Early Intervention In-Home to Online Evaluations: Why Online Assessments Work

By: Elizabeth Redhead Kriston, MS/CCC-SLP

Twenty-one years ago, when I started my career as an Early Intervention home visiting Speech-Language Pathologist, smartphones and GPS assist did not exist. My flip phone had no capabilities beyond voice calls and voicemail.  My desktop computer served two purposes: MapQuest directions and email. Technology, as we know it today, was in its infancy.

Since then, a seismic shift from low-tech to high-tech occurred. Now, my entire workday centers around all sorts of technology. While technology crept into our professional practice, the way Early Interventionists delivered services also evolved. Time and experience moved our profession from direct, hands-on therapy providers to the coaching model of intervention. In short, we progressed from doing to showing; empowering parents to become the interventionist between therapy sessions.

Who knew that this would set us up for our current state of affairs?  Luckily, Early Interventionists are experts on adaptations and thinking on their feet. The available technology combined with the coaching model seemed a perfect fit to serve families virtually. It took a pandemic to push us into the unknown and make online assessments work in Early Intervention.

And they work beautifully.

Why and How Online Evaluations Work

1.  Current relaxation of HIPAA laws mean online therapy service modes are selected based on each family’s capabilities including conference call, Facetime, Zoom, or other video formats.

2. Selecting a developmental testing tool that permits parent reporting provides flexibility in obtaining a standardized score. Colleagues report successfully using a variety of tools including the Battelle Developmental Inventory, 2nd Edition (BDI-2), the Developmental Assessment of Young Children Second Edition (DAYC-2), the Receptive-Expressive Emergent Language Test, Third Edition (REEL-3) and others. For 3-5yr old Early Intervention kids, current editions of the Goldman-Fristoe Test of Articulation (GFTA-3) and Preschool Language Scales, Fifth Edition (PLS-5) are available to use online with formats provided by the publisher, Pearson.

3. Parents who agree to online evaluations participate fully. When provided with a list of materials to have handy, the parents cooperate with engaging their child in structured play. When given very clear instructions on how to elicit certain skills and responses, such as “Ask Suzy to put the block in the cup, but please don’t point,” parents prove to be competent evaluation partners.

4. Enlisting parents to help administer the testing tool prepares them for the coaching model and online therapy if the child qualifies for services.

5. Multitasking parents bring the online evaluation team along while they complete routine tasks. This sets up a great opportunity to discuss how routines-based, coaching intervention works. Conversely, during in-person evaluations the parent completes similar tasks without inviting the evaluator along, lessening the opportunity for coaching and natural observations to occur.

6. The children behave more naturally than when 2-4 strangers come physically into the home. This provides a more accurate depiction of the child’s developmental levels.

7. The evaluation team does not have to cancel or reschedule for the weather, mild illness, or other factors.

8. Laptops and testing materials brought into the home distract children making the evaluation less effective.

When the COVID-19 crisis comes to end, we Early Intervention professionals need to reconsider the role online therapy should play in our practice. While in-person treatment and evaluations are preferred by most, online therapy should remain a viable option. A hybrid model is an efficacious approach to Early Intervention. This model allows for online therapy to occur for both intervention and evaluation when in-person services are not feasible.

There are numerous scenarios where online therapy would be the best choice. This pandemic has given us a valuable opportunity to test and learn a new service delivery model for Early Intervention.

For those reasons and more, Early Intervention professionals and supervisors should open their minds and laptops to the best practices for each individual family’s needs. Online therapy will allow us to serve more children with consistency and ingenuity while empowering parents to provide stimulating environments to support their child’s development.

Let’s embrace our skills and technology and do what is best for children and families.

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