Making Informed Decisions Umbrella

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Making Informed Decisions Umbrella
Think about the overall process of gathering
information to make informed decisions as a
decision making umbrella. Each spoke of the
umbrella represents a different purpose for
gathering information (i.e., screening,
evaluation to determine diagnoses or eligibility,
assessment, outcome assessment or accountability
and program monitoring). Additionally, each
spoke can depict different strategies or tools
used to gather information (e.g., observation,
interview, norm referenced tests, and criterion
based instruments). Picture an umbrella To
keep from getting wet during rain storms, all of
the spokes of the umbrella must be working
properly. Similarly, to make well informed
decisions about services and supports for young
children, families must understand all components
of the evaluation and assessment processes.
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Making Informed Decisions Umbrella

Lets take a closer look at each spoke of the
decision making umbrella
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When considering the spokes of evaluation and
assessment, we might think of testing in the
traditional sense. For example, we may picture a
child sitting quietly in a chair at a table,
focusing on a pen and pencil task designed to
identify his/her abilities and challenges. In
early intervention, evaluation and assessment are
DIFFERENT!
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Information is gathered in various ways for
different reasons in EarlySteps.

• eligibility evaluations and assessments for IFSP
  planning
• First, information is collected to determine
  whether a child is eligible to receive services
  through Part C in Louisiana. This is referred to
  as the eligibility evaluation in EarlySteps.
• Assessment is the ongoing process of gathering
  information to make informed decisions and
  develop relevant goals/outcomes and objectives
  for the Individualized Family Service Plan
  (IFSP). IFSPs are individualized, based on the
  unique strengths and needs of infants or toddlers
  and their families.

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• involve families in entire process
• In EarlySteps, families of infants and toddlers
  with disabilities partner with early intervention
  professionals to conduct evaluations and
  assessments, to an extent not typically seen in
  evaluations and assessments with older children.
  
• completed using tools or procedures from CDA
  (comprehensive developmental assessment), medical
  and health information, family reports, and or
  informed clinical opinion
• In relation to tools and procedures used in Part
  C, multiple types of information are collected
  from different sources, to obtain as much
  information as possible about the child and
  family versus utilizing a single test score.

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• assist the IFSP team to identify educational
  targets formulate developmentally appropriate
  goals and documentation of outcomes reflecting
  child progress over time
• Finally, information is collected so childrens
  progress and outcomes can be clearly described
  over time.
• In EarlySteps, evaluations and assessments of
  young children are conducted in their natural
  environments and with familiar caregivers.
• Based on the information gathered, childrens
  strengths and needs and families resources,
  priorities, and concerns are documented. This
  information is used to help develop IFSP outcomes
  and objectives.

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Do you mean evaluation OR assessment?
Which is right? Well it depends!!
As you probably noted in the overview of the
evaluation and assessment processes in
EarlySteps, the terms assessment and
evaluation are both used. Sometimes these
terms are used interchangeably. Other times,
they refer to different procedures. Keep the
definitions of these terms in mind as you
participate in this training module. Next,
lets take a closer look at different strategies
and purposes of gathering information to make
informed decisions in early intervention.
You say to-mae-to I say to-mah-to Lets
DONT call the whole thing off!!
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What information is gathered
Why information is gathered
How information is gathered
To obtain cut-off scores PASS screening (score
above cut-off) no further evaluation FAIL
screening (score below the cut-off) need
further evaluation
Ages Stages Questionnaires Vision
Screening Hearing Screening Observation
SCREENING Brief procedure designed to identify
children who need more intensive assessment or
evaluation.
EVALUATION Procedures used by appropriate
qualified personnel to determine a childs
initial and continuing eligibility for Part C
services (IDEA)
To determine if children are eligible or not for
Part C services
Referral Information on Health
Family Documentation of diagnosis Battelle
Developmental Inventory (BDI-2) Observation Family
interview
To gather about children and families that can
be linked to meaningful IFSP outcomes and
intervention strategies
ASSESSMENT Ongoing procedures throughout
childrens eligibilityto identify childrens and
families unique strengths and needs
appropriate services
Family CPR Autism Screening Can use curriculum
or single domain assessment Daily and monthly
data collection and analyses
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The terms screening, evaluation, and assessment
refer to related, but different, procedures in
the early intervention system. Each procedure
collects data or information on children, and
sometimes families, in order to make a decision.
They differ in the type of decisions being made
Screening results decide if children need more
intensive information collected from him or her.
Evaluation results are used to help determine
eligibility. Assessment results decide what
IFSP outcomes and intervention activities are
most appropriate for individual children and
families.
ALL collect data to make INFORMED DECISIONS.
Each informs DIFFERENT decisions!
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Screening The first step in gathering
information in the evaluation process of
EarlySteps..
Fail yes, more information
needed
Screening
Pass no more information needed
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Screening is a brief procedure designed to
identify children that should receive a more
intensive evaluation or assessment. A screening
is typically the first encounter children and
families have with the evaluation process.
Screening tests are used to answer the
question Is more information needed? For
example, results of a developmental screening
helps inform decisions about whether more
information needed about a childs developmental
status. If children pass a developmental
screening test, then we infer that their
development is consistent with an expected range
of development for children of the same age.
When this information is combined with other
sources of information about the children and
families as part of a comprehensive screening, we
might make an informed decision that these
children might not need further assessment.
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If a childs scores in various areas on the ASQ
are below the cut-off scores, then skills in at
least one developmental area are below an
expected range of skill development for children
of the same age. This is considered a failed
screening. When combined with other sources of
information as part of a comprehensive screening,
we might make an informed decision that we need
to gather additional information about the child
and family. In EarlySteps, additional
information is usually gathered by a formal
standardized evaluation and less formal
assessment activities. Remember, screening
results do not provide comprehensive quantitative
information relative to the childs developmental
status nor should screening results ever be used
to make informed decisions about services or IFSP
outcomes/goals or objectives.
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What are Screening?
Screening
First Alert
Brief (10-20 minutes) Pass/Fail?
Standardized
Objective
Accurate
Cost effective
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Screening of a young childrens development
typically includes developmental history
from the family caregiver descriptions of
childrens preferences temperament, concerns,
and skills information about the families
native language and culture short,
standardized instrument to assess developmental
areas

Developmental screening tests can be based on
childrens performance (e.g., Denver
Developmental Screening Test) or caregivers
reports of childrens development, like the Ages
and Stages Questionnaires (ASQ). The ASQ is the
screening tool used in EarlySteps. Although it
is a caregiver report measure, it is optimal to
engage the caregivers in the administration of
the test and to observe the interactions between
them and their children, as they complete each
task.
Ages and Stages Questionnaires A Parent
Completed, Child Monitoring System (2nd edition)
(ASQ) (Brookes Publishing, 1999).
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ASQ Ages and Stages Questionnaires
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Remember that screenings do not provide
comprehensive quantitative information relative
to a childrens developmental status. The
screening spoke of the making informed decisions
umbrella answers the question Is more
information needed? On the ASQ, scores from
the areas of cognitive, gross motor, fine motor,
communication and social-emotional development
are compared cut-off scores in these areas. If
scores fall below the cut-off scores in one or
more areas, children are referred for evaluation
, the next spoke of the making informed decisions
umbrella, to gather more information. In early
intervention, evaluations are conducted to
diagnose medical or developmental problems and/or
to determine eligibility to receive early
intervention services and supports. You have to
follow the instructions for scoring to know if
the child need to be referred for an evaluation.

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The evaluation spoke of the umbrella can answer
the more specific question Does a medical or
developmental problem exist?
Diagnosis-Evaluation
Medical
Developmental
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Children who do not pass screenings should be
referred for an evaluation to determine if a
medical or developmental problem exists. In
EarlySteps, an evaluation is part of the
determination factor. Information about
childrens medical and developmental status is
used in the evaluation process. Different
medical and developmental procedures can be used
to determine if children have diagnoses that
impact their health or development.
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The Merriam-Webster Dictionary defines diagnosis
as the act of identifying a disease from its
signs and symptoms. Diagnostic evaluation is
a process designed to confirm or rule out the
existence of a condition. For medical diagnoses,
the evaluation process may include medical
history, observation of symptoms, laboratory
tests, informed clinical opinion, etc. From
this collected information, qualified medical
professionals can make informed decisions about
whether children have medical diagnoses and, if
they do, they can determine the nature of the
diagnoses.
Diagnoses do not drive the services chosen the
diagnoses provide additional information
concerning childrens health and development.

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In addition to medical diagnoses, an evaluation
is conducted to determine if the child has a
developmental delay diagnosis.
Developmental delay diagnoses are based on
analyses of childrens development across
developmental domains. According to the Zero To
Three New Visions For Parents Website
(www.zerotothree.org), a developmental diagnosis
should offer parents a precise and detailed
description of the characteristics of a childs
development, including strengths and the ways in
which a child learns.
www.zerotothree.org
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Lets take look a closer look at the eligibility
spoke of the making informed decisions umbrella
and see how children and families qualify for
Part C services and supports ..
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Eligibility for Part C Services
Federal requirements for eligibility

Eligibility
Eligibility criteria specified by each state
Eligibility criteria in Louisiana
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Federally, the Individuals with Disabilities
Education Improvement Act (IDEA, 2004) requires
states to serve two categories of young children
under Part C

• Children with a diagnosed physical or mental
  condition that has a high probability of
  resulting in developmental delay.
• Children experiencing developmental delays as
  measured by appropriate diagnostic instruments
  and procedures in one or more of the areas of
  cognitive, physical, communication,
  social-emotional, and adaptive development.

IDEA 2004 gives states the discretion to
establish an eligibility criteria for a third
category, those children who are at risk for
developmental delay, but only a few states
offer this category of eligibility. Louisiana
is not one of these states. Additionally, each
state participating in the Part C
system identifies its own criteria for these
eligibility categories.
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In Louisiana, children and families may qualify
for services and supports in Part C by meeting
the following eligibility criteria Diagnosed
Conditions If children are diagnosed with one or
more of the medical conditions, which have a high
probability of resulting in developmental delays,
they are eligible to receive services through
EarlySteps. Developmental Delay Children who
have a developmental delay of at least 1.5
standard deviations below the mean on the
Battelle Developmental Inventory -2 (BDI-2) in
two areas of development (i.e., cognitive,
physical, communication, social/emotional,
adaptive skills) or sub-domains of physical
and/or communication development (i.e., fine and
gross motor, receptive and expressive
communication) are eligible for EarlySteps.
The BDI-2 is the comprehensive developmental
assessment tool used in eligibility determination
evaluation.
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Informed Clinical Opinion Children who do not
qualify under the developmental delay or medical
diagnoses criteria, may qualify by informed
clinical opinion of developmental delay if they
exhibit abnormal sensory-motor response or an
affective or social disorder/condition. Go to
www.earlysteps.dhh.louisiana.gov scroll to
Resource, click EarlySteps Manual, Initial
Eligibility to review detailed information about
the evaluation process in EarlySteps, including
the list of diagnosed conditions with IDC-9 codes
and additional information related to
developmental delay and informed clinical opinion
eligibility criteria. You will learn more about
evaluation in EarlySteps, as you review the
processes of evaluation and assessment in our
early intervention program in Louisiana, at the
end of these modules
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After eligibility has been determined for Part C
services through screening and evaluation, how
are informed decisions made about individualized,
family centered, developmentally appropriate
outcomes and intervention strategies?
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In early intervention, assessment information is
gathered to help teams, including families, make
ongoing decisions about intervention and
outcomes..
Assessment
Flexible, ongoing decision making process
Developmentally appropriate -Whole
child -Responsive to individual -Natural
environment
Partnership between families and professionals
Meaningful view of daily function
Observation, curriculum based assessment (CBA),
play assessment
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Assessment is the spoke of the decision making
umbrella that helps guide decisions about IFSP
outcomes and intervention strategies for
individual children and their families.
Assessment is the ongoing process by which
qualified professionals, together with families,
through standardized tests and observation, look
at all areas of childrens development and their
learning to identify both areas of strength and
those requiring support and intervention (adapted
from Zero To Three, www.zerotothree.org).

• A variety of strategies are used in assessment
• Observations
• Play assessments
• Curriculum based assessments (e.g., Assessment,
  Evaluation, and Programming System (AEPS)).

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Recommended practices in the field of early
intervention note key features of high quality
assessment of young children.. Assessment is
a flexible, collaborative, and ongoing decision
making process in which families are full
partners. Families provide assessment
information on themselves and their children,
have full input into the decisions that are made,
and validate findings for authenticity.
Developmentally appropriate practices in
assessment are those that recognize that young
childrens behavior is NOT congruent with
behavioral restrictions associated with the
administration of traditional, standardized
developmental tests.
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Developmentally appropriate
assessments are A
comprehensive picture of how the child functions
in his natural environment across all
developmental domains and information about
family resources, priorities, and concerns is
essential to informing decisions related to IFSP
outcomes and intervention plans.
flexible individualized to childs specific
interests and needs conducted in the childs
natural environments by familiar people
provide a view of the whole child, including
all developmental domains, temperament,
motivations, etc.
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In addition to evaluation and assessment for the
purposes of diagnoses, eligibility, and
intervention planning, program monitoring
evaluation is important.
Program Monitoring Evaluation
How effective is the early intervention program?
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Information collected for program monitoring
and/or program evaluation purposes is used to
determine how well the program is operating and
to assess the effectiveness of the program. To
do this, information on individual children and
families, as well as the progress of all children
and families, collectively, is gathered and
analyzed.
Program monitoring includes assessing the
effectiveness of IFSPs, identifying revisions
and/or additional information needed for the
intervention plan. Data may be collected via
observation, family report and results of
curriculum based assessments. Program
evaluation questions are answered with
information derived from individual and group
progress during the program and from children and
families outcome data.
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What outcome information is collected to evaluate
the early intervention program?
Families Better
understand their childrens strengths, abilities
and needs Know their rights and advocate
effectively for their children Help their
children develop and learn Access support
systems, desired services, programs and
activities in their community
Outcome Measures
Children Acquire and utilize knowledge and
skills Have positive social-emotional
skills Use appropriate behaviors to meet their
needs

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The Individuals with Disabilities Education
Improvement Act (IDEA 2004) added another
purpose for assessment accountability.
Annually, all states participating in Part C
must report on three identified child and family
outcomes to the United States Department of
Education, Office of Special Education Programs.
The required outcomes approach child development
from a holistic perspective. Rather than require
data on each area of development, each outcome
actually incorporates all developmental domains
applicable to children at any age. The child
outcomes are
Children have positive social emotional skills
(including social relationships). Children
acquire and use knowledge and skills (including
early language/communication, early literacy).
Children use appropriate behaviors to meet
needs.

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All states are required to gather data to measure
progress on children who are receiving services
through Part C and have been receiving IFSP
services for at least 6 months. At minimum, 2
data points are collected at entry into the Part
C program and close to when children exit the
Program.
In addition to childrens outcomes, family
outcomes have been identified to evaluate Part C
programs. Each state must provide data related
to the percentage of families who report that
early intervention services have helped them
Know their rights and advocate for their
children. Effectively communication their
childrens needs. Help their children develop
and learn.
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All of the information collected under the spokes
of the making informed decisions umbrella (i.e.,
screening, evaluation, assessment, and program
evaluation) help families and other members of
the early intervention team support childrens
development.