Abstract
Comprehensive interdisciplinary, clinically oriented evaluation becomes an intervention by educating the parent (primary caregiver) about a child's development, providing a context for observation, confirming the parent's suspicions of developmental problems, identifying child and family strengths that can be capitalized on, and helping the parent to interpret the child's behavior and to interact in new ways. During the evaluation process, parents become more observant, gain understanding of the child's development and behavior, and on their own begin to develop strategies for dealing with developmental issues. During the evaluation process, clinicians and parents begin to build partnerships that will be important to further intervention and developmental follow-up.
WHEN early childhood professionals think about early intervention, they tend to focus on providing services for a child and family. Evaluation is conceptualized as a means of identifying service needs. Yet the evaluation process itself can become an intervention when it enhances parent-child interaction by educating the parent about the child's development, confirms the parent's suspicions of developmental problems, provides diagnostic clarification, identifies child and family strengths, and helps the parent to interpret the child's behavior and to interact with the child in new ways.
In the following discussion, the term evaluation refers to comprehensive, interdisciplinary, clinically oriented evaluation, conducted over several weeks. Clinicians representing different disciplines conduct their own evaluations, then meet as an interdisciplinary team to formulate diagnoses and recommendations. The primary purpose of this kind of evaluation is to clarify a young child's developmental status, including the identification of developmental disabilities. The family's ability to support the child's development is explored as part of the evaluation process.
Clinically oriented, interdisciplinary evaluation is by no means the only evaluation model available to young children and their families. The assessment model recommended by the Division for Early Childhood of the Council for Exceptional Children (Hemmeter, Joseph, Smith, & Sandall, 2001) involves a transdisciplinary approach. Team members are interdependent and release professional roles, based on discipline-specific skills, to one another. The team includes parents and may also include other individuals (pediatricians, relatives) who are part of a child's life. Assessment often occurs in naturalistic settings. The goal is to identify and implement functional objectives such as supporting the child and optimizing the child's ability to participate in his or her daily life. Evaluation based on a transactional-ecological model, incorporating the interactive influences of genetics and environment, as described in a report by the National Research Council and Institute of Medicine (Shonkoff & Phillips, 2000), would broadly explore environmental influences on a child's development, and would be conducted on an ongoing basis.
While acknowledging the value of other evaluation models, the focus of the following discussion will be limited to the clinical model. The purpose of the discussion is to suggest some ways to extract extra benefit from an activity funded specifically as evaluation. Evaluation should not be considered a substitute for intervention, but rather a first step or component of intervention. In the following discussion, the term parent refers to the primary caregiver (biological parent, foster parent, or relative).
Consider these situations:
A foster mother brought a young child for screening to determine possible need for evaluation. She disagreed with the screener's impressions, but surprised the screener by readily agreeing to have the child evaluated. She said that a previous foster child had been evaluated, noting that she had "learned a lot" during the evaluation process. This suggests the educational function of evaluation.
During one of the early sessions of an interdisciplinary evaluation, a mother said, "I think my son is retarded." The evaluator asked why. The parent replied, "Because his older brother has that diagnosis and this child is acting the same way." This mother was seeking confirmation of what she already suspected.
Another child was brought for a screening appointment. The child had been previously evaluated, placed in an appropriate preschool program, and was receiving good services. When the screener asked the parents why they had come, they said that they wanted to know what was wrong with the child. This family was seeking diagnostic clarification. They wanted a name for the child's problem, and sought information about the cause of the problem and about what to expect in the future.
During several evaluation sessions, clinicians noticed that despite significant difficulty expressing herself verbally, a 3-year-old girl tried hard to communicate. She sought eye contact with adults, pointed at toys she wanted or objects she found interesting, vocalized with conversational intonation, and used a few words and phrases. Her mother looked at her, listened patiently, attempted to understand what she was trying to communicate, and was sometimes able to "translate" for clinicians. When discussing the child at an interdisciplinary team meeting, clinicians agreed that communicative intent was a strength for both the child and her mother, and one that could be capitalized on in intervention and in the daily life of the family.
At the beginning of a feedback session during which results of a multidisciplinary evaluation were to be shared, the clinician asked family members how the child was doing. They replied, "She's doing much better. She has improved a lot." The clinician wondered how this could be. No intervention services had yet been provided or even suggested to the family. For this family, the evaluation process had shown the family some new ways of observing and interacting with the child.