1. High Quality IFSP Outcomes
Early Intervention Training Center
2017
Let look at how to write high quality IFSP outcomes based on families routines, concern, and priorities. It in imperative that we remember that the information needed for the development of high quality outcomes can only be generated when we conduct functional assessment activities.

2. Learning Objectives
To take functional assessment information from families and turn them into high quality IFSP outcomes
The learning objectives for this mini lesson are as follows…
Early Intervention Training Center
MA Department of Public Health

3. Using Information to Develop Outcomes
Start with parents’/caregivers’ priorities about child’s learning/development and/or family’s needs
Consider what’s working and what’s challenging in everyday routines and activities
Consider how the child’s developmental skills, needs and disability influence the child’s learning and participation in everyday routines and activities
In developing IFSP outcomes, there are 3 key pieces of information that need to be used.
First, it’s critical to start with the parent’s/caregiver’s priorities about what they hope for the child and family and what’s most important or meaningful to them. Special focus should be placed on their desires related to participation in family and community activities. Using focused open-ended questions can help parents and other care providers reflect on how they want the child to participate in activities and routines that are meaningful to them and what factors impact their child’s successful participation. It is these family priorities, not the practitioner’s or teacher’s priorities, that should serve as the basis for a high quality, participation-based outcomes.
Second, it’s also important to consider what’s working and what’s challenging at home, in the community, and in the classroom (if applicable). Make note of those situations that are motivating and interesting to the child and family and those that impact participation in family and community life. Asking parents what the child enjoys doing and what they enjoy doing together helps to clarify the context where the child is learning and participating. Similarly, asking parents which parts of their day are not going well provides an understanding of what the parents would like to see different in the future.
The third piece of information needed is what has been learned from evaluation and assessment. The professional must incorporate what has been learned during the evaluation and functional assessment process about the child’s developmental skills, needs and disability and their impact on the child’s learning and participation.
All 3 pieces of information are critical for developing quality outcome and goal statements, as well as informing decisions about strategies and activities that will most effectively promote incidental learning and the opportunity to practice new skills to meet outcomes. 3
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4. Relationship of Outcomes to Placement and Services
First… develop IFSP outcomes based on functional, authentic assessment information Then… determine services and supports based on what is necessary to meet the outcomes
Remember to develop the outcome before determining services and supports. The services a child needs to receive should be based on the outcome, not the other way around.
Discussion Question: What does this mean for your process? Does this change the way you are currently developing IFSP services? 4
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5. IFSP Outcomes
IFSP Outcomes: “What would your family like to see happen for your child/family?”
Two types of outcomes
Child Outcomes
Family Outcomes
IFSP outcomes are equivalent to asking a family: “What would your family like to see happen for your child?”
There are two types of IFSP outcomes, child outcomes and family outcomes. 5
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6. IFSP Child Outcomes Two types of child outcomes: Participation-based
Routine/activity-based
Child outcomes should:
Enhance learning through functional participation in everyday activities (child is learner/actor)
Be important and meaningful to the family/caregiver (priorities)
Expand activity settings so child can be competent
Be based on child’s interests
Often, IFSP child outcome statements are participation-based, focusing on the child’s interests and assets that will provide opportunities for learning and development. Other times, IFSP outcome statements focus on the routines and activities that parents want or need to go more smoothly, such as mealtimes or bedtime routines.
Child Outcomes should:
Enhance the child’s learning through functional participation in everyday activities (child is learner/actor),
Be important and meaningful to the family/caregiver (their priorities),
Expand activity settings in which the child can be competent, and
Be based on the child’s interests. 6
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7. Lily will go fishing with her family and hold her own fishing pole
Example:
Lily will go fishing with her family and hold her own fishing pole
Lily will go fishing with her family and hold her own fishing pole
This example is a participation based outcome. It is identifying how the family would like Lily to be able to participate in this activity. Through the functional assessment, information was gathered that showed that Lily and her family enjoy fishing together, but until now Lily has not been able to hold her own pole because she is not yet steady on her feet. This is an outcome that the family hopes she can achieve in the coming months.
It is also possible that this outcome is a routine-based outcome… through functional assessment, the information gathered could have identified that the family has stopped going fishing because someone is always having to look after Lily because she is not able to hold her own pole, so the activity is no longer enjoyable for any of the family member.
The functional assessment drives the content of the IFSP outcome.
Discussion: Take a minute and think about all the possible developmental skills Lily may need to be able to hold her own fishing pole…
Hold her hands at midline
Stand on her feet
Follow directions
Grasp with two hands….
This will help participants think about how EI can support such a specific outcome

8. IFSP Family Outcomes Two types of family outcomes: Participation-based
Resource-based
Family outcomes should:
Enhance capacity of (family is learner/actor)
Support accessing community resources and supports (service coordinator supported)
Be important and meaningful to the family/caregiver (priorities)
Be based on family’s interests
There are two types of family outcomes – participation-based or resource based outcomes.
Family Outcomes should:
Enhance the capacity of the family to meet the needs of their child (family is learner/actor),
Support accessing community resources and supports (service coordinator supported),
Be important and meaningful to the family/caregiver (priorities), and
Be based on the family’s interests. 8
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9. Example:
Frank and Tamara would like to be comfortable taking Dawn with her siblings to their grandmother’s house.
An example of a participation-based family outcome is:
“Frank and Tamara would like to be comfortable taking Dawn with her siblings to their grandmother’s house.”
Discussion: Take a minute and think about all the reasons why Frank and Tamara may need support to do this…
Behavior concerns
Public transportation
She always throws up in the car
Her overgrowth syndrome makes riding in the car a safety concern…
This will help participants think about how EI can support specific family outcomes

10. Jeri will find child care for her son within 25 miles of her new job.
Example:
Jeri will find child care for her son within 25 miles of her new job.
An example of a resource-based family outcome is:
“Jeri will find child care for her son within 25 miles of her new job.”
Discussion: Take a minute to brainstorm about all the reasons Jeri may need support to do this…
Financial concerns
This will help participants think about how EI can support different family outcomes

11. High-Quality, Functional IFSP Outcomes
Necessary and functional for child’s and family’s life
Reflect real-life contextualized settings
Crosses developmental domains and is discipline-free
Jargon-free, clear and simple
Emphasize the positive, not the negative
Uses active words rather than passive words
So how do we know if the IFSP outcome developed is of high quality or not? NECTAC, ECO and WRRC, in collaboration with Dathan Rush and M’Lisa Shelden at the Family Infant and Preschool Program in Morganton, NC, have identified 6 unique criteria for determining if an IFSP outcome statement is of high quality. These are:
Are statements necessary and functional for the child and family’s life?
Does the statement reflect real-life contextualized settings?
Does the outcome cross developmental domains, and is it discipline-free?
Is the wording jargon-free, clear and simple
Is the outcome stated in active words rather than passive words?
[add personal examples throughout the IFSP outcomes criteria to make information more relatable to “real” life, also engage participants with questions about what they think i.e. can someone give an example of jargon or a passive word? Might be helpful to take examples off actual IFSP’s at the program]

12. Criteria Definitions
Necessary and functional for child’s and family’s life
Supports participation in community life and family activities
Based up on what is important to the family
Supports child’s progress towards outcomes
It is not based on what the practitioner thinks
Let’s take a deeper look at the definitions of each of these criteria. The first criteria is that the outcome statement is necessary and functional for the child’s and family’s life. This means that the outcome focuses on ways to support the child and family’s participation in community life and family activities that are important to them. For example, for the outcome to be necessary and functional, it should benefit the child by focusing on social relationships, acquiring and using knowledge and skills, and/or using appropriate actions to meet needs. It should also help the child and/or family improve participation in chosen activities and/or help them begin new activities that are important to them. It is important to note that the determination of what is necessary and functional is not based upon what the practitioner thinks is meaningful and functional for the family.

13. Criteria Definitions Reflects real-life, contextualized settings
Everyday activity settings and routines for the child and family
Includes typical routines such as meal time
Also includes routines and activities specific to the family.
Test items are not real-life or contextualized
The next criteria is that the statement reflects real-life contextualized settings. This means that outcome statements reflect the everyday activity settings and routines for the child and family. This includes what might be called typical routines and are common across families, such as meal-time, bathing and riding in the car. This also includes routines and activities that are specific to the individual family. Specific isolated skills e.g., test items that were missed during evaluation, are not considered real-life or contextualized.

14. Criteria Definitions
Integrates developmental domains and is discipline-free
Written to describe the child’s participation in routines and activities
Promote the child’s skill development in multiple domains
Addressable by any member of the IFSP team
Written so that child and family are the “actors”
Early interventionists and therapists are not the actors in the outcome
The third criteria is that the outcome statement integrates developmental domains and is discipline-free. This means that the outcome is written to describe the child’s participation in routines and everyday activity settings, promoting skill development across multiple domains which can be addressed by any member of a child’s IFSP team. It also means that the outcome should be written so that the child and/or family are the “actors” or persons doing something, rather than the occupational therapist or early interventionist. For example, an outcome might state, "Annabelle will help her dad with the laundry by pulling up and standing at the dryer on her own and putting clothes into the laundry basket with her dad close by," as opposed to, "Annabelle will pull to a standing position at the couch and maintain her balance."

15. Criteria Definitions Is jargon-free, clear and simple
Understandable by family and the general public.
Doesn’t include professional jargon or practitioner “speak”
The next criteria is that the wording of the statement is jargon-free, clear and simple. This means that the outcome is written so that is understandable by the family and the general public, and does not include professional jargon or practitioner “speak.”. For example, the outcome should describe how the child will move, such as reaching up or down for toys, instead of using phrases like “range of motion.”. Another example would be wording an outcome so that it describes a child able to use words clearly to make herself understood, rather than using the term “articulation”.

16. Criteria Definitions Emphasizes the positive, not the negative
Focus of the whole outcome is positive
States what the child and family will do
Doesn’t state what the child will not do or will stop doing
Any negative words creates a negative statement
In order to be high quality, the wording of outcomes statement must emphasize the positive, not the negative. This means that the focus of the whole outcome statement is positive, and states what the child and/or family will do, rather than what they will not do or stop doing. If there are any negative words within the statement, it is not a positively worded outcome. For example, the outcome should state, “Johnny will chew and swallow food when eating with his family” rather than “Johnny will not spit out food when eating with his family.”

17. Criteria Definitions Uses active rather passive words
Words encourage the child and family’s active participation
Words indicate what the child or family will do
Passive words reflect a state of being or a change or lack of change in performance
The last criteria for high quality is that the statement uses active words rather than passive words. This means using words that encourage a child and/or family’s active participation or engagement. Active words include eat, play, talk, walk, etc. and indicate what the child or family will do. Passive words reflect a state of being (such as tolerate or receive), or a change or lack of change in performance (such as increase, decrease, improve or maintain). These words should not be used in a high quality outcome statement.

18. 3rd word rule
The third word of the IFSP child outcome statement should be a contextualized action that is functional
Example: “Kim will eat with her family at mealtime eating the foods they eat”
Shelden, M.L., &Rush, D.D. (2009) Tips and Techniques for Developing participation-Based IFSP Outcome Statements. Briefcase, 2(1). Retrieved from
Another approach is to use the “third word” rule, identified by Rush and Shelden. The third word rule refers to the third word in the outcome statement. As a test of whether the outcome statement is participation based, examine the third word for an action that is functional for the child. The word “eat” in the example of Kim used in the slide meets the criteria.
In the brief case article (in materials packet) Sheldon and Rush discuss that… The third word rule in the child-focused, participation based outcome statement should be a functional concept not a specific skill. The application of the “third word rule” can often serve as a litmus test regarding functionality of the outcome statement. For example, consider a situation in which a particular family shared with the early intervention team that their son, Sanjay does not like taking a bath. They further describe bath time as a rough time for the entire family. The family feels that Sanjay’s inability to sit makes him uncomfortable and frightened so that he cannot enjoy his bath. A possible outcome statement could be, “Sanjay will sit in the bathtub during his bath”. The third word is sit in this IFSP outcome statement. Sitting is a skill that Sanjay does not currently possess . Sitting is certainty an important skill, but a caution would be that the focus could be placed on the act of skill of sitting instead of the enjoyment of bath time. In contrast, “Sanjay will play with his toys and be happy during bath time with sitting up in the tub” has a third word of play, which is a contextualized activity that requires a variety of different skills (integrates developmental domains, discipline free). The caution is removed as the focus of playing with toys in the tub is a real-life contextualized activity setting. The third word rule does not hold true 100% of the time but is an effective filter to use when developing participation-based IFSP outcome statements.
Another example of an outcome statement with a functional third word is “Thomas will ask for food he wants during meal times.” In contrast, “Thomas will say three words when asked to repeat them” is skill-based and does not provide context for learning and engagement.
Early Intervention Training Center
MA Department of Public Health

19. Developing Criteria, Procedures and Timelines
What are the ways in which the family and team will work toward achieving this outcome?
Who will help and what will they do?
How will the team know they’ve made progress or if revisions are needed to outcomes or services?
Once a quality IFSP outcome is developed, the team must identify the measureable criteria, procedures and timelines that will be used to determine the degree to which progress toward achieving the results or outcomes is being made, and whether modifications or revision of the expected results/outcomes or services are necessary. The questions on the slide can be used to facilitate a discussion with parents and caregivers:
What will the IFSP team do to work toward the outcome?
and
Who will help and what will they do
Methods and strategies must be identified to be used in every day routines and activities. The IFSP team will need to identify the opportunities in the child’s daily activities and routines that they can practice the skills they need to achieve the identified IFSP outcome.
We also want to identify family, friends and other informal supports and early intervention services needed to achieve the outcome.
If an outcome on the IFSP is: Kim will sit at the table with her family during meals and eat the foods that they eat.
An example of who will work together and what methods and strategies will be used is:
The OT will use coaching strategies with family members to identify and try new foods and specific techniques to assist Mrs. Doe in helping Kim gain weight and decrease Kim’s gagging and refusal of foods.
Mrs. Doe will offer the same foods as the family to Kim at meals and will monitor which foods that she eats.
Mrs. Doe will give a list of foods that Kim eats to daycare so that they can offer the same foods so she can have more opportunities to try the foods during the day.
Once we establish the methods and strategies, it is important to determine as a team the measurability criteria: How will we know that we’ve made progress?
In Kim’s example the IFSP determined that the measureable criteria was:
“We’ll know this outcome is met when Kim eats at least two meals with her family, sitting independently with or without adaptive supports, eating regular table food, gaining at least one pound per month or 6 pounds in 6 months.”
As you can see, this statement is very specific to Kim and is based on information learned through the functional assessment process.
This part of the IFSP development requires the appropriate IFSP team members to be present to represent the necessary perspectives for that child and family.
Early Intervention Training Center
MA Department of Public Health

20. EXAMPLES:
Outcome: “Kim will eat with her family at mealtime by eating the foods that they eat”
Statement of Measurability: We will know we are successful when Kim eats at least two meals with her family, sitting independently with or without adaptive supports, eating regular table food, gaining at least one pound per month.
If we continue to look at Kim’s example, the statement of measurability is where we are going to talk about how we will know if they have made progress or if revisions are needed to outcomes or services. The statement of measurability is developed through a conversation between the IFSP members to determine when the entire team will know if progress has been made, it should be based on the information gathered through the functional assessment process. It should include the time line as well as the child’s expected rate of progress.
Given this statement of measurability OR the measurement criteria, there could be a very long list of strategies that the IFSP team will use to work toward achieving this outcome.
The strategies is where we can add in the expertise of the EI’s teams different disciplines. Strategies should include things that EI providers are going to do as well as what the family will do. (Emily’s example: Mom will move the ottoman into the middle of the room and place toys on it while playing in the living room. Mom, Dad, and Grandparents will finger walk Lacey to the highchair at meal times). Strategies are also where you can address a behavior you want to see stop of decrease (biting, hitting, vomiting, stimming)
Early Intervention Training Center
MA Department of Public Health

21. Strategies to Meet IFSP Outcomes
What will we do to accomplish the outcome? Strategies specify who will do what in which everyday routines, activities and places.
The next step, after creating high quality IFSP outcomes for a child, is to determine strategies for meeting those outcomes. In other words, what will we do to accomplish the outcome? Strategies determine who will do what in which everyday routines, activities, and places.

22. Strategies must: Help achieve the outcome
Be based on how all children learn throughout the course of everyday life, at home, in early care and education settings, and in the community
Be developmentally appropriate for the child
Support primary caregivers to provide children with everyday learning experiences and opportunities that strengthen and promote a child’s competence and development
Specifically, strategies for IFSP outcomes must:
Help achieve the outcome by describing who will do what.
Be based on how all children learn throughout the course of everyday life, at home, in early care and education settings, and in the community-this includes identifying things that have high levels of interest and engagement for the child and family
Be developmentally appropriate for the child,
Support primary caregivers to provide children with everyday learning experiences and opportunities that strengthen and promote a child’s competence and development, so that they can build on familiar activities and routines
Once strategies have been developed, it may be helpful for the team to consider:
Do these strategies build on child and family interests?
Do these strategies build on familiar activities and routines?
Do these strategies describe who will do what?
Discussion: What types of strategies are you currently developing with families? Facilitate a discussion about how we could work with families to develop even greater individualized strategies. 22
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23. Additional Benefits of an Integrated Process
More understandable, measureable individualized IFSP Outcomes
Families can tell when their children are achieving desired outcomes
Reinforces the assessment and planning cycle
Improves practice
Supports progress in the overarching areas that are central to EI
In addition, when we use the 3 global outcomes as a framework for developing IFSPs and IEPs, it produces understandable, focused, measureable, and individualized outcomes and goals that are meaningful to families. The 3 outcomes also help families understand what programs are trying to do.
The 3 outcomes tie assessment, planning, and intervention together in order to improve practice and help the programs focus firmly on (1) what they are trying to achieve in positive results for children and families, and (2) what federal accountability expects of programs and states.
Integrating Child and Family Outcomes into the Individualized Family Service Plan (IFSP) Process

24. For even better understanding…
This is a video vlog created out of Virginia to help better understand why we are writing outcomes this was and how Early Intervention can support this type of outcome.
Early Intervention Training Center
MA Department of Public Health

25. Sample outcome format
__________________ will ___________________ who? Do what? _________________________________________ How well/How often? Condition required for outcome to be met?
This is a sample format you can use to help you develop high quality IFSP outcomes…
Remember:
Outcomes should be written in language that everyone can understand. The use of jargon may put a barrier between family members and providers, leading to an assumption that providers are the “experts” rather than building family confidence
Outcomes should have a positive strength based focus. This encourages families to consider their child’s potential
Outcomes should be functional, measurable and within the context of the family's everyday activities. Anyone who reads the outcome should be able to know when the outcome has been met. When outcomes are created as part of a family’s current activities , there is less of an emphasis on “parents as therapists” and more of a focus on family members learning how to support their child in everyday routines and activities.
*See attached activity to practice using this format*
Early Intervention Training Center
MA Department of Public Health

26. Discussion questions
How are we currently developing outcomes with families?
What piece of information (from the 3 key pieces, slide 3) are we gathering well? What piece do we need to gather more purposefully?
What supports do you need to feel more confident in writing high quality outcomes?
Use these questions to facilitate a discussion about how you are developing high quality outcomes and what supports or changes might need to occur to help people be more confident.
Early Intervention Training Center
MA Department of Public Health

27. Developing High-Quality, Functional IFSP Outcomes
Portions of this training used materials created by the ECTA center and RRCP, 2 national technical assistance centers for a presentation called:
Welcome to Developing High-Quality, Functional IFSP Outcomes.
presented in collaboration with
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28. Developers Anne Lucas Kathi Gillaspy Mary Peters ECTA Center / WRRC
This presentation was adapted from presentations originally created by staff from the Early Childhood Technical Assistance Center (ECTA Center) and the Western Regional Resource Center (WRRC) and reviewed by staff from the South Eastern Regional Resource Center (SERRC), and the Department of Defense/ Army Early Intervention Services.
With contributions from Naomi Younggren, Department of Defense/Army Early Intervention; Debbie Cate, ECTA Center; Megan Vinh, WRRC; Joicey Hurth, ECTA Center/NERRC; Christina Kasprzak, ECTA Center; and Grace Kelley, SERRC 28 28