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Mindy Bridges, Ph.D., CCC-SLP,
Assistant Professor, Department of Hearing and Speech, Intercampus Program in Communicative Disorders
University of Kansas Medical Center
For the Episode 37 Transcript, Click "Read More" below
0:00:10 Tiffany Hogan: Welcome to See Hear Speak Podcast, episode 37. I’m excited to be back at it, hosting the podcast. In this episode, I talk with Dr. Mindy Bridges about all things Response to Intervention, which is commonly referred to as RTI. We talk about the difference between MTSS and RTI, the history of RTI, and the benefits and challenges of implementing RTI in schools, and just a lot more. Even though I am back, I do have a few more guest hosted episodes that I’ll be sharing soon, so stay tuned. Thank you for listening, and don’t forget to check out our website, www.seehearspeakpodcast.com, to sign up for email alerts for new episodes and content, read a transcript of this podcast, access articles and resources that we discussed, and find more information about our guests. And, if you like this podcast, don’t forget to subscribe and leave a positive rating in Apple Podcasts, or wherever you are listening. That can help others to find the podcast. Thank you so much.
0:01:15 TH: Welcome to See Hear Speak Podcast. Today, I'm speaking with Mindy Bridges about Response to Intervention. And I'll have Mindy start by introducing herself.
0:01:27 Mindy Bridges: Hi, I'm Mindy Bridges. I am a speech language pathologist and also an assistant professor at the University of Kansas Medical Center. Prior to then, my position at KUNC, I was a research scientist at KU for about six years. I have research interests in the area of language and reading development and disorders. I have a particular interest in RTI. I have worked quite a bit on that. And I also, in the past, served as an RTI consultant for a large school district in Missouri, in the Kansas City Metro area. So, I have quite a bit of experience working with practitioners, teachers, SLPs, administrators, on how to implement RTI and problem solving.
0:02:12 TH: It's so good to be back to the podcast with you, Mindy, because we've known each other for so long. What was it, 2001 or 2002? We first met when you started the doctoral program with Hugh, and I was his student already. And we've just known each other for a long time and have lots of experiences on grants and papers and have a new grant, which we may talk about some point together. So, it's good to be back with you in particular.
0:02:26 MB: I'm so happy to see your face. You look great. And our first meeting, by the way, we talked about grad school, but we also talked about books for I think 30 minutes.
0:02:45 TH: Oh yes. Absolutely. I remember. And were we at Applebee's? I remember it was like a chain.
0:02:49 MB: We were at Applebee's in Kansas City on the way to Lee's Summit.
0:02:52 TH: Yeah, I think so. I'm picturing, it was like a Applebee's or a Chili's? But it was a memorable event and I'm so excited that we're still here, being able to talk about this. So cool. And that we're still working together. It's great. Well, I'm glad to have you here talking about Response to Intervention. I think we'll start out very basic and just have you tell the listeners: What is Response to Intervention? What's the history behind Response to Intervention, or RTI?
0:03:16 MB: Sure. So, I'll talk a little bit first about what RTI is, Response to Intervention is. And then I'll talk a little bit about the history and where it came from. But first, just to give a real basic overview of RTI, RTI is really a tiered system of instruction and assessment for students, for all students. And so, RTI really is a way to try to provide both preventative intervention for students, but also a way to identify students who might be at risk. And I will talk a lot, by the way, about reading when I talk about RTI because that's my world, that's my research. But I do think it's important for people to remember that RTI is also a framework that's used for math and other educational components. But, again, my discussion will all be based in reading because that's what I think about. And so basically, RTI is a tiered system, and most people use three tiers. Now I've heard... I've seen in the past districts that use five or six tiers. That seems pretty complicated.
0:04:18 MB: But typically, it's a three-tier system. The first tier or level, some people say level, but the first tier is general education. And so, within general education, we're trying to provide quality instruction, quality, evidence-based, research-based instruction to all students in the classroom. And that quality, evidence-based instruction is really key. And that's I think one of... We'll talk about that later but I think that's one of the best things that have been brought up with the advent of RTI. Within that Tier 1, there are screenings, typically three or four times throughout the year. These are quick screening measures to try to identify children who might be at risk for reading. So, we're not talking about a diagnostic assessment. We're talking about trying to find students who are at risk. Students are deemed to be at risk for some sort of reading or learning problem then move to Tier 2. And Tier 2 is typically a small group, extra intervention.
0:05:18 MB: And what's important about this is that this intervention is additional. So, you shouldn't be providing this intervention during regular instruction time. They should get all the regular instruction that kids are getting in Tier 1, but then that Tier 2 is an additional, usually 30 minutes, but that varies widely depending on the needs of the child. In that Tier 2, the intervention isn't necessarily really different but it's more. So, it's more intense, it's more systematic. And the intensity can be accomplished by adding more time but also is accomplished by adding a smaller group. Because within a smaller group, children have an opportunity to provide more input, to have more practice. During Tier 2, children are progress-monitored somewhat frequently. And there's lots of thoughts about how frequently children should be progress-monitored, but typically it's weekly or every other week. And the response to that really targeted instruction is watched very carefully.
0:06:24 MB: And for students that make good progress... So, a lot of times we see maybe kindergarteners or first graders go to Tier 2, and after a really good couple of months of good, intensive intervention, their progress monitoring shows that they're catching up and they go back to the regular classroom. They don't need that intervention. There are kids, of course, that still struggle. That intervention isn't enough. And those children typically are then provided with a larger diagnostic battery and often are placed into special education where they're seen by someone that is more qualified. I shouldn't say more qualified, somebody who gives them more intensive intervention, typically one on one. And often, that intervention then does look different. So, we do have some really good research coming from people like Doug Fuchs and Don Compton and other people that really are looking at those children in Tier 3, the children who are really struggling. And we're still working on it. Those are tough kids to address both with dyslexia or reading comprehension. But those kids need more, and they need more intense services. So that's kind of what RTI is in a nutshell.
0:07:31 TH: And the history then would be that in contrast, before RTI, how is it different than what we see now?
0:07:38 MB: For years, we really used – the royal we – we used the IQ-Achievement Discrepancy often so we had to see... Children were only diagnosed with a reading disability, and only provided any kind of intervention at all, if there was a significant discrepancy between what they were achieving and what their IQ was. And there was a lot of dissatisfaction with this. So, way back in 1983, I always forget how to say his name but, Yesseldyke, I think it was the name, had this really great seminal study looking at different ways to identify students that he found... He or she, actually I don't know if it's a he or she, found 17 different types of definitions of learning disabilities across the United States, and tested kids and multiple kids qualified in one and not the other. I think a large percentage of kids qualified in one of the definitions. And even about 10 years past that, Heller and colleagues also talked a lot about kind of an RTI type of approach.
0:08:44 MB: So, they talked a lot about measuring a child's potential and how they responded to instruction. So, this has been around, this idea, in education for a long time. But it really wasn't until 2004 with the reauthorization of IDEA, that it was actually put into law that you did not have to use a discrepancy model. So, they didn't specifically say you had to use an RTI model, but it opened the door for people to use other ways to identify children. That discrepancy model really had lots of challenges, including because of the way IQ tests are made and because of some statistical properties, kids often weren't identified until third or fourth grade. Well, hopefully everybody on this podcast knows how important early intervention is. And if we're waiting until third or fourth grade for students to really get the extra reading help, you've just lost so much ground. And kids, by that time, are unmotivated. And not only are they unmotivated, but teachers kind of have negative thoughts about how this child might respond. So, there's just this host of negative problems that come from waiting that long.
0:10:00 TH: Yeah, so you led me right to the next questions to think about the benefits of RTI compared to that approach. And also, just thinking even as someone who looks at a lot of data like you do, in the past it sounds like there was this one time point of measurement. You either qualify for services or you don't. And then you have to wait a whole another year or maybe two years. Whereas with RTI, you're really looking at the growth over time and the growth is what's predicting whether you need those services more intensively. So, if you have a lot of growth and are in Tier 2, like you said, then maybe you don't need those, the Tier 3 or IEP level services. You would go back into the general classroom. You can continue to be monitored. But if you have a flat line even with that instruction or very little growth with that Tier 2 extra instruction, boy, that's a sign that you are on the more severe end, that you need to have the intervention that's more tailored directly to the individualized education plan. So what are the benefits of RTI then?
0:10:58 MB: So, I think there's a lot. In my eyes, there's a lot of benefits and we'll talk, I think, about challenges too because there are some challenges as well. But I think one of the most important things that I see as beneficial coming from the RTI framework movement is the emphasis on good quality, evidence-based Tier 1 instruction. I can't emphasize enough how much I've seen a shift in... So, I was a school-based SLP for years before I went back and got my PhD. And I was always interested in literacy. And I remember children who were struggling with reading. The general education teachers were kind of like, "These are your kids," or, "These are the reading specialist’s kids." And there wasn't a lot of talk about what could be done in the classroom. And I'm not bashing teachers. Teachers are amazing. Sometimes teachers are using curricula that are not evidence-based. In fact, we know that teachers are often using curricula that espouse ideas that are actually opposite of what research should do.
0:12:02 MB: So, I think one of the things that I saw was just this really emphasis on choosing and spending a lot of time looking at the evidence related to Tier 1 curricula. And so, when I was an RTI consultant in schools, one of my – this was in 2006, I think, or 2008 maybe – and this district was just starting to implement RTI. Every school was at a different place and the administration was letting each school find their own footing. And I remember one school, I went to go visit them and they were so excited to start Tier 2. They had pulled all these materials and done all these things. And I looked at their data. In their kindergarten and first grade, over 55% of their children were at risk on DIBELS.
0:12:49 MB: And I said, "Oh, nope. You can't do Tier... We're not doing any type of Tier 2 for at least a year. Your job this year is to really firm up your kindergarten and first grade. And that's the only grades I'm... That's all you can do, kindergarten and first grade. And you're really going to emphasize Tier 1 general education instruction." And they were… at first, I think it was really disappointing to them 'cause they had pulled all these great supplemental materials. But two years later, if I remember correctly, their at-risk levels were about 30, which is a little bit high for the school that I was in but still it was so much better, and they had really emphasized that Tier 1. So, for me, that's one of the most important benefits. I also think there's a benefit in that I think with the advent of the RTI framework, there's a whole school feeling. It's just like what I said before, all of the kids are... Everybody's responsible for all of the kids, right.
0:13:48 MB: And I saw administrators, because of all the talk about data and using data to inform instruction and inform kids, when kids should move out of Tier 1, Tier 2, I think the emphasis in using data to make decisions, I had never seen the levels of conversation in MTSS meetings or whatever you call your meetings. And administrators were involved, reading specialists were involved. In schools that were more progressive, SLP's were involved, which they should be. We should be involved in those decisions and those discussions. But I really think that that, those are two of I think the most important pieces is improving a Tier 1 instruction and also using and talking about data and using it in a meaningful way, which I think is just really, really amazing.
0:14:41 TH: You just really hit on the data part, I think is so critical, like you said because I was in a similar situation when I would work in schools, is that it was kind of an us versus them situation. It was like, there's general education, there's a budget, there's training, there's special education. And it was, if this kid isn't doing well in my classroom that's a special education problem, and there wasn't this integration. I think one thing I've seen, also looking at so much data, is you start to see that it's on a continuum. It's not an us verses them, it's just a continuum of kids from really doing well to not doing so well and understanding and seeing that normal distribution play out. Then you can start to see that there is this gray area of kids. It's not just an us or them there's kids who are in the subclinical who kind of don't quite qualify but could qualify later. And so, you do see this range and I think seeing the range really highlights that everyone is responsible for every kid. So special educators have a lot to say about practices that could happen in the classroom.
0:15:44 TH: General educators have so much to say about what can happen with kids who are struggling, and everyone brings in their expertise for these interprofessional teams. That's kind of one of the big benefits I see, too, of RTI is that approach as opposed to the us or them. You mentioned your work with schools and working on these models. What does it take to develop a school-based plan for literacy instruction? What are the components you see are just really critical for a school to implement a successful RTI program or what does it mean to have success?
0:16:15 MB: Well, first, the first two things are time and patience. You have to be patient but also you have to have time. The thing that I love about educators, all teachers, speech pathologists, administrators, we want to do what's right for children, and we want... Most educators embrace change, so when RTI was kind of coming about, they were all in. They wanted to do it all. And you just can't, you can't do that. It has to be a thoughtful process and I like people to start small. So, besides time and patience, you have to have leadership and staff buy in. I think that's crucial. When I was working in as this consultant I kind of developed... I'm so mad I wasn't a researcher then 'cause I had so much data that I did not keep.
0:17:05 MB: I developed a survey, kind of a readiness survey, for RTI to see where a school was at. And that really helped me decide if they were ready to start in or if we needed just some time to just do a lot of professional development and discussions. So that was really helpful. I think schools need to have quality Tier 1. So that's another piece that everybody needs to have, whether it's reading, whether it's math. Whatever you're thinking about in terms of an RTI framework, you need to have a good quality Tier 1. I think there needs to be lots of thoughtful discussions about screening and progress monitoring, so I think there needs to be some good decisions about screening measures that have good psychometric properties.
0:17:49 MB: The... What is it now? The National... I always forget it. I think National Center on Intensive Interventions have tool charts now that they've reviewed a lot of different measures related to math and literacy, and they give you really specific information on what grades, what aspects are being used, but also the reliability, the validity, sensitivity, specificity. So, I think thinking about your screening measures – what measures but also how often you want to use them in and what data, like how low does a child have to score before you are able to provide them intervention, and it's so funny everyone thinks that's a set in stone number. I think RTI people always say 30% of kids should be getting intensive intervention. I think it relates to what's happening in your school. So, one, if you have funds to support all kids who are at risk, great. If you don't, that's the kids you're serving. So, if you only have funds to serve 20% of your kids at risk, that's who you're gonna serve, but I think making those plans...
0:18:57 MB: But I also think, and this sometimes is hard. So, I said that educators embrace learning and embrace doing new things, but sometimes I think we're also really averse to change when we've put a lot of time and effort into a system. Like RTI now, we've had some pretty hardcore research in RTI for probably the last 15 years. Really hard research. Things are continually changing. I am continually reading really great research from people like Amanda Van Der Heiden or other people about screening and measurement that maybe change what I thought was the most appropriate way to do things and that's really hard for people. Teachers and administrators were like, "Well, we've just implemented this system." And so, I'm not saying... I do think sometimes we change too much but I do think you have to be ready to change with the research that's available to you, and that sometimes is hard.
0:19:51 MB: So, having a team in place that can really make those decisions and have the expertise to make those decisions. Larger school districts often have somebody who's really good with statistics and looking at data, that person should be involved, always. Because I think some of the larger school districts that I've seen that do the best job with RTI are actually using their own... They have enough data over years that they can use their own norms to figure out at risk. So instead of using national norms they can say, "Well, within our district, this is the cut-off point 'cause this is what kids in our district should or should not be doing." And I think that can be really powerful.
0:20:31 TH: That makes a lot of sense and I think... You talk about the change. I think there's that normal distribution we see in teachers and administrators, educators, researchers, scientists, people just in general, of how likely they are to wanna do change. So, some are really resistant, some are like, "Let's do it." I know that this year, in the schools that I've worked with, I'm sure you've seen it too, wow, talk about change with COVID. It has forced a flexibility which has been painful and also probably insightful. At least it has for us in our districts too, is just realizing how flexible you have to be and how... There's nothing like the flexibility caused by a pandemic. It's so crazy.
0:21:13 TH: But I really appreciate your focus on the growth that has to occur. It almost seems like if a school district wants to implement RTI, they really need a 10-year plan. And it needs to be systematic and build in change and adaptability to new research, but also building in that idea that it's just gonna take a long time to move mountains. It takes a long time and maybe within the 10 years, different aspects of RTI are gonna come online. Like you said, first it's gotta be about kind of assessing the situation, getting Tier 1, but then other aspects are coming online. And I appreciate you bringing up the Tools Chart. So, I think you knew this, but I was part of the original team that created the Tools Chart. And the one thing I remember about that team, which gosh, it's now been almost 15 years maybe, between 10 and 15 years ago that we've been doing this, and I'm so glad you gave it a shout out because it's such a good resource and it gets better every year. And I can't take credit for it only as I'm a consultant, so I am one of the people that review the test and give some feedback.
0:22:19 TH: But one other thing I remember is sitting in a room for a whole day with 15 people trying to think of the good definition for screening, which I bring this story up because it's just not set in stone. Everything is debatable and I think that's one thing that you bring up about the change part is that everything changes and there's always... If you have 15 academics in a room, just like if you have 15 teachers in room, you're gonna have 15 different views of points. And I think that using the Tools Chart and really thinking thoughtfully about the measurement, also such a critical part that you bring up which I think is so important, which is a nice segue. Oh, go – did you wanna say something before I segued? Yes.
0:23:01 MB: Yeah. So with the Tools Chart, just so the listeners know, there's also interventions and I actually reviewed for those. Yeah. And so there's, besides the screening tools, there's also a whole bunch of interventions that are both math and language literacy and more like word reading type interventions. And they are also... They go through a rigorous screening process before they're allowed to be up there. So, if you're looking for an intervention... So, I do have a lot of schools still, but for sure when I was a consultant, that asked, "We got some money available and we want… What's the one best intervention?" Well, there's not. And so then I would talk about things need to be systematic, explicit, have a scope and sequence. But I did point a lot of people to that chart to say, "This is a really good place to look for interventions and look to see what they have." So, I think that's a really great place. The Florida Center for Reading Research, their website also has a really great overview of different interventions. That is a website that I always give to every... Any time I give a talk to schools or SLPs or anybody related to literacy, I always give the Florida Center for Reading Research, their website, a shout out. It's really great. But yeah, the Tools Chart has interventions as well. So sorry to interrupt but I wanted to make sure how you got 'cause it's such a great resource.
0:24:26 TH: Yeah, I always forget that too, since I was so focused on the assessment part of the Tools Chart. So that's really helpful. And I think you and I both have talked. We're so committed to translational science and really thinking about the practice to research to practice gap so this kind of two-way. So, I think, too, listeners should know that there's lots of resources out there to evaluate these things for you so you don't have to be the one that goes out and does all of that leg work. We're really trying to have resources out there. And the government funds a lot of different mechanisms as well to have resources to say what is the evidence for or against intervention that you might use. And trying to give that approach of saying, "Is it best for your school or not?" And that does lead me to think more about... Thinking about assessment, thinking about interventions. Do you think that RTI does a good job in the language realm? So, you mentioned reading, but should we expand RTI to language? What would that look like? What are some of the issues around that?
0:25:29 MB: So that's such a hard question for me. Of course, I think it should because I'm a language person. And language in and of itself is so important for social, for academics, for everything. But also we know that language is so highly related to reading comprehension success. And I've been thinking about this a lot. It's tricky because I think that RTI so far, the RTI framework, has been most successful in the literacy world in looking at the discrete skills, like things related to word reading because there are things that you... alphabet knowledge there's a finite number of letters and sounds and once you learn those you can move forward.
0:26:13 MB: Language is so broad. There's so many components. Children can have deficits in vocabulary, in syntax or grammar, in morphology, the small pieces of speech, they can have trouble with inferencing, in narrative language, there are so many... It's so broad. We are really behind in progress monitoring measures. We're really behind in interventions, definitely in interventions that work one-on-one. We have lots of kids who are language disordered that we know we're probably not going to cure them of that. Kids with maybe developmental language disorders. And there are some interventions that have shown growth, but a lot of times they're really intensive and they're one-on-one, they're delivered by an SLP. So, I definitely think we should, but I think we're really far from being super successful.
0:27:04 MB: What I will tell you and what I've been excited about is the work with Trina Spencer and Doug Petersen with their CUBED, I think their dynamic language... Dynamic measurement systems. I kind of forget. It's gone through a little bit of transitions or different changes, but they have this great body of work, years of research. They're both excellent researchers and they have this body of work talking about narrative language, and we know that narrative language is related to good reading comprehension. Narrative language is something that speech pathologists just have worked on in general as a part of a language goal, and they're finding some really great results with their intensive interventions related to narrative, and they have that really great paper that came out a couple of years ago that actually showed that their narrative intervention actually expanded over to writing. They didn't actually work on writing. And when I mean writing, I don't mean handwriting, but kind of written work. That narrative intervention expanded over to kids making gains in writing, and they also have this really great set of measures, they have screening measures, they have progress monitoring measures that are now equated, I believe for quite a few grades.
0:28:16 MB: And when I say equated, a lot of times you have to be careful when you choose a progress monitoring system. You wanna make sure that the progress monitoring measures are equated, meaning that they're all either equally difficult or equally easy so that you don't see dips or highs and lows in performance just based on this one progress monitoring measure that was really hard in that particular week, or you wanna know that they've thought about it across the year so that they're appropriate at that time. They have put so much work into that that I do have more confidence that we're going to get there. But it's hard. I don't have a lot of really great answers. I don't know that we have enough evidence yet that a Tier 2, that kids who have language disorders are gonna go to a Tier 2 and get a little bit of small group intervention and move back, but we might. I think if we just have... Well, you and I, we can talk about that later, we're looking at that. So, I think that it's something that I have confidence that we're gonna find out more about, and I think there are some things we can do to start, but I do think we're not as far along as we are with skills related to word reading.
0:29:32 TH: Yeah, I agree. And definitely, too, the work showing that the current measures are missing children who have language problems in the future. So, we know that there's groups of children that have language problems, but they do well in word reading or well enough, I'll say for sure, and then later on, they struggle, and they've been called late emerging poor readers. But what we know now, based on the work you and I have done and many others, that these poor readers later on, they're not late emerging. They always had problems, but we, or the measures we used didn't pick up on those problems. So, we definitely have measurement issues that we need to resolve. But I agree, Trina Spencer and Doug Petersen have done some amazing work over decades. This is like decades of work they've done, and it's... And the other thing I love about it is it's basically what we say about some of the LARRC work we've done, it's prepaid. It's free. Most of the work they have is online and free and Trina has a toolkit, Trina's Toolbox, I believe it's called. We can link in the show notes and resources that it's not just the assessment, but looking at some of the interventions and what we know. And it's free online because it was paid for by tax dollars so you prepaid it, and I think more people need to know about those kinds of resources.
0:30:56 MB: I do too. I also do wanna give a shout out to you and to also our former advisor, Hugh Catts. You both are doing some work looking at trying to find those kids who have DLD or have language problems early. So you both are doing some great work that I'm really excited to see how that comes out. I'm so excited about everything. So my to-do, my to-read pile is... And I say pile, 'cause honestly, I do keep digital files, but things I really wanna read, I'm old, I still have my pile of papers because I don't know why. It's terrible, but I'm admitting that. But anyway, there are so many things happening right now, and I think what's really exciting is that people are starting to understand.
0:31:42 MB: I remember when I first started going to SSSR, which is the national reading conference, and I would say I was a speech language pathologist, and people are like, "Why are you here?" Even with leaders in the reading field, like Hugh Catts, and Shelly Gray does great stuff, and Laura Justice does great stuff and all these people, and even with that now, I feel like it's very... People understand the role that SLPs have which I think is so great because we are in this unique, great position to do a lot of things in an RTI-type framework.
0:32:20 TH: I think that's a good point. I remember the first time I went to the SSSR conference with Hugh and was looking around going, "Who's an SLP?" He'd be like, "There's no one that's an SLP here." At that point, it really was just him and maybe a few others, but they happened to not be at that conference, and I was just blown away by that. But of course, you know, the history being that our field has many topics to cover, and now we have people who specialize more in the literacy aspect, and we know that's in our scope of practice. So, it's pretty exciting to see that change occur, and I think you're right. We have a lot of work to do when it comes to language, but we're part of that work, which we'll get to for sure. Before we do that, I do wanna hit on something that you mentioned. You mentioned an MTSS meeting. So what is the difference between MTSS and RTI?
0:33:06 MB: Right, so I'm gonna start with the similarities and then go to the differences. And I will tell you that there's lots of... I think this is one of those terms, dichotomy terms, where some people feel like the differences are pretty minimal and some people feel like the differences are huge, but they're both multi-tiered systems.
0:33:26 TH: Oh, and let's just say what MTSS is first 'cause I don't think I said it.
0:33:30 MB: Yeah. Multi-Tiered Systems of Support.
0:33:31 TH: Okay, perfect.
0:33:32 MB: Okay. So that's what MTSS stands for. And RTI, Response to Intervention. They're both multi-tiered systems. They both have this assessment, instruction intervention as very important components and really intertwined. So the assessment or the screenings or whatever you use, in both cases, are very highly intertwined with instructional decision making. And they both really highlight the importance of using evidence-based practice.
0:34:04 MB: The difference is that, really, I like to think of MTSS as almost an umbrella term where RTI is a framework that kind of fits underneath it. RTI is really a framework to look at an academic type of intervention, so math, language, if you wanna talk about that, reading for sure. MTSS is integrated in that it looks at not only those academics sections, but also behavior. So positive behavioral support, I think PBIS. Is that right? When people think about MTSS, I think they also expand it to looking at the school, parents, the community, so I think there's a little bit of a difference. MTSS includes things like professional development for teachers. It includes things on helping support adults, teachers or educators supporting kids, so it's just a little bit broader. But they both are systems that are utilizing a tiered system of support to try to provide prevention and identification of children. So I think a lot of school districts are moving away from the RTI language and going to MTSS because it encompasses everything. But RTI is just a framework. It's one way to address academic difficulties within an MTSS framework. Does that help?
0:35:31 TH: Yeah, that makes a lot of sense and it leads right into thinking about challenges that we might be facing, that we are facing, in implementing these multi-tiered systems like RTI and MTSS. I imagine MTSS might be almost a response to some of the challenges of RTI being too focused just in one area. So MTSS might be a way that RTI has grown, is that what you would say?
0:35:55 MB: Yeah, I think so. And I also think there's somewhat of a... It seems like MTSS is a term that's used more by educators and by a district because, again, they're thinking about impacting children within a whole system, whereas RTI is a framework that I think we researchers use a lot because we're looking at very specific components of screening or very specific components of how progress monitoring works or how an intervention might work. It's not to say that there aren't researchers researching the larger system, but I do think that that's one of the... From what I see when I go to a conference, most people are talking about RTI framework. When I go and speak for districts or large educational organizations, they are asking me to talk about MTSS which I typically, because my knowledge and my research is within the RTI framework, I'll talk about it all but then I'll hone in on what I'm interested in. But again, they are both still tiered systems of support. They are a way to provide early intervention, preventative intervention of some sort, whether it's behavior, whether it's academic. And the goal of both of those is to help children who are struggling succeed.
0:37:21 TH: That makes a lot of sense. I think it's really helpful to clarify those terms 'cause I definitely see them thrown out, and it's helpful to think about even who uses those terms and why. I think it's very helpful. So, what are some of the challenges that you see in implementing these systems?
0:37:36 MB: One of the things that I find really interesting, this is a weird challenge but it's one that I think about a lot, I think sometimes there's a disconnect between how researchers think about RTI and how practitioners, educators out in the field think about it. I think when you think about RTI, people who are out in the trenches doing the really hard work, which by the way, shout out to teachers this year. They deserve every kudos. They always deserve it, but this last year has just been something. So anyway, I think when they think of RTI, they think of it as a preventative measure. They think about providing extra intervention. That's the whole point of it, it's like to do that. In the research world, I actually think we definitely think about that. We're thinking about interventions, but we're thinking about RTI as a process of identification.
0:38:24 TH: Absolutely.
0:38:24 MB: So when I, for instance, I was part of a research study that Hugh Catts and Dianne Nielsen, who was an educator, a really great professor at KU, we had a grant looking at response to intervention for kindergarten children. And it was a research study, so there was some protocols in place but we developed a narrative and vocabulary intervention. And it was so hard for the people that we hired to do the extra intervention. They wanted to do more. They were like, "If I just... Could I keep Johnny five more minutes and do a little bit more with him?" I'm like, "No, because that's extra." And so, what is hard for teachers, I would find out... So, when I was this consultant and I'd find out that I'd be working with this group, this small group, like a specialist who was working with the small group, and I'd say, "Oh my gosh. Johnny is making amazing progress. How's that happening?" And she's like, "Well, I've been keeping Johnny 15 minutes extra three times a week." And I said, "By himself?" She said, "Yeah." And then said, "Isn't that great?" And I'm like, "Well, it's great that Johnny's doing better but you're giving him Tier 3. And no one's paying for it." Do you know what I mean?
0:39:41 TH: Yes.
0:39:42 MB: And she was so excited and that's so great. She wanted this kid to make progress and he was making progress. But he needed really a lot of extra intensive services. And so, he should have probably been in Tier 3. So that's one of I think the hardest challenges is just the disconnect between the purpose of it. So, I think that's been really hard and I think that goes in RTI, when you think about Tier 2, there's a problem-solving protocol or a standard protocol. And what that means is the problem-solving protocol for Tier 2 intervention is you make lots of changes, right. So, you have a small group, and depending on how they're doing, you make changes as you go to boost their performance. And in theory, that sounds great. That's what we wanna do. But what's difficult about that is it's hard to decide when it's too much and when you need to be giving them extra whereas a standard protocol is you use a pretty set curricula.
0:40:43 MB: So that doesn't mean you're not individualizing intervention. It doesn't mean that you're not providing prompts and scaffolding, but you're not adding way extra time. You're not going above and beyond. I always say in Tier 2, you shouldn't be using heroic efforts. If you need to be using heroic efforts to get through it, they need to be going to Tier 3. And so those are challenges with that because I think there's a struggle between wanting to help the kids. But sometimes that help isn't actually helping in the long run because you're hiding the fact that this child really needs a lot. So I think that's a really big struggle. I think we're still...
0:41:21 TH: Can I comment on that, Mindy?
0:41:22 MB: Yeah.
0:41:22 TH: I think that you bring up such a good point about the focus for researchers versus practitioners. And I think about this a lot, too, in terms of the RTI framework we bring. We have RTI. It was for a reason. It was to help improve the early identification. That was the original reason. Of course, then it also helps prevent problems of future, it supports all children. There's all these benefits. But when we talk about language, for instance, I've been thinking a lot about how maybe, for different kids too, the RTI system isn't something we have to be bound to. So, for instance, there could be kids with language impairment. We know language impairment could be identified accurately. Accurate identification can occur in kindergarten. So then sometimes I think about which kids would need RTI for language and which wouldn't. Like which ones can just be identified and moved straight to IEP status because what's the point in doing this Response to Intervention when we already know they have a diagnosis.
0:42:23 TH: But that might seem kind of, "Wow. That's really thinking out of the box” in terms of RTI. But in terms of our field, it's not because that's what we do. We assess and then if they qualify, we put them in. And so, I think it also is thinking RTI was created to solve the problem of waiting to see and making kids delay intervention. And that was because the measurements weren't good. We know that. The measurements weren't great early on, so we had to do a Response to Intervention 'cause the initial measurement wasn't capturing the kids that struggled and there were too many people that looked like they were struggling who weren't really going to struggle later on, so we had to do RTI to get the slope to see who's gonna grow and who's not. But with language, I don't know that we always need that. So, I do think it goes back to that flexibility, like when is RTI needed for early identification and prevention and when is it not? And for what kids?
0:43:18 MB: So, I think two things. First, that exactly, that idea, is called the Smart RTI. I think it was Don Compton and Doug Fuchs and some colleagues from there that talked about how there might be a great group of kids that you do just move forward. These kids might be so low for whatever reason. It was low performing that that Tier 2 probably just isn't enough. And can we just fast track these kids to Tier 3?
0:43:46 TH: I didn't know that. That's great.
0:43:47 MB: Yeah, it's really cool. And I do think, though, that when you say sometimes we need RTI and we don't, that can still happen in RTI. So just because you're using a different measure or a different way to make a decision, that still can be part of the RTI framework. You can just have different decision-making points or different types of decisions. And I think you're right. There's kids with language impairments that we just aren't gonna... They're not gonna make that Tier 2 progress in 10 weeks or 12 weeks, or even one semester. In the same token, I think there's kids like those kindergarten kids who score really low at the beginning of kindergarten, even through November. We used to spend a lot of time doing assessments with them, diagnostics, putting them in intervention. And then by February, they got it. And it might be because they never were exposed to formal instruction before, which is fine. They're in kindergarten.
0:44:41 MB: But what this does is allow those kids to get that Tier 2 intervention and make a really good progress fast 'cause you can make. We know there's a lot of really good interventions now for letter ID, letter knowledge, for word reading. For most kids, if you get them that early, they'll really make great progress. But I do think it's important to remember that even though your decision... Even if you do something like Smart RTI, where you fast-track kids, that's still the RTI process. There's also people that talk about gated approaches, which I think is really cool. I think I'm going off topic a little bit, but...
0:45:19 TH: No, I'd love to hear it.
0:45:20 MB: Yeah, where you give... Well in fact, my dissertation 500 years ago, was about that where you give all students a screening measure. Screening measures are meant to be quick. Whenever I see a school that has a screening measure and they're saying, "Oh, it's like 17 minutes to administer." That not a screen. That's so cumbersome. You give a screening measure, like AIMS, whatever, or the DIBELS or one of the other great measures that can identify kids quickly, and then let's say that gives you 35% of the kids or 30% of the kids. A lot of people are recommending giving another assessment, that's not still a full diagnostic assessment, maybe, but maybe a sub-test of something or something else that's a little bit more in depth, a dynamic assessment. So in my dissertation, I gave a dynamic assessment of phonological awareness as a secondary screen.
0:46:10 MB: And it really did... What it did was it weed out those kids who just needed... They just didn't understand the process. But they did well once they understood how the testing worked. And it turned out that those kids in the kindergarten really were the kids that were probably fine. So that takes a little bit more time and it takes a secondary measure that's well developed. But a lot of folks are suggesting doing that so that you use a screening measure to quickly weed out the kids that are actually great. These kids are gonna be fine. Then you have this pool of kids who might be at risk. You do something secondary that might take longer, but you're not doing it to your whole classroom. You're just doing it to a certain subset of kids. And I think there's a lot of promise for that for language kids. So doing something as a secondary screen with language.
0:47:00 TH: Yes. I think you said you might be off topic, but I actually think you're right on topic because my next question was how to overcome those challenges. But you've just talked about some of the ways, like using gating approaches, as you mentioned from your dissertation, using dynamic assessment, even thinking the Smart RTI approach, that kind of thing. That seems like great ways to create a more flexible RTI approach to deal with this. And I do think you're right. With the language assessment work we've been working on with screening, what we're finding is that we can have really good confidence, if a child passes our screen, that they are okay. What it does is it takes like 70% of the kids and says, "Okay, you're good." And then it gives you a smaller set of kids to do those kinds of diagnostics on, just like you mentioned. But it's 30% of kids you're having to do some further testing on, then that's a big difference from a 100. So, it still is efficient and appropriate, I think. Because in those 30% that are at risk, there's a lot of false positives. There just are.
0:48:00 MB: Sure.
0:48:00 TH: But then you can do some further testing to say, "Well, this kid actually didn't pass the language test because he didn't have the experience or he didn't know how to do the test.” Or there are many reasons they can fail that don't relate to actual language ability. So that makes a lot of sense to me what you're mentioning. And I think that's part of it. But I wanted to get back to... I think you had another challenge you wanted to mention. I wanna make sure we don't miss it.
0:48:20 MB: Well, I think the other one is, for me, one of the primary ones is who's providing Tier 2? And how you make that work? And so, I do think some schools kind of have this universal RTI time where the whole school from like 10:00 to 10:30 shuts down and either regular education kids are getting some sort of enhancement or doing something else. And there's these Tier 2 groups going on all over. And what that means is kind of every person in the school is doing something. So you might have a... This is maybe extreme, but you might have a music teacher doing something, versus schools where they have the reading specialist or a teacher or the most highly qualified person do all of the intervention but then that's so hard for scheduling, right. And what I really see, and I've heard of a few districts doing this and I'm so interested, and I would love to see more data, but I think our future is having interventionists within a district who move, who move around schools.
0:49:25 MB: So you're trained to be a literacy intervention specialist or a math intervention specialist or whatever, and you are really trained to develop this Tier 2 intervention, 'cause it takes a lot of skills. It takes not only just behavior management, small group skills, but it takes being able to choose appropriate interventions to group students appropriately. I think sometimes we're just grouping all kids who are at risk in second grade in one group. But this kid might have a fluency problem, these two might have reading comprehension and this child might not even know his letters yet. That's ridiculous, but that's what happening. I think the future, or what I would love for the future to be, is this group of roaming interventionists that are trained to do this.
0:50:07 MB: And what I think is really cool about that is I think we as a profession, speech pathologists, would be great at that intervention because we know how to use data. We know how to pick good interventions and curricula and tailor that. We know how to take progress monitoring data. We do that when we teach our students, hopefully, to do that all the time. And we have a really good knowledge of how to scaffold and provide appropriate responses. This happened like 15 years ago, but I will never forget sitting in a kindergarten, Tier 2. Part of my job was to watch interventions and not respond during them, but then provide the interventionist with support. And this interventionist was working on the letter G, the 'guh', the hard 'guh' sound. And she asked children to name words that begin with 'guh'. And she provided giraffe as one of the examples.
0:51:04 MB : Because again, we know... As adults, we know that the word begins with the letter G, and so that's just what we say but that's not a hard 'guh' sound. And I remembered all of these kids sitting and looking. These really at-risk kids were like... I could see them. Like, "What? Guh? Giraffe. Guh?" But nobody said anything 'cause these are kids that are at risk and so they trust the adults. They're not gonna... And so that was so striking to me because that person didn't have... She had a pretty scripted program actually that she was using, but she didn't have the foundational knowledge. So I think that is a really big... Besides all the other things that we just don't know yet, I think trying to hone in on who is the most appropriate interventionist and how to give them the support and the training in everything they need, I think we might just need to be looking at different service delivery type models at some point.
0:52:02 TH: I think that makes a lot of sense. And I know in some of the districts I've worked with have used some of their, what we call here, Title 1 funds to hire and train specialists in Tier 2 which I think, in the districts I've worked with, has been pretty successful. The one thing I've seen has been most successful, in terms of that background training, is getting the whole district trained on the language foundation, maybe through a letters training or something similar, we'll say. Something where they're all trained. Because I also think you brought up this idea, which is so critical, that Tier 2 shouldn't be radically different than Tier 1. And so I think you're right about training these people in Tier 2 but my fear is that some districts, and I've seen this happen, they do a great training in Tier 2, but they don't connect it to Tier 1. So, it almost seems like you need to have two-fold, like a training of everyone and then take those Tier 2 and really train them up. I think that makes a lot of sense.
0:52:55 MB: That's a really great point. Because I have seen people in the secondary intervention, for instance, using a whole different letter. The whole school might be using Animated Literacy, which has its own scope and sequence. And then in the Tier 2, they're using a different sequence, so I'm like, "You need to teach what they’re… you need to emphasize what they're teaching in class." So that's a great, great point.
0:53:20 TH: I've seen that happen too. I've totally see it happen, it's like they go into Tier 2 and it's radically different, totally different, everything's different. And that's just hard to then integrate back in. But I've also seen districts who do it so well where their Tier 2 is just right in line with Tier 1, and they'll say, it's so nice for the kids too, they're getting that integration, like, "Like you were taught yesterday, now we're going to do more of that,” and then it's just such a nice integration. But then that means that the Tier 2 person has to be trained on also Tier 1 and that connection. So that's a tall order. I know that in terms of overcoming challenges, one thing that you and I are passionate about is implementation science and what that could look like. And we've been working in our lab closely with districts and really thinking about... It goes back to the MTSS versus RTI discussion. What does the researcher see versus the clinician?
0:54:20 TH: And we've been trying to work with districts and work together in situ, so in the actual context, with teachers and administrators and special educators and speech pathologists, to see about solving the problems and implementing together and then keeping data, which is a very different approach than what I was trained on, and I think what's typically done. So, I think that your experience, you've been on ASHA's committee, looking at implementation science, so I'd love for you to talk about how you think implementation science might help also with these challenges in a similar way.
0:54:45 MB: So I'm not on the ASHA committee, just to clarify.
0:54:47 TH: Oh, okay. I thought you were.
0:54:48 MB: I do… I'm not but I do meet, monthly, with the group of people in the field that talk about implementation science. So yes. Implementation science is so interesting. It's something that I think as a term was new to me about five years ago when I took my position as... I teach an implementation science seminar for our SLPD students. But then when I started learning about it, I was like, "Well, this is kind of what I've been doing. This is the kind of research that I wanna be doing all my life." But then what it did was helped me understand how to do it better and how to think about it better. Basically, implementation science is just trying to think about how we can take these practices that we know are evidence-based and... Because that's important, implementation science has to be based on pushing forward programs, interventions, whatever it is, professional development systems that have been shown to be evidence-based.
0:55:47 MB: So you don't wanna be pushing out something that you don't know if it's good or not. But how to get that out to a broader context? So, if you have this tightly controlled research study and then you found that something works, and multiple people, there's converging evidence that this works, how can we get more districts to do it, or how can we do it this certain population? And how can we help make adaptations? 'Cause adaptations are going to happen when you take something to the field because life is not perfect. Schools are messy, and schools are different. This school district is different than this, so how can we implement things and make adaptations? I think what we used to do when we scaled up is we just made adaptations as we went, just haphazardly. Maybe took data on it.
0:56:33 MB: But what implementation science does is you plan for that. You plan for that. So, you might do needs assessments first, and then you might use a framework to help you figure out how to do this next piece, so it really is... It's a really planful way to take our research and move it forward, it's so exciting. It's hard work. It's… we’re as a field, I think behind more like public health and nursing, they've been... When you read a lot of the articles related to implementation science, and a lot of the frameworks come from those two fields, but we're moving and I think a lot of us have been doing it, we just didn't really know. We didn't know what it was. So I do know, I think there's a special edition. There's going to be one of the ASHA journals that's tackling, well, I know there is, tackling some of the work that our field has done in implementation science. We do have some folks like Natalie Douglas and Megan... I just lost her name. Sealat?
0:57:37: Oh, Megan Sleet. Yeah, Sleet. I never know if I'm saying it right too, sorry Megan.
0:57:44 MB: Yes. Sorry Megan. I can't always see your name. But anyway, lots of people. There's lots of people in our field, and I think Trina Spencer is actually the chair of the CRISP committee now which is that ASHA committee you were talking about. One of my colleagues at KU, Megan Davidson. There's a lot of us that are really interested in this, because we're starting it. We are a young field too, in terms of research, and we have so many areas that we can cover in research. I do think we're starting to get to the point where we have a lot of evidence-based practices that we know. Especially in reading. We know that there's some things that work and we are seeing it happen, so I think it's really cool that we're starting to really push into that, and I think you and I, I think we've been dabbling in this for years without knowing it.
0:58:29 TH: Yes. Well, I think the LARRC project was implementation science, a hybrid approach. But we definitely have been doing it without the framework, so it's nice to have the framework. And I think, too, with our clinical background, I think one thing that is most exciting for me in implementation science is the voice of the clinician, and hearing through these needs assessments, working so closely with those who are on the ground, as opposed to creating something in the lab and then expecting it to work in a situation that is not as controlled as a lab situation. And so that's pretty exciting. And shout out to Rouzana Komesidou, one of my colleagues who's interested in implementation science and has been doing this implementation Thursday on Twitter where she's highlighting work in implementation. And Crystal Alonzo and Rouzana led a paper from our team that hopefully will be in that special issue, focused on some of the collaborations that we have and what we've been up to. So it is pretty exciting. I think it's something that will really help with this, tackle some of these challenges in a systematic way. Well, I'm mindful of our time. I want to ask you two final questions that I ask every guest. So first one is, what are you working on now that you're most excited about?
0:59:43 MB: I mean, I feel like you know the answer to this one, don't you Tiffany?
0:59:46 TH: I think I do.
0:59:47 MB: I am so grateful and so excited to be working on a NIH-funded project with Tiffany and Shay Peosta from the Ohio State. Also, Candace Fleming is an investigator, she's a great methodologist here at KU. And this project is looking at taking that LARRC curricula that we developed. I know you've talked about it before on your podcast. It's a language-focused curricula for preschool through third grade. We took the first-grade curricula and we are adapting it to be used for a Tier 2. So it's a very language-focused Tier 2. We'll be starting this fall. I'm in the hot and heavy process of doing all of the modifying the lessons to be appropriate for Tier 2, so I'm working hard on that. But then we'll be identifying kids in Ohio and Boston this fall, and we'll have a subset of the kids that are at risk that will be identified as having DLD. And so, we're gonna see how this Tier 2 intervention works for them, and also, the growth in the intervention, kind of how that looks after. I think we're following it to third grade. Is that right?
1:00:57 TH: Yes, yeah.
1:01:00 MB: And this is something that when we were like the second year in LARRC, I was already thinking, "This needs to be a Tier 2, this needs to be a Tier 2." And I'm so thankful that the three of us sat down and did this work with this grant, and we were shocked to get it really quickly. But I remember telling my husband that this was my dream grant, and I have... I love my grants that I'm on currently, but this intervention and this work is something that I've really thought about for a long time. So that's what I'm most excited about. I just wish I had a magic fairy to kind of get some of this work done this summer. It's already July.
1:01:38 TH: I know, it's crazy. The time is flying by. I agree with you, it's a dream grant and a dream team. And really your pilot work early on, as you mentioned, looking at adapting this Tier 1 curriculum to a small group, that pilot work you did at KU, that's the work that I think was the linchpin in getting the grant, showing some of those effects early on. So it's pretty exciting, and I know you've been working with Maura Curran who did the similar kind of adaptation during the pandemic, from the LARRC. Yeah, so it's so exciting. It's great to be able to work with your friends. That's really fun.
1:02:11 MB: It really is.
1:02:12 TH: Yeah. And the last thing is, what's your favorite book from childhood or now? And I know you and I love to read, especially you. You are probably the most ferocious reader that I know. You're my book recommender. [chuckle] So what books do you like?
1:02:25 MB: Well, this was such a hard question for me. Here's what I did is I thought about... I have an eight-year-old. My daughter just turned eight and every year my mom and I since she was born, for Christmas, we each give her one book that is one of our favorite books. So my mom gave her Little Women when she was little. I have given her Heidi and all these. The book that I'm so excited to read to her, I think we're gonna start this fall, is Ballet Shoes. So do you know the Dancing Shoes series by Noel Streatfeild?
1:02:52 TH: No, I don't.
1:02:54 MB: It's a great book. I remember reading it when I was a kid. I have a really worn copy of it, but it's still out in print. And I couldn't pick one. The other one is A Little Princess by Frances Burnett. I like that movie and the book, both. So maybe not my favorite books, although they are very beloved, but they're books that I can't wait to read with my daughter. So that was such...
1:03:18 TH: That's fantastic.
1:03:19 MB: I stressed the most about that question, Tiffany.
1:03:22 TH: Of course, because you've read so many books!
1:03:24 MB: Like, how do I choose? So, but anyway, yeah.
1:03:28 TH: Oh, that's fantastic. Well, thank you for sharing. And, Mindy, thank you for your time. I know you're very busy as we all are, and I really appreciate just you being the first one back as I get back into the podcasting mode, which I've really missed. So thank you for being a guest today.
1:03:44 MB: First of all, this was so fun. That time went so quickly. I can't tell you how happy I am to see your beautiful, healthy face in front of me. So, you're a cherished friend and colleague, so I'm so glad you're doing this podcast.
1:03:57 TH: Thank you.
1:04:01 TH: Check out www.seehearspeakpodcast.com for helpful resources associated with this podcast including, for example, the podcast transcript, research articles, and speakers bios. You can also sign up for email alerts on the website or subscribe to the podcast on Apple Podcasts or any other listening platform, so you will be the first to hear about new episodes. Thank you for listening and good luck to you, making the world a better place by helping one child at a time.