Intervention Start-Up Worksheet
Fall Intervention Start-Up Check
Blank Worksheet
K–12 MTSS Data-Teaming Resource • Intervention Launch & Barrier Audit
“Your screening results are in. Who is still waiting for support?”
Instructions Bring this to an existing team meeting and use it alongside current student-support records.
Supporting Notes Screening flags possible risk—it does not automatically determine placement. Review core instruction alongside individual support when many students show similar difficulties. Do not delay required services.
School
Team / Grade
Meeting Date
Person Completing Check
1
Need and support
Student identifier or intervention group
Specific skill or support need
Evidence reviewed to confirm the need beyond the screening score
Planned intervention
Staff member responsible
2
Getting started
Scheduled days, duration, and location
Planned start date
Actual start date
Obstacle or barrier to delivery (if any)
Person to resolve
Next action date
3
Follow-through
Progress measure
Goal
Review date
Decisions before we leave
What needs to start or change?
Who will make it happen?
By when?
When check back?
Sources: National Center on Intensive Intervention (intensiveintervention.org) • Center on MTSS (mtss4success.org) Page 1 of 4 • Blank Worksheet
Fall Intervention Start-Up Check
Started on Schedule
Scenario 1: Support started as planned (Active service)
Fictional Reference Model
“Your screening results are in. Who is still waiting for support?”
Context Verified early reading decoding need. Staffing, materials, and master schedule aligned with zero delivery delay.
Target Note Sample progress goals shown below are illustrative examples, not recommended universal targets.
School
Oakridge Elementary
Team / Grade
Grade 3 Data Team
Meeting Date
September 24, 2026
Person Completing Check
R. Davis (Intervention Lead)
1
Need and support
Student identifier or intervention group
Reading Group 3-B (IDs: #302, #308, #314)
Specific skill or support need
Multisyllabic word decoding and vowel-team accuracy
Evidence reviewed to confirm the need beyond the screening score
Universal screener below 15th percentile verified with Quick Phonics Survey (0/5 on vowel digraphs); classroom running records confirm oral language comprehension is intact, isolating the gap to decoding.
Planned intervention
Explicit systematic phonics routine (Tier 2 small group)
Staff member responsible
Elena Rivera, Reading Specialist
2
Getting started
Scheduled days, duration, and location
Mon–Thu, 8:30–9:00 AM (30 min), Room 106
Planned start date
September 15, 2026
Actual start date
Sept 15 (On Schedule)
Obstacle or barrier to delivery (if any)
None. Materials delivered and student attendance at 100% in week 1.
Person to resolve
N/A (No barrier)
Next action date
October 6 (Log 3-wk probe)
3
Follow-through
Progress measure
Weekly oral reading fluency (ORF) 1-minute passage probe
Goal (illustrative sample)
+1.4 words correct per minute per week
Review date
October 27, 2026 (6 weeks)
Decisions before we leave
What needs to start or change?
Confirm weekly ORF data logging in tracker; ensure classroom teacher reinforces target vowel-teams during Tier 1 reading.
Who will make it happen?
Elena Rivera (Specialist) & Grade 3 team
By when?
October 2, 2026
When check back?
October 6, 2026
(Next data team)
Sources: National Center on Intensive Intervention (intensiveintervention.org) • Center on MTSS (mtss4success.org) Page 2 of 4 • Example 1 (Started on Schedule)
Fall Intervention Start-Up Check
Delayed: Schedule Conflict
Scenario 2: Support delayed by scheduling conflict (Action assigned)
Fictional Reference Model
“Your screening results are in. Who is still waiting for support?”
Context Verified rational number computation need. Launch blocked by master schedule collision with science lab; resolution owned by administrator.
Target Note Sample progress goals shown below are illustrative examples, not recommended universal targets.
School
West Lake Middle School
Team / Grade
Grade 7 Student Support
Meeting Date
September 23, 2026
Person Completing Check
D. Chen (Math Interventionist)
1
Need and support
Student identifier or intervention group
Student #7108 (Grade 7)
Specific skill or support need
Rational number operations (unlike denominator addition/subtraction)
Evidence reviewed to confirm the need beyond the screening score
Fall math screener Stanine 2 verified with Unit 1 diagnostic pre-test (0/5 on fraction equivalency); Tier 1 classwork shows persistent blockage despite active participation during core instruction.
Planned intervention
Targeted fraction and rational number intervention (small group)
Staff member responsible
David Chen, Math Interventionist
2
Getting started
Scheduled days, duration, and location
Tue, Thu, Fri, 1:15–1:50 PM (35 min), Math Lab 204
Planned start date
September 18, 2026
Actual start date
Pending schedule shift
Obstacle or barrier to delivery (if any)
Schedule collision: 1:15 PM slot overlaps with required Tier 1 science lab rotation; student cannot miss science core.
Person to resolve
Dr. Marcus Vance (AP)
Next action date
Sept 25 (Shift to advisory)
3
Follow-through
Progress measure
Bi-weekly 2-minute fraction computation skill probe
Goal (illustrative sample)
80% accuracy on fraction addition/subtraction
Review date
November 6, 2026 (6 weeks)
Decisions before we leave
What needs to start or change?
Dr. Vance will shift Student #7108 to Period 5 flex advisory slot; Mr. Chen will notify classroom teachers and send home schedule letter.
Who will make it happen?
Dr. Marcus Vance (AP) & David Chen (Interventionist)
By when?
Friday, Sept 25
(Launch: Sept 29)
When check back?
Tuesday, Sept 29
(Confirm launch)
Sources: National Center on Intensive Intervention (intensiveintervention.org) • Center on MTSS (mtss4success.org) Page 3 of 4 • Example 2 (Schedule Conflict Resolved)
Fall Intervention Start-Up Check
Verifying Need First
Scenario 3: Verifying need before placement (Diagnostic in progress)
Fictional Reference Model
“Your screening results are in. Who is still waiting for support?”
Context Screener flagged writing/task initiation risk. Team is distinguishing fine-motor physical fatigue from language comprehension before matching intervention.
Target Note Sample progress goals shown below are illustrative examples, not recommended universal targets.
School
Pine Crest Elementary
Team / Grade
Grade 2 Support Team
Meeting Date
September 25, 2026
Person Completing Check
P. Patel (School Psychologist)
1
Need and support
Student identifier or intervention group
Student #2044 (Grade 2)
Specific skill or support need
Pencil-to-paper task initiation vs. fine motor writing fatigue
Evidence reviewed to confirm the need beyond the screening score
Screener flagged urgent risk on written expression; teacher notes student orally dictates rich vocabulary and full sentences with high comprehension, but stops writing after 2 minutes due to hand pain.
Planned intervention
Pending diagnostic check (interim: Tier 1 pencil grip & visual task strip)
Staff member responsible
Priya Patel (Psych) & OT Liaison
2
Getting started
Scheduled days, duration, and location
In-class diagnostic observation during Tier 1 writing block (Rm 12)
Planned start date
September 22, 2026
Actual start date
Post-verification check
Obstacle or barrier to delivery (if any)
Screener alone does not distinguish fine-motor physical fatigue from language generation deficit; need direct observation before selecting targeted program.
Person to resolve
Priya Patel & OT Liaison
Next action date
Sept 29 (Conduct observation)
3
Follow-through
Progress measure
Classroom writing stamina sample (words transcribed in 3 minutes)
Goal (illustrative sample)
Initiate writing within 2 minutes; complete 3 sentences
Review date
October 2, 2026 (Reconvene)
Decisions before we leave
What needs to start or change?
Complete in-class pencil-grasp and writing stamina observation on Sept 29; provide classroom teacher with interim visual task checklist; reconvene team.
Who will make it happen?
Priya Patel (Psychologist) & Sarah Gomez (Teacher)
By when?
Tuesday, Sept 29 (Observation)
When check back?
Friday, Oct 2
(Finalize placement)
Sources: National Center on Intensive Intervention (intensiveintervention.org) • Center on MTSS (mtss4success.org) Page 4 of 4 • Example 3 (Diagnostic Verification)