COS Completion When Teams Can't Meet In PersonUpdated June 17, 2020, 8:26 AM
This document is intended to assist teams conducting COS rating determination meetings using telecommunication devices such as phones and/or computers with or without video to have discussions with team members in different locations through teleconferencing. Although there are many advantages to in-person meetings, teleconferencing can be accomplished successfully with careful planning.
The contents of this page were developed under a grant from the U.S. Department of Education, #H373Z120002, and a cooperative agreement, #H326P170001, from the Office of Special Education Programs, U.S. Department of Education. However, those contents do not necessarily represent the policy of the U.S. Department of Education, and you should not assume endorsement by the Federal Government. DaSy Center Project Officers: Meredith Miceli and Richelle Davis, ECTA Center Project Officer: Julia Martin Eile
While using teleconferencing is different than meeting in person, the content of a quality COS team process for determining a rating is not different. However, the preparation might require a bit more coordination and organization to fully engage and effectively involve the family and all practitioners.
This document is organized into seven broad actions:
- Determining Feasibility
- Practitioner Planning for COS
- Connecting with Families to Prepare for COS
- Getting the COS Meeting Started
- Discussing the Child's Functioning
- Using the Decision Tree to Determine COS Ratings
- Teleconferencing Practice Pointers
Aligned with each of these seven actions are considerations for administrators and practitioners to review when considering completion of COS rating determination via teleconferencing, and associated resources, such as links to related materials, best practice considerations, methods, examples and conversation starters. At the end of this document are additional teleconferencing resources.
This document provides information about the COS process for teams and highlights practices that may have specific considerations or variations when using teleconferencing approaches.
No. In addition to this guidance, teams are encouraged to review the Child Outcomes Summary – Team Collaboration (COS-TC) Quality Practices Checklist and Descriptions for more detail about COS meeting best practices. The COS-TC includes a checklist and descriptions of quality COS teaming practices designed to help teams explore current practices and identify opportunities for improvement. Within the COS-TC you will also find several explanations, conversation starters, and examples of the different quality components that are important whether the COS is completed in person or via teleconference.
Be sure to refer to your state and local COS training materials and policy guidance.
Before using teleconferencing for COS completion, be sure to check your state and local program guidance on the use of teleconferencing, paying particular attention to the confidentiality and system security guidelines.
Seven Broad Actions
denotes considerations and resources unique to COS completion when teams cannot meet in person
- Determine meeting feasibility via teleconferencing.
- Check your current state and local guidance on teleconferencing. Does your program allow for COS meetings via teleconferencing? What options are available for all? Pay particular attention to the confidentiality and system security guidelines.
- Are all team members, including necessary practitioners and the family, available?
- Do all team members have the technology needed (e.g., workable phone, computer, WIFI, bandwidth) to have the COS meeting?
- If an interpreter is needed, does the interpreter have the technology needed? Is the interpreter available and comfortable using teleconferencing?
- All families might not have the resources needed for teleconferencing. In this case, how might the team gather, share, and discuss information with the family using synchronous and/or asynchronous options? Review any existing guidance on making COS rating determinations if a family cannot participate in the team discussion.
- Is there a compelling reason to have the COS meeting via teleconferencing now versus waiting to have it in person? Consider the impact of waiting for an in-person meeting.
- Determine access to requisite information.
- Does the team have access to the requisite information about the child's current functioning to determine the COS rating?
- What additional information is needed from the family or other team members? Can that information be obtained? How?
- Consider the timeliness of data collection and rating determinations. Ratings require an understanding of the child's current functioning. Entry and exit COS rating determinations generally should occur as close to entry and exit as possible. If ratings are made too far away from entry or exit, the team may not fully capture the child's progress in the program.
- After exploring all options, if the team determines it is not feasible to have the meeting, all team members should be notified and efforts to overcome the impeding circumstance should be determined and acted upon.
- A designated team member should document pertinent information (e.g., the situation, contacts with and attempts to contact the family, team decisions and plans including timelines) and follow up accordingly.
- Planning for the Use of Video Conferencing for Early Intervention Home Visits during the COVID-19 Pandemic and Planning for the Use of Video Conferencing in Preschool Special Education and Early Care and Education during the COVID-19 Pandemic include comprehensive planning guidance for video conferencing visits and meetings.
- Remote Service Delivery and Distance Learning includes teleconferencing guidance from different professional organizations and a variety of tele-intervention and distance learning resources.
Best Practice Considerations
- Information about the child's functioning from multiple sources, including input from all the different team members, is essential for high quality COS rating determinations.
- Family involvement is essential. Only after exhausting all efforts to include the family should a team make a rating determination without the family. Even then, some means of obtaining parent information about the child's functioning remains essential.
- Rating determinations should not be made by a sole practitioner. Even if one practitioner is a family's primary provider or child's primary teacher it is best practice to involve another practitioner who is familiar with the functioning of same age children and the COS process.
- Do not make broad assumptions about the child's functioning if the required information is not available. Teams should not compromise the quality of the data about the child's functioning relative to the three outcomes by using partial information or making presumptions.
- If gaps in service delivery occur, ensure the latest information about the child's functioning is documented as close as possible to the gap or change in service. Ongoing progress monitoring and documentation of children's functioning across settings is best practice and also provides information for COS discussions
- Know the available resources for assisting team members with teleconference access (e.g., schools, libraries, online help desks, hot spots).
- Programs and states should have a process for documenting and handling circumstances if/when COS meetings and rating determinations are not possible (in-person or teleconferencing) due to extenuating circumstances.
- Identify a lead facilitator to compile the information available about the child's functioning relative to the three outcome areas.
- Identify the secure means for sharing information between practitioners. Share compiled information with the other practitioners on the team. If possible, use a shared platform or drive. Otherwise, determine how the information can be shared, perhaps during a virtual pre-meeting or via a secure email.
- Ask the other practitioners to review the shared information, verify its accuracy, and add their input about the child's functioning. Further information from the family can be collected before or during the meeting depending upon the type and amount of information needed.
- When compiling and reviewing information about the child's functioning, confirm there is information:
- about the child's current functioning across the breadth of each outcome area
- about the child's functioning across settings and situations from multiple sources
- about how close or how far the child's functioning is to age-expectations (age-anchoring)
- If the required information above is not available, determine how and when it will be collected and the feasibility of doing so. Teams may need to incorporate new approaches to gather the information needed if in-person meetings with the family are not an option.
- Determine what, how, and when information will be shared with the family in preparation for the COS meeting. Information-sharing might be via email, mail, on-screen sharing, etc. Determine what works best for the family. To help the family prepare, consider sharing:
- an easy-to-understand write-up about the child's functioning in each of the three outcome areas.
- specific questions about the child's functioning that remain unanswered.
- a copy of the decision tree the team will use when working through the rating process.
- parent resources on outcomes measurement.
- Have a practitioner teleconference pre-meeting to discuss the information collected, the information to be shared with the family, and the meeting facilitation process. Include any special considerations for supporting family engagement in the meeting.
- Determine who will:
- contact the family
- share the essential information with the family prior to the meeting
- invite all participants
- facilitate the actual teleconference meeting and any necessary technology tests
- take notes during the meeting
Some different ways to gather information from families about their child's functioning include:
- talk with the family and ask them to describe their child's current functioning in specific situations.
- invite the family to share recent video clips of the child doing things typical for the child or engaging in a particular routine/activity.
- schedule a time for a teleconference to observe the child. Determine the routines to observe with the family and encourage their use of mobile equipment (e.g., phone, iPad) rather than a computer so it is easier for video to follow the child.
- engage the family in assessment and ask the family to complete an assessment tool or functional skill checklist. See Practice Improvement Tools on Assessment for related resources.
Following is an example of a partial write-up, including age-anchoring reference. Something similar could be shared with a family prior to the COS meeting.
"Outcome 2: Acquiring and Using Knowledge and Skills: As expected for his age (AE), Arnie is quick to figure things out, like using the stool to get the iPad from the countertop. When looking at books, he shows immediate foundational (IF) or just before skills. He looks at the pictures and points to his favored and familiar pictures (i.e., duck, baby, and train), but is not yet pointing at other pictures. His acquisition of language is more foundational (F) or like that of a much younger child, as he makes varied sounds and jabbers in sentence-like structure but is not yet using single words to communicate."
Best Practice Considerations
- Pre-COS meetings among practitioners are useful for verifying information completeness and accuracy. Definitive rating determinations should not be pre-determined before meeting with the family.
- Include children's functioning across settings and routines. If the child very recently experienced major changes in settings (e.g., with COVID-19), consider the child's functioning across settings before the change as well as across the child's current everyday reality (e.g., with different people, in different spaces, and across routines).
- Share information with families (by mail or electronically) well in advance so they have time to review it prior to the meeting.
- Contact the family using a program-approved means (e.g., telephone, secure email).
- Check in with the family. Inquire about how they are doing before jumping into planning and scheduling.
- Check parents' comfort and availability to participate in a teleconference. Discuss options, determine what works for the family, and provide them support to access and practice the teleconference method selected. Consider the equipment, software, bandwidth they have, and their familiarity with its use.
- When getting to the discussion about the COS meeting, specify the purpose of the meeting. Discuss meeting details so they are clear about what to expect.
- Clarify parent understanding about the meeting purpose and reinforce the importance of their input and participation. Acknowledge that parents know their child best.
- Discuss ways to prepare, such as where in the house they could meet to limit distractions. Also discuss ways to prepare others for the meeting such as engaging children in activities or choosing times that will allow the parent(s) to participate.
- Determine the teleconference means of connecting and set an agreeable time, specifying meeting duration and the participants.
- Let the family know you'll be sending them some information to review prior to the meeting (e.g., easy-to-understand write-up of the child's functioning in each of the three outcome areas, questions about the child's functioning, a decision tree and other parent resources for outcome measurement). Clarify the best means to share that information, keeping program restrictions and guidance in mind.
- When sharing information with the family, consider the material accessibility, including if it is in the family's preferred language.
- Provide all teleconference details together in one note. Include the teleconference connection details, the date, time, duration, purpose, and invited participants. Also, share contact information for who to contact if they have questions or need to reschedule.
- Be mindful about teleconference security and privacy guidelines and any program policies and practices for teleconferencing.
Send a reminder to all participants prior to the meeting and check that they received the shared materials. Follow up with a reminder the day before the meeting too.
(not intended as an exact script)
Family check-in questions
- How are you and your family doing under the current circumstances?
- What are some things you've been able to do as a family and with your child?
- How have your day-to-day routines changed?
- What changes have you seen in your child?
- What is your child doing now that's new or different?
- Make a point to acknowledge family successes, challenges, and emotions.
Talking about COS and a teleconference
- Thinking about how your child is doing, one of the things our program does is measure children's functioning and progress in three broad outcome areas. This information is important for us to understand the results of the program for you and your child and for all children across the program.
- If possible, we'd like to convene a teleconference with you to discuss this further. Have you used teleconferencing before?
- When we are not able to meet in person, we like to have the team meet through teleconference. How does that sound to you? Our teleconference options include (list phone and programs with video options such as Zoom, WebEx, Skype). Are any of these options workable for you? If you like, I can tell you a little more about how they work.
- So, at the teleconference, we'll talk together about your child's current functioning and determine his/her functioning in the three outcome areas. Your participation and input are so important and valued because you know your child best. What questions do you have about this outcomes measurement that I could help answer?
- We've found that teleconferencing works best if you have a relatively quiet space in your home, or when children are engaged in other activities that allow you to participate.
- If this is workable, let's look at our calendars and find a date and time. We'll probably need (#) minutes.
- To help you prepare, I'll send some information for your review prior to our teleconference. This will include (list items). What is the best way to send this to you (email address, mailing address)?
- Join the teleconference a little early (e.g., at least 15 minutes) to allow participants time to address any technology issues and get comfortable with the meeting features before the meeting starts.
- Start the teleconference with introductions and a review of the purpose and agenda for the meeting. Introduce participants or invite participants to introduce themselves. Check to see if participants are still available for the planned duration of the meeting.
- Before delving into meeting content, check that all members are familiar with teleconference system being used and discuss tips for effective group participation. Often the facilitator will need to review mute and unmute functions, chat functions, screen sharing, and view options. Explain that if two people are talking at once it will be difficult to hear, and agree upon ways to support turn-taking (e.g., using the raise-hand function, pressing a number on the phone to trigger a beep, and encouraging longer pauses for all to respond after speaking). Having a designated meeting facilitator is important for assisting with the flow of the meeting. Depending upon the teleconference system being used and practitioner familiarity, it may also be necessary to have a designated technology facilitator to keep an eye on the chat, facilitate screen sharing, and troubleshoot.
- Describe and seek consent for any planned recording and/or note-taking and discuss how that information will be used and shared. Be sure to look at your program's policy guidance regarding recording.
- Ensure that all members have the necessary resources for the meeting. Verify if the family received the materials sent prior to the meeting. If a member does not have the requisite information, share it electronically and pause, as necessary, to ensure members have the information. Alternately, use the shared screen function and present in a font size large enough for others to read.
- Following the logistics of getting started, briefly explain the purpose of child outcomes measurement, provide an overview of the three outcomes being measured, how data were collected, and check for family understanding.
- Refer to resources sent ahead of time and, if possible, allow the whole group to see materials via screen sharing or online links.
- National resources for informing families about child outcomes measurement include A Family Guide to Participating in the Child Outcomes Measurement Process and the Child Outcomes Step-by-Step video.
- Additionally, many states have developed materials to inform families about outcomes measurement. Overview materials like these can be shared with families prior to the meeting and referenced at the start of COS meetings.
Best Practice Considerations
- Taking time for complete introductions and an overview of technology puts participants at ease and helps ensure all members are comfortable to contribute to the discussion. It is critical that all participants know and feel the important and equitable role they have in the meeting.
- As a team, determine which outcome to start with. Sometimes it might be easier to talk about a particular outcome area. For example, the functioning associated with Outcome #3 might be easier to visualize or it might be that the team has more concrete information about the child's functioning in Outcome #2 so that might be a good outcome to discuss first. Regardless, know that a team can determine the order of the outcome discussion. Whichever outcome is discussed first, the facilitator should provide an overview about that outcome before discussing the child's specific functioning.
- Discuss one outcome area at a time. The meeting facilitator should help the participants with this to minimize confusion about the functioning associated with each outcome.
- During the discussion, reference information shared with the family prior to the meeting to help them participate and follow along. If possible, use screen sharing to view documents together.
- Invite family input by asking questions about the child's functioning related to the outcome area being discussed. Encourage family members to share information about the child's participation in specific routines or related to particular areas of functioning.
- When working through each outcome area, consider:
- information from multiple sources (e.g., parent input, assessments, etc.)
- information about the child's functioning across settings and situations
- good detail about the child's functioning that team members can visualize
- the child's current functioning and participation in daily routines versus discrete skills
- age-expected skills the child has not yet mastered
- how close or how far the child's functioning is to age-expectation
Questions to encourage family member sharing about the child's current functioning:
- With regard to (outcome related functioning – interacting with you, looking at books, getting dressed) what is something you've noticed your child doing this week?
- Tell us about what you see your child do during (insert a routine where the outcome's skills are often observed).
Questions to invite family input about the child's functioning shared prior to the meeting:
- Did you have a chance to review the write-up we shared?
- Knowing that you know your child best, how did the writeup about his/her functioning in Outcome 2 compare with what you know and have seen your child do?
- How does this information fit with what you have observed your child doing recently?
- Was there anything that you wondered about as you read the write-up that we shared?
Best Practice Considerations
- The process of discussing a child's functioning is the same at a teleconference meeting as it would be at an in-person COS meeting. Use the same strategies to elicit input from all team members, including family members. Acknowledge that there may need to be longer pauses of silence on a teleconference, especially if you cannot see other people or if people need to unmute before speaking. Invite questions and engage all participants in discussion.
- If possible, use screen sharing to display the write-up about the child's functioning on the outcome being discussed. Although the information was sent to members in advance, seeing it often helps the group be more targeted in discussion. When using screen sharing, a note taker can also enter the additional information about the child's functioning shared during the meeting. This increases engagement among participants because they can see both the information shared prior to the meeting and information collected during the teleconference at the same time.
- Ensure the team has enough information about the child's functioning to comfortably work through the decision tree before intentionally using it to guide the rating determination.
- Facilitate the team's active use of the decision tree. Facilitate discussion about the child's functioning in such a way that the team describes the child's functioning, considers the questions on the decision tree, and reaches consensus. Be certain to also review the progress question for rating determinations made after the initial entry ratings.
- Share a visual of the decision tree. This might be by sharing the decision tree prior to the meeting and/or making it available online or via screen sharing.
- Ask the team to think of some examples at each relevant decision point on the decision tree. For example, at the first question "Does the child ever function in ways that would be considered age-expected with regard to this outcome?" invite the team members to describe some examples before landing on a "yes" or "no" response. Do the same for the remaining decision points on the tree, checking to see if team members have enough information to comfortably move through the decision tree.
- Be prepared to discuss the child's functioning relative to age-expectations and be open to additional information the family or other team members share.
- Encourage input from all members while keeping the meeting moving along.
- If more time is needed for discussion, talk through the options for reconvening rather than rushing into a rating.
- Verify team agreement verbally rather than through silence when approaching a rating determination. If there are questions, clarify the child's functioning and describe what is meant by the decision tree point until there is consensus.
- If new information emerges that makes agreement difficult, the team may need more information about the child's functioning or need to collect additional information to better understand distinctions before they can agree on a rating.
Best Practice Considerations
- The decision tree is a valuable tool. It is a series of questions about the extent to which a child exhibits age-appropriate skills and behaviors in each outcome area. Responses guide the team toward specific rating categories on the 7-point rating scale. Using the decision tree as a guide supports a consistent and transparent process and encourages equitable understanding among all team members.
- During a teleconference, when asking for examples about the child's functioning and looking for consensus, facilitators should invite individual responses rather than assume that silence means team members are in agreement with an idea that was shared. While this is good practice in all meetings, it is especially important when teleconferencing.
- Effective Documentation for Outcomes Ratings includes features of effective documentation to support COS ratings and key documentation points for each of the seven COS ratings.
- Developmental Progressions and the COS Process 7-Point Rating Scale describes the concept of foundational, immediate foundational, and age-expected skill progressions for understanding how to use the COS 7-point scale.
- Test the phone, software, WIFI access, microphone and video before the meeting. Plug into ethernet directly or locate yourself close to base WIFI for a strong signal. When possible, do a trial run. Offer to do a trial run with families that are new to the technology and may need an opportunity to practice.
- Remind participants about confidentiality and privacy in selecting their location and consider using headphones for the meeting.
- Consider your background. Look at what is behind you and make sure it is what you want others to see. Encourage this of all participants.
- Have a backup plan for what to do if the connection fails or you cannot connect.
- Prepare and share the meeting purpose, agenda, and resources prior to the meeting. This allows the team time to securely receive information and review it before the meeting.
- Send a meeting reminder, with any additional resources, directly to all participants, include any password protection and/or conference code/meeting ID for confidentiality.
- Check-in with the family to confirm their availability for the meeting.
- Just prior to the teleconference, silence other devices and minimize distractions. Before the meeting, consider closing email and activating focus assist, a tool that limits notifications for a specific time period, to avoid screen popups. Close other browsers and applications or re-start computer to maximize bandwidth.
- Have a host open the teleconference early (at least 15 minutes) and invite participants to join to troubleshoot technology issues and try technology features.
Best Practice Considerations
- Check state and local guidance about sharing documents electronically. Pay particular attention to what type of information requires greater protections.
- Designate a single point person to be responsible for all electronic communications about the meeting; this reduces confusion.
- If possible, restrict the meeting only to meeting invitees. Use a password and lock the meeting after all join to avoid lurkers and maintain privacy and confidentiality.
- Be sure everyone is introduced or has an opportunity to introduce themselves, as it is not always possible to see all participants. Give each a chance to contribute.
- Allow for some relationship-building small talk.
- Help participants understand how to mute and unmute to support effective listening.
- Monitor the chat and ensure the facilitator discusses those comments too.
- Review technology features (e.g., cameras, microphone, chat, dial-in numbers).
- Clarify what to do in the event of technical difficulties.
- Clarify means of participation so everyone has opportunities to speak. Encourage introducing self before talking and refer to people by name during the meeting. Use longer pauses after calling on people so they can formulate thoughts and respond.
- Look at the screen (not something else) while others are talking. Close or minimize other windows/applications/devices to avoid interruptions and distractions.
- Make certain others are finished talking before jumping in. The facilitator should moderate the discussion to avoid interrupting and encourage member participation.
- Practice respect and courtesy while acknowledging the reality of distractions. We know that we might hear dogs barking, kids playing, doorbells ringing, etc.
- If necessary, discuss rescheduling.
- Near the end, summarize decisions that were made and any implications of those decisions (how they are used). Be sure to invite comments or questions from all.
- Discuss next steps that will occur following the meeting.
Best Practice Considerations
- Be mindful about the number of participants and the bandwidth needed for multiple videos. If using a phone, consider the number of different voices on the call and ease of participation.
- When possible, have the meeting facilitator share information synthesized across the practitioners. This can reduce confusion from many back-and-forth voices. Yet, encourage whole team discussion and response to questions.
- Fully document meeting information, resulting decisions, and the meeting format.
- Send a follow-up note and/or formal paperwork that thanks participants, summarizes decisions, and indicates next steps.
- Consider inviting feedback about what worked and what can be improved about the teleconference to support continuous improvement.
Best Practice Considerations
- Seek feedback from all teleconference participants and compile results for program improvement.
Additional Teleconferencing Resources
- Coronavirus Disease (COVID-19) Resources from ECTA Center includes the latest information for state Part C and Part B 619 programs. Resources, are organized by the following categories:
- Video Conferencing 101: Guidance for early interventionists on using video conference for home visits (and other purposes during the COVID-19 Pandemic by Larry Edelman. This document includes an overview and suggestions about videoconferencing, how it is being used, checklist of tips and considerations, resources related to Zoom, and links to guidance materials and resources related to service delivery.
- April 2020 Resources within Reason: Using Telepractice to Support Children and Families by the Division for Early Childhood (DEC). A collection of resources to support practitioners using teleconferencing.
- Use of Telehealth in Early Intervention (IDEA Part C) by the Public Consulting Group – Collection of resources to consider during the COVID-19 public health emergency. Resources are focused on tele-intervention for Part Cthough many issues span early childhood services.
- Tele-Intervention 101 Learning Courses by the National Center for Hearing Assessment and Management (NCHAM), Utah State University. This resource includes three short online training videos for administrators, providers, and families about using tele-intervention. Topics such as HIPAA/FERPA consideration, recording and licensure, setting up sessions, connectivity and technology issues, engaging and communicating with the family, teaming and using interpreters in this environment, and tips for successful sessions are included.
- Video Series: Use of Technology with Evidence Based Early Intervention by the Ohio Developmental Disabilities Council. This series of short videos includes an overview of using technology to support families, using video and video conferencing to support team members, using FaceTime to enhance team collaboration, virtual home visits and co-visits with families, and using video for reflective supervision.
- Early Childhood Intervention Tele-Practice by the Family, Infant and Preschool Program (FIPP) Center for the Advanced Study of Excellence (CASE). In addition to a brief video demonstration of tele-intervention, this resource includes tele-practice infographics and tools to support evidence-based practice.
- Tips for Families on Tele-Intervention by Family Guided Routines Based Intervention (FGRBI). This tip sheet focuses on tele-intervention but provides an example of informing families about teleconferencing.
- Tips for Families: Receiving Early Intervention Services through the Phone, Tablet, or Computer – by the Early Childhood Personnel Center (ECPC) and the University Center for Excellence in Developmental Disabilities (UCONN). This tip sheet includes strategies for families to prepare for a tele-intervention visit. Although geared for tele-intervention, the tips are broad enough to be relevant for a COS meeting via teleconferencing as well.