Hawaii Early Learning Profile

(HELP)

Notes 2
Illinois EI Principles 3
Sample from HELP Manual: Sound Awareness… 4
Guidelines for Determining DALs 10
How to Determine Levels of Development 15
Crediting Practice 18
Assessment Adaptations 20
Evaluation/Assessment Report Format (12/2015) 21
Tips and Tools 23
Evaluation 25

HELP 0-3 Plus Sample Booklet Separate

To order HELP materials, please visit the following:

http://www.vort.com/HELP-0-3-years-Hawaii-Early-Learning-Profile/

Let’s Keep in Touch!

Send mail: EITP at the University of Illinois, 51 Gerty Drive, Room 105, Champaign, IL 61820
Visit our website: https://eitp.education.illinois.edu Follow us on Twitter: @EITPIllinois
Join our Facebook page: https://www.facebook.com/EITPIllinois

Updated 2/2016; Eval 8/2019 Page 1

My Notes

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The Principles of Early Intervention
Adopted by the Illinois Interagency Council on Early Intervention (IICEI) - October 4, 2001

1. The primary goal of EI is to support families in promoting their child's optimal development
and to facilitate the child's participation in family and community activities.

2. The focus of EI is to encourage the active participation of families in the therapeutic process
by imbedding intervention strategies into family routines. It is the parents who provide the
real early intervention by creatively adapting their child care methods to facilitate the
development of their child, while balancing the needs of the rest of their family.

3. EI requires a collaborative relationship between families and providers, with equal

participation by all those involved in the process. An on-going parent-professional dialogue is
needed to develop implement, monitor, and modify therapeutic activities.

4. Intervention must be linked to specific goals that are family-centered, functional, and
measurable. Intervention strategies should focus on facilitating social interaction, exploration,
and autonomy.

5. Intervention shall be integrated into a comprehensive plan that encourages transdisciplinary

activities and avoids unnecessary duplication of services. The plan shall be built around family
routines, with written home activity programs to encourage family participation in therapeutic
activities on a daily basis.

6. Intervention should be monitored periodically to assure that the strategies implemented are
successful in achieving outcomes.

7. Children and their families in the Early Intervention System deserve to have services of highest
quality possible. High standards will be set for the training and credentialing of administrative
and intervention staff. Training, supervision, and technology will be focused to achieve
excellence.

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 Guidelines for Determining Approximate DALs from the HELP Strands

Developmental Age Levels (DALs)

Developed by: Stephanie Parks Warshaw

October, 2007
(Replaces Version: December 2006)

Purpose:
These Guidelines (also referred to as the “Rules”) were developed as a quick reference to help
determine approximate developmental age levels (DALs) when assessing children with the
HELP Strands. They are a supplement to Inside HELP, the administration and reference
manual for using the HELP Strands as a birth to three, curriculum-based assessment. The
“Rules” provide a set of procedures and clarifications to enhance consistent reporting across
staff and programs.

Reporting approximate DALs for individual Strands can assist in developing individualized
intervention plans, and, in efforts to quantify and track progress of infants and toddlers at the
Local, State, and Federal Level.

Development:
The “Rules” are considered an ongoing work in progress. They were included based upon need
for clarification as identified by HELP inservice trainings, questions submitted to VORT and the
author of HELP Strands, and, from a detailed review of completed HELP Strands submitted by
the field. Check for updates on VORT’s website at:
http://www.vort.com/osep/Guidelines_for_Determining_Approximate_DALs_for_HELP_Strands.pdf

Important Notes:

1. HELP is a curriculum-based assessment process. The “Rules” cannot provide exact “scores”
or age equivalents. Approximate DALs derived from the “Rules” are:

• Considered approximate or estimated levels of development compared to the general

birth-three population; and,

• Best understood if shared with families and other team members within a framework
of:
- qualitative descriptions of the child’s unique strengths and needs, and,

- explanation that all children develop at varying rates, and,

- understanding that any month levels reported are approximate, not exact, and are for
quantification purposes only.

2. The term “Rules” is used in this document as a quick name for “General guidelines”.
“Rules” are really about what make sense for this child, at this time, to reflect this child’s
functioning. The “Rules” should not be rigid - they are guidelines!

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 Guidelines for Determining Approximate DALs from the HELP Strands

The “Rules”
Instructions:
1. The “Rules” are only applicable to the HELP Strands. They provide a guide to determine
an approximate DAL for individual Strands within a Domain, e.g., Strand 1-1
‘Development of Symbolic Play’, which is a strand within the broader Cognitive domain.
2. The “Rules” should only be used by professionals who use Inside HELP with the HELP
Strands within the context of the stated “Purpose” and “Important Notes” on page 1.
3. If you are viewing the “Rules” online, click the blue underlined example links to view
samples of completed HELP Strands that demonstrate the “rule”.
4. Individual skill items must be credited and recorded correctly prior to determining
approximate DALs for the Strands. Use the “Credit key”, skill definitions, and credit
criteria from Inside HELP and HELP Strands to insure proper recording and consistent
and accurate skill crediting.
5. Sometimes a child may display persistent atypical or dysfunctional skills and behaviors
that are not typical or appropriate at any age, e.g., pervasive repetitive behaviors, self
destructive behavior, obligatory abnormal posturing. A description of these patterns is
usually more appropriate to report than approximate DALs.

Most important rule: Since each situation, circumstance, and child is unique,
there will always be exceptions to the “rules”

“Rules”
1. General rule - Plus, plus, minus, minus:
Report the last age range with a “+” credit after two consecutive “+” credits followed by
two “–“ credits, unless the Strand ends before two “- “ can be observed. Link to example
for “Rule” 1.
Rationale: If a child displays two consecutive “+ +” (observed or reported) skills or
behaviors in a strand with good quality, you can generally assume earlier skills have
been achieved because of the hierarchical nature of the Strands.
Exceptions & Clarifications:
1.1 This “Rule” does NOT apply to Strands 0.0 or 1-5. Skills in these Strands are
conceptually based and in consecutive age order, but are not hierarchical, i.e., one
skill is not necessarily dependent upon the other. Use clinical judgment if assigning
age levels for Strand 1-5. It is not appropriate to assign age levels to Strand 0-0;
instead report descriptions of appropriate, hyper, or hypo reactions.
1.2 If any skills or behaviors are credited with “A”, you should check earlier skills.
1.3 If something “just doesn’t seem right”, check earlier skills.
1.4 If the child’s chronological age (CA) falls within the final age range credited, report
the child’s CA, or OK, rather than the age range.

2. Age gaps within a Strand. Sometimes there is a several month gap between skills
within a Strand. If so, and, if the child’s CA is higher than the last skill credited “+”, but
lower than the highest age on the next skill, report approximate DAL as “OK”, or as the
child’s CA.

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 Guidelines for Determining Approximate DALs from the HELP Strands

Link to example for “Rule” 2: In Strand 1-4, an 18 month old child is credited with skill
1.67, at 12-15 mo., but not the next skill #1.98, listed as 18-22 mo. Record OK, not 12-
15. Rationale: 15-18 mo. implies a delay. Typically developing children can develop skill
1.98 anytime between 18 to 22 months and this child is not yet 22 months .

3. Add “A” atypical to, or in place of the Strand approximate DAL, whenever skills in
a strand are recorded as “A” because of quality concerns. This is very important to
help insure that needs are identified regardless of DAL, appropriate interventions are
planned, and, progress is measured. Criteria for “A” is listed for each applicable skill in
Inside HELP.
3.1 If a child displays atypical behaviors for most skills in a Strand or behaviors
that are not typical at any age for most items, do not assign an age range,
only “A”.
Link to example for “Rule” 3.1: In Strand 3-4, ‘Weight-bearing in Standing’, a 6
month old displays abnormal muscle tone & postures. Although he demonstrated
some weight-bearing skills up to 6 months, he does so with abnormal patterns and
postures. Record “A” for this strand rather than an approximate DAL. When writing
reports or planning interventions describe child’s motor patterns and needs rather
than noting a DAL.

3.2 If only one or two skills in a Strand were assessed as “A”, add “A” to the
approximate DAL.
Link to example for “Rule” 3.2 In Strand 5-4, ‘Learning Rules and Expectations’, a
15 month old displayed skills and behaviors up to 15 months but a few are extreme.
Record “15 A” for data collection or other quantification purpose, however, a report
for planning and evaluation would say something like, “Johnny displays many
behaviors in this area that are typical for a child his age, however, some of his
behavior is extreme and is interfering with daily activities for him and his family (list
examples)”.

3.3 Add “A” to the DAL for a Strand that assesses, “Left” and “Right” (e.g., left
and right grasp or reach) when skills are observed on one side but not on the
opposite side.
Link to example for “Rule” 3.3 10 month old child displays reaching skills up to 10
months but only using his left arm. For data entry or other quantification purposes
Approximate DAL = 10 A. However, a curriculum planning and assessment report
would say something like, “Johnny displays reaching skills (give examples)
appropriate for age with his left arm, but he avoids or stiffens right arm”

4. Always assess, and consider skills highlighted with an * (asterisk) when

assigning an approximate DAL to a Strand, even if the skill is far below the child’s
age. These are considered foundational lifetime core skills, and should always be
evaluated regardless of age. If the skill is missing or atypical, record “A” for that skill, and
add “A” to the approximate DAL assigned to the Strand.
Link to example for “Rule” 4: Skill 5.04 “Establishes eye contact”, under Strand 5-1
‘Attachment/Separation/Autonomy’: If the child rarely looks at people, record “A” for that
item and add an “A” to the approximate DAL for Strand 5-1.

5. Recording N/A. Do not include individual skills/behaviors assessed as “ N/A” in your

computations to determine approximate developmental age level nor to measure
progress.
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 Guidelines for Determining Approximate DALs from the HELP Strands

a. “N/A” at the Skill level:

(1) Some HELP Skills/behaviors are for anticipatory guidance only. For these
skills and behaviors, mark “N/A” rather than “-“. These skills and “N/A”
instructions are noted in the definition of applicable skills listed in the HELP
Strands assessment booklet.
Link to example for “Rule” 5a(1) Strand 3-2 ‘Supine’, skill 3.35 “Raises hips …in
supine”.
(2) Since most skills within a Strand are in hierarchal order, skills build into
more complex or difficult skills with age. Therefore, when applicable, if a
child does not appropriately display an earlier skill, record “N/A” rather
than “-‘’ so that it is not considered when determining an approximate DAL.
Link to example for “Rule” 5a(2) Strand 1-4C, ‘Cause and Effect’: if child
displays skill 1.50 “Guides action on toy manually”, you can assume the child
can accomplish prior skill 1.24 “Touches toy or adult hand to restart an activity”.
Therefore, if you do not the see the child do this, do not mark “-“. Leave blank
or record “N/A”.

b. “N/A” at the Strand level: Record “N/A” for an entire Strand when the Strand is not
appropriate to assess due to age, disability or circumstance. In these situations, do
not consider the Strand when determining approximate DALs, but provide
explanation.
(1) Some areas of development may be inappropriate to assess due to a child's
disability, e.g. Strand 1-6 A. "Picture Concepts" for a child who is blind, or
"Advancing Postural Control and Motor Planning" skills for a child who is non-
ambulatory. If however you are able to adapt skills in a Strand to accommodate
a child’s disability (see Strand Prefaces in Inside HELP), continue with
determining approximate DAL and add a notation about the adaptation (see
Rule 12)
(2) Some areas of development may be inappropriate to assess due to a child's
age or circumstance. Link to examples for “Rule” 5b(2), example 1, example 2

6. Usually you do not need to consider isolated “-‘’ credits when determining
approximate DALs. All skills are not necessary, appropriate, or relevant to all children.
It is normal not to demonstrate all skills. Use clinical judgment when an isolated “-“
should be considered.
Link to example for “Rule” 6 Strand 1-7 A, ‘Matching and Sorting’: Although this child did
not match black and white colors (skill 1.137) he demonstrated other matching and
sorting skills. His mother reported that her child’s toys are mostly primary colors. Skill
1.139, “Matches identical simple pictures”, was marked “N/A” because it was not
assessed since materials were not available, and, since this child displayed a higher
level skills, i.e., “Can match similar pictures” (skill 1.145), per “Rule” 1.
Exception: Skills marked with * (asterisk) are considered foundational core skills. They
are always relevant and should always be assessed, per “Rule” 4.

7. ‘Aging-out’: If the child is older than, but within a few months of, the age of the last skill
in the strand (which the child displayed with good quality), record “OK” for the
approximate DAL.
Link to example for “Rule” 7 9 month old displays final skill in Strand 4-1 ‘Visual
responses and tracking’, which ends at 5-6 months. Record “OK” rather than 5-6 mo. for
this strand since that could imply a delay in visual tracking.

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 Guidelines for Determining Approximate DALs from the HELP Strands

8. If the last skill credited “+” in a Strand has an age range that includes the child’s
age, record “OK” rather than reporting the skill’s age range.
Link to examples for “Rule” 8, example 1, example 2

9. If the child’s age (e.g., 14 mo.) is less than the last skill credited with a “+” in a
Strand (e.g., 18-24 mo), report the lowest of the highest age in the range for the
approximate DAL, (e.g., 18 mo. for data recording purposes).
Link to example for “Rule” 9

10. If the age range of the last skill accomplished for a child in a strand is greater
than the age range of the next skill in the strand (that the child could not accomplish),
do not report the child’s DAL as the full age range listed for the last skill accomplished.
Link to view example for “Rule” 10 If the child is 12 mo. and the highest skill
accomplished in Strand 1-4B. ‘Means-ends’ is 1.26 “Works for desired, out of reach
object” that has an age range of 5-9 months, and, the next skill in the Strand (which the
child did NOT accomplish), 1.40 “Retains two of three objects” has age range of 6.5-
7.5, the approximate DAL for this child would be about 5-7 mo. rather than 5-9 mo.

11. It is not appropriate to determine an approximate DAL for Section 0.0 -

Regulatory/Sensory Organization. The purpose of this section is to look for patterns
of preferences, capacities, and difficulties related to regulatory and sensory
organization issues. Instead of determining DALs, child responses can be described as
"Typical," "Over-reactive" or "Under-reactive."

12. When you adapt skills in a Strand to accommodate a child’s disability or other
special needs determine the approximate DAL with adaptations and add a notation or
description to qualify the credit and help plan interventions. Suggested adaptations are
available for each Strand Preface in Inside HELP:

Assessment Adaptations

The “Rules” are an extension of Inside HELP’s ‘Assessment Notes’ included in each Strand
Preface and, ‘Instructions’, pages 1.23-i.26. They are considered an ongoing work in progress.
Check for updates on VORT’s website at:
http://www.vort.com/osep/Guidelines_for_Determining_Approximate_DALs_for_HELP_Strands.pdf

DAL Guidelines  2007 VORT Corporation. All rights reserved. October, 2007 Page 5 of 5

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How to Determine and Report Levels of Development Instructions

Important Reminders:
• No child is expected to display all HELP skills listed nor display all skills for an age range. Be sure to
consider individual, environmental, or cultural differences per child.
• The age ranges reported in HELP are the ages at which a skill or behavior (for children who do not have
disabilities) typically begins according to the literature. These age ranges are not when a skill begins and
ends! Some skills are time-limited and emerge into more complex skills, while others are lifetime skills.
Literature varies regarding the age at which a skill emerges, for example, one source may have reported
9 month, another source 10 months, and another source 12 months. HELP would list that skill at the 9-
12 month age range.
• HELP is a curriculum-based assessment, not a standardized test. As such, there is no validity or
reliability data available for HELP. It will not yield a definitive single age level or score. The major
purpose of HELP as a curriculum assessment is to identify curriculum outcomes, strategies and
activities.
• If your program requires standardized scores for eligibility purposes, HELP can be used in conjunction
with a standardized test (see page i.34) to help pinpoint strengths and needs, and to help develop
outcomes, strategies, and activities.

The following instructions and examples provide general "rule of thumb" guidelines for determining approximate
developmental levels. There are no exact rules or formulas that will apply for every child or every assessment to derive
developmental levels. Use clinical judgment and item analysis in this process.

Each Strand Preface in Inside HELP provides specific strand-related information for determining and reporting
developmental levels under "General Assessment Procedures."

Using the HELP Strands (see examples 1 - 5 below) to Determine Approximate Levels of Development

1. The highest skill in each strand.

The highest skill in each strand that the child can accomplish with good quality is, generally, the approximate
developmental level of the child for that strand when he has accomplished at least two consecutive skills. If a
child displays two or more skills in a row with good quality, you can generally assume that he has achieved
earlier skills because of their hierarchical relationship within the strand. Conversely, after a child misses more
than two skills or behaviors in a sequence, you can generally assume the child has not yet accomplished higher
skills in that particular strand. See the examples below.

Example 1: Reporting for a 24 month-old child from

Strand 1-4A. Object Performance (Cognitive Domain)
Date Credit Skill # Age Skill
7/14/96 + 1.49 9-12 Finds hidden object under three superimposed screens
7/14/96 + 1.62 11-13 Hidden displacement one screen
7/14/96 + 1.78 13-14 Hidden displacement two screens
7/14/96 + 1.80 14-15 Hidden displacement three screens
7/14/96 + 1.81 14-15 Hidden displacement two screens alternately
7/14/96 - 1.94 17-18 Series of hidden displacements; object under last screen
7/14/96 - 1.113 21-22 Series of hidden displacements; object under first screen
Note: the Date and Credit are shown in italics to represent your assessment information for the child.

What is the developmental age level? _______ months

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How to Determine and Report Levels of Development Instructions

2. The age range listed for the highest skill is not always the developmental range that you will report.
This situation can occur when:
a. There is a wide age range listed for a skill, e.g., more than 3 months
b. There is a several month gap between skills
c. A child is older or developmentally higher than the age range listed for the last skill in a strand.

2a. If the age range of the skill which is the child's highest credit is greater than the age range of the next
skill in that strand (which he could not accomplish), you would not report the child's developmental level
as the full range reported for the skill accomplished.

Example 2a: Reporting for a 12 month-old child from

Strand 1-4B. Means-0End (Cognitive Domain):
Date Credit Skill # Age Skill
7/14/96 + 1.25 5-6.5 Reaches for a second object purposefully
7/14/96 + 1.26 5-9 Works for desired, out-of-reach object
7/14/96 - 1.40 6.5-7.5 Retains two of three objects offered
7/14/96 - 1.45 8-10 Retains two and reaches for third object
1.47 8-10 Retrieves object using other material
1.46 8-11 Overcomes obstacle to obtain object

In example 2a above, the "approximate" developmental level for the child on Strand 1-4B would be 5-7 months
since the highest skill mastered in Means-Ends was #1.26 "Works for desired, out of reach object." This skill
has an age range of 5-9 months. But since the child could not master higher skills in this strand with a lower age
range, e.g., "Retains two of three objects offered," with an age range of 6.5-7.5, and "Retains two and reaches
for 3rd object" with an age range 8-10 months, you would not report that the child displayed Means-Ends skills
in the 5-9 month range. Instead, you could report e.g., "Johnny displayed Means-Ends skills at about the 5-7
month developmental level. He worked to attain an out-of-reach object, and purposely reached for a second
object while holding one, but could not yet figure out how to obtain a third object."

2b. If there is a gap in age between skills within a strand, use clinical judgment to report the child's
developmental level in that area, depending on the situation.

Example 2b: Reporting for a 17 month-old child from

Strand 1-4C. Cause and Effect (Cognitive Domain)
Date Credit Skill # Age Skill
1.30 5.5-8 Shows interest in sounds and objects
1.24 5-9 Touches toy or adult’s hand to restart activity
2/12/97 + 1.50 9-12 Guides action on toy manually
2/12/97 + 1.67 12-15 Hands toy back to adult
2/12/97 - 1.98 18-22 Attempts and then succeeds in activating mechanical toy

What is the developmental age level? _______ months

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How to Determine and Report Levels of Development Instructions

2c. If a child accomplishes the highest level skill in a strand which has an age range less than the child's
actual age, and if he displays higher level skills in other strands, use the higher ranged strand as your
point of reference.
Example 2c: Reporting for a 10 month-old child (Gross Motor Domain):

Strand 3-1: Prone (lying on stomach)

Date Credit Skill # Age Skill
6/10/97 + 3.07 3-5 Holds head up 90 degrees in prone
6/10/97 + 3.26 4-6 Bears weight on hands in prone
6/10/97 + 3.43 6-7.5 Holds weight on one hand in prone

Strand 3-2: Supine (lying on back)

Date Credit Skill # Age Skill
6/10/97 + 1.29 5-6 Brings feet to mouth
6/10/97 NA 3.35 5-6.5 Raises hips pushing with feet in supin
6/10/97 + 3.42 6-8 Lifts head in supine
6/10/97 + 5.27 6-12 Struggles against supine position

Strand 3-3: Sitting

Date Credit Skill # Age Skill
6/10/97 + 3.33 5-6 Holds head erect when leaning forward
6/10/97 + 3.34 5-8 Sits independently indefinitely but may use hands
6/10/97 + 3.51 8-9 Sits without hand support for 10 minutes

Strand 3-4: Weight bearing in Standing

Date Credit Skill # Age Skill
6/10/97 + 3.60 9.5-11 Stands momentarily
6/10/97 - 3.68 11-13 Stands a few seconds
6/10/97 - 3.71 11.5-14 Stands alone well

What is the developmental age level? _______ months

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 Crediting Practice
Maya: Report of Observed Behavior
Maya has lots of toys in her child care center to choose from, but she tends to
gravitate towards the building blocks and animal figures. She often makes the animals
stand on the blocks and make animal noises. While looking at books with animal
pictures with her dad, she often touches the pictures and tries to make the animal
sound. When her dad asked her to choose the toy animal figure pictured in the book
from a few that were on the ground, she was able to match the horse, but did not
match the other animals. When her parents or child care provider ask her “what’s
this” while looking at pictures or real objects, she often smiles, but has not yet said the
name of any of the objects.

How would you credit the following skill items for Maya?

• Skill item #5.47 (PAGE 25 of STRANDS 0-3Plus) “Shows toy preferences,” in

Strand 5-2?

• Skill item #1.107 (PAGE 7 STRANDS 0-3Plus) “Matches objects to pictures,” in

Strand 1-6?

• Skill item #1.82 (PAGE 7 STRANDS 0-3Plus) “Pats picture”, in Strand 1-6?

Jose’s Video Clip

How would you credit the following skills items for Jose?

• Skill item #4.38 “Transfers object,” in Strand 4-4

• Skill item #4.54 “Uses both hands freely,” in Strand 4-5

• Skill item #3.51 “Sits without hand support for 10 minutes,” in Strand 3-3

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9 month-old baby boy
How would you credit the following skill items for this 9 month old baby boy?

• Skill item #1.15 “Uses hands and mouth for sensory exploration of objects”?

• Skill item #4.39 “Bangs object on the table”?

• Skill item #1.26 “Works for desired, out of reach object”?

• Skill item #1.53 “Uses locomotion to regain object, resumes play”?

• Skill item #2.14 “Vocalizes attitudes other than crying”?

18 month-old playing ball

How would you credit the following skill items for an 18 month old child playing ball?

• Skill item #1.56 “Responds to simple verbal requests”?

• Skill item #2.49 “Echoes prominent or last word spoken”?

• Skill item #3.102 “Picks up toy from floor without falling”?

• Skill item #3.103 “Squats in play”?

• Skill item #5.62 “Experiences a strong sense of self-importance – the “me”

stage”?

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Assessment Adaptations
Visual Adaptations

Motor Adaptations

Auditory &/or Verbal Adaptations

Attention-related Adaptations

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 Page 1 of 2

ILLINOIS EARLY INTERVENTION

EVALUATION/ASSESSMENT REPORT (FORMAT)

SECTION 1: Demographic Information

Child’s Name: Early Intervention #: CFC #:
Date of Birth: Chronological Age: Adjusted Age:
Parent’s Name: Language Spoken in home:
Service Coordinator’s Name: Physician’s Name:

SECTION 2: Type of Report

Check One: Evaluation/Assessment (for Eligibility Determination) Assessment (if child already eligible)
Date of Evaluation/Assessment or Assessment:
Provider Name: Provider Phone Number:
Provider Discipline: OT PT DT SLP SW Other:
Location of Evaluation/Assessment: (check one) Home Other Setting (identify where):

SECTION 3: Referral Information

Please list reason for referral, who referred to Child & Family Connections, and Parent/Guardian Concerns:

SECTION 4: Instrument(s) Administered during Evaluation and/or Assessment

Percent of
Title of Instrument Used Developmental Domain Addressed Age Equivalent*
delay*

*Required for Evaluation/Assessment. If completing Assessment only, provide if known.

SECTION 5: Evaluation and/or Assessment

A. Child’s developmental history and summary of parents’ concerns. Include information from other sources such as
family members, other caregivers, social workers, and educators, as necessary to understand the full scope of the
child’s unique strengths and needs.

B. Summary of medical history, including pregnancy, delivery, child’s health since birth, hearing and vision.

C. Behavioral Observations of the child (also include if observed behavior was viewed as typical or atypical as
compared to child’s usual behavior).

R12/01/15
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 Page 2 of 2

D. Child’s level of functioning (identifying strengths and needs) in each of the developmental areas tested. As
appropriate, include explanation of use of Clinical Opinion in determining eligibility. For annual reviews, also include
information about the child’s progress towards IFSP outcomes.

E. Provide justification for annual re-determination for children not meeting original eligibility criteria:

SECTION 6: Summary and Interpretation

A. Brief summation of the child’s unique strengths and needs, ability to perform functional skills and how the child is
able to participate in family routines. Include a statement about tool’s accuracy in portraying child’s development.

B. If applicable, recommendations for referrals for additional EI assessments and/or other resources outside of Early
Intervention to be discussed at the IFSP meeting.

Evaluator Printed Name

Evaluator Signature Date

R12/01/15
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 Child’s Name:________________________________ DOE:______________
DOB:____________ Age:____________ Adjusted Age:__________________

PLAY SPEECH MOVEMENT

SELF HELP FEEDING BEHAVIOR

2013-2014 Page 23

 Child’s Name:________________________________ DOE:______________
DOB:____________ Age:____________ Adjusted Age:__________________

Ring stack Body parts Pretend Play

Nesting cups Animals Wind Up Toy

Books Colors Picture ID

Crayons Blocks Container Play

Sounds/Words Heard & Reported:

2013-2014 Page 24

Dear Training Participant,

We are conducting a study on the impact of our training program on practices of early intervention providers.
This study is part of the work of the Early Intervention Training Program at the University of Illinois. For
purposes of this study, we would like to invite you to participate by completing the training evaluation form
related to this training as part of the study. By completing this evaluation, you are consenting to be a part of
this research study.

The evaluation can be completed in approximately 5-10 minutes. You do not have to answer any of the
questions that you do not wish to answer. You will not be required to include your name in the form.
Furthermore, we will be aggregating the data from the completed evaluation and analyzing them as a group.
Upon completion of the project, we will destroy all the individual data collected from this study. Results of this
study will be used for a final report due to the Illinois Department of Human Services, journal articles, and
conference presentations. In any publication or public presentations related to this study, pseudonyms will be
substituted for any identifying information.

We want to assure you that information derived from your completed evaluation forms and artifacts will be held
in strictest confidence, and that you may withdraw from the study at any time without penalty. Your
participation in this project is completely voluntary and your choice to participate or not will not impact your
current and future participation in any trainings offered by EITP, your job, and your status in our field. Faculty,
students, and staff who may see your information will maintain confidentiality to the extent of laws and
university policies. Personal identifiers will not be published or presented. We do not anticipate any risk to this
study greater than normal life and we anticipate that this project will contribute to the improvement of training
in the area of early intervention.

For questions about your rights as a participant in research involving human subjects, please feel free to contact
the University of Illinois Institutional Review Board (IRB) Office at (217) 333-2670 or by email at irb@illinois.edu.
You are welcome to call collect if you identify yourself as a research participant.

If you would like a copy of this consent form, one can be provided for your records. Thank you in advance for
your consideration of this request. If you have any questions about this request, you may contact me by
telephone at 217-300-9661 or toll free 866-509-3867 or via email at suec@illinois.edu

Sincerely,

Susan Connor
Early Intervention Training Program at the University of Illinois

Michaelene M. Ostrosky, PhD

Principal Investigator, Early Intervention Training Program at the University of Illinois

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 Training Evaluation Form for Assessment Tools
Please provide feedback on this event sponsored by the Early Intervention Training Program at the University of Illinois
(EITP) around a global assessment, screening or evaluation tool. We appreciate your input and thank you for your time.

Training Event: _______________________________________ Date: _______________________

Presenter(s): _________________________________________ City: ___________ ____

CFC(s) you work with: _____________________________ Position/Role (check one): □ Billing/Admin/Support Staff
□ CFC Manager □ DT □ DT-H □ DT‐V □ Family Member □ Interpreter/Translator □ LIC Coordinator □ Nurse/Nutritionist
□ OT/OTA □ PL □ PT/PTA □ SC □ Lead SC □ SES □ SLP/SLPA □ SW/Psych/LCPC □ TA Rep. □ Other: _________________
Length of Time in Profession: □ Not Yet in EI System □ < 1 Year □ 1‐3 Years □ 3‐5 Years □ 5‐10 Years □ >10 Years
Length of Time in EI System: □ Not Yet in EI System □ < 1 Year □ 1‐3 Years □ 3‐5 Years □ 5‐10 Years □ >10 Years
Highly Largely Somewhat Barely Not
Relevant Relevant Relevant Relevant Relevant

(1) Please rate the relevancy of the presented information and activities
to your understanding of this screening, evaluation or assessment tool.
    
(2) Please rate the relevance of this tool in the process of screening,
evaluation and assessment in early intervention.
    
Great Good Moderate Few No
Please rate your ability to do the following: Skills Skills Skills Skills Skills
5 4 3 2 1
(3) implement the administration and scoring of this assessment tool
in early intervention – BEFORE taking this training.
    
(4) implement the administration and scoring of this assessment tool
in early intervention – AFTER taking this training.
    
(5) discuss the results from this tool for the purpose of making
referrals or determining eligibility – BEFORE taking this training
    
(6) discuss the results from this tool for the purpose of making
referrals or determining eligibility – AFTER taking this training
    
Strongly Agree Neutral Disagree Strongly
Agree Disagree

(7) Content was presented in an organized, easily understood manner.     

(8) Content included explanation and illustration of specific content
knowledge and practice to be learned.
    
(9) This event provided opportunities to practice and/or problem solve.     
(10) This event provided opportunities to engage in reflection of the
material and/or practices.
    
(11) I felt a sense of belonging throughout this training (e.g. you felt
accepted and your contributions were valued as a participant.)
    

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 Strongly Agree Neutral Disagree Strongly
Agree Disagree
I have increased my knowledge, awareness and/or understanding of the following:
(12) the assessment tool’s purpose and how they support the child and
family.
    
(13) the assessment tool’s key components and objectives.     
(14) how to explain the administration and results of this tool to a
family member or other individual who may be unfamiliar with this tool
    
(15) the history, background and/or research to support the use of this
tool
    
(16) the guidelines for the administration of this tool     
(17) deriving an accurate score/result using this tool     
(18) accurately interpreting the results from this tool     
(19) utilizing data from this tool and other sources to make a referral,
identify a delay, determine eligibility, or establish next steps
    
(20) applying recommended assessment strategies     
(21) Please describe one new thing you will try to incorporate into your practice as a result of participating in this training.

(22) What aspects of the training (e.g., goals, format, interactions, activities, trainer, materials) were particularly strong?

(23) If there were aspects of the training that could be improved, what could we do better?

(24) What additional information, skills or training would be most helpful for you using this tool and what you learned in
this training?

(25) Please share any additional comments/suggestions.

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