Provider Perceptions of the Child Outcomes Summary Process Lauren Barton and Cornelia Taylor October 27, 2012 Measuring and Improving Child and Family Outcomes Conference Minneapolis, MN

Brief ENHANCE project update Describe provider survey study Share findings Discuss implications Today’s Session

ENHANCE Project Update

Focus  Under what conditions are COS data meaningful and useful for accountability and program improvement?  Impact of COS on programs/staff  Identify needed revisions to COS form and guidance SRI International was funded by U.S. Dept. of Education, IES -- July 1, 2009 ENHANCE

Four ENHANCE Studies 1)Comparison with Child Assessments 2)Team Decision-Making 3)State Data Study 4)Provider Survey

Studies 1,2, & 4: 34 Project Data Collection Sites 17 Part C (Birth to 3) Illinois Maine Minnesota New Mexico Texas North Carolina Virginia 17 Part B Preschool (3-5) Illinois Maine Minnesota New Mexico Texas South Carolina

Comparison with Child Assessments Study Goals Compare COS ratings to BDI-2, Vineland-II scores  Program Entry  Program Exit Compare conclusions from COS and assessments Study Status Final stages of recruiting families Find Out More See poster at reception for promising findings from preliminary analyses

Team Decision-Making Study Goals Learn more about implementation of the COS process. What is team understanding of outcomes and rating criteria? Study Status Videos coming in Early stages of coding videos Find Out More Tabletop discussion tomorrow morning  What is quality COS process?  Share draft video coding protocol

State Data Study Goals Analyze characteristics of COS data Are patterns consistent with those predicted for high quality data? Status Analyzing and compiling data Find out more See reception poster with early findings We are looking for more states to participate.

Participate at different levels: Share results from analyses you already do for APR OR Share de-identified child level data set used in your APR analyses Work with SRI to either:  Share expanded data set* that we analyze and discuss with you OR  Conduct extra analyses and share results with project * Expanded data set examples: include extra child descriptors (race, gender, primary disability) or variables describing the setting or composition of services Participating in the State Data Study

Benefits of Participation See how your data fits relative to other state patterns Have more analyses to learn from—extra tables for deeper understanding Technical assistance around unique issues in your data Make a difference, generating new knowledge about a topic that matters For more information, contact (650)

ENHANCE Provider Survey

Question: How is COS implementation going? Method Online survey sent to providers in program participating in the assessment and video studies Study Status Completed data collection Early stages of analysis Provider Survey

Provider Survey Sample  856 providers in 8 states  Primary population o EI: 472 (55%) o ECSE: 302 (35%) o Mix: 82 (10%)  Roles o 50% early interventionists/teachers o 38% therapists and asst. (SLP, OT, PT) o 9% coordinators/psychologists o 3% other  75% previously worked with children without disabilities in some capacity.

Provider experience with COS ratings 51% 31 or more COS ratings 21% 10 or fewer COS ratings

Provider training Asked about training across a variety of formats (e.g., in person, technology, one-on-one, material review) How many total hours of training do you think most providers reported? None? 1-4 hours? 5-8 hours? 9-12 hours? 13 hours or more? ECO recommends 8-12 hours of training to get familiar with the COS process

Provider training on COS Process is limited 90% of providers received some training 68% reported 4 hours or less of training

COS Process: Time involved On average, how long does it take to identify a child’s outcome ratings and document it on the form?  Identify rating  Discuss child’s functioning if directly related to rating decision or exceeds discussions that would have occurred anyway  Time to complete information on the form  Do NOT include data entry of form, if done after form is completed min., min., min., min., more than 60 min.

COS Rating Process is Fairly Brief 36% 1-15 minutes 35% minutes EI reported less time than ECSE

What do you think? A team process? Teaming practices vary a lot from program to program. How often are COS ratings actually decided in teams? Do the teams include more than one professional? How often are families involved?

COS Process: More than one professional usually was involved. 75% had most ratings decided by a team (at least 1 professional in addition to respondent) 79% had at least one other professional provide input about the child’s functioning

COS Process: Family involvement was limited. 34% had family members present for most of their COS rating decisions. 68% considered input from family members in determining the rating

Functioning across settings and assessment data was considered in most COS ratings. 75% used information about the child’s functioning from multiple settings and situations 76% used information from one or more assessment tools during rating decisions

Most felt their COS process matched what it was supposed to be. 78% thought the process used for deciding COS ratings matched how it was supposed to be done

Most felt the process was thorough enough to be effective. 85% felt there was enough information about each outcome area to determine a COS rating 80% felt there was enough time to review child functioning in each outcome area. 85% in most of the decisions, all involved considered information carefully in an effort to decide an accurate rating.

Most providers felt that most COS ratings given were accurate.

Skills Needed for COS Ratings Training should focus on skills essential for COS ratings. For example:  Understanding age-expected functioning  Comparing specific child’s skills to age-expected  Understanding the 3 child outcomes  Discussing functioning in outcomes with others To what extent do you think providers report having these kinds of skills?

Providers said they understood the content behind COS ratings. Age-expected functioning 89% understood age expected functioning 92% knew how to compare children’s functioning to what is age expected The three child outcomes 85% understood the three child outcomes 83% knew how to discuss functioning in the outcomes with others * Endorsed statements of understanding as mostly true or very true.

How much do providers  Understand why COS data are collected,  Realize what happens with the data, and  Feel they can explain the need for gathering COS data? Same or different? Understanding the Purpose and Uses for COS Data

Few providers understood why and how COS data are used. 65% understood why COS data are being collected 37% understood what happens with the data 52% knew how to explain the need for child outcomes data to others

What kinds of feedback and support are available to providers? What do providers think about the system of feedback and support available related to the COS?  Are there people available to help them?  Is ongoing support adequate?  Are there people reviewing the COS forms? Excellent, good, adequate, fair, poor, or a combination?? “Tell me and I forget, teach me and I may remember, involve me and I learn.” - Benjamin Franklin

Limited ongoing support for providers with the COS process 82% someone is available to provide support if I ask for it 50% someone in my program provides support 47% ongoing support related to the COS process is adequate 37% someone in my program checks completed COS forms for accuracy

What do providers say about how the COS process impacts them?  Change awareness?  Influence assessment or IFSP/IEP outcomes?  Influence conversations and relationships with others?  Impact on time for other activities? Does it seem? Positive? Neutral? Negative? How do providers describe the impact of COS on their practice?

Neutral impact of COS process on practice Overall impact of COS on your work with children and families Specifics reported about COS Process: 2% had negative impacts on relationships with families 17% improved the assessment process 31% takes time away from other important actives 30% helps focus discussion on the whole child

Summary and Implications

Summary: COS Process Most received limited training and support Providers felt comfortable with background content Had limited understanding about what happens with the data or how to explain it Didn’t feel like the COS process impacts their work much Got quality COS data?

Implications and Discussion Implications of findings  For professional development?  For supervision and administrators of programs?  For data quality? Learning from providers  Have others done surveys or focus groups to learn from providers?  Why or why not?  How can surveys like this inform improvement activities in your state?

Find out more ENHANCE Website – ECO Center Website – Contact ENHANCE staff –