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Clinical HELP (0-3) FAQ (from Inside HELP)
by Stephanie Parks, M.A. (includes latest updates to questions)
Overview of Inside HELP Important Reminders IDEA, Part C and HELP - a comparison Introduction to HELP Instructions for Using HELP (from Inside HELP) 1. HELP covers so many items, where do I begin? [Top] No other currently available birth-to-three curriculums include as many developmental skills, behaviors, and intervention strategies as the HELP. The density and comprehensiveness of HELP can, at first glance, appear overwhelming, especially to the new user. However, the comprehensiveness of HELP offers the clinician more variety and options for assessment and curriculum planning, and enables families and clinicians to plan and monitor progress in small, incremental steps. The following tips can help make using HELP more manageable. a. Remember: HELP is not a "one-time" tool [Top] HELP is an ongoing curriculum-based assessment which is not intended to be completed in one assessment session. There are a large number of skills, but they span three years and are intended to be addressed over a long period of time. b. Not all skills are pertinent All of the HELP skills and behaviors listed are rarely pertinent to any one child. Many will not be pertinent due to the child's age and developmental level, some skills may not be functional due to a child's disability, some skills may not be culturally relevant, and other skills may not be necessary to assess because they are judged not to be important to assess for a particular child, e.g., ability to walk on a balance beam if the child displays no difficulty in motor planning or balance skills. As you consider these variables, the scope of skills appropriate to assess during initial observations and family interview can become narrower and more manageable. c. Don't assess each skill, strand, or domain separately [Top] Although each skill, strand, or domain has an underlying key concept or focus, it is typically unnecessary and inappropriate to assess each separately. Each observation of a child completing a task or involved in an interaction or daily activity yields information about a variety of skills and behaviors - simultaneously. For example, if you observe a parent asking the child to, "Throw the ball," and in response the child says, "ball" and throws the ball in a playful way to his parent, you could credit in receptive language his understanding of the words "ball" and "throw" in Strand 2-1, as well as his ability to follow a direction in Strand 2-2. In addition, you could credit his expressive vocabulary with the word "ball" in Strand 2-3, as well as his ability to produce single consonant vowel combinations in Strand 2-6. The gross motor and social interaction skills of throwing a ball can also be credited in the Gross Motor and Social-Emotional domains. Thus, a single response is likely to elicit information on several skills in several strands. d. Get a general idea of where to begin before you begin [Top] Parents can provide an enormous amount of information about their child to give you a general idea of level of functioning in most areas of development. This information can be gathered from family interviews over the phone, in person, and through application questionnaires. In addition to family interviews, additional developmental information may be available from previous screenings or formal evaluations. Since many of the items on the HELP are similar to items contained in various screening and evaluation tools, this information is likely to be useful in identifying were to begin with the HELP. 2. Can I use HELP to determine program eligibility? [Top] This will depend primarily on your program's policies and the individual needs of the child. It is your professional responsibility to use instruments and qualified personnel that meet local, state, and federal requirements. HELP is not standardized and thus should not be used if your program requires standardized instruments to determine developmental delay. In addition, since HELP cannot provide a single score or definitive developmental age, HELP should not be used to determine eligibility for children who may be experiencing mild developmental delays. In such cases, however, HELP can be used to compliment standardized instruments to support "informed clinical opinion" requirements, and it can be used as an initial and ongoing assessment to help identify the child's unique strengths and needs, services appropriate to meet those needs, and the resources, priorities, and concerns of the family. If your program does not require standardized instruments, HELP can be used to help support your informed clinical opinion regarding eligibility for children with significant delays and atypical development. HELP can also be used as an initial and ongoing assessment to help identify the child's unique strengths and needs, services appropriate to meet those needs, and the resources, priorities, and concerns of the family. In addition, if a child is referred to your program with a previously diagnosed disability or special need that already meets program eligibility requirements, HELP can be used as an initial and ongoing curriculum-based assessment. 3. Can HELP be used to determine a % delay for Part C eligibility? [Top] States are required to define "developmental delay" as part of their state's system for early intervention under Part C of IDEA. To meet this requirement, many states use a specific percent of delay in one or more areas of development to define developmental delay. In response, programs are developing methods to quantify curriculum-based assessments such as HELP. Although HELP was not developed as a "test", and does not have the psychometric properties to yield standardized scores, we understand the needs of programs to quantify HELP assessment information. Guidelines for determining approximate developmental age levels for the HELP Strands are available in Inside HELP, pages i.23-i.26 and, as expanded version available for download here. The guidelines are intended to enhance consistent reporting of across staff and programs. Percent delay is usually computed by comparing a child's developmental age (DA) with the child's chronological age (CA) or adjusted age for prematurity when applicable to the child and program. If this process is used with HELP, the findings should be viewed as "approximate" and used to help support informed clinical opinion rather than as a definitive "score", "age equivalent" or the sole criterion to determining eligibility i. This use is consistent with the current and proposed May 9, 2007 regulations of Part C ii. 4. Can HELP be used to monitor progress for OSEP's child outcomes? [Top] Yes. An online system, as well as various to materials for download, is available through VORT to measure and monitor progress for OSEP's Part C, Child Outcome Statements. This system builds uses ECO's HELP Crosswalks and builds upon ECO's 7 point rating system. It is available here. 5. Can a child's age be adjusted for prematurity when using HELP? For example: I used the HELP Strands to evaluate an 11 1/2 month old child who was 11 weeks premature. [Top] Yes, you can adjust for prematurity to assist in identifying and reporting approximate age levels. There is space on the cover of the HELP Stands booklet to include prematurity assigned along with other identifying information. If you adjust for prematurity, be sure to note this on the HELP Strands and any resulting records or reports for the child. Clinically, although it is not specifically required by HELP, adjusting a child's age for prematurity (i.e., subtracting the number of weeks/months prematurity of a child from the child's chronological age) can provide a better understanding of the child's development, strengths, and needs. If and how you adjust for prematurity will be dependent upon how you are using the HELP, and, upon your individual program or state regulations. Some states or programs for example, recommend adjusting for prematurity up to 2 years chronological age (CA), if the child is more than 4 weeks premature when screening or evaluating for eligibility. As a child becomes older, this adjustment will be less significant for evaluation and programming. For example a 5 week prematurity adjustment for a two month old would be about a 50% adjustment of CA, whereas a 5 week adjustment for a 24 month old would be less than 5%. Using the child in your question as an example, for an 11 ½ month old who is 11 weeks premature, it would be appropriate to observe if this child is displaying HELP skills and behaviors expected for children who are about 9 months old, being extra careful to observe quality as defined in Inside HELP for relevant HELP skills. Remember that the age range listed for skills and behaviors on the HELP Strands is the range that the skill typically emerges according to the literature, and, that all HELP Skills are not necessary for typical development. Thus if a HELP skill is listed as 6-8 months and the child's adjusted age is 9 months, this child may not be delayed in that skill or area of development if the skill is not present. There is only a one-month difference between 8 months (upper age range when skill typically emerges) and child's adjusted age of 9 months. Special note regarding prematurity and OSEP child outcome ratings: ECO has directed Part C programs and test developers not to use adjusted age to determine child outcome ratings. Therefore, prematurity adjustment does not occur on VORT's HELP for OSEP online system. 6. Which HELP assessment recording form(s) should I use? [Top] HELP offers three formats for recording initial and ongoing assessments and collecting child data: the HELP Strands and the HELP Checklist, while the HELP Charts are most typically used for communicating progress to parents. The HELP Strands breaks the six major domains into sub-groups (strands) according to underlying skill concept; structured so that one skill leads to the next skill. The HELP Strands are thus usually better suited for children who have disabilities and/or more uneven development within a major domain. The HELP Strands are available in two formats: a loose-leaf format and a booklet format. The loose-leaf version pulls apart by major domain. If more than one discipline will be assessing at one time, use the loose-leaf format. The HELP Checklist and HELP Charts list skills according to age and major developmental domains, but the skills are not sub-grouped within domain. Thus one skill does not necessarily lead to the next. The HELP Checklist can be used for children who have more even development or who do not have disabilities. There is also a HELP form available for collecting family information -- the HELP Family-Centered Interview. This form can be used from initial contacts with the family and throughout intervention to record and update family concerns, priorities, and resources. 7. Why are some age ranges on the HELP Checklist, Charts and Activity Guide different than the age ranges in Inside HELP and HELP Strands? [Top] The original HELP products, i.e., the HELP Activity Guide and the HELP Charts, were developed in 1976-1979. Since that time, infant/toddler literature has expanded and more information has become available. Although most of the original HELP skill wording and age ranges remain the same, some skills needed to be revised to reflect current literature. These changes were made on the HELP Strands and in Inside HELP in 1992, and on the HELP Charts and HELP Checklist in 1994, and the HELP Activity Guide in late 1997. Check the © date on your copies to see if you have the latest versions. 8. Why are some HELP skills repeated in different strands? [Top] Some skills are repeated in more than one strand because these skills involve more than one underlying key concept. For example, skill 4.29 "Reaches and grasps object" is listed in the Cognitive strand 1-5 "Spatial Relationships" and in Fine Motor Strand 4-3 "Reach/Approach." This skill is built upon the cognitive concepts related to depth perception and relationship of objects in space, as well as fine motor skills required for reaching. The definitions and credit criteria, therefore, will differ somewhat between strands for the same skill when it is repeated in different strands. 9. Is there an assessment kit available that has all the materials needed for the assessment? [Top] No. HELP is not standardized and does not require standardized materials. The materials you use can be individualized to meet individual child preferences and needs. Whenever possible, use toys and materials in the child's natural environment which are functional and meaningful for the child (see Assessment Materials in Inside HELP). i Proposed Sec. 303.320(a)(2)(ii) no single procedure may be used as the sole criterion for determining the child's eligibility for Part C services ii Proposed Sec. 303.320(b)(2) would expressly require that the lead agency allow qualified personnel to use their informed clinical opinion to assess a child's present level of functioning in each of the developmental areas identified in proposed Sec. 303.21(a)(1) and to establish a child's eligibility, even when other instruments fail to establish eligibility. This is consistent with the Department's monitoring experience, which has indicated confusion in States that do not expressly allow the use of informed clinical opinion as a separate basis to establish eligibility. This is necessary because instruments may not adequately capture the extent of the developmental delay. Thus, informed clinical opinion may be used to establish a child's eligibility under this part even when other instruments do not establish eligibility. However, under proposed Sec. 303.320(b)(2), informed clinical opinion cannot be used to negate eligibility established through the use of other appropriate assessment instruments. As provided in the note following current Sec. 303.300, the use of informed clinical opinion in establishing eligibility for early intervention services under Part C of the Act is especially important when standardized instruments are unavailable, unreliable or inappropriate for use in measuring developmental delay (as they often are for children under the age of three) or for evaluating a diagnosed condition such as autism spectrum disorder or pervasive developmental delay. Although the language of the note would be removed by these proposed regulations, the use of informed clinical opinion in establishing eligibility continues to be necessary and would therefore be included in proposed Sec. 303.320(b)(2) as previously discussed. |
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