The Child Outcome Summary 7-Point Rating Scale Kathi Gillaspy, NECTAC

The Child Outcome Summary 7-Point Rating Scale

Kathi Gillaspy, NECTACSharon Ringwalt, NECTAC/MSRRC

Maryland State Department of Education/Division of Special Education/Early Intervention Services/Early Childhood

Intervention and Education Branch

Session Agenda

• Overview of the 3 Early Childhood Outcomes

• Overview of and practice with the 7-point scale

• Key concepts when choosing a rating

• Using the 7-point scale – Kim’s case study

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The Who, What, How, When and Where of the COS

3

Percentage of states using the following for child outcomes measurement: • COS = 75%• Publisher = 5%• One tool for whole state = 13%• Other = 7%

4

WHO - The 3 Early Childhood Outcomes

• Children will develop positive social and emotional skills (including social relationships).

• Children will acquire and use knowledge and skills.

• Children will use appropriate behaviors to meet their needs.

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WHAT - The 3 Early Childhood Outcomes

Global Outcomes vs. Domain specific…

• Eva communicates by waving when she sees her mother, asking for ‘nilk’ when she wants her milk, and saying “brrmmmm” when she plays with cars. She can make the sounds of a cow and a sheep. She signs help when she has trouble putting on her socks and says “Mama!” when she’s scared or shy.

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WHAT - The Child Outcomes Summary

Key Features of the COS:• It is not an assessment tool.• It uses information from assessments and observations

to get a global sense of how the child is functioning across settings and situations at one point in time in each of the 3 outcome areas.

• It uses the 7-point rating scale to rate the child’s functioning at these points in time.

• Ratings are based on the child’s functioning compared with what is expected given the child’s age.

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HOW is information used for the COS?

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Parent Input

Naturalistic Observation

RBI

Professional Opinion

Progress

& More

Assessment Results

COS

Single rating for each of

the three outcomes

WHEN is the COS completed?

• @ Initial and Exit• To what extent does the child show behaviors and skills related

to each outcome appropriate for his/her age across a variety of settings and situations? (Rating 1-7)

• @ Exit• Has the child shown any new skills or behaviors related to each

outcome since the last outcomes summary? (yes or no)

• Ratings are based on the child’s functioning:• What the child does across settings and situations• Compared with what is expected given the child’s age

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WHERE is the COS completed?

STRENGTHS AND NEEDS SUMMARY

NEW!!

The 7-Point Scale and Age-Expected Development

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Comparison to Age-Expected Development

• Children can be described with regard to how close they are to age expected behavior for each of the three outcomes.

• Most children in the population demonstrate the outcomes in age-expected ways.

• By providing services and supports, early intervention is trying to move children closer to age-expected behavior.

• Some children will never achieve this.

Age Expected, Immediate Foundational and Foundational Skills

• Age-Expected skills are those that we expect to see in children of a certain age.

• Immediate Foundational skills are the set of skills and behavior that occur developmentally just prior to age-expected functioning.

• Foundational skills are skills and behaviors that occur earlier in development and serve as the foundation for later skill development.

Why do we compare to age-expected functioning?

• Part of federal requirement• Stronger evidence of program’s effects• Set high expectations (and many do attain them),

but also celebrate different kinds of progress• Want to promote active and successful

participation now and in the future (including school readiness)

• Families want to know both individual progress and relative to age-expected (avoid being surprised later)

Steps in the process

1. Collect information about the child’s functioning across settings and situations in the 3 outcomes.

2. If needed, assemble resources on age expectations.3. Meet as a team to review the information (often at IFSP).4. Write summary of each outcome area reflecting how

child uses skills relative to age-expectations.5. Use resources (including the decision tree to discuss and

agree upon a descriptor statement (rating) for Outcome 1.

6. Repeat for Outcomes 2 and 3.

Essential knowledge for Using the 7-Point Scale

Among them, team members must:

1. Know about the child’s functioning across settings and situations

2. Understand age-expected child development

3. Understand age expectations for child functioning within the child’s culture

4. Understand the content of the three child outcomes

5. Know how to use the rating scale

The 7-Point Scale

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Thinking about children’s functioning

Movementaway fromage-expectedfunctioning

Movementtowardage-expectedfunctioning

Age-expectedskills and behavior

Early Childhood Outcomes Center18

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

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20

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

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

4• Child shows occasional age-appropriate

functioning across settings and situations • More functioning is not age-appropriate

than age-appropriate.

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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

2• Child occasionally uses immediate

foundational skills across settings and situations

• More functioning reflects skills that are not immediate foundational than are immediate foundational

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

ECO and MD Descriptor Statements

Adapted from the Early Childhood Outcomes Center and from materials developed by Naomi Younggren, DoD for EDIS

Child Outcomes Summary (COS) Ratings and Maryland COS Descriptors w/Buckets

Ove

rall

Age-A

ppro

pria

te

Completely means:

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• 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. Relative to same age peers, ______ 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]).

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• 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. Relative to same age peers, ______ has the skills that we would expect of his age in regard to (outcome); however, there are concerns with how he (functional area that is of concern/quality of ability/lacking skill).

Som

e N

ot A

ge-App

ropr

iate

/Som

e A

ge-A

ppro

pria

te

Somewhat means:

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• 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. Relative to same age peers, ______ 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).

4

• Child shows occasional age-appropriate functioning across settings and situations. More functioning is not age-appropriate than age-appropriate. Relative to same age peers, ______ shows occasional use of some age expected skills, but more of his skills are not yet age expected in the area of (outcome).

Not

Age

App

ropr

iate

Nearly means:

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*. Relative to same age peers, ______ is not yet using skills expected of his age. He does however use many important and immediate foundational skills to build upon in the area of (outcome).

2

• Child occasionally uses immediate foundational skills across settings and situations. More functioning reflects skills that are not immediate foundational than are immediate foundational. Relative to same age peers, ______ is showing some emerging or immediate foundational skills, which will help him to work toward age appropriate skills in the area of (outcome).

Not yet means:

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. Relative to same age peers, ______ functioning might be described as like that of a much younger child. He shows early skills, but not yet immediate foundational or age expected skills in the (outcome) area.

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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

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

$200

$100

$300

$200

$300

$200

$100

$300

Using the 7-Point Scale

• Kim’s Case Study

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Is the rating subjective?

• What is subjective? – “relating to the mind of the thinking

subject and not the nature of the object being considered”

• The ratings involve clinical decision making from the team– much like that used in deciding on goals

and intervention strategies

Informed Decisions

Conditions: 1. Operational definitions of

the observed attributes2. Structured rating format to

record informed opinion3. Gather data from multiple

sources4. Establish consensus-

decision making process5. Provide training to

facilitate reliable ratings

Research on clinical judgment shows that professionals can reach reliable conclusions under certain conditions

The process meets all of these conditions.

Questions?

Contact Information

Kathi Gillaspy, NECTACkathi.gillaspy@unc.edu

919.843.5950

Sharon Ringwalt, NECTAC/MSRRCsharon.ringwalt@unc.edu

919.843.2275