Parents: Partners in Assessment
Using the ASQ Questionnaire
Using the Ounce Scale
Our Early Head Start program at Early Education Services (EES) in Windham
County, Vermont, serves 107 infants and toddlers. We work hard to ensure
the participation of families in the assessment of their children. From
the outset of our program, several beliefs have guided and informed our
assessment process, including–
- Parents know more than anyone else about their children and can provide
meaningful and reliable information. Families' observations, ideas,
and concerns must be central to planning and performing assessments
- Parents benefit from taking part in evaluations of their children.
During the screenings or assessments, when parents focus on their child
and get support and information, they increase their understanding of
their child's development, strengths, and needs.
- Parents should choose how they will participate in the assessment
process. The more actively involved they are, the better experience
it will be for them, their child, and the home visitor.
- Including families in the process, in ways that they want to participate,
sends the message that they are an important part of the assessment
and more importantly, of their child's life. If we exclude parents
from the process, we risk not only losing important information about
the child, but parents may not fully engage in goal setting, planning,
or the program itself–resulting in fewer benefits for the child
and the family.
Keeping these ideas in mind, we do everything we can to include parents
and to make screening and assessment interesting, fun, and worthwhile.
Parents: Partners in Assessment
When a child is enrolled in the program, the home visitor's first task
is to get to know the family and the child. The goal is to establish a
mutually trusting and respectful relationship, which is valuable because
it enables parents and home visitors to work together to support the child's
development and the parent-child relationship. When parents are active
partners in the assessment (and intervention) process, home visitors and
families share an understanding or belief in what is best for the child,
the parents' priorities are acknowledged, and parents and professionals
work toward shared goals.
In our program, observation and conversation are at the heart of
assessment. We provide ongoing training and supervision to our home visitors
in observing and recording infant and toddler behavior. We also use training
materials and an observation guide that focus on coaching parent-child
interactions. Home visitors become skilled at observing the subtle aspects
of interaction that indicate the quality of the parent-child relationship
and the ways parents and their young children communicate.
At the beginning of a home visit, the professional might ask a question
like: "What kinds of things has Janie been doing since my last visit?"
Noticing that 16-month-old Steven reaches for his bottle on the table
and repeats "ba-ba", the home visitor may say, "What are
some of the ways he lets you know what he wants?" His mother might
begin to describe his emerging language and how talkative he is. These
questions are open-ended, non-threatening and give parents a chance to
say what they want. There is no right or wrong; the parent is the expert.
The home visitor is an active listener and is skilled at engaging parents
in an easy conversation about their child.
When home visitors describe their observations of the child's development,
parents are delighted. It shows that the professional knows the child
and appreciates his or her growth. These observations also validate the
parents' competence as parents and their important role in their
child's development. "I watched how Rosa turns her head when
she hears your voice in the other room. She wants to know where you are!"
Such an observation can also be an opportunity for the home visitor to
talk about the social and emotional development of infants. In this way,
parenting education is a natural outcome of ongoing assessment.
When parents and Early Head Start staff share their thoughts and observations
of the child, it leads to planning and thinking about what goals to set
and which activities will enhance the child's development. In one
family, the toddler was taking great joy in his mobility–he was on
the move all the time. When the home visitor saw how much the child wanted
to practice his newfound skills, she and the family discussed how to encourage
him, even though it was the middle of a very cold winter in Vermont when
outdoor activity was limited. She suggested several indoor places in the
community where he could walk and run. As trust between the families and
the home visitors builds, the sharing of information and observations
increases between them.
Using the ASQ Questionnaire
To supplement ongoing assessment based on observing the child and talking
with the family, EES uses the Ages and Stages Questionnaire (ASQ),
which is designed for child monitoring. The items represent milestones
in five key developmental areas: communication, gross motor, fine motor,
problem solving, and personal-social. There are six items in each category
and they are checked as either: yes, sometimes, not yet. Sample items
at eight months include–
- Does your baby make sounds like "da," "ga", "ka,"
and "ba?" (communication);
- Does your baby pick up small toys with only one hand? (fine motor);
- Does your baby feed himself a cracker or cookie? (personal-social).
At the end of the form, there are a few Yes/No questions appropriate for
the child's age. For example, the ASQ used at eight months asks
these final questions:
- Do you think your child hears well?
- Uses both hands equally well?
- When you help your baby stand, are her feet flat on the surface most
of the time?
Parents are asked to explain any "no" answers. These last items
can be used for screening purposes to indicate areas of concern.
Starting when the infant is 4 months old, the ASQ is used at designated
intervals. We chose Ages and Stages because it is simple to use and
has proven to be reliable and valid. The items are easy to understand and
illustrated. The manual offers guidelines for determining whether children
are at high or low risk in the various developmental areas. Concerns identified
when completing the questionnaire are usually not a surprise to parents
and home visitors, but most likely are questions and observations they have
had on their minds.
Administering the ASQ is relatively simple and straightforward. Although
it was designed for parents to use on their own, home visitors and families
do it together. It does not take long to complete–maybe one half hour–but
the most important part is that it is an opportunity to observe and talk
together. Whenever possible, natur-al observations are used as the basis
for filling out the ASQ. If one of the items pertains to the child's
using the pincer grasp (thumb and forefinger), the child might be observed
eating Cheerios during lunch, picking up one at a time. Sometimes our home
visitors suggest ways to elicit the child's behavior, like inviting
a parent to clap her hands and watch how the baby imitates.
Data from the ASQ are discussed at a meeting between the supervisor
and the home visitor. At this time, the child's accomplishments and
any areas of concern are highlighted and next steps can be planned. EHS
has a large resource library with many curriculum books that staff can use
to plan developmentally appropriate experiences for individual children.
Information from the ASQ is sometimes shared at the agency's
case management meeting–referred to as "Family Update in a Nutshell,"
or F.U.N. At this meeting, held quarterly for each family, the group of
EHS professionals discusses the family. The home visitor briefly updates
the group and discusses relevant issues about the child and family. If necessary,
interventions are planned or a referral is made.
Scales like the ASQ provide useful information about a child's
skills, yet they can also cause undue anxiety for some parents when a child
has not yet reached a milestone. Our home visitors understand child development
and can reassure families that children develop at different rates. They
also provide insight into the growth of the individual child by explaining
that sometimes a spurt in one area of development means a plateau or even
backsliding in another. A home visitor might explain: "The reason Kayla
is not talking much is that most of her energy is going into learning to
walk. When she masters that new skill, her verbal development will probably
Using the Ounce Scale
To better link assessment, planning, and intervention, EES is piloting
a new infant and toddler assessment measure, The Ounce of Prevention
Scale, still in draft form. It not only provides information about
what the child is doing but also helps parents and providers understand
how children use those skills and abilities, and how the environment and
parent-child relationship can support children. It focuses on everyday,
naturally occurring, practical behaviors and accomplishments that are
easily recognized by parents and others. The child's developing social
competency and adaptive capacity are highlighted in the Ounce materials.
The Ounce incorporates multiple strategies of assessment,
including an observational record and accompanying guidelines with
questions and examples of children's behavior at different ages. A
family album enables family members to become actively involved in
making observations about the child's development and offers
suggestions about ways to enhance the child's development and
strengthen their relationship. Finally, a summary record assesses
the child's mastery across different areas of functioning.
We may find that the Ounce Scale complements the ASQ
and use both of them. It is too
soon to tell. We know that any assessment in our program must
involve parents and strengthen their understanding and appreciation
of their children's unique characteristics and progress over time.
Assessment must also help home visitors understand and adapt to the
strengths of each family and respond to their priorities and
concerns. When families and professionals are partners in
assessment, everyone benefits.
Leah Bratton is the Early Childhood Coordinator for the home visiting
program of Early Education Services. T: 802-254-3742; E: firstname.lastname@example.org
I would like to thank Mary Moran, Director of EES, and Dot Marsden,
co-developer of the Ounce Scale, for their help with this article.