IDEAs - Partnerships - Results
NECTAC Notes
Issue No. 10
May 2002
Based on previous paper by Patti Biro, Deb Daulton, and Eleanor Szanton, in consultation with Constance Garner
The term “informed clinical opinion” appears in the regulatory requirements for the implementation of Part C of the Individual with Disabilities Education Act (IDEA) as an integral part of an eligibility determination (see Table 1). It must be included in evaluation and assessment procedures, since it is a necessary safeguard against eligibility determination based upon isolated information or test scores alone. Since the term carries different meanings for individuals and agencies, it is important to clarify the meaning and use of “informed clinical opinion” in the context of Part C. This document uses a question-and-answer format to address three key issues:
What does informed clinical opinion mean in the context of Part C?
Informed clinical opinion is used by early intervention professionals in the evaluation and assessment process in order to make a recommendation as to initial and continuing eligibility for services under Part C and as a basis for planning services to meet child and family needs. Informed clinical opinion makes use of qualitative and quantitative information to assist in forming a determination regarding difficult-to-measure aspects of current developmental status and the potential need for early intervention. For example, a physical therapist must make judgments about muscle tone abnormality based on the therapist’s training and experience with other children. Likewise, a psychologist may note in observing a child playing that she performs tasks in adaptive ways not permitted during the administration of a standardized cognitive assessment.
The knowledge and skill of the early intervention multidisciplinary team, including the parents, constitute the basic foundation for the process of becoming "informed" about a child's developmental status within a socially valid context. In essence, they seek to answer the question, "What are the child's abilities and needs within his/her natural environment?" Thus, appropriate training, previous experience with evaluation and assessment, sensitivity to cultural needs, and the ability to elicit and include family perceptions are all important elements of informed clinical opinion.
The individuals and agencies responsible for implementing Part C need to consider who might have an informed clinical opinion, what these people might have an informed clinical opinion about, and how their informed clinical opinion can be integrated into the process of evaluation and assessment. In the context of Part C, these questions should be considered both at the level of the individual early intervention professional and at the level of the multidisciplinary team.
Subpart D - Program and Service Components of a Statewide System of Early Intervention Services.
§ 303.300 State eligibility criteria and procedures.
General
Each statewide system of early intervention services
must include the eligibility criteria and procedures,
consistent with § 303.16, that will be used by the
State in carrying out programs under this part.
NOTE: Under this section and § 303.322(c)(2), States are required to ensure that informed clinical opinion is used in determining a child’s eligibility under this part. Informed clinical opinion is especially important if there are no standardized measures, or if the standardized procedures are not appropriate for a given age or development area. If a given standardized procedure is considered to be appropriate, a State’s criteria could include percentiles or percentages of levels of functioning and standardized measures.
§ 303.322 Evaluation and assessment.
Each lead agency shall adopt nondiscriminatory evaluation and assessment procedures. The procedures must provide that public agencies responsible for the evaluation and assessment of children and families under this part shall ensure, at a minimum, that--
Early Intervention Program for Infants and Toddlers With Disabilities Rule (2001)
How does informed clinical opinion affect the determination of eligibility?
Informed clinical opinion should be taken into account at both the individual and team levels.
INDIVIDUAL TEAM MEMBER LEVEL The individual early intervention professional uses both qualitative and quantitative information to shape an informed clinical opinion about a child's development and need for early intervention services. To do so, the professional must have knowledge of the multiple domains of development characteristic of infants and toddlers; the expected sequence of development; and the broad range of individual variations that may be seen in appropriately developing infants and toddlers. In order to reach an informed clinical opinion about the development of a particular infant or toddler, the professional may use any or all of the following:
Information derived from these examples and additional psychometric and diagnostic data are synthesized to become the "informed clinical opinion" of an individual. The informed clinical opinion should reflect a meaningful assessment of the individual child's development and family resources, priorities, and concerns, and suggest areas that may require further evaluation.
TEAM LEVEL The multidisciplinary team, which includes family embers, then synthesizes and interprets all available information, both qualitative and quantitative, about a child and family offered by the team participants.
This opportunity to integrate observations, impressions, and evaluation findings of the individuals facilitates a "whole child' approach to evaluation and assessment that goes beyond a reporting of test scores. In this way, the functional impact and the implications of noted delays or differences in development can be discussed and considered by the team in determining eligibility and developing the Individualized Family Service Plan (IFSP). Knowledge about available services is useful in formulating the IFSP, but should not limit the recommendations made by the team.
Why is it necessary to document informed clinical opinion? Appropriate documentation of sources and use of informed clinical opinion is important for two reasons. First, documentation provides a baseline against which to measure the progress and changing needs of the child and family over time. The initial recommendations of the multidisciplinary team reflect the needs of the child and family at a specific point in time. In Part C, assessment and subsequent eligibility determination is an ongoing process that may require modifications in the IFSP. The perceptions and impressions of individual early intervention professionals may change over time. Documentation of the individual and team findings can facilitate transition when families move, change service providers, or enter additional or new service delivery systems.
Secondly, documentation of the sources and use of informed clinical opinion also can provide information to assure that procedural safeguards were provided in the evaluation and assessment process and the determination of eligibility. This documentation should be maintained by a designated person, such as the interim or permanently assigned service coordinator and the parent.
Thus, the regulations regarding informed clinical opinion are intended to accomplish the following: 1) ensure a dynamic assessment approach; 2) support and encourage the acquisition and interpretation of multiple sources of information as part of the evaluation and assessment process; and 3) permit greater compatibility between a child and family's needs and the provision of services.
References
Early Intervention Program for Infants and Toddlers With Disabilities Rule of 2001, 34 C.F.R. §303 (2001).
Citation Please cite as:
Shackelford, J. (2002). Informed clinical opinion (NECTAC Notes No. 10). Chapel Hill: The University of North Carolina, FPG Child Development Institute, National Early Childhood Technical Assistance Center.
This document appears at http://www.nectac.org/pubs/pdfs/nnotes10.pdf and updates to the data herein will be announced at http://www.nectac.org/pubs/
NECTAC Notes No. 10 is an update of NECTAS Notes #4 disseminated in 1991.
About the Authors
Jo Shackelford is a Technical Assistance Specialist for Part C with NECTAC. Her research interests include eligibility, interagency coordination, and health issues.
Patti Biro, Deb Daulton and Eleanor Szanton were formerly associated with NECTAS.
Constance Garner was a policy and program specialist for the U.S. Department of Education, Office of Special Education Programs, Early Childhood Branch, when the previous edition of this paper was prepared.
NECTAC Notes is produced and distributed by the National Early Childhood Technical Assistance Center (NECTAC), pursuant to contract ED-01-CO-0112 and no-cost extension of cooperative agreement number H024A-60001-96 with the Office of Special Education Programs, U.S. Department of Education (ED).
Contractors undertaking projects under government are encouraged to express their judgment in professional and technical matters. Opinions expressed do not necessarily represent the Department of Education's position or policy.
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