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.
