Live Observation Rating Form

Caregiver-Child Social-Emotional Relationship Rating Scale (CCSERRS) Caregiver: ______Orphanage ______Ward: ______HTS: Yes _____ No ____ Date of Observation: ______Pre ____ Post____ FUp ______Assessor: ______If Reliability Other Assessor: ______Context: Feeding ______Changing, Dressing, & Bathing ______Free Play ______Episode 1st 2nd 3rd 4th 5th 6th Average Behavior 5 min. 5 min. 5 min. 5 min. 5 min. 5 min. Score Caregiver Engagement 1 Detached, unaware, distant Available, receptive, engaged, . unavailable, disengaged, non-interactive interactive with children 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Caregiver Responds to Children 2 Fails to respond Responds contingently to children, . to children’s acts reciprocal interactions 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Caregiver vs. Child Directed Behaviors 3 Caregiver directed, no expectation Child directed, let’s children lead or of child participation, tells/shows do what they want and supports them . children what to do 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Caregiver Disciplinary Control 4 Intrusive, behavioral control, demand Caregiver supportive, empathetic; . for obedience/discipline, punishes a child encouragement, provides guidance 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Caregiver Affect 5 Negative or flat affect; Positive, warm, affection; . harsh, hostile, punitive appropriate emotional lability 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Child Engagement 6 Detached, unresponsive, withdrawn, Engaged in activities or social interaction; . no social anticipation responsive, social anticipation 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Child Responds to Caregiver 7 Fails to respond to adult-initiated Responsive, anticipation . activities 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Child Affect 8 Negative or flat affect, upset/angry, sad/flat, Positive, happy, alive, animated, . no affect when it would be appropriate appropriately modulated affect 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Child-Caregiver Relationship 9 No relationship, no special Secure, help-seeking relationship, . social interaction with caregivers mutual engagement 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3

Caregiver Total + ______- ______; Child Total +______-______09/15