Child Outcomes Summary (COS) Ratings

The Bottom Line

Child Outcome Summary (COS) ratings must be completed for all children entering and exiting Part C and Part B ECSE services if they will receive 6 months or more of ECSE services.

States are required to submit data gathered from COS ratings to the federal government in order to receive federal funding for special education services.

Go-To Tools

The handy tools that help you get the job done efficiently.

Decision_Tree.pdf

Decision-making tree to support in assigning the correct rating for each outcome for a child. ➡️

Part C (birth-3) Cross Walks

Others

Part B (ages 3-6) Crosswalks

Purpose of Child Outcome Summary (COS) Ratings

States are required to report on the percentage of infants and toddlers with Individualized Family Service Plans (IFSPs) or preschool children with Individualized Education Programs (IEPs) who demonstrate improved:

Positive social-emotional skills (including social relationships),
Acquisition and use of knowledge and skills (including early language/communication [and early literacy*]), and
Use of appropriate behaviors to meet needs.

COS ratings gather this information to be submitted to the state for federal reporting purposes.

Additionally, districts can use district-wide COS data to help inform programming at the local level and make positive program changes that support infants, toddlers, and preschoolers with disabilities to learn and grow.

What are Child Outcomes?

three-child-outcomes-breadth.pdf

The three child outcomes encompass functional skills and behaviors that are meaningful for a child's participation in everyday routines.

They cut across developmental domains to represent the integrated nature of how children develop, learn, and thrive.

The breadth of these outcomes provides a framework for describing and consistently measuring children's functional skills and behaviors across settings and situations.

What are the COS Ratings?

The COS uses a 7-POINT scale for rating a child’s functioning in each of the three outcome areas.

To determine a rating, the team needs to think about the many skills and behaviors that allow a child to (1) function in an age–expected way in each outcome area and (2) understand the developmental continuum that leads to age-expected functioning.

Ratings Should Reflect Everyday Functioning:

The team must be familiar with the functioning of the child being rated in the outcome across a variety of situations and settings.

Ratings should reflect the child’s current functioning across settings and in situations that make up his/her day. Ratings should convey the child’s functioning across multiple settings and in everyday situations, not his/her capacity to function under unusual or ideal circumstances. A standardized testing situation is an unusual setting for a young child. If the child’s functioning in a testing situation differs from the child’s everyday functioning, the rating should reflect the child’s everyday functioning.

Foundational Skills

To assign ratings, teams should have an understanding of foundational skills:

An important developmental concept for understanding how to use the COS scale is the concept of foundational skills. Earlier skills that serve as the base and are conceptually linked to the later skills are “foundational skills”. For example, children play near one another before they interact in play.

All skills that lead to higher levels of function are foundational skills, however, the set of skills and behavior that occur developmentally just prior to age-expected functioning can be described as the immediate foundational skills in that they are the most recent set of foundational skills that children master and move beyond.

A child whose functioning is like that of a younger child is probably showing immediate foundational skills (COS ratings of 2, 3, 4, or 5). A child's functioning does not meet age expectations, but they demonstrate skills and behaviors that occur developmentally just prior to age expected functioning and are the basis on which to build age-expected functioning.

A child who functions like a MUCH younger child does not meet age expectations or demonstrate skills and behaviors that immediately precede age-expected functioning. She has foundational skills, but not yet at an immediate foundational level (COS rating of 1).

When to Complete a COS Rating?

Part C (ages birth-3)

Entrance to Part C rating:

When children initially qualify for Part C services, a COS rating should be filled out within 1 month of starting services.

*Note: A COS rating is only needed if the child will receive 6 months or more of early intervention services before their third birthday. If the child is 30 months or older at entrance, a COS rating is not needed.

Exit from Part C rating:

When a child exits Part C services, a COS rating needs to be filled out. This includes exiting Part C services for the following reasons:

- No longer resides in Minnesota
- Met IFSP outcomes and exited Part C early
- Was withdrawn early by parent
- Turned 3

Part B (ages 3-6)

Entrance to Part B rating:

When children initially qualify for Part B ECSE services, a COS rating should be filled out within 1 month of starting services.

*Note: A COS rating is only needed if the child will receive 6 months or more of Part B ECSE services

Exit: Children identified for this collection met all of the following criteria:

When a child is existing Part B ECSE services, an exit COS rating needs to be completed. This includes:
- Entrance to Kindergarten
- No longer resides in Minnesota
- Was withdrawn early by parent
- Early childhood withdrawal; IEP objectives met
Received Special Education and related services for a minimum of six months (cumulative).

*Note for Part B entrance and exit: If the TS GOLD tool (minimum of 80% of objectives) was completed and finalized during entrance or exit, the team does not need to assign an entrance or exit to Part B COS rating for that period as item-level data from TS GOLD will be pulled and submitted to the state

**Exception: For students who are 5 years of age on September 1 (age-eligible for Kindergarten), MDE will not use child-level assessment data to calculate COS ratings.

How to Assign COS Ratings

STEP 1: GATHER DATA

In preparation for completing the COS ratings for a particular child, team members should gather information from multiple sources. The determination of a child's functioning relative to age expectations can be based on:

observations in the child's home;
observations in early care and education settings;
observations in other settings where that child regularly spends time;
criterion- or curriculum-based instruments or norm-referenced scales;
interviews with family members, child-care providers, and caregivers;
informed clinical opinion; and
work samples.

An age-anchored assessment tool needs to be completed (i.e. TS GOLD, HELP).

STEP 2: USE CROSSWALK and DECISION TREE

Instrument crosswalks (see below) developed by the Early Childhood Outcome Center (ECO) should be used to assure consistency across teams in the developmental milestones included in each of the three outcomes.

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

TEAMS should use (1) the decision tree (or the questions in SpEd Forms) along with (2) the crosswalk AND (3) other data collected by the team to determine COS ratings for each outcome.

CROSSWALKS

Part C (birth-3)

Part B (ages 3-6)

DECISION TREE

Decision_Tree.pdf

*The guiding questions listed in the Decision Tree are ALSO provided in SpEd Forms so teams can choose to use these instead.

*Elements Specific to Children Identified as Experiencing Hearing Loss

Minnesota Department of Health also collects data on as a part of the Early Hearing Detection and Intervention (EHDI) initiative. Children who are deaf and hard of hearing who are identified and provided access to language early (with the goal by six months of age) are more likely to meet language milestones typical of other children their age. The Early Hearing Detection and Intervention (EHDI) program at MDH evaluates outcomes and ensures culturally appropriate resources and services are available for children with a confirmed hearing loss and their families.

IMPORTANT NOTE: You should report hearing loss data elements for any Part C student who has a hearing loss regardless of the disability category.

Fill out the form titled "EHDI Information" in SpEd Forms. This form needs to be completed for all children exiting Part C and Part B ECSE services The directions for answering the questions are described in the video below.

Entering COS Ratings and EHDI information into SpEd Forms

COS Ratings should be entered into SpEd Forms. Start the video at 9:42.

Family Outcome Survey

Family Outcome Survey also needs to be completed by families of children who receive Part C services. Go to the Part C Page to learn more about this.

What happens to the COS data?

Local programs (districts) report data to the state agency for early intervention (DCYF) or early childhood special education (MDE). Annually, the state agency analyzes the data and provides summary reports to the federal government. The federal government analyzes the data from all the states and provides a national picture to Congress. At the local, state, and federal levels, the data also provide information to improve services for infants, toddlers, preschoolers and their families.

Because for several years practitioners like you all over the country have been providing outcomes data, there is state-by-state and national information on children’s progress in early intervention and early childhood special education. We know what percentage of these children are performing like same-age peers and what percentage show greater than expected growth by the time they leave a program. And we know this for each of the three outcomes. Furthermore, because these data exist, the US Department of Education can provide Congress with evidence that the investment in these programs is money well spent.

✋ Frequently Asked Questions

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 selfstimulating 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.

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