1. Module 3 Essential Knowledge for Completing the Summary of Functional Performance
Every day, we are honored to take action that inspires the world to discover, love and nurture the greatness in all children.
Welcome to Part Three of the Early Support for Infants and Toddlers training in a 6 - part series on measuring the child outcomes.

2. Overview of modules
Module 1: Setting the Stage: Global Child Outcomes and the SFP
Module 2: Learning More About the SFP and COS Rating
Module 3: Essential Knowledge for Completing the SFP and COS Rating
Module 4: Guidance for Completing the SFP and COS Rating Within the Team Process
Module 5: Understanding Age-expected Child Development, Developmental Trajectories, and Progress
Module 6: Using COS Data to Inform Program Improvement at all Levels
In this training, you’ll learn more about the essential knowledge that is needed to complete the Summary of Functional Performance on the Washington IFSP. You will hear information about:
Recommended practices for assessment to gather information from everyone who knows the child for the Summary of Functional Performance;
Age-anchoring children’s development;
Framing children’s development within the context of their culture; and
The 7-point rating scale and use of the decision tree.
Within this section you’ll have some opportunities to check your understanding of these essential knowledge areas. Let’s start by looking at recommended practices for assessment.
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3. How we learn about the child’s functioning across settings and situations
1. Good Assessment
We learn about the child’s everyday functioning through good assessment practices. Research indicates that to be effective in supporting families to understand and influence their children’s development, we have to begin the planning process for services with functional assessment. Functional or authentic assessment of a young child’s skills happens in the real life contexts of family, culture and community rather than in isolation. Functional assessment results in reflecting the “whole child”, and gives us a picture of how a child uses his or her skills in everyday activities and routines, across settings and situations. Through the information gathered in the functional assessment process, we have the foundation necessary to develop functional outcomes and goals for young children with identified needs. Additionally, functional assessment gives us the information that is needed to complete the Summary of Functional Performance.
Let’s take a look at what some of our professional associations say about recommended practices for assessment.
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4. DEC* recommended practices for assessment
Involve multiple sources
Examples: family members, professional team members, service providers, caregivers
Involve multiple measures
Examples: observations, criterion- or curriculum-based instruments, interviews, norm-referenced scales, informed clinical opinion, work samples
*Division for Early Childhood of the Council for Exceptional Children
Our professional organization for early childhood special education, the Division for Early Childhood of the Council for Exceptional Children, defines high quality assessment practices as those that use multiple sources of information, and multiple measures. Examples of sources include family members, other team members and service providers, and the child’s caregivers. Examples of multiple measures include those that are standardized or norm-referenced, but also includes observation, and interviews. Both suggest that a wide variety is needed in order to gain a more complete picture of the child.
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5. Assessment practices appropriate for outcomes measurement: ASHA*
ASHA recommended practices:
Gather information from families, teachers, other service providers
Collect child-centered, contextualized, descriptive, functional information
*American Speech-Language-Hearing Association
The American Speech-Language and Hearing Association, or ASHA, says that a balanced assessment includes information from families, teachers, other service providers, and information that is child-centered, contextualized, descriptive, and functional.
The practices in this module are consistent with both the ASHA and DEC Recommended Practices. Both professional organizations suggest that best practices in assessment includes information that is functional and contextualized for each individual child and family. When used, these recommended practices in assessment yield better information for individualized family service planning and for the completion of the Summary of Functional Performance. Authentic assessment is a key practice in the completion of the Summary of Functional Performance. Authenticity is important because the more realistic the task, the more motivated the child will be, and the more applicable it is to every day events and situations. Authentic tasks reinforce the competency-based approach used in educating young children, assessment across disciplines of complex skills and processes, and generalization across learning settings. Finally, authentic tasks require that the assessor make no inference about the child’s capabilities because the behaviors sampled are directly observable. This is a key concept needed to measure the child outcomes.
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6. Listening and learning form parents is good assessment
See the discussion prompts on the ESIT website for possible questions to ask families
The Routines-Based Interview and other family-directed assessment tools offers lots of information
Check in with parents to see how the child is doing and incorporate this information into the SFP rating process
Families are the most important sources of information about their child. They have information about their child in multiple settings and situations, and can provide valuable insight into the child’s development. This module contains a handout of discussion prompts that include some questions you can ask families about their child’s skills and behaviors in everyday life. These are possible questions; it is not expected that you would ask all of the questions to the same family. This ‘real life’ information provided by family’s answers helps determine the child’s level of functioning across different aspects of the global outcomes, and helps identify the most appropriate rating. If used in your program, the Routines Based Interview, or RBI, is another great source of information from the family. Since the Summary of Functional Performance is a part of the IFSP that you will be reviewing periodically, it might be a good practice to seek information about the child’s functioning in three outcome areas on an ongoing basis so that you can incorporate that information into the next scheduled completion of the Summary of Functional Performance. This might be especially handy if the child and family unexpectedly leave the early intervention program, and an exit SFP is needed.
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7. A domain score on an assessment tool does not translate into an outcome rating
Ratings require:
Looking at functional behaviors
Collecting and synthesizing input from many sources familiar with how what the child does in across different settings and situations
Thinking about functioning across all aspects of outcome content
It is important to note that there is not a one-to-one correlation between domain scores on an assessment tool and a rating for one of the three child outcomes. First of all, it is important to remember that the three child outcomes are global, and cross all the domains in their descriptions. Second, was just mentioned in our discussion about recommended practices in assessment, it is important to consider multiple sources of information about a child when determining the rating for an outcome area. A provider of early intervention services should never make decisions about a child based on any single assessment source, such as the scores from one tool, even when planning the child’s outcomes. The rating on the Summary of Functional Performance should reflect all the information we can learn about a child to understand not only the skills he has acquired, but also how he uses them in everyday life.
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8. Crosswalks
Many of the instruments used to assess young children have been cross walked by the three outcomes
Crosswalks are to be used to show what other sources of information may be needed.
For many programs, gathering information about young children includes using some kind of norm-referenced or criterion-referenced, standardized evaluation or assessment. These instruments can provide good information about a child’s functioning but may not offer the breadth or depth of information needed to inform the outcomes ratings for children. To help providers learn about the instruments they use and to think about other sources of information that may be needed to inform the rating, the ECO Center has cross walked many of the commonly used instruments to the three child outcomes. Each will show examples of items that address each of the outcome areas. Let’s look at an example.
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9. Title—32 point font Kids' Potential, Our Purpose
This is a page from the cross walk for the Batelle Developmental Inventory, or BDI-2. As you can see here, there are several communication items that could inform the rating for each of the outcomes. Providers may want to look at the items and then think, “What else might I want to know about the child communicating with others?”, which is the first item in Expressive Language under outcome 1. We might want to know how the child communicates with others. We may want to know who the child communicates with, and how often. Perhaps we might want to know if gestures or signs are a part of the child’s communication.
The next step in assessment planning is to then determine what sources of information we might use to gather this additional information to inform the outcomes ratings.
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10. Ratings are based on… Types of information Sources of information
Curriculum-based assessments (e.g., AEPS)
Norm-referenced assessments (e.g., BDI-2)
Developmental screenings (e.g., Ages & Stages)
Structured interviews (e.g., Routines Based Interview, Vineland-II)
Observation and report
Sources of information
Parents and family members
Service providers
Therapists
Physicians
Child care providers
Teachers
People familiar with the child in all of the settings and situations that s/he is in
These are some of the possibilities for additional sources of information for the completion of the Summary of Functional Performance. Continuing the example from the previous slide, we might decide that observation would give us some of the information we need, as would parent report. Those types and sources of information should be added to the assessment process to give a full picture of the child’s functioning across settings and situations.
When filling out the Summary of Functional Performance on the IFSP, you will be asked to document the sources of the information used to determine the ratings on the three outcomes. Please keep in mind that multiple providers are assessing the child, and that this information should all be used to inform the rating. Team members who assess the child should share information with other team members, and discuss the results across settings and situations, so that the Summary of Functional Performance can accurately reflect the child’s functioning.
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11. SFP: Documenting Assessment Instruments and Information Sources
On the form itself, you will see that there is a place to indicate the assessment instruments used and the sources of information that guided your rating process. Be sure to include all of the sources of information used to determine the ratings on the three outcomes.
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12. Reflection
What other sources of information could you include in your assessment process in order to get more functional information about children’s development across settings and situations?
Before moving on to the next section, we’d like you to consider how you will apply the information shared. Using your piece of paper, write out a response to the following question:
What other sources of information could you include in your assessment process in order to get more functional information about children’s development across settings and situations?
You may want to refer back to information in this module to support your response. If you like, you may share your response with a co-worker or supervisor, and talk about how to include this information in your conversations with families.
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13. Essential knowledge for completing Summary of Functional Performance
2. Understand age-expected child development
Let’s move on now to the next area of essential knowledge for completing the child outcomes measurement. The next key ingredient of the Summary of Functional Performance process is knowledge of age-expected child development.
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14. Why do we intervene?
Development in young children follows a predictable course
Children who acquire new skills at a slower rate get further and further behind
Section 2 of this series described how measuring child outcomes is the mechanism by which we see how much we’ve made a difference in children’s development, by looking at how their rating at the beginning of early intervention is different from the rating at the end of early intervention services.
Age expected development follows a predictable course. If children with special needs are not keeping up with age expectations, we provide services to help move their development along so that they do not keep getting farther and farther behind. Comparing the child’s skills and behaviors to those expected for his age over time helps us document whether our services are making a difference. This is based on an assumption that services provided through early intervention help children with special needs move closer to the age expectations.
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15. Hypothetical Language Acquisition Rates for four Groups of Children: Change in Development Trajectory (Progress toward Closing the Gap)
This slide shows what we are trying to do through intervention services…
The pink line on this graph represents typical development. The graph title says ‘language acquisition’ but it could just as easily say social interaction or problem solving or independence. Development follows a predictable course that involves acquiring more skills and more complex behaviors as children get older. We also know there is variation in development and no child’s development follows this kind of a line. We can however describe what we expect of 4 year olds and that differs from what we expect of 3 year olds. If children are developing new skills a little slower than other children, the aqua line after 21 months, these children will be a little bit behind when they arrive at kindergarten. Other children are acquiring new skills so slowly that they are substantially behind other children and we say these children have a developmental delay (red line). We intervene to change their trajectories (blue line), to bring their skills closer to age-expected levels than they would have been if they had stayed on the same course. Without intervention, we assume that these children will continue on their same course. The goal is to do everything we can to help them achieve and follow a trajectory as close to age-expected development as possible.

16. Child Development Resources can…
Help you identify the time period when skills often emerge in the general population
Remind you about the sequences in which the skills develop
Washington State Early Learning and Development Guidelines
In order to compare a child’s development to what is expected given their age, we must be knowledgeable in child development. Most providers in early intervention have at one time or another taken a course in child development and have learned what typical development looks like. Some providers may have taken courses in the past, while others have received that information more recently. Many providers report that over time, what they define as “typical” starts to shift and become relative to the skills they see among the children with delays that are served, rather than being relative to the pattern of child development seen for children developing in the age-expected pattern. Using information about child development from recollection or experience may not always produce the most accurate ratings on the outcomes. For that reason, it is recommended that teams completing the Summary of Functional Performance use child development resources to complete the age-anchoring part of the process. Child development resources might include instruments (for example, the HELP), developmental checklists, or other resources, such as the Washington State Early Learning and Development Guidelines, that list when certain developmental milestones are expected for each age range. Using these resources can help you consistently and accurately identify when certain skills and behaviors are expected, and remind you of the order in which skills progress developmentally.
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17. Resources for understanding age-expected child development
Website list:
CDC milestone lists by age
MEISR-COSF- routines by outcomes with approximate age levels
ND state compiled milestone lists in each outcome area by age
There are many other resources on the ECTA outcomes website that give information on child development. If you have questions about what to use, please contact your program consultant in the ESIT program for more information and support.
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18. What age to use for comparisons?
For these ratings, use actual chronological age.
Do NOT correct for prematurity.
This way we can show the progress preemies make as their skills become closer to those of full-term children born at the same time.
For the purposes of the Summary of Functional Performance, you will not adjust for prematurity so that comparison to the child’s same-age peers is more accurate. Even if assessment tools correct for prematurity, use the child’s actual chronological age to determine the child’s rating in each of the three outcome areas. This may mean that you will need to age anchor the child’s development according to the chronological age in addition to determining scores on assessment tools by adjusted age. Not correcting for prematurity is the only way we can show the progress that children who were born prematurely make as they grow and develop.
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19. Thinking about development in sequences
Skills build on each other to allow more complex behavior
Need to understand what skills are expected at a given age
Where is each child in the progression of skills
Part of understanding age-expected development is being familiar with the sequences of skills that build on each other over time. This means we need to not only know what’s expected at a given age, but that we need to know where the child is within a progression of skills, and what skills are needed to produce more complex behavior.
We must use age-expected skills so that we know what the benchmark for a skill is.
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20. Looking at Development…
For the Summary of Functional Performance process, children’s development is looked at in three categories. One way to think about development is like stair steps, with the skills that emerge first forming the foundation for later skills. Skills that come just before age-expected skills complete the foundation for age-expected development.
When you gather information for the Summary of Functional Performance, it is important to know enough information about how the child uses his/her skills to understand where in the progression of skills the child is functioning.
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21. An example… Kids' Potential, Our Purpose
Let’s look at how skill progression works, using walking as an example. If a child is months, an age-expected skill would be walking. To understand what an immediate foundational skill is in this area of development, we would check our age-anchoring resources and find that pulling to stand and cruising are the skills that come just before independently walking. To figure out what foundational skills would be, we would check our resources further back in the age ranges and discover that other items such as crawling and pushing up on to all fours are skills that children have in place before they pull to stand and cruise. While this is not an exhaustive list of all the foundational or immediate foundational skills connected to walking, they illustrate the concepts that each level is meant to include.
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22. What are foundational skills?
Foundational skills are…
The skills and behaviors observed before immediate foundational skills
Skills and behaviors that occur earlier in development and serve as the foundation for later skill development
Teachers and interventionists often use foundational skills to help children move to the next level developmentally
Foundational skills, on the other hand, are skills we expect to see much earlier in the developmental progression. These are skills that, as their name reflects, form the foundation upon which the developmental progression of skills is built. For many children with disabilities, these foundational skills are the focus of intervention intended to help the child move closer to age-expectations.
A child whose development is primarily foundational might be describe as functioning like a much younger child than his or her peers.
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23. Immediate foundational skills
The set of skills and behavior that occur developmentally just prior to age-expected functioning
Are the basis on which to build age-expected functioning
Immediate foundational skills are distinguished from foundational skills in that they are what we expect to see in the developmental progression just before age-expected skills. Often in intervention planning, these are the skills that we focus on to help the child get closer to age-expected functioning.
Children whose development is primarily immediate foundational might be described as functioning like a slightly younger child than his or her peers.
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24. Caution: Interpreting age-expected skills
A child developing typically often demonstrates skills or behaviors that are not age-expected. In other words… Children continue to use the skills that developed at younger ages.
When determining what is age-expected is important to determine, using your child development resources, when we expect a skill to initially develop. Many skills develop at a young age and are maintained into higher age levels (such as walking or eye contact). Others are built upon larger developmental progressions that have different age-expectations for the different steps in the progression. Carefully identifying when a skill is age-expected using available child development resources is critical. We do not count a skill as “age expected” unless the skill the child is displaying is one that comes in around that age for children whose development follows a pattern consistent with age-expected growth.
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25. Essential Knowledge for Completing Summary of Functional Performance
3. Understand age expectations for child functioning within the child’s culture
Another consideration for the completion of the Summary of Functional Performance is the influence of culture on a child’s development.
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26. Age appropriateness and culture
The age appropriateness of some behaviors varies across cultures
Especially those related to independence and self care
Important for working with the child and for completing the Summary of Functional Performance to understand expectations within the child’s culture
As you know from working with families of different cultures, expectations for development may vary -- especially with regard to independence and self care skills. It’s important for the team to learn from the family about their culture’s expectations for their child’s development and learning. If a child’s skills are not at the same level as same age peers of our mainstream culture, it may be that there is a different expectation within that child’s culture. Teams must be aware and sensitive to these differences. The rating on the Summary of Functional Performance is to reflect age expected functioning within the child’s culture-- so the team needs to spend time with talking with the family in order to understand those expectations.
The Washington Early Learning and Development Guidelines provide more information on the important context of culture as it is related to a child’s skill development.
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27. Reflection
How would you explain immediate foundational and foundational skills to a new teammate?
Before moving on to the next section, we’d like you to consider how you will apply the information shared. Using your piece of paper, write out a response to the following question:
How would you explain immediate foundational and foundational skills to a new teammate?
You may want to refer back to information in this module to support your response. If you like, you may share your response with a co-worker or supervisor, and talk about how to include this information in your conversations with families.
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28. 4. Understand the content of the three child outcomes
Essential knowledge for completing the Summary of Functional Performance
4. Understand the content of the three child outcomes
For effective participation in the Summary of Functional Performance process, we need to understand the content of the three child outcomes we’re measuring.
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29. The 3 Child Outcomes
Module 1 of this training series introduced the three child outcomes. Let’s take a moment to look at them in detail. To begin this section, please click on the link on the slide, and watch the Child Outcomes Step by Step Video.
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30. Outcome 1: Children have positive social relationships
Involves:
Relating with adults
Relating with other children
For older children, following rules related to groups or interacting with others
Includes:
Attachment/separation/autonomy
Expressing emotions and feelings
Learning rules and expectations
Social interactions and social play
Let’s recap some of the key concepts outlined in the video about the content of the three outcomes.
The first child outcome is that ‘children will have positive social relationships.’ This refers to how children interact with adults and also with peers, and for older toddlers, how well children can participate in a group setting. When assessing the child’s skills and behaviors in this area, we’ll also look at his or her ability to express emotions and feelings, and participate in social play, with a caregiver or another child.
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31. Outcome 2: Children acquire and use knowledge and skills
Thinking
Reasoning
Remembering
Problem solving
Using symbols and language
Understanding physical and social worlds
Early concepts
symbols
pictures
numbers
Imitation
Acquiring vocabulary
Early literacy
The second child outcome is that children will ‘acquire and use knowledge and skills.’ Included in this outcome area are thinking, reasoning, problem solving and the use of symbols, such as words, to represent objects and actions. Assessment in this area will also include the child’s early literacy and numeracy skills.
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32. Another slide on literacy
For infants and toddlers, early literacy and communication includes:
Looking at caregivers, objects and pictures
Early social turn-taking games (Peek-A-Boo)
Producing sounds, babbling, and early gestural communication (pointing, reaching, using sign language)
Patting pictures in a book, helping to flip pages
It may not be instinctive to think about early literacy skills for infants and toddlers, so let’s take a look at what that could mean. For very young children, early literacy includes:
Looking at caregivers, objects and pictures
Early social turn-taking games (Peek-A-Boo)
Producing sounds, babbling, and early gestural communication (pointing, reaching, using sign language)
Patting pictures in a book, helping to flip pages
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33. Another slide on numeracy
For infants and toddlers, early numeracy might include:
Concept of “more”
Early rote counting (1, 2, 3)
Concepts of “one” and “all”
Similarly, we don’t often consider what numeracy means for infants and toddlers. Just briefly, some ideas include:
Concept of “more”
Early rote counting (1, 2, 3)
Concepts of “one” and “all”.
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34. Outcome 3: Children take appropriate action to meet their needs
Involves:
Taking care of basic needs
Getting from place to place
Using tools (e.g., fork, toothbrush, crayon)
In older children, contributing to their own health and safety
Includes:
Integrating motor skills to complete tasks
Self-help skills (e.g., dressing, feeding, grooming, toileting, household responsibility)
Acting on the world to get what one wants
The third outcome, that children will take appropriate action to meet their needs, addresses how the child takes care of basic needs, such as feeding, toileting, and dressing. It includes the ability to express their needs, and to move from place to place to get needs met. As children get older, assessment of this outcome area will include the child’s awareness of health and safety issues, for example, not running into the street or touching a hot stove. This outcome goes much beyond looking at motor skills to understand how children are using skills to act on the world around them to meet their needs.
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35. Functional child outcomes
Refer to things that are meaningful to the child in the context of everyday living
Refer to an integrated series of behaviors or skills that allows the child to achieve the important everyday goals
Meaningful behaviors in meaningful context – what child usually does in situations (crosses domains)
NOT – unusual, isolated circumstances, only in structured, specific standardized, elicited situations
See
An overarching concept this important to understand is that the three child outcomes are functional outcomes. They are intended to focus on the child’s functional skills, that is how the child integrates his/her skills across domains to accomplish tasks that are meaningful to the child. Instead of looking for discrete skills out of context ,for instance, says 10 words - the focus is instead on how the child uses words to tell a caregiver she wants milk or food, to sing songs with her mother, or to label pictures in a book during story time.
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36. Functional Assessment
Our Focus Shifts
From To
Knows how to make eye contact, smile, and give a hug
Initiates affection toward caregivers and respond to others’ affection
Knows how to imitate a gesture when prompted by others
Watches what a peer says or does and incorporate it into his/her own play
Uses finger in pointing motion
Points to indicate needs or wants
Shows a skill in a specific situation
Uses a skill in actions across settings and situations to accomplish something meaningful to the child
Looking at children’s skills in an functional way requires that we shift our focus from specific skills in specific situations to a more complete functional picture of the child. For example, our focus shifts from noticing that the child makes eye contact, smiles and gives hugs to noticing how the child initiates affection with the important people in his/her life. We shift from just knowing the child can point, to knowing that the child points to let us know what he wants or needs. It’s a shift in thinking from knowing more than just what skills the child has, to how the child uses the skills that she or he has.  As a result, knowing skills that a child has based on an assessment may need to be paired with observations and reports from parents and providers about how the child uses those skills in functional ways in everyday settings as you gather information for the SFP.

37. Outcomes Jeopardy $100 $100 $100 $200 $200 $200 $300 $300 $300
Pointing to the cabinet for cereal
Can tell you his name
Eats with a spoon
Biting
Plays by himself in child care
Points to pictures in a book
Building a house from blocks with a friend
Problems sleeping
Sharing a cookie at lunchtime
$100
$100
$100
$200
$200
$200
Let’s see how familiar you now are with the content of the three child outcomes. In the following activity, read each response and determine whether the skill listed belongs with Outcome 1, Outcome 2 or Outcome 3. Write down your answers, then click “Play” to see how you did.
$300
$300
$300

38. Outcomes Jeopardy $100 $100 $100 $200 $200 $200 $300 $300 $300
Pointing to the cabinet for cereal
Can tell you his name
Eats with a spoon
Biting
Plays by himself in child care
Points to pictures in a book
Building a house from blocks with a friend
Problems sleeping
Sharing a cookie at lunchtime
$200
$200
$200
Let’s start with the $100 questions. For each response, determine whether the skill listed belongs with Outcome 1, Outcome 2 or Outcome 3. Write down your answers, then click “play” to see how you did.
$300
$300
$300

39. Outcomes Jeopardy Pointing to the cabinet for cereal
Can tell you his name
Eats with a spoon
Outcome 2 or 3, depending on context
Outcome 1, 2 or 3 depending on the context in which he is telling you his name
Outcome 3
Pointing to the cabinet for cereal could either be Outcomes 2 or 3, depending on the context. For Outcome 2, pointing could be a form of communication. For Outcome 3, pointing could be a mechanism for getting needs met.
A child telling his name could be in any one of the three outcomes. In Outcome 1, a child could be telling his name to a peer in a social situation. In Outcome 2, a child could tell his name in response to a question. And in Outcome 3, the child could be telling his name to get a need met, such as finding his mother.
Eating with a spoon is tool use, which is found under Outcome 3.
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40. Outcomes Jeopardy $200 $200 $200 $100 $100 $100 $300 $300 $300
Pointing to the cabinet for cereal
Can tell you his name
Eats with a spoon
Biting
Plays by himself in child care
Points to pictures in a book
Building a house from blocks with a friend
Problems sleeping
Sharing a cookie at lunchtime
$100
$100
$100
Now let’s try the $200 questions. For each response, determine whether the skill listed belongs with Outcome 1, Outcome 2 or Outcome 3. Write down your answers, then click “play” to see how you did.
$300
$300
$300

41. Outcomes Jeopardy
Biting
Plays by himself in child care
Points to pictures in a book
Outcome 1, 2 or 3, depending on how biting is affecting the child’s functioning
Outcome 1
Outcome 2
Biting could be in any one of the Outcome areas. In Outcome 1, biting could affect social skills in social situations, Outcome 2, biting could be in response to a question or direction, and in Outcome 3, it could be to get a need met.
Outcome 1 covers social interactions, so if a child is playing by himself while he is at child care, that would be considered under Outcome 1.
Pointing to a picture in a book represents the pre-literacy skills we mentioned earlier which fall under Outcome 2.
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42. Outcomes Jeopardy $100 $100 $100 $300 $300 $300 $200 $200 $200
Pointing to the cabinet for cereal
Can tell you his name
Eats with a spoon
Biting
Plays by himself in child care
Points to pictures in a book
Building a house from blocks with a friend
Problems sleeping
Sharing a cookie at lunchtime
$100
$100
$100
$300
$300
$300
$200
$200
$200
Finally, let’s try the $300 questions. For each response, determine whether the skill listed belongs with Outcome 1, Outcome 2 or Outcome 3. Write down your answers, then click “play” to see how you did.

43. Outcomes Jeopardy Building a house from blocks with a friend
Problems sleeping
Sharing a cookie at lunchtime
Outcomes 1 and 2
Outcome 1, 2 or 3 depending on how the lack of sleep is affecting the child’s functioning
Outcome 1 or 3
Building a house from blocks with a friend could be Outcome 1 for the social aspect of playing with a friend, or Outcome 2 for representational play.
Problems sleeping could be in any one of the outcome areas, depending on the impact of the lack of sleep has on the child. In Outcome 1, it could make the child grumpy and fussy, and not respond well or at all to social interactions. In Outcome 2, being sleepy could impact a child’s ability to participate in early learning activities and thus gain new skills. Finally, the routines around sleeping as a self-care routine may be difficult, which would be considered under Outcome 3.
And finally, sharing a cookie could either be Outcome 1, for sharing with a peer, or Outcome 3, participating in lunchtime.
How did you do? If you need to review more about the content of the outcomes, consider re-watching the Child Outcomes Step by Step video on the ECTA website.
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44. 5. Know how to use the rating scale
Essential Knowledge for Completing the Summary of Functional Performance
5. Know how to use the rating scale
The last key area of essential knowledge is the 7-point scale. Participants in the Summary of Functional Performance process – most notably, the professionals on the team, must understand how to use the 7-point rating scale. That means understanding the definition of each of those 7 points and how descriptor statements correspond to those points. This knowledge helps team members and programs all use the scale the same way. Let’s review what descriptor statements are and the definitions for each of the scale points.
In this discussion about the 7-point rating scale, it will be important to keep in mind the definitions of foundational, immediate foundational and age-expected development. To what extent the child shows each type of development is key in deciding which of the 7 points to apply to an outcome area.
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45. Descriptor Statements
There are 7 categories of ratings
Instead of identifying a number, the team selects a descriptor statement which corresponds to a rating
For each of the 7 rating categories, there are several “descriptor statements” that describe and summarize how the child is functioning in the outcome area
Descriptor statements are selected verbatim in the data system. The data system inserts the child’s name in the statement and associates the statement with a rating for later reports
Instead of selecting a rating number to describe the child’s functioning, the team selects from a list of statements that summarize how the child is functioning in that outcome. Each of the 7 points on the scale has one or more statements that describe a child functioning at that level. When the information is entered into the data system, the screen will show the set of possible statements and the person entering the data will select the appropriate statement.
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46. Kids' Potential, Our Purpose
As you can see from this screenshot of the DMS, the descriptor statements are arrayed in seven sections with each section corresponding to one of the seven points on the scale. When the team has decided upon the descriptor statement, you will enter that information into the DMS by clicking on the circle beside the chosen statement.
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47. 7
Child shows functioning expected for his or her age in all or almost all everyday situations that are part of the child’s life
Functioning is considered appropriate for his or her age
No one has any concerns about the child’s functioning in this outcome area
Let’s start at the top of the scale. The team would consider a rating of ‘7’ in an outcome area for a child who is ‘completely age appropriate’ in just about all of the settings that make up his or her life – and for whom there are no concerns in this particular outcome.
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48. 7 Descriptor Statements
For a child whose functioning in the outcome is completely age appropriate, choose one of the following descriptor statements:
Relative to other children [CHILD’S NAME]’s age, he has all of the skills that we would expect of a child his age in the area of (outcome [e.g., taking action to meet needs]).
[CHILD’s NAME] has a good mix of age expected skills in the area of (outcome).
In this first example, the team has reviewed the information about the child' s functioning in the outcome, they used the decision tree -- more on the decision tree in a minute -- and have decided that the child is functioning like same age peers in this outcome. They will select one of the two descriptor statements that can be used to convey that the child is at the highest point on the rating scale. They can pick whichever of the two they like the best. In the data system, the child's name will appear automatically in the descriptor statement as well the outcome related information.

49. 6
Child’s functioning generally is considered appropriate for his or her age but there are some significant concerns about the child’s functioning in this outcome area
These concerns are substantial enough to suggest monitoring or possible additional support
Although age-appropriate, the child’s functioning may border on not keeping pace with age expectations
You would consider a rating of ‘6’ if the child’s functioning is overall age appropriate in the outcome you’re measuring, but the team does have some concerns about the child’s development in this area. Concerns are not simply target areas for improvement. Concerns should be serious enough that one would want to keep an eye on the child’s development because you suspect, although the child is functioning at an age-expected level right now, unless concerns area addressed, the child will not be able to keep up with those peers who are developing according to age expectations.
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50. 6 Descriptor Statements
For a child whose functioning is currently age-appropriate, but where there are substantial concerns that may interfere with maintaining age-expected functioning:
Relative to same-age peers, [CHILD] has the skills that we would expect of her age in regard to (outcome); however, there are concerns with how she [insert functional area of concern].
Aside from the concern regarding, [CHILD] is demonstrating skills expected of a child her age in the area of (outcome).
Here the two descriptor statements that can be selected. Both indicate some type of substantial concern as well as acknowledge functioning that is currently age-expected.

51. Common confusion Summary Rating ≠ Eligibility
Ratings reflect child’s functioning NOW, not anticipating future delays associated with a child’s diagnosis or condition
Ratings do NOT correct for prematurity – use actual chronological age
Ratings ARE based on functioning with whatever assistive technology is typically available in everyday settings
Ratings reflect child’s FUNCTIONAL use of skills across settings now, not discrete skills a child has, but doesn’t use.
Just a reminder that the summary rating at entry is completely independent of the eligibility determination. There is no reason to be concerned that the ratings might lead someone to question the child's eligibility. Children receiving services may be functioning at age-expected levels on one or more outcomes. Some children receiving services may be functioning at age-expected levels on all three outcomes at entry, for example if the young child has a diagnosed condition or a sensory impairment where services are preventing developmental decline and the child is functioning effectively. Another example is if assistive technology or supports have helped the child to function at a high level.
Note that the ratings are based on the child's functioning with the use of assistive technology to whatever extent it is available to the child in his/her everyday environments.
Ratings are to reflect the child 's current functioning relative to age-expected functioning. Do not correct for prematurity.
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52. 5
Child shows functioning expected for his or her age some of the time and/or in some settings and situations
Child’s functioning is a mix of age-appropriate and not age-appropriate behaviors and skills
Child’s functioning might be described as like that of a slightly younger child
A rating of ‘5’ means that the child does show age-expected skills and behaviors, but not in all of the settings or all the situations that make up his or her everyday life. The child’s functioning may appear to be more like that of a slightly younger child.
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53. 5 Descriptor Statements
For a child whose functioning show a mix of age-appropriate and not age-appropriate skills:
For a # month old child, [CHILD] has many skills expected of his age, but he also demonstrates some skills slightly below that expected at the age in the area of (outcome).
Relative to same age peers, [CHILD] shows many age-expected skills, but continues to show some functioning that might be described like that of a slightly younger child in the area of (outcome).
[CHILD] is somewhat where we would expect him to be at this age. This means that [CHILD] has many skills we would expect at his age in regard to (outcome), but he does not yet have all of the age-expected skills.
The mix of skills consistent with a rating of 5 can look somewhat different depending on the combinations of skills. The three different descriptor statements allow teams to choose which statement sounds most like the child’s current functioning. Any of these three statements also will register a “5” as a rating associated with the child’s summary of functional performance.

54. 4
Child shows occasional age-appropriate functioning across settings and situations
More functioning is not age-appropriate than age-appropriate.
The team would consider a rating of ‘4’ if a child occasionally shows skills and behaviors that are at age level, but most of the time appears more like a younger child in an outcome area.
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55. 4 Descriptor Statements
For a child whose functioning show a mix of age-appropriate and not age-appropriate skills where more of the skills are not yet age-appropriate:
At # months, [CHILD] shows occasional use of some age-expected skills, but more of his skills are not yet age-expected in the area of (outcome).
At # months, [CHILD] shows occasional use of some age-expected skills, but has more skills that are younger than those expected for a child his age in the area of (outcome).
[CHILD] has a few of the skills we would expect in regard to (outcome), but he shows more skills that are not age-appropriate.
These are the three descriptor statements that are available to represent a rating of 4. Note that they accurately convey the idea that child is showing more development that is not age-expected than age expected. You may want to pause and review the descriptor statements for a rating of 4 and a rating of 5 to familiarize yourself with the difference between the two ratings and their corresponding statements.

56. 3
Child does not yet show functioning expected of a child of his or her age in any situation
Child uses immediate foundational skills, most or all of the time across settings and situations
Immediate foundational skills are the skills upon which to build age-appropriate functioning
Functioning might be described as like that of a younger child
A rating of ‘3’ means that the child is not showing age-expected skills and behaviors in an outcome area. The child’s functioning is close to, but not at, age level. The skills that are close to, but not at, age expectations, we call ‘immediate foundational skills.’ These are the skills that practitioners will build on to help move the child to age expected functioning.
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57. 3 Descriptor Statements
For a child whose functioning is not yet showing age-appropriate skills and most or all of the time includes immediate foundational skills:
Relative to same age peers, [CHILD’S NAME] is not yet using skills expected of his age. He does however use many important immediate foundational skills to build upon in the area of (outcome).
In the area of (outcome), [CHILD’S NAME] is nearly displaying age-expected skills. This means that he does not yet have the skills we would expect of a child his age. He has the immediate foundational skills that are the building blocks to achieve age-appropriate skills.
There are two different statements to choose from to describe children who mostly use immediate foundational skills, but not yet age-expected functioning across everyday situations.

58. 2
Child occasionally uses immediate foundational skills across settings and situations
More functioning reflects skills that are not immediate foundational than are immediate foundational
The rating of ‘2’ means the child occasionally uses immediate foundational skills, but most of the time his or her functioning uses skills that would be considered foundational rather than immediate foundational.
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59. 2 Descriptor Statements
For a child whose functioning is not yet showing age-appropriate skills and occasionally uses immediate foundational skills:
At # months, [CHILD] shows occasional use of some immediate foundational skills that will help him move toward age-appropriate skills. More of his functioning displays earlier skills in the area of (outcome).
Relative to same age peers, [CHILD] is showing some immediate foundational skills, but has more skills that developmentally come in earlier in the area of (outcome).
For a # month old, [CHILD] occasionally uses immediate foundational skills, but has a greater mix of earlier skills that he uses in the area of (outcome).
Overall in the outcome area, [CHILD] is just beginning to show some immediate foundational skills which will help him work toward age appropriate skills.
Children in this category often show a rich array of foundational skills and occasionally exhibit immediate foundational skills. There are 4 descriptor statements to choose from that correspond to a rating of “2”.

60. 1
Child does not yet show functioning expected of a child his or her age in any situation
Child’s functioning does not yet include immediate foundational skills upon which to build age-appropriate functioning
Child functioning reflects skills that developmentally come before immediate foundational skills
Child’s functioning might be described as like that of a much younger child
Children in this category are showing all skills at the foundational level. There are two descriptor statements that may be chosen to represent a rating of “1”.
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61. 1 Descriptor Statements
For a child whose functioning includes foundational, but not yet age-appropriate or immediate foundational skills:
Relative to same age peers, [CHILD] has very early skills in the area of (outcome). This means that [CHILD] has the skills we should expect of a much younger child in this outcome area.
For a # month old, [CHILD] shows early skills in the outcome area. She does not yet show age-expected skills or the skills that come right before those.
The team would consider a rating of ‘1’ for a child who is not showing age-expected functioning or immediate foundational sills. A rating of ‘1’ does not mean that the child has no skills. It means the child has not yet acquired the skills considered immediate foundational skills for a child of his or her age. It does mean that his or her functioning probably looks like a much younger child.

62. Common confusion
Children with descriptor statements equivalent to 1 still display many skills
Skills are just at a foundational level
It is important to note that children with descriptor statements corresponding to a rating of 1 will show many skills, and, at exit, often have acquired many more skills than were displayed at program entry. The key is that all of the skills used are at a foundational level. They are not the skills that come just before what would be expected of a child that age.
It may be important to note at this point that ratings of 1 or 2 should not be avoided – if a child is truly functioning at that foundational level – and there are some children that we serve whose disability impacts their functioning very significantly – then a rating of 1 or 2 should be applied as determine by the process. The ratings are statements of the child’s status at this point in their development – they are not judgments about the child or their potential for growth.
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63. Assistive technology
If the child regularly uses assistive technology, rate the child’s level of functioning with the assistive technology.
Note that if a child uses assistive technology, the team should consider the child’s functioning WITH the assistive technology IF the child uses it in every day life. If the child has a communication board, for example, but does not use it, the team should rate the child’s functioning in the three outcomes without the communication board. If the assistive technology is used in some settings, but not others, then ratings should be based on how the child is functioning in each of those settings and will likely reflect a mix of functioning. If the child uses the board in his or everyday life, the rating should reflect the child’s functioning with that technology.
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64. Rating Scale Jeopardy $100 $100 $100 $200 $200 $200 $300 $300 $300
Age appropriate functioning – no concerns
Mix of age appropriate and not age appropriate functioning
No age appropriate functioning – not yet showing immediate foundational skills
Some age appropriate functioning but very little
No age appropriate functioning – lots of immediate foundational skills
Age appropriate functioning – some concerns
Rarely shows age appropriate functioning
No age appropriate functioning – some immediate foundational skills
Age appropriate functioning
$100
$100
$100
$200
$200
$200
Now let’s check your knowledge of the 7 points on the Child Outcomes Summary rating scale. In the following activity, read each response and determine whether the skill listed belongs with Outcome 1, Outcome 2 or Outcome 3. Write down your answers, then click “play” to see how you did. Ready? Click “play” when you are ready to begin.
$300
$300
$300

65. Rating Scale Jeopardy $100 $100 $100 $200 $200 $200 $300 $300 $300
Age appropriate functioning – no concerns
Mix of age appropriate and not age appropriate functioning
No age appropriate functioning – not yet showing immediate foundational skills
Some age appropriate functioning but very little
No age appropriate functioning – lots of immediate foundational skills
Age appropriate functioning – some concerns
Rarely shows age appropriate functioning
No age appropriate functioning – some immediate foundational skills
Age appropriate functioning
$200
$200
$200
Let’s start with the $100 questions. For each description, determine which of the 7 points on the scale are described. Write down your answers, then click “play” to see how you did.
$300
$300
$300

66. Rating Scale Jeopardy Age appropriate functioning – no concerns
Mix of age appropriate and not age appropriate functioning
No age appropriate functioning – not yet showing immediate foundational skills
Rating = 7
Rating = 4 or 5
Rating = 1
A child who is demonstrating age-expected functioning without any concerns on the part of the team is rated a 7.
The second statement indicates that the child has a mix of age appropriate and not age appropriate. If you said this could be either a 4 or a 5, you were correct. Which rating it would be depends on how much of each type of development the child has.
A child who is not showing any age appropriate skills or immediate foundational skills is only showing foundational skills, which is the definition of a rating of 1.
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67. Rating Scale Jeopardy $200 $200 $200 $100 $100 $100 $300 $300 $300
Age appropriate functioning – no concerns
Mix of age appropriate and not age appropriate functioning
No age appropriate functioning – not yet showing immediate foundational skills
Some age appropriate functioning but very little
No age appropriate functioning – lots of immediate foundational skills
Age appropriate functioning – some concerns
Rarely shows age appropriate functioning
No age appropriate functioning – some immediate foundational skills
Age appropriate functioning
$100
$100
$100
Now let’s try the $200 questions. For each description, determine which of the 7 points on the scale are described. Write down your answers, then click “play” to see how you did.
$300
$300
$300

68. Rating Scale Jeopardy Some age appropriate functioning but very little
No age appropriate functioning – lots of immediate foundational skills
Age appropriate functioning – some concerns
Rating = 4
Rating = 3
Rating = 6
If a child is described as having very little age appropriate functioning and more functioning is not age-appropriate, that child would be given a rating of 4.
A child who has many immediate foundational skills and no age appropriate skills would be rated a 3.
A child is rated a 6 when he has age appropriate skills in most settings and situations, but there is still a concern about the child’s development.
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69. Rating Scale Jeopardy $100 $100 $100 $300 $300 $300 $200 $200 $200
Age appropriate functioning – no concerns
Mix of age appropriate and not age appropriate functioning
No age appropriate functioning – not yet showing immediate foundational skills
Some age appropriate functioning but very little
No age appropriate functioning – lots of immediate foundational skills
Age appropriate functioning – some concerns
Rarely shows age appropriate functioning
No age appropriate functioning – some immediate foundational skills
Age appropriate functioning
$100
$100
$100
$300
$300
$300
$200
$200
$200
And we’ll finish with the $300 questions. For each description, determine which of the 7 points on the scale are described. Write down your answers, then click “play” to see how you did.

70. Rating Scale Jeopardy Rarely shows age appropriate functioning
No age appropriate functioning – some immediate foundational skills
Age appropriate functioning
Rating =4
Rating =2
Rating = 6 or 7
A child who is described as rarely showing age appropriate functioning has some age expected skills, but not enough for there to be described as using them over many situations and settings. Therefore, this child would be rated a 4.
A child who only has a few immediate foundational skills, and no age appropriate functioning is rated a 2.
And lastly, if you wrote down that a child could either be a 6 or 7 for age appropriate functioning, you were correct! Both describe age appropriate functioning across most settings and situations.
How did you do? If you need to review more about the 7 point rating scale, consider reviewing the rating scale definitions that are found on the ECTA website.
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71. Summary of Functional Performance Ratings
If you think you have read and heard the word ‘functioning’ many times in this presentation, you are right!! Measuring child outcomes focuses on how a child functions in everyday life – for infants, it is about the presence/absence of skills - but how the child integrates skills to interact with others, learn, and get his or her own needs met. This ‘word cloud’ shows other ‘themes’ in the use of the rating scale as well, including the need to compare the child’s functioning with age-appropriate development across situations and settings.
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72. Essential Knowledge for Completing the Summary of Functional Performance
Use the Decision Tree!
In order to help the team make the best possible decision about which of the 7 ratings to select for a child, it is recommended that teams use the Decision Tree.
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73. The decision tree helps teams distinguish between the different summary ratings. After discussing the child’s functioning, teams can consider the extent to which age-expected behavior, immediate foundational skills, or foundational skills were described and see how the mix of these skills in each outcome area relates to ratings. Discussions about children who show any age-expected development will follow the right side of the tree, and result in a rating between 4 and 7, depending on the extent to which the child demonstrates age-expected development. Discussions about children who are not yet showing any age-expected development will follow the left hand side of the tree, and result in a rating between 1 and 3.
The Decision Tree is a tool that helps teams thinking about the critical distinctions in the criteria for each rating when looking at the evidence collected about the child’s functioning. Information about age-expected, immediate foundational and foundational skills gathered during the assessment process, information about the child’s culture and information about the child’s use of assistive technology will all support the team’s understanding of the child’s functioning in an outcome area and determine the most appropriate rating in each of the three child outcomes.
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74. Reflection
How could you incorporate the decision tree into your team Summary of Functional Performance process?
To conclude this module, we’d like you to consider how you will apply the information shared. Using your piece of paper, write out the following:
A description of how you would use the decision tree to support the team’s process in completing the Summary of Functional Performance.
You may want to refer back to information in this module to support your response. If you like, you may share your response with a co-worker or supervisor, and talk about how to include this information in your conversations with families.
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75. Resources
ESIT Early Intervention Training Modules- Module 2: Functional Assessment
At A Glance: Summary of Functional Performance Decisions
These are some resources that will provide additional information on the topics presented in this module.
ESIT has three online modules that may be accessed at the link provided on the slide. Module 2 on Functional Assessment focuses on assessment practices that should be used to gather information for both the Summary of Functional Performance as well as the development of the child’s IFSP outcomes and activities.
ESIT’s training page contains many resources for the child outcomes. One document on this page is the At A Glance: Summary of Functional Performance Decisions. This 3-page resource includes background on the use of descriptor statements in the Summary of Functional Performance process, a list of the descriptor statements that may be used (and correspond to what is available in the DMS), and the decision tree.
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76. Resources
Changes to the Child Outcomes Summary Process in ESIT’s Re-designed IFSP
Who Wants to Be A Millionaire? Outcomes Rating Scale Activity
In December 2011, Early Childhood Outcomes Center staff paired with ESIT staff to present an overview of how the child outcomes measurement process changed as a result of the newly designed IFSP. This Power Point presentation includes information on the decisions about descriptor statements, as well as information about entering the Summary of Functional Performance into the DMS.
Finally, the Early Childhood Technical Assistance Center website has many training activities that may be helpful for boosting understanding of the key concepts outlined in this module. One activity that mirrors the popular game show “Who Wants to Be a Millionaire?” provides an opportunity to ensure understanding of the definitions of the 7 points on the rating scale. Individuals may use this activity by themselves, or it may be used with a group either during a staff development or training event.
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77. Coming Next
Module 1: Setting the Stage: Global Child Outcomes and the SFP
Module 2: Learning More about the SFP and COS Rating
Module 3: Essential Knowledge for Completing the SFP and COS Rating
Module 4: Guidance for Completing the SFP and COS Rating Within the Team Process
Module 5: Understanding the Age-Expected Child Development, Developmental Trajectories and Progress
Module 6: Using COS Data to Inform Program Improvement at All Levels
The next module focuses on how to complete the Summary of Functional Performance. It includes:
Completing the Summary of Functional Performance for each outcome;
Documenting the rating;
Examples of the Summary of Functional Performance;
The team process and reaching consensus; and
Addressing subjectivity.
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