Self-Assessment of MTSS Implementation (SAM)
Note: This is a digital form. If you are working in a web browser, you can print the information that you enter in
this form but it will not save. To save the information you enter, please work and save in a PDF program such as
the free Adobe Reader. You can also print the form to fill in manually.
Overview of MTSS
This instrument is used to measure school-level implementation of a Multi-Tiered System of
Supports (MTSS). MTSS is a term used to describe an evidence-based model of educating
students that uses data and problem solving to integrate academic, behavior, and social-
emotional instruction and intervention to maximize the success of all students. Instruction and
intervention is provided to students across multiple tiers of intensity based on need. Staff make
data-based decisions in order for resources (e.g., time, staff, and evidence-based strategies) to
reach the students at the appropriate levels to increase the performance of ALL students with
the goal of achieving and/or exceeding proficiency.
Quality implementation of MTSS is associated with increased likelihood of instruction and
interventions leading to successful student outcomes. Thus, it is important for schools to
monitor not only student outcomes, but also how assessments, instruction, interventions, and
data-based problem solving are put into place (i.e., the fidelity with which these elements are
implemented). Successful implementation is influenced by many factors within and around the
school system (e.g., professional development, administrative support, data systems, staff
member perceptions, successful adaptation, etc.). As a measure of school-level
implementation of an MTSS, the focus of this instrument is on the necessary actions and
activities to successfully implement and sustain the critical elements of MTSS with fidelity. The
critical elements of MTSS referred to throughout the instrument include:
Curriculum standards
Assessments used to inform instruction
Multiple tiers of instruction and intervention
Data-based problem solving used to make decisions
To promote a common understanding, staff that complete the instrument are urged to discuss
the elements of MTSS and how they relate to components of their school’s system for
educating all students. MTSS should not be thought of as a separate initiative or program
that must be implemented. Rather, MTSS provides a framework for the integration of
academic, behavior, and social-emotional supports. Other initiatives such as implementation of
educational policies and regulations, new assessment systems, or new instructional strategies
also should be considered in the context of how they fit within a MTSS. MTSS provides a
framework for implementing educational practices to ensure academic, behavioral, and
social-emotional success of all students.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice.
Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM National Pilot Version 2.0 (November 2014) Page
i
Directions for Completing the Instrument and Using the Data
The school leadership team that has responsibility for allocating resources to improve
student learning should complete this instrument. Completion involves a three-step process:
1. Each team member should review the SAM instrument and Endnotes
independently and think how s/he, personally, would respond to each item.
2. After reviewing the SAM items independently, the team members should
come together to discuss their responses and reach agreement on which
answer best represents the current status of implementation at their school.
Endnotes provide additional clarifying information or definitions that the
team should utilize, especially as team members are first becoming familiar
with the SAM instrument. Endnotes provide critical information for ensuring the
SAM instrument is completed accurately and results in valid scores. Record
consensus scores on the SAM Scoring Sheet. The Scoring Sheet has
abbreviated language and should only be used to record responses and to
provide a visual representation of items with higher and lower scores.
3. Use the SAM instrument and the Scoring Sheet data to inform your action plan
to improve MTSS implementation.
Rate each item on a scale from 0-3 (0 = Not Started; 1 = Emerging/Developing; 2 =
Operationalizing; 3 = Optimizing) using the definition provided for each rating.
Superscript numbers (e.g.,
2
) correspond with endnotes that provide additional clarifying
information or definitions relevant to the content within the item.
There are 39 items organized into six domains:
1)
Leadership
Leadership is key to successful implementation of any large-scale innovation. The
building principal, assistant principal(s), and school leadership team are critical to
implementing MTSS at the school level. They engage staff in ongoing professional
development for implementing MTSS, plan strategically for MTSS implementation, and
model a data-based problem solving process for school improvement. The school
principal also supports the implementation of MTSS by communicating a vision and
mission to school staff, providing resources for planning and implementing instruction
and intervention, and ensuring that staff have the data needed for data-based problem
solving.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective
Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM National Pilot Version 2.0 (November 2014) Page - ii
2)
Building the Capacity/Infrastructure for Implementation
School-wide capacity and infrastructure are required in order to implement and sustain
MTSS. This capacity and infrastructure usually includes ongoing professional development
and coaching with an emphasis on data-based problem solving and multi-tiered instruction
and intervention; scheduling that allows staff to plan and implement instruction and
intervention; and processes and procedures for engaging in data-based problem solving.
3)
Communication and Collaboration
Ongoing communication and collaboration are essential for successful implementation of
MTSS. Many innovations fail due to a lack of consensus, to a lack of feedback to
implementers to support continuous improvement, and to not involving stakeholders in
planning. In addition to including stakeholders in planning and providing continuous
feedback, it is also important to build the infrastructure to communicate and work with
families and other community partners. These practices increase the likelihood that
innovative practices will be implemented and sustained.
4)
Data-Based Problem Solving
The use of data-based problem solving to make educational decisions is a critical element
of MTSS implementation. This includes the use of data-based problem solving for student
outcomes across content areas, grade levels, and tiers, as well as the use of problem
solving to address barriers to school-wide implementation of MTSS. While several models
for data-based problem solving exist, the four-step problem-solving approach evaluated
in this instrument includes: 1) defining the goals and objectives to be attained, 2)
identifying possible reasons why the desired goals are not being attained, 3)
developing a plan for and implementing evidence-based strategies to attain the goals,
and 4) evaluating the effectiveness of the plan.
5)
Three-Tiered Instructional/Intervention Model
The three-tiered instructional/intervention model is another critical element of MTSS
implementation. In a typical system, Tier 1 includes the instruction delivered to all
students; Tier 2 includes supplemental instruction or intervention provided to students
not meeting benchmarks; and Tier 3 includes intensive, small-group or individual
interventions for students facing significant barriers to learning the skills required for school
success. It is important to consider academic, behavior, and social-emotional instruction
and interventions when examining this domain.
6)
Data-Evaluation
Given the importance of data-based problem solving within a MTSS model, the need for
a data and evaluation system is clear. In order to do data-based problem solving, school
staff need to understand and have access to data sources that align with the purposes of
assessment. Procedures and protocols for administering assessments and data use allow
school staff to use student data to make educational decisions. In addition to student
data, data on the fidelity of MTSS implementation allow school leadership to examine the
current practices and make changes to increase implementation.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective
Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM National Pilot Version 2.0 (November 2014) Page - iii
SAM!National!Pilot!Version!2.0!(November!2014)!Page!<!1!
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+ 0+=+Not+Implementing+ 1+=+Emerging/Developing+ 2+=+Operationalizing+ 3+=+Optimizing+
Rating+
1. Leadership Domain (Items 1-5)
1. The!principal!is!actively
involved!in !a n d !fa cilit at es !
MTSS!implementation!
The!principal!does!not!
actively!support!MTSS.!
The!principal!communicates!an!
urgent!desire!to!implement!
MTSS,!participates!in!professional!
development!on!MTSS,!and!is!
establishing!a!MTSS!vision!
and!The!principal!actively!supports!
the!leadership!team !and !staff!to!
build!capacity!for!implementation!
and The Principal actively!
supports!data-based!problem
solving!use!at!the!school!+
2. A!leadership!team!is
established!that!includes!6<8!
members!with!cross<
disciplinary!representation!
(e.g.,!principal,!general!an d !
special!education!teachers,!
content!area!experts,!
instruction a l!su p p o rt!s ta ff,!
student!support!personnel!
1
)!
and!is!responsible!for!
facilitating!MTSS!
implem en ta tio n !
2
No!leadership !team!with!
explicit!responsibility!for!
leading!M T S S !
implem en ta tio n !e xis ts!
A!leadership!team!exists!
that!includes!cross-
disciplinary!representation
and'The!leadership!team'has!
explicit!expectations!for!
facilitating!MTSS!implementation!
and!The!leadership!team'members!
have!the!beliefs,!knowledge,!and!
skills!to!lead!implementation!efforts!
3. The!leadership!team
actively!engages!staff!in!
ongoing!professional!
development!and!coaching!
3
!
necessary!to!support!MTSS!
implem en ta tio n !
The!leadership!team!does!
not!have!a!needs<based!plan!
to!provide!staff!with!
professional!development!or!
coaching!to!support!MTSS!
implem en ta tio n !
A!needs!assessment!is!conducted!
to!gather!information !on!b eliefs,!
knowledge,!and!skills!to!develop!
a!professional!development!plan!
to!support!MTS S!im plementation!
and!A!professional!development!
plan!is!created!based!on!the!needs!
assessment!and!used!to!engage!
staff!in!ongoing!professional!
development!and!coaching!+
and!Ongoing!professio n a l!
development!activities!are!
informed !b y !d at a!c o lle cte d !o n !th e!
outcomes!of!professional!
development!and!coaching!for!
continuous!improvement!
4. A!strategic!plan!for!MTSS
implem en ta tio n !is !d ev elo p e d!
and!aligned!with!the!school!
improve m e n t!p la n!
No!strategic!plan!for!MTSS!
implem en ta tio n !e xis ts!
Leadership!team!is!engaging!
district,!family,!and!community!
partners!to!identify!stakeholder!
needs,!resources!for,!and!barriers!
to!MTSS!imp lem en tation !
and!As!part!of!the!school!
improve m e n t!p la n n in g!p ro c e ss! a!
strategic!plan!is!developed!that!
specifies!MTSS!implementation!
4
!
and!A!strategic!plan!for!MTSS!
implem en ta tio n !is!update d!as!
needed!based!on!student!outcome!
and!implementation!fidelity!data!as!
part!of!the!school!improvemen t!
planning!process!
5. The!leadership!team!is
actively!facilitating!
implem en ta tio n !o f!MTSS!
5
!as!
part!of!their!school!
improve m e n t!p la n n in g!
process!
The!leadership!team!is!not'
actively!engaging!in!efforts!to!
facilitate!MTSS!
implem en ta tio n !
The!leadership!team!engages!in!
action!planning!!
and!has!created!a!strategic!plan!
to!facilitate!implementa tion !of!
the!critical!elements
6
!of!MTSS!
and!The!leadership!team!provides!
support!to!educators!implementing!
the!critical!elements!of!MTSS!
identified!in !th e !stra te g ic!p la n !
and!The!leadership!team!uses!data!
on!implementation!fidelity!of!the!
critical!elements!of!MTSS!to!
engage!in!data-based!problem
solving!for!the!purpose!of!
continuous!school!improvement!
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
2. Building the Capacity/Infrastructure for Implementation Domain (Items 6-16)
6. The+critical!e le ments!
6
!of
MTSS!are!defined!and!
understood!by!school!staff!
No!informa tio n !o n !th e !
critical!elements!of!the!
school’s!MTSS!is!available!
The!critical!elements!of!MTSS!are!
being!defined!!
+and!The!critical!elements!of!MTSS!
are!defined!and!are!communicated!
to!school!staff!!
and!The!curriculum,!assessment,!
and!instructional!practices!that!
define!the!school’s!critical!elements!
of!MTSS!can!be!communicated!by!
all!school!staff!
7. The!leadership!team
facilitates!professio n al!
development!and!coaching!
7
!
for!all!staff!members!on!
assessments!and!data!
sources!used!to!inform!
decisions!
Initial!profe ss io n a l!
development!is!not!provided!
to!all!staff!members!
The!staff!engages!in!initial,!job<
embedded!professional!
development!focusing!on:!!
Purpose!and!administration!of
assessment!tools!
Role!of!assessment/data
sources!in!making!instructional!
decisions!
Review!of!current
assessments/data!sources
being!utilized!and!those!being
considered
Analyzing!and!using
assessment!results!to!improve
instruction
Using!various!types!of!data!to
inform!in stru c tio n a l!p ra ctic e s
to!meet!the!needs!of!d iverse
learners
Comm unicating!and!partnering
with!families!about!data!and
assessment!practices
and!The!staff!engages!in!ongoing!
professional!development!and!
coaching!related!to!the!
administration!of!assessments!and!
interpretatio n !o f!t h e!d a ta /d a ta !
sources.!Professional!deve lop m en t!
includes:!
Changes!or!updates!t
o
assessments/data!sources
Changes!to!data!collection,
tra
cking,!and!analysis
Ongoing!coaching!on
instructional!pra ctices!and
interpreting !assessment!results
and!The!leadership!team!analyzes!
feedback!from !sta ff!as!w e ll!as!
outcomes!in!order!to!ide ntify!
professional!development!and!
coaching!needs!in!the!area!of!
assessment/data!sources!in!support!
of!continuous!improvement!!
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission
was granted to the IEPRC to utilize the tool.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission
was granted to the IEPRC to utilize the tool.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission
was granted to the IEPRC to utilize the tool.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission
was granted to the IEPRC to utilize the tool.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission
was granted to the IEPRC to utilize the tool.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission
was granted to the IEPRC to utilize the tool.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM!National!Pilot!Version!2.0!(November!2014)!P age!V !2!
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
8. The!leadership!team
facilitates!professio na l!
development!and!coaching!
7
!
for!staff!members!on!data-
based!problem solving!!!
relative!to!their!job!
roles/responsibilities!
Professional!development!
does!not!focus!on!data-based!
problem solving!
Initial!professional!development!
on!data-based!problem solving!is!
provided!that!includes!the!
following!elements:!
Rationale!for!use!of!data-based
problem solving
Problem<solving!steps!to
address!school<wide,
classroom,!small<group,!and
individua l!stu d e n t!n e ed s
Roles!and!responsibilities!for
team!members!engaging!in
data-based!problem solving
and!Ongoing!professional!
development!and!coaching!on!
data-based!problem solving!is!
delivered!that!includes!the!
following!elements:!
Differentiation!of!professional
development!based!on!staff
roles/responsib ilities
Coaching
Modeling,!practice,!and
collaborative!feedback!on
problem<solving!steps
Support!for!collaboration!and
teaming!skills
and!Data!on!use!of!problem<solving!
skills!and!application!are!used!to!
inform!co n tin u o u s !im p ro v e m e n t!o f!
professional!development!and!
coaching!efforts!
9. The!leadership!team
facilitates!profession al!
development!and!coaching!
7
!
for!all!staff!on!multi<tiered!
instruction !a n d !in ter ve n tio n !
relative!to!their!job!
roles/responsib ilities!
No!explicit!connection!to!
multi<tiered!instruction!an d!
interventio n !is!evident!in!
professional!development!
provided!
Initial!profe ss io n a l!d ev e lo p ment!
on!multi<tiered!instruction!and!
interventio n !is!p ro v id ed !t ha t!
includes!th e !fo llo w in g !ele ments:!
Rationale!for!and!modeling!of
instruction a l!a nd !in t erv e nt io n
design!and!delivery!(e.g.,
Common!Core!State!Standards,
instruction a l!ro u tin e ,!Tie r!1
Positive!Behavior!Supports
,
lesson!pla n n ing !fo r!a c tiv e
st
udent!engagemen t)
Conne
ctions!are!made
regarding!how !the !practice s
are!aligned!with!and
integrated !in to !MTSS
How!data!informs!in s tru c tio n
and!intervention!design!and
delivery!that!reflects!studen
t
diversity!and!results!in!learning
opportunities!for!all!stude
nts!
8
and!Ongoing!professional!
development!and!coaching!on!
multi<tiered!instruction!an d!
interventio n !is!p ro v id ed !t ha t!
includes!th e !fo llo w in g !ele ments:!
Differentiation!of!professional
development!and!coaching!base
d
on!staff!roles/responsibilities
Coaching
Modeling!of,!practice!of,!and
collaborative!feedback!on
evidence<based!practices
and!The!leadership!team!regularly!
uses!data!on!student!needs!and!
fidelity!of!how!evidence<based!
practices!are!implemented!to!
continuously!imp ro v e !p ro fes sio n a l!
development!and!coaching!efforts!
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM!National!Pilot!Version!2.0!(November!2014)!P age!V !3!
SAM!National!Pilot!Version!2.0!(November!2014)!Page!<!4!
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
10.
Coaching!
7
!is!used!to
support!MTSS!
implem en ta tio n !
No!coaching!is!provided!to!
build!staff!capacity!to!
implem en t!t he !c ritic al!
elements!of!MTSS!
Initial!coach in g !is !o cc u rrin g !th a t!
is!focused !p rim a rily !o n !
facilitating!or!mod elin g!th e!
components!of!MTSS!!
and!Coaching!activities!are!
expanded!to!include:!
Opportunities!to!practice
Collaborative!a
nd
performance!feedback
and!Data!on!professional!
development,!implementation!
fidelity,!and!studen t!o utc omes!are!
used!to!refine!coaching!activities!!
11. Schedules!provide
adequate!time!for!trainings!
and!coaching!support!
Schedules!do!not!include!
time!allocated!to!
professional!development!
and!coaching!for!MTSS!
Schedules!include!time!allocated!
for!trainings!
and'Schedules!include!time!for!
ongoing!coaching!support!
and'Schedules!permit!personnel!to!
access!additional!training!and!
coaching!support!that!is!
differentiated!based!on!their!needs!
12. Sched u les!p ro vid e
adequate!time!to!administer!
academic,!behavior,!and!
social<emotional!assessments!
needed!to!make!data<based!
decisions!
Schedules!do!not!include!
time!allocated!to!
administering!assessments!
needed!to!make!decisions!
across!tiers!
Schedules!include!time!for!
academic,!behavior,!and!social-
emotional!assessments!
administered!to!all!students!(e.g.,!
universal!screening)!
and'Schedules!include!time!to!
administer!more!frequent!progress!
monitoring!assessments!to!
students!receiving!Tier!2!and!3!
services!as!specified!(e.g.,!weekly!
or!monthly!assessments)'
and'Schedules!permit!personnel!to!
administer!additional!assessment!
(e.g.,!diagnostic!asses sm en ts)!
across!content!areas!and!tiers!
needed!to!engage!in!data-based!
problem solving!
13. Sched u les!p ro vid e
adequate!time!for!multiple!
tiers!of!evidence<based!
instruction !a n d !in ter ve n tio n !
to!occur!
The!master!schedule!is!
developed!without!student!
data!and!does!not!include !
time!for!multi<tiered !
interventio n s!
The!master!schedule!is!
developed!utilizing!student!data!
and!includes!time!for!multi<
tiered!interventions!!
and'The!master!schedule!facilitates!
effective!implementation!of!multi<
tiered!interventions!m atch ed!to !
student!needs!by!content!area!and!
intensity!(Tie r!1 ,!T ier!2 ,!T ier!3 )!
and!The!master!schedule!allows!for!
flexible!student!groupings!
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
14. Sched u les!p ro vid e
adequate!time!for!staff!to!
engage!in!collaborative,!
data-based!problem solving!
and!decision making!
The!master!schedule!does!
not!provide!opportunities!
for!collaborative,!data-based!
problem solving!and!decision
making!to!occur!
The!master!schedule!provides!
opportunities!to!engage!in!
collaborative,!data-based!
problem solving!and!decision
making!to!occur!
and!The!master!schedule!provides!
sufficient!time!for!the!process!to!
occur!with!fidelity!
and'The!master!schedule!provides!
opportunities!for!collaborative,!
data-based!problem solving!and!
decision making!to!occur!in!
settings!such!as:!
Leadership!team!meetings
Grade<level!meetin gs
Cross!grade<level!meetings
Cross<departmental!meetings
Professional!Learning!Community
meetings
15. Proces se s,!pr oc ed u res ,
and!decision rules!
9
!are!
established!for!data-
based!problem solving!
No!systematic!processes,!
procedures,!or!decision
rules!are!established!
Processes,!procedures,!and!
decision rules!needed!to!engage!
in!data-based!problem solving!
are!developed!and!existing!
structures!and!resources!are!
incorporated!
and'!The!steps!of!problem solving;!
procedures!for!accessing,!
submitting,!and!using!data;!and!
decision rules!needed!to!make!
reliable!decisions!are!
communicated!to !staff!
10
and!Data-based!problem-solving!
processes,!procedures,!and!
decision rules!are!refined!based!on!
data!and!feedback!from!staff,!
schedule!changes,!and!resource!
availability!
16. Resou rc es !
11
!available!to
support!MTSS!
implem en ta tio n !a re !
identified!and!allocated!
No!process!exists!for!
mapping!and!allocating!
resources!availab le!to!
support!MTSS!
implem en ta tio n !
Leadership!team!memb ers!are!
gathering!information!on!the!
personnel,!funding,!materials,!
and!other!resources!available!to!
support!MTSS!implementation !!
and!Resource!inventories!are!
established!using!the!gathered!
informat io n !on ! th e!pe rson ne l,!
funding,!mate rials,!an d !other!
resources!availab le!to!su pp ort!
MTSS!implementation!!
and!plans!for!allocating!the!
resources!are!estab lished !
and!Existing!resource!maps!and!
resource!allocation s!are!updated!at!
least!annu a lly !ba s ed !o n !st u d en t!
need,!available!personnel,!funding,!
materials,!and!other!resources!
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM!National!Pilot!Version!2.0!(November!2014)!P age!V !5!
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
3. Communication!and!Collaboration!Domain!(Items!17<20)
17. Staff!
12
!have!consensus
and!engage!in!MTSS!
Implem e n ta tio n !
13
Staff!are!not!provided!
opportunities!to!gain!
understanding!of!the!need!
for!MTSS!
Staff!are!provided!opportunities!
to!gain!understanding!of!the!
need!for!MTSS!!
and!Staff!has!opportunities!to!gain!
understanding!of!its!relevance !to !
their!roles!and!responsib ilities!
and!Staff+has!opportunities!to!
provide!input!on!how!to!implem en t!
MTSS!!
18. Staff!are!provided!data!on
MTSS!implementation!fidelity!
and!student!outcomes!
14
Staff!are!not!provided!any!
data!regarding!MTSS!
implem en ta tio n !fid e lity !nor!
student!outcomes!
Staff!are!rarely!(1x/year)!
provided!data!regarding!MTSS!
implem en ta tio n !fid e lity !!
and'student!outcomes!!
Staff!are!regularly!(2x/year)!
provided!data!regarding!MTSS!
implem en ta tio n !fid e lity !!
and'student!outcomes!
Staff!are!frequently!(3x+/year)!
provided!data!regarding!MTSS!
implem en ta tio n !fid e lity !!
and!student!outcomes!
19. The!inf ras tru ctu re !ex ists !to
support!the!school’s!goals!for!
family!and!co m m u n ity!
engagement!
15
!in!MTS S!
Family!and!community!
engagement!is:'not!defined!
and!monitored!with!data;!
not!linked!to!sc h o o l!go a ls!in !
SIP/MTSS!plan;!
and+procedures!for!
facilitating!2<way!
communication!do!not'exist!
Family!and!community!
engagement!are!1'of'the'
following'3:!!
defined!and!monitored!with
data
linked!to!sc ho o l!g o
als!in
SIP/MTSS!plan
supported!by!procedures!for
facilitating!2<wa
y
communication
Family!and!community!engagement!
are!2'of'the'following'3:!!
defined!and!monitored!with!data
linked!to!sc h o o l!go a ls!in
SIP/MTSS!plan
supported!by!procedures!fo
r
facilitating!2<way!communicat
ion
exists
Family!and!community!engagement!
are'all'of'the'following:!!
defined!and!monitored!with!data
linked!to!sc h o o l!go a ls!in
SIP/MTSS!plan
supported!by!procedures!fo
r
facilitating!2<way!communicat
ion
exist
20. Educa to rs!a ctively!engage
families!in!MTS S!
Staff!do+none'of+the+
following:!
actively!engage!families
that!represent!the!diverse
population!of!the!school
engage!families!in
problem solving!when
their!children!!need
additional!supports
provide!intensive!outreach
to!unresponsive!fam ilies
16
increase!th
e!skills!of
families!to!support!their
children’s!education
Staff!do!1'of'the'following'4:!
actively!engage!families!that
represent!the!diverse
population!of!the!school
engage!families!in!problem
solving!when!their!children
need!additional!supports
provide!intensive!outreach!t
o
unresponsive!families
increase!th e!s kills !o f!fa milies!to
support!their!children’s
education
Staff!do!2'or'3'of'the'following'4:!
actively!engage!families!that
represent!the!diverse !po pu latio n
of!the!school
engage!families!in!problem
solving!when!their!children!need
additional!supports
provide!intensive!outreach!t
o
unresponsive!families
increase!th e!s kills !o f!fa milies!to
support!their!children’s
education
Staff!do!all'of'the'followin g:!
actively!engage!families!that
represent!the!diverse !po pu latio n
of!the!school
engage!families!in!problem
solving!when!their!children!need
additional!supports
provide!intensive!outreach!t
o
unresponsive!families
in
crease!the!s kills !o f!fa milies!to
support!their!children’s
education
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM!National!Pilot!Version!2.0!(November!2014)!P age!V !6!
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
4.
Data-Based!Problem Solving!Domain!(Items!21-27)
21. In t eg ra te d !data<based
problem solving!
17!
for!
student!academic,!behavior!
and!social-emotional!
outcomes!occurs!across!
content!areas,!
grade!levels,!and!tiers!
18
!
Data!on!academic,!behavior,!
and!social<emotional!
outcomes!may!be!collected,!
but+data-based!problem
solving!does!not'occur+
across:!
academic,!behavior,!and
social<emotional!content
areas
any!grade!levels
any!tier
Data-based!problem solving!
occurs!across!1'of'the'following'
4:!
at!least!2!content!areas!(e.g.,
reading,!behavior,!socialV
emotional, etc.)
at!least!50%!of!grade!levels
a!single!tier
only!academic!outcomes!or
only!behavior!and!social<
emotional!outcomes
Data-based!problem solving!
occurs!across!2'of'the'following'3:!!
at!least!3!content!areas
at!least!75%!of!grade!levels
at!least!two!tiers
Data-based!problem solving!
occurs!across!all'of'the+following:!!
across!all!content!areas
all!grade!levels
all!tiers
22. Across!all!tiers,!data!are
used!to!identify!the!
difference!or!!“gap”!between!
expected!and!current!student!
outcomes!relative!to!
academic,!behavior,!and!
social-emotional!goals!
The!gap!between!expected!
and!current!student!
outcomes!is!not!identifie d !
The!gap!between!expected!and!
current!outcomes!is!identified!!
and!The!gap!between!expected!and!
current!outcomes!is!identified,!!
and!is!associated!with!academic,!
behavior,!and!social-emotional!
goals!
and'The!gap!between!expected!and!
current!outcomes!is!identified!
relative!to!academic,!!behavior,!and!
social<emotional!goals!and!is!used!
to!identify!the!approp riate!leve l!
(tier)!of!instruction/in terv entio n!
23.
Academic,!behavior,!and
social-emotional!data!are!
used!to!identify!and!verify!
reasons!why!
19
!students!are!
not!meeting!expectations!
Reasons!why!students!are!
not!meeting!expectations!are!
not!identified!!
Reasons!why!students!are!not!
meeting!expectations!are!
identified!!
and'Data!are!used!to!verify!the!
reasons!why!students!are!not!
meeting!expectations!
and!The!reasons!why!students!are!
not!meeting!expectations!span!
multiple!reasons!related!to!
instruction !a n d !th e!le a rn in g!
environment!of!why!students!
struggle!and!are!verified!using!a!
range!of!assessm en t!m eth od s!!
24. Specific
instruction a l/intervention!
plans!are!developed!and!
implem en te d !based!on!
verified!reasons!why!
students!are!not!meeting!
academic,!behavior,!and!
social<emotional!
expectations!
Instructional/!intervention!
plans!are!not!developed!
Instruction a l/ in te rve n tio n !p la n s !
are!developed!
and!Instruction/intervention!plans!
consistently!specify!what!will!be!
done,!by!who,!when!it!will!occur,!
and!where!with!enough!detail!to!be!
implem en te d !
20
!
and'Instructiona l/ in te rv en t io n !
plans!consistently!are!developed!
based!on!verified!reasons!students!
are!not!meeting!expectations!
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM!National!Pilot!Version!2.0!(November!2014)!P age!V !7!
SAM!National!Pilot!Version!2.0!(November!2014)!Page!<!8!
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
25. Stude nt !pro g res s!sp ec ific
to!academic,!behavior,!
and!social-emotional!
goals!specified!in!
intervention!plans!are!
monitored!
Progress!monitoring!does!
not!occur!and!student!
progress!is!not!evaluated!
Plans!for!monitoring!progress!
toward!expected !stud ent!
outcomes!are!developed!!
and'In!most!cases!data!are!
collected!to!monitor!student!
progress!and!intervention!fidelity!
and'Changes!are!made!to!
instruction /in t erv en t io n !ba s ed !o n !
student!responses!
26.
Data-based!problem
solving!informs!how!patterns!
of!student!performance!
across!diverse!groups!(e.g.,!
racial/ethnic,!cultura l,!social<
economic,!language!
proficiency,!disability!status,
etc.)!are!addressed!
Patterns!of!student!
performance!across!diverse!
groups!are!not!identified!!
Data!on!student!outcomes!are!
collected!
and!Patterns!of!student!
performance!across!diverse!groups!
are!identified!
and!Data!on!student!outcomes!
informs!how!MTSS!
implem en ta tio n !e ffo rt s!a re!
impactin g!d if fere n t!g ro u p s!o f!
students!
27.
Resources!for!and
barriers
21
to!the!
implementation!of
!
MTSS!are!
addressed!through!a!data-
based!problem-solving!
process!
Data-based!problem solving!
of!resources!for!and!
barriers!to!implementation!
of!MTSS!does!not!occur!
School!leadership!discusses!
resources!for!and !barrie rs!to!
implem en ta tio n !o f!MTSS!!
School!leadership!discusses!
resources!for!and !barrie rs!to!
implem en ta tio n !o f!MTSS!and!does!
one'of'the'following:!!
collects!data!to!assess
implem en ta tio n !le ve ls
develops!action!plans!
to!increase
implem en ta tio n
School!leadership!discusses!
resources!for!and !barrie rs!to!
implem en ta tio n !o f!MTSS!and!does!
both'of'the'following:!!
collects!data!to!assess
implem en ta tio n !le ve ls
develops!action!plans!
to!increase
implem en ta tio n
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
5.
Three-Tiered!Instructional/Intervention!Model!Domain!(Items!28-33)
(Items in this section alternate between addressing academic, behavior, and social-emotional!practices.)!
28. Tier!1!(co re )!ac ad emic
practices!exist!that!clearly!
identify!lear n in g!stand ards!
22
,!
school<wide!expectations!
23
!
for!instruction!tha t!en gag es!
students,!and!school<wide!
assessments!
24
!
Tier!1!elements!are!not'
developed!and/or!clearly!
defined!
Tier!1!elements!incorporate!
!1'of'the'following'4:!
clearly!defined!learning
standards
s ch ool<wide!expectations!for
instruction !a n d !en g a ge m e n t
link !to !behavior!and!social<
emotional
content/instruction
assessments/data!sources
Tier!1!elements!incorporate!
!2'or'3'of'the'following'4:!
clearly!defined!learning
standards
schoo l<wide!expectations!for
instruction !a n d !en g a ge m e n t
lin
k!to!behavior!
and!social<
emotional!content/instruction
assessments/data!sources
Tier!1!elements!incorporate+
all'of'the'following:!
clearly!defined!learning
standards
schoo l<wide!expectations!for
instruction !a n d !en g a ge m e n t
lin k!to !behavior!and!social<
emotional!content/instruction
assessments/data!sources
29. Tier!1!(co re )!behavior!and
social<emotional!practices!
exist!that!clearly!identify!
school<wide!expectations,!
social<emotional!skills!
instruction ,!classroo m!
management!practices!
25
,!
and!school<wide!behavior!
and!social<emotional!data!
26
!
Tier!1!strategies!are!not'
developed!and/or!clearly!
defined!
Tier!1!strategies!incorporate!
!1'of'the'following'4:!
clearly!defined!school<wide
expectations
classroom !management
practices
lin k!to !T ie r!1 !ac a d emic
content/instruction
accessing!school<wide
behavior!and!social<emotional
data!sources
Tier!1!strategies!incorporate!
2'or'3'of'the'following'4:!
clearly!defined!school<wide
expectations
classroom !man agem ent!practices
lin k!to !T ie r!1 !academic
content/instruction
accessing!school<wide!behavior
and!social<emotional!data
Tier!1!strategies!incorporate!
all!of'the'following:!!
clearly!defined!school<wide
expectations
classroom !man agem ent!practices
lin k!to !T ie r!1 !academic
content/instruction
accessing!school<wide!behavior
and!social<emotional!data
30. Tier!2!(su p ple m e n tal)
academic!practices
!
exist!that!
include!stra te gie s!a d d re ss in g!
integrated!c o mmon!s tu d e n t!
needs,!are!linked!to!Tier!1!
instruction
27
,!and!are!
monitored!using!
assessments/data!sources!
tied!directly!to!the!academic,!
behavior,!and!social-
emotional!skills!taught!!
Tier!2!strategies!are!not'
developed!and/or!clearly!
defined!
Tier!2!strategies!incorporate!
1'of'the'following'4:!
com m on!studen t!needs
lin k!to !T ie r!1 !in stru c tio n
lin k!to !behavior!and!social<
emotional!content/instruction
assessments/data!sources!link
directly!to!the!skills!taught
Tier!2!strategies!incorporate!
!2'or'3'of'the'following'4:!
com m on!studen t!needs
lin k!to !T ie r!1 !ins tru ct io n
lin k !to !behavior!and!social<
emotional!content/instruction
assessments/data!sources!link
directly!to!the!skills!taught
Tier!2!strategies!incorporate!
all!of'the'following:!!
com m on!studen t!needs,
lin k!to !T ie r!1!instruction
lin k!to !behavior!and!social<
emotional!content/instruction
assessments/data!sources!link
directly!to!the!skills!taught
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM National! Pilot! Version! 2.0! (November! 2014)! Page! V !9!
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
31. Tier!2!(su p ple m e n tal)
behavior!and!social<
emotional!practices!exist!that!
address!integrated!common!
student!needs,!are!linked!to!
Tier!1!instruction
28
,!and!are!
monitored!using!
assessments/data!sources!
tied!directly!to!the!skills!
taught!
Tier!2!strategies!are!not'
developed!and/or!clearly!
defined!
Tier!2!strategies!incorporate!
!1'of'the'following'4:!
com m on!studen t!needs
lin k!to !T ie r!1 !in stru c tio n
lin k!to !academ ic
content/instruction
assessments/data!sources!link
directly!to!the!skills!taught
Tier!2!strategies!incorporate!
2'or'3'of'the'following'4:!
common!student!needs
link!to!Tier!1 !in stru c tio n
link!to!academic
content/instruction
assessments/data!sources!link
directly!to!the!skills!taught
Tier!2!strategies!incorporate!
all'of'the'following:!!
com m on!studen t!needs
lin k!to !T ie r!1 !in stru c tio n
lin k!to !academ ic!content
assessments/data!sources!link
directly!to!the!skills!taught
32. Tier!3!(in ten siv e )!aca d emic
practices!
29!
exist!that!include!
integrated !stra te gie s!t h at !ar e!
developed!based!on!
students’!needs,!are!aligned!
with!Tier!1!and!Tier!2!
instruction a l!go a ls!a n d !
strategies,!and!are!monitored!
using!assessments/data!
sources!that!link!directly!to!
skills!taught!
Tier!3!strategies!are!not'
developed!and/or!clearly!
defined!
Tier!3!strategies!incorporate!
1'of'the'following'4:!
developed!based!on!students’
needs!across!academic,
behavior,!and!social-
emotional domains
aligned!with!Tier!1!and!Tier!
2
instruction
lin k!t o !behavior!and!social<
emotional!content/instruction
assessments/data!sources!that
link!directly!to !t h e!sk ills!t au g h t
Tier!3!strategies!incorporate!
2'or'3'of'the'following'4:!
developed!based!on!students’
needs!across!academic,!behavior,
and!social-emotional!domains
aligned!with!Tier!1!and!Tier!
2
instruction
lin k!to!behavior!and!social<
emotional!content/instruction
assessments/data!sources!that
link!directly!to !t h e!sk ills!t au g h t
Tier!3!strategies!incorporate!
all'of'the'following:!
developed!based!on!students’
needs!across!academic,!behavior,
and!social-emotional!domains
aligned!with!Tier!1!and!Tier!
2
instruction
lin ke d !to !behavior!and!social<
emotional!content/instruction
monitored!using
assessments/data!sources!that
link!directly!to!the!skills!taught
33. T ie r!3!(in te n sive )!behavior
and!social<emotional!
practices
30
!include!in t eg ra ted !
strategies!that!are!developed!
based!on!students’!needs!
and!strengths,!are!aligned!
with!Tier!1!and!Tier!2!
instruction a l!go a ls!a n d !
strategies,!and!are!monitored!
using!assessments/data!
sources!that!link!directly!to!
skills!taught
!Tier!3!strategies!are!not'
developed!and/or!clearly!
defined!
Tier!3!strategies!incorporate!
!1'of'the'following'4:!
based!on!students’!needs
across!academic,!behavior,!and
social-emotional!domains
aligned!with!Tier!1!and!Tier!2
instruction
link!to!academic
content/instruction
assessments/data!sources!that
link!directly!to !t h e!sk ills!t au g h t
Tier!3!strategies!incorporate!
!2'or'3'of'the'following'4:!
based!on!students’!needs!across
academic,!behavior,!and!social-
emotional!domains
aligned!with!Tier!1!and!Tier!
2
instruction
link!to!academic
content/instructio n
assessments/data!sources!that
link!directly!to !t h e!sk ills!t au g h t
Tier!3!strategies!incorporate!
all'of'the'following:!!
based!on!students’!needs!across
academic,!behavior,!and!social-
emotional!domains
aligned!with!Tier!1!and!Tier!
2
instruction
link!to!acad e mic!content/
instruction
assessments/data!sources!that
link!directly!to !t h e!sk ills!t au g h t
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM!National!Pilot!Version!2.0!(November!2014)!Page!V !10!
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
6. Data<Evaluation!Domain!(Items!34<39)
34. Staff!un d ers tan d !an d !ha ve
access!to!academic,!behavior,!
and!social-emotional!data!
sources!that!address!the!
following!purposes!of!
assessment:!
identify!stu d en ts !at<risk
academically,!socially,!
and/or!emotionally!
determine!why!student!is
at<risk!
monitor!student!academic
and!social<emotional!
growth/!progress!
inform!academic!and!social<
emotional!
instruction a l/intervention!
planning!
determine!student
attainment!of!academic,!
behavior,!and!social-
emotional!outcomes!
Staff!do!not!understand!and!
have!access!to!academic,!
behavior,!and!social-
emotional!data!sources!or!
that!address!the!purposes!of!
assessment!
Staff!learn!the!purposes!of!
assessment!within!MTSS!!
and!the!leadership !team !selects!
measures!for!the!purposes!of!
assessment!across!academic,!
behavior,!and!social-emotional!
areas!that!are!reliable,!valid,!and!
accessible,!as!well!as!culturally,!
linguistically,!and!
developmentally!appropriate!
and!Staff!engage!in!assessment!
with!fidelity!to:!
answer!predetermined
guiding/critical!questions!
regarding!studen t!
functioning/o utc omes!
identify!stu d en ts !w h o !a re!a t<risk
at!least!3<4!times/year!
determine!why!a!student!is!at<
risk
monitor!student
growth/progress
inform!in stru c tio n a l/intervention
planning!
determine!student!attainment!of
academic,!behavior,!and!social-
emotional!outcomes
and'The!leadership!team!and/or!
staff!collaboratively!and!
systematically!evaluate!and!refine!
(as!needed)!critical!guiding!
questions!and!adjust!assessment!
practices!to!ensure!availability!of!
accurate!and!useful!data!to!inform!
instruction ; !assessment!tools!are!
evaluated!for!continued!value,!
usefulness,!and!cultural,!linguistic,!
and!developmental!
appropriateness'
35. P o licie s!an d !pr oc ed u res
for!decision making!are!
established!for!the!
administration!of!
assessments,!access!to!
existing!data!sources,!and!
use!of!data!
31
!
No!policies!and!procedures!
are!in!place!
The!leadership!team!has!policies!
and!procedures!for!decision
making!that!include!schedules!for!
screening,!use!of!diagnostic!
assessments,!progress!
monitoring!frequency,+and!
criteria!for!determining!tier(s)!of!
support!needed+
and!Staff!consistently!administer!
assessments,!access!data!
sources,!and!make!data-based!
decisions!using!the!policies!and!
procedures!for!decision making!
with!fidelity!!
and!Adherence!to!and!effectiveness!
of!policies!and!procedures!for!
decision making!are!evaluated!
regularly!for!efficiency,!usefu ln ess,!
and!relevance!for!students!and!staff,!
and!data!are!used!to!make!
adjustments!to!the!policies!!
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM!National!Pilot!Version!2.0!(November!2014)!Page!V !11!
Self%Assessment+of+MTSS+Implementation+(SAM)
Item+
0+=+Not+Implementing+
1+=+Emerging/Developing+
2+=+Operationalizing+
3+=+Optimizing+
36. Effective!data!tools!
31
!are
used!appropriately!and!
indepen d en tly !b y!s ta ff!
Staff!do!not!have!access!to!
tools!that!efficiently!prov ide!
data!needed!to!answer!
problem-solving!questions!
for!academic,!behavior,!and!
social<emotional!issue s !
The!leadership!team!ensures!
availability!of!tools!that!can!track!
and!graphically!display!
academic,!behavior,!and!social-
emotional!data,!and!staff!are!
trained!on!the!use!of!the!tools!
and!on!their!responsibilities!for!
data!collection,!entry,!and!
management!
and'Staff!use!the!data!tools!and!are!
provided!assistance!as!needed!
and!Data!tools!are!periodically!
assessed!and!the!necessary!changes!
are!made!in!order!to!improve!
functionality,!efficien cy,!an d !
usefulness,!and!staff!is!proficient!
and!independent!with!data!tools!
and!easily!support!new!staff!
members!
37. Data!so u rce s !
31
!are!used!to
evaluate!the!implementa tio n !
and!impact!of !M T S S!
No!data!sources!to!evaluate!
implem en ta tio n !o f!t h e!
critical!elements!of!MTSS!
have!been!identified!
The!leadership!team!has!
identified!data!sources!that!will!
be!used!to!evaluate!
implem en ta tio n !o f!t h e!c ritic al!
elements!of!MTSS!
6
and!The!leadership!team!uses!data!
sources!to!evaluate!implementation!
and'to!make!system ic !
improve m e n ts!t o !th e!c ritic a l!
elements!of!MTSS!!
and!The!Leadership!team!
periodically!conducts!analyses!to!
determine!how!implementation!of!
critical!elements!of!MTSS!relate!to!
positive!student!outcomes!
38. Availab le !res ou rc es !are
allocated!effectively!
Resources!are!not!allocated!
based!on!student!need!and!
the!availability!of!time,!
available!personnel,!funding,!
and!materials!
Resources!are!allocated!based!on!
student!need!
and'the!relationship!betw e en!th e!
resources!allocated !an d!th e!
outcomes!of!students!is!evaluated!
and'Processes!and!criteria!for!
resource!allocatio n!are !refine d!
based!on!strategies!that!result!
in!improved!student!outcomes!!
39. D a ta !so ur ces !are
monitored!for!consistency!
and!accuracy!in!collection!
and!entry!procedures!
Data!sources!are!not!
monitored!for!accuracy!or!
consistency!
The!leadership!team!ensures!that!
staff!understand!the!importance!
of!accurate!and!consistent!data!
collection!practices!and!have!
provided!professional!
development!on!policies!and!
procedures!for!methods,!types,!
and!frequency!of!data!collection!
and'The!leadership!team!uses!a!
protocol!(e.g.!email!notifications!for!
failure!to!take!atten da n ce,!etc .)!to!
monitor!data!consistency!and!
accuracy!
and'The!leadership!team!
periodically!conducts!analyses!to!
determine!consistency!and!
accuracy!of!data!!
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM!National!Pilot!Version!2.0!(November!2014)!Page!V !12!
Self-Assessment of MTSS Implementation (SAM) Endnotes
1. Instructional support staff may include: interventionists, coaches, and behavioral
specialists.
Student support personnel are comprised of school psychologists, school counselors,
social workers and school nurses.
2. Responsibilities for facilitating MTSS implementation are not limited to, but can include:
Promoting a school-wide vision and mission for MTSS implementation, including the
development and dissemination of a school-wide implementation plan.
Allocating resources (e.g., time, personnel, and materials) for the planning and delivery of
evidence-based assessment, instruction, and intervention.
Providing ongoing professional development and coaching support to school staff.
Collecting and analyzing data on MTSS implementation efforts.
3. Professional development and coaching are ongoing activities that develop the capacity
of staff to implement MTSS. Efforts should be aligned with results of school needs
assessments and modified based on the results of professional learning.
4. A strategic plan for MTSS implementation should address the following components (at
a minimum):
Communication and collaboration strategies.
Capacity building targets and activities.
Data to monitor implementation fidelity of the critical elements of MTSS.
5. Different approaches to facilitating school-wide implementation of a MTSS model can
include:
The focus on a three-stage model of consensus building, infrastructure development, and
implementation of practices consistent with an MTSS model.
The focus on a specific set of activities related to successful implementation of a designated
model of service delivery (e.g., National Implementation Research Network framework).
The approach to facilitating school-wide implementation of a MTSS model should be
connected to the School Improvement Plan (SIP), as well other school-wide plans. If your
district/state has provided guidance on an approach to implementing MTSS, then
school leadership teams should consider using the specified approach.
6. Critical elements of MTSS communicated to staff include:
Curriculum standards,
Assessment data used to inform instruction,
Multiple tiers of instruction and intervention, and
Data-based problem solving used to make decisions.
7. “Coaching” is defined as technical assistance and support provided to school staff to
improve implementation of components of an MTSS model (e.g., engaging in data-
based problem solving, use of assessment data, and development of multi-tiered
instruction and intervention), including:
Co-planning
Modeling/demonstration
Co-facilitation
Guided practice with high quality feedback
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective
Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM National Pilot Version 2.0 (November 2014)
- Endnotes, Page 1
8. Independent practice with guided reflection:
Instruction and intervention design and delivery that reflect student diversity make learning relevant
and effective for all students by evaluating and accounting for diverse students’ culture,
language, backgrounds, beliefs, knowledge, skills, and contexts. In a culturally responsive school
effective teaching and learning occur in a culturally-supported, learner-centered context, where
student strengths are identified and utilized to promote student outcomes across all tiers.
9. Schools will need to establish and communicate the problem-solving process to be
used
,
specific steps to be followed, and criteria to use when making decisions (e.g., what is
good, questionable, or poor RtI?). Schools should consider district and state guidelines when
available.
10. Processes and procedures for problem solving, data collection and use, and decision rules
include:
Specific guidelines on the steps of problem-solving to be used,
Documentation requirements,
Opportunities for engaging in data-based problem solving (e.g., Professional
Learning
Communities, Intervention Teams, etc.), and
Roles and responsibilities of participants.
11. Resources encompass not only available monetary assets but also available personnel,
instructional materials, and time that will facilitate the implementation and sustainment
of
an MTSS as a framework for supporting all students.
12. Staff refers to employees at the school that will be impacted by or will be involved in
implementation of MTSS. This will always include administration, teachers, other
professional (e.g. student support services personnel) and para-professional support staff.
The degree to which other employees (e.g. bus drivers, cafeteria workers, administrative
support staff, and facilities staff) are included may be d
etermined by their level of
involvement with/implementation of MTSS components at the individual school level.
13. Efforts to engage staff should align with district and state guidance regarding MTSS
implementation to facilitate staff understanding of connections between school,
district, and state initiatives.
14. Data on student outcomes, school-level implementation fidelity, the capacity of ed
ucators
to implement, and commitment from staff are needed to inform implementation. Staff
roles and responsibilities will drive the specific data they need to inform implementation.
15. Family and community engagement is the active and meaningful partnership that educators
build and maintain with students’ families and the broader community for the purpose of
supporting student learning.
16. Intensive outreach to unresponsive families refers to ad
ditional activities undertaken by the
school to engage families of students who need additional supports, but who are not
engaging with the school's typical outreach practices (e.g. letters and phone calls home).
Intensive outreach is an individualized approach requiring information gathering and
problem solving to identify outreach strategies that are more likely to be successful for a
family.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective
Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM National Pilot Version 2.0 (November 2014)
- Endnotes, Page 2
17. Data-based problem solving refers to a multi-step process that includes examining
performance related to goals/expectations (Problem Identification), understanding
variables causing problems (Problem Analysis), selecting/designing and implementing
strategies to lessen barriers and achieve goals (Instruction/Intervention Delivery),
and
monitoring effectiveness (Monitoring/Evaluation).
18. Data-based problem solving should occur (a) across content areas (reading, math, science,
behavior, social-emotional, and other relevant content areas for a school), (b) within and
across grade levels (e.g., horizontal meetings for 6th, 7th, 8th, as well as vertical meetings
for 6
th
through 8
th
), and (c) across tiers (performance data in response to instruction used to
engage in problem solving for all students [Tier 1], for some students receiving
supplemental instruction [Tier 2], and for students receiving individualized support [Tier 3]).
19. Reasons why students are not meeting expectations are sometimes referred to as
hypotheses or barriers to learning. The big idea is that schools identify potential
curriculum, instruction, environmental (e.g., peer distractions, classroom management
issues, etc.), and learner (e.g., skill deficits) for why the student is not meeting
expectations and collect data/information to determine which reasons are contributing to
the problem.
20. Specific instruction/intervention plans include information outlining:
The goal of the intervention/action plan.
What intervention or action steps (e.g., curriculum adjustments, instructional processes and
procedures, etc.) will be put in place.
How often (daily/weekly/etc.) the intervention will be utilized.
How long each session is to be implemented.
Who is responsible for intervention implementation and support.
Where and when the intervention will happen.
Plan for monitoring instruction/intervention fidelity and progress towards identified goals.
Timeframe (dates) for periodic review of progress-monitoring data and decision points.
21. Structured problem solving is utilized to identify resources that can be used to
facilitate implementation and barriers that are hindering implementation for the purpose of
developing specific action plans to increase implementation levels.
22. Priority learning standards are curriculum standards that define what students should
know and be able to do for a given content area and grade level (e.g., Common Core
State
Standards, state specific standards, Social-Emotional Learning Standards, etc.).
23. Expectations for instruction often include elements related to the instructional routine (e.g.,
whole-group, small-group, and independent practice), amount of time dedicated to
instruction, and which evidence-based instructional strategies are used.
24. Both statewide assessments and formative assessments administered to all students are
important to identify so that expectations for the data needed to inform decisions are
consistent.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective
Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM National Pilot Version 2.0 (November 2014)
- Endnotes, Page 3
25. Structured instruction of behavioral expectations and social and emotional skills is provided
to all students. Classroom routines include social and emotional learning principles and
classroom management strategies embedded into instruction. School climate and
environments support student well-being. A small number of clearly defined school-wide
expectations that are positively stated are a foundational element of a Tier 1 school-
wide
behavior support system.
26. School-wide social-emotional behavior data may include Office Discipline Referrals, In-
School Suspensions, Out-of-School Suspensions, and social-emotional screening data
sources used to examine the effectiveness of Tier 1 behavior and social-emotional supports.
27. Tier 2 interventions should be aligned with Tier 1 instructional goals and expectations,
address high-probability barriers to achieving instructional goals and expectations, and
include assessments which measure specific skills, general outcomes, and student progress.
28. Tier 2 interventions should be aligned with school-wide behavior and social-emotional
expectations, address high-probability barriers to meeting instructional goals and student
well-being, and include assessments that monitor student discipline incidents, social-
emotional skills, and well-being.
29. Tier 3 interventions generally provide increased exposure (time in minutes) to quality
instruction or intervention, more focused instruction matched to student need, and smaller
groupings. Additionally, Tier 3 interventions often are developed during individual student
focused problem-solving sessions. Importantly, Tier 3 interventions focused on academic
issues should be linked to Tier 1 and 2 instructional content and processes and also should
consider what behavioral or social-emotional supports are needed for success.
30. Tier 3 interventions are matched to a students specific behavior and social-emotional
needs and ensure the student has access to Tier 1 and Tier 2 supports. For a few students
with complex needs, individualized interventions may involve wraparound supports across
systems (e.g., mental health, education, medical, family, etc.). Individualized interventions
include specific prevention and consequence-based strategies based on assessment
information (i.e., Functional Behavior Assessment), and may include modifications to the
classroom environment or instruction, teaching new skills, and reinforcement of desired
behaviors as well as a range of supports such as mental health services.
31. District and states typically create or adopt data management systems. They also specify
access and use requirements. School leaders should coordinate with district and state
leaders to understand requirements and establish and communicate procedures for using
the data system at their school. Quality indicators for data management systems include:
real-time relevant data for academic, behavior, and social-emotional content, the ability to
graphically represent data, provision of tiered intervention data, integrated academic,
behavior, and social-emotional data, and the data are customizable at the school level.
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective
Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.
SAM National Pilot Version 2.0 (November 2014) -
Endnotes, Page 4
SAM!National!Pilot!Version!2.0!(November!2014)!
SAM$Scoring$Sheet$
THIS$SCORING$SHEET$HAS$ABBREVIATED$LANGUAGE$AND $SHO ULD $ONLY$BE$USED$TO$RECORD$AND$DISPLAY$RESPONSES$
Rate!each!item!on!a!scale!from!0?3!(0"=!Not"Started;"1"="Emerging/Developing;"2"="Operationalizing;"3"="Optimizing)!
1. Leadership!Domain!(Items!1?5)
Rating!0?3!
1. The!principal!is!actively!involved
0!
1!
2!
3!
2. A!leadership!team!is!established
0!
1!
2!
3!
3. The!leadership!team!actively!engages!in!ongoing!professional!development
0!
1!
2!
3!
4. A!strategic!plan!for!MTSS!implementation!is!developed
0!
1!
2!
3!
5. The!leadership!team!is!actively!facilitating!implementation
0!
1!
2!
3!
2. Building!the!Capacity/Infrastructure!for!Implement at io n !D o m a in !(Ite ms!6?16)
Rating!0?3!
6. The!critical!elements!of!MTSS!are!defined!and!understood
0!
1!
2!
3!
7. Professional!development!and!coaching!provided!to!staff
0!
1!
2!
3!
8.
The!leadership!team!facilitates!PD!on!data-based!problem solving
0!
1!
2!
3!
9. The!leadership!team!facilitates!PD!on!multi?tiered!instru c tio n !a n d!in t erv e n tio n
0!
1!
2!
3!
10. Coaching!is!used!to!support!MTSS!implementation
0!
1!
2!
3!
11. Schedules!provide!adequate!time!for!training!and!coaching
0!
1!
2!
3!
12. Schedules!provide!adequate!time!to!administer!assessments
0!
1!
2!
3!
13. Schedules!provide!adequate!time!for!multiple!tiers!of!instruction/interventions
0!
1!
2!
3!
14.
Schedules!provide!adequate!time!for!data-based!problem solving
0!
1!
2!
3!
15.
Processes,!procedures,!and!decision rules!are!established!for!DBPS
0!
1!
2!
3!
16. Resources!to!support!MTSS!implementation!are!identified!and!allocated
0!
1!
2!
3!
3. Communication!and!Collaboration!Domain!(Items!17?20) Rating!0?3!
17. Staff!have!consensus!and!engage!in!MTSS!Implementation 0! 1! 2! 3!
18. Staff!are!provided!data!on!MTSS!fidelity!and!student!outcomes 0! 1! 2! 3!
19. The!infrastructure!exists!to!support!family!and!community!engagement 0! 1! 2! 3!
20. Educators!actively!engage!families!in!MTSS 0! 1! 2! 3!
4.
Data-Based!Problem Solving!Domain!(Items!21-27)
Rating!0?3!
21. DBPS!for!student!outcomes!occurs!across!content!areas,!grade!levels,!and!tiers
0!
1!
2!
3!
22. Across!tiers,!data!used!to!identify!“gap”!between!expected!and!current!outcomes
0!
1!
2!
3!
23. Data!are!used!to!identify!reasons!why!students!are!not!meeting!expectations
0!
1!
2!
3!
24. Plans!based!on!verified!reasons!why!students!are!not!meeting!expectations
0!
1!
2!
3!
25. Student!progress!specific!to!academic!or!behavior!goals!are!monitored
0!
1!
2!
3!
26. Data!are!used!to!address!performance!across!diverse!group
0!
1!
2!
3!
27.
Resources!for!implementation!of!MTSS!are!addressed!through!data-based!problem solving
0!
1!
2!
3!
5.
Three-Tiered!Instructional/Intervention!Model!Domain!(Items!28-33)
Rating!0?3!
28. Tier!1!academic!practices!clearly!identify!learning!sta n d ar d s
0!
1!
2!
3!
29. Tier!1!behavior!practices!identify!school?wide!expectations
0!
1!
2!
3!
30. Tier!2!academic!practices!include!common!student!needs,!are!linked!to!Tier!1
0!
1!
2!
3!
31. Tier!2!behavior!practices!include!common!student!needs,!are!linked!to!Tier!1
0!
1!
2!
3!
32. Tier!3!academic!practices!are!based!on!students’!needs,!aligned!with!Tier!1!and!Tier2
0!
1!
2!
3!
33. Tier!3!behavior!practices!are!based!on!students’!needs,!aligned!with!Tier!1!and!Tier!2
0!
1!
2!
3!
6. Data?Evaluations!Domain!(Items!34?39)
Rating!0?3!
34. Staff!understand!and!have!access!to!data!sources
0!
1!
2!
3!
35.
Policies!and!procedures!for!decision making!are!established
0!
1!
2!
3!
36. Effective!data!tools!are!used!appropriately!and!independently!by!staff
0!
1!
2!
3!
37. Data!sources!are!used!to!evaluate!the!fidelity!and!impact
0!
1!
2!
3!
38. Available!resources!are!allocated!effectively
0!
1!
2!
3!
39. Data!sources!are!monitored!for!consistency!and!accuracy
0!
1!
2!
3!
The SAM instrument was developed by Florida PS/RtI Project Staff and Florida’s PBS: Effective
Practice. Permission was granted to the Indiana IEP Resource Center to utilize the tool.