1990s, but also into the early 2000s. This evidence indicated that when there is a problem with student progress, the problem is more likely to be found in the quality, intensity, and/or type of instruction. In other words, the problem exists within the environment rather than within the child. RtI is an early intervening framework that seeks the instructional and/or behavioral interventions to support student progress. This refers to things that can be changed within the environment that can make a difference for kids who are struggling with learning.

RtI is a Collaborative, Team Approach

I want to emphasize here that RtI is a collaborative team approach. It is not inclusive to educational personnel, but rather it includes and assumes all members of the team are valuable resources for struggling learners. This also includes folks who are historically special education related only.

Features of a RtI Framework

Here are the features that you will see in play when schools are implementing a RtI framework. 

• Universal Screenings
• High-quality, evidence-based instructional methods, and interventions
• Data collection, data analysis and data-based decision-making (e.g., progress monitoring)
• The focus is on general education students who are struggling with behavior and/or academics that impact learning
• Interventions are provided with increasing levels of intensity through tiers
  • School-wide
  • Small group
  • Individualized

Typically, you will see universal screenings, and in this case, I am using screening as it is used by educators, meaning an assessment that is informal in nature to take a look and see how kids are doing. This is not a formal screening that is part of an evaluative process as we are used to in the world of OT and PT, but rather an informal screening in an education sense.

Another feature is high quality evidence-based instructional methods and interventions. Teachers have to pay attention to what is published in their own literature, and their administrators need to be ensuring that those are the things that are carried out.

Next is the data collection. Data analysis and decisions are made based on the data that is collected and analyzed. Another term for that in education is progress monitoring.

Another feature is a focus on general education students who are struggling with behavior and/or academics that impact learning. What was so interesting in the research during the 1990s, and reviews of research even earlier than that, is that essentially the need for intervention and the way that the picture develops for both behavior and academics encompass similar percentages of students in general education. I will show you that graphically in just a few minutes.

Interventions are provided through increasing levels of intensity through tiers, beginning with school-wide interventions, things that might be useful to all children, and then the second tier is more focused on small groups of children, and then finally individualized interventions.

Examples of Interventions Utilized in a RtI Framework

Here are some examples of those interventions that are used in a RtI framework.

• Universal screenings
• Universal Design for Learning (UDL)
• Curriculum and/or environmental modifications
• Positive Behavioral Interventions and Supports (PBIS)
• Professional Development for Instructional Personnel

We talked about universal screenings. These may be implemented in the early or primary grades. Universal Design for Learning, which as a concept is very familiar to us as therapists, but in the education world, has only really come to prominence probably over the last decade. Curriculum and/or environmental modifications is another example of an intervention that might be used in a RtI framework. Again, we are talking about general education that is inclusive of all students. Positive behavioral interventions and supports is an example of an intervention that is used in a RtI framework. And of course, there is professional development, particularly for instructional personnel.

Advantages of a RtI Approach for Students

What are the advantages of a RtI approach for students?

First, the focus shifts from who is eligible for services to provide effective instruction. Again, this is not a systemic thing that identifies kids at the beginning of the process. This is a system that looks first at what the adults in the environment are doing to try to achieve the most effective instruction for all of the students. It does not require a teacher or a parent referral. It is a process that occurs in general education. However, I do know that some states, including my own, now require parents be notified if their child is involved in a RtI framework or process in their school. The approach allows students access to intervention immediately, rather than waiting for that 45 to a 60-day period often in special ed and sometimes longer before an IEP is developed. This is a systemic approach in regular ed that can be implemented right away. If pre-referral interventions are not successful through the RtI process, then the student's referral to special ed will include all of the data about the general education interventions that have been employed, and how the child has responded to those. Then, there is already a nice picture for the evaluators in special education to see how the child is doing.

Advantages of a RtI Approach for the Education System

What are the advantages of a RtI approach for the educational system as a whole?

Over time, employment of a RtI framework reduces the number of minority and low-income students referred for special education. In other words, it is a tool for reducing disproportionate numbers of children from minority and low-income groups appearing in special ed populations. This has been a problem since the beginning of special education in the 70s, a problem that all states continue to work on. RtI also provides needed interventions for students who are transient, who have limited English proficiency or have social and economic disadvantages. In other words, it helps ensure that when a special education evaluation is being conducted that what we are identifying, through the evaluation process, is indeed a disability and a need for services, and not just limited English proficiency or the fact that a student's family is transient and moves routinely from place to place without a great deal of time in anyone's school district to benefit from the instruction that is being provided. Another advantage of the education system is that referrals to special education may be reduced. You heard me say earlier that one of the goals or benefits of a RtI process is that there are typically fewer referrals to special education. This is because any sort of issues, with at-risk children, are caught quickly and mediated, hopefully before it becomes a special education issue. And then, RtI promotes the unity of special ed and general ed. It can help facilitate a system that is more seamless and less segregated or fragmented.

In Figure 1, I am attempting to give you a picture of what RtI looks like when it is in play.

Figure 1. Overview of RtI.

In this triangle, represented are 100% of the kids in any particular classroom. Again, this is based on research that was done in the 1990s, and through the early 2000s. This is with an excellent instruction that is evidence-based and with the universal screening being applied to make sure that no one is falling behind and continued progress monitoring throughout the school year.  Progress monitoring using screens, or sometimes called probes, occur about every nine to 12 weeks through the school year for the class as a whole. Again, with typical good instruction, while keeping an eye on how the students are doing through progress monitoring, you would expect 80 to 90% of children to be keeping up with instruction and making progress as projected through the school year.

Now, within this particular classroom, you would also expect, based on the literature, anywhere from 10 to 15% of the students to be at risk for learning difficulties. Those would be identified through the progress monitoring system or the screens or probes that are administered every nine to 12 weeks. For that population, 10% to 15% of all the kids in the classroom, secondary preventive strategies would be employed, using either more intensive instruction, often seen as tutoring, before, after or during the school day, or differentiated instruction. Differentiated instruction is the modifying of the instructional methodologies. So the teacher knows what the student is learning. Progress monitoring typically at a tier two level will become more frequent. You often see kids working in small groups, but sometimes the tutoring will be one-on-one in a tier two intervention. Again, this can occur either because the academic progress is not being made as anticipated or at the rate anticipated, or because the behavioral instruction is not being picked up by the student and employed in day to day interactions with others in the environment.

When you get to tier three, now you are talking about one to five percent of the students in those classrooms who may not respond to the tier two targeted interventions as desired. There will be an increasingly intensive instruction and more individualized interventions, and in some states, this will actually be the point at which a referral to special education may be made. I want to emphasize that this is a basic three-tier RtI model. In some communities, you will find that they have subdivided this even further into maybe five tiers. But for our purposes today, we are just going to talk about three basic tiers. If it is a model with four or five tiers, what that means is that they have added further steps in the process in their locales.

Now let's look again at the model but superimposing the roles that OT and PT practitioners may make through this process as seen in Figure 2.