1. Thinking about Functional Child Outcomes
OSEP Early Childhood Outcomes Meeting
August in Baltimore, MD
Presented by:
Donna Spiker, Lauren Barton, Mary Beth Bruder
Early Childhood Outcomes Center

2. What we will cover How did we get to functional child outcomes?
Key decisions about OSEP child outcomes
What exactly are functional child outcomes?
How can we help people think functionally about child outcomes?
How can we use assessment data to think functionally about child outcomes?
Early Childhood Outcomes Center

3. Key Challenges
Reorganizing thinking into 3 outcomes rather than domains
Switching to thinking about integrated, functional outcomes rather than if a child can or cannot do a series of discrete skills
Understanding how assessment data informs a rating of child functioning on the 3 outcomes
What does the assessment data you have tell you?
What information is missing that you need?
Early Childhood Outcomes Center

4. One set of outcomes for all children with disabilities
How did we get to functional child outcomes? Key decisions about child outcomes
Outcomes are statements of what EI and ECSE are trying to do for children and families (fundamental statements of what these programs are all about)
One set of outcomes 0-5
One set of outcomes for all children with disabilities
Early Childhood Outcomes Center

5. Don’t build the child outcomes around domains
How did we get to functional child outcomes? Key decisions about child outcomes (Cont.)
Don’t build the child outcomes around domains
Use the outcomes to drive practice forward
Outcomes should reflect best practice
Do no harm
Outcomes should be easy to understand
Providers are overburdened
Young children with disabilities could possibly be participating in several accountability efforts
Early Childhood Outcomes Center

6. How the goal for children leads to functional child outcomes
Active and successful participants
Now and in the future
In variety of settings
in their homes with their families, in childcare or school programs, and in the community
Early Childhood Outcomes Center

7. What exactly are functional child outcomes?
Understanding the Three Child Outcomes
What exactly are functional child outcomes?
Early Childhood Outcomes Center

8. The 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

9. Outcomes are functional
Functional outcomes:
Refer to activities and integrated behaviors that are meaningful to the child in the context of everyday living
Refer to an integrated patterns of behaviors or skills that allow the child to achieve important everyday goals
Early Childhood Outcomes Center

10. Functional outcomes are NOT
A single behavior
The sum of a set of discrete behaviors or splinter skills
such as…..
*Knows 10 words
*Pincer grasp (picks up a raisin)
*Smiles at mom
*Goes up and down stairs with one foot on each stair
*Stacks 3 blocks
Early Childhood Outcomes Center

11. Functional outcomes
Not domains-based, not separating child development into discrete areas (communication, gross motor, etc.)
Refer to behaviors that integrate skills across domains
Can involve multiple domains
Emphasize how the child is able to carry out meaningful behaviors in a meaningful context
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

12. Thinking functionally (within age-expected bounds)
Isolated skill/behavior
Knows how to imitate a gesture when prompted by others
Uses finger in pointing motion
Uses 2-word utterances
Functional skill/behavior
Watches what a peer says or does and incorporates it into his/her own play
Points to indicate needs or wants
Engages in back and forth verbal exchanges with caregivers using 2-word utterances
Another way of thinking about this is: What do you know about the child when you know that he/she can do X skill? Thinking functionally requires putting those data into context.
Early Childhood Outcomes Center

13. Thinking functionally
If you know a child can point, do you know that the child can communicate her wants and needs?
If you know a child can’t point, do you know that the child can’t communicate his wants and needs?
How does knowing about pointing help you understand how the child takes action to meet his/her needs?
Early Childhood Outcomes Center

14. Thinking functionally
Discrete behaviors (e.g., those described by some items on assessments) may or may not be important to the child’s functioning on the outcome
Individually, they are not especially informative
Summed, they may or may not be useful, depending on the functionality of the behaviors/items
Early Childhood Outcomes Center

15. Children have positive social relationships
Involves:
Relating with adults
Relating with other children
For older children, following rules related to groups or interacting with others
Includes areas like:
Attachment/separation/autonomy
Expressing emotions and feelings
Learning rules and expectations
Social interactions and play
Early Childhood Outcomes Center

16. Children acquire and use knowledge and skills
Involves:
Thinking
Reasoning
Remembering
Problem solving
Using symbols and language
Understanding physical and social worlds
Includes:
Early concepts—symbols, pictures, numbers, classification, spatial relationships
Imitation
Object permanence
Expressive language and communication
Early literacy
Early Childhood Outcomes Center

17. Children take appropriate action to meet their needs
Involves:
Taking care of basic needs
Getting from place to place
Using tools (e.g., fork, toothbrush, crayon)
In older children, contributing to their own health and safety
Includes:
Integrating motor skills to complete tasks
Self-help skills (e.g., dressing, feeding, grooming, toileting, household responsibility)
Acting on the world to get what one wants, taking appropriate action to meet needs
Early Childhood Outcomes Center

18. Outcomes reflect global functioning
Each outcome is a snapshot of:
The whole child
Status of the child’s current functioning
Functioning across settings and situations
Rather than:
Skill by skill
In one standardized way
Split by domains
Early Childhood Outcomes Center

19. An exercise: Uses finger in pointing motion
Give one example of how this skill could be information to describe a functional outcome, for:
Outcome 1: Positive social relationships
Outcome 2: Acquire and use knowledge and skills
Outcome 3: Use appropriate behaviors to meet needs
Early Childhood Outcomes Center

20. Another exercise: Uses 2-word utterances
Give one example of how this skill could be information to describe a functional outcome, for:
Outcome 1: Positive social relationships
Outcome 2: Acquire and use knowledge and skills
Outcome 3: Use appropriate behaviors to meet needs
Early Childhood Outcomes Center

21. Video segment: Do you see functional child outcomes?
Identify 3 discrete behaviors or skills that are not necessarily functional
Identify 3 functional behaviors or skills observed
Early Childhood Outcomes Center

22. Thinking about Outcome 1: Children have positive social relationships
How does the child relate to his/her parent(s)?
How does the child relate to strangers? At first? After a while? In different settings?
How does the child display emotions?
Does the child seeks out others after an accomplishment? How?
How would you describe the child’s participation in games (e.g., joint attention, social, cooperative, rule-based, with turn-taking)?
How does the child interact with other children?
How does the child let others know he/she needs help? Is frustrated?
Early Childhood Outcomes Center

23. Thinking about Outcome 2: Children acquire and use knowledge and skills
How does the child use words and skills he/she has in everyday settings (e.g., at home, at the park, at childcare, at a store or mall, at a restaurant, with different people)?
How does the child understand and respond to directions and requests from others?
Can the child answer questions of interest in meaningful ways?
Does the child use something learned at one time at a later time or in another situation? Describe some examples.
How does the child interact with books, pictures, and print?
Early Childhood Outcomes Center

24. Thinking about Outcome 3: Children take appropriate action to meet their needs
What does the child do when he/she can’t get or doesn’t have what he/she wants?
What does he child do when he/she is hungry? Frustrated? Needs help? Is upset or needs comfort?
Tell me about the child’s behavior when dressing and undressing. When eating? Describe the child at mealtime.
Does the child display toy preferences? How?
How does the child respond to unwanted or problematic peer behavior?
Are the actions the child uses to meet his/her needs appropriate for his/her age? Can he/she accomplish things that peers do? Describe examples.
How does the child demonstrate that he/she understands and avoids danger?
Early Childhood Outcomes Center

25. Remembering the overarching goal
“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.”
Source: The ECO Center recommendations regarding child and family outcome statements, revised April 2005.
Early Childhood Outcomes Center

26. Assessing the Accomplishment of the Three Child Outcomes
How can we use assessment data to think functionally about child outcomes?
Early Childhood Outcomes Center

27. What is assessment?
“Assessment is a generic term that refers to the process of gathering information for decision-making.”
McLean, Wolery, and Bailey (2004)
McLean, M., Wolery, M., & Bailey, D. B. (Eds.). (2004). Assessing infants and preschoolers with special needs. Englewood Cliffs, NJ: Prentice-Hall, Inc.
Early Childhood Outcomes Center

28. DEC recommended practices for early childhood 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
See earlier slides about best practices in assessment of young children
Early Childhood Outcomes Center

29. Use of 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.
Early Childhood Outcomes Center

30. Assessment tool lens
Each assessment tool carries its own organizing framework, or lens.
Many are organized around domains.
But across different measures, the content in the domains isn’t always the same, even if the names are the same.
Early Childhood Outcomes Center

31. Currently available assessment tools
Each assessment tool sees children through its own lens.
Each lens is slightly different.
There is no right or wrong lens.
Key question:
How much and what information will a given tool provide about the attainment of the three functional child outcomes?
Early Childhood Outcomes Center

32. Does our assessment process provide information on functional outcomes?
Does the assessment process tap the child’s functioning when doing things that are meaningful to the child?
Do we assess what a child typically does or assess in unusual situations?
Do we know about the child’s actual performance across settings and situations?
Do we observe how a child uses his/her skills to accomplish tasks?
Does it go beyond domains to consider integrated functioning?
Give examples of settings and situations – with family, with siblings, with peers, playground, park, grocery store, home, child care, in therapy, etc.?
Integrates skills to accomplish a task
Early Childhood Outcomes Center

33. Assessing functional outcomes: Key questions to ask
What does the child usually do?
What is the child’s actual performance across settings and situations?
How does the child use his/her skills to accomplish tasks?
Application of knowledge and skills in more realistic situations.
Early Childhood Outcomes Center

34. Assessing functional outcomes: Key issues to remember: Thinking functionally about child outcomes
Not the child’s capacity to function under unusual or ideal conditions
Not necessarily the child’s performance in a structured test situation
Not necessarily discrete behaviors that the child only demonstrates in isolated situations or settings
Application of knowledge and skills in more realistic situations.
Early Childhood Outcomes Center

35. 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. Thus, teams may “override” the results from an assessment tool
Early Childhood Outcomes Center

36. 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 tool captures functioning across settings
Early Childhood Outcomes Center

37. 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

38. Considerations in thinking functionally about child outcomes
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.
Teams need to consider child behavior and functioning across age-appropriate settings.
Early Childhood Outcomes Center

39. Key concepts in thinking functionally about child outcomes
Gathering good information about the child’s:
Engagement
Independence
Social relationships
Note: Based on work by Deborah Hatton
Early Childhood Outcomes Center

40. Engagement
How does the child interact with the environment in developmentally and contextually appropriate ways?
Probe for examples of everyday situations and how the child behaves and interact with the physical and social environment.
Early Childhood Outcomes Center

41. Independence
How does the child engage with the environment and daily settings and tasks with as little assistance from others as possible?
When probing for descriptions of everyday functioning, ask specifically about the degree to which the child needs help or assistance to engage in the task or routine.
Early Childhood Outcomes Center

42. Social relationships
How does the child engage in social relationships that provide the context and motivation to communicate, to get along with others (adults and peers), to develop trust, to interact and play appropriately, and to form friendships?
Get descriptions of each of these areas of functioning.
Early Childhood Outcomes Center

43. Functional child outcomes means looking at………
What specific skills and behaviors the child has
And then learning about:
How the child actually uses skills and behaviors in daily situations and routines.
How easily the child functions in daily situations, tasks, and routines (fluency).
How well the child uses skills and behaviors in many different situations and with many different people (generalization).
Early Childhood Outcomes Center

44. Training strategies
How can we develop training materials and strategies to help staff think functionally about child outcomes?
Discussion prompts (handout on ECO web site)
Videos to use in team trainings and discussions (
Use of routines-based assessment (see National Individualizing Preschool Inclusion Project –
Early Childhood Outcomes Center

45. Can we learn to think functionally about child outcomes?
Video exercises
Can we learn to think functionally about child outcomes?
Early Childhood Outcomes Center

46. Video segment #2
What do you see here that helps you make a rating of this child’s functioning for outcome 3?
What additional questions do you want to ask to rate this child for outcome 3?
Outcome 3:
Children use appropriate behaviors to meet their needs
Bagnato, S. J., & Neisworth, J. T. (1991). Assessment for early intervention: Best practices for professionals. New York: Guilford.
Early Childhood Outcomes Center

47. Video segment #3
What do you see here that help you make a rating of this child’s functioning for outcome 1?
What additional questions do you want to ask to rate this child for outcome 1?
Outcome 1:
Children have positive social-emotional skills (including positive social relationships)
Bagnato, S. J., & Neisworth, J. T. (1991). Assessment for early intervention: Best practices for professionals. New York: Guilford.
Early Childhood Outcomes Center

48. Discussion
What are some of the obstacles that make it difficult for people to think functionally about child outcomes?
What kinds of training strategies and other TA can be provided that support thinking about child outcomes functionally?
Early Childhood Outcomes Center

49. ECO Center
Additional information, including additional crosswalks, training slides, discussion prompts, 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

50. As states move to collecting and using high quality information on outcomes, children and families will reap the benefits.
Early Childhood Outcomes Center

51. Additional Take Home Resources
Early Childhood Outcomes Center

52. What are some key questions we should be asking about our assessment processes and training?
In meeting with state and program staff, these are a number of questions that have come up – ideas to consider in thinking about how outcomes may be linked with current practice and what you might like to see in the future.
Early Childhood Outcomes Center

53. Examining the assessment process and use of the information it provides
This is an opportunity to consider how we conduct and use assessment in practice.
Decisions can be made and actions can be taken at all levels.
States may or may not provide guidance to local level as a result of accountability demands.
Early Childhood Outcomes Center

54. Overarching questions
How might the process of collecting child and family outcomes data be useful for program improvement?
How might the data that is collected be useful for program improvement?
Early Childhood Outcomes Center

55. What assessment tool(s) do we use?
Different assessment tools view development through slightly different lenses
How do current assessment frameworks fit with our intervention/program approach?
How do they fit with our purposes for doing assessment?
Early Childhood Outcomes Center

56. Is our assessment process consistent with NAEYC and DEC recommended practices?
When, how, and with whom does assessment occur?
Is it a central part of our program?
Is it conducted in a way that is developmentally appropriate?
Is it culturally and linguistically responsive?
Is it tied to children’s daily activities?
Does it include families in meaningful and respectful ways?
Does it show strengths, needs, and progress for the child and/or group of children?
Does our professional development support assessment?
Early Childhood Outcomes Center

57. Do we gather information from multiple sources and multiple settings?
Multiple sources, for example:
Family members
Professional team members
Direct service providers
Caregivers
Multiple measures, for example:
Observations
Criterion- or curriculum-based instruments
Interviews
Informed clinical opinion
Assessment tools spanning all 3 outcome areas
Early Childhood Outcomes Center

58. Does our assessment process provide information on functional outcomes?
Does the assessment process tap the child’s functioning when doing things that are meaningful to the child?
Do we assess what a child typically does or assess in unusual situations?
Do we know about the child’s actual performance across settings and situations?
Do we observe how a child uses his/her skills to accomplish tasks?
Does it go beyond domains to consider integrated functioning?
Give examples of settings and situations – with family, with siblings, with peers, playground, park, grocery store, home, child care, in therapy, etc.?
Integrates skills to accomplish a task
Early Childhood Outcomes Center

59. Does our assessment process help us consider comparison to age-expected functioning?
Ways to think about children’s functioning:
A child’s own progress over time
and
How the child’s overall functioning or progress compares to that of same-aged peers
How is this information discussed, shared, and used?
In ways that help the child?
In ways that help the program?
Could include circle figure (see end)
Early Childhood Outcomes Center

60. How do we know that our assessment process gives us meaningful information?
Are there consistent guidelines and approaches in our assessment process?
Is assessment an area covered during supervision?
What quality assurance efforts are in place to know if assessment information accurately reflects child functioning?
Early Childhood Outcomes Center

61. How do we use the assessment information that we have?
Does it help us identify significant concerns for a particular child that might require further intervention?
Does it help us make sound decisions about teaching and learning?
Does it help our program improve our developmental and educational interventions?
Early Childhood Outcomes Center

62. How do we use the assessment information that we have?
Is access to information timely?
Do we have access to reports that make using the information easy?
How and when do we share, discuss, and use the information we have?
With families
With other IFSP/IEP team members
With funders
With interested stakeholders at other levels
Is the level of detail in our information appropriate for our purposes?
Last point – talk about more detail with providers, less detail/need for data reduction as go up the chain…
Early Childhood Outcomes Center