IFSP Quality Rating Scale

Manual

Purpose

Family Infant Toddler (FIT) provider agencies will use the IFSP Quality Rating Scale to review their program’s IFSPs on a systematic basis to ensure that IFSPs reflect family priorities, address functional routines-based needs, and provide supports to help families implement strategies during daily routines and activities.

This manual will demonstrate the criteria reviewed for each section of the IFSP and will provide examples to demonstrate the ratings of “Needs Improvement”, “Acceptable”, and “Exemplary”.

Section A: “Your Family” Everyday Routines, Activities, Places and People in Your Life (pg. 3)

Section B: Summary of Relevant Health Information (pg. 8)

Section C: Present Abilities, Strengths and Needs (pg. 12)

Section D: Child / Family Outcomes (pg. 15)

Section E: Child / Family Outcomes – Strategies (pg. 19)

Section F: Supports and Services Needed to Achieve Outcomes (pg. 26)

Section G: Natural Environment Justification (pg. 29)

Section H: Periodic Review of the IFSP (pg. 30)

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RBI – Foundation of IFSP

Intake / Routines Based Interview (RBI)

During intake, information is shared about early intervention, families are asked about their concerns, and consent is obtained.

Intake and the RBI process should include conversation about the family being an active partner in the development and implementation of the IFSP. A discussion as to how early intervention will provide the family with suggestions they can use during their daily routines so their child has multiple opportunities to learn and practice skills and desired behaviors will help parents/caregivers understand the purpose of RBI questions.

An RBI is much more than a form completed during intake. As IFSP supports are provided, families will continue to be asked open ended questions about how their child’s strengths and needs are impacting his participation in family life.

When using the RBI during intake to learn about the family’s daily routines, the family is asked the following:

• What their daily routines and activities are;

• What everyone (parents, child, child’s siblings) is doing in the routine;

• Child’s engagement;

• Child’s independence;

• Child’s social relationships;

• Family’s satisfaction with the routine RBI questions support the parents in painting a picture of their routines, helps them identify what they would like to happen differently, and what is going well. The interviewer may “star” routines of concerns. Identifying routines of concern help the family begin to think about the outcomes they would like their IFSP to address.

IFSP Quality Rating Scale

SECTION A: “YOUR FAMILY”

EVERYDAY ROUTINES, ACTIVITIES,

PLACES AND PEOPLE IN YOUR LIFE The information in the “Your Family” section provides the foundation for the entire IFSP. This information should include a family’s daily routines, their concerns about their child, the family’s resources, and what is working well or what is challenging in their everyday routines, activities and places. This information helps identify how the child’s development is impacting the child’s ability to participate in family life. Information about the family’s everyday routines and activities, family concerns and priorities, and family resources is obtained through an RBI process. Parents need to know the purpose of RBI questions, how the information will be used and where the information will be kept so they feel comfortable sharing. If a family declines providing this information, they must initial their refusal at the bottom of both “Your Family” pages.

The “Your Family” section on the rating scale looks at the following 3 areas: A1: Everyday routines, activities and places; A2: Concerns and Priorities; and A3: Family Resources

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IFSP Quality Rating for “Your Family” A1 A1 contains information about the family routines. The IFSP reviewer should not just see a daily schedule (e.g. 7:00 am Wake up; 7:15 am Breakfast, etc.). There should be a good sampling of the routines important to the family. For example, depending on the child’s age, family routines could include mealtimes or feeding, diapering, dressing, bedtime, bathing, playtime/playful interactions, etc. The IFSP reviewer will want to see:

• Who participates in the routines (parents, siblings, etc.,)

• What the child does during the routine (engagement)

• What the child can do by himself (independence)

• How the child communicates and gets along with others (social relationships)

• What is enjoyable or challenging about the routine?

• How do the family concerns (generally this is what caused the referral to early intervention) impact the routines?

A1. g Descriptions Rating Clarification/example How to improve:

This section is rated as Needs Rate as Needs Improvement when the information in Ask open ended questions to find out more information

Improvement when information about all the identified routines does not adequately describe about each identified routine. For example, for the

family routines is: what is happening during the routines, and/or there is morning routine ask:

no information about what makes all the routines • Who typically changes Sara’s diaper and gives her a

not described or is missing challenging or enjoyable, who participates, and what the bottle? (e.g., Mom)

information related to the following most child is doing during the routines. • What makes this routine challenging? (e.g., Sara common routines: waking up, takes a long time to finish her bottle and mom is diapering/dressing, feeding/meals, An example of limited information is seen below in the feeding her while helping the other kids get ready to playtime or playful interactions, bath description of a child’s morning routine: catch the bus). time, bedtime

• What is Sara doing during the routine? (e.g., Wakes up at 7:00 am, diaper changed, and distracted by siblings so not finishing her bottle, has a bottle. crying because her milk gets cold, etc.).

This section is rated as Acceptable when Rate as Acceptable when there is information about • Ask about Sara’s “mood” (e.g., can you tell me more information about family routines is: all identified routines but the information does not about how Sara’s mood might affect her drinking her clearly describe what makes the routines/activities bottle?) described with limited information challenging or difficult. • Ask what mom has tried (e.g. what helps Sara finish

related to the following most common her bottle?)

routines: waking up, diapering/dressing, Sara wakes up around 7:00 am and mom changes

feeding/meals, playtime or playful her diaper. Sometimes Sara is a good eater and will

interactions, bath time, bedtime finish her morning bottle, but it depends on her

mood.

Ratin

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A1. Rating Descriptions Rating Clarification/example How to improve:

This section is rated as Exemplary when Rate as Exemplary when the information in all information about family routines is: identified routines provides a clear picture of what is making each identified routine enjoyable or challenging described with detailed information such as:

related to the following most common routines: waking up, diapering/dressing, Sara wakes up around 7:00 am and mom changes feeding/meals, playtime or playful her diaper. Weekday mornings are stressful because interactions, bath time, bedtime other kids must be fed and ready to get on the bus at

7:30. Sara gets distracted as there is a lot of noise and interruptions. Her milk gets cold and she starts crying. Mom may have to warm her bottle at least twice. Sara spits up a lot during her morning bottle.

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IFSP Quality Rating for “Your Family” A2: Prioritized Concerns The IFSP reviewer will want to see a description of the family’s concerns and how the family’s concerns about their child are impacting their everyday routines and activities. The FSC should review the family concerns that were identified during the RBI and, if needed, review the reason for the referral, or the reason the child was made eligible, to help the family articulate which concerns they want addressed.

A2. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the family’s Ask open ended questions to learn what the family Improvement when, with family concerns are listed but the information does not include means when they say Sara is “fussy”. The family’s concurrence, information about family how their concerns impact their day. For example: definition is important to understanding what Sara is prioritized concerns is: doing when she is “fussy”. Sara is fussy a lot. not adequately described • What does “fussy” look like?

• Inquire about “a lot” (e.g, most of the day, part of

day, specific times during the day, etc.?)

This section is rated as Acceptable when, Rate as Acceptable when the family’s concern is Ask open ended questions to find out more, such as: with family concurrence, information about clearly described such as: family prioritized concerns is: • What might be causing Sara to be “very fussy” Sara is very fussy when she wakes up in the when she wakes up (e.g., wet, hungry, doesn’t like described but not connected to the morning. She makes faces, arches her back, cries, to wait for her morning bottle, etc.)

challenges in the family’s everyday turns her head away, and refuses to drink her

routines and activities bottle.

This section is rated as Exemplary when, Rate as Exemplary when the family’s concern is with family concurrence, information about clearly described and connected to challenges in their family prioritized concerns is: day such as: described and connected to the family’s Weekday mornings are stressful. Sara is very fussy

challenges in everyday routines and when she wakes up. Changing her diaper seems to activities bother her as she makes faces, arches her back and often cries. Other kids talking loud or TV noise

bothers Sara and she will stop drinking her bottle and fuss.

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IFSP Quality Rating for “Your Family” A3: Family Resources A3 is a description of the family’s resources including how these resources support the child and family. The IFSP reviewer will want to see a description of who is involved in the family’s life. This includes family members, extended family, friends, neighbors, child care, Early Head Start, etc. The reviewer will want a description of how these resources provide support to the family. Important resources should be considered when developing strategies and services. For example, if grandparents take care of child during the week, consider if one or more IFSP strategies might be needed to support grandparents in making the best use of this time.

A3. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the resources are listed but there Ask open ended questions to find out Improvement when, with family is no information as to how the resource provides them the family with more information about how each concurrence, information about the family support, such as: resource provides support such as: resources: Mom’s parents, mom’s sister, husband’s brother and sister • What kinds of support do these lists resources, though does not provide support when needed. extended family members

describe how the family’s resources provide? provide them with support

This section is rated as Acceptable when, Rate as Acceptable when the family’s resources are listed and there is Ask open ended questions to find out with family concurrence, information about a description of how each resource provides support such as: more information about how each the family resources: resource provides support around My parents stay with Sara on Saturdays so we can have a family the family’s concerns such as: lists resources, and specifies how the day with our older kids.

family’s resources provide them with • How do your parents help Sara be support My sister helps me keep my sense of humor by listening and less “fussy” when they are with helping me find something to laugh about or be grateful for. her?

We spend Saturdays with our older kids and my husband’s brother and sister. We go to the zoo, bio park, kid movies, etc.

This section is rated as Exemplary when, Rate as Exemplary when the family’s resources are clearly described with family concurrence, information about and connected to challenges in their day such as: the family resources: My mom seems to know just how to talk to, bathe, dress, diaper, lists resources and specifies how the and give Sara her bottle. Sara rarely cries when my mom takes

family’s resources provide them with care of her. The house is quite and the TV is off. They support and connects them to (grandparents) give us a much-needed break and we don’t have to challenges in the everyday routines worry about Sara.

OVERALL RATING FOR SECTION A: “YOUR FAMILY”

“Your Family” is a MUST PASS section. A1, A2 and A3 must be rated as Acceptable or Exemplary Practice.

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SECTION B: SUMMARY OF RELEVANT HEALTH INFORMATION This section of the IFSP must contain a summary of the child’s overall health including vision and hearing. Information may include pregnancy, birth history, growth, allergies, nutrition, well-child visit information, medical/developmental diagnosis, hospitalizations, medications, specialists, other interventions, etc.

The IFSP Quality Rating Scale focuses on vision and hearing results. The IFSP reviewer will want to see that vision and hearing were screened and that needed referrals were made. When vision and/or hearing results can’t be obtained, or if a vision or hearing referral is needed, the reviewer will want to see that at least one IFSP strategy was

written to keep vision and/or hearing on the team’s radar until the results of the referral(s) are obtained.

B1.1. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the Vision section is: • Obtain medical documentation of previous vision Improvement when vision results: • Left blank screening results, if applicable

• Missing information • Participate in training provided by NMSBVI as were not determined or were not needed • Recommendation(s)/Referral(s) are needed but there is documented in the IFSP

• Complete ALL areas in Vision section on no documentation to show this happened Summary of Relevant Health Information page

This section is rated as Acceptable Rate as Acceptable when: • Complete ALL areas in Vision section on when vision results: Child’s vision was screened and results were documented in IFSP Summary of Relevant Health Information page but the tool used to screen vision (NM B-3 Vision Screening or including instruments used were determined and results were Other) is not documented such as:

documented in the IFSP • Date Tested: 11/12/14 • Results: Pass

• Instrument Used: Not identified

This section is rated as Exemplary Rate as Exemplary when: when vision results: Child’s vision was screened and results were documented in IFSP and the tool used to screen vision (NM B-3 Vision Screening) is were determined and results were documented such as:

documented in the IFSP, and • Date Tested: 11/12/14 include the instruments used • Results: Pass

• Instruments Used: NM Birth to 3 Vision Screening

Item B1 branch 1 Vision Results: (THIS WOULD NOT BE A SCORED ITEM, JUST A BRANCH POINT, IF RATED AS NO, SKIP TO VISION RESCREENING OR REFERRAL HEARING RESULTS) REQUIRED? YES

NO

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B1.2 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when: • Participate in training provided by Improvement when a child required NMSBVI as needed rescreening or referral for vision and: There is no documentation to show if rescreening has been scheduled and/or

• Develop an IFSP strategy to referrals have been made (e.g., referrals to NMSBVI or ophthalmologist

address how to obtain vision status no follow up is noted (there is no documented in the IFSP) such as:

• Date Tested: 11/12/14 within a specified time frame strategy for follow-up or no notes on Summary of Relevant Health • Results: Didn’t pass Information page regarding • Instruments Used: NM Birth to 3 Vision Screening follow-up); or follow-up is noted

• Recommendation(s)/Referral(s): Not identified but does not include a specific provider or timeline • Follow-up screening: Not identified

This section is rated as Acceptable Rate as Acceptable when: • Develop an IFSP strategy to when a child required rescreening or address how to obtain vision status referral for vision and: Rescreening is scheduled and/or referrals were made (e.g., referrals to within a specified time frame NMSBVI or ophthalmologist are documented in the IFSP) such as:

(documents that needed follow-up rescreening is scheduled and/or • Date Tested: 11/12/14

is being addressed) referrals were made (e.g., referrals • Results: Didn’t Pass to NMSBVI or ophthalmologist • Instruments Used: NM Birth to 3 Vision Screening are documented in the IFSP) • Recommendation/referral: Family to schedule first available appointment with pediatric ophthalmologist

This section is rated as Exemplary Rate as Exemplary when: when a child required rescreening or

referral for vision and: Rescreening is scheduled and/or referrals were made (e.g., referrals to

NMSBVI or ophthalmologist are documented) AND an IFSP strategy is

rescreening is scheduled and/or developed to address how to obtain vision status within a specified time frame

referrals were made (e.g., referrals (indicates the agency will follow-up) such as:

to NMSBVI or ophthalmologist • Date Tested: 11/12/14

are documented) AND an IFSP • Results: Didn’t Pass strategy is developed to address • Instruments Used: NM Birth to 3 Vision Screening how to obtain vision status within • Recommendation(s)/referral(s): Family to schedule first available a specified time frame (indicates appointment with pediatric ophthalmologist. the agency will follow-up • IFSP strategy: Mom has scheduled a 12/19/14 vision assessment appointment with Dr. Durso and she will sign a release requesting that a

copy of the report be mailed to our program.

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B2.1 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when: • Obtain medical documentation of Improvement when hearing results: • Area is left blank PASS hearing screening results • Newborn hearing PASS screening results are older than six months • Participate in training provided by were not determined or were not NMSD as needed • Program attempts to test child but child will not cooperate (no planned

documented in the IFSP follow-up noted) • Maintain equipment

• Program cannot test child because equipment is not working or equipment • Schedule OAEs early enough so that

isn’t available (no planned follow-up noted) screening can be conducted prior to IFSP meeting • Family reports child passed newborn hearing screen but program doesn’t

have/doesn’t obtain documentation • Complete ALL areas in Hearing

section on Summary of Relevant Health Information page

This section is rated as Acceptable Rate as Acceptable when: • Complete ALL areas in Hearing when hearing results: Child’s hearing was screened and results were documented in IFSP but the tool section on Summary of Relevant used to screen hearing (OAE/Typm or Other) is not documented such as: Health Information page and were determined and results • Date Tested: 9/1/14

record the instrument used were documented in the IFSP • Results: Pass –Right

Pass-Left

• Instrument Used: Not identified

This section is rated as Exemplary Rate as Exemplary when: when hearing results: Child’s hearing was screened and results were documented in IFSP and the tool used to screen vision (NM B-3 Vision Screening) is documented such as: were determined and results • Date Tested: 9/1/14

were documented in the IFSP, • Results: Pass – Right and include the instruments used

Pass – Left

• Instruments Used: OAE/Tymp

Item B2 branch 2 (THIS WOULD NOT BE A SCORED ITEM, JUST A BRANCH POINT, IF

HEARING RESCREENING OR REFERRAL REQUIRED? RATED AS NO, SKIP TO SECTION C. YES

NO

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B2.2 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when: • Participate in training Improvement when a child required There is no documentation to show if rescreening has been scheduled and/or referrals provided by NMSD rescreening or referral for Hearing have been made (e.g., referrals to NMSD, audiologist or ENT are documented in the

• Develop an IFSP strategy to and: IFSP) such as:

address how to obtain • Date Tested: 9/1/14 hearing status within a no follow up is noted (there is no • Results: Pass –Right

strategy for follow-up or no notes specified time frame Pass - Left

on Summary of Relevant Health • Instruments Used: OAE/Tymp Information page regarding follow-

up); or follow-up is noted but does • Recommendation(s)/Referral(s): Not identified

not include a specific provider or • Follow-up screening: Not identified timeline

This section is rated as Acceptable Rate as Acceptable when: • Develop an IFSP strategy to when a child required rescreening or Rescreening is scheduled and/or referrals were made (e.g., referrals to NMSD, address how to obtain referral for Hearing and: audiologist or ENT are documented in the IFSP) such as: hearing status within a • Date Tested: 9/1/14

specified time frame to rescreening is scheduled and/or • Results: Pass – Right document needed follow-up referrals were made (e.g., referrals

Pass - Left to NMSD, audiologist or ENT are is being addressed

• Instruments Used: OAE/Tymp documented in the IFSP) • Recommendation(s)/referral(s): Follow-up hearing test by 12 months of age

due to risk factor of prematurity or earlier if concerns arise.

This section is rated as Exemplary Rate as Exemplary when: when a child required rescreening or Rescreening is scheduled and/or referrals were made (e.g., referrals to NMSD, referral for Hearing and: audiologist or ENT are documented) AND an IFSP strategy is developed to address how to obtain hearing status within a specified time frame (indicates the agency will rescreening is scheduled and/or follow-up) such as:

referrals were made (e.g., referrals • Date Tested: 11/12/14 to NMSD, audiologist or ENT are • Results: Pass –Right documented) AND an IFSP

Pass - Left strategy is developed to address

• Instruments Used: OAE/Tymp how to obtain hearing status within a specified time frame (indicates • Recommendation(s)/referral(s): Follow-up hearing test by 12 months due to

the agency will follow-up) risk factor of prematurity or earlier if concerns arise.

Overall Rating for Section B: Hearing and Vision Results: Hearing and Vision Results in the Summary of Relevant Health Information is a MUST PASS section. B1.1, B1.2, and B2.2 must be rated as Acceptable or Exemplary.

Note: The Family Service Coordinator (FSC) must complete a Prior Written Notice before adding vision or hearing follow-up results to the IFSP if these results will require change(s) in IFSP outcomes or services. If results will not impact outcomes or services, document results in FSC notes only.

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SECTION C: “PRESENT ABILITIES, STRENGTHS AND NEEDS (PASN)” The Present Abilities, Strengths and Needs (PASN) page of IFSP includes information obtained from the RBI, observations, and evaluation or assessment. Evaluation and assessment results are used for determining eligibility, monitoring progress, and intervention planning. Children with established conditions are automatically eligible. All children must have a multidisciplinary evaluation to determine their current level of performance in five domains: cognitive, communication,

gross and fine motor, social and emotional, and self-help.

On the PASN page, the child’s present abilities, strengths and needs are described per the following three areas of child functioning (Early Childhood Outcomes): Developing Positive Social-Emotional Skills, Acquiring and Using Knowledge and Skills, and using Appropriate Action to Meet Needs. The child’s developmental levels based on evaluation and assessment results are provided on the right side of the page. The PASN page also includes what is going well and what is challenging for the child and family. When the child’s strengths and needs are described in functional skills and behaviors during daily routines and activities, the IFSP team has a more accurate picture of how the child integrates his skills and behaviors as he goes about his day. This comprehensive view of the child’s skills and behaviors, in conjunction with how the child’s development is impacting family routines, helps the team think about what the child needs to be successful at home and in the other environments where he spends his day. The information on the PASN page must be written in family friendly language. The FSC reviews the information at the IFSP meeting and the team helps update/correct the information as needed. This review helps the IFSP team think about what the child needs to be successful. The review also prepares the family to identify IFSP outcomes that are based on their concerns.

IFSP Quality Rating for Section C: Present Abilities, Strengths, and Needs

• Child’s status (including strengths and needs) is described in the context of everyday routines and activities for each required functional area: (1) Developing positive social emotional skills, (2) acquiring and using knowledge and skills, (3) using appropriate action to meet needs.

• Additionally, the child’s present levels of development are recorded for each of the five domains: (1) gross and fine motor (2) cognitive (3) communication (4) social and emotional, and (5) self-help (adaptive).

C1. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Improvement Rate as Needs Improvement when: • Complete ALL developmental levels using age when the developmental level (age range): • One or more developmental levels are left blank ranges obtained from evaluation and

• Standard deviations are used instead of age ranges assessment results. is not recorded for one or more

developmental levels (domains) or is

incorrectly recorded (such as in standard

deviations) (Acceptable) (none)

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C1. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Exemplary when the Rate as Exemplary when all developmental levels are developmental level (age range): identified in age ranges obtained from evaluation and assessment results AND the test/tool used is documented at the top of the page. An example: is recorded for each domain AND includes

test/tool used • Instrument(s) Used: IDA, Infant Toddler

Sensory Profile

• Developmental Levels:

Social: 1-2 months Emotional: 1-2 months Communication: 1-2 months Cognitive: 1-2 months Gross Motor: 1-2 months Fine Motor: 1-2 months Self Help: 1-2 months

C2. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when: • Complete ALL developmental levels using age Improvement when the summarized • One or more developmental levels are left blank ranges obtained from evaluation and description of child’s current functioning assessment results. • Test results are used instead of functional skills in each functional area: • Provide functional description of strengths and

• Information focuses on child deficits needs instead of test activities/items is not recorded for one or more • Information does not include child’s strengths • Identifies child’s strengths

functional area(s); or lists • Provide functional descriptions that include activities/results (raking pellets, An example of a statement that would be rated as needs what will support child in making progress in inserting forms into form board, etc. improvement: each developmental area instead of functional skills; or is Sara’s functioning in the areas of social and emotional focused on child deficits and is vague development is severely impacted by her constant about child strengths irritability. She avoids interactions by turning her

head, crying and screaming. While the above statement is accurate, it does not provide any information about Sara’s emerging social and emotional strengths.

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C2. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Acceptable Rate as Acceptable when: • Complete ALL developmental levels using age when the summarized description of • All developmental levels are documented using age ranges ranges obtained from evaluation and child’s current functioning in each obtained from evaluation and assessment results assessment results functional area: • Functional descriptions of strengths and needs are provided Provide functional description of strengths and • Functional descriptions include what will support child in • is recorded for all functional areas needs instead of test activities/items making progress in each developmental area

AND includes clear functional • All information is written using family friendly (no jargon)

descriptions, including strengths and language

needs, using family friendly language • Identify child’s strengths

Example of an acceptable description of child’s strengths and

needs in the areas of social and emotional development: • Provide functional descriptions that include

Strengths what will support child in making progress in Sara looks at her parents/grandparents and responds to each developmental area their voices when they use a soft voice. She sometimes vocalizes “ah” when her parents/grandparents talk to her.

• Address challenges and identify strengths in Needs Reducing the amount of light, noise and activity level everyday routines and activities.

around Sara and speaking to her in a soft voice helps her relax so she can enjoy interactions with her family.

This section is rated as Exemplary Rate as Exemplary when: when the summarized description of • All developmental levels are documented using age ranges child’s current functioning in each obtained from evaluation and assessment results functional area: • Functional descriptions of strengths and needs are provided • Functional descriptions include what will support child in is recorded for all functional areas making progress in each developmental area

AND includes clear functional • All information is written using family friendly (no jargon) descriptions, including strengths and language needs, using family friendly language, • Relevance to daily life AND includes relevance to challenges and what is working well in everyday An example: routines and activities Strengths

Sara communicates using cries, facial expressions and body movements such as turning her head away Needs Reduce lighting, noise and activity around Sara to support her in drinking her bottle without crying or spitting up.

Note: In the Needs Column, include the IMMEDIATE skill(s) in which the child needs support INSTEAD OF the next large developmental milestone(s). Immediate skills should be described in terms of the child’s functioning in daily routines and activities and the support needed to help the child make progress in the skill area. Immediate skills may also be considered when identifying IFSP outcomes and strategies.

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SECTION D: CHILD / FAMILY OUTCOMES Functional IFSP outcomes are developed from the routines-based needs identified by families in the RBI. The RBI process supports families in thinking about what their child needs to be engaged, social and independent in everyday routines and activities. As families are asked about their daily routines, they identify routines that are challenging and they begin to consider what would need to happen differently for the routine(s) to be more enjoyable.

Functional Child Outcomes are developmentally appropriate for the child and reflect the family’s priorities for their child and family. All IFSP team members contribute to the development of outcomes. During the IFSP meeting, the Family Service Coordinator summarizes the information from the “Your Family” and the evaluation or assessment “PASN” pages of the IFSP. This summary helps remind the family of the routines they identified as challenging. IFSP team members can provide information from the evaluation or assessment to help the family consider what might increase their child’s engagement and independence so the child can more effectively participate, and therefore learn, during the family’s daily routines and activities. A functional child outcome can be thought of as a roadmap describing what the family wants to happen. Function child outcomes should be able to answer the following questions:

• What does the family wants to see happen?

• Where, when, or with who will it happen?

• What are the specific routine(s) in which it will happen? An example of a Child Outcome: “John will use his fingers to feed himself during meal and snack times”. Functional Family Outcomes are related to family needs and may be related to their child (e.g., such as getting information about developmental milestones or their child’s diagnosis, learning how to use behavioral techniques, etc.). Family outcomes may also be for the entire family or a family member (e.g., respite services, support groups, information on other services, childcare resources, etc.). An example of a Family Outcome: “Mom will have a list of child care resources within 10 miles of her work”.

The Progress Statement for Child and Family Outcomes will describe what progress will look like to the family and state when the family

hopes the progress will have been made. Progress Statements should include an observable and measurable description of progress, who will

observe and report the progress, and a meaningful family timeline. The Progress Statement should be specific enough so the family and the

rest of the IFSP team has the same understanding of what achievement will look like.

An example of a progress statement for the above child outcome: “By his first birthday, mom will report that John is able to feed himself

foods such as cheerios, bananas and small, cut-up pieces of meat using his fingers”.

An example of a progress statement for the above family outcome: “One month before Mom’s maternity leave is over, parents will have a

list of child care resources close to mom’s work so parents can schedule visits at the child care facilities of their choice”.

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IFSP Quality Rating for Section D: Child /Family Outcomes

The IFSP reviewer will to see the following:

• Child and family outcomes correlate with family priorities and concerns relative to the child’s development.

• Child outcomes are functional, measurable (including criteria, procedures, and timelines), and related to participation in specified daily routines.

D1.1. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the • Review reason for referral Improvement when the development outcome has no clear connection to family • Summarize information from the RBI to remind family of their of Child and Family outcomes: concerns and priorities and seem to be

concerns seem to be based on provider based on provider priorities such as:

• Summarize information from the evaluation or assessment priorities (e.g., there is not a clear connection with the concerns and Sara will look at her rattle when it is • Provide input from other IFSP team members to support family in

priorities expressed by the family) placed in her hand. identifying functional, routines based outcomes

This section is rated as Acceptable Rate as Acceptable when the outcome • Review reason for referral when the development of Child and reflects family concerns and priorities in • Summarize information from the RBI to remind family of their Family outcomes: the Your Family section such as,

concerns

• Summarize information from the evaluation or assessment are clearly based on family concerns Sara will participate in bottle feeding and priorities (e.g., there are clear without crying or spitting up. • Provide input from other IFSP team members to support family in

connections between information identifying functional, routines based outcomes on IFSP Section, Your Family)

This section is rated as Exemplary Rate as Exemplary when the outcome when the development of Child and reflects assessment information and the Family outcomes: family concerns and priorities in the Your Family section such as are clearly based on family concerns

and priorities (e.g., there are clear Sara will participate in bottle feeding connections between information without crying or spitting up and in on IFSP Section, Your Family) diapering, bath time and dressing AND relate to areas of concern without crying or screaming. from the child’s latest assessment

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D1.2 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the • Review reason for referral Improvement when the development outcome has no relation to the child and • Summarize information from the RBI to remind family of their of Child and Family outcomes: family’s everyday routines and activities:

concerns

• Summarize information from the evaluation or assessment do not relate to the child and family’s Sara will look at her rattle when it is everyday routines and activities placed in her hand. • Provide input from other IFSP team members to support family in

identifying functional, routines based outcomes

This section is rated as Acceptable Rate as Acceptable when the outcome • Review reason for referral when the development of Child and supports the child’s ability to participate in • Summarize information from the RBI to remind family of their Family outcomes: daily routines and activities such as,

concerns

• Summarize information from the evaluation or assessment support child’s ability to participate Sara will drink her bottle without in daily routines and activities crying or spitting up. • Provide input from other IFSP team members to support family in

identifying functional, routines based outcomes

This section is rated as Exemplary Rate as Exemplary when the outcome when the development of Child and reflects assessment information and the Family outcomes: family concerns and priorities in the Your Family section such as support child’s ability to participate

in daily routines and activities AND Sara will participate in bottle feeding are written in words that reflect the without crying or spitting up and in family’s perspective or in family diapering, bath time and dressing friendly language without crying or screaming.

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D2 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the outcome is written • Review reason for referral Improvement when Child and Family in discipline-specific therapeutic language and is not • Summarize information from the RBI to outcomes are written: functional and measurable per family identified criteria such

remind family of their concerns as:

• Summarize information from the evaluation or in vague (confusing or will be difficult to measure) terms OR as Outcome: Sara will have a sensory profile to determine assessment

services to be provided OR in why she can’t regulate her sensory system. • Provide input from other IFSP team members discipline-specific therapeutic to support family in identifying functional language rather than written as Progress Statement: By Easter, sensory supports will outcomes functional and measurable have helped Sara self-regulate so she is crying less.

This section is rated as Acceptable Rate as Acceptable when the outcome is written in • Review reason for referral when Child and Family outcomes are functional terms and is measurable based on family identified • Summarize information from the RBI to written: criteria, procedures and timelines such as:

remind family of their concerns in functional terms and measurable

• Summarize information from the evaluation or terms, including criteria, procedures Outcome: Sara will participate in bottle feeding without and timelines crying or spitting up. • assessment

• Provide input from other IFSP team members Progress Statement-By Easter, Sara will drink her bottle to support family in identifying functional

without crying or spitting up. outcomes

This section is rated as Exemplary Rate as Exemplary when the outcome reflects assessment when Child and Family outcomes are information and the family concerns and priorities in the Your written: Family section such as in functional terms and measurable Outcome: Sara will participate in bottle feeding without

terms, including criteria, procedures, crying or spitting up and in diapering, bath time and and timelines AND in relationship dressing without crying or screaming. to participation in everyday routines and activities, AND in relation to Progress Statement-By Easter, parents will report that timelines which are significant to the Sara can drink her bottle when she is with the rest of family the family and show she is happy and comfortable

during diapering, bathing and dressing by smiling, laughing, etc.

OVERALL RATING FOR SECTION D: CHILD/FAMILY OUTCOMES: Child/family outcomes is a MUST PASS section. D1.1, D1.2, and D2 must be rated as Acceptable or Exemplary.

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SECTION E: CHILD / FAMILY OUTCOMES - STRATEGIES

The IFSP reviewer will want to see functional, routines based, developmentally appropriate strategies designed to support achievement of IFSP outcomes. The IFSP reviewer will also want to see that coaching strategies will be used to help family/caregivers embed IFSP strategies in daily routines and activities so the child has multiple opportunities to learn and practice skills and desired behaviors. Strategies should not imply that the service providers’ role is to teach the child skills during one-hour home visits. Strategies should specify how service providers will use home visits to provide the family/caregivers with information, demonstration and coaching so they can support the child’s development in the desired skill area(s) between home visits.

Coaching strategies include: • information sharing

• observation

• demonstration/modeling

• direct teaching

• guided practice

• feedback

• problem solving

• reflection

IFSP Quality Rating for E: Child/Family Outcomes – Strategies

• IFSP strategies should be based on a knowledge of child development in the area(s) of concern. As needed, developmental knowledge will

be obtained PRIOR to the IFSP meeting.

• Early intervention strategies and activities should build family capacity (confidence and abilities).

• Early intervention strategies and activities should be written in family-friendly language, be individualized to the family, address the child

and family’s specific needs and concerns, and build on child and family strengths.

• Early intervention strategies and activities should link to the child’s functional skills and everyday routines and be connected to the

identified outcomes.

• Early intervention strategies should support the child’s relationships and interactions with parents/caregivers and with siblings/peers.

• Early intervention strategies should include the use of coaching to support the family in maximizing their child’s learning and successful

participation in family life.

• When services include co-visits, ideally a strategy would be written to describe how the co-visits will be used to support the family in

learning and using the strategies.

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E1.1 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the strategies and • Work in partnership as an IFSP team to develop Improvement when strategies and activities have no professional role defined or are only what functional strategies the family can incorporate activities reflect: the FIT providers will do, or only include specialized places into their daily routines and activities. and equipment such as:

• Work in partnership as an IFSP team to assure only what the family will do with no strategies don’t include service providers professional role defined OR only The Occupational Therapist will work with Sara to help

what the FIT Program providers will her regulate her reactions to sounds, temperature, lights spending most of home visits in direct

do with the child, OR only include and textures so she can better tolerate them. interaction with the child. specialized places and equipment

This section is rated as Acceptable Rate as Acceptable when strategies support the • Work in partnership as an IFSP team to develop when strategies and activities reflect: family/caregivers in implementing intervention strategies, functional strategies that families can incorporate during daily routines and activities such as: into their daily routines and activities. that FIT Program providers are • Specify how the service providers will support

supporting the family/caregivers to The Occupational Therapist will show Jane and John, family/caregivers in learning and using strategies

implement intervention strategies, and Grandmother, Jill, how to massage Sara to help her during daily routines (i.e., see coaching strategies

during daily routines and activities relax before her bath, before diaper changes, and at on page 19). bedtime.

• Work in partnership as an IFSP team to assure

strategies don’t include service providers spending

most of home visits in direct interaction with the

child.

• Include siblings and extended family in IFSP

strategies.

This section is rated as Exemplary Rate as Exemplary when the outcome reflects assessment when strategies and activities reflect: information and the family concerns and priorities in the Your Family section such as: that FIT Program providers are

The Occupational Therapist will show Jane and John, supporting the family and/or and Grandmother, Jill, how to use a warm oil massage caregiver(s) to implement Sara to help her relax before her bath, before diaper intervention strategies in the context changes, and at bedtime. Occupational therapist will of everyday routines and activities of provide guidance as parents and grandmother use the interest AND family resources massage techniques to help them assess how Sara is (people and places) are considered responding to the massage, help them determine when to and incorporated into IFSP adjust the amount of pressure, when to move to a strategies different part of Sara’s body, etc.

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E1.2 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the strategies and • Work in partnership as an IFSP team to develop Improvement when strategies and activities are not likely to strengthen the family capacity functional strategies that families can incorporate activities are: because they don’t include modeling and coaching such as: into their daily routines and activities. • Specify how the service providers will support not likely to strengthen the family’s Occupational therapist will try different weighted blankets

family/caregivers in learning and using strategies capacity to support their child’s with Sara and will inform parents as to the type of

during daily routines (i.e., see coaching strategies development as they don’t include weighted blanket that is most beneficial

on page 19). modeling and coaching • Work in partnership as an IFSP team to assure

strategies don’t include service providers spending

most of home visits in direct interaction with the

child.

• Include siblings and extended family in IFSP

strategies.

This section is rated as Acceptable Rate as Acceptable when the strategies and activities reflect • Work in partnership as an IFSP team to develop when strategies and activities are: a mixture of direct services and consultation: functional strategies that families can incorporate into their daily routines and activities. based on sharing of information, Occupational therapist and Jane will work together to • Specify how the service providers will support

modeling and reflection to determine if a weighted blanket will help Sara calm and/or family/caregivers in learning and using strategies

support/increase family/caregiver go to sleep. during daily routines (i.e., see coaching strategies

ability to incorporate strategies into on page 19). routines and activities.

• Work in partnership as an IFSP team to assure

strategies don’t include service providers spending

most of home visits in direct interaction with the

child.

Include siblings and extended family in IFSP

strategies.

This section is rated as Exemplary Rate as Exemplary when outcome strategies include a when strategies and activities are: mixture of direct services and consultation and modeling/coaching for family/caregivers learning and comprised of coaching specific problem solving such as:

strategies to support family/caregiver learning, problem- Occupational therapist and Jane will explore different solving, ability to use strategies weighted blankets to determine the most effective weighted effectively, and generalize strategies blanket to help Sara sleep and if a weighted blanket would to new routines and activities be helpful when Sara is drinking her bottle.

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E2 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the strategies and • Work in partnership as an IFSP team and use Improvement when strategies and activities are written in professional jargon and don’t build on family friendly language to write functional activities are written: what is already working well such as: strategies and activities based on what is already

working well in everyday routines and strategies. in professional jargon AND without

building on what is already working Occupational therapist will use a variety of sensory well in the family’s everyday routines activities with Sara to reduce her hypersensitivity to and activities different textures.

This section is rated as Acceptable Rate as Acceptable when the strategies and activities are • Work in partnership as an IFSP team and write when strategies and activities are written in language meaningful to the family and address their strategies and activities in language meaningful written: needs and concerns: to the family to address their needs and

concerns. in language meaningful to the family, Occupational therapist and Jane will explore mixing cereal

to address the individualized specific with breast milk to create different types of textures (runny, needs and concerns of the child and thick, etc.) during Sara’s lunch time feeding. family

This section is rated as Exemplary Rate as Exemplary when the strategies and activities are when strategies and activities reflect: written in language meaningful to the family and the strategies and activities build on child and family strengths: language meaningful to the family, to

address the individualized specific Occupational therapist and Jane will explore mixing cereal needs and concerns of the child and with breast milk to create different types of textures (runny, family, AND to build on child and thick, etc.) during Sara’s lunch time feeding to determine family strengths which texture encourages Sara to try the cereal. Jane will have a bottle ready and not continue trying to feed Sara if

she becomes upset. Jane will continue trying the cereal texture that Sara likes best during lunch time feedings.

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E3.1 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the strategies and • Work in partnership as an IFSP team and write Improvement when in relation to the activities are not connected to the outcomes or they are not strategies and activities connected to the child’s functional skills and everyday linked with the child’s functional skills/behaviors OR to outcomes and linked to the child’s functional routines, strategies and activities are: everyday routines:

skills/behaviors in daily routines. not connected to the outcomes (e.g., The Developmental Specialist will use a variety of oral

they could be implemented in motor activities with Sara to reduce her oral isolation without achieving the hypersensitivity to different textures, tastes and outcome), or not linked with the temperatures. child’s functional skills/behaviors OR to everyday routines

This section is rated as Acceptable Rate as Acceptable when the strategies and activities are • Work in partnership as an IFSP team and write when in relation to the child’s functional linked to the outcome and reflective of child’s functional strategies and activities linked to the outcomes skills and everyday routines, strategies skills/behaviors and linked to everyday routines such as: and related to the child’s functional and activities are:

skills/behaviors in daily routines identified as

enjoyable or challenging. linked to the outcome, reflective of Developmental Specialist and Jane will work together to the child’s functional show Sara’s sisters (Megan and Jean) how to approach skills/behaviors, and linked to Sara such as waiting to talk to her until she looks at them. everyday routines

This section is rated as Exemplary Rate as Exemplary when the strategies and activities are when in relation to the child’s functional linked to the outcomes and related to child’s functional skills and everyday routines, strategies skills/behaviors in daily routines identified as enjoyable or and activities are: challenging such as: linked to the outcome, reflective Developmental Specialist and Jane will work together to

of the child’s functional show Sara’s sisters (Megan and Jean) how to approach skills/behaviors, and related to Sara such as waiting to talk to her until she looks at them. specific everyday routines (utilizing After school, Jane will show Megan and Jean how Sara strengths and challenges the family likes to be held (tight up against the chest and close to the identified in the routines based face of the person holding her), and how to gently rock interview) Sara.

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E3.2 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the strategies and • Work in partnership as an IFSP team to develop Improvement when in relation to the activities are not supportive of the child’s development in all strategies and activities that support the child’s child’s functional skills and everyday environments and routines: development in all environments and routines of routines, strategies and activities are:

concern. The Occupational Therapist will use massage during home not supportive of the child’s visits to help Sara relax.

development in all environments and routines

This section is rated as Acceptable Rate as Acceptable when the strategies and activities are • Work in partnership as an IFSP team to develop when in relation to the child’s functional supportive of the child’s development in MOST strategies and activities that support the child’s skills and everyday routines, strategies environments and routines: development in all environments and routines of and activities are:

concern.

supportive of the child’s Occupational Therapist will show Jane and John how to development in MOST

use a warm oil massage to help Sara relax before her bath, environments and routines

before diaper changes, and at bedtime. Occupational therapist will provide guidance as parents use the massage

techniques to help them assess how Sara is responding to

the massage, help them determine when to adjust the

amount of pressure, when to move to a different part of

Sara’s body, etc.

This section is rated as Exemplary Rate as Exemplary when the strategies and activities are when in relation to the child’s functional supportive of the child’s development in ALL environments skills and everyday routines, strategies and routines: and activities are: supportive of the child’s Occupational Therapist will show Jane and John, and

development in ALL environments grandmother, Jill, how to use a warm oil massage to help and routines Sara relax before her bath, before diaper changes, and at bedtime. Occupational therapist will provide guidance as

parents and grandmother use the massage techniques to help them assess how Sara is responding to the massage, help them determine when to adjust the amount of pressure, when to move to a different part of Sara’s body, etc.

Note: For children who spend most of the time in one environment (ex. infant at home), the difference between an Acceptable and an Exemplary rating in E3.2 is the quality of the information provided as it relates to the child’s routines and environments.

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E3.3 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when the strategies and Work in partnership as an IFSP team to develop Improvement when in relation to the activities are not specific as to how the family will incorporate strategies and activities that include coaching child’s functional skills and everyday them into their daily routines and activities: strategies to support the family in knowing how to routines, strategies and activities are:

use the strategies effectively during routines. The developmental specialist will suggest strategies not specific as to how family will parents can use to help calm Sara.

incorporate into their daily routines and activities

This section is rated as Acceptable Rate as Acceptable when in relation to the child’s functional Work in partnership as an IFSP team to develop when in relation to the child’s functional skills and everyday routines, strategies and activities are coaching strategies that include examples that will skills and everyday routines, strategies specific (includes at least one example) as to how family support the family in knowing how to use the and activities are: will incorporate into their daily routines and activities:

strategies effectively during routines. specific (includes at least one The developmental specialist and Jane will discuss Sara’s

example) as to how family will stress cues during feeding such as arching her back and incorporate into their daily routines

how Jane can use these cues to help interpret what Sara and activities

may need such as being swaddling.

This section is rated as Exemplary Rate as Exemplary (includes more than one example) when in relation to the child’s functional when the strategies and activities are very specific as to how skills and everyday routines, strategies the family will incorporate them into their daily routines and and activities are: activities: very specific (includes more than The developmental specialist and Jane will discuss Sara’s

one example) as to how family will stress cues during feeding (arching her back, turning her incorporate into their daily routines head away, grimacing, changes in skin color, etc.) and and activities how Jane can use these cues to help interpret what Sara may need to help her drink her bottle such as swaddling,

gentle rocking, soft humming, soft lighting, etc.

OVERALL RATING FOR SECTION E: CHILD/FAMILY OUTCOMES - STRATEGIES Section E: Child and Family Outcomes- Strategies is a MUST PASS section. E1.1, E1.2, E2, E3.1, E3.2, and E3.3 must be rated as Acceptable or Exemplary.

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SECTION F: SUPPORTS AND SERVICES NEEDED TO ACHIEVE OUTCOMES IFSP Quality Rating for F: Supports and Services Needed to Achieve Outcomes

• All columns and sections of the supports and services page are completed appropriately.

• Frequency, intensity, and method of specific early intervention services relate to child and family

outcomes and the family’s / caregiver’s capacity and need for support and problem solving of

challenges.

F1. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when one or more fields has • Check to make certain all fields are Improvement when completion of all missing or inaccurate information. complete and information is correct columns and sections of the supports and services page indicate: information is missing or inaccurate

This section is rated as Acceptable when Rate as Acceptable if all fields have required information and • Check to make certain all fields are completion of all columns and sections of the the information is accurate. complete and information is correct supports and services page indicate:

• Work as an IFSP to identify services that information on supports and services

will support achievement of the page is complete and accurate outcomes

• Select Primary Service Provider who will

provide the most relevant coaching and

modeling

This section is rated as Exemplary when Rate as Exemplary when all fields include the required completion of all columns and sections of the information, the information is accurate, selected services will supports and services page indicate: support achievement of the outcomes, and the Primary Service Provider is selected per who will provide the most relevant information on supports and services coaching and modeling.

page is complete and accurate and specific to Child/Family outcomes and strategies

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F2.1. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when services are not being • Work in partnership as an IFSP team to Improvement when the service locations provided in the places where the child spends most of his time identify where services should be provided listed: (e.g., home) to assure that regular caregivers have the are not provided in settings where child

support needed to embed strategies into typically spends the day/week

daily routines and activities.

This section is rated as Acceptable when the Rate as Acceptable when services are being provided in the • Work in partnership as an IFSP team to service locations listed: places where the child spends some of his time (e.g., with identify where services should be provided are only provided in settings where child Grandparents) to assure that regular caregivers have the

spends portions of the day/week support needed to embed strategies into

daily routines and activities.

This section is rated as Exemplary when the Rate as Exemplary when the services are being provided in the service locations listed: places where child spends most of his time (ex., home, with Grandparents, day care) are provided in a mixture of settings

where child typically spends his/her day/week

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F2.2. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Rate as Needs Improvement when services / service • Work in partnership as an IFSP team to Improvement when the services listed: providers: identify the frequency, intensity and method for each service or provider so do specify the frequency, intensity and • don’t appear to provide the supports needed for regular

that services fit into the family’s daily method for each service or provider, but caregivers to be able to address outcomes by embedding

routines and activities, and support appear inappropriate or unrelated to strategies in daily routines and activities achievement of the outcomes achievement of outcomes • have the potential to overwhelm or burden the family

• don’t appear to relate to the child’s developmental status

• appear to be a clinical, direct therapy approach

This section is rated as Acceptable when the Rate as Acceptable when the frequency, intensity and method • Work in partnership as an IFSP team to services listed: for each service or service provider: identify the frequency, intensity and specify the frequency, intensity, and method for each service or provider so

method for each service or provider to • appears to provide the supports needed for regular caregivers that services fit into the family’s daily

support achievement of the outcome(s) to be able to address outcomes by embedding strategies in routines and activities and support

daily routines and activities achievement of outcomes

This section is rated as Exemplary when the Rate as Exemplary when the frequency, intensity and method services listed: for each service or service provider: specify the frequency, intensity, and • appears to provide the supports needed for regular caregivers

method for each service or provider to to be able to address outcomes by embedding strategies in support achievement of the outcome(s) daily routines and activities AND support the building of family

• supports building of family capacity through capacity (documented in the strategies) modeling/coaching and consulting across disciplines through consulting across disciplines and

modeling/coaching with the family

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SECTION G: NATURAL ENVIRONMENTS JUSTIFICATION

• Adequate information and evidence is provided to support the rationale that a child’s needs and outcomes

cannot be achieved in natural settings.

G1. Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Improvement when Rate as Needs Improvement when one or more • Work in partnership as an IFSP team to service delivery location indicates: services are: select service locations that are natural environments for the child one or more services are not in a natural • being provided in a setting that is not a natural

• Justify why the service location better environment for the child and family AND there environment for the child and family, AND meets the needs of the child is no justification or the justification is not based • there is no justification for why the services are being

on the needs of the child, but appears to be for provided in the setting, OR • Develop a plan for when and how services any of the following reasons: for administrative • there is justification but the justification is not based will be moved to a natural setting convenience, fiscal reasons, personnel limitations, on the needs of the child and family or parent/therapist preferences

This section is rated as Acceptable when service Rate as Acceptable when: • Work in partnership as an IFSP team to delivery location indicates: select service locations that are natural • child is receiving all services in natural environments for the child the child is receiving most services in natural environments, OR

• Justify why the service location better environments, and when a service is provided in a • a justification that is based on the needs of child meets the needs of the child setting that is not a natural environment, a illustrates why the services are not be provided in a

justification is included I the IFSP that is based on natural environment • Develop a plan for when and how services the needs of the child, justifying that the setting is will be moved to a natural setting necessary to achieve the outcome

This section is rated as Exemplary when service Rate as Exemplary when: delivery location indicates: • child is receiving all services in natural The child is receiving services in natural environments, OR

environments, and when a service is provided in a • a justification is included in the IFSP that is based on setting that is not a natural environment, a the needs of the child, AND justification is included in the IFSP that is based • a plan is in place to move services into natural on the needs of the child, justifying that the settings setting is necessary to achieve the outcome, AND for each service justified there is a plan to transition interventions into natural settings

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SECTION H: PERIODIC REVIEW OF THE IFSP

• Child/family response to strategies and progress toward achieving child and family outcomes is

documented and necessary changes are made in the IFSP.

H1.1 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Improvement when Rate as Needs Improvement when there is: • Work in partnership as an IFSP team to documentation of the periodic review related to review progress toward outcomes and strategies demonstrates: • inadequate information on how well strategies are assessment information and determine working for the child/family and if child/family

if the strategies, services, and service there is inadequate information on how well strategies outcomes are being achieved providers need to be changed are working for child/family and if child and family

• information focuses on what providers are doing outcomes are being achieved with the child and not on how family is using strategies during daily routines and activities

This section is rated as Acceptable when documentation of Rate as Acceptable when information: • Work in partnership as an IFSP team to the periodic related to strategies review demonstrates: review progress toward outcomes and • describes how well strategies are supporting assessment information and determine information describes how well strategies are working achievement of all child and family outcomes if the strategies, services, and service

toward achieving all outcomes providers need to be changed

This section is rated as Exemplary when documentation of Rate as Exemplary when information: the periodic review related to strategies demonstrates: • describes how well strategies are supporting detailed information describes how well strategies are achievement of all child and family outcomes

working toward achieving all outcomes AND provides • includes examples of child’s functional skills as

examples of child’s functional skills (from observations they relate to progress/lack of progress toward or video, assessment results, etc.) related to progress or achieving outcomes lack of progress toward achieving each outcome

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H1.2 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Improvement when Rate as Needs Improvement when • Work in partnership as an IFSP team to documentation of the periodic review related to family change/continuing without change: review progress toward outcomes and accommodations demonstrates: assessment information and determine if the • does not accommodate family/caregivers strategies, services, and service providers change/continuing without change is NOT need to be changed

accommodating to family/caregivers

This section is rated as Acceptable when Rate as Acceptable when change/continuing • Work in partnership as an IFSP team to documentation of the periodic review related to family without change: review progress toward outcomes and accommodations demonstrates: assessment information and determine if the • accommodates family/caregivers strategies, services, and service providers change/continuing without change is need to be changed

accommodating to family/caregivers

This section is rated as Exemplary when Rate as Exemplary when change/continuing documentation of the periodic review related to family without change: accommodations demonstrates: • accommodates family/caregivers change/continuing without change is • describes how child’s behaviors and skills in

accommodating to family/caregivers AND there is daily routines show progress toward outcomes detailed information on progress toward meeting the outcomes described in terms of child’s behavior and skills related to functioning in family’s everyday routines and activities

32

H1.3 Rating Descriptions Rating Clarification/example How to improve: This section is rated as Needs Improvement when Rate as Needs Improvement when changes or • Work in partnership as an IFSP team to documentation of the periodic review related to continuing without change is not justified by: review progress toward outcomes and developmental progress demonstrates: • progress/lack of progress toward outcomes assessment information and determine if the • changes in the child’s health or developmental strategies, services, and service providers change/continuing without change is NOT justified status need to be changed

by progress, lack of progress, or changes in the child’s health or developmental status

This section is rated as Acceptable when documentation Rate as Acceptable when change/continuing • Work in partnership as an IFSP team to of the periodic review related to developmental without change is justified by: review progress toward outcomes and progress demonstrates: • progress/lack of progress toward outcomes assessment information and determine if the • changes in the child’s health or developmental

strategies, services, and service providers change/continuing without change is justified by status

need to be changed progress, lack of progress, or changes in the child’s health or developmental status

• Provides sufficient documentation

This section is rated as Exemplary when documentation Rate as Exemplary when change/continuing of the periodic review related to developmental without change is justified by: progress demonstrates: • progress/lack of progress toward outcomes • changes in the child’s health or developmental change/continuing without change is justified by status

progress, lack of progress, or changes in the child’s • sufficient detail so reviewer can determine that health or developmental status AND information is the modifications/revisions are appropriate detailed enough for reviewers to determine whether • progress toward outcomes described in terms of modifications and revisions are appropriate AND child’s behaviors and skills consistent with progress toward meeting outcomes

described in terms of child’s behaviors and skills