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Provider Perceptions of the Child Outcomes Summary Process. Lauren Barton and Cornelia Taylor October 27, 2012. Measuring and Improving Child and Family Outcomes Conference Minneapolis, MN. Today’s Session . Brief ENHANCE project update Describe provider survey study Share findings

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Provider perceptions of the child outcomes summary process

Provider Perceptions of the Child Outcomes Summary Process

Lauren Barton and Cornelia Taylor

October 27, 2012

Measuring and Improving Child and Family Outcomes Conference

Minneapolis, MN

Today s session
Today’s Session

  • Brief ENHANCE project update

  • Describe provider survey study

  • Share findings

  • Discuss implications


  • Focus

    • Under what conditions are COS data meaningful and useful for accountability and program improvement?

    • Impact of COS on programs/staff

    • Identify needed revisions to COS form and guidance

  • SRI International was funded by

    U.S. Dept. of Education, IES -- July 1, 2009

Four enhance studies
Four ENHANCE Studies

  • Comparison with Child Assessments

  • Team Decision-Making

  • State Data Study

  • Provider Survey

Studies 1 2 4 34 project data collection sites

17 Part B Preschool (3-5)




New Mexico


South Carolina

Studies 1,2, & 4:34 Project Data Collection Sites

17 Part C (Birth to 3)

  • Illinois

  • Maine

  • Minnesota

  • New Mexico

  • Texas

  • North Carolina

  • Virginia

Comparison with child assessments study
Comparison with Child Assessments Study


  • Compare COS ratings to BDI-2, Vineland-II scores

    • Program Entry

    • Program Exit

  • Compare conclusions from COS and assessments

    Study Status

  • Final stages of recruiting families

    Find Out More

  • See poster at reception for promising

    findings from preliminary analyses

Team decision making study
Team Decision-Making Study


  • Learn more about implementation of the COS process.

  • What is team understanding of outcomes and rating criteria?

    Study Status

  • Videos coming in

  • Early stages of coding videos

    Find Out More

    Tabletop discussion tomorrow morning

    • What is quality COS process?

    • Share draft video coding protocol

State data study
State Data Study


  • Analyze characteristics of COS data

  • Are patterns consistent with those predicted for high quality data?


  • Analyzing and compiling data

    Find out more

  • See reception poster with early findings

    We are looking for more states

    to participate.

Participating in the state data study
Participating in the State Data Study

Participate at different levels:

  • Share results from analyses you already do for APR OR

  • Share de-identified child level data set used in your APR analyses

  • Work with SRI to either:

    • Share expanded data set* that we analyze and discuss with you OR

    • Conduct extra analyses and share results with project

      * Expanded data set examples:

      include extra child descriptors (race, gender,

      primary disability) or variables describing

      the setting or composition of services

Benefits of participation
Benefits of Participation

  • See how your data fits relative to other state patterns

  • Have more analyses to learn from—extra tables for deeper understanding

  • Technical assistance around unique issues in your data

  • Make a difference, generating new knowledge about a topic that matters

For more information, contact (650) 859-5314

Provider survey
Provider Survey


How is COS implementation going?


  • Online survey sent to providers in program participating in the assessment and video studies

    Study Status

  • Completed data collection

  • Early stages of analysis

Provider survey sample
Provider Survey Sample

  • 856 providers in 8 states

  • Primary population

    • EI: 472 (55%)

    • ECSE: 302 (35%)

    • Mix: 82 (10%)

  • Roles

    • 50% early interventionists/teachers

    • 38% therapists and asst. (SLP, OT, PT)

    • 9% coordinators/psychologists

    • 3% other

  • 75% previously worked with children without disabilities in some capacity.

Provider experience with cos ratings
Provider experience with COS ratings

  • 51% 31 or more COS ratings

  • 21% 10 or fewer COS ratings

Provider training
Provider training

  • Asked about training across a variety of formats (e.g., in person, technology, one-on-one, material review)

  • How many total hours of training do you think most providers reported?


    1-4 hours?

    5-8 hours?

    9-12 hours?

    13 hours or more?

ECO recommends 8-12 hours of training

to get familiar with the COS process

Provider training on cos process is limited
Provider training on COS Process is limited

  • 90% of providers received some training

  • 68% reported 4 hours or less of training

Cos process time involved
COS Process: Time involved limited

  • On average, how long does it take to identify a child’s outcome ratings and document it on the form?

    • Identify rating

    • Discuss child’s functioning if directly related to rating decision or exceeds discussions that would have occurred anyway

    • Time to complete information on the form

    • Do NOT include data entry of form, if done after form is completed.

      1-15 min., 16-30 min., 31-45 min., 46-60 min., more than 60 min.

Cos rating process is fairly brief
COS Rating Process is Fairly Brief limited

  • 36% 1-15 minutes

  • 35% 16-30 minutes

  • EI reported less time than ECSE

What do you think a team process
What do you think? limitedA team process?

Teaming practices vary a lot from program to program.

  • How often are COS ratings actually decided in teams?

  • Do the teams include more than one professional?

  • How often are families involved?

Cos process more than one professional usually was involved
COS Process: More than one limitedprofessional usually was involved.

75% had most ratings decided by a

team (at least 1 professional in addition to respondent)

79% had at least one other professional provide input about the child’s functioning

Cos process family involvement was limited
COS Process: limitedFamily involvement was limited.

34% had family members present for

most of their COS rating decisions.

68% considered input from family members in determining the rating

F unctioning across settings and assessment data was considered in most cos ratings
F limitedunctioning across settings and assessment data was considered in most COS ratings.

75% used information about the child’s functioning from

multiple settings and situations

76% used information from one or more assessment tools during rating decisions

Most felt their cos process matched what it was supposed to be
Most felt their COS process matched what it was supposed to be.

78% thought the process used for

deciding COS ratings matched

how it was supposed to be done

Most felt the process was thorough enough to be effective
Most felt the process was thorough enough to be effective. be.

  • 85% felt there was enough information about each outcome area to determine a COS rating

  • 80% felt there was enough time to review child functioning in each outcome area.

  • 85% in most of the decisions, all involved considered information carefully in an effort to decide an accurate rating.

Most providers felt that most cos ratings given were accurate
Most providers felt that most COS ratings given were accurate.

76% felt confident that most of the ratings given

were accurate

88% reported that NONE of the COS ratings were

selected to make the program look good

Skills needed for cos ratings
Skills Needed for COS Ratings ratings given were accurate.

  • Training should focus on skills essential for COS ratings. For example:

    • Understanding age-expected functioning

    • Comparing specific child’s skills to age-expected

    • Understanding the 3 child outcomes

    • Discussing functioning in outcomes with others

  • To what extent do you think providers report having these kinds of skills?

Providers said they understood the content behind cos ratings
Providers said they understood the content behind COS ratings.

Age-expected functioning

  • 89% understood age expected functioning

  • 92% knew how to compare children’s functioning to what is age expected

    The three child outcomes

  • 85% understood the three child outcomes

  • 83% knew how to discuss functioning in the outcomes with others

* Endorsed statements of understanding

as mostly true or very true.

Understanding the purpose and uses for cos data
Understanding the Purpose and Uses for COS Data content behind COS ratings.

  • How much do providers

    • Understand why COS data are collected,

    • Realize what happens with the data, and

    • Feel they can explain the need for gathering COS data?

      Same or different?

Few providers understood why and how cos data are used
Few providers understood why and how COS data are used.

  • 65% understood why COS data are

    being collected

  • 37% understood what happens with

    the data

  • 52% knew how to explain the need

    for child outcomes data to others

What kinds of feedback and support are available to providers
What kinds of feedback and support are available to providers?

  • What do providers think about the system of feedback and support available related to the COS?

    • Are there people available to help them?

    • Is ongoing support adequate?

    • Are there people reviewing the COS forms?

      Excellent, good, adequate, fair, poor, or a combination??

“Tell me and I forget,

teach me and I may remember,

involve me and I learn.”

- Benjamin Franklin

Limited ongoing support for providers with the cos process
Limited ongoing support for providers with the COS process providers?

82% someone is available to provide support

if I ask for it

50% someone in my program provides support

47% ongoing support related to the COS process

is adequate

37% someone in my program checks

completed COS forms for accuracy

How do providers describe the impact of cos on their practice
How do providers describe the impact of COS on their practice?

  • What do providers say about how the COS process impacts them?

    • Change awareness?

    • Influence assessment or IFSP/IEP outcomes?

    • Influence conversations and relationships with others?

    • Impact on time for other activities?

      Does it seem? Positive? Neutral? Negative?

Neutral impact of cos process on practice
Neutral impact practice?of COS process on practice

Overall impact of COS

on your work with

children and families

Specifics reported about COS Process:

  • 2% had negative impacts on relationships with families

  • 17% improved the assessment process

  • 31% takes time away from other important actives

  • 30% helps focus discussion on the whole child

Summary cos process
Summary: COS Process practice?

  • Most received limited training and support

  • Providers felt comfortable with background content

  • Had limited understanding about what happens

    with the data or how to explain it

  • Didn’t feel like the COS process

    impacts their work much

Got quality

COS data?

Implications and discussion
Implications and Discussion practice?

  • Implications of findings

    • For professional development?

    • For supervision and administrators of programs?

    • For data quality?

  • Learning from providers

    • Have others done surveys or focus groups to learn from providers?

    • Why or why not?

    • How can surveys like this inform improvement activities in your state?

Find out more
Find out more practice?


ECO Center Website

Contact ENHANCE staff