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Decision Tee Summary Ratings Discussions

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Decision Tee Summary Ratings Discussions

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This PDF shows the questions that should be used to guide the rating process.

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This site reviews the functional outcomes that should be reviewed when working with children.

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Updated August 16, 2022, 8:38 AM

This document helps teams think about measuring a child's use and integration of functional skills to participate in their everyday routines. This resource will help teams further their understanding of the following questions:

The goal of early intervention and early childhood special education is to enable young children with disabilities to be active and successful participants during their early childhood years and in the future. Child outcomes are the benefits that children and families experience as a result of early intervention or early childhood special education services. The three child outcomes selected for federal reporting reflect a child's global functioning in three broad areas of development:

Outcome 1: Positive Social-Emotional Skills (including social relationships)

Outcome 2: Acquisition and Use of Knowledge and Skills

Outcome 3: Use of Appropriate Behaviors to Meet Needs

To measure a child's functioning and progress toward these outcomes, teams must identify how children use and integrate their functional skills to participate in their everyday routines, activities, and interactions. Teams using the Child Outcomes Summary (COS) Process 7-point rating scale for outcomes measurement aim for a snapshot of the whole child. This includes where the child's functioning is at in relation to age expectations, and how the child is functioning across settings and situations.

Key Takeaway

Child outcomes measurement and the COS Process are based on the functional skills children demonstrate in the context of their routines, activities, and interactions.

What makes a skill functional?

Each of the three child outcomes encompasses an array of functional skills involved in a child's participation in day-to-day routines. Functional skills are those skills a young child uses to complete tasks and participate in everyday life. To understand a child's level of functioning, the team must know the child's intent and purpose when using a skill. Functionality is not inherent to a skill itself, but can be found in a child's meaningful use of that skill.

For example, the ability to stand on one foot is an isolated, discrete skill. Determining function is a process of asking why -Why is the child standing on one foot? Is it to put on a pair of pants, to play hopscotch with friends, or so that a caregiver can dry the other foot off after bath time?

K-12 educators sometimes use functional skills as a term to refer to those skills a student needs to live independently (for example, riding the bus). Functional skills are contrasted with academic skills, which are those skills taught in the general education curriculum. However, in early childhood and for the purposes of this document and for thinking about the outcomes in the COS process, functional skills are defined more broadly, and include the skills a child demonstrates in the context of their everyday life. In this view, functional skills include self-help skills, skills used when interacting with others, and even academic skills (for example, counting out carrot sticks for snack time-number concepts are functional when their use is meaningful and in context).

Isolated, discrete skill

Functional use of skill

Reaches around a barrier to retrieve a toy.

When playing with the ball, Ingo goes behind the couch to retrieve it when it rolls under the couch so that he can continue playing.

Repeat a 3-digit sequence in order

During art activities, Alira regularly follows directions to collect three materials for an activity, for example, "Go get a paint brush, smock, and paper," or "Go get the Play-Doh, cookie cutters, and rolling pin".

Extend index finger in a pointing direction independent of other fingers and thumb

When Esteban wants a cookie, he looks up at the top of the fridge where the cookie jar sits and he points at the jar, says "me cookie", and looks at his mom.

Key Takeaway

Functional skills are those a child integrates to complete tasks and participate in everyday life. Functional skills have intent and purpose in a context meaningful to the child.

How does context help align functional skills with each of the three outcomes?

Once teams know the function and context of a skill, they can align it with a specific outcome. The process of aligning skills to outcomes helps the team know whether they have enough information about a child's functioning to measure outcomes. For example, skills can be aligned with outcomes, as well as skills bundles that are encompassed within each outcome.

Detailed information about how a child uses skills in the context of everyday routines helps teams determine the functional purpose of the skill, and the outcome to which that functional skill aligns. When information about the child's functioning lacks detail about the context or function of a skill, the team must gather more information. Further observation and interviews with caregivers can provide the detail needed to understand the function of a skill and align it with an outcome.
See also: Aligning A Child's Functional Skills with the Breadth of the Three Child Outcomes
Following directions - What is the function?

Playing - What is the function?

Manipulating objects - What is the function?

Key Takeaway

Teams need detailed information about how the child uses the skills in everyday routines before they can determine the functional purpose and use of the skill and align it with the relevant child outcome.

How do teams assess functional skills?

Authentic assessment methods help teams gather information about a child's functioning across settings and situations. These methods include direct observation and interviews with those who spend time with the child as described in the DEC Recommended Practices.

Teams can ask questions to determine the function of skills to understand skills not adequately described, or learn about a child's everyday functioning in meaningful routines and activities, for example:

What does the child usually do?

How do does the child perform in different settings and situations?

How does the child use skills to accomplish tasks?

Some formal assessment tools are not useful for understanding a child's functioning. These tools tend to provide information about isolated, discrete skills that are demonstrated in a testing environment, with no apparent function. For example, a test item assesses if a child can point. Pointing is an isolated, discrete skill. To understand a child's functioning, the team will need to know how the child uses pointing, such as to communicate wants and needs (Outcome 3) or to activate a toy (Outcome 2).

Formal assessment tools help establish a child's eligibility for early intervention or early childhood special education services. However, when assessment items are administered in a structured testing situation without clear purpose within meaningful contexts, they provide minimal information about a child's functional use of skills in everyday life. Assessment outside of the child's natural context does not provide the team information on how the child uses a skill in a typical daily routine, and is not sufficient for determining if the skill is functional for the child.

Key Takeaway

Authentic assessment methods, such as observation and interviews with caregivers, provide teams with information about a child's functional use of skills.

Child Outcomes Summary Process Resources

For further information and practice opportunities, refer to the following resources:

Aligning A Child's Functional Skills with the Breadth of the Three Child Outcomes - This resource supports high-quality Child Outcomes Summary (COS) ratings by helping teams connect their observations of children's functional skills and behaviors with the three child outcomes. Effectively aligning functional skills and outcomes will help Part C early intervention and Part B, Section 619 preschool special education program teams improve their outcome measurement.

Child Outcomes Practice Scenarios (COS-PS) - The COS-PS is a collection of scenarios of children, ages 6 months to 5 years, that allow you to practice aligning information about each child with the three child outcomes and anchoring the information by age.

Instrument Crosswalks - Crosswalks cross-reference the functional skills assessed by various published instruments with the three child outcomes required by OSEP for Part C and Part B, Section 619 programs to assess the degree to which these instruments measure the required outcomes.

Topical COS Professional Development Activities - These activities focus on aspects of the COS Process providers frequently need additional training and support (see Assessing Functional Skills).

Child Outcomes Summary (COS) Process Quick Reference Guide

Developing High-Quality, Functional IFSP Outcomes and IEP Goals Training Package - This training package was developed collaboratively with staff from the ECTA Center and the Western Regional Resource Center (WRRC) in response to the need expressed from state and local providers to have specific information and resources about developing Individualized Family Service Plan (IFSP) outcomes and Individualized Education Program (IEP) goals.

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Understanding Functional Skills: Background for the COS Process

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Updated August 16, 2022, 8:38 AM This document helps teams think about measuring a child's use and integration of functional skills to participate in their everyday routines. This resource will help teams further their understanding of the following questions: The goal of early intervention and early childhood special education is to enable young children with disabilities to be active and successful participants during their early childhood years and in the future.

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Child Outcomes Summary (COS) Form and Instructions (Including Decision Tree and Rating Process)

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This website from ECTA goes into details around the COS form, getting started, building the team and going through evidence to use the decision tree tool.

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The Child Outcomes Summary (COS) Process is a team process for summarizing information related to a child's progress on each of the Three Child Outcomes on a 7-point rating scale.

The COS process can be used:

When the state wants to use multiple sources of information to describe a child's functioning on each of the outcomes. The information could include one or more norm-referenced or curriculum-based assessments, parent report on child's skills and behavior, progress notes of therapists working with the child, observations by a teacher or child care provider, or other sources; or

When different assessments have been given to different children across the state and the results need to be placed on the same scale to be aggregated.

Outcomes reflect these beliefs about young children:

It is important that all children be successful participants in a variety of settings both now and in the future. Achieving the three outcomes is key to being successful participants in life.

Programs for young children and their families are working to ensure that all children will have the best possible chance of succeeding in kindergarten and later in school-even though school might be several years off for some children. Children who have achieved the outcomes at a level comparable to their same aged peers prior to kindergarten entry have a high probability of being successful in kindergarten.

Learning and development occur continuously in the years preceding kindergarten. There is much variation in how children develop but children whose development is consistently below what is expected for their age are at risk of not being successful in kindergarten and later school years.

The COS Form is not an assessment instrument:

The COS Form is used for summarizing across multiple sources of information about the child. The COS process allows states to address the OSEP reporting requirement as well as look at the child outcomes data in other ways.

Using the COS process does not require that programs collect more data about children's progress; it is a mechanism that allows them to summarize assessment information for federal reporting as well as for their own purposes, such as for accountability, program planning, and program improvement.

The team completing the COS process includes those who know the child best:

Those who know the child best frequently includes family members, professionals who work with the child, and anyone else familiar with the child's functioning.

States might also determine who completes the COS process. States frequently report team sizes of 2-7 people.

Some states complete the form as part of or meetings.

To provide data for the OSEP reporting requirements, the COS process must be completed at program entry and again at program exit with at least 6 months between. States that collect outcome data for their own purposes frequently complete the form annually, or every 6 months.

Training is essential for effective and reliable use of the COS process:

ECTA Center provides COS Process Professional Development resources on child outcomes measurement and the three outcome areas, recommended assessment practices. The included information, activities, and case examples clarify critical choices and requirements for determining a rating, for example, using the rating scale, gathering multiple sources of assessment information, and comparing information to age-expectations.

Some states gather feedback from providers using the COS process:

Feedback allows individual providers to ask questions, share effective strategies for working with local populations.

Feedback can be used enhance the consistency of approaches used.

Developmental framework assumptions:

Children develop new skills and behaviors and integrate those skills and behaviors into more complex behaviors as they get older.

These skills and behaviors emerge in a developmental sequence in most children, allowing for descriptions of "what 2-year-olds generally do", "what 3-year-olds generally do", and so on.

The development of children with disabilities can be compared to the development of same-age peers. A child's development might be characterized by delays, acquiring skills and behaviors at a substantially slower pace than others their age.

A child's development might be atypical-with functioning so different from that of others their age that it is considered outside the limits of age-expected behavior.

Skills and behaviors:

Foundational (F) skills and behaviors develop early, and provide a scaffold for later skills to build upon in predictable ways.

Immediate foundational (IF) skills and behaviors indicate a higher level of developmental functioning. For example, children play alongside one another before they interact in play.

Age-expected (AE) skills and behaviors are those expected for the child's chronological age.

Rating scale assumptions:

Achieving each of the three child outcomes aligns with the goal of programs and services for children: active and successful participation across a variety of settings now and into the future.

For many young children with disabilities, recieving high-quality services allows them to move toward age-appropriate functioning than they would without such services.

Documenting children's progress toward age-appropriate functioning is one type of evidence for the effectiveness of early intervention and early childhood special education.

The highest end of the scale represents age-expected or age-appropriate functioning, with each lower point being a degree of distance from age-expectations.

The Decision Tree for Summary Rating Discussions contains a series of questions about age-appropriate skills and behaviors within the Three Child Outcomes. Responses to these questions guide the user to a rating category on the 7-point rating scale. The version with no rating scale can be especially useful when families are directly involved in team discussions that describe a child's level of functioning.

Step 1

Does the child ever function in ways that would be considered age-expected with regard to this outcome?

Step 2

Does the child use any immediate foundational skills related to this outcome upon which to build age-expected functioning across settings and situations?

If "YES", then proceed to Step 3

If "NO", then "Uses skills that are not yet immediate foundational", then Rating = 1 (end)

Step 3

To what extent is the child using immediate foundational skills across settings and situations?

Step 4

Does the child function in ways that would be considered age-expected across all or almost all settings and situations?

Step 5

To what extent does the child function in ways that are age-expected across settings and situations?

Step 6

Does anyone have concerns about the child's functioning with regard to the outcome area?

El Paso 1

¿El funcionamiento del niño es el esperado para su edad con respecto a este resultado?

El Paso 2

¿El funcionamiento del niño utiliza las habilidades y comportamientos inmediatas, relacionados a este resultado, antes de las esperadas para su edad sobre las cuales puede desarrollar el funcionamiento esperado para su edad en distintos entornos y situaciones?

Si a respuesta es "SI", continúe con el Paso 3

Si a respuesta es "NO", entonces "Utiliza habilidades y comportamientos básicas muy alejadas para su edad", entonces la Calificación = 1 (fin)

El Paso 3

¿Hasta qué punto el niño utiliza un funcionamiento inmediato antes de lo esperado para su edad en distintos entornos y situaciones?

El Paso 4

¿El funcionamiento del niño, relacionados a este resultado, es el esperado para su edad en todos o casi todos los entornos y situaciones?

El Paso 5

¿Hasta qué punto el funcionamiento del niño es el esperado para su edad en distintos entornos y situaciones?

El Paso 6

¿Alguien tiene preocupaciones sobre el funcionamiento del niño con respecto al área de resultados?

Building the COS Team: COS ratings are more consistent and accurate when family members provide information about the child's functioning. If family information on child functioning was not included, mark "Not included" on the first page. Additional state-specific information also may be requested.

Completing the COS Form: Completing the form requires gathering information, documenting supporting evidence, and determining a rating for each of the three outcomes. For a rating to accurately reflect the child's current functioning, the COS Form-including all information-gathering-should be completed within a six-week period.

Revisiting the COS Form: Questions 1b, 2b, and 3b are to be completed after some time has passed since the initial completion of the COS Form. Indicate if the child has made progress since the previous outcomes rating. Progress is defined as the acquisition of at least one new skill or behavior related to the outcome. Describe the nature of any progress made.

People Who Know the Child: Gather information from a range of people in the child's life, including their parents, family members, caregivers, child care providers, therapists, service providers, case managers, teachers, physicians, and others who can provide information about the child.

Settings and Situations: Find out what is known about how the child behaves across a variety of settings and situations (for example, at home, the grocery store, or a playground).

Assembling Evidence: The information gathered by the Team might include firsthand accounts of child functioning, clinical observation, curriculum-based assessments, norm-referenced assessments, service provider notes about performance in different situations, and progress or issues identified in an IFSP or IEP process you have collected.

Omitting Sources: Don't include sources that do not know the child, for example, information available in a child's records.

Cite the Source: Indicate the source of the evidence (a parent, speech therapist, teacher, or specific assessment) and the nature of the evidence from the source.

Functional Skills: Identify the specific functional skills the child uses in everyday settings and situations, and the consistency with which they are observed.

Age-Anchoring: Describe the presence and absence of age-anchored skills-Foundational (F), immediate foundational (IF), and age-expected (AE)-that are consistent with the selected rating.

Function, not Progress: Focus on the child's current level of functioning rather than how much progress the child has made.

Compare to Same-Age Peers: Compare the child's skills and behaviors to those of same-age peers. For each of the three child outcomes, determine the extent to which the child's skills and behaviors are age-expected.

Example COS Form Supporting Evidence:

Candace's mom

April 12, 2023

When Candace eats by herself, she makes a mess. She eats finger foods but does not a fork or spoon. She uses a "sippy" cup with two hands.

Candace has not started toilet training.

Candace does not let mom know when she has a wet or soiled diaper.

Candace pulls off her socks when getting ready for bed.

Candace's child care provider

April 5, 2023

Carolina Curriculum for Infants and Toddlers with Special Needs

Administered March 13, 2023

Self-Help: Eating - 12-15 months

Self-Help: Dressing - 15-18 months

Self-Help: Grooming - 18-21 months

Self-Help: Toileting - <15-18 months

Developmental specialist

Observed over a 4-week period, March 2023

Observed structured activities in child care environment and unstructured play time.

Candace clapped and jumped during a group song.

During free play, Candace sat quietly unless engaged in a play activity by caregiver.

Candace did not object to having hands washed by caregiver, but needed assistance.

Summary Ratings: A summary rating provides an overall picture of how the child behaves across the variety of people and settings in their life at this particular time in their life. It is a number on the 7-point rating scale.

Provide Guidance: Before determining a rating, ensure all team members have been provided guidance and instruction for using the rating scale.

Assessment Tool Results: Assessment tools can be a useful source of information for reaching a summary decision. However, many assessment tools are "domain-based", and don't provide information about functional behaviors across a variety of situations. Knowing wether or not a child has mastered assessment items related to an outcome provides helpful information, but this information must be placed in context with what else is known about the child. A high score in a domain related to an outcome doesn't mean a child has achieved that outcome. Conversely, a low score does't mean a child hasn't achieved it.

Standardized Test Results: A standardized test environment is an unusual setting for a young child. If the child's functioning in a testing situation differs from the child's everyday functioning, the rating should reflect the child's everyday functioning.

Adaptations and Assistive Technology: A rating should describe the child's functioning using any adaptations. However, if technology is only available in some environments or is not available for the child, rate the child's functioning with whatever assistance is commonly present. Ratings should reflect the child's observed functioning across a range of settings, not their capacity to function under ideal circumstances.

Cultural Expectations: Some cultures have expectations that differ from published developmental milestones, for example, feeding and dressing oneself. In these instances, use the expectations for the child's culture to determine if child's functioning is age-expected.

Prematurity: Use expectations for the child's chronological age, not a corrected age. The COS form is intended to describe the child's current functioning relevant to expectations for their age. Over time and with support, many children born prematurely will eventually perform like same age peers.

Findings of Insufficient Information: It is common for a team to need to gather more information before determining a rating.

Overall Age-Expected

Overall Not Age-Expected

3

Provide examples of the child's IF functioning.

For a rating of 3, evidence presents more IF than F functioning.

1

Provide examples of the child's functioning that is not yet AE or IF.

For a rating of 1, evidence presents only F functioning.

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Child Outcomes Summary (COS) Form and Instructions

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The Child Outcomes Summary (COS) Process is a team process for summarizing information related to a child's progress on each of the Three Child Outcomes on a 7-point rating scale. The COS process can be used: When the state wants to use multiple sources of information to describe a child's functioning on each of the outcomes.

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This graphic shows the three areas examined during the COS process.