RAND partnered with Texas Higher Education Coordinating Board and American Institutes for Research to support the state's developmental education reform efforts through a combination of continuous improvement support and analysis of statewide data on implementation. One of the reforms examined through the study was the state's recommendation that colleges should offer targeted academic support to students who tested at the lowest levels on the state placement exam (i.e., below the ninth-grade level) beginning in fall 2015. To support colleges, Texas policymakers offered resources and guidance in three areas: (1) new, detailed assessment scores that were developed to better identify students entering at the lowest levels of readiness; (2) course offerings and funding that allow colleges to offer concurrent academic support alongside entry-level courses; and (3) guidance and funding to support the referral of students into to adult and continuing education programs. In addition to describing these reform efforts and the students they targeted, this report provides findings from case studies and statewide survey data regarding how institutions responded to the state's recommendations and the challenges colleges faced. The report also highlights lessons learned for colleges in Texas and across the nation as they explore options for serving students who test at the lowest levels of readiness.