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Improving Systems, Practices, and Outcomes

COS Rating Discussions and Practice

COS rating discussions occur near program entry, near program exit, or any other time COS ratings are completed. 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.

Throughout the the discussion, COS team members should reference:

The COS rating process is a discussion!

  • Always determine a COS rating as a team, as described under COS Teaming.
  • Encourage all team members to contribute. Allow them to share their thoughts fully.
  • 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 a 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 refer to a child as a number on the rating scale.
  • 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.

Before the ratings discussion, providers should:

  • Ensure they understand the COS process by reviewing the COS Process Online Module
  • Share information about the COS process with the family and other COS team members
  • Review age-expected growth and development for the child's age
  • Ensure there is information about the child's current functioning across settings and situations
  • Ensure multiple sources of information about the child's functioning are available for review for each of the three child outcome areas
  • Reference age-anchoring tools and resources to identify which of the child's skills are age-expected (AE), immediate foundational (IF), or foundational (F)

As teams gather information to discuss, states frequently encourage activities like routines-based interviewing, authentic assessment, and progress monitoring. They also may use a system for file sharing, so team members can review information gathered by others before the discussion.

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 identifies a rating that reflects the child's functioning for each outcome:

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.

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

  • 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 the discussions about child's skills and behaviors across settings and situations.
  • Next, the team reviews rating criteria, and reaches concensus on a rating that best describes the child's functioning at this time.
  • After reaching consensus on a rating, COS team members answer a question about whether the child has made "any progress" since entry for each outcome. "Any progress" is defined as the child having acquired at least one new skill or behavior related to the outcome since the entry rating. Because age expectations change along a the child's age, they could have made progress, even if a rating is the same or lower than at entry. In these cases, the answer to whether the child has made "any progress" is yes.
  • As child's daily routines change over time and different people become involved in service delivery, those who know the child changes. The composition of COS team membership should change accordingly.
  • When gathering and age anchoring information about the child's functioning for an interim or exit rating, 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.

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

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