Baby TALK Parent Information Form
Mom (first name) ______(last name) ______Mom’s date of birth ______Mom’s Address (street, city, county, zip) ______Phone (home) ______(cell)______
Email (please print legibly) ______
Ethnicity (circle): White, Non-Hispanic | Black, Non-Hispanic | American Indian/Alaskan Native | Hispanic | Multiracial/Ethnic | Asian/Pacific Islander
Last grade of school completed: ______OR (circle) Current high school student | Some high school, no diploma | High school diploma/GED | Vocational School Training | Associates Degree | Some college | Bachelor’s Degree
Marital Status (please circle) : Married | Single | Widowed | Divorced | Separated
Dad (first name) ______(last name) ______Dad ’s date of birth ______
Dad’s Address (street, city, county, zip) ______Phone (home) ______(cell)______
Email (please print legibly) ______
Ethnicity (please circle): White, Non-Hispanic | Black, Non-Hispanic | American Indian/Alaskan Native | Hispanic | Multiracial/Ethnic | Asian/Pacific Islander
Last grade of school completed: ______OR (circle) Current high school student | Some high school, no diploma | High school diploma/GED | Vocational School Training | Associates Degree | Some college | Bachelor’s Degree
Marital Status (please circle) : Married | Single | Widowed | Divorced | Separated
Baby’s name ______Sex (circle) Male | Female Date of birth ______
Birth Weight ___ lb ___ oz Language spoken at home (circle): English | Spanish | Other ______
Family Structure of the Baby (circle): Two Parent Home | Single Parent Home | Living with Grandparents | Living with other relatives | Living in an extended family | Living with Guardian | Living with Foster Parent | Other
Other children in the Family (first name, last name) ______Date of Birth ______Date of Birth ______Date of Birth ______
Mom’s Employment Status (circle): Unemployed/not seeking employment | Unemployed/seeking employment | Unemployed/enrolled in job training | Employed 20 hrs a week or less | Employed 20 hrs a week or more | Self -employed
Dad’s Employment Status (circle): Unemployed/not seeking employment | Unemployed/seeking employment | Unemployed/enrolled in job training | Employed 20 hrs a week or less | Employed 20 hrs a week or more | Self -employed
Family Range of Income per year (circle): Under 10,000 | 10,000-25,000 | 25,000-50,000 | 50,000-75,000 | 75,000-100,000 | 100,000 and over
WIC eligible (circle) YES | NO
Baby TALK has permission to refer me to other opportunities for my child (signature)______
Baby TALK © All Rights Reserved
Baby TALK Parent Interview Form
Today’s date ______
Mom’s Full Name______Mom’s Date of birth______
Home Phone______
Address______Street Address
______City State Zip
Email (please print legibly) ______
Ethnicity (circle): White, Non-Hispanic | Black, Non-Hispanic | American Indian/Alaskan Native | Hispanic | Multiracial/Ethnic | Asian/Pacific Islander
Last grade of school completed: ______OR (circle) GED | High school diploma | Associate’s Degree | Some Vocational | Completed Vocational School | Some college | Bachelor’s Degree | Master’s Degree | Doctorate Degree
Marital Status (please circle) : Married | Single | Widowed | Divorced | Separated
Dad’s Full Name______Dad’s Date of birth______
Home Phone______
Address______Street Address
______City State Zip
Email (please print legibly) ______
Ethnicity (circle): White, Non-Hispanic | Black, Non-Hispanic | American Indian/Alaskan Native | Hispanic | Multiracial/Ethnic | Asian/Pacific Islander
Last grade of school completed: ______OR (circle) GED | High school diploma | Associate’s Degree | Some Vocational | Completed Vocational School | Some college | Bachelor’s Degree | Master’s Degree | Doctorate Degree
Marital Status (please circle) : Married | Single | Widowed | Divorced | Separated
Baby TALK Parent Interview Form
Baby’s Full Name ______Baby’s Date of birth______
Sex (circle) Male or Female Birth Weight ____lb ____oz
Language spoken at home (circle): English Spanish Other______
Family Structure of the Baby (circle): Two Parent Home | Single Parent Home | Living with Grandparents | Living with other relatives | Living in an extended family | Living with Guardian | Living with Foster Parent | Other
Other children in the Family (first name, last name) ______Date of Birth______
______Date of Birth______
______Date of Birth ______
Mom’s Employment Status (circle): Full time (more than 20 hours per week) | Part time (20 hours or less per week) | Student Unemployed in job training | Self-employed | Unemployed (seeking employment) | Unemployed (not seeking employment)
Dad’s Employment Status (circle): Full time (more than 20 hours per week) | Part time (20 hours or less per week) | Student | Unemployed in job training | Self-employed | Unemployed (seeking employment) | Unemployed (not seeking employment)
Family Range of Income per year (circle): less than 5,000 | 5,000-9,999 | 10,000-19,999 | 20,000- 29,999 | 30,000-39,999 | 40,000-49,999 | 50,000-74,999 | 75,000-99,999 | 100,000 and up
WIC eligible (circle) YES | NO
Baby TALK has permission to refer me to other opportunities for my child. (signature)______
Baby TALK Parent Interview Form
PRIMARY CAREGIVER (if other than parent)
Name______Home Phone______
Address______Street Address
______City State Zip
Highest Grade Completed in School______
Occupation______
Business Address______Phone______
EMERGENCY TELEPHONE NUMBERS
Name Relationship to Child Phone Number
______
______
______
Baby TALK Parent Interview Form
MEDICAL INFORMATION AND HEALTH HISTORY
During this pregnancy, did mother experience any unusual illnesses, conditions, or accidents? ____ Yes ___ No (If Yes, please describe)
______
______
Length of Pregnancy______
Complications during delivery? ____Yes ____ No (If Yes, please describe)
______
______
Birth Weight______
Did the baby have trouble breathing? ____Yes ____ No (If Yes, please describe)
______
______
Did the baby have feeding problems?______
Did the baby have seizures?______
Other problems? ____Yes ____ No (If Yes, please describe)
______
______
Check the illnesses the child has had. Please indicate the child’s age at the last occurrence and whether or not the child was hospitalized:
Illness Yes No Age
Measles ______Chicken Pox ______Mumps ______Strep Throat ______Tonsillitis ______Ear Infections ______Seizures ______Meningitis ______Whooping cough ______
Baby TALK Parent Interview Form
Were any of these illnesses followed by noticeable changes in the child’s general behavior? ____Yes ____ No (If Yes, please describe)
______
______
Describe any surgeries the child has had Surgery Date Hospital ______
______
______
Has your child ever been hospitalized? For what reason? ______
______
______
Does your child have allergies? ____Yes ____ No (If Yes, please describe)
______
______
List medications your child may take on a regular basis: Medication Why? ______
______
______
______
Please list the names of your child’s doctors:
______
______
______
______
Baby TALK Parent Interview Form
Is your child up to date on his/her immunizations? ____ Yes ____ No _____ I’m not sure
What is your child’s current weight?______Height?______
Do you have any concerns about your child’s vision? _____Yes _____ No
If yes, please describe:______
Do you have any concerns about your child’s hearing? ____Yes ____No
If yes, please describe: ______
DEVELOPMENTAL HISTORY
Has your child ever had a developmental screening, assessment or evaluation? ____Yes ____No
If yes, please describe the results. ______
______
Date of the screening, assessment or evaluation ______
What is your child learning right now? ______
______
Do you have any concerns about your child’s development? ______
______
Does your child have behaviors that concern you? If yes, please explain:______
______
Baby TALK Parent Interview Form
SOCIAL INFORMATION
Does your child currently attend a child care center/program? ____Yes ____No
If yes, where?:______
What are your child’s most enjoyable activities?______
______
What frightens your child?______
What do you do to comfort your child?______
______
What is your child’s schedule for snacks and meals?______
______
What is your child/s sleeping/napping schedule?______
______
What are your child/s favorite playthings?______
______
List the places your child frequently visits:______
______
List the significant people in your child’s life:______
______
Describe any special information you would like Baby TALK to be aware of:______
______
______
______
Baby TALK Parent Interview Form
CONSENT TO SCREEN
I hereby authorize certified personnel of Baby TALK, Inc, to administer a developmental screening or assessment to my child ______, for the purpose of providing appropriate services. I understand the results of the screening will be shared with me.
______Parent/Guardian Signature
______Date
Baby TALK Parent Interview form
Today’s Date:
Mother’s Information Name:
Home phone: Date of birth:
Street address:
City: State: Zip:
Email:
Ethnicity: Marital status:
Last grade of school completed:
Father’s Information Name:
Home phone: Date of birth:
Street address:
City: State: Zip:
Email:
Ethnicity: Marital status:
Last grade of school completed:
Baby TALK Parent Interview Form Page 1 Baby TALK Parent Interview form
Child’s Information Name:
Date of birth: Birth weight: Lb. Oz.
Sex: Language spoken at home:
Ethnicity: Family structure of baby:
Other children in the family:
Mom’s employment status:
Dad’s employment status:
Family range of income per year: WIC eligible: Yes No
Baby TALK has permission to refer me to other opportunities for my child.
(Signature)
Primary Caregiver (if other than parent) Name:
Home phone: Date of birth:
Street address:
City: State: Zip:
Email:
Baby TALK Parent Interview Form Page 2 Baby TALK Parent Interview form
Occupation:
Last grade completed in school:
Business address:
Business phone:
Emergency telephone numbers Name:
Relationship to child: Phone:
Name:
Relationship to child: Phone:
Name:
Relationship to child: Phone:
Name:
Relationship to child: Phone:
Baby TALK Parent Interview Form Page 3 Baby TALK Parent Interview form
Medical Information and Health History During this pregnancy, did mother experience any unusual illnesses, conditions, or accidents? Yes No (If yes, please describe)
Length of Pregnancy (weeks):
Complications during delivery? Yes No (If yes, please describe)
Did the baby have trouble breathing? Yes No (If yes, please describe)
Did the baby have feeding problems? Did the baby have seizures? Yes No Yes No
Other problems? Yes No (If yes, please describe)
Check the illnesses the child has had. Please indicate the child’s age at the last occurrence and whether or not the child was hospitalized:
Illness Yes No Age (in months)
Measles
Chicken Pox
Mumps
Strep Throat
Baby TALK Parent Interview Form Page 4 Baby TALK Parent Interview form
Tonsillitis
Ear Infections
Seizures
Meningitis
Whooping cough
Were any of these illnesses followed by noticeable changes in the child’s general behavior? Yes No (If yes, please describe)
Describe any surgeries the child has had.
Surgery Date Hospital
Has your child ever been hospitalized? Yes No
(If yes, for what reason)
Does your child have allergies? Yes No
(If yes, please describe)
Baby TALK Parent Interview Form Page 5 Baby TALK Parent Interview form
List medications your child may take on a regular basis:
Medication name Why?
Please list the names of your child’s doctors:
Doctor’s name:
Doctor’s name:
Doctor’s name:
Is your child up to date on his/her immunizations? Yes No I’m not sure
What is your child’s current weight and height? lbs. oz. ft. in.
Do you have any concerns about your child’s vision? Yes No
Do you have any concerns about your child’s hearing? Yes No
(If yes, please describe)
Baby TALK Parent Interview Form Page 6 Baby TALK Parent Interview form
Developmental History Has your child ever had a developmental screening, assessment or evaluation? Yes No Date of the screening, assessment evaluation: Describe results:
What is your child learning right now?
Do you have any concerns about your child’s development? Yes No If yes, please explain:
Does your child have behaviors that concern you? Yes No If yes, please explain:
Social Information Does your child currently attend a child care organization? Yes No If yes, where:
What are your child’s most enjoyable activities?
What frightens your child?
What do you do to comfort your child?
What is your child’s schedule for snacks and meals?
Baby TALK Parent Interview Form Page 7 Baby TALK Parent Interview form
What is your child’s sleeping/napping schedule?
What are your child’s favorite playthings?
List the places your child frequently visits?
List the significant people in your child’s life?
Describe and special information you would like Baby TALK to be aware of?
Consent to Screen I hereby authorize certified personnel of Baby TALK, Inc., to administer a developmental screening or
assessment to my child , for the purpose of providing
appropriate services. I understand the results of the screening will be shared with me.
Parent/Guardian Signature
Date
Baby TALK Parent Interview Form Page 8
Baby TALK Screening for Eligibility Tool
Qualifiers for Intensive Services / Case Management
Parent’s Name ______Today’s Date ______Child’s Name ______Date of Birth ______Child’s Name ______Date of Birth ______Child’s Name ______Date of Birth ______
Family refers to the immediate family, mom, dad and live-in grandparents. Immediate enrollment as space allows
Family is involved in domestic violence Yes No A family member has alcohol or substance abuse involvement A family member has a developmental delay Family has mental health needs Family member who is incarcerated/probation/parole Family is homeless or has insecure housing Family has had involvement with Child Protective Services Parent is a teen Parent is an English Language Learner
3 pts Child has a developmental delay and/or IFSP _____ Child has a possible delay in development (as determined at developmental screening) _____ Child has a chronic medical condition _____ Mother has a chronic medical condition _____ Mother has had postpartum depression _____ Parent desires positive interactions with child, and an understanding of child development and/or parenting skills _____
2 pts Family is living in a home which does not have basic utilities to include power/water _____ Family is on public aid, receives food stamps, WIC or has a medical card _____ Family does not have a health care provider _____ Family lives in isolation without a support system (family, friends, medical, faith based) _____ Family consists of more than 2 children under 5 years of age _____ Child lives with another adult other than the birth parent _____ Child has a medical concern _____ Mother has a medical concern _____ Mother has had a high risk pregnancy _____ Parent is a non-high school graduate _____
1 pt Family member is an active member of the military _____ Family member is unemployed _____ Family consists of a single parent _____
Child had a birth weight of 5.5 pounds or less _____ Child had a premature birth _____ Child has a sibling who is habitually truant from school _____ Mother has had an unfulfilled pregnancy (miscarriage, abortion) _____
Other: ______TOTAL: _____
Does the family receive Family Support through another agency? If yes, which agency? Name of case manager?
If yes, what services are needed by the family which Baby TALK can provide and the other agency cannot provide?
Family qualifies for Family Support services: Yes / No
The family will be enrolled in the following program:
The Baby TALK staff member assigned is:
The family qualifies for Family Support services and will be placed on the waiting list: Yes / No
If the family is referred to another agency, name of agency and date of referral:
Comments:
Baby TALK © All Rights Reserved Baby TALK Screening for Eligibility Tool
Qualifiers for Intensive Services / Case Management
Parent’s name Today’s date
Child’s name Date of birth
Child’s name Date of birth
Child’s name Date of birth
Family refers to the immediate family, mom, dad and live-in grandparents Immediate enrollment as space allows Yes No Family is involved in domestic violence Yes No A family member has alcohol or substance abuse involvement Yes No A family member has a developmental delay Yes No Family has mental health needs Yes No Family member who is incarcerated/probation/parole Yes No Family is homeless or has insecure housing Yes No Family has had involvement with child protective services Yes No Parent is a teen Yes No Parent is an English language learner Yes No
3pts Child has a developmental delay and/or IFSP
Child has a possible delay in development (as determined at developmental screening) Child has a chronic medical condition Mother has a chronic medical condition Mother has had postpartum depression Parent desires positive interactions with child, and an understanding of child development and/or parenting skills
2pts Family is living in a home which does not have basic utilities to include power/water Family is on public aid, receives food stamps, WIC or has a medical card Family does not have a health care provider
Family lives in isolation without a support system (family, friends, medical, faith based) Family consists of more than 2 children under 5 years of age Child lives with another adult other than the birth parent
Baby TALK Screening for Eligibility Tool Page 1 Child has a medical concern Mother has a medical concern Mother has had a high risk pregnancy Parent is a non-high school graduate
1pt Family member is an active member of the military Family member is unemployed Family consists of a single parent Child had a birth weight of 5.5 pounds or less Child had a premature birth Child has a sibling who is habitually truant from school
Mother has had an unfulfilled pregnancy (miscarriage, abortion) Other TOTAL
Does the family receive Family Support through another agency? Yes No If yes, which agency?
Name of case manager?
If yes, what services are needed by the family which Baby TALK can provide and the other agency cannot provide?
Family qualifies for Family Support services Yes No
The family will be enrolled in the following program
The Baby TALK staff member assigned is The family qualifies for Family Support services and will Yes No be placed on the waiting list If the family is referred to another agency, name of agency and date of referral Name of agency Date of referral Comments
Baby TALK Screening for Eligibility Tool Page 2
Baby TALK Family Support Checklist
Name ______
Form Timeline Date Completed
Parent Interview Form Screening ______(Family demographics, home language survey, health history, social history, consent to screen)
Child Developmental Screening(ASQ/HELP)Screening ______
Screening for Eligibility Tool Screening ______
Family Welcome Letter Enrollment ______
Intensive Services Enrollment Form Enrollment ______
Copy of Child’s Birth Certificate Enrollment ______(If child is not born in Macon county)
Consent to Release Information Enrollment ______
Consent to Photograph/Video Enrollment ______
Family Resource Assessment& Monitoring 6 weeks after enrollment, ongoing ______(Developmental assessment, health, vision, hearing))
IFSP 2 months after enrollment ______
Transition Plan 6 months before exiting program ______
ISBE Outcomes Questionnaire (by staff) Before exiting program or at semester ______
ISBE Parent Questionnaire (by parent) Before exiting program or at semester ______
Intensive Services Exit Form Closing ______
Baby TALK © All Rights Reserved
Baby TALK Home Visiting Reference Guide
Newborn Newborn Developmental Perspectives
1 Month One Month Developmental Perspectives IELG: I love your voice! - Knows your voice Let’s TALK- A Cry of Passion, crying IELG: My eyes can track! - Follows an object Handout and Activity: Can My Baby See, art book IELG: I can lift my head - Lifts head briefly Let’s TALK- The Powerful Newborn, newborns impact their world
IELG: Why do I startle? - Responds to a noise
Handout and Activity: Large Motor Development, foot rattle Supplemental Material(s)
2 Months Two Month Developmental Perspectives
IELG: So, these are MY hands! - Hand awareness
Let’s TALK- The Diaper, opportunities in diapering
IELG: Do you want to talk? - Mouth noises, face-to-face interactions Handout and Activity: Hey Good Lookin’, mirror card IELG: Is this what I look like, too? - Loves to look at faces
Let’s TALK-That Bad Baby, good baby vs. bad baby
IELG: I know what happens next! - Begins anticipating routines Handout and Activity: Attachment, fleece blanket Supplemental Material(s)
3 Months Three Month Developmental Perspectives
IELG: I can lift my head and chest! - Raises head and chest when on tummy
Let’s TALK- The Eyes Have It, learning through observation IELG: Shake, rattle, and grasp! - Grasps and shakes toys Handout and Activity: Along for the Ride, car seat gallery IELG: Baby’s Got Babble! - Begins to imitate sounds Let’s TALK- A Face in the Crowd, stranger recognition IELG: You make me smile! - Smiles socially
Handout and Activity: Look Into My Eyes, tracking toy
Supplemental Material(s)
4 Months Four Month Developmental Perspectives IELG: Rolling to back - Rolling over Let’s TALK- The Mozart Effect, music’s impact
IELG: Sitting so Pretty - My neck is becoming stronger Handout and Activity: Puppet Play, bunny puppet IELG: Learning through my senses, my mouth is the best! - Explores objects with his mouth
Let’s TALK- Born to Learn, support baby’s learning
IELG: The World is a Rainbow - I can see lots of colors now Handout and Activity: Mother Goose Rhymes, book Supplemental Material(s)
5 Months Five Month Developmental Perspectives
IELG: That’s my name! - When you call his name
Let’s TALK-Daily Reunion, reuniting with baby
IELG: (Almost) In the palm of her hand! - Rakes small objects with whole hand
Handout and Activity: Fun with Blocks, soft blocks IELG: Listen to the beat! - Reacts to music by cooing Let’s TALK-Being with Babies, being present with baby IELG: Hand to mouth! - Brings toys to mouth Handout and Activity: Visual Development, picture cards
Supplemental Material(s)
6 Months Six Month Developmental Perspectives
IELG: Left, Right, Write- Fine Motor & Early Pre-Writing Skills - Transfers objects between hands
Let’s TALK-Affairs of State, state management
IELG: Peek-A-Boo! I Learn By Looking At You! - Plays peek-a-boo Handout and Activity: Colors All Around, book of colors
IELG: Partially out of sight…but not out of mind! - Finds partially hidden toy
Let’s TALK-Stressed Out!, stress in babies
IELG: Infant with a cause…and reaction! - Begins to understand cause and effect
Handout and Activity: Object Permanence, peek-a-boo board
Supplemental Material(s)
7 Months Seven Month Developmental Perspectives
IELG: I feel for you! - Responds to your facial expressions Let’s TALK- They Don’t Miss a Thing, babies and cognition IELG: Meet me in the middle - Holds objects mid-line Handout and Activity: The Value of Board Books, spool ring IELG: BIG on Books Even Though I’m Little - Listens to you read and talk about pictures
Let’s TALK- Universal Issues, Unique Responses, culture impacts parenting
IELG: Your Little Handful Has Her Hands Full - Holds two of three objects offered
Handout and Activity: Music for Your Baby, rockin’ drums Supplemental Material(s)
8 Months Eight Month Developmental Perspectives
IELG: My Babble has meaning! - Babbling with consonants? Da, Ma, or Ba?
Let’s TALK-About Face, face to face interactions
IELG: I can use my fingers! - What small items does she want to pick up with her pincer grasp?
Handout and Activity: Sibling Adjustment, bear puppet
IELG: Who’s that baby! - I reach out and pat the things I see in the mirror
Let’s TALK-Just When You Thought . . . , developmental pace
IELG: Ready, set, move! - Is the baby interested in motor activities? Handout and Activity: Baby-proofing Your Home, rolling toy Supplemental Material(s)
9 Months Nine Month Developmental Perspectives
IELG: What is the limit? - Setting limits Let’s TALK-The Parent Connection, parents support one another
IELG: Bang, bang, bang! - Bangs objects together at midline
Handout and Activity: Creating Your Own Family Culture, jingle drums IELG: Here is my nose and there is a ball! - Points to body parts Let’s TALK-Building Parental Muscles, parental development
IELG: New people can be scary! - Stranger anxiety Handout and Activity: Going to the Doctor, doctor bag Supplemental Material(s)
10 Months Ten Month Developmental Perspectives
IELG: Books are yummy! - Looks at picture books Let’s TALK-Take Care, self care IELG: Look what my body can do! - Pulls to stand
Handout and Activity: Leaving Your Baby, babysitter board
IELG: “The wheels on the bus go…” - Likes moving parts on toys Let’s TALK-Tug of War, parental responsibilities IELG: Look what I did!!!! - shows pride in accomplishments Handout and Activity: Sweet Success, clothes pin drop Supplemental Material(s)
11 Months Eleven Month Developmental Perspectives IELG: How big is baby…so big! - Playing “so big” Let’s TALK-Falling in Love Again, changes in families
IELG: Since you thought that was funny, I’ll do it again! - Repeats actions if laughed at
Handout and Activity: Out & About with Your Baby, stroller toy IELG: Fill and dump, fun, fun, fun! - Puts objects in containers Let’s TALK-Learning Ups and Downs, developmental model IELG: What’s on that spoon? - Holds a spoon Handout and Activity: Cause & Effect, magic scarf box Supplemental Material(s) 12 Months Twelve Month Developmental Perspectives
IELG: Listen to me! - May say a few words: "mama," "dada," and "uh- oh"
Let’s TALK-Comfort and Joy, self-regulation IELG: Roll, roll, roll your ball! - Begins to roll or push a ball
Handout and Activity: Daily Schedule, naptime sign IELG: I know what you mean! - Responds to directions Let’s TALK-Learning to Respond, emotional and cognitive development IELG: I can do it myself…please help me! - Wants to be independent Handout and Activity: Bath Time, bathtub stick-ons Supplemental Material(s)
13 Months Thirteen Month Developmental Perspectives
IELG: I love you the best! - strongly attached to a specific toy Let’s TALK-Your Mother and Mine, motherhood IELG: May I have this dance? - likes to dance to music
Handout and Activity: Balls, ball play
IELG: I’m “telling” you no! - Shakes head “no”
Let’s TALK-One Bite at a Time, the small things count IELG: What’s the point? - Understands and uses pointing Handout and Activity: Bedtime, bedtime moon Supplemental Material(s)
14 Months Fourteen Month Developmental Perspectives
IELG: I am SO frustrated! - Shows frustration by having a tantrum Let’s TALK-Taking on Temperament, temperament and behavior IELG: Let me show you how much I love you! - Shares affection Handout and Activity: Big and Little, growth chart IELG: Waving, signing? Communication is fun! - Waves bye-bye and can communicate with sign language
Let’s TALK-No More Buy Buy Baby- relationships impact development
IELG: Page by page, I am learning to love to read! - Wants to turn pages in books and Enjoys looking at picture books
Handout and Activity: Sign Language, basic signs
Supplemental Material(s)
15 Months Fifteen Month Developmental Perspectives
IELG: Even when it’s hidden I know it’s still there! - Finds a hidden toy Let’s TALK-Collecting Expertise, parents learning curve
IELG: I want to be friends…maybe - Shows more interest in playing with others
Handout and Activity: Farm Animals, paper bag puppet
IELG: It may have been ok last week, but now I am SCARED! - May show fear and insecurity with a previously accepted situation
Let’s TALK-Face It, power of a parents face
IELG: Let’s have a (pretend) picnic! - Enjoys “Make Believe” play; wants to imitate adults
Handout and Activity: Fish, paint a fish scene
Supplemental Material(s)
16 Months Sixteen Month Developmental Perspectives
IELG: How high can I go? - Builds a 4 block tower
Let’s TALK-All in a Night’s Work, sleep
IELG: I can climb stairs, and furniture, and who knows what! - Walks up steps and Climbs from one piece of furniture to another
Handout and Activity: Going to the Zoo, zoo puppets
IELG: I am talking, are you listening? - Babbles with expressions; may use simple words
Let’s TALK-Totally (Not) Prepared, proactive/reactive parenting
IELG: Pouring water? Bath time just got more fun! - Pours water into different sizes of containers during bath time
Handout and Activity: Sign Language, family signs Supplemental Material(s)
17 Months Seventeen Month Developmental Perspectives
IELG: I see what you’re asking and I can point to it! - Points to pictures of familiar objects
Let’s TALK-Bubble-Wrap the Baby, keeping baby safe
IELG: I can do it again, and again, and again, and again… - Enjoys doing the same things over and over
Handout and Activity: Sign Language, social signs
IELG: I can clean, fold, sweep…and I love it! - Helps in your jobs around the house
Let’s TALK-The Tipping Point, tantrums
IELG: The cow says moo, the dog say woof! - Makes animal sounds while looking at books about animals
Handout and Activity: Rain, crayon and watercolor picture Supplemental Material(s)
18 Months Eighteen Month Developmental Perspectives
IELG: Let's sing and motion together - Imitates songs and finger plays Let’s TALK-The Soul of a Story, reading to children IELG: I can do it by myself! - Does things for himself
Handout and Activity: Sign Language, food
IELG: If I want it, it’s mine; if I see it, it’s mine; if I had it, it’s still mine! - Is possessive of toys
Let’s TALK-The First Time, celebrating baby’s firsts
IELG: If you cry I will give you a hug! - Shows sympathy Handout and Activity: Bugs, plastic bug sensory activity Supplemental Material(s)
19 Months Nineteen Month Developmental Perspectives
IELG: Kicking and throwing a ball is fun! - Tries to kick a ball; tries to throw a ball
Let’s TALK-The Power of Persistence, parental endurance
IELG: Head, shoulders, pants, and shoes! - Points to body parts and clothing when named
Handout and Activity: Bears, clay paw prints
IELG: Family pictures are fun to look at, especially when they include me! - Enjoys looking at a family book made out of family pictures
Let’s TALK-Great Expectations, discipline
IELG: Budding Monet, look at my drawing! - Scribbles on paper Handout and Activity: Fall Leaves, leaf and contact paper project Supplemental Material(s)
20 Months Twenty Month Developmental Perspectives
IELG: I want you, don’t go! - May have difficulty with separation Let’s TALK-Trips with Tots, traveling with a toddler IELG: I can put the puzzle pieces in! - Completes a simple three or four piece puzzle
Handout and Activity: Sign Language, animals
IELG: Bring me the ball? No problem! - Is able to follow simple directions Let’s TALK-Toddlers-What Two Do?, toddler development
IELG: I know what I want, I can let you know too! - Indicates wants Handout and Activity: Trucks, book of vehicles Supplemental Material(s)
21 Months Twenty-One Month Developmental Perspectives
IELG: I want it now, now, now - temper tantrums Let’s TALK-Washing Dishes, learning through “helping” IELG: Ooey, gooey, messy fun! - messy play Handout and Activity: Ducks, paint with feathers
IELG: Cleaning, cooking, sweeping, dusting…house work is fun! - Imitates housework and “helping” you
Let’s TALK-When Kids Know Best, children’s choices
IELG: Let me see how far I can reach - Stands on tip toes Handout and Activity: Tails, matching animal heads and tails Supplemental Material(s)
22 Months Twenty-Two Month Developmental Perspectives IELG: In the fold - Folds paper Let’s TALK-Backing Off and Stepping In, parental involvement
IELG: I can make up my own mind now! - Wants to make decisions
Handout and Activity: Night Sky, star project
IELG: Playing charades - Uses gestures when communicating with others
Let’s TALK-Life in the White Spaces, spending time with your child
IELG: My scribbles are becoming more purposeful! - Imitates a circular scribble
Handout and Activity: I Can Get Dressed!, paper bag clothes
Supplemental Material(s)
23 Months Twenty-Three Month Developmental Perspectives
IELG: I know where my toys go! - Remembers where objects belong Let’s TALK-Super Hero Parents, reactions to threats to our child IELG: Up and down I go! - Goes up and down a slide Handout and Activity: Gardening is Fun, plant seeds
IELG: Stringing beads, one by one! - Strings one-inch beads
Let’s TALK-Thar She Blows!, temper tantrums
IELG: The Wheels on the Bus go Round and Round, Round and Round… - Sings phrases of songs
Handout and Activity: Dinosaurs, fern rubbing Supplemental Material(s)
24 Months Twenty-Four Month Developmental Perspectives
IELG: My block is a phone! - Begins engaging in simple pretend play Let’s TALK-The Parrot, power of our words IELG: Let’s put these in order - Nests blocks or stacks rings in right order when shown
Handout and Activity: Happy Birthday, birthday drawing
IELG: Will you be my friend and play next to me? - Engages in parallel play alongside other children
Let’s TALK-A Little Help From our Friends, system of support IELG: The cow says moo! - Matches sounds to animals Handout and Activity: Birds, pinecone birdfeeder Supplemental Material(s)
25 Months Twenty-Five Month Developmental Perspectives IELG: I can pedal my trike! - Rides a tricycle Let’s TALK-Cause to Clean Up, learning through cleaning up
IELG: I can eat all by myself and it is messy and fun! - Feeds himself
Handout and Activity: Animal Homes, animal cut out activity
IELG: I think I need to go! - Begins to anticipate the need to go potty Let’s TALK-Daily Dance Party, music IELG: Help me get to the next step - Transitioning in activities Handout and Activity: Camouflage, animal camouflage activity Supplemental Material(s) 26 Months Twenty-Six Month Developmental Perspectives IELG: We are family! - Names people in family Let’s TALK-To Pee or Not to Pee, toilet training IELG: 1, 2, 3…count with me! - Understands the number one
Handout and Activity: Funny Bunny Fun, bunny paper plate
IELG: Brush, brush, brush your teeth! - Brushes teeth with assistance Let’s TALK-Whose Goal Is It?, the child’s developmental agenda IELG: I want to make you feel better, my friend! - Is self-centered, but tries to comfort others
Handout and Activity: Boats Float, float/sink play Supplemental Material(s)
27 Months Twenty-Seven Month Developmental Perspectives
IELG: I can take off my clothes all by myself! - Independently removes clothes
Let’s TALK-Silence is Golden, the value of silence
IELG: My scribbles are starting to look more like drawings! - Draws “pictures”
Handout and Activity: Circus, pretend circus play
IELG: Ask me a question, I bet I can answer it! - Answers questions
Let’s TALK-Kids and Medicine, sick children
IELG: Will you play with me, friend? - Plays with dolls Handout and Activity: Squirrels, acorn play Supplemental Material(s)
28 Months Twenty-Eight Month Developmental Perspectives
IELG: Circle to circle, square to square, matching shapes is fun - Matches shapes (circle, triangle, square)
Let’s TALK-The Story of the Day, bedtime routines
IELG: I can pay attention for a longer time, wow! - Gradually increases attention span
Handout and Activity: Summer Fun, sand art
IELG: Snip, snip, snip with my scissors! - Makes snips with scissors Let’s TALK-More Than One Way, differences in parenting styles IELG: I am a boy, I have blue eyes and brown hair! - Identifies self as boy or girl Handout and Activity: Clouds, cloud painting
Supplemental Material(s)
29 Months Twenty-Nine Month Developmental Perspectives IELG: This is for this and that is for that - Understands functionality of objects
Let’s TALK-Conversing with Kids, conversation
IELG: Say what? - What words do you hear from your toddler during play?
Handout and Activity: Spiders, paper plate spider web
IELG: Bookworm - Looks at books on his own Let’s TALK-A Perfect Storm, family demands IELG: Come out, come out, wherever you are! - Plays hide and seek
Handout and Activity: Children’s Play, thumbprint and pompon caterpillars
Supplemental Material(s)
30 Months Thirty Month Developmental Perspectives
IELG: Picture this - Imitates adult when coloring/drawing Let’s TALK-Efficiency Dilemma, in the moment with your child IELG: So, this is what numbers mean! - Begins understanding the concept of numbers, especially one and two
Handout and Activity: Consequences, mouse bookmark
IELG: I'm giving it the boot! - Kicks a ball
Let’s TALK-High Octane Parenting, consistent discipline IELG: First this, then that - What happens next? Handout and Activity: Daily Schedules, daily routine chart
Supplemental Material(s)
31 Months Thirty-One Month Developmental Perspectives
IELG: I’ve got this grammar thing down! – what does the _ say?
Let’s TALK-The Emergence of Empathy, emotional development
IELG: I want you, I don’t want you, I need you! - Often displays contradiction in independence/dependence
Handout and Activity: A Fun Family Feast, healthy food collage IELG: How big is this? - describing size Let’s TALK-Mindful Parenting, helpful routines
IELG: I pretend to be mommy, and teacher, and doctor…oh so fun! - Enjoys pretend play, such as feeding a teddy bear
Handout and Activity: No One Like Me, book about me
Supplemental Material(s) Months Thirty-Two Month Developmental Perspectives
IELG: Let's talk? - Actively participates in conversations
Let’s TALK-Parenting Karma, caring adults
IELG: SO, I think this means I have to go potty! - Begins to control bladder and bowels during the day
Handout and Activity: Read for Joy, make a book, IELG: Is less more? - Which group has more? Let’s TALK-“Jump at de Sun”, child’s sense of competence IELG: Let me sort these out - Identifies categories Handout and Activity: Ready for Preschool, school bus project
Supplemental Material(s)
32 Months Thirty-Three Month Developmental Perspectives
IELG: Jump like a kangaroo - Jumps one to two feet in distance Let’s TALK-How Does Your Garden Grow, gardening and parenting IELG: Let's make something - Likes creating Handout and Activity: School Readiness Skills, color shape game IELG: Will it float? - Learns about sinking and floating Let’s TALK-Fuel for Growth, how a child develops
IELG: I follow the rules! - Begins to follow simple rules Handout and Activity: Sharing, cookie counting game Supplemental Material(s)
33 Months Thirty-Four Month Developmental Perspectives
IELG: Let me tell you about this - Draws picture and tells story about it Let’s TALK-Dare Ya to Love Me, challenging behavior IELG: Blue and red make… - Plays with mixing colors
Handout and Activity: Birth Order, family book
IELG: I can do that AND that - follows multi-step directions Let’s TALK-Making Friends, children’s friendships IELG: Make it stick! - Glues items on paper Handout and Activity: Germ Warfare, germ painting Supplemental Material(s)
34 Months Thirty-Five Month Developmental Perspectives
IELG: Suishy fun! - Plays with modeling dough
Let’s TALK-Parenting in the Present, cherishing the moment
IELG: Red with red, circle with circle, I’ve got this! - Sorts colors and shapes when shown
Handout and Activity: Monsters, clay monster
IELG: I look like a flamingo! - Stands on one foot for five seconds Let’s TALK-When Worlds Collide, co-parenting IELG: You can't pull a fast one on me! - Wants books read just as written (Don’t skip any pages!)
Handout and Activity: We’re Different, We’re the Same, handprint rainbow
Supplemental Material(s)
35 Months Thirty-Six Month Developmental Perspectives IELG: And a one, and a two - Knows sequencing Let’s TALK-Birthday Dreams, birthday celebrations IELG: A trusted friend - Likes characters in books Handout and Activity: Children’s Fears, emotions puppets IELG: Look at my vocabulary grow! - Learning prepositions Let’s TALK-Learning from our Little Ones, children teach us IELG: Dancing to the beat! - Enjoys moving to music Handout and Activity: Too Much TV, make play-dough Supplemental Material(s)
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PHOTOGRAPH/VIDEOTAPE RELEASE Use in Staff Trainings and Research
PHOTOGRAPH/VIDEOTAPE RELEASE Use with Program Staff
PHOTOGRAPH/VIDEOTAPE RELEASE Public Relations and Social Media
I, ______, do hereby freely grant Baby TALK permission to
photograph and videotape me and my child for public relations in any media including, but not limited to,
television, print, internet and/or social networking; use in staff trainings and research; and to use with program
staff to support my role as a parent. I further release Baby TALK from any and all claims for damages for libel,
slander, invasion of the right of privacy, or any other claims based on, arising out of, or connected with the use
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Child’s Name______
Signature of Parent/Legal Guardian ______
Today’s date ______
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I hereby REQUEST AND AUTHORIZE for following agencies to release and exchange: Attendance information Developmental information Medical information Family support/case management information Any other relevant information about my child(ren) and me to the Baby TALK Family Support Program
County Health Department Mental Health Services Department of Human Services Local Prenatal Clinic/Hospital Department of Child and Family Services Head Start Public School System Low income Pediatric Medical Care Provider Crisis Pregnancy Center County Probation Office Circuit Clerk Office Child and Family Connections MIECHV Early Head Start Other______
Information requested for the period between ______and ______
Parent(s) or Legal Guardian:
Signature:______Date______
Signature:______Date______
Child:______Date of Birth______
Child:______Date of Birth______
Signature of Witness:______
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Baby TALK Family Resource Assessment & Monitoring
Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D.
Parent’s Name ______
Mental/Educational/Careers “Having the mental abilities and acquired skills (reading writing, and computing) to deal with daily life.”
Date Original This is 1st 2nd 3rd 4th 5th Family part of the Update Update Update Update Update Need family’s IFSP (Y/N) High School GED College Courses ESL Job search Become a citizen Career counseling Improving academic skills Improving computer skills Other
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Physical “Having physical health and mobility.”
Date Original This is 1st 2nd 3rd 4th 5th Family part of the Update Update Update Update Update Need family’s IFSP (Y/N) Pre-natal care Birth control Dental health (for adult) Vision/Hearing (for adult) Medical Doctor (for adult) Medical Doctor (for children) Counseling Anger Management Special medical care Other
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Emotional “Being able to choose and control emotional responses, particularly to negative situations, without engaging in self-destructive behavior. This is an internal resource and shows itself through stamina, perseverance, and choices.”
Date Original This is part 1st 2nd 3rd 4th 5th Family of the Update Update Update Update Update Need family’s IFSP (Y/N) Mental Health services Substance Abuse support Marriage/ relationship counseling Depression/ Anxiety Controlling emotional responses Domestic violence Smoking cessation Able to make good choices Perseverance I am basically negative I am basically positive I am able to choose my emotions I feel safe in my environment Other
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Financial “Having the money to purchase goods and services.”
Date Original This is part 1st 2nd 3rd 4th 5th Family of the Update Update Update Update Update Need family’s IFSP (Y/N) WIC (Women Infant Children) Cash Assistance Medical Card SNAP (Supplemental Nutrition Assistance Program) Housing placement/ assistance Child Care assistance CCRRS Utility Support (gas, light, phone) Social Security Budgeting Child support payments Food/Clothing assistance Other
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Spiritual “Believing in a divine purpose and guidance.”
Date Original This is part 1st 2nd 3rd 4th 5th Family of the Update Update Update Update Update Need family’s IFSP (Y/N) Affiliation with a faith-based organization I can get assistance from a local faith- based organization Other
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Relationships/Role Models “Having frequent access to adult(s) who are appropriate, who are nurturing to the child, and who do not engage in self-destructive behavior. It is largely from role models that a person learns how to live life emotionally.”
Date Original This is part 1st 2nd 3rd 4th 5th Family of the Update Update Update Update Update Need family’s IFSP (Y/N) I have someone I can go to if I have a problem I have someone positive I like to spend time with I have someone I want to be like Other
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Support Systems “Having friends, family, and backup resources available to access in times of need. These are external resources.”
Date Original This is part 1st 2nd 3rd 4th 5th Family of the Update Update Update Update Update Need family’s IFSP (Y/N) I have someone to care for my child Transportation assistance Use of public transportation I have someone to call if I need something I have someone I can count on Other
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Child Growth and Development
Date Name of Child: This is part of 1st 2nd 3rd 4th 5th the family’s Update Update Update Update Update IFSP (Y/N) *Developmental assessment or evaluation-HELP *Vision screening *Hearing screening *Well child visits (Health) *Immunization records Stages of development Developmental activities Toys and Sensory play Feeding/Mealtime Naps/Bedtime Separation Issues Learning through play Playing with others Discipline Other
*To be completed within 2 months after enrollment, ongoing every 6 months
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Child Growth and Development
Date Name of Child: This is part of 1st 2nd 3rd 4th 5th the family’s Update Update Update Update Update IFSP (Y/N) *Developmental assessment or evaluation-HELP *Vision screening *Hearing screening *Well child visits (Health) *Immunization records Stages of development Developmental activities Toys and Sensory play Feeding/Mealtime Naps/Bedtime Separation Issues Learning through play Playing with others Discipline Other
*To be completed within 2 months after enrollment, ongoing every 6 months
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Child Growth and Development
Date Name of Child: This is part of 1st 2nd 3rd 4th 5th the family’s Update Update Update Update Update IFSP (Y/N) *Developmental assessment or evaluation-HELP *Vision screening *Hearing screening *Well child visits (Health) *Immunization records Stages of development Developmental activities Toys and Sensory play Feeding/Mealtime Naps/Bedtime Separation Issues Learning through play Playing with others Discipline Other
*To be completed within 2 months after enrollment, ongoing every 6 months
Key: 0 – Desires 1 – Is beginning steps to achieve 2 – Has achieved somewhat/sometimes 3 – Has achieved in full N/A
Baby TALK Form © All Rights Reserved
Baby TALK Family Resource Assessment & Monitoring
Family Strengths With the resources in place at this time, the family demonstrates strengths in the following areas:
Date Strengths At enrollment 1st Update 2nd Update 3rd Update 4th Update 5th Update
Baby TALK Form © All Rights Reserved
Baby TALK Individual Family Service Plan
Name ______Date ______Signature of Parent ______Signature of Family Support Specialist ______
Note: Goals should be specific, measurable, achievable, realistic, and time bound. Example of types of goals: parent – child interaction, personal, child development, work, academic, etc.
Goal Action Steps by Parent Action Steps by FSS Target Progress Accomplished Completion Date
Goal
Goal
Progress Key: 0-No progress, 1-Initial progress, 2-Some progress, 3-Much progress, 4-Goal no longer applicable
Baby TALK © All Rights Reserved
Baby TALK
Individual Family Service Plan Goals should be SMART Name Date Specific Measurable Signature of Parent Achievable Realistic Signature of Family Support Specialist Time bound
Examples of types of goals: parent-child interaction personal work academic child development etc. Goal: Action Steps by Parent
Action Steps by FSS
Target Completion Date Progress Date Accomplished Goal: Action Steps by Parent
Action Steps by FSS
Target Completion Date Progress Date Accomplished Goal:
Action Steps by Parent
Action Steps by FSS
Target Completion Date Progress Date Accomplished
Baby TALK Newborn Encounter Documentation
Open ended questions - Pause - Eye contact - Repeat - Avoid judgment, ask opinion, advise last
The goal of this visit is to build family relationships using Touchpoints principles with the focus on discovering the newborn.
Date of Visit______Parent Educator______
Location of Encounter: home ______community______
Mom______Baby______Birth Date______
Mom’s prenatal care: clinic______private doctor______other______
Baby’s birthweight:______lb.______oz. Premature? yes or no?
Concerns regarding baby? sleeping; eating; crying; development______heatlh______
Visit included: Baby; Mom; Dad; Siblings:______
Grandparents:______Other______
Baby’s state (circle all observed): deep sleep; light sleep; wide-awake alert; active alert; crying; drowsy
Baby’s behavior: sleeping; hand grasp; foot reflexes; rooting; orientation to face; orientation to voice; tracking of red ball; imitation; crying; habituation; pull-to-sit; crawl
Parent’s reaction to baby’s behaviors: negatively responsive positively responsive unresponsive How has the baby’s behavior changed the family’s life? ______
What interaction did you see between Mom & Baby? (circle all observed) holding; eye contact; talking to baby; imitation; calming/comforting; smiling/laughter; physical care; protective behaviors; other______
What interaction did you see between Dad & Baby? (circle all observed) holding; eye contact; talking to baby; imitation; calming/comforting; smiling/laughter; physical care; protective behaviors; other______
Tools of conversation (circle all used): tell me about your baby; baby’s name; who does baby look like; reflexes; tracking; vaginal delivery; C-section; bottle; breast; knowing voices; Touchpoint: The Real Baby
What was the critical issue today? Social service referral______Child development______Health______Family Enviroment______
What mention was there of support? baby’s mom; baby’s dad; grandparents; extended family; faith-based; social network; social services; other______
Family wants information regarding: child’s development/education; housing; adult education; employment; medical care; social services; counseling; other______
Referrals made &/or other follow up:______
How responsive was this family to you? very; average; not at all Reflection: The connection with the family happened when______
What was the “emotional temperature” of the room when you entered? very warm; warm; cool; very cold
What was the “emotional temperature” of the room when you left? very warm; warm; cool; very cold
Comments:______
Baby TALK © All Rights Reserved
Baby TALK Personal Encounter Documentation
Open ended questions - Pause - Eye contact - Repeat - Avoid judgment, ask opinion, advise last
Date of Visit______Professional’s Name______
Location of Encounter: home community ______
Parent______Child______Birth Date______
Visit included: Child; Mom; Dad; Siblings:______
Grandparents:______Other______
Regarding child? eating | sleeping | crying | development ______health______
Child’s behavior observed: (circle all observed) Fussing | sleeping | verbalizations | independent play/exploration | guided play/exploration | active | quiet ______
______
What meaning do the parents make of the child’s developmental behavior?______
How has the child’s behavior changed the family’s life?______
______
Parent’s reaction to child’s behavior: negatively responsive | positively responsive | unresponsive
What interaction did you see between Mom & Child? (circle one number for each behavior observed) Holding 0 (parent does not have child near or with during visit) 1 (parent has child with or near briefly) 2 (parent is holding or has within arm’s length frequently during the visit) Eye contact 0 (parent does not make eye contact with child during visit) 1 (parent makes eye contact for engagement fewer than 3 times during the visit) 2 (parent uses eye contact as a strategy for engagement with the child frequently during the visit) Talking to child Tune in 0 (parent does not/rarely pays attention to what the child is communicating) 1 (parent pays attention to what the child is communicating and responds) 2 (parent pays attention to what the child is communicating and expands on it with more descriptive words) Talk more 0 (parent uses more directives than child-directed or descriptive words) 1 (parent uses more child-directed and/or descriptive words than directives) 2 (parent uses child-directed and/or descriptive words the majority of the time) Take turns 0 (parent does not encourages child to respond to words and actions) 1 (parent encourages child to respond to words and actions) 2 (parent encourages child to respond to words and actions and engages in extended conversation) Calming/comfort 0 (parent makes no attempt to respond to child’s stress cues or responds negatively) 1 (parent responds to child’s stress cues apathetically) 2 (parent responds to child’s stress cues empathetically) Smiling/laughter 0 (parent does not smile at or with child during the visit) 1 (parent initiates or responds to the child’s smile or laughter <=2 times during the visit) 2 (parent initiates or responds to the child’s smile or laughter >2 times during the visit)
Serve and Return 0 (parent ignores child’s attempts of engagement) 1 (parent offers minimal acknowledgement of the child’s attempts at engagement) 2 (parent acknowledges the child’s attempt at engagement most of the time) Baby TALK © All Rights Reserved
Serve and Return 0 (parent ignores child’s attempts of engagement) 1 (parent offers minimal acknowledgement of the child’s attempt at engagement) 2 (parent acknowledges the child’s attempt at engagement most of the time) Play Behaviors Engagement 0 (parent shows little to no interest in the child’s play activity) 1 (parent will participate in an interactive activity with the child when requested and will maintain interaction) 2 (parent initiates interaction with child and purposefully transitions to a new activity when the child demonstrates an interest) Encouragement 0 (parent makes no attempt to offer verbal or physical support of a child’s effort) 1 (parent offers some verbal or physical support of a child’s effort) 2 (Parent offers >4 verbal or physical supports of a child’s effort) Extension 0 (parent makes no attempt to extend the intention of the play activity) 1 (parent extends the play activity after being prompted) 2 (parent initiates an extension of the play activity)
What interaction did you see between Dad & Child? (circle one number for each behavior observed) Holding 0 (parent does not have child near or with during visit) 1 (parent has child with or near briefly) 2 (parent is holding or has within arm’s length frequently during the visit) Eye contact 0 (parent does not make eye contact with child during visit) 1 (parent makes eye contact for engagement fewer than 3 times during the visit) 2 (parent uses eye contact as a strategy for engagement with the child frequently during the visit) Talking to child Tune in 0 (parent does not/rarely pays attention to what the child is communicating) 1 (parent pays attention to what the child is communicating and responds) 2 (parent pays attention to what the child is communicating and expands on it with more descriptive words) Talk more 0 (parent uses more directives than child-directed or descriptive words) 1 (parent uses more child-directed and/or descriptive words than directives) 2 (parent uses child-directed and/or descriptive words the majority of the time) Take turns 0 (parent does not encourages child to respond to words and actions) 1 (parent encourages child to respond to words and actions) 2 (parent encourages child to respond to words and actions and engages in extended conversation) Calming/comfort 0 (parent makes no attempt to respond to child’s stress cues or responds negatively) 1 (parent responds to child’s stress cues apathetically) 2 (parent responds to child’s stress cues empathetically) Smiling/laughter 0 (parent does not smile at or with child during the visit) 1 (parent initiates or responds to the child’s smile or laughter <=2 times during the visit) 2 (parent initiates or responds to the child’s smile or laughter >2 times during the visit) Serve and Return 0 (parent ignores child’s attempts of engagement) 1 (parent offers minimal acknowledgement of the child’s attempt at engagement) 2 (parent acknowledges the child’s attempt at engagement most of the time) Play Behaviors Engagement 0 (parent shows little to no interest in the child’s play activity) 1 (parent will participate in an interactive activity with the child when requested and will maintain interaction) 2 (parent initiates interaction with child and purposefully transitions to a new activity when the child demonstrates an interest) Encouragement 0 (parent makes no attempt to offer verbal or physical support of a child’s effort) 1 (parent offers some verbal or physical support of a child’s effort) 2 (Parent offers >4 verbal or physical supports of a child’s effort) Extension 0 (parent makes no attempt to extend the intention of the play activity) 1 (parent extends the play activity after being prompted) 2 (parent initiates an extension of the play activity)
Tools of conversation (circle all used): “Tell me about your baby” ______Using the behavior of the child as your common language ______sleeping ______feeding______crying ______developmental milestone______parental mastery ______predictable Touchpoint ______family function______child mastery______Using the pivot ______Curriculum Baby TALK ______IELG ______Other______Critical issue ______Time spent today? Child only______Parent/child interactions______Parent only______
What mention was there of support? (Circle all that apply) baby’s mom | baby’s dad | grandparents | faith-based | social network | social services |extended family ______Parent wants info regarding: child’s development/education | housing |adult education | employment | medical care | social services | counseling | other______
Referrals made &/or other follow up: Referral made Referral follow-up by professional Referral follow-up made by family ______
______
Reflection: The connection with the family happened when______
What was the “emotional temperature” of the encounter at the BEGINNING? very warm, friendly, welcoming, enthusiastic | warm | cool | very cold, detached, unfriendly, unwelcoming, unenthusiastic
What was the “emotional temperature” of the encounter at the END? very warm, friendly, welcoming, enthusiastic | warm | cool | very cold, detached, unfriendly, unwelcoming, unenthusiastic Baby TALK Personal Encounter Documentation form
Use OPERA listening Open- ended questions Date of Visit Pause make Eye-contact Personal Encounter Documentation Repeat Avoid judgment, Ask opinion, Advise last Professional’s Name Location of Encounter Home Community Parent’s Name Child’s Name Date of birth Visit Included
Child Mom Dad Siblings Grandparents Names not included above:
Regarding child?
Eating Sleeping Crying Health Development Notes:
Child’s behavior observed (pick all observed)
Fussing Sleeping Verbalizations Active Independent play/exploration Guided play/exploration Notes:
What meaning do the parents make of the child’s developmental behavior?
How has the child’s behavior changed the family’s life?
Parent’s reaction to child’s behavior
Negatively responsive Positively responsive Unresponsive
Baby TALK Personal Encounter Documentation form Page 2 Baby TALK Personal Encounter Documentation form
What interaction did you see between Mom & Child?
Holding
Eye Contact
Talking to child Tune in
Talk more
Take turns
Calming/comfort
Smiling/laughter
Serve and Return
Play Behaviors Engagement
Encouragement
Extension
What interaction did you see between Dad & Child?
Holding
Eye Contact
Talking to child Tune in
Talk more
Take turns
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Calming/comfort
Smiling/laughter
Serve and Return
Play Behaviors Engagement
Encouragement
Extension
Tools of conversation (choose all used)
“Tell me about your baby”
Sleeping
Feeding
Crying
Developmental milestone
Parental mastery
Predictable Touchpoint
Family function
Child mastery
Using the pivot
Using the behavior of the child as your common language
Baby TALK Personal Encounter Documentation form Page 4 Baby TALK Personal Encounter Documentation form
Curriculum
Baby TALK
IELG
Other
Key Discussion Topic
System of Support
What mention was there of support? (choose all that apply)
Baby’s mom Baby’s dad Grandparents Social services Faith-based Social network Extended family Notes:
Parent wants info regarding (choose all that apply)
Counseling Medical Care Adult Education Housing Social Services Employment Child’s development/education Other Notes:
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Referrals made and/or other follow up:
Agency name of referral Date
Follow-up by professional Date
Follow-up by family Date
Reflection
Time spent today?
Child only
Parent/child interactions
Parent only
The connection with the family happened when…
What was the “emotional temperature” of the encounter at the BEGINNING?
What was the “emotional temperature” of the encounter at the END?
Misc. Notes
Baby TALK Personal Encounter Documentation form Page 6
Baby TALK Group Encounter Documentation
Open ended questions - Pause - Eye contact - Repeat - Avoid judgment, ask opinion, advise last
Date of Encounter______Professional’s Name______
Location of Encounter______
Concerns regarding families within the group? ______
Use children’s behavior as your language with parents: Note changes in children’s development since the last group: ______
How has children’s behavior changed family’s lives?______What interactions did you see: Parent/child______Parent/Parent______Child/Child______
Tools of conversation (circle all used): “Tell me about your baby” | parent/child interactions | sleeping | feeding | crying | developmental milestone | parental mastery | predictable Touchpoint | family adjustments | child mastery | connect families using common ground | facilitation of children’s interactions
What was the critical issue today?______
System of Support—Did any family struggle to fit into the group?______Referrals made &/or other follow up:______
What was the “emotional temperature” of the group at the BEGINNING? very warm | friendly, welcoming, enthusiastic | warm | cool | very cold, detached, unfriendly, unwelcoming, unenthusiastic
What was the “emotional temperature” of the group at the END? very warm | friendly, welcoming, enthusiastic | warm | cool | very cold, detached, unfriendly, unwelcoming, unenthusiastic
Reflection-on-action: ______
______
Baby TALK © All Rights Reserved
Baby TALK Group Encounter Documentation form
Use OPERA listening Open- ended questions Pause Date of Visit: make Eye-contact Repeat Group Encounter Documentation Avoid judgment, Ask opinion, Advise last
Professional’s Name
Location of Encounter
Concerns regarding families within the group
Use children’s behavior as your language with parent Note changes in children’s development since the last group:
How has children’s behavior changed family’s lives?
What interactions did you see parent/child
parent/parent
child/child
Baby TALK Group Encounter Documentation Page 1 Baby TALK Group Encounter Documentation form
Tools of conversation (choose all used)
“Tell me about your baby”
parent/child interactions
sleeping
feeding
crying
developmental milestone
parental mastery
predictable Touchpoint
family adjustments
child mastery
connect families using
common ground
facilitation of children’s
interactions
Baby TALK Group Encounter Documentation Page 2 Baby TALK Group Encounter Documentation form
Key Discussion Topic
System of Support Did any family struggle to fit into the group?
Referrals made and/or other follow up
What was the “emotional temperature” of the encounter at the BEGINNING
What was the “emotional temperature” of the encounter at the END
Reflection-on-action
Baby TALK Group Encounter Documentation Page 3
Baby TALK Transition Document
Child’s Name: EI#: Participant ID#: Date: Transition Planning Worksheet A Transition Planning Worksheet should be completed and included prior to any transition. As your child and family transition within or from Birth to 3, transition planning will occur. Transition planning provides for 1) discussions and training regarding future services and other matters related to your child’s transition, 2) procedures to prepare your child for changes in service delivery, including steps to help your child adjust to and function in a new setting, and 3) with your family’s consent, transmission of information about your child to an Early Childhood classrooms. Discussions regarding transition may occur at any time during the Birth to 3 process. Transition planning may be used to facilitate a variety of transition experiences, including transitions to new service providers, to new service delivery options, to the home after hospital stay, to new living arrangements, or to Early Childhood classrooms. Record all discussions around transition topics in the space below: Date we would Who will help? Transition Issue Strategies like this Who would you like to help? completed by Date: Do you have any questions about transitions?
Date: Are there any transition activities that you would like to be doing now?
Date: Are there community activities that you would like to explore for your child or your family?
Date: Do you have any questions regarding your parent rights and responsibilities regarding transitions?
Date: Would you like to talk to other parents about transition? Date: What would help you prepare for this transition?
Date: Are there people you want notified about the transition?
Date: Do you have any questions about leaving Birth to 3 services? When would you like to discuss them? Child’s Name: EI#: Participant ID#: Date: Transition Activities Required Prior to Third Birthday Date Completed 1. Completed Transition Planning Worksheet in order to ensure a smooth transition from Birth to 3 program to preschool programs/or other community programs? 2. Explored Early Childhood options with Baby TALK or agency? 3. Discussed options for referral with Baby TALK or agency, if applicable? 4. Discussed parental rights and responsibilities with Baby TALK or agency? 5. Identified and implemented steps to assist Baby TALK or agency in evaluating eligible programs and services? 6. Sent specific information, including evaluation and assessment information to the Early Childhood classroom/or other community programs with informed, parental consent? 7. Convened a conference with, at a minimum, a representative from Birth to 3, a representative from Early Childhood classroom, and Baby TALK or agency (at least 90 days before the child’s third birthday or, if earlier, the date on which the child is eligible for the preschool program, with parental consent? Transition Notes:
Baby TALK © All Rights Reserved
Baby TALK
Child’s name EI# Participant ID# Date
Transition Planning Worksheet (complete and include prior to any transition) • As your child and family transition within or from Birth to 3, transition planning will occur. Transition planning provides for: 1) discussions and training regarding future services and other matters related to your child’s transition 2) procedures to prepare your child for changes in service delivery, including steps to help your child adjust to and function in a new setting 3) with your family’s consent, transmission of information about your child to an Early Childhood classrooms. • Discussions regarding transition may occur at any time during the Birth to 3 process. Transition planning may be used to facilitate a variety of transition experiences, including transitions to new service providers, to new service delivery options, to the home after hospital stay, to new living arrangements, or to Early Childhood classrooms. • Record all discussions around transition topics in the space below: Date Transition Issue – Do you have any questions about transitions?
Strategies
Who will help? Who would you like to help? Date to be completed by
Date Transition Issue – Are there any transition activities that you would like to be doing now?
Strategies
Who will help? Who would you like to help? Date to be completed by
Date Transition Issue – Are there community activities that you would like to explore for your child or your family?
Strategies
Who will help? Who would you like to help? Date to be completed by
Date Transition Issue - Do you have any questions regarding your parent rights and responsibilities regarding transitions?
Strategies
Who will help? Who would you like to help? Date to be completed by
Baby TALK Transition Document Page 1 Date Transition Issue - Would you like to talk to other parents about transition?
Strategies
Who will help? Who would you like to help? Date to be completed by
Date Transition Issue – What would help you prepare for this transition?
Strategies
Who will help? Who would you like to help? Date to be completed by
Date Transition Issue – Are there people you want notified about the transition?
Strategies
Who will help? Who would you like to help? Date to be completed by
Date Transition Issue – Do you have any questions about leaving Birth to 3 services? When would you like to discuss them?
Strategies
Who will help? Who would you like to help? Date to be completed by
Transition Activities Required Prior to Third Birthday Date Completed Completed Transition Planning Worksheet in order to ensure a smooth transition from Birth to 3 program to preschool programs/or other community programs? Explored Early Childhood options with Baby TALK or agency?
Discussed options for referral with Baby TALK or agency, if applicable?
Discussed parental rights and responsibilities with Baby TALK or agency? Identified and implemented steps to assist Baby TALK or agency in evaluating eligible programs and services?
Sent specific information, including evaluation and assessment information to the Early Childhood classroom/or other community programs with informed, parental consent? Convened a conference with, at a minimum, a representative from Birth to 3, a representative from Early Childhood classroom, and Baby TALK or agency (at least 90 days before the child’s third birthday or, if earlier, the date on which the child is eligible for the preschool program, with parental consent?
Baby TALK Transition Document Page 2
Transition Notes:
Baby TALK Transition Document Page 3 PREPARATION ☐ Prepare with an open mind ☐ Recognize what I bring to the interactions - See Reflection questions ☐ Lesson Plan ☐ Age appropriate toys/materials ☐ Toys/materials from the home ☐ Curriculum use ASSESSMENT ☐ Environment Attentiveness: Acknowledgment: ☐ Other people in the environment, ☐ Location for visit in the home ☐ Safety concerns ☐ Other people ☐ Safety concerns ☐ Other elements of the physical environment ☐ Availability of Parents Attentiveness: Acknowledgment: ☐Environment noise ☐Environmental noise ☐Affect/behavior of parent ☐Parent’s affect/behavior ☐General health and well-being parent/family members ☐HV adjusting approach based on assessment process ☐ Formal Assessment Tool: AFFILIATION ☐ Open-ended questions ☐ Pause ☐ Make eye contact ☐ Repeat ☐ Avoid judgment ☐ Ask opinion ☐ Advise last
☐ Tell me about your baby ☐ Child’s Development ☐ Family Systems ☐ Relationship Building ☐ Active listening body language of HV ☐ Affect of HV
OBSERVATION ☐ Shared (parent and professional) observation of the child Narrating developmental behaviors Inquiring about developmental behaviors observed
☐ Professional’s observation of the parent-child interactions HV proximity to the interactive activity Narrating developmental behaviors Inquiring about developmental behaviors observed Asking questions to extend interaction
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 1 DEVELOPMENTAL BEHAVIORS ☐ Knowledge in support of the facilitation of parent-child interactions ☐ Use of age appropriate materials in support of the parent-child interactions ☐ Statements or questions related to this particular developmental age including Touchpoints ☐ Adult Learning Principles
☐ Skills used in the facilitation of parent-child interactions % of time HV interacting with child ______% of time HV facilitating interaction ______
☐ HV introduction of materials ☐ Use of adult learning principles ☐ State matching
☐“Coming alongside” ☐ Respect for cultural/linguistic diversity ☐ Behavior of the child as common language ☐ Supporting parental mastery ☐ Meaning a parent is making of child development or behavior ☐ Use of we statements ☐ Compassionate confrontation ☐ Collaboration ☐ Reinforcement of serve and return ☐ Use of the pivot (moving discussion from crisis/issue to impact of crisis/issue on child’s development/behavior)
☐ Dispositions necessary to facilitate parent-child interactions
☐Body language ☐Responsiveness ☐Flexibility ☐Non-judgmental attitude ☐Empathy ☐Warmth ☐Optimistic attitude ☐Patience ☐Cultural humility
SYSTEM OF SUPPORT / SYSTEM OF CARE Acknowledgment of ☐ “Who the parent brings into the room.” ☐ Current support system ☐ Current community resources ☐ Parent’s perceived need through Referral/Advocacy:
Use of ☐ Additional materials/curriculum ☐ Collaborative planning of the next encounter
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 2 PREPARATION ☐ Prepare with an open mind ☐ Recognize what I bring to the interactions - See Reflection questions Materials include: ☐ Lesson Plan ☐ Age appropriate toys/materials ☐ Toys/materials from the home
☐ Curriculum use Titles Topics
ASSESSMENT ☐ Assessment of the Environment Look for: Attentive, alert and aware of other people in the environment Attentive, alert and aware of safety concerns
Listen for: Asking where the visit should take place Acknowledgment other people in the environment Acknowledgment of safety concerns Acknowledgment of other elements of the physical environment
☐ Assessment of Availability of Parents Look for: Attentive, alert and aware of environment noise Attentive, alert and aware of affect/behavior of parent
Listen for: Acknowledgment of environmental noise Acknowledgment of parent’s affect/behavior Questioning of the general health and well-being parent/family members HV adjusting approach based on assessment process
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 1
☐ Formal Assessment Assessment tool: AFFILIATION
☐ Open ended questions • Always Notes: ☐ Open ended questions • Sometimes ☐ Open ended questions • Never ☐ Pause • Always ☐ Pause • Sometimes ☐ Pause • Never ☐ Make eye contact • Always ☐ Make eye contact • Sometimes ☐ Make eye contact • Never ☐ Repeat • Always ☐ Repeat • Sometimes ☐ Repeat • Never ☐ Avoid judgment, ask opinion, advise last • Always ☐ Avoid judgment, ask opinion, advise last • Sometimes ☐ Avoid judgment, ask opinion, advise last • Never Describe
What challenges do you observe regarding OPERA strategies?
☐ It seems difficult for HV to ask open•ended questions ☐ Family members do not have a lot to say in response to open•ended questions ☐ Silence during long pauses seems uncomfortable or HV does not allow for silence ☐ Family members do not make eye contact back ☐ HV does not explore responses through “repeat”; asks more questions or moves on quickly ☐ Family members ask for advice ☐ Family members indicate they feel indecisive and want help making decisions ☐ Family members refuse to engage completely, so the focus is on the child during encounter ☐ Other (please specify)
What do you observe the HV do to overcome the challenges?
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 2
On average, to what extent does HV offer advice to families? (Note: Giving advice is more than providing information and/or options for community supports or optional courses of action. Giving advice includes offering instructions, direct guidance, or your opinion. For instance, statements like "You should...", "I would...", "You need to...", "When I was raising my kids...")
☐ Frequently ☐ Sometimes ☐ Rarely ☐ Never Notes:
At what point do you observe advice giving, if at all?
☐ A problem or crisis arose ☐ There was a clear need for something to be done ☐ To decide among multiple options ☐ When setting goals and objectives ☐ When a family member is struggling to complete an objective or goal ☐ When a family member does not know what to do ☐ When a family member asks for advice ☐ Never
Notes:
☐ Tell me about your baby Listen for: Statements or questions leading the parent to “take the agenda” Follow up questions for more information
☐ Child’s Development Listen for: Comments/questions leading parent to share expertise of child’s developmental skills, behaviors, routines Follow up questions for more information
☐ Family Systems Listen for: Statements or questions acknowledging a previously discussed part of the family system
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 3 Follow up questions for more information
☐ Relationship Building Look for: Active listening body language of HV Affect of HV
Listen for: Statements or questions in support of the parent-professional relationship
OBSERVATION ☐ Shared (parent and professional) observation of the child Look for: Parent and HV intentionally looking at the child at the same time HV attentiveness and awareness of parent’s body language or comments during or after the observation
Listen for: HV invitation to parent to observe the child together if not already happening Description of the behaviors observed Follow-up questions
☐ Professional’s observation of the parent-child interactions Look for: HV proximity to the interactive activity HV attentiveness and awareness during interaction
Listen for: Description of the behaviors observed Acknowledgment of parent’s body language or comments during or after the interaction Follow-up questions
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 4 To what extent does HV observe parent/child interactions? ☐ The majority of the time ☐ Frequently ☐ Rarely ☐ Never, describe:
What are some specific parent/child interactions HV uses in their observation with the family?
How does HV support mastery around parent's interaction with the child?
☐ Professional’s observation of the parent-other siblings interaction Look for: HV attentiveness and awareness during interaction
Listen for: Description of the behaviors observed Acknowledgment of parent’s body language or comments during or after the interaction Follow-up questions
☐ Professional’s observation of other adults- child interactions Look for: HV proximity to the interactive activity HV attentiveness and awareness during interaction
Listen for: Description of the behaviors observed Follow-up questions related to collaboration or gatekeeping
DEVELOPMENTAL BEHAVIORS ☐ Knowledge in support of the facilitation of parent-child interactions Look for: Use of age appropriate materials in support of the parent-child interactions
Listen for: Statements or questions related to this particular developmental age including Touchpoints
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 5 Adult Learning Principles
To what extent does HV incorporate/apply knowledge and materials related to early childhood development?
☐ The majority of the time ☐ Frequently ☐ Rarely ☐ Never ☐ Other, describe:
☐ Skills used in the facilitation of parent-child interactions % of time HV interacting with child ______% of time HV facilitating interaction ______
Look for: HV introduction of materials brought for the home visit encounter Use of adult learning principles State matching between the parent and professional
Listen for:
“Coming alongside”
Respect for cultural/linguistic diversity
Using the behavior of the child as common language
Supporting parental mastery
Use of the pivot (moving discussion from crisis/issue to impact of crisis/issue on child’s development/behavior)
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 6 Investigation of the meaning a parent is making of child development or behavior
Use of we statements
Compassionate confrontation
Collaboration
Reinforcement of serve and return
☐ Dispositions necessary to facilitate parent-child interactions Look for: Body language
Listen for: Responsiveness
Flexibility
Non-judgmental attitude
Empathy
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 7 Warmth
Optimistic attitude
Patience
Cultural humility
SYSTEM OF SUPPORT / SYSTEM OF CARE ☐ Acknowledgment of “who the parent brings into the room.”
☐ Acknowledgment of current support system
What does HV introduce to the family in terms of support?
☐ Acknowledgment of current community resources
☐ Acknowledgment of parent’s perceived need through
Referral/Advocacy:
☐ Supporting materials/curriculum
☐ Collaborative planning of the next encounter
☐ Other, specify
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 8
On average, how would you describe, HV inclusion of members of the family's extended support system?
If no extended family present: ☐ Frequently in conversation ☐ Often in conversation ☐ Seldom in conversation ☐ Never in conversation If present: ☐ Frequently in person ☐ Often in person ☐ Seldom in person ☐ Never in person
REFLECTION-ON-ACTION
What is the perception of the HV about the preparation for this encounter that was the most effective?
How did the HV feel about the encounter?
What did the HV notice about the physical and emotional environment and how did it influence the encounter?
What is the HV perception of what he/she was able to bring to the family during this encounter?
When did the HV feel the connection with the family happen?
What did the HV learn about the parent/child relationship?
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 9 Did the HV hear a concern to be followed up on?
What will the HV document that will prepare the HV for the next encounter?
What will the HV continue or change for the next encounter to “become ever better”?
Note: ______% time spent on child/child development ______% time spent on parent ______% time spent on parent/child relationship & interaction
DOCUMENTATION
Review documentation in folders or on babyTECH
For sample file review (NOT for specific observation)
Does HV capture the physical assessment within documentation? ☐ Yes ☐ No ☐ Somewhat, describe:
Does HV capture the emotional assessment within documentation? ☐ Yes ☐ No ☐ Somewhat, describe:
Does HV capture parent•child interactions within documentation? ☐ Yes ☐ No ☐ Somewhat, describe:
Does your documentation have a way of capturing the point of connection? ☐ Yes ☐ No ☐ Somewhat, describe:
Does HV capture a common "picture" of where families are (emotionally, physically, support systems, etc.) within encounter documentation? (e.g. does HV capture a regular set of relevant points at a common level of detail or does encounter documentation differ significantly across HV)
☐ Yes ☐ No
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 10 ☐ Somewhat, describe: ☐ N/A: Single•staffed program
In a review of documentation, to what extent would do find it to be subjective vs. objective/non•judgmental? ☐ Bias free ☐ Generally objective with some subjective opinions ☐ More subjective opinions than objective observations Mostly subjective opinions ☐ Other: please specify
Baby TALK Quality Confirmation Process - Service Delivery Protocol Page 11 Baby TALK, Inc. Annual Individual Goals Worksheet, Professional Development Plan and Evaluation
Name:______Date:______Position:______Supervisor:______
The purpose of this document is to identify employee strengths, areas where growth is needed, and establish work goals for the fiscal year. Goals are statements of end results expected within specific periods of time. For each goal you should describe the end result and indicate quantity, quality, time frame, percentages or other specific measures. Each goal should fit into and support the overall strategy of the program it involves. Include any professional development or other support necessary to accomplish the goal as well as reflective supervision and practice efforts employed.
“The success of a home visiting program rides on the shoulders of its home visitors. From the point of view of families, home visitors ARE the program.” (Gomby, 2005)
The field agrees the competency and success of a professional rely on:
1. Knowledge 2. Skills 3. Dispositions
EXAMPLES OF KNOWLEDGE Human Growth and Development (Focus on prenatal, newborn, infancy and toddlerhood) o Correlation between the four developmental domains o Identify Illinois Early Learning Guidelines and their relationship to child development and appropriate Parent-child interactions o Emergent Literacy o Impact of trauma and/or stress from prenatal through adulthood o Administer, analyze, and communicate the results of a global assessment tool o Typical and atypical child development o Adult Learning Theory
Building Relationship-Based Family Partnerships o Baby TALK Model (12 Words, Critical Concepts, Protocols) o Motivational Interviewing o Family interactions/systems o Strength-based practice o Parenting styles o Touchpoints Principles of Practice o Utilization of problem solving techniques o Adult Learning Theories o Verbal and non-verbal communication
Professional Practices o Reflective practice and supervision o Implementation of home visitation model with fidelity o Confidentiality o Professional boundaries o Becoming Ever Better o Objective Documentation o Assess-Plan-Encounter (e.g. intentional planning, observation, and reflection)
Cultural Humility o Understand own biases and prejudices o Understand values, traditions, strengths and needs of individual families o Understand the roles of racism, discrimination, and poverty on families
Health and Safety-Individual, Family, Community o Mandated reporting o Behavioral and environmental health and safety issues o Understand characteristics and needs of families experiencing substance abuse, child abuse or neglect, grief and loss, mental illness, domestic violence, and/or homelessness. o Recognize signs of resilience o Stress management o Health and nutritional information application prenatal through adulthood
Community Collaborations o Community resources and personal contacts o Referral procedure o Transition procedures o Advocacy
“Family engagement with home visiting programs is related to: the home visitor’s capacity to develop a positive helping relationship with families (Korfmacher, Green, Spellman, & Thornburg, 2007).
EXAMPLES OF SKILLS Use the behavior of the child as a strategy for engagement with the parent Support parental mastery using descriptive language of what you see and hear Use moment-to-moment interactions to promote parental attunement Establish rapport Problem-solve to address issues that families present in the moment when they are presented Facilitate parent and child interactions Reinforce “serve and return” Use family stressor to transition parent to focus on child’s development (the Pivot) Focus on parental affect and child’s response to affect Explore parent’s early childhood experiences Help parents find joy in interaction with their child Set and maintain professional boundaries Organization to deliver the home visitation curriculum while still responding to family needs as arise Ability to do the required documentation Ability to resolve personal difficulties Individualize approach to working with the family based on cultural strengths Utilize data and outcomes to develop efficient and effective strategies for working with families Examine personal thoughts, feelings, experiences and biases in relationship to your approach to families Reflective practice Recognizes and responds to cross-cultural communication issues Active listening Observation Engage in goal-oriented partnerships Compassionate confrontation
“How we are with families is as important as what we do.” Jeree Pawl
EXAMPLES OF DISPOSITIONS* *A person’s inherent qualities of mind and character; how a person sees all aspects of his or her work in the profession
Trustworthy Empathic Responsive Conscientiousness and persistence with families Non-judgmental Optimistic attitude Patience Creativity “Holding families in their minds” Reflective Respectful Cultural humility Teachable Accepts Responsibility Flexible Collaborative Expresses emotions constructively
Identify areas of strength in the following:
Knowledge
Skills
Dispositions
Identify areas of needed growth:
Knowledge
Skills
Dispositions
Describe an area of frustration in your work:
Describe an area which excites you about your work:
List at least three goals for this fiscal year, keeping in mind the 3 areas of competence: Goal #1
Professional development plan to support goal #1 attainment
On-going Reflective Practice Documentation for Goal #1
Looking back over the last year: What progress did I make toward changes in behaviors?
How did these changes impact my work?
Year-end comment
Goal #2
Professional development plan to support goal #2 attainment
On-going Reflective Practice Documentation for Goal #2
Looking back over the last year: What progress did I make toward changes in behaviors?
How did these changes impact my work?
Year-end comments
Goal #3
Professional development plan to support goal #3 attainment
On-going Reflective Practice Documentation for Goal #3
Looking back over the last year: What progress did I make toward changes in behaviors?
How did these changes impact my work?
Year-end comments
Goal Setting: I have read and understand my goals. Employee:______Date:______
Goal Assessment: I have discussed and understand the evaluation of my goals with my supervisor. Employee:______Date:______
Supervisor:______Date:______
Date of Baby TALK Training: ______
Date of Touchpoints Training: ______
Becoming Ever Better: Program Development Plan
The purpose of the BTMFSA is to identify program strengths, areas where growth is needed, and establish work goals for the fiscal year. Goals are statements of end results expected within specific periods of time. For each goal, describe the end result and indicate quantity, quality, time frame, percentages, other specific measures. Each goal should fit into and support the overall strategy of your program. Include professional development or other support required to accomplish the goal.
Program Click here to enter text. Fiscal Year Click here to enter text.
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Target Date Click here to enter a date.
Progress Click here to enter text.
Completion Click here to enter a date.
How may Baby TALK support you? Click here to enter text.
Who else do you need support from? Click here to enter text.
Goal Click here to enter text.
Action Steps Click here to enter text.
Target Date Click here to enter a date.
Progress Click here to enter text.
Completion Click here to enter a date.
How may Baby TALK support you? Click here to enter text.
Who else do you need support from? Click here to enter text.
Page 1 Becoming Ever Better: Program Development Plan
Goal Click here to enter text.
Action Steps Click here to enter text.
Target Date Click here to enter a date.
Progress Click here to enter text.
Completion Click here to enter a date.
How may Baby TALK support you? Click here to enter text.
Who else do you need support from? Click here to enter text.
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