TABLE OF CONTENTS › ecln › FIT › pdfs › IDA Lead Training Binder...• Compare the IDA...

1 Day One Presentation 13 CME Report Guidance

Template

2 Day Two Presentation 14 Key Principles of IDA

3 IDA Lead Reflection

Journal 15 Clarification MEMO, 2011

4 Role of the IDA Lead 16 IDA FAQs, 2nd ed.

5 Framework for Reflective

Questioning 17 IDEA-IDA Crosswalk

6 Observer’s Notes 18 IDA Online Case Study

Requirements

7 Feedback Worksheet 19 Article: Framework for Reflective Questioning

8 IDA Checklist 20 Article: Coaching

Practices

9 IDA Visual Checklists 21

10 Summary Paragraph 22

11 CME-IDA Record

Comparison Flowchart 23

12 Eval & Eligibility Record

Review Form

TABLE OF CONTENTS

2/3/2015

1

IDA Lead Institute:

Coaching and Mentoring

Jen Brown, MAUNM‐CDD‐ECLN

Objectives• Explain the role of the IDA Lead in relation to coaching/mentoring

• Explore methods for reflective questioning to support staff/contractors

• Provide supportive feedback to staff/contractors to encourage professional development

• Deconstruct the IDA Record to develop a more thorough picture of the child’s skills

• Compare the IDA record to the CME Report to ensure consistency of information

Housekeeping Items….

• We value your experience and want these sessions to be a dialogue for everyone

• Please silence your cell phones and save your calls and texts for the breaks

• Times on the agenda are approximate; we will try to be flexible in order to meet everyone’s needs

• A “Parking Lot” is posted for any issues/items that come up during the session that would be best addressed at another time

• Continuous Improvement is a crucial aspect of our system, please complete the evaluations with as much feedback as possible to assist future efforts

2/3/2015

2

And now, a brief word from our sponsor…

Fears, Rumors, and Concerns

Role of the IDA Lead

Review the Introduction to IDA online’s Summary of Performance letter with staff/contractors who have completed the training; provide guidance and clarification as necessary

Provide coaching and mentoring, including shadowing of evaluation sessions, to all staff/contractors in implementing the IDA process with consistency and fidelity

Be available, as needed, to provide clarification and guidance on specific questions from staff as they implement the IDA process

As designated by the program, participate in Quality Assurance activities related to the evaluation process

Gather information on practitioners’ experiences, struggles, questions, concerns and areas needing clarification.

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Coaching/Mentoring: What Is It?• An adult learning strategy in which the coach promotes the learner’s ability to reflect on his or her actions as a means to determine the effectiveness of an action or practice and develop a plan for refinement and use of the action in immediate and future situations.

• Can be used to improve existing practices, develop new skills, and promote continuous self‐assessment and learning. The role of the coach is to provide a supportive and encouraging environment in which the learner (parent, colleague, etc.) and coach jointly examine and reflect on current practices, apply new skills and competencies with feedback, and problem‐solve challenging situations.

(Rush and Sheldon, 2005)

Benefits of Mentoring: For the Agency

• Encouraging retention• Reducing turnover costs• Improving productivity

• Elevating knowledge transfer from just getting information and to retaining the practical experience and wisdom gained from long‐term employees.

• Enhancing professional development.

• Linking employees with valuable knowledge and information to other employees in need of such information

• Creating a mentoring culture, which continuously promotes individual employee growth and development.

Benefits of Mentoring: For the Mentor

• Gains insights from the mentee’s background and history that can be used in the mentor’s professional and personal development.

• Gains satisfaction in sharing expertise with others.

• Gains an ally in promoting the organization’s well‐being.

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Benefits of Mentoring: For the Mentee• Gains from the mentor’s expertise

• Receives critical feedback in key areas, such as communications, interpersonal relationships, and technical abilities,

• Develops a sharper focus on what is needed to grow professionally within the organization

• Learns specific skills and knowledge that are relevant to personal goals

• Gains knowledge about the organization’s culture and unspoken rules that can be critical for success; as a result, adapts more quickly to the organization’s culture

• Has a friendly ear with which to share frustrations as well as successes.

Active Listening‐ A Key Skill for Coaching

Components of Active Listening:

Listening to understand vs listening to respond Relaxed, open body language; eye contactUtilizing silence; avoid interrupting

Restating what you have heard, including feelings E.g. – “It sounds like you..”, “So you mean that…”

Asking questions to assist with clarifying E.g.‐ “Can you tell me more about…?”

Reflective Questioning for Coaching

Reflection is a component of a capacity‐building process…

“The purpose of reflection is to build the capacity of another person in such a way as to promote ongoing self‐assessment, planning, and knowledge/skill acquisition by teaching the person receiving coaching supports to be aware of, continually examine, and refine his or her current practices and behavior” (Rush, Shelden, & Raab,

2008)

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Awareness questions are used to promote the understanding of what the person being coached already knows or is doing, and how the effective the current strategies are (e.g. – What have you tried?)

questions are asked to support the other person in examining how what is currently happening matches what she wants to have happen… (e.g.- How does that compare to what you like to have happened?)

questions are used to provider person receiving coaching with an opportunity to consider a variety of possible options to obtain the desired results (What are all the possible options to consider?)

questions assist in developing the joint plan of the coach and colleague are going to between coaching interactions as a result of the current conversation (e.g. – Who is going to do what before the next time we meet?)

Reflective Questioning is a Conversation!

• The framework provides a wayto think about the types of questions that you, as a coach, might want to ask

• Reflective questioning is NOT linear, rather it is a conversation!

• The nature of the questions that you ask will depend upon the areas in which coaching is needed and the nature of the responses from the person being coached

Observation of the Session

2/3/2015

6

Role Play!

Using your Observer's Notes handout, practice asking questions of the evaluator from the video….

Approaching the Relationship

Coach/Mentor

Expectations of

• Professional responsibility

• Potentially accountable

• Supportive

• Available

Mentee

Needs

• Recognition of competence

• Safety

• Support

• Access

Effective Feedback

• Be factual and describe the situation or action and the result.

• Feedback that is specific to what worked promotes encouragement!

Timely Balanced Specific

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Opportunities for GrowthOpportunities for Growth

Be factual in your comments: describe the situation• Describe the action that the person took and the result

• E.g. – “When you started looking for the crayon, the child watched you and lost interest in the blocks before you could see how many he could stack.”

Use reflective questioning to assist the person in recognizing what could have been different• E.g. – “So, how do you think you might approach that

situation next time?”

Follow up by discussing the potential (positive) outcomes of the change in action/approach• E.g. – “What do you think might happen if you try it that

way next time?”

Video – Giving Effective Feedback

Role Play!

Consider one area from the evaluation video where you would like to provide some feedback to the evaluator regarding her performance during the session.

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Synthesis & Support for the CME Report

CME Report

Child

Health

Environment

Profile Items

“Score”

ELIGIBILITY

Questions & Continuous Improvement

What questions do you have?

What worked for you today?What could have been better?

See you Tomorrow!Refreshments @ 8

Start @ 8:30

2/3/2015

1

IDA Lead Institute:

Coaching and MentoringDay Two

Jen Brown, MAUNM‐CDD‐ECLN

Objectives• Explain the role of the IDA Lead in relation to coaching/mentoring

• Explore methods for reflective questioning to support staff/contractors

• Provide supportive feedback to staff/contractors to encourage professional development

• Deconstruct the IDA Record to develop a more thorough picture of the child’s skills

• Compare the IDA record to the CME Report to ensure consistency of information

Housekeeping Items….

• We value your experience and want these sessions to be a dialogue for everyone

• Please silence your cell phones and save your calls and texts for the breaks

• Times on the agenda are approximate; we will try to be flexible in order to meet everyone’s needs

• A “Parking Lot” is posted for any issues/items that come up during the session that would be best addressed at another time

• Continuous Improvement is a crucial aspect of our system, please complete the evaluations with as much feedback as possible to assist future efforts

2/3/2015

2

Role of the IDA Lead






Reflections on Day One

What did you bring with you from yesterday’s session?

Key Points from Day One

• Mentoring has many benefits for the agency, the mentor, and the mentee

• It’s all about conversations within the context of relationships!

• Reflective questioning is a technique that assumes a joint commitment from both mentor & mentee

• Feedback is important – both areas of strengths & areas for growth

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Deconstructing the IDA Record

Checklist for IDA Review to check the Provence Profile components

Consider Summary Paragraph (if present)

Child development lens

List your questions

Reframe questions in a reflective manner

Practice!

Deconstruct the sample IDA Record:

‐ Use the Visual Checklist for IDA and your child development lens

‐ Flipchart the questions that your group would like to ask

Let’s Reframe!

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IDA Process and the CME Report

CME Report

Child

Health

Environment

Profile Items

“Score”

ELIGIBILITY

Consistency Between the CME Report & IDA Record

At a minimum:

• Scores

•Percentages of delay

• Eligibility

Additionally consider the manner in which the skills are described and paint a picture of the WHOLE child

Practice!

Compare and contrast the sample IDA Record and CME Report for a little girl (Ida Record) ‐ Use the flowchart for

the initial comparison of the CME Report and the IDA Record;

‐ Do NOT stop at any given area, continue to compare and analyze ANY aspects that you wonder about;

‐ Note these differences and/or questions on the CME‐IDA Record Table

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What Happens in Your Agency?

o To what extent do you implement these types of QA measures?

o Who is responsible for that process?o If you do not currently implement any of these measures, what does your agency need ton order to provide this type of mentoring to new staff?

Mentoring: A Process of Reflection& Feedback

• Evaluation Session• Reflective questioning to explore how it went/felt

• Feedback to emphasize strengths & areas of growth

• Completion of the IDA Record• Reflective questioning to explore the skills of the child


• Comparison of the CME Report & the IDA Record• Reflective questioning to explore the differences


What Additional Supports Are Needed?

• What additional supports do you still need?

• What additional supports do you think your agency still needs?

• What are your thoughts on how to best meet those needs?

2/3/2015

6

ECN Training & Development Consultants for IDA:

Jen Brown (505) 272‐[email protected]

Cathy Riley (505)263‐[email protected]

Michelle Staley (505)272‐6511 [email protected]

Alta Mira, CARC, ENMRSH, Inspirations, Laguna, LifeROOTS, MECA, New Vistas, PEI, UNM DCCP, UNM FOCUS

Abrazos, Las Cumbres, Los Angelitos, MAECP, NAPPR, NMSBVI, PB&J, Pine Hill, PMS Roundtree, Region IX, Tobosa

Aprendamos, Casa Alegre, Children’s Workshop, DSI, GIB, La Vida, Life Quest, Positive Outcomes, Tresco, Zia

THE END

Please be sure to complete your evaluations and also list any additional support that you need and/or any ideas on how to best provide those

supports.

1

IDA Lead

Reflection

Journal

1

Created by Jen Brown for UNM, Center for Development & Disability Early Childhood Learning Network October, 2014.

My Reflections from the IDA Lead Institute:

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Considerations to bring back to my agency:

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Additional thoughts and reflections:

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Prepared by UNM, CDD Early Childhood Learning Network, June 2011

Building Capacity to Utilize the IDA

Each program is asked to designate an IDA Lead or Leads who will serve as support to all practitioners in their program in their use of the IDA to determine initial and on-going eligibility for FIT.

By building a cadre of effective IDA Leads, each FIT program will ensure that newly hired staff and contractors have access to timely, relationship-based peer support and mentoring in learning about the IDA process. Developing this internal structure will support the effective use of IDA in evaluation of young children. It is recommended that this system of ongoing support be described and included in the policies and procedures of the program.

IDA Leads will NOT be responsible for initial training of staff. An online training on IDA is available on the ECLN website that provides an introduction to the IDA process for newly hired staff and contractors.

IDA Leads will:






Bring information gathered to their ECLN Consultant in order to receive clarification and/or additional support and to support continued technical assistance efforts within the FIT system.

Follow up with practitioners by providing clarification and guidance as needed.

Participate in any IDA learning opportunities that may be offered and share information presented with program staff/contractors as appropriate.

Observer’s Notes: What Do I Want to Know More About?

Interaction with Child Interaction with Parent Administration of Items Other

Reflective Questions that I might ask:

Reflective question(s) to ask-

_________________________________________________________

_________________________________________________________

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If looking at areas of growth, also define the following:

Situation (Descriptive facts only)

Action (Descriptive facts only)

Result (Descriptive facts only)

Change in action for next time Anticipated Positive Result

Feedback Worksheet

Excerpt from the NM Family Infant Toddler (FIT) Program Evaluation & Assessment TA document

IDA Checklist:

The IDA Process: The Provence Profile was administered by a team of two professionals from different

disciplines who were both present during the session. ALL eight developmental domains were assessed by BOTH professionals. ALL of the items in three age zones were either administered and/or reported on by the

parent if direct observation was not a possibility. The TEAM discussed their impressions of the findings from the parent interview, health

review, and developmental information. The TEAM considered potential contributing factors (such as experience, health issues, etc.)

when interpreting the results from the Provence Profile. The following must be completed on the IDA Record: Cover page (Page 1) Provence Profile protocols for Scoring Child’s Development for the Child’s Age (Pages 2 – 7):

o for least three different age zones i.e. above and below the child’s age (adjusted if applicable)

o for all eight domains Worksheets for Applying Scoring Criteria (Pages 8 & 9) The TEAM “tallies” ALL of the

credited items and transferred them to the scoring worksheets in the IDA Record for all domains and all three age zones:

o The TEAM determines a performance age range for each domain and records this at the bottom of the corresponding domain column (below the missed starred items).

Summary of Scoring and Findings (Page 10): o The TEAM determines a Developmental Rating of either “Competent” or “Of

Concern” for each domain, in accordance with the IDA Directions for Scoring Section of the IDA Administration Manual.

o The TEAM calculates and documents the percentage of delay (if applicable) for each domain (using EITHER Table 5 or Table 6 in the IDA Administration Manual) and records the percentage of delay for each domain in the “Salient Qualitative Findings” column. e.g “>25% delay”, “<25% delay”.

Developmental and Behavioral Concerns (Page 11): o The TEAM completes those items of concern and entered “None” if there were no

concerns.

Not Required: Summary Paragraph (Page 14):

o The TEAM may this utilize this page to record their consensus regarding the child’s eligibility under one or more of the following eligibility categories: “Developmental Delay”, Established Condition”, “Biological / Medical Risk” and / or “Environmental Risk” OR if the child is not eligible for the FIT Program.

Created by Jen Brown for UNM, Center for Development & Disability Early Childhood Learning Network, Revised September, 2014.

1) Are at least 3 age zones completely scored across all developmental domains?

2) Are the criteria and associated age-ranges appropriate for the number of credited items?

3) Is the number of missed starred

items reasonable? (i.e. – none or

1-3 or so; not 6, etc.)

2

2

2

2

2

2

4

2 1

1

1 0

2

2

2

2

2

2

4

2 1

1

1 0

EXAMPLE

1

Created by Jen Brown for UNM, Center for Development & Disability Early Childhood Learning Network, Revised September, 2014.

=

Do the total number of credited items equal (=) the number of items tallied on the scoring worksheets?

9 10 4 4

4 3

5 5

0 0 0 0

Created by Jen Brown for UNM, Center for Development & Disability Early Childhood Learning Network, December, 2012

Review the actual “scoring” of items within

and across developmental domains:

1) Are ALL of the items from at least

3 age zones scored?

2) Are all cross-referenced items

scored appropriately across

domains? (See IDA

Administration Manual for more

information)

+

+

+

+

+

+

-

Em

-

-

RI - Relationship to

Inanimate Objects

L - Language/

Communication

Created by Jen Brown for UNM, Center for Development & Disability Early Childhood Learning Network, 2012; updated September, 2014.

1) Are the domains marked “Competent”

also at age level?

2) Are the domains that are below age-

level, marked “Of Concern”?

3) Was Table 6 used as the primary table

for calculating the 25% percent delay

needed for FIT Program eligibility?

Created by Jen Brown for UNM, Center for Development & Disability Early Childhood Learning Network, 2012; updated September, 2014.

Is the Developmental and

Behavioral Concerns page

completed or marked with “None”

if there are no concerns?

X X

X

Main Areas of Strength: What is the child successful with in her daily life? What

supports her in her play and learning? Which developmental domains are the

strongest and/or are supportive of other domains?

Main Areas of Concern: What does she struggle with in her daily routines? What

skills are not yet present? Are there any other developmental or behavioral

concerns?

Any areas of significance related to health or medical issues, family dynamics

and/or interpersonal relationships that impact the child’s development

Whether or not the child is eligible for the NM FIT Program and, if so, under

which category or categories of eligibility? Developmental Delay category

MUST include domains and percentages of delay.

Recommendations and/or next steps to assist the child and family in

addressing areas of concern – program options (e.g. - preschool or early

intervention – PLEASE NOTE: this does NOT mean that specific early

intervention services are recommended; consultation with additional

specialists may be recommended in order to gain more information about the

child, but specific ongoing services are only determined by the IFSP team once

the outcomes have been developed); supportive play and/or care approaches

that can be incorporated into daily routines (tummy time, practice using a

spoon, cruising the couch, etc.)

aagosa

Highlight

CME Report and IDA Record Comparison Initial Process

* All components may be present but not

necessarily accurate.

Use the IDA Visual Checklists to make sure that the basic components of the IDA Record are present

Consider the scores (age ranges) in the IDA Record and compare them to the scores

listed in the CME report

Review the Record with the CME team and complete missing

components

*Are all the components present/accurate?

Do the scores (age ranges) match?

Does the eligibility statement “match” the

scores (age ranges)?

Consider the “conclusion” of the CME report, does it explain

the discrepancy between scores and eligibility?

Does eligibility “match” the conclusion of the

report?

Review the information with the CME team to

determine what changes might be needed in either

the Record or the CME Report; edit as indicatedReview the information

with the CME team to determine correct

eligibility; rewrite report if necessary

Basic components met; consider more thorough QA review

of report **

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

** If questions regarding the description of the child’s skills arise during the review, complete a more thorough review of the

content of the CME Report as needed.

Child Record Review Form-Evaluation & Eligibility-Minimum Requirements ---February 2013 Page 1

Evaluation & Eligibility Child Record Review Form - Minimum Requirements

Child’s Name: Child’s Service Coordinator:

Date of Birth: Reviewer’s Name:

Date of CME: Date of File Review:

CME: Is documentation present in narrative report for: Yes No Comments/Clarifications

a) Child’s name and birth date are correct.

b) CME conducted by at least 2 qualified professionals from different disciplines? NMAC 7.30.8.10 (F) (4), DDSD Service Standards-for list of qualified professionals able to participate in CME 1. Audiologist – licensure from the NM Audiology Board 2. Developmental Specialist certification II or III –in accordance with Family Infant Toddler Program regulations (7.30.8 NMAC) and DDSD

Policy 3. Family therapist – licensure from the Counseling and Therapy Practice Board as a Family Therapist, Professional Clinical Mental Health

Counselor, Professional Mental Health Counselor, or Registered Mental Health Counselor 4. Nurse – licensure from the NM Board of Nursing as a registered nurse 5. Nutritionist – licensure from the NM Nutrition and Dietetics Practice Board 6. Occupational Therapist– licensure from the NM Board of Occupational Therapy Practice 7. Physical Therapist – licensure from the NM Physical Therapy Licensing Board 8. Psychologist – licensure from the NM Board of Psychologist Examiners 9. Social worker – licensure from the NM Board of Social Work Examiners 10. Speech/Language Pathologist – licensure from the NM Board Speech, Language Pathology, Audiology and Hearing Aid Dispensers

Board

Clarifying note: A Developmental Specialist I, Certified Occupational Therapy Assistant (COTA), or Physical Therapy Assistant (PTA) may contribute to the evaluation but cannot serve as one of the two multidisciplinary team members representing two professional disciplines.

c) Information gathered from caregiver(s)? NMAC 7.30.8.10 (F) (2)

d) Description of accommodations for language/ culture, as applicable? (check yes if not applicable) NMAC 7.30.8.10 (F) (10)

e) Childs level of functioning in each developmental area (physical/motor; cognitive; communication; social/emotional; adaptive) is assessed and summarized

NMAC 7.30.8.10 (F) (6)


CME: Is documentation present in narrative report for: Yes No Comments/Clarifications

f) The evaluation team used the tool(s) approved by the FIT program. NMAC 7.30.8.10 (F) (8) DDSD Service Standards-for list of approved tools

The team shall use all phases of the Infant-Toddler Developmental Assessment (IDA) as the approved statewide tool as part of the Comprehensive Multidisciplinary Evaluation.

Teams must complete all six phases of the IDA: I. Referral & Pre-interview Data Gathering

II. Initial Parent Interview III. Health Review IV. Developmental Observation and Assessment V. Integration and Synthesis

VI. Share Findings, Completion, and Report. Given the unique characteristics of infants and the challenges of determining their developmental levels:

For infants under one (< 1) month of age (adjusted) the IDA will not be used. Instead one of the approved tools below shall be used together with informed clinical opinion.

For infants over one (>1) month of age (adjusted) and under four (<4) months of age (adjusted) the IDA shall be used in conjunction with one of the following approved tools:

o AIMS (Alberta Infant Motor Scale) o TIMP (Test of Infant Motor Performance) o Infant Toddler Sensory Profile o Peabody Developmental Motor Scale (PDMS-2) o Motor Skills Acquisition Checklist o REEL-3 o Newborn Individualized Developmental Care and Assessment Program

Other domain specific tools may be used in addition to the IDA as part of the Comprehensive Multidisciplinary Evaluation (CME). If the IDA does not indicate a 25% delay, a domain specific tool can be used to determine eligibility under developmental delay.

g) Acquisition and review of related medical/health records, including vision & hearing?

NMAC 7.30.8.10 (F) (5)(6) DDSD Service Standards state:

A review and summary of the child’s records related to current health status and prior medical history.

Vision and hearing tests or screenings must be addressed in order for the CME to be complete. A statement summarizing the results must be provided in the written evaluation report and may include documented newborn hearing results (valid only for 6 months from the date of the screen), OAE and tympanometer results, NMSBVI screening tool or vision and hearing screening by a well child exam.

h) Developmental level adjusted for prematurity, if needed?

NMAC 7.30.8.10 (G) (3)

i) Recommendations regarding the child’s eligibility for FIT? (If child is eligible in multiple categories, all must be

listed in the report.) NMAC 7.30.8.10 (F) (12)


Eligibility Yes No Category Criteria

Is eligibility

determination

appropriate? NMAC 7.30.8.10 (G)

Develo

pm

en

tal

Dela

y

Evaluation tools are completed correctly and fully Scores on evaluation tools are correct Raw scores are converted correctly to demonstrate a 25% delay utilizing IDA tables (in the IDA administration manual), if

applicable Documentation in the evaluation report indicates either a developmental delay or significant atypical development.

And one of the following set of criteria

Child has a developmental delay of 25% in one area of development OR

Child has a score of 1.5 or greater standard deviation below the mean on a domain-specific tool OR

Informed clinical opinion is used to make child eligible for Developmental Delay AND there is documentation to support the following Child’s eligibility is justified to indicate a determination of significant atypical development. (This documentation must

provide a description of the child’s abilities and areas of concern including why these abilities differ from typical children of the same age and

the manner in which they impact the child’s daily activities).

A second level review and sign off occurred within the EI agency by someone of equal or higher certification or licensure that was NOT part of the evaluation team. And one of the following reasons justified the use of Informed Clinical Opinion

A clear developmental level could not be gained through the use of the approved tool(s) or domain-specific tools OR

There are inconsistencies in the child’s performance OR

There were inconsistencies in the results of the evaluation

Esta

bli

sh

ed

Co

nd

itio

n

Diagnosis by a physician or other health care provider is included in child’s record. Stated medical condition is on FIT Program list of approved conditions for ESTABLISHED CONDITION Condition has not been resolved prior to CME (continues to have a high probability of developmental delay at time of CME)

At

Ris

k

(Bio

/Med

)

Diagnosis by a physician or other health care provider is included in child’s record. Stated medical condition is on FIT Program list of conditions for MEDICAL/BIOLOGICAL RISK Condition has not been resolved prior to CME (continues to increase risk of developmental delay at time of CME)

En

v.

Ris

k

Environmental Risk Assessment (ERA) tool is completed and scored correctly Reference is made in the written report to use of the ERA tool and the general findings related to the child’s risk factors. Scores are calculated utilizing the ERA tool’s combination of risk factors to determine eligibility.


NMAC 7.30.8.10

F. Evaluation. (1) A child who is referred for early intervention services, and whose parent(s) has given prior informed consent, shall receive a comprehensive multidisciplinary evaluation to determine eligibility, unless the child receives a screening in accordance with the screening requirements of this rule and the results do not indicate that the child is suspected of having a developmental delay. Exception: If the parent of the child requests and consents to an evaluation at any time during the screening process, evaluation of the child must be conducted even if the results do not indicate that the child is suspected of having a developmental delay. (2) The evaluation shall be timely, non-discriminatory, comprehensive, multidisciplinary, and shall include information provided by the parent(s). (3) If parental consent is not given, the family service coordinator shall make reasonable efforts to ensure that the parent(s) is fully aware of the nature of the evaluation or the services that would be available; and that the parent(s) understand that the child will not be able to receive the evaluation or services unless consent is given. (4) A comprehensive multidisciplinary evaluation shall be conducted by a multidisciplinary team consisting of at least two professionals from different disciplines. (5) The family service coordinator shall coordinate the evaluation and shall obtain pertinent records related to the child’s health and medical history. (6) The evaluation shall include information provided by the child’s parents, a review of the child’s records related to current health status and medical history and observations of the child. The evaluation shall also include an assessment of the child’s strengths and needs and a determination of the developmental status of the child in the following developmental areas: (a) physical/motor development (including vision and hearing); (b) cognitive development; (c) communication development; (d) social or emotional development; and (e) adaptive development. (7) If the child has a recent and complete evaluation current within the past six months, the results may be used, in lieu of conducting an additional evaluation, to determine eligibility. (8) The evaluation team shall use the tool(s) approved by the FIT program. Other domain specific tools may be used in addition to the approved tool(s). (9) The tool(s) used in the evaluation shall be administered by certified or licensed personnel who have received training in the use of the tool(s). (10) The evaluation shall be conducted in the child and family’s native language or other mode of communication, unless it is clearly not feasible to do so. (11) The evaluation team will collect and discuss all of the information obtained during the evaluation process in order to make a determination of the child’s eligibility for the FIT program. (12) An evaluation report shall be generated that summarizes the findings of the multidisciplinary evaluation team. The report shall summarize the child’s level of functioning in each developmental area based on assessments conducted and shall describe the child’s overall functioning and ability to participate in family and community life. The report shall include recommendations regarding approaches and strategies to be considered when developing IFSP outcomes. The report shall also include a statement regarding the determination of the child’s eligibility for the FIT program. (13) Parents shall receive a copy of the evaluation report and shall have the results and recommendations of the evaluation report explained to them by a member of the evaluation team or the family service coordinator with prior consultation with the evaluation team. (14) Information from the evaluation process and the report shall be used to assist in determining a rating for the initial ECO. G. Eligibility determination. (1) The child’s eligibility for the FIT program shall be determined by the multidisciplinary evaluation team, the family service coordinator and the parent(s). (2) The multidisciplinary team shall review and consider information, including: medical records; observations; information gathered from the parent(s); information regarding the child’s development from the use of the approved evaluation tool(s); and any other tools used, in order to provide their opinion regarding the determination of the child’s eligibility. (3) The child’s age shall be adjusted (corrected) for prematurity for children born less than 37 weeks gestation. The adjusted age shall be until a child is 24 months of age for the purpose of eligibility determination.


(4) Informed clinical opinion may be used by the evaluation team to determine eligibility when the approved tool(s) or other domain-specific tool are not able to establish a developmental level due to the age of an infant or the child’s level of arousal and ability to participate at the time of the assessment; or when there are inconsistencies in the child’s performance or inconsistencies in the results of the evaluation; and the team determines that the child has significant atypical development. (a) If informed clinical opinion is used to determine the child’s eligibility, documentation must be provided to justify the child’s eligibility. (b) A second level review and sign off shall occur within the early intervention provider agency by someone of equal or higher certification or licensure that was not part of the evaluation team. (c) Informed clinical opinion may only be used to qualify a child for more than one year with review and approval of the FIT program. (5) A statement of the child’s eligibility for the FIT program shall be documented in the evaluation report. (6) The child must be determined eligible under one of the following categories. (a) Developmental delay: a delay of 25% or more, after correction for prematurity, in one or more of the following areas of development: cognitive; communication; physical/motor; social or emotional; adaptive; (i) 25% delay shall be documented utilizing the tool(s) approved by the FIT program; (ii) if the FIT program approved tool does not indicate a 25% delay, a domain-specific tool may be used to establish eligibility if the score is 1.5 standard deviations below the mean or greater; (iii) informed clinical opinion in accordance with this rule may be used if a clear developmental level cannot be gained through the use of the approved tool(s) or domain-specific tools; or when there are inconsistencies in the child’s performance or inconsistencies in the results of the evaluation; and shall be documented as “significant atypical development”. (b) Established condition: a diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (i) genetic disorders with a high probability of developmental delay, including chromosomal anomalies including Down syndrome and Fragile X syndrome (in boys); inborn errors of metabolism including Hurler syndrome; and other syndromes, including Prader-Willi and Williams; (ii) perinatal factors, including toxoplasmosis, rubella, CMV, and herpes (TORCH); prenatal toxic exposures including fetal alcohol syndrome (FAS); and birth trauma, including neurologic sequelae from asphyxia; (iii) neurologic conditions, including congenital anomalies of the brain including holoprosencephaly lissencephaly, microcephaly, hydrocephalus; anomalies of spinal cord including meningomyelocele; degenerative or progressive disorders including muscular dystrophies, leukodystrophies, spinocerebellar disorders; cerebral palsy (all types), including generalized, hypotonic patterns; abnormal movement patterns including generalized hypotonia, ataxias, myoclonus, and dystonia; peripheral neuropathies; traumatic brain injury; and CNS trauma including shaken baby syndrome; (iv) sensory abnormalities, including visual impairment or blindness; congenital impairments including cataracts; acquired impairments including retinopathy of prematurity; cortical visual impairment; and chronic hearing loss; (v) physical impairment, including congenital impairments including arthrogryposis, osteogenesis imperfecta, and severe hand anomalies; and acquired impairments including amputations and severe burns; (vi) mental/psychosocial disorders, including autism spectrum disorders; and (vii) conditions recognized by the FIT program as established conditions for purposes of this rule; a genetic disorder, perinatal factor, neurologic condition, sensory abnormality, physical impairment or mental/psychosocial disorder that is not specified above must be recognized by the FIT program in order to qualify as an established condition for purposes of this rule; department of health physician, designated by the FIT program manager, shall make a determination of whether a proposed condition will be recognized within seven days of the FIT program manager’s receipt of the request for review. (c) Biological or medical risk for developmental delay: a diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (i) genetic disorders with increased risk for developmental delay, including chromosomal anomalies including Turner syndrome, Fragile X syndrome (in girls), inborn errors of metabolism including Phenylketonuria (PKU), and other syndromes including Goldenhar neurofibromatosis, and multiple congenital anomalies (no specific diagnosis); (ii) perinatal factors, including prematurity (less than 32 weeks gestation) or small for gestational age (less than 1500 gms); prenatal toxic exposures including alcohol, polydrug exposure, and fetal hydantoin syndrome; and birth trauma including seizures, and intraventricular or periventricular hemorrhage; (iii) neurologic conditions, including anomalies of the brain including the absence of the corpus callosum, and macrocephaly; anomalies of the spinal cord including spina bifida and tethered cord; abnormal movement patterns including severe tremor and gait problems; and other central nervous system (CNS) influences, including CNS or spinal cord tumors, CNS infections (e.g., meningitis), abscesses, acquired immunodeficiency syndrome (AIDS), and CNS toxins (e.g., lead poisoning);


(iv) sensory abnormalities, including neurological visual processing concerns that affect visual functioning in daily activities as a result of neurological conditions, including seizures, infections (e.g., meningitis), and injuries including traumatic brain injury (TBI); and mild or intermittent hearing loss; (v) physical impairment, including congenital impairments including cleft lip or palate, torticollis, limb deformity, club feet; acquired impairments including severe arthritis, scoliosis, and brachial plexus injury; (vi) mental/psychosocial disorders, including severe attachment disorder, severe behavior disorders, and severe socio-cultural deprivation; (vii) other medical factors and symptoms, including growth problems, severe growth delay, failure to thrive, certain feeding disorders, and gastrostomy for feeding; and chronic illness/medically fragile conditions including severe cyanotic heart disease, cystic fibrosis, complex chronic conditions, and technology-dependency; and (viii) conditions recognized by the FIT program as biological or medical risk conditions for purposes of this rule; a genetic disorder, perinatal factor, neurologic condition, sensory abnormality, physical impairment, mental/psychosocial disorder, or other medical factor or symptom that is not specified above must be recognized by the FIT program in order to qualify as an medical or biological risk condition for purposes of this rule; department of health physician, designated by the FIT program manager, shall make a determination of whether a proposed condition will be recognized within seven days of the FIT program manager’s receipt of the request for review. (d) Environmental risk for developmental delay: a presence of adverse family factors in the child’s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the tool approved by the FIT program. (7) The families of children who are determined to be not eligible for the FIT program shall be provided with prior written notice and informed of their rights to dispute the eligibility determination and shall receive information on the ages and stages for kids (ASK) developmental screening and tracking program and other appropriate community resources. Families shall be informed about how to request re-evaluation at a later time should they suspect that their child’s delay or risk for delay increases. H. Redetermination of eligibility. (1) The child’s eligibility for the FIT program shall be re-determined annually in accordance with the eligibility determination requirements of this rule. (2) The child’s continued eligibility shall be documented on the IFSP. (3) If the child no longer meets the requirements under the original eligibility category, the team will determine if the child meets the criteria for one of the other eligibility categories before exiting the child. (4) If the child is determined to no longer be eligible for the FIT program the family shall be provided with prior written notice and informed of their rights to dispute the eligibility determination. The family service coordinator will assist the family, with their consent, with referrals to other agencies and shall inform them of the ages and stages for kids developmental tracking program. I. Ongoing assessment. (1) Each eligible child shall receive an initial and ongoing assessment to determine the child’s unique strengths and needs and developmental functioning. The ongoing assessment will utilize multiple procedures including the use of a tool that helps the team determine if the child is making progress in their development, to determine developmental levels for the IFSP and to modify outcomes and strategies, and to determine the resources, priorities, and concerns of the family. (2) Assessment information shall be used by the team as part of the process of assisting to determine early childhood outcome (ECO) scores at the time of the initial and annual IFSP and prior to the child exiting the FIT program. (3) An annual assessment of the resources, priorities, and concerns of the family shall be voluntary on the part of the family. The IFSP shall reflect those resources, priorities and concerns the family has identified related to supporting their child’s development. [7.30.8.10 NMAC - Rp, 7.30.8.10 NMAC, 6/29/12]


DDSD SERVICE DEFINITIONS AND STANDARDS

Comprehensive Multidisciplinary Evaluation The Comprehensive Multidisciplinary Evaluation is designed to inform the eligibility determination process through a timely, non-discriminatory, comprehensive and interdisciplinary approach. The evaluation is designed to determine the developmental status of the child and must cover the following developmental areas:

Cognitive Physical/ motor (including vision and hearing) Communication Social or emotional Adaptive behavior

SCOPE OF SERVICE This service includes activities provided by early intervention personnel in order to complete an initial comprehensive multidisciplinary developmental evaluation (in accordance with 7.30.8 NMAC) for children who are referred to the FIT Program. Evaluation personnel should have a background in child development and be trained in the tool they are administering. Activities required include:

If the team decides to first conduct a developmental screening for a child referred and in accordance with NMAC 30.30.8 10. E. the Ages and Stages Questionnaire (ASQ) shall be utilized.

The team shall use all phases of the Infant-Toddler Developmental Assessment (IDA) as the approved statewide tool as part of the Comprehensive Multidisciplinary Evaluation.

Given the unique characteristics of infants and the challenges of determining their developmental levels: o For infants under one (< 1) month of age (adjusted) the IDA will not be used. Instead one of the approved tools below

shall be used together with informed clinical opinion. o For infants over one (>1) month of age (adjusted) and under four (<4) months of age (adjusted) the IDA shall be used in

conjunction with one of the following approved tools below. o Approved tools for infants include:

AIMS (Alberta Infant Motor Scale) TIMP (Test of Infant Motor Performance) Infant Toddler Sensory Profile Peabody Developmental Motor Scale (PDMS-2) Motor Skills Acquisition Checklist REEL-3 Newborn Individualized Developmental Care and Assessment Program (NIDCAP) - for use with newborns in the

newborn intensive care setting only Other tools as approved by the FIT Program.

o Due to the varying nature and purpose of the scores of each of the above approved tools, the scores themselves will not lead to eligibility but rather they will provide additional information for the team to consider in reaching a determination of the child's developmental status.

Other domain specific tools may be used in addition to the IDA as part of the Comprehensive Multidisciplinary Evaluation (CME). If the IDA does not indicate a 25% delay, a domain specific tool can be used to determine eligibility under developmental delay.

A review and summary of the child’s records related to current health status and prior medical history.

Vision and hearing tests or screenings must be addressed in order for the CME to be complete. A statement summarizing the results must be provided in the written evaluation report and may include documented newborn hearing results (valid only for 6 months from the date of the screen), OAE and tympanometer results, NMSBVI screening tool or vision and hearing screening by a well child exam.

The completion of a typed Comprehensive Multidisciplinary Evaluation (CME) report that summarizes the child’s functioning in each developmental domain, gives a picture of the child’s overall functioning and ability to participate in family and community life, makes recommendations regarding the child’s eligibility and recommends approaches and strategies to be considered by the IFSP team when developing outcomes.

A FIT Program “Evaluation Summary Form”, which summarizes the evaluation results, may be used if the full evaluation report will not be completed at the time of the initial IFSP. However, the full evaluation report must be completed and given to the team within 30 days of the evaluation.


This service unit includes the participation of early intervention personnel in determining the child’s eligibility for the FIT Program. SERVICE REQUIREMENTS These conditions and requirements apply to the Comprehensive Multidisciplinary Evaluation:

Children are eligible for this service who:

Are from birth to three years old (If a child is referred to the FIT Program fewer than 45 days prior to the child’s third birthday an evaluation will not be conducted.)

Reside in the state of New Mexico

Have been referred for evaluation or early intervention services

Have received prior informed consent from their parent(s)

The provider is responsible for determining eligibility for early intervention services, and maintaining documentation of eligibility status on file.

AGENCY REQUIREMENTS The provider must adhere to the following: A. Administrative Requirements

The typed report that addresses all developmental domains, vision, hearing, and medical information, shall serve as documentation for Comprehensive Multidisciplinary Evaluation.

B. Staffing Requirements

The agency must provide adequate supervision to all staff providing Comprehensive Multidisciplinary Evaluation.

Personnel conducting a Comprehensive Multidisciplinary Evaluation must have a BS/BA or higher and Developmental Specialists must be certified at level II or III. Personnel must be trained and/or licensed to administer instruments used in an evaluation.

The Multidisciplinary evaluation team shall include personnel from two or more of the following disciplines: 11. Audiologist – licensure from the NM Audiology Board 12. Developmental Specialist certification II or III –in accordance with Family Infant Toddler Program regulations (7.30.8 NMAC)

and DDSD Policy 13. Family therapist – licensure from the Counseling and Therapy Practice Board as a Family Therapist, Professional Clinical

Mental Health Counselor, Professional Mental Health Counselor, or Registered Mental Health Counselor 14. Nurse – licensure from the NM Board of Nursing as a registered nurse 15. Nutritionist – licensure from the NM Nutrition and Dietetics Practice Board 16. Occupational Therapist– licensure from the NM Board of Occupational Therapy Practice 17. Physical Therapist – licensure from the NM Physical Therapy Licensing Board 18. Psychologist – licensure from the NM Board of Psychologist Examiners 19. Social worker – licensure from the NM Board of Social Work Examiners 20. Speech/Language Pathologist – licensure from the NM Board Speech, Language Pathology, Audiology and Hearing Aid

Dispensers Board

Clarifying note: A Developmental Specialist I, Certified Occupational Therapy Assistant (COTA), or Physical Therapy Assistant (PTA) may contribute to the evaluation but cannot serve as one of the two multidisciplinary team members representing two professional disciplines.

COMPREHENSIVE MULTIDISCIPLINARY EVALUATION REPORT

Quick Guidance Template

Child’s Name:

Child’s Date of Birth:

Date of Evaluation:

Child’s Chronological Age:

Referred by:

Child’s Adjusted Age

Location of Evaluation:

(if applicable)

Participating Team Members:

Name: Role / Discipline / Title:

Referral Information:

Describe the concerns of the referral source. Explains the primary concerns of the family. Explains goals of the assessment.

Child Background / Prenatal & Birth History / Current Health Status:

References pertinent medical records reviewed related to the child’s health and medical

history, Reviews caregiver’s description of relevant medical issues, such as prenatal and birth

history and child medical information.

Pertinent Family Information:

Describes family makeup (age of siblings, living arrangements of parents and children) Explains the accommodations made for the child and family’s native language or other mode

of communication Describes family support, if relevant

Child’s Name: Child’s Date of Birth:

Comprehensive Multidisciplinary Evaluation Report Page 2 Date of Evaluation:

Tip: To streamline paperwork, if the child becomes eligible, this information can be copied into the IFSP, Our Family Life, Part 1. It will be a good starting point to which more specific information may be added to the IFSP, as necessary.

Information Provided by the Parent(s) Regarding Child’s Daily Routines and Activities:

Describes child’s daily routines and what is working and

not working in the family routine.

Vision and Hearing (Screening / Testing Results):

Includes a statement summarizing the results of the

hearing screening. May include o Documented (not just reported by parent) newborn hearing results (valid only for 6

month from the date of the screen) o OAE and tympanometer results

o Hearing screening results by a well child exam

o Any recommended follow up.

Includes a statement summarizing the results of the vision screening. May include o NMSBVI screening tool o Vision Screening results from a well child exam. o Any recommended follow up.

Developmental Evaluation:

The developmental evaluation consisted of information gathered in the areas of fine and

gross motor skills, relationship to inanimate objects (considered to reflect aspects of

intellectual development, traditionally referred to as “cognitive”), language and

communication, self-help, and relationship to persons, emotions and feeling states and

coping behavior to describe various aspects of social and emotional development.

Tools / Procedures Utilized:

Documents and describes the procedures used to conduct the evaluation, such as:

o parent interview,

o review of medical records,

o Infant-Toddler Developmental Assessment (IDA),



Tip: To streamline paperwork, if the child becomes eligible, information from the 5 domains below can be pasted into the IFSP’s present levels and abilities section.

o Play-based Observation in Family Home

o FIT Program Environmental Risk Assessment Tool

o Etc.

Describe the setting(s) in which the evaluation and supporting observations occurred.

Notes whether, according to caregiver, child behaved in usual/typical manner to the

child during the evaluation.

Motor Development (Incl. gross motor, fine motor and sensory motor skills):

Describes child’s ability to master movement and balance (gross motor), eye-hand coordination

and manipulate small objects with control (fine motor). Contains information from both functional items from the assessment tool and the evaluator’s

observations to capture the use of both fine and gross motor movements. Notes any differences in abilities related to gross vs. fine motor skills. Treats child as individual, not just person with problem. Includes information from the family, and respects and values the family’s expertise. Describes behavior/skills in functional terms. Uses understandable words/explains professional language. Treats the child and family with dignity. Includes age range skill level.

Communication Development (Incl. expressive and receptive communication skills):

Describes both the child’s receptive and expressive language and verbal and nonverbal

expressions. Contains information from both functional items from the assessment tool and the

evaluator’s observations to capture the child’s exchange of ideas, information, and feelings. Notes any differences in responses related to receptive vs. expressive abilities Treats child as individual, not just person with problem.

Includes information from the family, and respects and values the family’s expertise. Describes behavior/skills in functional terms. Uses understandable words/explains professional language. Treats the child and family with dignity. Includes age range skill level.



Cognitive Development (Incl. relationship to inanimate objects, playing, thinking,

problem- solving skills):

Describes the child’s abilities such as attention, memory, purposive planning, decision

making, and discrimination. Contains information from both functional items from the assessment tool and the

evaluator’s observations to capture the child’s level of understanding, reasoning, perception and judgment in everyday activities.

Treats child as individual, not just person with problem. Includes information from the family, and respects and values the family’s expertise. Describes behavior/skills in functional terms. Uses understandable words/explains professional language. Treats the child and family with dignity. Includes age range skill level.

Social and Emotional Development (Incl. relationship to persons & emotions and feeling

states):

Describes child’s engagement in meaningful social interactions with parents, caregivers,

peers, and others in his environment. Contains both functional items from the assessment tool and the evaluator’s observations to

capture the child’s social awareness, social relationships, and social competence. Treats child as individual, not just person with problem. Includes information from the family, and respects and values the family’s expertise. Describes behavior/skills in functional terms. Uses understandable words/explains professional language. Treats the child and family with dignity. Discusses strengths and areas of concern. Includes age range skill level.

Self Help / Adaptive Development (Incl. feeding, washing, toileting skills):

Describes the child’s ability to do for him/herself, including feeding, dressing, sleeping and

toileting. Contains both functional items from the assessment tool and the evaluator’s observations to

capture the child’s level of independence in his/her environment. Treats child as individual, not just person with problem. Includes information from the family, and respects and values the family’s expertise. Describes behavior/skills in functional terms. Uses understandable words/explains professional language. Treats the child and family with dignity. Discusses strengths and areas of concern.



Includes age range skill level.

Any Other Developmental Information (Incl. activities that occur across domains e.g.

play; mealtime; preschool readiness, etc.):

Evaluation Summary:

Summarizes the overall results References both the parents concerns and concerns of the referral source Includes additional concerns or observations made by the evaluator

Evaluation Results Domain/Area of Development Age Equivalent Motor Months

Communication Months

Cognition Months

Social-Emotional Months

Self Help/ Adaptive Months

Vision Results Hearing Results

Eligibility:

Provides eligibility statement.

Recommendations:

Addresses some of the parents’ immediate concerns with general strategies

Signatures of Evaluation Team:

Discipline/Credentials:

Excerpt from the NM Family Infant Toddler (FIT) Program Evaluation & Assessment TA document

Appendix A: Key Principles of the IDA Process in

New Mexico

In order to determine both initial and ongoing eligibility for the NM FIT Program, use of the IDA is required. Implementing the IDA with integrity is the goal for all FIT provider agencies and requires that agencies and all evaluation staff embrace the following key principles of the IDA process.

The IDA:

I. Is an integrated system of assessment that is designed to describe the story of who the child is in the context of her health and the context of the family.

II. Requires that practitioners have a thorough understanding of infant toddler development.

III. Utilizes a transdisciplinary approach. All practitioners act as both a generalist and expert, with a particular knowledge base, to observe and assess all developmental domains within the evaluation process.

IV. Is a system of assessment rather than a test that is scored. Information from all six phases, including the Provence Profile (which is scored), are integrated and synthesized to develop a more complete picture of the child.

V. Is designed to be implemented by a team who informs one another of information that

has been gathered, who are present together for the evaluation, and who discuss their

findings together in order view the developmental domains, and the child, as a whole.

The NM FIT Program, in adhering to the framework of the IDA process, expects that a child’s

eligibility determination through IDA will involve more than a team’s review of the “score”

from the Provence Profile. Rather, eligibility for the FIT Program should be based upon the

team’s understanding of the significance of those “scores” in relation to the child’s current

home environment, family relationships, and health status. If there are contributing factors

that result in a “score” that is not substantiated by the evidence, the team is required to use

their professional wisdom to make a determination regarding whether or not a delay truly

exists.

New Mexico FIT Program

Infant Toddler Developmental (IDA) Assessment Clarifications

Rationale

The NM FIT Program, with approval from the Interagency Coordinating Council

(ICC) and the previous Health Secretary Dr. Vigil, has decided that the Infant

Toddler Developmental Assessment (IDA) will be the primary tool to be used to

determine eligibility for our Part C system. The IDA is a tool that meets our states’

eligibility determination requirements and embodies the principles found in the

recommended practices promoted in the field of early intervention and included in

the NM FIT Program’s Technical Assistance Document Evaluation & Assessment,

2006. To determine eligibility for premature and infants younger than 4 months

other recommended tools will be used in conjunction with the IDA and

incorporating informed clinical opinion (ICO).

Those familiar with the IDA recognize and value its’ strong family – centered

framework, flexible administration, suitability for use in determining eligibility,

(includes tables for % delay) and utilizing a trans-disciplinary team approach.

While the IDA Provence Profile has relatively fewer items than other tools used in

early intervention, it is comprehensive. It includes eight domains and most

importantly, provides a grounded framework to ensure that the principles we

acknowledge as being critical for a thorough, integrated and family-sensitive

evaluation process are employed. In choosing the IDA, we are choosing to

“embrace the complexity”. The IDA demands keen observation skills, knowledge

of typical child development and communication among team members to realize

its effectiveness.

However, we also acknowledge that the IDA Provence Profile contains scoring

criteria that may not be easy to interpret and could result in variations in

evaluation findings. The publisher of the IDA, PRO-ED, plans to revise the IDA

Administration Manual in the near future. This plan presents us with an ideal time

to initiate some clarifications of IDA scoring procedures that meet our system

requirements and New Mexico’s unique cultural and demographic make-up.

IDA Procedures

The FIT system has requested assistance from one of the authors of the IDA and a

national consultant to address scoring questions. The following clarifications of

IDA scoring procedures are approved by our IDA consultants and will be

implemented in New Mexico within the FIT system effective 7/1/11. We anticipate

that revisions to the IDA Administration Manual by PRO-ED may not be available

for at least a year or more.

The procedures described below will be incorporated into all IDA training

facilitated by ECLN, Spring 2011. To compare the clarifications described below

with what is currently found in the IDA Administration Manual, see pages 44-45

of the Manual.

Overview

When determining whether a child’s performance and development is either

“competent” or “of concern” the IDA uses 3 factors:

• quantitative scoring from the Provence Profile (in the IDA Record)

• quality of the child’s abilities, performance, and

• the starred items.

The following sequence is recommended when considering these three factors:

1. Total number of items completed with credit (+, R+) in each domain

and appropriate age zone. (Refer to Scoring Criteria, IDA

Administration Manual).

2. Consider strongly the qualitative aspects of the child’s performance:

3. Consider importance of any starred items that did not receive credit

in age zones BELOW the child’s chronological age.

These factors are noted directly on the Provence Profile (IDA Record) and

described in the final report. Using informed clinical opinion (ICO) the team may

determine that any of these factors may result in item(s) recorded as no credit or

possibly emerging. While we want to facilitate optimum performance for the child,

ICO would be used to describe/document the child’s response to the task, previous

experience with like tasks/behaviors, and the level of support used by the team to

facilitate the child’s response. With these factors considered, the team would then

determine whether to give credit (+, R+) for that task/behavior .

Substitutions

The directions for scoring in the IDA Administration Manual states:

“an item completed in the age zone above may be counted as a success and

substituted for an item missed in the zone below.” Use of substitutions has been

problematic for evaluation teams for several reasons including:

• In some cases substitutions are made for related but different skills, for

example, substituting a receptive language item for an expressive language

item.

• Difficulty determining the child’s level of performance required for the

IFSP.

For purposes of determining eligibility and levels of performance as required in

New Mexico’s FIT Program, we propose the following to ensure consistent

scoring procedures:

• To determine a level of relative competence in each domain area, use the

zone where the child has achieved the most credit for items within that

domain. That means there will be no substitutions of items from one zone

to another in any domain. Successes in higher zones (older) will be noted

on the Provence Profile in the IDA Record and included in the written

evaluation report.

Zone Selection:

There are often questions about how many zones to use and confusion about how

to use them. The following are steps to follow when choosing the zones

appropriate for the child by the team:

• Choose a minimum of three (3) zones

• Select an age zone (usually child’s current chronological age). This is the

middle zone.

JBrown

Highlight

• The other zones used are one above (younger than) and one below (older

than) than the middle zone.

• Once the Service Coordinator or team has met the child & family – then

decide if the zones chosen best match based on what you now know about

the child. If not, adjust the zones to better match where the child appears to

be developmentally.

• Can move higher or lower in specific domain areas, as needed, to

determine competence. For example, if needed, within a domain area such as

Language /Communication, it is allowable to move to younger or older

items to achieve a relative level of competence.

Prepared by: Mary Zaremba, UNM CDD Early Childhood Learning Network, April 25, 2011

and approved by; Joanna Erickson, MPH., and Jennifer Rosinia, PhD, OTR/L

Early Childhood Learning Network, UNM Center for Development & Disability, June, 2014.

IDA – Frequently Asked Questions, 2nd ed.

The Process:

Q: When can we use Parent Report to score a Provence Profile item on the IDA?

A: Parent Report can be obtained as part of the intake process and recorded on the Provence Profile (by a

qualified evaluation team member) for an initial evaluation. However, it is still best to try and elicit the skill from

the child during the evaluation session as well in order to examine aspects of quality, relationships and/or

environmental influences on development, etc. Please remember that how you ask the questions will impact the

type of responses that are given! Asking open-ended questions that require the parents to describe what they

see and hear is crucial to gain an accurate picture of the child (e.g. – “How does he get around the house?”, “How

does he let you know when he needs something?”) This process would also hold true for any updates to the IDA:

- Give credit to the child for skills that you have observed over time

- If you are unsure of the child’s skill: attempt to elicit the skill first, use parent report if the skill cannot be

elicited

- You may also use a technique to “split” the scoring box on the Provence Profile in order to record

BOTH the parent report and the results of elicited skills (see example below). The difference between

what was observed and what was reported should be discussed in the report as well.

Q: Can a therapist just do “their section” of the IDA?

A: No. The IDA, and the Provence Profile, were designed to be used by a team of two different disciplines, but

with each professional acting as a generalist within the evaluation process and examining the child’s overall

development across all domains. This design was intended to offer multiple perspectives of the child and her

skills so that no one person or perspective is making a determination of the child’s skills in isolation. In practice,

this means that both team members equally assess each item in all 8 developmental domains and then both

professionals come together to discuss and integrate their individual perspectives and expertise regarding the

child’s skills. This approach also aligns with FIT Program regulations regarding the requirements for the evaluation

process.

Q: When do we adjust for prematurity?

A: According to FIT Regulations, “Adjusted age (corrected age)” means adjusting / correcting the child’s age for

children born prematurely (i.e. born less than 37 weeks gestation). The adjusted age is calculated by subtracting

the number of weeks the child was born before 40 weeks of gestation from their chronological age. Adjusted Age

(Corrected Age) should be used until the child is 24 months of age.” Therefore, in NM, we will begin adjusting a

child’s age for use with the IDA if they were born less than 37 weeks or earlier. No adjustments would be made

for a child born later than 37 weeks.


Percentages of Delay:

Q: Which table do we use to establish a percentage of delay for FIT eligibility?

A: The best and easiest method for determining the 25% delay required for FIT eligibility is to use Table 6 on

pages 52-55 of the IDA Administration Manual.

Q: When would you use Table 5 to determine a percentage of delay?

A: If you need to determine a percentage outside of the 25% required by the FIT Program, you would use Table

5 on page 50 of the IDA Administration Manual;

Examples include, but are not limited to, the following:

- Needing a percentage of delay (e.g. – 30%) as part of the information provided to the schools at the time

of transition

- When the evaluation team would like to determine the percentage of delay when it is less than a 25%

delay

- Documentation of specific levels of delay needed for services such as SSI or DD Waiver

Q: What percentage do we use if the age-range “score” for the child falls between the 25% and the 50% levels on

Table 6 in the manual?

A: A child does not need to have a “score” that specifically matches the age ranges listed in those two categories.

If you are simply determining eligibility for the FIT Program, you can just state that the child has a greater than

25% delay and be sure to include the performance-age range, etc. in any required documentation, such as the

CME Report.

If you are determining a percent of delay for a reason beyond eligibility for the FIT Program (e.g. – transition to

LEA), you can use Table 5 on page 50 of the IDA Administration Manual to obtain a more specific percentage as

needed.

Q: How do we determine a percentage of delay in the Emotions and Feelings States domain on a child who is

over 24 months old?

A: You cannot determine a percentage of delay in this domain for a child who is over 24 months of

age. The percent delay charts for Table 6 only go up to 24 months for the child’s chronological age in this

domain because the IDA authors felt that there was too much variability within the subtle skills of a child’s

development in this domain for children over the age of two. The Provence Profile and, thus, IDA, were designed to

determine if there were concerns regarding a child’s development; meaning that IDA can determine if a child’s skills are

solid in this area OR if there are concerns. If a child over 24 months of age is exhibiting concerns with respect to

his expression of emotions, this will typically cross over into other domains. However, if this is the only domain

of concern and/or suspected delay, the team (if appropriately trained) can choose to use a more specific tool to

examine the social-emotional development of the child and/or consider the use of Informed Clinical Opinion for

the purposes of eligibility determination.

In terms of the documentation required for the developmental level on IDA, the team would simply state that a

percentage of delay could not be obtained.


Q: Can you calculate a percentage of delay for an infant who is less than 2 months old?

A: No. The charts in the IDA Administration Manual do not provide information to support such a

determination, therefore no percentage of delay can be calculated to use for FIT eligibility.

Provence Profile Items:

Q: If a child uses a pacifier, does that count for Coping Item 9: “Uses transitional object for self-comfort?”

A: No. The criteria in the IDA Administration Manual, pg. 182, states “…It is an indirect form of psychological

comfort as opposed to the more direct gratification from the breast or bottle, thumb, or pacifier that give comfort, but are

not transitional objects in this sense.” This paragraph is distinguishing between a child’s use of a more

physiologically-related comfort (bottle/pacifier) and one that is more psychological in nature and “represents” a

comforting person with its softness, etc.

PLEASE NOTE: For many children, this is an “integrated skill” – meaning that the child displays the skill for a

period of time and then the skill becomes integrated into the whole of the child and is no longer displayed to the

outer world. If a child transitions well without the use an object at all (including a pacifier, etc.), discuss the

history of the child’s coping with transitions with the family to discover if there is any concern in this area (e.g.-

under-reactive to external stimuli, etc.) or if the child is simply moved past the need for any transitional object of

any kind and is, therefore, developmentally appropriate.

Q : For Self-Help Item 13: “Is able to give full name when asked”, what if the child has never been called by that

name? How do we score?

A: Always keep in mind that IDA was designed to incorporate the information from the child’s family,

environment, and culture into the considerations for whether or not to give credit for any given item. If a child’s

family and/or culture is that he is only ever called by his first name, a nickname, or other adorations, then the

evaluation team should ask the family questions such as: What name do you typically use for him? What does he

respond to? What name does he go by? Have you (or teachers, etc.) taught him his last name? The evaluation

team would determine if credit for the item should be weighed based upon first and last name, or another

measure based upon the child and family’s culture and environment.

Q: Can we give credit for the Language/Communication items that ask about the child’s vocabulary and

expressive language skills if the child is using signs?

A: Of primary importance is establishing whether the child is using signs as gestures or as true language. This may

be difficult to do if the child is only using 1 or 2 "signs". The IDA practitioner must first ask the following

questions regarding the child and family situation:

- Does the child have a diagnosed hearing loss or another condition of some kind that precludes the use of

spoken language and signs are being taught as the primary language of the child?

AND/OR


- Is the primary language of the family ASL (American Sign Language) so that is then the native language of the

child?

If the answer to the above questions is NO and the child is expected to have spoken language, then the IDA

practitioner would NOT be able to give credit for those language items. If the practitioner were to give credit for

these items, then they run the risk of denying eligibility to a child who might, in actuality, qualify for the FIT

Program!

If there is any doubt regarding any child, with or without hearing loss, and their use of signs relative to the IDA,

please call the New Mexico School for the Deaf (NMSD) early intervention program at 505-476-6402 for

guidance. Additionally, always remember to involve NMSD in any evaluation situation where the child and/or the

parent has a known hearing impairment.

The IDA Record:

Q: Can a child’s skills in a particular domain be considered “Competent” if they are not at age-level?

A: No. A child’s skills in a particular domain must be in the performance-age range that corresponds to the

child’s chronological age in order to be considered “Competent”. The IDA Administration Manual provides

Tables 7-14 on pages 56-63 that explicitly depict what is required to be considered “competent” for a given age.

Q: Can a child’s skills in a particular domain be considered “Of Concern” even if they have a score that is at age-

level?

A: Yes. A child may be demonstrating age-appropriate skills in a particular domain but the evaluators may still

have concerns; concerns may be due to the quality of the child’s performance, ability to generalize the skill across

environments, or other reasons. See pages 64-68 in the IDA Administration Manual for additional information

regarding qualitative considerations.

Q: Do we include the number of missed starred items WITHIN the child’s chronological age zone as well as the

younger age zone?

A: No. When looking at the number of missed starred items for each domain to determine if there are

concerns, you would look at the missed starred items in age zone YOUNGER than the chronological age zone;

the evaluation team may take note of starred items missed within the chronological age zone if they appear to be

of significance in relation to the child’s overall developmental status.

This graphic is to emphasize the overlap of the five (5) IDEA developmental domains under which a child is determined eligible for the FIT Program, and the eight (8) IDA developmental domains. If a child is displaying a 25% or greater delay in ONE of the IDA domains that correspond to an IDEA domain, they are determined eligible for FIT. PLEASE NOTE: As you can see, the Coping domain crosses over all domains. Therefore a delay of ANY kind

in the Coping domain does NOT make a child eligible for the FIT Program!

Overview of IDA Online & Case Study Record Requirements

If all of the items on this checklist are not included upon submission of your IDA Case Study Record, your work will be returned to you before any consideration for a certificate.

If you have questions and/or need support, please contact your agency’s IDA Lead and/or your ECLN Program Consultant.

All lessons within the online training have been

fully completed

Your certificate of completion for the online

portion of the course is printed & will be

submitted with your Case Study Record

All items within 3 age zones are scored

(Development across domains is typically uneven with a child possessing more skills in one area and less in another. By reviewing skills in age zones both younger and older than the child’s age, we can gain a better understanding of the

child’s developmental strengths and areas of need.)

“Evidence”: page and line number from the written case study listed next each item scored

(This information assists in understanding the rationale

behind any given scoring decision)

Performance age-ranges must be listed for each developmental domain

(The performance age-range must be identified in order to calculate a percentage of delay. It also provides information to determine if the child’s skills are considered “Competent”

or “Of Concern” in any given domain)

Missed starred items need to be listed (or a 0 entered) for each domain

(If a child has missed 2 or more starred items in the age zone younger than chronological age, that domain is immediately considered to be “Of Concern”. Starred items refer to certain foundational skills that are necessary to continued

development within that domain.)

Please note: these visuals are just SAMPLES. They are not reflective of the Case Study.

Competent or Of Concern should be marked for each domain

(A child’s skills must be at an age-appropriate level to be considered “Competent”. A child may have skills that are considered to be “Of Concern” but still not qualify for FIT services. The determination “Of Concern” indicates that this area may need to be monitored, etc. and should be included in the evaluation

recommendations as appropriate.)

Percentages of delay should be calculated

for any domain that is not at age-level

(A percent delay of at least 25% is required to qualify for FIT under the Developmental Delay category. A percent delay that is less than 25% is important to note as it

indicates an area of concern.)

Summary Paragraph- a bulleted list that includes the following:

o Areas of strength o Areas of concern o Any areas of significance related to

health/medical, family dynamics, etc. that impact the child’s development

o Eligibility categories & percentages of delay (both as appropriate)

o Recommendations and/or next steps (these are NOT services)

(This summary provides a comprehensive foundation for the team in writing the evaluation

report.)

ARTICLES

A Framework for Reflective Questioning When Using a

Coaching Interaction Style

http://fipp.org/static/media/uploads/casetools/casetool_vol4_no1.pdf

Evidence-Based Definition of Coaching Practices

http://fipp.org/static/media/uploads/caseinpoint/caseinpoint_vol1_no6.pdf

http://fipp.org/static/media/uploads/casetools/casetool_vol4_no1.pdf

http://fipp.org/static/media/uploads/caseinpoint/caseinpoint_vol1_no6.pdf

TABLE OF CONTENTS › ecln › FIT › pdfs › IDA Lead Training Binder...• Compare the IDA...

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Transcript of TABLE OF CONTENTS › ecln › FIT › pdfs › IDA Lead Training Binder...• Compare the IDA...