Developing
High-Quality,
Functional
IFSP Outcomes
presented in collaboration with
Presentation Goal
Understand how to:
• Develop functional, high quality
IFSP outcomes
• Rate the quality of the outcomes
Functional
Assessment
Meaningful
IFSP Outcomes
2
Using Information
to Develop Outcomes
1) Start with parents’/caregivers’ priorities about
child’s learning/development and/or family’s
needs
2) Consider what’s working and what’s
challenging in everyday routines and activities
3) Consider how the child’s developmental skills,
needs and disability influence the child’s
learning and participation in everyday routines
and activities
3
Notes:
There are 3 key pieces of information that need to be used when developing
high quality IFSP outcomes:
• First, it’s critical to start with the parent’s/caregiver’s priorities regarding
what they hope for their child what is most important or meaningful to them.
– Special focus should be placed on family desire related to participation
in family and community activities.
– Use open-ended questions to help parents and other care providers
reflect on how they want the child to participate in activities and routines
that are meaningful to them, as well as what factors impact their child’s
successful participation.
– Family priorities, not the practitioner’s priorities, should serve as the
basis for a high quality, participation-based outcomes and goals.
• Second, it is important to consider what’s working and what’s challenging
at home and in the community.
– Make note of those situations that are motivating and interesting to the
child and family and those that impact participation in family and
community life.
– Ask parents what the child enjoys doing, what they enjoy doing
together, and what parts of their day may not be going well
4
Notes, continued:
•
Third, is what has been learned from evaluation and assessment.
– The EI professional must incorporate what has been learned during the
evaluation and functional assessment process into the IFSP outcomes,
including:
• Child’s current levels of development
• Child’s and family’s needs
• Child’s disability and its impact on the child’s learning and
participation in daily activities.
All 3 pieces of information are critical for developing high quality
outcome statements, as well as making decisions about strategies and
activities that will most effectively promote incidental learning and the
opportunity to practice new skills to meet the identified outcome.
5
Relationship of Outcomes
to Placement and Services
First…
develop IFSP outcomes based on functional, authentic
assessment information
Then…
determine placement, services and supports based on
what is necessary to meet the outcomes/goals
6
Notes:
•
Remember to develop the outcome before determining location and type
of services, and supports.
– The services a child needs to receive should be based on the outcome,
not the other way around.
– Location of services should be based on whether or not the outcome
and goal can be met in the natural environment.
7
Requirements for IFSP Outcomes
IFSP must include:
•A statement of the measurable results or measurable
outcomes expected to be achieved for the child and family
(including pre-literacy and language skills as
developmentally appropriate for the child)
•The criteria, procedures, and timelines used to determine
the degree to which progress toward achieving the results
or outcomes is being made and whether modifications or
revision of the expected results or outcomes or services
are necessary
34 CFR §303.344 (c)
8
Notes:
The IDEA-Part C Regulations released in September 2011 state that an IFSP
must include:
• A statement of the measurable results or measurable outcomes expected to
be achieved for the child and family (including pre-literacy and language
skills as developmentally appropriate for the child); and
• The criteria, procedures, and timelines used to determine the degree to
which progress toward achieving the results or outcomes is being made and
whether modifications or revision of the expected results or outcomes or
services are necessary.
9
IFSP Outcomes
• IFSP Outcomes: “What
would your family like to
see happen for your
child/family?”
• Two types of outcomes
– Child Outcomes
– Family Outcomes
10
Notes:
•
IFSP outcomes are equivalent to asking a family: “What would your family
like to see happen for your child?”
•
There are two types of IFSP outcomes
1. Child outcomes
2. Family outcomes.
11
IFSP Child Outcomes
Two types of child outcomes:
• Participation-based
• Routine/activity-based
Child outcomes should:
• Enhance learning through functional participation in everyday
activities (child is learner/actor)
• Be important and meaningful to the family/caregiver (priorities)
• Expand activity settings so child can be competent
• Be based on child’s interests
12
Notes:
IFSP child outcome statements may be participation-based and ocus on the
child’s interests and assets that will provide opportunities for learning and
development. Child outcome statements may also be routine based and
support activities that parents want or need to go more smoothly (i.e.,
mealtimes or bedtime routines).
Child Outcomes should:
• Enhance the child’s learning through functional participation in everyday
activities (child is learner/actor),
• Be important and meaningful to the family/caregiver (their priorities),
• Expand activity settings in which the child can be competent, and
• Be based on the child’s interests.
13
IFSP Family Outcomes
Two types of family outcomes:
• Participation-based
• Resource-based
Family outcomes should:
• Enhance capacity of (family is learner/actor)
• Support accessing community resources and supports (service
coordinator supported)
• Be important and meaningful to the family/caregiver (priorities)
• Be based on family’s interests
14
Notes:
There are two types of family outcomes – participation-based and resource
based outcomes.
Family Outcomes should:
• Enhance the capacity of the family to meet the needs of their child (family is
learner/actor),
• Help the family access community resources and supports (service
coordinator supported),
• Be important and meaningful to the family/caregiver (priorities), and
• Be based on the family’s interests.
An example of a participation-based family outcome is:
• “Frank and Tamara would like to be comfortable taking Dawn, with her
siblings, to their grandmother’s house.”
An example of a resource-based family outcome is:
• “Jeri will find child care for her son within 25 miles of her new job.”
15
Developing IFSP Outcome Statements
Step 1:
Determine the functional area(s)
Eating
Step 2:
What routine(s) does this affect?
Meal time with the family
Step 3:
Child will participate in
[routines in question]
“Kim will eat with her
Family at mealtime…”
Step 4:
“by ________ing”
(address specific behaviors)
“…eating the foods
they eat.”
McWilliam, R.A. (2006). Steps to build a functional outcome. Retrieved from
http://www.siskin.org/downloads/Steps_to_Build_a_Functional_Child_Outcome.pdf
16
Notes:
•
The 4 step process on the previous slide reflects the development of the
IFSP outcome statement to ensure that the core portion of the statement is
written functionally and is participation-based. (adapted from a 7 step process that includes
criteria, procedures and timelines developed by Robin McWilliam.)
•
While we recognize that states provide differing guidance on writing
outcomes, this process should be applicable despite some variation across
states.
17
Notes, continued:
Let’s walk through the example we’ve developed using this 4 step sequence:
1. First, based upon the parent’s/caregiver’s priorities, determine the functional
area that the outcome relates to. In our example, we selected “eating.”
2. Second, determine the routines affected. We selected “meal time with the
family.”
3. Third, develop a statement that reflects how the child will participate in the
routines, such as “Kim will eat with her family at mealtime . . .”
4. Finally, add to the initial part of the outcome statement developed in Step 3,
what the child will do (defining specific behaviors). “. . . eating the foods
they eat.”
So the complete outcome statement that we developed using this framework is:
“Kim will eat with her family at mealtime eating the foods they eat.”
18
Third Word Rule
• The third word of IFSP
child outcome statement
should be a
contextualized action
that is functional.
• Example: “Kim will eat
with her family at
mealtime eating the foods
they eat.”
Shelden, M. L., & Rush, D. D. (2009). Tips and Techniques for
Developing Participation-Based IFSP Outcome Statements.
Briefcase, 2(1). Retrieved from
http://www.fipp.org/Collateral/briefcase/briefcase_vol2_no1.pd
f
19
Notes:
•
The “third word” rule was identified by Rush and Shelden. The third word
rule refers to the third word in the outcome statement. As a test of whether
the outcome statement is participation based, examine the third word for an
action that is functional for the child. The word “eat” in the example of Kim
used in the slide meets the criteria.
•
Another example of an outcome statement with a functional third word is:
“Thomas will ask for food he wants during meal times.”
– In contrast, “Thomas will say three words when asked to repeat them”
is skill-based and does not provide context for learning and
engagement.
20
Developing Criteria,
Procedures and Timelines
• What are the ways in
which the family and
team will work toward
achieving this outcome?
• Who will help and what
will they do?
• How will the team know
they’ve made progress or
if revisions are needed to
outcomes or services?
21
Notes:
•
Once a quality IFSP outcome is developed, the team must identify the
criteria, procedures and timelines that will be used to determine the degree
to which progress toward achieving the results or outcomes is being made,
as well as if modifications or revision of the expected results/outcomes or
services are necessary. The questions on the previous slide can be used to
facilitate a discussion with parents and caregivers, focusing on:
• Criteria that shows progress is being made, as well as procedures and
realistic timelines. For example, “We’ll know this outcome is met when
Kim eats at least two meals with her family, sitting independently with or
without adaptive supports, eating regular table food, gaining at least one
pound per month or 6 pounds in 6 months.”
22
High-Quality, Functional
IFSP Outcomes
IFSP outcomes need to be functional; however,
many providers struggle to define what makes an
outcome “functional.” When determining if an
outcome is functional consider the following
questions:
• Does this outcome support the child’s participation in
everyday activities?
• Does this outcome support the fundamental belief that
children learn best through their participation in everyday
activities and routines with familiar people?
23
High-Quality, Functional
IFSP Outcomes
Three skills that are CRITICAL when developing
outcomes are:
•
the ability to understand how to gather information from
families throughout the process
•
the ability to conduct a functional assessment that gives
a clear picture of the child’s abilities and needs in the
child’s natural, everyday settings, activities and routines
•
the ability to use the information to develop outcomes
24
High-Quality, Functional
IFSP Outcomes
Throughout the process of
gathering information from
families, special attention
should be paid to the
information the family
shares about
what’s working well for them,
as well as what is
challenging
25
High-Quality, Functional
IFSP Outcomes
• Necessary and functional for child’s and family’s life
• Reflect real-life contextualized settings
• Crosses developmental domains and is discipline-free
• Jargon-free, clear and simple
• Emphasizes the positive, not the negative
• Uses active words rather than passive words
26
Notes:
So how do we know if the IFSP outcome developed is of high quality or not?
NECTAC, ECO and WRRC, in collaboration with Dathan Rush and Lisa
Shelden at the Family Infant and Preschool Program in Morganton, NC, have
identified 6 unique criteria for determining if an IFSP outcome statement is of
high quality.
These criteria are:
1. Are statements necessary and functional for the child and family’s life?
2. Does the statement reflect real-life contextualized settings?
3. Does the outcome cross developmental domains?
4. Is it discipline-free?
5. Is the wording jargon-free, clear and simple
6. Is the outcome stated in active words rather than passive words?
27
Criteria Definitions
Necessary and functional for child’s
and family’s life
– Supports participation in community life and
family activities
– Based upon what is important to the family
– Supports child’s progress towards outcomes
• It is not based on what the practitioner thinks
28
Notes:
Let’s think more about the first high-quality outcome criteria statement on the
previous slide: Necessary and functional for the child’s and family’s life.
The outcome should focus on ways to support participation in community and
family activities that are important to the family. The outcome should benefit the
child by focusing on social relationships, acquiring and using knowledge and
skills, and/or using appropriate actions to meet needs of the child and family. It
is important to note that the determination of what is necessary and functional
is not based upon what the practitioner thinks is meaningful and functional for
the family.
29
Criteria Definitions
Reflects real-life, contextualized settings
Everyday activity settings and
routines for the child and family
• Includes typical routines such
as meal time
• Also includes routines and
activities specific to the family
Test items are not real-life or contextualized
30
Notes:
The second high-quality outcome criteria statement from the previous slide
states: Reflects real-life, contextualized settings
This means that outcome statements should reflect the everyday activity
settings and routines for the both the child and family. This includes any
typical routines that are common across families, such as meal-time, bathing
and riding in the car. This also includes routines and activities that are specific
to the individual family. Specific isolated skills can include test items that were
missed during an evaluation, and are not considered real-life or contextualized.
31
Child Outcome: Example reflects
real-life and contextualized
This
Not This
Marcus will play in the
backyard getting around
on his own using his
walker.
Marcus will take ten
steps with his walker.
32
Criteria Definitions
Integrates developmental domains and
is discipline-free
– Written to describe the child’s participation in routines
and activities
• Promote the child’s skill development in multiple
domains
• Addressable by any member of the IFSP team
– Written so that child and family are the “actors”
• Early interventionists and therapists are not the
actors in the outcome
33
Notes:
The third high-quality outcome criteria statement from the previous slide states:
Integrates developmental domains and is discipline-free
This means that the outcome is written to describe the child’s participation in
routines and everyday activities, and promotes skill development across
multiple domains. This can be addressed by any member of a child’s IFSP
team. It also means that the outcome should be written so that the child and/or
family are the “actors” or persons doing something, rather than the direct
service provider.
34
Child Outcome: Example reflects
developmental domains and discipline-free
This
“
Annabelle will help her
dad with the laundry by
pulling up and standing
at the dryer on her own
and putting clothes into
the laundry basket with
her dad"
Not This
"Annabelle will pull to a
standing position at the
couch and maintain her
balance"
Criteria Definitions
Is jargon-free, clear and simple
– Understandable by family and
the general public.
• Doesn’t include professional
jargon or practitioner “speak”
36
Notes:
The fourth high-quality outcome criteria statement from the previous slide
states: Jargon-free, clear, and simple.
This means that the outcome is written so that is understandable by the family
and the general public. It does not include professional jargon or practitioner
“speak”. The outcome should describe how the child will move, such as
reaching up or down for toys, instead of using phrases like “range of motion”.
37
Child Outcome: Example reflects
Jargon-free, clear, and simple
This
Not This
“David will reach up and
grab the toy when he is
playing with his mom”
“David will increase his
“range of motion”
38
Child Outcome: Example reflects
Jargon-free, clear, and simple
This
Not This
“Carrie will ask for a
cracker when she is
having lunch with her
family”
“Carrie will improve her
articulation skills”
39
Criteria Definitions
Emphasizes the positive, not the negative
– Focus of the whole outcome is positive
– States what the child and family will do
Doesn’t state what the child will not do or will stop doing
– Any negative words creates a negative statement
40
Notes:
The fifth high-quality outcome criteria statement from the previous slide states:
Emphasizes the positive, not the negative.
This means that the focus of the whole outcome statement is positive, and
states what the child and/or family will do, rather than what they will not do or
stop doing. If there are any negative words within the statement, it is not a
positively worded outcome.
41
Child Outcome: Example reflects
the positive, not the negative
This
Not This
“Johnny will chew and
swallow food when
eating with his family”
“Johnny will not spit out
food when eating with
his family”
42
42
Criteria Definitions
Uses active rather than passive words
– Words encourage active participation from the child
and family
– Words indicate what the child or family will do
• Passive words reflect a state of being or lack of
change in performance
43
Notes:
The sixth, and final high-quality outcome criteria statement from the previous
slide states: Use active rather than passive words.
This means using words that encourage a child and/or family’s active
participation or engagement. Active words may include eat, play, talk, walk,
etc., and indicate what the child or family will do.
•
Passive words reflect a state of being (i.e., tolerate or receive), or a change
or lack of change in performance (i.e., increase, decrease, improve, or
maintain). Passive words should not be used in a high quality outcome
statement.
44
Child Outcome: Example reflects
use of active rather than passive words
This
Not This
“Charlotte will sit next to
her sister and play with
the toys”
“Charlotte will tolerate
her sister’s presence at
playtime”
45
Child Outcome: Example reflects
use of active rather than passive words
This
Not This
“Abigail will talk with her
family during meals”
“Abigail will increase her
communication during
meals”
46
High-Quality, Functional
IFSP Outcomes
If available, the child’s complete record can
reveal if an IFSP outcome is based on:
•Information gathered from the family (e.g., priorities and
concerns)
•Evaluation and functional assessment of child (e.g., skills,
degree of participation, behaviors across settings ,
strengths, and needs)
47
Developing Child Outcomes
Parent states:
“I wish he could sit without as much
support when he eats and plays – it is
hard work holding him all the time.”
48
Child Outcome: Example
This
Not This
“Romeo will play with
toys and eat meals with
his family by sitting
without much support.”
“Romeo will improve
muscle tone for sitting.”
49
Notes:
Based on the priority shared by Romeo’s parents, the previous slide illustrates
an example of a high quality IFSP child outcome statement in comparison to a
statement that is not high quality.
50
Developing Family Outcomes
Parent states:
“We want to be able
to take Romeo with us in the car;
we need a travel car seat.”
51
Family Outcome: Example
This
Not This
“Karen and Mark will
explore options for
financial assistance for
car seats and secure
one.”
“Staff will explore
options for financial
assistance for travel
chairs.”
52
Notes:
Based on the priority shared by Rome’s parents, the previous slide illustrates
an example of a high quality IFSP family outcome statement in comparison to a
statement that is not high quality
53
IFSP Outcomes Rating Activity
Now it’s time to check apply what you have learned about
understanding outcome criteria necessary to develop and
write high quality, functional, participation-based
Individualized Family Service Plan (IFSP) outcomes.
At this time (if you haven’t already), please Download and
print a copy of the Worksheet for Rating IFSP outcomes.
Please rate each outcome statement by writing “yes” or
“no” in each quadrant of the table, based on whether the
statement meets each of corresponding criteria.
When you are finished, check your answers by
continuing with the PowerPoint
54
Lily will go fishing with her family
and hold her own pole
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
55
56
Lily will go fishing with her family
and hold her own pole
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
Yes
Yes
Yes
Yes
Yes
Yes
This is a participation-based,
functional, high-quality IFSP
outcome!
56
57
Davis will talk more and pronounce
words better
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
57
Davis will talk more and pronounce
words better
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
Yes
No
No
Yes
Yes
Yes
Remember to include real-life
situations that promote skill
acquisition in more than one
developmental domain
58
59
Robin will stop having tantrums at
separation from primary caregiver
when going to daycare
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
59
Robin will stop having tantrums at
separation from primary caregiver when
going to daycare
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
Yes
Yes
Yes
No
No
Yes
Use “Mom”, “Dad”, or “Grandma” instead of
“primary caregiver”, and state the outcome
positively by saying “say goodbye calmly” instead
of “stop having tantrums”
60
Kammie will play with her toys so Grandma
can cook breakfast and get the older kids off
to school
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
61
Kammie will play with her toys so Grandma
can cook breakfast and get the older kids off to
school
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
Yes
Yes
Yes
Yes
Yes
Yes
This is a participation-based,
functional, high-quality IFSP
outcome!
62
Lanesha will gradually stop eating
baby food and eat more solid foods
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
63
Lanesha will gradually stop eating
baby food and eat more solid foods
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
Yes
No
Yes
Yes
No
Yes
Remember to create an outcome where the child
and family can be actively involved in the success
of the outcome through their daily activities or
routines. Focus on what you want Lanesha to donot what you want her to stop doing.
64
Thomas will put up with lying on his
stomach for 10 minutes without crying
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
65
Thomas will put up with lying on his stomach
for 10 minutes without crying
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
Discipline-Free
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
No
No
Yes
Yes
No
No
It would be more functionally appropriate to have
activities that encourage to play (i.e.: Thomas will play
with toys on the floor rolling, reaching, and grabbing).
Again, the focus should be on real-life settings, and
the outcome should be framed positively and actively.
66
Ahmet will get to eat what he wants during
meals by pointing or looking at the choices his
parents provide
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
67
Ahmet will get to eat what he wants during
meals by pointing or looking at the choices
his parents provide
Necessary/
Functional
Real-life
Contextual
Settings
Crosses
Domains/
DisciplineFree
Jargon-Free
Positive, Not
Negative
Active, Not
Passive
Yes
Yes
Yes
Yes
Yes
Yes
This is a participation-based,
functional, high-quality IFSP
outcome!
68