Functional Assessment: Part 1 OVERVIEW Early Intervention Training Center 2017 Lets take a look at what functional assessment really means and what clinical skills we can use to gather good functional assessment information.

Learning objectives Understand what functional assessment is and how we go about gathering information. The learning objectives for this mini lesson are as follows… [read slide] Early Intervention Training Center MA Department of Public Health

Functional Assessment Learning about children and families’ participation in their activities and routines We know that the birth to three population learns best through frequent repetition of skills occurring within the context of their everyday routines. So now lets talk about how can we figure out how to support families and learn about their family/ child routines and activities to ensure that they have the most opportunities for practicing in these everyday learning opportunities. The research indicates that to be effective in supporting families to understand and influence their children’s development, we have to begin the planning process for services with functional assessment. Through the information gathered in the functional assessment process, we have the foundation necessary to develop functional outcomes for young children with identified needs. NOTE: the IFSP process starts with eligibility determination and functional assessment, but functional assessment does not end with the initial IFSP, on-going assessment activities should be occurring throughout the child and families enrollment in EI. We can keep learning new information about the child and family and the changes that occur. Early Intervention Training Center MA Department of Public Health

How does this fit in the MA EI? MA definition of Evaluation: MA definition of assessment: “A face to face meeting with the child and parent(s) for the purpose of determining a child’s initial or continuing eligibility for early intervention services.” BDI-2 Review of records Parent interview Assessment “On going procedures used by qualified personnel throughout the child’s eligibility to identify Strengths Resources Priorities and concerns Supports and services needed Information about the child/family” So, how does this fit into our MA EI system? Let’s just remind ourselves of the specific definitions for assessment and evaluation in MA. Evaluation is a face to face meeting with the child and parent(s) for the purpose of determining a child’s initial or continuing eligibility for early intervention services. It is through EVALUATION that we determine eligibility. For this process, we use a number of resources: BDI-2 - is approved as the developmental evaluation tool to be used to determine eligibility for Early Intervention services in MA. An Evaluation must be completed by a multi-disciplinary team and looks at the child’s cognitive, physical, communication, adaptive/self help and social/emotional development and determines if a child is eligible to receive Early Intervention (EI) services. review of records parent interview, clinical observation Informed clinical opinion In MA we define assessment as the on going procedures used by qualified personnel throughout the child’s eligibility to identify strengths, resources, priorities and concerns, supports and services needed and information about the child/family An assessment gathers information about the child and/or family. It is a way to look at the ongoing strengths and needs of the child and it can show how the child is making progress, developing skills and how EI services and supports can help. We engage in assessment activities in a variety of ways and this should be something that we do in an ongoing way as we get to know children and families. Even though assessment and evaluation may look very similar, an assessment can happen at any time and does not determine eligibility. We should be using assessment though out the evaluation process but you do not need to do an evaluation to conduct assessment. Early Intervention Training Center MA Department of Public Health

What is Functional Assessment? Assessment of the young child’s skills in the real life contexts of family, culture and community rather than discrete isolated tasks irrelevant to daily life Functional or authentic assessment of a young child’s skills happens in the real life contexts of family, culture and community rather than in isolation. In this definition, ‘tasks’ is not necessarily referring to items on a standardized test, but in general… any discrete skills that a child may demonstrate, but without meaning or intent. Functional assessment is really showing how a child uses their skills in their day to day activities and routines, it shows us how the child is participating.   Functional assessment is done through gathering and compiling information about the child’s functioning from multiple sources, using multiple approaches to assessment, and observing across multiple settings in order to yield information that links assessment to services, programs and outcomes.

Why is Functional Fundamental? Translates concerns into priorities Guides identification of functional individualized outcomes Functional assessment practices translate family concerns, such as: “She can’t let others know what she wants.” “He doesn't’t sit at the table with us during meals.” into positive statements, such as: “I want her to be able to let others know what she wants.” “I want him to be able to sit with us during meals.” NOTE: these positive statements are probably the family priorities. They show how they would like their child to participate in different activities and routines. Ultimately, this guides the identification of functional individualized outcomes.

Who performs Functional Assessment? Families and familiar, knowledgeable caregivers in the child’s life Providers Teachers Others, less familiar, can also contribute Functional Assessment is conducted by a team of families and professionals from various disciplines. The team can observe and analyze a wide range of tasks/skills and provide a greater sampling of behaviors in real and natural contexts. Functional information enhances team observations and validates team findings. Of course, when we work in teams, communication between and among team members is needed to provide a coordinated process, minimize the intrusiveness of the process for the child, family, and others in the setting, and to ensure that a comprehensive process is completed.

When is Functional Assessment performed? Over time: “One-time observations even in the natural context, are insufficient and often misleading.” You’ve probably already noticed that observation is a theme throughout this section. Functional assessment involves: observation of the child in natural circumstances, and information shared about the observations of people familiar with the child.   When families share their observations, we develop a more complete and accurate picture of the child. It’s important to let families know that you value their observations and participation in ongoing authentic assessment. Giving families concrete examples of the kinds of information you would like them to share is helpful. Functional assessment is conducted over time and across settings. Bagnato, S.J., Neisworth, J.T., & Pretti-Frontczak, K. Linking Authentic Assessment and Early Childhood Intervention -Best Measures for Best Practices, Second Edition. Brookes Publishing, Baltimore, MD. 2010.

Involving Families Listen to the family story Observe and ask about the child’s day-to-day routines and activities related to engagement independence social relationships Ask parents to show or describe Observe how the parent engages the child Observe the child in play scenarios  Involving families in functional assessment is more than asking questions, going over questionnaires, or developmental profiles. To truly involve families providers must: Listen to the family story, Observe and ask about the child’s everyday routines and activities related to engagement, independence and social relationships, Ask parents to show or describe what happens in everyday routines and activities, Observe parent/caregiver/child interactions, and Observe the child playing.  

How: Gathering Relevant Information… Improve Functional Abilities Social Relations Engagement Independence Routines/Activities not going well Employ Strategies Hindering Factors Helping Factors Identify Learning Opportunities Enhance Learning Opportunities Employ Strategies As we think about what information we need to obtain from our functional assessment activities, we can use this chart as a guide. It illustrates how this information can be helpful. Let’s start on the left hand side of the chart.   If, through conversation with the family, the family shares that bath time is a great time of day for the child and family, the team may think about identifying and enhancing learning opportunities during that time of day. Let’s say that having the child use words to express wants and needs is a priority for the family. The team may be able to employ some intervention strategies during bath time that will ultimately increase the child’s functional abilities to use words throughout the day. Routines and activities that are going well provide a great opportunity to identify and enhance learning or PRACTICE opportunities to address family priorities. On the flip side, if the family shares information about routines and activities that are not going well, these may become priorities that families want to work on with early intervention. For example, if bath time was very difficult because the child fusses and has difficulty sitting in the tub, the team may identify the hindering and helping factors, and employ intervention strategies to ultimately improve bath time. This in turn promotes the child’s functional abilities in the areas of social relationships, engagement and independence. By understanding what is going well and what is challenging, the team can work within those natural routines to increase the child’s functional abilities. Through functional assessment, we have the opportunity to help identify activities and routines where children can practice skills AND identify routines and activities that are not going well for the child and family. Improve Routine Promote Social Relations Engagement Independence Routines/Activities going well Campbell, P. [n.d.] Intervention Decision-Making Chart. Thomas Jefferson University. Retrieved September 2012 from http://jeffline.tju.edu/cfsrp/pdfs/Intervention%20Decision%20Making%20Chart.pdf.

The BDI-2 and other conventional assessment tools Usefulness of Conventional Assessment Tools: To distinguish typical from atypical performance To provide one more source of information “Everything that can be measured counts, but not everything that counts can be measured.” The BDI is the tool we have to use in the evaluation process to determine a child’s eligibility but it can also be used as a piece of information to inform functional assessment. The Battelle can be used to gather information on a child’s baseline level of skills that will help us inform what are some of the barriers to engagement and participation. Example: Why can’t a child request a favorite food during dinner, or why can’t they play with their sibling during bath time. The BDI-2 and other conventional assessment tools have their place in early intervention. They help us to distinguish typical from atypical performance.    The BDI-2 allows us to see something very specific… how a child responds to specific materials and prompts. It allows us to see how known disabilities impact a child’s performance and can give us some information about the strengths and concerns areas for the child. It also allows us to compare a child’s development to their same aged peers giving us an overall understanding of next steps for the child. Clinics, pediatricians, and schools find evaluations results very helpful too. The BDI can also help to inform our clinical opinion about a child. We will use the BDI-2 results along with our functional assessment results to create high quality functional outcomes. We need all of this information to understand and support families in creating practice opportunities for their children in their activities and routines. Conventional assessment helps to identify skill areas that are concerning However, traditional standardized evaluations alone do not: provide the information needed to develop functional IFSPs that can be implemented within the day to day routines of the family/community/child care. determine what the child is able to do, likes to do, or needs to do in regard to the family’s/caregivers’ priorities. provide a clear understanding of the child’s abilities across environments and care providers – this is accomplished through observation and information sharing. Once concern areas are identified through the BDI-2 and additional information gathering, we are able to support families in determining their priorities related to their concerns. Concern: Kim doesn’t eat different foods Priority: We want Kim to eat dinner with us and try new foods NECTAC/ECO/WRRC 2012

Ending Discussion Do we have functional assessment built into our existing process and practices? Do you need to change our process or practice to help better conduct functional assessment? How can the BDI-2 inform further inform our functional assessment? Use these questions to get participants thinking about the importance of this information and how this information should inform their practice.

Functional Assessment: Part 2 Clinical Skills gives and overview of the clinical skills associated with this process and offers activities for practice Early Intervention Training Center MA Department of Public Health

Developing High-Quality, Functional IFSP Outcomes Portions of this training used materials created by the ECTA center and RRCP, 2 national technical assistance centers for a presentation called: Welcome to Developing High-Quality, Functional IFSP Outcomes. presented in collaboration with ECTA Center/WRRC 2014 14

Developers Anne Lucas Kathi Gillaspy Mary Peters ECTA Center / WRRC This presentation was adapted from presentations originally created by staff from the Early Childhood Technical Assistance Center (ECTA Center) and the Western Regional Resource Center (WRRC) and reviewed by staff from the South Eastern Regional Resource Center (SERRC), and the Department of Defense/ Army Early Intervention Services. With contributions from Naomi Younggren, Department of Defense/Army Early Intervention; Debbie Cate, ECTA Center; Megan Vinh, WRRC; Joicey Hurth, ECTA Center/NERRC; Christina Kasprzak, ECTA Center; and Grace Kelley, SERRC 15 15