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Evaluation & Assessment Baby Watch Early Intervention, Part C
IDEIA 2004 Requires 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’s strengths 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 procedure MEANS . . . • Standardized norm-referenced tests • Criterion-referenced tests • Procedures for assessing functional daily skills • Observation in various settings • Tools for assessing parent-child interactions • Parent or other caregiver reports • Health, hearing, and vision screenings • Medical records • Other relevant information…
Be Family Friendly • Provide parents with ways to participate during the first contacts • Prepare parents as fully as possible for their roles as participants • Parents should be able to make choices about the process • Parents provide the foundation for understanding the child
Assessment Is defined as the ongoing methods, techniques and procedures utilized to gather information about the child and family
Assessment • Assessment is the process that integrates information from multiple sources and is the ongoing procedure used throughout the period of the child’s eligibility. • It is the basis for developing IFSP outcomes, intervention and programming strategies, and provides appropriate information to parents.
Evaluation • Evaluation 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
Diagnosed Condition Children diagnosed as having a physical or mental condition that has a high probability of resulting in developmental delay.
Documenting Diagnosis • EI staff do NOT diagnose children • Must 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
A Significant Delay: Moderate: At or between 1.5 and 1.9 standard deviations below the mean OR at or between the 3rd and 7thpercentiles Severe: At or greater than 2.0 standard deviations below the mean OR at or below the 2nd percentile
Not Eligible: Not Significant: At or above one standard deviation below the mean OR at or better than the 16thpercentile Mild: At or between 1.1 and 1.4 standard deviations below the mean OR at or between the 8th and 15thpercentiles
Not Significant – Within Normal limits Mild Mod Severe -2.0 -1.5 -1.0 + 1.0 + 1.5 +2.0 2nd 7th 16th Percentile
Exit Criteria: 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 15thpercentiles
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
Documenting Significant Delay • Summarize 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”
3 Types of Assessmentat KOTM Ongoing Developmental Assessment Eligibility Determination Specialized Evaluations
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!
Writing the CLD • CLD due by IFSP meeting • If child appears Not eligible give Service Coordinator advance notice • Follow guidelines for writing adequate CLD (see CLD guidelines)
The Eligibility Form • The eligibility form is used to summarize the information on which eligibility was determined • The CLD is used for eligibility summarization every six months • Reason for eligibility may change over time
Changing Eligibility Examples… • Come in on Standardized test – using HELP for continued eligibility requires Informed Clinical Opinion • Come in on Informed Clinical or Standardized test – child now has qualifying diagnosis (e.g., Autism)
Recommended Practices • Obtaining a developmental history of the child and beginning description of the family’s experience, their concern about their child’s development, and their expectation of the early intervention program. • Observe the child in the context of unstructured play.
Recommended Practices • Include the parents. Listen to their views of the child’s strengths and challenges, and discuss the issues to be explored in the evaluation and assessment process. • Educate the parents about their rights and the ways that they can contribute and participate in the process.
Recommended practices Do pre-assessment planning with the child’s parents and other appropriate team members to discuss: • Child and family concerns • Developmental, health, and medical background • Goals for the evaluation and assessment process • Specific testing instruments, team composition, roles and responsibilities, etc.
Recommended Practices • Use a “whole” child model as a framework • Integrate the data collected from all sources • Convey and discuss assessment findings with parents • Keep the focus on the child within the context of the family • Make it descriptive of the child’s ability to function in the natural environment of the family • Remember the purpose – use information to determine appropriate IFSP outcomes and interventions
Recommended Practices • Prepare for testing: • Review information already collected • Prepare test materials and adaptations in advance • Avoid settings which will distract or upset the child (hospital rooms, white coats, etc.) • Plan the best time for the child • Allow enough time, or do multiple sessions if needed • Permit warm up time for parent and child before testing
Quiz 1.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 whendetermining 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
Purpose of Health, Hearing & Vision Assessments • Developmental implications • Provide appropriate EI service mix • Protect child health • Potential Service Coordination needs • Potential family goals
Health Assessment • BWEI Protocol by KOTM Nurse • Medical records provided by a doctor • Child Health Survey completed by family • Family waives Health assessment
Hearing Hearing Status must be determined by one: • Audiology Report • Hearing screening by a trained professional • Functional assessment based on observations and parent report
Vision Vision status must be determined by one: • Ophthalmology Report • Vision screening by a trained professional • Functional assessment based on observations and parent report
Which Type at KOTM? New Kids: • Try for BWEI Protocol by KOTM Nurse • Records review if family prefers Ongoing Kids: • Child Health Survey unless team requests otherwise
“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
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)
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
Clarify what YOU want WHY…. • 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?
If approved by team: Listed on the Board Child’s name Date assigned Staff member assigned Type of evaluation Target month for evaluation
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
Specialist reports evalto team Conclusions Recommendations – clarify WHY Team determines action to take Everyone should be clear on roles and expectations Report to Child Study