Module 4 Guidance for Completing the SFP and COS Rating Within the Team Process

1. Every day, we are honored to take action that inspires the world to discover, love and nurture the greatness in all children. Module 4Guidance for Completing theSFP and COS Rating Within the Team Process

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 Kids' Potential, Our Purpose

3. The Present Levels of Development (PLODs) • The PLODs are intended to: • Be a brief summary of assessment results by domain • Focus on what the child can and cannot yet do • Include the child’s developmental level (e.g., % delay, age-equivalent, standard deviations) • Be used to determine eligibility for Part C services See the IFSP Resource Guide: http://www.del.wa.gov/publications/esit/docs/IFSP_Resource_Guide.pdf Kids' Potential, Our Purpose

4. By Comparison: The Summary of Functional Performance and COS • For each outcome, you will: • Synthesize all information about the child and provide a brief summary of the child’s functioning across settings and situations in that outcome area • Select a “descriptor statement” that best matches the child’s functioning relative to age expectations Kids' Potential, Our Purpose

5. Differences Kids' Potential, Our Purpose

6. SFP vs. PLOD Knowledge Check 2. True or False The SFP is useful for determining the child’s program eligibility. True or False The SFP is an open space on the IFSP to repeat and re-emphasize statements about a child’s skills that were recorded on the PLOD. Kids' Potential, Our Purpose

7. SFP vs. PLOD Knowledge Check 2. True or False: The SFP is useful for determining the child’s program eligibility. False • True or False: The SFP is an open space on the IFSP to repeat and re-emphasize statements about a child’s skills that were recorded on the PLOD. False Kids' Potential, Our Purpose

8. Completing a Summary of Functional Performance for Each Outcome • Do not simply repeat PLOD statements • The summary should paint a picture of how the child uses his/her skills in everyday functioning • Specifics about what the child does and how • Specifics about that the child does not yet do Example: Alex has three words: Mama, Dada, and No • PLODs: Alex has three words • SFP: Alex uses three words. He says Mama and Da when he wants help or when he wants to show his parents something. He is only using them at home, not when he’s out in public with his parents. Kids' Potential, Our Purpose

9. Summary of Functional Performance… For Each Outcome • Describe how the child uses his/her skills across domains in meaningful ways related to the outcome • Include examples of things the child does and does not yet do and a sense of the mix of skills observed • Include information from multiple sources and observations across settings • Include specific examples of the child’s functioning related to the range of content for each outcome Kids' Potential, Our Purpose

10. Summary of Functional Performance… For Each Outcome (Continued) • Include information from one or more assessment tools • Describe functioning with respect to age-expected functioning, immediate foundational skills, and/or foundational skills as appropriate to provide support for the descriptor statement • Describe functioning at the current point in time (that is, do not compare functioning to a previous time point) Kids' Potential, Our Purpose

11. Reflection • How are you gathering information beyond the assessment tools that you use? • What types of information do you collect? What else do you need to collect? • How do you incorporate that information in the IFSP process? Kids' Potential, Our Purpose

12. Why is it important to document the child’s functioning? Documentation… • Provides a record of the rationale for the rating decision • Provides quality assurance information so others can see whether people are using the system consistently and appropriately (i.e., using definitions, rating similar children in the same ways) • Helps identify needs for future training and technical assistance • Describes the child’s functioning for new team members reviewing the file Kids' Potential, Our Purpose

13. How much to write? Write enough to provide a rich (but not overly long) description of how the child is doing in the outcome. The writing should provide evidence to support the descriptor statement that the team selects. Kids' Potential, Our Purpose

14. Example 1: Alex, 23 monthsSummary of Functional Performance Alex can say 3 words, however, these can be difficult for others outside the family to understand and are rarely heard other than during quiet times with his parents at home and during play with Dad, with the exception of the word, “No.” He does not yet use words other than “no,” “Mama,” and “Da” regularly across settings and situations. He points to items that he wants, and understands familiar, recurring 2-step directions like going to get his shoes and bringing them to his Mom when he is getting ready to leave the house. Alex uses gestures effectively to communicate when calm, but often gets overwhelmed in social situations with peers or in loud settings and may cry, scream, hit, or kick when he is frustrated rather than using gestures or words. He will listen to a short story, but usually loses interest after about two minutes. He can point to pictures in a book and sometimes jabbers along with the adult reading the book, imitating the adult’s voice and some of the sounds in the words they use. Alex responds to his own name and recognizes lots of objects, showing his understanding of named objects by pointing to them from pictures or picking them out of a group. Alex’s talking includes lots of jabbering that sounds like sentences.   Kids' Potential, Our Purpose

15. Example 1: Alex, 23 months What did you notice? Kids' Potential, Our Purpose

16. Example 2: Kim, 17 monthsSummary of Functional Performance In regards to Outcome 3, using appropriate behavior to get needs met, Kim: • holds objects when placed in her hand (toys, spoon) but is still working on picking them up herself • knows what she wants, but often cries and fusses when she is not understood and cannot yet convey those wishes using words or actions • has not yet begun to use toys as tools to get other toys or interact with toys in sequences of exploratory actions like other children the same age • eats mostly baby food, taking between 5-10 spoonfuls of food that is fed to her per meal, seated in an adapted high chair • eats small meals every 3-4 hours; is tube fed twice a day and is on a feeding tube at night • not yet able to assist in dressing or bathing due to her motor challenges • able to move short distances forward (twisting her body to inch along) and is motivated to attempt to get her toys, with occasional success at touching a toy, but not yet picking it up Kids' Potential, Our Purpose

17. Example 2: Kim, 17 months What did you notice in this example? Kids' Potential, Our Purpose

18. SFP vs. PLODs How is this description different from information you might find if you just looked at the PLOD? • Child’s skills domain by domain • Assessment tools individually Kids' Potential, Our Purpose

19. Kim’s abilities by Domain

20. Reflection Think about: • What would you do to improve the way teams in your program write the Summary of Functional Performance section ? • Can others easily read it and have enough specific information to see how and why you chose the descriptor statement you did? • What differences do you see between your Summary of Functional Performance and PLOD sections? Kids' Potential, Our Purpose

21. SFP and PLODs IFSP Process and Resource Guide: http://www.del.wa.gov/publications/esit/docs/IFSP_Resource_Guide.pdf Kids' Potential, Our Purpose

22. The Collaborative Team Process Kids' Potential, Our Purpose

23. Teaming and Collaboration DEC Recommended Practices: Teaming and collaboration practices promote and sustain collaborative adult partnerships, relationships, and ongoing interactions to ensure that programs and services achieve desired child and outcomes and goals. Kids' Potential, Our Purpose

24. Teaming in Early Intervention • Teaming is well-established as a key component of providing high quality early intervention services to young children with disabilities and their families. • The word “team” appears 49 times in the Individuals with Disabilities Education Act (IDEA) Kids' Potential, Our Purpose

25. Why do we team? Many young children’s developmental needs are too complex to be addressed by a single discipline. Kids' Potential, Our Purpose

26. Why do we team for the Summary of Functional Performance and COS Rating? • Determining the correct rating at entry and exit requires knowledge of the SFP process AND knowledge of the child across settings and situations. • Multiple perspectives on the child’s functioning increase the likelihood of selecting a rating that accurately reflects what the child can and cannot do. Kids' Potential, Our Purpose

27. WA Expectations • The SFP should not be completed by just sending reports to the FRC, or selecting descriptor statements individually and hoping it matches the FRC’s or parents’ input • It is a part of the IFSP meeting • It is a discussion with the family and all members of the team together • It can be face to face or through meeting participation over the phone Kids' Potential, Our Purpose

28. Who should be on the child’s team? • Individuals who can contribute knowledge about the child’s functioning across settings and situations in the three outcomes areas. • Examples: early interventionists, child care providers, therapists, FRCs, and families Kids' Potential, Our Purpose

29. Essential Knowledge for the SFP and COS Ratings Among them, team members must: • Know about the child’s functioning across settings and situations • Understand age-expected child development • Understand age expectations for child functioning within the child’s culture • Understand the content of the three child outcomes • Know how to use the rating scale Kids' Potential, Our Purpose

30. Quote None of us is as smart as all of us. - Ken Blanchard Kids' Potential, Our Purpose

31. Reflection • What does your team look like? Are there others that should be involved? • How does your team composition reflect understanding of all five areas of essential knowledge for the Summary of Functional Performance? Kids' Potential, Our Purpose

32. The Team Discussion Process • The team describes the child’s functioning (not just test scores or ratings) • The child’s current functioning is considered relative to what is seen in same-age peers • Discussion includes the child’s full range of functioning (describing skills that are immediate foundational or foundational) • The summary of functional performance written by the team on the IFSP describes the child’s functioning and serves as the rationale for the descriptor statement • Decide which descriptor statement best describes the child’s current functioning Kids' Potential, Our Purpose

33. Descriptor Statements Early Childhood Outcomes Center Kids' Potential, Our Purpose

34. In a high-quality team discussion… • All team members participate • Parent input is respectfully elicited and used to inform the selection of the descriptor statement • Multiple sources of assessment information are considered (observation, family report, formal ‘testing’) • Discussion focuses on the child’s functioning on the outcomes and includes the full range of content of the outcome • Group reaches consensus on rating Kids' Potential, Our Purpose

35. Tools • Using the decision tree as a guide and language of descriptor statements will: • Help make the process family-centered • Produce more valid, consistent ratings • Focus examples shared to more efficiently fit discussion into time available/meeting flow • Family outcomes brochure on ESIT website will help introduce the outcomes and summary process to families Kids' Potential, Our Purpose

36. 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 Kids' Potential, Our Purpose

37. Suggestions for reaching consensus on SFP and COS ratings • Whole team participation in the process • Re-visit process – describe functioning first, not # • Focus on outcome content – considering range of outcome content, does the skill fit, is it functional? • Share examples – settings, situations, supports, and describe if view as AE, IF, F (do not correct for prematurity) • Include more discussion about skills that would be seen in a child with typical developmental patterns for comparison See https://del-public-files.s3-us-west-2.amazonaws.com/ESIT/Consensus.pdf Kids' Potential, Our Purpose

38. Example probe in team discussion • Tell me about the kinds of evidence that suggest to you this child has [AE, IF, F] functioning in this outcome? • When have you observed those skills? In what situations? • How frequently does that occur? • Were the accommodations/supports available in that setting? What were they? • Are there other steps in the sequence of development that need to occur between developing this skill and the skills same-aged peers display (AE) in this area? (when an IF skill is identified) • Is there other information we need to be better equipped to make this decision? Kids' Potential, Our Purpose

39. Reflection Think about your recent teaming on the summary of functional performance. • What could you do to facilitate higher quality team discussions in the future ? • What else would help other teams in your program also have high quality discussions? Kids' Potential, Our Purpose

40. 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 summary of functional performance ratings involve clinical decision making from the team • much like that used in deciding on outcomes and intervention strategies Kids' Potential, Our Purpose

41. Effective Team Decisions Research on clinical judgment shows that professionals can reach reliable conclusions under certain conditions. The SFP meets all of these conditions. Kids' Potential, Our Purpose

42. Validation of the Summary of Functional Performance • The Summary of Functional Performance* is currently being studied to validate the conditions under which the process provides the most meaningful information. • See the ENHANCE project for more information http://enhance.sri.com • Surveys, team decision-making videos, and a longitudinal study are all underway. * In other states, the summary of functional performance is called the Child Outcomes Summary (COS) process. Kids' Potential, Our Purpose

43. Emerging National Validity Evidence Across studies using different methods, evidence supports the following validity claims: • Minimal indication of explicit intent to alter ratings or teams selecting ratings intentionally to make the program look good. • Trained teams apply accurate knowledge of which skills relate to various outcomes. • Trained teams assign ratings consistent with rating criteria. • Children with more severe impairments receive lower ratings. • Ratings at exit from Part C are consistent with other state-wide information, including the percentage of children subsequently eligible for Part B Preschool services. Kids' Potential, Our Purpose

44. When to complete ratings ESIT requires selection of descriptor statement (rating) at entry and exit • Optional at intervening times, such as at the annual IFSP review • Benefits of interim use: • Consistency in team actions – familiar each time to caregivers/team • - Promotes good discussions about child’s functioning with caregivers • - Will have a more recent rating if family exits suddenly Kids' Potential, Our Purpose

45. IF completing the 2nd, 3rd, etc., rating • Do NOT look at the previous rating. Each rating is independent and is to be based on where the child functioning is now. • Looking at the previous rating can introduce bias into the rating process. • Complete the progress question. Kids' Potential, Our Purpose

46. The SFP in the DMS Kids' Potential, Our Purpose

47. The “progress” question • This question is answered “yes” if the child has acquired ANY new skill or shown any improvement related to this outcome since the last summary of functional performance, e.g., • Using one new word • Using one new gesture b. Has the child shown any new skills or behaviors related to [this outcome] since the last outcomes summary? Kids' Potential, Our Purpose

48. Team Ratings of Functioning Kids' Potential, Our Purpose

49. Knowledge Check 2. The SFP summary should include: • Specific statements about the child’s current functioning. • Specific statements about skills the child does not yet use or cannot yet do. • Functional assessment information • Information anchoring the child’s skills against age-expected functioning • All of these 1. True or False. Since every child is unique, I need to write a specific, individualized descriptor statement for each child. Kids' Potential, Our Purpose

50. Knowledge Check 2.The SFP summary should include: e: “all of these” 1. True or False: Since every child is unique, I need to write a specific, individualized descriptor statement for each child. False Kids' Potential, Our Purpose