Integrating the Child Outcomes into the IFSP Process

Integrating the Child Outcomes into the IFSP Process
Anne Brager, VA Part C Program Sherri Britt Williams, NC Part C Program Kathi Gillaspy, ECTA Center May 22, 2014 2014 Inclusion Institute

Why Integrate Outcomes?

Goal of Early Intervention
For children 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, preschool or school programs, and in the community For families to enable families to provide care for their child and have the resources they need to participate in their own desired family and community activities Now let’s focus on making the connection between what we know about how children learn and how the adults in a child’s life can best support his/her development and what professionals do with children and families. The ultimate goal of EI services is to enable children to be active and successful participants in a variety of settings throughout their lives. In order to accomplish this goal, professionals must use the methods, models and interventions supported by research to help reinforce the confidence and competence of families to meet their child’s needs and to participate in the community in ways that are meaningful to them. The goals for children and families, as they are worded here, were developed by the Early Childhood Outcomes (ECO) Center in the process of developing the three outcomes that we now measure to show the effect of IDEA services on the development of young children ages birth through 5 years. A year long process involving stakeholders from all over the nation and from many perspectives – providers, state and local administrators, researchers, family members, TA providers, and so forth – resulted in defining the overarching goals and the specific outcomes of early intervention and early childhood special education programs. Trainer notes: We recommend using the hyperlink included in the slide above to show participants the ECO document as well as printing a copy prior to the training as a presenter copy. This will reduce paper handouts and allow those interested to download the document after the training. If copies are desired, the handout may be downloaded from this link, saved and printed. The Early Childhood Outcomes Center (2005). Family and Child Outcomes for Early Intervention and Early Childhood Special Education. Retrieved August From

Mission of Early Intervention Services
Part C early intervention builds upon and provides supports and resources to assist family members and caregivers to enhance children’s learning and development through everyday learning opportunities. Mission and Key Principles of Early Intervention Services Seven Key Principles Looks Like/Doesn’t Look Like Both Part C early intervention and Section 619 early childhood special education have developed mission statements to guide professionals in the field. In 2008, a workgroup was created to review the current literature and common wisdom and practices in early intervention, and to come to consensus on the core mission, principles and practices of service delivery in early intervention. The resulting mission statement reads, “Part C early intervention builds upon and provides supports and resources to assist family members and caregivers to enhance children’s learning and development through everyday learning opportunities.” There are two documents (“Mission and Key Principles of Early Intervention Services” and “Seven Key Principles Looks Like/Doesn’t Look Like”) that provide information about the mission of early intervention and the principles by which services are provided in EI. The “Looks Like/Doesn’t Look Like” document provides specific illustrations of the principles found in the “Mission and Key Principles of Early Intervention”, both in what we expect to see in practice, as well as those practices that are outdated and do not illustrate the core concepts of the principles. Trainer notes: Links to all the documents are on the slide. We recommend using the hyperlinks included in the slide above to show participants the document, and printing a copy of each prior to the training as presenter copies. This will reduce paper handouts and allow those interested to download the documents after the training. If copies are desired, the handouts may be downloaded from these links, saved and printed. If a choice needs to be made of only one handout for the early intervention section to share, we recommend printing the document at the second bullet (Looks Like/ Doesn’t Look Like). NECTAC/ECO/WRRC 2012

3 Global Child Outcomes Positive social emotional skills (including positive social relationships) Acquisition and use of knowledge and skills (including early language/communication and for preschool, literacy) Use of appropriate behaviors to meet their needs Now let’s shift our focus from the goals and mission of early intervention and early childhood special education to the outcomes of the programs. These are the three outcomes of early intervention and early childhood special education programs, defined by the year-long stakeholder process. Notice they are functional, they are the same for infants, toddlers and preschool children, and they are the kinds of outcomes any parent would want for their child. And, when a child’s individual IEP goals are functional and meaningful to everyday life, they support the child’s growth and development in positive social relationships, the acquisition and use of knowledge and skills, and using appropriate behaviors to get his or her needs met.

Integrating Outcome Measurement into IFSP Process
The IFSP Process plans supports and services to address priorities and to support successful participation in daily activities Individual outcomes or goals for each child build on his/her interests/skills and reduce barriers to successful participation in daily learning opportunities Through participation – all children learn (interest-based learning, practice and independence) When we establish clear connections between the purpose of early intervention/early childhood special education, the global child and family outcomes, and individual child’s IFSP outcomes, services have a greater impact on children and families. It stands to reason that if we integrate the process of measuring child and family outcomes with the IFSP process, children’s outcomes are also more likely to be written in a way that promote successful participation in daily activities and consequently, promote learning and development, and paperwork is more streamlined and easier for families to understand and for practitioners to complete. NECTAC/ECO/WRRC 2012

Making the Connection: Using Functional Assessment
Functional assessment is the means by which we accomplish an integrated process, including developing individual outcomes/goals as well as determining the rating for each of the three global child outcomes. Through functional assessment we can gather information about the child’s functioning in daily routines and activities needed to determine the rating through the Child Outcome Summary (or COS) process, as well as the information about the child’s interests, strengths and needs that is necessary to develop individualized, functional outcomes or goals for the child. NECTAC/ECO/WRRC 2012

The Right People, the Right Situation, the Right Time
Why not complete the Child Outcome Summary (COS) rating while talking about the child’s functioning and development? Providers who are integrating the outcomes work, suggest that the completing the COS rating at the IFSP meeting to summarize the assessment results is a natural and enriching conversation Outcomes and goals become more functional – routine and activity based For more information about integrating outcomes into the IFSP/IEP process, please visit the ECO website at So why not complete the child outcomes summary, or COS, rating while you’re already talking about the child’s functioning and development? It’s the perfect time with the right people – the child’s team, including the parent – at the right time – while discussing the child’s present levels of development – to add to the family’s understanding of their child’s development. Many programs are already integrating the two processes. They are reporting that it is a logical addition to the conversation about assessment information, and supports the family’s understanding of their child’s development. They also report that the outcomes developed are naturally more functional and based in the child’s routines and activities. For more information about integration, there are resources on the ECO Center’s website. We’ll talk a little more about it later in the presentation. NECTAC/ECO/WRRC 2012

Integrating Outcomes Measurement: Focus and Purpose
Let’s take a moment to step back and think about why we might strive to integrate child outcomes measurement activities within the IEP process.

Integration – Outcomes and IEP Processes
Not just about creating a more seamless process…not just details and how BIG Critical to the picture of what we are all trying to accomplish Integrating outcomes measurement is not just about streamlining forms or making the entire process feel more cohesive for families. Those benefits will occur. But, the main reason for integration is that embedding the global outcomes in all facets of our practice helps us achieve the vision of what we want to accomplish for and with children and their families.

Disconnect? States accountable for…. Programs working toward….
Providers focus on…. Children achieve…. Now we have a global set of outcomes that states are held accountable for. Programs are working to ensure they can help children show progress on these, and want to see that children’s progress in their program is moving in the direction of state targets. And, we have providers focusing on individualized outcomes with children and families. These help guide children’s achievements and progress… But, is there a disconnect? Does the emphasis at the level of the intervention support the global outcomes that the program is trying to achieve and that the state is held accountable for?

Alignment Across Levels
States accountable for…. Programs working toward…. Providers focus on…. Children achieve…. We want these pieces to come into alignment. Focusing on the 3 global outcomes is the glue that can connect these pieces. Integrating the 3 global outcomes into the IEP process brings what we want to accomplish for all children and families into the discussion about how we can best support each individual child and family.

Ultimate Goals for EI and ECSE
For children: “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, preschool or school programs, and in the community.” Based on the ECO stakeholder process when identifying 3 functional outcomes The 3 outcomes aren’t just about having a set of numbers for accountability. Remember the overall goal for ECSE that we’ve talked about both days now? Integrating the child outcomes into the IEP process helps us be better able to accomplish our vision. Making progress on the 3 outcomes is critical for all children for successful participation. By focusing on the 3 outcomes, programs can help children be active and successful participants now and in the future in all the settings they are in… at home, at school, in child care, and in the community.

Thinking There is always some kind of thinking, or a framework, that teams are using. They use frameworks as they gather and interpret assessment information and use it to formulate an individualized plan for each child.

What is the Framework Guiding Our Thinking?
Providers always bring some kind of framework for taking information about the skills a child currently uses and planning where they want to see the child go next Are these guiding ideas explicit or unspoken? Are they using a unified framework or multiple frameworks? What is the framework that guides your thinking for identifying outcomes for a child? Is it explicit? Is it one framework? Or are there really multiple frameworks? Maybe each provider on the team is using a different one.

Examples of Guiding Frameworks
The items on a specific assessment tool A milestone checklist or series of skills to learn based on a provider’s specialty area A specific curriculum, with assessment identifying starting point Whatever the family wants Here are some examples of the kinds of frameworks that practitioners might use: Teams might use items from a specific assessment tool. They might look at the next item in the sequence and use that to plan an intervention. Or, the framework might be a series of skills or a specific milestone checklist based on the provider’s specialty area that guides planning. Another option is that a specific curriculum might be the guide for planning. Or, sometimes teams completely follow the family member’s lead. The plan is based on whatever the family wants. Early Childhood Outcomes Center

The 3 Outcomes as a Guiding Framework
The 3 functional outcomes can be a framework, a lens, for viewing child functioning and planning intervention The three functional outcomes are an alternative framework. They are a lens through which to view child functioning and plan interventions. This does NOT mean that the family’s concerns and priorities are not considered. It means that what matters to families is talked about with regard to each of the three outcomes.

The 3 outcomes are general statements of what we want the child to achieve. Remember, we want all children to be successful participants in a variety of settings. The global outcomes are a way to think about what skills the child uses. They also provide a lens to organize how to help the child continue to learn to use his/her skills in richer, more complex, successful ways. Having positive social relationships Taking appropriate action to meet needs Acquiring and using knowledge and skills Global Outcomes =

Why Use the Outcomes?? Socially validated – reflect what we are trying to achieve Functional They’re integrated – emphasize the whole child Flexible – not wedded to one particular assessment, curriculum, or level of child functioning With all these frameworks, why should we use the 3 global outcomes? The 3 global outcomes have been socially validated - thousands of stakeholders all over the country, including families of children with disabilities, have said that these are important outcomes for children The 3 global outcomes also are functional. So, they reinforce the need to gather functional information about how children use their skills to perform meaningful tasks during assessments and they reinforce the need to write functional individualized IEP goals. The 3 outcomes focus on the whole child. They aren’t tied to any one domain. Instead, they emphasize the whole child. Integration across domains is critical for effective participation. Finally, the 3 outcomes are flexible. Because they are global, they are not wedded to the use of any one particular assessment, curriculum, or level of child functioning.

What Might It Look Like? Assessment
What does our assessment tell us about the child’s functioning in each outcome area across settings and situations? Organizer for planning breadth and type of assessment approaches needed and who should be involved in it Organizer for writing or sharing results Produces information for outcomes and planning What does assessment look like when it is organized around the 3 outcomes? The global outcomes focus the collection and reporting of information on the child’s functioning in each outcome area across settings and situations. The 3 outcomes serve as an organizer for the type of assessment approaches to use. The 3 outcomes also are an organizer for how teams write or share results, organizing results by outcome rather than by the domains. Assessments are still individualized to the child, but the outcomes provide a useful framework for organizing the information.

Assessment Global Outcomes =
The framework provided by the 3 global outcomes is helpful through all phases of assessment and intervention. The 3 outcomes inform the initial assessment process and what is learned about how the child uses his/her skills in everyday situations. Assessment Having positive social relationships Taking appropriate action to meet needs Acquiring and using knowledge and skills Global Outcomes =

What Might It Look Like? IEPs
Planning IEP goals: Has the team considered how to write individualized outcomes that continue help the child progress in each of the 3 outcome areas? Will the individualized goals written support effective participation (overarching goal)? With global outcomes as an organizer for where we want the child to go, use of discrete, domain-specific objectives won’t make sense. What do IEPs look like when the global outcomes provide the framework? Thinking about the global outcomes challenges teams to consider how the individualized outcomes help the child progress in each of the 3 global outcome areas--again, because success in the three global outcomes is critical to the overarching goal of effective participation. The global outcomes do not dictate the individualized outcomes. Rather, they provide a framework for thinking about development and learning. They help a team identify where they need to support the child’s functioning in a way that will be far more effective than domains or discrete skills.

IEP Development Global Outcomes =
The 3 outcomes provide a framework during the IFSP or IEP meeting that helps teams consider the individualized outcomes and shape an intervention plan that supports the child’s effective participation across settings. IEP Development Having positive social relationships Taking appropriate action to meet needs Acquiring and using knowledge and skills Global Outcomes =

IEP Development Global Outcomes =
Note that use of the 3 global outcomes as an overarching organizer for individualized outcomes helps teams think about a broad array of individualized goals to guide the intervention. It does not mean that there should be a one-to-one correspondence between each global and individualized goals. The team decides what the right mix should be. IEP Development Having positive social relationships Taking appropriate action to meet needs Acquiring and using knowledge and skills Global Outcomes =

What Might it Look Like? Intervention
The three global outcomes continue to be an overarching consideration as intervention activities are implemented and the team examines progress on the individualized goals. Intervention Having positive social relationships Taking appropriate action to meet needs Acquiring and using knowledge and skills Global Outcomes =

What Might it Look Like? IFSP/IEP Review
At the IEP review meeting, we discuss progress on the individualized outcomes and revisit the 3 global outcomes to identify if the intervention and support activities are making a difference. If the child did not have an individualized outcome in one or more of the 3 outcome areas, the review is a good time for the team to make sure that the child’s development remains on target in this outcome. This review discussion informs the development of new individualized outcomes and interventions that will help the child continue to make progress in the 3 global outcomes. IEP Review Having positive social relationships Taking appropriate action to meet needs Acquiring and using knowledge and skills Global Outcomes =

Benefits More understandable, measureable individualized IFSP outcomes
Families can tell when their children are achieving desired outcomes Reinforces the assessment and planning cycle Improves practice Supports progress in the overarching areas that are central to early intervention Using the 3 global outcomes as a framework produces understandable, measureable, individualized outcomes that are meaningful to families. The 3 outcomes also help families understand what programs are trying to do. The 3 outcomes tie assessment, planning, and intervention together. They improve practice and help programs to keep the focus firmly on what it is trying to achieve and what the state is being held accountable for. Supporting children in acquiring the outcomes is critical…. Early Childhood Outcomes Center

Active and Successful Participation
To helping all children achieve what matters.

Army EDIS Nationally, states are recognizing that are many benefits to an integrated process and are shifting away from completing the outcomes process in isolation. States with red stars have either integrated or are in the process of integrating the outcomes into the IFSP process. States with orange stars are those that are doing the same for the IEP.

Virginia Option to integrate narratives from initial training in Jan/Feb 2007. In 2011, identified need to update training materials. Group of LSMs, providers, state TA, state staff Training wasn’t enough – it was philosophical shift that was needed Virginia has a long history of allowing localities quite a bit of flexibility. As a local, I love this option! When we implemented the child outcomes summary process in March 2007, we gave all localities the option of integrating the narrative. A handful of us chose to do this. Over the next five years, a few more systems came on board with integrating the child outcomes, but not all. Everyone who integrated the child outcomes into their narratives were happier with the process. In 2011, the need to update the training materials was a glaring issue. Our materials were too focused on the initial implementation of the child outcomes process, rather than on bringing new staff on to a system already in place. Gathered a group of stakeholders –state office staff, TA Partners, and locals at varying places in the integration work

Integrating the Child Indicators in Virginia
Understanding that the 3 child indicators serve as the foundation for the full EI process Understanding that information related to the 3 child indicators begins at referral and continues throughout the EI process Introduced new Indicator Statements Introduced a new IFSP format for writing ASP narratives Child outcomes are not a “task” on our to do list – they are the foundation of everything we do from the initial referral all the way through transition. In the Spring of 2012, we had revised the IFSP to reflect this change. We had planned to implement 7/1/12, but decided we needed to utilize early implementers to ensure we had all materials ready for statewide use.

Virginia’s Integration of Child Outcomes into IFSP Process
Quality Practices provided the foundation of VA’s integration Focus was on process not changes to the IFSP form Consistent framework statewide Anne Used as the foundation of our integration to help service coordinators and providers see the link between what they do and the child outcomes. It was very important to take the emphasis off of it being a new way to complete the IFSP but instead a whole new way of doing business starting from that very first phone call at referral, thru each step of the family’s journey in early intervention until the time they eave the program at transition. The Quality Practices document provided that consistent framework for systems to integrate child and family outcomes into each step of their local processes.

Keys to Successful Implementation
Early Implementers chosen from regions across the state Quality Practices aligned with Virginia’s IFSP process Each component rolled out one month at a time Purposefully chose systems from each region of the state so they could support the statewide implementation through the monthly regional meetings with TAs By breaking QP and our process into components, it gave Local systems time to review what was presented and discussed and integrate it that month for each particular function in the EI process (for example – what the people on the phone say when they get a referral, revision of intake form, training staff in how to communicate about outcomes as the purpose of EI, not about services EI provides), etc. Infant & Toddler Connection of Virginia

Regular Meetings with Ongoing Assessment
We had monthly meetings with all early implementers including the local system managers, service coordinators, providers, single point of entry staff, who ever was involved in the process. Each call included presentation of information including that months section of the Quality Practices for implementation plus discussion and questions. An essential piece was local system ongoing assessment of where they were and what they could do to improve. Here are two documents used, one is a self assessment systems used to review their process and the other is a planning tool that systems completed based on their findings of the self assessment and turned into to us each month. A lot of months, the feedback resulted in changes to materials, the development of new materials, changes to the IFSP. Infant & Toddler Connection of Virginia

I mentioned we changed the language of our indicator statements
I mentioned we changed the language of our indicator statements. Some of the language including near somewhat were confusing to some providers and families so we tweaked the statements and color coded them. 6 and 7 green for all age expected skills. Yellow some age expected and pink no age expected. We also have the statements on a laminated card without the numbers for providers to share with families during discussions.

Functional narrative related to the specific indicator
Indicator Statement Functional narrative related to the specific indicator We also included the statement on the IFSP which has really led to honest communication with families as they are now part of the discussion. Indicator Statement

Getting From Domains to Indicators
The “Book” Guiding Questions Indicator Statements Feedback on Narratives Getting From Domains to Indicators

Feedback on Narratives
Feedback provided to each system on 2-3 IFSPs per month Feedback also provided to each system statewide before full statewide implementation Providing feedback on the IFSP narratives was huge for us for quality assurance purposes. While it was very time consuming it allowed us the opportunity to see what supports folks needed and the additional training that was needed as we planned for the statewide rollout. Switching from writing the narrative from the perspective of the five developmental domains to the three child outcomes was definitely a challenge for some as well as writing functional assessment findings vs discreet test items. Thru the feedback process we did a lot of work around the supporting evidence of the rating and interrater reliability. Feedback continued during statewide rollout during monthly regional meetings. Each system brought an IFSP that was reviewed during the meeting with the intent of modeling to the local system managers how to provide feedback to their staff. The TAs made this a standing activity at regional meetings until the LSMs were confident in their systems understanding of the process and the validity of the data. The other piece we saw through the process was how our focus on the three child indicators and using the QP document leads NATURALLY to identification of specific functional individualized child outcomes (and supports earlier work of the state in providing statewide training/TA on functional individualized child outcomes). Infant & Toddler Connection of Virginia

Connecting the Dots in Virginia
Replaced state principles with national 7 Key Principles Child Outcomes Gone Awry: Putting the Pieces Together trainings Statewide Coaching Initiative Connection of Key Principals Visuals Virginia has adopted the 7 Key Principles as our way of doing business and replaced our 10 principles (which pretty much aligned with the national principles except for a couple of process items around family cost) in our Practice Manual. Last summer at our annual Creating Connections to Shining Stars conference we launched our Putting the Pieces Together focus. While searching the internet for videos for the training, I came across Judy Swett’s Child Outcomes Gone Awry video and it has become a wonderful tool for training and discussion of how the key principals like functional outcomes, coaching, families as the best teachers and using familiar routines and activities all fit together to influence child and family outcomes results. This work continues around the state thru local and regional trainings. Kathy, can we watch this video? To support the work we have been doing with the quality practices and key principles, we have brought Dathan Rush and M’Lisa Sheldon to most of the regions of the state. They have provided master coaches and coaches training with six month followup support via coaching logs and phone calls. We have two more trainings scheduled in the spring and we will have reached the entire state. The implementation of QP has also reinforced the information team members need to be able to use coaching and natural learning environments practices. A draft visual of what early intervention is and looks like for use with families, physicians and stakeholders. This and a quote or two from the American Academy of Pediatrics Position Statement on Early Intervention will be added to our Child Indicator booklet in an attempt to really explain what early intervention really looks like in every day life. These principles really describe what it is that we want to do with children and families to support the overall achievement of the mission. Infant & Toddler Connection of Virginia

Connecting the Dots- the what, the why and the how
Laminated cards providers use to explain early intervention to families Infant & Toddler Connection of Virginia

Infant & Toddler Connection of Virginia
Providers have been asking for a simpler, family friendly way to explain what early intervention is and what it looks like for use with families, physicians and stakeholders. They like the key principles but at times find them too jargony for some families. This is a draft of a poster we are doing. This and a quote or two from the American Academy of Pediatrics Position Statement on Early Intervention will be added to our Child Indicator booklet in an attempt to explain what early intervention really looks like in every day life. These principles really describe what it is that we want to do with children and families to support the overall achievement of the mission. Infant & Toddler Connection of Virginia

Local Uses of QP in Virginia
Initial and follow-up self assessment Electronic Health Record TA’s use it to orient new local system managers LSM’s use it for orientation and training When we began our integration we initially began with 10 systems as early implementers to help guide us in developing materials and training in preparation for the full statewide implementation. We rolled this out with the early implementers in the steps broken down in the adapted for VA QP document. Each month the early implementers used the document to complete a self assessment and make subsequent changes to their systems to align with the quality practices. We structured our statewide roll out the same way with the TA’s using the QP as a guide to work with their local systems thru the implementation period. Many of our local systems have switched over to electronic health records and have integrated the components of the QP tool to assure that they were utilizing best practices throughout the entire process. By using this tool along with another tool we have outlining documentation requirements, helped the systems assure they were following good practices and capturing good documentation in their electronic record. TA’s use it for training local system managers, reference it at regional meetings, speak the language of the QP when working with teams. Our local system managers love it because it provides the consistent language we want all of our service coordinators and providers to be using with families. Systems have revised their referral and intake process to begin gathering information about the child’s functioning in the three child outcome areas. Many use the attached Guiding Questions document or an adapted version to begin capturing the rich, functional information families share at each step of the process. The information is then passed on to the Intake and eligibility teams who continue to add to it and it ultimately becomes a useful starting point of the assessment for service planning process. Families appreciate that someone has listened, captured and shared with team members along the way the information the family has shared. Infant & Toddler Connection of Virginia

Local Uses of QP in Virginia
Single Point of Entry and service coordinators use it to explain EI and introduce child and family outcomes Some LSMs use it as an observation and feedback tool for staff and contractors Focused trainings based on outcomes results They use it to help the single point of entry and sc’s become more “fluent “ about explaining our services at that first contact. To incorporate the language/common terms that the family will hear throughout. ( Terms like functional things your child does to get their needs met) I wish I had of thought of this last one when I was supervising staff, some of our local system managers use it for supervision as an observation checklist and then review it to provide feedback to providers and service coordinators. And of course, we use it for focused trainings if we want to target a particular outcome or if a systems results on child and family outcomes was below the state target. For instance, if a system’s results for parents knowing their rights is below the target, we would work with the system manager and staff to target those practices that impact family’s knowing their rights to see where improvements could be made. Systems have revised their referral and intake process to begin gathering information about the child’s functioning in the three child outcome areas. Many use the attached Guiding Questions document or an adapted version to begin capturing the rich, functional information families share at each step of the process. The information is then passed on to the Intake and eligibility teams who continue to add to it and it ultimately becomes a useful starting point of the assessment for service planning process. Families appreciate that someone has listened, captured and shared with team members along the way the information the family has shared. Infant & Toddler Connection of Virginia

Child Indicator Guiding Questions
Many use the Guiding Questions document or an adapted version to begin capturing the rich, functional information families share at each step of the process. The information is then passed on to the Intake and eligibility teams who continue to add to it and it ultimately becomes a useful starting point of the assessment for service planning process. Families appreciate that someone has listened, captured and shared with team members along the way the information the family has shared. Began using this in MD as a way to capture the rich functional information service coordinators were gathering during their initial conversations with families so that it could be shared with the assessment team.

Essential Components/Next Steps
Feedback Not a one time training Next Steps: Continue to connect the dots Explore formal integration of family outcomes Coordinate this work with the SSIP Creating a safe learning environment was essential! Providers were initially hesitant to send their IFSP’s but by providing constructive feedback often referencing back on the Quality Practices and Key Principles turned out to be the key to in helping the field feel competent and confident. And for us, being open to the feedback from the field whether it was changes recommended by our early implementers prior to the statewide rollout and ongoing. We are in the process now of making the third revision to our child indicator booklet as well as making changes to the decision tree to better align to our indicator statements. When we did our statewide trainings, we did it regionally to allow for the maximum number of providers to be present. We also did them early enough before the July 1 rollout date so providers had a lot of time to practice and receive feedback. If local systems found they needed more support, we did follow-up trainings geared specifically at their needs. Building the capacity of the local system managers to provide the ongoing training and feedback was also critical. We continue to provide feedback on narratives thru our Quality Management Review process and regional work. Continue to help providers connect the dots. We are revising many of our training materials, online modules, Kaleidoscope (required training for SCs) and our practice manual in a way that helps providers see the connection. As we move forward in our professional development activities, especially the increased focus on evidence based practices, the key principles and coaching we will continue to tie it all back to the relationship between quality practices and outcomes for children and families. How might use the tool to facilitate the integration of outcomes in your state?

Integrating Child Outcomes With the IFSP Process
North Carolina’s Journey

Like VA, NC sees this effort as a philosophical shift as we think about the 3 CO’s as the framework for everything we do. Graphic developed by: Maryland State Department of Education Division of Special Education/Early Intervention Services Early Childhood Intervention and Education Branch June 2011 NECTAC/ECO/WRRC 2012

Stages of Implementation
Exploration Articulate Desired Changes/Results Compare Approaches Explore Implementation Conduct Public Awareness Move On To Installation Installation Secure Leadership Support Develop a Communication Plan/Message Materials Build Implementation Team Determine System Supports Build Training & Technical Assistance Capacity Develop an Implementation Plan Move on to Initial Implementation Initial Implementation Implement Training & TA Implement an Integrated IFSP and COM Process Support Reflection & Use of Feedback Loops Adapt and Adjust Infrastructure to Support Practices Evaluate Fidelity and Quality of Initial Efforts Make Changes to Support Sustainability Full Implementation Maintain & Improve Skills and Practice Maintain Infrastructure for Data Collection and Monitoring Assess Implementation of Integrated Process Create Organizational Structures to Support Integrated Process Take Action to Ensure Sustainability We used an implementation science framework for planning for implementing child outcomes integration and paid careful attention to cover the key components of each of the four main stages of implementation. We also took advice from other states already implementing as we participated in the Child Outcomes Integration Learning Community facilitated by the Early Child Outcomes Center. NECTAC/ECO/WRRC 2012

Exploration Phase The exploration phase involved convening a committee to discuss whether or not we were ready to begin implementation and what the next steps should be. As we began discussions about child outcomes integration, we had already provided some extensive training and TA statewide on rating and how to enter entry and exit rating data into a statewide database, so staff were already feeling very comfortable with that piece. It still felt a like a separate activity that didn’t really involve families, though, and we wanted to take child outcomes rating to the next level by integrating child outcomes into our work and discussions with families. We found this flow chart to be helpful as we used it to identify existing opportunities for embedding child outcomes information and assessment with what we are already doing to make this a true integration effort and not just something that is added on to what we are already doing. We looked at each of our key points and time and discussed what we are already doing and what we may need to revise, add, and eliminate as part of the integration effort. s. NECTAC/ECO/WRRC 2012

Benefits of Integrating Child Outcomes With IFSP Process
Exploration Phase Benefits of Integrating Child Outcomes With IFSP Process Local Program Staff Intervention Providers Statewide Program Families Understanding how child is functioning compared to age expectations Gaining confidence in ability to observe child & share observations with others Learning to track and celebrate progress Being active in IFSP discussions and development of IFSP outcomes Relating evaluation and assessment results to child outcomes and discussing as a team, including the parent/caregiver Keeping focus on how child functions during everyday situations and routines Improving interrater reliability Planning interventions to impact child outcomes Discussing with family how observations and interventions relate to child outcomes Discussing progress within the context of child outcomes and how child is functioning compared to age expectations Helping local programs use child outcome data to inform local decisions about practice, including improvement planning Providing families and other stakeholders information about statewide child outcomes data and how it is used to inform statewide planning During the exploration phase, we also discussed the benefits of integrating child outcomes with the IFSP process and came up with this rationale. Using the advice from other states who implemented before us, we also chose pilot sites who were eager to engage. We also decided to commit state staff to frequent and routine onsite TA throughout the process, meeting with pilot sites at least monthly onsite and more frequently as needed via web meetings as well as onsite. NECTAC/ECO/WRRC 2012

Installation Phase According to the research presented on the National Implementation Research Network (NIRN) website, Implementation Teams are essential to success (80% vs. 14%; Fixsen, Blase, Timbers, & Wolf, 2001; Balas & Boren, 2000) in helping to develop the staff competencies required, helping to adjust roles and functions, and helping leaders fully support the process by incorporating the necessary implementation supports. We identified implementation team members for each pilot site during the Installation Phase of Implementation and they have been involved in the planning from the very beginning and implementation and evaluation of the process so far. As part of the Installation Phase, the implementation teams assessed current practices and identified areas that needed to change. They also looked at the roles of various practitioners and current processes and practices locally and how those can be adjusted to accommodate a more integrated approach. They also began to identify some existing tools and resources developed by ECO Center, ECTA Center, and other states that they thought would be very helpful as they begin implementation. Like VA, the implementation teams decided to develop indicator statements to describe what the number ratings mean and to format the IFSP to arrange evaluation and assessment summaries by child outcome categories rather than the 5 developmental domains. NECTAC/ECO/WRRC 2012

Installation Phase As we met regularly with Implementation Teams for planning implementation at their sites, we came up with a logic model for the global child outcomes implementation as a way to communicate with the rest of the practitioners at the pilot sites, and also with state leadership, about what the pilots identified as the key activities and outputs as they begin implementation. The implementation teams worked to identify or develop the outputs shown here – decision tree, guide for documenting outcomes ratings, handout for families, talking points for staff, samples of evaluation and assessment summaries arranged by child outcomes (rather than by five developmental domains), and an overview presentation for direct service providers – which they felt were important and useful resources for beginning implementation. NECTAC/ECO/WRRC 2012

Initial Implementation Stage
Team Staff Team Meetings Individual Supervision State Leadership/ Support During the initial implementation stage, the implementation teams did some “trial runs” of different new approaches identified during planning. We also developed training for the rest of the staff. As part of the theme of integration, rather than “adding on” something else to do, we used the existing structure within the local programs of bi-weekly team meetings that were already in place. Information was presented by implementation team members during those team members through structured discussion questions, mini-trainings, and exercises with practicing communicating and documenting information relating to the child outcomes. The regular team meetings are now used as part of the feedback and communication loop as implementation continues. Individual supervision meetings that were already in place are also used to help practitioners discuss and get more specific assistance. NECTAC/ECO/WRRC 2012

Initial Implementation Stage
One component of the Initial Implementation stage is to evaluate initial efforts and that’s where we are in the process currently. We have developed an Evaluation Plan for Implementation, which is a formative evaluation just to check in and see how implementation is going so far. The evaluation includes a record review tool for evaluating quality of practices thus far. It also includes focus group interviews and a survey to gather the impressions of all practitioners in the pilots. We are organizing the focus group information using the template Virginia presented earlier to help us identify areas we need to tweak and next steps. The evaluation information will also help us to see which preparatory activities were most helpful for beginning implementation and whether or not the outputs or tools we chose for beginning implementation were effective. Because we have a statewide data system and can access historical child outcomes ratings data, we are also planning to compare entry rating data before and after implementation for these pilot sites just to see if we discover any significant changes resulting from implementation. Our next steps will be to analyze the information from this initial implementation evaluation and use the information for continued planning and implementation. We plan to do another formative evaluation in a few months and then a summative evaluation near the end of the year when we have a good amount of entry and exit data so we can look more closely at quality practices and determine final recommendations for statewide implementation. NECTAC/ECO/WRRC 2012

Essential Components Dedicated State Level TA and Support
Local Implementation Teams Communication and Feedback Loops Practice Time Evaluation of Fidelity and Quality Reviewing and Revising Some components that we have learned have been especially important thus far NECTAC/ECO/WRRC 2012

Key Resources Virginia’s Child Indicators Booklet Maryland’s Family Worksheet Decision Tree (adapted) Guide to Documenting Global Outcomes Ratings (adapted) PACER Center’s Family Guide to Participating in the Child Outcomes Rating Process Some great resources for tools for beginning implementation NECTAC/ECO/WRRC 2012

Time to get your feet wet!
Activity – flow chart here. Time to get your feet wet! NECTAC/ECO/WRRC 2012

Integrating Outcomes Resources
ECTA Website - Outcomes Measurement – Integrating Outcomes into the IFSP Considerations for Implementation Flow charts and activities Training resources State resources and sample IFSPs Integrating Outcomes Learning Community: Monthly calls Secure website Face to face meeting at conferences NECTAC/ECO/WRRC 2012

Integrating the Child Outcomes into the IFSP Process Contact Information Anne Brager, VA Part C Program Sherri Britt Williams, NC Part C Program Kathi Gillaspy, ECTA Center May 22, 2014 2014 Inclusion Institute NECTAC/ECO/WRRC 2012

Integrating the Child Outcomes into the IFSP Process

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