Applying a response-to-intervention model to literacy instruction for students who are blind or have low vision.
Article Type: Report
Subject: Response to intervention (Education) (Research)
Response to intervention (Education) (Usage)
Visually disabled children (Research)
Visually disabled children (Education)
Authors: Kamei-Hannan, Cheryl
Holbrook, M. Cay
Ricci, Leila A.
Pub Date: 02/01/2012
Publication: Name: Journal of Visual Impairment & Blindness Publisher: American Foundation for the Blind Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 American Foundation for the Blind ISSN: 0145-482X
Issue: Date: Feb, 2012 Source Volume: 106 Source Issue: 2
Topic: Event Code: 310 Science & research
Accession Number: 282068138
Full Text: Structured Abstract: Introduction: Response to intervention (RTI) has become widely recognized and used in education. Propelling its significance is its systematic and schoolwide approach and emphasis on using a problem-solving approach to providing appropriate instruction for each child. Children with visual impairments (that is, blindness and low vision) are primarily included in public school classrooms and educated under the overall guidelines that apply to all children. Therefore, professionals who work with children with visual impairments must understand RTI and its implications within the context of visual impairment. Methods: Key principles of RTI are examined, including universal screening, multitiered models, monitoring of progress, and the use of evidence-based practices. Results: An RTI framework within the context of literacy instruction for children who are visually impaired is presented. Discussion: The benefits of embracing RTI are discussed. First, RTI ensures that collaborative planning takes place by using a problem-solving approach in which data from ongoing assessments are collected and the results are used to plan instruction using evidence-based interventions. Second, RTI can be used to identify students who are at risk of academic failure and can assist in the identification of additional disabilities. Early identification of students who are struggling with literacy is not only essential to providing necessary instruction, but data-driven decisions should be made to ensure that specific skills are addressed by qualified individuals who are familiar with the unique needs of individuals with visual impairments. Implications for Practitioners: The authors conclude by encouraging professionals in the field of visual impairment to become actively involved with the implementation of RTI in their local education agencies.


The 2004 passage of the Individuals with Disabilities Education Improvement Act (IDEIA; P.L. 108-446), which included response to intervention (RTI) as an option for identifying students with specific learning disabilities, has prompted systemwide reforms in many state and local education agencies (LEAs). One major principle that has propelled this reform is RTI's universal screening, which uses schoolwide assessments to provide evidence about every student's academic performance (Deno et al., 2009). These assessment data enable educators to adjust instruction to better address the needs of students who are at risk for academic failure. The multitiered nature of RTI provides for ongoing monitoring of a student's progress, with research-based instructional interventions of various levels of intensity within each tier (Hoover & Patton, 2008).

LEAs that have adopted RTI models are developing them without consideration of students with visual impairments (that is, those who are blind or have low vision). In this article, we discuss the implications of RTI models within the context of the core curriculum (specifically literacy instruction) for students who are visually impaired. When one applies RTI to the education of students with visual impairments, the unique instructional needs, services, and eligibility requirements of this special population must be considered. For example, the frequency and duration of services from specialists (such as teachers of students with visual impairments), intensive specialized instruction in areas of the core and expanded core curriculum (for example, braille literacy, low vision visual efficiency, and instruction in assistive technology), and the continuum of placement options (including general education, resource rooms, special day classes, and specialized schools) must be factors in defining how the RTI model is applied to these students.


The proponents of RTI describe it as both an innovative service delivery model and a promising alternative method to the IQ-achievement discrepancy model that is traditionally used to identify children with specific learning disabilities (Barnes & Harlacher, 2008). For more than 30 years, the field of learning disabilities has witnessed a contentious debate over the use of the IQ-achievement discrepancy model (Mesmer & Mesmer, 2008; Vaughn & Fuchs, 2006). In that model, a significant difference must exist between a student's scores on IQ tests and achievement scores in the area of oral expression, listening comprehension, written expression, basic reading skills, reading comprehension, mathematical calculation, or mathematical reasoning to document the "severe discrepancy between achievement and intellectual ability" required for the diagnosis of a learning disability (U.S. Department of Education, 1977).

The IQ-achievement discrepancy model has elicited strong criticism for several reasons. First, the amount of time required before children exhibit a significant discrepancy between IQ and achievement represents a wait-to-fail approach, depriving students of receiving early interventions that could have prevented them from falling further behind (Fletcher et al., 2002; Mesmer & Mesmer, 2008; Vaughn & Fuchs, 2003). Second, the interventions that are used for students who are at risk of academic failure (such as students who are performing below expected grade-level benchmarks or below a set percentile on a universal screening tool) and those used for students who are identified as having a learning disability are often the same. Therefore, many students could benefit from intense, research-based interventions, regardless of whether a discrepancy is present. Another criticism of the IQ-achievement discrepancy model is that the establishment of a discrepancy does not determine whether highly qualified instructors used appropriate interventions with the student (Fuchs & Fuchs, 2006; Vaughn & Fuchs, 2006). Finally, the IQ-achievement discrepancy model has been criticized for the overidentification of students from culturally and linguistically diverse backgrounds in special education because of such factors as language differences, rather than the presence of a true disability.

"Representing a major shift in special education law in 2004, IDEIA allowed states to adopt a process in which a child's responsiveness to research-based interventions could be used as an alternative to the IQ-achievement discrepancy in identifying students with learning disabilities" (Yell & Walker, 2010, p. 125). In this RTI model, a student's lack of response to increasingly intense, high-quality, research-based interventions may be used as evidence of the presence of a learning disability if other data also support this diagnosis (Brown-Chidsey & Steege, 2005). Since this shift, many state agencies and LEAs have begun to implement various RTI models. The proponents of RTI have argued that successful implementation of RTI will ensure better educational outcomes for all students, thereby reducing the overidentification of children for special education (Barnes & Harlacher, 2008).

Principles of RTI

Children with visual impairments are primarily included in public school classrooms and are therefore educated under the overall guidelines that apply to all children. Thus, professionals in the field of visual impairment who work in public school systems must understand the RTI model and its implications. Four key principles that consistently appear in models of RTI include the use of (1) universal screening to identify students who are at risk of poor academic performance, (2) a schoolwide, multitiered approach to prevent such school failure, (3) continuous monitoring of progress (hereafter progress monitoring) to document a student's progress (or lack thereof) and to make decisions about instruction, and (4) evidence-based interventions of increasing intensity that are effectively matched to the needs of the student (Deno et al., 2009; Fletcher & Vaughn, 2009; Fuchs & Fuchs, 2006; Glover & DiPerna, 2007; National Center for Response to Intervention, NCRTI, 2010; Vaughn & Fuchs, 2006). Although implementation can vary from state to state and school district to school district, these key principles typically form the underpinnings of RTI.

The use of RTI in general education is currently related exclusively to instructional practices in areas of the core curriculum. Although teachers of students with visual impairments provide instruction in both the core and expanded core curricula, the purpose of this article is to examine how RTI may be useful in the core curriculum area of literacy instruction. In the future, it may also be helpful to use RTI to frame instruction in the expanded core curriculum.


RTI calls for universal screening of all students using brief, standardized, criterion-based measures that are reliable, valid, and accurate in predicting academic and behavioral difficulty (Deno et al., 2009; Fuchs & Fuchs, 2006). Typically, universal screening is conducted three times a year--at the beginning, middle, and end of the academic year--to identify students who have not met expected benchmarks of academic performance or who are at risk of failing high-stakes tests. Measures such as the Dynamic Indicators of Basic Early Literacy Skills (DIBELS; Good & Kaminski, 2002), Phonological Awareness Literacy Screening (Invernizzi, Justice, Landrum, & Booker, 2005), or AIMSweb can be used for universal screening in literacy (Barnes & Harlacher, 2008; Glover & DiPerna, 2007). By screening all students early in the schooling experience, educators can design more timely and effective instruction for students who may otherwise experience academic failure.



Another key principle underlying RTI is the use of a schoolwide, multilevel approach for optimizing students' achievement and reducing problem behaviors (Fuchs & Fuchs, 2006; NCRTI, 2010). As is shown in Figure 1, RTI calls for a multitiered system of interventions, most typically three levels of increasingly intensive instruction. At Tier 1, which is the least intensive and preventive tier, all students participate in the general education classroom. If schoolwide screening measures reveal that students are not responding to the general curriculum (for instance, that they are performing below expected benchmarks or below a set percentile on a universal screening tool), these students are considered at risk and are provided instruction that is considered to be Tier 2 intervention. In this second tier, students receive more intense instruction, often through one or more of the following strategies: increasing the duration and frequency of instruction; placing students in smaller groups; or providing instruction by teachers with more expertise, such as a reading specialist in addition to the primary instruction in the general education classroom (Fuchs & Fuchs, 2006). If students fail to make progress with Tier 2 intervention, they are then provided instruction that is considered Tier 3 intervention, which consists of even more intense individualized instruction or an alternative research-based curriculum. If a student continues to be unresponsive to Tier 3 intervention, then a learning disability is suspected, and the referral process for special education may begin.


To determine how students are performing and whether the provision of more intense instruction is necessary, continuous progress monitoring across the three tiers of intervention is also an essential component of RTI (Deno et al., 2009; Fuchs & Fuchs, 2006). When monitoring progress, educators use brief and efficient curriculum-based measures, such as DIBELS or AIMSweb, in frequent intervals of three to four weeks to assess a student's growth over time (Barnes & Harlacher, 2008; Glover & DiPerna, 2007; Jackson, n.d.). Using this dynamic and immediate indicator of academic progress, educators can pinpoint specific areas of a student's need and make timely decisions regarding placement, instructional programming, and intensity of instruction for the student if "nonresponsiveness" is found (Barnes & Harlacher, 2008; Gersten & Dimino, 2006). With RTI, students who are receiving appropriate educational services are expected to show progress (for example, "responsiveness" to intervention) in their current instructional program. A student who is responding to instruction will show growth over time in a progress-monitoring data chart. In contrast, a nonresponsive student will not show the expected growth.


Another important principle underlying RTI is the use of evidence-based interventions within the various tiers of instruction (Fuchs & Fuchs, 2006; Mesmer & Mesmer, 2008; NCRTI, 2010). Evidence-based interventions are those instructional practices that have been proved effective through empirical, scientific, and rigorous research (Brown-Chidsey & Steege, 2005; NCRTI, 2010). These interventions may include such programs as SRSD for Writing Strategies, Stepping Stones to Literacy, or Number Rockets (NCRTI, 2010). Since nonresponsiveness to an intervention could also be due to the "absence of good instruction," RTI models call for interventions to be delivered by individuals who are highly qualified and knowledgeable (Fuchs & Fuchs, 2006). With RTI, educators seek to provide students with instruction that is associated with positive outcomes for at-risk students, such as advance organizers, numerous opportunities for students to respond, and systematic and immediate corrective feedback (McEwan & Damer, 2000). By using a multitiered system with evidence-based interventions whose progress is monitored frequently, RTI provides educators with the ability to better distinguish and serve both at-risk students and those with specific learning disabilities.

Students with visual impairments in a systemwide approach

Because implementation of RTI emphasizes universal screening, forming a concept of how students with visual impairments fit into RTI models is critical, especially for students who are included in general education classrooms and therefore participate in schoolwide universal screening. Although the appropriateness of universal assessment for students with visual impairments may be questioned, we do not present a debate about universal assessment. Rather, we contend that the components of RTI models may be used effectively to improve current practices in the education of students with visual impairments. To illustrate how the RTI model may be used effectively with students who are visually impaired, we focus on the achievement of literacy.

Research has suggested that students with visual impairments may lag behind their sighted peers in reading performance, particularly in the areas of reading fluency, vocabulary, and concept development (Emerson, Holbrook, & D'Andrea, 2009). Although a student who is visually impaired may progress on grade level during preschool and kindergarten, he or she may begin to fall behind by the third grade. Like sighted students, students who are visually impaired must have access to literacy instruction by a qualified teacher (that is, a teacher of students with visual impairments who is qualified to teach the use of braille, print, or both as literacy media).

Assessment practices in the field of visual impairment

In the field of visual impairment, there has been little emphasis on the use of monitoring progress (Jackson, n.d.). Hannan (2007) found that assessment practices most often occur annually and triannually and that consistent monitoring is not widely practiced. Many decisions regarding educational programming continue to be made on the basis of informal data, including anecdotal and subjective information (Ferrell, 2006). Even when statewide assessments occurred annually, Hannan (2007) found that 73% of the teachers in her study thought that standardized tests were not valid, and 61% stated that the scores from these tests were not useful. In the study, the respondents thought that the scores were not relevant to day-to-day educational programming and that testing was a mandatory, procedural event. When asked what assessment tools were used, they reported that informal checklists and observations by teachers were the most commonly used. Criterion-referenced tools, such as the Brigance Comprehensive Inventory of Basic Skills-Revised (CIBS-R) and basic reading inventories were also commonly used with students with visual impairments.

Learning media assessments (Koenig & Holbrook, 1995) and functional vision assessments have become widely adopted practices (Hannah, 2007). Hannah found that of the 20 teachers who were interviewed for her study, all conducted both types of assessments "regularly." However, "regularly" was loosely defined; 14 of the 20 teachers conducted both types of assessments every three years or as needed and only 3 conducted them annually.

Potential impact of embracing RTI

We believe that embracing the RTI model has potential for improving current educational practices in the field of visual impairment. First, the systemwide approach mandates that children with visual impairments be considered within the universal screening process and thus requires collaboration between the general education teacher and the rest of the educational team when planning instruction.

Second, the multiple tiers of RTI ensure that changes in instruction will be made with increasing or decreasing levels of support for students with visual impairments, as determined by ongoing assessments. A problem-solving method is used to improve instructional programming, and movement between tiers is tied to evidence (Vaughn & Fuchs, 2006).

Third, the implementation of RTI ensures that the learning needs of students with visual impairments are monitored on a continuous basis. Data from ongoing assessments can be used to determine changes in educational programming for students by providing support for or challenging current practices. Such data-driven decisions form the basis for effective educational programming. Ultimately, RTI ties monitoring of progress to the intensity and individualization of instruction. Thus, a model that implements systematic assessments may improve current practices to identify students who are at risk and thus provide them with interventions so that they do not fall further behind.

Fourth, RTI encourages the implementation of evidence-based practices for students with visual impairment. This has been a challenging aspect of RTI for the field of visual impairment. As Ferrell (2006, p. 42) stated, "best practices are more often than not based on tradition, superstition, anecdote, and common sense rather than science." This RTI principle challenges those in the field of visual impairment to investigate and use scientifically validated educational interventions.

Finally, RTI may help identify students who have a dual diagnosis of learning disability and visual impairment. The identification of students with both visual impairments and learning disabilities can be difficult for a number of reasons: (1) visual impairments are typically identified much earlier than learning disabilities, and, therefore, educational teams may assume that learning difficulties are the result of the loss of vision; (2) visual impairments are more commonly understood by the general public than are learning disabilities; and (3) some people believe that it is more socially and educationally acceptable for educational difficulties to be the result of a visual impairment and therefore avoid the label of learning disability (Erin & Koenig, 1997). By following a framework for the systematic identification of students who are at risk of academic failure and by creating a multitiered approach to determine responsiveness, educators may be able to improve current practices better to identify students who may have a specific learning disability along with their visual impairment.

A framework for RTI for the field of visual impairment

Using the three-tiered model (Council for Exception Children, 2007) described earlier, we propose that students with visual impairments can be included in the application of RTI (see Figure 2). In Tier 1, students who qualify for special education under the eligibility criteria of visual impairment receive instruction by a qualified teacher, who could be the general education teacher or a qualified teacher of students with visual impairments, depending on the results of a student's learning media assessment and the decisions of the student's educational team. Instruction consists of the general education curriculum or specialized literacy instruction afforded to students who are visually impaired, such as a basal reader curriculum specific to students who are learning to read in braille like Building on Patterns (American Printing House for the Blind, 2006). The educational setting will also be determined by the student's educational team on the basis of the student's specific needs and may be a general education classroom, a visual impairment resource room, pull-out instruction, or a specialized school. The specific qualifications of the teacher and the appropriateness of the educational placement can be determined only on the basis of the documented needs of the individual student.

If a student who is visually impaired does not respond to Tier 1 instruction, then Tier 2 can be implemented. Tier 2 instruction is individually planned and designed to address specific areas of non-response (such as fluency, comprehension, and concept development), and will further support the student's development of literacy skills. Instruction in this tier continues to be provided by qualified teachers, including a classroom teacher and a teacher of students with visual impairments. Additional consultation or supplemental instruction may be provided by a low vision specialist, physical therapist, occupational therapist, speech-language specialist, or reading specialist.


For students who do not respond to these Tier 2 interventions, even more intensive support may be offered in Tier 3. The third tier consists of intense, highly individualized instruction that is designed to meet the academic and functional needs of the student. Instruction in this tier continues to be provided by qualified teachers, including a classroom teacher and a teacher of students with visual impairments, and is supplemented with support from specialists in reading, special education, occupational or physical therapy, and low vision. The intensity of instruction may be adjusted by increasing the duration or frequency of the intervention or by changing the instructional program.

In all tiers of RTI, data-based decisions are used to determine educational programming for students who are blind or have low vision. Progress is monitored continuously to check for the appropriateness of the instructional intervention. Changes in instructional programming occur on the basis of the student' s responsiveness to intervention. If a student is responding to the intervention, then he or she continues to be provided instruction that is consistent with the current tier. However, if the student is not responding, then instruction is intensified to a subsequent tier. According to Koenig and Holbrook (1995), students should be assessed annually using learning media assessments. Before a tier is changed, data from a current learning media assessment must be available to inform the educational team. The purpose of a learning media assessment is to collect and document data that will have an impact on decisions regarding learning and literacy media (braille, print, or a combination of braille and print). The individualization of instruction-including changes in the frequency, duration, and intensity of an intervention--occurs throughout the proposed model and relies on progress-monitoring data, thus assuring that changes occur on the basis of evidence.


As we mentioned earlier, RTI was developed primarily to address issues that are related to identification and instruction of students with learning disabilities. It has been widely adopted for use in school districts as a method for examining how all children respond to high-quality instruction. Since RTI was not conceptualized with the needs of students with visual impairments in mind, it is critical that professionals with a focus on the education of this population determine the application of RTI. In doing so, there are several key limitations that must be considered.


The research that has been done to support the use of RTI has focused primarily on students with learning disabilities. There is a great need for research on applying the principles of RTI to students with visual impairments.


Although the principles of RTI are commonly applied to a large number of students (for example, entire school districts), students with visual impairments typically are found in small numbers within these larger jurisdictions. Therefore, the unique characteristics and learning needs of these students are often overshadowed by policy decisions that are made to address the larger population.


In determining how children with visual impairments fit into an existing LEA's RTI model, it is imperative that each child's current instructional program and progress toward academic achievement be considered before a child is placed within a tier. Although level-of-service and placement options (that is, options within the hierarchy of the least restrictive environment) are factors in applying an RTI framework, they should remain independent of decisions regarding the child's classification within a tier. In other words, children who receive intensive services from a teacher of students with visual impairments should not automatically be placed in Tier 3.


Given that one purpose of RTI is to identify students with learning disabilities and determine their eligibility for special education, at a glance RTI may seem inappropriate for students with visual impairments. Because students with congenital visual impairments are often identified in infancy, their eligibility for special education occurs prior to kindergarten. Hence, in a three-tier classification system, some professionals and school administrators may automatically believe that students who are visually impaired need to begin in Tier 2 of the RTI model. However, students who are visually impaired may be performing at grade level. Therefore, using an RTI model solely to identify a disability and define educational services beyond instruction by teachers who are qualified in general education as Tier 2 is inappropriate for students who may require specialized instruction even when performing at or above grade level.

In addition, students who are visually impaired may be placed in classrooms outside the general education classroom setting (such as in a specialized school for students who are visually impaired, a special day class, or a resource room) from the beginning of elementary school. These placements are not considered within the adopted RTI frameworks of most LEAs, mainly because RTI was created without students with visual impairments in mind. Likewise, supports, such as those provided by a teacher of students with visual impairments, are challenges to the existing tiers of RTI. Students who are visually impaired may be receiving intense, ongoing services from a teacher of students with visual impairments and may successfully achieve in the general education curriculum. These students should be classified in Tier 1. However, if a student is not showing progress, then additional supports and Tier 2 intervention must be considered. Given that the purpose of RTI is to identify students who are at risk of academic failure and provide them with appropriate early intervention and that many students with visual impairment perform below grade level, components of this model can be applied to monitor their progress and make appropriate decisions regarding instructional programming.

Essentials of a successful RTI model for students with visual impairments

As RTI in LEAs becomes more prevalent, teachers of students with visual impairments must become actively involved with its implementation related to students who are visually impaired. At the same time, it is important to advocate for the appropriate use of RTI for this population when there are special considerations. As RTI is being implemented in school systems, professionals working with students who have visual impairments should consider the following:

* Teachers of students with visual impairments appropriately provide direct instruction in areas of the core and expanded core curricula to students who are identified as receiving Tier 1 instruction. The provision of direct instruction by a qualified teacher of students with visual impairments is not an automatic indication of the need for Tier 2 or more intense instruction.

* Direct, evidence-based instruction that focuses on academic and specialized skills must be provided by highly qualified professionals. In the case of students with visual impairments in Tier 1 instruction, these professionals must include both general education teachers and teachers of students with visual impairments. Researchers and curriculum developers who focus on the education of students with visual impairments must work to define evidence-based instruction within the context of this low-incidence, heterogeneous population.

* Monitoring of progress is an important component of an effective RTI model, and teachers of students with visual impairments must fully engage as members of students' educational teams, providing appropriate data and interpretation of assessment data from other sources.

RTI is an important initiative being used in school systems throughout the United States. Students with visual impairments who are included in general education classrooms are also included in this initiative by virtue of their placement in general education, yet little attention has been paid to the unique issues of high-quality instruction by qualified personnel for these students. It is imperative that professionals who work with students who are visually impaired be fully aware of administrative decisions as they relate to the use of RTI with this population.


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Cheryl Kamei-Hannan, Ph.D., assistant professor, Charter College of Education, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032; e-mail: . M. Cay Holbrook, Ph.D., associate professor, Faculty of Education, University of British Columbia, 2125 Main Mall, Vancouver, BC V6T1Z4, Canada; e-mail: . Leila A. Ricci, Ph.D., assistant professor, Charter College of Education, California State University, Los Angeles; e-mail: .
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