Implementing an Integrated Child and Family Outcomes and IFSP/IEP Process
The purpose of this interactive guide is to assist state, regional and local early intervention (EI) and early childhood special education (ECSE) providers to take the steps needed to integrate the child and family outcomes measurement with the Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP) process. Over the last 5 years, the idea of combining the process of measuring child outcomes as a part of the IFSP or IEP process has been gaining momentum, and several states now have IFSPs and/or IEPs that contain the child outcomes measurement within the form.
Other states have created integrated processes (without combining the forms) in which the evaluation and assessment information gathered is used for both purposes, and families are informed and asked to participate in the outcomes ratings. The results of this combination have been reported to be more complete and accurate IFSPs, IEPs and outcomes measurement, increased involvement in and understanding of the processes by the families, more functional child and family IFSP outcomes and child IEP goals, and improved monitoring of individualized outcomes and goals over time. Work continues to expand and improve integrating outcomes into the IFSP and IEP processes, including the inclusion of family outcomes.
This guide was developed in response to requests from states and programs considering integrating the outcomes with the IFSP/IEP to have a resource that would help them think through how they might create an integrated process in their state or program. It is designed to be a "place to start" when considering the multiple factors that go into creating an integrated process.
This guide was developed by members of a workgroup from the Early Childhood Outcomes (ECO) Center's Integrating Outcomes Learning Community with support from staff from the ECO Center, the Western Regional Resource Center (WRRC), and the Early Childhood Technical Assistance Center (ECTA Center).
State Workgroup Members:
- Shannon Dunstan, Idaho
- Lenita Hartman, Colorado
- Peggy Kemp, Kansas
- Phoebe Rinkel, Kansas
- Michelle Staley, New Mexico
- Kristen Votava, North Dakota
- Naomi Younggren, Army EDIS
The guide contains the four stages of implementation as described by the implementation science literature as well as concrete steps within each stage that providers may take to develop a comprehensive, efficient and integrated process.
The guide is organized in the following ways:
- Each of the four stages of implementation (exploration, installation, initial implementation and full implementation/sustainability) are described, and examples specific to the integration of outcomes with the IFSP/IEP process given;
- Each of the stages includes several steps that may be taken in order to move towards an integrated process;
- Each stage contains links to tools that state, regional and /or local EI and ECSE providers may use to support or facilitate the completion of the steps within the stage;
- Each stage also contains links to resources from state and national sources to show examples of how the steps have been implemented by other programs.
The guide is designed to be interactive and self-paced, and may be used by an individual or a group to guide the process. For those who are not already familiar with implementation science, resources and literature may be found on the websites of NIRN and SISEP.
Stages and Steps
Before you begin to explore the possibility of integrating outcomes into your IFSP or IEP process, you will need to identify an exploration team. This is a core team of individuals who will lead the exploration process. This group will:
- Explore the implementation literature and resources for the change process,
- Discuss perceived needs, issues, and/or opportunities to be addressed,
- Identify any evidence or data that substantiates the percieved needs, issues or opportunities as well as information gaps and needs,
- Determine whether or not there will be support from key decision makers and administrators to begin the exploration process (and eventually implement an integrated process),
- Identify stakeholders who should be engaged in the process,
- Determine how the group should function and determine structures needed for communication throughout the process, and
- Decide whether or not to move forward with exploration.
Your exploration team will be crucial in all the implementation stages. If the decision is made to move forward with implementation, this team will be asked to continue as part of the state or local leadership team that designs and implements an integrated outcomes and IFSP/IEP process.
It is important to note that exploration is not a linear process- the work of exploration often builds upon the work of the previous steps, but it can also overlap across steps. It's a normal part of the process to go back and forth through not only the steps of each stage, but through the stages of implementation themselves.
- Key Considerations for Implementation: In this presentation to the Integrating Outcomes Learning Community, NECTAC staff discuss the steps to take in considering and adopting a plan for integrating outcomes unto the IFSP/IEP process.
- Child Outcomes Framework and Self-Assessment and Family Outcomes Framework and Self-Assessment: These tools are designed to be used by state agencies to assess progress towards full implementation of a child outcomes measurement system (COMS) and Family Experiences and Outcome measurement system. Programs considering integration of outcomes measurement into their IFSP/IEP process may want to consider engaging in these self-assessments to ensure that key components of their outcome measurement systems are in place before moving forward.
During exploration, your state, regional or local program must spend time considering multiple factors that will influence the ways in which you might implement an integrated outcomes and IFSP/IEP process. There are several state and program examples that have been designed to fit a specific need, so consideration must be given to how these models might "fit" with your infrastructure, management and staffing, as well as how they "fit" with your mission and principles as a program. It is critical to be able to articulate why an integrated process is needed, as well as to identify critical components from other states that will be needed to create a successful process in your program. Exploration offers you the opportunity to explore the options, talk with critical stakeholders, articulate what you want to change and why, and to begin to let others know of your plans. It also provides the critical foundations for communication and feedback loops that will be needed throughout implementation. To begin this stage, your exploration team may want to meet to develop a timeline of the activities within exploration. Exploration includes five key areas:
- Articulate desired changes and results,
- Compare approaches,
- Explore implementation,
- Conduct public awareness, and
- Move on to implementation.
- Integrating Outcomes Learning Community Exploration Webinar: This webinar provided an overview of the exploration stage, particularly steps that relate to exploring an integrated IFSP/IEP and outcomes process. Three state presenters share their exploration activities and outcomes.
In order to begin, you must clearly articulate the expected benefits for all stakeholders: families, providers, administrators, the State Education Agency (SEA) and/or the Lead Agency (LA). This is the answer to the question, "Why are we doing this?"
Here are some questions that may facilitate this conversation:
- What is our purpose for pursuing an integrated outcomes and IFSP/IEP process?
- What is the intended result of integrating child and family outcomes within our IFSP or IEP process?
- Why is it important to do this work now?
- How will integrating outcomes improve outcomes for children and families?
Here are some potential answers to these questions:
- Streamlined and more efficient paperwork and use of staff time,
- Less missing child and/or family outcomes data,
- Improving authentic assessment practices for providers to connect the assessment and evaluation information to both processes,
- More functional individual child and family outcomes,
- Improved family understanding of their child's functioning in the measurement of outcomes,
- Improving families' understanding of the purpose of EI/ECSE and participation in services and supports, and
- Improved providers' understanding of the meaningful connection between the child and family outcomes and the purpose of EI/ECSE.
You will also have the opportunity to get specific about the changes that will be made in order to integrate the child and family outcomes into your IFSP/IEP process by comparing what you have learned from other programs to where you are now. This step is also an opportunity for you to consider changes at multiple levels that will support the purpose that you articulate and will ensure sustainability once the changes are implemented.
- Identify and bring together a diverse group of stakeholders that will assess needs and develop a common understanding of the purpose and outcomes of developing an integrated outcomes and IFSP/IEP process. Consider representation from state and local administrators, training and technical assistance (TA) staff, service providers and parents. Ensure that the group contains individuals who are capable of making decisions or has a plan to take recommendations to decision makers.
With your stakeholders, you will then:
- List the specific concerns or issues that you are trying to address, at all levels of the system. Include considerations for state, regional and local programs as well as families and children. Use data and other evidence (monitoring or general supervision information) to assist in identifying concerns or issues.
- List the specific outcomes, benefits and changes that will be addressed by the integrated outcomes and IFSP/IEP process. List specific outcomes, benefits and changes for all the groups listed above.
- Review your current infrastructure and support systems, such as staffing, training and TA and consider the following:
- Is our current infrastructure sufficient to support the integration of the two processes?
- Do we have adequate means of providing mentoring and supervision?
- Is our current training and TA support sufficient to support the integration of the two processes?
- What can we identify now that will need to change in order for both the infrastructure and training and TA to support an integrated process?
- What additional resources and barriers exist?
- Integrating Outcomes Exploration Tool and Instructions to Exploration: This tool is used after you have decided to explore integrating the early childhood outcomes into the IFSP/IEP process. The purpose is to guide the Exploration Team in assessing the readiness of your system for implementation. The instructions document provides recommendations for the use of the tool.
- How Why Who Tool: This tool supports the exploration team in considering multiple factors including how families, providers, administrators, the State Education Agency (SEA) and/or the Lead Agency (LA) will benefit from integration process. After considering the benefits, the team will be able to begin articulating why the team is exploring moving toward an integrated process.
- Articulating Desired Changes and Results Tool: This tool supports the exploration team in determining and articulating the desired changes and results by framing the discussion around the purpose and need for the change, along with the potential results of integration.
- Introduction to IFSP/IEP Integration: This voice over PowerPoint presentation provides an overview to the IFSP/IEP integration processes across work with ECO, NECTAC, and a number of early childhood professionals interested in these processes, in addition to highlighting recent work.
- State Resources: Idaho: Idaho used an online survey to gather information from providers about current practices, challenges in implementing an effective child outcomes measurement process, and training and technical assistance needs. The reports attached shows information from the survey, which formed the basis of conversation for moving forward with integrating outcomes into the IEP.
In this step, program staff and/or stakeholders should consider what has been done in other states or programs. The purpose of this investigation is to help you gather resources that may be useful to your program if adapted, and to determine specifically what is doable given your program’s current structure and resources.
- Review and discuss examples from experienced states and/or programs of processes, policies, procedures and guidance documents that support the integration of child and family outcomes, and, if available, examples of integrated IFSPs and IEPs. Ask yourselves:
- What do we like about the forms, policies, procedures and guidance?
- What might work in our program? What will not work?
- Discuss as a group integration of outcomes and the IFSP/IEP into forms as well as existing processes. Ask yourselves:
- Where will change come more easily? Where might we have challenges?
- What are changes that we can make now? Which changes may take longer to make?
- Discuss as a group what changes to your process are feasible given your current system structure and staff and fiscal resources.
- Integrating Outcomes Web Page- ECO Center: This page contains several resources and examples from multiple states, including sample forms, exemplars and guidance documents. In particular, the Sample IFSPs and IEPs and State Resources may be helpful when comparing approaches.
- Flow Chart - State Examples: Several states have individualized flow charts that describe their IFSP or IEP process with the outcomes measurement included.
In this step, you will measure the readiness of your system, as well as explore the commitment and leadership of potential early adopters. The purpose of this measurement is to “take the temperature” of your field to determine who might be willing to support the integrated processes and be an example to others. It will also help you identify where additional training and TA might be needed in order to change both thinking and behavior in order for the integrated outcomes and IFSP/IEP to be successful. In this step, you will also assess your IFSP/IEP process to determine where opportunities to integrate child and family outcomes exist. Lastly, this is the final step before deciding whether or not to move forward.
- Conduct self-assessments at the local, regional and/or state levels to determine where structures are in place to support an integrated outcomes and IFSP/IEP process, and to identify where additional supports will be needed.
- Conduct program staff and/or stakeholder discussions to identify where within the existing IFSP or IEP process opportunities to integrate child and family outcomes exists.
- Review the information and literature available about implementation science.
- Conduct stakeholders' meetings to complete and/or share the results of the self-assessment and the IFSP/IEP review process and to identify individuals or programs that may be considered to be early adopters based on results of self-assessment. Review the stages of implementation to create a common understanding of the process to be used. Begin to discuss how to evaluate the effectiveness of the changes based on the desired outcomes stated in Steps A and C.
- Based on the information gathered through steps A-C, decide whether or not to move forward towards implementation of an integrated outcomes and IFSP/IEP process.
- Using Information from Functional Assessment within the IFSP/IEP Process: this worksheet was created by technical assistance providers in Kansas, as an adaptation to a slide presented in Developing High-Quality, Functional IFSP Outcomes and IEP Goals: A Training Package. It is a tool that may be used in early discussions about integrating outcomes into the IFSP/IEP to help programs identify where they are already using assessment information for both the child outcomes rating and for IFSP and IEP decisions.
- IFSP/IEP Self Assessments: These documents describe in further detail when and how to collect information for child outcomes as part of IFSP and IEP processes. The documents also invite the reader to reflect upon the extent to which one's own program is integrating child outcomes measurement in each step of the IFSP or IEP (e.g. 'not implemented,' 'needs improvement' or 'implemented').
- The IFSP Outcomes Integration Tool and Recommendations for Use of the IFSP Outcomes Integration Tool: The IFSP Outcomes Integration Tool supports the exploration team in examining current practices and identifying priorities. You can use this tool to explore how the three global outcomes can be integrated into your current IFSP process. The Recommendations for Use document includes ideas for use of the tool.
- The IEP Outcomes Integration Tool and Recommendations for Use of the IEP Outcomes Integration Tool: The IEP Outcomes Integration Tool supports the exploration team in examining current practices and identifying priorities. You can use this tool to explore how the three global outcomes can be integrated into your current IEP process. The Recommendations for Use document includes ideas for use of the tool.
Now that you've decided to move forward, this step creates the opportunity to prepare your system for the changes that will be needed in order to create an integrated outcomes and IFSP/IEP process. In all likelihood, you’ve been doing some level of public awareness all along; however, this step is a specific opportunity to create the communication feedback loops that will be in place throughout implementation of the integrated process. This will serve as the foundation for all future communication and feedback about the integrated processes, so it is critical that the message is clear and reflects the work done in steps A - D.
- Ensure that your stakeholders understand the basis for integrating the outcomes and the IFSP/IEP process. Create introductory webinars, presentations and/or talking points to explain the changes to others.
- Use needs assessment to identify additional content areas or background information that is necessary to understand the change.
- Disseminate similar information to the field.
- Provide opportunities throughout initial communication for questions to be answered and communicated back out to the field.
- Ask for deliberate, specific input from the field. Consider multiple sources including stakeholders, state and local administrators, service providers and families.
- Consider the input received when moving on to the next stage. Consider communicating back to the field how their input was used.
- Maryland Integration Graphic: This visual was created to help the field understand the integration process of child outcomes measurement into the MD IFSP.
- Idaho Stakeholder Webinar: Idaho presented information to key stakeholders and administrators sharing the results of a provider survey which demonstrated the need for integrating the outcomes measurement into the IEP. This PowerPoint presentation is an example of the presentations given.
The next step in the implementation process is installation. In this stage, you will develop your communication plan, build supports in administration, training and technical assistance capacity, and develop your implementation plan.
Before you move on to the next stage of implementation, your exploration team should consider the following:
- Listen for feedback from the public awareness activities for information that indicates that more exploration is needed before moving to the next stage. Consider revising steps A-D based on the feedback received.
- Hold a discussion with your exploration team to prepare for the following Installation Stage activities:
- Asking members if they are committed to the change and will work on the state leadership team;
- Revisiting membership of the state leadership team and identify any changes (substitutions or additions) to membership before moving to installation; and
- Creating an "elevator speech", name and/or logo for the change initiative so that the team members and/or stakeholders may quickly articulate the purpose of the work to potential new members and early adopters.
At the end of the previous stage, you determined with your exploration team which members would continue to serve on your state leadership team. Throughout this next stage, your state leadership team’s goal will be to “get the system ready” to implement an integrated outcomes and IFSP/IEP process. During installation, your team will move from thinking about implementation to beginning to actually build the supports and structures that will make it possible to create an integrated outcomes and IFSP/IEP process. During this stage, your team will continue to gather support from leadership within as well as outside your own agency. You also will begin to develop communication materials and messages, as well as new system supports, such as staffing, training and technical assistance to support the initial implementation of the integrated processes. This is the stage in which your state leadership team will develop plans for implementing an integrated process and identify the team or teams that will be the early implementers of the new practice.
To begin this stage, your state leadership team may want to meet to develop a timeline of the activities necessary for installation. Installation includes seven key areas:
- Secure leadership support,
- Develop a communication plan, message and materials,
- Build implementation team(s),
- Determine system supports,
- Build training and technical assistance capacity,
- Develop an implementation plan, and
- Move on to initial implementation.
- Integrating Outcomes Learning Community Installation Webinar: This webinar provided an overview of the Installation stage, particularly steps that relate to getting ready for an integrated IFSP/IEP and outcomes process. Three state presenters shared their Installation activities' outcomes.
In this step, your state leadership team should consider who beyond the exploration team and those contacted in the exploration stage should be informed of the intent to integrate the outcomes and the IFSP/IEP process. At this point, you will also examine your state leadership team for any gaps or opportunities, and potentially invite additional members to participate in the team. Those contacted could include leadership within the agency in which early intervention or early childhood special education is administered, or other key agencies within the early childhood, health, or mental health sectors that have relationships with the early intervention and/or early childhood special education programs. Consideration about needs for shared funding or staff as well as memoranda of understanding or agreements for service delivery should be given when identifying key leadership stakeholders. It also may be important to consider legislators or leadership from programs and agencies outside of early childhood with an investment in early care and education, (e.g. child protective services, juvenile justice), for their potential to advocate and support the work. At the same time, it also is important to consider leadership on the local and/or regional level to identify potential support and early implementers of the new practice. Individuals with high involvement in other early intervention or early childhood special education activities, including those involved in parent support and information agencies should be considered.
As a group, discuss the agencies with whom additional relationships are in place, and identify individuals within those agencies who should be:
- Informed of the intent to integrate child and family outcomes with the IFSP/IEP process because some aspect of the work impacts their activities within the early childhood system.
- Invited to participate in the installation activities to ensure that their interests are well represented in the planning for and implementation of an integrated process.
- Invited to participate as an advocate for the integrated process. These individuals may be decision makers who can facilitate a smoother transition to an integrated process based on their positions within agencies.
- Determine how, what and when to communicate to each individual. Incorporate the communication with these individuals into the communication feedback loops, listening for any areas that need to be addressed before moving forward.
- Share this information within your team and determine how the information impacts other installation activities. Develop a plan for the involvement of these individuals in the future steps of this stage, as well as the future of implementation of an integrated outcomes and IFSP/IEP process.
In this step, your state leadership team will develop the mechanisms that will ensure all key stakeholders, staff, and providers are adequately informed of activities related to integrating outcomes with the IFSP or IEP within this and future implementation stages. At this stage, the team will be informing the field of the decision to move forward with an integrated process as well as steps that are being taken along the way. This communication plan will include feedback loops, which are needed to gather information from those that are getting ready to and then are implementing the integrated processes in order to know whether what has been put in place is working and what might be improved. In many cases, the feedback loops are the ways in which you will become aware that some people are feeling resistant to the change, and will need additional support and information in order to feel more secure moving forward. During this step your team will create initial materials with your message about the purpose for and expected results of integrating the outcomes with the IFSP or IEP.
- Determine specific audiences for each message. The group should ask: What information do we want to share at this time? Who needs to know this information and why? When deciding how to communicate information about integrating outcomes with the IFSP or IEP, consider not only how professionals will be informed, but also how individual families and family groups will be informed.
- Discuss ways in which to communicate each message. Evaluate past communications for what has worked, and what hasn't, when determining how to communicate information about the outcomes and IFSP/IEP integration to various audiences. Consider multiple methods for delivering the message, including written material such as memos, website postings, webinars, etc.
- Develop a schedule of communication content and release. The communication plan should include multiple opportunities for sharing information and gathering and incorporating feedback from the field.
- Review examples of communications from other states about the integrated process. This could include stakeholder meeting agendas, fliers, memoranda or guidance documents.
- Review the feedback that is received, and identify and analyze areas of resistance. Develop a plan for how to engage those that are resistant; it may be the case that the sources of resistance indicate a need to revise aspects of the implementation plan. Consider additional conversations to determine the source of their discomfort with an integrated process, and develop a plan for addressing their concerns.
- Engage stakeholders to review and provide feedback on communications before they go out to the field.
- NC Benefits of Integrating Child Outcomes with IFSP Process: This graphic was developed to articulate the benefits of integrating outcomes to stakeholders and staff.
- ESIT Guiding Concepts, TA Guide: These materials were developed by the Early Support for Infants and Toddlers (ESIT) program in Washington State to outline the mission, principles and outcomes of the program. The accompanying TA guide explains to providers how and why the Guiding Concepts were developed, and the video provides information on the Guiding Concepts for families and providers.
In this step, your state leadership team will start to identify and secure the leadership of the teams that will form the initial implementation teams. These teams will consist of individuals from local and/or regional programs who will “try out” the integrated outcomes and IFSP/IEP process. The individuals on the teams should be representative of your state and could include those that have experience with or have shown high levels of interest in integrating outcomes with the IFSP/IEP.
- Select the membership of the implementation team. Consider perspectives needed in order to get a full picture of the integrated outcomes and IFSP/IEP process, including families, providers, data managers, administrators, etc. Invite those whose roles and responsibilities provide the information needed to fully implement an integrated process.
- Select the implementation team leaders to work with and be the liaison between the state leadership team and the implementation team.
- Schedule regular meetings of the implementation team. Determine frequency, duration and location of meetings needed in order for members to feel fully informed and supported throughout the process.
- Establish clear roles and responsibilities for the team. Create clear expectations for the team during the installation stage, as well as in the upcoming initial implementation stage. This may include attendance and participation in the regular meetings, feedback mechanisms and information requested, etc.
- Determine the resources and skills of the implementation team to make the change to an integrated process happen; use this information to determine what additional information and supports will be needed for success.
In this step, your state leadership team will identify and plan for changes that are needed in order to create an integrated outcomes and IFSP/IEP process. Information collected during the exploration phase will be used to determine which changes are actually made to create an integrated process. Changes to forms, procedures, guidance, and practice will be outlined and communicated.
- Identify and make changes in administrative structures. Changes in staffing, staff responsibilities, procedures, guidance and forms should all be considered and changed as needed in this step. For the latter, drafts of forms and other documents may be circulated for feedback and comment. For changes in staffing or staff responsibilities, proposals for change may be drafted and shared with those with decision making capacity for approval.
- Identify and make changes in teaming. Careful assessment of the current teaming practices and comparison to other approaches by other states should be done and used as the foundation for the creation of the teaming process to be used in integrating outcomes with the IFSP/IEP.
- Identify and make changes in training and technical assistance. Changes in staffing, staff responsibilities, topical areas or processes should be considered and changed as needed to support the implementation team’s full understanding of the integration of the outcomes into the IFSP or IEP process.
- Identify and make changes in funding structures to support the integrated process. Review current funding structures that support staff, training and technical assistance and administration and make changes as needed to support the integrated process.
In this step, your state leadership team will identify and plan for training and technical assistance (TA), both for the initial implementation of the integrated process, but also for the full implementation statewide of the integrated process. This step includes determining what information is needed to support full understanding on all levels of what it means to integrate outcomes into the IFSP and IEP both on a philosophical level as well as a practical one. It also includes creating the materials, ensuring that there is adequate personnel to provide the training and TA, and that there are evaluation procedures in place to determine the effectiveness of the training and TA.
- Complete a needs assessment. Determine from the field where knowledge of outcomes measurement and IFSP or IEP development is secure, and which aspects of basic practice in both areas need additional training, TA or support in order to be implemented correctly.
- Review examples of training and TA materials created by other states and programs for content, format or other information that can be used to meet the needs identified in the needs assessment. Develop materials for training and TA.
- Ensure adequate personnel resources in training and TA to implement the training and TA that has been designed. This could include revising staff priorities for training topics, as well as expanding training and TA staff to deliver the content. This could also include the need to develop materials as well as ensuring capacity for coaching, mentoring, reflective supervision and personnel support.
- Create evaluation for the training and TA for measuring effectiveness, and so that changes may be made as appropriate.
- Outcomes Integration Needs Assessment and Instructions: This document is designed for providers/teachers to self-assess their understanding of the integration of child outcomes and the IFSP/IEP process. The instructions document provides instructions on the use of the self-assessment.
- Idaho Integrated Outcomes-IEP Planning Worksheet: This document from Idaho allows individuals and teams to assess the status of the integrated outcomes and IEP process and determine next steps and needed resources.
- Maryland Healthy Beginnings: This document is a version of the Maryland Early Learning Standards, cross walked by the three child outcomes, which was developed to facilitate the implementation of an integrated IFSP process within the state.
- Washington Introduction to IDEA Part C: Three Interactive Modules: These three modules were developed for the Early Support for Infants and Toddlers Program (ESIT) in the Department of Early Learning by the Washington Systems Improvement Project Team in 2011. The three modules include Foundations of Early Intervention, Initial and Ongoing Functional Assessment, and Developing Initial and Continuing Individualized Family Services Plans. Information about integrating child outcomes into the IFSP process is included in each of the topics within the module. These modules were used to support provider understanding of the integrated process as well as implementation of the new IFSP with the child outcomes included.
Now that systems and supports have been changed to support the process, and an implementation team identified and trained, your state leadership team will develop a plan for the initial implementation (or “trying out”) of the integrated outcomes and IFSP/IEP process. This step involves setting dates and making specific plans for implementing the change, when feedback will be asked for and the types of feedback needed. The communication feedback loops will be checked for effectiveness and updated to ensure that information from the field about the integrated process continues to come to the state leadership team for review.
- As a team, develop an implementation plan that includes the following:
- A schedule of events for the initial implementation; consider dates for the beginning of initial implementation, the length of time the implementation teams wil "try on" the integrated process and give you feedback, dates for feedback, etc.;
- A plan to evaluate the newly integrated process that includes outputs, outcomes, measurement and review of evaluation information;
- Information about roles and responsibilities of the implementation teams and the state leadership team members in regard to implementing and supporting the newly integrated process;
- The key components of the training and TA to be provided, resources and infrastructure needed, and steps for sustainability of the integrated outcomes and IFSP/IEP process after initial implementation.
- Create specific opportunities for feedback, such as scheduled surveys, focus groups, written examples of new IFSPs or IEPs, etc.
- Schedule specific dates to review feedback and discuss future changes based on what is learned.
- Create specific opportunities to share back with the field the results of initial implementation, including changes made or not made (and reasons) based on feedback. Consider scheduling these activities throughout the initial implementation stage, rather than just at the end.
- Identify or develop a data system for collecting, analyzing, and reporting evaluation information gathered during implementation.
- NC Part C Implementation Plan: This document outlines activities and timelines for integrating outcomes into the IFSP process in North Carolina. Activities listed follow those in the Interactive Guide.
- Early Implementers Assessment/Planning Tool- Virginia: This form was developed by Virginia to assist in the implementation planning for an integrated IFSP and outcomes process.
- Wisconsin Child Outcomes Workplan: This document provides an outline of the program components, objectives, resources, responsible parties and due dates needed to create an improved and integrated child outcomes process. The document is organized by practice and policy, data, training, and resources.
The next step in the implementation process is initial implementation. In this stage, your state leadership team will finalize forms, guidance and procedures to be used in the newly integrated outcomes and IFSP/IEP process. Your team will also assist your implementation teams in being prepared by providing them with the needed training and resources to implement the new process.
Before you move on to the next stage of implementation, your state leadership team should consider the following:
- Listen for feedback from activities for additional information that indicates that more support, resources, and/or information is needed in order for your field to be ready to integrate the outcomes into the IFSP/IEP. Consider revising steps A-F based on the feedback received.
By the end of the previous stage, you will have put in place many of the structures needed to successfully implement an integrated IFSP/IEP and outcomes measurement process. During the Initial Implementation stage, the early implementers identified in Installation will begin using the integrated processes. Throughout this next stage, your State Leadership Team’s goal will be to support your early implementers and the Implementation Teams in the use of the integrated process and in learning from their experiences. The Implementation Team will provide coaching, mentoring, and training to support and develop the confidence and competence of your early implementers as they begin to implement the integrated processes according to your implementation plan. During this stage, both the Implementation Teams and the State Leadership Team will ensure that feedback loops are open; adaptions and adjustments are made to the state, regional and local infrastructures to support the integrated practices; and evaluation measures are in place and used to ensure that the integrated practices are being implemented as intended. Throughout initial implementation, it is critical to examine elements that could impact sustainability of the practices over the long term.
The Initial Implementation stage is a good stage in which to make mistakes, determine what works and what does not, and to make needed changes prior to the full implementation of the integrated IFSP/IEP and outcomes measurement process.
To begin this stage, your State Leadership Team may want to meet to develop a timeline of the activities within initial implementation, remembering that many activities overlap with one another. Initial Implementation includes 6 key areas:
- Implement training and technical assistance,
- Implement an integrated IFSP/IEP and outcomes measurement process,
- Support reflection and use of feedback loops,
- Adapt and adjust infrastructure to support practices,
- Evaluate fidelity and quality of initial efforts, and
- Make changes to support sustainability.
- Integrating Outcomes Learning Community Webinar: This webinar provided an overview of the initial implementation stage, particularly steps that relate to implementing an integrated IFSP/IEP and outcomes process. A state representative shared her initial implementation activities and outcomes.
In this step, several methods will be used to ensure that the early implementers have the knowledge, skills and abilities to implement the newly integrated IFSP/IEP and outcomes measurement process. Using the plan that was developed in the Installation stage, training, coaching, and mentoring may all be used on an ongoing basis to ensure that individuals know how to and do make the changes to their practices with the necessary support. Those who provide the training and technical assistance services must be aware of and support individual reactions to change, and should find multiple ways to celebrate successes along the way to maintain the momentum of the new practice. In this step, training and technical assistance providers convey the key message to the early implementers that mistakes and roadblocks are expected, even welcome, because they provide opportunities for making necessary adjustments and adding critical support before full implementation.
- Use guidance and training materials to support the development of individual knowledge, skill and ability with the materials, forms and processes of the integrated IFSP/IEP and outcomes measurement. Use training and TA to support the early implementers’ understanding of the expectations within initial implementation and to encourage disclosure of challenges and successes throughout.
- Implement and evaluate the training and TA plan developed in Installation, making modifications and adaptations to the training and TA on integrating outcomes based on the feedback of the early implementers and the results of the evaluation.
- Provide support to the early implementers through ongoing coaching and mentoring. Note which skills are the primary focus and which approaches are most effective for various individuals on the early implementer teams; also note early implementer responses to coaching and mentoring that is focused on other skills (e.g. general IFSP development or measurement of child outcomes) or that uses alternate approaches to the integrated process.
- Verify that early implementers have the necessary skills to implement an integrated process.
- Develop an ongoing training and technical support plan, based on the experiences of the early implementers and in preparation for full implementation. Ensure that there are materials available to support the ongoing learning of the early implementers, as well as materials for those that are new to the integrated process.
- COS Training for Maryland Part C Providers: These resources were used in the COS training offered to providers in November of 2011. The training is organized by tracks – Track 1 content is intended for new users of the COS process, while Track 2 is designed for advanced users and trainers.
- Kansas "Realizing Results: Integrating Early Childhood Outcomes (ECO) with the IEP": This training was presented to Kansas 619 providers to introduce integration of early childhood outcomes into the IEP.
- Virginia Child Indicators Booklet: This guidance document provides information for service coordinators, providers and families about the child outcomes within the context of the integrated Virginia IFSP. Updated in 2013, it reflects the change in practice from the first version ("Determining the Status of Infant/Toddler Development in Relation to the Three Office of Special Education Programs (OSEP) Outcomes") to the new practice of integrating child outcomes measurement within the state's IFSP.
- Washington IFSP Process and Resource Guide: This guidance document provides information and instructions for the IFSP process, including the measurement of the three child outcomes. Specific instructions and best practices are outlined for each section of the IFSP Process Document.
It is essential for the early implementers to focus on implementing the integrated IFSP/IEP and outcomes measurement process with attention to the suggested plan. For activities to be useful, early implementers must use expected forms, follow suggested policies/procedures, and have access to the level of training, guidance, and support that is expected to be widely available in the eventual launch of changes. Early adopters must also actively participate in key piloting activities such as documenting observations and reactions, sharing feedback, evaluating their practices, and suggesting improvements.
- Early implementers implement the integrated outcomes and IFSP/IEP process.
- The Implementation Team of each site implementing the integrated process oversees all aspects of implementation and actively participates in all action steps in Initial Implementation, including implementation of practices, use coaching and mentoring, and evaluation of implementation as planned.
- State Leadership Team ensures that site Implementation Team and all early implementers participate in feedback loops so that information and data from the local site about the integrated process is shared in a timely manner and responsive changes can be made.
- Implementation Teams and early implementers evaluate early activities according to the evaluation plan, with particular attention to variations that emerge in the implementation processes, practice fidelity, early implementers’ satisfaction with the forms, materials and process, costs, and emerging outcomes. The State Leadership Team should establish a process for regular review of and conversation about the information, involving stakeholders as needed, to make timely changes that support implementation of the integrated process.
- The State Leadership Team makes adaptations and changes and provides additional supports and resources as needed so that practices that support an integrated process are carried out.
- State-Developed IFSP/IEP-Outcomes Integration Materials: This page contains forms and exemplars from states actively implementing an integrated outcomes and IFSP/IEP process.
- Virginia Child Indicator Guiding Questions: This document provides prompts and questions to guide the discussion with families, from initial contact through the completion of the assessment for IFSP development.
In this step, your State Leadership Team will support the use of the feedback loops that were created in Installation that will ensure there is circular communication between the early implementers, the Implementation Teams, and the State Leadership Team. The purpose of having feedback loops is to learn as much as possible about the experiences of early implementers, including identifying gaps in training/guidance, challenges, barriers and factors associated with resistance, and to identify potential solutions and/or process changes quickly. Alternate approaches may quickly develop and be implemented throughout the Initial Implementation stage, offering additional opportunities for timely feedback. The feedback loops are a critical component to the evaluation of the fidelity and quality of the initial efforts; as such, it is critical for the State Leadership Team to create an environment in which information is freely given and received.
- State Leadership and Implementation Teams create an environment in which reflection and communication is encouraged and both positive and negative feedback are valued from individuals at all levels and with all roles in the process. This effort may begin with the State Leadership Team by creating transparency in their efforts, and then is further supported by the participation of the early implementers and Implementation Teams. Different mechanisms for planned sharing of feedback may be used (e.g. email, a wiki or secure web page, phone calls or team meetings, focus groups, TA calls) based on the needs and geography of the various individuals involved in implementing the integrated process.
- State Leadership Team ensures that all involved understand and know how to use the feedback loops, and provides training (if needed) in the use of online mechanisms, and shares the schedule for team meetings and phone calls well in advance.
- State Leadership Team uses the information shared in feedback loops quickly and in constructive ways. This might include problem solving about identified barriers, identifying additional supports or creating infrastructure changes, and testing adaptions to the integrated process. The State Leadership Team has a process in place for discussions within and across the State Leadership and Implementation Teams for deciding what to do with the feedback received. If changes are not made as a result of feedback, the State Leadership Team communicates with those in the feedback loop so that they will understand the rationale for maintaining the existing approach.
- The State Leadership Team ensures that there is sufficient time built into the process of early implementation to allow early implementers to absorb and use the new materials, forms and process, and to revisit and revise the materials, forms and process.
In this step, your State Leadership and Implementation Teams will ensure that all the needed information and resources are in place to support the full implementation of an integrated IFSP/IEP and outcomes measurement process. Based on the experiences of and feedback from the early implementers, adjustments may be needed at the state, regional or local levels. The goals of these adaptations and adjustments are to ensure fidelity in the implementation of the integrated process and to continue to manage change at all levels to ensure long term sustainability of the new practices when you move to full implementation of the integrated process.
- Ensure that policies and procedures are in place, and are aligned with the expectations of the integrated process.
- Adjust administrative structures to be in alignment with new practices. This may include revising contracts and interagency agreements, and changing fiscal policies and procedures to support an integrated process.
- Revise policies, procedures, forms and guidance based on the feedback from the early implementers.
- Provide general supervision and oversight to the early implementers and Implementation Teams.
- Manage change in a positive and proactive way in order to support a positive culture at the state, regional and local levels.
- The Valley View Early Childhood Center in Romeoville, IL has developed several forms to support the initial and ongoing assessment of children's skills according to the three outcomes areas:
- ID Early Childhood Outcomes Collection Worksheet: This document supports providers and teams in gathering information about the child's functioning across multiple sources of information.
Throughout the implementation process, your State Leadership Team has reviewed information coming from the early implementers and Implementation Teams about the implementation of the integrated IFSP/IEP and outcomes measurement practices. Prior to moving to full implementation, your State Leadership Team will need to analyze the information; looking for initial indications that the practices within the integrated outcomes and IFSP/IEP process are resulting in the outcomes articulated in the Exploration stage. Information about whether programs and individuals are implementing the practices as intended, the quality of the implementation and the outcomes of the process will be critical for decision-making prior to full implementation. The information can also be used for creating monitoring and evaluation procedures that will be used in the long term to evaluate the quality and implementation of the integrated process.
- Use data from the evaluation of initial implementation efforts to make adaptions to training, support and infrastructure. This should be done on an ongoing basis throughout initial implementation. Compare the data to the outcomes that were developed in the Exploration stage.
- Adapt the fidelity and quality measures and tools to ensure that they measure the critical elements and intended outcomes of an integrated process.
- Provide feedback to the early implementers and stakeholders related to the data collected. This should be done on an ongoing basis throughout Initial Implementation. Relate information shared with the outcomes created during the Exploration stage.
In this step, your State Leadership Team will identify and plan the long term implementation of an integrated IFSP/IEP and outcomes measurement process. Plans for infrastructure, training and technical assistance, and continued buy-in must be in place prior to the full implementation of the integrated process. In this step, your State Leadership Team may want to consider providing training materials and other information about the integrated IFSP/IEP and outcomes measurement process to higher education and professional organizations. Implementation of an integrated IFSP/IEP and outcomes measurement process could potentially impact pre-service education and licensing requirements, and create better understanding of the integrated process in providers coming straight from school.
- Continue to provide infrastructure and fiscal support to the integrated process. As other practice initiatives are adopted, consider the impact of the new initiative on the integration of the IFSP/IEP and the outcomes, and adjust support as needed.
- Continue to provide training and technical assistance to ensure fidelity and quality practices. Develop a tiered plan that includes ongoing support to early implementers as well as support for existing staff new to the integrated process and new staff coming into the program. Alternatively, if a tiered system of supports currently exists, consider how the integration of the outcomes measurement into the IFSP/IEP fits.
- Continue buy-in efforts and expand the support base for the integrated process. Continue to identify relevant stakeholders at each level, and provide information and support to create continued buy-in for the integrated process.
- Continue evaluating the integrated process by integrating evaluation criteria during Initial Implementation into ongoing monitoring procedures.
The next step in the implementation process is Full Implementation. In this stage, your state will move from having a select group of early implementers to having a high percentage of people in your state using the newly integrated IFSP/IEP and outcomes measurement process. Full implementation doesn’t mean that the job is done; it signals the beginning of statewide support and resources to ensure that the practices are being used as intended, the practices are resulting in the intended outcomes, and that long term implementation can be sustained.
Before you move on to Full Implementation, your State Leadership Team should consider the following questions:
- What does our evaluation data tell us? What do we need to consider and/or adapt before we move forward?
- How might our early implementers support our transition to Full Implementation (e.g. support with roll out, getting buy-in from others, sharing benefits, etc.)?
- What is our plan for moving toward Full Implementation? Will we implement in stages, create transformation zones, or go to statewide implementation all at once?
- What is our expectation and definition of full implementation? Is it 100% (or some other number) of our providers using an integrated process?
- How do we ensure the same level of supports and resources given to early implementers will be given to those that will be engaging in the new practices in Full Implementation? What additional supports and resources might we need to move to Full Implementation?
- During Full Implementation, how will we ensure that the integrated process is embedded into our state procedures, so that if leadership changes, the practices will stay in place?
- What supports need to be in place to sustain the State Leadership Team?
During Initial Implementation, your early implementers used the integrated IFSP/IEP and outcomes process and provided feedback to the Implementation and State Leadership Teams. Lessons were learned by the early implementers and shared through the feedback loops. Feedback and data were collected and analyzed, and changes and modifications were made along the way to support successful implementation of the integrated process. In Full Implementation, these activities will continue while you move to having a high percentage (if not all) of your state implementing the integrated IFSP/IEP and outcomes process. The overall goal of this stage is to move the integrated process from being implemented in a few sites to being implemented state-wide. By the end of this stage, the new ways of working will become standard practice within your state. The State Leadership and Implementation teams will continue to focus on and provide support to practitioners to implement the practices with fidelity and to ensure long term sustainability. Leadership activities at the state, regional and local levels will strengthen leaders’ ability at all levels to ensure ongoing implementation and continued effectiveness of the integrated process.
Full Implementation doesn’t mean that the implementation process is finished. As the whole state implements the newly integrated IFSP/IEP and outcomes process, they will need similar training and technical assistance, coaching, feedback loops and organizational supports as the early implementers. All of these supports will be needed on an ongoing basis to sustain the new integrated process. Full Implementation is also the time to begin cycles of continuous program improvement, which provides practitioners an opportunity to ask questions and offer feedback and provides leadership the opportunity to assess the quality of the newly integrated process. Leadership at every level can then use that information to establish cycles of improvement based on practitioner feedback and monitoring that are timely and responsive, which in turn creates additional support and buy-in from the field. Continuous program improvement supports sustainability of practice fidelity, and any shifts in practice can be noted and corrected quickly.
As the new practices are fully implemented throughout the state with good fidelity, continuous program improvement cycles can ensure that as new evidence-based and best practices are developed within the field, these new practices are included in a thoughtful manner.
To begin this stage, your State Leadership Team may want to meet to develop a timeline of the activities within Full Implementation, remembering that many activities overlap with one another. Full Implementation includes 5 key areas:
- Maintain and improve skills and practices,
- Maintain infrastructure for data collection and monitoring,
- Assess implementation of integrated process,
- Create organizational structures to support integrated process, and
- Take action to ensure sustainability.
- Integrating Outcomes Learning Community Webinar: This webinar provided an overview of the full implementation stage, particularly steps that relate to implementing an integrated IFSP/IEP and outcomes process. State examples of full implementation activities and outcomes were also shared.
In this step, State Leadership and Implementation Teams will ensure that activities such as training, supervision, coaching and mentoring are of high quality, are widely available to all practitioners, and are an ongoing part of Full Implementation. Plans are made during this step to orient and support new staff entering the system to effectively work within the integrated IFSP/IEP and outcomes measurement process. Plans are also made for the continued support and supervision of all implementers. The feedback loops that were active during Initial Implementation remain open and continue to be encouraged so that practitioners can provide their insights and experiences and receive support.
- Create selection criteria for new staff that include the competencies that match the skills needed to implement the integrated IFSP/IEP and outcomes process.
- Conduct training for new staff to orient them to the integrated process and the practices expected in implementation of the integrated process.
- Determine the need for and frequency of refresher trainings and provide these trainings to all staff in need of support to continue implementing the integrated process successfully.
- Provide regular supervision, coaching and mentoring to staff regarding the practices in the integrated process.
- Continue to use feedback loops to gather information about practitioners’ experiences with the integrated approach. Ensure a process is in place to share results of feedback received (i.e. whether it resulted in change or not).
It is critical that structures be in place to provide information to providers and administrators about the implementation of the integrated IFSP/IEP and outcomes process. Monitoring activities will need to be in place to check for fidelity and to identify additional areas for professional development and technical assistance. Collecting data about the newly integrated process will ensure that practices are measured for effectiveness and desired outcomes are being achieved. Reports from data collection will ensure that there is continued review of practices in the integrated process and discussion about needed changes and/or improvements.
- Develop or adapt monitoring systems to include the integrated IFSP/IEP and outcomes process and promote use by state and local administrators.
- Include fidelity measures in performance assessments and reporting processes to ensure practices continue to be implemented and used as intended.
- Ensure that data systems are in place and/or are adapted so that they include specific information about the IFSP or IEP and the child outcomes measurement. Create various reporting capabilities to share information with local programs about their practices and outcomes on a regular basis.
- Gather data collected and information received through the feedback loops to make decisions about local, regional and/or state program improvements.
- Review and update policies and procedures as needed to reflect the integrated process at the state, regional and local levels.
- Update the implementation plan as steps are achieved to track the progress made.
- EDIS IFSP-PD Handbook: This 2013 handbook serves as the manual for IFSP completion for the Army Educational and Developmental Intervention Services program. The child outcomes are integrated into the IFSP in this program, and the guide includes expected practices and specific instructions for the process and completion of the form. Information specific to outcomes within the IFSP appears on pages 50-57.
In this step, each practitioner and program should be assessed to determine if they are implementing the integrated IFSP/IEP and outcomes process as it has been designed. Success in this stage of Full Implementation is dependent on the use of the practices with fidelity and achievement of desired outcomes across the state. To ensure the fidelity of implementation, state and local leadership must ensure that there are procedures and tools available to assess the use of practices. At the state level, that could include having an expectation of local administrators to observe and document comments on staff’s practices. At the local level, individuals and teams may participate in self-assessments or supervisory discussions to identify areas of strength and areas needing further support and development.
- Develop and use performance assessments that include key practices and competencies needed to effectively implement an integrated IFSP/IEP and outcomes process. Performance assessments may include multiple sources of information, including observation, self-report or fidelity checklists.
- Ensure that providers are informed of and understand what they are being assessed on, and are provided feedback in a timely, helpful manner.
- Train assessors on the key indicators of the performance assessment prior to implementation of the performance assessment, and to provide effective, consistent and timely feedback.
- Share data with state, regional and program administrators, and support training and technical assistance and changes in administrative or program structures as needed.
- EDIS Early Intervention IFSP Quality Rubric: This document is included in the EDIS IFSP-PD Handbook (June 2013). It is designed to "facilitate uniform understanding of IFSP development and evaluate quality practices" as a part of comprehensive review of the IFSPs developed in the program. It includes the outcomes measurement as an integrated part of the IFSP. The rubric appears in Appendix 1 (page 89).
As the practices are fully implemented, organizational structures at the state, regional and local level need to be continually assessed to assure they align with and support the sustainability of the practices of the integrated IFSP/IEP and outcomes process. For some programs, this may mean changing local policies and procedures to align with state expectations and policies and procedures. For others, it could mean support (e.g. additional time, discussions, extra mentoring, etc.) to create a positive environment to adjust to and implement the new practices. Across the board, administrators at all levels need to be actively engaged in looking at data, listening to their providers, and making decisions that support the full integration of the IFSP/IEP and outcomes processes.
- Align new practices with program mission, values and philosophy.
- Take action steps to reduce or eliminate identified barriers to the implementation of the integrated process.
- Use feedback loops and engage in clear, honest and frequent communication with the field about the integrated process. Information about what will change and what will not change and why those decisions have been made is communicated clearly and in a timely manner.
Throughout the implementation process, your State Leadership Team has been reviewing information coming from the field about the implementation of the integrated IFSP/IEP and outcomes measurement practices. As a part of Full Implementation, leadership at the state, regional and local levels will need to analyze and use this information to ensure that the integrated process can be sustained over time. Specific information about the practices used in the integrated process and the infrastructure in place to support the integrated processes will need to reviewed and analyzed on an ongoing basis. Leadership at each level will need to create cycles of continuous program improvement during this step, to ensure that there are ongoing efforts to support the quality of the integrated IFSP/IEP and outcomes process. In this stage, it is critical for leadership, particularly at the state level, to begin or continue discussions with institutes of higher learning so that the practices needed for the integrated process will be included in pre-service learning and added to licensure programs, as appropriate within your state.
- Use structures for ongoing, clear and frequent communication to receive and provide information about concerns and successes from local providers.
- Share data on successful implementation, outcomes and satisfaction to expand buy-in and support across the state. Look for opportunities to include strong supporters in activities related to sustainability.
- Review and adjust as needed the fiscal and infrastructure support needed to sustain an integrated IFSP/IEP and outcomes process.
- Review and adapt training and technical assistance over time to include new and improved practices or procedures related to the integrated process.
- Use data for making decisions about program improvement.
Now that the child outcomes are fully integrated into your IFSP or IEP process, it may feel like the time to move on to the next project and to check this off the list as accomplished. To some extent, the really difficult work is finished, but it is critical at this point to think about keeping the integrated process effective and producing the improved outcomes for children, families, providers and programs that are just starting to emerge. Early intervention and early childhood special education is an ever evolving field - the solutions that we just put in place to create the integrated process may not be the solutions that work over time. Rather than to be in a position of reacting to needed changes or adaptations, being proactive and intentional in making updates and changes to the process will result in better outcomes.
Continuous program improvement has four components:
- Plan: Programs look at and decide what it is they want to do. In the instance of the integrated process, this may be tweaking the use of certain practices, developing additional training and technical assistance to support providers struggling with the use of the practices, or perhaps changing the process of IFSP or IEP team meetings to support the integrated process. The planning step must include a plan for using data that is collected through the data system, and/or include other data that will be needed to know whether the desired changes have occurred. Timelines and responsibilities need to be included here for every component of the continuous program improvement cycle.
- Implement: Programs follow the plan as written and collected the data prescribed.
- Check: Program staff and administrators look at data and analyze what they see.
- Reflect: Program staff and administrators look at current practices and answer, “Are we where we want to be?” If not, the plan is reviewed and the improvement process continues. Hallmarks that things are going well are 1) practices are implemented with fidelity, and 2) practices are resulting in the desired changes and outcomes.
You might not always start with the same component; at some times your data (Check) might tell you something needs to change. At others, a new initiative (Plan) might create the necessity for changes in the integrated process. Additionally, these four components rarely happen in just one cycle, but rather in a continuous motion that leads to improvements over time. There is no prescription for how often continuous program improvement should be used, nor is there a specific time frame for each step in the process, so leadership may determine when it will be the most helpful to the ongoing improvement of their own programs. Engaging in this process regularly, however, will boost leadership’s understanding of the strengths of a program or system and assist the leadership in proactively and intentionally address challenges with the implementation of an integrated IFSP/IEP and outcomes process.
Now that you’ve completed your review of the guide, please take a moment to fill out the following survey. This is an evolving resource and we look forward to hearing from your suggestions for future development of this product. If you have questions, contact Megan Vinh.Leave Feedback email@example.com