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Learning HELP 0-3

The following HELP 0-3 Training Tips are provided by Stephanie Parks Warshaw, author of HELP 0-3.


Introduction: If you are using HELP 0-3 just for assessment, then you need to purchase Inside HELP–the essential assessment administration and reference manual along with the HELP Strands (and perhaps the HELP Charts for communication with parents). If you are using HELP 0-3 just for curriculum, then you need HELP at Home or the HELP Activity Guide with the HELP Charts or HELP Checklist. Assessment and curriculum can be considered two different components.

Inside HELP is a comprehensive administration and reference guide to be used in conjunction with all the HELP (Hawaii Early Learning Profile, Birth-3) curriculum and assessment materials: the HELP Strands, HELP Checklist, HELP Charts, HELP Activity Guide, HELP at Home, HELP When the Parent has Disabilities, and the HELP Family-Centered Interview.

Inside HELP is intended to maximize the use of HELP as a curriculum-based assessment. It includes clear definitions, flexible and authentic assessment guidelines, and credit criteria for each of the 685 developmental skills and behaviors appearing in all the HELP products (Birth-3). In addition, it provides guidelines for understanding and interpreting the child's skills and behaviors in the context of his caregiving relationships and environments, and recognizes families as central to the assessment process. As a curriculum-based assessment, HELP is directly linked with parent and professional curriculum activities and strategies to help promote the child's development and positive parent-child interactions.

Objectives of Inside HELP–the essential Reference Manual for using HELP 0-3
Using Inside HELP with the HELP Strands, Charts, or Checklist will facilitate the professional's efforts to:
  • Identify and report qualitative descriptions of the child's developmental skills and behaviors along multiple lines of development
  • Determine approximate developmental levels within and between major domains of development
  • Identify strengths and needs within and between major domains of development
  • Interpret how one area of development may be influencing another area of development
  • Conduct a family-directed assessment of family concerns, priorities and resources as they relate to the development of their child;
  • Recognize factors in the child's physical environment that support development
  • Recognize caregiver interactions that support and facilitate the child's development
  • Develop child and family outcome statements with the family that are meaningful and functional to the child and family.
  • Designed to support Infant and Toddler Legislation (IDEA)
  • Professionals who work within early intervention programs will find Inside HELP especially valuable because it addresses many of the requirements for multidisciplinary, family-centered assessment as required under Part C, Individuals with Disabilities Education Act, and ongoing assessment and curriculum under the Head Start Act.
Guiding Principles
The development and intended use of Inside HELP is based upon the following guiding principles:
  • Curriculum assessment is a multidimensional ongoing process
  • Curriculum assessment should go beyond evaluation and observation of a child's skills and behaviors;
  • Curriculum assessment should be family-centered
  • The curriculum assessment process should be pleasurable and meaningful for infants and families
  • Disabilities should not interfere with a true assessment of a child's abilities;
  • Assessment should be logically linked to intervention.
Issues Regarding Density and Multiple Lines of Development
One of the most unique features of HELP - applauded by both parents and professionals - is its density: the high number of quality, specific skills. No other currently available birth-to-three curriculum includes as many developmental skills and behaviors and intervention strategies as the HELP. This density provides families and clinicians considerable choice in the process of assessment and curriculum planning, and facilitates monitoring of the child's progress in small incremental steps. The density and comprehensiveness of Inside HELP can appear overwhelming to the new user. Remember, however, that Inside HELP is intended to be an administration and reference guide. As such it is intended to be used as a resource for the professional to refer to on an "as needed basis" for clarification of specific skills when using HELP products, and for review or expansion of knowledge and skills in early childhood development and assessment. As you become familiar with the HELP skills and format of Inside HELP, the comprehensiveness and ease of use as a reference tool will become more apparent.

Important Key Point for using HELP as a curriculum-based assessment: Although the HELP is formatted along multiple lines of development through the use of developmental domains and strands, no domain, strand or skill can be understood in isolation of other areas of development or in isolation of the environment. Separating development into domains and strands can be helpful for understanding and pinpointing underlying areas of strengths and needs, but children should never be viewed in separate, fragmented or isolated areas of development. The challenge for the clinician is to analyze the mutual impact and interplay of these multiple lines of development and then integrate findings with the family to determine integrated intervention strategies and functional outcomes. Inside HELP stresses the importance of interdependence and interrelatedness between and within domains, strands, and the environment.

History of HELP
The original HELP materials, the Hawaii Early Learning Profile (HELP) Charts and HELP Activity Guide, were developed by the multidisciplinary pediatric team of Setsu Furuno, Ph.D., Katherine A. O'Reilly, R.P.T., M.P.H., Carol M. Hosaka, M.A., Takayo T. Inatsuka, O.T.R., Toney L. Allman M.A., and Barbara Zeisloft M.S.,Sp., through a federal demonstration and training project, the Enrichment Project for Handicapped Infants, from 1971 to 1979. This project was conducted under the auspices of the School of Public Health, University of Hawaii, and was funded by the Bureau of the Education of the Handicapped. Six-hundred and eighty-five (685) developmental skills and behaviors were selected by the multidisciplinary team from numerous available growth-and-development scales and standardized tests. The age ranges provided for the skills on the Charts and in the Activity Guide were "based on a synthesis of research and project data." There was "not always agreement in growth and development literature as to when a skill begins," and thus "age ranges" in months for when a skill typically emerges was included rather than one specific "month" level.

These 685 developmental skills provided the framework for developing curriculum activities for the HELP Activity Guide and HELP Charts within the six traditional domains: Cognition, Language, Gross Motor, Fine Motor, Social-Emotional and Self Help. All skills are not necessary or critical to the child's development, but were included according to the project team because of their teachability and amenability to intervention. The HELP Charts and HELP Activity Guide were field-tested by numerous programs for infants and toddlers with disabilities. The materials were also used and reviewed by programs in 35 states and 7 different countries for additional feedback.

Additional HELP materials have been developed to meet the growing field of early intervention: HELP at Home, HELP When the Parent has Disabilities, HELP Checklist, the HELP Family-Centered Interview, and the HELP Strands. Most recently, materials have been translated into Spanish and a data-tracking/reporting component has been developed (KinderCharts). Each of these derivatives build upon and are cross-referenced to the 685 core HELP skills and behaviors and are based on (dependent on) Inside HELP.

Development of Inside HELP
Inside HELP was developed to provide: (1) flexible, clear, and valid definitions, (2) credit criteria, and (3) assessment procedures for each of the 685 core HELP skills and behaviors. This manual is intended to promote consistency and a common framework of reference among multidisciplinary professionals using HELP as a curriculum assessment for planning comprehensive programs for infants and toddlers with special needs and their families. This manual is not intended to provide standardized evaluation, or diagnosis.

The definitions, credit criteria, and assessment guidelines were derived from a variety of growth and development scales, standardized norm-referenced tests, infant curriculums, and extensive early intervention research papers, articles, and texts listed under References at the end of this manual. The guidelines presented in each strand "Preface" (e.g., Family Friendly definitions, Parent Questions, Transactional Assessment, etc.), were drawn from infant and family literature as well as from experience and collaboration with families and professional colleagues.

A core interdisciplinary team of pediatric therapists who work in the Prince William County Parent Infant Education Program contributed to the search of the literature process and development of this manual. A vision specialist who works with the Virginia Department for the Visually Handicapped provided her expertise and research in developing the adaptations for the visually impaired. When definitions, credit criteria and assessment guidelines were vague or unclear in the literature, the team, in concurrence with at least two additional professionals from the applicable discipline, developed clarification and criteria through clinical judgment and experience. Each of the contributors to this work has a Masters degree and a minimum of 10 years of experience in the field. The pediatric physical and occupational therapists are NDT certified and have training and experience in sensory integration principles. The final draft was sent to four outside experts in the field for final critique and review.

Purpose of the HELP Strands
The HELP Strands is a curriculum-based developmental assessment booklet for direct use with individual children. It covers the same core 685 skills and six traditional developmental domains included in the original HELP materials, but it has been structured like Inside HELP to provide a more precise framework for assessment and planning - the traditional HELP domains have been divided into 58 developmentally sequenced conceptual strands. Each strand includes HELP skills which focus upon a specific underlying key concept and are hierarchical in nature; i.e., one skill leads to or builds the foundation for the next skill. Developmental levels, strengths, and needs within each domain can thus be more easily identified for curriculum assessment and individualized planning.

Skills listed on traditional developmental checklists and standardized tests, although generally listed in a developmental order according to age, are not generally hierarchical. For example, if a child "passes" one skill it does not necessarily mean that he is ready to learn the next skill. Conversely, if a child "fails" an item, this does not mean that he cannot accomplish or is not ready to learn a skill placed higher on the continuum. Without careful item analysis, it can be difficult to identify strengths and needs within a major area of development and difficult to identify "next steps" for planning. The HELP Strands were developed to address this need and to provide an additional option to the clinician for assessment and monitoring.

Features of the HELP Strands
  • Regulatory/Sensory Organization (0.0) is a new section that has been added to the framework of the HELP Strands. It includes pertinent HELP skills selected from all domains which tap the child's self-regulation capacities (i.e., sleep cycles, regulation of moods, attention, and consolability), and, the child's capacities to perceive and organize various sensory experiences (i.e., sights, sounds, touch, taste, smell, vestibular [body movement through space and head position] and proprioception [awareness of body position in space])
  • Condensed definitions are included directly on the HELP Strands assessment form for quick reference..
  • Some of the original (1979) HELP skills age ranges and wording have been updated to reflect current literature (these updates are are listed in Inside HELP, Appendix A and B.)
  • Completely cross-indexed: Each skill in the HELP Strands has the same skill identification number used in all of the HELP products. This allows for easy cross reference and linkage between all HELP materials (birth-3).
Development of the HELP Strands
The development and restructuring of the 685 core HELP skills into the HELP Strand format began in 1988. The first step included analyzing each of the HELP skills for its underlying concept regardless of the domain in which it was originally placed. This process was completed through clinical judgment, review of the early intervention literature, and collaboration with an interdisciplinary team of pediatric therapists and infant specialists. The skills were then sorted into respective multiple conceptual strands within the traditional six major domains and sequentially ordered by age. Several skills included more than one underlying concept and were thus placed in more than one strand. Initial drafts of the HELP Strands (with definitions) were then developed and field-tested during the following three years with more that 200 infants and toddlers enrolled in the Prince William County, Parent Infant Education Program located in Manassas, Virginia. The infants and toddlers were aged birth (adjusted age for prematurity) to 35 months and were enrolled in ongoing early intervention services because of developmental delays, atypical development, and/or disabilities. Program staff conducting the curriculum assessments were experienced and licensed pediatric speech, occupational and physical therapists, and infant educators.

The primary purpose of field testing was to test the adequacy of the initial sequencing of skills within strands based on a hierarchical structure. If a child "failed" more than two items in a row but then passed a higher item in spite of assessment adaptations for disabilities, the relevant skill items were more closely scrutinized. In some cases, the skill ended up "fitting" better conceptually and sequentially in another strand. In other cases, by the nature of the several-month age range span in which the skill typically emerges, the skill had simply been misplaced in the sequence. In some cases, through a search of more recent literature, it became evident that the age range references listed in the original HELP Charts needed to be revised, either to a higher or lower range. Some skills within strands such as 1-5 "Spatial Relationships," and 0.0 "Regulatory/Sensory Organization," although conceptually related, were not expected to have complete sequentiality because they include more than one underlying concept. This is noted when applicable in the applicable strand prefaces. This ongoing process of refinement and reordering of skills within and between strands continued until the strands were considered as sequential and as hierarchical in nature as possible. The final HELP Strands were then reviewed by outside experts in the field for final confirmation.

HELP Revisions and Updates
Inside HELP and the HELP Strands were purposefully built upon the core original (1979) HELP skills to provide consistency and easy cross-referencing between all the HELP materials. As a result of literature searches, some relatively minor revisions were made to some of the original HELP skill wordings and age ranges (on products showing a © date prior to 1992.) These changes were incorporated to reflect current literature and trends in the field. (Refer to Appendix A and B of Inside HELP.)

Approximate Developmental Levels
The HELP assessments, including the HELP Strands, are not norm-referenced or standardized, and will not yield a single age level or score. The primary purpose of HELP as a curriculum assessment is to identify curriculum outcomes, goals, strategies and activities. The HELP Strands can, however, be used to help determine approximate developmental age ranges within and between areas of development, document that a child is not displaying skills and behaviors expected for his age, provide meaningful descriptions of a child's skills and behavior, and document when skills and behaviors are of poor quality, atypical, or dysfunctional.

Editorial and Formatting Notes
Skill ID#: As noted, specific identification #'s have been assigned to each of the HELP skills. This numbering system is consistent across all the HELP products to facilitate quick cross-referencing between products. This numbering system was developed with the first HELP materials, i.e., HELP Charts and HELP Activity Guide according to major domains, e.g., 1.0 Cognitive, includes skills 1.01, 1.02, 1.03, etc. The HELP skill ID#'s were originally (1979) assigned based upon the skill's placement on the HELP Charts, but the numbers do not necessarily reflect sequentiality. Skills within strands are in sequential order, and thus do not always appear in numerical order within a strand. A cross-reference index of the numerical order of skill ID#'s is on pages 376-379. If you are using the HELP Charts or HELP Checklist, pages 376-379 are intended to act as a quick reference for finding the page in Inside HELP for each of the skills.

Note: children are referred to as "he" throughout this manual. No gender bias is intended.
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Quick Tour of Inside HELP

Inside HELP is a comprehensive administration and reference guide to be used in conjunction with all the HELP (Hawaii Early Learning Profile: Birth-3) curriculum and assessment materials: the HELP Strands, HELP Checklist, HELP Charts, HELP Activity Guide, HELP at Home, HELP When the Parent has Disabilities, and the HELP Family-Centered Interview.

Important Notes:
  • The following instructions and examples provide general "rule of thumb" guidelines for determining approximate developmental levels. There are no exact rules or formulas that will apply for every child or every assessment to derive developmental levels. Use clinical judgment and item analysis in this process.
  • Each Strand Preface in Inside HELP provides specific strand-related information for determining and reporting developmental levels under "General Assessment Procedures."
Important Reminders:
  • No child is expected to display all HELP skills listed nor display all skills for an age range. Be sure to consider individual, environmental, or cultural differences per child.
  • The age ranges reported in HELP are the ages at which a skill or behavior (for children who do not have disabilities) typically begins according to the literature. These age ranges are not when a skill begins and ends! Some skills are time-limited and emerge into more complex skills, while others are lifetime skills. Literature varies regarding the age at which a skill emerges, for example, one source may have reported 9 month, another source 10 months, and another source 12 months. HELP would list that skill at the 9-12 month age range.
  • HELP is a curriculum-based assessment, not a standardized test. As such, there is no validity or reliability data available for HELP. It will not yield a definitive single age level or score. The major purpose of HELP as a curriculum assessment is to identify curriculum outcomes, strategies and activities.
  • If your program requires standardized scores for eligibility purposes, HELP can be used in conjunction with a standardized test (see page i.34) to help pinpoint strengths and needs, and to help develop outcomes, strategies, and activities.

1. Inside HELP is divided into seven major sections corresponding to developmental domains. Each domain is assigned a Domain ID #
for easy cross-reference among all HELP materials.
Examples

Domains
0.0 Regulatory/Sensory Organization
1.0 Cognitive
2.0 Language
3.0 Gross Motor
4.0 Fine Motor
5.0 Social Emotional
6.0 Self-Help

2. Domains are sub-divided into Strands.
Each strand has a number.
The Contents for Inside HELP corresponds directly to the structure of the Strands. The upper corner or each page of Inside HELP shows the Strand, e.g., 5-1.
Domain sub-divided into Strands
1.0 Cognitive
1-1 Development of Symbolic Play
1-2 Gestural Imitation
1-3 Sound awareness
1-4 Problem Solving

3. HELP skills are sequential and developmentally ordered within each strand, i.e., each skill leads to and builds the foundation for the next skill. Each skill uses the HELP skill ID# for easy cross-reference.

  • The skill ID#'s within Strands do not always follow numerical order. This is because the skill ID#'s are based on the original HELP Charts which were not broken down into Strands.
  • Age range indicates when a skill typically emerges, not when a skill begins and ends.
  • Skills are sequential within each Strand:
1-2 Gestural Imitation
Skill# Skill Description
1.42a Imitates familiar gesture
1.42b Imitates new gesture
1.66 Imitates several new gestures
1.84 Imitates invisible gesture
4. Definitions, example Observation Procedures (assessment procedures), and Credit Criteria are listed for each skill. Skill
1.42a Imitates familiar gesture

Definition: The child makes a familiar visible gesture in imitation of a model. A familiar gesture is a movement that the child already uses frequently during daily activities...
Example observation opportunities: Observe gestures that the child typically makes during play or daily activities. These may be observed while assessing the child's play interactions...
Credit:
+ imitates at least two familiar visible
gestures
5. Each Strand Has a Preface in Inside HELP. The strand Preface provides 10 key sections of assessment information related to all skills within the strand.

Examples

"Family Friendly" Interpretation of Strand Concepts, Assessment, and Purpose
A jargon-free definition and interpretation of the underlying strand concept. This includes a clear explanation of what you are assessing and why it is important to the child's development.
"Family Friendly" Interpretation
We will be observing how your child is learning to play with toys and other objects. Play is very important in a child's learning and development. Play helps children learn how to solve...
Professional FYI
Various information about the strand which may be helpful or important for the professional, e.g., the relationship of this strand to other strands or domains, special considerations, rationale for inclusion of certain skills, etc.
Professional FYI
1. This strand focuses on the child's interaction with objects and toys leading to the development of symbolic play. Social interactions and play with other children and adults, although closely related, is not highlighted...
Parent Questions
Sample questions to facilitate a family-directed
assessment of their child's unique strengths and needs as well as family concerns, priorities and resources related to enhancing their child's development. These questions help identify family roles, beliefs, and values as they relate to the development of their child, and family preferences regarding the assessment process and content.
Parent Questions
* Can you tell me a little about how he plays with some of the toys you mentioned?
* Are there certain toys that he does not seem to like?
* Has he ever played with the kind of toys we have here today?
Sample functional outcome statements which may be generated by the family and related to the strand concepts, skills and behaviors.
These are only samples to help move away from the more rigid operational objectives that many of us were trained to develop. The actual outcome statements you use are those generated directly from the family through sensitive interview and active listening techniques.
Sample functional outcome
statements

My child will:
* Enjoy playing with toys;
* Play with his friends at daycare;
* Play with a toy for more than a few
seconds;
* Play with his toys instead of always
putting them in his mouth.
We will:
* Know what objects around home our child will enjoy playing with;
* Know more about the ways our child can learn through play.
Transactional Assessment of environment and caregiver interactions
This section offers examples of key factors in the child's caregiving environment which can promote or compromise the child's development. This section is also useful to review the professional's own interactions and environment in the assessment and interventions provided to children and
families.
Transactional Assessment
1. Supportive:
The child's caregiving environments usually:
* Have a variety of safe and develop-
mentally appropriate play materials;
* Have safe spaces for the child to play;
* Keep play materials accessible to the child.
2. Compromising:
* The child's caregiving environments usually do not have safe or developmentally appropriate toys or materials.
Identifying and Interpreting Needs
Help in sorting out why a child may display
a delay or atypical behavior in a particular strand. This will help determine what types of interventions are most appropriate.
Identifying and Interpreting Needs
If a child is significantly delayed or displays persistent atypical development in this area, he may be having difficulty with mental processes needed to engage in meaningful play with objects. This includes being able to:
1. Perceptually discriminate the qualities and functions of objects;
2. Mentally represent or internalize an action or object that is not present, i.e., representational thought.
Assessment Adaptations
Examples of adaptations for specific disabilities and special needs to use when assessing skills and behaviors in the strand.
Assessment Adaptations
Motor impairments: involve a pediatric therapist in the assessment of the child's play so that the therapist can adapt materials and positioning to meet the child's individual needs and promote
interactions and mobility with toys. The following are some general adaptations:
Use play materials, battery-operated toys, and touch-sensitive switches that can be easily manipulated and adapted to accommodate the child's type of grasp. Larger or stabilized materials may help.
General child assessment procedures
Assessment procedures which are applicable to all skills in the strand. Although each skill also has specific assessment procedures, there are some procedures which are applicable to all the Strand's skills and are included in the Preface to avoid redundancy.
General child assessment procedures
a. Most items in this strand can be assessed simultaneously, i.e., observe the child's interactions with the objects and toys until he becomes repetitive in his play and is not displaying higher level interactions. Credit predominant play interactions accordingly.
b. Provide the child with some of the "example eliciting play materials" that are suggested under the procedure for each item in this strand.
Credit notes
Suggestions for documenting the presence or absence of particular skills and behaviors. Although specific credit criteria is included for each skill, there are general credit notes which are applicable to all skills in the strand and are thus included in the Preface to avoid redundancy.
Credit notes
+ child displays defined play interaction as a predominant interaction; not observed or reported.
+/- appears to be an emerging play scheme; displayed play scheme with adult prompting and modeling, but it is not considered a predominant scheme.
Assessment Materials
A list of materials and toys which are likely to elicit responses for assessment of skills within the strand. The materials listed are typically available in the child's natural environments. Notes are included to use materials which are culturally relevant, safe, and motivating.
Assessment Materials
Birth to approximately 1 year:
Several easy-to-grasp toys which have different textures, sounds, and consistencies. Examples include: smooth plastic rattles; small blocks, some that have different pictures on the sides, such as alphabet blocks; soft textured squeak toy; crumpled piece of paper; dinner bell; plastic cup; toy cars; small doll.
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How to Use HELP - Before the Assessment

Before the Direct Child Assessment
Suggested Steps


1. Begin the family-centered interview process through home or center visits, and the telephone. During the interview:
a. Explain the purpose of the assessment, what to expect, and options for how family members can participate as part of the assessment team.
b. Get a general idea of the child's key milestones, e.g., how does he move around, what toys does he play with, how does he communicate.
c. Identify family's primary concerns, priorities, expectations and preferences related to the assessment.


2. With written parental permission, collect, review, and collaborate with other professionals and the family about other information pertinent to the current assessment of the child and family, e.g.:
a. Medical history, contraindications, and current conditions.
b. Previous developmental evaluations, assessments, screenings.
c. Other information family feels is important to the assessment.



3. Secure necessary releases and therapy prescriptions to conduct direct assessments.



4. Select the most appropriate HELP assessment recording form to use during the direct child assessment, i.e., HELP Strands or HELP Checklist (the Strands are recommended.) The HELP Charts are more often used for communicating progress to families after the assessing with the Strands.



5. Highlight several skills above and below the child's approximate developmental age on the HELP Strands (or Checklist or Charts) within each developmental domain you anticipate assessing.

6. Locate the skills you anticipate assessing in Inside HELP to prepare and plan for the direct child assessment.
a. Review relevant strand Prefaces which correspond to selected skills.
b. Review the definitions, credit criteria, suggested assessment procedures, and materials for each skill.
c. Select and prepare for five-to-ten play and daily activity situations (from "Example Observation Opportunities") to include in the direct assessment. Choose activities which are likely to elicit several skills concurrently across developmental domains, e.g., playing with a ball or rattle, looking in a mirror, diaper changing.


7. You can record notes from this planning and review phase directly onto the HELP Strands or Checklist, or on separate note paper to take into the direct assessment.

HELPful Tips


Use the HELP Family-Centered Interview or review and select Parent Questions from various strand Prefaces in Inside HELP.














From the collected information:
* Determine assessment team (i.e. disciplines), format (e.g., multidisciplinary, arena, or interdisciplinary), assessment content, methods, and adaptations
* Get a general idea of the child's current development to help target where to begin the assessment.


Some states require some therapists to have a prescription.


Use the HELP Strands if the child has
specific disabilities or displays apparent "uneven" development.
Use the HELP Strands "loose leaf" format (Prod. No. 158-B) if more than one
discipline will be assessing at one time.

The skills you highlight will be based upon the information gathered in
steps 1 and 2 above.

If you are using HELP Strands, go directly to the corresponding strand in Inside HELP to locate the specific skills.
If you are using HELP Checklist or HELP Charts, use the Skills Index on page 376 of Inside HELP to locate the highlighted skills you anticipate assessing.


You do not need to assess all skills or strands. Observation of one activity is likely to provide information about the child's development across many strands.

As you become more familiar with HELP, your preliminary preparation time and notes will be reduced.

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How to Use HELP - During the Assessment

During the Direct Child Assessment
Suggested Steps


1. Bring any notes you've prepared prior to the direct assessment (i.e., "Eliciting Situations" and Credit Notes) with the HELP assessment recording form you've chosen (i.e., HELP Strands or HELP Checklist) into the direct assessment.


2. Record the child's responses to eliciting situations and observations of parent-child interactions directly on the HELP assessment form or note paper.
Suggested credit codes:
+ skill or behavior is present
- skill is not present
+/- skill appears to be emerging
A skill or behavior is atypical or dysfunctional
N/A item is not applicable or not appropriate to assess due to disability or parent preference.
O circle any credit (i.e.,. +,-, or A) when the environment or caregiver interactions compromise the child's development in this area, and whenever family requests additional
information or help in this area.
Note: In domain 0.0 - Regulatory/Sensory Organization, there are two credit options for "Atypical" reactions or responses:
A+ hyper responsive
A- under responsive






3. Continue assessing until the child losses interest, tires, or cannot complete higher level tasks.
If you are using the HELP Strands:
a. If a child displays two or more skills in a row with good quality, you can generally assume that he has achieved earlier skills because of their hierarchical relationship.
b. You can usually stop trying to elicit skills in a strand after the child has missed two skills in a row.
Using the HELP Checklist or the HELP Charts, since skills are not always in hierarchical order, you may need to assess at least 4-5 skills above and below the child's apparent developmental level. Use clinical judgment.


4. Continue the family interview process.

HELPful Tips


You generally do not need to bring Inside HELP into the direct child assessment. Use it for a reference guide prior to and after the direct assessment.

Abbreviated definitions and credit notes are already included on the HELP Strands.

If more than one discipline is involved during the direct assessment, they can act as a consultant to the primary evaluator (professional and/or parent) by "coaching from the sidelines" to help elicit specific skills, and to record responses and interactions.

Some crediting is tentative at this point and will need to be confirmed after the assessment with the credit criteria listed for each skill in Inside HELP.

Record any needed adaptations directly on the HELP assessment you are using.





If a child "masters" a skill, you will still include it in your intervention plan if it is circled, for example, if the child can "Pull up to stand" but there are no sturdy furnishings at home for the child to use, you would circle this credit and could include interventions.



See "Sample Structure of a Direct Assessment."

If permitted, use videotaping to help
capture subtle responses and to confirm questionable credits after the assessment.
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How to Use HELP - After the Assessment

After the Direct Child Assessment
Suggested Steps


1. Team Collaboration: Review Observation and Credit Notes from the direct child assessment with all team members to ensure a comprehensive, interdisciplinary perspective.



2. Refer to "Credit Criteria" in Inside HELP to
confirm any questionable credits you may have had during the direct assessment.
Note regarding use of A (Atypical): Atypical variation does not definitively indicate that the child is abnormal in his development. Variation in development is common. In addition, atypical motor or behavior patterns can be transient, especially during the first year.





3. Note any items which were not assessed that need to be followed up on or reassessed.




4. Determine any further specialized evaluations that may need to occur.




5. Determine approximate developmental levels across and within major domains. Be sure to note any adaptations used during the assessment to qualify credits and to help plan successful interventions.


6. Develop outcome statements with the family which reflect their concerns and priorities related to enhancing their child's development. The groundwork for developing outcome statements will have already occurred from initial contacts through the direct child assessment.
Outcomes may be long- or short-term, and may change frequently as the child and family
concerns, priorities, and resources change.



7. Determine services and strategies to meet the unique needs of the child and family to achieve identified outcomes. These will be based upon several variables, e.g., family resources, concerns and priorities, child's strengths and needs, factors contributing to child's delays.

HELPful Tips


Remember, parents are an integral part of the team.

Review available videotaping.


If a child displays persistent atypical patterns, it is important to refer to a professional with expertise in that area of development; however, it is important not to unduly alarm families. Atypical patterns should be monitored and reassessed over a period of several months before assuming it is a more lasting area for concern.



For example, the child may have tired before you had an opportunity to assess a certain item, or certain eliciting situations or materials were not available.

For example, if the child displayed atypical muscle tone, further motor assessment by a pediatric therapist should be
scheduled.

See "How to Determine and Report Levels of Development" for detailed steps.




If you are using the HELP Family-Centered Interview, confirm and prioritize with the family the tentative outcomes you have outlined in the final column "Possible Final Outcome Statements."


Use the following sections from the Strand Preface to help determine services and strategies:
* Transactional assessment
* Identifying and Interpreting Needs for Intervention
* Assessment Adaptations

Address skills which were credited A, i.e., Atypical, and skills which were circled.

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Using HELP to Achieve Outcomes

Suggested Steps


1. For each outcome listed:
a. Determine which HELP skills and behaviors are most relevant for achieving that outcome. These will usually be the skills/behaviors which were rated as emerging, not achieved, atypical, and/or achieved but circled because the family needs additional support in this area.
b. Be sure to integrate skills from all areas of
development.
c. If you are using the HELP Strands, you can usually assume that the "next step" in a strand will be the next skill in the strand that the child has not yet mastered.
d. Review family resources which are most relevant for achieving outcomes. These should be readily available from the HELP Family-Centered Interview.


2. Use Inside HELP to refine or pinpoint the most
appropriate intervention strategies.
a. Review Transactional Assessment data to
identify if interventions related to the environment and/or parent-child interactions are
needed to achieve outcomes.
b. Use Assessment Adaptations when appropriate as intervention strategies.
c. Review Identifying and Interpreting Needs for Intervention for strands which the child displayed significant concerns or delays. This section can provide insight into underlying needs to help determine the most appropriate
disciplines and strategies.


3. Use HELP curriculum materials to choose a variety of activities designed to support targeted skills to achieve outcomes. All HELP skills are cross-referenced to HELP curriculum materials. The HELP
curriculum materials, although cross-referenced to specific skills, do not focus on teaching "to the test." Instead, HELP activities focus on the underlying concepts and skills that lead to functional skills and outcomes. Skills are listed in numerical order in HELP curriculum materials. If you are using HELP Strands, use the Cross-Reference Index on pages 376-379 in Inside HELP to match skill ID#'s with page numbers in HELP at Home.

HELPful Tips


If the outcome is: "Danny won't become hysterical when his mother leaves the room," then the applicable HELP skill areas to target might be (depending upon child's development):
Cognition: Object (people) Permanence: remembering that the parent still exists even when out-of-sight.
Motor: crawling to search for parent from one room to another.
Auditory Localization: being able to find the parent when hearing her voice.
Language: Vocalizing rather than crying to attract parent's attention.
Social-Emotional: providing parents additional anticipatory guidance related to separation anxiety.
Applicable family resources could be:
"Family home has intercom system so Danny can hear parents from other rooms."
"Mother has had experience dealing with separation anxiety with Danny's older sister but it was not this extreme."

If the "child is unable to lift head in prone":
a. Transactional Assessment, e.g., if there are no interesting objects for child to look at, interventions may include adapting the environment.
b. Assessment Adaptations, e.g., if child has reflux, implement interventions in prone before feeding.
c. Identifying and Interpreting Needs for Intervention: If child has neuromotor or musculo-skeletal problems which interfere with the development of controlled extension, a pediatric therapist should be involved in planning and implementing therapy
activities.

HELP curriculum materials to help achieve outcomes include:
a. HELP at Home: ready-to-use activity sheets which you can individualize and copy for families.
b. HELP Activity Guide: in-program
activities and strategies.
c. HELP When the Parent has Disabilities: suggestions for adapting child interventions to include family members who have a disability.

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Using HELP as an Ongoing Assessment

HELP is an ongoing curriculum-based assessment. Since the developmental needs and priorities of young children and families change rapidly, assessment should be considered an ongoing cyclical process. Use HELP throughout your 0-3 intervention by completing or "filling-in" the HELP Strands (or Checklist or Charts) as skills and behaviors are mastered.

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Sample Structure of a Direct Assessment

Process and Format: A sample structure for a direct child assessment appears below. However, the actual face-to-face assessment process and format will differ for each child and family and depend on family preferences and individual child variables, e.g., age of child, level of stranger anxiety, degree of involvement and role the family chooses to take, as well as the place, time, and duration of the assessment.

Duration: An initial direct assessment of the child can generally be expected to last from 45-90 minutes, but in some cases may only last 15-20 minutes. Remember, this is only the initial assessment, you may need to see the child more than one time in more than one setting to get a better picture of the child's strengths and needs. After the initial assessment and planning, continued assessment and planning will be an ongoing process.

Be sure to review "General Assessment Guidelines and Precautions"

Suggested Steps

1. Free-play /warm up period:
10-15 minutes
Professional(s) sit unobtrusively on the "sidelines."
a. Provide a few developmentally appropriate play materials which are likely to elicit some of the skills and behaviors that you have targeted to assess before the direct assessment (see Instructions).
b. Review purpose of assessment and "warm-up"
period with family.
c. Invite family members to play with their child any way they choose.




2. Structured facilitation:
approximately 15-30 minutes
a. Transition to a more structured format as the child becomes comfortable. This part of the assessment is aimed at "fine-tuning" and filling in the gaps for skills which could not be observed incidentally
during the free play and warm-up period.
b. Review the assessment activities and materials you selected before the direct assessment. Implement the activities which are most likely to elicit targeted Cognitive, Language, Fine Motor skills; e.g., table-top activities, drawing, looking at books, building with blocks, playing in a dramatic play corner, etc. Each activity is likely to yield information in
several domains.
c. Observe how the child approaches and plays with materials and equipment before structuring eliciting situations directly with or through the parent.
d. Adapt toys and activities for specific disabilities and to ensure cultural sensitivity.
e. Continue interviewing the parent(s) with questions related to their child's typical skills and behaviors as well as their concerns and priorities. Use the HELP Family-Centered Interview or your notes from the Parent questions in strand Prefaces from Inside HELP.




3. Movement/motor activities:
approximately 10-15 minutes
Review the assessment activities and materials you selected before the direct assessment. Implement the activities which are most likely to elicit the targeted Gross Motor skills which have not yet been observed spontaneously. Provide mats, balls, and other large play equipment dependent upon the child's age and motor abilities, such as a tunnel, things to climb on, small slide, Tyke bike, or balance beam.

If it is necessary to directly test reflexes and postural responses, save this part of the assessment until toward the end, as this may be upsetting for the child.























4. Feeding or Snack time:
approximately 10-20 minutes
Include washing up before and after snack to observe the child's participation in washing as well as his reactions to having his face washed. If the child is older, invite him to help clean up by wiping the table and throwing away some of the trash.
Most of the feeding assessment can occur by observing the parent feeding their child.


5. Additional activities or closing time:
If the child is still alert and interested, additional assessment activities may be included to help fill in any gaps. If a therapist needs to do handling which may be disliked by the child, this could be scheduled toward the end.

HELPful Tips

During "warm-up" and throughout the assessment, you may observe and identify:
* the style and level of family-child
interaction
* additional structured activities you may want to incorporate
* some of the child's positional, movement, and toy preferences
* how the child solves problems
* child's spontaneous language.

Follow the child's cues when he is ready to transition from one activity and/or toy to another.

If more than one discipline is involved, they can act as a consultant to the primary evaluator (professional and parent) by "coaching from the sidelines" to help
elicit specific skills, and recording the child's responses.


While you are targeting one skill, observers can simultaneously assess other skills; e.g., if you are facilitating Symbolic Play, the physical therapist can observe how the child moves from one toy to another; the occupational therapist may observe the type of grasp the child uses and his sensory responses to different
textures sights and sounds; and the speech/language therapist may observe the child's spontaneous vocalizations, communication to others, and apparent understanding of directions.

Be sure to note any adaptations which were used to help assess skills.

Include parent responses to questions about their child's skills as part of the assessment.


If the child has or is suspected of having physical disabilities or motor dysfunction, have a pediatric PT or OT conduct and/or directly consult during assessment.

If the child is walking with good quality you can probably skip Section I. of Gross Motor strands and go directly to Section II., Strand 3-7 "Advancing postural control and Motor planning."

If the child is under 15 months or is not yet walking well, you can skip Section II. of the Gross Motor Strand.

If the child displays motor skills of good quality it may not be necessary to assess reflexes.


If oral motor dysfunction or feeding problems are present, schedule a separate assessment during the child's regular feeding time in his natural environmental with a pediatric speech or other therapist specializing in feeding.

Snack or meal time provides an excellent opportunity to observe the child's oral motor skills, independent feeding abilities, food and texture preferences, and any tactile reactions, posture during feeding, communication, and behavior.

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General Assessment Guidelines and Precautions

Make assessments culturally relevant
It is important to assess and adapt items to reflect the child's relevant cultural and environmental experiences. Assessment should occur using the child's primary native language, both verbal and non-verbal, using toys and materials which are meaningful to the child. Some skills listed in the HELP may not be culturally relevant or appropriate to assess. Sample family interview questions have been included in the strand Preface to promote meaningful and culturally sensitive assessment and planning.

Assess in natural environments A complete picture of a young child's development can be difficult to achieve by unfamiliar observers in unfamiliar settings, especially with a shy or hesitant child. Although an initial assessment may need to be center-based, especially if more than one discipline is involved, whenever possible, also observe the child in multiple settings that the child is familiar with, e.g., home, day care. Most assessment items in this manual include example multiple naturalistic opportunities to observe the child's development during the course of typical daily activities, play and parent-child interactions which can be observed in a variety of settings.

Include observations of the environment and caregiver interactions in your assessment A child's development cannot be fully assessed or understood in isolation of the environment. Assessment of child skills and behaviors should include assessment of the child's physical environment and caregiver interactions which support development. For example, during the course of assessment it may be noted that the child is not pulling to stand. A child-focused assessment may generate specific motor therapy techniques to reach this goal. A transactional assessment, however, would consider factors in the environment which may be inhibiting the development of this skill. For example, if there are no sturdy, safe furnishings in the child's environments, it may be more appropriate to focus interventions on adapting the environment rather than specific therapy skills.
The "Transactional Assessment" section in the Preface of each strand provides examples of key factors in the child's caregiving environment which can promote or compromise the child's development. Assessment of the physical environment and caregiver interactions can occur through observations of the child's primary environment, parent-child interactions during play and daily activities, and through sensitive parent interview. Important note: No family or environment can be expected to display all of the given examples of sensitive interactions and supportive environments. Day-to-day stresses, being in an unfamiliar environment with professionals, cultural diversity, and other situational factors can influence how a caregiver interacts with the child at any particular time. The Inside HELP examples are only provided to help clinicians consider patterns of interactions and environments which can support and facilitate the child's development as intervention strategies are planned.

Incorporate variety! Since the HELP is an ongoing curriculum-based assessment, it is likely that items will be repeated with children as they are incorporated into curriculum activities and are periodically reassessed to measure progress. It is thus extremely important, especially in the Cognitive and Language areas to incorporate variety into the example Eliciting Procedures and use of materials to ensure generalization. Assessment and interventions should occur in multiple settings using a variety of materials and eliciting techniques.

Be sure to identify medical limitations, precautions, and contraindications It is very important to review the child's medical history and current medical status carefully, including vision and hearing if available, before assessment and intervention. Many conditions may require a medical clearance from the child's physician for assessment and intervention. Existing or prior medical conditions can restrict movements and positioning as well as influence the child's strength, endurance, quality and age of achieving motor milestones. Consult with the child's family, medical records, and physician regarding existing conditions or a history of: e.g., respiratory and/or cardiac difficulties; medications; surgeries; seizures; medical equipment: e.g., use of G-tubes; colostomy bag, oxygen, apnea monitor, or history of long-term IV. If the child has poor strength and endurance, limit the number of activities assessed at any one time. Watch carefully for any signs of fatigue, and discontinue or modify the assessment at the first sign of physiological distress, e.g., shortness of breath, rapid breathing, changes in the child's skin or his behavior.

Involve families in every step of the process 1. Families should be invited to participate and make decisions during all phases of the assessment process. Assessment content, process, and expectations should be adapted to respect and fit individual family priorities, beliefs, and values. For example, families should be afforded the opportunity to make choices and preferences regarding:
- Their level of decision-making, participation, and involvement during the assessment;
- Which family members to include in the assessment;
- Which professionals and disciplines will participate in the assessment;
- Assessment settings: times, places, duration;
- Assessment content: priorities of skills and behaviors to assess, types of toys and materials to use;
- Assessment methods: direct handling versus observation, types of encouragement;
- Who should receive copies of reports which may be generated by the assessment.
2. Parents are experts in their child's development and can provide valuable and valid assessment information related to their child's skills and behaviors. Only families can assess their own concerns, priorities, and resources. As noted, example open-ended as well as specific skill-related interview questions are provided in the Preface of each strand. These are included to facilitate a family-directed assessment of their child's skills and abilities as well as of their concerns, priorities, and resources. Remember, family concerns, priorities, and resources can change frequently; a family-directed assessment is an ongoing process which occurs naturally throughout interventions.
3. It is important to always explain what you are assessing and why. Asking a child to draw a line, stack blocks, or find a hidden toy can be confusing and meaningless to a parent. "Family Friendly," jargon-free definitions and rationales for assessing various developmental skills and behaviors are included in the Preface of each strand. These examples and explanations should be further adapted for individual families.

Involve a multidisciplinary team Children with disabilities often have complex, multifaceted needs which require professionals from a variety of disciplines. There are generally three models in early intervention for involving multiple disciplines in the assessment: Multidisciplinary, Interdisciplinary, and Transdisciplinary. It is beyond the scope of this manual to describe the roles, functions, benefits, and weakness of each model, but all HELP materials can be used within each model. Whichever model is used, parents should always be considered a vital part of any team, and it is critical that team members work collaboratively to avoid fragmented views of a child's development and to ensure integrated curriculum assessment and planning.

Throughout Inside HELP, suggestions are made regarding which disciplines to include in an assessment and when to seek further evaluation. In addition, the "Identifying and Interpreting Needs for Intervention" and "Family Friendly Interpretation" sections in the Preface of each strand, and the clear definitions provided for each skill, promote interdisciplinary sharing and understanding of all areas of development, regardless of a discipline's area of expertise. In all cases, use your own clinical judgment to involve the necessary and appropriate disciplines.

Adapt for disabilities Assessment adaptations and modifications should be made to help ensure that a disability or delay in one are of development does not interfere with a true assessment of the child's capacities in other areas of development. In each strand Preface, Sample Adaptations are included to help assess a child's performance related to the underlying strand concept.