1. Part C Training: Implementing the Child Outcomes Process
The Early Childhood Outcomes (ECO) Center
National Early Childhood Technical Assistance Center (NECTAC)
Hello my name is Kristie Musick and I am the Director of Team for Early Childhood Solutions (TECS). I would like to welcome you to our second face-to-face training regarding the child outcomes process. We have a busy day planned for you and hope that you will leave here with a better understanding of how to implement the child outcomes process using the ECO resources presented. This training is being videotaped so we ask that you be mindful of sidebar conversations and background noises that may be picked up during recording. Information regarding when videotape will available for viewing will be announced through the TECS list serv and website.
Each of you should have received a red packet at registration. On the LEFT side of the packet you should find resources relevant to SC’s implementation of the child outcomes process (i.e. a copy of the child and family outcomes portion of the APR submitted Feb. 2007; TECStab on CBAs; Allied eHealth Network Newsletter excerpts related to child outcomes process, etc.) and on the RIGHT side of the packet you should find ECO related resources used in the SC child outcomes process and needed for your group hands on practice activities (i.e. Functional Thinking handout; Age Appropriate Development handout; COW; COSF; Decision Tree, etc). You will NOT find a copy of the slides presented today in your packet. This and all of the handouts for today’s training will be available for viewing and downloading on the TECS website under the child outcomes section.
For the sake of time and videoing, no questions will be taken during the first portion of the presentation. If you have questions please use the index cards provided to jot them down. You can give them to a TECS staff person or drop them in the box at the registration table. We will do our best to address questions during the small group activity and wrap up portions of the agenda.
If you have not paid for you lunch you need to quietly do so at this time by visiting Libby in the back of the room so that your lunch will be delivered. If you did not bring lunch, there are some close eating places that TECS staff will be glad to share with you, including a Sonic across the street and a Pania Deli about two blocks left on Garners Ferry Road.
Those of you who volunteered to bring cases should remain in this room for a brief meeting during lunch. The restrooms are just outside of the right exit doors of the auditorium to the right. There is coffee and candy in the rear of the room so help yourself.
Columbia SC,
June 11, 2007
Early Childhood Outcomes Center

2. Training Discussions to Include:
Background of child outcomes data collection
South Carolina BabyNet child outcomes process
Child outcome forms & resources
Provider input
Consensus ratings
Crosswalk, COW, COSF & developing a consensus rating with hands on practice
Today we will share with you….
Background of child outcomes data collection
South Carolina BabyNet child outcomes process
Child outcome forms & resources
Provider input
Consensus ratings
Crosswalk, COW, COSF & developing a consensus rating with hands on practice
Continuing education certificates have been prepared and will be issued at the end of the training.
Early Childhood Outcomes Center

3. Your Presenters Team for Early Childhood Solutions (TECS)
Dr. Lesly Wilson
Early Childhood Outcomes Center (ECO)/The National Early Childhood Technical Assistance Center (NECTAC)
Lynne Kahn
Robin Rooney
Today’s training is a joint effort of the Team for Early Childhood Solutions (TECS), Early Childhood Outcomes Center (ECO) and the National Early Childhood Technical Assistance Center (NECTAC). The presenters for today will be… Dr. Lesly Wilson, Lynne Kahn, Robin Rooney
Early Childhood Outcomes Center

4. Background for Data Collection
Hello my name is Lesly Wilson and welcome again. I am so glad to see that everyone made it here safely, as I feel we have developed a personal relationship during the training registration process!!
I want you to know that we are so fortunate to have national experts with us from the ECO and NECTAC today. Not all states have been as fortunate to have the ECO/NECTAC staff come to share their expertise, as these ladies have been extremely busy sharing their expertise and training all over the United States. SC is unique because this is the second time that TECS has presented with ECO/NECTAC concerning the child outcomes process.
With that being said we want to make sure that we optimize our time with Lynne & Robin. So please use the index cards provided to jot down any pressing questions that may arise during the presentation. And, if you don’t have index cards or need additional cards during the presentation please raise your hand an a staff person will make sure you receive some cards. Hopefully as we move through the day you will find that your questions will be addressed. However, we will do our best to address these questions during the small group time and wrap-up. Responses to those questions not addressed today will be posted on our TECS website for later review.
Now we will move into discussing the background for data collection by first re-introducing the goal of early intervention….
Early Childhood Outcomes Center

5. Goal of Early Intervention
“…To enable young children to be active and successful participants during the early childhood years and in the future in a variety of settings – in their homes with their families, in child care, in preschool or school programs, and in the community.”
(from Early Childhood Outcomes Center,
Enabling young children to be active and successful participants during early and later years of life…not just at home with their families but in a variety of settings.
Early Childhood Outcomes Center

6. Findings for Part C Results not demonstrated
“While the program has met its goal relating to the number of children served, it has not collected information on how well the program is doing to improve the educational and developmental outcomes of infants and toddlers served.”
Read more at ExpectMore.gov
In OSEP’s review of the goal of early intervention it was evident that although the quantity of children being served was increasing, there was no documented measurement of the quality within Part C or B programs. This review came at a time when all agencies/programs receiving federal funding was being analyzed closely and held accountable….
Early Childhood Outcomes Center

7. Public Policy Context Age of accountability
Accountability increasingly means looking at results, not just process
Office of Special Education Programs (OSEP) is under increasing pressure to produce outcome data on children participating in early intervention and early childhood special education programs
All government entities found themselves in what is known as the “Age of Accountability”, needing to show and document results in order to justify the level of federal funding being received with OSEP under pressure to produce outcomes of its programs.
OSEP responded by….
Early Childhood Outcomes Center

8. OSEP’s Response
Required states to submit outcome data in their Annual Performance Report (APR)
Funded the Early Childhood Outcomes Center to do research, make recommendations, and assist states
Mandating states to report outcome data in their APR and funding ECO to research, make recommendations & assist states…
Early Childhood Outcomes Center

9. OSEP Reporting Requirements: Child Outcomes
Positive social-emotional skills (including social relationships)
Acquisition and use of knowledge and skills (including early language/communication [and early literacy])
Use of appropriate behaviors to meet their needs
After much research and collaboration with stakeholders three broad outcomes were established by ECO.
Outcome 1: getting along with others
Outcome 2: children as learners
Outcome 3: meeting their needs
Early Childhood Outcomes Center

10. OSEP Reporting Categories
Percentage of children who:
a. Did not improve functioning
b. Improved functioning, but not sufficient to move nearer to functioning comparable to same-aged peers
c. Improved functioning to a level nearer to same-aged peers but did not reach it
d. Improved functioning to reach a level comparable to same-aged peers
e. Maintained functioning at a level comparable to same-aged peers
Along with the three outcome areas, five reporting categories established which focused on the percentage of functional progress of children who had received Part C services.
3 outcomes x 5 “measures” = 15 numbers
Early Childhood Outcomes Center

11. Why Collect Outcome Data?
Data on outcomes are important for state and local purposes.
To document program effectiveness
Increase in funding?
To improve programs
Identify strengths and weaknesses
Allocate support resources, such as technical assistance
And, ultimately to better serve children and families
It became critical to collect outcome data to document program effectiveness and to improve programs on a federal and state level in order to ultimately provide better services to children and families within this system.
Early Childhood Outcomes Center

12. Reporting Schedule Entry information (Age expected? Yes, No)
Was reported February 2007 for children entering between July 1, 2005, and June 30, 2006
Data in reporting categories at exit for all children who have been in the program for at least 6 months
Must be reported for the year beginning July 1, 2006
Due February 2008
Repeat with next year’s data in 2009, etc.
So, OSEP established clear reporting requirements and schedules for all states. So, OSEP essentially provided what states with the “Who”, “What” and “WHEN”. Who needed to be measured; what needed to be measured and when reporting was due. It was left up to states “HOW” to get it done with guidance from ECO.
Early Childhood Outcomes Center

13. South Carolina’s Part C Process
Now we will look at the “How” as outlined in the Outcomes Manual which can be found in the appendix of the BabyNet Policy Manual. It is very important that each of you go through the online training, take some time to familiarize yourselves with the outcomes manual, and frequently visit the TECS website’s child outcomes section for information regarding BabyNet child outcomes process.
Early Childhood Outcomes Center

14. “HOW” will South Carolina collect outcome data?
Data collected at ENTRY and EXIT of BabyNet system.
ENTRY= completion the IFSP process for initiation of services in system
EXIT= completion of the IFSP for transition/discharge from system
See sections for further details concerning inclusions and exclusion of data capturing.
Early Childhood Outcomes Center

15. Data Exclusions children 24 months or older at ENTRY
children who have received less than 6 months
Early Childhood Outcomes Center

16. ECO Resources used in South Carolina
COW (modified resource)
COSF
Decision Tree
Crosswalks
ECO has developed and made available several resources for use by states. I want to spend some time discussing the COW and the COSF, as Lynne & Robbin will talk more about the Decision Tree & Crosswalks. South Carolina has adopted all of the resources made available with adaptations made to the COSF to develop our state specific COW. The COW was developed from the pretenses of the COSF.
Early Childhood Outcomes Center

17. The COW verses the COSF:
Both forms provide the same critical content information needed for determining a consensus rating
The process for gather information for both forms are the same
For further information regarding the COW and COSF refer to Part 1: Child Outcomes Sections 2.1 and 2.2 in child outcomes manual.
Early Childhood Outcomes Center

18. The Child Outcomes Worksheet (COW)
Unique to South Carolina
Completed only by Service Coordinator (Intake/Fast Track/Ongoing)
Early Childhood Outcomes Center

19. The Child Outcomes Worksheet (COW)
Provides foundational information regarding child’s functional status captured from CBA and family input
A communication tool between the Service Coordinator and other team members
A guide to be completed by the Service Coordinator only
Early Childhood Outcomes Center

20. The Child Outcome Summary Form (COSF)
Used by at least 30 states to capture outcomes data
Completed by team members and includes a rating for each outcome area
Includes the functional status category progress measure
Includes “yes” or “no” choice option
Early Childhood Outcomes Center

21. Entry Status Data Capture: Intake Coordinator/Fast Track Coordinator
Gathers current functional status
input from:
1) family
2) early care educator
3) cross-walked CBA items
4) any existing providers
Service Coordinator
Documents input
on the
Child Outcome
Worksheet (COW)
Based on input &
Decision Tree process,
assigns child an
Entry Rating on each
of the three outcomes
Documents Entry Rating
on-line AND
places completed
COW with
a Copy of online inputted
Entry Rating
in child’s file
Now we will discuss the entry and exit processes. These processes are clearly outlined in Part 1: Child Outcomes section 2.4 of manual.
The Intake Coordinator/Fast Track Coordinator:
Gathers all necessary information from all sources of input during 45-day SPOE process
Completes the Child Outcome Worksheet (COW) on all three child outcomes
Uses the Decision Tree to determine a Summary Entry Rating for child in each outcome area
Documents Entry Rating in data system, prints on-line page, and
Files all supporting evidence as a part of child’s BabyNet Educational Record
Now, you’re going to describe the process for Service Providers…
Early Childhood Outcomes Center

22. Reporting Data Entry Rating: Based on COW consensus rating.
There should be three pieces of data inputted at ENTRY, one rating for each outcome.
A copy of COW with rating should be stored in child’s record in order to follow child through the system and to be available at EXIT.
BNIC/Fast Track Coordinator documents the team ENTRY rating during the development of the initial IFSP. Note that either the COW can be completed during the entry process as typically service coordination maybe the only service at time of entry. If this is the case the SC can complete a COW and determine rating using the decision tree with no additional need to complete a COSF on the child at entry. Rating would only be based on both COW and COSF if additional providers were providing services at time of entry.
The ENTRY rating for each outcome area is the only information that the BNIC/Fast Track Coordinator should submit into the online data system. (one rating for each area or three pieces of data). Remember to place the hard copy of the COW in the child’s record so that it can follow child through the system and be available at EXIT.
It is important to remember that all ratings entered into the online data system should be based on team input, however the BNSC is responsible for coordination and reporting during the rating process.
Early Childhood Outcomes Center

23. Exit Status Data Capture: Ongoing Service Coordinator – at exit from BN
Gathers current functional status
input from:
1) family
2) early care educator
3) cross-walked CBA items
4) other relevant persons?
Documents input
on the
Child Outcome
Worksheet (COW)
Forwards to all
team members
Okay, so the child is about to exit the system. It could be that it’s time to transition b/c he’s nearing the age of 3, or it could be for other reasons that he’s exiting the system. It doesn’t make a difference in terms of collecting child outcome data. The process remains the same.
The Ongoing Service Coordinator:
Gathers input from the family, early care educator, cross-walked CBA items , "other" relevant persons and providers, and transfers this information to the COW. This document is sent to the existing BN Service Providers. They, in turn, use this information along with their tx notes and experiences with the child and family, to complete the COSF. They will determine a rating score.
These COSF documents will come back to the SC so that s/he can synthesize ratings & information from all providers.
The SC will use the Decision Tree to determine a Consensus Exit Rating for the child in each outcome area.
The last step of the process is critical.
In the on-line database, the SC documents:
both the Entry Rating and the Exit Rating,
determines a current Functional Status Category for the child on each outcome, and
documents whether New Skills have been acquired by the child.
Earlier in the presentation you heard about functional status - that is, choosing whether the child maintained function, reached function, improved function, or did not improve function relative to same-age children. This is based on the comparison of the Entry and Exit ratings.
The on-line data pages are printed and filed in the child’s record.
Using the Decision Tree, and the
all completed COSFs,
assigns an Exit Rating
Inputs on-line:
Entry Rating (present in
child’s file)
and Exit Rating
Child Status category
Yes/No – new skills
Early Childhood Outcomes Center

24. Reporting Data Exit Rating
Based on COSF consensus rating, ongoing service coordinator enters one rating for each outcome
Status category
Select one category that best reflects the difference in the child’s function between the rating at entry and at exit
New Skills
Indicate ‘YES’ or ‘NO’ for acquisition of any new skills by the child related to each outcome between entry and exit.
‘New Skills’ refers to any new skills the child has learned in this area of function, not just the CBA items
While,
The Ongoing SC will enter three pieces of information into the online data system:
EXIT rating for each outcome area,
STATUS category at time of exit for each outcome area (progress made between entry and exit) and
YES/NO to whether the child acquired any NEW SKILLS OR BEHAVIORS related to each of the three child outcomes at time of exit for each outcome area.
Early Childhood Outcomes Center

25. Reporting Data:
Data will be reported electronically using an online database system.
A link to the database is located on the TECS web site (
Data will be reported using the child’s BabyTrac ID#.
Data extractions will be on a collective level and not individualized.
Data will be stored on a secure server.
At EXIT, The consensus COSF rating will be reported into our online database system, located through a link on the TECS website. The online database will allow for electronic collection of data while supporting time efficiency for BSNCs. You will need to access the TECS website and click on the DATA link button. To access database you will need to enter the child’s BabyTrac ID#, once the system recognizes ID# access will be granted and the submission process can begin. Be sure to print a copy of the page, then click submit at the bottom of the page.
If the child’s BabyTrac ID # is not valid, access will not be granted to the online database system.
Any challenges with accessing the online database system can be addressed to Dr Wilson at with the subject line stating "Data Question". Be sure to specifically state issue and include proper contact information (i.e. your name, title, agency, and phone number). These responses will be addressed in a timely manner.
**Note that the online database system is an interim step, as BabyTrac is being prepared to support the data reporting and recording efforts for child outcomes in the near future.
Early Childhood Outcomes Center

26. Underlying Logic Need to make a documented case that …
Outcomes are better than they would have been without the program
The logic of collecting and reporting the change in children’s functional status is that this will establish ongoing documentation of the effects of participating in Part C services, relative to these three broad outcomes, are better than they would have been without participation.
We know that children will make developmental progress without intervention. The challenge is documenting that progress can be attributed to participation in Part C. The functional status categories allow us to report not just that children made progress, but also the nature of that progress, reflecting the benefit of participating in Part C.
Early Childhood Outcomes Center

27. The SC SPP/APR: the First phase of child outcomes reporting
Child outcomes is indicator #3 in the SPP
Submitted February 2007 to OSEP
Reported measure of:
% of infants and toddlers who are functioning comparable to same-aged peers.
% of infants and toddlers who are functioning below same-aged peers.
This baseline data was captured between August-December Cross-comparison of data from BabyTrac with TECS entry data found that 810 children entered system (per BabyTrac) with 346 children entry data reported (per TECS).
Early Childhood Outcomes Center

28. Outcome #1- Positive social-emotional skills
42% of children were reported as functioning comparable to same-aged peers while
58% of children were reported as functioning below same-aged peers.
810 children entering system with 346 reported into online database
Within the 58% of children functioning below their same-aged peers the greatest ratings (above 10%) were of 4 (15% of children) and 5 (27% of children). This indicates that most children are between “emerging” and “somewhat” or at “somewhat” based on the ECO rating definitions for this outcome.
Early Childhood Outcomes Center

29. Outcome #2- Acquisition and use of knowledge and skills
21% of children were reported as functioning comparable to same-aged peers while
79% of children were reported as functioning below same-aged peers.
Within the 79% of children functioning below their same-aged peers the greatest ratings (above 10%) were of 3 (14% of children), 4 (23% of children) and 5 (31% of children). This indicates that most children are at “emerging”, between emerging” and “somewhat”, or at “somewhat” based on the ECO rating definitions for this outcome.
Early Childhood Outcomes Center

30. Outcome #3- Use of appropriate behaviors to meet their needs
35% of children were reported as functioning comparable to same-aged peers while
65% of children were reported as functioning below same-aged peers.
Within the 65% of children functioning below their same-aged peers the greatest ratings (above 10%) were of 4 (18% of children) and 5 (25% of children). This indicates that most children are between “emerging” and “somewhat” or at “somewhat” based on the ECO rating definitions for this outcome.
Early Childhood Outcomes Center

31. OSEP Reporting Categories for APR/SPP 2008- February
Percentage of children who:
a. Did not improve functioning
b. Improved functioning, but not sufficient to move nearer to functioning comparable to same-aged peers
c. Improved functioning to a level nearer to same-aged peers but did not reach it
d. Improved functioning to reach a level comparable to same-aged peers
e. Maintained functioning at a level comparable to same-aged peers
In 2008 all states including SC will report the on the children with baseline collected data reported in 2007 the % of children who improved within the five categories.
Data is continuing to be collected for this reporting cycle. As we are in the data verification phase so some of you may get s or phone calls from our office as we attempt to fill in missing child ID#s or outcome data points. After all data is collected and verification process is completed, analysis of data will be completed and then a final report will be generated. All data must be shared with the public and DHEC has made their report available via the Internet and Library.
3 outcomes x 5 “measures” = 15 numbers
Early Childhood Outcomes Center

32. SPECIAL THANKS TO: TECS STAFF Lily Nalty Libby Horton Leah Perry
Glenda York
Stephanie Hicklin
Antiono Heath (CDR student)
Marquita Heath (CDR student)
Early Childhood Outcomes Center

33. Using the Child Outcomes Summary Form
Robin Rooney and Lynne Kahn
The Early Childhood Outcomes (ECO) Center
Part C
South Carolina
June, 2007
Early Childhood Outcomes Center

34. Three Child Outcomes
Children have positive social-emotional skills (including social relationships)
Children acquire and use knowledge and skills (including early language/communication [and early literacy])
Children use appropriate behaviors to meet their needs
Early Childhood Outcomes Center

35. Goal of Early Intervention
“…To enable young children to be active and successful participants during the early childhood years and in the future in a variety of settings – in their homes with their families, in child care, in preschool or school programs, and in the community.”
(from Early Childhood Outcomes Center,
Early Childhood Outcomes Center

36. Refer to USING and APPLYING skills, not just having skills
Functional Outcomes
Not domain pure, not separating child development into discrete areas (communication, gross motor, etc.)
Refer to USING and APPLYING skills, not just having skills
Refer to behaviors that integrate skills across domains
The focus is functionally meaningful actions. Many assessment tools have items that measure discrete skills that aren’t individually meaningful to the child. The skills are meaningful only when they are integrated with other things so that the child can accomplish something.
Early Childhood Outcomes Center

37. Thinking about Each Outcome
How does the child show affection?
Does the child knows that an object continues to exist when it is out of sight?
How does the child interact with others?
How does the child indicate hunger?
Early Childhood Outcomes Center

38. Thinking about Each Outcome
Does the child understand and avoid danger?
Does the child know his or her name?
How does the child interact with siblings?
Does the child know where things are kept in the house (e.g., what cabinet the cereal is in)?
Early Childhood Outcomes Center

39. Assessing Functional Outcomes
What does the child do across settings and situations
How the child uses his/her skills to accomplish tasks
Not the child’s capacity to function under unusual or ideal circumstances
Not necessarily the child’s performance in a structured testing situation (“noncompliant”)
Application of knowledge and skills in more realistic situations.
Early Childhood Outcomes Center

40. Critical Assumptions Related to the Three Child Outcomes
Achievement of the outcomes is based on age expectations. Children of different ages will demonstrate achievement in different ways
There are many pathways to competence for children with atypical development (e.g., using sign language, wheelchair). This seems obvious but can get lost when an assessment tool uses a different assumption
Early Childhood Outcomes Center

41. Importance of understanding age-expected child development
Where to get refreshers on child development:
Web resources list
Many assessment tools
States’ Early Learning Guidelines or Early Childhood Standards
Early Childhood Outcomes Center

42. 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
Early Childhood Outcomes Center

43. Assessment Instruments
Assessment tools can inform us about children’s functioning in each of the three outcome areas
Challenge: There is no assessment tool that assesses the three outcomes directly
Key question:
How much and what information will a given tool provide about the attainment of the three child outcomes?
Early Childhood Outcomes Center

44. Making Use of Assessment Tool Information
Information from formal or published assessment tools can be very useful, but it needs to be understood and used in the context of achievement of the three outcomes
Teams may have additional information that paints a picture of the child that differs from one provided by an assessment. Teams may “override” the results from an assessment tool
Early Childhood Outcomes Center

45. Remember This
Flexibility is required in applying assessment tool results to the outcomes
Teams need to decide what information from an assessment tool is relevant for this child
Early Childhood Outcomes Center

46. Using Information from Assessment Tools
The ECO Center has “crosswalked” assessment tools to the outcomes
Crosswalks show which sections of assessment tools are related to each outcome
Having many items does not necessarily mean the assessment captures functioning across settings
Early Childhood Outcomes Center

47. The Carolina Curriculum for Infants and Toddlers with Special Needs, Third Edition (CCITSN): Crosswalk to Child Outcomes
Outcome 1: Has positive social relationships
Outcome 2: Acquires and uses skills and knowledge
Outcome 3: Takes appropriate action to meet needs
Personal-Social
2. Interpersonal Skills
a-bb. Smiles reciprocally, participates in simple games, approaches peer or adult to initiate play, works collaboratively toward a goal with peers, etc.
3. Self-Concept
a-t. Responds to name, plays with mirror image, expresses feelings (4 or more types), “performs” for others, shows pride in achievements, shows guilt or shame over accidents or prohibited behavior, etc.
Communication
14. Conversation Skills
a-ll. Smiles to person who is talking and/or gesturing, laughs, waits for adult to take a turn, plays reciprocal games, greets familiar people with an appropriate vocalization or sign, sustains conversation, etc
a-t. Recognizes self and others in mirror, identifies objects as “mine”, distinguishes and names self in photographs, knows age, tells own first name, answers correctly when asked if he or she is a boy or a girl, etc.
Cognition
5. Attention & Memory: Visual/Spatial
a-h. Visually fixates for at least 3 seconds, shows anticipation of regularly occurring events in everyday care, retrieves object fully hidden under a cover, reacts to a change in familiar game, retrieves objects from usual locations on request, recognizes the covers of several books and labels them, tells the name of an object or picture shown briefly and shown again in an array of four, etc.
6-II. Visual Perception: Matching & Sorting
a-d. Sorts by size, matches primary colors, sorts by shape, sorts by two characteristics, etc.
1. Self-Regulation & Responsibility
a-o. Comforts self, entertains self with toys for a short period of time, gets toys to play with from a box or shelf of toys, explores, avoids common dangers, etc.
a-t. Makes choices, says “no” or otherwise indicates refusal, resists attempts from others to assist with feedings, identifies objects as “mine”, competes with peers for toys, asks for snacks or drinks, shows determination/ persistence in choosing or continuing activities, is selective about what tasks he or she will or will not try (recognizes limitations), etc.
4-I. Self-Help: Eating
a-z. Smoothly sucks from a nipple, holds own bottle, feeds self with fingers, holds and drinks from a cup, begins to use fork, etc.
4-II. Self-Help: Dressing
a-l. Cooperates in dressing and undressing, unties shoes, removes shoes, removes coat, undoes fasteners, etc.
Early Childhood Outcomes Center

48. Ways to Use and Not Use the Crosswalks
As a general guide as to how the content of the assessment tool maps to the 3 outcomes
As a guide to help you understand the content of the 3 outcomes
Do not use
As a checklist
Remember: Lots of items does not necessarily mean the tool is a good measure of functioning in an outcome area.
Quantity may not equal quality.
Early Childhood Outcomes Center

49. Including Parents in the Discussion
Parent input about the child’s functioning is critical
Family members see the child in situations that professionals do not
Need to ask family members about what the child does at home
The team will need a way to learn what family members know about the child
The three outcome areas have been found to be a useful way of reviewing with families how their child is doing, in preparation for planning individualized IFSP outcomes
Early Childhood Outcomes Center

50. Global Program Outcomes for All Children and individualized IFSP Outcomes
Accomplishing the three global outcomes are the EI program’s purpose and intention for all participating children
Individualized IFSP outcomes reflect the route each may take in reaching these program outcomes, based on the child’s strengths and needs
The 3 global outcomes are the bottom line for whether the individualized IFSP outcomes have improved the child’s functioning in real life.
Early Childhood Outcomes Center

51. Summary Ratings Are Based on…
Types of Information
Curriculum-based assessments (e.g., HELP)
Norm-referenced assessments (e.g., BDI-2)
Developmental screenings (e.g., Ages & Stages)
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 he/she is in
Early Childhood Outcomes Center

52. Let’s look at the COSF and Instructions
Early Childhood Outcomes Center

53. What are immediate foundational skills?
Foundational skills are….
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
Immediate foundational skills are…
Skills that are conceptually linked to later skills and immediately precede the later skills developmentally
Example: Children play alongside one another before they interact in play
Early Childhood Outcomes Center

54. Special Considerations
Children with no concerns related to that outcome
Correcting for prematurity
Ratings for very young children
Children who have only articulation problems
Can a child have all 7’s? (AKA, why are we serving this child?)
Assistive technology
Early Childhood Outcomes Center

55. Always Provide Ratings for All Three Outcomes
Ratings on all three outcomes should be reported for every child enrolled
Ratings are needed in all areas even if:
No one has concerns about a child’s development.
A child has delays in one or two outcome areas, but not in all three outcome areas
Early Childhood Outcomes Center

56. Correcting for Prematurity
The purpose of the rating is to document current functioning
The ECO Center recommends not correcting for prematurity
At a later age, the child’s functioning may show a higher rating, reflecting that the child has now caught up with age expectations
Early Childhood Outcomes Center

57. Ratings for Very Young Children
It is very difficult to identify 7 points of difference for a 4 week old.
Possible solutions:
Use a limited number of points (1,3, and 7)
Don’t use the rating scale with children younger than a certain age, e.g., 4 months.
Early Childhood Outcomes Center

58. Children Who Have Only Speech Articulation Problems
Discussion needs to examine whether and how articulation difficulties are affecting the child’s functioning with regard to each of the three outcomes
Examples:
Will anyone play with him/her?
Can others understand him/her on the playground?
How does he/she convey critical needs (e.g., safety needs)?
Depending on the child, discussion could yield ratings of 5, 6, 7 in any of the three areas
Ex. Outcome 3: 6 vs. 7 because of potential impact for safety
Early Childhood Outcomes Center

59. Assistive Technology and Accommodations
Ratings should reflect the child’s level of functioning using whatever assistive technology or special accommodations are present in the child’s day-to-day settings
Early Childhood Outcomes Center

60. Where to Focus in Deciding the Rating
Focus on the child’s overall functioning across settings and situations
Functioning that is displayed rarely and/or when the child is provided with a lot of unusual support or prompts is of little significance for the rating
Early Childhood Outcomes Center

61. The Process for Answering Questions 1a, 2a, 3a
For each outcome…
Discuss the child’s current functioning in this outcome area across settings and situations
Identify areas where the child’s functioning is age appropriate
If not all functioning is age appropriate, identify areas where the child’s functioning reflects immediate foundational skills
Decide which rating best describes the child’s current functioning
Early Childhood Outcomes Center

62. the Child Outcomes Summary Form
Practice Example
with
the Child Outcomes Summary Form
We suggest starting with a case that is a slightly older child (toddler or older). We tend to find rating young infants’ behavior is more difficult.
Some states have guidelines about not doing ratings until a child is a certain age. We have heard 4 months or 6 months as the most common minimum ages.
Practice cases are always harder than real ones because everyone present doesn’t know the child. “Team members” will have an opportunity to ask lots of questions needed to try to make a decision, but it isn’t the same as when you have a knowledge base about the child to start from. So, ideally work with cases where there are at least two people who know the child—that way, you can see their slightly different impressions as well.
If the group being trained is more than 20 or 25 people, we recommend doing one or two practice cases with the entire group and then breaking into smaller groups of 10 or fewer to give each person ample opportunity to practice deciding on ratings. Ask for a recorder for each small group to note any issues that emerge that need to be addressed with the whole group. The trainer(s) need to float from group to group during small-group practice sessions and then reconvene the large group to address any questions or issues.
Early Childhood Outcomes Center

63. When practicing
Describe the child’s functioning now- not how he or she has changed
Describe so that we can picture the child; e.g. she runs to her father with a big smile and her arms up when he comes home (as opposed to has positive relationship with father)
Review the discussion prompts- right behind section 3 divider in the notebooks
For the COSf rating, we don’t need to know or understand the WHY’s of the functioning- just HOW the child is functioning
Early Childhood Outcomes Center

64. Discussing the Outcomes
One of the important things we want ___to learn is how to get along well with the people in his/ her life. Let’s talk about how ___ is doing in social relationships. We want to talk about how ___ interacts with adults and with other children. We also want to look at how s/he follows rules and participates in routines with groups.
Who are the adults in ___’s life?
Is s/he around other children? [Who?]
[if child is old enough] Is s/he in situations where she/he is expected to participate in routines with others or to follow rules related to being with others?
Early Childhood Outcomes Center

65. Strengths
Let’s start by talking about _____’s strengths in this area. What are some of ____ strengths in social relationships and getting along with others? For example,
What are the things that ___does well when it comes to relating to adults? (See conversation prompts)
What are some of his/her strengths in relating to other children?
What are some of his/her strengths when it comes to following rules or routines?
Early Childhood Outcomes Center

66. Areas of concern
What are some of the things we are concerned about/would like to work on with ___ in the area of social relationships? For example,
What are the things that we are concerned about with regard to how ____ relates to adults? (See conversation prompts)
What are some of our concerns with regard to how ____ relates to other children?
What are some of our concerns with regard to how ____ follows rules or routines?
Early Childhood Outcomes Center

67. Expectations
We know that as children develop they learn to do different things at different ages. Some of the things we would like to see children doing in this area at ___[child’s age] are……
Early Childhood Outcomes Center

68. Looking for age appropriate functioning
Is ___ doing any of the things related to social relationships that we expect to see at his/her age?
Possible answers:
Yes, he is doing ____ [See slide 92]
No, not yet. [See slide 93]
Early Childhood Outcomes Center

69. Extent of age appropriate functioning
[if yes] Would we say that all or almost all of ____’s functioning for this outcome is what we would expect to see for a child this age?
[if yes] ___ is doing really well in this area. Is there any thing related to how ___ interacts with others that we are concerned about and that we think we should monitor or give him some help with?
If no. “This means we want to say his development in this area is “completely” what we expect for a child this age.
If yes. This means we want to say his development in this area is “between completely and somewhat” for what we expect of a child this age.
[If no] Would we say that ____ rarely shows examples of what we expect to see for children this age or that she/he shows a solid mix of functioning that is age appropriate and not age appropriate yet?
If a solid mix. This means we will say that his development in this area is “somewhat” age appropriate.
If rarely. This means we will say that his development is between “emerging and somewhat”.
Early Childhood Outcomes Center

70. Looking for immediate foundational skills
[if not yet] Just before children learn to _____[age expected functioning], they _____[immediate foundational skills]?
Is ___ doing anything related to social relationships at this level?
Possible answers:
Yes, he is doing ____[slide 94]
No, not yet. This tells us we need to work with ____to help him/her develop some skills such as [immediate foundational skills] to help him improve in this area. Since _____ hasn’t yet developed what we call immediate foundational skills, we will code his development in this outcome as “Not Yet.”
Early Childhood Outcomes Center

71. Extent of Immediate Foundational Skills
[if yes] Would we say that just about most or all of ____’s functioning in this area is showing the kind of skills that develop just before what children do at this age?
[if yes] That helps us know where ___ is functioning so we can work with the skills he/she has and help him/her move to the next step. It means the rating should be “Emerging.”.
[If no] That helps us know where ___ is functioning so we can work with the skills he/she has so we can help him/her move to the next step and suggests the rating should be between “Not Yet” and “Emerging.”
Early Childhood Outcomes Center

72. Early Childhood Outcomes Center

73. Explaining the Rating to Parents
If parents are included in deciding on a rating, professionals will need to be able to explain this process to parents
Even if parents are not included in deciding on a rating, professionals will need to be able to explain why the rating is being done and what it means
The ECO Center is developing materials to help with this discussion
However, if your state develops materials before we do, please share them with us!!
Early Childhood Outcomes Center

74. Decision Tree for Summary Rating Discussions
Does the child
ever
function in wa
ys that
would be considered age
appropriate with
regard to this outcome?
Does the child use any immediate foundational skills related to this outcome on which to build age-appropriate functioning across settings and situations?
Is the child’s functioning age appropriate across all or almost all settings and situations?
To what extent is the child using immediate
foundational skills across settings and situations?
To what extent is the child using
age -
appropriate skills across
settings and situations?
Rating = 1
Rating = 2
Rating = 3
Rating = 4
Rating
= 5
Rating = 6
Rating = 7
Does anyone have
concerns about the
child’s functioning
with
regard to the
outcome area?
No (consider rating 1 3)
Yes (consider rating 4-7) No
Yes
Child rarely
uses
foundational
skills across
settings and
situations
Child uses
situations most or
all of the time
Child rarel
y uses
appropriate
skills.
There is
much more
behav
ior
that is
not age
appropriate than
appropriate.
Child uses age
appropriate skills
some of the time a
cross settings and
situations.
There is a
mix of appropriate
and not appropriate
behaviors and skills.
The Early Childhood Outcomes Center, Revised
We suggest letting teams practice with one case first and then introducing and walking through the decision tree.
Early Childhood Outcomes Center

75. More Practice with the Child Outcomes Summary Form
We suggest starting with a case that is a slightly older child (toddler or older). We tend to find rating young infants’ behavior is more difficult.
Some states have guidelines about not doing ratings until a child is a certain age. We have heard 4 months or 6 months as the most common minimum ages.
Practice cases are always harder than real ones because everyone present doesn’t know the child. “Team members” will have an opportunity to ask lots of questions needed to try to make a decision, but it isn’t the same as when you have a knowledge base about the child to start from. So, ideally work with cases where there are at least two people who know the child—that way, you can see their slightly different impressions as well.
If the group being trained is more than 20 or 25 people, we recommend doing one or two practice cases with the entire group and then breaking into smaller groups of 10 or fewer to give each person ample opportunity to practice deciding on ratings. Ask for a recorder for each small group to note any issues that emerge that need to be addressed with the whole group. The trainer(s) need to float from group to group during small-group practice sessions and then reconvene the large group to address any questions or issues.
Early Childhood Outcomes Center

76. Instructions to Small Groups
Present what is known about child with regard to outcome 1.
Examine (and record) the child’s functioning with regard to age expectations.
What is age appropriate? What is not?
What should be considered immediate foundational skills?
Decide on a rating and record it.
Repeat for outcomes 2 and 3.
Note issues, “sticky points,” or questions that arise.
Be prepared to share a case with the large group.
Early Childhood Outcomes Center

77. Documenting the Rating
On the form, you will need to document:
What evidence led to the selected rating, evidence of …..
Age expected functioning?
Immediate foundational skills
Skills and behaviors that will lead to foundational skills
Who participated in the conversation and the decision.
Documentation provides a record of the rationale for the rating decision
Early Childhood Outcomes Center

78. Why is it important to document the rating?
Evidence can be reviewed to see whether people are using the system properly (i.e., rating similar children in the same ways)
Documentation helps identify needs for future training and technical assistance
Documentation may be useful for new team members reviewing the file
Early Childhood Outcomes Center

79. Supporting Evidence for Answers to Questions 1a, 2a, 3a
Source of
information
Date
Samples/Examples of Relevant Results
Early Childhood Outcomes Center

80. Source: Who or What Contributed Information
Speech therapist
Psychologist
Mother
Battelle Developmental Inventory
Carolina Curriculum for Infants and Toddlers with Special Needs
Early Childhood Outcomes Center

81. The Progress Questions (1b, 2b, 3b)
Apply only if a Child Outcomes Summary Form has been completed previously
Compare the child’s current and past behavior
Has the child shown any new skills or behaviors in the goal area since the last rating? (Yes or No)
Small steps of progress count!
Examples…
Most will select “Yes.”
Early Childhood Outcomes Center

82. Practice with the Documenting the Ratings
We suggest starting with a case that is a slightly older child (toddler or older). We tend to find rating young infants’ behavior is more difficult.
Some states have guidelines about not doing ratings until a child is a certain age. We have heard 4 months or 6 months as the most common minimum ages.
Practice cases are always harder than real ones because everyone present doesn’t know the child. “Team members” will have an opportunity to ask lots of questions needed to try to make a decision, but it isn’t the same as when you have a knowledge base about the child to start from. So, ideally work with cases where there are at least two people who know the child—that way, you can see their slightly different impressions as well.
If the group being trained is more than 20 or 25 people, we recommend doing one or two practice cases with the entire group and then breaking into smaller groups of 10 or fewer to give each person ample opportunity to practice deciding on ratings. Ask for a recorder for each small group to note any issues that emerge that need to be addressed with the whole group. The trainer(s) need to float from group to group during small-group practice sessions and then reconvene the large group to address any questions or issues.
Early Childhood Outcomes Center

83. Group Sharing Questions? Needed clarifications? Comments? What worked?
What didn’t?
Does this seem feasible?
Do you envision using the full range of ratings?
Early Childhood Outcomes Center

84. ECO Center Next Steps for Work on Child Outcomes
Additional information, including additional crosswalks, training slides, and materials for parents, will be posted on our website
Usually somewhere in the COSF training is a section delivered by state personnel to help individuals see how this will be specifically implemented in the state. This section describes state policies, how the process fits with current activities (and tips to help it work and flow), guidelines for when and how to report ratings, what to count as entry and exit, how to handle children who leave a program in one community and move to another community within the state, expectations about who will be involved (including parent involvement), the timing and location of start-up, plans for ongoing quality assurance and opportunities to regroup and discuss what is working and what is challenging and what needs clarifying, how exit from Part C links (or doesn’t) to entry to Part B preschool, expectations about whether or not age for rating should include correction for prematurity (ECO Center recommends that it does not), minimum age of children included in rating process, how this fits with family outcome data collection, and so on. If it is a train-the-trainer session, there may be time in the day to talk about tips and expectations for training others and implementing the process.
We suggest providing trainees with PowerPoints; overview, introduction, and COSF forms; expanded detail about each of the three child outcomes (April 2005 document from the ECO Center on child outcomes, developed for recommendations to OSEP); decision tree; information about where to seek resources—information on the ECO Center and information available from the ECO Center website, resources on websites to review for more information on child development and age-expected behavior for children who are developing in typical patterns.
Early Childhood Outcomes Center