Thinking about Functional Child Outcomes

1. Thinking about Functional Child Outcomes OSEP Early Childhood Outcomes Meeting August 2007 in Baltimore, MD Presented by: Donna Spiker, Lauren Barton, Mary Beth Bruder Early Childhood Outcomes Center

2. What we will cover • How did we get to functional child outcomes? • Key decisions about OSEP child outcomes • What exactly are functional child outcomes? • How can we help people think functionally about child outcomes? • How can we use assessment data to think functionally about child outcomes? Early Childhood Outcomes Center

3. Key Challenges • Reorganizing thinking into 3 outcomes rather than domains • Switching to thinking about integrated, functional outcomes rather than if a child can or cannot do a series of discrete skills • Understanding how assessment data informs a rating of child functioning on the 3 outcomes • What does the assessment data you have tell you? • What information is missing that you need? Early Childhood Outcomes Center

4. How did we get to functional child outcomes?Key decisions about child outcomes • Outcomes are statements of what EI and ECSE are trying to do for children and families (fundamental statements of what these programs are all about) • One set of outcomes 0-5 • One set of outcomes for all children with disabilities Early Childhood Outcomes Center

5. How did we get to functional child outcomes?Key decisions about child outcomes (Cont.) • Don’t build the child outcomes around domains • Use the outcomes to drive practice forward • Outcomes should reflect best practice • Do no harm • Outcomes should be easy to understand • Providers are overburdened • Young children with disabilities could possibly be participating in several accountability efforts Early Childhood Outcomes Center

6. How the goal for children leads to functional child outcomes • Active and successful participants • Now and in the future • In variety of settings • in their homes with their families, in childcare or school programs, and in the community Early Childhood Outcomes Center

7. Understanding the Three Child Outcomes What exactly are functional child outcomes? Early Childhood Outcomes Center

8. The three 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 Early Childhood Outcomes Center

9. Outcomes are functional Functional outcomes: • Refer to activities and integrated behaviors that are meaningful to the child in the context of everyday living • Refer to an integrated patterns of behaviors or skills that allow the child to achieve important everyday goals Early Childhood Outcomes Center

10. Functional outcomes are NOT • A single behavior • The sum of a set of discrete behaviors or splinter skills such as….. Early Childhood Outcomes Center

11. Functional outcomes • Not domains-based, not separating child development into discrete areas (communication, gross motor, etc.) • Refer to behaviors that integrate skills across domains • Can involve multiple domains • Emphasize how the child is able to carry out meaningful behaviors in a meaningful context Early Childhood Outcomes Center

12. Isolated skill/behavior Knows how to imitate a gesture when prompted by others Uses finger in pointing motion Uses 2-word utterances Functional skill/behavior Watches what a peer says or does and incorporates it into his/her own play Points to indicate needs or wants Engages in back and forth verbal exchanges with caregivers using 2-word utterances Thinking functionally (within age-expected bounds) Early Childhood Outcomes Center

13. Thinking functionally • If you know a child can point, do you know that the child can communicate her wants and needs? • If you know a child can’t point, do you know that the child can’t communicate his wants and needs? • How does knowing about pointing help you understand how the child takes action to meet his/her needs? Early Childhood Outcomes Center

14. Thinking functionally • Discrete behaviors (e.g., those described by some items on assessments) may or may not be important to the child’s functioning on the outcome • Individually, they are not especially informative • Summed, they may or may not be useful, depending on the functionality of the behaviors/items Early Childhood Outcomes Center

15. Children have positive social relationships • Involves: • Relating with adults • Relating with other children • For older children, following rules related to groups or interacting with others • Includes areas like: • Attachment/separation/autonomy • Expressing emotions and feelings • Learning rules and expectations • Social interactions and play Early Childhood Outcomes Center

16. Children acquire and use knowledge and skills • Involves: • Thinking • Reasoning • Remembering • Problem solving • Using symbols and language • Understanding physical and social worlds • Includes: • Early concepts—symbols, pictures, numbers, classification, spatial relationships • Imitation • Object permanence • Expressive language and communication • Early literacy Early Childhood Outcomes Center

17. Children take appropriate action to meet their needs • Involves: • Taking care of basic needs • Getting from place to place • Using tools (e.g., fork, toothbrush, crayon) • In older children, contributing to their own health and safety • Includes: • Integrating motor skills to complete tasks • Self-help skills (e.g., dressing, feeding, grooming, toileting, household responsibility) • Acting on the world to get what one wants, taking appropriate action to meet needs Early Childhood Outcomes Center

18. Outcomes reflect global functioning • Each outcome is a snapshot of: • The whole child • Status of the child’s current functioning • Functioning across settings and situations • Rather than: • Skill by skill • In one standardized way • Split by domains Early Childhood Outcomes Center

19. An exercise: Uses finger in pointing motion • Give one example of how this skill could be information to describe a functional outcome, for: • Outcome 1: Positive social relationships • Outcome 2: Acquire and use knowledge and skills • Outcome 3: Use appropriate behaviors to meet needs Early Childhood Outcomes Center

20. Another exercise: Uses 2-word utterances • Give one example of how this skill could be information to describe a functional outcome, for: • Outcome 1: Positive social relationships • Outcome 2: Acquire and use knowledge and skills • Outcome 3: Use appropriate behaviors to meet needs Early Childhood Outcomes Center

21. Video segment: Do you see functional child outcomes? • Identify 3 discrete behaviors or skills that are not necessarily functional • Identify 3 functional behaviors or skills observed Early Childhood Outcomes Center

22. Thinking about Outcome 1: Children have positive social relationships • How does the child relate to his/her parent(s)? • How does the child relate to strangers? At first? After a while? In different settings? • How does the child display emotions? • Does the child seeks out others after an accomplishment? How? • How would you describe the child’s participation in games (e.g., joint attention, social, cooperative, rule-based, with turn-taking)? • How does the child interact with other children? • How does the child let others know he/she needs help? Is frustrated? Early Childhood Outcomes Center

23. Thinking about Outcome 2: Children acquire and use knowledge and skills • How does the child use words and skills he/she has in everyday settings (e.g., at home, at the park, at childcare, at a store or mall, at a restaurant, with different people)? • How does the child understand and respond to directions and requests from others? • Can the child answer questions of interest in meaningful ways? • Does the child use something learned at one time at a later time or in another situation? Describe some examples. • How does the child interact with books, pictures, and print? Early Childhood Outcomes Center

24. Thinking about Outcome 3: Children take appropriate action to meet their needs • What does the child do when he/she can’t get or doesn’t have what he/she wants? • What does he child do when he/she is hungry? Frustrated? Needs help? Is upset or needs comfort? • Tell me about the child’s behavior when dressing and undressing. When eating? Describe the child at mealtime. • Does the child display toy preferences? How? • How does the child respond to unwanted or problematic peer behavior? • Are the actions the child uses to meet his/her needs appropriate for his/her age? Can he/she accomplish things that peers do? Describe examples. • How does the child demonstrate that he/she understands and avoids danger? Early Childhood Outcomes Center

25. Remembering the overarching goal “To enable young children to be active and successful participants during the early childhood years and in the future in a variety of settings—in their homes with their families, in child care, in preschool or school programs, and in the community.” Early Childhood Outcomes Center

26. Assessing the Accomplishment of the Three Child Outcomes How can we use assessment data to think functionally about child outcomes? Early Childhood Outcomes Center

27. What is assessment? “Assessment is a generic term that refers to the process of gathering information for decision-making.” McLean, Wolery, and Bailey (2004) Early Childhood Outcomes Center

28. DEC recommended practices for early childhood assessment • Involve multiple sources • Examples: family members, professional team members, service providers, caregivers • Involve multiple measures • Examples: observations, criterion- or curriculum-based instruments, interviews, norm-referenced scales, informed clinical opinion, work samples • See earlier slides about best practices in assessment of young children Early Childhood Outcomes Center

29. Use of assessment instruments • Assessment tools can inform us about children’s functioning in each of the three outcome areas. • Challenge: There is no assessment tool that assesses the three outcomes directly. Early Childhood Outcomes Center

30. Assessment tool lens • Each assessment tool carries its own organizing framework, or lens. • Many are organized around domains. • But across different measures, the content in the domains isn’t always the same, even if the names are the same. Early Childhood Outcomes Center

31. Currently available assessment tools • Each assessment tool sees children through its own lens. • Each lens is slightly different. • There is no right or wrong lens. • Key question: • How much and what information will a given tool provide about the attainment of the three functional child outcomes? Early Childhood Outcomes Center

32. Does our assessment process provide information on functional outcomes? • Does the assessment process tap the child’s functioning when doing things that are meaningful to the child? • Do we assess what a child typically does or assess in unusual situations? • Do we know about the child’s actual performance across settings and situations? • Do we observe how a child uses his/her skills to accomplish tasks? • Does it go beyond domains to consider integrated functioning? Early Childhood Outcomes Center

33. Assessing functional outcomes: Key questions to ask • What does the child usually do? • What is the child’s actual performance across settings and situations? • How does the child use his/her skills to accomplish tasks? Early Childhood Outcomes Center

34. Assessing functional outcomes: Key issues to remember: Thinking functionally about child outcomes • Not the child’s capacity to function under unusual or ideal conditions • Not necessarily the child’s performance in a structured test situation • Not necessarily discrete behaviors that the child only demonstrates in isolated situations or settings Early Childhood Outcomes Center

35. Making use of assessment tool information • Information from formal or published assessment tools can be very useful, but it needs to be understood and used in the context of achievement of the three outcomes • Teams may have additional information that paints a picture of the child that differs from one provided by an assessment. Thus, teams may “override” the results from an assessment tool Early Childhood Outcomes Center

36. Using information from assessment tools • The ECO Center has “crosswalked” assessment tools to the outcomes • Crosswalks show which sections of assessment tools are related to each outcome • Having many items does not necessarily mean the assessment tool captures functioning across settings Early Childhood Outcomes Center

37. Use: As a general guide as to how the content of the assessment tool maps to the 3 outcomes As a guide to help you understand the content of the 3 outcomes Do not use: As a checklist Remember: Lots of items does not necessarily mean the tool is a good measure of functioning in an outcome area. Quantity may not equal quality. Ways to use and not use the crosswalks Early Childhood Outcomes Center

38. Considerations in thinking functionally about child outcomes • Flexibility is required in applying assessment tool results to the outcomes. • Teams need to decide what information from an assessment tool is relevant for this child. • Teams need to consider child behavior and functioning across age-appropriate settings. Early Childhood Outcomes Center

39. Key concepts in thinking functionally about child outcomes • Gathering good information about the child’s: • Engagement • Independence • Social relationships Note: Based on work by Deborah Hatton Early Childhood Outcomes Center

40. Engagement • How does the child interact with the environment in developmentally and contextually appropriate ways? • Probe for examples of everyday situations and how the child behaves and interact with the physical and social environment. Early Childhood Outcomes Center

41. Independence • How does the child engage with the environment and daily settings and tasks with as little assistance from others as possible? • When probing for descriptions of everyday functioning, ask specifically about the degree to which the child needs help or assistance to engage in the task or routine. Early Childhood Outcomes Center

42. Social relationships • How does the child engage in social relationships that provide the context and motivation to communicate, to get along with others (adults and peers), to develop trust, to interact and play appropriately, and to form friendships? • Get descriptions of each of these areas of functioning. Early Childhood Outcomes Center

43. Functional child outcomes means looking at……… • What specific skills and behaviors the child has And then learning about: • How the child actually uses skills and behaviors in daily situations and routines. • How easily the child functions in daily situations, tasks, and routines (fluency). • How well the child uses skills and behaviors in many different situations and with many different people (generalization). Early Childhood Outcomes Center

44. Training strategies • How can we develop training materials and strategies to help staff think functionally about child outcomes? • Discussion prompts (handout on ECO web site) • Videos to use in team trainings and discussions (www.videatives.com) • Use of routines-based assessment (see National Individualizing Preschool Inclusion Project – www.individualizinginclusion.us) Early Childhood Outcomes Center

45. Video exercises Can we learn to think functionally about child outcomes? Early Childhood Outcomes Center

46. Video segment #2 • What do you see here that helps you make a rating of this child’s functioning for outcome 3? • What additional questions do you want to ask to rate this child for outcome 3? Outcome 3: Children use appropriate behaviors to meet their needs Early Childhood Outcomes Center

47. Video segment #3 • What do you see here that help you make a rating of this child’s functioning for outcome 1? • What additional questions do you want to ask to rate this child for outcome 1? Outcome 1: Children have positive social-emotional skills (including positive social relationships) Early Childhood Outcomes Center

48. Discussion • What are some of the obstacles that make it difficult for people to think functionally about child outcomes? • What kinds of training strategies and other TA can be provided that support thinking about child outcomes functionally? Early Childhood Outcomes Center

49. ECO Center • Additional information, including additional crosswalks, training slides, discussion prompts, and materials for parents will be posted on our website: www.the-eco-center.org Early Childhood Outcomes Center

50. As states move to collecting and using high quality information on outcomes, children and families will reap the benefits. Early Childhood Outcomes Center