The referral process of early elementary grade level students can be long and complex. National statistics show that most of the referrals are done during or after fourth grade. This study worked around the decreasing number of students referred to the Special Education Program during the early grade level stages. The purpose of this qualitative case study was to explore teachers' perceptions about factors of risk for reading difficulties in the early grade levels. In this study the participants were teachers that deal every day with students under factors of risk and the development of reading skills. The data were collected using semi-structured interviews. Ten teachers from Texas, Georgia, and Puerto Rico participated. Their answers were recorded, using the Zoom platform, and professionally transcribed. The answers were coded to identify the main emergent themes: differentiation, reading levels, reading placement, academic failure, less resources, and small group setting. All the participants responded they use that information to differentiate their instruction. The participants answered that factors should be used as indicators of reading difficulties in the early grade levels. Recommendations for practice included using f interventional strategies to work with students under factors of risk, using the enrollment information to create contingency plans and provide those students with learning experiences based on their needs, and creating professional development to instruct teachers, intervention staff, reading recovery teachers, and any other staff related with the Student Support Team (SST) process on how to use factors of risk as indicators of possible reading difficulties. Recommendations for future research included the integration of other factors of risk, include teachers from older grade levels, and include other school staff, such as reading specialists, administrators, or SST team members. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]