Functional Outcomes: The Guide for Early Intervention Supports and Services

Outcomes point to where a family wants to go.



Functional outcomes point to where a family wants to go. They provide direction for collaboration between family members and early intervention providers about how to reach a family’s desired outcomes. Too often, IFSPs focus only on child outcomes and do not address family supports from early intervention providers and other community resources (Jung & Baird, 2003; Boone et al, 1998; McWilliam et al, 1998). Identifying functional outcomes with families is the cornerstone for developing the IFSP document since the outcomes specify what should happen for families and children as a result of their participation in early intervention.

The following questions guide early intervention providers and family members in identifying functional outcomes that are meaningful, family-desired, specific and achievable

Measurable criteria for each outcome is included in a different section of the Maryland IFSP document.



Meaningful:

Do the outcomes promote a child’s competence in situations, activities and routines that are meaningful for each family and child?

Meaningful outcomes promote a child’s functioning in three key foundations of early development - social interaction, mastery over environment, and engagement in learning - in ways specific to each family and child (McWilliam, 2002; National Research Council, 2000).

Examples Include
Social interaction (e.g., understanding and expressing emotions, forming friendships, interacting with family members and peers)

Mastery over environment (e.g., caring for one’s self, navigating spaces and places, using tools, toys and objects purposefully in specific activity settings)

Engagement in learning (e.g., acquiring and using information from body and environment in play and relationships, adapting to familiar and novel people or objects in specific situations, figuring out cause and effect)

These three foundations of early development - social interaction, mastery over environment, and engagement in learning - cover the domain-specific skills that have traditionally been identified as child outcomes on IFSPs. Traditional outcomes typically focus on isolated motor, language, social and emotional, cognition, and self-help skills, and often lose sight of the family or community context in which a specific behavior or skill will be used. Meaningful outcomes include a real life context.  For example, how and/or where a child or parent will use an identified action or interaction (Rosenketter, & Squires, 2000).

Examples of functional and traditional child outcomes
Traditional outcomes
Focus on child’s skills within a specific domain 
Functional outcomes
What child and/or family will do in a specific context
Neena will improve eating skills Neena will eat and drink by mouth like other kids during family outings
Tommy will improve expressive language skills or Tommy will say 25 words Tommy will tell mom what he wants to eat and play with so that both are happier with each other.
Jermaine will develop motor skills at the 12-14 month level

Jermaine will decrease muscle tone in his legs
Jermaine will walk on his own with family during after dinner outings 

Examples of functional outcomes for families:

  • Paula and Pete will find a wheelchair for Megan and feel comfortable using it during family outings (Megan gets around her home by rolling over and crawling, but has to be carried on family outings. Pete and Paula are interested in using a wheelchair so they can all go out together, and need help with paying for it.)
  • Sylvia will take Paolo to the park and shopping, by herself (Sylvia has a significant visual impairment and wants to “shine” as a parent and take her son to the library, a park, or the mall,by herself.)


Family-selected:

Are the outcomes, selected by each family, written in language understood by family members?

IFSP outcomes should be written in language that reflects a family's understanding about “where we are going.” The outcomes reflect how family/child knowledge, skills, actions will help a child participate successfully in family and community life. Early intervention providers can help families with IFSP outcomes by using words that a family might say, rather than the professional jargon understood by early intervention providers (Nebraska Department of Education, Early Development Network, 2004; Rosenkoetter & Squires, 2000).

This does not mean writing down word-for-word what a parent says without trying to understand what they really want to happen. For example, when parents identify a very broad outcome, e.g., they would like their child to walk and talk better, it is helpful to clarify what walking or talking would look like and how a child could participate to a greater extent in family/community life before making it an IFSP outcome.

The following vignette illustrates how Jana, a service coordinator, prompted a mother, Mayra, to think more specifically about the daily activities she hoped her son could participate in more fully.

Mayra's Story
"Mayra, when we first met, you told us that you wanted to help Pedro understand language like other children his age,” summarizes Jana. “When we visited you at home to do his evaluation, we looked at how much Pedro understands and what he said. Then we all talked about what we observed. Now it’s time to think about how we can help you and your husband take care of Pedro."

Mayra responds, “I want him to understand what others say to him, just like his brothers did at his age.”

“That’s important, for sure,” agrees Jana. “Can you tell us a little more about the times you would really like Pedro to understand what people are saying to him?”

“Well, he really likes going to nursery school on Mondays and Wednesdays, but has a hard time keeping up with what the teacher says,” explains Mayra. “She plays a song on the tape recorder for snack and Pedro thinks it’s time to go outside. Then when she says it’s time to go back inside after lunch, he runs over to the sandbox. He’s always doing things different than the other kids.”

Jana (wondering if there are other times this happens) asks, “Do you notice this at home too?”

“Oh, yes! There are some things, like getting up in the morning and eating dinner, that we do the same way most of the time, so Pedro knows what’s happening. But when we change his schedule, or go somewhere only one or two times a week, like nursery school or my sister’s, then he has a hard time keeping up.”


Understanding that Mayra really would like Pedro to fit in with the flow of activities at nursery school, at home and his aunt’s home provides a context for a functional outcome that early intervention providers and family can address together. Without this information, it would be easy to misinterpret what Mayra really means by “understanding language like other children.” So far, she has told us what she thinks about an outcome being:

  • Meaningful  (help Pedro “fit in” at his nursery school and at home)
  • Specific  (Pedro will understand what to do and where to go when given a direction)
Regarding the guideline that a functional outcome be understandable to a family and reflect words that a family might use, an outcome could be worded to reflect Mayra’s desires for Pedro as:
Pedro will join activities with others at home and nursery school by understanding and following directions from his family and teacher.



Specific:

Does each outcome identify the positive knowledge, skills or actions for a child and/or family members?

Functional outcomes identify specific behavior or knowledge that support a child’s and family’s participation in family and community life. Non-specific outcomes are very broad and often use words such as improve, increase, change, decrease etc. (e.g., Mina will improve her fine motor skills; Sara will decrease aggressive behavior). Identifying positive and specific actions and skills is one of the key factors in writing family-centered IFSPs (McWilliam, Ferguson, Harbin, Porter, Munn & Vandiviere, 1998).

Examples of specific outcomes:

Family outcome: Charlotte and Bruce will know how well Sonya hears people and sounds.

Family outcome: Darla will be cared for competently in their church nursery while Denise and Denny attend services.

Child outcome: Mina will play with small toys and feed herself little bites of finger food.

Child outcome: Sara will play with other children her age on playground equipment at her local playground.

Child outcome: Chantell will let her family know what she wants and answer simple questions, using words and short phrases.



Achievable?

-DOWNLOAD TABLE 2.1

Can the outcomes reasonably be achieved within 4-6 months?

This guideline for a functional outcome considers whether or not an action, knowledge or skill is achievable by a child or family member within 4-6 months, given the child’s expected rate of progress, family routines and current responsibilities and commitments (Rosenkoetter & Squires, 2000). Parents often think of things they want for their children that will be achieved in the distant future. It is important for early intervention providers to acknowledge that they accept a family’s long-range goal as guiding their supports and services over the next 4-6 months. (Remember that Jana agreed with Mayra that it was very important that Pedro understand language like his brothers did before asking her to describe it more specifically).

Sometimes a parent insists on an outcome that will probably be achieved in more than a year (e.g., Darla will walk by herself). In order to support a family’s desire for this future outcome, use the parent’s preferred wording in the outcome statement. Then, talk with the family about an intermediate step that is achievable in 4-6 months and record that in the criteria section of the IFSP (e.g., Darla will hold on to furniture or another’s hands and take at least 5 steps, 3x per day).

Table 2.1 provides additional examples of functional outcomes with guidelines for avoiding wording that is broad, negative or domain-specific.