Individualized Family Service Plan Quality and Alignment of Child-Focused Outcomes to Federal Outcomes and State Early Learning Guidelines

Abstract

We used two judgment-based scales to evaluate quality features of 623 individualized family service plans (IFSP) contributed by 73 service coordinators in one state. We also explored the alignment between the skills specified in child-focused IFSP outcomes, the three Individuals With Disabilities Education Act (IDEA) early childhood outcome categories, and the knowledge and skill statements included in state early learning guidelines. Findings showed IFSP content generally was family-centered and of good quality. Outcomes were more frequently aligned with the IDEA outcome categories addressing the use of appropriate behaviors to meet needs and the acquisition and use of knowledge and skills. Outcomes were aligned more frequently with early learning guidelines in the areas of physical development, speech/language development, and approaches to learning. We discuss how instruments and procedures could be used to evaluate IFSP quality and determine connections to expected knowledge and skills for all children identified by state and federal programs.

Keywords

individualized family service plans early childhood outcomes early learning guidelines

The individualized family service plan is both a process and a document (Gatmaitan & Brown, 2015) that guides individualized services and supports for infants and toddlers with developmental delays and their families eligible for services under Part C of the Individuals With Disabilities Education and Improvement Act (IDEA). IDEA specifies eight statutory requirements of an IFSP: child’s present level of development; family’s resources, priorities, and concerns; statement of measurable outcomes or goals (see Note 1); specific services necessary; statement of natural environments in which early intervention will be provided; projected dates for initiation of services and anticipated length, duration, and frequency; identification of the service coordinator; and steps to support the transition of the toddler to preschool or other services. Early intervention scholars have identified features of IFSPs that result in quality plans for children and families. These features include alignment between families’ concerns and priorities and the outcomes included in the plans (Ridgley & Hallam, 2006), outcome statements that address specific and functional skills, inclusion of families as implementers of intervention related to outcomes, and natural environments and routines as contexts for intervention (Jung & Baird, 2003; Jung & McWilliam, 2005). In addition, the IFSP should be aligned with information gathered about the child and from the family about the child’s development and family’s routines (e.g., Gatmaitan & Brown, 2015; Jung & Grisham-Brown, 2006; Ridgley, Snyder, McWilliam, & Davis, 2011; Shelden & Rush, 2013).

Studies examining the content of IFSP documents have found they generally include the eight statutory requirements (e.g., Jung, 2010; Jung & Baird, 2003; Jung & McWilliam, 2005). When IFSPs have been evaluated using indicators that reflect quality features, findings have shown most plans lacked a number of these quality features. For example, although IFSPs should include a statement of family’s resources, priorities, and concerns, the outcomes included in the document may not address these priorities and concerns (Jung & Baird, 2003). Outcome statements often do not address functional skills or lack specificity when identifying the skill, conditions for demonstrating the skill, or the criteria for knowing when the skill and outcome have been achieved (Bailey, Winton, Rouse, & Turnbull, 1990; Hughes-Scholes, Gatt, Davis, Mahar, & Gavidia-Payne, 2016; Jung & Baird, 2003; McWilliam, Ferguson, Harbin, Porter, & Vanderviere, 1998). Furthermore, family outcomes have been shown to be included rarely in the IFSP document, despite the encouragement to focus on the family as a whole (Boone, McBride, Swann, Moore, & Drew, 1998; Boone, Moore, & Coulter, 1995; Gallagher & Desimone, 1995; Jung & Baird, 2003; McWilliam et al., 1998; Polmanteer & Turbiville, 2000).

In a few studies, professionals received supports or training to enhance or improve the quality of the IFSP document. Jung (2010) conducted a study in which prompts were embedded into the IFSP form and instruction manual. IFSP quality improved, including outcomes written with more family-centered language, clearly specified behaviors or skills, and greater alignment with family concerns or priorities. In addition, when the form with prompts was used, the IFSPs included families as implementers more often than when it was not used. Boavida, Aguiar, and McWilliam (2014) provided training to practitioners in Portugal on routines-based early intervention, specifically the Routines-Based Interview (RBI; McWilliam, 2010) through face-to-face sessions and follow-up, and examined improvements in the outcomes written. They found the training resulted in IFSPs with fewer and higher quality outcomes. In a similar study, a group of Australian professionals was trained to implement routines-based early childhood intervention that included implementing the RBI. Individualized outcomes were reviewed to explore the relationship in the quality of the RBI and the functionality of outcomes, but no statistically significant relationship was found (Hughes-Scholes et al., 2016).

Over the past decade, the outcomes for infants and toddlers and their families receiving early intervention services have received increased attention due to the implementation of federal requirements for state early intervention and preschool programs to report data on early childhood outcomes under the IDEA (Early Childhood Technical Assistance Center, 2015). States are required to report annually to the Office of Special Education Programs in the U.S. Department of Education the percentage of infants and toddlers with IFSPs who demonstrate improvement in three major outcomes areas: social emotional; acquisition and use of knowledge and skills, including communication skills; and use of appropriate behaviors to meet needs. Recent reports indicated that between 68% and 76% of children with developmental delays or disabilities who received services through early intervention showed greater than expected growth between program entry and exit across the three outcomes areas (Early Childhood Technical Assistance Center, 2017), suggesting that IFSP outcomes might be increasingly focused on developmental or functional skills associated with these outcomes.

Another trend over the past decade has been the development of early learning guidelines or standards (see Note 2) that specify the learning expectations, including the knowledge and skills all young children are to demonstrate and that are widely accepted for children (National Association for the Education of Young Children [NAEYC], 2009a; Peterson, Jones, & McGinley, 2008). Currently, all 56 states and territories in the United States have adopted early learning guidelines for preschoolers and most have early guidelines for infants and toddlers (Administration for Children & Families, Office of Child Care, 2016). The early learning guidelines often are state specific, even though leaders in the field have called for a unified set of early learning guidelines (e.g., Bagnato, McLean, Macy, & Neisworth, 2011). Although development of a unified set of early learning guidelines across states has yet to be realized, a review of early learning guidelines across 21 states determined that infant and toddler guidelines commonly addressed physical development and motor skills, social and emotional development, language and communication development, and cognitive development and general knowledge (Scott-Little, Kagan, Frelow, & Reid, 2009). Scott-Little et al. found that fewer states addressed indicators associated with approaches to learning.

Professional organizations, such as ZERO TO THREE and the NAEYC, have explicitly encouraged developers of early learning guidelines to consider infants and toddlers with disabilities when developing guidelines and supporting resources (NAEYC, 2002; Peterson et al., 2008). Scott-Little and her colleagues (2009) suggested that inclusive programs should use the early learning guidelines as a resource to determine knowledge and skills that should be fostered for all children, while the specific needs of infants and toddlers with disabilities should be the focus of IFSP outcomes. These authors asserted that early learning guidelines complement and strengthen efforts in early intervention to address the broader IDEA child outcomes. Early learning guidelines can help early intervention practitioners and families identify more specific areas of development and learning that could inform the development of individualized child-focused outcomes on the IFSP. Furthermore, Scott-Little and her colleagues encouraged ongoing analysis of the alignment between early learning guidelines and the early childhood outcomes required by IDEA to support the understanding of specific skills within each broad outcome area.

As early interventionists and researchers develop and identify potential strategies for improving the quality of IFSPs, continuing to evaluate IFSPs based on quality features is critical. In addition to previous quality indicators identified in the literature (e.g., Jung & McWilliam, 2005), contemporary analyses should include examining the extent to which skills specified in child outcomes on the IFSP are aligned with the early childhood outcome areas required by IDEA and the knowledge and skills specified in early learning guidelines adopted by states. Such analyses would also help inform areas in which early learning guidelines might need to be modified to ensure they are appropriate for use with children of varying developmental and ability levels (Scott-Little et al., 2009).

The purposes of the present study were to (a) evaluate the quality of a set of IFSP documents obtained in one state as part of a federally funded research project using two judgment-based rating scales, (b) explore the alignment between the skills specified in child-focused IFSP outcomes and the IDEA early childhood outcome categories, and (c) explore the alignment between the skills specified in the IFSP outcomes and the knowledge and skill areas included in early learning guidelines for the state. Exploring the alignment between IFSP outcomes and IDEA early childhood outcomes and early learning guidelines provides information about the extent to which IFSP outcomes are linked to expected knowledge and skill outcomes identified by state and federal initiatives. By exploring the connectedness between what is targeted learning for young children with disabilities in their IFSPs and widely accepted learning targets for all children, substantive information is learned about the IFSP outcomes, enhancing knowledge about the specific content addressed in the IFSP documents. This study is an initial attempt to explore such alignment or connectedness between IFSP outcomes and early learning guidelines and IDEA outcomes. Therefore, one purpose of this study is to provide preliminary information about this additional quality feature of IFSP documents that could inform the work of professionals in the field writing IFSPs with families or guide future studies examining IFSPs across states.

Method

Participants

The IFSPs used in this study were acquired as part of a larger study designed to develop, validate, and evaluate a job-embedded professional development (PD) intervention within one state’s early intervention data system (Ridgley et al., 2011). As part of the larger study, 73 service coordinators were recruited from four early intervention service districts in Tennessee. All service coordinators met the state’s qualifications for being a service coordinator (i.e., a bachelor’s degree and 1 year experience in counseling, early intervention, service coordination, early childhood education, or assessing individuals with disabilities, or a bachelor’s degree with graduate coursework in a related field). Fifty-eight percent of the service coordinators had participated in RBI (McWilliam, 2010) training. Of the service coordinators participating in the present study, 52% reported having a bachelor’s degree, 45% reported having earned a master’s degree, and 1% reported having earned a doctoral degree. Ninety-two percent of the service coordinators were female, and 71% reported their race as Caucasian, 27% African American, and 1% Hispanic. Years of experience as a service coordinator varied, with 35% of service coordinators having 1 year of experience or less, 51% having 1 to 4 years of experience, 10% of service coordinators having 4 to 10 years of experience, and 4% with more than 10 years of experience. All service coordinators in the state were dedicated service coordinators, meaning they did not provide any direct early intervention services to families. They were responsible for coordinating services and service delivery, including development and monitoring of the IFSP.

Deidentified IFSPs from each participating service coordinator were collected from families assigned to their caseload, resulting in 623 IFSPs from individual children/families. The number of IFSPs each service coordinator submitted ranged from 1 to 36 (M = 9; SD = 7). At the time the IFSP was written, children ranged in age from 1 month to 35 months (M = 20.4 months; SD = 9.3). Table 1 shows the demographic characteristics of the children and their families for whom IFSPs were provided. The number of outcomes on each IFSP ranged from 2 to 18, with a mean number of seven outcomes per IFSP (SD = 2.8).

Table 1.

Demographic Characteristics of Children and Families (N = 623).

Characteristic	n	%
Child gender
Male	397	63.7
Female	226	36.3
Child race
White	427	68.5
Black	82	13.2
Hispanic	24	3.9
Other	24	3.8
Did not report	66	10.6
Family income
US$20,000 or less	118	19.0
US$20,001–US$40,000	96	15.4
US$40,001–US$60,000	68	10.9
US$60,001–US$80,000	64	8.7
>US$80,000	77	12.4
Did not report	210	33.7
Eligibility
Developmental delay	392	62.9
Diagnosed condition	231	37.1

Measures

Three measures were used to analyze different features of the IFSPs. One, the Individualized Family Service Plan Rating Scale (IFSP-RS) evaluated the overall quality of the entire IFSP document. The Goal Functionality Scale III-TP (GFS III-TP) evaluated the child outcomes within the IFSP to determine functionality and, in this study, the connection of IFSP child outcomes to federal child outcomes. Finally, the Tennessee Early Learning Developmental Standards (TN-ELDS) alignment review was a researcher-developed tool used to capture alignment of the skills specified in IFSP child outcomes with the knowledge and skills specified in state’s early learning guidelines.

IFSP-RS

IFSP-RS (McWilliam & Jung, 2001) is a judgment-based measure of global IFSP quality. It was developed to assess the extent to which family-centered practices are evident in IFSPs. Thirteen indicators within four subscales (i.e., present level of development, priorities and concerns, outcomes, and natural-environment statement) are rated on a 5-point Likert-type scale anchored to the amount of consistency with family-centered practice (i.e., 1 = least consistent with family-centered practice; 5 = most consistent with family-centered practice). The specific indicators within the Present Level of Development subscale focused on writing, positiveness, and functionality. The specific indicator within the Priorities and Concerns subscale addressed alignment between priorities and concerns statements and IFSP outcomes. The specific indicators within the Outcome subscale addressed writing, necessity, specificity, context appropriateness of the outcome, the family’s role in the outcome, the match between outcomes and associated procedures, and the match between outcomes and priorities or concerns. The Natural Environments subscale included one indicator related to location of services included on the IFSP. For each IFSP, each of the 13 indicators was rated individually, four subscale means were generated, and a total IFSP mean score was calculated.

Although the IFSP-RS indicators are consistent with the indicators used in prior studies, two differences existed in the current study. In some prior studies, the writing indicator was rated after reviewing all components of the IFSP (Jung & Baird, 2003; Jung & McWilliam, 2005). In the present study, similarly to Jung (2010) and Jung, Bradley, Sampson, & McWilliam (2015), writing was rated using two indicators after reviewing the present levels of development section and the outcomes section, respectively, resulting in 13 indicators. In addition, the Natural Environments subscale and associated indicator were labeled “location” in earlier studies.

In a study using the rating scale with 120 IFSPs, the internal consistency score reliability was .88 (Jung & McWilliam, 2005). A principal components analysis yielded a three-component solution accounting for 64% of the variance, with the components labeled outcome writing, natural environments practices, and outcome selection. In an analysis of the same IFSPs using a Rasch partial credit model, item score reliability (α) was .98 (Jung et al., 2015).

GFS III-TP

The GFS III-TP (McWilliam, 2009) was a revision of the Goal Functionality Scale II (McWilliam, 2005) and is a judgment-based measure of the functionality of individual outcomes included on the IFSP. In this study, the GFS III-TP focused solely on child outcomes; outcomes targeting family outcomes were not evaluated. In addition, this version of the tool was used to determine alignment between IFSP child outcomes and the three IDEA child outcomes monitored by the Office of Special Education Programs. When using the GFS III-TP, each IFSP outcome connected to a daily routine and addressing child learning or development was judged on eight indicators using the prompt, “Does the outcome (goal)” (1) emphasize the child’s participation in a routine, (2) state specifically (observable and measurable manner) what the child will do, (3) address a skill that is either necessary or useful for participation in home, “school,” or community routines, (4) state an acquisition criterion (i.e., a statement of when the child can do the skill), (5) have a meaningful acquisition criterion (i.e., one that shows improvement in functional behavior), (6) have a generalization criterion (i.e., using the skill across routines, people, places, materials, etc.), (7) have a criterion for the time frame within which the behavior should be displayed, and (8) specify a skill that aligns with the operational definitions for one of the IDEA child outcomes (choose the IDEA child outcome most closely related to the skill reflected in the IFSP outcome). The three IDEA child outcomes were social-emotional relationships; acquisition and use of knowledge and skills, including communication; and use of appropriate behaviors to meet needs. Each indicator on the GFS III-TP was rated as yes or no. When a yes was indicated for Indicator 8 (i.e., skill specified in IFSP outcome aligns with one of the IDEA child outcome categories), the IDEA outcome category most closely related to the behavior or skill specified in the IFSP outcome was selected. For this measure, the decision was made to require the rater to choose one IDEA child outcome for each IFSP outcome to provide insight into which IDEA outcomes were addressed more frequently in the IFSPs.

For each IFSP, a GFS III-TP indicator percentage score across outcomes and an IFSP mean percentage score were calculated. Specifically, for each IFSP, the percentage of outcomes with a yes rating for each GFS III-TP indicator (i.e., Indicators 1–7, respectively) was calculated by totaling the number of yes responses for each indicator, dividing by the total number of child outcomes, and multiplying the quotient by 100. In addition, a mean percentage score across all child outcomes on the IFSP was calculated by averaging the total percentage scores for each child outcome on the IFSPs. For the IDEA child outcome indicator, the percentage of child outcomes on each IFSP addressing each IDEA outcome was calculated by adding the total number of IFSP child outcomes addressing each IDEA outcome, dividing the total by the total number of child outcomes, and multiplying the quotient by 100.

TN-ELDS alignment review

The early learning guidelines for the targeted state were first adopted and published in 2004 (Tennessee Department of Education, 2004). Although the TN-ELDS were revised in 2013, the 2004 version was used in the present study because these were the guidelines in use at the time of data collection. The 2004 TN-ELDS included seven sections (i.e., theoretical domains), 14 areas of learning, and 53 associated components. Table 2 outlines the specific sections, areas of learning, and associated components addressed in the standards. For each component, the age span at which children might exhibit the skills(s) is identified; this information is outlined in the results.

Table 2.

Sections, Area of Learning, and Associated Components for Tennessee Early Learning Developmental Standards (2004).

Section	Area of learning	Component
Speech/language development	Communication	Receptive language Expressive language Speech
Early literacy	Book knowledge and appreciation	Book-handling skills Looking and recognition skills Picture and story comprehension skills Story reading behaviors
	Early literacy	Book-reading skills Auditory discrimination Phonological awareness Verbal expression and communication Listening and understanding Print awareness Visual discrimination Visual-whole-part-whole relationship Visual sequencing Letter recognition
	Early writing	Early writing behaviors and skills
Math and science	Math	Problem solving and spatial sense Problem solving Numbers Spatial sense to develop understanding of conservation, geometry, and numbers Patterns Spatial sense Number and operations Patterns and algebra Geometry and spatial sense Problem solving and analyzing data Measurement
Math and science	Science	Sensory awareness, observation, and exploration Sequencing and time Problem solving Life science Earth and space science Physical science
Social studies	Social studies	Human interactions/culture History Geography Economics
Creative arts	Creative arts	Music Art Movement and dramatic play
Approaches to learning	Approaches to learning	Self concept Self control Cooperation Management of self within the learning environment
Physical	Gross motor	Movement and coordination
	Fine motor	Fine motor
	Health	Health status and practices Health practices Self-help skills
	Health and safety	Self-help and safety
	Health practices	Personal and social responsibility

The research team developed the TN-ELDS alignment review as a tool for identifying the specific TN-ELDS developmental areas and knowledge and skills components addressed in IFSP child outcomes. For each IFSP, coders reviewed each IFSP outcome, identified if the outcome was a child-focused outcome or a different type of outcome (see description below), and then identified the TN-ELDS component they judged to be most aligned with the behavior or skill specified in the child-focused outcome. If an IFSP outcome addressed more than one TN-ELDS component, the outcome was aligned with all of the components it addressed. To help make decisions about alignment, the examples of skills associated with each TN-ELDS component included in the TN-ELDS document produced by the State (i.e., knowledge and skills examples) were reviewed as needed. In addition, the research team developed decision rules to guide decision making (e.g., “When a skill is specified in an IFSP child outcome that is aligned with more than one of the TN-ELDS components, assign the outcome to all components in which it fits”; “When aligning a skill specified in an IFSP child outcome to the math component of-problem solving and spatial sense, also review the skill specified in the outcome for alignment to the science component-sensory awareness, observation, and exploration, and any other related components.”).

Some outcomes on IFSPs were not directly focused on child skills (e.g., finding child care) or focused on general, nonspecific child outcomes (e.g., provide strategies that engage the child in age-appropriate skills) and could not be aligned with the TN-ELDS developmental areas and components. Therefore, when IFSP outcomes focused on family issues (e.g., finding child care; identifying date nights for parents), the outcome number was noted on the review form as an outcome not related to the TN-ELDS. When an IFSP outcome focused on child development or learning but was not specific in identifying a developmental area or component of learning (e.g., provide information on child development; provide strategies that engage the child in age-appropriate skills), the outcome number was noted as an outcome that generally addressed the TN-ELDS.

After all outcomes on each IFSP were reviewed, the total number of outcomes associated with each TN-ELDS component, not related to the TN-ELDS, generally addressing the TN-ELDS, and addressing one or more TN-ELDS component category were calculated. These summary data are the focus of the present study.

Before the present study was conducted, the TN-ELDS alignment review was piloted using 65 IFSPs with 263 total outcomes. The number of outcomes on each of the IFSPs ranged from 2 to 8 (M = 4.1; SD = 1.4). The mean number of child-focused outcomes on each IFSP aligned with one or more TN-ELDS component was 2.5 (range = 1–7; SD = 1.3). The mean number of outcomes on each IFSP that were not child-focused outcomes and therefore not related to the TN-ELDS components was 1.4 (range = 1–5; SD = .7). The mean number of outcomes on each IFSP that generally addressed the TN-ELDS components was 0.1 (range = 0–2; SD = .4).

In the pilot study, 35 IFSPs of the 65 total IFSPs were coded by two researchers. Interrater agreement for identifying alignment of IFSP outcomes with TN-ELDS components was 94.3% on 140 total outcomes (range = 2–8; M = 4; SD = 1.6). After the pilot study, the TN-ELDS decision rules were revised to provide more precise decision rules for aligning specific skills on child-focused outcomes with TN-ELDS components. In addition, the TN-ELDS Alignment Review Form was revised to provide space to total the number of outcomes aligned with each component and each area. Based on pilot study findings, the TN-ELDS Alignment Review Form appeared feasible to use to evaluate alignment of skills specified in IFSP outcomes with early learning guidelines.

Interrater agreement

For each measure used in the present study, a subset of IFSPs was independently selected for interrater agreement and was coded by two researchers to monitor and calculate interrater agreement. Throughout the study, each of the three measures was applied to the IFSPs independent of the other measures. Therefore, for each measure, when completing interrater agreement, IFSPs were randomly selected from the total IFSP pool. A total of 134 IFSPs of the 623 total IFSPs (21.4%) were coded by two researchers using the IFSP-RS. Interrater agreement across the four subscales ranged from 81.7% to 93.2%, with an overall agreement of 85.9%. Specific indicator agreement ranged from 74.7% (i.e., writing in the Present Level of Development subscale) to 96.8% (i.e., active).

The GFS III-TP was used by two researchers to independently code 129 IFSPs (i.e., 20.7% of the total sample) with 599 child outcomes (i.e., family outcomes were not addressed in the GFS III-TP measure). Overall agreement across all outcomes and indicators was 81.0%, with a range across all indicators of 57.4% to 100% agreement. The three indicators with low agreement (57.4%, 64.7%, and 56.1%, respectively) were Indicator 2 (i.e., state specifically what the child will do), Indicator 5 (i.e., have a meaningful acquisition criterion), and Indicator 6 (i.e., have a generalization criterion). Interrater agreement for the three IDEA child outcomes indicators were 90.5% for social-emotional relationships; 76.1% for acquisition and use of knowledge and skills, including communication; and 82.5% for use of appropriate behaviors to meet needs.

A total of 158 IFSPs (i.e., 25.4%), with 1,085 total outcomes were reviewed independently by two researchers using the TN-ELDS alignment review. The number of outcomes on each of these selected IFSPs ranged from 2 to 13 (M = 6.9; SD = 2.4). Interrater agreement for identifying alignment of IFSP outcomes with TN-ELDS sections was 97.3%, with component agreement ranging from 84.2% to 100%.

Results

The IFSP-RS is a measure of global IFSP quality anchored to its consistency with family-centered practices. The overall mean for the IFSP-RS for the 623 IFSPs was 4.2 on the 5-point Likert-type scale. Subscale means ranged from 3.6 (i.e., Natural Environments subscale; SD = 1.3) to 4.3 (i.e., Outcomes subscale; SD = 0.4), with indicator means ranging from 2.9 (i.e., outcome-context appropriate; SD = 1.6) to 4.8 (i.e., outcome-necessity; SD = 0.4). Table 3 shows the mean scores for IFSP-RS indicators, the four subscales, and the overall scale.

Table 3.

IFSP-RS Quality Indicator Ratings (N = 623).

Indicator	M	Minimum	Maximum	SD
Present Level of Development subscale	4.2	1.0	5.0	0.5
Writing	3.4	1.0	5.0	0.8
Positive	4.6	1.0	5.0	1.0
Functionality	4.6	1.0	5.0	0.5
Priorities and Concerns subscale	3.9	1.0	5.0	1.1
Priorities and concerns with goals	3.9	1.0	5.0	1.1
Outcome subscale	4.3	1.8	5.0	0.4
Writing	4.2	1.0	5.0	0.9
Active	4.8	1.0	5.0	0.5
Necessity	4.8	1.7	5.0	0.4
Specificity	4.1	1.0	5.0	0.8
Context appropriate	2.9	1.0	5.0	1.6
Family’s role in intervention	4.8	1.0	5.0	0.5
Match between outcomes and procedures	4.8	1.5	5.0	0.5
Match between outcomes and priorities/concerns	3.7	1.0	5.0	1.2
Natural Environments subscale	3.6	1.0	5.0	1.3
Location	3.6	1.0	5.0	1.3
Overall score	4.2	2.1	4.9	0.4

Note. Rating scale ranges from not consistent with family-centered practice (1) to most consistent with family-centered practice (5). IFSP-RS = Individualized Family Service Plan Rating Scale.

The GFS III-TP was used to evaluate the quality of child outcomes on the IFSPs. For the 623 IFSPs evaluated using the GFS III-TP, 3,328 child outcomes were written, and the number of child outcomes on IFSPs ranged from 1 to 16 with a mean of 5.34 (SD = 2.55). Across the 623 IFSPs, 66.0% of outcomes addressed all seven GFS III-TP indicators. Across all IFSPs, the mean percentage of outcomes per IFSP addressing the indicator “address a skill that is either necessary or useful for participation in home, ‘school,’ or community routines” was 93.5% (SD = 3.5), while the mean percentage of outcomes per IFSP addressing the indicator “states an acquisition criterion” was 91.3% (SD = 25.5). Across all IFSPs, the least frequently addressed indicator was “has a generalization criterion”; the mean percentage of outcomes per IFSP was 19.1% (SD = 24.7). Table 4 shows the GFS III-TP mean percentage scores, standard deviations, and range for all indicators and overall.

Table 4.

GFS III-TP Scores (N = 623).

Indicator	M %	Minimum	Maximum	SD
Emphasize child’s participation in a routine	75.6	0.0	100	36.5
State specifically (i.e., in an observable and measurable manner) what the child will do	44.5	0.0	100	30.6
Address a skill that is either necessary or useful for participation in home, “school,” or community routines	93.5	12.5	100	13.5
State an acquisition criterion (i.e., an indicator when the child can do the skill)	91.3	0.0	100	25.5
Have a meaningful acquisition criterion (i.e., one that shows improvement in functional behavior)	62.8	0.0	100	32.3
Have a generalization criterion (i.e., using the skill across routines, people, places, materials)	19.1	0.0	100	24.7
Have a criterion for the time frame	74.8	0.0	100	33.6
Total GFS III-TP	66.0	7.1	100	18.8

Note. M % = Mean percentage of child outcomes per IFSP addressing the indicator. GFS III-TP = Goal Functionality Scale III-TP; IFSP = Individualized Family Service Plans.

The skills specified in all child outcomes aligned with at least one of the IDEA child outcomes. Raters judged that across all IFSPs, the average percentage of outcomes that addressed the IDEA social-emotional outcome was 14.4% (range = 0–100; SD = 19.1). The average percentage of outcomes across all IFSPs that addressed the IDEA outcome focused on acquisition and use of knowledge and skills was 39.6% (range = 0–100; SD = 28.2). An average of 45.7% of IFSP child outcomes across all IFSPs (range = 0–100; SD = 27.2) addressed the third IDEA outcome, using appropriate behaviors to meet needs.

The TN-ELDS alignment review included review of all outcomes on the IFSP to determine which outcomes had child behaviors or skills that could be aligned with the state early learning guidelines. The total number of outcomes on the IFSPs ranged from 2 to 18 (M = 7.0; SD = 2.8). The total outcomes per IFSP in which behaviors or skills specified in the outcome were aligned with the components included in the TN-ELDS (i.e., child outcomes) ranged from 0 to 16 (M = 5.2; SD = 2.5). The number of outcomes in which behaviors or skills specified in the outcome was not related to the TN-ELDS (i.e., addressed content other than child development and learning) ranged from 1 to 6 (M = 1.5; SD = 0.8). The number of outcomes generally addressing the TN-ELDS (i.e., not specific in identifying a developmental area or component of learning) ranged from 0 to 4 (M = 0.3; SD = 0.6). Table 5 shows the mean percentage of outcomes per IFSP that aligned with each TN-ELDS section and component.

Table 5.

Percentage of IFSP Child Outcomes Aligned With Tennessee Early Learning Developmental Standards.

Section	Component	Age span (months)	M %^a	Range	SD
Speech/language development			43.2	0–100	28.9
	Receptive language	0–60	16.3	0–100	20.9
	Expressive language	0–60	36.6	0–100	26.9
	Speech	9–60	29.3	0–100	24.9
Early literacy			7.2	0–100	16.3
	Book-handling skills	0–24	0.9	0–100	5.8
	Looking and recognition skills	9–24	3.3	0–100	10.6
	Picture and story comprehension skills	9–30	2.0	0–100	7.6
	Story reading behaviors	13–36	0.3	0–50	2.9
	Book-reading skills	25–30	0.4	0–50	3.2
	Auditory discrimination	25–36	0.3	0–100	4.2
	Phonological awareness	25–60	0.0	0–13	0.5
	Verbal expression and communication	37–60	0.9	0–100	6.9
	Listening and understanding	37–60	0.6	0–50	3.7
	Print awareness	37–60	0.1	0–33	1.3
	Visual discrimination	37–60	0.4	0–33	2.8
	Visual-whole-part-whole relationships	37–60	0.5	0–50	3.3
	Visual sequencing	37–60	0. 0	0	0.0
	Letter recognition	37–60	0.2	0–50	2.6
	Early writing behaviors and skills	9–30	1.5	0–100	7.0
Math and science			17.5	0–100	19.9
	Problem solving and spatial sense	0–60	10.5	0–100	15.1
	Problem solving	19–36	2.4	0–100	8.3
	Numbers	19–60	1.0	0–50	5.4
	Spatial sense to develop understanding of conservation, geometry, and numbers	19–60	1.4	0–50	6.0
	Patterns	25–60	2.4	0–100	8.9
	Spatial sense	25–36	0.9	0–50	4.6
	Number and operations	37–60	0.1	0–25	1.2
	Pattern and algebra	37–60	0.8	0–50	4.1
	Geometry and spatial sense	37–60	0.1	0–50	2.1
	Problem solving and analyzing data	37–60	0.1	0–33	1.6
	Measurement	37–60	0	0	0
	Sensory awareness, observation, and exploration	0–36	15.5	0–100	18.7
	Sequencing and time	25–36	0.6	0–50	4.4
	Problem solving	25–36	0.1	0–50	2.1
	Life science	37–60	0.0	0–25	1.0
	Earth and space science	37–60	0	0	0
	Physical science	37–60	0	0	0
Social studies			13.4	0–100	19.1
	Human interactions/culture	0–60	12.6	0–100	18.4
	History	19–60	1.2	0–50	5.5
	Geography	31–60	0.0	0–20	0.8
	Economics	49–60	0	0	0
Creative arts			23.0	0–100	24.9
	Music	0–60	3.5	0–50	8.9
	Art	0–60	6.2	0–100	12.1
	Movement and dramatic play	0–60	16.0	0–100	21.2
Approaches to learning			39.7	0–100	30.6
	Self concept	0–60	19.8	0–100	22.9
	Self control	0–60	19.7	0–100	22.8
	Cooperation	9–60	4.3	0–100	10.5
	Management of self within the learning environment	49–60	0.3	0–50	3.1
Physical			56.7	0–100	30.3
	Movement and coordination	0–60	27.3	0–100	24.9
	Fine motor	0–60	29.1	0–100	23.9
	Health status and practices	0–36	8.3	0–100	14.5
	Health practices	19–30	13.1	0–60	15.1
	Self-help skills	31–36	9.0	0–67	13.1
	Self-help and safety	37–48	1.6	0–50	6.1
	Personal and social responsibility	49–60	0.3	0–33	2.7

Note. Section means bolded. IFSP = Individualized Family Service Plans.

Represents the mean percentage of child outcomes per IFSP aligned with each section or component.

Discussion

The purpose of this study was to describe quality features of a sample of 623 IFSPs written by 73 service coordinators in one state. In addition, we explored the content alignment between behaviors or skills specified as part of IFSP outcomes and the IDEA early childhood outcome categories as well as with the early learning guidelines for the state.

Overall Quality of the IFSP

Scores on the IFSP Rating Scale suggest the present sample of IFSPs generally was reflective of family-centered practices with the total mean score exceeding 4 on a 5-point scale. The Outcome subscale had the highest mean score of the four subscales that are part of the rating scale. Mean scores for indicators under this subscale all exceeded 4 on a 5-point scale, with the exception of the indicator focused on context appropriateness, which had a mean less than 3. This indicator is designed to evaluate the extent to which outcomes and strategies are able to be embedded in daily activities and routines rather than needing specialized times, places, objects, or people (McWilliam et al., 1998). A mean score less than 3 suggests the outcomes and strategies, as written, generally were connected to a specific service or professional rather than the daily activities and routines of the child or family. Routines or natural activities that would be appropriate contexts for embedded learning were not specified in all IFSPs, which is inconsistent with recommended practices in early intervention (Division for Early Childhood, 2014). Nevertheless, the mean score for the context appropriate indicator in the present study was very similar to the mean score reported by Jung (2010) in her analysis of 188 IFSPs obtained from a sample of 94 service coordinators in Kentucky.

The other IFSP Rating Scale indicators with a mean less than 4, indicating poorer quality, were the writing indicator in the Present Level of Development subscale, priorities and concerns with outcomes indicator, match between outcomes and priorities/concerns indicator, and location indicator. Writing in the Present Level of Development subscale evaluates the extent to which the language describing development in each domain, strengths, and needs is family friendly. A rating of 5 indicates that the information is written in a manner that would likely be clear to families. Many times, the information included in this section is taken from developmental assessment reports, RBI details, or other related information. The ease with which service coordinators are able to include these details using family friendly language often varies based on the process used to gather the information. Developmental assessment reports often provide less family friendly language. Prior studies evaluating the quality of writing within IFSPs have had mixed results (Jung, 2010; Jung & Baird, 2003).

Two indicators evaluated the connectivity between the priorities and concerns identified by families and the resulting IFSP outcomes. Other studies evaluating these criteria found that IFSPs generally have outcomes that address priorities or concerns/or a priority or concern has a corresponding outcome included (Jung, 2010; Jung & Baird, 2003). Results from the present study suggest the sample of IFSPs rated included outcomes that were driven primarily by professionals rather than by the priorities and concerns of families. When service coordinators are reminded and prompted to refer to the priorities and concerns identified by families (Jung, 2010) or use a process in which families choose the outcomes they want to address in the IFSP (McWilliam, 2010), outcomes are more clearly connected to the priorities and concerns of families.

The natural environments indicator was designed to evaluate the settings within which early intervention services would be provided. A rating of 5 indicated that all early intervention services would be received in natural environments, such as home and community-based settings, whereas a rating of 1 would indicate all services were planned to be provided in segregated settings (McWilliam & Jung, 2001). In the 120 IFSPs evaluated by Jung and Baird (2003), this indicator had a mean score of 4.5, which is relatively higher than the mean score in the current study (i.e., M = 3.6). This indicator is directly associated with the service delivery systems established in states and communities. At the time of data collection, Tennessee reported 88% of infants and toddlers receiving early intervention had a primary services setting of home or community based (U.S. Department of Education, 2012). Although some early intervention services were provided in home- and community-based settings, most occupational, physical, and speech/language therapy services were provided in clinics or other segregated settings.

Functionality Quality of Child Outcomes

Findings associated with the functionality quality of child outcomes as measured by the GFS III-TP showed IFSP child outcomes were generally functional. On average, more than 75% of the IFSP outcomes emphasized the child’s participation in an activity or routine, but based on findings from the IFSP rating scale, these outcomes and the activities and routines in which they were addressed might not have been priorities of the family. On average, more than 90% of the IFSP child outcomes rated in the present study addressed a skill that was necessary or useful or included an acquisition criterion.

Other studies have used the Goal Functionality Scale III (McWilliam, 2009), an earlier version of the tool, which included rating each criterion on a 1 (not at all) to 4 (very much) rating scale (Boavida et al., 2014; Boavida, Aguiar, McWilliam, & Correria, 2016; Hughes-Scholes et al., 2016; Rakap, 2015). Boavida and colleagues (2014) and Hughes-Scholes et al. (2016) found results similar to those in the current study for the presence of GFS-III criterion related to necessity or usefulness and inclusion of an acquisition criterion. Rakap (2015), in a review of 100 individualized education programs developed for preschool children with disabilities in Turkey, found that professionals generally included skills that were necessary or useful (M = 2.9) in goals, but were unlikely to include acquisition criterion (M = 1.0).

Alignment of Skills Specified in IFSP Child Outcomes With IDEA Outcomes and Early Learning Guidelines

The skills specified in the IFSP child outcomes included in this study were aligned with each of the IDEA child outcomes and the early learning guidelines for the state. Outcomes were more frequently aligned with two IDEA outcome categories: (a) the use of appropriate behaviors to meet needs and (b) acquisition and use of knowledge and skills. Fewer outcomes were aligned with the social-emotional outcome, despite the recognized importance of addressing and assessing social-emotional development and learning during the early childhood years, including for infants and toddlers with disabilities (Darling-Churchill & Lippman, 2016).

The TN-ELDS alignment review indicated the early learning guidelines in physical development, speech/language development, and approaches to learning were addressed in IFSP outcomes more frequently than early literacy, math and science, social studies, and creative arts. The combination of these data sources indicates that IFSPs are somewhat focused on the areas that federal and state education agencies have indicated should be priorities. The TN-ELDS alignment review highlights a lack of focus in child-focused IFSP outcomes on specific early literacy learning guidelines related to engaging with books. Although supporting the early literacy development of all infants and toddlers is valued and encouraged by early childhood professional organizations (e.g., NAEYC, 2009b; ZERO TO THREE, 2003), families receiving early intervention services may not view this early literacy skill area as an immediate priority. Alternatively, service coordinators and families might discuss and identify engaging with books as a strategy for promoting receptive or expressive communication development, a frequently targeted skill area. This finding suggests that early intervention programs could benefit from integrating early learning guidelines within their work to strengthen their efforts to support children’s acquisition of widely accepted knowledge and skills and develop cohesiveness across programs (Scott-Little et al., 2009).

Limitations of the Present Study

Several limitations of the present study are noted. First, the number of IFSPs contributed by each service coordinator varied with some service coordinators contributing up to 36 IFSPs. Given the exploratory focus of the present study, we did not conduct analyses that accounted for the nesting of IFSPs within service coordinators. Second, the IFSPs were collected from only one state. The training and processes instituted by the targeted state focused on the IFSP is likely reflected in these data. Third, interrater agreement for three indicators of the GFS III-TP was low. Fewer than 50% of the outcomes included two of the three GFS III-TP indicators: “state specifically what the child will do” and “have a generalization criterion.” More than 50% of the outcomes, however, included the indicator “have a meaningful acquisition criterion.” With interrater agreement less than acceptable, data for these indicators should be interpreted cautiously. Finally, this was the first study using the TN-ELDS alignment review. The tool was developed using the initial version of the early learning guidelines rather than the most current. Using the latest version of the early learning guidelines would provide more relevant information to practitioners. However, the overarching content included in the 2004 version of the guidelines was consistent with current guidelines (Tennessee Department of Education, 2013) and the process used for aligning the IFSP outcomes with the guidelines would be applicable to other state’s early learning guidelines. Interrater agreement with the TN-ELDS alignment review was acceptable. More research is needed to confirm the reliability and utility of the information gathered when using this tool and process.

Implications for Future Research and Practice

Although the present study used IFSPs from one state, the instruments and processes might be useful for personnel working in other early intervention programs at local and state levels. This study described processes that can be used to identify how knowledge and skills specified in IFSP child-focused outcomes aligned with content included in state early learning guidelines and IDEA child outcomes. The present study provides processes that state administrators might use when evaluating the quality and content of IFSPs.

Considering the extent to which IFSPs address widely accepted early learning guidelines and functional outcomes would facilitate use of these guidelines and provide a context for increasing providers’ and families’ awareness and integration of learning expectations that are appropriate for all children. As states develop early childhood initiatives focusing on early literacy or social-emotional development and learning, early intervention providers can evaluate their inclusion of knowledge and skills and related to these areas, enhancing cohesiveness across state programs and initiatives. Furthermore, by purposefully focusing on early learning guidelines and IDEA child outcomes when developing IFSP child-focused outcomes, families and caregivers will become more informed about developmental expectations and resources available for supporting their children’s development (Scott-Little et al., 2009).

The present study highlights the need to evaluate the quality and the content included in IFSPs on an ongoing basis. Early intervention program administrators should provide regular opportunities to support service coordinators and others involved in the writing of IFSPs with developing strategies for ensuring outcomes are written that align with families’ priorities and include activities and routines that are logical and natural for the targeted skills to be addressed. Another area of focus for administrators should be to help families and teams identify individually appropriate outcomes that align with widely accepted early learning expectations that will position children to develop skills that support their ongoing learning and development in variety of contexts. The GFS III-TP data from the present study suggest that providers could benefit from discussion about specificity within IFSP outcomes, particularly related to writing IFSP outcomes that include measurable and observable skills. A heightened focus on the defining characteristics of measurable and observable skills, examples and nonexamples, and the purpose and usefulness of this quality feature could enhance early intervention providers’ knowledge and skills about writing quality outcomes in collaboration with families.

The current study included a relatively large sample of IFSPs from one state. Although early intervention practices have advanced over the past 25 years, findings from the present study suggest the quality of IFSPs has improved, but continues to be variable. With the adoption of early learning guidelines and IDEA early childhood outcomes, additional research is needed to explore how IFSPs are addressing developmental and learning expectations for all children and supporting individualization for each child and their family. Exploring how the early learning guidelines and the IDEA early childhood outcomes align with families’ priorities and concerns and guide the work of early interventionists would be helpful to the field. As efforts to create unified frameworks and assessment systems continue to guide the work of all early childhood practitioners supporting young children, research of this type could support the alignment and use of common language and tools for supporting children with and without disabilities in natural environments.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Work reported in this article was supported, in part, by a grant from the National Center for Special Education Research in the Institute of Education Sciences to Siskin Children’s Institute (R324A070003). The views expressed are those of the authors, not the funding agency.

ORCID iD

Robyn Ridgley

Notes

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