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

2. Learning objectives
Understand what functional assessment is and how we go about gathering information.
Understand the clinical skills needed to conduct high quality functional assessment activities when working with families.
The learning objectives for this mini lesson are as follows…
Early Intervention Training Center
MA Department of Public Health

3. 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

4. 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

5. 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.

6. 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.

7. 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.

8. 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

9. 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.

10. 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

11. 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

12. Clinical Skills for effective functional assessment How do I do it?
Now that we know what functional assessment is… let’s take a closer look at HOW to do it.
Early Intervention Training Center
MA Department of Public Health

13. Clinical Observation An act of instance of noticing or perceiving
An act or instance of regarding attentively or watching
General Information: One of the most powerful skills you will need to use in Early Intervention is your ability to observe a child and in the context of his family and other ‘natural environments’
Observation is defined as: An act or instance of noticing or perceiving An act or instance of regarding attentively or watching.
Observations are what you see and hear while you are with the child and family and do not include your opinions or perceptions.
*Question to group: when do you make observations in your practice.
As people shout out answers encourage them through their answers to think about the difference between “watching” kids and clinically observing. You may hear participants say “we do this all the time, in all we do, at every home visit”. Challenge them to think about doing this as a separate activity. They are always multitasking but to really clinically observe you need to step back and really intently watch without other distractions, priorities, or things to do i.e. paperwork, evaluation, intake…
Early Intervention Training Center
MA Department of Public Health

14. Interviewing Traditional Ethnographic
I know what I want to find out, so I’m setting the agenda for this interview
I don’t know much about the parents point of view, so I need to encourage them to set the agenda OR I don’t know what the parents want for their child
Let’s focus on interviewing skills.
There are different types of interviewing for different purposes.
In traditional interviewing, the interviewer sets the agenda and seeks out specific information.
In an ethnographic interview there is a more open ended quality, the interviewer is looking to learn about the parent’s perspective. Throughout the IFSP process, we need to engage in both types of interviewing.
Think about your current practice and processes…. What are different reasons or points in time that you would or already use each of these types of interviewing?
[Allow for shout out responses or facilitate discussion about current process]
Interviewing can be both formal (part of an intake or other meeting) and informal (home visits and phone calls, etc). It is a way to gather information from family members and caregivers. These skills should be used throughout the IFSP process, not only during formal interviewing times.

15. Interviewing Use open-ended questions
Ask for use instead of meaning (examples)
Avoid multiple questions at once
Avoid leading questions
Avoid why questions
Restate using exact words of interviewee
Summarize statements and allow for corrections
General Question-Asking Principles
The ways that questions are asked can either facilitate or disrupt the development of rapport and an effective interview. The following are general principles to consider when asking questions:
Use open-ended questions rather than dichotomous questions that trigger a yes or no response. 
[For example-if needed], asking Jay, “In what ways does Marco’s crying frustrate you?” may elicit more information than the question, “Does Marco’s crying frustrate you?”]
Ask for use instead of meaning. Ask for examples of what the parent is reporting. If the interviewer asks for meaning, clients may provide information that may or may not be useful or specific.
[For example-if needed] asking Sarah, “What do you mean that Jonny hits?” may result in her simply saying, “Sometimes he hits other kids.” This response does not provide the clinician with information about the nature of Sarah’s concern for Jonny’s hitting. In contrast, the request, “Give me an example of when Jonny hits,” may elicit specific information regarding the situations in which Jonny hits other kids—information that may be important in formulating intervention strategies.
Avoid multiple questions. Ask one question at a time.
[For example-if needed] if the clinician asks, “Sarah, you mentioned you forget things. What things do you forget, in what situations do you forget them, and what do you do to remember things better?” Sarah may become overwhelmed and not know where to begin. Asking singular questions, “Sarah you mentioned you forget things. Can you give me some examples of techniques you use to try to remember things?” allows Sarah to focus on the specific information asked.
Avoid leading questions that tend to orient the person to respond in a particular direction. Leading questions can often be yes/no questions, although they do not always have to be. Example: Dora commented, “We’ve had some problems with Paul’s teacher.” A question such as, “What do you dislike about Paul’s teacher?” would be a leading question because Dora has not said she dislikes Paul’s teacher, only that she has had some problems with her. A more appropriate response to Dora’s statement might be “Tell me about your experiences with Paul’s teacher.”
Do participants have any examples?
Avoid using why questions because such questions tend to sound judgmental and assume that the person knows why. 
[For example-if needed] Instead of asking Jay, “Why have you refused to wear hearing aids?” the audiologist asked, “What are your reasons for not wearing hearing aids?” In response, Jay described how, as a child, he always felt different. He believed that wearing hearing aids would be another way he would be seen as different.
Restate what the parent says by repeating the parent’s exact words; do not paraphrase or interpret. Restating what is said by the parent lets the person know that you are listening and ensures that you are not interpreting the client’s or parent’s statements from your own perspective.
[For example-if needed] If Dora says, “None of my family helps me with Paul,” you might be tempted to say something such as, “That must really be hard” or “That must make you feel angry.” These are your interpretations, not Dora’s, and Dora is likely to respond with a simple yes or no. By restating what Dora has said, “Your family doesn’t help you with Paul,” Dora is likely to explain, “They want to help, but they are afraid they will do the wrong thing and make matters worse.” This provides you with information you can use in planning intervention.
Summarize the parent’s statements and give them the opportunity to correct you if you have misinterpreted something they have said. It is beneficial to summarize not only at the end of an interview, but also at points within the interview where a change of topic occurs.
[For example-in needed] when you have completed a topic you may want to say, “Before we talk about Kai at daycare, I want to make sure I understand what you told me about being frustrated at home. You mentioned that you feel frustrated because Kai will hit the baby and you can’t predict when it will happen and you feel like you can’t put the baby down.”
As with observation, we have to be aware of what influences our interviewing skills. What prevents us from asking a question to a particular person, or what influences how we hear the response? Are there situations that we make assumptions about the answers?
Asking the Right Questions in the Right WaysStrategies for Ethnographic Interviewing Carol Westby; Angela Burda; Zarin Mehta. The ASHA Leader, April 2003, Vol. 8, 4-17. 

16. Active Listening
Along with being able to ask questions or interview, we also must be ready to receive information from the parents and caregivers. Interviewing and active listening go hand and hand.
Active listening enhances your ability to absorb and pass on the information given during the exchange. By developing your skills and techniques to actively listen your communications will offer your listeners greater clarity and empathy.
When practicing active listening make sure that you are paying attention, showing that you are listening, providing feedback, without judging, and responding appropriately. Sometimes families give us a lot of information. We need to make sure we are listening and using that information to help the child achieve developmental progress.
Make sure you HEAR what the parent is saying: This includes paying attention to the speaker’s non-verbal cues such as body language, facial expressions, tone, and rate of speech. Only listening to the words, you miss 65% of the message.
EMPATHIZE with the speaker: Acknowledgement can be something as simple as a nod of the head or a simple “uh huh.” You aren’t necessarily agreeing with the person, you are simply indicating that you are listening. Consider your body language and other signs and if they show the parent that you are listening.
ANALYZE the speaker’s words and thoughts: Consider what your observations and what you are hearing and determine if you need more information. Analysis may also require you to ask more questions and to repeat the speaker’s words or use other interviewing skills.
RESPOND to the person who is speaking and think about what your own ‘listening’ habits are… the body movements and behaviors you use when listening and how other’s may perceive you.
Active listening and interviewing go hand in hand and it is important to be actively and intentionally using these skills during all conversations with parents.
Early Intervention Training Center
MA Department of Public Health

17. Informed Clinical Opinion
Decision making that utilizes the individual and collective knowledge of the IFSP team through information gathering.
Now that we have gathered information through observing, interviewing, and active listening, what do we do with it?
We must use our individual and collective informed clinical opinion to become informed about a child’s developmental status within their social context or answer the question ‘what are the child’s abilities and needs within his/her natural environment?’

18. Informed Clinical Opinion
Individual knowledge
Collective/Team knowledge
IFSP development
Awareness of our own beliefs and perspectives.
Impact of implicit or unconscious bias
Individual EI specialists must have knowledge of the multiple domains of development for infants and toddlers, an understanding of the expected sequence of development, and be aware of possible variations that may be seen in developing children to apply to the functional assessment and evaluation information that has been gathered.
Then the IFSP team, which includes the family, must together integrate all of the information that has been gathered to look at the functional impact and implications of any developmental delays on activities and routines in order to determine the best IFSP outcomes and strategies for the child and family.
It is important to remember that informed clinical opinion is based on knowledge and facts and we have to be cautious about applying our own beliefs, opinions, or assumptions. Our functional assessment process should provide us with the information that is needed to move through the IFSP process, but if there are questions or uncertainties, it is important to continue the process and use our clinical skills to learn more from the child and family.
Our own beliefs and perspectives are both conscious and unconscious.

19. What influences your clinical skills
What influences your clinical skills? Observation Interviewing Active Listening Informed Clinical Opinion
Functional assessment, when done properly, is culturally sensitive because it is gathering information about the child and family from the family's point of view. We all have to consider what factors influence our clinical skills, our ability to remain objective or unbiased. Sometimes we are aware of these factors and sometimes we are not.
Implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control (Blair, 2002;. Rudman, 2004a)
Think about the parent that you are hesitant to discuss the family risk factors with… or the family that lives in the neighborhood that makes your nervous, or even the child with the behaviors that makes you dread going to the home visit…
Some of these are conscious biases, but others are reactions based on your implicit or unconscious bias.
*Ask participants for personal example*
Early Intervention Training Center
MA Department of Public Health

20. 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 are we using these clinical skills? Do we need additional support to better understand utilize these skills?
Use these questions to get participants thinking about the importance of this information and how this information should inform their practice.

21. 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 21

22. 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 22 22