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 FriendlyProvide parents with ways to participate

during the first contacts Prepare parents as fully as possible for their

roles as participantsParents should be able to make choices

about the processParents provide the foundation for

understanding the child

AssessmentIs defined as the ongoing methods, techniques and procedures utilized to gather information about the child and family

AssessmentAssessment 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 FormThe 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 PracticesObtaining 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 PracticesInclude 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 PracticesUse 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

HearingHearing 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 prefersOngoing 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: ReliabilityRefers 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

ExamplesNorm-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 ParentsA parent’s role in the

process is to be a parentParents 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