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

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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

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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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