The District of Columbia Early Intervention Program has referred Kaila to you for an evaluation. Kaila is 15 months old. She attends an Early Head Start program. Her mother, who is described as having some cognitive limitations, dropped out of high school at 15 years of age and now at 22 is attending a program for adults with developmental disabilities. Her mother is also homeless and lives in transitional housing. Kaila’s mother and her teacher at the Early Head Start program think an evaluation is appropriate. Although she consented to have Kaila evaluated, her mother is not very concerned about Kaila nor her development. She did express some frustration with Kaila’s “fussiness” and her lack of sleeping, however. Kaila’s primary child care provider is extremely concerned about Kaila’s physical growth. Kaila appears very small for her age of 15 months. Kaila’s mother is not sure how much Kaila weighs but did indicate that her pediatrician is following Kaila for her growth. Kaila is described as being a picky eater. She is bottle-fed and is difficult to feed. Although her mother indicated that she has no trouble feeding her at home, the primary child care provider indicated that Kaila often gags and throws up at child care. Kaila’s primary child care provider is also concerned about her temperament. She describes Kaila as having a “flat” affect. Kaila often wants to be held and cries when other children approach her. Her development sounds as though it has been generally slow all around, although not likely 50% delayed. Kaila has just started to walk by herself. She babbles and says “ma ma”. She will wave “bye bye” as well. She will finger feed but will not use a spoon or drink from a cup. Her mother and social worker will accompany Kaila to the evaluation. Her primary child care provider will not be able to attend the scheduled evaluation.
Questions—Kaila
- You are assigned to be the service coordinator for this child and family and will have the opportunity to speak with the mother by phone prior to conducting the evaluation. What additional information would you like to obtain prior to conducting the evaluation on Kaila? Based on the information provided above make a list of questions you would like to ask.
- What information should you share with Kaila’s mother prior to her visit?
- What areas should be addressed during the evaluation and how will you address these areas?
- Who should conduct this evaluation?
- Do you think there may be any mental health issues described? If so how will these be addressed?
- If Kaila is not 50% delayed is it possible that she may still be found eligible for early intervention services? On what basis?
- Are there any other community-based personnel you would like to talk to about Kaila and her mother?
- Develop a comprehensive care plan that addresses the needs of Kaila. Include in the plan the services that can be utilized to help meet those needs, who should be assigned responsibility for them, and a timeline for plan implementation.
Full Answer Section
- Feeding Details:
- What type of bottles are used?
- How long does feeding take?
- What foods does Kaila like/dislike?
2. Information to Share with Kaila's Mother Prior to the Visit:
- Purpose of the Evaluation:
- Explain that the evaluation will assess Kaila's development in various areas.
- Emphasize that the goal is to identify any potential needs and provide support.
- Evaluation Process:
- Describe what will happen during the evaluation (e.g., play-based activities, observation, parent interview).
- Explain that the evaluation is non-invasive and child-friendly.
- Confidentiality:
- Assure her that all information shared will be kept confidential.
- Her Role:
- Encourage her to participate actively in the evaluation and share her observations.
- Explain that her input is valuable.
- Early Intervention Services:
- Provide a brief overview of early intervention services and how they can benefit Kaila.
- Explain that the evaluation will determine eligibility.
- Transportation/Logistics:
- Provide clear directions to the evaluation site.
- Confirm the date and time of the appointment.
3. Areas to Address During the Evaluation and How:
- Physical Development:
- Growth assessment (weight, height, head circumference).
- Observation of motor skills (gross and fine motor).
- Feeding assessment (observation of feeding, oral motor skills).
- Cognitive Development:
- Play-based assessment to observe problem-solving, exploration, and object permanence.
- Assessment of cognitive milestones.
- Communication Development:
- Observation of babbling, vocalizations, and gestures.
- Assessment of receptive and expressive language skills.
- Social-Emotional Development:
- Observation of interaction with mother and evaluator.
- Assessment of temperament and attachment.
- Observation of affect.
- Adaptive Development:
- Assessment of self-help skills (e.g., feeding, dressing).
- Parent-Child Interaction:
- Observation of the mother-child interaction to assess attachment and parenting skills.
4. Who Should Conduct the Evaluation:
- A multidisciplinary team, including:
- Developmental pediatrician or pediatric nurse practitioner.
- Speech-language pathologist.
- Occupational therapist.
- Developmental psychologist or early childhood specialist.
- Service coordinator.
5. Mental Health Issues:
- Kaila's "flat" affect and social withdrawal could indicate potential social-emotional difficulties.
- The mother's own history and current situation increase the risk of maternal depression and anxiety, which can impact child development.
- A developmental psychologist, or social worker with mental health training, should be included in the evaluation.
- Referral for maternal mental health assessment is important.
6. Early Intervention Eligibility:
- Even if Kaila is not 50% delayed, she may still be eligible based on:
- "At-risk" status due to environmental factors (homelessness, maternal limitations).
- Clinical judgment of the evaluation team.
- A diagnosed medical condition that has a high probability of developmental delay.
- Atypical development.
7. Community-Based Personnel:
- Pediatrician: To obtain medical records and discuss Kaila's growth.
- Early Head Start staff: To gather further information about Kaila's behavior and development in the childcare setting.
- Social worker: to gain further information regarding the mothers situation.
- Transitional housing staff: To better understand the living enviroment.
8. Comprehensive Care Plan:
- Needs:
- Growth and nutritional support.
- Developmental delays in motor, communication, and social-emotional areas.
- Maternal support and education.
- Mental health assessment and intervention.
- Services:
- Nutritional counseling and feeding therapy.
- Physical therapy (gross motor).
- Speech therapy (communication).
- Occupational therapy (fine motor, self-help skills).
- Developmental intervention (play-based therapy).
- Parent education and support groups.
- Maternal mental health assessment and therapy.
- Case management and resource coordination.
- Responsibilities:
- Service coordinator: Overall plan coordination.
- Therapists: Direct therapy services.
- Social worker: Maternal support and resource linkage.
- Pediatrician: Medical monitoring.
- Mother: Active participation in therapy and parent education.
- Timeline:
- Within 1 week: Contact pediatrician and Early Head Start.
- Within 2 weeks: Complete evaluation.
- Within 3 weeks: Develop and implement IFSP.
- Ongoing: Regular monitoring and adjustments to the plan.
Sample Answer
This is a complex case requiring a multi-faceted approach. Here's a breakdown of how to address Kaila's situation:
1. Additional Information to Obtain (Phone Interview with Mother):
- Detailed Medical History:
- Specifics about Kaila's growth curve from her pediatrician.
- Any known medical conditions or diagnoses.
- History of illnesses, hospitalizations, or allergies.
- Detailed feeding history: types of formula, amounts, frequency, any supplements.
- Information about Kaila's sleep patterns at home.
- Developmental History:
- More specific milestones: when did she sit, crawl, etc.?
- Any concerns about hearing or vision.
- Details about her play and social interactions at home.
- Information about her daily routines.
- Family History:
- Any family history of developmental delays or disabilities.
- Information about the father of the child.
- Information about any support systems the mother has.
- Environmental Factors:
- Details about the transitional housing environment.
- Access to food and resources.
- Any exposure to toxins or other environmental hazards.
- Information regarding the mothers support system.