The authors report findings from a systematic observational study of middle school educators (Grades 6-8) in two states who provided reading interventions within Tier 2 and Tier 3 of a Response to Intervention (RTI) framework. Intervention sessions were coded and analyzed to understand (a) the frequency and type of evidence-based strategies implemented for students with learning disabilities and reading difficulties, and (b) whether observed practices within secondary and tertiary intervention settings align with researcher recommendations regarding middle school reading instruction based on extant research. The findings indicated that more than 12% of time was devoted to logistical and non-academic activities, and evidence-based interventions including explicit instruction, cognitive strategy instruction, content enhancements, and independent practice opportunities were reported infrequently, although instructional differences across sites were demonstrated. Encouraging findings include evidence of peer-mediated reading and explicit performance feedback. Implications for teacher preparation, professional development, and future research for RTI are discussed.