Despite not being able to meet in person, tele-intervention (telehealth) has brought new opportunities to think about how we are talking about the child outcome summary process. Let’s be completely honest. Tele-intervention forces us to use good teaming practices because there cannot be any side conversations among professionals and everyone is only able to see and hear the same information. This helps us think outside of the box to ensure that all team members have the exact same information so caregivers can make the best decisions for their child.

After completing tele-assessments, I have experienced great success incorporating the caregivers in the Child Outcomes Summary (COS) discussion. The COS process summarizes a child’s functional development in three child outcome areas: positive social-emotional skills (including social relationships), acquire and use knowledge and skills (including early language/communication), and use of appropriate behaviors to meet their needs. The Decision Tree can be a helpful tool to facilitate the COS process.

All caregivers participate in the COS discussion using the Decision Tree. This includes deciding with the team which rating statement represents their child’s functioning compared to other kids of the same age. (Click here for more information about the Decision Tree and Virginia’s COS Process). Before even going through the process, it is most helpful to discuss who will facilitate the discussion with the caregiver and the rest of the team members. This includes sharing the screen to show the Decision Tree.   This can be the service coordinator or a provider. Here are 6 steps you can use throughout the process that I have found beneficial.

6 Steps for Engaging Caregivers during the COS Process

1. Explain the caregiver’s role as a team member.

This is an important step. Caregivers need to understand their role in the process and how they can participate. When they are unsure of what to do, they may be more reluctant to participate. Encourage their voices by involving them throughout process, giving thorough explanations, and asking open-ended questions to receive more in-depth answers.

2. Explain each outcome area and the use of the Decision Tree.

The second page of the Decision Tree shows the Infant & Toddler Connection of Virginia Child Outcomes Summary handout. This handout was specifically designed to support the caregiver’s understanding of the process. It is helpful to send this handout to caregivers prior to the meeting and share the screen with the document pulled up while discussing and highlighting different outcome areas. This will also encourage caregivers’ participation when they fully understand what is being discussed and why.

3. Discuss each outcome area with individualized examples.

During the Assessment for Service Planning, the team discusses functional development within each outcome area based on parent report, observation, clinical opinion, etc. Functional child development focuses on what matters in the family’s daily life, showing how the child is engaging, initiating, and participating throughout their day. It has little meaning to a caregiver if a child can stack blocks, so a functional example would be, “During bath time, Sydney enjoys lining her plastic blocks on the bathtub ledge before knocking them off and laughing. Her mother commented Sydney enjoys playing this game the entire time.” Embedding functional information like this contributes rich examples to the Decision Tree discussion that help all team members understand the child’s abilities and needs. During the discussion, it is also helpful to share the screen to show each outcome area on the IFSP as it is discussed. Screen sharing gives the parent the opportunity to follow along.

4. Review typical functional development.

This is an important step and not to be missed. It truly helps each team member, including the caregiver, understand what is typical for the child’s age within that given child outcome area. This will help each team member understand whether or not the child has “age-expected” functional skills. Utilize your resources for typical development. This can include a combination of resources such as the Act Early Milestones, Functional Development, Age-Expected Snapshots of Development, etc. Again, sharing the screen to show this information and/or sending the info prior to the meeting is beneficial to all team members.

5. Use the Decision Tree discussing each question and prompt.

Again, sharing the screen and/or sending the Decision Tree to the family prior to the meeting can be really helpful. Screen sharing allows each team member (including the caregivers) to look at the same information and follow along accordingly. Ask each question out loud for each decision point. Pause for discussion or examples. When choosing between two items at the decision point, read it and reflect with the caregiver and other team members about specific examples to reach an agreement on the best possible choice. By this point, caregivers should feel empowered to help make the best decision based on the information given to them and understand the importance of their voice.

6. Decide as a team the best statement.

Everyone has a voice. Check in with each person to make sure everyone is in agreement including the caregiver. Discuss specific examples if there is a difference of opinion at any given point in time.

Please note: When I share my screen, I already have these resources pulled up and ready to share as they are discussed: Decision Tree and the Infant & Toddler Connection of Virginia Child Outcomes Summary handout, the child’s IFSP, and information about typical functional development (See #4 above).

What are your top tips to engage families during the Child Outcome Summary Process?

How do you help facilitate the discussion?

Share your tips and ideas by leaving a comment below!

For more information about the COS process and the Decision Tree, check out these resources:

Decision Tree Tutorial

Virginia’s Child Outcomes Booklet: Team Engagement in the Child Outcomes Summary Process

The Decision Tree: A Tool for Teaming and Family Engagement – Parts I and II

ECTA COS Completion: When Teams Can’t Meet in Person

Extra! Extra! Read All About….Integrating the Decision Tree

Logan is Not a Number! – Explaining the Child Outcomes Process

COS Completion – When Teams Can’t Meet in Person

The post Successfully Engaging Caregivers in the Child Outcomes Summary Process Virtually appeared first on Early Intervention Strategies for Success.

Here’s the question: Whoever, in a million years, thought we’d be doing developmental assessments using video conferencing??

Really, when you think about that, it’s equally unnerving and amazing. Unnerving because it can seem like a completely new way of gathering information about a child’s development without even being physically present with the child. Amazing because you are doing it, and from what I hear, doing it well.

Worries and Successes

Over the past few weeks, I’ve been hearing more and more about tele-assessment, with practitioners sharing common worries like: How will I collect the information I need to score my tool? How will we get the toddler to stay where we can see him? What if the technology doesn’t work? These are very real worries, but the great news is that there are programs out there who are figuring this out. After the initial stress response that came with the shift to tele-intervention due to the pandemic, EI practitioners are settling in and finding answers to these questions. I’ve also begun to hear some amazing successes, such as families who are realizing that they can do this, they know their children so well, and they are valued, essential team members who can facilitate activities while the other team members (aka you) observe and share support.

New Resource Alert! – EI Tele-Assessment Video Chats

To get those successful strategies for tele-assessment out there, I recently hosted two video chats with practitioners and leaders from around Virginia. Each chat is between 35-40 min long and includes five different practitioners discussing how to prepare families and other team members, what tele-assessment looks like, and advice for others who are on tele-assessment teams. Block some time in your schedule to sit back and listen. I’m pretty sure you’ll learn something and hopefully feel like you are not alone in your tele-assessment learning process.

A special thank you to the EI practitioners who participated in this chat: Lauren Bernhard, Speech-Language Pathologist and Jen Saddington, Physical Therapist (Infant & Toddler Connection of Fairfax-Falls Church), Sandi Harrington, Local System Manager and Educator (ITC of of Norfolk), Ginny Heuple, Local System Manager and Physical Therapist (ITC of Greater Prince William), and Maria Grady, Physical Therapist and Service Coordinator (ITC of Loudon).

Another huge thank you to the following EI practitioners who participated in this chat: Brandie Kendrick, Service Coordinator, Human Development Professional, and Intake Coordinator (Infant & Toddler Connection of Danville-Pittsylvania), Kathy Phillips, Local System Manager and Developmental Service Provider and Erica Price, Speech-Language Pathologist (ITC of Middle Peninsula-Northern Neck), Stacie Jackson, Local System Manager and Service Coordinator and Kim Sprangel, Service Coordinator and Developmental Service Provider (ITC of Staunton-Waynesboro).

Strategies for Tele-Assessment

Just to get you started, here are a few strategies mentioned in the video chats:

Be sure to do a quick tech check and planning session before the actual tele-assessment – Meet with the family for 10-15 minutes a few days before the tele-assessment to test your technology, help the family connect, and plan together about where to position the device for the best view. Explain what to expect and talk with the family about any routines they might like the assessment team members to observe.

Let go of your stress about the test and toys – This is such an important tip. Acknowledge the fact that you will not have your assessment kit with you and you will not be able to observe every item on the test – and that is okay. Right now, you will use your coaching skills to help the parent facilitate activities that help you see what you need to see. Yes, you do still need to gather information to summarize the child’s developmental strengths and needs, but look at this situation as an opportunity to grow your assessment skills. Sure, you might provide the family with some ideas of items to have handy if possible (please don’t ask for 1-inch blocks!), but be ready to be flexible and…(see next tip)

Use your knowledge of development and informed clinical opinion to help you observe the child’s abilities during natural activities – Think creatively and consider how you can observe the same concepts and abilities in natural activities. Don’t have the tiny pegs and the bottle? That’s okay – ask to see the child pick up cheerios and drop them in a small cup or toilet paper tube. Be sure to watch the video chats for some great discussion about this!

Look through a functional lens – This is a perfect opportunity to practice translating assessment items into their functional equivalents. Pay attention and observe the child, even in the background while you chat with the parent. Ask about what goes well and what’s challenging. How children interact with others in their environment is as important as any item on the ELAP. Now’s the time when you will really be able to appreciate that so be open and get your functional lens ready.

Do the best you can – In most cases, you will be able to learn enough about the child and family to plan for the IFSP. Do your best, follow-up if you need additional information, and lean on your colleagues for ideas and support. You’ve got this!

Ready to keep learning? Watch the video chats for more strategies from your colleagues!

What’s one of your best tips for conducting tele-assessment?

Have an example of a tele-assessment that went well? Share it in the comments below!

For information, videos, webinars, and online training related to tele-intervention, visit these sites:

COVID-19 and EI Tele-Intervention Updates – VA EI Professional Development Center

Coronavirus Disease (COVID-19) – ECTA Center

The post EI Tele-Assessment Video Chats & Strategies: You’ve Got This! appeared first on Early Intervention Strategies for Success.

An important and ongoing part of a service coordinator’s job is gathering information from families about their child and how that child fits into the daily routines of their life. This information ebbs and flows, changing as children and parents develop together over time. By gaining insight into these routines service coordinators can facilitate an IFSP rich with meaningful outcomes and goals and can aim to provide services that best meet the needs of the child and family. Come walk a mile with me as we step through a day in the life of a family. Simple though it may seem, let’s start in the very beginning…

It’s time to wake up.

There’s so much information that can be gained by simple, open-ended questions about how a child moves through his/her day. Does a child wake up like a ray of sun or a storm cloud? Does the 7-day forecast call for sunshine or partly cloudy skies? Ask questions about what constitutes a child’s daily routines. Also ask how that child is participating in their day within those routines. If a child starts their day in tears, does it continue to pour or are there rainbows?

Little Sammy wakes up with the sun with tears in his eyes. He calls out “mommy” while sitting in his toddler bed. After a few minutes of snuggles he’s ready to start the day. When his mom asks what he wants to wear today he pulls open the dresser drawer and says “Paw Patrol” while pulling out his shirt. He lays down on the bed in anticipation of having his diaper changed. He grabs it and says “peepee.” As soon as he is dressed and dry he runs out the door calling out for “daddy” and tells him he’s ready for “a snack” (aka breakfast). He pulls over the kitchen stool to the pantry. He gives a “bar” to dad for help opening the package.

This small part of Sammy’s morning routine alone contains a wealth of information. He has a healthy attachment to his parents. He is growing in independence. Sammy recognizes the routines in his day and participates in dressing. He is showing early signs of readiness for toilet training. Sammy calls out to his family by name. He is using words to tell others what he needs and to identify when he needs help. He is using nice problem solving to figure out how to get something himself. What other things can we ascertain about Sammy from the first 15 minutes of his day?

The days are long, but the years are short.

Most of us are probably familiar with this little adage but unless you are still in those days, then it can be all too easy to forget just how long the days can be. As the family talks about the ins and outs of their daily routines, ask follow-up questions about the child’s likes and dislikes, what do they love to play with and how do they play with it, and what happens when it’s time to stop doing that activity. Are there times of the day the family dreads? The family’s answers can provide a valuable insight into what direction to take with the providers as you plan for the assessment and segues smoothly into the conversation about the family’s concerns and priorities. It can also help you identify challenges within the day the family might not recognize as a challenge.

Service Coordinator: Does your son take a nap?

Mom: Yes, after lunch.

Service Coordinator: How long are his naps?

Mom: Usually about an hour and a half.

In this interaction we’ve established that Sammy takes a nap but a few follow-up questions might reveal that Sammy can easily take up to an hour (or more) to fall asleep and will only stay asleep with his mom next to him. It’s a challenge and frustration for his mom because she doesn’t have that time free to get a few things done around the house. Meanwhile, at daycare he’s the only child in the room that doesn’t nap. His teachers have given up rubbing his back and he now spends the 2 hours lying still in his cot not allowed to talk or move. He has come to associate daycare with being forced to lie still for 2 hours and now drop-off has become a challenge, filled with tears and begging not to go. Take a moment to reflect on how you frame questions to families about their child’s routines. Challenge yourself to think more reflectively and capture the quality of the routines.

Pulling it all together.

The benefits of delving more deeply into daily routines and activities during the development of the IFSP are numerous. Those benefits include a broader knowledge of the child’s natural environments and possible locations for services to take place in the future, capturing challenging moments in the day that might not have been reported at the initial referral, and identifying naturally-occurring routines that can be used to develop richer, more meaningful outcomes and goals for the child and family, only to name a few. Empathy and open-mindedness are useful tools that will enable you to meet a family where they are. Using those tools to gather information from families about their child and how their child fits into the daily routines of their life lends itself naturally to capturing a true picture of a child’s development and functioning that enables us to move beyond our assessment tools. Early intervention supports and services are bound to be more successful when they’re meaningful to the family and embedded naturally into the child’s daily activities and routines.

While we walk alongside a family in the direction of their rainbow, what questions can you ask to better understand how to walk a mile in their shoes?

Share your ideas in the comments below.

Kimberly Morse, MS, CFCS-HDFS, EIP, lives and works in Chesapeake, VA. She holds a BA in Psychology and MS in Child Development and Family Relations. She began working in Early Intervention for the State of North Carolina in December of 2008. She relocated with her family to Virginia in 2015 and resumed working in Early Intervention first through the Infant and Toddler Connection of Norfolk and currently through the Infant and Toddler Connection of Chesapeake. Kimberly and her husband Matthew have 2 little boys, ages 2 and 6. Days spent as their mother are filled with loving memories, a few tears, and a healthy dose of humility and perspective. Kimberly can be reached at kimberly.morse@chesapeakeibh.net.

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You’ve got 30 minutes until your next visit. Sure, you could pull over in a parking lot and scroll through your email or social media, or maybe return that text that will take you about 10 seconds to type…OR you could listen to the new podcast, EI on the Fly: A Podcast about All Things Early Intervention!

I’m pretty excited about this new project. Podcasting has been a fun new world for me, both to learn about and listen to. Last year, Emily Webb, with the Massachusetts Early Intervention Training Center, emailed me to ask if I’d be interested in collaborating on a podcast. We both work in EI professional development, both have been EI practitioners, and, as it turns out, have both experienced EI from the parent perspective. It sounded like a new adventure so, of course, I said yes!

Our First Series: Functional Assessment

Over the past year, Emily and I have recorded the Functional Assessment series, which will include eight episodes. Episodes will be released monthly on Podbean, but are also available on iTunes and Google Podcasts. Here’s a sneak peak at what’s coming:

Episode 1 – What is Functional Assessment and Why Does It Matter? (Run time: 32:37)
Episode 2 – Intentional Observation (Run time 30:44)
Episode 3 – Asking Meaningful Questions
Episode 4 – Active Listening
Episode 5 – Implicit Bias
Episode 6 – Functional Assessment and the Initial IFSP
Episode 7 – Ongoing Functional Assessment
Episode 8 – What Functional Assessment Means to Supervisors, Practitioners, and Families

We’ve released the first two episodes so far. Episode 1 provides an introduction to functional assessment (FA). We define FA and introduce important concepts (PDF, New Window) such as conducting observation, asking meaningful questions, using active listening, and learning about how children interact and learn during daily activities. We talk about what ongoing FA should look like, compare it to traditional assessment, consider examples, and think about how to integrate it into your work with families.

In Episode 2, we dive into the first component of functional assessment: observation. We define observation in the context of early intervention and consider how it helps us “watch to listen and learn.” We discuss observation during the initial evaluation/assessment and service delivery, emphasizing how observation helps us gather functional information about children, how they interact with family members, and what interests and motivations them – all without inferring meaning or judgement. We’ll also review tips for helping families understand the importance of observation.

The Car’s Great but How Else Can You Use the Podcast?

Here are a few more ideas:

For individual practitioners: Rather than blocking another time slot to get something else done, pair the podcast with another activity. Catch an episode while driving to work, preparing breakfast or dinner, or maybe even while taking a walk or cleaning your house (fun!). It’s easily accessible through apps on your phone, and can be downloaded to listen to later.

For System Managers and Directors of EI programs: Plan for a group discussion during your next staff meeting. Email out the episode link before the meeting with an open-ended discussion question as food for thought. Blast the link out by email to the service coordinators and service providers in your system. It’s another free resource that we hope programs will find easy to use!

I’ll be writing posts about the individual episodes in the coming months to give you additional ideas on how to dig into the topics yourself or with your staff. We hope you’ll subscribe and stay tuned for future episodes.

Teaser: Emily tells some great stories about her experiences as a mom receiving EI that really put FA in context – you won’t want to miss them!

PS: A huge and special thanks to Jeanne (VA) and Laura (MA) who are the technical specialists behind-the-scenes helping us with producing and posting the episodes!

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Logan’s annual IFSP review is underway and you are excited to celebrate his progress. You’ve been working with his family for a year so you’ve seen the steady pace at which Logan continues to develop. When he first entered early intervention, he was only two months old and doing most of the things a two-month-old needed to do. Now that he’s 14 months old, his delays appear more significant but you want his parents to remain hopeful so you and your colleagues explain the assessment results, celebrating his gains and acknowledging the next skills to come.

When the team discusses the child outcomes summary process, the service coordinator uses the Decision Tree (PDF, New Window) as a guide. Because of his age and slow but steady progress, Logan is showing very early skills when compared to his same age peers, which sounds very different from the discussion the team had last year. You want to help Logan’s parents understand why this is, but then another team members drops this question:

“So what do we think? Is Logan a 1 or a 2 now?”

“OMG,” you think, “Logan is NOT a number!” Now what do you do?

Children are Not Numbers on the Decision Tree

This is an important point that ALL team members need to understand. The discussion about the child outcomes and the Decision Tree (PDF, New Window) should never include labeling a child with a number. It should be about using the information you have to make an informed decision as a team that describes Logan’s development according to the three global child outcomes (“global” because these are outcomes we’d like to see for all children during their early childhood years).

During the meeting, the team describes the child’s development using summary statements on the Decision Tree, not numbers (see the Child Outcomes Booklet (PDF, New Window) for more info). The numbers on the Decision Tree can be thought of as categories that describe skill development related to the child outcomes – not categories of children. For example, “Category 1” includes a summary statement (or description) that tells us that Logan has “very early skills in this area. This means that [Logan] has the skills we would expect for a much younger child.” This does NOT mean that “Logan is a 1.” While the service coordinator does have to report a number for each outcome in documentation back at the office, and these numbers are referred to as “child ratings” according to the Office of Special Education Programs (OSEP), it’s a really good idea to let go of the idea that the child outcomes discussion results in a number for the child. Let. It. Go.

Here’s why: If you hold this belief, even an underlying belief in linking a child to a number, then you will convey this belief to the family. No parent wants their infant or toddler rated or numbered. It can be hard enough for a parent to hear the age equivalency scores from the assessment tool. Parents must be involved in the child outcomes discussion, and we want them to understand the process – a process that, admittedly, can be hard to explain.

The Words You Use Matter – Tips for Developing Your Script

The words you use to explain this process matter. Yes, some parents may be mentally exhausted by the time you get to this discussion, but that does not mean you should sugarcoat it, skip it, or hurry through it, which can be tempting to do. It can also be tempting to let the professional team members discuss the process without much explanation for the parent. To avoid this, try these tips:

1. Write down a sample script for how you can explain the process to all team members (including and especially the parent) without assigning the child a number, then let a colleague read it and give you feedback.
2. Read it out loud to yourself and see how it sounds.
3. Listen to how others explain the process and “borrow” their words.
4. Ask families who are already enrolled in your program what they understood about the child outcomes discussion from their initial or annual IFSP meeting.

Here’s a big one: Dig in a bit and reflect – Are you the team member who asked about a child’s “number” at an assessment or IFSP meeting? If you are, then it’s a good thing to recognize that now and commit to a change in thinking for your next assessment or IFSP meeting.

There is No Need to Pick a Number at the Meeting

How you explain the process will likely differ from your colleague’s script and that’s okay. The words you use may change a bit with each meeting depending on your style, the team with whom you work, the family’s understanding and learning needs, etc. The important point here is to think about the message you (and your team members) convey with the child outcomes process. There is no need to “pick a number” for a child during the meeting, but there is a need to be accurate, respectful, and sensitive while helping all team members understand, participate in the process, and identify summary statements to describe the child’s development.

Open the door for this discussion with your team members using the questions here, or share your thoughts by adding a comment below:

How do you explain the child outcomes discussion process to families? What are your go-to phrases to help all team members understand?

If a team member tries to pick a number at the meeting, what could you say in response?

For more information, check out these resources:

Virginia’s Child Outcomes Booklet (PDF, New Window)

Virginia’s System for Determining Child Progress (OSEP Child Outcomes)

Decision Tree Tutorial Video

The post Logan is Not a Number! – Explaining the Child Outcomes Process appeared first on Early Intervention Strategies for Success.

Have you heard the news? Assessment teams all over Virginia are integrating the Decision Tree (PDF, New Window) into practice (Drum Roll Please). The Decision Tree is a tool used for teaming and family engagement during the child outcomes summary process.

Let’s imagine that a team from Collaboration County is successfully using the Decision Tree. What might this look like? Keep reading to find out.

Let me introduce you to the team as we check in with them prior to, during, and after their assessment for service planning (ASP).

Margaret – Local System Manager (LSM)
Khadijah – Service Coordinator (SC)
Anika – Speech Therapist (ST)
Charles – Educator (Ed)
Parent – Marisol (Tyler’s Mother)

Before reading about this team’s example below, print the Key Tips handout (PDF, New Window). Highlight the tips you see as the team implements the Decision Tree.

Prior to the ASP

At the staff meeting, Margaret (LSM) introduced the new Decision Tree to the team and handed them a copy. She helped the team familiarize themselves with the Decision Tree by facilitating a discussion using a scenario-based Learning Byte (PDF, New Window). Margaret divided the team into pairs.

Khadijah (SC) practiced facilitating the discussion on Social/Emotional Skills, including social relationships with Anika (ST). Khadijah explained what is expected in this area for a 28 month old child. She discussed some specific examples when prompted on the Decision Tree. Khadijah asked Anika for additional input. Khadijah did not feel comfortable at first, but began to feel more familiar with the flow of the Decision Tree. Anika (ST) took a turn and practiced as well. Anika and Khadijah quickly realized the importance of gathering information about a child’s development and participation across all settings and situations in order to be successful implementing the Decision Tree.

Margaret (LSM) reflected with her staff on the activity and provided time to ask questions and support each other through this process. Everyone loves how the Decision Tree engages the caregiver as an integral member of the team.

After the meeting, Khadijah (SC), Anika (ST), and Charles (Ed) discussed who would facilitate the child outcomes summary discussion at their next assessment with Tyler and his family. Khadijah (SC) agreed with her team to facilitate the discussion.

During the Meeting

During the assessment for service planning, Charles (Ed) helped to ensure team members asked a variety of open-ended questions that included how the child participated throughout several settings and routines. When it was time to discuss the three outcome areas, Khadijah (SC) showed Marisol, Tyler’s mom, the handout on the Infant & Toddler Connection of Virginia Child Outcomes Summary Process as she explained what the three child outcomes entail. Anika (ST) noticed Marisol’s eyebrows furrowed. She asked Tyler’s mom, “What questions do you have for us?” After answering questions, Khadijah continued to facilitate the discussion in each child outcome area. Anika (ST) and Charles (Ed) each provided specific examples of the child’s strengths and areas of growth. Marisol added individualized examples of Tyler’s functional skills within different routines like waking up and going to the grocery store.

During the discussion, Tyler began to cry and Marisol stated he was probably hungry. Khadijah (SC) asked Marisol if she would like to move the meeting to the kitchen while Tyler ate a snack. Marisol agreed this would be best before continuing to help her focus on the discussion. Khadijah (SC) showed the team the Decision Tree to thoughtfully reflect on each question. Marisol contributed specific examples of Tyler’s abilities and activities along with Anika (ST) and Charles (Ed) until they agreed on a statement to describe Tyler’s functional behaviors compared to his same aged peers.

After the Meeting

Khadijah, Anika, and Charles left the home and met back up at a coffee shop. They reflected on what went well. They agreed each of them provide a different perspective and supported to the family throughout. Changing rooms to finish the discussion helped satisfy Tyler when he was hungry and engage Marisol in the discussion. Team members provided support to each other throughout the process.

Khadijah, Anika, and Charles identified ways they could grow as a team. Khadijah (SC) reflects that her explanation to Marisol on the child outcomes summary process could have been more detailed to help Marisol understand and feel comfortable participating. Charles (Ed) wants to write down examples within routines and settings so he does not forget as they discuss each area. Anika (ST) showed Charles the tool she utilizes called the Assessment for Service Planning Notes Template. Anika (ST) wants to practice asking more open-ended questions around routines.

At the next staff meeting, Margaret (LSM) reflected with her staff on how implementation of the Decision Tree was going. It was a rich discussion filled with what has been going well and how her staff would like to improve.

You heard it here first folks. The Collaboration County team is engaging families and utilizing strong teaming and collaboration throughout the child outcomes summary process.

How do you implement the Decision Tree in your locality?

What ways do you enhance your teaming process?

What strategies do you use to engage the family in the child outcomes summary process?

The post Extra! Extra! Read All About…Integrating the Decision Tree appeared first on Early Intervention Strategies for Success.

Think about the following perspectives during the Assessment for Service Planning and IFSP development process:

Team Members Arrive

SC: I arrive to facilitate the assessment for service planning and IFSP development for Jacoby. I meet Franklin, occupational therapist, and Maria, developmental specialist. We all walk in and I introduce Marilyn and Kevin (Jacoby’s mother and father) to Franklin and Maria.

Family: I open the door and immediately feel intimidated and outnumbered as Tamira, our service coordinator, walks in with two other people. She introduces them, but I already forgot their name and discipline. I am not even sure what they do exactly.

Assessment

SC: I begin to explain what to expect over the next couple of hours. I update the team and check in with the Marilyn and Kevin on any new updates or concerns. Franklin and Maria begin the assessment for service planning, engaging Marilyn and Kevin in questions and Jacoby in play. This is going to take a long time. Jacoby keeps running away. I have a lot of paperwork to get signed and we still need to develop the IFSP.

Family: Jacoby runs away the moment he sees everyone. I hope he cooperates throughout the visit. I am feeling anxious about what to expect. They are asking us a lot of questions. Maybe I should have been paying more attention to Jacoby because I do not know all the answers. I really wish Jacoby would sit down and play with them. He is getting fussy. I bet he wants a snack. I guess he will have to wait.

IFSP Development

SC: I facilitate the IFSP development. When we begin to write outcomes, I begin the discussion by asking Marilyn and Kevin, “What would you like to see Jacoby doing?” 

Family: Jacoby is really becoming upset right now. They are the experts. Just tell me what to do.

Remember the Family Perspective

Assessment for service planning and IFSP development are complex processes which require several tasks be completed by the EI team (including the family). Juggling these tasks can lead all team members to feel some level of stress or anxiety. Parents may feel unsure about what to expect. They may also feel anxious about how to manage their child’s participation and care during the meeting. Marilyn and Kevin were hoping to find answers, support, and future guidance on how to help Jacoby. Tamira, Franklin, and Maria have set tasks to complete during this time and are hoping to complete everything in a timely manner. How can Tamira, Franklin, and Maria provide support to Marilyn and Kevin during this time? Here are some easy tips to support parents.

Be mindful. Before going in the home, take a couple deep breaths and reflect on what this visit means to the family. It can be easy to forget about the parents’ perspective. Remember, the words and actions within each family interaction can impact their perspective of early intervention. Remain aware of feelings that lose focus on the family such as thinking, “I need to hurry before my next visit.” Hurrying may make parents feel unimportant and unheard. Mindfulness allows professionals to be conscious of the caregiver’s feelings and needs.

Check-in periodically with families. Throughout the process, pay attention to the caregiver’s nonverbal cues. Check-in to see if they need a break or have any questions. Caregivers may need a moment to feed their child, change their child’s diaper, use the restroom, or simply step away to quietly process all of the information given. Caregivers may feel like they will interrupt the process. Let caregivers know it is okay to take a break if needed.

Explain. Explain. Explain. Explain what you are doing and why you are doing it. Try not to use acronyms or jargon that may be unfamiliar to the family. Read a caregiver’s nonverbal cues while you explain to see if you need to pause and check for understanding.

In the scenario above, Kevin and Marilyn are experiencing an array of emotions. They are looking to the early interventionists for guidance and understanding. Tamira, Franklin, and Maria can support the family by being mindful, checking in with them, and explaining the process to alleviate some of the family’s worries.

How do you stay focused and present during your interactions with families? 

What are some strategies you use to check-in with families?

What could Tamira, Franklin, and/or Maria do to ease Kevin and Marilyn’s worries throughout the visit?

What other tips would you add to support families?

Add your tips and strategies to the comments below!

The post Don’t Forget the Family’s Perspective appeared first on Early Intervention Strategies for Success.

Wyatt is a happy 19-month old child who was recently released from the hospital, where he lived for the first 17 months of his life. Wyatt was born very prematurely and has been diagnosed with a visual impairment and cerebral palsy. You want to conduct an assessment to learn about Wyatt’s strengths and needs, especially related to communication, which is a priority for his family. When you look at the assessment tools, you worry that Wyatt is likely to score much lower than his chronological age. You wonder – Is this is good test to use? How do I get meaningful information that will help our team write good goals?

Thinking Beyond the Test Scores

From experience, we know that young children with multiple disabilities often perform much lower than their chronological or adjusted age on our developmental assessments. We walk into an assessment bracing ourselves for how to tell a family that their 19-month old son has the skills of a 4-7 month old infant. We struggle because we don’t want to hurt a parent’s heart with this difficult news. We also struggle because I think, on a deeper level, we realize that this information really isn’t all that meaningful. While we can quantify that Wyatt can or cannot do certain tasks on the test, we also know that qualitatively, Wyatt has had more experiences than a 4 or 7 month old infant. Wyatt may be just starting to roll over, hold a toy, and make babbling noises but he is not an infant.

Establishing a developmental age is something we have to do when children enter EI and annually to help us track progress. We can’t avoid it, and shouldn’t, because it is helpful when considering what will come next developmentally for Wyatt. Perhaps our more important task, then, is to think about how to gather meaningful information about Wyatt’s functional abilities, including how he communicates and engages others, acquires and uses knowledge, and takes actions to meet his needs.

Tips for Assessing Young Children Who Have Multiple Disabilities

I recently came across a great resource that prompted me to think more deeply about how we assess very young children with multiple disabilities: Assessing Communication and Learning in Young Children Who are Deafblind or Who Have Multiple Disabilities (Rowland, 2009) (PDF, New Window). This document includes some great tips that we could use if we really were conducting Wyatt’s assessment, such as:

Plan for extra time – It takes time to get to know the child and learn how to read his cues, how to position him, how to offer assessment materials, etc. Assessing Wyatt would involve more than observation and conversation with his caregivers; it would also be a process of experimentation to figure out what he can do and how to support him in doing it. Wyatt may also need extra time to complete activities and/or extra rest time between them.

Select appropriate assessment tools – Look for tools that include info about how to adapt assessment items for children with sensory or motor disabilities. The Carolina Curriculum for Infants and Toddlers and the Assessment, Evaluation, and Programming System for Infants and Children (AEPS) are two examples.

Gather information about Wyatt’s everyday life – Prepare a list of specific questions you want to ask, such as:

• How does Wyatt react when you talk to him?
• What cues do you notice that tell you what Wyatt wants/needs?
• What does Wyatt like to do/not like to do?
• How does he use his vision?
• What would you like for Wyatt to be able to do?
• What would make things easier for you/for Wyatt? 

Ask the caregiver to “show” you how she plays with Wyatt, positions him, and engages him. Find out about Wyatt’s interests, preferences, what motivates and alerts him, and what tires him out.

Do a “head to toe inventory” when assessing communication – Look for the child’s movements, reactions, and sounds and consider which appear to be voluntary and which have communicative intent. If you aren’t sure, keep observing throughout the assessment to see if you notice the behavior or sound again. Watch for patterns and take careful notes.

Always assess sensory and motor skills too – The presence of hearing, visual, and motor disabilities will affect how Wyatt communicates. He could have cognitive skills closer to his adjusted age, but his difficulties with movement and vision could make it really hard for him to show you what he knows.

Rather than approaching Wyatt’s assessment with the worry that he’ll score low, the author of the resource encourages us to approach it as a “process of discovery.” You will use all of your tools – the test results, specific observations, conversation with the family, insights from other team members – to try to discover what Wyatt can do now and what comes next for him. Helping Wyatt be an active participant in his daily life is our goal, regardless of whether his skills are at the 4-7 or 19-month levels.

What strategies do you keep in mind when assessing an infant or toddler with multiple disabilities?

How do you share assessment info with families?

Add your comments below!

Want more information? Visit our VEIPD topic pages on Motor Delays & Disabilities, Multiple Disabilities, and Visual Disabilities.

The post Assessing Children with Multiple Disabilities – Tips and a Great Resource! appeared first on Early Intervention Strategies for Success.

Rosemary, speech therapist, has been seeing Caleb for five months and it is time for his annual IFSP next month. She is worried she does not have enough information to provide developmental age ranges for the annual IFSP. According to the practice manual (Chapter 6, page 2), ongoing assessment is defined as:

“Assessment that occurs as a routine part of service delivery based on observation of the child’s functioning and skills across all developmental domains and indicator areas. The purpose of ongoing assessment is to give the provider and the IFSP team, including the family, information on the child’s progress on the IFSP outcomes and short-term goals being addressed by the current activities and to assist in identify any emerging concerns in other areas of development. No assessment tool is required; but, when needed, the service provider may use an assessment tool as a reference point, especially for areas of development outside his/her area of expertise.”

Rosemary reflects back on past visits and reads her progress notes. She pulls out the initial protocol (or assessment form) used for Caleb and updates it accordingly. Rosemary begins to feel more confident as she realizes she has seen Caleb performing during a variety of activities and routines including the park, car, grocery store, meals, and playtime with his brother and family. Rosemary realizes she has more than enough information to update Caleb’s progress in the three child outcome areas. She also uses the protocol as an anchor tool to provide developmental ranges as part of ongoing assessment.

A Deeper Look at the Definition of Ongoing Assessment

When you read the state’s definition, what key words related to the process of ongoing assessment do you notice?

Observation, functioning, progress, and emerging concerns are key words to ongoing assessment. Ongoing assessment is the continuous observation process you use to monitor a child’s progress, notice any emerging concerns, and discuss them with your team as needed. When we look at the whole child’s development across time, we are ensuring we are monitoring progress and routinely individualizing services throughout the process.

Three Strategies to Improve Ongoing Assessment Practices

Ongoing assessment is something you are probably already doing during each visit with the family. Here are some simple tips to feel confident before your next annual IFSP review.

• Document ongoing assessment in your contact notes. Contact notes should clearly reflect a child’s progress since ongoing assessment is a part of the contact note requirements (page 9) (PDF, New Window). Sometimes, there will not be as much progress week to week, but it is still important to document what the family and child did (current progress), so that progress will be clearer when something happens in the future. Ongoing assessment helps you identify progress towards IFSP outcomes/short-term goals and also any new functional skills in the three child outcome areas. Updates about progress in the three outcome areas are fundamental information that should be documented in your contact note.
• Read your records before your next visit. We can easily get in the routine of just going from visit to visit. A simple glance over your last contact note may help guide you during your discussions with families. Check in with the family and compare what you learn to your protocols. Some service providers regularly update their protocols throughout the time they see a child. This helps providers think about the whole child versus just their specialized area. You might also want to review the IFSP narrative and note differences in the child’s skills since the IFSP was developed. What has changed? What other activities or routines do you want to observe?
• Visit the family within different routines and activities including going out in the community. This will help you observe skills in a variety of settings. Observing the child in a variety of settings will help you ensure the information you gather during ongoing assessment is not only accurate, but also identifies learning opportunities throughout the child’s early intervention experience.

In the scenario above, Rosemary was able to see other ways Caleb was functioning. She walked with the family to the car to see what strategies Caleb’s mom was already using to help Caleb communicate. She observed them talking about the weather when they walked outside and using words like “up” when he was climbing into the car. However, there was so much more going on than just using words. Caleb walked down the steps holding his mom’s hand and transitioned from the grass to the sidewalk when she told him to “stop” and “come here” as he tried to run to the tree in the middle of the yard. There was a neighbor outside and Caleb waved after seeing his mom wave at the neighbor. Once he was in his seat, he wanted to try to buckle himself which was a puzzle all on its own. Caleb was determined and able to use his fingers to push the buckle down. He was focused and proud of himself once he did this on his own.

Rosemary realizes ongoing assessment occurs naturally. She has integrated this as a standard practice by documenting ongoing assessment in her contact notes, reviewing records before her visit, and seeing families within different routines and activities. She has all of the information she needs about Caleb’s communication and other areas of development and is ready to update the IFSP.

What practices do you find helpful during ongoing assessment?

Please share any tips you may have in your local program.

For more information, please check out:

Decision Tree Seeds for Success: Functional Assessment is Not the Same Thing as Testing (PDF, New Window)

The post Ongoing Assessment Occurs Naturally appeared first on Early Intervention Strategies for Success.

Assessments continue to evolve in a variety of settings including the medical and educational fields. Though these assessments look and feel different, there is one very large commonality.  True individualization is ultimately valued. As we move toward conducting functional assessments, we have to learn how to gather information differently. Rather than interviewing the parent straight from the assessment tool, going item by item, we know that we can gather richer information by having a conversation with the parent about the child’s daily life. Sure, we still need to observe the child and complete the items on the protocols, but these conversations help us relate what we observe to the child’s everyday life – his/her functional development. This helps us individualize assessment, and provide services, in a meaningful, functional way.

What does a functional assessment look like?

One simple way is to start with the parents’ concerns and any new updates, including medical information, since the intake. This is a fantastic role for the service coordinator because they have the information from the intake and can explain what the parents can expect during the assessment process.

Then, begin to ask open-ended questions with the start of a child’s day to bedtime, covering sleep, mealtime, playtime with others and self, naps, community outings, bath time, car rides, and any other relevant routines to the family. This will help trigger any concerns about the child’s day the caregiver may have previously forgotten. Analyzing the caregiver’s responses to the questions can lead into deeper questions and discussion. Try to wait to complete any protocols until the majority of the questions have been asked and the play is completed. This will help the parent feel more open to discussing details of their personal life. This is a vulnerable time and listening and observing help make this process more comfortable. Take a few minutes after the assessment to take the protocols out and complete them prior to reporting out in the three outcome areas. This may feel uncomfortable at first, not having the protocols in front of you. Practicing and understanding the reasoning behind the questions in protocols helps this become a more natural process.

Here are some practical strategies to move toward functional assessment.

1. Ask open-ended questions centered on a child’s day.

The key is to ask open-ended questions during an assessment that are centered on a child’s routines and activities to gain meaningful information. Open-ended questions strengthen the relationship with the caregiver because we are actively listening and creating rich conversations in order to understand the whole picture of the child’s development within the context of the family’s life. We see the meaning behind the child’s behaviors versus simply identifying behaviors. Consider these questions: What do yes or no answers from an assessment tool really tell us about the child? Can these questions feel intimidating to parents? How can we truly gain a deeper understanding of the dynamics that affect a child’s development? Understanding the dynamics surrounding a child’s life is essential.

Please follow this link (PDF, New Window) for an example of how a functional assessment might flow, including examples of open-ended questions to ask.

2. Teaming

Functional assessments still include observation, clinical opinion, parent report, and any protocols. Each locality may be set up differently, in terms of who conducts assessment, what tools are used, etc. As long as the teams are communicating information, this should still look similar across localities. The service coordinator facilitates the assessment and supports the family and providers throughout the process. One of the service providers may focus on asking open-ended questions while the other provider facilitates play with the child.

One strategy to increase teaming is to communicate each person’s role in the assessment. After the assessment, discuss what went well and areas to grow. It is important to not be judgmental as this is a learning process for all of us. Communication is the most effective way to build stronger teams. Respect the perspective each person brings to the table and ensure everyone participates in the assessment. Remember, parents play a huge role in our team.

3. Practice makes perfect.

Incorporating functional assessment into your existing assessment process is easier than expected with practice. Each locality has different processes that need to be individualized to serve the same purpose of a functional assessment. How can we gain a clear picture of a child’s life in order to help provide quality services? Some providers may have set assessment slots that provide a multitude of opportunities to practice and strengthen their knowledge and confidence in conducting functional assessments.

Practice during assessments by asking more open-ended questions and relying less on the protocols being in front of you. During assessments, practice viewing development from a functional perspective looking at how the child will use skills to be successful in his daily life. Role-playing is another way to practice with a colleague. Take turns asking questions as the provider while the other acts as the caregiver.

Every assessment has different variables that may add additional stressors such as a barking dog or siblings. The functional assessment process gains rich information while providing opportunities to consider each child’s interests and family dynamics. In the end, we gain an understanding of the child’s personality, relationship to the caregivers and other people, temperament, learning style, and participation in daily routines and activities. Functional assessments are thorough and help us to receive valuable information to help us create a truly individualized plan for each child.

I would love to hear your own strategies for functional assessments.  Please share your tips on completing functional assessments in your locality.

What are some of your favorite strategies to ask open-ended questions, practice, and/or collaborate as a team?

What are some challenges you encounter when implementing functional assessments?

The post Enhancing Quality Functional Assessments for Each Individual Family appeared first on Early Intervention Strategies for Success.