How Screening and Assessment Practices Support Quality Disabilities Services in Head Start

The Head Start Performance Standards do not require that any particular strategy, instrument or technique be used. Appropriate procedures, however, should conform to sound early childhood practice and be valid, measuring what they are supposed to measure, and reliable, yielding consistent results over time and across users. Agencies should consult with the program's content area experts in health, child development, and mental health, with parents, and with the Health Services Advisory Committee as they design and implement a developmental screening approach.

Guidance related to 45 CFR 1304.20(b)(1-3)

Head Start works with families and community partners to enable the early detection of obstacles to children's development and then intervenes to reduce or eliminate these barriers. For many children, enrollment in Head Start provides the first indication that a disability or health condition may be affecting their development. To promote developmental and learning outcomes for all children, Head Start programs must plan and implement a sound, systematic approach for developmental screening and ongoing assessment. This screening and assessment system must include the careful selection and administration of instruments and procedures and the competent interpretation of results. The system must be understood and used by the program and parents as a means to support developmental and learning outcomes for all children.

The Performance Standards require that within 45 days of a child entering Head Start, appropriate screening procedures must be completed to identify any developmental, sensory (visual and auditory), and behavioral concerns. These procedures should be appropriate for the child's age, cultural background, and language and be conducted in collaboration with parents. The Performance Standards also require that, when appropriate, standardized developmental screening instruments exist, they should be used, and consultants to the program should be involved in helping programs select procedures. Sound screening instruments are designed to have the sensitivity to identify children who need further assessment and the specificity to exclude those who do not.

For some children the results of screening procedures, combined with information available from the ongoing assessment of progress required for every child (1304.21), may indicate the need for referral for a formal evaluation by a professional. As the Performance Standards (1308.6(b)) note, even standardized developmental screening is insufficient to determine disability. This screening merely identifies those children who require a referral. The formal evaluation, utilizing multiple sources of information from the family and program (including the ongoing developmental assessment of the child) will more fully assess the child's status, and determine what intervention may be needed. (e.g., special education or related services). A successful screening and assessment system requires appropriate instruments and procedures. When staff and parents are well-informed and supported to understand and act upon the information the system provides, it will positively affect child outcomes. When staff and parents commit time and energy to necessary procedures (e.g., docu-mentation of parent permission, timelines, scores, etc.), they expect the program to act upon the information in a timely and systematic manner to address identified needs and concerns. A process that responds to the child's needs can reinforce the parents' expectations that future screening and assessment will be a meaningful activity for them and their child.

The remainder of this article describes approaches to involving all the stakeholders in the screening and assessment system and ways of increasing their understanding and effective participation.

Engaging the Meaningful Participation of Staff and Parents

The planning and implementation of a screening and assessment system requires coordination and communication within the program as well as with community partners. The Disabilities Services Coordinator has the responsibility to provide leadership to the Head Start team and others so that their activities lead to effective parent involvement and developmental services for children with disabilities. (See below) But in addition to these activities, the involvement of the persons with the greatest day-to-day influence on the child's development–the parents and the teachers–is critical.

Some Important Activities for Disabilities Services

• Work with the program team to ensure that parents are informed of the screening's purpose, procedures and results, and kept informed throughout any formal evaluation that may be required.
  
  
• Arrange for a formal evaluation of children who have been identified as possibly having a disability. Make a referral to the Local Education Agency/Child Find/Part C Agency as soon as the need is evident.
  
  
• Assist Head Start parents and program staff to take an informed and active role in decision meetings required by the Individuals with Disabilities Education Act (IDEA).
  
  
• Coordinate with managers and staff implementing health services, ongoing developmental assessments, and family partnerships to assure that the full range of information available is used continuously to inform appropriate program planning for children with disabilities.
  

Guidelines for Screening and Assessment

1. Screening and assessment should be viewed as services–as part of the intervention process–and not only as a means of identification and measurement.

2. Processes, procedures, and instruments intended for screening and assessment should only be used for their specified purposes.

3. Multiple sources of information should be included in screening and assessment processes.

4. Developmental screening should take place on a periodic basis. It is inappropriate to screen young children only once during their early years. Similarly, provisions should be made for reevaluation or reassessment after services have been initiated.

5. Developmental screening should be viewed as only one path to more in-depth assessment. Failure to qualify for services based on a single source of screening information should not become a barrier to further evaluation for intervention services if other risk factors (e.g., environmental, medical, familial) are present.

6. Screening and assessment procedures should be reliable and valid (i.e., consistent in their ability to measure what they are intended to measure).

7. Family members should be an integral part of the screening and assessment process. Information provided by family members is critically important for determining whether or not to initiate more in-depth assessment and for designing appropriate intervention strategies. Parents should be given complete informed consent at all stages of the screening and assessment process.

8. During screening and assessment of developmental strengths and problems, the more relevant and familiar the tasks and setting are to the child and the child's family, the more likely it is that the results will be valid.

9. All tests, procedures, and processes intended for screening or assessment must be culturally sensitive.

10. Extensive and comprehensive training is needed by those who screen and assess very young children.

Meisels, S.J. & S. Provence. 1989. Screening and Assessment: Guidelines for Identifying Young Disabled and Developmentally Vulnerable Children and Their Families. Washington, DC: National Center for Clinical Infant Programs, p. 24.

Common Pitfalls in Screening

• Scheduling a screening when the problem is already observable. When trained staff report an obvious problem, a referral for a formal evaluation may be the appropriate first step.
  
  
• Ignoring screening results. Some times, initial screening test results are not taken seriously and a "wait and see" attitude is adopted. Good screening instruments are usually right, and there is risk of harm from delayed diagnosis and intervention.
  
  
• Relying on informal methods. Informal tools such as checklists often miss problems. Validated and standardized tools carry the burden of proof that informal measures lack. We would never select tools for blood lead or other medical screens with questionable or unknown levels of accuracy. Why do this with development?

Adapted from F.P.Glascoe and H.L. Shapiro, "Developmental and Behavioral Screening," 1999.

Communication

Head Start staff may have limited experience in discussing the results of screening and ongoing assessment with families. When the evidence suggests that there may be a developmental concern requiring more formal evaluation, some staff may be reluctant to present this information to parents. For some Head Start families, this may be the first time that a developmental concern has come to their attention, others may have had concerns but were reluctant to discuss them, and still others may have been trying to get information about their concerns for some time. Whatever the situation, the quality of the communication between staff and families will have an impact on a family's willingness to consider and act upon the screening and assessment findings. Training and supervision must support this important function.

Programs need a well-planned system for communicating the screening and assessment results to parents. When communication is not planned and purposeful, parents of young children with disabilities often relate a common story of suspecting a problem but being reassured that the child will "grow out of it." Parents are more likely to accept information when they believe that they have good communication with the person doing the screening. Head Start, in its ongoing parnerships with families, has an opportunity to communicate screening and assessment results to parents in a man ner that recognizes the child's strengths while systematically responding when a concern warrants it.

Staff members also need opportunities to explore and discuss with supervisors any reservations, questions, and concerns about making a referral.

There are hidden costs to discounting screening findings–missed opportunities for early intervention may complicate a problem. This issue is often present in screening for emotional and behavioral concerns that carry a stigma. If not addressed, the child's behavioral difficulties often produce rejection by peers. Managers and consultants need to solicit feedback from staff and parents on whether the screening and assessment are helping them support children's development. If staff perceive the procedure as having consequences (e.g., a stigmatizing "label") without resulting in useful guidance about how to address the behavioral concern, then they are less likely to endorse the system.

Throughout the year, programs should provide opportunities for feedback from staff and parents on the screening and assessment system. Inquire about what is useful, confusing, or perhaps being rejected. Provide feedback on what the system has accomplished. Acknowledge that any screening process will "detect" some concerns that, upon further evaluation, do not warrant intervention; it will also fail to detect some problems that do require intervention. No screening instrument is perfect but each is tested and retested to be better than unstructured observations and impressions. To the extent that families and staff see that the system takes into account their feedback, respects their knowledge of their children's development, and makes a difference for children, they will be more supportive of screening and assessment.

Use Information Continuously

Screening and assessment systems should contribute to the Head Start program's ongoing efforts to help children reach developmental and learning outcomes. When implemented well, a system provides specific and timely information to inform teachers and parents about each child's progress and can support the individualization needed to address developmental outcomes for each child. For children with disabilities, the results of formal assessments and the objectives from individualized plans for special education and instructional supports provide guidance that must inform their daily experiences.

Remember that while ongoing assessment is, by definition, expected to occur throughout the program year, screening is most often associated with the child's entry into the program. Given the rapid growth and changes which young children display, screening should occur on a periodic schedule consistent with the Early and Periodic Screening, Diagnosis and Treatment program (EPSDT) recommendations. For most children, the screening and assessment system offers reassurance that the child is on track for achieving the expected developmental outcomes. Furthermore, staff and parents should be provided direction and support to remain vigilant and responsive to any concern that emerges after the initial screening period. Sound procedures have decision rules on when to conduct a rescreening or additional assessment.

Empower Parents of Children with Disabilities

Parents of children with disabilities can benefit from Head Start experiences that help them practice communication, advocacy, and decision-making skills using screening and assessment results for their children. Parents of school age children with disabilities often describe their early experiences with assessment reports and individualized planning as confusing and intimidating. Head Start can empower families with expectations they will carry with them into their child's school career–that assessment procedures and results must be explained to generate informed decisions, that parent concerns must be addressed, and that resources, including other parents, must be identified to provide support and guidance.

Parents of children with disabilities will need orientation to key concepts from the Individuals with Disabilities Education Act (IDEA), such as parental consent, evaluations, confidentiality of records, eligibility for special education and related services, services in the least restrictive environment, and rights to due process. Opportunities in Head Start for parent education on their rights and on the school's obligations under IDEA will help them develop a sound foundation for their child's school experience. The Disability Services Coordinator should play an important role in supporting parents' goals in these areas.

Managing Child Records in the Screening and Assessment System

Key features include–

1. A record of the procedures used for screening and assessment
   
2. Evidence that the child's family provided information in the screening process
   
3. A report on the results of screening, including steps taken if further assessment was indicated (including obtaining written permission from the parents)
   
4. Evidence that screening and any follow-up assessments and actions were completed in a timely manner
   
5. Evidence that information is handled in accordance with the program's confidentiality requirements and is readily available for ongoing use by staff members who need to act on this information.
   

Ensuring Outcomes for All Children

As Head Start programs focus attention on how their practices contribute to developmental and learning outcomes, it is important to recognize that the 1998 reauthorization of the Individuals with Disabilities Education Act (IDEA) specified that children with disabilities should be included in state and local efforts to measure educational outcomes for children. Advocates for children with disabilities make a convincing argument that excluding children with disabilities from measures of child outcomes will reduce or deflect from a school's expectation, and accountability for ensuring, that all children make significant progress toward the desired outcomes.

Similarly, in Head Start, an approach that documents success only for those children without disabilities is not sufficient. All Head Start children, including those with disabilities, should receive ongoing assessment linked to Child Outcomes Framework, curriculum planning, and communication with parents. For most children with disabilities, the key to achieving positive outcomes will be the provision of needed supports. When the progress of children with disabilities is included in a program's self-assessment, the program can develop information on best practices that support the achievement of outcomes for children with a variety of strengths and needs.

Jim O'Brien is a Program Specialist in the Health and Disabilities Services Branch of the Head Start Bureau. T: (202) 205-8646, E: jobrien@acf.dhhs.gov.