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Assessment From Birth to Three

Preparing the Family. Introductory letter, warm and welcomingHelp parents know what to expectHelp parents prepare their child. Before the Interview Begins. Consent to treatInformed consentDevelopmental historyBasic concernsQuestionnaires: PSI, CBCL, etc.. Settling In. Meet immediate needsWarm-up time for fun and exploration (where are the toys?) Offer support and encouragementDescribe what will happen in the interview. (Did anyone tell you why you're here?)Address fears that are re9462

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Assessment From Birth to Three

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    1. Assessment From Birth to Three Family Interview & Interactive Observation E. Kay Barickman, Ph.D.

    2. Preparing the Family Introductory letter, warm and welcoming Help parents know what to expect Help parents prepare their child

    3. Before the Interview Begins Consent to treat Informed consent Developmental history Basic concerns Questionnaires: PSI, CBCL, etc.

    4. Settling In Meet immediate needs Warm-up time for fun and exploration (where are the toys?) Offer support and encouragement Describe what will happen in the interview. (Did anyone tell you why you’re here?) Address fears that are readily apparent

    5. Listen in Earnest Encourage family members to talk as openly as they can about their greatest concerns Help them prioritize these concerns so that the most pressing ones are addressed first Again, offer support and nurturance Continue to address fears as they arise

    6. Genogram/Family History After listening to their primary concerns, ask for permission to find out who’s who, and to find out more about the family’s history. Narrative or genogram - take your pick.

    7. Family Relationships Parent-child relationships Relationships among caregivers Sibling relationships Extended family relationships, sources of support Co-parenting issues Early experiences with the child & timeline of changes in the relationship “Missing persons” and “ghosts in the nursery”

    8. Attachment Separation events (hospitalizations, losses, deaths, moves) Neglect/Abuse Emotional Availability Indiscriminate attachments, extreme ambivalence or distrust, frozen posture

    9. Family Stressors Financial Distress Moves Family Conflict Homelessness/Shelter Living Incarceration Substance abuse Separation/divorce

    10. Parent-Time Refers to “visitation” Degree of cooperativeness among caregivers Consistency & flexibility in scheduling Child’s willingness and ability to tolerate transitions Adults’ use of preparation strategies and transitional objects

    11. Abuse/Neglect/Exposure to DV Any history of suspected or confirmed harm to the child? What happened? Was it reported? To whom? What was the result? Any ongoing investigative, legal, or emotional repercussions?

    12. Daycare/Preschool/Peer Relationships Where do they go? For how long? Prior strengths and concerns in these settings? Ability to separate from caregivers? Quality of peer relationships? Relationships with child care providers? Precipitating events?

    13. Behavioral Concerns Externalizing “Paint a picture for me with words...” Tantrums Whining, defiance, noncompliance Destructiveness, aggressiveness Transition problems Frequency, intensity Precipitating events

    14. Emotional Concerns Internalizing Sleep and appetite disturbances Loss of prior developmental skills Withdrawal, apathy, lethargy Mood (depression, anxiety, anger, lability) Serious, somber or fearful facial expression Interest in play Clinginess, difficulty separating Signs of bereavement Signs of possible trauma

    15. Sensory Integration Tactile (including food textures) Auditory Visual Vestibular Sensitivity to environmental “commotion”

    16. Development & Self-Help Skills Motor development (including oral-motor) Language development Cognitive development Feeding Dressing Toileting “Relatedness”

    17. Development - References The First Twelve Months of Life The Second Twelve Months of Life The Early Childhood Years: The 2 to 6 Year Old Authors = Theresa and Frank Caplan - The Princeton Center for Infancy and Early Childhood

    18. Medical History/Concerns Accidents, illnesses, injuries Prior/current medication (& responses to them, if applicable) - why were they prescribed? Allergies? Foods, meds, environmental Neurological/seizures/head trauma

    19. Legal Issues Parental separation/divorce Custody/visitation disputes Ongoing or previous investigations Caregivers’ legal issues (assault, domestic violence, incarceration, substance-related charges, probation, protective orders, etc.) Be sure to clarify your role!!!

    20. Previous Efforts to Get Help Prior assessments? Where? When? What was it like for you? Was it helpful? Hurtful? How am I doing? Helpful? Hurtful? Need to repair or listen more carefully? Missing important things? Emphasizing the wrong things?

    21. Family History of Psychiatric or Developmental Disorders Maternal family history Paternal family history Immediate family members Are they or have they gotten help? Do they need referrals? Exploration of fears and sources of conflict Support and encouragement

    22. Parent-Child Interactive Assessment Reciprocal interaction? Initiate & Maintain? Emotional tone? Adult: Emotionally available vs. preoccupied? Able to follow child’s lead? Sense of timing? Reflective functioning? Empathic sensitivity? Responsiveness? Balance of nurturance vs. limit setting? Positive vs. malevolent attributions? Child: Able to “woo” the adult, signal needs effectively (cues vs. miscues), make use of available help? Ability to regulate body and emotions?

    23. Interaction Between Child and Evaluator Response to outreach: Appropriate reticence? Presence of secure-base behavior with familiar adults? Able to warm-up? Ability to initiate and maintain interactions Emotional tone, quality of interaction Flexibility and complexity of play interactions Regulatory skills (physical and emotional) Developmental strengths & concerns

    24. Mental Status Exam Appearance, size, activity level Facial expression, eye contact Affect, mood Regulation of physical activity & attention Adaptability Ability to cooperate with caregiver(s) Self-concept Content of play themes

    25. Selected Social and Emotional Assessment Tools

    26. BRIGHT FUTURES TOOL FOR PROFESSIONALS Infancy Checklist

    27. Summarize Interpretation of Behavioral Checklists Who was the informant? Descriptive information. Diagnostic implications?

    28. Formulation A short description of the child within his/her family context. What prompted this assessment? What were the findings? What are the underlying dynamics? What does this child’s behavior “say” to us?

    29. Diagnosis DC: 0-3 --- “Baby-sensitive”, descriptive, developmentally relevant DSM-IV --- Some overlap, conceptually, with DC:0-3. Required for billing third party payers. Not “baby-sensitive”.

    30. Recommendations What other multi-disciplinary supports/referrals may be needed? (Write down resources, and how they can be accessed). Is help needed to access? Further assessment needed? If so, what specific types of assessment, and where may they be obtained? Specific, in-home suggestions for family members. Write them down. Model them. Act them out. Encourage feedback from them. Enlist them in a collaborative effort, and “fire” yourself as the expert.

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