The process of identifying students at risk for reading difficulties is analogous to using blood pressure results to screen patients for heart disease. This medical "assessment" indicates that a patient is at risk if the results are beyond a certain range identified as healthy. The doctor must then identify and understand the root of the problem and prescribe a course of treatment. The blood pressure reading, or the screening assessment, is just the starting point.
The doctor must consider what steps to take next, depending on the severity of the risk. Lesson 2 of this module presents examples of decision trees, which provide a way of determining risk and level of intervention based on the difference between the predetermined cut score and a student's score. For a student who scores close to the cut score, you may decide to monitor the student's progress for a short time to verify that there is a need for more intensive instructional support. Likewise, the doctor may conduct additional tests after a short interval to confirm the high blood pressure issue.
Now consider the patient with a blood pressure number that is in the high-risk category. The doctor will likely want to intervene immediately. In order to create a treatment plan, the doctor must understand what kinds of issues can cause high blood pressure and try to determine which of those factors are true for that particular patient. The doctor might interview the patient to collect qualitative data about the patient's lifestyle and request specific tests to understand more about the patient's cardiac function. After analyzing this initial round of data, she may suggest a treatment plan that includes a change in the patient's diet and a specific medication. The doctor will typically schedule the patient to come into the office after a brief interval on this regimen to check blood pressure and possibly repeat other tests. This way, the doctor can monitor the patient's progress and see how well the patient's intervention is working to determine if the indicators of heart health are improving.
Action Step A3 focuses on the next step that occurs after struggling students have been identified by asking educators to use data to identify the specific needs students have and what intervention(s) will most likely help them get back on track for reaching grade-level literacy goals. There are several sources of data, which are explored below, that can guide you in this determination.
Using screeners to inform intervention instruction for individuals
Universal screening provides educators with data about every student. Many screeners are designed exclusively for identifying struggling students. Screeners that serve only this purpose can be seen to function like a thermometer does in healthcare settings. A thermometer identifies that a patient has a fever and will likely need further care. The thermometer cannot, however, determine what it is that is causing the patient's fever. In the same way, many screeners can identify only that a student is struggling, but they cannot determine the specific causes for the academic deficit in the domain that was screened for.
There are some screeners, however, that do provide further information about students' specific instructional needs beyond simply identifying them as at risk. These screeners enable teachers to adjust their instruction to meet the exact needs of their students. For example, some commercially available screeners provide tools to analyze struggling students' reading difficulties, facilitate grouping, and plan intervention instruction. Tools like these can be an invaluable resource for teachers. To determine how the screener used on your campus functions, consult the manual and/or online guide, as it should provide specific guidance on this topic.
It is important to remember that assessment data is most valid when it is used only for the purpose the assessment was designed for, and it is less valid when used for other purposes. If the screener you use was not designed for identifying specific instructional needs—as is the case with state accountability assessments—you will need to use additional data to try to understand the roots of students' difficulties.
Using diagnostic data to pinpoint individuals' difficulties
Students who perform significantly below their grade-level peers will most likely need very intense support to help them close the gaps in their literacy development. Just as a doctor should do in treating the patient with a very high blood pressure reading, it is likely that your staff will need to conduct brief follow-up or additional testing for students who show significant risk for reading difficulties. A doctor would be negligent if she failed to conduct relevant tests to inform her treatment plan or prescribed medication based solely on the pharmaceutical samples she had on hand. Similarly, educators need to avoid materials-based or uninformed intervention plans, especially for those students most at risk.
Instead, you and your staff may need to dig a little deeper and attempt to understand the roots of a student's difficulties. This can be done through informal testing by a classroom teacher and additional assessments completed by trained staff such as an interventionist or reading specialist.
The Texas Middle School Fluency Assessment (TMSFA) is an example of such a diagnostic assessment. In this context, "diagnostic" does not imply the need for a licensed diagnostician or referral process. This term is used as another way to say "determine specific needs," as in this TMSFA description:
"The Grade 7 diagnostic reading assessment focuses on the specific skill deficiencies students have in word analysis and fluency that are affecting their comprehension. The results of this assessment provide diagnostic information that districts can use to offer reading intervention to these students based on their specific needs" (Jackson, 2008).
The TMSFA is administered at the beginning of the year to students who did not pass the reading assessment the previous school year. The data is used to help teachers and interventionists determine literacy targets for these students and focus instructional interventions on these specific skills.
It is important that assessment results are communicated clearly to all staff who serve the students. This may require you and your team to consider what systems are needed to share and explain this information to the many teachers and other staff who work with each individual student receiving intervention. Many times, specialists create reading clinic reports (McKenna & Dougherty Stahl, 2009) that summarize the assessments given and provide recommendations to practitioners. Schools that have established systems for communicating data on a regular basis are in the best position to support good instructional decision making and effective collaboration between classroom teachers and interventionists in helping struggling students to close gaps.
Using progress monitoring data to inform next steps
How do we know, though, when an intervention is helping improve a student's reading skills? Progress monitoring data should be used throughout an intervention to evaluate the efficacy of the targeted instruction. These data can enable teachers to understand if the intervention is improving outcomes and if it is doing so quickly enough. After a specified time, if progress monitoring data and student performance indicate the student is making insufficient progress toward the targeted goals, it might be necessary to modify the instruction and implement a different, more intensive intervention. Progress monitoring is discussed in detail in Lesson A4—Monitoring student progress; it is relevant to this discussion, too, because the data from progress monitoring assessments help determine the student's ongoing instructional needs.

TO LEARN MORE: To learn more about using assessment data to inform individualized intervention instruction, you may want to review the following sources:
Assessment for Reading Instruction: Second Edition by McKenna and Dougherty Stahl (2009) provides an excellent overview on using assessment data to guide reading instruction. There is also important information on how to create individualized Clinical Reading Reports and what information in these reports might be most useful for teachers.
Instructional Decision-Making Procedures: Ensuring Appropriate Instruction for Struggling Students in Grades K–12 provides more information on the clinical teaching approach and the practical ways in which principals and school leaders can plan for and support using data to guide reading instruction.
The Data-Based Individualization (DBI) Training Series, produced by the National Center on Intensive Intervention at American Institutes for Research, provides several extensive trainings on ways in which educators can use assessment data to make individualized instructional decisions about classroom and intervention instruction.
The Response to Intervention Implementer Series Self-paced Learning Modules, from the Center on Response to Intervention at American Institutes for Research, also provide several extensive trainings on ways in which educators can use assessment data to make individualized instructional decisions about classroom and intervention instruction.