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Evaluation and Assessment

Children referred to First Steps, birth through two years of age, are entitled to receive a timely, comprehensive, multidisciplinary evaluation, including a review of documentation and assessment activities related to the child and the child's family. The state of Indiana has chosen to use the Assessment and Evaluation Programming System for Infants and Children (AEPS) as the primary tool for determining eligibility. Other tools may be utilized as needed and providers may use informed clinical opinion in some situations. Families must give consent prior to an evaluation being conducted (see procedural safeguards). Providers should conduct evaluations and assessments in ways that are family-centered and promote communication among team members. The terms "Evaluation" and "Assessment" have very specific meanings within the First Steps System:

  • Evaluation: the review of information relating to a child's development for determining initial and ongoing eligibility for a First Steps Early Intervention Services. This must include assessment in the following developmental areas: Cognitive, Physical(including vision and hearing), Communication, Social/Emotional and Adaptive.
  • Assessment: The performance of activities to identity each child's unique strengths and needs and to identify the concerns, priorities, and resource needs of families. Information gathered from assessment activities is used as part of a comprehensive, multidisciplinary evaluation of the child for eligibility determination and for the creation of the Individualized Family Service Plan.

For more information about evaluation and assessment, check out the Assessment Manual.

As mentioned above, evaluation and assessment activities are completed to assist in the determination of eligibility. In Indiana, there are two eligibility categories: a documented developmental delay or a physical or mental condition which has a high probability of resulting in developmental delay.  Infants and toddlers younger than 36 months of age meet eligibility guidelines if the multidisciplinary team determines they have any one of the following conditions, as further described in the eligibility guidelines:

  • Documented developmental delay(s), Developmental Delay means a delay in one or more of the areas of childhood development as measured by appropriate diagnostic instruments and standard procedures.  Areas to be assessed include: cognitive development, physical development, including vision and hearing, communication development, social and/or emotional development, adaptive development, including eating skills, dressing and toileting skills and other areas of daily routines.
  • Indiana law defines developmental delay as:
    • A delay in one (1) or more areas of development as determined by two (2) standard deviations below the mean; or  twenty-five percent (25%) or more in function below the chronological age (adjusted for prematurity, if applicable) on an assessment instrument that yields scores in months; or 
    • A delay in two (2) or more areas of development as determined by one and one-half (1 1/2) standard deviation below the mean; or twenty percent (20%) or more in function below the chronological age (adjusted for prematurity, if applicable) on an assessment instrument that yields scores in months.
    • A physical or mental condition which has a high probability of resulting in developmental delay. 
      • The following are the diagnosed physical or mental conditions that have a high probability of resulting in developmental delay:
        • (1) Chromosomal abnormalities or genetic disorder.
        • (2) Neurological disorder.
        • (3) Congenital malformation.
        • (4) Sensory impairment, including vision and hearing.
        • (5) Severe toxic exposure, including prenatal exposure.
        • (6) Neurological abnormality in the newborn period.
        • (7) Low birth weight of less than or equal to one thousand five hundred (1,500) grams.
  • Every child referred to First Steps is entitled to have an Eligibility Determination meeting during which the results of the evaluation and assessment activities are explained and families are officially informed about whether or not their child is eligible to receive early intervention services.
  • STATE REQUIREMENTS BEST PRACTICE RECOMMENDATIONS
    • The service coordinator, with informed consent, will gather pertinent information about the child and family.
    • The Assessment Team will be composed of at least two providers from two different disciplines who are trained in the AEPS and knowledgeable about informed clinical opinion. For a service to be recommended, a provider of that discipline must have conducted the evaluation (with the exception of oral motor/feeding issues, see issue clarification, 2012)
    • Practitioners work as a team with the family and other professionals(e.g., child care) to gather assessment information. Practitioners should take into consideration other information beyond the AEPS scores (e.g., medical records, previous assessments).
    • The evaluation must be completed within 45 days of referral; if the 45 day timeline is not achievable, the service coordinator must document the circumstances.
    • The intake service coordinator should schedule the Eligibility Determination meeting and initial IFSP meeting far enough in advance of the 45 day deadline so that the if the family has to reschedule the deadline can still be met. The service coordinator should keep detailed clinical documentation about contacts with the family     (date, time, content).
    • If a child is found not to be eligible, the intake service coordinator should still talk with the family about other resources that might be helpful and offer contact information if the family has concerns in the future.

    Division of Early Childhood (DEC) Recommended Practices (2014):

    • A2. Practitioners work as a team with the family and other professionals to gather assessment information.
    • A3. Practitioners use assessment materials and strategies that are appropriate for the child’s age and level of development and accommodate the child’s sensory, physical, communication, cultural, linguistic, social, and emotional characteristics.
    • A6. Practitioners use a variety of methods, including observation and interviews, to gather assessment information from multiple sources, including the child’s family and other significant individuals in the child’s life.
    • A7. Practitioners obtain information about the child’s skills in daily activities, routines, and environments such as home, center, and community.
    • A8. Practitioners use clinical reasoning in addition to assessment results to identify the child’s current levels of functioning and to determine the child’s eligibility and plan for instruction.
    STATE REQUIREMENTS
    BEST PRACTICE RECOMMENDATIONS
    • Assessment activities must be voluntary. The service coordinator must provide procedural safeguards to the family prior to the assessment. See procedural safeguards.
    • The service coordinator should remind families about their procedural safeguards in a clear way and get confirmation that they understand and want to proceed.
    • Assessment activities must be conducted by trained personnel.
    • Assessment team members should seek out specialized training in the early childhood-related areas to allow them to provide the best possible developmental assessment.
    • Assessment activities must be family-directed and focus on the resources, priorities, and concerns of the family. A parent must be present for at least part of the assessment activities.
    • The intake coordinator should conduct a family interview during the initial visit that gathers information about daily routines and family priorities. The information should be shared with the assessment team members prior to their visit. The assessment team members should familiarize themselves with this information and continue to gather information about routines and priorities during the assessment. The assessment team should conduct the initial evaluation and assessment activities in settings that are familiar to the child and family to ensure accuracy of assessment information.
    • Assessment team members will take into account family information gleaned through the intake coordinator's visit and through interview questions during the assessment.
    • Assessment team members should include parents/caregivers as equal team members and as experts on their child, and assessment team members should document and consider all information provided by the family.
    • Assessment team members should direct all questions to the family and not the translator and should maintain eye contact with the family during all interactions.
    • The initial assessment is facilitated by the intake coordinator but the annual re-evaluation and any other on-going assessment activities are facilitated by the on-going service coordinator.
    • The intake coordinator should share the combined enrollment form, the assessment materials, and any family interview notes with the on-going service coordinator in a timely fashion.
    • The on-going service coordinator should allow enough time to communicate with the family about changes to routines, priorities, etc. prior to the annual re-determination of eligibility.

    Division of Early Childhood (DEC) Recommended Practices (2014):

    • A1: Practitioners work with the family to identify family preferences for assessment processes. Observation of the child in regular routines supports the knowledge of how the child functions within the context of family activities. This process also helps to identify how the family is impacted by the child’s functional abilities.
    • A6: Practitioners use a variety of methods to gather assessment information from multiple sources, including the child’s parents, family members, and other significant individuals in the child’s life.
    • A7: Practitioners obtain information about the child’s skills in daily activities, routines, and environments such as home, center, and community.
    STATE REQUIREMENTS BEST PRACTICE RECOMMENDATIONS
    • Providers will administer the evaluation and supply assessment materials in the parent's native language whenever possible.
    • If the evaluation and assessment materials are not available in the parent's native language, the service coordinator should arrange for an interpreter to be present. Even if the materials are in the native language, an interpreter should be used if the assessment team members do not speak the family’s language.
    • Providers will administer the evaluation and supply assessment materials that are not racially or culturally discriminatory.
    • Providers should research the materials that they use to see if there is data on racial or cultural bias. If there is no data to guide usage, providers should be aware of the potential for bias and make accommodations if an item seems problematic.
    • Providers must utilize multiple methods for gathering evaluation and assessment information in determining eligibility.
    • Providers should recognize the equality of all IFSP team members and utilize the expertise of the entire IFSP team, including on-going provider reports and family information.

    Division of Early Childhood Recommended Practices (2014):

    A2: Practitioners work as a team with the family and other professionals to gather assessment information.
    A3: Practitioners use assessment materials and strategies that accommodate the child’s sensory, physical, communication, cultural, linguistic and temperament differences.”
    A5: Practitioners assess in the child’s dominant language or in multiple languages if the child is exposed to two or more languages.
    TC3: Practitioners use communication and group facilitation strategies to enhance team functioning and interpersonal relationships with and among team members.

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