MTSS-2 Standard Treatment Protocol/Group Problem Solving Form

MTSS-2 Standard Treatment Protocol/Group Problem Solving Form

Washoe County School District / STANDARD TREATMENT PROTOCOL/GROUP PROBLEM SOLVING FORM-Instructional Planning Form

This form may be used in replacement of the Individual Problem Solving (MTSS-1) when the Intervention Assistance Team has reviewed school wide data and found converging evidence (student grades and 3 sources of testing data) to suggest a need for a standard treatment protocol based intervention to be delivered to a group of students. Individual goals and graphs must be kept for each participating student. Participation rates (attendance) of each student in the group intervention must be documented. Decisions regarding the success of the intervention are to be made on an individual student basis. Information form this form can be inputted within the MTSS tab in Infinite Campus.

Team Meeting Date: ______Area of Concern: __ Reading __ Math __ Writing X Behavior

Student Name: ______(complete 1 form for group, make copies, and write individual student names on one form for each participating student)

PROBLEM IDENTIFICATION
List the sources of data reviewed by the team for selection of students
IC Attendance Record / List the criteria determined for inclusion in the group intervention
90% of school days attended
BRIEF PROBLEM ANALYSIS
Describe the common instructional need identified among this group of students
Support with increasing attendance
PLAN DEVELOPMENT
GOAL SETTING

• On each individual student progress monitoring graph, list student baseline score and goal

INTERVENTION
Brief Description: / Attendance Intervention / When: / Prep Period for Student/Parent Contact
Advisory Period for Student Attendance Tracking/Reward
Description of Needed Materials: / Attendance Intervention Documentation Form, IC, Phone, Incentives, Resources to Support Barrier Removal / Where: / Advisory Classroom
Intervention Implementer: / Academic Teams/Advisory Teacher / How Often: / Initial Contact, follow up as necessary
Daily for attendance tracking, periodically for reward

• Intervention Plan is attached which describes the intervention activities in detail

MEASUREMENT SYSTEM
Data Collection System: / IC Attendance, Attendance Intervention Documentation Form / Frequency of Data Collection: / Daily
Data Collector: / Advisory Teacher / When will Data be Collected? / Advisory Period
What Will Be Recorded? / Absences, % days attended
Decision Making Rule
Slope/Trend Analysis Level of Performance Consecutive Data Point Rule Other:______

Intervention Start Date: ______Review Date: ______Time: ______Place: ______

Nevada Dept. of Educ. Policy Statement provided to & signed by parent. Date: ______

Infinite Campus has been updated to reflect student’s supports within MTSS tab.

Student: ______Grade: ______Date: ______

Teacher: ______School: ______

Activity
Focus or Skill Teaching Strategy / Materials / Arrangements / Time / Motivational
Strategy
Identifying Barriers to Attendance / Parent Contact
Student Contact / Interview Questions
Attendance Intervention Documentation Form / Phone contact with parent
Face to face interview with student
Removing Barriers to Attendance / Consult with MTSS Team / Attendance Intervention
Documentation Form
Will vary depending on need and available resources / Discuss in weekly MTSS Meetings via MTSS Team Representative
Incentive
Interview / Identify meaningful incentive menu / Interview Questions
Attendance Intervention Documentation Form / Phone contact with parent
Face to face interview with student
Rewarding Attendance / Check-in with student
Mark in attendance on Tracking Sheet
Reward for meeting attendance goal / Attendance Intervention Documentation Form
Rewards / Advisory Period Daily / Rewards from Incentive menu contingent on reaching short- and long-term attendance goals