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This research report shares the results of a mixed methods qualitative study of interim assessment use in mathematics in eight relatively high performing elementary schools from two Pennsylvania school districts, Philadelphia and Cumberland. Both districts used the same curriculum and offered substantial support for the implementation and use of the interim assessment to improve instruction. The assessments were well aligned with curriculum and learning goals and educators had access to professional development; electronic analysis tools and help, and time both for analyzing results with colleagues and for planning subsequent instructional moves. According to the authors, the district’s and school’s leadership also clearly communicated their expectations for assessment use. Among the findings was that teachers consistently used the interim assessment results, but usually as a starting point for additional diagnosis of students needs and instructional responses tended to be procedural re-teaching, rather than techniques aimed at increasing students’ conceptual understanding. Further, many teachers attributed weaknesses in their students’ mathematical weaknesses to contextual and other factors that were beyond their control, for example, reading ability, limited English proficiency and/or difficulty maintaining focus/attention. The authors offer recommendations for policy and research based on their findings.