Child Outcomes Summary (COS)
Process Training Module
Session 8:
The Exit COS Rating
What Happens at the Exit COS?
At the exit COS, there are two parts to the discussion:
Determining the rating
• The process is just like the entry rating.
Discussing progress since the entry COS rating
was assigned
• This part is new.
2
Thinking about Progress
• Development follows a
predictable course.
• Development can be
measured and plotted.
• Example: Growth charts used
by pediatricians
Skill Acquisition Over Time
Skill Acquisition Over Time
Developmental Trajectory
Skill acquisition over time
25
Number of Skills
20
15
10
5
0
0
6
12
18
24
30
Age in Months
36
42
48
54
60
Comparing Developmental Trajectories
Skill acquisition over time
25
typical development
Number of Skills
20
15
children with slower
development
10
5
0
0
6
12
18
24
30
36
42
48
54
60
Age in Months
Both lines show the children are acquiring new skills
Acquiring new skills and changing rate of growth
Skill acquisition over time
Number of Skills
25
20
Typical development
15
Increased rate of development—
skill levels are moving closer to
typical development
10
Children with slower
development
5
0
0
6
12
18
24
30
36
42
48
54
60
Age in Months
• Children in the yellow line group have narrowed the gap.
• All three groups acquired new skills.
A flat trajectory indicates no new skills
Skill acquisition over time
25
Typical development
Number of Skills
20
15
10
5
Children who stopped acquiring skills
0
0
6
12
18
24
30
36
42
48
54
60
Age in Months
Very few children show no growth (or lose skills)
over time.
Two Questions Addressed at Exit
Rating Question: To
what extent does the
child show ageappropriate
functioning, across
settings and situations,
on this outcome?
Progress Question: Has
the child shown any
new skills or behaviors
related to this outcome
since the last outcomes
summary?
How to Answer the Progress Question
!
Answer “yes” if the
child has acquired ANY
new skill related to any
aspect of the outcome
since the entry rating.
•Example:
•Using one new word or
gesture to get his needs met
!
Answer “no” if the child
has not acquired ANY
new skill related to any
aspect of the outcome
since the entry rating.
Skill Acquisition
Over TimeOver Time
Skill Acquisition
Answer to
Progress Question is
10
10
9
9
8
8
7
7
6
exit
5
4
3
entry
2
Number of Skills
Number of Skills
Answer to
Progress Question is
6
5
4
3
entry
2
1
exit
1
0
0
1
2
3
4
Age in Months
5
6
7
1
2
3
4
5
Age in Months
6
7
Points to Consider
Answer “yes” if the child
has acquired any new
skill, even if the child
has...
• Not made progress across all
the skills in an outcome area
• Not moved closer to ageexpected development
What Happens During the Exit COS
Process?
For each
outcome,
the team
will:
Gather information about the
child’s functioning
Discuss the information and
determine the rating
Document the rationale for the
rating
Answer the progress question
Should the team look at the entry COS ratings
when determining exit ratings?
No!
This may bias the
team’s determination
of the exit ratings.
When to Complete the Exit COS
Complete the exit COS process as close to the child’s
discharge from the program as possible.
What if the team members who participated at the exit are different from
those who participated at entry?
What if...the team
members who participated at
the exit COS are different
from those who participated
at entry?
17
What if a family has left the program without notice?
What if... a family
has left the program
without notice?
18
One Last Point on the Relationship
between the Ratings and the Progress
Question
A rating of 4 at
entry is not the
same as a rating
of 4 at exit.
Entry
Exit
Closing
Click the back arrow to return to the module.