1. The Three Global Outcomes
Section 6
Facilitator’s Notes:
This section walks through the process for determination of the child’s strengths, needs and child outcomes summary rating in each of the 3 Global Outcomes.
Handouts Needed for Section 6: The Three Global Outcomes
Noah’s IFSP
Josie’s IFSP
3 Global Outcomes Description and Considerations
ECO Center Child Outcomes Discussion Prompts (Resources)
Colorado Global Outcomes Guiding Questions
UNICORN Global Outcomes Tab Screenshot (Resources)
Colorado Global Outcomes Family Worksheet (Resources)
Timelines for Child Outcomes Summary Ratings (Resources)
Decision Tree for Child Outcomes Summary Process (Colorado)
Maryland’s Strengths and Needs Summary/Matthew
The Three Global Outcomes

2. Key Principles for Early Intervention Service Provision
Infants and toddlers learn best through every day experiences and interactions with familiar people in familiar contexts
All families, with the necessary supports and resources, can enhance their children’s learning and development
The primary role of the service provider in early intervention is to work with and support the family members and caregivers in a child’s life
IFSP outcomes must be functional and based on children’s and families’ needs and priorities
OSEP TA Communities of Practice – Part C Settings
Facilitator’s Notes:
The section is primarily related to the first four Key Principles for Early Intervention Service Provision.

3. Key Points
The 3 global outcomes are discussed with the family in relation to the whole process from referral to transition
A rating at entry and exit is required for the Office of Special Education Programs (OSEP), annual ratings will be conducted as part of the IFSP and entered into the UNICORN but not submitted to OSEP
The 3 global outcomes will be discussed at each IFSP meeting
Facilitator’s Notes:
Review with participants. Note that Colorado has determined that the global outcomes will be reviewed and determined annually. This is in addition to requirements of OSEP. Reviewing the global outcomes along with the annual IFSP will give us valuable information and allow for “course correction” if we see that a child is not showing progress in one of the global outcomes areas.

4. Resources 3 Global Outcomes Description and Considerations
ECO Center Child Outcomes Discussion Prompts (Resources)
Colorado Global Outcomes Guiding Questions (Activities)
UNICORN Global Outcomes Tab Screenshot (Resources)
Timelines for Child Outcomes Summary Ratings (Resources)
Decision Tree (Activities)
Maryland’s Strengths and Needs Summary/Matthew (Activities)
Facilitator’s Notes:
Review handouts with participants. Discuss the difference between the terminology of Global Outcomes and Child Outcomes Summary rating and when those terms are used.
Global Outcomes: the process of determining and documenting the child’s strengths and needs in relation to the 3 global outcomes areas
Child Outcomes Summary Rating: the determination of where the child falls in each global outcome area. This determination is made by determining the level of skills the child is demonstrating (age-expected, immediate foundational, and foundational) and how often they are demonstrating that skill level. -

5. Functional Global Outcomes
Snapshot of the whole child
Provides status of child’s current functioning
Looks across all settings and situations
Functional global outcomes are not the child’s capacity to function under ideal or unusual circumstances, skill by skill, domain by domain
Facilitator’s Notes:
Review with participants. Consider if the child can carry out meaningful behaviors in a meaningful context, NOT if the child can perform discrete behaviors such as knowing 10 words, stacking 3 blocks, has a pincer grasp, or can walk backward.
Good questions to ask to gain information to help with the determination of global outcomes are;
What does the child usually do?
How does the child use her skills to accomplish tasks?
How does the child interact with others during activities?

6. What Makes it Functional???
The 3 global outcomes are functional in the sense that they refer to behaviors, knowledge, and skills that are meaningful for all children in their everyday lives
Functional outcomes represent an integrated series of behaviors or skills that allow the child to achieve important everyday goals.
Asks how the child uses skills in action across settings and situations to accomplish things meaningful to him/her, not just his/her ability to show a skill in a specific or isolated situation
Facilitator's Notes:
Handout – Global Outcomes Considerations and Descriptions
Review this handout with participants. This provides further guidance for how to determine where a skill falls in relationship to the 3 global outcomes. The next 3 slides provide a brief review of areas that each global outcome addresses, but the handout contains further considerations and descriptions of skills that are aligned with each outcome.

7. Functional Global Outcomes, cont.
Children will have positive social emotional skills (including social relationships)
Addresses:
Relating with adults
Relating with other children
Interacting with others or following group rules
Facilitator’s Notes:
Review with participants. These are the “pillars” for Global Outcome #1. Orient participants to the further considerations and descriptions described in the handout.

8. Functional Global Outcomes, cont.
Children will acquire and use knowledge and skills (including communication skills)
Addresses:
Thinking, reasoning, and problem-solving
Understanding symbols
Understanding the physical and social world
Facilitator’s Notes:
Review with participants. These are the “pillars” for Global Outcome #2. Orient participants to the further considerations and descriptions described in the handout.

9. Functional Global Outcomes cont.
Children will use appropriate behaviors to meet their needs
Addresses:
Taking care of basic needs
Contributing to own health and safety
Getting from place to place and using tools
Facilitator’s Notes:
Review with participants. These are the “pillars” for Global Outcome #3. Orient participants to the further considerations and descriptions described in the handout.

10. Summarizing a Child’s Strengths and Needs
The Strengths and Needs Summary on the Global Outcomes page serves three critical purposes: 1) To document comprehensive information about a child related to development across the three global outcome areas; and 2) To complete the COS (Global Outcomes) rating process at entry and exit from the Early Intervention Colorado program as required by OSEP; and 3) Conducting a rating at the annual IFSP meeting for planning and assessment purposes
Facilitator’s Notes:
Review with participants.
The Strengths and Needs Summary should capture combined information obtained from multiple sources, including:
the child’s present levels of development (gained through the multidisciplinary evaluation/assessment process, e.g., naturalistic observation, direct assessment, parent interview, family assessment); and
a review of the family’s concerns, priorities, resources, and routines in natural environments.
This comprehensive information is used to summarize the child’s strengths and needs in the 3 global outcome areas.

11. Summarizing a Child’s Strengths and Needs
A strength is what a child enjoys doing and/or a skill a child demonstrates or is beginning to demonstrate
A need may represent an activity or skill area where a child requires considerable support and/or practice
Facilitator’s Notes:
Handout: Noah’s IFSP, Global Outcomes page
Review with participants. Have participants review the strengths and needs that are documented on Noah’s Global Outcomes page of the IFSP.

12. Summarizing a Child’s Strengths and Needs
For each skill/behavior identified as a strength or need, consider the following questions to guide the conversation with the family and to identify the appropriate COS rating descriptor for the global outcome area:
Are the skills and behaviors demonstrated for this area what one would expect for a child this age? (i.e., age-expected skills)
If not, are they like those of a younger child? Are they the skills and behaviors that come just before the age-expected skills and behaviors? (i.e., immediate foundational skills)
If not, are they like those of a MUCH younger child? Are they much earlier than age-expected skills and behaviors or atypical? (i.e., foundational skills)
Facilitator’s Notes:
Review with participants. Remind participants again that we are not adjusting age for the child when determining whether a skill is age-expected. Note that we will start looking at these for Josie in the next activity.

13. Global Outcomes Page
Organized with the 3 global outcomes as a framework
Documents strengths and needs in all 3 global outcome areas
This information should be gathered as part of all of the activities leading up to this step of the IFSP process
Facilitator’s Notes:
Review with participants. Use Noah’s IFSP Global Outcomes page as an example.

14. Facilitator’s Notes:
Handouts:
Colorado Global Outcomes Family Worksheet
Child Outcomes Discussion prompts
Colorado Guiding Questions
Review these resources. The family worksheet can be given to a family prior to the IFSP Global Outcomes process to help them to begin thinking about the strengths and needs of their child.
This is a screen shot of the Global Outcomes page. The strengths and needs columns summarize the skills that the child is demonstrating or not demonstrating. These are discussed with the family based on all informaiton collected up to this point. The far right column documents the child’s outcome summary rating. When determining the rating, the numbers are no longer used, only the words. There is a rating key at the bottom of the page. A drop-down with these words is in the UNICORN (early intervention data system). The exit and annual COS rating includes the yes/no progress question for each of the 3 global outcomes.

15. UNICORN Global Outcomes Tab
Facilitator’s Notes:
Handout: UNICORN Global Outcomes Tab screenshot
Orient participants to how the Global Outcomes page looks in the data system, under the Global Outcomes tab. Note the drop down containing the words that correspond to the Child Outcomes Summary rating. e

16. Determining a COS (Global Outcomes) Rating
Facilitator’s Notes:
In the next few slides, we will review when to determine a child outcomes summary (global outcomes) rating for an eligible child.

17. Determine an Initial Rating and enter in the UNICORN for:
Children who are at least 6 months of age
COS rating is determined when child reaches the age of 6 months (for children who are born prematurely, age is not adjusted for COS rating)
Children who move into Colorado from another state
Children who receive at least one EI service
Facilitator’s Notes:
Review with participants. Note that although a COS rating is typically done as a part of the initial IFSP, for children who are less than 6 months of age, it will be done at the first periodic review.

18. Do Not Determine an Initial Rating and enter in the UNICORN for:
Children who are not eligible for early intervention
Children whose initial IFSP is completed less than 6 months prior to their third birthday
Children who transfer from another Community Centered Board (CCB) where an initial rating was already determined
Facilitator’s Notes:
Review with participants.
Note that current state rule states that a rating is not determined for children who are eligible solely because they are living with a parent with a disability. However, pilot communities will be determining a rating for children who are eligible under this criteria.

19. Determine an Exit Rating and enter in the UNICORN for:
Children who have been in early intervention services for at least 6 months
Calculation of time in services begins from the initial IFSP date
Children who leave early intervention services for any reason, not just turning three
Facilitator’s Notes:
Review with participants.

20. Do Not Determine an Exit Rating or enter in the UNICORN for:
Children who do not have an entry rating
Children who have left early intervention services suddenly, and a rating cannot be completed with the family
Facilitator’s Notes:
Review with participants. Note that if a child’s family moves unexpectedly, the exit rating should not be completed. A family discussion is required for each global outcomes process and rating. Therefore, a rating cannot be determined without the participation of the family.

21. Timelines for Child Outcomes Summary (COS) Rating
Entry
Periodic
Annual
Exit
3 Global Outcomes Discussed w/family
YES
COS Rating Conducted w/family NO
Unless it is an initial rating for a child turning
6 mos. old
Preliminary rating at last IFSP meeting prior to exit
COS Rating Entered in the UNICORN
* Not reported to OSEP
YES*
Includes the progress question
Finalize rating w/in 90 days of exit
Facilitator’s Notes:
Review with participants.
Global Outcomes:
Discussed with family throughout the IFSP process, from referral to exit
COS rating conducted with family:
At Initial IFSP, unless the child is younger than 6 months
In this case, it will be conducted at the first periodic review.
Note that the new page on the IFSP does NOT use the words “child outcome summary rating”. It is important to use the words “global outcomes” with families, as well as describing these to the family in words that are familiar to the family.
At the annual IFSP
Preliminary rating determined at last IFSP prior to the child’s third birthday, generally at the same meeting in which the transition plan is developed
Rating is finalized with input from family, providers and SC within 90 days of the child’s third birthday
COS rating entered in UNICORN
At Entry (Initial IFSP)
At Annual IFSP
At exit (same as above)
COS rating not entered in UNICORN
At periodic review (ratings are not conducted at reviews)

22. To Determine a Rating
Consider the child’s functioning across settings and situations
Understand age-expected child development
Understand the content of the three global outcomes
Know how to use the rating scale
Understand age expectations for child functioning within the child’s culture
Facilitator’s Notes:
Review with participants. These are factors that must be in place to determine an accurate COS rating.

23. Required Document Decision Tree
To be used each time the IFSP team is completing a COS (Global Outcome) rating
Language tied to the numbers should be the focus of the discussion with the family, not the numeric ratings
Facilitator’s Notes:
Handout: Decision Tree for Child Outcomes Summary Process (Colorado)
The Decision tree is a required tool for COS rating determination in Colorado. It is a helpful tool for facilitating COS rating decision-making for each of the 3 global outcomes. This tool, shown on the next slide, guides the team through the process via a series of questions. For example, if the team answers "yes" to the first question (i.e., Does the child ever function in ways that would be considered age-appropriate with regard to this outcome?), the discussion proceeds down the right side of the tree. On the contrary, if they answer "no" to that same question, then they would proceed down the left side of the decision tree, and so on.

24. Facilitator’s Notes:
Most participants will be familiar with this tool. Make note of the fact that this revision does not use the numerical ratings, but instead the words that correspond with the rating and the key at the bottom of the Global Outcomes page on the IFSP.

25. Video From Maryland: Engaging Families in the COS Process (Part 2)
Video Link
Facilitator’s Notes:
This is a video shows the discussion of the rating with a family as their child prepares to transition from early intervention. Notice that they use words to describe how the child is functioning in relation to same-aged peers, not the number that corresponds with the description.

26. Activity 6.1 Case Study - Josie
Complete the Global Outcomes Page
Document strengths and needs
Age-anchor Josie in each outcome area
Determine if skills in each global outcome area are age-expected, immediate foundational or foundational
Using the Decision Tree, determine a rating
Facilitator’s Notes:
Activity 6.1:
Handouts Needed for Activity:
Noah’s IFSP
Matthew’s Strengths and Needs Summary (Maryland)
Josie’s IFSP
Age Anchoring tool(s)
Decision tree
Small group activity: Complete Global Outcomes page of the IFSP for Josie
In groups of 2-4, including at least one provider and one service coordinator in each group whenever possible, complete the Global Outcomes page for Josie.
Have each team complete one global outcome area.
Review handouts: Noah’s example and Matthew’s example
Review the information you have recorded on the IFSP, including the strengths and needs you identified in the evaluation and assessment and family assessment sections
Using the descriptions of the 3 Global Outcomes (Description and Considerations Document), think about which skills of Josie’s show how she is functioning in each of the three global outcomes and document in the related section
Determine the age range of the skills Josie is demonstrating in each global outcome area (Age-anchoring)
Determine if skills are age-expected, immediate foundational or foundational
Using the Decision Tree, determine a rating for the outcome area.

27. Additional Global Outcomes Resources
Illinois 3 videos (referenced in age anchoring section as well)
Maryland tutorial – video of IFSP meeting where rating is discussed:
Facilitator’s Notes:
These are additional resources used or referenced in this Section.

28. Break Facilitator’s Notes:
If presenting the full-day training, break here.