BRIGANCE III TRAINEE BOOKLET MATERNAL AND CHILD HEALTH

BRIGANCE III TRAINEE BOOKLET MATERNAL AND CHILD HEALTH NURSES

Outline • Guidance for MCH use why, what, how and when • What is different about Brigance III? • Brigance in MCH practice - 2016 survey results - practice - scoring options - referral pathways - resources

Slides and Training Booklet • Booklet in order of presentation but some slides are not in booklet • Yellow outline of slide indicates it is not in training booklet

Resources for MCH Nurses Resources include: tip sheets with entry points, cut off scores, colour coded data sheets, information about interpreting results, discussing results with parents and case studies for use with this training presentation. http: //www. education. vic. gov. au/childhood/profe ssionals/health/Pages/mch. aspx#link 43

BRIGANCE screens Why?

The key principles underpinning child development • • development has age- related manifestations development is directional every child develops uniquely development is malleable

Screening • Purpose to identify problems as early as possible • A brief measure that sorts children who possibly have problems from those who probably don’t.

Screening • Brigance screen is a secondary screen after PEDS path A or B • Screening tests do not yield a diagnosis • Assessment with more detailed measures is usually indicated after score below cut off on a screening test

Parents Evaluation of Development Status (PEDS) • PEDS is our primary developmental screen • Supports a comprehensive developmental assessment • We need accurate recording of PEDS • Ensure you have completed the online training for PEDs 2017

PEDS Expect: • 10% Path A • 20% Path B • 20% Path C • 50% Path D/E

PEDS • Ensure you have good understanding of the paths, especially Path B • If PEDS is Path B, Brigance should follow (except in exceptional circumstances) • If Path A, Brigance will support your referral

BRIGANCE Screens What are they?

Introduction to Brigance III a short video http: //www. youtube. com/watch? v=2 RLPnf 1 keg 8 (2. 5 min)

BRIGANCE screens • Series of developmental screens 7 screens across screen books, covering ages 1 m to 7 years • Uses direct observation of skills (in 2+ years ) • Can be administered by a range of professionals (nurse/teacher) • Administered and scored in 10 -15 minutes

3 Core Developmental Domains • Physical Development Gross and Fine Motor Skills • Language Development Receptive and Expressive Language Skills • Academic Skills/Cognitive Development adaptive skills for infants and toddlers (self help and socioemotional)

Infant skills (1 -11 months) Physical Language Adaptive. Self help and socioemotional Gross motor eg: • rolling sitting crawling walking • transferring objects between hands Receptive eg: • responds to name • looks at named objects • Responds to commands • waving • gives block on command Self help eg: • holds bottle/cup • feeds self • cooperates in dressing Fine motor eg: • holding objects • squeaking toys • grasp and release of objects • putting objects into a container Expressive eg: • vocalising • gesturing • pretend talks • says real words Socio- emotional eg: • plays peek-a-boo • gives affection • initiates interaction with others • explores and returns to caregiver

Toddler (12 -23 months) Physical Language Adaptive. Self help/socioemotional Gross motor eg: • standing • walking • jumping • running Receptive • waves, gestures • responds to simple commands • points to body parts • identifies pictures • knows animal sounds Self help eg: • feeds self • assists in dressing • holds cup • removes shoes Fine motor eg: • pincer grasp • grasp and release • pour/dumps • scribble Expressive • communicating talking • names common objects • repeats phrases says 2 -3 word phrases Socioemotional eg: • gives affection • initiates interactions • opens doors • imitates other children • watches faces for emotional clues • wants to do things for self

2 year old skills Physical Cognitive Language Gross Motor • Jumping • Walking backwards • Balance on one foot (1 sec) • Walking on tiptoe Literacy • Repeats sentences • Matches colours Receptive • Identifies body parts by pointing Numeracy Understands concepts of: Fine motor • number (one, one • Scribbling/drawing more) • Building tower of blocks • and size ( big, little) Expressive • Names common objects • Knows use of common objects • Verbal fluency and articulation

3 year old skills Physical Gross motor • Balancing on one leg (5 sec) Cognitive Literacy • Identifies self by first and last name and age • Repeats sentences • Walking heel to toe 4 steps Numeracy • understands concepts of Fine motor number • Drawing copying lines and circles • building tower with blocks Language Receptive • points to named colours • points to named body parts Expressive • identifies pictures by naming • knows use of objects • knows prepositions and irregular plurals

4 year old skills Physical Cognitive/Academic Gross motor • Identifies self by first and • Balancing on last name, age, address one leg (10 sec) Literacy • Hopping both feed (5 hops) • Visually discriminates shapes, letters • Walking heel to toe 5 steps Numeracy • Counts by rote Fine motor • Copy shapes • Recognises and names quantities of 3, 5, 8 circle, +, X, counting without touching square, rectangle Language Expressive • names colours • names body parts • names pictures • Verbal fluency Sentences of 3+ words, 90% of speech is understandable Receptive • follows verbal directions- 2 step, 3 step

5 year old skills Physical Gross motor • Balancing on one leg (10 sec) • Balancing on one leg with eyes closed (1 sec) • Walking backwards heel to toe 4 steps Fine motor • Copy shapes X, square, rectangle, triangle, diamond • Prints first and last name Cognitive/Academic • Language Identifies self by name, age, Expressive birthday, phone number, address • names body parts Literacy • Recites alphabet • Recognises letters of alphabet • Experience with books and text- knows front and back of a book, understands progress text from L) to R), top to bottom Numeracy • Counts by rote • Sorts objects by size, shape and colour • Matches quantities with numerals • Adds 2 groups of numbers • names pictures

6 year old skills Physical Cognitive/Academic Language Fine motor Literacy • Prints first and last name • Writes numbers in sequence Receptive • Auditory discrimination for beginning and ending of sounds • Knows personal information • Reads lower case letters • Visually discriminates Expressive letters within words • Identifies initial letters • Word recognition in words • Identifies common Numeracy themes among words • Sorts objects by size, colour, shape • Addition and subtraction sums • Solves word problems

Some useful BRIGANCE features Located after the core assessments in screen books Following slides discuss each of these in detail: • Screening Information Forms (for all ages) • Parent – Child Interaction forms ( Infant and Toddler) • Parent Feedback form (for ages 2 and up) • Self-help and Social-Emotional Scales (for ages 2 and up) • Supplemental assessments (for ? “gifted” children)

Screening information forms • Available for all ages see p 67 -70 of 0 -35 month screen book and p 91 of 3 -5 year screen book • Used to assist your observation of child’s behaviour during screening in following areas • • Vision Auditory Behaviour Speech Self reliance Motor skills Physical appearance

Screening information forms continued • Copy and use with screening as needed • Can use to help you record observations on data sheet • NOT scored

Parent- Child interaction forms • Only in infant and toddler screen p 71 -72 0 -35 month screen book • Observation of parent/child interaction • Assessment of some psychosocial risk factors • Can be scored • Use precaution in making assumptions based on a singe observation/situation

Parent feedback form See p 75 and 76 of 0 -35 month screen book (2 yo) p 97 and 98 of 3 -5 year screen book (3 yo) • Available for 2 year old and 3 year old screens • To help parents understand skills expected/being assessed for age group • To help the nurse understand what child is reported to be able to do at home • NOT scored

Parent feedback form continued • Many items the same as what is in the core screen as well as self help and socioemotional screens • Give to parent prior to coming in for Brigance screen, or done with parent • If information is not compatible with what you observe, is helpful to know this (could be sent with referral)

Self help and socio emotional domains See p 77 -84, 0 -35 m screen book P 102 -112, 3 -5 y screen book • For 2 year olds plus • 0 ption of adding Brigance self help and socio emotional scales to the core assessments. • Can be scored, which adds these two important domains to your assessment

Self help and Socio emotional scales Parent report of child’s: • Eating, dressing toileting skills • Relationship with adults and peers • Play skills • Self confidence and self regulatory skills • Can be scored • Can be done by parent at home prior, or with nurse

Supplemental Assessments • For those children not challenged by core assessments • Useful if you want to gain more information about the child’s skills • Not scored • Not anticipated will be used by MCH much (The picture opposite p 58 in 0 -35 m screen book has picture for use in general conversation with children)

Standardisation of Brigance III

Glossary Term Definition Sensitivity Percentage of children with delay correctly identified Specificity Percentage of children without delay correctly identified Standardisation Score comparison of large nationally representative group Norm referenced Score measured against standardised group to compare performance Reliability Extent to which test results are consistent when administered by different examiners or test-retest with same examiner Validity Extent to which a test measures what it claims to measure Raw score Total number of points awarded for responses to all test items. Total possible score = 100 Cut off score BRIGANCE screen raw score below which children with disabilities or those at risk of academic difficulties are best identified Psychosocial risk factors No one factor predicts risk but multiple factors compound effect on the child’s development

BRIGANCE screens can be used either as Criterion Referenced Measures a student’s performance based on mastery of a specific set of skills. OR Norm-referenced Measures a student’s performance in comparison to the performance of same-age students on the same assessment.

Brigance III Standardisation (resulting in cut off scores) • conducted over 12 months, published in 2013 • across 33 American states • nearly 2000 children Children Infant Toddler 2 yo 3 yo 4 yo 5 yo 6 yo Total Number 588 209 158 230 167 322 1929 255 • representative range of socioeconomic and demographic characteristics

Reliability • Internal consistency . 94 – . 98 • Test/retest reliability . 92 – . 99 • Inter-examiner reliability . 93 – . 96 Figures relate to the correlation coefficient – the closer to 1, the better the reliability

Accuracy- Sensitivity Correctly identified below cut off screen/full assessment % Infant 57 / 63 89 Toddler 19 / 22 86 2 yo 26 / 29 90 3 yo 17 / 18 94 4 yo 26 / 29 90 5 yo 14 / 15 93 6 yo 26 / 28 93 185 / 204 91 TOTAL Total children assessed=1929 Sensitivity is the accuracy of cut off scores in predicting developmental delay

Accuracy- Specificity Correctly identified above cut off screen / full assessment % Infant 451 / 522 86 Toddler 154 / 187 82 2 yo 200 / 226 88 3 yo 130 / 140 93 4 yo 179 / 201 89 5 yo 136 / 152 89 6 yo 238 / 294 81 1488 / 1722 86 TOTAL Total children assessed=1929 Specificity is the accuracy of cut off scores in predicting normal development

BRIGANCE screens How?

First step • Age calculated in years, months and days and corrected for prematurity if 36 weeks gestation or less up to age of 2 years • Age needs to be exact to determine use of correct screen as well as correct cut off score for age CDIS will tell you child’s exact age in years, months and days

If required (i. e. not on CDIS yet), there is a way to avoid spending valuable time working out the Brigance age. . … Hawker Brownlow website has a free age calculator you can download onto your computer, Go to: http: //www. hbe. com. au/series-brigance/downloads-tools. html

Preparing data sheet • Record child details, your details, today’s date • Record cut off score Table is in screen book, or can be printed from Brigance III resources on DET, MCH website Brigance III 0 -35 m screen book, p xxi Brigance III 3 -5 year screen book p xviii (ensure looking at cut off score for delay, not giftedness)

Marking the data sheet • Show mastery of skill with • If incorrect or unable to demonstrate mark with a slash

Administration guidelines • Simple explanation to parent • Ensure child is well • Ideally done without distraction of disruptive siblings if possible • MUST use interpreter if needed • Some items are parent questions, some are direct observation and some can be either check instructions

Administration guidelines • Pleasant manner, establish rapport • ‘games’ not ‘tests’ • Non committal encouragement - whether response is correct or not! • Want child to feel successful, no matter what eg: “ you are doing a good job listening”

Screening directions

Screening Directions Be familiar with all directions for each item/page Follow clear and prescriptive directions on each page Use script as written but in a natural way Incorporate questions/observations into conversation and consultation eg gross motor/ drawing/ pictures can be part of “warm up time” but these skills are observable and scorable • Some items can be assessed together eg: ask colours while building tower of blocks • •

Screening Directions (cont) Assessments can be administered in any order But……. within each assessment, questions/items need to be asked from L) to R) as they are listed in order of difficulty

Screening Directions • Take notice of discontinuation points noted on screen page and data sheet • Screen/cover parts of page if needed • Record observations as you go

Common errors • Gazing at correct choice • Excessive prompts

Scoring • Add across each row, then add total score • Compare to cut off • Observe domain scores (more about this later) • Make referral decisions • Record “next steps”

How is Brigance III different? It is similar enough to be familiar, yet more effective and user friendly

Brigance III • Brigance III screen books and data sheets are all new and NOT interchangeable with Brigance II • Very DIFFERENT cut off scores • Changes to many items- order and content

Brigance III • Screen book and data sheets are less busy • Instructions are clearer • No 2. 5 year old screen • For MCH 2 screen books instead of 3 (0 -35 months and 3 -5 years)

Cut off scores Infant age v. II v III 4 m < 23 < 27 5 m < 27 < 33 6 m < 32 < 36 7 m < 39 8 m < 40 < 43 9 m < 43 < 57 10 m < 56 < 60 11 m < 68 < 67

Cut off scores Toddler age v II V III 12 -13 m < 22 < 32 14 -15 m < 35 < 39 16 -17 m < 40 < 49 18 -19 m < 55 < 56 20 -21 m < 60 < 66 22 -23 m < 65 < 70

Cut off scores 2 year old age V III 2 -0 to 2 -2 < 47 2 -3 to 2 -5 < 61 < 54 2 -6 to 2 -8 < 72 < 62 2 -9 to 2 -11 < 76 < 75

Cut off scores 3 year old age v 11 3 -0 to 3 -2 <52 3 -3 to 3 -5 <55 3 -6 to 3 -8 < 71 3 -9 to 3 -11 < 71 v 111 3 -0 to 3 -3 < 42 3 -4 to 3 -7 <45 3 -8 to 3 -11 <49

Cut off scores 4 year old age v II 4 - 0 to 4 - 3 < 58 < 42 4 - 4 to 4 - 7 < 72 < 69 4 -8 to 4 - 11 < 80 < 71

Cut off score 5 year old age v III 5 -0 to 5 -5 <61 5 -6 to 5 -11 <78 <70

Most importantly, Brigance III reduces over referrals

Important points to remember • Prepare as much as possible • Follow the instructions- they are clear and comprehensive • All screening needs practice

Recall of Brigance II kits Pack up all of your old Brigance II kits and have them ready for collection by the Department

Brigance III Summary • Will accurately identify children at risk of developmental delay • Quick and easy to use • Can help to inform referral decisions • Will support your referral

Maternal and Child Health Nurse BRIGANCE III TRAINING PART 2 PRACTICAL WORSHOP

GP knowledge of Brigance

Infant and toddler screens some specific points to note

Infant and toddler screens- entry points • Items in the infant and toddler screens have different entry points depending on age of child • If time permits, place a mark on the data sheet at entry points for each item prior to screening • Entry points are clearly marked on each page of the screen. • Tip sheet with entry points for age group is available on MCH DET website under Brigance Resources for MCHNs

Basal Point (Infant and Toddler) • Need three in a row to establish a “basal point” • Once basal point achieved, give credit for all lower skills

Scoring (Infant and Toddler) • If three in a row not achieved from entry point, go to lower entry point

Scoring (Infant and Toddler) • If three in a row not achieved at all, give credit for any items achieved. eg: 1 and 3 correct but unable to demonstrate basal of 3 in a row, still receives credit for 1 and 3

2 and 3 year old screens • Entry point is always item no 1 • Continue L) R) until discontinuation point/end of each item 4 8

Parent report vs examiner observation • • Most of infant and toddler skills are parent report Most of 2 year old skills are observed All of 3 year old are observed Instructions re this are clearly marked on each page of the screen book

When asking the parent questions: • Use the wording provided • If parent answers “most of the time” • If the answer is “sometimes”, “if I let her” , “ a little” or “she hasn’t tried yet”, the skill is emerging and not yet mastered emerging skill not enough, looking for mastery

12 min video of 22 month old Lily http: //www. curriculumassociates. com/professio nal-development/professional-developmentbrigance. aspx

Interpreting the results reasons for score below cut off • Potentially unreliable performance (testing conditions, behaviour) Psychosocial risk factors • Destabilised performance unwell, untreated vision / hearing, language / cultural barrier, experiential • Likely developmental delay / disability see p 30 -32 Brigance III Technical Manual or handout supplied with training materials

As long as performance was not destabilised or unreliable The cut off is the cut off! Refer if below cut off

Domain scores need to be considered • Score may be above cut off and all domains above average no need for any action • Score may be above cut off but below average in a particular domain • May be below cut off and need referral, but useful to know which domains are below average

3 options for scoring to enable domains to be considered 1. Manual - with coloured data sheets to help 2. On line –free option 3. On line OMS, charge applies

OPTION 1 Manual scoring • MCH nurses are accustomed to previous Brigance screen use • Tip sheets available to assist in assessing domain scores. Colour coded data sheets with table of below average domain scores • See www. education. vic. gov. au (Brigance resources)

OPTION 2 Free on line scoring tool ***USEFUL FOR MCH USE ONLY*** • NOT SUITABLE TO SHOW/GIVE PARENTS due to inclusion of age equivalent scores • Hawker Brownlow website www. hbe. com. au • Go to Brigance • Downloads and tools • Screens III Scoring Tool • Screens III Self-Help and Social-Emotional Scales Tool

OPTION 3 On Line Management System (OMS) may be introduced in the future

Where to from here? • Sharing the results with parents: Tip sheet available with training resources or see p xxvi Brigance 0 -35 month screen book • Does the child need referral? – hearing, vision, speech path, playgroup, childcare, GP, paediatrician, Early Childhood Intervention Services • Resources- readiness activities, books, websites, library • Follow up

Resources

Resources • • Standardisation details Interpreting results Discussing results with parents Appendix B has parenting tip sheets • Building Speech and Language Skills • Building preschool skills • Social development resources for parents

Resources • Department of Education website for resources developed for Victorian MCH nurses for use with BRIGANCE screens III http: //www. education. vic. gov. au/childhood/professionals/health/Pa ges/mch. aspx#link 43 • Hawker Brownlow Education website for FAQs, free scoring tool , on line training http: //www. hbe. com. au/series-brigance/downloads-tools. html • Curriculum Associates- on line training and videos www. curriculumassociates. com/professionaldevelopment/professional-development-brigance. aspx Scroll down to Early childhood and click on:

Resources • • www. zerotothree. org www. raisingchildren. net. au www. cyh. com http: //www. peds. org. au • Recommended reading: Ajay Sharma and Helen Cockerill. (2014) Mary Sheridan's From birth to five years. Children's developmental progress 4 th Edition. Routledge Oxon. AND Ajay Sharma and Helen Cockerill. (2014) From birth to five years. Practical Developmental Examination Routledge Oxon. • ALL BRIGANCE resource enquiries to: mch@edumail. vic. gov. au

Resources from Royal Children’s Hospital Centre for Community Child Health Monitoring the health, development, learning and wellbeing of young children through the use of screening tools files/Monitoring%20 child%20 health%20 development%20 and%20 wellbeing. pdf Key principles underpinning children's development files/Key%20 principles%20 underpinning%20 children%27 s%20 development. pdf Risk and protective factors PDF files/Early%20 Years%20 Key%20 Risk%20 and%20 Protective %20 Factors. pdf

References • Centre for Community Child Health, Royal Children’s Hospital, Melbourne, : Research Projects that have used Parent’s Evaluation of Developmental Status (PEDS) http: //www. rch. org. au/uploaded. Files/Main/Content/ccch/PEDS_in_ Research(1). pdf • Brigance® Screens III: Technical Manual • CA 14300 • © 2014. Hawker Brownlow Education • Brigance® Early Childhood Screens III 0 -35 months • CA 14294 • © 2014. Hawker Brownlow Education • Brigance® Early Childhood Screens III 3 -5 years • CA 14296 • © 2014. Hawker Brownlow Education