Using Assessment to Help Us Work with Families

A Coordinator's Story

Providing ongoing support and technical assistance to home visitors in Early Head Start programs takes a lot of knowledge, insight, patience, and trust. As the Coordinator of Early Childhood Education (ECE) and Disability Services for Project Eagle/University of Kansas Medical Center in Kansas City, one of my primary job responsibilities is to provide our Family Support Advocates (FSAs) with technical assistance in the areas of child development, parent-child interactions, early education, and early intervention. In addition to helping them achieve certification in the Parents as Teachers curriculum and the Denver II screening instrument, I conduct four to six training sessions a year. I work with 11 staff members and am responsible for assessing their ongoing work with families and helping them build their skills.

One way I support the Family Service Advocates is to work closely with them on all aspects of their home visits with families. I start out by helping to identify major concerns, issues, and goals prior to a family visit. We set aside time to debrief after each visit. I am required to make two home visits with each FSA every six months. More frequently, I am invited on a home visit by an FSA and I end up making closer to 25 home visits per quarter. When we make a visit together, I look for evidence relevant to our earlier discussions and evaluate the strengths and areas needing improvement. If appropriate during the home visit, I may take advantage of a "teachable moment" and model an intervention strategy.

Our program has developed the Continuous Quality Improvement Checklist (see attached CQI) to help me assess interactions during the family visit. Sixteen items focus on the Advocate's behavior. Each one is marked as either: 'needs improvement'; 'adequate'; or 'highly successful'. This tool emphasizes instructive and positive feedback to families. When I am observing the Family Service Advocates, I model the same style of feedback to them. At the end of the form, there is space for additional comments or observations. After the home visit, the FSA and I meet to discuss the CQI checklist and my overall observations and interpretations. He, too, discusses what he thought was happening during the visit and how he felt about it. We brainstorm ways to improve the quality of the visits and consider his next steps. We both sign off at the end of the form.

This assessment process is a strengths-based approach. I look at the FSA's abilities and learning style. Together, we come up with an action plan to help refine skills, deepen understanding, and increase confidence. Looking across the program, the CQI checklists help us plan staff development for the team of Family Service Advocates.

How we assess Family Service Advocates is not much different from how we assess children and their families. Our goal is to identify their strengths and competencies and from there, address their needs.

A Family Service Advocate's Story

In Project Eagle Early Head Start, I work with 14 to15 families every week. My first responsibility is to develop a partnership with parents and help them address their family's needs. In turn, I need ongoing support from the Coordinator to do my job well. What follows is a "family story" about how I work with a parent and her children, and how the Coordinator and I work together to meet the individualized needs of this family (whose names have been changed).

At the time of enrollment, May was 22 years old and a single parent. Her son, Tae, was one year old and she was expecting her second child in a few months. May was experiencing a high-risk pregnancy due to medical complications. She was living in a rent-assisted housing project and receiving cash assistance and medical coverage through the Medical Assistance Program. May's original goals were to have a full-term baby, find child-care for Tae (she was confined to bedrest during her pregnancy), and once the baby was born, work on her employment goals. May, a high school graduate, wants to go on with vocational training. She is very motivated to improve her family's conditions, and she has a close network of family members.

Our home visits occur weekly at May's apartment. We also have two agency-sponsored parent-child socialization play-groups each month. I have observed May with her children and the children with their fathers. May has good parenting skills. She is able to describe her children's development, understands their temperament, and sets appropriate limits. She maintains an open relationship with the children's fathers so that they can be involved in family life. The family is very interested in the motor development of the baby, Journie. They want to help her learn to move, roll over, and hold her head up. We talk about all areas of development, but motor development continues to be the one they consider most important. I think there is an underlying concern about Journie's motor development because of her mother's undetermined seizure disorder. In my role, I have to be aware of parental worries and how they can affect parent-child interactions.

When Journie was just a few months old, I invited the Coordinator, Stephanie, to attend the child-parent socialization group to help me identify more home visiting strategies. I asked her to help me observe Tae's and Journie's overall development and specifically to focus on the baby's motor development. Stephanie evaluated me by observing the first seven items on the CQI form. We sat together after the playgroup and reviewed the interactions I had with the family and she gave me feedback on the items. Stephanie pointed out that I listened carefully to May while she discussed Journie's motor movements during the playgroup. She also noted that I talked to May about the next developmental stages she should expect to see now that Journie is rolling over. Stephanie made me aware that I had pointed out to May that she had read Journie's cues correctly when the baby wanted to be picked up. Based on her CQI observation, Stephanie praised me for all the positive feedback I gave May. One area that I needed to improve on was asking more open-ended questions to find out from May what kind of progress and accomplishments Journie had shown during the past week. I found this suggestion very helpful and a reminder of how to improve my future interactions with May.

Stephanie also recommended additional ways I could support the family during our weekly visits. She pointed out that children like to be in different positions. The parents might try having Journie bear some weight on her legs and supporting her in a sitting position. Also, she talked about dangling a toy and moving it to the side to really encourage Journie to explore and move in that direction. We talked about how these activities could be incorporated into the family's routines, maybe during bathing, mealtimes or diapering. Using the CQI observation form to guide our discussion is non-threatening and useful; the items are specific and Stephanie finds a number of behavioral examples to back up her comments.

In Project Eagle, we use the Parents as Teachers curriculum and supplemental resources to individualize lesson plans for each family. It is up to me to understand developmentally appropriate practice and adapt the curriculum if needed. The Coordinator has helped me look at child-initiated play and the routines of the family to work out a program that promotes a "goodness of fit" between the parents and the child. The parents, in this case, like activities where they interact in active, hands-on ways. Though May likes to do things, her baby is more passive. We have tried to show how important it is to let Journie struggle just a little to build new skills. Journie's parents read her cues well and do not let her struggle too long.

It is also imperative that the Coordinator looks at the Advocate/parent "goodness of fit" when developing an appropriate plan for the family. Stephanie has encouraged me to let May's family "struggle" with new skills and give them time to explore new ideas. She has helped me to look for the family's cues indicating they have reached their limit and, in response, reduce or change activities. During one visit, she showed me how to address a family's concern by listening, offering suggestions, and providing immediate feedback. She has also shown me that flexibility during a visit is sometimes more important than following a specific plan.

The Coordinator is invaluable for helping me rethink the situation and think "outside the box." This process of learning results in changes in my ways of interacting during home visits and sharing information with the family. As I work closely with the Coordinator, my skills are enhanced so that I am able to provide family-centered, culturally sensitive, and individualized lessons for the child and family. When assessment is not a scary experience, but an opportunity for me to grow and learn, I benefit–and so do the families.

ECE Home Visit–Continuous Quality Improvement Checklist

Date: ________________ Advocate: _________________________

________ Advocate is able to listen carefully to parents/primary caregivers (PCG) needs in the area of child development and parent-child relationships.

________ Advocate asks "open-ended" questions that are helpful in gaining more information about the parent-child relationship or about the child's development.

________ Advocate uses "instructive feedback" (i.e., Advocate responds to something specific that she/he observes while the parent-child are interacting) which points out why the parent/PCG's behavior is important to their child's development.

________ Advocate uses "positive feedback" (i.e., positive, specific & contingent on the parent's/PCG's appropriate nurturing behavior with their child during the home visit) with the parent/PCG.

________ Advocate demonstrates knowledge of child development and is able to review and discuss developmental domains with parents/PCG's.

________ Advocate is able to observe parent-child interactions, read infant/toddler and parent/s or PCG's cues.

________ Advocate is able to guide, coach and model appropriate intervention strategies that support the parent/PCG's interactions with their child and may be integrated into their daily routines.

________ Advocate is able to administer a screening and an assessment in a developmentally and culturally appropriate manner.

________ Advocate is able to review the ECE Recommended Practices/Outcomes with the parent/s or PCG and write individualized family and child action plans with them.

________ Advocate describes which PAT lesson plan is being used and why with the parent/s or PCG.

________ Advocate clearly states the objectives of the activity/lesson.

________ Advocate presents the individualized lesson plan in a clear, concise and friendly manner.

________ Advocate asks the parent or PCG how the "follow-up" activity worked for them.

________ Advocate explains and reviews the focus of the next PAT lesson with the parent/s or PCG.

________ Advocate provides parent/PCG with options for a "follow-up" activity.

________ Advocate encourages parent/s or PCG to assess their child's developmental progress and to complete the observation and comment sections of the lesson plan.

Further comments/observations:

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–Needs Improvement       Adequate      + Highly Successful

COORDINATOR of ECE ________________

ADVOCATE_______________