CFR 1304.20(b)(1-3)
Engaging the Meaningful Participation of Staff and Parents
Some Important Activities for Disabilities Services
Guidelines for Screening and Assessment
Common Pitfalls in Screening
Communication
Use Information Continuously
Empower Parents of Children with Disabilities
Managing Child Records in the Screening and Assessment System
Ensuring Outcomes for All Children
CFR 1304.20(b)(1-3)
The Head Start Performance Standards do not require that any particular
strategy, instrument or technique be used. Appropriate procedures, however,
should conform to sound early childhood practice and be valid, measuring
what they are supposed to measure, and reliable, yielding consistent
results over time and across users. Agencies should consult with the
program's content area experts in health, child development, and mental
health, with parents, and with the Health Services Advisory Committee
as they design and implement a developmental screening approach.
Guidance related to 45 CFR 1304.20(b)(1-3)
Head Start works with families and community partners to enable the early
detection of obstacles to children's development and then intervenes to
reduce or eliminate these barriers. For many children, enrollment in Head
Start provides the first indication that a disability or health condition
may be affecting their development. To promote developmental and learning
outcomes for all children, Head Start programs must plan and implement
a sound, systematic approach for developmental screening and ongoing assessment.
This screening and assessment system must include the careful selection
and administration of instruments and procedures and the competent interpretation
of results. The system must be understood and used by the program and
parents as a means to support developmental and learning outcomes for
all children.
The Performance Standards require that within 45 days of a child entering
Head Start, appropriate screening procedures must be completed to identify
any developmental, sensory (visual and auditory), and behavioral concerns.
These procedures should be appropriate for the child's age, cultural background,
and language and be conducted in collaboration with parents. The Performance
Standards also require that, when appropriate, standardized developmental
screening instruments exist, they should be used, and consultants to the
program should be involved in helping programs select procedures. Sound
screening instruments are designed to have the sensitivity to identify
children who need further assessment and the specificity to exclude those
who do not.
For some children the results of screening procedures, combined with
information available from the ongoing assessment of progress required
for every child (1304.21), may indicate the need for referral for a formal
evaluation by a professional. As the Performance Standards (1308.6(b))
note, even standardized developmental screening is insufficient to determine
disability. This screening merely identifies those children who require
a referral. The formal evaluation, utilizing multiple sources of information
from the family and program (including the ongoing developmental assessment
of the child) will more fully assess the child's status, and determine
what intervention may be needed. (e.g., special education or related services).
A successful screening and assessment system requires appropriate instruments
and procedures. When staff and parents are well-informed and supported
to understand and act upon the information the system provides, it will
positively affect child outcomes. When staff and parents commit time and
energy to necessary procedures (e.g., docu-mentation of parent permission,
timelines, scores, etc.), they expect the program to act upon the information
in a timely and systematic manner to address identified needs and concerns.
A process that responds to the child's needs can reinforce the parents'
expectations that future screening and assessment will be a meaningful
activity for them and their child.
The remainder of this article describes approaches to involving all the
stakeholders in the screening and assessment system and ways of increasing
their understanding and effective participation.
Engaging the Meaningful Participation of Staff and Parents
The planning and implementation of a screening and assessment system requires
coordination and communication within the program as well as with community
partners. The Disabilities Services Coordinator has the responsibility
to provide leadership to the Head Start team and others so that their
activities lead to effective parent involvement and developmental services
for children with disabilities. (See below) But in addition to these activities,
the involvement of the persons with the greatest day-to-day influence
on the child's developmentthe parents and the teachersis critical.
Some Important Activities for Disabilities Services
- Work with the program team to ensure that parents are informed of
the screening's purpose, procedures and results, and kept informed throughout
any formal evaluation that may be required.
- Arrange for a formal evaluation of children who have been identified
as possibly having a disability. Make a referral to the Local Education
Agency/Child Find/Part C Agency as soon as the need is evident.
- Assist Head Start parents and program staff to take an informed and
active role in decision meetings required by the Individuals with Disabilities
Education Act (IDEA).
- Coordinate with managers and staff implementing health services, ongoing
developmental assessments, and family partnerships to assure that the
full range of information available is used continuously to inform appropriate
program planning for children with disabilities.
Guidelines for Screening and Assessment
- Screening and assessment should be viewed as servicesas part of the
intervention processand not only as a means of identification and measurement.
- Processes, procedures, and instruments intended for screening and assessment
should only be used for their specified purposes.
- Multiple sources of information should be included in screening and
assessment processes.
- Developmental screening should take place on a periodic basis. It is
inappropriate to screen young children only once during their early years.
Similarly, provisions should be made for reevaluation or reassessment
after services have been initiated.
- Developmental screening should be viewed as only one path to more in-depth
assessment. Failure to qualify for services based on a single source of
screening information should not become a barrier to further evaluation
for intervention services if other risk factors (e.g., environmental,
medical, familial) are present.
- Screening and assessment procedures should be reliable and valid (i.e.,
consistent in their ability to measure what they are intended to measure).
- Family members should be an integral part of the screening and assessment
process. Information provided by family members is critically important
for determining whether or not to initiate more in-depth assessment and
for designing appropriate intervention strategies. Parents should be given
complete informed consent at all stages of the screening and assessment
process.
- During screening and assessment of developmental strengths and problems,
the more relevant and familiar the tasks and setting are to the child
and the child's family, the more likely it is that the results will be
valid.
- All tests, procedures, and processes intended for screening or assessment
must be culturally sensitive.
- Extensive and comprehensive training is needed by those who screen
and assess very young children.
Meisels, S.J. & S. Provence. 1989. Screening and Assessment: Guidelines
for Identifying Young Disabled and Developmentally Vulnerable Children
and Their Families. Washington, DC: National Center for Clinical
Infant Programs, p. 24.
Common Pitfalls in Screening
- Scheduling a screening when the problem is already observable. When
trained staff report an obvious problem, a referral for a formal evaluation
may be the appropriate first step.
- Ignoring screening results. Some times, initial screening test results
are not taken seriously and a "wait and see" attitude is adopted. Good
screening instruments are usually right, and there is risk of harm from
delayed diagnosis and intervention.
- Relying on informal methods. Informal tools such as checklists often
miss problems. Validated and standardized tools carry the burden of
proof that informal measures lack. We would never select tools for blood
lead or other medical screens with questionable or unknown levels of
accuracy. Why do this with development?
Adapted from F.P.Glascoe and H.L. Shapiro, "Developmental and Behavioral
Screening," 1999.
Communication
Head Start staff may have limited experience in discussing the results
of screening and ongoing assessment with families. When the evidence suggests
that there may be a developmental concern requiring more formal evaluation,
some staff may be reluctant to present this information to parents. For
some Head Start families, this may be the first time that a developmental
concern has come to their attention, others may have had concerns but
were reluctant to discuss them, and still others may have been trying
to get information about their concerns for some time. Whatever the situation,
the quality of the communication between staff and families will have
an impact on a family's willingness to consider and act upon the
screening and assessment findings. Training and supervision must support
this important function.
Programs need a well-planned system for communicating the screening and
assessment results to parents. When communication is not planned and purposeful,
parents of young children with disabilities often relate a common story
of suspecting a problem but being reassured that the child will "grow
out of it." Parents are more likely to accept information when they believe
that they have good communication with the person doing the screening.
Head Start, in its ongoing parnerships with families, has an opportunity
to communicate screening and assessment results to parents in a man ner
that recognizes the child's strengths while systematically responding
when a concern warrants it.
Staff members also need opportunities to explore and discuss with supervisors
any reservations, questions, and concerns about making a referral.
There are hidden costs to discounting screening findingsmissed opportunities
for early intervention may complicate a problem. This issue is often present
in screening for emotional and behavioral concerns that carry a stigma.
If not addressed, the child's behavioral difficulties often produce rejection
by peers. Managers and consultants need to solicit feedback from staff
and parents on whether the screening and assessment are helping them support
children's development. If staff perceive the procedure as having consequences
(e.g., a stigmatizing "label") without resulting in useful guidance about
how to address the behavioral concern, then they are less likely to endorse
the system.
Throughout the year, programs should provide opportunities for feedback
from staff and parents on the screening and assessment system. Inquire
about what is useful, confusing, or perhaps being rejected. Provide feedback
on what the system has accomplished. Acknowledge that any screening process
will "detect" some concerns that, upon further evaluation, do not warrant
intervention; it will also fail to detect some problems that do require
intervention. No screening instrument is perfect but each is tested and
retested to be better than unstructured observations and impressions.
To the extent that families and staff see that the system takes into account
their feedback, respects their knowledge of their children's development,
and makes a difference for children, they will be more supportive of screening
and assessment.
Use Information Continuously
Screening and assessment systems should contribute to the Head Start program's
ongoing efforts to help children reach developmental and learning outcomes.
When implemented well, a system provides specific and timely information
to inform teachers and parents about each child's progress and can support
the individualization needed to address developmental outcomes for each
child. For children with disabilities, the results of formal assessments
and the objectives from individualized plans for special education and
instructional supports provide guidance that must inform their daily experiences.
Remember that while ongoing assessment is, by definition, expected to
occur throughout the program year, screening is most often associated
with the child's entry into the program. Given the rapid growth and changes
which young children display, screening should occur on a periodic schedule
consistent with the Early and Periodic Screening, Diagnosis and Treatment
program (EPSDT) recommendations. For most children, the screening and
assessment system offers reassurance that the child is on track for achieving
the expected developmental outcomes. Furthermore, staff and parents should
be provided direction and support to remain vigilant and responsive to
any concern that emerges after the initial screening period. Sound procedures
have decision rules on when to conduct a rescreening or additional assessment.
Empower Parents of Children with Disabilities
Parents of children with disabilities can benefit from Head Start experiences
that help them practice communication, advocacy, and decision-making skills
using screening and assessment results for their children. Parents of
school age children with disabilities often describe their early experiences
with assessment reports and individualized planning as confusing and intimidating.
Head Start can empower families with expectations they will carry with
them into their child's school careerthat assessment procedures and results
must be explained to generate informed decisions, that parent concerns
must be addressed, and that resources, including other parents, must be
identified to provide support and guidance.
Parents of children with disabilities will need orientation to key concepts
from the Individuals with Disabilities Education Act (IDEA), such as parental
consent, evaluations, confidentiality of records, eligibility for special
education and related services, services in the least restrictive environment,
and rights to due process. Opportunities in Head Start for parent education
on their rights and on the school's obligations under IDEA will help them
develop a sound foundation for their child's school experience. The Disability
Services Coordinator should play an important role in supporting parents'
goals in these areas.
Managing Child Records in the Screening and Assessment System
Key features include
- A record of the procedures used for screening and assessment
- Evidence that the child's family provided information in the screening
process
- A report on the results of screening, including steps taken if further
assessment was indicated (including obtaining written permission from
the parents)
- Evidence that screening and any follow-up assessments and actions were
completed in a timely manner
- Evidence that information is handled in accordance with the program's
confidentiality requirements and is readily available for ongoing use
by staff members who need to act on this information.
Ensuring Outcomes for All Children
As Head Start programs focus attention on how their practices contribute
to developmental and learning outcomes, it is important to recognize that
the 1998 reauthorization of the Individuals with Disabilities Education
Act (IDEA) specified that children with disabilities should be included
in state and local efforts to measure educational outcomes for children.
Advocates for children with disabilities make a convincing argument that
excluding children with disabilities from measures of child outcomes will
reduce or deflect from a school's expectation, and accountability for
ensuring, that all children make significant progress toward the desired
outcomes.
Similarly, in Head Start, an approach that documents success only for
those children without disabilities is not sufficient. All Head Start
children, including those with disabilities, should receive ongoing assessment
linked to Child Outcomes Framework, curriculum planning, and communication
with parents. For most children with disabilities, the key to achieving
positive outcomes will be the provision of needed supports. When the progress
of children with disabilities is included in a program's self-assessment,
the program can develop information on best practices that support the
achievement of outcomes for children with a variety of strengths and needs.
Jim O'Brien is a Program Specialist in the Health and Disabilities
Services Branch of the Head Start Bureau. T: (202) 205-8646, E: jobrien@acf.dhhs.gov.
