This study, conducted during the 2006/07 academic year, describes how four midsize urban school districts in the Northeast and Islands Region--Worcester, Massachusetts; Nashua, New Hampshire; Yonkers, New York; and Providence, Rhode Island--were providing foundation skills assessments and programs to struggling middle-grade readers. Researchers found variations, but also some similarities, in the districts' use of tests and programs. The study found that all four districts were testing to screen students, diagnose problems, and monitor student progress. But all were in the beginning stages of testing and programming. Districts varied in the tests that they used and in the numbers of students that they included. The information presented here can help state and local education agency decision makers plan, implement, and evaluate their own foundation skills testing and intervention programs. The following are appended: (1) Glossary of Key Terms; (2) Demographic and achievement statistics for participating districts; (3) Reading assessments; (4) Foundation skills intervention; (5) Methods; and (6) Interview questions by category. (Contains 6 boxes and 5 tables.) [This report was prepared for the Institute of Education Sciences (IES) by Regional Educational Laboratory Northeast and Islands administered by Education Development Center, Inc.]