Figuring out how to measure IFSP outcomes is always the elephant in the room when talking about writing IFSPs. Individualizing outcomes, measuring them, taking the time to make sure they reflect family priorities, trying to write them so that they will meet requirements and make the insurance company happy (at least in Virginia)…all of these important yet challenging aspects of outcome development can really hang up an IFSP team.
Determining which outcomes to write, what words to use, what context to describe, and how to measure them are all so important to developing an IFSP that is meaningful to the family. The IFSP belongs to the family. The outcomes should be written so that the parent (and other team members) will feel confident in understanding when the goal is met. The awesome part of the process is that you, as the service coordinator or other team leader, have an invaluable resource on your team to help you figure out how to define and measure the outcome – the parent.
Asking that Additional Question
You’ve probably asked a parent a question like “what would you like for your child to be able to do?” or “what are your goals for your child?” Questions like these can elicite broad dreams or specific milestones, depending on the parent’s priorities and how you facilitate the conversation. When a parent replies “I just want him to walk!” he or she is being honest. For the purpose of writing the IFSP outcome, though, which needs to be functional, measurable, and reflect a natural context, you need to probe a little further. Asking additional questions like “what would it look like to you when he’s walking?” – even though this seems like a silly question with an obvious answer – can help the IFSP team, including the parent, flesh out the outcome and how to measure it.
Here’s an Example
One time I asked a mother these questions, and at first she looked at me with eyebrows raised as if saying “isn’t it obvious?” I laughed with her and told her that figuring out what walking looks like to her will help us understand how to measure the outcome. I asked another question to help her think about this – “how will things be easier for you when he can walk?” She thought about this and told us that when her son could walk when they go to the mall, which they did about once a week, things would be much easier for her. At that time, she had to push her infant in a stroller and carry her almost 2 year old on her hip because he couldn’t walk. When her son could walk by holding her hand or at least by toddling nearby, this would make things easier for her. This rich information provided the team with the context for the outcome and led to a discussion about criteria to measure it. The outcome we developed looked something like this: Jason will walk independently 20 feet from the elevator to the play area when his family visits the mall once per week across 4 weeks. Everyone on the team agreed that when Jason was able to walk to the play area independently across 4 visits to the mall, then the outcome would be met. Asking those additional questions provided the information needed to better understand the mother’s priority and reflect that on the IFSP. Intervention will address Jason’s mobility at home, at the mall, at daycare or wherever the intervention visits occur, but we will know when Jason has met the outcome when he can walk at the mall like his mother wanted.
Words Do Matter
There are folks out there (I hope you aren’t one of them) who think that how outcomes are written is semantic, that the words don’t matter. Put yourself in the shoes of the parent. Imagine if I had told Jason’s mother that the IFSP outcome would be “Jason will walk 20 feet during 4 therapy sessions.” What message does this send to her? Who is responsible for getting him to walk – the interventionist at the session. When the outcome reflects her priority and a location that is meaningful to her, who becomes responsible? The “20 feet” is the same, but measuring it as the distance between the elevator and the play area at the mall gives her a familiar, meaningful frame of reference and fun time in their family’s life to monitor Jason’s progress. Supporting that pivotal parent role starts with how the IFSP is written.
A Golden Opportunity
Think of the outcome development process as a golden opportunity to support the parent’s participation in the entire early intervention process, to help him/her feel like a valuable member of the child’s team. Writing outcomes on the initial IFSP with this in mind also sets the stage for the purpose of the plan, which is to support the parent in enhancing the child’s development between intervention visits during those rich opportunities that naturally happen on family outings like trips to the mall.
What other questions do you ask to help the team develop IFSP outcomes? How do you help the team move from the concern “I just want him to walk…or talk…or sit up…” to an individualized outcome?
Need more info about IFSP outcome development? Visit the VA Early Intervention Professional Development Center’s IFSP & Outcome Development page. Do you know of other great resources? Please share them below!