Download Assessment - Connecticut Birth to Three System

Effective Date: July 1, 1996
Date Revised: July 1, 2013
Title:
CT Birth to Three System
ASSESSMENT FOR PLANNING INTERVENTION
Purpose: Describes the initial and ongoing process used by qualified personnel to
identify the child’s unique strengths and needs and the family’s concerns,
priorities, and resources in order to plan appropriate supports and services
and to track a child’s developmental progress using a curriculum embedded
assessment.
Overview
Assessment is a formal measurement of a child’s strengths and needs in each area of
development as well as the family’s concerns, priorities, and resources in order to plan
appropriate, family-centered supports and services. Use of an authentic, curriculumbased assessment helps in overall program planning and tracking of child development.
Use of a curriculum gives both families and providers a framework for viewing overall
child development.
Written Consent for Assessment
The parent must sign Form 1-4, Consent to Conduct an Evaluation/Assessment. If the
initial eligibility evaluation and assessment occur at the same time, only one consent
form is needed. The permission must be specific to the assessment tool(s) listed. The
parent will need to sign a new Form 1-4 whenever any additional assessments are to
be administered or existing assessments need to be updated. If the parent or legal
guardian refuses to give their consent for an assessment, the service coordinator will
make a reasonable effort to ensure that the parent is fully aware of the following:
 the nature of the assessment and,
 that an assessment is required for the writing of the initial Individualized Family
Service Plan (IFSP) which is necessary for services to begin and,
 that ongoing assessments are required to keep the IFSP current so that services
can continue.
Family Participation in the Assessment
Family members must participate in the assessment of their child. If parents are not
active participants, valuable information may be missed, families may not assume
ownership of decisions made or interventions planned and families may not feel like
part of the team. Their participation may take many forms, based on the family’s
perceptions of what is appropriate and important. These perceptions will be shaped by
their cultural backgrounds, economic status, and value system as well as the
assessor’s attitude and communication skills. Part of the assessment process must be
the consideration of the family’s preference for their role in the assessment. Those
roles, as described on a continuum from most involved to least involved are:

demonstrator
the parent, at the assessor’s request, has the child demonstrate
various skills
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
validator

interpreter

informant

observer
the parent validates for the assessor that the child’s behavior on a
test item is or is not typical
the parent can interpret for the assessor, “oh, when he does that it
means___” or “saying ‘ba’ means he wants his baby doll”
the parent provides information about what the child can and
cannot do
the parent watches as the assessor administers test items
Initial Child Assessment
An assessment indicating each eligible child’s unique abilities in all five developmental
areas must be completed by a multidisciplinary team. Even a child who is automatically
eligible due to a diagnosed condition must receive an initial multidisciplinary
assessment that covers all five areas of development based on objective criteria. The
initial assessment must be completed prior to the meeting to develop the initial
Individualized Family Service Plan (IFSP). Assessors must avoid making
recommendations regarding type, frequency, duration or location of specific services
until the IFSP meeting. Results of the initial assessment must be documented in a
typed report and parents must receive a copy within two weeks.
Programs must assure that children’s hearing and vision are within normal limits prior to
completing the initial assessment. For children with a speech or language delay, it is
critical that the child’s hearing be screened or evaluated by an audiologist, or screened
by a pediatrician using an OAE screener before beginning early intervention services.
Any previous audiological testing or screening results, including newborn hearing
screening, are only valid for one year. If current testing indicates a hearing loss, the
program must address that in the child’s IFSP. For vision, unless the child’s physician
has specifically evaluated the child’s vision, the assessor should use Form 3-17 “Birth
to Three Vision Screening” and, if any items on the screen are answered “yes”, the
results should be sent with a cover letter to the child’s physician with parental consent
for follow-up.
Curriculum Embedded Assessments
In keeping with the recommendations from the Division of Early Childhood of the
Council for Exceptional Children, the Birth to Three System requires that a curriculumembedded assessment be used for all children who will be enrolled for at least 6
months from their first service until they exit. This includes children who are being
served by general programs or specialty programs and those who are receiving
services at no cost. The assessment should be completed as they enter the Birth to
Three System and as they exit. Additional assessments may be identified in the future,
but those currently approved are:
1. The Hawaii Early Learning Profile (The HELP)
2. The Carolina Curriculum for Infants and Toddlers with Special Needs (The Carolina)
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3. The Assessment, Evaluation, and Programming System for Infants and Toddlers
(AEPS)
Summarizing Curriculum-embedded Assessment Information and Data Entry
The reason for conducting an assessment pre- and post is to measure the amount of
developmental progress that the child has made while enrolled in the Birth to Three
System. The curriculum-embedded assessment, if used during intake, will meet the
criteria for assessing the child’s needs after determining eligibility. For a newly referred
child with a diagnosed condition who is automatically eligible, a program can use a
curriculum-embedded assessment as their initial assessment. Data from the
curriculum-embedded assessment will be entered into the Birth to Three data system at
least twice for each child who is enrolled for more than six months from their first
service until they exit. This includes children who are receiving services at no cost.
When the curriculum-embedded assessment is used regularly to chart a child’s
progress, the updated checklist or strand sheet should be shared with the family so they
can be familiar with the skills that will be emerging.
In order to report child outcome data, the Birth to Three System is tracking child
progress on three outcomes that were identified by the Office of Special Education
Programs (OSEP). These outcomes were identified for this federal report and do not
need to be part of the IFSP. The three outcomes are as follows:
1. Positive social-emotional skills (including social relationships);
2. Acquisition and use of knowledge and skills (including early language/communication);
3. Use of appropriate behaviors to meet their needs.
Programs will use a 7-point rating scale (see next page or Form 3-18a “Child Outcomes
Definitions”) to complete Form 3-18 “Child Outcomes Summary (COS)”. For any child
less than 30 months of age at entry, programs will enter a number from 1 to 7 for each
of these three outcomes. At exit (when at least six months have elapsed from their first
service) programs will again enter a number from 1 to 7 for each of these three
outcomes and, if the rating in any area is less than 7 (which means, “at age level”) the
program will answer “yes” or “no” to the question: Has the child shown any new skills or
behaviors related to positive social relationships since the last outcomes summary?”
Providers will team with families using the information gained from the initial eligibility
evaluation and/or curriculum-based assessment and then again from the final
administration of the curriculum-based assessment in order to decide on the
appropriate rating. A crosswalk of the items from each of the curriculum-based
assessments is available on the Birth to Three website as provided by the Early
Childhood Outcomes Center
(http://projects.fpg.unc.edu/~eco/pages/crosswalks.cfm#Crosswalks).
If for any reason it is not possible to meet with the family to complete the COS before
the child exits the system, the scores should not be entered into the data system.
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The entry scores and exit scores should each be selected on blank COS forms (Form
3-18). Exit scores should not be written on the same form as entry scores since the
conversation with families at both points is unique to how the child is doing at that time.
If a child has an initial set of COS scores, exits the Birth to Three System and returns,
and the child’s original Birth to Three number in the data system is reactivated, use the
original COS scores.
Since child outcome data is used for the State’s Annual Performance Report (APR),
reported to the public, and used for monitoring, it is important to enter complete COS
scores as you close a child’s record in the data system. In addition, before transferring
a child to another program, the Entry scores should be entered prior to committing the
transfer.
Ongoing Child Assessment
During the child’s enrollment in the Birth to Three System, it is expected that providers
will engage in informal ongoing assessment each time they see the child. Providers
should also regularly update the information on the curriculum-based assessment in
order to help the family and other team members objectively track the child’s progress.
Consideration should be given to the possible need for additional screenings (such as
autism, mental health, or nutrition using Birth to Three Nutrition Screening Form 3-16
(see Service Guidelines 1, 4, and 6 respectively) or a need for other specialty
assessments.
Ongoing assessment, whether it is the use of an additional instrument or the updating
of an instrument will require an additional written consent from the parents using Form
1-4.
Assessment Information for the Annual Review of the IFSP Meeting
According to IDEA Part C regulations, a meeting must be conducted on at least an
annual basis to evaluate the IFSP and revise its provisions as appropriate. The results
of any current evaluations conducted under § 303.321 and other information available
from the ongoing assessment of the child’s development in all five domains and the
family concerns must be used in determining the status of the outcomes, what services
are needed, and what services will be provided. This information does not need to be
the result of a multidisciplinary assessment. The child’s primary interventionist (if that
person is qualified under the Birth to Three Personnel Standards to complete
evaluations and assessments) can provide all of the assessment information, although
if there are others serving the child and family, their information must be included.
A child does not have to meet the Birth to Three eligibility criteria when reassessed. If
assessment results lead the evaluators to request a review to determine if the child
continues to need services from Birth to Three or to add or delete a service, (or when
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scheduling any IFSP review or annual IFSP meeting) they must give the parent prior
written notice and schedule a meeting with a multi-disciplinary team to review the IFSP.
Assessment Report
The initial assessment, and any assessment that is updated prior to the meeting held at
least annually to review the IFSP or updated for transition to the local public schools,
must result in a written typed report. The report should reflect the child’s functional
activities within all developmental areas, (e.g. cognition, communication, adaptive,
social-emotional and physical, including motor, vision, and hearing) and should provide
comprehensive, strength oriented information on the child’s functional abilities within
the context of the family’s daily activities.
To make this report meaningful it should be based not only on the child’s skills but also
on knowledge of his or her routines, preferred activities, and the people who will be part
of his daily care and play. This, along with the family’s concerns, priorities and interests
for their child and family can help to identify desired outcomes and formal and informal
supports to attain them.
Each professional participating on the team will contribute to the development of one
report in the areas pertaining to his or her discipline and sign the report. The person(s)
who reviewed any outside evaluations that were used should indicate in the written
report that such a review was performed. The report should be readable and useful to
parents. Professional jargon should be eliminated, or if essential, defined. Results of
the assessment should be linked to recommendations. Recommendations should be
written generally and be related to functional outcomes for the child and family.
The report must also include the following:
1. The program name and address, child name, parent’s name(s) and their
address.
2. The child’s date of birth, the date of the assessment and the child’s age at the
time of the assessment.
3. The location of the assessment.
4. A description of the process and instruments used to complete the assessment.
5. A description of the child and family’s daily routines.
6. Language that describes how the family was involved in the assessment
process. This involvement should be evidenced throughout the report
7. Child’s responses and their strengths and needs.
8. Current levels of development across all 5 areas (e.g. cognitive, physical
including vision, hearing, motor and health, communication, social or emotional,
and, adaptive skills, also known as self-help or daily living skills).
9. The next steps in development.
10. Signatures of at least the two qualified staff members who completed the
assessment.
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When the report is complete, the parents must be given an opportunity to read it and
receive a copy of it within two weeks. It is recommended that one of the team members
meet with the parents to review the document. If the child is found to not be eligible
and the report is mailed then a follow up call to the parent to confirm receipt and check
for questions is advised. If the parents have additional information or desire changes,
the report should be modified to reflect their input. To the extent feasible, families with
limited proficiency in English should receive a summary of the written report in their
native language. The service coordinator should ask the parents for written consent
(Form 3-3) to release the report to the child’s primary physician as well as anyone else
the parent feels would benefit from the information (such as childcare staff, local school
district, DCF, or medical specialists).
Family Assessment
Under § 303.321(c)(2) of Part C regulations, a family-directed assessment must be
conducted by qualified personnel in order to identify the family’s resources, priorities
and concerns and the supports and services necessary to enhance the family’s
capacity to meet their child’s needs. This family assessment must be voluntary on the
part of the family; be based on information obtained through an assessment tool and
also through interview with those family members who elect to participate in the
assessment and must be conducted in the language in which the family is comfortable
and fluent. Interpreter services may be required for the interview.
There are family assessment tools available to assist with gathering this information.
One such recommended tool is the Routine Based Interview by Dr. Robin McWilliam.
Additional suggestions can be found in the Connecticut Birth to Three IFSP Handbook.
Family assessment, similar to child assessment, is an ongoing process. Although a
family assessment is required prior to writing the initial IFSP, additional and revised
information pertaining to the family should be obtained during the course of the child’s
enrollment in the Birth to Three System. It is recognized that the information obtained
for the initial IFSP will be less in-depth due to the newness of the relationship with the
family.
Assessing a Child for Autism Spectrum Disorder (ASD)
All children referred to the Birth to Three System who are at least 16 months old
are screened for ASD as part of the initial evaluation process with parent consent
using Form 1-4. If a child has been recently screened as part of routine medical
care, these screening results will be used in lieu of conducting an additional
autism screening. The preferred Birth to Three screening instruments include the
Modified Checklist for Autism in Toddlers (M-CHAT) (Robins, Fein, Barton &
Green, 1991) and the Brief Infant Toddler Social-Emotional Assessment
(BITSEA) (Briggs-Gowen & Carter, 2001).
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General programs must remember to screen children who enrolled in Birth to
Three at an earlier age when those children reach 16 months of age.
This process should be repeated at any time during a child’s enrollment if a
parent, a Birth to Three provider, the referral source, a care provider, or
someone else who knows the child observes that a child is having difficulty with
developing meaningful communication or is regressing in communication skills,
has issues with social reciprocity, and/or is limited in development by repetitive
behaviors.
When the screening tool indicates that the child may have an ASD, the general
Birth to Three Program will offer the family an autism assessment. Typically, this
will be done by one of the autism-specific Birth to Three programs. Per the CT
state insurance statute, this diagnosis can be completed by a licensed physician,
licensed psychologist or licensed clinical social worker. Any Birth to Three
program – autism-specific or general - diagnosing an ASD must ensure the
following: that the core features of autism spectrum disorder are assessed, use
autism-specific diagnostic instruments, and develop a differential diagnosis.
The purpose of this assessment process is to assure that children who meet the
criteria for a DSM-IV diagnosis of ASD have access to appropriate services
provided either by autism-specific programs or, if families prefer, by general
programs. Autism assessment reports (as well as those diagnostic evaluation
reports received from outside evaluators, must include information on the three
core deficit areas of ASD (communication, social interaction, and a restricted
range of interests and activities) as well as general developmental information
that led the evaluator(s) to conclude that the child has an autism spectrum
disorder. Additional information on ASD can be found in The CT Birth to Three
System Service Guideline One Autism Spectrum Disorder at
http://www.birth23.org/providers/SG1-Autism.pdf.
When a positive screen has been completed, the following steps should be addressed
before or during the assessment:
1. An in-depth review of the completed autism screening to confirm the “red flags”
identified. This may be done as part of the original screening completed by a
Birth to Three general program.
2. A review of the child’s health information to determine if the child’s hearing has
been screened or evaluated to rule out a possible hearing loss. If the child’s
hearing has not been screened or evaluated this must be done before
completing an autism spectrum disorder assessment.
3. A review of evaluations or assessments recently completed on the child to
assure that the child demonstrates a delay greater than 1 standard deviation
below the mean in receptive language, expressive language, social-emotional or
adaptive behavior skills. If needed additional developmental assessments such
as the Vineland Adaptive Behavior Scales or a Preschool Language Scale-5
should be completed to give a full picture of the child.
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4. If it is determined that there is a need for further assessment, the administration
of a validated assessment measure such as the Autism Diagnostic Observation
Schedule (ADOS) (for children 12 months and older), the Autism Diagnostic
Interview-Revised (ADI-R) (for children 24 months and older), or the Childhood
Autism Rating Scale (CARS) (for children 24 months and older) by a professional
or professionals with appropriate training will be completed. Assessors will
adhere to the recommendations or limitations of the instrument (e.g. children
under 12 months of age must be walking for the ADOS to be completed).
A child who has already been determined eligible for Birth to Three by a general
program may be referred to an autism-specific program to determine if the child has a
DSM-IV diagnosis of ASD. The autism-specific program does not need to determine if
the child is eligible since this has been done. The child remains with the general
program and the current service coordinator during the autism assessment and when
the assessment is completed a written report will be sent to the general program.
If the child is determined to have ASD, the parents will be offered the choice of: 1)
transferring to the program that completed the ASD assessment, 2) choosing a different
autism-specific program that serves their town, or 3) choosing one of the general Birth
to Three programs that serves their town, as long as the program they choose is
accepting new referrals.
_________________________________________
References:
Assessment “Crosswalks”: AEPS (draft) / Carolina / HELP
Form 1-4, Consent to Conduct Evaluation/Assessment
Form 1-6, Prior Written Notice
Form 3-3, Authorization for Programs to Release Information
Form 3-16, Birth to Three Nutrition Screening
Form 3-17, Birth to Three Vision Screening
Form 3-18, Child Outcomes Summary
Form 3-18a, Child Outcomes Definitions
34 CFR Section 303.321 (a) through (c)
Exit Procedure
Accountability and Monitoring Procedure
Family Handbook: Guide I
C.G.S. 17a-248-4(c)
Birth to Three IFSP Handbook