Provider Perceptions of the Child Outcomes

Summary Process

Lauren Barton and Cornelia TaylorOctober 27, 2012

Measuring and Improving Child and Family Outcomes ConferenceMinneapolis, MN

• Brief ENHANCE project update• Describe provider survey study• Share findings• Discuss implications

Today’s Session

ENHANCE Project Update

• Focus Under what conditions are COS data meaningful and

useful for accountability and program improvement? Impact of COS on programs/staff Identify needed revisions to COS form and guidance

• SRI International was funded by

U.S. Dept. of Education, IES -- July 1, 2009

ENHANCE

Four ENHANCE Studies

1) Comparison with Child Assessments

2) Team Decision-Making3) State Data Study4) Provider Survey

Studies 1,2, & 4:34 Project Data Collection Sites

17 Part C (Birth to 3)• Illinois• Maine• Minnesota• New Mexico• Texas • North Carolina• Virginia

17 Part B Preschool (3-5)• Illinois• Maine• Minnesota• New Mexico• Texas • South Carolina

Comparison with Child Assessments Study

Goals• Compare COS ratings to BDI-2, Vineland-II scores

Program Entry Program Exit

• Compare conclusions from COS and assessments

Study Status• Final stages of recruiting families

Find Out More• See poster at reception for promising findings from preliminary analyses

Team Decision-Making Study

Goals• Learn more about implementation of the COS process.• What is team understanding of outcomes and rating criteria?

Study Status• Videos coming in• Early stages of coding videos

Find Out MoreTabletop discussion tomorrow morning

What is quality COS process? Share draft video coding protocol

State Data Study

Goals• Analyze characteristics of COS data• Are patterns consistent with those predicted

for high quality data?

Status• Analyzing and compiling data

Find out more• See reception poster with early findings

We are looking for more states to participate.

Participate at different levels:• Share results from analyses you already do for APR OR• Share de-identified child level data set used in your APR

analyses• Work with SRI to either:

Share expanded data set* that we analyze and discuss with you OR

Conduct extra analyses and share results with project

* Expanded data set examples: include extra child descriptors (race, gender, primary disability) or variables describing the setting or composition of services

Participating in the State Data Study

Benefits of Participation

• See how your data fits relative to other state patterns• Have more analyses to learn from—extra tables for deeper

understanding• Technical assistance around unique issues in your data• Make a difference, generating new knowledge about a topic

that matters

For more information, contact cornelia.taylor@sri.com (650) 859-5314

ENHANCE Provider Survey

Question:How is COS implementation going?

Method• Online survey sent to providers in program participating in

the assessment and video studies

Study Status• Completed data collection• Early stages of analysis

Provider Survey

Provider Survey Sample

856 providers in 8 states Primary population

oEI: 472 (55%) oECSE: 302 (35%) oMix: 82 (10%)

Roleso 50% early interventionists/teacherso 38% therapists and asst. (SLP, OT, PT)o 9% coordinators/psychologistso 3% other

75% previously worked with children without disabilities in some capacity.

Provider experience with COS ratings

• 51% 31 or more COS ratings• 21% 10 or fewer COS ratings

Provider training

• Asked about training across a variety of formats (e.g., in person, technology, one-on-one, material review)

• How many total hours of training do you think most providers reported? None?

1-4 hours?

5-8 hours?

9-12 hours?

13 hours or more?

ECO recommends 8-12 hours of training

to get familiar with the COS process

Provider training on COS Process is limited

• 90% of providers received some training• 68% reported 4 hours or less of training

COS Process: Time involved

• On average, how long does it take to identify a child’s outcome ratings and document it on the form? Identify rating Discuss child’s functioning if directly related to rating decision

or exceeds discussions that would have occurred anyway Time to complete information on the form Do NOT include data entry of form, if done after form is

completed.1-15 min., 16-30 min., 31-45 min., 46-60 min., more than 60 min.

COS Rating Process is Fairly Brief

• 36% 1-15 minutes• 35% 16-30 minutes

• EI reported less time than ECSE

What do you think?A team process?

Teaming practices vary a lot from program to program.

• How often are COS ratings actually decided in teams?

• Do the teams include more than one professional?

• How often are families involved?

COS Process: More than one professional usually was involved.

75% had most ratings decided by a

team (at least 1 professional in addition to respondent)

79% had at least one other professional provide input about the child’s functioning

COS Process: Family involvement was limited.

34% had family members present for most of their COS rating decisions.

68% considered input from family members in determining the rating

Functioning across settings and assessment data was considered in most COS ratings.

75% used information about the child’s functioning from multiple settings and situations 76% used information from one or more assessment

tools during rating decisions

Most felt their COS process matched what it was supposed to be.

78% thought the process used for deciding COS ratings matched how it was supposed to be done

Most felt the process was thorough enough to be effective.

• 85% felt there was enough information about each outcome area to determine a COS rating

• 80% felt there was enough time to review child functioning in each outcome area.

• 85% in most of the decisions, all involved considered information carefully in an effort to decide an accurate rating.

Most providers felt that most COS ratings given were accurate.

76% felt confident that most of the ratings given were accurate

88% reported that NONE of the COS ratings were

selected to make the program look good

Skills Needed for COS Ratings

• Training should focus on skills essential for COS ratings. For example: Understanding age-expected functioning Comparing specific child’s skills to age-expected Understanding the 3 child outcomes Discussing functioning in outcomes with others

• To what extent do you think providers report having these kinds of skills?

Providers said they understood the content behind COS ratings.

Age-expected functioning• 89% understood age expected

functioning • 92% knew how to compare children’s

functioning to what is age expected

The three child outcomes • 85% understood the three child

outcomes • 83% knew how to discuss functioning

in the outcomes with others * Endorsed statements of understanding as mostly true or very true.

• How much do providers Understand why COS data are collected, Realize what happens with the data, and Feel they can explain the need for gathering COS

data?

Same or different?

Understanding the Purpose and Uses for COS Data

Few providers understood why and how COS data are used.

• 65% understood why COS data are

being collected

• 37% understood what happens with

the data

• 52% knew how to explain the need

for child outcomes data to others

What kinds of feedback and support are available to providers?• What do providers think about the system of

feedback and support available related to the COS? Are there people available to help them? Is ongoing support adequate? Are there people reviewing the COS forms?

Excellent, good, adequate, fair, poor, or a combination??

“Tell me and I forget, teach me and I may remember,

involve me and I learn.”- Benjamin Franklin

Limited ongoing support for providers with the COS process

82% someone is available to provide support if I ask for it

50% someone in my program provides support

47% ongoing support related to the COS process is adequate

37% someone in my program checks completed COS forms for accuracy

• What do providers say about how the COS process impacts them? Change awareness? Influence assessment or IFSP/IEP outcomes? Influence conversations and relationships with others? Impact on time for other activities?

Does it seem? Positive? Neutral? Negative?

How do providers describe the impact of COS on their practice?

Neutral impact of COS process on practice

Overall impact of COS on your work with children and families

Specifics reported about COS Process:• 2% had negative impacts on relationships with families• 17% improved the assessment process• 31% takes time away from other important actives• 30% helps focus discussion on the whole child

0 10 20 30 40 50 60 70 80

negative/ very nega-

tive, 7

neutral; 68

positive/ very posi-

tive, 25

Summary and Implications

Summary: COS Process

• Most received limited training and support

• Providers felt comfortable with background content

• Had limited understanding about what happens with the data or how to explain it

• Didn’t feel like the COS process impacts their work much

Got quality COS data?

Implications and Discussion

• Implications of findings For professional development? For supervision and administrators of programs? For data quality?

• Learning from providers Have others done surveys or focus groups to learn

from providers? Why or why not? How can surveys like this inform

improvement activities in your state?

Find out more

• ENHANCE Website– http://ENHANCE.sri.com

• ECO Center Website– http://www.the-ECO-center.org

• Contact ENHANCE staff– Email: ENHANCE@sri.com