STATE OF WASHINGTON Department of Social and Health Services

1
STATE OF WASHINGTONDepartment of Social and
Health Services

• Washingtons statewide Part C Program is called
  the Infant Toddler Early Intervention Program
  (ITEIP)
• Our website is at http//www1.dshs.wa.gov/iteip
  or Google ITEIP
• Our website has our data please check it out.

2
What Did States Learn from Child Outcomes Pilots
and Field Tests?
Overview of Session

• Provide key points as defined below
• 1. Provide relevant information about how your
  state is organized/structured.
• 2. Describe the approach your state program is
  taking to measure child outcomes including the
  decision to use the COSF and the pilot/phase in
  process you are implementing.
• Describe the resources and supports you utilized
  to implement the child outcomes process (could be
  your state staff, state or national TA providers,
  GSEG resources, etc.)
• Describe the first pilot/phase-in site(s) for
  collecting child outcomes measurement process.
• What feedback was gathered? What was learned
  from the early implementation of the data
  collection?
• What changes did you make as a result of the
  early feedback? e.g. Was there any change in
  requirements or guidance around the process? Was
  there any changes made to the form? Were any new
  materials or resources developed?
• Next Steps for continuing to learn and improve
  the process (e.g. quality assurance)

3
Child and Family Outcomes

• 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
• Family Outcomes
• Percent of parents/families participating in
  Part C who report that Early Intervention helped
  the family
• know their rights
• effectively communicate their childrens needs
• help their children develop and learn

4
What do you know about Washington?

• Who is our states Governor?  
• Christine Gregoire
• Where is the State Capital?
• Olympia
• Who is the State Part C Lead Agency?
• Department of Social and Health Services
• How many Counties are in WA?
• 39
• How many islands does Washington
• State have?
• Go to Access Washington to find
• the number but the hint is lots
• Where was this picture taken?

5
There are 29 Federally Recognized Tribes
6
Washington State Symbols

• Arboretum Washington Park Arboretum
• Bird Willow Goldfinch
• Colors Green and Gold
• Dance Square Dance
• Fish Steelhead Trout
• Flower Coast Rhododendron
• Folk Song" Roll On Columbia, Roll On" by Woodie
  Guthrie
• Fossil Columbian Mammoth of North America
• Fruit Apple
• Gem Petrified Wood
• Grass Bluebunch Wheatgrass

• Marine Mammal Orca
• Insect Common Green Darner Dragonfly
• Motto Alki, meaning "bye and bye
• Nickname The Evergreen State
• Ship "President Washington
• Song "Washington, My Home" by Helen Davis
• Tartan Background green (rich forests)
  perpendicular bands blue (lakes, rivers, and
  ocean), white (snow-capped mountains), red (apple
  and cherry crops), yellow (wheat and grain
  crops), black (eruption of Mt. St. Helens).
• Tree Western Hemlock

7
Washington State Population and Forecast
Birth rates Annual births are at 82,000 now and
should increase to about 100,000 by 2016. By
2030 there are estimated to be106,000 births per
year. State and local populations are greatly
influenced by Military impact (Army, Navy,
Marines, Coast Guard, Air Force) in multiple
counties throughout the state the large number
of families who move to WA each year for
agricultural employment and ongoing population
shifting from place to place according to crop
seasons, military assignment, and employment
related to states largest industry
(agriculture). Islands Created on June 1, 1951,
Washington State Ferries (WSF) is the largest
ferry system in the United States and the largest
ferry system in the world based on vehicles
carried. More than 24 million people a year ride
the ferries and over 30,000 vehicles a day use
this critical link in the state highway system.
WSF has a fleet of 26 vessels and operates 20
terminals throughout Puget Sound.
8
Washington State is a great place to work and
play. We need early intervention staff - so come
join us!

• Google Access Washington and see
• http//www.experiencewashington.com/v5/GuidesAndMa
  ps/publications.aspx
• The Official Site of Washington State Tourism
  Visitor Guides

9
Washington Attractions
10
Washington State Historical Facts/Timelines

• 1579 Sir Francis Drake sailed up the Pacific
  Northwest Coast and named the entire region New
  Albion.
• 1775 Spain laid claim to the area.
• 1792 Many of our state landmarks named by Captain
  George Vancouver. Captain Robert Gray explored
  the lower reaches of the Columbia River.
• 1805-06 Lewis and Clark expedition explored the
  Northwest and reached the Pacific Ocean at the
  mouth of the Columbia River.
• 1818 Fort Walla Walla built by the North West
  Company. This enabled the United States to claim
  joint occupancy of the Oregon Territory with
  England.
• 1819 Spain gave the United States any and all
  rights claimed by Spain to the Oregon country.
• 1846 Oregon Territory became a part of the United
  States when the United States and Great Britain
  agreed to the 49th parallel as the northern U.S.
  boundary.

• 1848 Oregon Territory was established with
  Washington as the northern part of the territory.
• 1853 Washington Territory, separate from Oregon,
  was created. Isaac Stevens was the first
  territorial Governor.
• 1863 Idaho Territory was created from part of the
  Washington Territory.
• 1889 Washington admitted to the United States on
  November 11 as the forty-second state. Elisha
  Ferry was the first elected Governor of
  Washington State.
• 1941 Grand Coulee Dam completed.
• 1980 Mount St. Helens erupted May 18.
• 1989 Washington celebrated 100 years of statehood
  on November 11.

11
Counties with Population Density Less Than 100
Persons per Square Mile
As of April 1, 2007, the following counties had a
population density of fewer than one hundred
persons per square mile. Actual population
densities in persons per square mile are shown in
parentheses.

• Adams (9.14)
• Grant (30.77)
• Pend Oreille (9.00)
• Asotin (33.53)
• Grays Harbor (36.93
• San Juan (90.90)
• Benton (95.65)
• Jefferson (15.76)
• Skagit (66.45)
• Chelan (24.37)
• Kittitas (16.67)
• Skamania (6.46)
• Clallam (39.38)
• Klickitat (10.63)
• Stevens (17.35)
• Columbia (4.72)

• Lewis (30.78)
• Wahkiakum (15.14)
• Cowlitz (85.89)
• Lincoln (4.46)
• Walla Walla (45.89)
• Douglas (19.94)
• Mason (56.81)
• Whatcom (88.84)
• Ferry (3.43)
• Okanogan (7.55)
• Whitman (19.77)
• Franklin (54.25)
• Pacific (23.15)
• Yakima (54.51)
• Garfield (3.31)  

12
Many think of Washington related to our major
population centers and cities
Washingtons most populated counties are King,
Pierce, Spokane, and Snohomish. Other counties
with density areas above the last chart are
Clark, Skagit, Kitsap and Island. Here are a few
examples of some of our largest cities

• Seattle
• Tacoma
• Everett
• Bellevue
• Spokane
• Yakima

• Bellingham
• Kent
• Auburn
• Vancouver
• Wenatchee
• Tri Cities (Richland, Pasco, Kenniwick)

13
Much of Washington hasmany miles to travel to
get to where children and families live, learn,
and play.
14
Infant Toddler Early Intervention Program (ITEIP)
Structure(WA Early Intervention Services)
Children Eligible and Their Families
(Logo courtesy of the Department of Social and
Health Services Infant Toddler Early Intervention
Program funded by the Individuals with
Disabilities Education Act.)
ITEIP
(Part C)
DSHS
DEL
OSPI
DOH
DSB
Federal
(Department of Social and Health Services)
(Department of
Tribes
(Department of Health)
(Services for the Blind)
(Office of Superintendent
BIA, HS, EHS,
of Public Instruction)
Early Learning)
(Bureau of Indian Affairs,
State Lead Agency
SICC Member
SICC Member
SICC Member
Head Start Early Head Start)
SICC Member
ITEIP
Coordination and direct
Provide direct service support for
SICC Member
services.
families of eligible children with
SICC Member
blindness or vision impairments.
Local Lead Agencies
Support and assist in service
School Districts
ESDs
delivery options.
Provide early intervention services including
Family Resources Coordinators (FRCs) facilitate
identification of eligible infants, assist with
eligibility determinations, participate in the
development and implementation of the individual
Family Service Plans, and coordinate services
delivery activities and funding.
(Educational
Service Districts)
Provide local
funding and direct
services.
Children With Special Health Care Needs (CHSCN)
CA
RDA
ADSA
HRSA
ODHH
Indian Policy
Economic Services
(Children's Admin.)
(Deaf and Hard of
(Research and Data
(Health Recovery Services Administration)
(Aging Disability Services
Administration
and Support
Hearing)
Provides economic, employment and training, child
support, medical, and other services to help
people in need achieve and maintain their highest
level of self-sufficiency.
Analysis)
Working to
Coordinates and

Collaborates on
increase referral
Provides
develops
Many services
efforts to
DDD
technical
linkages in the
specialized
are provided to
facilitate early
CA for the
assistance in the
(Division of Developmental Disabilities)
services for eligible infants and toddlers
and their families.
infants and their
intervention
purpose of
collection and
families through
services for Tribal
implementing
interpretation of
medical coupons.
infants' toddlers and families.
IDEA.
data used to
DDD is the
(Major Funder)
understand
programmatic
program delivery
home for
ITEIP
issues and
MH
develop service
DASA
(Drug and Alcohol)
(Mental Health)
delivery options.
Helps identify
County Health
Coordinates to
Local Health
Infants with
assure that
Department
District
Fetal Alcohol
mental health
Syndrome (FAS)
ADSA/
services are
DDD Regions
WorkFirst (TANF)
Information
and other
accessible and
Technology
conditions. FAS
available to infants and toddlers and
their families.
Provide Care Coordination thru Children With
Special Health Care Needs
has been
(Temporary
Assistance for Needy
included as an
ITEIP Data
County Human Services Child Development Svcs.
ITEIP category of
Families)
Management System
eligibility.
Collaborate on
treatment
programs.
Created by the ITEIP Data System Project Team
Updated August 6, 2007
ITEIP Web site -- http//www1.dshs.wa.gov/iteip/
15
Summary of approach Washington is taking to
measure child outcomes

• Washington implemented the Child and Family
  Outcomes Measurement Project as a multi-phased
  project to
• Gather input from Washington Stakeholders
  concerning
• Method of the identification and measurement of
  child and family outcomes
• Determine how best to amend the ITEIP Data
  Management System and,
• Gear up to implement federal and related state
  requirements across Washington.

16
Washington State Parameters for Child and Family
Outcomes Measurement and Data Collection

• Collection and reporting State Performance Plan
  data, including child and family outcomes is a
  federal requirement, not an option.
• Reports must be aggregated data for state and
  local geographic areas and are to be reported to
  the U.S. Department of Education, Office of
  Special Education Programs, the Governor, and the
  public.
• ITEIP worked with a stakeholder advisory group
  and the State Interagency Coordinating Council to
  determine the best approach.
• Parents and families will be involved in child
  and family outcome measurement and skill summary
  discussions and collection. The ECO Center
  narrative terms are to be used to define the
  skills and progress for each child at entry into
  and exit from the Washington ITEIP and services.
• Five sites piloted process and forms and their
  input was incorporated into Washingtons state
  implementation training held in May 2007. All
  training materials are on our ITEIP Website.

17
WA State Parameters - Continued

• Individualized Family Service Plan (IFSP) teams
  must complete and collect data for child
  outcomes. The National Early Childhood Outcome
  Center (ECO) Childhood Outcomes Center Summary
  Form (COSF) and process has been modified for
  Washington and will be used statewide. Teams are
  to include the professions licensed or
  credentialed who evaluate, assess, and explain
  results, the parent(s), and the FRC assigned to
  the family/child at the time of entry and time of
  exit.
• The team discusses and works together for
  consensus on summaries of childs skills and
  progress made.
• Beginning July 1, 2007, entry child outcome
  summaries are being completed for each child
  entering ITEIP who were less then 2 years, six
  months old.

18
WA State Parameters - Continued

• Exit summaries must be completed for all infants
  and toddlers leaving ITEIP who have entry
  summaries AND who have been in early intervention
  services for six months or more. This occurs as
  soon as possible after July 1, 2007 for all
  infants and toddlers who have been in ITEIP for
  at least six months and who entered before the
  child was 2 and one half years old.
• More than one evaluation and assessment tool is
  allowed for use at entry and exit times when
  measuring and collecting child outcomes data.
  All information available is part of the process.
  Functional skills and outcomes are to be
  discussed, incorporated, and recorded as part of
  the summary process.
• Washington will not use any numbers when
  completing our summary process and forms. The
  forms have been modified to focus on language and
  not use numbers. We want no option or
  conversation for children to ever be referenced
  as, or related to, a number.

19
WA State Parameters - Continued

• Teams may choose to do outcome summaries and
  complete forms more often than at entry and exit.
  If so, they need to clearly document them as NOT
  the entry or exit form.
• Because we are doing entry summaries upon the
  time of entry for all infants and toddlers, the
  infants who enter the system within the first few
  months of life may look very different in four to
  six months. Therefore we encourage the team to
  determine whether they should complete an
  additional summary for these children.
• The Infant Toddler Early Intervention Program
  (ITEIP) Data Management System is being updated
  to collect, record, and generate aggregate state
  and local reports for child outcome data. Until
  the system is updated and ready, electronic or
  paper summary forms are being completed. Data
  will need to be entered into the data system
  prior to finalizing our Annual Performance Report.

20
Family Outcome Measurement

• Washington Family Outcomes will be measured by
  use of the National Early Childhood Outcome
  Center (ECO) survey tool and used statewide.
  This year, ITEIP has asked local lead agencies
  for assistance with distribution to complete the
  survey by Fall 2007.
• As funding is available, we will be updating the
  ITEIP Data Management System to include the ECO
  survey, so it can be used to generate surveys and
  share with families at the time of the annual
  IFSP meetings and at the time of transitions by
  age three. These are times when interpreters are
  involved and available to assist non-English
  speaking and non reading parents and families
  complete the surveys.

21
Family Outcome Measurement - Continued

• We are planning to align child identification
  numbers and family surveys in a confidential
  analysis of how we are doing for the families and
  how the child is doing as well.
• We want to review child and family outcomes to
  see if there are system issues identified. For
  example
• At Entry - To what extent does this child show
  age-appropriate functioning, across a variety of
  settings and situations, on each outcome?
• How does this relate to what the parents shared
  with us?
• At Exit - Has the child shown any new skills or
  behaviors or not related to (each outcome) since
  the last outcome summary?
• How does this relate to what the parents shared
  with us at the time of transition?

22
Resources and supports utilized to implement the
child and family outcomes process

• This was a true national and state partnership.
  Our progress could not have been done without the
  partnership and support from WESTAT, SRI/ECO
  Center, NECTAC, state parents, SICC,
  stakeholders, and pilot sites.
• During late 2005, WA state Infant and Toddler
  Early Intervention Program (ITEIP) partnered with
  WESTAT Inc. to submit a General Supervision
  Enhancement Grant (GSEG) proposal to the U.S.
  Department of Education, Office of Special
  Education Programs.
• In March of 2006, WESTAT and ITEIP were notified
  of their selection to receive the grant. The
  purpose of the grant was to develop and pilot
  State Outcomes Indicators and Methods for Early
  Childhood Measurement.
• The grant was used to assist the state in
  developing and implementing the Part C outcomes
  indicators, including methods to collect and
  analyze ITEIP state child outcome measures for
  infants and toddlers, birth to three, and their
  families.

23
Resources and Supports - Continued

• In partnership, WESTAT and ITEIP, had four phases
  in the GSEG project
• obtain stakeholder input on the child and family
  outcomes
• send the recommendations to a broader group of
  stakeholders
• pilot collection of child and family outcome
  data and,
• plan and begin programming and updating the ITEIP
  Data Management System to collect and document
  the child outcome measures.
• As part of this grant, we have obtained
  assistance from the nationally recognized staff
  of SRI International, Early Childhood Outcome
  Center. SRI has provided Kathy Hebbeler, a
  leading researcher in the field for outcomes and
  positive research results of early intervention
  and preschool services, to work with us.
• We have also received support from NECTAC
  consultants Lynn Kahn, Robin Rooney, and
  Christina Kasprzak.

24
Specific Details of the Washington Child and
Family Outcomes Measurement Project

• Phase 1
• August 2006 through January 2007 Stakeholder
  Workgroup Meetings
• August 21, 2006, a statewide teleconference kick
  off call was conducted. DSHS Secretary Robin
  Arnold-Williams, SICC Chair Bonnie Sandahl, and
  Kathy Hebbeler were our key speakers and outlined
  state and national plans and details.
• A total of 130 individuals from 68 sites in
  Washington State participated in this call.
  During the presentation participants learned
  about
• Purpose of the project and the role of the
  Workgroup in the activities.
• Stakeholders represented a variety of interest
  groups such as parents, state and community
  organizations, schools, universities, and health
  plans.
• All conference call participants were invited to
  apply to the Stakeholder Workgroup.

25
Phase 1 - Continued

1. Early in September 2006 - Thirty Stakeholders
   were selected based on an application process and
   a variety of factors, including their geographic
   location, affiliation, availability to attend
   scheduled meetings, and complete assignments
   between them. Workgroup members included
   parents, providers, representatives from state
   agencies and a university.
2. WESTAT and ITEIP worked together to recruit and
   hire a State Outcomes Project Coordinator. The
   Coordinator was key in assisting with work group
   selection, preparing materials and agendas for
   workgroup meetings.
3. The charge of this Workgroup was to provide input
   on the measurement of child and family outcomes
   in Washington State and make recommendations on
   the process to be used.
4. Three Stakeholder Workgroup meetings were
   conducted September 18, October 19, and November
   20. Summaries from each meeting are available on
   the ITEIP Website.
5. In addition to meetings, four conference calls
   were conducted during this timeframe to address
   questions and obtain additional input from
   Workgroup members.

26
Phase 2 January 2007 through February
2007 Stakeholder Feedback Select Pilot Sites

• The following recommendations were identified by
  the Workgroup
• Enhance the Infant Toddler Early Intervention
  Program (ITEIP) Data Management System to
  facilitate analysis of child outcome data by
  selected variables.
• Pilot the Child Outcomes Summary Form (COSF)
  developed by the Early Childhood Outcomes Center
  (ECO) to gather child outcomes data.
• Select pilot sites using a range of criteria.
• Use the Early Childhood Outcomes Center (ECO)
  Family Survey to gather family outcomes data.
• Form a Pilot Site Steering Committee.

27
.
Phase 3December 2006 through April 2007Set up
and Conduct Pilot

• Pilot site application announcements were sent
  via email to all ITEIP Stakeholders.
• The application deadline was January 9, 2007.
  Five pilot sites were selected from a total of
  seven applicants to pilot the process of using
  the Child Outcomes Summary Form. We received no
  completed applications from Regions 4 or 6.
• Pilot sites were selected based on timely
  submitted application meeting designated
  criteria, and diverse locations throughout
  Washington State, and DSHS Regions. Pilots were
  located within the following DSHS regions and
  counties
• Region 1 Chelan/Douglas
• Region 2 Yakima
• Region 3 Skagit
• Region 5 Kitsap and Pierce

28
Phase 3 Continued

• On February 5-6, 2007 pilot site team members, a
  total of 48 professionals, participated in a one
  and a half day training session that instructed
  them in how to use the process and form. Pilot
  Site Steering Committee and SICC members were
  also invited to participate in the pilot site
  training.
• Following the training, weekly conference calls
  were conducted with pilot site key contacts and
  their teams to assess the implementation process
  and provide technical assistance on completed
  summary forms and to answer questions.
• The Outcomes Project Coordinator (Jean Dauphinee)
  was key in providing ongoing assistance for pilot
  sites, coordinating state materials and
  activities and conducting weekly technical
  assistance calls for each pilot site. WESTAT
  staff, (Joy Markowitz), and ITEIP staff were also
  essential to the ongoing ITEIP outcomes
  measurement activity.
• Washington would not be where we are today
  without the hours of work by Jean and Joy from
  Westat, and the assistance from the SRI/NECTAC
  team. It took all their efforts, in addition to
  the ITEIP staff time and work, to really pull the
  entire project together and to implement
  statewide training.

29
Phase 3 Continued

1. Conference calls were also conducted on March 8
   and April 12, 2007 for pilot site reporting to
   other pilot sites, Project Steering Committee and
   ITEIP/Westat, SRI and NECTAC. During the calls,
   teams shared their pilot experiences and outlined
   challenges. The Project Coordinator, ITEIP
   staff, and national consultants participated in
   these calls and continued to provide technical
   assistance to teams.
2. A total of 80 COSF processes were completed
   during the pilot period. At the conclusion of
   pilot site activities, a total of 150
   professionals had participated in at least one
   COSF process with parents and families. Pilot
   teams trained an additional 77 professionals
   during their pilots and since the pilot site
   training.
3. Information gathered from pilot sites related to
   their implementation of the COSF process assisted
   in the identification of initial training needs
   and tools for Washington State.

30
Phase 3 Continued

• The following tools were developed and/or
  customized for Washington State as a result of
  pilot site activities
• Child Outcomes Summary Form and definitions
• Parent/family talking points
• Team Decision Tree
• Guidance on recording Samples/Examples of
  Relevant Results on the Child Outcome Summary
  Form
• Brochure
• Birth through Three Growth and Development Guide

31
Phase 4 April 2007 through December
2007Statewide Training and Data System Changes

1. Information gathered from pilot sites related to
   their implementation of the COSF, assisted in the
   identification of initial training needs within
   Washington State and the development of
   additional training materials provided at the
   statewide training and available on our website.
2. May 22, 23, and 24, 2007 the Child and Family
   Outcome statewide training occurred, training
   approximately 400 additional individuals
   throughout Washington, using the tools and
   adapted Child Outcome Summary Form (COSF).
   Required COSF statewide collection began on July
   1, 2007, using the paper process.
3. Pilot site volunteers participated as mentors in
   the statewide training and shared their processes
   and experiences.
4. Between October and December 2007, the ITEIP Data
   Management System upgrades will be completed.
   Providers and local lead agencies will be
   required to input data and information into the
   system.
5. We will continue to look for funding and
   resources to maintain and update our data system.
   This is a challenge with the ongoing federal
   changes and timelines, so we will continue to
   work with OSEP to discuss and try to align the
   timing of data collection with the ability for
   states to update their process or systems and to
   complete the training needed to implement change
   statewide.

32
What was learned from pilot sites and
stakeholders early data collections? What
changes did you make as a result of the early
feedback?

• Statewide Training and Data System Changes
• ITEIP and the Project Coordinator worked with
  WESTAT, SRI, and NECTAC staff to amend or create
  additional national and Washington materials for
  use in and out of the state. The materials were
  customized for our state.
• On May 10, 2007 the Stakeholders Workgroup
  participated in a conference call to listen to
  pilot site reports and make final recommendations
  based on the findings. All the materials were
  developed and modified according to requests by
  the five pilot sites, ITEIP staff, National SRI,
  NECTAC, and WESTAT partners, and were finalized
  and prepared for the statewide training.
• SRI and NECTAC staff Kathy Hebbeler, Lynn Kahn,
  Robin Rooney, and Christina Kasprzak, and our
  Westat Project Coordinator, Jean Dauphinee,
  traveled with ITEIP staff to assist in three full
  days of training across the state (Seattle,
  Ellensburg, and Spokane). Trainers and local
  IFSP team members all traveled to spread the
  travel time out for all involved and minimize
  overall expenses.

33
The following is a list of points raised during
pilot site team conference calls. They were
provided at statewide training to guide team's
implementation of the Child Outcomes Summary Form
(COSF) process

• Teams should use descriptive terms to discuss a
  childs functioning and outcomes, rather than
  numeric ratings. Be sure that team and state
  staff practice positive skill language that does
  not reflect referring to a child as a number.
• Reminder, there is no correction for prematurity
  in the Washington ITEIP.
• Ensure that there are concrete examples of
  children's functional skills in the supporting
  evidence tables for each outcome. Standard scores
  and percentages are inclusive enough information
  for this purpose. Age ranges are relevant (e.g.,
  eating skills 12-15 months). It might be helpful
  to consider change the column header
  from "Summary of Relevant Results" to "Samples or
  Examples of Functional Skills"

34
Documents developed and/or modified for the state
training

• The COSF Discussion Prompts document is designed
  to assist teams in asking questions during their
  discussions of child outcomes. It is a resource
  document that teams may refer to in preparing for
  and conducting discussions of childrens
  functional skills. One or two discussion prompts
  from each area may be used to inform families
  about the type of functional skills that will be
  discussed for the COSF. However, the entire list
  of questions is not designed as a checklist and
  should not be distributed to parents/families.
• One pilot team identified the following web-based
  resource as particularly helpful in identifying
  examples of age appropriate behaviors and
  functional skills - http//www.talaris.org/timelin
  e_use.htm.
• Additional resources were needed and developed.
  An informational brochure or talking points is in
  development by ITEIP and the National Consulting
  Team as a resource to support teams in discussing
  the measurement of child and family outcomes with
  parents and families.
• Determining functional levels for very young
  infants is difficult. Teams have identified a
  need for additional resource information in this
  area. ITEIP and Project staff will continue to
  confer with ECO and NECTAC staff.

35

ECO Form was modified and Washington process was
aligned with National ECO Centers process in
requirements and guidance around the process as
follows

• The statewide Washington training used the Child
  Outcomes Summary Form, modified to delete
  numbers, and was conducted May 22-24, 2007. It
  was based on the input from the pilot sites, work
  between the Project Coordinator, ITEIP staff,
  WESTAT and the national SRI and NECTAC
  consultants.
• Materials were jointly developed and customized
  for ITEIP/Washington use, as well as designed for
  general use for other states. SRI/ECO/NECTAC
  staff have worked to add additional generic
  material to the National ECO Website, and to be
  used as appropriate when assisting other states.
• The ITEIP Data Management System is being updated
  to facilitate collection and reporting of child
  and family outcomes. We expect this to be tested
  in October and to be competed no later then
  December 2007.

36
Washington Infant Toddler Early Intervention
Program
Sandy Loerch Morris, Program DirectorEmail
loercsk_at_dshs.wa.govPhone [phone]
37
Exhibit A
CHILD OUTCOMES AND THE CHILD OUTCOMES SUMMARY
FORM (COSF) PROCESSFrequently Asked Questions

• What are the child and family outcomes?
• 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.
• Family Outcomes
• Percent of parents/families participating in
  Part C who report that Early Intervention helped
  the family
• - know their rights
• - effectively communicate their childrens
  needs
• - help their children develop and learn.
• Additional Family Outcomes that will be
  measured using the Early Childhood Outcome Center
  Family Survey
• Understand their childs strengths,
  abilities and special needs
• Access desired services, programs, and
  activities in their communities
• For national information about the COSF and
  resources available on the Early Childhood
  Outcome Website, please visit http//www.fpg.unc.
  edu/eco/.

For additional Washington State information see
the ITEIP Website http//www1.dshs.wa.gov/iteip/
38
COSF ProcessFrequently Asked Questions -
Continued

• 2. How is Washington going to measure
  parent/family outcomes?
• We will use the Early Childhood Outcomes Center
  Family Survey. National and state survey forms
  can be obtained from the respective web addresses
  listed previously. ITEIP plans to ask families to
  complete the survey at time of annual IFSPs and
  when they transition from the program.
• How are child outcomes being summarized in WA
  State?
• We will use the Early Childhood Outcomes Center
  Child Outcome Summary Form. Existing information
  about each childs functioning and abilities will
  be aligned using the form to guide documentation
  of skills. Information recorded in the ITEIP
  Data Management System will be used in this
  process. Teams will work to reach agreement on
  skills and functions within the IFSP team
  process.
• 4. When do I complete the COSF?
• At least upon entry into ITEIP, and when
  transitioning out of early intervention. Teams
  may decide to complete a new COSF process to
  document substantial changes in the childs
  skills in addition to these required points in
  service, at any time. If so, they must be marked
  to document they are in addition to entry or exit
  summaries.
• How do I integrate the COSF process into the IFSP
  meeting?
• Based on input from pilot sites, teams felt it
  was easier to complete the COSF process at the
  beginning of IFSP meetings rather than the end.
• What if the child only exhibits delays in one
  outcome area?
• Functional skills in one outcome area may impact
  other outcome areas (i.e. articulation issues may
  influence functional behaviors across all three
  outcome areas.) It is important to document
  skills in at least the three areas.

39
COSF ProcessFrequently Asked Questions -
Continued

• Concerning the COSF Process
• What children should have child outcome
  measurements?
• All children, eligible for ITEIP, entering and
  exiting the state program, except children who
  enroll at the age of 31 months or older, must
  have outcome summaries completed. There should
  only be one entry and one exit summary completed
  per child/family. Teams may use the summary form
  and process more often, but if doing so, should
  clearly document extra summaries to ensure state
  entry and exit summaries can accurately reflect
  aggregate reporting needs.
• When and how long should a child be in ITEIP
  before his/her skills are measured?
• Initial child outcome measures should occur upon
  family and childs entry and be completed as part
  of the initial IFSP. Measurement summaries may
  occur throughout the time of the child and their
  familys participation. However, any outcome
  measurement summaries completed between entry and
  exit will not be part of the aggregate data
  reported to OSEP for entry or exits.
• Measurement must also occur as the child is
  exiting the state ITEIP and be conducted as part
  of the transition planning process. The child
  must be have been in service for at least six
  month before child outcome progress summaries can
  be collected. At this time, Washington will not
  include summaries of progress for children in the
  state program less than six months.
• How do we handle children served by more than one
  early intervention program or service provider?
• The FRC assigned at the time of entry into WA
  ITEIP, facilitates the team outcome measurement
  summary process and submits data into the data
  management system. This documentation may be
  printed for the child/family paper record. All
  IFSP team members, including parents/families,
  participate in the skill measurement discussion.
  Some teams may elect to only enter minimum
  summary information into the data management
  system, in which case they must maintain a
  comprehensive copy in the paper record.

40
COSF ProcessFrequently Asked Questions -
Continued

• Concerning the COSF Process Continued
• For children born prematurely, do we compare to a
  typical child of the same chronological age, or
  of the same corrected age?
• Yes, compare to a typical child the same
  chronological age. Washington State ITEIP does
  not adjust age for children born prematurely.
• If we know a child is exiting the local program
  before age three, should we complete another COSF
  process at the exit meeting? Does this depend on
  how recently the childs development and skills
  were documented?
• Complete a COSF process at the last team meeting
  with the family, no matter when a previous
  summary was done, unless the child/family are
  exiting before being in the program for at least
  six months. Information is needed from all
  members of the IFSP team to determine exiting
  functional skill levels. Note if in service
  less than six months, we will need to note the
  child was in the program less then six months so
  an exit summary was not completed. This should
  be recorded in Progress Notes of the ITEIP Data
  Management System.
• Who is the team?
• The team consists of parents/family members, and
  professionals involved in evaluations,
  assessments, and providing services to the
  child/family. Professionals who are licensed to
  interpret and discuss evaluation and assessment
  data with parents/teams are critical members for
  discussions and reaching consensus of the childs
  skills and developmental status. The Family
  Resources Coordinator, assigned to the
  family/child, both, at the time of entry and at
  the time of exit from the state program, should
  facilitate the team meeting and process.
  Families and children often move around so the
  summary/data will be maintained in the electronic
  system and also in paper files for reference as
  needed if teams are electing to only enter
  minimum summary details in the electronic system.

41
COSF ProcessFrequently Asked Questions -
Continued
Definitions of Child Outcome Summaries 1. What
are foundational and immediate foundational
skills? An important developmental concept for
understanding how to use the Child Outcomes
Summary Form is the concept of foundational
skills. Some of the skills and behaviors that
develop early serve as the foundation for later
skills and behavior. Or expressed another way,
later skills build on earlier skills in
predictable ways. Teachers, therapists, and
parents can use the earlier skills to help
children move to the next higher level of
functioning developmentally. We refer to these
earlier skills that serve as the base and are
conceptually linked to the later skills, as
foundational skills. For example, children play
along side one another before they interact in
play. Development in the early childhood years
proceeds through several levels of foundational
skills with skills and behavior becoming more
complex and more proficient as children get
older. All skills that lead to higher levels of
functional abilities are foundational skills,
however, the set of skills and behavior that
occur developmentally just prior to age-expected
functioning can be described as the immediate
foundational skills in that they are the most
recent set of foundational skills that children
master and move beyond. A child whose
functioning is like that of a younger child is
probably showing immediate foundational skills.
Her functioning does not meet age expectations,
but she demonstrates skills and behaviors that
occur developmentally just prior to age expected
functioning and are the basis on which to build
age-expected functioning. A child whose
functioning might be described as like that of a
MUCH younger child does not meet age
expectations, nor does she demonstrate skills and
behaviors on which to build age-expected
functioning. She has foundational skills, but not
yet at an immediate foundational level. See also
the document posted on the ITEIP Website titled
Age-Expected and Immediate Foundational Skills
and the Child Outcome Summary Form Seven Point
Skill Summary
42
COSF ProcessFrequently Asked Questions -
Continued

• Concerning the Child Outcome Summary Results
• Can the form be modified?
• No, this is a form that must be used
  consistently statewide. The national form has
  been modified, for Washington, based on input
  from pilot sites and national consultants. One
  form is critical so that the state has consistent
  data for baselines and progress tracking.
• 2. Could there be different forms for
  different children for children with
  developmental delays of various severity or
  children at risk, for example?
• No, we can not do this. The data recorded,
  using different forms, would not be consistent or
  allow aggregate information to be summarized. It
  is critical to have information collected that
  can be summarized in the same way for all child
  outcome measurements.
• 3. Why was the Child Outcome Summary Form
  designed and why did Washington decide on it to
  be the states process?
• There is no existing assessment based on the
  three child outcomes. The Child Outcomes Summary
  Form affords a method for providers to summarize
  information collected from multiple sources to
  address the three child outcomes. The COSF
  process is intended to facilitate state and local
  reporting and program improvement, as well as to
  meet federal reporting requirements. The COSF
  process is used to determine to what extent a
  child's functioning on each outcome is
  appropriate given his or her age, and whether
  that child made progress toward age appropriate
  behavior. Teams will determine individual child
  developmental status through discussion of the
  childs functional skills and behaviors across a
  variety of settings and situations, and of child
  development expectations. ITEIP worked with a
  stakeholder workgroup and the State Interagency
  Coordinating Council (SICC) to determine this was
  really the only process available at this time to
  fully meet data requirements.

43
COSF ProcessFrequently Asked Questions -
Continued

• Concerning the Child Outcome Summary Results -
  Continued
• What do I record on COSF forms in the Persons
  involved in deciding the outcome skills summary
  section?
• Record all members of the team who were
  physically present during the IFSP meeting in
  which the child outcome summaries were discussed
  and determined.
• 5. What do I record on COSF forms in the
  Samples/Examples of Relevant Results boxes?
• Record functional skills for the child that
  demonstrate individual abilities in each of the
  three outcome areas. Use of clear and positive
  statements and examples is necessary to summarize
  skills that demonstrate the childs functional
  skills and level of development. Please
  reference the following document for examples of
  how to summarize samples/examples of relevant
  results ITEIP Website link to the COSF Guidance
  document.
• 6. The box for samples/examples of relevant
  results (next to the a question) isnt big
  enough to include all the child can do.
• The box allows the IFSP team to summarize
  progress the child is making, especially if the
  child is not catching up to typical functioning
  or is very atypical (e.g. in the Emerging or
  Not Yet categories in the b question.)
  Detailed information on child progress should be
  written into the IFSP progress notes. There is
  no requirement to enter a lot of examples of
  progress. This should be brief statements or
  skill progress points describing progress.
• What do I record in the b boxes on the child
  outcomes measurement summary forms?
• (If Question 2a has been answered previously)
• Has the child shown any new skills or behaviors
  related to acquiring and using knowledge and
  skills since the last outcomes summary? (Select
  one)
• Yes ? If Yes, Describe progress
• No ?

44
COSF ProcessFrequently Asked Questions -
Continued
Concerning the Child Outcome Summary Results -
Continued 8. Do I record information from the
Family Statement on the COSF? To summarize
skills and report progress, it is important to
use all existing evaluation, assessment,
observation, and parental and professional
reports, or any information recorded in the ITEIP
Data Management System. Parents are key
informants and know how their child does when
others are not around. Parent information must
be included in this process.
45
COSF ProcessFrequently Asked Questions -
Continued
Concerning the Team Process 1. What do I do if
a member of the IFSP team does not attend
the scheduled/confirmed IFSP meeting?  The IFSP
meeting must include, at least, the parent, FRC,
and the qualified professionals from disciplines
needed to interpret results of the evaluation,
assessments, and other means of information
documentation. The IFSP meeting must be
scheduled to ensure appropriate attendance or
participation in the team process. If qualified
professionals are not available to be at the
meeting, the meeting is not an IFSP meeting. 2.
What should providers do if there is
disagreement among team members as to what rating
category to assign to a child on one of the
outcomes? In order to minimize disagreements, we
suggest teams start by talking about the
functional outcome and the various ways,
settings, and situations in which the child
demonstrates skills and behaviors related to the
outcome. The team should refer back to the
progress notes, ongoing assessments, and
observations, and add new information to the COSF
and IFSP to describe the childs progress toward
each outcome. At the same time, it is
recommended that team members who are most
familiar with child development provide examples
of skills or behaviors typical of a child the
same age and those typical of a younger child.
We also suggest providers ask parents whether
they know other children the same age as their
child (cousins, etc.), without delays, and what
they see those children doing in the outcome
area. Focus on how the child is doing at the
time. If one person feels a very different skill
discussion is appropriate, the FRC/facilitator
should ask that person to describe the childs
behaviors or skills and in what settings they are
seen, which led them to their recommendation.
The person who is facilitating the meeting should
summarize what has been said and suggest the team
work for consensus, reading the description of
the skill summary category.
46
COSF ProcessFrequently Asked Questions -
Continued
Concerning the Team Process continued Write
this evidence in the COSF, too. Then look at all
the evidence together. Through this discussion,
the team may come to a closer agreement. If the
disagreement is only between two adjacent
categories, the team may agree to average the
ratings or choose one or the other. The team
does need to reach agreement. In some cases the
team may not reach total agreement. If team
members disagree between adjacent categories, the
team can choose any method they like to pick
which one to check for instance, majority
rules or the team may agree to average the
ratings. 3. Some children may never show
typical behavior/skills. Due to their
disability, disease or condition, their behavior
will remain far below typical or even regress.
How can the team approach the Child Outcome
Summary Process without upsetting the parent? If
the team has just finished reviewing the
assessment results and writing the
samples/examples of relevant results, the parent
is already thinking about their childs level of
development. Be sure the parent/family is part
of the information sharing. Ask the parent to
share positive skills they see even if not where
his cousin, neighbor, or friend is at. Assist in
recognizing and documenting all progress.
47
COSF ProcessFrequently Asked Questions -
Continued
Concerning the Team Process continued 4. Do
we have to complete an entire Child Outcomes
Summary Form process for children who are only
eligible for speech or language services? Yes,
summary information is needed for each of the
three child outcomes. Functional skills in one
outcome area may overlap with skills and outcomes
in other outcome areas (i.e. articulation issues
may influence functional behaviors across all
three outcome areas.) 5. What do I do
if there is only a single contracted service
provider who serves the child/family and no one
else at my location has recently interacted
with the child/family? Comprehensive evaluations
and assessments are required to be part of the
IFSP process, whether doing outcome summaries or
not. When resources are not available in the
area, FRCs and Local Lead Agencies must have
methods to bring in team members from other areas
to participate in the process until local
resources can be recruited. Obtain the
information from all professionals and family
members who have knowledge of the childs
functioning across situations and settings.
48
COSF ProcessFrequently Asked Questions -
Continued

• Concerning Relationship of Child Outcomes to
  Other Assessments
• 1. How is the COSF summary process different
  from standardized assessment results (e.g. BDI,
  HELP, AEPS, etc.)?
• The purpose differs. Assessments document child
  development in the five developmental domains in
  detail, so IFSPs can be developed.
• Child outcome summary discussions should enhance
  assessment information. This process compares
  childs behavior and skills in the three
  functional outcomes across multiple situations
  and settings, to a typical child. Other
  standardized assessments compare a sample of the
  childs behavior and skills in each of the five
  domains to typical development.
• Should I record results of ongoing assessments on
  the COSF?
• Yes. Use current assessment results for the time
  the summary is being done. Ensure that there are
  concrete examples of children's functional
  skills, at the time of the meeting, in the
  supporting evidence tables for each outcome.
  Standard scores and percentages are not relevant
  information for this outcomes measurement summary
  purpose, as they do not state skills in
  functional terms. Age ranges are relevant (e.g.,
  eating skills 12-15 months with examples of
  skills).
• 3. For a child exiting early intervention and
  moving into 619 preschool, can the exit COSF be
  used as an intake measurement for 619?
• The Office of the Superintendent of Public
  Instruction (OSPI) 619 preschool program is using
  the ECO Child Outcomes Summary process as well.
  There is a slightly different process however,
  and timelines many differ as well. IFSP and IEP
  teams must work together to coordinate ITEIP exit
  data with three to five preschool special
  education entry processes. We hope to see
  collaborative strategies on how to do the entry
  and exit process as comprehensively as possible,
  while minimizing the need for multiple meetings
  and avoiding duplication of discussions for
  parents, families and team members.

49
COSF ProcessFrequently Asked Questions -
Continued
Concerning Relationship to IFSP 1. Will every
child be required to have an IFSP outcome related
to one or more of the three outcome measurement
areas? No. IFSP outcomes and criteria should
still reflect the IFSP team members priorities
of what is most important for the family and
child, and what the next steps are in addressing
those important areas. IFSP teams will want to
consider the three outcomes while discussing and
prioritizing what functional skills and behaviors
are important to achieve within the next
year. 2. At what point in the IFSP meeting
will the outcome summary occur? Pilot teams felt
completing the COSF process at the beginning of
IFSP meetings was most effective. The
discussions should be integrated into team
meetings and be completed prior to finalizing the
IFSP and prior to the child leaving the state
ITEIP. Concerning Staff Overload 1. Can we use
a single, ongoing assessment to report outcome
data? Currently, no single standardized
assessment directly addresses the three
functional outcome areas and compares the child
to a typically developing child in those areas.
OSEP requires us to report data on child progress
in the three outcomes. The Early Childhood
Outcome Center (ECO) was contracted with by OSEP
to provide a method to document child and family
outcomes. The Child Outcomes Summary Form (COSF)
and process provides a method to summarize all
available information about a childs functioning
(e.g. evaluations, assessments, and observations)
for roll up discussion and documentation on the
forms.
50
COSF ProcessFrequently Asked Questions -
Continued

• Concerning Interpretation of the Child Outcome
  Data
• How will outcome data for children and families
  be used?
• Summary results of child and family outcome data
  will be used to
• Improve local services and programs for children
  and families in Washington State. Summary
  reports can be used on an ongoing basis to review
  outcome data.
• Provide the state with aggregate results to
  inform policy and technical assistance. Local and
  state summary data is required to be reported to
  the federal government, state agency, Governor,
  and the public in aggregate reports and on an
  annual basis.
• Inform federal and state policy and
  decision-making after several years of data
  collection.
• 2. Will state/OSEP be looking at length of time
  the child is served to explain benefit or lack of
  benefit? How will the measurement system include
  how much the child/family actually participated
  in services?
• OSEP has not requested any data on length of
  enrollment or participation in services. In
  ITEIP, we are collecting the date of each
  measurement. The range from first to last date
  of measurement will approximate the duration of
  enrollment. All children entering will have their
  skills summarized in the three areas. Children
  in service six months or more will have an exit
  summary, which include progress data as well.
• 3. If OSEP sees poor child outcomes, will they
  then take away dollars from programs when the
  problem may be bigger than a program can effect
  (e.g. a systems problem, a societal problem,
  etc.)?
• It is not yet known how OSEP will use the
  aggregate outcomes data. We are discussing how
  to report the data to help policy makers
  understand the complexity which underlies
  benefits achieved. It will be critical to
  carefully analyze data and include details
  relating to data that will aid individuals
  reading reports to have information that helps
  explains aggregate summaries and data.

51
COSF ProcessFrequently Asked Questions -
Continued

• Concerning Interpretation of the Child Outcome
  Data - Continued
• 4. Will OSEP understand the kinds of intense,
  complex needs families have?
• Qualitative descriptions will enhance
  understanding of the summary data and define the
  population of infants, toddlers, and their
  families served throughout the state and country
  for all of us.
• Concerning Data Submission
• 1. Where will outcome summary data go?
• ITEIP is modifying the existing data
  management system so information from the Child
  Outcomes Summary Form
• (COSF) can be entered into the enhanced
  Washington ITEIP Data Management System. Data
  will be entered at
• the local service level, and transmitted
  electronically to the ITEIP/DSHS. Data will be
  combined into a report for
• OSEP through the system for state and
  local aggregate data reporting.
• 2. Who enters the COSF information into the Data
  Management System?
• ITEIP prefers this to be the FRC. However,
  some local agencies assign entering information
  to another individual.
• Therefore, it should be the same individual
  who enters the IFSP into the system.
• Concerning Implementation in Washington
• 1. What are the timelines?
• Statewide Training for implementation of
  Child and Family Outcomes Measurement Process
  May 22-24, 2007
• COSF training will be provided communities
  around the state via three central locations.
  The implementation of