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184 REPRODUCIBLE
How RTI Works in Secondary Schools • © 2012 Solution Tree Press • solution-tree.com
Visit go.solution-tree.com/rti to download this page.
Problem-Solving Team Plan Evaluation Form
This form is used to summarize the achievement outcome of the intervention described on the
Problem-Solving Team Intervention Form. Team will note whether or not both the intervention plan was
implemented as designed and progress monitoring data were collected as planned. A graph of student
progress data collected per the Problem-Solving Team Intervention Form should be attached to this
form. Teams then use the decision-making rule identied on the Problem-Solving Team Intervention
Form to decide on the outcome of the intervention plan.
School or District:
Student: Review Date:
Intervention #: 1 2 3
Midintervention Checks Resulting in No Change of Plan:
Date # Data Points Comments
Plan Evaluation:
Date:
Attach graph of student progress data.
This intervention began on
and continued through .
Total # of sessions received:
Total # of data points being considered:
1. As a result of this intervention implementation:
Goal was met
Trend line shows student on track to meet or exceed goal
Consecutive data points show student on track or meet or exceed goal
Trend line shows student is not on track to meet or exceed goal
Consecutive data points show student is not on track to meet or exceed goal
2. For the academic concern for which student is not on track (or skip to item 3):
Trend line shows student making at least one year’s growth in one year’s time
Consecutive data points show growth, with data points not far from aimline.
Trend line shows student making less than one year’s growth in one year’s time
Consecutive data points show scores far below aimline with very at growth
3. Optional comments regarding plan evaluation decision:
Page 1 of 2
REPRODUCIBLE 185
How RTI Works in Secondary Schools • © 2012 Solution Tree Press • solution-tree.com
Visit go.solution-tree.com/rti to download this page.
4. The next steps for the team will be to:
Discontinue intervention—goal met
Maintain or generalize current plan
Select a new problem (New Problem Identication form)
Select a new hypothesis for the same problem (New Problem Analysis form)
Retain current hypothesis, but modify the intervention plan (New Student Intervention Plan
form)
5. Is a referral for a special education evaluation being considered at this time?
Yes
No
Next Meeting Date:
(If none is needed, information should be placed in the student’s cumulative record.)
Page 2 of 2
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Completed 20 September 2021

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