COS Rating Discussions and Practice

COS rating discussions can happen near program entry, program exit, or in the interim. After gathering and age anchoring information about child functioning, COS team members discuss the child's functioning and work to reach consensus on a rating for each of the three child outcomes.

To guide the discussion, COS team members will use:

The COS rating process is a discussion!

Never determine a COS rating alone.
Actively involve family members. Discuss the information and examples they've shared about the child's functioning. The entry COS rating shouldn't be the first time providers and families discuss the three child outcomes or concepts like "functional skills".
Never ask parent or family member to simply select the rating that most accurately describes the child's functioning after explaining the rating scale.
Discuss the child's functioning with detailed description. Do not reduce the child to a number on the rating scale during the discussion.
Explain that the discussion and rating are about the child's functioning relative to what is age-expected in a developmental progression. The focus is not about comparing one child to another.
Encourage all team members to contribute, and allow them to share their thoughts fully.

Before the Ratings Discussion

Before the ratings discussion, providers should:

Engage the family and other COS team members. Share information about the COS process with them.
Review COS Process Online Module sessions as needed.
Review age-expected growth and development for the child's age.
Ensure multiple sources of information about the child's functioning are available for review for each of the three child outcome areas.
Ensure there is information about the child's current functioning across settings and situations.
When referencing age-anchoring tools and resources, consider which of the child's skills are age-expected (AE), immediate foundational (IF), or foundational (F).

States often encourage activities like routines-based interviewing, authentic assessment and progress monitoring, and shared documentation so that team members can review information gathered by others before the meeting.

Discussing Child Functioning and Reaching Consensus

For each outcome, COS team members discuss:

Examples of the child's current functioning across the breadth of skills within the outcome
What the family has shared about the child's functioning for the outcome
Information about the child's current functioning gathered from multiple sources and across different settings and situations
The child's functional use of skills (as opposed to discrete skills), including details about how the child uses skills in meaningful ways
Which skills the child has and has not yet mastered
How the child's functioning compares to age-expected functioning

Then, the team rates the child's functioning for each outcome:

Use the COS Decision Tree for Summary Rating Discussions to guide the discussion toward consensus.
Summarize initial conclusions about child's functioning with detailed description. A summary is more useful for reaching consensus on a rating than simply using the numbers on the rating scale.
Once the team reaches consensus on a rating, ensure it is consistent with the COS Definitions: 7-Point Rating Scale Criteria.
Provide effective documentation of supporting evidence for the determined rating.

Sometimes, the discussion will reveal that teams must gather more information to fully understand the child's functioning across the breadth of the three outcomes relative to age expectations, and resume the rating discussion at a later time.

Resources and Tools for COS Rating Discussions

COS Process Online Module, Session 6 describes effective teaming practices in the context of the COS process.
Child Outcomes Summary Team Collaboration (COS-TC) includes a checklist of quality indicators for COS teaming and rating discussion practices.
COS Practice Scenarios (COS-PS) is a collection of scenarios of children, ages 6 months to 5 years, that allow you to practice aligning information about each child with the three child outcomes and anchoring the information by age.
COS Completion When Teams Can't Meet In Person details how teleconferencing can be accomplished successfully with careful planning.

Interim or Exit COS Ratings

Most of the COS process is identical for ratings made when a child enters the program, interim ratings while they are enrolled, and exit ratings made when leaving the program. For each rating, COS team members gather and age anchor information about the child's functioning. The COS Definitions: 7-Point Rating Scale Criteria and COS Decision Tree for Summary Rating Discussions guide team members through discussions about child's skills and behaviors across settings and situations. Then the team reviews rating criteria, and reaches concensus on a rating that best describes the child's functioning.

Each subsequent COS rating describes the child's functioning as a "snapshot" in time.

After reaching consensus on a rating, COS team members also determine whether the child has made any progress since entry for each outcome. This "any progress" isn't the same as the progress categories for federal reporting—rather, "any progress" is defined whether or not the child has acquired at least one new skill or behavior related to the outcome since the entry rating. Because age expectations change along with the child's age, a child can still make progress, even if their rating is the same or lower than at entry.
As different people become involved in service delivery, and the child's daily routines change over time, those who know the child inevitably changes. The composition of COS team membership should change accordingly.
When gathering and age anchoring information about the child's functioning, teams have access to information collected during service delivery and as part of progress monitoring. Some states have requirements for the types of assessments to complete at entry, interim, or exit.
State guidance tells COS teams about timing and requirements for interim and exit ratings. This includes identifying children exiting the program with at least 6 months of services provided anywhere within the state.

Resources and Tools for Interim or Exit COS Ratings

COS Process Online Module, Session 8.
COS Completion When Teams Can't Meet In Person assists teams in conducting COS rating discussions by teleconference.
Topical COS Professional Development Activities includes a Who Wants to be a 7-Point Rating Scale Millionaire? actitity under the COS Ratings.

Integrating the COS Process with EI and ECSE

States and local programs are making child outcomes measurement more efficient and effective by integrating the COS process' activities and discussions with EI and ECSE practices, including:

child find and referral
intake, evaluation, and assessment
determining eligibility
development and implementation of IFSPs or IEPs
transition and exit

IFSP/IEP-Outcomes Integration

Integration might include a wide range of activities, for example:

Making modifications to IFSP or IEP forms
Supporting practitioners to use the three child outcomes as a framework for asking families about their child's functioning during referral
Aligning evaluation results, discussions, and reports to the three child outcomes
Using information about child functioning and the three child outcomes to develop high-quality, functional IFSP outcomes and IEP goals
Documenting and sharing child progress on IFSP outcomes or IEP goals and in the three child outcomes with all COS team members, and families
Embedding quality child outcomes data collection practices and IEP processes into staff feedback, reflective supervision, and program monitoring activities
Embedding information about the COS process into broad, service-related professional development (as opposed to "stand-alone" training)

Integration Benefits

Improved data quality and completeness
Higher-quality, functional IFSP outcomes or IEP goals
Improved interactions with families
Richer discussions about child functioning relative to age-expectations
Increased family understanding and capacity to communicate their child's strengths and needs
Improved practitioner understanding of meaningful connections between outcomes measurement and IFSP or IEP development
Improved recognition of the child's progress, and planning for services and supports to meet IFSP outcomes and IEP goals

Resources and Tools for Integrating COS with EI and ECSE

IFSP/IEP-Outcomes Integration provides and overview to help discuss and plan for IFSP/IEP integration.
Implementing an Integrated Child and Family Outcomes and IFSP/IEP Process provides stages and steps for IFSP/IEP integration using best practices from implementation science.
Developing High-Quality, Functional IFSP Outcomes and IEP Goals Training Package

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