DARS-ECI: Making It Work - Evaluation & Assessment
Section 3. Evaluation, Assessment, BDI-2
Instructions:
For this section, you will need to get the handouts from your
supervisor. Your supervisor will provide you with these handouts,
which will be referenced throughout the section. He/she will also work
with you to complete the activities accompanying these handouts:
 ECI Needs Assessment, ID and Referral Checklist
 Electronic Eligibility Statement with Calculator
 Handout 3.2: BDI-2 Cover Sheet
 Handout 3.4: Basal and Ceiling
 Handout 3.5: Tallying the Score
 Handout 3.6a: Eligibility Statement, Andre
 Handout 3.6b: Raw Scores-Andre
 Handout 3.7: Percent Delay Conversion
 Handout 3.8: Eligibility Statement, Elizabeth
 Handout 3.9: Eligibility Statement, Riley
 Handout 3.10: Risk Factors Checklist
3.1 Next phase of pre-enrollment
Notes:
Let's move on to the next phase of pre-enrollment -- evaluation and
assessment.
In ECI, we talk a lot about evaluation and assessment. Many
professions use the terms interchangeably, but in ECI, they serve
different purposes. Let’s take a closer look ...
3.2 Evaluation
Notes:
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MIW SC:
Evaluation is the process of reviewing all of the relevant information
about a child to determine if she is eligible for ECI services. In ECI,
the term “evaluation” can be used synonymously with “eligibility
determination."
There are three ways to complete evaluation and they correspond to
the three ways children are eligible for ECI services:
 For children with a qualifying medical condition, evaluation does
not require administration of a test, but includes a review of
documentation and discussion of medical records, and a
determination that the child needs ECI services.
 To determine if a child is eligible due to a developmental delay,
the team must complete the Battelle Developmental Inventory,
or BDI-2, including the application of informed clinical opinion.
 For children who have identified hearing or vision loss,
evaluation includes a review of the documentation that meets
the criteria established by the Texas Education Agency.
Eligibility must be re-determined at least annually for every child in
ECI.
3.3 Assessment
Notes:
MIW SC:
Assessment is about identifying a child's unique strengths and needs.
There are three types of assessment in ECI:
 Initial assessment is conducted to identify child and family
needs during the enrollment process. The initial assessment
includes review of evaluation information and medical
documentation to help determine child needs. An interview with
the family, conducted as part of the initial and annual evaluation
of the IFSP, is also conducted to identify the child’s functional
abilities, and needs, as well as the needs, concerns, and
priorities of the family.
 The second type of assessment is ongoing throughout a child’s
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enrollment in ECI. Ongoing, informal assessment should occur
in every ECI service delivery session, because we need to
constantly assess and adjust strategies, activities and
intervention methods based on the status of the child and family.
 The third type of assessment, called re-assessment, is specific
to ECI. It is planned on the IFSP and is an assessment in which
a team member documents information about a child's progress
on the IFSP outcomes, and helps the team decide whether any
changes to the IFSP are needed. Re-assessment is covered in
more detail in the IFSP and service delivery sections of this
module.
3.4 Comprehensive Evaluation
Notes:
MIW SC:
If the child does not have a qualifying medical diagnosis or a
documented auditory or visual impairment, the interdisciplinary team
must conduct a comprehensive evaluation using the BDI-2 to
determine developmental delay. In a comprehensive evaluation, the
child’s level of functioning in all developmental domains-cognitive,
communication, personal-social, motor, and adaptive-is tested.
A parent may be concerned about only one area of their child’s
development, or even one skill. For example, they may be worried
their child is not walking yet. In these cases, the temptation is to
evaluate only in the area of concern, but the ECI team must complete
a comprehensive evaluation.
There are several reasons to complete a comprehensive evaluation.
Evaluation limited to the area of concern can result in a deficit-based
intervention. We need to evaluate the entire child, so that we can use
the developmental strengths of the child to address the areas of delay.
We also know that developmental areas in young children are
interconnected. Parents may be focused on the fact that their twoyear-old is not saying words. Comprehensive evaluation is needed to
determine whether there is an underlying delay in cognition affecting
communication, or whether development in other areas, perhaps
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personal-social, is being impacted by the communication delay.
Parents may be so focused on a specific area of their child’s
development that they don’t recognize needs in another domain.
Some parents may not know enough about typical child development
to realize their child has delays other than those they have identified.
A comprehensive evaluation allows parents and the rest of the team
to learn about potential delays in other areas.
So far in this section, Elizabeth is eligible for services because of her
medical diagnosis of Down Syndrome, so an initial comprehensive
evaluation is not needed. Riley and Andre do not automatically qualify,
so comprehensive evaluations are needed.
BDI-2
3.5 Need for BDI-2
Notes:
MIW SC:
We will need to conduct a comprehensive evaluation for both Andre
and Riley. We need to administer the BDI-2 for Andre and Riley.
Take some time now to learn more about the BDI-2. I'll check back
with you in a bit ... In the meantime, your coach will be available if you
have questions.
3.6 Intro to BDI-2
Notes:
MIW Coach:
You've probably got some questions about how the BDI works.
Here’s an overview:
Is it reliable? The BDI-2 is a standardized test. This means there
are consistent, standard methods for administering the test
established when the test was developed. To administer the test
correctly, the team must follow the standardized test procedures
described in the test manuals. Texas ECI uses a standardized
instrument to help ensure eligibility determination is as consistent as
possible across the state.
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How is it organized? The BDI-2 is a developmentally sequenced
tool. It is generally accepted that child development occurs in a
particular sequence which means that the attainment of one skill
typically depends on the acquisition and mastery of preceding skills.
The test items in the BDI-2 are presented in the general order a child
develops skills in each developmental domain.
What does it evaluate? The BDI-2 is a comprehensive instrument
that evaluates a child’s development in multiple developmental
domains. IDEA Part C requires that every child receive a
comprehensive evaluation including the areas of personal-social,
adaptive, motor, communication and cognitive development. The
BDI-2 covers all of these required developmental areas. Each of the
five domains in the BDI-2 is divided into two or three sub-domains.
How is it scored? The test scoring allows the team to identify skills
that are emerging, and gives partial credit for those skills. The scores
are either a 2,1 or 0.
3.7 Activity: Principle 7: BDI-2 and the 7 Key Principles.
Notes:
Using the BDI-2 to determine eligibility is related to principal #7,
which states, “Interventions with young children and family members
must be based on explicit principles, validated practices, best
available research and relevant laws and regulations.” The BDI-2 has
been tested for reliability and validity, and we strive to apply the
criteria for eligibility consistently across families.
Select if you think each of the following four questions looks like or
doesn’t look like Principle 7.
Quiz (4 questions):
Question 1: Administering the BDI-2 without following the
standardized procedures
A. Looks like Principle 7
B. Doesn’t look like Principle 7
The answer is B; this doesn’t look like that principle.
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Question 2: Determining eligibility based only on the BDI-2 scores or
a diagnosis.
A. Looks like Principle 7
B. Doesn’t look like Principle 7
The answer is B; this doesn’t look like Principle 7.
Question 3: Using the BDI-2 Examiner’s Manual and Domain Books
with every child, which ensures that the tool is administered correctly.
A. Looks like Principle 7
B. Doesn’t look like Principle 7
The answer is A; this does look like Principle 7.
Question 4: Considering culture, language, and functional abilities
when interpreting the BDI-2 score or qualifying a child with a medical
diagnosis.
A. Looks like Principle 7
B. Doesn’t look like Principle 7
The answer is A; this does look like Principle 7.
3.8 Will you administer BDI-2?
Notes:
MIW Coach:
Will you be part of a team that administers the BDI-2 as part of your
job with ECI? Unless you are an Early Intervention Specialist or a
Licensed Practitioner of the Healing Arts, you will only need to know
the basics of the BDI-2. We will go through the BDI-2 in depth. If you
don’t administer the BDI-2, you can skip to section 3.33.
For Staff Who Administer the BDI-2
3.9 Other training is needed for the BDI-2
Notes:
Through this next portion of the module, we will take a closer look at
the BDI-2 and how this tool is used in determining eligibility. Please
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note: this training module is not meant to be a comprehensive training
covering all components of BDI-2 test administration. You will need
to access the more in-depth training provided by DARS-ECI, such as
the archived webinars: Eligibility and BDI-2 (parts 1 & 2), as well as
BDI and Eligibility: Mythbusters Edition. You can also ask your
supervisor for trainings available to you at your local program.
Here are links for the webinars:
Eligibility and the BDI-2, part 1:
https://www1.gotomeeting.com/register/639797856
Part 2: https://www1.gotomeeting.com/register/176360857
BDI and Eligibility: Mythbusters edition:
https://www1.gotomeeting.com/register/635681832
3.10 BDI-2 materials
Notes:
Ready to take a closer look at the BDI-2?
The materials include an Examiner’s manual, a test kit of toys and
other manipulatives, and five domain booklets. Some ECI programs
use paper scoring booklets while others use an electronic version. It
is available in both English and Spanish, but note that the BDI-2 was
standardized using only the English version. Refer to the BDI-2
Examiner’s Manual for information on evaluating children whose first
language is not English.
3.11 The BDI-2 test booklet
Notes:
MIW Coach:
Let's discuss the key sections of the BDI-2 paper test booklet. It
contains 31 pages, and there is a cover sheet. The other pages list
the skills tested in each domain, in developmentally sequenced order.
Because the BDI-2 is copyrighted, you must get the booklet from your
supervisor.
Get a copy or the link to Handout 3.2, BDI-2 Cover Sheet, from your
supervisor.
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Here’s an overview of the components of the cover page
1. In the top right portion of the cover sheet, the team records
identifying information about the child.
2. Underneath that section, also in the upper right, you determine the
chronological age of the child.
3. In the center column, you enter the raw scores from each of the
sub-domains of the BDI-2. It is important to follow the instructions for
administering the BDI-2 exactly. A score of either 0,1,or 2 is
determined for each item, based on the scoring criteria in the domain
booklets.
4. Age equivalent scores are determined using the BDI-2 Examiner’s
Manual and entered in to this center column to the left of the
subdomain scores.
5. The bottom left part of the form can be used to calculate and
interpret other related scores.
We will discuss this form at length from 3.12-3.17.
There is also an electronic version of the BDI-2, that is the preferred
method to calculate the scores.
3.12 Paper cover sheet of the BDI-2
Notes:
The top of the BDI-2 gathers basic demographic information such as
name, sex, examiner, school/program, teacher, classroom, grade, etc.
3.13 Calculating the child's age
Notes:
MIW Coach:
The BDI-2 has specific requirements for calculating the child's age.
On the cover sheet of the test booklet there is a space to enter the
year, month, and date of the child’s birth. This is subtracted from the
year, month and date of testing, to result in a chronological age
expressed as year/month /day. The age must be expressed as
months. To convert the age to months, the days are dropped
(ignored), so a child who is 23 months and 29 days of age is 23
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months for test purposes. After you are finished testing the child, you
will take prematurity into consideration. You will learn more about this
in the next section.
Use this formula: Number of years times 12, plus number of months,
subtract extra days = months of age
3.14 Activity: Calculating chronological age
Emilio’s DOB (Date of birth) is 1/17/2012.
His date of testing is 6/8/2014.
Calculate his chronological age in months based on the information
you just learned.
Correct answer: 28 months. Did you remember to convert the age to
months? Did you remember to drop the days?
3.15 Domain Booklets
Notes:
MIW Coach:
The BDI-2 domain booklets contain important information for test
administration, and must be used every time you test a child. There
are five developmental domains in which the child is tested:
Personal/Social, Communication, Cognitive, Motor and Self-Care.
The books describe the materials to be used for each test item, and
how the materials are to be presented. They also often include
specific language to use when speaking to the child or parent.
In the electronic version of the BDI-2, the tester sees on the computer
screen all of the information contained in the domain booklets.
3.16 Finding the Age Equivalent Score
Notes:
MIW Coach:
The BDI-2 results provide a raw score for every sub-domain which
must be converted to an age equivalent score. You will use the
Supplemental Raw Score To Age Equivalent Tables found in the BDI-
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2 Examiner’s Manual (appendix A) to find age equivalents (or AEs)
for each sub-domain.
You will use the age equivalent to calculate the percent of delay. The
instructions for the ECI Eligibility Statement Form contain detailed
guidance for this step. Many programs use the Electronic Eligibility
Statement Form which includes an automatic calculator for
determining percent of delay.
3.17 Other calculations
Notes:
The BDI-2 scores can also be used to calculate Scaled Scores, a
Developmental Quotient Profile, and a Sub-domain Profile of Scaled
Scores. The profile can be useful when interpreting scores, since it
supplies a visual summary of how the child compares to other
children his age, and how his scores in all of the sub-domains relate
to each other. These additional calculations are not required by ECI,
but if your program uses an electronic version of the BDI-2 the
calculations are automatic.
3.18 Electronic BDI-2
Notes:
MIW Coach:
The electronic version of the BDI-2 has a section to enter identifying
information about the child. The child’s chronological age is
automatically calculated. Information from here will be transferred to
the BDI-2 Data Manager where you can print the Score summary
report and chart.
In the electronic version, when you select the scores for each test
item, the program automatically calculates the raw scores and age
equivalents.
3.19 Start Points
Notes:
The BDI-2 groups test items by age. The first item in each grouping
is the start point for testing a child of that age. A start point is not an
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age equivalent. Use the child's chronological age, not adjusted age,
to determine the start point. For example, in the Self-Care subdomain, the start point for children from 12 through 23 months is Item
8. So for a 20-month-old child, you will usually begin testing at item 8.
If you suspect a child has significant delays, you might choose to
begin at a lower start point, but you must never begin at a start point
above a child's age.
Check your knowledge: The test item GM 20 is "Creeps or crawls up
4 steps without assistance." It is the start point for the 16 to 23
months grouping.
Check your understanding: Does this mean most children who are 18
months old are just starting to show the skill?
Answer: No. Starting points were selected to ensure that a typically
developing child will have a high probability of success for the initial
test items for his age.
3.20 Learn more about the BDI-2
Notes:
MIW Coach:
I've got to run to another appointment now. Take some time to learn
more detail about the BDI-2 and I'll check back with you in a bit ... in
the meantime, the MIW Service Coordinator is available to help. This
training isn’t intended to provide all the necessary information for
administering the BDI2. It is an overview of the test and procedures.
If you are going to be on a team administering the BDI2, you will need
to complete other, more in-depth training and observation before you
participate in an evaluation.
Next you are going to learn about the types of items on the BDI-2;
you will learn more about item scoring, and you will learn about basal
and ceiling levels.
3.21 Types of items
Notes:
The BDI-2 allows items to be administered in three ways: structured,
observation, or interview. Every item in the test has instructions
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regarding how it is to be administered.
3.22 Structured Items Description and Demo
Notes:
STRUCTURED administration of test items requires specific
procedures for presenting the test item in a controlled way. On most
items, structured administration is the preferred method to ensure
that a child has mastered the skill according to the standardization of
the test. The procedures for structured administration are written in
the domain book and must be followed carefully.
Sometimes accommodations are allowed, if they don’t affect the skill
that is being measured. The BDI-2 Examiner’s Manual describes
when and how to make accommodations. Additionally, the test kit
materials must be used unless a test item specifically says that there
is flexibility. Your program has test kits containing all of the
necessary items.
Most structured items require staff to present the test stimulus;
however, there are a few items that allow more parent participation.
The domain booklets clearly state when a parent may present a test
item.
Video transcript:
Structured Items, 1st part:
The ECI provider is with mom and toddler in this video. The ECI
provider is sitting on the floor on the right; the mother is sitting in the
chair with her child.
ECI Provider: “So Jennifer I’ve got some, I’m going to give him some
cubes, a cube, and what we are hoping to see if he’ll when I offer
him another one if he will he put the other one into his other hand.”
Mother: “OK”
The ECI provider hands one cube to the toddler and then another
one; the toddler transfers the first to his other hand and then accepts
the second cube.
ECI Provider: “So. Ok, well Thank you. I need you to do that two
times. There, good job so we would score that a two.”
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Structured Items, 2nd part
ECI provider: “Now while we got the cubes out we are going to do
another one which is to see if he will drop it.”
ECI provider demonstrates how to just drop the cube.
ECI Provider: “you do it.”
She demonstrates this objective three times and the toddler doesn’t
drop the cube
ECI Provider: “you don’t want to let them go?”
ECI Provider: “that is a little bit above what we would expect him to
do, ok good.”
3.23 Observation Items Description and Demo
OBSERVATION allows the team to look for particular behaviors by
watching a child doing typical activities in the natural environment.
Observation often requires seeing a child over time to see mastery of
the skill.
Video transcript: Observation
The ECI Provider is with dad, toddler and grandmother. Dad is
holding the baby and grandmother is feeding the toddler baby food,
while the ECI provider observes
ECI provider: Are ya’ll ready?
Dad: “See his little mouth?”
ECI provider: “He says yea I’m ready”
Grandmother: “Open your mouth, no, no hands; yea good job you
want me to give you some more, no hands there we go.”
ECI provider: “Can he um yet he might not get it if you just pull it
straight out and don’t help him scrap it off like that?”
Grandmother: “I don’t know if he will or not.
ECI Provider: “Yes he can. He did. That is beautiful try that again.”
“So he this is a lot of times we have to do this one by interview and its
weather he eats when you put it in his mouth does he swallow it?
What kinds of foods?” “How frequently does he eat his food from a
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spoon in a day?”
Dad: “About once a day when we give it to him when we have time
yes.
ECI Provider: “How much does he take?
Dad: “about half of that”
ECI Provider: “And that is his regular routine to eat that about once a
day.”
Grandmother: “He has the cereal the rice cereal in the morning then
at night from the infant feeder.” Baby starts wanting more food so
makes little sounds.
ECI Provider: “didn’t know this was a lunch date.”
3.24 Interview Items Description and Demo
INTERVIEW. In order to determine if a child has mastered a skill, it
is often necessary to ask parents questions about their child. When
using the interview procedure to administer an item you must use the
script provided in the domain booklet.. Although acceptable for many
items, and sometimes the only way to get the needed information,
interview is the least preferred because it relies on the interpretation
and report of the caregiver, who may not have knowledge of child
development.
Video: Interview Item
The ECI provider is with dad and toddler in this video. The ECI
provider is sitting on the floor and dad is sitting on the couch the
toddler is playing with …
ECI provider: “Does your child use actions, sounds or other nonverbal means to communicate?”
Dad: “yes.”
ECI Provider: “Give some examples”
Dad: “She points at the refrigerator when she is thirsty and makes
sounds.
ECI Provider: “And how typical is this behavior performed? “
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Dad: It’s Typical”
ECI Provider: “Ok next we will go to this one.” “ Does your child ever
use words to communicate or persuade others? “
Dad: “yes”
ECI Provider: “Give some examples of how she uses request to
satisfy her needs.”
Dad: “Um, for instance if she wants us to turn on the TV she’ll point
at the TV and get the remote and say da da da over and over until we
turn it on.”
ECI Provider: “Does she use words first when trying to get her way
or get something?”
ECI Provider: “No, she usually just points” but then if we ignore her
she will use words.”
ECI Provider (talking to toddler): “Hold on sweets, I’m going to give
you, you can do this one.”
ECI Provider: “Does your child ever communicate without using
words?
Dad: “Yes she just points.”
ECI Provider: “Yes just give some examples. How often does she do
this?”
Dad: “She does this pretty often.
ECI Provider: “Okay like all the time” the provider confirms.
3.25 Item scoring
Notes:
MIW SC:
Each item is scored either a 2, 1 or 0.
You must use the criteria as described in the domain book to score
the item. Do not score the item based only on the description in the
test booklet, or on your ideas about whether or not the child can
perform the task.
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3.26 Scoring close-up
Notes:
Here’s an example of a test scoring item:
2: Walks backward with coordination and balance, without support 5
or more feet.
1: Walks backward with coordination and balance, without support
fewer than 5 feet.
0. Does not walk backward without support.
3.27 Basal & ceiling
Notes:
MIW SC:
The BDI-2 requires the tester to establish a basal and ceiling level for
every sub-domain. A basal is reached when the child scores "2" on
three consecutive items, and it is then assumed that the child has
mastered all the skills before the basal. A ceiling is reached when the
child scores 0 on three consecutive items. The procedure is
described in the BDI-2 Examiner’s Manual.
3.28 Activity: BDI-2 Basal & Ceiling
For this activity you will need to get the handout or link for Handout
3.4 from your supervisor. There are three questions to this activity.
Review the Handout 3.4 BDI-2 Self-care scoring sheet and determine
if a correct basal or ceiling were found. There are three sample pages,
A, B and C. Each is on one separate page.
Question 1
Review Sample A and select the correct answer:
A. Only the basal is correct
B. Only the ceiling is correct
C. Both the basal and ceiling are correct.
Answer: B. Only the ceiling is correct. The team found a ceiling of
three “0s” in a row, but never established a basal. In this case, the
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team should have gone backwards, below the child’s starting point
until the child scored three “2s” in a row. The basal is not correct
because The child did not score three consecutive “2s.” In this case,
the team should have gone backwards, through earlier test items to
find the basal.
Question 2:
Review Sample B and select the correct answer:
A. Only the basal is correct
B. Only the ceiling is correct
C. Both the basal and ceiling are correct.
Answer: A, only the basal is correct. The team found a basal of
three “2s” in a row, but did not find a ceiling of three “0s” in a row. A
ceiling was not found because although the child scored three “0s,”
they are not consecutive, which is required to find a ceiling.
Question 3:
Review Sample C and select the correct response:
A. Only the basal is correct
B. Only the ceiling is correct
C. Both the basal and ceiling are correct.
The answer is B: only the ceiling is correct. The team never found a
basal; although the child scored three “2s,” they are not consecutive.
And remember, to reach a ceiling, there should be three scores of “0”
in a row.
3.29 Results for activity
How did you do on that activity?
3.30 Tallying the score
Notes:
In each sub-domain, add the scores (2 and 1) for all items including
two points for every item below the basal. If the BDI-2 is completed
electronically, the scores are added up for you. The electronic form is
so much easier.
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3.31 Activity: Tallying the BDI score
You will need to get the worksheet or link for Worksheet 3.5 from your
supervisor. The worksheet has three sample pages on three separate
sheets. There are three questions for this activity.
Question 1: Sample A
What is the score for this part of the BDI-2?
Correct answer: 19
Question 2: Sample B
What is the score for this part of the BDI-2?
Correct answer: 32
Question 3: Sample C
What is the core for this part of the BDI-2?
Correct answer: 15
3.32 Results for Activity
How did you do on that activity?
Eligibility Statement
3.33 Intro to eligibility statement
Notes:
Completion of the ECI Eligibility Statement form is required by ECI
Rule 40 TAC §108.804 to document the eligibility decisions of the
team.
There are two versions of the form: electronic and paper. Learn more
about these formats ...
 The electronic version automatically calculates chronological
age, adjusted age when applicable, age equivalents, and
percent delay. The electronic version is a spreadsheet, with
tabs at the bottom naming the sections. The team must
have a laptop or tablet in the home of the family at the time
of evaluation to use this version. Here is a link for the
Electronic Version of the Eligibility Statement with the
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Calculator: https://admin.abcsignup.com/files/{07D0901F86B6-4CD0-B7A2908BF5F49EB0}_59/Elig_Statement_Electronic_with_Calc_
Premie_Calc_Excel2007_11_01_13.xlsx.
 In the paper version, the team makes all the necessary
calculations by hand and enters them in to the form.
DARS-ECI recommends the electronic version because it reduces
errors. You will have to ask your supervisor if you can access a copy
of the electronic version of the calculator.
3.34 Andre's Eligibility Statement
Notes:
Let's take a closer look now at the raw scores for Andre and see how
they translate to the Eligibility Statement. Be sure you have the two
documents before proceeding: Worksheet 3.6a, Andre's Raw Scores
and 3.6b, Andre’s Eligibility Statement. You will get these from your
supervisor.
3.35 "Calculator" tab
Notes:
When you click on the "calc" tab of the electronic Eligibility Statement,
you can enter the raw scores from the BDI-2, as well as the child’s
name, chronological age, adjusted age and the age used to
determine delay. There is a space to the right on the spreadsheet,
where you can enter the child’s birth date and the date of testing.
3.36 Calculating age
Notes:
When you enter a child's date of birth, and the date of testing, the
electronic calculator will automatically calculate the child’s
chronological age in months, according to the instructions in the BDI.
In this example you have a child whose DOB is 11/7/2013; the testing
date is 3/27/2014. Note that the days are dropped; so, in this example,
the child is 4 months and 20 days old, which means his chronological
age is 4 months old. You can also do this calculation by hand.
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Use the calculator to determine the chronological age for Melissa. Or,
you can calculate by using your own math skills. She was born at 40
weeks gestation. Use the same formula as before: Number of years
times 12, plus number of months, subtract extra days = months of
age.
DOB: 3/16/12
Date of testing: 6/12/14
Answer: Calculator result is 2 years, 2 months, 27 days. Age for
testing is 26 months.
3.37 Activity: Using electronic calculator
Notes:
The calculator can also be used to find the adjusted age. ECI adjusts
for prematurity for a child under 18 months of age who was born
before 37 weeks gestation. Adjusted age is calculated by subtracting
either the number of months or weeks premature from the
chronological age, again disregarding days.
Entering the birthday of the child, the date of evaluation, and the
gestational age provides two results: 1) adjusted age using the week
calculation and 2) adjusted age using the month calculation. DARSECI allows calculation of adjusted age using either weeks, or months;
the evaluation team must determine which calculation best reflects
the child’s current status. After you enter the chronological age in
months and the adjusted age in months, click yes under “Use
Adjusted Age.” Both numbers will show up on the front page of the
statement.
Use the calculator or your own math skills to determine the age of
baby Joey, who was born at 34 weeks gestation.
Joey was born at 34 weeks gestation. His DOB is 7/16/13; his date of
testing is 6/12/14. What is his age in months?
Answer: 8 months using weeks calculation. 9 months using months
calculation.
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3.38 Raw scores from BDI-2
Notes:
Let's go back to Andre's eligibility form. In the left column of the
"calculator" tab, are the five domains (Adaptive, Personal Social,
Communication, Motor and Cognitive). If the child is less than 24
months old, enter the raw score for each of the 9 sub-domains in the
green boxes. If the child is over 24 months old, enter raw scores for
all 13 sub-domains.
In our example, in the Adaptive domain, Andre has a raw score of 33
in Adaptive Self Care. He does not have a score in Adaptive Personal
Responsibility, because he is less than 24 months of age.
The age-equivalent score (SC AE or PR AE in this example) of each
sub-domain is automatically calculated in the yellow boxes. The
Domain Age Equivalent found in the blue boxes, or in this example,
Adaptive AE, is the average of the sub-domain scores. The form
automatically calculates the AE based on the raw scores. The orange
boxes are populated with the months delay and percent delay of each
domain.
In our example, Andre has a Self Care Age Equivalent (AE) of 21.
The Domain Adaptive Score is 21, and Andre is 20 months old, so
there is no Adaptive months delay.
On the other hand, take a look at the Communication Domain. Andre
has a Receptive Communication Age Equivalent of 17 and an
Expressive Communication Age Equivalent of 16. His Domain
Communication Score is 16.5 (average of 17 and 16). The
Communication Months Delay is 3, and the % Delay is 15%.
3.39 Eligibility Statement (top half)
Notes:
You will need to get this handout or link for this worksheet from your
supervisor: ECI Needs Assessment, ID and Referral Form
This top section documents eligibility. Choose the type of evaluation:
entry, annual, or re-determination for a child who qualified with a
qualitative developmental delay or other. You will enter the child’s
name, ID, date of birth and eligibility date. If using the electronic
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eligibility statement, the chronological age will automatically populate
once the calculator page is completed. “Duration” is the length of time
it takes to determine eligibility. Enter the first and last names, and
disciplines, of all team interdisciplinary members who participated in
the eligibility determination.
Before discussing eligibility, let’s discuss the boxes below it on the
form.
1. Medically Diagnosed Condition: When a child has a qualifying
medical diagnosis, you enter the name of the diagnosis and the
ICD-9 code. The check box next to the statement "Child’s chart
contains medical records confirming diagnosis" indicates that
the team has verified that the required documentation is in the
child’s ECI record. At this point, the Medically Diagnosed
Condition box and eligibility box will automatically populate.
2. Hearing/ Vision Impairment: If the child has a documented
hearing or vision impairment that meets TEA criteria this box is
checked, and the child automatically qualifies. The Eligibility
Box at the top will automatically be populated.
3. The section on the bottom of this page documents
developmental delay. Let's take a closer look ...
3.40 Eligibility Statement (bottom half)
Notes:
If you are using the electronic version of the statement, the Domain
Age Equivalent, months of delay, and percent delay all automatically
populate from the calculator. In our example, Andre’s Adaptive
domain AE is 21 months, so we see "no delay."
In the far right column of this section, we document Qualitative
Determination of Delay (QDD). The scores automatically populate
from page two of the form, which we'll discuss in more depth later in
the module.
Take some time now to look at how the numbers on the raw score
document for Andre translates to this Developmental Delay section of
the Eligibility Statement.
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3.41 Activity: Percent Delay
Here's an opportunity for you to practice finding the age equivalent
score and percent delay. The electronic version of the statement
calculates these for you, but it's good to see how these numbers are
determined.
Step 1: Determine the domain Age Equivalent (AE) scores by
averaging the appropriate sub-domains.
Step 2: Determine the months of delay for the domain.
Step 3: Use the conversion table to determine the percent delay.
You will need to get a copy or the link to the Handout 3.7, percent
delay conversion table, from your supervisor.
There are 10 questions for this Activity.
Question 1: Adjusted age is 11 months. Adaptive self-care: 10
months. What is the Adaptive AE?
Answer: 10 months. Since only one sub-domain is administered for
children under two, the age equivalent for that sub-domain becomes
the domain age equivalent.
Question 2: Adjusted age is 11 months. Adaptive Self-Care is 10
months. Adaptive AE is 10 months. What are the adaptive months
delay?
Answer: 1. To get the months of delay, just subtract the child’s age
equivalent from her adjusted age (11 - 10 = 1).
Question 3: Adjusted age is 11 months. Adaptive Self-Care is 10
months. Adaptive AE is 10 months. Adaptive months delay is 1 month.
What is the Adaptive percent delay?
Answer: 9. To determine the percentage of delay, you need to divide
the months of delay by the baby’s adjusted age.
Question 4: Adjusted age is 11 months. Receptive communication is
11 months; expressive communication is 9 months. What is the
communication AE?
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Answer: 10 months. When two sub-domains are administered, you
need to average the age equivalents to arrive at the domain age
equivalents.
Question 5: Adjusted age is 11 months. Receptive communication is
11 months; expressive communication is 9 months.Communication
AE is 10 months. What is the communication months delay?
Answer: 1 . The months of delay is the difference between the child’s
adjusted age and her age equivalent (11 - 10 = 1).
Question 6: Adjusted age is 11 months. Receptive communication is
11 months; expressive communication is 9 months. Communication
AE is 10 months. Communication months delay is 1 month. What is
the communication percent delay?
Answer: 9. To determine the percentage of delay, you need to divide
the months of delay by the baby’s adjusted age.
Question 7: Adjusted age is 11 months. Gross Motor is 7 months.
What is the Gross Motor AE?
Answer: 7. Since only one sub-domain is administered for children
under two, the age equivalent for that sub-domain becomes the
domain age equivalent.
Question 8: Adjusted age is 11 months. Gross Motor is 7 months.
Gross Motor AE is 7 months. What is the Gross Motor months of
delay?
Answer: 4. To get the months of delay, just subtract the child’s age
equivalent from her adjusted age (11 - 7 = 4).
Question 9: Adjusted age is 11 months. Gross Motor is 7 months.
Gross Motor AE is 7 months. Gross Motor Months of Delay is 4
months. What is the Gross Motor percent delay? (round to the
nearest whole number)
Answer: 36 %. To determine the percentage of delay, you need to
divide the months of delay by the baby’s adjusted age.
Question 10: You've calculated the percent delays in three domains.
Here are the others. Her percent delays:
 Adaptive= 9%.
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 Personal-Social= 0%.
 Communication= 9%.
 Gross Motor= 36%.
 Fine Motor= 18%.
 Cognitive= 0%.
Based on these results, is Virginia eligible for services?
A. Yes
B. No
Answer: Yes. Virginia is eligible based on her gross motor delay of
36%.
3.42 Andre is eligible
Notes:
Now let’s go back to Andre's Eligibility Statement. Take a look at the
top of the form. Because Andre has a 30% delay in the cognitive
area and he qualifies for services, the electronic form populates
the “eligible” box, with an “X.” If he did not qualify, the “not eligible”
box would be marked.
3.43 Activity: Eligibility Statement for Elizabeth
Notes:
MIW Coach:
You will need to get either the worksheet or link for Activity 3.8.
Elizabeth’s eligibility Statement, from your supervisor.
We've reviewed Andre's Eligibility Statement and we've talked about
each section of the form. Now I'd like you to take a look at the
Eligibility Statement for Elizabeth. I noticed it contains an error. Can
you spot what's missing or incorrect?
See Elizabeth’s Eligibility Statement: What do you think? What is
wrong with the Eligibility Statement for Elizabeth? More than one may
be correct.
A. Information about the child is missing or inaccurate
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B. Information about the team members is missing or inaccurate
C. Information about the evaluation is not indicated (e.g., date,
duration)
D. The BDI-2 scores are not listed
E. The type of eligibility is not indicated
Correct Answer: B. The first and last names of the team members
and their disciplines must be included. Elizabeth's name, date of birth,
and age are all included as required. The team included the date and
duration of the evaluation. Because Elizabeth has a qualifying
diagnosis, the BDI-2 is not required. The X in the box by “medically
diagnosed condition” correctly indicates her type of eligibility.
QDD and HELP
3.44 Sometimes Qualitative Determination of Delay (QDD)
needed
Notes:
We need to determine if Riley is eligible for ECI services. Riley did
not qualify based on his BDI-2 scores, but concerns about his
functional abilities indicate that we should conduct a qualitative
determination of delay. We are going to look up QDD in TAC, and
discuss QDD with your MIW coach.
3.45 QDD in TAC
Notes:
Let's take a closer look at requirements around QDD ...
State rules about QDD can be found in 40 TAC, Section108.821.
When the results of the designated test protocol do not accurately
represent the child's development and do not indicate a qualifying
developmental delay; the interdisciplinary team must document
corroborating evidence of a qualitative developmental delay from a
supplemental protocol designated by DARS ECI.
Can you find this in TAC? According to TAC, when must the
supplementary protocol (QDD) be administered?
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The link is located here:
http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&t
i=40&pt=2&ch=108.
Answer: When the interdisciplinary team determines there is
evidence that the results of the standardized tool do not accurately
reflect the child's development (Section 108.821).
3.46 When is QDD appropriate
Notes:
Qualitative Determination of Delay (QDD) is a sub-type of the
Developmental Delay category of ECI eligibility. In some limited
cases, the team can use other information in addition to the scores on
the BDI-2 to qualify a child. There are specific requirements for QDD
eligibility.
The team may feel there is a concern regarding the child’s
development that was not identified in the BDI-2. The child may
demonstrate significant functional delays in motor, communication, or
personal-social skills. In those cases, the team should use the
qualitative determination of delay process to determine if the child is
eligible. The evaluation team must document why they feel the BDI-2
did not reflect the child’s development.
The following are some examples of when a team might move
forward with qualitative determination of delay.
o A child who is verbal and communicative may score at
age level on the BDI-2 in the communication domain, but
have speech that is difficult for family members to
understand.
o A child who uses only one arm and hand may score at
age level on the BDI-2 in the fine motor sub-domain.
o A child who has extremely low muscle tone and has an
adjusted age of 0 and scored at zero months on the BDI.
QDD eligibility is effective for only 6 months, so the team must inform
the parents that the program will have to re-determine eligibility within
6 months.
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3.47 How HELP strands are used
Notes:
DARS has designated the Hawaii Early Learning Profile Strands as
the supplementary protocol to determine QDD in children 3 months
and older. A different procedure is used for infants under three
months of age. The HELP is a comprehensive, family-centered
curriculum based assessment. The team administering the HELP
Strands to determine eligibility must include a LPHA with knowledge
in the area of concern and who is acting within the scope of their
license. The team must also utilize the “Inside HELP” manual to
accurately administer and score the strands.
When your team uses the HELP Strands, you will not administer the
complete tool; you will only administer the strands in the area of
concern. The only strands permitted for use to determine QDD are
identified on page two of the eligibility statement. They are strands in
the developmental domains of gross motor, fine motor, social
emotional and communication. One resource about administering
and scoring the HELP Strands is the DARS-ECI "Help with HELP"
training module. Ask your supervisor for more information.
3.48 QDD for very young infants
Notes:
You will need to get the link for the Eligibility Statement with
Electronic Calculator. The link is here:
https://admin.abcsignup.com/files/{07D0901F-86B6-4CD0-B7A2908BF5F49EB0}_59/Elig_Statement_Electronic_with_Calc_Premie_
Calc_Excel2007_11_01_13.xlsx
For children with a chronological or adjusted age of less than 3
months, a licensed therapist with expertise in the area of concern
must be part of the team who determine eligibility. The HELP Strands
are not administered. The licensed therapist will document clinical
impressions of the child’s abilities, and must include information
about how the child’s functioning is impacted by the delay. The team
will then determine a need for services.
For these babies, the team will complete the page titled "Qualitative
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Determination of Delay for Ages Birth through 2 Months." It's the
ES_P3 tab of the Eligibility Statement. The top section will
automatically populate. Click to indicate if the delay is in
Communication | Oral Motor or in Motor.
The clinical description section should describe what was observed or
reported during the administration of the BDI2. This might include:
Movement patterns, muscle tone, low tone; torticollis, loss of liquid
when feeding, slow feeding, etc. This may be written in technical
language.
In the second section, effects/ observations/ caregiver’s report,
describe how the clinical findings significantly interfere with the child's
functional abilities. Include observations and caregiver report. This
requires a description of current and observable limitation(s), not
limitations that might clinically be anticipated. Use functional
language, with descriptions that are relevant to daily family life.
The LPHA then signs, dates, and enters his/her discipline. Once
everything is filled out on this page, the type of eligibility automatically
populates on the first page.
There is a space at the bottom of the page to indicate the team
informed the parent/guardian that qualitative developmental delay
status will be re-determined on or before this date. The date
automatically populates based on the date you entered on the first
page as the eligibility date.
If you're a therapist, complete the following activity 3.49 about
evaluating very young infants. Otherwise, you can go to item 3.50.
3.49 Quiz for Therapists only, Clinical Concerns and Functional
Effects:
Notes:
As a therapist, you have a responsibility to support and lead your
team when evaluating very young infants. Very specific knowledge
and skill is needed to identify functional limitations in infants whose
chronological or adjusted age is less than three months.
Documentation on page three of the eligibility statement requires two
components: 1) identification of the clinical concern, and 2)
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identification of the functional limitations manifested by the concern.
A clinical concern alone is not sufficient to qualify a child for ECI.
Current, observable functional limitations resulting from the concern
must also be described.
Quiz, Part 1 (8 questions):
Read these descriptions and determine whether the statement would
be a Clinical description of concern (CD) or a description of functional
effects (FE).
What do you think? Is this a Clinical Description of concern (CD) or a
description of Functional Effects (FE)?
Question 1: Low muscle tone. CD or FE?
Answer: CD
Question 2: Dx (diagnosis) from a physician of torticollis. CD or FE?
Answer: CD
Question 3: When laying on back, keeps head turned to left, with legs
still and flat on surface. CD or FE?
Answer: FE
Question 4: Will nurse only on left side. CD or FE?
Answer: FE
Question 5: Doesn't like to be on stomach and will cry, arch back to
try to turn over. CD or FE?
Answer: CD
Question 6: Doesn't seem to like to be held -- arches back, cries. CD
or FE?
Answer: CD
Question 7: Doesn't turn his head to both sides to look at faces or
other stimulus. CD or FE?
Answer: FE
Question 8: Not able to lift head to clear nose and mouth when
placed on tummy. CD or FE?
Answer: FE
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Remember, a clinical description includes observations or reports of
the condition of the child, based on therapist expertise. Functional
effects describe how the clinical condition interferes with the child’s
abilities in daily life.
Quiz, Part 2 (8 questions):
Read these descriptions and determine whether the statement would
be a Clinical description of concern (CD) or a description of functional
effects (FE).
What do you think? Is this a Clinical Description of concern (CD) or a
description of Functional Effects (FE)?
Question 1: Difficult to calm. CD or FE?
Answer: CD
Question 2: Irritability; easily stimulated. CD or FE?
Answer: CD
Question 3: Loses milk during feeding. CD or FE?
Answer: CD
Question 4: Not tracking faces or light. CD or FE?
Answer: FE
Question 5: So fussy during the day that she is unable to focus her
attention on stimulation (e.g., faces, sounds, etc.). CD or FE?
Answer: FE
Question 6: Concern that baby has lost a few ounces in weight. CD or
FE?
Answer: FE
Question 7: Feeding from bottle is loud; gulping sounds noted. CD or
FE?
Answer: CD
Question 8: Feedings that take more than 30 minutes. CD or FE?
Answer: FE
Remember, clinical description includes observations or reports of the
condition of the child, based on therapist expertise. Functional
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effects describe how the clinical condition interferes with the child’s
abilities in daily life.
Now that you know more about QDD, let’s take a look at where it
shows up on the Eligibility Statement.
3.50 QDD for Riley: Eligibility Statement
Notes:
This is the text in the box which describes the QDD for Riley:
Concerns and observations: Document concerns based on and
observations and/or caregiver report:
Documented concern: Riley has a 23% delay in Personal-Social on
the BDI-2. Riley was difficult for the evaluators to engage and
displayed multiple repetitive actions such as walking around in circles
and word/ sound repetition. Riley received a score of 0 on several red
flag indicators correlating to the M-CHAT during administration of the
BDI-2. Further questioning revealed that Riley babbled very little
when he was younger.
Parts of the form:
The Name, Eligibility Date, ID number and Duration automatically
populate from the previous pages. In the yellow section the team
documents why they determined it was necessary to move to the
HELP. More detailed observations and concerns about the child’s
skills will be documented in the LPHA’s evaluation report or progress
note about the evaluation.
In the yellow boxes under “Strand Age Equivalent,” enter the age
equivalent for each sub-strand tested. It is not required to complete
all domains (personal-social, oral motor, gross motor, etc.) on this
page to determine eligibility. However, you must administer all of the
sub-domains of the domain you are evaluating to determine the AE.
After you fill in the yellow boxes, the Domain AE, Months of Delay,
and Percent Delay will automatically populate.
This percent delay then automatically populates on the first eligibility
page as seen here ...
There is a space at the bottom of the page to indicate the team
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informed the parent/guardian that qualitative developmental delay
status will be re-determined on or before this date. The date
automatically populates based on the date you entered on the first
page as the eligibility date.
3.51 Activity: Find the error(s)
For this activity, you will need to get the handout or link for Activity
sheet 3.9: Riley’s Eligibility Statement, from your supervisor.
Notes:
MIW SC: Please take a look at the front page of the Eligibility
Statement for Riley. I noticed it contains errors. Can you spot what's
missing or incorrect?
What do you think? What is wrong with the Eligibility Statement for
Riley? There may be more than one right answer.
A. Information about the child is missing or inaccurate
B. Information about the team members is missing or inaccurate
C. Information about the evaluation is not indicated (e.g., date,
duration)
D. The BDI-2 scores are not listed
E. The type of eligibility is not indicated
Correct answers: C and D. Two things were entered incorrectly.
While the team entered the date of the evaluation, they did not enter
the duration. Also, the BDI-2 scores were not indicated. Riley's name,
date of birth, and age are all included as required. This team
correctly included their full names, and their disciplines. The X in the
box by “Qualitative Determination of Delay” indicates Riley's type of
eligibility, so that is correct.
3.52 Eligibility redetermination
Notes:
Children who enroll in ECI services must be re-evaluated periodically
to determine if they are still eligible for ECI services. For a child with
a developmental delay determined by BDI-2, re-evaluation for
eligibility must be completed within one year of enrollment. Children
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who were enrolled based on a qualitative determination of delay,
must be re-evaluated within 6 months of the date they were enrolled.
The BDI-2 is the only tool that can be used to re-determine eligibility.
A qualitative determination of delay can be made only at initial
enrollment. After 6 months, children who were eligible based on a
qualitative determination of delay must show a delay on the BDI-2 or
have documentation of a qualifying medical diagnosis or auditory or
visual impairment to continue receiving ECI services.
To continue to receive ECI services, at re-evaluation the child must
show a delay on the BDI of at least 15% in at least one domain. This
criterion also applies to those children whose only delay is in
expressive communication at re-evaluation.
Children who qualify for ECI due to a medical diagnosis or with an
auditory or visual impairment must also have their eligibility redetermined each year. The child’s record must contain documentation
that he or she still has a qualifying medical diagnosis, or a qualifying
auditory or visual impairment. The team will then reassess to
determine if the child still has a need for services.
Eligibility can be reviewed at any time. If the team serving a child
thinks he or she may have “caught up” developmentally, they should
discuss this with the parents.
Needs Assessment, ID and Referral
3.53 Needs Assessment, ID and Referral Form: Organizing
evaluation information
Notes:
You will need to get a copy or link to the document “Needs
Assessment, Identification and Referral Checklist.
To ensure that all of a child’s unique needs are identified, ECI
requires assessment of other areas that are not covered in the BDI-2.
To accomplish this, the team will complete the ECI Needs
Assessment, Identification, and Referral Form as part of the
evaluation process. The form is used to organize information that is
gathered during evaluation; they are not new assessments.
Information captured on the form helps to identify any needs for
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further evaluation or testing.
Page 1 is the Risk Factors Checklist; page 2 is the Needs
Assessment. Now we will discuss each page in detail.
3.54 Risk Factors Checklist
Notes:
The first step in identifying hearing and vision needs is to complete
the Risk Factors Checklist. This step might be completed during initial
conversations with the family about any conditions, medications, or
treatments the child has had. If the child medical records are
available, they may contain information about risk factors. A
condition may occur during a child’s infancy and cause a vision or
hearing loss months or years later. These Late Onset risk factors
and are marked with a star on the Checklist. Alert parents to the fact
that although the child might not have problems with hearing or vision
at this time, monitoring for changes is very important, and vision and
hearing status should be reviewed at least every six months.
If any risk factor is identified, it is important that the child receive
further testing. It is our responsibility to help the parent understand
the importance of early identification of vision and hearing loss, and
to make the necessary referrals for further testing.
The column on the far right of the risk factors list is related to nutrition.
Although you do not need to identify nutrition concerns until a child
has qualified, you can mark the risk factors while you are reviewing
the medical history to save time and avoid asking parents the same
questions later.
3.55 Activity: Risk Factors
Notes:
Use the handout titled Activity 3.10 Short Risk Factors Checklist, to
identify what type of referral is needed for each condition.
There are six questions. What type of referral is needed for each
condition? Choose all that apply.
Question 1: Jaundice
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A. Hearing
B. Vision
C. Nutrition
Answer: B. A vision referral is needed.
Question 2: Meningitis
A. Hearing
B. Vision
C. Nutrition
Answer: A and B, a hearing and a vision referral are needed.
Question 3: Seizure Disorder
A. Hearing
B. Vision
C. Nutrition
Answer: B and C. A vision and a nutrition referral are both needed.
Question 4: Low Birth Weight
A. Hearing
B. Vision
C. Nutrition
Answer: A, B and C. All three referrals are indicated by this condition.
Question 5: In utero infection, toxoplasmosis
A. Hearing
B. Vision
C. Nutrition
Answer: A and B. A hearing and a vision referral are needed.
Question 6: Prader-Willi Syndrome
A. Hearing
B. Vision
C. Nutrition
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Answer: C. A nutrition referral is needed.
3.56 Needs Assessment form
Notes:
If you choose, you can get a copy or link to this document from your
supervisor.
After completing the Risk Factors Checklist, you will fill out the rest of
the Needs Assessment,, Identification and Referral form.
The form is split into six areas. We will now review each area of the
form. :
Vision Red Flags and Crosswalk
If any of the red flags are checked in the vision section, a referral
should be made for further vision testing. If any risk factors were
identified on the risk factors checklist, you will check the first box, and
stop there. If no risk factors were identified, determine whether any
of the other red flags are present. You can do this by reviewing
medical records, observing the child, and talking with the parents.
After considering red flags, review the Crosswalk. This is a list of
items from the BDI-2 that strongly correlate to a child’s use of vision.
Review the BDI-2 to see if any of the items on the crosswalk were
administered to the child. If the child scored a 0 on any of the starred
items, refer for further testing. If the child scored a 1 or 2 on all the
starred items that were administered, but got a 0 on 25% or more of
the other items listed, the team should discuss the possibility of a
vision concern and determine whether a referral is needed. If you did
not administer the BDI-2 because the child had a medical, AI or VI
qualifier, you won't complete the crosswalk.
Hearing
If the child has any risk factors for hearing, check the first box in the
hearing section and make a referral for hearing testing. You do not
need to complete the rest of the items related to hearing. If there are
no risk factors identified, you will need to determine whether the child
shows developmental indicators for hearing loss.
For any child with a speech or language delay, hearing loss must be
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ruled out as a causative factor. The American Academy of Pediatrics
(AAP) recommends every child with a speech and language delay
have a diagnostic audiology assessment by the time he is 24 to 30
months of age. These AAP guidelines indicate that every child who
has a communication delay needs a referral for hearing testing,
whether or not he qualifies for ECI services.
Assistive Technology
In addition to hearing and vision, the team must determine whether
the child has assistive technology (AT) needs. The Code of Federal
Regulations defines assistive technology as: "Any item, piece of
equipment, or product system, whether acquired commercially off the
shelf, modified, or customized, that is used to increase, maintain, or
improve the functional capabilities of children with disabilities.”
The team can identify assistive technology needs in one of three
ways. Some programs use an assistive technology screening tool.
Another option is to complete the Assistive Technology section of the
Needs Assessment, Identification and Referral form. The third way is
for a physical therapist, occupational therapist, or a speech language
pathologist to review AT needs as part of the team’s interdisciplinary
evaluation.
VCFS Checklist
Velo-cardio-facial syndrome (VCFS) is a genetic disorder. Current
Texas law (Tex.Hum.Res.Code §117.076) requires ECI to provide
information to families whose child has two or more characteristics of
this rare condition. The presence of these characteristics does not
mean a child has VCFS. Many of our infants and toddlers will display
two or more of these characteristics that are found in the "What is
VCFS?" brochure, though very few of these children will have VCFS.
Here is a list of characteristics:
 Hypotonicity
 Articulation disorder
 Resonance disorder
 Nasal regurgitation during feeding with no history of cleft palate
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 Recurrent ear infections combined with cardiac anomaly,
feeding disorder, cleft palate, or sub-mucosal cleft palate
 Eligible for ECI with fine motor or gross motor delay
 Eligible for ECI with communication delay
If a child does exhibit two or more of the characteristics, the parent is
provided with information about VCFS, along with a recommendation
to contact the child’s physician for follow-up.
Nutrition
Nutrition needs assessment is required for children who qualify for
ECI services and is conducted post eligibility for families who intend
to enroll in ECI. According to the Early Childhood Technical
Assistance Center, decades of rigorous research show that the three
components critical for early brain development are positive early
experiences, safe and supportive environments, and appropriate
nutrition. For this reason, a careful assessment of every child’s
nutritional needs is essential.
Your first step in identifying nutrition needs will be to look back at the
Risk Factors Checklist and make note of whether the child has any
risk factors for nutrition. If one of the factors requiring a referral for a
nutrition evaluation is checked, the process is complete and you do
not need to go any further; a referral to a dietician is needed.
Additional review of nutrition may be completed by any of the
following:
 a review of medical records,
 administration of the DARS ECI Nutrition Screen,
 a Nutrition evaluation, a nursing evaluation, or
 discussion of family routines which includes a detailed
discussion of the child’s food intake.
Autism Spectrum Disorders
Each of these checkboxes is an indicator of possible autism that the
team will review. If the team identifies any of those issues they will
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explain the importance of early screening for autism and, with
consent, will complete the Modified Checklist for Autism in Toddlers
Revised (M-CHAT-R) unless the child has already been screened by
the child's licensed healthcare provider.
Wrap-Up:
To document that you met all requirements for identifying hearing,
vision and assistive technology needs, as well as risk for VCFS,
nutrition, and Autism, fill in all applicable areas of the forms. If no risk
factors were identified on the Risk Factors Checklist, draw a line
through the column for check marks. Be sure you have checked all
boxes to indicate when a need was identified or a referral was made.
If a need was identified, but a referral was not made, document the
reason on the form or in a progress note. If a parent declines a
referral, you should document that you explained the importance of
further testing and the implications of possible hearing or vision loss
to the parent.
3.57 Completing the Needs Assessment for MIW children
Notes:
Good job! Now take what you've learned and apply it to Andre,
Elzabeth and Riley ...
3.58 Needs assessment to-do list for children
Notes:
The Needs Assessment, Identification and Referral form would be
completed in its entirety for all three children. I've identified certain
sections I'd like you to take a look at here ...
3.59 Activity: Vision, Hearing, Nutrition for Elizabeth
Refer to Handout 3.10: Risk Factors Checklist, for this activity.
Elizabeth is 3 weeks old and has received a medical diagnosis of
Down Syndrome.
Based on the Risk Factors Checklist table, which of the following are
indicated for Elizabeth? Check all that apply.
A. Hearing
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B. Vision
C. Nutrition
Answer: A, B and C. Children with Down Syndrome are at risk for
hearing, vision and nutrition challenges. It is our responsibility to help
the parent understand the importance of early identification of vision
and hearing loss, and to make the necessary referrals for further
testing
3.60 Activity: Vision Referral for Andre?
While interacting with Andre you did not observe anything unusual
about his eyes or vision.
On the BDI-2, he scored:
 0 on RC 9
 2 for FM 6
 2 for FM 9
 1 for AM 7
 0 for AM 11
Did you identify a vision need for Andre or is a referral needed, based
on this information?
A. Yes
B. No
Correct answer: Yes. Andre scored a zero on two items, meaning he
failed two of the five items tested, so 40% of the test items were failed.
This requires a referral for a vision evaluation.
3.61 Activity: Hearing Referral for Andre?
Andre's qualifying delay is in the cognitive domain. He also has
delays in the personal-social domain. Here are Andre’s other scores:
 Adaptive: AE= 21, no percent delay
 Personal-Social: AE= 16, 20% delay
 Communication: AE= 16.5; 15% delay
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 Expressive Communication: AE= 16.0; 20% delay
 Gross Motor: AE= 24.0; no delay
 Fine Motor: AE= 25.0; no delay
 Cognitive: AE= 13.5; 30% delay
Based on this information, did you identify a hearing need for Andre
or is a referral needed?
A. Yes
B. No
The correct answer is A, Yes. Andre is over 12 months, eligible for
ECI services and has a delay in communication.
3.62 Activity: Assistive technology referral for Riley?
MIW Coach:
If an OT, PT, or ST is part of the interdisciplinary team during
evaluation, check the box to indicate “team reviewed AT needs as
part of evaluation.” In this example an EIS and LPC completed the
evaluation, so the team answered the questions in the Assistive
Technology section.
Read this sample from the Assistive Technology portion of the Needs
Assessment, ID and Referral Form. Each of these questions is either
True or False:
Beginning of Sample:
 Child has functional communication system: False
 Child’s positioning does not limit interactions: True
 Child has age appropriate physical abilities to explore: True
 Childs’ sensory skills (auditory, visual, or tactile) don’t interfere with
ability to interact effectively: True
 Child does not have medical diagnosis that usually includes
physical limitation: True
End of Sample
Question: What do you think? According to this example, is there a
need to refer Riley for AT evaluation?
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A. Yes
B. No
The correct answer is Yes. Riley does not have a functional
communication system (i.e., he is unable to communicate his wants
and needs), so a referral for an AT assessment should be made.
3.63 Activity: VCFS referral for Riley?
Read the following excerpt from the VCFS portion of the Needs
Assessment, ID and Referral Form for Riley:
Beginning of excerpt:
If child has 2 or more characteristics listed below and is not under
the care of a physician for VCFS, provide family with DARS ECI
VCFS brochure and recommend follow-up
Hypotonicity-No
Articulation disorder-No
Resonance disorder-No
Nasal regurgitation during feeding with no history of cleft palate-No
Recurrent ear infections combined with cardiac anomaly, feeding
disorder, cleft palate, or sub-mucosal cleft palate-No
Eligible with fine motor or gross motor delay-No
Eligible with communication delay-Yes
Are 2 or more of these characteristics present? No
End of Excerpt
Notes:
MIW Coach:
After discussion with the family, review of records and eligibility, and
evaluating the child, you determine Riley does not have two or more
characteristics to indicate further follow up with VCFS.
What do you think? Riley has only one item in the list, but if two items
were checked, what would you do?
A. Tell the family you have diagnosed Riley with VCFS
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B. Do not tell the family anything, this is really more for records at
your program
C. Provide the DARS-ECI VCFS brochure to the family.
The correct answer is C: Provide the DARS-ECI VCFS brochure to
the family. And be sure to enter the date in the blank provided.
3.64 Autism risk ID for Riley
Notes:
MIW Coach:
Let’s review Riley’s eligibility statement. In reviewing Riley’s medical
records, you see Riley has not been screened for autism before.
Recall the reason we moved to QDD was a delay in Personal-Social,
more specifically adult interaction. Let's take a look at which box(es)
should be checked on this section of the Needs Assessment, ID and
Referral form.
The first box is checked. Riley is 26 months old, and his medical
records do not indicate he has been screened for autism.
Next -- there is no family history of autism and there is no
documentation that Riley has lost previously acquired speech or
social skills so the next two boxes are not checked.
The fourth box is checked. Riley has a qualifying QDD in the area of
Personal Social using the HELP and delay is indicated on the BDI-2.
The next two boxes are also checked, as Riley shows a
Communication and Cognitive delay using the BDI-2.
Risk factors are present, so this box is checked. It is appropriate
either for the ECI team to screen Riley or refer him to his doctor to
complete the MCHAT-R. In this case, the ECI team decided to
complete the screening, so that box is checked.
Informed Clinical Opinion
3.65 Informed clinical opinion
Notes:
IDEA requires that eligibility determination not be based on test
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scores alone. Teams must use Informed Clinical Opinion when a child
qualifies under developmental delay. “The term 'informed clinical
opinion' appears in the regulatory requirements for the
implementation of Part C ... as an integral part of an eligibility
determination. It must be included in evaluation and assessment
procedures, since it is a necessary safeguard against eligibility
determination based upon isolated information or test scores alone.”
Citation for quote: Anne Lucas and Evelyn Shaw (2012) “Informed
clinical opinion” (NECTAC Notes No. 28). Chapel Hill: The University
of North Carolina, FPG Child Development Institute, National Early
Childhood Technical Assistance Center.
Your professional knowledge and expertise are of the basis for the
ECI eligibility process. To provide an informed clinical opinion, each
team member must have knowledge about all developmental
domains, the expected sequence of development and the range of
individual variations in typical infant and toddler development.
Team members must also have knowledge of the child’s level of
functioning in all developmental areas and her unique strengths and
needs. The team will gather some of this information from the BDI.
However, they must also collect and review information about the
child’s history from the parents and with parental consent, from other
sources that would be applicable (for example - the child’s
pediatrician or medical specialist).
The informed clinical opinion of team members must be documented
in the child’s record.
3.66 Informed clinical opinion in evaluation
Notes:
When is informed clinical opinion used?
Take some time to explore all the occasions when clinical opinion is
used ...
To an individual test item, when appropriate:
Informed clinical opinion is often applied to individual test items when
administering the BDI-2. You might need to use informed clinical
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opinion to measure a particular skill against the scoring criteria. For
example, let’s look at gross motor item #11 that says the child “turns
from prone to supine position unassisted”. The scoring criteria for 2
points describes the movement as being performed intentionally,
using a smooth, coordinated movement. Informed clinical opinion
must be applied to evaluate the quality of the movement for accurate
scoring.
In a few cases, you might use informed clinical opinion to determine
whether to administer a test item. For example, if you know from
administering Expressive Communication item 14 that a child does
not use 2-word phrases, you won’t administer EC item 17, which asks
about 3-word phrases.
When interpreting a score:
A team may also use informed clinical opinion when interpreting a
domain score. For example, attainment of skills in areas such as selfcare like self-feeding and dressing, can vary with culture, and in some
cases, a low score could be due to the family’s expectations of
development. When eligibility decisions are based on the team’s
interpretation of a qualifying score, it’s important to clearly document
the reasons.
When reviewing results with a parent:
A team may also use informed clinical opinion to explain test results
to parents. Team members use informed clinical opinion to describe
what the scores mean, and how the scores relate to the child’s overall
development. For example, if a child has a sizable delay in fine
motor skills, and a smaller, but still significant delay in adaptive skills,
the team might talk about the ways a deficit in fine motor skills can
make it hard for a child to learn self-care activities. Interpretation of
the Subdomain Profile Scaled Scores on the BDI-2 score sheet can
provide meaningful information.
To restate a question on the BDI-2:
Another situation in which you might use informed clinical opinion
occurs when a parent doesn’t understand the scripted question in the
BDI-2. You would use your knowledge of the intent of the item and
the skill that is being measured to rephrase the question in a way the
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parent can understand, but does not change the intent of the item.
When making a qualitative determination of developmental
delay:
Sometimes, informed clinical opinion may indicate that the BDI-2
scores do not reflect a qualifying delay, but a child has some delays
that are not reflected in the test results. In those cases based on
informed clinical opinion, as well as professional knowledge and
experience, the team may determine that additional evaluation is
indicated to determine if the child is eligible with a qualitative
determination of delay.
The team will also use clinical opinion to determine age equivalences
during the QDD process. Unlike the BDI-2, the HELP Strands scoring
does not result in an age equivalent. Team members apply their
informed clinical opinion and knowledge of typical child development
to determine the appropriate age equivalent.
Informed clinical opinion is a critical piece of determining eligibility for
children under 3 months of age who qualify with a qualitative
determination of delay. The licensed therapist with expertise in the
area of concern will evaluate the child's skills. The team then uses
that information, along with their informed clinical opinion to
determine if the child needed ECI services.
When the family's native language is not English:
Another instance in which a team will use informed clinical opinion is
for children whose families do not speak English, or for children who
are learning two languages. As required by TAC, the evaluation must
be conducted in the language normally used by the child, if
developmentally appropriate.
If the child has a qualifying score in communication, but does exhibit
delay in any other domain, the team may need to do an additional
evaluation to determine eligibility. To determine whether the child is
delayed or whether the score is the result of language differences,
the team may administer the Preschool Language Scale ( PLS-4 or
PLS-5) to gather more information. A team administering the PLS
must always include a Speech Language Pathologist to interpret the
results. If the child doesn't show a delay on the PLS, he or she does
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not qualify for ECI services.
3.67 Activity: Clinical opinion quiz
In each of the following five scenarios, are you using clinical opinion?
Answer yes or no to each of the questions.
Question 1: During the administration of the BDI-2, Mom doesn’t
understand what you are asking her. You substitute a different word
that still allows you to measure the same skill. Are you using informed
clinical opinion?
A. Yes
B. No
The correct answer is A, Yes. You use your clinical opinion when you
adjust the interview question to help the parent understand what you
are trying to measure. You use your clinical opinion to make sure you
aren’t changing the construct of the question when you substitute a
word.
Question 2: You determine the basal and the ceiling for the child on
the BDI -2 gross motor strand. Are you using informed clinical
opinion?
A. Yes
B. No
The correct answer is No. You aren’t using your clinical opinion. You
are simply following the directions on how to administer the BDI-2.
Question 3: You and the other member of the team explain the
results of the BDI-2 to Mom and discuss how her child’s
developmental delay in language is related to a delay in her cognitive
skills. Are you using informed clinical opinion?
A. Yes
B. No
The correct answer is A, Yes. You are using your clinical opinion
when you interpret and explain the test results, including how one
area of delay affects another area.
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Question 4: You complete page 1 of the eligibility form. Are you using
informed clinical opinion?
A. Yes
B. No
The correct answer is B, No. You aren’t using your clinical opinion.
You are simply completing the eligibility form.
Question 5: You and the team determine that the BDI-2 does not
accurately reflect the child’s development. You and the team make a
decision to move forward with qualitative determination of
developmental delay. Are you using informed clinical opinion?
A. Yes
B. No
The correct answer is A, Yes. You need to use your clinical opinion to
determine when it is appropriate to move to qualitative determination
of delay.
3.68 For the children on your caseload
Notes:
MIW Coach:
Let's look at how the teams have applied informed clinical opinion so
far for each of the children.
Andre’s team used clinical opinion when administering the BDI-2. The
team administered an item to measure whether Andre could occupy
himself for 10 or more minutes without demanding attention. The item
includes watching television as an activity. Andre’s foster mom
reports that he likes to watch Dinosaur Train and Spongebob with the
older kids when they get home from school. Based on the foster
mom’s responses, the team needed to determine if Andre was
actively engaged or passively viewing the shows. The team also used
clinical opinion to determine what to ask mom to solicit this
information without changing the intent of the test item.
Elizabeth’s team used clinical opinion when performing her
comprehensive needs assessment. They changed some of the
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questions on the IFSP form to be more appropriate for her age.
Because of her age she isn’t showing an obvious delay, so the team
used their knowledge of child development and Down syndrome to
document her need for services based on her muscle tone and some
subtle feeding issues.
Riley’s team used clinical opinion to know when to consider
qualitative determination of delay. He did not show a qualifying delay
on the BDI-2, but the team felt that his BDI scores did not accurately
reflect his development. The team was specifically concerned about
how difficult it was for Riley to engage with the evaluators and that he
displayed multiple repetitive actions such as walking around in circles
and word/ sound repetition. Riley received a score of 0 on several red
flag indicators correlating to the M-CHAT during administration of the
BDI-2. Further questioning revealed that Riley babbled very little
when he was younger, and doesn't make very many consonant
sounds, so the team administered HELP Strands to gather more
information.
3.69 Activity: Clinical opinion for Riley
In the following four scenarios, was clinical opinion used in each case.
You will answer yes or no.
Question 1: Did the team use clinical opinion to determine Riley's age
equivalent for the domains on the HELP Strands?
A. Yes
B. No
The correct answer is Yes. The HELP does not provide exact age
equivalents. The team used clinical opinion to determine Riley's age
equivalent based on the answers to the items in the strands.
Question 2: Did the team use clinical opinion to determine which
HELP Strands to administer to Riley?
A. Yes
B. No
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The correct answer is Yes. The team used clinical opinion to choose
the appropriate HELP Strands based on the concerns identified when
the BDI-2 was administered.
Question 3: Did the team use clinical opinion to determine which BDI2 domains to administer to Riley?
A. Yes
B. No
The correct answer is No. A comprehensive evaluation is required,
which means administering all strands domains and sub-domains
appropriate for his age.
Question 4: Did the team use clinical opinion deciding that the LPHA
should determine eligibility by documenting a clinical and functional
delay on the eligibility form?
The correct answer is No. This is only an option for children under
three months of age.
3.70: Listening Activity: Explaining evaluation results
Notes:
Before moving on to the next section -- IFSP -- let's put everything
together that you've learned about the evaluation & assessment
process. Read this short role-play of an ECI eval team meeting with a
mother and her baby, Liam. The EIS is Rachel, on the left; the mother
is in the middle, Stephanie, with her baby. The occupational therapist
is Carole, on the right.
Beginning of Role-Play:
EIS, Rachel: That was the last question we have for Liam’s
evaluation. Now we’ll score his evaluation. Do you have any
questions about the evaluation process?
Mother, Stephanie: Not about the process, I only want to know if he
needs services.
End of Role-Play.
EIS, to listener: Before our team shares the results of Liam’s
evaluation, pause and develop a role play about how you will share
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evaluation results with the families you serve. Be sure to include any
tips you have learned from observing evaluation teams at your
program.
Now, take a few minutes to reflect.
Notes:
After reflection, did you use any of these tips in your role play?
· Did you remind the family that the BDI evaluated all of the
child’s developmental areas?
· Did you explain that a delay in one area may cause a delay in
another developmental area?
· Did you show the family the age equivalency scores for each of
the subdomains and explain what is meant by “age
equivalency”?
· Did you use the scaled scores or standard deviation chart to
explain what the delay means?
· Did you review the eligibility criteria and state whether or not
the child qualifies for services?
Now let’s check back in with Liam and his evaluation team.
Beginning of Role Play, Part 2:
Occupational Therapist, Carole: Stephanie, remember how we talked
about how the BDI measures all areas of Liam’s development? I
know you and his doctor are concerned about how Liam’s muscles
are developing. A baby and young child’s developmental areas are all
connected, so sometimes a delay in one area might cause a delay in
another area. We looked at all of his developmental areas to make
sure we aren’t missing anything Liam might need help with.
Liam does qualify for ECI with his gross motor skills. The gross motor
part of the evaluation looked at how he is using his head and neck
muscles and will focus on rolling, sitting, crawling and walking as he
gets older. Liam’s score on the BDI in gross motor is the same as
what is typically seen for a 2 month old, which is a 50% delay for his
age.
Mother- That seems really bad.
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EIS- His percentage of delay is high because of his age. He has only
been alive for 4 months, so a 2 month delay is significant for him. I
know you are worried about Liam. You are already helping him by
having him evaluated and identifying that he needs services.
Mother: Carol, you said all developmental areas are connected. Is he
delayed with anything else?
Occupational Therapist: Liam also shows a delay on the BDI in the
feeding area because he is not eating solid food yet. But, as we
talked about, this is not an area of concern for you or your doctor. He
has no trouble drinking from his bottle.
Liam is not showing a delay in any of his other developmental areas
at this point. All of his other skills are at the level we expect for a four
month old. He is smiling in response to you, he can follow toys and
people with his eyes, he loves to be held and snuggled and responds
to your and Chris’ voices.
Mother: What happens now?
EIS: If you want to enroll in ECI, our next step is to develop Liam’s
plan for services, the Individualized Family Service Plan or IFSP. If
you would like, we can take a little break and then meet to develop
his IFSP or we can come back at a later time so you have more time
to prepare.
Mother: No, I want to get started with services right away.
EIS: Alright, let me give you the notice for the IFSP meeting. This
notice shows you that we are going to have the meeting today and
that we will use the information from Liam’s BDI and the other
information we gathered during his evaluation to help plan the
meeting. During the IFSP we will ask you more questions about what
happens during the day with Liam, set goals for him and plan
services to help you meet Liam’s goals.
Mother: Sounds great.
EIS: Let’s take a quick break. Carol and I will put our test kit back in
the car and then we will be right back….
End of role play.
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3.71: Congratulations!
You have completed Section 3 of the Making It Work module,
Evaluation and Assessment. You will now move on to Section 4,
IFSP.
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