Module II: Evaluation and Assessment
Unit I Lesson 4: Informed clinical process
Informed Clinical Opinion is a process by which information that has been gathered about a child is organized and considered. Among more traditional information such as test results, the information includes:
· background/history
· medical records
· impressions about skills
· systematic observations of the child’s abilities and weaknesses
· emotional and temperamental patterns
The information should come from multiple sources.
An informed clinical opinion is based on the knowledge and skills of the entire team, including the parents. The sole use of test scores for eligibility determination is insufficient without further interpretation, observations, and information gathered from interviews and other informal assessments. Informed clinical opinion involves synthesizing all of the information gathered about the child.
To read more about informed clinical opinion from the National Early Childhood Technical Assistance Center, click here. (Or copy this to your browser
http://www.eric.ed.gov/ERICDocs/data/ericdocs2/content_storage_01/0000000b/80/27/f1/28.pdf )
The following are some essential elements that must be considered by all individuals participating in the multidisciplinary evaluation of the child.
Parent Priority
Parents MUST be heard and further know that their opinion is valued by professionals.
Importance and relationship to the daily routine
Concerns of the individuals participating in the multi-disciplinary evaluation process must be evaluated in relation to the functional skills that lead to independence. For the infant-toddler population, all participants should look for functional skills that result in independence and mastery of skills in natural environments.
Pervasiveness
Consider the child’s performance relative to his/ her peers. To be a concern, the child must display a pattern that is atypical of normal developmental milestones.
Enduring
Ensure that concerns are examined relative to the child’s history, such as examining emotional or behavioral reactions to transitory event in the child’s life (e.g., divorce, move, death in family).
Independent of linguistic difference
Areas related to language must be closely examined when assessing a child from a linguistically different background. A language difference must be discerned from a language delay. Children who are truly language delayed or have a language-related disability must demonstrate those deficits in their primary language.
Lack of opportunity or experience
In reviewing information, consider the instructional models and learning opportunities to which the child has been exposed. Careful consideration should be taken to examine whether the child’s difficulties may be due to lack of learning that is related to lack of experience. When reviewing information, confirm that the gathered data has come from multiple sources and that the sources are organized in a valid and reliable manner.
The following is a list of some possible sources that may be considered when determining if a child is eligible for First Steps:
- Testing Examples:
- norm-referenced and criterion-referenced tools
- Checklists Examples:
- behavioral and developmental “Yes/No” questionnaires or rating scales completed by the family and other individuals important to the child’s life (e.g. babysitter, grandmother)
- Direct Observation Examples:
- information collected by therapists and caregivers while watching the child during naturally occurring events or routines, anecdotal notes, time sampling, running narratives
- Documentary Evidence
- a review of evaluation reports, medical history, case history, pre referral interventions history, progress notes
- Ecological Assessment
- information gathered from the child’s environment Examples: comparison of the child’s behavior with the behavior of a peer or sibling; a checklist on the use of developmentally appropriate practice in a child care setting; expectations held by caregivers or service providers regarding behaviors or skills; functional behavioral assessments that identify environmental events associated with a child’s difficulty; identification of child care organization (e.g. schedules, routines)
- Interview
- information gathered from in depth conversations with family or child care providers regarding their perceptions of the child’s performance, concerns, and priorities
- Products
- material produced by the child Examples: audiotapes, videotapes, photographs
While the First Steps evaluation process must be multidisciplinary in Missouri, it is not necessary that the eligibility determination be made by a team. However, in some cases, the service coordinator will determine that the eligibility decision is not clear cut and that it is necessary to pull together the individuals who participated in the multidisciplinary evaluation (including the parents) to discuss and synthesize all available information.
Once the determination of eligibility is made, parents have the right to stop. They may choose not to continue to IFSP development. The process also may stop if the child is determined not eligible for First Steps services. If the latter occurs, then the service coordinator should help the parents identify other community services available and provide the family with a Notice of Action for Ineligibility and a copy of the Parental Rights brochure. Please click here to familiarize yourself with the Parental Rights brochure as you will be sharing this information with families.
http://dese.mo.gov/divspeced/Compliance/Part-C/Parental-Rights.pdf
Review questions:
1. The last lesson touched briefly on "informed clinical opinion." How did the Jo Shackleford article change your thinking about what an "informed clinical opinion" is?
2. Can both qualitative and quantitative information be used in deciding the eligibility questions?
3. In Part C, is eligibility and assessment an ongoing process?
4. If a family is non-English speaking, how can an assessment be made of language skills?
5. Define, what is an "informed clinical opinion?"
Reflection questions:
1. What is the purpose of the Parents Rights brochure?
2. How can the multidisciplinary team assemble a "whole child" assessment from all the different data and observations collected?
3. If a child is found not eligible for FS what should the service coordinator do?
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If you have a question about this module please check the Q & A pages. If you still have a question after reviewing the Q & A pages please send an email to: webreplyspefs@dese.mo.gov or call 573.751.0187