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Role of the Family in Ratings Discussions

The family plays several important roles in Virginia’s System for Determination of Child Progress, including team member, child information provider, rating participant and customer.

Team Member: Just as families are members of IFSP teams, they are critical to the assessment team. DEC Recommended Practices (2005) tell us “Early childhood assessment is a flexible, collaborative decision-making process in which teams of parents and professionals repeatedly revise their judgments and reach consensus…”

Information Provider: Child Indicator Summary Form (CISF) rating rely on information about a child’s functioning across situations and settings. Parent input is crucial: family members see the child in situations that professionals do not. The rest of the team will need to learn what family members know about the child- what the child does at home, at grandma’s house, in the grocery store, etc.

Participant is CISF Rating Discussions: As members of the IFSP team, families are natural participants in the CISF rating discussion. Their role in the rating is child expert, while other members of the team will know child development and the skills and behaviors expected at various age levels.

Customer: Professionals need to be able to explain why the rating is being done and what it means.

Functional Outcomes/ Indicators

What is an outcome/indicator?

  • Outcomes (or “indicators” as they are called in Virginia) are the benefits that children and families experience as a result of early intervention
  • The three child indicators, as measured for accountability purposes, are different than IFSP outcomes in that:
    • The three child indicators reflect global functioning in three broad areas of development (social-emotional, knowledge and skills, getting needs met)
    • IFSP outcomes are specific to an individual child, based on his or her individual needs
  • Each outcome is a snapshot of
    • The whole child
    • Status of the child’s current functioning
    • Functioning across settings and situations

What makes an indicator functional?

Functional indicators:

  • Refer to things that are meaningful to the child in the context of everyday living
  • Refer to an integrated series of behaviors or skills that allow the child to achieve the important everyday goals

How do I assess functional indicators?

  • Emphasize meaning. Ask “Can the child carry out meaningful behaviors in a meaningful context?” not “Can the child perform discrete behaviors such as knowing 10 words, smiling at mom, stacking 3 blocks, pincer grasp, walking backward?”
  • Observe a child in natural settings to learn:
    • What does the child usually do?
    • What is his actual performance across settings and situations?
    • How does the child use his/her skills to accomplish tasks?
  • The assessment of functioning is NOT about:
    • The child’s capacity to function under unusual or ideal circumstances, skill by skill, domain by domain
    • The child’s performance In a structured testing situation in on standardized way

Why isn’t assessing the child’s ability to perform discrete behaviors enough?

Discrete behaviors (e.g., those described by some items on assessment instruments) may or may not be important to the child’s functioning on the indicator.

  • Individually, they are not especially informative
  • Summed, they may or may not be useful, depending on the functionality of the behaviors/items

Think about isolated behaviors ad what observing them tells you about the child. For example, suppose an assessment instrument asks you to observe whether or not a child can point:

  • If you know that a child can point, do you know that the child can communicate her wants and needs?
  • If you know that a child can’t point do you know that she can’t communicate her wants and needs?
  • How does knowing about pointing help you understand how the child takes action to meet needs?

What about domains?

  • Functionality is not domains-based; children function across developmental domains
  • Functionality can involve multiple domains and can cross domains
  • Functional outcomes refer to behaviors that integrate skills across domains

What does functionality have to do with using the Child Indicator Summary Form?

Ratings on the seven-point scale for each outcome are a snapshot of:

  • The whole child
  • Status of the child’s current functioning
  • Functioning across settings and situations

Ratings are based on the child’s functioning:

  • What the child does across settings and situations
  • Compared with what is expected given the child’s age

Check your understanding….

Look at the list of skills below. Which are examples of isolated skills? Which are examples of functional skills?

a. Knows how to imitate a gesture when prompted by others
b. Uses finger in pointing motion
c. Uses 2-word utterances
d. Watches what a peer says or does and incorporates it into his/her own play
e. Points to indicate needs or wants
f. Engages in back and forth verbal exchanges with caregivers using 2-word utterances

(Answers: a, b, c = isolated; d, e, f = functional)

Age-Expected and Immediate Foundational Skills and the Child Indicator Summary Form (CISF) 7-Point Rating Scale

The CISF uses a 7-point scale for rating a child’s functioning in each of the three indicator areas. To determine a rating, the team must be familiar with the child’s functioning in the indicator area across a variety of situations and settings. The team needs to think about the many skills and behaviors that allow the child to function in an age-expected way in each indicator area. The team needs to understand the developmental continuum that leads to age-expected functioning, asking

1. Are the skills and behaviors demonstrated what one would expect for a child this age?
2. If not, are they like those of a younger child? Are they the skills and behaviors that come just before the age-expected skills and behaviors?
3. If not, are they like those of a MUCH younger child? Are they farther away from age expected skills and behaviors? (much earlier or atypical skills and behaviors).

Foundational Skills

Some of the skills and behaviors that develop early serve as the foundation for later skills and behavior, or expressed another way, later skills build on earlier skills in predictable ways. Teachers and therapists can use the earlier sills to help children move to the next higher level of functioning developmentally. We refer to these earlier skills that serve at the base and are conceptually linked to the later skills as “foundational skills.” For example, children play along side one another before they interact in play. Development in the early childhood years proceeds through several levels of foundational skills with skills and behavior becoming more complex and more proficient as children get older. All skills that lead to higher levels of function are foundational skills, however, the set of skills and behavior that occur developmentally just prior to age-expected functioning can be described as the immediate foundational skills in that they are the most recent set of foundational skills that children master and move beyond.

A child whose functioning is like that of a younger child is probably showing immediate foundational skills. Her functioning does not meet age expectations, but she demonstrates skills and behaviors that occur developmentally just prior to age expected functioning and are the basis on which to build age-expected functioning.

A child whose functioning might be described as like that of a MUCH younger child does not meet age expectation, nor does she demonstrate skills and behaviors that immediately precede age-expected functioning. She has foundational skills, but not yet an immediate foundational level.

Some foundational skills get replaced by newer skills whereas others continue in children’s (and adult’s) repertoires throughout life. The nature of interacting with other children changes fundamentally as children get older. On the other hand, skills like making eye contact, turn-taking, and eating with a fork get incorporated into more sophisticated routines but never disappear. To identify whether functioning that continues throughout life constitutes an immediate foundational skill, ask yourself at what age one would first expect to see this functioning and how close it that to the child’s current age. For instance, being able to make eye contact is not an immediate foundational skill for a three year old.

Example 1: Chrissa is 30 months (2 ˝ years) old. Although she does not play with other children, she watches them with great interest. A child who is 30 months of age or so should play with other children, even taking turns. A younger child (18-24 months or so) would play alone, but would be very aware of other children, such as the toys another child is using, and may snatch a toy away from another child. A much younger child (12 months or so) would stay very close to his or her primary caregiver, showing early awareness of other children. Chrissa is more than aware of other children; she visually follows their play with enthusiasm. She has immediate foundational skills on which to build the next level of relationships with peers, which would involve playing with other children and turn taking.

Child development does not progress in a neat and tidy sequence. Children spend various amounts of time in any one stage of development. Areas of development may overlap with one another. It is impossible to pin down the exact age at which every child will have achieved a specific milestone. Children manifest developmental expectations in different ways. All children follow general sequences, but each child will develop in unique ways, depending upon the child’s personality, context and experiences. In determining the extent to which a child’s functioning meets age expectations, the team must look at an overall pattern, rather than specific fragments, of development.

Example 2: Justin is 24 months (2 years) old. He uses a spoon, but often spills the food before it gets to his mouth. Without his mom’s help he wouldn’t get much to eat at mealtime. A child who is 2 should be able to meet his feeding needs without much help, using various kinds of tools, including his fingers. The younger child (toddler) experiments with tool use, but with limited success. The much younger child (infant) participates in feeding by opening his mouth, but does not attempt to feed himself.

• How would you describe Justin’s skills and behaviors? Are they age-expected? Immediate foundational? Or not yet?
• What if Justin were 12 months old? How would you describe his skills and behaviors? What if he were 36 months old?

Indicator Ratings

A domain score on an assessment does not necessarily translate directly into an indicator rating. Indicator ratings require:

• Looking at functional behaviors
• Collecting and synthesizing input from many sources familiar with the child in many different settings and situations

To Decide on a Rating…

• Know what behaviors and skills are appropriate for the child’s age; How do children who are developing typically function on this indicator?
• Review the available sources of information to determine how the child functions across a variety of situations and settings
• Understand the differences between response options on the summary form

Overall Age Appropriate Completely means: 7 Child shows functioning expected for his or her age in all or almost all everyday situations that are part of the child’s life. Functioning is considered appropriate for his or her age. No one has any concerns about the child’s functioning in this outcome area.
Concerns 6 Child’s functioning generally is considered appropriate for his or her age but there are some concerns about the child’s functioning in this outcome area. These are minor concerns and may be related to the quality of performance.

Some Age Appropriate: Some Aspects and/or some of the Time Somewhat means: Somewhat
means:
5 Child uses most or all aspects of the skills for this indicator some of the time across some settings.
Near
Somewhat

means:
4 Child uses age appropriate skills rarely and not in all settings or situations OR child only has age appropriate skills in some aspects of the indicator

Overall Not Age Appropriate Emerging means: 3 Child does not yet show functioning expected of a child of his or her age in any situation. Child’s behaviors and skills include immediate foundational skills upon which to build age appropriate functioning. Functioning might be described as like that of a younger child.
Not yet
means:
2 Child’s behavior and skills include some immediate foundational skills, but not yet in all aspects or across all settings and situations.
Not yet
means:
1 Child does not yet show functioning expected of a child his or her age in any situation. Child’s skills and behaviors also do not yet include any immediate foundational skills upon which to build age appropriate functioning. Child’s functioning might be described as like that of a much younger child.
Click here to find Typical developmental information Click here for ages 1 through 6 months developmental milestones Click here for ages 7 through 12 months developmental milestones Click here for ages 13 through 24 months developmental milestones Click here for ages 27 through 36 months developmental milestones


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