Compass Referral Sheet Middle School MTSS Framework
Compass Referral Guide
COST Protocol
Form Ref: COST-A1
Pre-Referral Action Checklist (Required Before COST Submission)
Verify current academic and attendance data in SIS.
Implement minimum of 2-3 Tier 1 classroom strategies (4+ weeks).
Establish direct communication with parent/guardian.
Conduct 1-on-1 student conference to discuss concerns.
Referral Indicators Matrix (Tier 2 & Tier 3 Needs)
Academic & Classroom Performance
Tier 2 Indicators: Significant academic regression, missing >20% assignments, sudden drop of 2+ letter grades, chronic disengagement during instruction.
Tier 3 Indicators: Severe processing gaps, persistent non-compliance with work, failure of multiple core subjects despite targeted reading/math interventions.
Attendance & Engagement
Tier 2 Indicators: Chronic absenteeism (missing 10-19% of school year), regular tardiness to 1st/2nd period, pattern of classroom "skipping" or frequent nurse visits.
Tier 3 Indicators: Severe chronic absenteeism (missing 20%+ of school), complete disengagement, no contact from family for consecutive school days.
Social-Emotional & Mental Health
Tier 2 Indicators: Elevated anxiety, acute sadness/withdrawal, frequent peer isolation, significant low self-esteem, difficulty with emotional regulation or self-coping.
Tier 3 Indicators: Expression of hopelessness, self-harm indicators, trauma-induced panic/dissociation, sudden extreme shifts in hygiene, appearance, or mood.
Behavioral & Restorative Needs
Tier 2 Indicators: Recurrent classroom disruptions, argumentative posture with peers/staff, difficulty working in groups, patterns of minor referral offenses.
Tier 3 Indicators: Defiant, aggressive physical or verbal outbursts, destruction of property, severe dysregulation requiring crisis response or suspension support.
Asset-Based Referral Practice: COST referrals must emphasize student strengths, cultural assets, and personal interests. Interventions are built by leveraging what works well for the student, rather than focusing solely on perceived deficits.
Compass Middle School COST Staff Guide • Page 1 of 2 Confidential Support Document
Middle School MTSS Submission
Compass Referral Sheet
COST Protocol
Form Ref: COST-A2
Student Name
Grade / Section
Student ID
Referring Staff Member
Relationship to Student
Date of Submission
Primary Domains of Concern (Select all that apply)
Academic Performance
Attendance / Punctuality
Social-Emotional Needs
Behavioral / Regulation
Student Strengths, Assets, & Interests
(e.g., artistic, strong relationship with peer X, loves sports, highly verbal)
Observed Challenges & Triggers
(e.g., transition between classes, high-stakes testing, group presentation)
Tier 1 Classroom Strategies Attempted (Required Checkboxes)
Preferential Seating
Cool-down corner breaks
Scaffolded assignments
Individual student conference
Parent/Guardian contact
Positive reinforcement system
Detailed Reason for Referral & Impact on Learning
State objective observations only. Describe how these behaviors or factors block student performance or well-being.
Parent / Guardian Contact Record MUST BE COMPLETED
Contact Date:
Parent response:
Compass Middle School COST Staff Referral Form • Page 2 of 2 Submit to COST Box or cost@compassms.org
Synergy Meeting Protocol Middle School COST Standards
Synergy Meeting Protocol
Standard Operations
Doc Ref: COST-B1
Standard Confidentiality & Asset Orientation
All discussions regarding student support, behavior, mental health, and family dynamics are strictly confidential. We focus on leveraging student strengths to design supportive pathways rather than focusing on deficit narratives.
Defined COST Roles & Duties
Facilitator
Paces the meeting strictly according to the agenda. Guides conversation away from venting and focuses on asset-based action planning.
Note-Taker
Records key data, specific interventions, responsible owners, and timelines in the student tracker or SIS in real-time.
Data Specialist
Pulls and presents multi-source data (grades, attendance, behavioral referrals, historical assessment scores).
Case Manager
Acts as the primary communication bridge for student/family. Monitors response to school-wide interventions.
30-Minute Student Intervention Agenda
Time Agenda Item Protocol Focus & Actions 00 - 03 min Setup & Roles Assign facilitator, timer, and note-taker. Confirm student files and logs are open. 03 - 08 min Case Presentation Referring teacher summarizes referral sheet. Focus on academic/behavior/SEL patterns and key student assets. 08 - 14 min Data & Profile Review Data Specialist reviews attendance trends, behavior charts, grade history, and past support. 14 - 22 min Intervention Design Collaborative brainstorm of evidence-based Tier 2/3 interventions (CICO, small group counseling, check-ins). 22 - 28 min Action Planning Formulate action plan: Define target goal, select coordinator, and set follow-up check-in date (6-8 weeks). 28 - 30 min Family Coordination Finalize family communication plan. Designate counselor/admin to coordinate Tier 2 intervention options.
Decision Rule for Escalation to Tier 3
If student demonstrates less than 50% progress on Tier 2 goals after 6 weeks, modify strategy. If zero progress is made after 8 weeks with high implementation fidelity, escalate to Tier 3 intensive individual plan.
Target Fidelity 80%+ Implementation Rate
Compass Middle School COST Protocol • Page 1 of 1 Confidential Support Document
Alliance Action Plan Middle School MTSS Planning
Alliance Action Plan
Tier 2 & 3 Support
Doc Ref: COST-C1
Student Name
Grade / Team
Meeting Date
COST Case Manager
Service/Intervention Tier
Tier 2 (Targeted) Tier 3 (Intensive)
SMART Goal Statement (Measurable, Specific, & Time-Bound)
e.g., "Student will attend first period on time at least 90% of school days over the next 6 weeks, as measured by SIS."
Selected Intervention Strategies (COST Approved)
Check-in Check-out (CICO)
Daily connection with a designated staff mentor.
Social-Emotional Support Group
Weekly counselor-led curriculum (e.g., coping skills, anxiety).
Targeted Academic Support
Scheduled pull-out tutoring or scaffolded learning plan.
Attendance Contract & Mentoring
Personal home/school contract with restorative tracking.
Implementation & Responsibilities
Action / Support Strategy Frequency / Schedule Responsible Party Location / Environment
Support Coalition Pact
By signing below, we agree to coordinate our efforts to support the student's growth. We commit to executing the strategies listed above with transparency, compassion, and consistency. We will meet again on the 6-week review date to measure progress and adapt support as a coalition.
Student Commitment Signature
Parent / Guardian Signature
COST Case Manager Signature
6-Week Review Date: Target Goal Progress Required: Min. 50% Positive Trend
Compass Middle School COST Student Agreement • Page 1 of 1 Copy to: Student File, Parent, and Case Manager
Pinnacle Data Tracker Middle School MTSS Progress Monitoring
Pinnacle Data Tracker
Data Tracking Log
Doc Ref: COST-D1
Student Name
Grade / Team
Track Start Date
Intervention Strategy
Primary Metric Monitored
(e.g., CICO score %, class attendance %, counseling session logs, behavioral incidents)
8-Week Intervention Data Grid
Wk Dates Metric % / Score Absences / Tardy Weekly Notes / Observations (Fidelity, Mood, Response) W1 W2 W3 W4 W5 W6 W7 W8
8-Week Intervention Outcome Review
To be completed during the COST debriefing session at week 8.
Goal Met: Graduate
Partial Progress: Continue Tier 2
Unmet: Escalate to Tier 3
Refer for Assessment
Summary of Next Steps & Modifications Agreed by the Team
Compass Middle School COST Progress Monitor • Page 1 of 1 File in confidential COST records with student action plan
Anchor Support Guide Middle School MTSS Tier 1
Anchor Support Guide
Classroom Interventions
Doc Ref: COST-E1
Fidelity Strategy Trial (3+ Weeks) Before submitting a COST referral, middle school teachers are expected to implement and track at least two of the following Tier 1 strategies for a minimum of 3 weeks. These interventions build a strong classroom foundation and often resolve challenges without escalation.
Academic & Processing
Task Chunking: Break large assignments into 10-15 minute increments with intermediate verbal check-ins.Visual Scaffolds: Provide pre-filled graphic organizers, step-by-step checklists, or annotated examples on desks.Response Options: Allow alternative formats (verbal recordings, typed outlines, or visual models) to demonstrate mastery.
Behavior & Regulation
Proactive Seating: Relocate student adjacent to instructional focus or positive peer influences; away from distractions.Non-Verbal Cues: Agree on a private hand sign or sticky note signal to redirect off-task behavior without public callouts.Movement Breaks: Allow a discrete 2-minute errand or quick stretch break when dysregulation signs appear.
Social-Emotional Support
Cool-Down Corner: Designate a quiet area in the room with stress balls, drawing pads, or breathing exercises.2x10 Relationship Building: Spend 2 minutes a day for 10 consecutive days talking to the student about their personal interests.Private Check-In: Conduct a 1-minute empathetic chat during independent work to ask: "How can I support you today?"
Belonging & Attendance
Threshold Greeting: Welcome the student by name at the classroom door every day to establish high belonging.Classroom Role: Assign a specific daily responsibility (e.g., tech assistant, materials lead) to incentivize attendance.Peer Coordinator: Pair the student with a highly supportive classmate to assist with transitions and notes.
Fidelity Log (Pre-Referral Evidence Template)
Strategy Tried Start / End Dates Weekly Frequency Student Response / Observations Trial 1:
Clarity Discussion Guide Middle School RTI & COST Facilitation
Clarity Discussion Guide
Questioning Framework
Doc Ref: COST-F1
Student-Centered Collaborative Inquiry Use these structured questions during RTI and COST meetings to keep conversations focused on multi-source data, root cause analysis, and student-centered support planning. Avoid venting; focus instead on solutions and leveraging student strengths.
1
Grounding in Baseline Data
What do the objective metrics say?
What is the current attendance percentage, academic grade average, and referral rate compared to peer benchmarks?
Are there patterns or trends over time?
Does the student's behavior or performance fluctuate by time of day, day of the week, or class subject?
2
Mapping Assets & Strengths
When is the student most successful?
What environments, subjects, or routines bring out the student's highest engagement and academic focus?
Who is the student's anchor adult?
Which educator, counselor, or support staff member does this student have the strongest, most trusting relationship with?
3
Identifying Barriers & Root Causes
What is the functional need?
Is the behavior or lack of engagement driven by an academic skill gap, communication challenge, or avoidance of difficulty?
Are basic or emotional needs met?
Does the student face barriers related to food/housing security, sleep, physical safety, or acute anxiety/trauma?
4
Defining Support & Accountability
What specific Tier 2 intervention matches?
How does the planned intervention leverage the student's strengths and directly address the functional root causes?
How will we monitor implementation?
Who is taking ownership of tracking the daily/weekly data, and what does success look like at our 6-week checkpoint?
RTI Session Success Check
Verify that your meeting successfully touched upon data points, student strengths, specific interventions, and set a clear follow-up timeline prior to concluding.
Data
Assets
Date Set
Compass Middle School Clarity Discussion Guide • Page 1 of 1 Confidential Support Document
