New York University Tertiary Prevention Care Programs Discussion

Question Description

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List two agencies in your community that provide prevention care. Explain if they provide effective primary, secondary, and tertiary care for the population. What makes these agencies effective?

Identifying Students for Secondary and Tertiary Prevention Efforts: How Do
We Determine Which Students Have Tier 2 and Tier 3 Needs?
In comprehensive, integrated, three-tiered models, it is essential to have a systematic method for
identifying students who need supports at Tier 2 or Tier 3. This article provides explicit information on how
to use multiple sources of data to determine which students might benefit from these supports. First, the
authors provide an overview of how to make an assessment schedule for all schoolwide data. Second,
the authors outline how to create a blueprint for Tier 2 and Tier 3 supports in a given school, including a
description of the strategy or practice; inclusionary criteria; data to monitor progress; and exit criteria.
Last, the authors provide an overview of how to connect students to support and monitor their progress.
Keywords: data-informed decision making; monitoring student progress; professional development; social
validity; Tier 2 supports; treatment integrity
An important component of any Comprehensive, Integrated, Three-Tiered (CI3T) model of prevention is
accurate detection of which students may require supports beyond primary prevention efforts. As
discussed in earlier articles in this special issue, there are some issues regarding Tier 1 and teacher-level
considerations to address before moving toward student-level interventions for some students with
common needs (Tier 2, secondary-level supports for some) and a few students with more individualized
needs (Tier 3, tertiary-level supports for a few). In terms of Tier 1 implementation, it is important to first
examine treatment integrity data to make certain the core features of the primary prevention plan are in
place (Lane, Oakes, & Menzies, 2010; Lane, Oakes, Menzies, Oyer, & Jenkins, 2013). Likewise, it is
important to examine data for the overall school as a whole to determine how students are performing
academically, behaviorally, and socially according to systematic screening tools to make certain primary
preventions efforts—if implemented with integrity—are yielding desired outcomes. Furthermore, it is also
important to examine student performance data at the classroom or teacher level to ensure approximately
80% of students are responding in a given context. If not, it may be that relatively simple, research-based
shifts in teachers’ behaviors could be introduced and evaluated to support all students if behavioral and
academic screening data suggest a substantial (e.g., 30%) number of students in a given class are
struggling (Lane, Menzies, Ennis, & Bezdek, 2013; Lane, Oakes, Menzies, & Germer, in press; Scott,
Jolivette, Ennis, & Gilkey-Hirn, 2012). Examples of these research-based techniques include
incorporating choice into instruction (e.g., Kern, Manteegna, Vorndran, Bailin, & Hilt, 2001), increasing the
use of behavior specific praise for students meeting expectations (e.g., Reinke, Lewis-Palmer, & Martin,
2007), increasing students’ opportunities to respond (e.g., Haydon, Mancil, & Van Loan, 2009; Partin,
Robertson, Maggin, Oliver, & Wehby, 2010), or incorporating precorrection strategies into instructional
routines (e.g., Ennis, Schwab, & Jolivette, 2012). Yet, if data suggest primary prevention efforts are being
implemented with integrity and yielding the desired outcomes for approximately 80% of the student body
and the vast majority of teachers have fewer than 20% of students in their class with demonstrated needs
in academic, behavioral, or social domains, Tier 2 and 3 supports may be warranted.
Tier 2 and 3 supports are supplementary strategies, practices, and intervention programs designed to
provide assistance to those students for whom primary prevention efforts are insufficient. In some cases,
remediation may be necessary to build specific skills sets such as reading comprehension skills (Chard,
Ketterlin-Geller, Baker, Doabler, & Apichatabutra, 2009), self-determination skills (e.g., goal setting,
decision making; Carter, Lane, Crnobori, Bruhn, & Oakes, 2011), study skills (Kalberg, Lane, & Lambert,
2012), and social skills (Elliott & Gresham, 2008a). However, in other situations, students are highly
successfully in given areas (e.g., reading skills), and may benefit from interventions to improve their
academic motivation or extend their learning experiences (e.g., book studies for those reading at or
above grade level; Oakes et al., 2012).
Interventions can vary in scope and intensity, with Tier 2 interventions of lower-magnitude intensity such
as those noted in the previous paragraph. While traditional Tier 2 supports often include small group
interventions (e.g., Behavior Education Program, also known as Check-in/Check-out; Crone, Horner, &
Hawken, 2010), they can also include low-intensity supports such as behavioral contracts (Downing, [ 8])
and self-monitoring (Menzies, Lane, & Lee, 2009). Tier 3 efforts are more ideographic and intensive in
nature such as functional assessment-based interventions, 1:1 reading interventions, wraparound
services, and family-based supports such as multisystemic therapy (Eber, Breen, Rose, Unizycki, &
London, 2008; Kern & Manz, 2002; Schoenwald, Brown, & Henggeler, 2000).
Given our collective decades of experience as teachers, researchers, and behavior specialists, we are
confident that many schools have a wide range of Tier 2 and 3 supports in their buildings to enhance the
educational experiences of those requiring more focused assistance. Yet, we are equally confident that
many schools do not have information regarding these supplemental supports in a manner that (a) is
transparent to faculty, staff, students, and parents; (b) facilitates equal access for students who may
benefit from these strategies, practices, and intervention programs; and (c) incorporates all the necessary
features to evaluate how well each of the supplementary supports are benefiting the intended students.
In this article, we provide information on how to develop a blueprint of the Tier 2 and Tier 3 supports
available in a given school and explicit information on how to use multiple sources of data to determine
which students might benefit from these supports. Specific content includes how to (a) construct an
Assessment Schedule to provide an at-a-glance tool for organizing all data available and examined as
part of primary prevention efforts; (b) make a blueprint of available Tier 2 and 3 supports, referred to as
secondary and tertiary intervention grids; (c) connect students to supports; and (d) implement the core
components needed to monitor how students respond to these supplemental supports (e.g., student
performance, social validity, and treatment integrity). We conclude with a discussion of using a teambased process for implementing Tier 2 and 3 supports as well as a brief summary.
Assessment Schedule
The first step to systematically identifying student responsiveness to the primary level of the CI3T plan is
determining which data need to be monitored to make decisions (Lane, Kalberg, & Menzies, 2009). One
way to do this is to establish a schoolwide Assessment Schedule that involves (a) identifying pertinent
schoolwide data collected as part of regular school practices, (b) developing a schedule of when data are
collected and available for review, (c) adding any additional needed data sources, and (d) developing
procedures for data analysis.
First, CI3T school-site leadership teams identify data sources they are currently collecting that will glean
information on comprehensive student progress in all domains—academic, behavioral, and social.
Academic measures may include schoolwide data such as grades, course failures, high-stakes state
tests, and academic screening tools (e.g., benchmarks). Behavioral measures may include office
discipline referrals (both minor and major incidents), suspensions, expulsions, daily progress reports/point
sheets, as well as systematic screenings of behavior (e.g., Student Risk Screening Scale [Drummond,
[ 9]] and the Behavior and Emotional Screening Scale [BASC-2; Kamphaus & Reynolds, [24]]). Social
measures may include information on bullying and counseling referrals, as well as behavior screening
tools such as the Strengths and Difficulties Questionnaire (Goodman, [17]) that includes a subscale
measuring prosocial behavior.
Second, CI3T school-site leadership teams develop a schedule of data collection. This schedule can be
created by listing all data sources in a row of a table with columns for each month of the school year (see
Table 1 for an example for elementary school and Table 2 for an example for middle and high school).
For each month that these data will be collected, place a check or an × in the corresponding cell. The
schedule of data collection will often be dictated by the type of data being collected. For example, state
testing data may only be collected once a year while academic and behavior screening tools are collected
three times a year (fall, winter, and spring) and attendance and office discipline referral summaries may
be compiled monthly.
Table 1. Elementary Assessment Schedule
School demographics
Academic measures
Report cards
Statewide assessments
SRSS-IE behavior
Minor office discipline
× ×
Suspensions/expulsions ×
× ×
Bullying referrals
× ×
Counselor referrals
× ×
× ×
CI3T model program
PIRS social validity
SET treatment fidelity
10001 Note. SRSS-IE = Student Risk Screening Scale–Internalizing and Externalizing (Lane et al., [32]);
SSBD = Systematic Screening for Behavior Disorders (Walker & Severson, [52]); SSIS-PSG = Social
Skills Improvement System–Performance Screening Guide (Elliott & Gresham, [11]); CI3T model =
comprehensive, integrated, three-tiered model; PIRS = Primary Intervention Rating Scale (Lane, Kalberg,
Bruhn, et al., 2009); SET = School-Wide Evaluation Tool (Horner et al., [22]). Adapted from Figure 5.3 in
Lane, Kalberg, and Menzies (2009). Developing schoolwide programs to prevent and manage problem
behaviors: A step-by-step approach. New York, NY: Guilford Press.
Table 2. Secondary Assessment Schedule
School demographics
Academic measures
Report cards: Grade
point average
Course failures
(progress reports)
Behavior measures
SRSS-IE behavior
Discipline: office
discipline referrals
Special education
Prereferral intervention
Counseling or social
worker support
CI3T model program
Social validity: PIRS
Treatment integrity of
Treatment integrity
CI3T model: Teacher selfreport survey
Treatment integrity
CI3T model: Direct
observation by outside
20001 Note. SRSS-IE = Student Risk Screening Scale–Internalizing and Externalizing (Lane et al., [32]);
CI3T model = comprehensive, integrated, three-tiered model; PIRS = Primary Intervention Rating Scale
(Lane, Kalberg, Bruhn, et al., 2009); SET = School-Wide Evaluation Tool (Horner et al., [22]). Adapted
from Figure 5.3 in Lane, Kalberg, and Menzies (2009). Developing schoolwide programs to prevent and
manage problem behaviors: A step-by-step approach. New York, NY: Guilford Press.
Third, once all data currently collected are included in the Assessment Schedule, the CI3T leadership
team should determine whether additional pieces of information need to be added to ensure there are
multiple data sources for academic, behavior, and social domains (Lane, Kalberg, & Menzies, 2009). For
example, many schools have chosen to adopt systematic screening measures (Lane, Menzies, Oakes, &
Kalberg, 2012; Lane, Oakes, Cox, & Messenger, 2014, this issue) to provide information on students’
behavioral and social needs. Likewise, the Assessment Schedule should include measures of social
validity and treatment integrity collected on a regular basis to ensure that the CI3T model is being
implemented as planned (treatment integrity) and is socially acceptable to teachers, students, and other
stakeholders (social validity; Lane, Kalberg, Bruhn, Mahoney, & Driscoll, 2008; Lane, Oakes, & Magill,
2014, this issue).
Fourth, once all needed and existing data have been identified and added to the Assessment Schedule,
the next step is to collect and analyze the data. CI3T leadership teams will want to consider the following
recommendations: (a) there are consistent and accurate methods of data collection; (b) there is a
designated person who will be responsible for gathering and monitoring each type of data; (c) there is
time allotted in CI3T leadership team meetings as well as grade level (elementary or middle schools) or
department meetings (high schools) to review and interpret data; (d) the data collection procedures are
reasonable considering the other duties of those responsible; and (e) the findings are shared with all
stakeholders on a regular basis (Lane, Kalberg, & Menzies, 2009). These steps should be taken on a
consistent basis to inform the decision-making process. This decision-making process involves
determining responsiveness to Tier 1 supports as well as connecting students to needed Tier 2 and 3
Developing Tier 2 and 3 Intervention Grids
As previously outlined, even schools who are effectively implementing CI3T plans expect 15% to 20% of
their school population will require Tier 2 or Tier 3 supports (Lane et al., [36]). Nonresponsiveness is not a
tragedy, but it is a realistic expectation (Cook & Odom, [ 5]). Primary prevention simply cannot address
the academic, behavioral, and social needs of all students; in short, one size does not necessarily fit all.
So, it is reasonable to expect some students will have Tier 2 and Tier 3 needs over the course of their K–
12 educational careers. This does not mean they are a “Tier 2 or Tier 3 student”; instead, it means they
need (usually on a temporary basis) assistance beyond primary prevention efforts to address their
academic, behavioral, or social needs.
Using an assessment schedule and procedures for data collection such as those previously detailed will
help ensure that students who may benefit from these supports are not overlooked. CI3T leadership
teams should work together to establish a blueprint of existing supports that their school provides at Tier
2 (secondary, low intensity) and Tier 3 (tertiary, high intensity). Intervention grids for both tiers can be set
up in a similar manner, as Tier 2 and 3 intervention grids should include a column with information for
each of the following: name of support, description of support, entry criteria, data to monitor progress, and
exit criteria. The following are considerations for each of these areas to help guide the composition of a
school’s Tier 2 and 3 blueprints (see Tables 3 and 4 for examples).
Table 3. Secondary (Tier 3) Intervention Grid
Entry criteria
Data to monitor progress
Exit criteria
Student measures: Weekly
Students who need
progress reports for all subject
remediation of one or more
areas Homework completion
academic content areas
Treatment integrity: Tutors keep
meet with tutor teachers Academic:
records of attendance, including Passing grades
two afternoons per week Students failing activities attempted/completed AND all
after school for 30-min
two or more
during club time Social validity: assignments
sessions to work on
classes as
Students complete surveys to
completed at
Homework targeted academic skills determined by assess satisfaction with the
next grading
progress reports support
Participating students
Student measures: Daily
Low risk on the
check in and out with a
Moderate or high progress reports Treatment
SRSS-IE at the
mentor each day. During risk on the
integrity: Coach completes
next screening
check-in, students receive SRSS-IE Two or checklist of all BEP steps and
period and 1
Entry criteria
Data to monitor progress
Exit criteria
a daily progress report that more office
whether they were completed
month with no
they take to each class for discipline
each day (percentage of
office discipline
feedback on their progress referrals in a
completion computed) Social
meeting the schoolwide
given quarter
validity: Pre- and postsurveys:
CI3T model expectations.
teacher (IRP-15) student (CIRP)
Identified students meet
with counselors twice per
week during lunch for
40 min. During sessions,
Student measures: No
the counselor leads social Social: SSIScounseling referrals for two
skills lessons (including
PSG (score of 1 weeks. Intern in school
explicit instruction,
or 2 on prosocial psychology assesses the number
modeling, and
behavior) Four of positive social interactions and
opportunities to practice) office discipline play ground Treatment integrity:
with student participants. referrals related Counselor keeps record of
Specific skill sets
to negative socialattendance, including topics of
corresponding lessons
interaction on the discussion and level of
determined by the SSIS– playground
participation by each student
Rating Scales results as during the first Social validity: Students complete (score of 4 or 5
completed by teachers andquarter of the
surveys to assess satisfaction
on prosocial
Skills Club parents.
with the support
30001 Note. BEP = Behavior Education Program (Crone, Horner, & Hawken, 2010); CI3T model =
comprehensive, integrated, three-tiered model; SRSS-IE = Student Risk Screening Scale–Internalizing
and Externalizing (Lane et al., 2012); SSIS-PSG = Social Skills Improvement System–Performance
Screening Guide (Elliott & Gresham, 2007); IRP-15 = Intervention Rating Profile (Witt & Elliott, 1985);
CIRP = Children’s Intervention Rating Profile (Witt & Elliott, 1985). Adapted from Figure 1 in Lane, Oakes,
Menzies, Oyer, and Jenkins. (2013). Working within the context of three-tiered models of prevention:
Using schoolwide data to identify high school students for targeted supports. Journal of Applied School
Psychology, 29, 203–229.
Table 4. Tertiary (Tier 3) Intervention Grid
Data to monitor
Entry criteria
Exit criteria
A functional assessment
is completed to develop
an individualized
intervention plan.
Functional assessment:
review of student records;
Student measures:
interviews: teacher,
Data on target and
The behavioral
parent, student; and
replacement behaviors objective is
direct observation of the
are collected daily.
established based on
target behavior; SSIS
Treatment integrity is current levels of
Rating System Functional
assessed and data are performance and
assessment information
graphed to determine expected levels of
is placed in the function
effect of the
behavior. Students
matrix (Umbreit, Ferro,
intervention. Treatment exit support when
Liaupsin, & Lane, 2007) Academic: GPA of integrity: Component goals are achieved
The Decision Model
less than 2.75
checklist for A-R-E
and maintained for
(Umbreit et al., 2007) is Behavior: More
intervention tactics
three consecutive data
used to determine the
than six office
(see Majeika et al.,
points. Maintenance
method of the
discipline referrals 2012) Social validity: data are collected to
Assessment- intervention Intervention in the previous
Pre- and postsurveys: ensure behavior
components: (A)
school year SRSS teacher (IRP-15)
maintains without
Intervention antecedent adjustments, = 9–21 (high risk) student (CIRP)
(R) reinforcement, and
(E) extinction
Entry criteria
Data to monitor
Exit criteria
Student measures:
Academic: GPA of Two or fewer office
2.75 or lower
discipline referrals
Students Taking a Right Behavior: SRSS: earned GPA meeting
Stand (Center for Youth high (9–21) or
standards for
Issues, 1984) individual moderate (4–8), promotion Treatment
counseling (as deemed rated by either
integrity: Counselors
appropriate by STARS
second- or
maintain records of
Specialist) to focus on
topics covered and
skills to create school
teacher Two or
number of sessions
STARS counselor
success. Counseling
more office
students attend. Social determination based
services will be
discipline referrals, validity: Students
on goals met. Low risk
determined by STARS
complete surveys to
on SRSS screening to
Counseling intake paperwork and
concerns with peer assess satisfaction with monitor progress over
(individual) individual specific needs. interactions
the support.
40001 Note. SRSS = Student Risk Screening Scale (Drummond, [ 9]); SSIS = Social Skills Improvement
System (Elliott & Gresham, 2008). Adapted from Figure 1 in Lane, Oakes, Menzies, Oyer, and Jenkins
(2013). Working within the context of three-tiered models of prevention: Using schoolwide data to identify
high school students for targeted supports. Journal of Applied School Psychology, 29, 203–229.
Existing Supports
To begin, the team lists all supports for small groups and individuals currently available at the school. The
CI3T model draws on the expertise of representatives from all grade levels and departments in their
school to ensure that existing supports are not overlooked during this process. Once this list is completed,
the leadership team evaluates the current supports to determine whether these strategies, practices, and
programs have sufficient evidence to justify using them with students (Cook & Tankersley, [ 6]).
Resources available at the What Works Clearinghouse,1 National Center on Response to
Intervention,2 and the Office of Special Education Technical Assistance Center on PBIS 3 may be helpful
in determining whether current practices are evidence based and for identifying additional supports
needed. The CI3T leadership team then revises and organizes the list to include only the supports
provided going forward, as some will need to be eliminated because they are no longer used on a
consistent basis or are not considered a research-based or evidence-based strategy or practice. See
Oakes, Lane, and Germer (this issue) for recommendations on effective implementation of Tier 2 and Tier
3 supports.
When describing each Tier 2 support, it is important to include sufficient information on the support such
as who is providing what for whom, and under what conditions (Wolery & Dunlap, [54]). In other words,
there must be enough detail for someone to read the description of the support and understand all the
logistics. For example, a social skills group may be led by the guidance counselor, three days a week for
45-min sessions taking place during study hall time in a conference room. It is particularly important to be
clear on any supports that take place before or after school as transportation may be an issue. Also, as a
gentle reminder—a person (e.g., the guidance counselor) is not a support; it is what they do that is
the support.
Entry Criteria
The next step is for the leadership team to list the entry criteria, or how students are currently identified
for the Tier 2 supports. The entry criteria should consist of scores on specific schoolwide data that would
indicate a student may benefit from a given support. Many schools currently rely solely on teacher
nomination for identification for more intensive supports. Although teachers can often accurately identify
students’ needs, a systematic, data-based approach is required to ensure that students are not
overlooked and that all students are a given equal access to available supports (Lane et al., [36]). Instead
of relying on teacher nomination alone, the CI3T leadership team should review the assessment schedule
to determine what information can be used to identify students for each given support. Often, more than
one data source is needed. For example, participation in the Behavior Education Program may be based
on office discipline referral data and ratings on the Student Risk Screening Scale-Internalizing and
Externalizing (Lane, Oakes, Harris, et al., 2012).
Data to Monitor Progress
Three types of data are used to monitor progress: treatment integrity data to make certain the
supplemental supports are being implemented as planned, student outcome data to see how students are
responding, and social validity data from key stakeholders (e.g., teachers, parents, students) to see what
they think about the goals, procedures, and outcomes of the extra support.
Just as it is important monitor the extent to which Tier 1 efforts are being implemented, it is also important
to collect treatment integrity data for all Tier 2 and 3 interventions. This information is needed to
determine the degree to which the strategy, practice, or program is being implemented as intended. This
can be done using behavioral component checklists (e.g., see Figure 1 for an example of a fidelity
implementation checklist for the Behavior Education Program). Without collecting information on
implementation it is not possible to draw accurate conclusions about how students are responding to
supports. Thus, teams use the treatment integrity data along with student outcome data to make
decisions about whether to continue to invest in certain supports or to seek other strategies, practices, or
programs to best meet those determined needs.
Graph: Fig. 1. Behavior Education Program treatment fidelity form. CICO = Check-in/Check-out; STARS =
Students Taking a Right Stand.
Data to monitor students’ progress include any data collected during an intervention to help determine
students’ progress in the intervention curriculum or framework. For example, for an academic homework
club intervention, teams may monitor students’ homework completion during participation as well as
students’ grades in their core academic content areas. This latter information could be used to examine
the degree to which student’s performance is generalizing beyond the intervention session. Similarly, it is
wise to monitor oral reading fluency on a weekly basis using curriculum-based probes to determine how
students respond to a Tier 2 intervention involving repeated readings. It is ideal for these data to be
graphed and reviewed by the teacher and student to evaluate progress. We also recommend, careful
attention be paid to monitoring the extent to which students were present for and engaged during the
intervention sessions. One could expect students to be more responsive to intervention efforts if they are
more fully engaged in the instruction, which again links back to the importance of treatment integrity. The
CI3T leadership team may want to draw on the expertise of those faculty and staff currently implementing
the intervention to decide which data pieces are most important for consistent monitoring.
We encourage social validity data be collected by team-members involved in the Tier 2 or 3 supports
(e.g., teacher, students, parents, guidance counselors) as all stakeholders should have a voice in the
intervention process. In particular, we encourage social validity data to be collected before implementing
any intervention to determine the degree to which stakeholders are comfortable with the intervention
goals, procedures, and potential outcomes. These assessments may be rating scales such as the
Intervention Rating Profile–15 (Witt & Elliott, [53]) for teachers and parents and the Children’s Intervention
Rating Profile (Witt & Elliott, [53]) for students or they may be far less formal (e.g., semi-structured
interview, or even just a few questions related to feasibility). If social validity ratings indicate that
stakeholders (a) are not committed to the intervention goals, (b) view the procedures as too cumbersome,
or (c) view the intervention as unlikely to achieve the desired outcomes, then additional training should be
offered to assist people in become more comfortable or perhaps an alternative support could be selected.
In theory, social validity is linked to treatment integrity in that if stakeholders view the intervention as
socially valid, it is more likely to be implemented with a high-level integrity—ultimately leading to desired
changes (Gresham & Lopez, [18]). We also recommend assessing social validity before beginning the
intervention and again at the end to determine whether the intervention met, exceeded, or fell short of
initial expectations.
Exit Criteria
The CI3T leadership team identifies exit criteria to determine when a student no longer needs a given
support. Similar to the entrance criteria, the exit criteria are established using schoolwide and progress
monitoring data to make decisions regarding when to conclude a given support and determine next steps.
While some interventions have specific ending points (i.e., the completion of a curriculum), data collected
as part of each support can be used to determine whether the given strategy, practice, or intervention
program adequately addressed the student’s identified need. For example, a group of students
participating in a Tier 2 social skills program that ends after eight weeks of instruction may have different
needs at the conclusion of instruction. Some students may be successful with only Tier 1 supports, other
students may require an alternate Tier 2 intervention, and other students, if nonresponsive, may require
individualized Tier 3 supports (Ennis & Swoszowski, [16]).
Last, after establishing Tier 2 and 3 intervention grids on the basis of existing supports, it is important to
identify additional supports needed in the school context. For example, the CI3T team may determine
additional supports are needed to assist (a) elementary-age students with internalizing issues who
experience high rates of absenteeism because of social anxiety or because they are away from their
parents, (b) middle school students with low levels of motivation that affects their work completion, or (c)
high school juniors with higher than average hyperactivity/inattention levels that negatively affect their
decision making and other self-determination skills. For each of these instances, CI3T teams would
review sources such as those mentioned previously as well as the IRIS Center for Training
Enhancements4 and Institutes of Education Sciences Practice Guides to determine which evidencedbased practices would be most effective and efficient in meeting their identified needs. Professional
development needs should be included in any plan to adopt new evidence-based practices in addition to
attention to measurement of student outcomes, treatment fidelity, and social validity.
Connecting Students to Supports
When considering how to provide students appropriate Tier 2 and 3 supports, we offer the following
suggestions. First, screening tools and data collected as part of regular school practices are a starting
point. Additional information is often needed to know how best to focus intervention efforts. For example,
if systematic screening data from the Social Skills Improvement System–Performance Screening Guide
(Elliott & Gresham, [11]) suggests a particular student has lower than average prosocial skills and office
discipline referral data indicate the student has earned four office discipline referrals related to negative
social interactions on the playground during the first quarter of the school year, Tier 2 supports are likely
warranted. It would be highly appropriate to seek input from the teacher, parent, and possibly the student
to determine how to focus social skill intervention efforts. In this case, the Social Skills Improvement
System-Rating Scales (Elliott & Gresham, [13]) could be completed by each stakeholder to identify
specific acquisition (can’t do problems), fluency (trouble doing problems), and performance (won’t
do problems) deficits to address in small group sessions. Information gleaned from rating scales can be
used to identify specific skill sets to constitute the small group intervention sessions (Elliott & Gresham,
Second, we emphasize decisions regarding Tier 2 and 3 supports are a team-based process and family
engagement is critical. Any supports beyond primary prevention efforts are determined by a team
comprised of teachers, support staff, parents, and when appropriate, the students themselves. During the
team meetings, the intervention grids would be reviewed and potential supports identified by the team
according to inclusion criteria. The team would decide collaboratively which support to design, implement,
and evaluate.
Third, we recommend this process be as transparent as possible, with the intervention grids readily
accessible by all site-level personnel as well as parents and students. In many schools we have
supported through the years, these intervention grids were available in notebooks, on the schools’
websites, and even displayed in the foyer on large tag-board posters. The intent of Tier 2 and 3 supports
is to provide all students with the academic, social, and behavioral supports needed at a given time and in
such a manner that ensures equal assess according to need. We also note that we provided just a few
illustrations of sample Tier 2 and Tier 3 supports in this article’s tables. The proposed secondary and
tertiary intervention grids would contain all supplemental supports—including those focused on
enrichment activities to address academic, behavioral, and social needs of all learners.
Monitor Progress
As with primary prevention efforts, it is essential to monitor the core components needed to draw accurate
conclusions about how well these supplementary strategies and practices are working. We have
discussed some of these points in previous sections. However, we close by emphasizing the importance
of these components, some of which include reliable measurement systems to assess student
performance; treatment integrity data to determine whether—and how well—the Tier 2 or 3 support is
being implemented as designed; social validity data to see how key stakeholders (e.g., students,
teachers, parents) view the goals, procedures, and outcomes; and designs that allow for experimental
control to be established, by allowing for at least one demonstration and two replications (see Horner
et al., [21]; Maggin, Briesch, & Chafouleas, 2013).
Reliable Outcome Measures
First, it is critical we monitor student performance frequently using reliable, valid, and feasible tools to be
confident in the decisions made about how well the intervention is working. For example, weekly oral
reading fluency probes from AIMSweb may be used to assess shifts in oral reading fluency for monitoring
the extent to which a Tier 2 repeated reading interventions is yielding increases in the rate and level
(trend) of a student’s oral reading fluency skills. Similarly, a teacher may use a MotivAider (a small
electronic devised used to signal when it is time to record the presence or absence of a given behavior in
the context of a momentary time sampling data recording systems) as part of a self-monitoring
intervention to determine whether a student’s rate of academic engagement is increasing. Likewise, a
teacher may monitor the percentage of assignments completed and the corresponding accuracy of
completed work to examine the effect of a behavioral contract designed to increase work completion.
Treatment Integrity
As we mentioned earlier, Just as it is important to assess treatment integrity of the full primary prevention
program, including performance at the class level (Bruhn, Lane, & Oakes, 2012), it is also important to
monitor treatment integrity of each Tier 2 and 3 support delineated in the schools’ CI3T plan. Without
specific data as to whether—and how well—a supplemental support is being implemented, we cannot
accurately evaluate student outcomes. For example, if two out of three students in a social skills group
are responding as evidenced by decreases in negative social interactions on the playground, one of the
first questions to be asked is the following: To what extent are all three students participating in the social
skills lessons? In other words, it is important to examine a student outcome in light of treatment integrity.
Just because a student is placed into a Tier 2 or 3 support does not necessarily mean they are fully
engaging in the support and if they are not, we would not expect changes in performance similar to those
of another student who is fully engaging in the experience.
Social Validity
Social validity is another core component needed to assess issues of feasibility as mentioned previously.
Social validity can be assessed in a number of ways. For example, there are social validity interviews,
some of which are very specific to the intervention at hand (e.g., Harris et al., [19]), ratings scales with
adequate psychometric properties (e.g., Intervention Rating Profile–15, Children’s Intervention Rating
Profile) to assess this information from adult and student perspectives, and social comparison techniques
in which direct observation data are collected on the target student as well as a comparison peer, who is
not a candidate for the intervention, in the same setting (Ennis, Jolivette, Fredrick, & Alberto, 2013).
Gresham and Lopez [18] also suggested use can actually serve as a behavioral marker for social
validity—in essence, if they use the intervention as intended (with integrity) then by definition they view
the intervention as acceptable.
Experimental Design
In this age of high skates accountability, it is imperative Tier 2 and Tier 3 supports be implemented with
sufficient rigor to determine whether a functional relation is established between the introduction of a
strategy, practice, or program and changes in student performance (Maggin & Chafouleas, [40]. In
addition to using a reliable system for measuring student performance, monitoring treatment integrity, and
assessing social validity, it is also important to incorporate an experimental design that allows for a test of
the intervention (Kennedy, [25]). For example, CI3T teams may use a simple A-B-A-B withdrawal design
to compare baseline patterns (A) and intervention effects (B). In an A-B-A-B design, the student serves as
his or her own control to evaluate the effectiveness of the Tier 2 or Tier 3 support, such as self-monitoring
intervention for on task behavior (e.g., Marshall, Lloyd, & Hallahan, 1993). During baseline (A), data are
recorded on a target behavior or behaviors and plotted on a graph for visual analysis. Next, the graph is
inspected to identify patterns in the data, specifically the level, trend, and variability. The first dimension
used to visually inspect a graph is the level, which is the average of the data points in a condition. The
second dimension is the trend; this refers to slope and magnitude of the data in the phase. The third and
final dimension is the variability, which is the degree to which the data deviate from the trend. After a
predictable pattern of student data has been established (a minimum of five data points), self-monitoring
(the intervention) is introduced. During the self-monitoring intervention, the student will assess and record
his or her own behavior. The same data that were recorded during baseline are recorded and used as a
comparison during the intervention (B) to determine whether the self-monitoring intervention changes the
student’s behavior. Once a pattern of stable responding has been established during the self-monitoring
intervention, the intervention is withdrawn (A-B-A) and data collection continues using the same
measurement system examine changes in the target behavior, and then the intervention is reintroduced
(A-B-A-B, after analyzing the data to determine when a phase changes is appropriate) to evaluate the
effects of self-monitoring.
By adhering to this rigorous standard of using single case methodology to run brief tests of intervention
effectiveness, teams can make accurate decisions about the effectiveness of the supplemental support.
More specifically, the CI3T team examines the graph to determine whether a functional relation was
established between the introduction of the strategy, practices, or intervention program and changes in
student performance. For example, accurate decisions can be drawn about when to conclude a Tier 2
support and perhaps move to an intervention of greater intensity (e.g., Tier 3), shift to another Tier 2
option, or move forward with only Tier 1 prevention efforts. In addition, this rigor enables accurate
decisions to be made by the CI3T team regarding the sufficiency of evidence for this practice for their
particular school population and needs. Practices delivered with high fidelity that do not yield the desired
results should be reviewed by the team to determine whether the support is a good investment of
resources or whether other supports to address the particular student need should be pursued.
In this article, we provided a step-by-step process for developing blueprints of available Tier 2 and Tier 3
supports available at a given school site. We offered information on how to use data from multiple
sources (e.g., academic and behavior screening tools as well as office discipline referral data) to
determine which students may benefit from supplemental supports. To this end, we provided guidance on
how to (a) construct an assessment schedule to provide transparency and easy access to information on
assessments that occur as part of primary prevention efforts, (b) make a blueprint of available Tier 2 and
3 supports, (c) connect students to supports, (d) implement the core components needed to monitor how
students respond to these supplement supports (e.g., student performance, social validity, and treatment
integrity), and (e) determine when these additive supports are no longer needed. We concluded with a
discussion of using a team-based process for implementing and evaluating Tier 2 and 3 supports.
Author Notes
Kathleen Lynne Lane is a professor at the University of Kansas. Her research interests focus on
preventing the development of learning and behavior challenges within the context of comprehensive,
integrated, three-tiered (CI3T) models of prevention, with an emphasis on systematic screening.
Wendy Peia Oakes is an assistant professor in Mary Lou Fulton Teachers College, Arizona State
University. Her research focuses on improving educational outcomes for young children with and at risk
for emotional and behavioral disorders within comprehensive, integrated, three-tiered (CI3T) models of
Robin Parks Ennis is an assistant professor in the Special Education Program of the Teacher Education
Department in Eugene T. Moore School of Education. Her interests include three-tiered models of
positive behavior interventions and supports, particularly Tier 2 academic and behavioral interventions for
students with and at-risk for E/BD.
Shanna Eisner Hirsch is a doctoral student at the Curry School of Education, University of Virginia. Her
research focuses on the judicious application of evidence-based practices for solving behavior and
learning problems in classroom settings for students with or at risk for emotional and behavioral disorders.
This research was supported in part by Project Support and Include, a technical assistance grant from the
Tennessee Department of Education (#GR-10-27642-00) to Vanderbilt University.
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By Kathleen Lynne Lane; Wendy Peia Oakes; Robin Parks Ennis and Shanna Eisner Hirsch
Reported by Author; Author; Author; Author
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