COS Rating Scale: Definitions and Decision Tree

Overall Age-Expected Functioning

Some Age-Expected Functioning

Not Yet Age-Expected Functioning

Funcionamiento en General Esperado para la Edad

Algún Funcionamiento Esperado para la Edad

Funcionamiento No Esperado Para la Edad

• COS Process Online Module, Sessions 4 and 5 provide background information about how to apply criteria to determine COS ratings. Session 8 provides information on exit ratings.
• Topical COS Professional Development Activities on COS Ratings.
• Applied Practice for COS Skill Building Activity includes activity instructions and written case studies for practitioners' applied practice.
• COS Practice Scenarios (COS-PS) are 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, age anchoring the information, and determining a rating.

• Answering the "Ever" Question on the Decision Tree: Key Points and Practice Scenarios supports team decision-making when answering the first question on the Decision Tree for Summary Rating Discussions.
• COS Process Online Module, Session 5.
• COS Professional Development, including COS Practice Scenarios (COS-PS) and Topical COS Professional Development Activities on COS Ratings.
• Child Outcomes Summary Team Collaboration (COS-TC) includes descriptions and interactive activities to observe if quality indicators of practice are present in video clips of teams referencing the decision tree.

• Specific culminating descriptor statements are adopted by the state, and associated with rating numbers used in the COS process.
• Teams do not write their own descriptor statements. Consistent use of descriptor statements across the entire state allows all teams to understand which specific criteria are represented when they reach consensus.
• The COS Definitions: 7-Point Rating Scale Criteria and COS Decision Tree for Summary Rating Discussions are still used to guide team discussion toward consensus on a culminating descriptor statement for each of the three child outcomes.
• Families can gain greater understanding of their child's skills from a culminating descriptor statement rather than a rating number.
• Each rating number might have more than one culminating descriptor statement associated with it. Two children might be determined to have the same rating, but the different pattern of skills each child displays might make one culminating descriptor statement for that rating the best choice.
• All team members must be familiar with the culminating descriptor statements, trained to understand the differences between them, and be comfortable using them.
• Some state data systems allow entry based on culminating descriptor statements. Others must enter the rating number that corresponds with the culminating descriptor statement.

The following tables cross references COS rating definitions with example desciptor statements. They include optional depictions of child functioning sorted into "buckets" to help teams summarize a mix of skills found in their description of the child's functioning.

Overall Age-Expected Functioning

Example Culminating Descriptor Statements — Overall Age-Expected Functioning

Rating	Definition	Example Culminating Descriptor Statements
7	Child functions in ways that are age-expected in all or almost all everyday situations that are part of the child's life. No one on the team has concerns about the child's functioning in this outcome area.	Relative to other children [Name]'s age, there are no concerns. [Name] has all of the skills that we would expect of a child their age for [Outcome]. For [Outcome], [Name] has age-expected skills, with no concerns.
6	Child's functioning generally is considered age-expected, but there are some significant concerns about the child's functioning in this outcome area. Although age-expected, the child's functioning may border on not keeping pace with age expectations.	For [Outcome], [Name] has similar skills as same-age peers. However, there are concerns with [functional area of concern, quality, or lack of skill]. The team should continue to monitor progress in this area. Aside from the concern regarding [Name]'s [functional area of concern, quality, or lack of skill], they demonstrate skills expected of a child their age for [Outcome].

Some Age-Expected Functioning

Example Culminating Descriptor Statements — Some Age-Expected Functioning

Rating	Definition	Example Culminating Descriptor Statements
5	Child functions using a mix of skills, with more skills that are age-expected than not age-expected, across settings and situations in this outcome area. Child's functioning might be described as like that of a slightly younger child.	As a [age in months] old child, [Name] has many skills expected of their age. For [Outcome], the skills they demonstrate are slightly below what is expected for their age. Relative to same-age peers, [Name] shows many age-expected skills, but continues to show some functioning that might be described like that of a slightly younger child for [Outcome]. [Name] is mostly where we would expect him to be at [age in months] old. This means that most of [Name]'s skills are expected at this age for [Outcome], but does not yet have all of the age-expected skills.
4	Child occasionally uses age-expected skills across settings and situations in this outcome area. More functioning is not age-expected than is age-expected.	At [age in months] old, [Name] shows occasional use of some age-expected skills, but more of their skills are not yet age-expected for [Outcome]. At [age in months] old, [Name] shows occasional use of age-expected skills, but has more skills expected for a younger child for [Outcome]. [Name] has a few of the skills we would expect for [Outcome], but shows more skills that are not yet age-expected.

Not Yet Age-Expected Functioning

Example Culminating Descriptor Statements — Not Yet Age-Expected Functioning

Rating	Definition	Example Culminating Descriptor Statements
3	Child uses immediate foundational skills most or all of the time across settings and situations. Child does not yet function in ways that would be considered age-expected in this outcome area. Functioning might be described as like that of a younger child.	Relative to same-age peers, [Name] is not yet using skills expected for their age. However, they use many important and immediate foundational skills to build upon for [Outcome]. For [Outcome], [Name] has nearly age-expected skills. This means that they don't have the skills we would expect of a child their age yet, but they have the immediate foundational skills needed to build upon to achieve age-expected skills.
2	Child occasionally uses immediate foundational skills across settings and situations. Child does not yet function in ways that would be considered age-expected in this outcome area. More functioning reflects skills that are foundational than are immediate foundational.	At [age in months] old, [Name] shows occasional use of some immediate foundational skills, but more of their abilities are foundational for [Outcome]. Relative to same-age peers, [Name] is showing some nearly age-expected or immediate foundational skills, but has more skills that developmentally come in earlier for [Outcome]. For [Outcome], [Name] has some immediate foundational skills which will help them develop more age-expected skills.
1	Child only uses foundational skills across settings and situations. These foundational skills are crucial to build immediate foundational skills. Child does not yet function in ways that would be considered age-expected or immediate foundational in this outcome area. Child's functioning might be described as like that of a much younger child.	Relative to same-age peers, [Name] has the very early skills for [Outcome]. This means that [Name] has skills we would expect of a much younger child for this outcome. For a [age in months] old, [Name]'s functioning resembles that of a much younger child. They show some foundational skills, but not yet immediate foundational or age-expected skills for [Outcome].

• COS Process Online Module, Session 4.
• Child Outcomes Summary (COS) Process Quick Reference Guide shows a table with both the rating numbers and culminating descriptor statements on it.
• States are encouraged to reach out to ECTA Center's Child Outcomes Measurement Topic Specialist or their DaSy State TA Liaisons to request technical assistance with identifying and implementing Culminating Descriptor Statements into their COS process.

Do children need ratings in all three outcome areas?

Yes. Ratings are always provided on all three outcome areas. This is true even if no one has any concerns about a child's development in an outcome area or if a child is showing delays in only one or two of the outcome areas. Ratings on all three outcomes are needed to provide a complete picture of the child's functioning.

Should we adjust a child's age for prematurity when using the COS process?

No. Do not adjust a child's age for prematurity when using the COS process. It is common practice in early intervention to assess children born prematurely using their adjusted ages; however, chronological age, not adjusted age, is used for Child Outcomes Summary ratings. One of the reasons we collect data on child outcomes is to examine the effectiveness of early intervention and early childhood special education programs. Using the child's chronological age provides a truer picture of the effect of services on the child's development. Documenting data relative to chronological age allows programs to show how children born prematurely catch up, demonstrating an important impact of early intervention services.

Should children who have only communication delays, especially articulation delays, be rated automatically as typically developing on Outcomes 1 and 3?

No. The team needs to consider how the child's communication, including articulation, is affecting the child's functioning in all three outcome areas. When thinking about how a child with articulation delays would be rated on all three outcomes, the team members should focus their discussion on how articulation or other aspects of the child's communication are affecting the child's functioning across settings in each of the outcome areas.

For example, when considering Outcome 1, the team should focus on how well the child is understood during social interactions and how well the child communicates with other children. When considering Outcome 3, the team should ask questions about the impact of articulation delays on the child's ability to make his or her wants and needs known or to convey critical safety needs to different people or in different situations. So, even if a child presents with only articulation concerns, development needs to be assessed and documented on all three outcome areas.

How should teams consider atypical behaviors in rating the child's functioning?

Children sometimes display behaviors that do not represent delays in the usual progression of skills. Rather, they exhibit a pattern of consistently reoccurring behaviors that are atypical. These kinds of atypical behaviors are markedly different from what is observed in the child's peers and uncommon in that group. Examples include self-stimulating behaviors, perseveration on specific activities, strict adherence to daily rituals, and echolalia. The team must consider the extent to which atypical behaviors influence the child's level of functioning in each outcome area across settings and situations. For example, if the child spends a lot of time engaged in self-stimulating behaviors, then she is not able to interact as much with people around her. If the child displays self-stimulating behaviors in response to others' actions instead of reciprocating and extending interactions with those people around her, then the self-stimulation has a functional impact on her relationships with others. The team must consider the extent of this impact on age-expected functioning across settings and situations. Sometimes, teams focus on the atypical behaviors but overlook what the child is doing in an age-expected way. For example, a child may be overly focused on cars, have several rituals related to toy cars, and perseverate on making car sounds. All of these may be interfering with the child's interactions with children and with the child's availability to engage in learning about new things. On the other hand, the child may also have strengths in an outcome area. For example, he may interact with books appropriately, be age-appropriate with regard to doing puzzles, and be able to provide good descriptions of past events. When deciding a rating in an outcome area, the team needs to examine the entire repertoire of the child's skills and determine which are and are not age-expected.

What is the role of assistive technology devices when considering a rating?

Ratings should reflect the child's functioning using whatever assistive technology devices are used in his or her everyday routines and activities. For example, teams discussing a child who wears glasses or hearing aids or who uses a walker or wheelchair should consider the child's functioning with the use of these items. In some cases, a child may have more access to assistive technology in particular settings than others. If so, then that variability in the child's use of the technology will probably mean he or she shows a mix of functioning across settings and situations. COS ratings describe how a child is functioning in everyday settings and situations, not what the child's optimal functioning could be. As programs help children and families access and use assistive technology across settings, the child's functioning may improve and COS ratings will be able to detect these changes.

Can teams appropriately rate a child's functioning as a 7 across all three outcome areas at program entry?

Yes. We do see that some children in early intervention or early childhood special education will have ratings of 7 in all three outcome areas. People may ask, "Why would a child with all 7s be receiving early intervention or early childhood special education services?"" The team needs to remember that eligibility determination is independent of the child outcomes summary rating. A rating is based on the child's everyday functioning in the outcome area across setting and situations. There are a number of examples of children who may have 7's on all three outcomes at entry, such as:

• A child who has sensory impairments but functions at age-expected levels when assistive technology is in place.
• A child with a diagnosed condition who displays age-expected functioning for a period of time but for whom delays are likely to emerge later in development.

Early intervention or early childhood special education for these children is trying to prevent delays in development from occurring.

Should the family's culture be taken into consideration when determining COS ratings?

Yes, a family's culture affects what is considered age-expected development. Certainly, within early intervention and within early childhood special education, we often work with families who come from cultures other than our own. Interventionists need to understand how cultural practices influence the age at which children develop certain skills. For example, some cultures don't expect the same level of independence in feeding, and parents may continue to assist their children with feeding into the preschool years. In working with these families, culturally competent interventionists would not see this as a problem because it has no long-term impact on development.

For identifying appropriate targets for interventions as well as for the Child Outcomes Summary process, the team needs to understand age expectations within the context of the family's culture. When teams see skills and behaviors that are below mainstream U.S. age expectations but are the result of cultural practices, like the example of independence, then they need to adjust age expectations for those skills for that child.

Working effectively with families from other cultures can be challenging for providers. These challenges are also challenges for the Child Outcomes Summary rating process. The team needs to understand what is considered age-appropriate in that child's culture and base their sense of what should be considered age-expected functioning for that child on that understanding.

• COS Process Online Module, Sessions 3 and 5.
• Child Outcomes Summary (COS) Process Quick Reference Guide provides key points about special considerations during the rating process.
• Answering the "Ever" Question on the Decision Tree: Key Points and Practice Scenarios, which are grouped into five themes: function, consistency, quality, health, and culture.