The CDC (2023) defines 'developmental screening' and differentiates it from 'developmental surveillance' and 'developmental evaluations;' below is the CDC's screening definition: 

"Developmental screening takes a closer look at how your child is developing. Your child will get a brief test, or you will complete a questionnaire about your child. The tools used for developmental and behavioral screening are formal questionnaires or checklists based on research that ask questions about a child’s development, including language, movement, thinking, behavior, and emotions. Developmental screening can be done by a doctor or nurse, but also by other professionals in healthcare, early childhood education, community, or school settings.

Developmental screening is more formal than developmental monitoring and normally done less often than developmental monitoring. Your child should be screened if you or your doctor have a concern. However, developmental screening is a regular part of some of the well-child visits for all children even if there is not a known concern."

SUGGESTED: Review the CDC handout on 'developmental monitoring and screening' [LINK HERE] and reflect upon 'who' completes the screening and 'why' the screening is complete; further, consider how screening is connected to more comprehensive evaluation/assessment recommendations. 

Crais (2011) defines screening as "a process of identifying children who are at risk for communication deficits so that their eligibility for services can be evaluated. More in-depth assessment can then be provided to guide the development of an intervention program" (pg 341-342). 

SUGGESTED: On pages 342-343 of the Crais (2011) article the "screening process and guidelines" are introduced; make a list of the different methods Crais (2011) discusses as appropriate for (communication) screening AND reflect on how Crais discusses the benefits of using multiple strategies for communication/developmental screening. 

Parents, caregivers, and teachers are the adults in a child's life that most closely observe the child's development and day-to-day interactions. Therefore these trusted adults serve as an important source that can influence clinical decision making during the screening process because they can provide input on the child's behaviors in a naturalistic environment (e.g., home, classroom, with peers). Screeners can gain the perspectives of parents/caregivers/teachers through report measures/questionnaires. For example, the Ages and Stages Questionnaires (ASQ, ASQ-SE) as well as the GRTG Cafes ask about the child's development and include specific questions about communication. 

SUGGESTED: Review the ASQ (48 months) [LINK HERE] and take note of the 'communication' focused questions. 

In addition to the report measures/questionnaires, screeners may find the need to supplement direct assessment and report measures with an additional conversation. Interviewing is a clinical technique that can be used in circumstances where (1) findings need to be confirmed or (2) additional information is needed to make an informed recommendation. Interviews (clinical) with parents, caregivers, or teachers should be viewed as a conversation. There are several interviewing competencies that should be considered (and practiced) in order to establish trust and gain clinical information that informs screening recommendations: 

• Create a welcoming environment (e.g., introduce yourself and explain your role as part of the screening team) 

• Explain procedures and purposes without jargon (e.g., the purpose of screening, the types of screening, aspects of development considered) 

• Use active listening behaviors and monitor your non-verbal reactions (e.g., eye contact, proximity to communication partner, nodding) 

• Use non-distracting note taking 

• Pose follow-up and confirmatory questions that are open-ended (i.e., not just yes/no questions) 

• Show sensitivity and respect for the child and family (i.e., strengths-based and person-first language) 

• Show gratitude and welcome follow-up 

During the screening process we may interview parents/caregivers and/or teachers that have very specific concerns about the child's (communication) development and in other cases they may have more general concerns. It is critical that we enter interview conversations with sensitivity and respect for each family/caregiver and/or teacher. Therefore it is often beneficial to begin interviews (conversations) with DESCRIPTIVE QUESTIONS. Descriptive questions are broad and general and allow people to describe their experiences, their daily activities, and objects and people in their lives. These descriptions provide the interviewer with a general idea of how individuals see their world. Descriptive questions are a critical first type of question(s) as the “responses to the descriptive questions will enable the interviewer to discover what is important to clients or their families. As interviewers listen to answers to descriptive questions, they begin to hear words or issues repeated. These words or issues represent important categories of knowledge. The interviewer wants to understand the relationships that exist among these categories.” In addition to descriptive questions, screeners may want to consider using STRUCTURAL QUESTIONS. Structural questions are used to explore responses to descriptive questions. They are used to understand how the adult, teacher, or parent/caregiver organizes knowledge. Regardless of the question type (descriptive or structural), it is critical that you work to ask questions and present responses with the following qualities: 

• Ask open ended questions 

  • • Tell me about your child's strengths and what you are worried about.

    • Is there something about your child's development that concerns you? Can you describe it? 

• Restate what the client says by repeating the client’s exact words; do not paraphrase or interpret; check-in on understanding.

• Summarize the client’s or parent’s statements and give them the opportunity to correct you if you have misinterpreted something they have said.

• Avoid multiple questions (e.g., chaining several questions together as if they are one question with multiple parts) 

• Avoid leading questions (i.e., questions that assume values or norms) 

• Avoid using "WHY" questions because such questions tend to sound judgmental and assume that the person knows why.

SUGGESTED: Review Table 1 on page 347 of the Crais (2011) article for sample interview questions and consider how these questions are both descriptive and open-ended article LINK HERE. 

Observation is a naturalistic strategy to document children's' interactions and development. For a screener, observing a child begins by noting how each child behaves, learns, reacts to new situations, and interacts with others. Observation within a home, school, or clinical setting includes: (1) observing and reflecting, (2) documenting and gathering evidence (examples), and (3) integrating observational notes with other sources of data (i.e., direct assessment, parent/caregiver report).  

SUGGESTED: Read pages 1-2 in the Forman and Hall article called, "Wondering with Children: The Importance of Observation in Early Education" [LINK HERE] and summarize the reasons observation is an effective method for developmental (communication) screening. 

The following models of observation are relevant to the Get Ready to Grow screening process:

Episodic: Routine-Based. An episodic routine-based observation is an opportunity to observe a child within a familiar/existing part of their routine (e.g., snack time) or as part of a transition (e.g., walk to the screening space). In this type of observation the child's speech, language (receptive and expressive), social interaction, and attention can be noted within familiar settings, with familiar peers/adults, and with familiar materials (e.g., toys). While an episodic routines-based observation may be short in duration, the insights gained can inform the screening results. NOTE: If the screener is part of the child's transition from one setting (e.g., classroom) to another setting (e.g., screening space) they should recognize the importance of that as time for an episodic observation. For example, rather than walking from one room to another in silence, use it as an opportunity to ask about the child's day, their age, what they were just doing, etc. These types of questions within an episodic assessment can give you a great deal of insight on the child and also serve as a chance to build rapport with the child.  

Episodic: Play-Based. An episodic play-based assessment occurs at one specific time in an early childhood, home, or clinical setting; the episodic nature suggests that this is for a limited duration (i.e., amount of time) and as a result of an existing part of the child's day/experience. In other words, this is a short period for observation that the screener does not facilitate. An episodic play-based assessment provides another authentic opportunity to observe all aspects of the child's development including their play (e.g., parallel play, symbolic play, pretend play, perseverative play).

Group (Pair): Play-Based. When a screener wants to complete play-based assessments including a group (or a pair) of children, they can arrange for a group play-based observation within a classroom or screening setting. Toys and materials would be provided for the children engaging in the group (pair) play-based observation; materials may include blocks, markers/crayons, matching game, story mat, etc. 

 Routine-based and play-based observations allow screeners to observe the following: 

• Non-verbal language (e.g., gestures, signaling behaviors)

• Vocalizations (e.g., jargon, real words) 

• Joint Attention and Social Reciprocity (responsiveness) 

• Communication models, supports and expectations 

• Peer social skills (and types of play) 

• Speech Intelligibility 

• Narrative Language (storytelling) 

• Direction following

• Communicative Intent and Repair

SUGGESTED: Review the "Areas to Evaluate and Assess Related to the Child's Abilities" section on pages 348-352 in the Crais (2011) article LINK HERE. ; jot connections you're making to other training topics OR previous experiences/learning. Consider how these may be observable skills within a play-based setting (at home or with peers). 

Observation is an ideal complement to standardized screening measures as it reduces the bias and limitations present in standardized assessment/screening: low-level skills focus, demonstration of skills/knowledge in isolation, inherent cultural and linguistic biases, etc. Owocki and Goodman (2002) wrote the following poem illustrating their commitment to observation and the documentation of children's (language and literacy) development:

I am the teacher who is committed to discovering what each

of my students knows, cares about, and can do. 

I am the teacher who wants to understand each of my student's 

ways of constructing and expressing knowledge. 

I am the teacher who helps my students connect 

what they are learning to what they already know. 

I am the teacher who respects the language and culture my students learn at home,

and who supports the expansion of this knowledge at school. 

I am the teacher who knows that there are multiple paths to literacy, 

and who teaches along each child's path. 

I am the teacher who is committed to social justice and

to understanding literacy and a sociocultural practice. 

I am the teacher who believes that each child can teach me

about teaching, language, and learning. 

I am the teacher who believes in the interconnectedness of

language, learning, and life. 

I am the teacher who supports child in writing

I CAN! on their wings. 

I am a kidwatcher. 

SUGGESTED: Watch the parent-child play-based interaction [LINK HERE] and document what you observe of the child and the adult; consider the communicative intent, the play-based opportunities, and the parent-child interactions. 

Health science and educational research incorporates multiple measurement strategies as a means to minimize error, increase accuracy of findings, and to interpret clinically relevant changes/differences; this process is called the "TRIANGULATION of data." Data source triangulation is a specific type that integrates different sources of data. While triangulation is often considered a research concept, there are clear connections to clinical practice and developmental screening. The Get Ready to Grow screening process includes data from multiple means of assessment: parent reports, observations, instrumentation, and direct assessment (e.g., PLS screener). The results from each method of screening are used to determine if a child demonstrates skills and behaviors expected for their age. 

SUGGESTED: Review the "Interpreting Evaluation and Assessment Results" section of the Crais (2011) article on the bottom of page 352 article LINK HERE. 

The Get Ready to Grow screening process is an opportunity to take a snapshot of a child's development; the process is/includes...

• Planned, purposeful, and evidence-based screening measures, processes, and instrumentation

• Results that are shared in a timely (i.e., same day and accessible format). 

Because the screening process integrates multiple sources of data (i.e., triangulation) in a short period of time to generate results and recommendations at the time of screening it is crucial that those conducting the screening must critically think about results in real time. Critical thinking is the ability to create and construct explanations, to think of implications, and to apply knowledge to solve problems, or in the specific case of screening to make recommendations. The following are qualities of critical thinkers (Browne and Keeley, 2017):

• Self-directed; independently seeing understanding and confirmation 

• Active learners

• Aware of own biases (implicit and explicit) 

• Respectful of evidence and reasoning (over anecdotal stories and generalizations)

• Interpretive and evaluative

• Questioners

Get Ready to Grow screeners will encounter the need to 'triangulate' their findings in order to generate results and recommendations in every screening case. At times screening activities will create red flags requiring critical thinking to determine next steps and recommendations. These may include monitoring, collecting additional information, or recommending a full evaluation or referral. In screening cases where red flags are apparent, the screener must demonstrate quick and informed critical thinking skills to integrate/triangulate the data so that it can be communicated to parents/caregivers and community partners (e.g., preschool providers). The following are suggested reflection questions applicable for screening cases: 

• What are the issues/challenges present? What are the child's strengths? Is more that one area of development impacted? 

• What data do I have? What might be missing? Do I have a complete enough picture to make an informed recommendation? 

• How have I considered expected developmental milestones? How have I considered cultural or linguistic mis-matches for the child? 

• What values and assumptions might I be making in the screening process? 

• What evidence do I have to justify the results/recommendations? What examples can I provide the family/providers? 

• Am I remaining cognizant of the fact that screening activities cannot be used beyond the purpose of identify a concern? Am I being sure to not suggest (to parents/providers) that screening results can determine a child's eligibility for services?

QUIZ 4