Family-Centered Assessment

Our Early Head Start program at Early Education Services (EES) in Windham County, Vermont, serves 107 infants and toddlers. We work hard to ensure the participation of families in the assessment of their children. From the outset of our program, several beliefs have guided and informed our assessment process, including–

• Parents know more than anyone else about their children and can provide meaningful and reliable information. Families' observations, ideas, and concerns must be central to planning and performing assessments and screenings.
  
  
• Parents benefit from taking part in evaluations of their children. During the screenings or assessments, when parents focus on their child and get support and information, they increase their understanding of their child's development, strengths, and needs.
  
  
• Parents should choose how they will participate in the assessment process. The more actively involved they are, the better experience it will be for them, their child, and the home visitor.
  
  
• Including families in the process, in ways that they want to participate, sends the message that they are an important part of the assessment and more importantly, of their child's life. If we exclude parents from the process, we risk not only losing important information about the child, but parents may not fully engage in goal setting, planning, or the program itself–resulting in fewer benefits for the child and the family.

Keeping these ideas in mind, we do everything we can to include parents and to make screening and assessment interesting, fun, and worthwhile.

Parents: Partners in Assessment

When a child is enrolled in the program, the home visitor's first task is to get to know the family and the child. The goal is to establish a mutually trusting and respectful relationship, which is valuable because it enables parents and home visitors to work together to support the child's development and the parent-child relationship. When parents are active partners in the assessment (and intervention) process, home visitors and families share an understanding or belief in what is best for the child, the parents' priorities are acknowledged, and parents and professionals work toward shared goals.

In our program, observation and conversation are at the heart of assessment. We provide ongoing training and supervision to our home visitors in observing and recording infant and toddler behavior. We also use training materials and an observation guide that focus on coaching parent-child interactions. Home visitors become skilled at observing the subtle aspects of interaction that indicate the quality of the parent-child relationship and the ways parents and their young children communicate.

At the beginning of a home visit, the professional might ask a question like: "What kinds of things has Janie been doing since my last visit?" Noticing that 16-month-old Steven reaches for his bottle on the table and repeats "ba-ba", the home visitor may say, "What are some of the ways he lets you know what he wants?" His mother might begin to describe his emerging language and how talkative he is. These questions are open-ended, non-threatening and give parents a chance to say what they want. There is no right or wrong; the parent is the expert. The home visitor is an active listener and is skilled at engaging parents in an easy conversation about their child.

When home visitors describe their observations of the child's development, parents are delighted. It shows that the professional knows the child and appreciates his or her growth. These observations also validate the parents' competence as parents and their important role in their child's development. "I watched how Rosa turns her head when she hears your voice in the other room. She wants to know where you are!" Such an observation can also be an opportunity for the home visitor to talk about the social and emotional development of infants. In this way, parenting education is a natural outcome of ongoing assessment.

When parents and Early Head Start staff share their thoughts and observations of the child, it leads to planning and thinking about what goals to set and which activities will enhance the child's development. In one family, the toddler was taking great joy in his mobility–he was on the move all the time. When the home visitor saw how much the child wanted to practice his newfound skills, she and the family discussed how to encourage him, even though it was the middle of a very cold winter in Vermont when outdoor activity was limited. She suggested several indoor places in the community where he could walk and run. As trust between the families and the home visitors builds, the sharing of information and observations increases between them.

Using the ASQ Questionnaire

To supplement ongoing assessment based on observing the child and talking with the family, EES uses the Ages and Stages Questionnaire (ASQ), which is designed for child monitoring. The items represent milestones in five key developmental areas: communication, gross motor, fine motor, problem solving, and personal-social. There are six items in each category and they are checked as either: yes, sometimes, not yet. Sample items at eight months include–

• Does your baby make sounds like "da," "ga", "ka," and "ba?" (communication);
  
  
• Does your baby pick up small toys with only one hand? (fine motor);
  
  
• Does your baby feed himself a cracker or cookie? (personal-social).
  

At the end of the form, there are a few Yes/No questions appropriate for the child's age. For example, the ASQ used at eight months asks these final questions:

• Do you think your child hears well?
  
  
• Uses both hands equally well?
  
  
• When you help your baby stand, are her feet flat on the surface most of the time?

Parents are asked to explain any "no" answers. These last items can be used for screening purposes to indicate areas of concern.

Starting when the infant is 4 months old, the ASQ is used at designated intervals. We chose Ages and Stages because it is simple to use and has proven to be reliable and valid. The items are easy to understand and illustrated. The manual offers guidelines for determining whether children are at high or low risk in the various developmental areas. Concerns identified when completing the questionnaire are usually not a surprise to parents and home visitors, but most likely are questions and observations they have had on their minds.

Administering the ASQ is relatively simple and straightforward. Although it was designed for parents to use on their own, home visitors and families do it together. It does not take long to complete–maybe one half hour–but the most important part is that it is an opportunity to observe and talk together. Whenever possible, natur-al observations are used as the basis for filling out the ASQ. If one of the items pertains to the child's using the pincer grasp (thumb and forefinger), the child might be observed eating Cheerios during lunch, picking up one at a time. Sometimes our home visitors suggest ways to elicit the child's behavior, like inviting a parent to clap her hands and watch how the baby imitates.

Data from the ASQ are discussed at a meeting between the supervisor and the home visitor. At this time, the child's accomplishments and any areas of concern are highlighted and next steps can be planned. EHS has a large resource library with many curriculum books that staff can use to plan developmentally appropriate experiences for individual children.

Information from the ASQ is sometimes shared at the agency's case management meeting–referred to as "Family Update in a Nutshell," or F.U.N. At this meeting, held quarterly for each family, the group of EHS professionals discusses the family. The home visitor briefly updates the group and discusses relevant issues about the child and family. If necessary, interventions are planned or a referral is made.

Scales like the ASQ provide useful information about a child's skills, yet they can also cause undue anxiety for some parents when a child has not yet reached a milestone. Our home visitors understand child development and can reassure families that children develop at different rates. They also provide insight into the growth of the individual child by explaining that sometimes a spurt in one area of development means a plateau or even backsliding in another. A home visitor might explain: "The reason Kayla is not talking much is that most of her energy is going into learning to walk. When she masters that new skill, her verbal development will probably take off."

Using the Ounce Scale

To better link assessment, planning, and intervention, EES is piloting a new infant and toddler assessment measure, The Ounce of Prevention Scale, still in draft form. It not only provides information about what the child is doing but also helps parents and providers understand how children use those skills and abilities, and how the environment and parent-child relationship can support children. It focuses on everyday, naturally occurring, practical behaviors and accomplishments that are easily recognized by parents and others. The child's developing social competency and adaptive capacity are highlighted in the Ounce materials.

The Ounce incorporates multiple strategies of assessment, including an observational record and accompanying guidelines with questions and examples of children's behavior at different ages. A family album enables family members to become actively involved in making observations about the child's development and offers suggestions about ways to enhance the child's development and strengthen their relationship. Finally, a summary record assesses the child's mastery across different areas of functioning.

We may find that the Ounce Scale complements the ASQ and use both of them. It is too soon to tell. We know that any assessment in our program must involve parents and strengthen their understanding and appreciation of their children's unique characteristics and progress over time. Assessment must also help home visitors understand and adapt to the strengths of each family and respond to their priorities and concerns. When families and professionals are partners in assessment, everyone benefits.

Leah Bratton is the Early Childhood Coordinator for the home visiting program of Early Education Services. T: 802-254-3742; E: lbratton@sover.net

I would like to thank Mary Moran, Director of EES, and Dot Marsden, co-developer of the Ounce Scale, for their help with this article.