A Meta-Analysis of Phonemic Awareness Instruction Provided to Children Suspected of Having a Reading Disability

Purpose:

The present meta-analysis sought to investigate the effects of phonemic awareness instruction provided to children suspected of having a reading disability.

Method:

Seven databases were systematically searched, and 1,643 unique manuscripts were reviewed for inclusion. Data were extracted from 138 included manuscripts to evaluate the use of phonemic awareness instruction with children suspected of having a reading disability. A random effects model was then used to conduct a meta-analysis of these data with regard to child outcomes.

Results:

Gains in this population associated with phonemic awareness instruction can vary as a function of the outcome being used. On average, phonemic awareness instruction had a medium effect on composite ( g = 0.511) and segmentation ( g = 0.571) outcomes and a small effect on outcomes measuring blending ( g = 0.341), first sound identification ( g = 0.428), and deletion ( g = 0.248). Instruction effects were strongest in kindergarten and first grade, but positive outcomes were also found for older children. There was not a significant relationship between cumulative intervention intensity and child performance.

Conclusions:

The present meta-analysis confirms that phonemic awareness instruction can be effective with children of varying ages and that significant gains can be observed on the key outcome measures of segmentation and blending. Graphemes should be incorporated into phonemic awareness instruction, and future studies need to provide information on dosage beyond just the length and frequency of sessions to clarify which aspects of these interventions are most efficient.

Supplemental Material:

https://doi.org/10.23641/asha.20277714

Speech Sound Disorder Treatment Approaches Used by School-Based Clinicians: An Application of the Experience Sampling Method

PURPOSE

Children with speech sound disorders (SSDs) comprise a large portion of caseloads for school-based speech-language pathologists (SLPs). Despite the existence of several evidence-based SSD intervention approaches, the translation from research to practice is often limited by ecological validity because of various factors unique to school settings (e.g., scheduling constraints, caseload size, child availability). The purpose of this study was to use the experience sampling method (ESM) to examine the current practices of school-based SLPs when treating children with SSDs on their caseloads.

METHOD

SLPs (N = 106) from 42 different states working full-time in school-based K-12 settings participated in this study. At the beginning of the study, each SLP completed a one-time demographic survey about treatment practices for children with SSDs. The SLPs then participated in a series of brief surveys every day for one workweek using a specialized ESM phone application that randomly alerted participants to report on their treatment practices for children with SSDs.

RESULTS

Findings revealed that although most SLPs reported using a variety of SSD intervention approaches in a one-time survey, the majority of SLPs reported using one of three approaches in situ: the traditional articulation therapy approach, cycles, and minimal pairs. We also report a significant negative relationship between the years of experience of an SLP and the number of different approaches used.

CONCLUSIONS

This study is the first to use the ESM to determine which approaches school-based SLPs use to treat children with SSDs. Findings demonstrate that SLPs have knowledge of many different SSD approaches but tend to utilize only a few in school-based settings.

Service Delivery Schedule Effects on Speech Sound Production Outcomes

Purpose Children with speech sound disorders feature prominently on the caseloads of speech-language pathologists working in schools, with many receiving services once or twice weekly for 20-30 min. This study compared the outcomes of services provided twice weekly for 30 min to those provided 4 times weekly for 15 min to examine their effectiveness in remediating speech sound disorders in an elementary school setting. Method A total of 35 students were recruited from an existing public school caseload for participation. Participants were randomly assigned to receive school-based speech therapy services for either 30 min twice weekly or 15 min 4 times weekly. There were no differences between groups in age, gender, or the amount of time spent in general education. Growth was measured by the percentage of Individualized Education Program goals mastered and the percentage of sounds produced correctly in isolation. Results After one calendar year, there was a negligible difference between groups on both the percentage of Individualized Education Program goals mastered and the percentage of sounds produced correctly in isolation. On average, both scheduling configurations were effective in meeting students' needs. Conclusions The results of this study suggest that children with speech sound disorders receiving school-based speech therapy services can benefit from a variety of scheduling options. Awareness of such options is an invaluable resource to speech-language pathologists wanting to provide effective and efficient services. Future research should continue investigating service delivery models' effects in applied settings.

How to Recruit, Support, and Retain Speech-Language Pathologists in Public Schools

Over the past two decades, there has been a persistent shortage of qualified speech-language pathologists (SLPs) across the United States. This shortage is predicted to continue, as data reported by the American Speech Language Hearing Association (ASHA) from the US Bureau of Labor Statistics indicates that there will be a 27% increase in job openings through the year 2028. In some states, the shortage has led to service provision from individuals without a background in speech-language pathology and/or without speech-language pathology certification and licensure. Speech and language services that are delivered by unqualified personnel may lead to inadequate time devoted to therapy—either too much, or too little—which is ultimately unethical, illegal, and expensive. However, there is a real issue at hand for school leadership—and that is: How to recruit, support, and retain highly qualified SLPs? In the current tutorial, we will provide evidence-based action steps for how and why to recruit, support, and retain certified and licensed SLPs. Specifically, we discuss the qualifications of the SLP, roles and responsibilities of school-based SLPs, caseload versus workload considerations, various service delivery models, and a review of SLP job satisfaction research. Throughout the tutorial, we will provide concrete and evidence-based ideas for school leadership to consider when recruiting, supporting, and retaining SLPs.

Maximizing Treatment Efficiency in Developmental Language Disorder: Positive Effects in Half the Time

Purpose When a behavioral treatment is generally efficacious, the central research questions shift to optimized dose delivery. In this study, we determine whether a validated treatment method can be made more effective or efficient by increasing the dose density employed. Method Twenty children were treated with Enhanced Conversational Recast methods to treat morphological errors. Half received 24 doses per session within a half hour (approximately 1 dose/1.25 min), and the other received the same number of doses within 15 min (approximately 1 dose/38 s). Generalization of morpheme use was probed throughout treatment and at a 6-week follow-up. Spontaneous use of treated morphemes was also tracked. Results Although the treatment was effective overall, there were no significant differences between treatment conditions on any of the outcome measures. Follow-up performance correlated significantly with performance at the end of the treatment period. Conclusion Minimal between-groups differences suggest that performance does not suffer when dose rates are compressed into half the time during treatment, making the high-density dose delivery method a more efficient delivery method. This could make time available within a treatment session to address other goals or allow for more classroom instructional time for the child. Supplemental Material https://doi.org/10.23641/asha.8968559.

Examining How Treatment Fidelity Is Supported, Measured, and Reported in K-3 Reading Intervention Research

Treatment fidelity data (descriptive and statistical) are critical to interpreting and generalizing outcomes of intervention research. Despite recommendations for treatment fidelity reporting from funding agencies and researchers, past syntheses have found treatment fidelity is frequently unreported (e.g., Swanson, The Journal of Special Education, 47, 3-13, 2011) in educational interventions and fidelity data are seldom used to analyze its relation to student outcomes (O'Donnell, Review of Educational Research, 78(1), 33-84, 2008). The purpose of this synthesis was to examine how treatment fidelity is supported, measured, and reported in reading intervention studies conducted with students at risk or with reading difficulties in grades K-3 from 1995 through 2015. All studies (k = 175) were coded to extract and classify information related to (a) the characteristics of the intervention study (e.g., publication year, research design); (b) treatment implementer training and support; (c) treatment fidelity data collection procedures, dimensions (i.e., adherence, quality, receipt, dosage, and differentiation), and levels of treatment fidelity data; and (d) the use of fidelity scores in the analysis of treatment effects. Results indicated that less than half (47%) of the reading intervention studies synthesized reported treatment fidelity data (numeric or narrative). Exploratory analyses showed that several study features were associated with the prevalence of fidelity reporting. Studies reporting treatment fidelity largely measured treatment adherence, and scores were, on average, high. Other dimensions of treatment fidelity (e.g., treatment differentiation), and analyses relating fidelity data to outcomes, were consistently absent from the corpus of reading intervention studies reviewed. Recommendations for enhancing how treatment fidelity data in intervention studies are collected and reported are presented.

Dose Schedule and Enhanced Conversational Recast Treatment for Children With Specific Language Impairment

Purpose

Dosage has been identified as an important element of treatment that may affect treatment efficacy. The purpose of this study was to examine the role of dose schedule for treatment of grammatical morphology deficits in children with specific language impairment (SLI).

Method

Sixteen 4-to-5-year-old children with SLI participated in a 5-week intervention consisting of equivalent daily Enhanced Conversational Recast treatment (Plante et al., 2014) targeting grammatical morphology. Half of the children received treatment in one 30-min session (massed condition). Half received treatment in three 10-min sessions (spaced condition) within one 4-hr period. Progress was assessed 3 times weekly by probing a child's use of his or her treatment morpheme and untreated morpheme (a maturational control) in untreated contexts.

Results

Pre- to posttreatment morpheme usage differed significantly for children regardless of dosage condition, and pre to post usage of an untreated morpheme was unchanged, demonstrating overall treatment efficacy. There were no differences in treatment effects for the massed and spaced conditions.

Conclusions

The study adds to evidence that Enhanced Conversational Recast can produce positive results in a short period of time for children with SLI. Furthermore, clinicians may have some flexibility in terms of the dose schedule they use to deliver this treatment in an evidence-based manner.

Intensity of language treatment: contribution to children's language outcomes

BACKGROUND

Treatment intensity is an important factor in designing and delivering treatments to children with language impairment (LI). However, to date very little is understood about cumulative intervention intensity for children with LI in the US public school system.

AIMS

To examine treatment intensity (dose: time spent on language; frequency: number of sessions; duration: one academic year) as delivered to children with LI within US public schools and to explore its relation to children's language outcomes.

METHODS & PROCEDURES

A total of 233 children with LI on the caseloads of 73 speech-language pathologists (SLPs) participated. Direct child measures, weekly treatment logs and videotapes were collected to characterize children's language outcomes and treatment experiences.

OUTCOMES & RESULTS

Children on average received 36 min of treatment during 1.3 treatment sessions per week. Children's language severity did not predict children's treatment intensity. Structural equation modelling indicated a significant interaction between frequency and dose of treatment: children receiving high frequency and low dose, or low frequency and high dose treatment had better outcomes than children receiving high frequency, high dose or low frequency, low dose treatment.

CONCLUSIONS & IMPLICATIONS

Findings suggest that more intensive language treatment, measured as time, is not necessarily associated with better treatment outcomes.

Algorithm-Driven Dosage Decisions (AD3): Optimizing Treatment for Children With Language Impairment

BACKGROUND

This study was designed to provide recommended amounts of treatment to achieve the optimal amount of language gain for children with language impairment.

METHOD

The authors retrospectively analyzed treatment outcomes for 233 children for delivered dose, intensity, and cumulative intensity of therapy. The steps of the analytical process they applied to arrive at algorithms for recommended amounts of treatment were (1) multilevel modeling to predict children's language gains from the 3 intensity parameters and (2) extraction of regression weights to create a recommended amount of treatment.

RESULTS

Optimal outcomes can be identified using an equation specifying Ŷ = desired points of change (e.g., 0.6 SD units), V = child's baseline language skills, D = average number of minutes spent targeting language in a session, F = total number of sessions conducted across the year, and D × F = product of planned dose and frequency (cumulative intensity). Input of the values for Ŷ and V provides recommended amount of treatment.

CONCLUSIONS

This study constitutes the first effort to provide empirical guidance on intensity of treatment for children with language impairment. The use of algorithm-driven dosage recommendations may be more effective than clinician judgment and trial and error, although these correlational results must be confirmed with experimental methods.

Improving Clinical Practices for Children With Language and Learning Disorders

Purpose

This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development.

Method

Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions, components of language therapy, grammar goals, and goal prioritization for students with language and learning difficulties.

Conclusion

The gaps that exist between current knowledge about learning, language development, and clinical practice often do not receive as much attention as the gaps in the evidence base that addresses the efficacy and effectiveness of language intervention practices and service delivery models. Fortunately, clinicians do not have to wait for future intervention studies to apply their knowledge of learning and language development to clinical practices.

Effects of dose frequency of early communication intervention in young children with and without Down syndrome

Children with intellectual disability were randomly assigned to receive Milieu Communication Teaching (MCT) at one 1-hr session per week (low dose frequency, LDF) or five 1-hr sessions per week (high dose frequency, HDF) over 9 months ( Fey, Yoder, Warren, & Bredin-Oja, 2013 . Non-Down syndrome (NDS) and Down syndrome (DS) subgroups were matched on intelligence, mental age, and chronological age. The NDS group had significantly more growth in spoken vocabulary than the DS group. In the DS subgroup, the HDF group had more spoken vocabulary growth than the LDF group when IQ was controlled. In both etiological subgroups, the HDF group yielded greater vocabulary production outcomes than the LDF group for children who played functionally with a range of objects.

Daily or weekly? The role of treatment frequency in the effectiveness of grammar treatment for children with specific language impairment

This study compared the effectiveness of a school-based treatment for expressive grammar in 5-year-olds with specific language impairment delivered in two different dose frequencies: eight sessions delivered daily over 8 consecutive school days or eight sessions delivered weekly over 8 consecutive weeks. Eighteen children received treatment daily and 13 children received treatment weekly. In both groups, treatment consisted of eight 1-hour sessions of small group activities in a classroom setting. Techniques included explicit instruction, focused stimulation, recasting, and imitation. Results were analysed at the group level and as a case series with each child as their own control in a single-subject design. The 8-weeks group showed significantly greater gain in test scores over the treatment period than in an equal time period prior to treatment, whereas the 8-days group did not (Cohen's d = 1.64 for 8-weeks group). Single-subject analyses indicated that 46% of children in the 8-week group and 17% of children in the 8-day group showed a significant treatment effect. It is concluded that expressive grammar treatment was most effective when dose frequency was weekly over 8 weeks rather than daily over 8 days for 5-year-old children with specific language impairment.

Is more better? Milieu communication teaching in toddlers with intellectual disabilities

PURPOSE

The authors sought to determine whether a program of 5 weekly doses of milieu communication teaching (MCT) would yield improvements in children's communication and word use compared with a once-weekly delivery of the same treatment.

METHOD

Sixty-four children with intellectual and communication delay were randomly assigned to receive 60-min sessions of MCT either 1 time or 5 times per week over a 9-month treatment. Growth curves were fit to data collected at 5 points before, during, and after the MCT was delivered.

RESULTS

With groups collapsed, significant growth across the experimental period was observed on all measures, but this was not associated unconditionally with treatment intensity. Children who played with 9 or more objects during a standard play assessment, an empirically identified cut-point, benefited more from the high- than from the low-intensity treatment on lexical measures (Hedges's g range = .49 to .65).

CONCLUSIONS

More MCT is not always better for all children. Clinicians can expect that increasing the frequency of MCT sessions will yield moderate enhancement of outcomes if the child has high interest in objects.

Studying the impact of intensity is important but complicated

This commentary suggests that the most commonly studied aspect intensity (dose frequency) on overall rate of response to treatment may often be weak or conditional. To improve statistical power of tests of weak effects additive statistical models have typically been used. However, multiplicative models may be a more productive route to understanding dose frequency effects on children's speech and language development. To illustrate, recent findings are presented that dose frequency effects on vocabulary development varied by two child characteristics. Finally, it is suggested that spacing of teaching episodes within an intervention session be included as a variable in the multi-dimensional model of treatment intensity. Spacing teaching episodes may eventually prove to be one of the more powerful aspects of intensity.

Optimal intervention intensity

Empirical evidence exists for many of the different interventions in speech-language pathology. However, relatively little is known about the optimal intensity of those interventions. In order for speech-language pathology services to be both effective and efficient speech-language pathologists need to know how to faithfully administer ideal doses of the active ingredients of interventions, in what forms, how often and for how long. This is the lead paper to a scientific forum on this fundamental yet under-studied issue of clinical practice. Borrowing from the work of Warren, Fey, and Yoder, the concept of intervention intensity is described. Issues involved in establishing the optimal intensity of interventions are identified, including what and how intervention goals are targeted. Given that speech-language pathology interventions can involve the delivery of therapeutic inputs (e.g., conversational recasts, questions) and/or clients carrying out an act (e.g., speech production, voice production, comprehending, naming, swallowing), a framework is proposed for measuring all potential inputs and acts that might contribute to the calculation of an intervention intensity. Client-, clinician-, condition-, and service-related variables that could influence the investigation and practical application of an optimal intervention intensity are also discussed.

Optimal intervention intensity in speech-language pathology: discoveries, challenges, and unchartered territories

This article is the final response in a scientific forum on the optimal intensity of intervention in speech-language pathology. It is a reflection on the state of knowledge offered by the 13 commentaries in this issue, addressing the areas of early communication and language impairment, speech sound disorders in children, emergent literacy, reading, aphasia, dysphagia, stuttering, motor speech disorders, voice disorders, and traumatic brain injury. Although more intense intervention can lead to better outcomes, the relationship between intensity and outcome is not always linear. More is not always better. Non-intense and intense schedules can yield similar outcomes. Intensity can also reach a point of diminishing return. The insights offered by the authors illustrate the challenges involved in studying this complex issue. To establish the optimal intensity of interventions in speech-language pathology our field needs to: identify active ingredients of interventions; better understand how principles of motor learning and neural plasticity facilitate learning; appreciate the contribution of individuals characteristics, values, and preferences; discover the effect of specific combinations of intensity (including dose, dose form, dose frequency, session duration, and total intervention duration) on treatment outcomes, and find practical solutions when disparities exist between research recommendations and workplace limitations.

Characterizing optimal intervention intensity: the relationship between dosage and effect size in interventions for children with developmental speech and language difficulties

Although Warren, Fey and Yoder (2007) have described the key components of "dosage", one needs to go beyond description if one is to understand "optimal" dosage, specifically one needs to relate the characteristics of the intervention to the size of the intervention effect. This study examines the association between dose, intensity, and effect size in 20 randomized controlled studies taken from a few systematic reviews focusing on interventions aiming to ameliorate vocabulary, phonology, and syntax. Reporting of dosage characteristics is an important issue. Our analysis shows that "teaching episodes" and "dose form" are rarely reported in the included studies. The other dosage characteristics are present but not always reported in a transparent fashion. Session length and cumulative intervention intensity is lower for phonology interventions than it is for vocabulary intervention. Dosage, however defined, is not directly associated with outcome, although the level of association varies across the three interventions, for example appearing stronger for vocabulary and phonology than syntax. Taking the three interventions together the dosage components are related to the intervention effects size, but the sample is small and the association is not statistically significant. This study concludes that, while the framework suggested by Baker (2012) and adapted from Warren et al. (2007) is useful but without reference to the effect size of a study, it can only ever tell half the story. One needs to be able to relate dosage to outcome, asking questions about the relationship between the different dosage characteristics and the intervention effect size. Given the available data, it is not, at this stage, possible to make recommendations about optimal dosage.

Optimal intervention intensity for emergent literacy: what we know and need to learn

In response to Baker (2012) unpacking critical components of optimal intervention intensity, this article explores what is currently known regarding intervention intensity for emergent literacy for children at risk for delays in this area of development. Studies specifically addressing intervention intensity related to phonological awareness and print knowledge suggest that more intensity does not always yield better results, and other factors suggested by Baker may influence the impact of intensity on children's outcomes. However, none of the research to date includes speech-language pathologists or children with diagnosed language disorders in the intervention models. Future research involving large-scale, systematic focus on intervention intensity in emergent literacy for children at risk for future reading disorders is needed to fully understand this construct within speech-language pathology services.

The Narrative Language Performance of Three Types of At-Risk First-Grade Readers

Purpose

This study investigated the narrative language performance of 3 types of readers who had been identified as being at risk through code-based response-to-intervention (RTI) procedures.

Method

In a retrospective group comparison, 32 at-risk 1st-grade readers were identified: children who resolved without intervention (early resolvers, n = 11), children who met criterion following 4 weeks of intervention (good responders, n = 8), and children who failed to meet criterion following 4 weeks of intervention (poor responders, n = 13). A narrative retell and a norm-referenced language test were obtained before intervention.

Results

There were no significant differences between the 3 learner types on the language test. However, the narratives of the good responders were significantly higher than the narratives of the other 2 groups on total number of words, number of different words, and number of communication units. The narratives of early resolvers and good responders differed significantly on the productivity index, number of coordinating conjunctions, and number of episodic elements. There were no other significant differences.

Conclusion

Types of learners distinguished by a code-based RTI model showed differences in their narrative language. First graders who responded well to code-based reading intervention retold stories that contained more language and better story grammar than first graders who did not respond well to intervention. These results indicate the need to evaluate narrative language performance within RTI, especially for early resolvers.

Program Intensity and Service Delivery Models in the Schools: SLP Survey Results

Purpose

School-based speech-language pathologists (SLPs) routinely work with team members to make recommendations regarding an intervention program’s intensity and method of service delivery for children with speech and language impairments. In this study, student, SLP, and workplace characteristics that may influence SLPs' recommendations were examined.

Method

Almost 2,000 school-based SLPs completed an online survey about the factors they consider when making recommendations regarding program intensity and service delivery model that students on their caseloads receive.

Results

SLPs reported that student characteristics, rather than SLP or workplace characteristics, were the factors they considered the most when making these recommendations. However, these same SLPs reported that current students on their caseload with severe to moderate disabilities participated in intervention 2–3 times a week for 20–30 min in groups outside of the classroom. Students with the least severe disability received intervention 1 time a week for 20–30 min in groups outside of the classroom.

Conclusion

The limited variety of intervention program intensities and service delivery models used suggests that student characteristics may not be the most important factor considered when making intervention recommendations, as reported by the SLPs. Instead, caseload size and years of practice appear to influence SLPs' recommendations regarding which program intensity and service delivery models to use.

A meta-analysis of the RTI literature for children at risk for reading disabilities

This article synthesizes the literature comparing at-risk children designated as responders and low responders to interventions in reading. The central question addressed in this review is whether individual differences in reading-related skills at pretest predict responders at posttest across a variety of interventions and sets of criteria for determining responding and low responding. A total of 13 studies met criteria for the meta-analysis, yielding 107 weighted effect sizes (ESs) at posttest (M = .76, SE = .03, 95% confidence interval [CI] =.71, .81) and 108 weighted ESs at pretest (M = 1.02, SE = .03, CI = 1.02, 1.13). The results showed that the magnitude of ES between responders and low responders increased from pretest to posttest on measures of reading (e.g., real word identification = 1.06 vs. 1.53, word attack = 1.10 vs. 1.28, and passage comprehension, 0.45 vs. 1.43). Hierarchical linear modeling indicated that overall posttest ESs were significantly moderated by pretest scores as well as the type of measure administered, whereas no significant moderating effects were found for number of weeks of intervention, length of sessions, number of sessions, type of intervention (one-to-one vs. small group instruction), and criteria for defining responders (cutoff, scores, discrepancy, benchmark). Overall, the synthesis suggested that regardless of type of treatment and identification criteria, response-to-intervention (RTI) conditions were not effective in mitigating learner characteristics related to pretest conditions.

A systematic meta-analytic review of evidence for the effectiveness of the 'Fast ForWord' language intervention program

BACKGROUND

Fast ForWord is a suite of computer-based language intervention programs designed to improve children's reading and oral language skills. The programs are based on the hypothesis that oral language difficulties often arise from a rapid auditory temporal processing deficit that compromises the development of phonological representations.

METHODS

A systematic review was designed, undertaken and reported using items from the PRISMA statement. A literature search was conducted using the terms 'Fast ForWord''Fast For Word''Fastforword' with no restriction on dates of publication. Following screening of (a) titles and abstracts and (b) full papers, using pre-established inclusion and exclusion criteria, six papers were identified as meeting the criteria for inclusion (randomised controlled trial (RCT) or matched group comparison studies with baseline equivalence published in refereed journals). Data extraction and analyses were carried out on reading and language outcome measures comparing the Fast ForWord intervention groups to both active and untreated control groups.

RESULTS

Meta-analyses indicated that there was no significant effect of Fast ForWord on any outcome measure in comparison to active or untreated control groups.

CONCLUSIONS

There is no evidence from the analysis carried out that Fast ForWord is effective as a treatment for children's oral language or reading difficulties.

An Experimental Study of Scheduling and Duration of "Tier 2" First-Grade Reading Intervention

This study compared the effects on reading outcomes of delivering supplemental, small-group intervention to first-grade students at risk for reading difficulties randomly assigned to one of three different treatment schedules: extended (4 sessions per week, 16 weeks; n = 66), concentrated (4 sessions per week, 8 weeks; n = 64), or distributed (2 sessions per week, 16 weeks; n = 62) schedules. All at-risk readers, identified through screening followed by 8 weeks of oral reading fluency (ORF) progress monitoring, received the same Tier 2 reading intervention in groups of 2 to 4 beginning in January of Grade 1. Group means were higher in word reading and ORF at the final time point relative to pretest; however, the groups did not differ significantly on any reading outcome or on rates of adequate intervention response. Of potential covariates, site, age, free lunch status, program coverage rate, and tutor were significantly related to student outcomes; however, the addition of these variables in multivariate models did not substantially change results. Rates of adequate intervention response were lower than have been reported for some first-grade interventions of longer duration.