Evaluation & Assessment
Baby Watch Early Intervention, Part C
IDEIA 2004Requires that every child receive individually
designed evaluation and assessment, using materials and procedures selected to
Answer the family’s questions about the child’s development
Include a family assessment (if family allows) Describe the child’s strengths and weaknesses Facilitate development of the Individualized Family Service Plan (IFSP) More than one procedure
Requires that every child receive individually designed evaluation and assessment, using materials and procedures selected to . . .
MEANS . . .
a variety of tools and procedures are used in different combinations based on individual child & family needs
The goal of either determining eligibility or understanding current level of functioning is ALWAYS achieved – but not always in the same way.
Variations in design WHO has relevant information about the child? HOW and WHAT information should we collect to
consider as part of this assessment?
WHAT kind of testing needs to take place? WHICH tests will yield the best information for our
purposes? WHO should do the testing?
WHEN and WHERE should assessment take place?
… Answer the family’s questions about the child’s development
MEANS . . .
Finding out their concerns about child What questions do they want answered? Design an assessment to meet these needs
… Describe the child’sstrengths and weaknesses
MEANS . . .
Assessing all areas of child’s development, including health, hearing, and vision status
Have some way to give relative strengths and weaknesses of child – for instance, comparing to same age peers, identifying child’s function in day-to-day living, etc.
… Facilitate development of the Individualized Family Service Plan (IFSP)
MEANS . . .
Team comes to some consensus on how child is currently functioning (Current Level Development)
Team comes to consensus on priority goals Team comes to consensus on services needed to meet
the goals
… More than one assessment procedureMEANS . . .
Standardized norm-referenced tests Criterion-referenced tests Procedures for assessing functional daily skills Observation in various settings Tools for assessing parent-child interactions Parent or other caregiver reports Health, hearing, and vision screenings Medical records Other relevant information…
Be Family Friendly
Provide parents with ways to participate during the first contacts
Prepare parents as fully as possible for their roles as participants
Parents should be able to make choices about the process
Parents provide the foundation for understanding the child
Assessment
Is defined as the ongoing methods, techniques and procedures utilized to gather information about the child and family
Assessment
Assessment is the process that integrates information from multiple sources and is the ongoing procedure used throughout the period of the child’s eligibility.
It is the basis for developing IFSP outcomes, intervention and programming strategies, and provides appropriate information to parents.
EvaluationEvaluation is a formal procedure completed
within 45 days following the referral to determine a child’s initial eligibility
Evaluation is also the process of analyzing ongoing assessment information to see if the child still meets eligibility criteria
Who Is Eligible For Part C Services?
Diagnosed ConditionChildren diagnosed
as having a physical
or mental condition
that has a high
probability of
resulting in
developmental
delay.
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Documenting Diagnosis
EI staff do NOT diagnose childrenMust have documentation of diagnosis in file
from professional competent to make the diagnosis
Documentation should be in place by time of first IFSP meeting
Entry to services:
Significant Delay
At least a moderate delay in one or more of the following areas:
Cognitive development Fine motor skills Gross motor skills Receptive communication Expressive communication Social /emotional development Adaptive (self-help) skills
Moderate: At or between 1.5 and 1.9 standard deviations below
the mean OR at or between the 3rd and 7th percentiles
Severe: At or greater than 2.0 standard deviations below the
mean OR at or below the 2nd percentile
A Significant Delay:
Not Significant: At or above one standard deviation below the mean OR at
or better than the 16th percentile
Mild: At or between 1.1 and 1.4 standard deviations below the
mean OR at or between the 8th and 15th percentiles
Not Eligible:
Standard Deviation Mean
Not Significant –Within Normal limits
Severe
-2.0 -1.5 -1.0
Mild
+ 1.0 +2.02nd 7th 16thPercentile
Mod
+ 1.5
Child should be better than mild delay in all areas of development – so at 16th or higher percentile.
Mild: At or between 1.1 and 1.4 standard deviations below the
mean OR at or between the 8th and 15th percentiles
Exit Criteria:
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Who makes the final decision?
Two (or more) people from
different disciplines, such as:
– Service Coordinator and nurse– Service Coordinator and SLP, PT, or OT– Service Coordinator and an outside professional – At least one person needs to be credentialed in EI,
or understand eligibility criteria
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Documenting Significant DelaySummarize on the eligibility form one of the
following:– Standardized test scores which show a moderate
developmental delay in one area of development (or more)
OR– Written, Informed Clinical Opinion makes the
case that child has a moderate developmental delay in one area of development (or more)
Informed Clinical Opinion:When Is It Best Used?
Developmental delay is present, but standardized test not constructed to measure it.
Standardized procedures are not appropriate for a given age or developmental area.
Diagnosis has high probability of delay, but not on the diagnosis list.
Corrected Age
Corrected age is used for premature infants (gestational age ≤ 37 weeks)
The evaluation and assessment of premature infants must be based on their gestational age or their corrected age, not their chronological age.
Corrected age is calculated week-for-week for at least the first year of life.
Using Corrected Age WITHIN a test given. Test manual tells you how to
correct for age of child. The test score has already taken corrected age into consideration.
INTERPRETING test score. Some tests do not have you use corrected age. In this case, give and score the test as usual, getting score based on the child’s chronological age. ALSO get a score for child’s CORRECTED age. Compare the 2 scores and use Informed Clinical if needed.
MEASURING PROGRESS. Comparing corrected age score to chronological age score over time may show the child is “closing the gap”
Assessment ProcessInitial Evaluation & Assessment
Develop IFSP & ServiceDelivery
Intervention
On-going Assessment
6 month IFSP Review
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3 Types of Assessmentat KOTM
Eligibility
Determination
Ongoing
Developmental Assessment
Specialized
Evaluations
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Which ongoing tool?
All new staff use HELP for ongoing assessment at least for first year
Experienced staff may use IDA/E-LAP for areas NOT of concern
If using IDA/E-LAP, should use specialty tool for area of concern
Use same tool over time (if possible) Fill in sticker information!
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Writing the CLD
CLD due by IFSP meeting
If child appears Not eligible give Service Coordinator advance notice
Follow guidelines for writing adequate CLD (see CLD guidelines)
The Eligibility Form
The eligibility form is used to summarize the information on which eligibility was determined
The CLD is used for eligibility summarization every six months
Reason for eligibility may change over time
Changing Eligibility Examples…
Come in on Standardized test – using HELP for continued eligibility requires Informed Clinical Opinion
Come in on Informed Clinical or Standardized test – child now has qualifying diagnosis (e.g., Autism)
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Recommended Practices
Obtaining a developmental history of the child and beginning description of the family’s experience, their concern about their child’s development, and their expectation of the early intervention program.
Observe the child in the context of unstructured play.
Recommended Practices
Include the parents. Listen to their views of the child’s strengths and challenges, and discuss the issues to be explored in the evaluation and assessment process.
Educate the parents about their rights and the ways that they can contribute and participate in the process.
Recommended practices
Do pre-assessment planning with the child’s parents and other appropriate team members to discuss:– Child and family concerns– Developmental, health, and medical background– Goals for the evaluation and assessment process– Specific testing instruments, team composition, roles and
responsibilities, etc.
Recommended Practices
Use a “whole” child model as a framework– Integrate the data collected from all sources– Convey and discuss assessment findings with parents– Keep the focus on the child within the context of the
family Make it descriptive of the child’s ability to
function in the natural environment of the family Remember the purpose – use information to
determine appropriate IFSP outcomes and interventions
Recommended Practices
Prepare for testing:– Review information already collected– Prepare test materials and adaptations in advance– Avoid settings which will distract or upset the child
(hospital rooms, white coats, etc.)– Plan the best time for the child– Allow enough time, or do multiple sessions if needed– Permit warm up time for parent and child before testing
Quiz1. Evaluations should be: (circle all that apply)
a. Family Friendly b. Comprehensive c. Designed by the family
2. T or F A child is eligible for EI with a -1.5 deviation, or 7th percentile in one area.
3. T or F Clinical opinion is the most appropriate procedure to use when determining eligibility for young children.
4. Which activities must be completed before eligibility can be determined? (circle all that apply) a. Assessment in all areas d. Identify family resources b. Review pertinent medical records e. Parent report/interview c. Vision screening
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Purpose of Health, Hearing & Vision Assessments
Developmental implicationsProvide appropriate EI service mixProtect child healthPotential Service Coordination needsPotential family goals
Health Assessment
BWEI Protocol by KOTM NurseMedical records provided by a doctorChild Health Survey completed by familyFamily waives Health assessment
Hearing
Hearing Status must be determined by one:Audiology ReportHearing screening by a trained professional Functional assessment based on
observations and parent report
Vision
Vision status must be determined by one:Ophthalmology ReportVision screening by a trained
professionalFunctional assessment based on
observations and parent report
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Which Type at KOTM?New Kids: Try for BWEI Protocol by KOTM Nurse Records review if family prefers
Ongoing Kids: Child Health Survey unless team requests
otherwise
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“Last Ditch” Effort
If Doctor records don’t come in time If for some reason Nurse or Child Health
Survey failed, but decide to go ahead with IFSP
SC then collects information at IFSP, and information handwritten on CLD
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Specialized Evaluations
Definition: In-depth evaluation of a particular developmental area or problem; conducted by a person with in-depth training in the area to be assessed.
Purpose: Designing appropriate services and interventions (rather than establishing eligibility)
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Specialty Evals at KOTM Language = SLPs Speech = SLP (includes Articulation) Communication Devices = SLP Adaptive Equipment = OT or PT or combination Fine Motor = Occupational Therapists Gross Motor = Physical Therapists Health issues, lactation, etc. = Nurse Cognitive = EI Provider-2 Social-emotional = EI Provider-2 Self-Help/Adaptive = Occupational Therapist Feeding = SLP or OT Sensory = OT
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Clarify what YOU want
To get intervention strategies?Because guidelines say to refer?To rule out underlying problems?To determine if different services are needed?What do you want from the specialist
evaluation?
WHY….
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If approved by team:
Listed on the Board
Child’s name
Date assigned
Staff member assigned
Type of evaluation
Target month for evaluation
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Professional Eval Report An appropriate assessment tool
– Communication by SLP – commercially available tool– Feeding – Feeding checklist by OT or SLP– Physical Therapist – KOTM PT Evaluation Report– Occupational Therapist – KOTM OT Evaluation Report
HV Report to document contact– Developmental status & observations– Relevant history– Specific conclusions reaching to root causes– Specific recommendations
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Report to Child StudySpecialist reports eval to team
– Conclusions– Recommendations – clarify WHY
Team determines action to takeEveryone should be clear on roles and
expectations
Types of Assessment
Tools
Consideration: Reliability
Refers to the extent a test shows consistent results.
Will the test measure the same thing when given time after time?
Can the test be administered, interpreted and scored identically by different examiners?
Instruments selected should have a reliability coefficient greater than 80% and preferably greater than 90%.
Consideration: Validity
Refers to the correctness and the extent that a test achieves the purpose for which it was intended.
Does the instrument measure what it was
designed to measure?
Test validity should be as high as the test reliability score greater than 80% and preferably greater than 90%.
Screening
Refer for further evaluation & assessment
Abbreviated version that usually gets the same results.
Diverse Cultural Backgrounds
Respect cultural differences
Evaluation/assessment and all materials should be provided and available in the native language of the populations in your community, unless it is not possible.
Determination of primary and functional language use.
Norm-Referenced Instruments
Compare child’s skills with other children of the same age & demographics
Examples
Norm-referenced tests
Mullen Scales of Early Learning Bayley Scales of Infant Development Battelle Developmental Inventory Peabody Motor Scales Preschool Language Scale - 4 (PLS)Many others
Norm-Reference Instrument Scores
Percentile scores – Mary is in 7th percentile. This means out of 100 children, 93 would score higher and 6 would score lower.
Standard score – describes where the score falls in comparison to the total distribution of scores on the bell curve
Best to use Percentile with parents
Criterion-Referenced• Criterion-referenced instruments are used to determine
if a child has learned a particular skill Usually arranged in a developmental hierarchy
(roughly) Describe the skills that a child can actually do or is
beginning to learn. They include items that are usually taught.
Examples Hawaii Early Learning Profile (HELP) Early Learning Accomplishment Profile (E- LAP) Rossetti
Age Equivalent Score
Age equivalent scores state the average age of children who demonstrate certain skills These scores are more easily understood by parents Can be used to support an Informed Clinical Opinion – using BWEI conversion chart You must understand how a test is organized in order to properly interpret age brackets
Age Range Reporting for Domains
Date Credit Age Skill
+ 6-8 Bears weight on hands in prone
+ 6-7.5 Holds weight on one hand in prone
+ 6-8 Lifts head in supine
+ 6-12 Struggles against supine
+ 9.5-11 Stands momentarily
- 11-13 Stands for a few seconds
- 11.5-14 Stands alone well
Reporting on a 10-m. old = “age appropriate” Do not report that the child is at 6-12m. Range for GROSS MOTOR unless he can pass higher skills for standing
Wide Range
Johnny was able to demonstrate by planning and retrieving, skillsat about the 5-7 month developmental level. He worked to obtainan out-of-reach object, and purposely reached for a second whileholding one, he has not yet learned to obtain a third object.
Date Credit Age Skill
+ 5-6.5 Reaches for second object purposefully
+ 5-9 Works for desired, out-of-reach object
- 6.5-7.5 Retains two of three objects offered
- 8-10 Retains two and reaches for third object
- 8-10 Retrieves object using other material
Gap In Age The approximate developmental age would be 12-15 months for any child 15
months or younger. Reporting for a 16-17 month-old child = displayed skills which are typical
for his age/age appropriate. Chronological age falls into the GAP You would not say that he displayed skills at the 12-15 month level
since this could imply a delay
Date Credit Age Skill
5.5-8 Shows interest in sounds of objects
5-9 Touches toy or adult’s hand to restart activity
+ 9-12 Guides action on toy manually
+ 12-15 Hands toy back to adult
- 18-22 Attempts and succeeds in activating mechanical toy
Scattered SkillsPass 8 consecutive/ Fail 3 out of 5 consecutive
Date Credit Age Skill
+ 10 Points, pokes, pries, touches with index finger
- 10 Stops activity when told “no-no”
+ 10 Uncovers toy seen hidden
+ 10 Looks at pictures in book
- 11 Repeats performance laughed at
+ 11 Pulls string to obtain ring
- 12 Vocalizes to music
- 12 Gives toy to adult on request
Using clinical judgment review relationship of passes and failed items for similarity. Provide written description of abilities
Play-Based AssessmentChild engages with play partnerMore naturalized, child directed playObservers glean informationObservers take notes and make
conclusions
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Appropriate Use PBA
Not good for: Kids who will not engage in play Infants
Good for: Kids that are hard to figure (new & old) 45 day time frame is almost over Parent considerations
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PBA Process Parent welcome & introductions Child play time & observations as assigned Partner, parent, observer, & child to motor
room while the team finishes observation sheet, may discuss some observations
Observer takes notes, summary statement for CLD.
Parent returns – team shares observations and possible next steps
IFSP is developed
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PBA Documentation
Observation sheets are collected Must write your summary in full
sentences CLD is typed by the Service
Coordinator Written information considered the
same as a “test protocol” in child’s file
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PBA Training
PBA book by Toni Linder Focus on the areas of observation We have adapted the process – a little
different from the book. Observe PBA Be an observer – paired with more
experienced staff.
Special ConsiderationsFor children with unique
challenges Hearing Impairment Visual Impairment Significant gross and
fine motor involvement Autism Extremely premature
infants
Feeding Regulation/Sleep and Sensory Function
Development in the areas of feeding, regulation/sleep, and sensory function are not considered separate domains.
Delays or dysfunction in these areas may impact, to a differing degree, one or all domains.
The sensory information is very useful for determining intervention methodologies.
Scenario A child with identified sensory concerns also has
significant feeding delays specifically in the areas of chewing, food texture, and hand washing.
This child’s adaptive domain is being affected by his sensory concerns.
Therefore, the developmental assessment used to assess his adaptive skills scored the child with a developmental delay.
The team must consider how the sensory issues are impacting development and which developmental domains are being impacted.
Clinical Observations andParent Report of Atypical Characteristics and
Excessive Behaviors These behaviors and characteristics have
been identified as concerns that are not usually evaluated or identified by typical testing methods or reflected in the evaluation scores.
They are behaviors and characteristics
that require the use of clinical opinion to determine the importance and impact of the behavior/characteristic on the child’s development.
Family Directed Assessment Is designed to determine the resources, priorities and concerns of the family related to enhancing the development of the child and is voluntary on the part of the family.
Family Information Gathering
Family resources Family concerns Family priorities Parent-child interactions Family environments Child needs and
characteristics that affect family functioning
Critical or stressful events
Family Directed InterviewCreate a comfortable environmentExplain purpose of the interviewDirect questions to both parentsBe both task directed & supportive of the parents Maintain a professional atmosphereAsk open ended questions in non-threatening
mannerClarify your impression of parent responses
Do’s and Don’ts for Parents
A parent’s role in the process is to be a parent
Parents should not feel “out-numbered”
Parents should not have to ask questions about technical terminology
Parents should be allowed to participate at
a comfortable level
Parents should know that they can request other or
more assessmentsParents should ask questions about the
testing process
Bailey and Simeonsson
Five Reasons to Involve Families
1. To meet legislative/legal mandate2. To understand the child as part of a system3. To identify family strengths that promote family adaptation4. To identify family needs for services5. To expand overall evaluation and assessment
efforts.
Routines-Based Interview
The Routines-Based Interview (RBI) is a clinical, semi-structured interview designed to:– Establish a positive relationship with the family,– Obtain a rich and thick description of child and family
functioning, and– Result in a list of outcomes/goals chosen by the interviewee
The interview assesses:– The child’s engagement, independence, and social relationships
within everyday routines;– The family’s satisfaction with home routines
The RBI can be used to obtain a narrative description of the child’s functioning in cognitive, motor, adaptive, communication, and social skills; it does not result in a developmental score.
RBI Family/Child Assessment
Primary Provider completes an RBI interview with Parents in preparation for the IFSP.
Training on administering the RBI– http
://eiweb.kotm.internal/wordpress/know-your-role/job-details/developmental-specialist/rbi-training/
Child Outcome Summary FormCOSF
Entry COSF score is compared toExit COSF score
To determine type of child progress
Required by Federal GovernmentAs an outcomes measurement
Positive Social-Emotional Skills
1. Refer to how children get along with others, how they relate with adults and with other children.
2. Includes the ways the child expresses emotions and feelings and how he or she interacts with and plays with other children.
Acquisition and Use of Knowledge and Skills
1. Refers to children’s abilities to think, reason, remember, problem solve, and use symbols and language.
2. Encompasses children’s understanding of the physical and social worlds.
3. Includes understanding of early concepts e.g., symbols, pictures, numbers, classification, spatial relationships, imitation, object permanence
4. Acquisition of language and communication skills, and early literacy and numeracy skills.
Use of Appropriate Behavior to Meet Needs
1. Refers to the actions that children employ to take care of their basic needs, including getting from place to place, using tools e.g., fork, toothbrush, crayon
2. Includes how children take care of themselves e.g., dressing, feeding, hair brushing, toileting, carry out household responsibilities, and act on the world to get what they want
3. Addresses children’s increasing capacity to become independent in interacting with the world and taking care of their needs, and contributing to their own health and safety
Test CommandmentsStandards for Educational &
Psychological Testing
should be “properly instructed in the appropriate test administration procedures”
should “understand the importance of adhering to the directions for administration that are provided by the test developer.”
should be properly instructed in the appropriate methods for interpreting test scores
Test CommandmentsStandards for Educational &
Psychological Testing
You are responsible for monitoring your own skills and making sure you has the “training and experience necessary to handle the responsibility...any special qualifications for test administration or interpretation noted in the manual should be met”
When evaluating and assessing individuals “whose special characteristics...are outside the range of their academic training or supervised experience,” test users “should seek consultation”
Learning A New Test Read the manual Read and practice each part of the test Administer the test to a professional peer Discuss the administration of each item Practice administering the test with a non-delayed child Have another professional observe and critique test
administration
Periodically reread the directions Periodically have a peer observe and review the scoring
& administration of the test
Test AdministrationThe examiner must use the instructions provided in the
manual accompanying the test. These instructions tell you:
How to present the task to the child What you can say to the child What you can do (prompting or not) How many times you give the child a chance to
complete the task The criteria to determine if the child actually
accomplished the task How to score the child’s response
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KOTM Commonly Used Tools BDI (Battelle Dev Inventory) – Eligibility DAYC - Eligibility PLS-4 (Preschool Language Scale) - Eligibility AIMS (Alberta Infant Motor Scale) – Eligibility ITSP (Infant Toddler Sensory Profile) – Support
Informed Clinical / Specialty HELP (Hawaii Early Learning Profile) – ongoing
assessment IDA (Infant Dev Assessment) – ongoing
assessment ELAP – ongoing assessment
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