IFSP Development, Practical Strategies

How to Get from “I just want him to walk” to a Measurable IFSP Outcome

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?

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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!

 

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7 Comments to “How to Get from “I just want him to walk” to a Measurable IFSP Outcome”

  1. I LOVE this topic and as a trainer, it is near and dear to my heart. I think that question, “What does it look like?” really opens up that discussion. One SC shared a story when she asked this question about meal time and it turned out that what the family REALLY wanted was for the child to be able to sit at the table while the family was eating. It was about a social activity much less than an “eating goal.” Without that additional question and hearing how the parent would perceive success, the IFSP outcome probably would have included something like, “Sally will eat three bites of food without choking”…blah, blah, blah when REALLY what the family wanted was a better seating situation so Sally could be comfortable and participate in this important family mealtime routine.

    • This is another great example of what happens when you ask the right questions! Every person on the team can perceive the outcome differently without all of the info. Thanks Cori!

  2. I also love this topic and when I was a service coordinator I used many of the same strategies to help get from the family’s priority to a measurable outcome. My favorite follow up question was “What will be different or better for you, your family, and/or Jason when he is able to walk”….or talk….or whatever the priority is. One thing I will say though is that the outcomes we often developed were not quite as specific as the example that was given in this article as we tried to stay away from specific numbers (i.e 20 feet and once a week for 4 weeks). We likely would have generalized the outcome to the activity the family wanted to improve…so an example would have maybe looked more like this: “Jason will walk independently from the elevator to the play area when his family visits the mall.” I am not sure there is a right or wrong way when it comes to the specifics as long as it is meaningful to the family and measurable upon review.

    • I really like your question, Sarah, about what will be different or better for the family. Every family has ideas about how things could be better so it can be a great place to start the conversation. In VA, our IFSP is used as a payor document meaning that it’s tied to reimbursement sources such as insurance and Medicaid. Because of this, we try to be as specific as we can when making goals measurable. We hope that being specific helps everyone on the team understand when the outcome will be met too. How outcomes are written does vary somewhat across states, but like you said, at the end of the day, the outcome needs to be meaningful and measurable over time – two very important points about outcome development. Thanks for adding your voice to this discussion!

  3. I sometimes ask parents to complete the following sentence- “Things will be easier or better or make me proud when “My child can…….” I ask them to complete the sentence with an action, and I provide some prompts (based upon what was discussed previously) such as- walk, sit in a grocery cart for 15 minutes, point to request a toy, give me a hug, say good bye, good to church nursery, etc). Then I ask them what time of day or activity or place would they most want to see that happen? If they have talked about how hard it is for the child to separate- is the hardest time at bedtime, drop off at child care, etc? Or is it something that they want the child to do in the same tradition as other children in the family? Participate in worship services by saying ‘Amen!’- at the right time, for example.

    • This is a great process, Lynne! What really struck me is how you ask the parent to think about what would make them proud. I’ve never thought of asking that but it’s a really nice prompt. Following your first sentence with asking when they want to see it happen gives the context and can lead right into a discussion that helps make the goal measurable. The answers to these questions could be different for every family and really help you truly individualize the IFSP. I love these strategies!

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