Information for Professionals

What makes ECHO Framework different?
1. It uses the 3 Global Child Outcomes (GCO)

It is the first early intervention service framework in Singapore to adopt and adapt the 3 GCOs, which US states are required to use when reporting data to the US government's Office Of Special Education Programmes. The GCO, which were designed to paint a functional and holistic portrait of a child's development across settings, have been adapted to Singapore's unique context via the ECHO Framework. GCO also serve to guide goal setting, intervention planning and progress monitoring for the child.

2. It is a practical tool that helps families play a more active role in their child's development

The ECHO Framework teaches parents how to conduct very basic therapy for their children outside of therapy centres, clinics & school hours through the Incidental Teaching approach. Capitalising on natural learning opportunities in daily life makes early intervention more efficacious and efficient, and gives parents an important sense of empowerment. This leads to deeper partnerships between parents and therapists, creating a stronger support system around the child.

3. It ensures that trans-disciplinary collaboration is systematic, not left to chance

The ECHO Framework helps an organization systemize the trans-disciplinary teaming approach to early intervention. By providing a common frame of reference and work processes validated during its pilot phase, the ECHO Framework helps staff work more effectively across disciplines as they synthesize findings from multiple sources. Organisations attain greater consistency of quality and fidelity to measure outcomes.

“By learning to use the teachers' techniques at home, we are seeing my son progress better."
- Madam Lai, parent of a 6-year-old boy with autism
7 Steps of ECHO Framework

Functional Assessment

1

The RBI is an interview with a child's caregivers conducted by a social worker, to gather information about the daily activities of the child and family. It aims to identify priorities for intervention. During a RBI, the social worker documents the family's daily routines from the time the first person in the house wakes up, to the time the last person goes to bed.

Interviewees may be parents or anyone who contributes significantly (more than 15 hours of a child's week) to the care of the child, such as teachers, grandparents, domestic helpers, etc. It paints a comprehensive picture of how a child participates in his or her daily environments to achieve the 3 Global Child Outcomes (3GCO), and what new skills the child needs to learn to function better in everyday contexts.

 
2

The SRO assesses a child's level of functioning in an EIPIC centre, enrichment centre or preschool. It is put together jointly by a child's occupational therapist, speech therapist, psychologist and teacher, as each first observes the child through their own professional lens and common lens of 3 Global Child outcomes (3GCO), then come together to compare notes.

It paints a comprehensive and multi-disciplinary picture of a child's level of engagement in school, and the new skills that the child needs to learn.

Formulation of child's profile

3

Through the RBI and SRO, the trans-disciplinary team is able to produce a large and diverse collection of observations of a child. These observations are called Behavioural Description, and standardised to the following format: Action + Trigger + Context

Action: What happened
Trigger: Describe what the action is in response to
Context: When, where and with whom

For eg. “Walks out of his bedroom to look for his parents when he wakes up in the morning.”

 
4

Once consolidated, Behavioural Description are categorised into 3 categories:

Global Child Outcome 1, Global Child Outcome 2, Global Child Outcome 3

These are three outcomes that are measured” which States in USA are required to use when reporting data to the office of Special Education Programme, and which have been adapted to Singapore's context via the ECHO framework. They provide a holistic snapshot of the child's development across settings.


Each GCO is divided into 3 Themes:

GCO1 focuses on Behavioural Descriptions that relate to a child's positive social-emotional relationships.

  • GCO1 / Theme 1: Relating to others
  • GCO1 / Theme 2: Responding to and expressing emotions
  • GCO1 / Theme 3: Following social rules of social interactions

GCO2 focuses on Behavioural Descriptions that relate to a child's acquisition and use of knowledge

  • GCO2 / Theme 1: Understanding (concepts/words/symbols) and literacy
  • GCO2 / Theme 2: Awareness and understanding of the environment
  • GCO2 / Theme 3: Pretend play

GCO3 focuses on Behavioural Descriptions that relate to how a child meets his or her needs

  • GCO3 / Theme 1: Taking care of and meeting needs
  • GCO3 / Theme 2: Participation and independence in Activities of Daily Living and leisure routine activities
  • GCO3 / Theme 3: Navigating the environment and overcoming obstacles


A Behavioural Description can belong in 1 or more GCOs.

Example: A child refuses to share a chocolate bar when asked by her classmate during snack time.
This can be categorised as GCO1 under Theme 3 (Following social rules of social interactions) if assessed to be the child's reluctance to share. But it can also fall into GCO3 under Theme 1 (Taking care of and meeting needs) if assessed to be a result of her hunger or love for chocolate.

Example: A child says “water cold!” to her mother who is giving her a cool shower on a hot afternoon.
This can be categorised as GCO 1 under Theme 2 (Responding to and expressing emotions). Alternatively, it can fall into GCO 2 under Theme 1 (Understanding concepts and literacy) if assessed to be a result of the child's awareness of temperature and the use of the word “cold” appropriately.

When a Behavioural Description can be categorised under more than one GCO, a judgment needs to be made based on the primary function and impact of the child's behaviour. In the example of the child who refuses to share her chocolate bar, GCO1 can be considered over GCO3 as the child can still eat the chocolate bar, albeit a smaller amount, after sharing it.

Staff who are unfamiliar with the GCOs can classify the Behavioural Descriptions into Threads first, which are a sub-division of Themes.

 
5

The GCO Summary describes a child's development according to the 3 GCOs. It is put together when the trans-disciplinary team (social worker, therapists, psychologist and teacher) sits down to discuss and synthesise their observations of a child, in a collaborative and open manner.

Before attending the GCO Summary discussion, each team member reviews his or her notes and individually estimates the functional age of the child for each GCO. This can be done by using a variety of child development resources including the Age Expectations Reference (AER). Developed specifically for Singaporean practitioners, the AER describes the expected behaviours of typically-developing children across 10 age bands. Each team member assigns the child to an age band for each of the 3 GCOs, based on observed behaviours. If a child's behaviour straddles age bands, intermediate age bands in the bottom row can be used.

During the GCO Summary discussion, the team discusses to arrive at a consensus on a child's functional age for each GCO, with the aid of a standardised meeting discussion guide.

The GCO Summary discussion ends with the team rating the child on a 10-point GCO Rating that summarises the gap between the child and his or her typically-developing peers.

Goals & Plans

6

After attaining clarity on the gaps that need to be addressed, the team puts together a plan for the child, called the IEP.

Usually covering the period of 1 year, the IEP is made up of Goals designed around the areas that the child requires help with. During goal setting, the team considers the goals which the family wants to achieve as well as what the child needs to achieve next.

 
7

The IEP provides the big picture; the ELS provides the execution details on a day-to-day basis, using the skill of Incidental Teaching.

It systematically describes the routines, places and actions, even going down to the detail of suggesting the actual words to use. The text is written in a way that is simple to understand, practical and precise. This document is also used to record the child's responses and to monitor progress.

There is an ELS for the team to use at the EIPIC centre, and an ELS for the family to use at home.

To encourage commitment, the parent or caregiver of the child is required to sign off on the ELS.

The ELS is reviewed every 3 months to ensure it aligns with the goals set out in the IEP.