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.
