Child Outcomes Summary (COS) Form and Instructions

Developmental framework assumptions:

• Children develop new skills and behaviors and integrate those skills and behaviors into more complex behaviors as they get older.
• These skills and behaviors emerge in a developmental sequence in most children, allowing for descriptions of "what 2-year-olds generally do", "what 3-year-olds generally do", and so on.
• The development of children with disabilities can be compared to the development of same-age peers. A child's development might be characterized by delays, acquiring skills and behaviors at a substantially slower pace than others their age.
• A child's development might be atypical—with functioning so different from that of others their age that it is considered outside the limits of age-expected behavior.

Skills and behaviors:

• Foundational (F) skills and behaviors develop early, and provide a scaffold for later skills to build upon in predictable ways.
• Immediate foundational (IF) skills and behaviors indicate a higher level of developmental functioning. For example, children play alongside one another before they interact in play.
• Age-expected (AE) skills and behaviors are those expected for the child's chronological age.

Rating scale assumptions:

• Achieving each of the three child outcomes aligns with the goal of programs and services for children: active and successful participation across a variety of settings now and into the future.
• For many young children with disabilities, recieving high-quality services allows them to move toward age-appropriate functioning than they would without such services.
• Documenting children's progress toward age-appropriate functioning is one type of evidence for the effectiveness of early intervention and early childhood special education.
• The highest end of the scale represents age-expected or age-appropriate functioning, with each lower point being a degree of distance from age-expectations.

The Decision Tree for Summary Rating Discussions contains a series of questions about age-appropriate skills and behaviors within the Three Child Outcomes. Responses to these questions guide the user to a rating category on the 7-point scale. The version with no numbers can be especially useful when families are directly involved in team discussions that describe a child's level of functioning.

Step 1

Does the child ever function in ways that would be considered age-expected with regard to this outcome?

• If "NO (Consider rating 1–3)", then proceed to Step 2
• If "YES (Consider rating 4–7)", then proceed to Step 4

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Step 2

Does the child use any immediate foundational skills related to this outcome upon which to build age-expected functioning across settings and situations?

• If "NO", then "Uses skills that are not yet immediate foundational", then Rating = 1 (end)
• If "YES", then proceed to Step 3

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Step 3

To what extent is the child using immediate foundational skills across settings and situations?

• If "Occasional use of immediate foundational skills", then Rating = 2 (end)
• If "Uses immediate foundational skills most or all of the time", then Rating = 3 (end)

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Step 4

Does the child function in ways that would be considered age-expected across all or almost all settings and situations?

• If "NO", then proceed to Step 5
• If "YES", then proceed to Step 6

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Step 5

To what extent does the child function in ways that are age-expected across settings and situations?

• If "Occasional use of age-expected skills; more skills are not age-expected", then Rating = 4 (end)
• If "Uses a mix of skills with more that are age-expected than not age-expected", then Rating = 5 (end)

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Step 6

Does anyone have concerns about the child's functioning with regard to the outcome area?

• If "NO", then Rating = 6 (end)
• If "YES", then Rating = 7 (end)

El Paso 1

¿El funcionamiento del niño es el esperado para su edad con respecto a este resultado?

• Si a respuesta es "NO (Considere calificar 1–3)", continúe con el Paso 2
• Si a respuesta es "SI (Considere calificar 4–7)", continúe con el Paso 4

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El Paso 2

¿El funcionamiento del niño utiliza las habilidades y comportamientos inmediatas, relacionados a este resultado, antes de las esperadas para su edad sobre las cuales puede desarrollar el funcionamiento esperado para su edad en distintos entornos y situaciones?

• Si a respuesta es "NO", entonces "Utiliza habilidades y comportamientos básicas muy alejadas para su edad", entonces la Calificación = 1 (fin)
• Si a respuesta es "SI", continúe con el Paso 3

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El Paso 3

¿Hasta qué punto el niño utiliza un funcionamiento inmediato antes de lo esperado para su edad en distintos entornos y situaciones?

• Si a respuesta es "Utiliza habilidades y comportamientos inmediatos de vez en cuando pero en la mayoría de ocasiones utiliza habilidades básicas muy alejadas para su edad", entonces la Calificación = 2 (fin)
• Si a respuesta es "Utiliza habilidades y comportamientos inmediatos a lo esperado para su edad la mayor parte o todo el tiempo.", entonces la Calificación = 3 (fin)

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El Paso 4

¿El funcionamiento del niño, relacionados a este resultado, es el esperado para su edad en todos o casi todos los entornos y situaciones?

• Si a respuesta es "NO", continúe con el Paso 5
• Si a respuesta es "SI", continúe con el Paso 6

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El Paso 5

¿Hasta qué punto el funcionamiento del niño es el esperado para su edad en distintos entornos y situaciones?

• Si a respuesta es "Utiliza ocasionalmente habilidades y comportamientos esperados para su edad; mayoritariamente utiliza habilidades y comportamientos inmediatos a lo esperado para su edad.", entonces la Calificación = 4 (fin)
• Si a respuesta es "Utiliza tanto habilidades y comportamientos esperadas para su edad y los inmediatos a lo esperado para su edad", entonces la Calificación = 5 (fin)

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El Paso 6

¿Alguien tiene preocupaciones sobre el funcionamiento del niño con respecto al área de resultados?

• Si a respuesta es "NO", entonces la Calificación = 6 (fin)
• Si a respuesta es "SI", entonces la Calificación = 7 (fin)

• Building the COS Team: COS ratings are more consistent and accurate when family members provide information about the child's functioning. If family information on child functioning was not included, mark "Not included" on the first page. Additional state-specific information also may be requested.
• Completing the COS Form: Completing the form requires gathering information, documenting supporting evidence, and determining a rating for each of the three outcomes. For a rating to accurately reflect the child's current functioning, the COS Form—including all information-gathering—should be completed within a six-week period.
• Revisiting the COS Form: Questions 1b, 2b, and 3b are to be completed after some time has passed since the initial completion of the COS Form. Indicate if the child has made progress since the previous outcomes rating. Progress is defined as the acquisition of at least one new skill or behavior related to the outcome. Describe the nature of any progress made.

• People Who Know the Child: Gather information from a range of people in the child's life, including their parents, family members, caregivers, child care providers, therapists, service providers, case managers, teachers, physicians, and others who can provide information about the child.
• Settings and Situations: Find out what is known about how the child behaves across a variety of settings and situations (for example, at home, the grocery store, or a playground).
• Assembling Evidence: The information gathered by the Team might include firsthand accounts of child functioning, clinical observation, curriculum-based assessments, norm-referenced assessments, service provider notes about performance in different situations, and progress or issues identified in an IFSP or IEP process you have collected.
• Omitting Sources: Don't include sources that do not know the child, for example, information available in a child's records.

• Cite the Source: Indicate the source of the evidence (a parent, speech therapist, teacher, or specific assessment) and the nature of the evidence from the source.
• Functional Skills: Identify the specific functional skills the child uses in everyday settings and situations, and the consistency with which they are observed.
• Age-Anchoring: Describe the presence and absence of age-anchored skills—Foundational (F), immediate foundational (IF), and age-expected (AE)—that are consistent with the selected rating.
• Function, not Progress: Focus on the child's current level of functioning rather than how much progress the child has made.
• Compare to Same-Age Peers: Compare the child's skills and behaviors to those of same-age peers. For each of the three child outcomes, determine the extent to which the child's skills and behaviors are age-expected.

Example COS Form Supporting Evidence:

Example COS Form Supporting Evidence

Source	Date	Evidence
Candace's mom	April 12, 2023	When Candace eats by herself, she makes a mess. She eats finger foods but does not a fork or spoon. She uses a "sippy" cup with two hands. Candace has not started toilet training. Candace does not let mom know when she has a wet or soiled diaper. Candace pulls off her socks when getting ready for bed.
Candace's child care provider	April 5, 2023	Candace is learning to use a spoon, but usually uses her fingers to feed herself. Candace uses diapers, and tugs on diaper after it is wet or soiled.
Carolina Curriculum for Infants and Toddlers with Special Needs	Administered March 13, 2023	Self-Help: Eating — 12–15 months Self-Help: Dressing — 15–18 months Self-Help: Grooming — 18–21 months Self-Help: Toileting — <15–18 months
Developmental specialist	Observed over a 4-week period, March 2023	Observed structured activities in child care environment and unstructured play time. Candace clapped and jumped during a group song. During free play, Candace sat quietly unless engaged in a play activity by caregiver. Candace did not object to having hands washed by caregiver, but needed assistance.