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The Family Outcomes Survey:Revisions, Data, Uses

Don Bailey, RTI InternationalRobin Nelson, Texas Part C Program

Nyle Robinson, Illinois Part C ProgramChelsea Guillen, Illinois Part C Program

Melissa Raspa, RTI International

Measuring Child and Family Outcomes National TA MeetingBaltimore, MDAugust 26, 2007

Goals for today

Remind everyone of the goals and format of the Family Outcomes Survey

Describe the revisions made to the survey this year and the rationale

Summarize selected data from an initial pilot study using the scale in Illinois and Texas

Describe plans to validate the scale Discuss ways the scale could be used to

help states answer questions of interest

ECO Family Outcomes

Understand their child’s strengths, abilities, and special needs

Know their rights and advocate effectively for their children

Help their children develop and learn Have support systems Access desired services, programs, activities

in their community

ECO Scale:Family Outcomes Survey

Three items for each of the five proposed family outcomes

Each item rated on a scale from 1-7 Descriptive statements for ratings of 1, 3, 5, 7 Blanks left for “in between” ratings of 2, 4, 6 Three additional items for states to use in

responding to APR requirements (two versions, one for Part C, one for Part B)

UNDERSTANDING YOUR CHILD'S STRENGTHS, ABILITIES, AND SPECIAL NEEDS

1.Your child is growing and learning. How much does your family understand about your child’s development?

12 3 4 5 6 7

We are just beginning to understand our child's development

We understand some about our child's development

We understand a good amount about our child's development

We understand a great deal about our child's development

2. Some children have special health needs, a disability, or are delayed in their development. These are often referred to as “special needs.” How familiar is your family with your child's special needs?

12 3 4 5 6 7

We are just beginning to understand our child’s special needs

We understand some about our child’s special needs

We understand a good amount about our child’s special needs

We understand a great deal about our child’s special needs

3. Professionals who work with you and your child want to know if the things they do are working. How often is your family able to tell if your child is making progress?

12 3 4 5 6 7

We seldom can tell if our child is making progress

We sometimes can tell if our child is making progress

We usually can tell if our child is making progress

We almost always can tell if our child is making progress

THE HELPFULNESS OF EARLY INTERVENTIONThe next questions ask how well early intervention has helped your family. When answering, think about the early intervention services you have received.

16. To what extent has early intervention helped your family know and understand your rights?

1 2 3 4 5 6 7

Early intervention has done a poor job of helping us know our rights

Early intervention has done a fair job of helping us know our rights

Early intervention has done a good job of helping us know our rights

Early intervention has done an excellent job of helping us know our rights

17. To what extent has early intervention helped your family effectively communicate your child’s needs?

1 2 3 4 5 6 7

Early intervention has done a poor job of helping us communicate our child’s needs

Early intervention has done a fair job of helping us communicate our child’s needs

Early intervention has done a good job of helping us communicate our child’s needs

Early intervention has done an excellent job of helping us communicate our child’s needs

18. To what extent has early intervention helped your family be able to help your child develop and learn?

1 2 3 4 5 6 7

Early intervention has done a poor job of helping us help our child develop and learn

Early intervention has done a fair job of helping us help our child develop and learn

Early intervention has done a good job of helping us help our child develop and learn

Early intervention has done an excellent job of helping us help our child develop and learn

What have we done in the past year?

States have begun to use the instrument Conducted a pilot study in Illinois and Texas

(summer, 2006) Reviewed and revised the scale (fall, 2006) Submitted application to IES to validate the scale

(summer, 2007) Completed cognitive testing of scale with Spanish

speaking families (summer, 2007) Currently conducting a second, larger pilot study in

Illinois and Texas (summer, 2007)

Questions Addressed in Pilot Study

How should the survey be distributed and what response rates might be expected?

What distribution of responses is seen for each item? Are respondents more likely to pick the odd

numbered items? How did responses on the APR items compare with

the outcome items? Did patterns of responses differ across the states? Did ratings of outcomes vary as a function of

language of the survey (English vs. Spanish?) What is the internal reliability of the instrument?

Methodological Similarities

Identical survey Similar accompanying materials Distribution method almost

identical Identical return mail methods Timeframe was almost the same

Differences in Approach

Texas used sampling Illinois surveyed all programs statewide Illinois found that IFSPs near 3 were

often extended, new meetings not held So, Illinois did not distribute surveys within

3 months of age 3 during the pilot Texas did more follow-up, utilized

replacement, Illinois depended on volume

Sampling, Distribution, Return Rates

Illinois Did not sample Distributed 1,976 surveys at 6-month and/or annual reviews

Texas Stratified programs by region and size Randomly selected 3 programs from 7 regions Randomly selected 1262 families

Return rates Texas – 44%, representative Illinois – 29%, not as representative

Data presented today represent 890 surveys (~100 Spanish)

Additional Construct: Looking Towards the Future

Both states added three additional items to the survey to assess: Current life situation Transition preparation Future life situation

Understanding Your Child’s Strengths, Abilities & Special Needs

0

10

20

30

40

50

60

Perc

enta

ge

1 2 3 4 5 6 7

Response

Item 1: How well do you understand your child's development?

Understanding Your Child’s Strengths, Abilities & Special Needs

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 2: How much do you know about your child's special needs?

Understanding Your Child’s Strengths, Abilities & Special Needs

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 3: Are you able to tell if your child is making progress?

Knowing Your Rights & AdvocatingFor Your Child

0

10

20

30

40

50

60

Perc

enta

ge

1 2 3 4 5 6 7

Response

Item 4: Do you know what programs and services are available for your child and family?

Knowing Your Rights & AdvocatingFor Your Child

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 5: How comfortable are you participating in meetings with professionals to plan services or activities?

Knowing Your Rights & AdvocatingFor Your Child

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 6: How well do you know your rights and what to do if you are not satisfied?

Helping Your Child Develop & Learn

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 7: How would you describe your ability to help your child develop and learn

Helping Your Child Develop & Learn

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 8: How would you describe your ability to help your child learn to behave the way you would like?

Helping Your Child Develop & Learn

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 9: How much are you able to help your child learn or practice new skills at home or in the community?

Having Support Systems

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 10: Does your family have someone you trust to listen and talk with you?

Having Support Systems

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 11: Do you have someone you can call on when you need help with things?

Having Support Systems

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 12: How much is your family able to do the things you enjoy?

Accessing Your Community

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 13: How would you describe the medical care you have for your child right now?

Accessing Your Community

0

10

20

30

40

50

60

Perc

enta

ge

1 2 3 4 5 6 7 NA

Response

Item 14: How would you describe the child care you have for your child right now?

Accessing Your Community

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7 NA

Response

Item 15: How would you describe your child's participation in activities right now?

Findings on Range of Responses

The items generated a range of responses We are not getting a normal distribution at the

item level, but what kind of distribution would you expect?

Ratings vary across items, suggesting that parents respond differentially and specifically to each item

77% of responses used the odd-numbered ratings (the ones with descriptors)

Knowing and Understanding Rights

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 6: How well do you know your rights and what to do if you are not

satisfied?

Knowing and Understanding Rights

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 6: How well do you know your rights and what to do if you are not

satisfied? (Mean = 4.81)

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 16: To what extent has early intervention helped you know and

understand your rights? (Mean = 5.54)

Helping your Child Develop and Learn

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 7: How would you describe your ability to help your child develop and

learn?

Helping your Child Develop and Learn

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 7: How would you describe your ability to help your child develop and

learn? (Mean = 5.11)

0

10

20

30

40

50

60

Per

cent

age

1 2 3 4 5 6 7

Response

Item 18: To what extent has early intervention helped your family be able to help your child develop and learn?

(Mean = 5.98)

Summary Comments and Analyses of APR and Outcome Items

The two sets of items do not generate equivalent response patterns

APR items more likely to have ratings of 6 and 7

Correlations are moderate .58 knowing rights .44 helping child develop and learn .26 communicate needs

Other Findings

IL & TX had almost identical mean scores across items, although patterns across some items differed

Same highest (EI help child dev & learn) and lowest (participation in activities) rated items

High internal consistency for total scale and OSEP items (Cronbach’s alpha > .90)

Factor analysis yields 1-2 factors Means for Spanish-speakers considerably

lower than English-speakers on most items

Specific Question Comparisons

IL slightly higher on “access to medical care” Better, more inclusive Medicaid system

TX slightly higher on “knowledge of rights” Both states have strong emphasis; does service

model make a difference? IL lower on “transition preparation”

Already aware of the problem, IL has put considerable emphasis on improving transition

Example: Effects of Primary Language (English vs. Spanish)

beginning to learn

programs and srvcs

2 3 4 5 6 very aware of program

and srvcs

know available services

0

10

20

30

40

Perc

ent

Lang

Eng

Spa

Example: Effects of Primary Language (English vs. Spanish)

beginning to learn

programs and srvcs

2 3 4 5 6 very aware of program

and srvcs

know available services

0

10

20

30

40

Perc

ent

Lang

Eng

Spa

just beginning 2

34

56

understand very well

understand child's development

0

10

20

30

40

50

Perc

ent

Lang

Eng

Spa

Value of Comparisons

Does service model make a difference? Texas SC has more contact with family

Did Illinois exclusion of kids nearest exit have an impact? Families were receiving services longer

Effect of demographics? Culture, acculturation

Demographic Comparisons

Illinois 55% White 24% Hispanic 17% Black 3% Asian 13% primary

language Spanish 60% Medicaid

Texas 38% White 47% Hispanic 12% Black 2% Asian 19% primary

language Spanish 61% Medicaid

Scale Revision

Systematic review by survey methodologists

Cognitive testing with 12 parents

Results from Scale Analysis

Problems identified with unclear meanings and inconsistencies across items

MUCH back and forth between methodologists and IL/TX folks about specific wording, resulting in significant revision (rewording only, same format and # items

Revised instrument now available on ECO web site

Consistent Set of Descriptors Used at Each Level

7 Great deal, almost always, very,

almost all, excellent 5 Usually, good amount, generally,

many, good 3 Some, sometimes, somewhat, fair 1 Just beginning, seldom, few, poor

Changes in APR Item Modifiers

Old Version1 - EI has not

helped…3 - EI has done a

few things…5 - EI has provided

good help…7 – EI has provided

excellent help…

Current Version1 – EI has done a

poor job…3 – EI has done a

fair job5 – EI has done a

good job7 - EI has done an

excellent job

IES Application: Validating the Family Outcomes Survey

Specific Aim 1: Determine the test-retest reliability of the FOS by examining stability of scores over a short (two-week) period of time.

Specific Aim 2: Establish the criterion validity of scores on the FOS by examining its relationship with six well-established criterion measures of family well being, addressing family empowerment, social support, parenting self-efficacy, quality of life, hope, and parenting stress.

Specific Aim 3: Determine sensitivity to change in scores on the FOS by comparing changes in family outcomes over 18-months to changes in scores on the six criterion measures.

Specific Aim 4: Document the convergent validity of scores on the FOS by examining the relationship between changes in family outcomes over 18 months and the extent to which early intervention programs used recommended practices in providing services to families.

Using the Family Outcomes Survey:What are the possibilities?

Using the scale to describe and classify outcomes attained by families

Using the scale to identify child, family, or program variables associated with outcome attainment

Using the scale to improve programs at the state or local level

Using the scale to work with individual families

Data Uses

How can states use the data from the Family Outcomes Survey to help identify both the “success stories” of early intervention and the families who may need more immediate help?

How do states track the progress of families in early intervention?

How can states examine the relationship between the quality and delivery of services and family outcomes?

Are family outcomes related to child outcomes?

Data Uses

Three areas of analysis Measurement-related analyses

Internal consistency Factor structure

Descriptive analyses Basic descriptive statistics Grouping families

Predictive analyses Describing variation between families Predicting variation between families

Measurement-Related Analyses

Internal consistency Total scale Five subscales

Factor Structure One factor Multiple factors

Descriptive Analyses

Basic descriptive statistics Mean, min, max, standard deviation

Threshold scores 5 or higher = outcome attained 3 or lower = “score of concern”

Score variation Most variable respondent Least variable respondent

Descriptive Analyses

Grouping families with similar response patterns Empirically derived

Success stories (scores of 5 or higher) Borderline (scores consistently 3 to 5) Immediate concern (scores 3 or below)

Statistically derived Clusters of families with similar response

patterns

Predictive Analyses

Two types of analyses: describing variation and predicting variation

Three types of “predictor variables” Child and family variables (e.g., health

status, eligibility, ethnicity, income, mother’s education)

Service quality variables (e.g., family-centered practices)

Service delivery or models (e.g., service coordination model, amount of services, location of services)

Predictive Analyses

Describing variation between families Do outcomes vary by child and family

characteristics? Does the quality of early intervention

services relate to family outcomes? Are service delivery models

associated with family outcomes?

Predictive Analyses

Predicting variation between families Do families of children who just entered

early intervention have lower family outcomes than families whose children have been receiving services for a longer period of time?

Is a dedicated and not independent service coordination model associated with better family outcomes?

Family Outcomes vs. Child Outcomes

Needs

Family

Concerns

Resources Priorities

Goals

ChildDevelopmental Status

Functional Abilities

Disability Type

Learning Style

Early Intervention

Child-Focused Services

Family-Focused Services

· Demonstrate positive social – emotional skills

· Acquire and use knowledge and skills

· Use appropriate behavior to meet needs

· Understand child’s abilities and special needs

· Know rights and advocate effectively

· Help child develop and learn

· Have support systems· Access the community

Child Outcomes

Family Outcomes

Discussion