Randal County Early Intervention Assessment Summary for Billy Donaldson

1. Randal County Early Intervention Assessment Summary for Billy Donaldson Julie Falconer/Social Worker Michelle Bechtel/Physical Therapy Amanda Higgins/Psychologist Carly Lopez/Nutritionist Stacy Walters / Speech and Language Therapist

2. Introduction Welcome to Randall County Early Intervention Program This presentation was developed to help Mae and Jack’s family understand their child’s evaluation and provide a quick reference for activities they can do with Billy to work toward his individual goals and objectives.

3. What is the role of a parent in the assessment process?“Your Partnership” • Because you know your child best, we invite you to Participate at a level you are comfortable with and always let us know if: • You feel your child will work better if you are not present • You may feel like an assessment would be more effective if you present test items yourselves. • You may feel uncomfortable "helping" while professionals are watching. or helpless and frustrated when your child will not or cannot do something. • try to remember, many professionals feel the same uneasiness and frustration whey they cannot get a child to respond. • We are here you help relieve your fears and anxieties or validate concerns you have about your child. It is important for both families and professionals to share feelings and concerns. Sharing feelings can help to begin to develop a partnership.

4. The Assessments • Each member of your team has evaluated Billy and prepared a summary of the results. We have also written some goals designed to help you and your family work from a position of strength while helping Billy grow Nutritionist Social Worker OT Billy Jack Mae PT Teacher Nurse

5. Issues Cannot sleep through the night Nutrition is difficult and Billy is too thin Need Online Support Increase social opportunities for Billy Recommendations Would like to see if nutrition piece had an affect here Nutritionist has designed a diet based on your doctor’s recommendations and supervision Will provide 3 discussion boards of parents who are experiencing the same thing you are. When you are ready, we will get Billy signed up with PEAK. This is a program for kids his age. Your Social Worker: Julie Falconer

6. Goals and Desired Outcomes • Family will consult with pediatrician/Dr. to find foods to increase Billy’s calorie intake • Billy will communicate his needs; food, drink, toys, etc., by using words and phrases. • Billy will gain strength and movement by doing daily exercises with help from mom to stretch his muscles and lower joints • Billy will sleep through the night without waking up more than once.

7. Speech / Language Assessment,Stacey Walters Observations: Billy completed many of the tasks in the 7-9 month age range. He can understand some words but uses appropriate gestures and his voice together with pointing. Billy’s listening and talking skills fall in the 7-9 month range. He babbles, imitates, mother, responds to name, waves or responds to “bye- bye”, attends to the conversation of others, says the words, bottle, Nanna (grandmother) shoes, boo, truck and “bye-bye”. He orients correctly to “mommy” and “daddy”. Recommendations: Billy’s language skills are 2-4 months delayed in development. Billy needs speech and language services at home in a play setting with SLP and Mae. Mae and Jack will have a a schedule of a variety of activities to do with Billy to strengthen his speech and language skills.

8. Observations Some distress when asked to perform specific tasks. Billy crawled in a bunny-hop fashion, moving both legs simultaneously.  No reciprocal motion was present in lower body. Billy was observed to prefer W-sitting, but was receptive to this being corrected into a tailor position.  Billy was able to stand to reach for a toy, but did not take any steps to acquire the item. He did not let go of support while standing.  When standing, his Achilles tendons were tight, not allowing his heels to touch the floor.  Billy also stood in somewhat of a “squatted” position, without full extension of his knee or hip joints.  Tightness in these joints was also noted. Billy is able to get into a sitting position on his own but needs correction He did not demonstrate quadruped crawling position during this assessment. .  Billy is able to roll over supine to prone and vice-versa.  Billy had a keen interest in moving toys and small toys. His pincer grasp was inferior compared to other children his age.  He passed objects from hand to hand at midline, never through When Billy was using hand-over-hand prompt, he demonstrated limited independent scribbling for a few seconds after the administrator faded the assistance.  When Billy was sitting, his upper extremities demonstrated appropriate strength and fluidity of movement.  At one time when Billy tried to reach for a toy from a standing position, it was noted that his right arm trembled.  Trunk control seemed appropriate during all phases of positioning. Physical Therapy: Michelle Bechtel

9. Physical Therapy Recommendations: • Billy would benefit from range-of-motion exercises with his lower extremities on a daily basis.  • Mae needs training to learn how to do stretching exercises with Billy.  Family needs information on an alternative to W-sitting.  • Billy is encouraged to participate in more fine-motor activities, such as scribbling drawing and stacking blocks.  • Crossing midline should be encouraged in all play, and some proprioceptive stimulation, such as spinning, rocking, and/or swinging may be beneficial to brain development. • Show Mae and Jack how to apply what they have learned.

10. Things I do well: Ring a bell Put my fingers in pegboard holes Put cubes in a cup when I am asked Beginning to learn how to drink from cup Can get around and explore Can play with my toys; reach, grab, pull, bang and throw his toys Things I find difficult or need help with: Imitate an adults actions; imitating stirring spoon in cup Pick up a cup to find a hidden object Developing object permanence Learning that objects have functions instead of just to chew on; phone, toothbrush Play with one toy at a time Study objects Build and take apart toy and objects Psychological EvaluationAmanda Higgins Playing, Thinking, and Exploring (Cognitive Skills)

11. Things I do well: Plays well with Dad and Mom Recognizes parents and their voices Coos and babbles, can communicate by pointing fingers and grunting at what he wants Responds to his name being called Expresses moods with different sounds and body movements Things I find difficult or need help with: Expressing needs; Billy is unable to talk, but can point to objects or things that he wants Billy is hyper susceptible to illness, so he has not had a lot of opportunity to play and interact with other children. Mimic facial expressions Play games like patty cake and peek-a-boo Interacting with Others(Social/Emotional Skills)

12. What we see now: Billy’s cognitive functioning is 8.1months. He is significantly below his chronological age of 14 months and his adjusted age for prematurity of 11.5 months. His developmental levels in social/adaptive functioning are also significantly below his chronological and adjusted age. Outcome Statement: What we would like to see happen for our child/family Support for Mom and Dad. Mom and Dad to continue to play with Billy. Billy’s eating habits improved. Sleep habits/routines to improve. Plan of ActionAmanda Higgins

13. Strategies to address best practices within the child/family’s everyday routines, activities, and environments Amanda Higgins • Continue to encourage parents to play with Billy. • Play games with Billy like peek-a-boo and patty cake. • Hide objects for Billy to find and help him understand that the objects are there even if he cannot see them. • Talk and read books to Billy and point out and say names for different objects around the house.