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Enhancing Quality Functional Assessments for Each Individual Family

Assessments continue to evolve in a variety of settings including the medical and educational fields. Though these assessments look and feel different, there is one very large commonality.  True individualization is ultimately valued. As we move toward conducting functional assessments, we have to learn how to gather information differently. Rather than interviewing the parent straight from the assessment tool, going item by item, we know that we can gather richer information by having a conversation with the parent about the child’s daily life. Sure, we still need to observe the child and complete the items on the protocols, but these conversations help us relate what we observe to the child’s everyday life – his/her functional development. This helps us individualize assessment, and provide services, in a meaningful, functional way.

What does a functional assessment look like?

One simple way is to start with the parents’ concerns and any new updates, including medical information, since the intake. This is a fantastic role for the service coordinator because they have the information from the intake and can explain what the parents can expect during the assessment process.

Then, begin to ask open-ended questions with the start of a child’s day to bedtime, covering sleep, mealtime, playtime with others and self, naps, community outings, bath time, car rides, and any other relevant routines to the family. This will help trigger any concerns about the child’s day the caregiver may have previously forgotten. Analyzing the caregiver’s responses to the questions can lead into deeper questions and discussion. Try to wait to complete any protocols until the majority of the questions have been asked and the play is completed. This will help the parent feel more open to discussing details of their personal life. This is a vulnerable time and listening and observing help make this process more comfortable. Take a few minutes after the assessment to take the protocols out and complete them prior to reporting out in the three outcome areas. This may feel uncomfortable at first, not having the protocols in front of you. Practicing and understanding the reasoning behind the questions in protocols helps this become a more natural process.

Here are some practical strategies to move toward functional assessment.

  1. Ask open-ended questions centered on a child’s day.

The key is to ask open-ended questions during an assessment that are centered on a child’s routines and activities to gain meaningful information. Open-ended questions strengthen the relationship with the caregiver because we are actively listening and creating rich conversations in order to understand the whole picture of the child’s development within the context of the family’s life. We see the meaning behind the child’s behaviors versus simply identifying behaviors. Consider these questions: What do yes or no answers from an assessment tool really tell us about the child? Can these questions feel intimidating to parents? How can we truly gain a deeper understanding of the dynamics that affect a child’s development? Understanding the dynamics surrounding a child’s life is essential.

Please follow this link for an example of how a functional assessment might flow, including examples of open-ended questions to ask.

  1. Teaming

Functional assessments still include observation, clinical opinion, parent report, and any protocols. Each locality may be set up differently, in terms of who conducts assessment, what tools are used, etc. As long as the teams are communicating information, this should still look similar across localities. The service coordinator facilitates the assessment and supports the family and providers throughout the process. One of the service providers may focus on asking open-ended questions while the other provider facilitates play with the child.

One strategy to increase teaming is to communicate each person’s role in the assessment. After the assessment, discuss what went well and areas to grow. It is important to not be judgmental as this is a learning process for all of us. Communication is the most effective way to build stronger teams. Respect the perspective each person brings to the table and ensure everyone participates in the assessment. Remember, parents play a huge role in our team.

  1. Practice makes perfect.

Incorporating functional assessment into your existing assessment process is easier than expected with practice. Each locality has different processes that need to be individualized to serve the same purpose of a functional assessment. How can we gain a clear picture of a child’s life in order to help provide quality services? Some providers may have set assessment slots that provide a multitude of opportunities to practice and strengthen their knowledge and confidence in conducting functional assessments.

Practice during assessments by asking more open-ended questions and relying less on the protocols being in front of you. During assessments, practice viewing development from a functional perspective looking at how the child will use skills to be successful in his daily life. Role-playing is another way to practice with a colleague. Take turns asking questions as the provider while the other acts as the caregiver.

Every assessment has different variables that may add additional stressors such as a barking dog or siblings. The functional assessment process gains rich information while providing opportunities to consider each child’s interests and family dynamics. In the end, we gain an understanding of the child’s personality, relationship to the caregivers and other people, temperament, learning style, and participation in daily routines and activities. Functional assessments are thorough and help us to receive valuable information to help us create a truly individualized plan for each child.

I would love to hear your own strategies for functional assessments.  Please share your tips on completing functional assessments in your locality.

What are some of your favorite strategies to ask open-ended questions, practice, and/or collaborate as a team?

What are some challenges you encounter when implementing functional assessments?

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2 Comments to “Enhancing Quality Functional Assessments for Each Individual Family”

  1. Moving towards more authentic and functional assessments invites us to also use a strengths based framework. I like to comment on what we natural see the infant or child doing and accomplishing (in their parent’s arms, during feeding, how and what they notice in the environment, or making their way around). In regards to filling out tools, the best way to capture a child’s performance is overtime. Therefore, any skill that is reported or seen from intake should be readily documented, which helps to broaden the functional picture of that child across a period of time.

    • Thank you Pamela for your wonderful insight. This is absolutely moving towards a strengths-based framework based on how a child is functioning in their natural environment. I love your comment about what we naturally see. Observation is critical because it truly gives us insight. One time, I was in an assessment for service planning and the provider was holding a two-month premature baby who became upset and crying. When the provider handed the baby to dad, you could not help but smile at the presence of the secure attachment to dad when the baby instantly relaxed and calmed in dad’s arms.

      Your comment about filling out tools overtime really speaks to ongoing assessment which is a critical process in early intervention. I know this is a requirement now on contact notes to document ongoing assessment over time. Thank you for emphasizing the value of ongoing assessment.

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