Chapter 1: Purpose & Design [ Title Slide start: ] Description Start: Title: Functional Scheme Content: Levels: 0-48 months Description End: Audio Description: A slide reads: Functional Scheme; Levels, zero to 48 months. At the bottom are logos for Pentrickton Center for Blind Children, Texas School for the Blind & Visually Impaired, and Perkins School for the Blind. [ Title Slide start: ] Description Start: Title: Presented by Content: Patty Obrzut, M.S., O.T.R. Assistant Director Penrickton Center for Blind Children Description End: Audio Description: Presented by Patty Obrzut, M.S., O.T.R. Assistant Director for Penrickton Center for Blind Children [ Slide end: ] Audio Description: Patty Obrzut, Assistant Director for Penrickton Center for Blind Children is seated at a table in a studio. Patty Obrzut: The functional scheme is an evaluation tool that was developed by Dr. Nielsen. [ Slide start: ] Description Start: Title: Functional Scheme: Purpose Content: To create the best possible basis for developing an appropriate learning program for an individual with special needs. Description End: Its purpose is to create the best possible basis for developing an appropriate learning program for an individual with special needs. [ Slide end: ] What I really like about this assessment is that Dr. Nielsen takes her time to really identify small skills of children between the ages of zero and 48 months. [ Slide start: ] Description Start: Title: 20 Functional Fields Content: List of all 20 functional fields Description End: The functional scheme is divided into 20 functional fields. It covers areas such as gross motor skills, fine motor skills, sensory perception, such as visual perception, auditory perception, tactile perception, but it also includes things like spatial relations, object perception, language, social skills, and the always important emotional level of a child. Each functional field is divided into 11 segments. [ Slide start: ] Description Start: Title: Divided into 11 Segments Content: left-side text: Three month segments for 0-18 months right-side text: Six month segments for 18-48 months Description End: Typically, most of the segments are divided at three month intervals between the ages of zero and 18 months. After 18 months, they're divided into six month segments. So what's really nice about this evaluation method is that there's a lot of emphasis on children from zero to three months, three to six months, and six to nine months. [ Slide end: ] I think you can find a lot of assessments out there that deal with children who function above a 2-year-old level, but it's extremely difficult to find an assessment that talks about children who are function at a level below a 2-year-old or 4-year-old level. And that's why I prefer to use the Functional Scheme. [ Slide start: ] content read by speaker Now, each segment of the Functional Scheme begins with a milestone statement, which is used to assess the appropriate level of development. In the milestone statement, for example, the perception through play and activity, one that's demonstrated here. [ Slide start: ] Description Start: Title: Perception through play & activity Content: Table of milestones with columns reading left-to-right; Level, Milestone, Yes, No; and rows for each developmental level 0-48 months. Description End: You'll see that at the zero to 3-month-old level, a child might play with their fingers. So the adult would look at this milestone statement and say, "Does the child play with their fingers? Yes or no?" In this circumstance, I gave the example that the child does, so I mark it with a yes. At the 3 to 6-month-old level, does the child grasp and release objects that are hanging over their hands or feet? I again said yes. When you get to the 6 to 9-month-old level, does the child move objects from hand to hand? I would say the child does not. And from the 9 to 12-month-old level, does the child use an object to bang on surfaces or other objects? I answered no. So in this example, I would look at the milestone statement and decide where would I want to begin my assessment. [ Slide start: ] content read by speaker You start your evaluation in the segment at the level you last stated yes to the milestone. So for the example I just gave, we would start the assessment at the 3 to 6-month-old level. So I would first work on that section, and if I find out that I have a lot of yeses or a lot of nos, I would also go back to the zero to 3-month-old, and complete that section, as well. If I end up performing the 3 to 6-month-old section and finding that I'm responding yes to a lot of things, I'm also going to move on to the 6 to 9-month-old level. [ Slide start: ] Description Start: Title: Recording Data Content: Recommended to mark each function with the month and yar, and with initials of the recorder (e.g. 2/14 PLO) Use minus sign (or n/a) for a function to indicate the function has been considered but is not applicable (e.g. learner is blind and function requires vision) Description End: When you're recording your data, it's recommended that you mark each function with the month and the year and then you're going to want to put your initials down that you were the recorder of that information. You can use a minus sign, or an NA sign, if you get to a function that doesn't really relate to the student that you're evaluating. [ Slide end: ] So for example, let's say I'm working with a child who has absolutely no vision whatsoever. When I get to the visual perception section, I may just mark everything as an NA, and not really evaluate the child any further, because it's not their fault that they can't see. So you're aware that they can't see, and you've assessed that, but really you're not going to assess it again in the future. [ Slide start: ] content described by speaker So, this is an example of the perception through play and activity section at the zero to 3-month-old level. You'll notice at the top, the function is the skill that you're assessing. So, the first one that's offered here is plays with fingers. So you have several options that you can answer the question. Number one, you could say, 'yes,' or you could say, 'no.' Now, what I mean if I say 'yes,' I mean that the child is absolutely able to perform the activity, without any assistance, any motivation, or any prompting from an adult. So, does the child play with their fingers independently? In this example, I said 'no,' that the child is not seen playing with their fingers. Now, you might also answer that you 'don't know,' because you haven't seen it, yet. You might also answer that the child 'was able to' do it, but is not doing it now. Or you might respond that the child is learning the activity. [ Slide end: ] You need to pick one box that best represents the answer for that question, and stick to that one box. Don't mark more than one box. [ Slide start: ] repeat previous slide So in this example, plays with fingers, I said, 'no.' Looks at fingers, I said, 'yes.' Pushes objects hanging over their hands and feet, I said 'no.' Moving legs, especially when naked, I said, that 'learning has begun.' And pushes feet against objects that give resistance, I said, I 'don't know.' [ Slide end: ] So, what this would mean is in a future assessment time, I would just keep my eye out for that last one, pushes feet up against an object, and if I happen to see that the child does do it, or doesn't do it, then I would go ahead and add the box that corresponds to what I've observed. So, let's say the child can do it, and I notice it a month from now. [ Slide start: ] repeat previous slide Then I'm going to go in in the section 'yes,' and I would put today's date and I would put my initials. I would also go ahead and leave that answer 'don't know' in that box. You don't have to erase that answer, because your dates are going to be different. [ Slide end: ] So what happens over time is this book is going to provide you with information about when children learn new tasks, when they start learning new tasks, and when they've completed their learning on a simple skill. Now, you're going to need to individualize the assessment, as needed. [ Slide start: ] Description Start: Title: Individualize Assessment as Needed Content: e.g. learners with CP that only performs skills with left or right side of body should have this indicated on the assessment. Assessment table with notation described by speaker. Description End: For example, you might have a child with cerebral palsy that can use one side of their body over the other. So, in this example, I have pushes objects hanging over their hands or feet, and I indicated that a child is beginning to do that task, but they only do it with the right hand. So, you might make a comment, 'right hand only,' so that you're aware that the child does not do it with their left hand, but is starting to do it with their right hand. I also want to point out the section that says 'performed in favorable conditions.' [ Slide end: ] Let's say you have a child that can reach for an object, but only when an adult asks them to do so. That means that the child is possibly trained in their responses, that they've learned to do it upon command, but they don't really do it independently. [ Slide start: ] Description Start: Title: Performs in Favorable Conditions and Performs Spontaneously Content: • May indicate child has been trained to do "on command" • Want them to do it independently - a "yes" • Performs spontaneously = Yes Description End: So, you can go ahead and mark that down in the 'performs in favorable conditions.' But what we want to see is a child that is in the yes box, that they do it independently, because they want to. I happen to feel that the 'performs spontaneously' box is the same thing as 'yes,' that they do it independently and on their own. [ Slide end: ] So, who should be using this assessment? I think anyone that's working with a child. [ Slide start: ] Description Start: Title: Who Should Assess Content: left-side text: • Teachers • Paraprofessionals • Caregivers • Therapists • Parents • Anyone involved in child's life right-side text: If you are working on the assessment and see that your opinion of a child's skill is different than another's, have a conversation with that person to determine the best response. Description End: Teachers, paraprofessionals, caregivers, therapists, parents, anyone can help perform this assessment. What's nice is, if you can get a team to help you complete the assessment, you also might find out that what a child does at school, they don't do at home, or what they do with grandma, they don't do with a parent. So if you work together as a team, you'll complete one book, and you'll all have your information going in one area. [ Slide end: ] So, if I go to answer a question and I find out that someone else has said, 'no,' when I think the answer is 'yes,' I need to seek out that person and have a conversation with them. What you'll find out that's happening is that maybe that person evaluated that... skill level, and they didn't have all the information. So, you start having a conversation, and you make a decision with the two of you. Was the answer yes? Was the answer no? Was it performed in favorable conditions, and someone marked it as a yes? And together you make a decision, and only have one answer. Chapter 3: Assessing Functions If you decide to use the Functional Scheme, you might sit there and find out, well what does this function really mean? You have to remember that Dr. Nielsen is from Denmark, and her original language origin was Danish. So her English is not necessarily the same English that we use. [ Slide start: ] Description Start: Title: What Does Each Function Really Mean? Content: Written by Dr. Nielsen who's language of origin is Danish. • Torch = flashlight • Chamber pot = toilet • When in doubt - look at typical development center graphic: table from assessment Description End: For example in some of these skill levels, she'll talk about a torch, and a torch in Europe is a flashlight. She also mentions frequently a chamber pot, and a chamber pot is a bathroom or a toilet here in the United States. So, when you're going through the assessment, remember that some of the skills are written for European languages. Also, when in doubt, try to look at typical development. I put, for an example, in the gross motor section, Lilli has a skill that says, when a child is supine do they maneuver their feet up and down, like a bird wagging their tail? [ Slide end: ] So the first time I saw this, I went, 'What does she mean by that?' And so I must tell you, I went online and watched birds, and birds take their tails, and they go up and down. Then I went online, and watched some videotapes of children between the ages of zero and three months, and sure enough the children will put their two legs together, and move their legs up and down. So, by watching what typical development was, I could assess that that's what she meant by that skill level, and give it a correct response. It's also very important that you assess the skill based on the field that you're in. [ Slide start: ] Description Start: Title: Consider the field you are in Content: These functions are NOT assessing the same thing! Table from Fine Motor field Table from Spatial Perception field Description End: I've given you two examples of a skill that are in different sections of the Functional Scheme. The first function is in the fine motor section, 'Does the child reach and grasp successfully?' So we're in the fine motor section. Does a child reach? In the second section, you're in the spatial relations section, and it says, 'Does the child touch and grasp an object in quick succession to assure that the object is present?' What you're assessing in this skill level is does the child 'grasp in quick succession to assure that it's present?' You're not assessing does the child grasp. So, it's-- in the second part here, do they touch and grasp the object in quick succession to compare the position of an object? So, you are evaluating can they compare the position of an object? Not do they touch or grasp the object. [ Slide end: ] So, when in doubt, look at the section that you're in, and make sure that you understand that you're not assessing touch and grasp. You did that in the fine motor section. So, you can have two different answers. I might say, 'yes,' to the fine motor, that a child can touch and grasp an object, but I may say, 'no,' that they don't touch and grasp an object to assure where they are present in their location. [ Slide start: ] Description Start: Title: Functional Scheme Content: • Some "skills" (functions) cannot be assigned to a particular level of development -- listed as supplement at the end of each segment. • This segment is called "irrespective of level" Description End: So, some skills or functions cannot be assigned to a particular developmental level. So Lilli has a section, usually at the end of the segment, and this section is called 'irrespective of level.' [ Slide start: ] Description Start: Title: Irrespective of Level - Emotional Level Content: Table from assessment; described by speaker Description End: So for example, at the emotional level section of the Functional Scheme, this is the irrespective of level skills. So, she has is this child characterized as being sensitive or introverted or extroverted? Is the child loving? Is the child active or passive? It's just giving you information that describes this child, so that you can pay attention to the characteristics of a child, and apply that to your treatment techniques. [ Slide end: ] There's also a segment in the Functional Scheme called 'developmentally impeding functions.' [ Slide start: ] Description Start: Title: Developmentally Impeding Functions Content: • Section makes note of functions that may impede development • Blanks are available to write in functions that are observed but not noted in the assessment. center graphic: Table from assessment; described by speaker Reference: Description End: This section makes notes of functions that may impede development. So, for example, does a child head bang? Does the child throw their body backwards? Do they tap their hands or objects on the mouth area? At the end of this section, Lilli provides blanks so that you can write in functions that you might observe, but that are not listed in the assessment. [ Slide start: ] table from assessment described by speaker. For example, I've written in on this assessment that a child grinds his teeth and that the child bites his hands. Chapter 4: Scoring Assessment [ Slide start: ] Description Start: Title: Scoring -- Assessment levels of function Content: • Overall view of the learners development can be recorded • Use a percentage to indicate skill level in that range (segment) • Divided number of "yes" responses into the number of segments assessed (do not count "n/a") • Treat "learning has begun" or "performs in favorable conditions" as a "no" response. Description End: A final assessment is provided so that you can get an overall view of the learner's development. [ Slide end: ] So, I use a percentage to be able to identify the skill level in an age range. The simplest way to do that is you count up the number of yeses that you responded to in a section. So let's say you have ten questions, and you responded with two yeses and the eights -- and the other eight are nos. Then you have a 20 percent range. If somebody does eight out of ten, then they're at 80 percent. [ Slide start: ] repeat previous slide Make sure that you treat 'learning has begun' or 'performs in favorable conditions' as a 'no' response. The only thing you should consider a 'yes' response is something in the yeses, [ Slide end: ] because if a child is just learning in favorable condition, or maybe learning has begun, you really want to pay attention that that child needs to work on that skill longer. [ Slide start: ] Description Start: Title: Remember Content: Some "no" responses should be treated as a "yes" if it is appropriate skill to eventually disappear in the course of typical development • Example: F005 in Fine Motor (0-3mo.) Grasp reflexively. If child can grasp purposefully you may say "no or was able to." The child passed this skill level developmentally. Description End: Now, some functions or skills that you respond 'no' to should be treated as a yes. So, what do I mean by that? Well, sometimes you have a skill that actually disappears over the course of normal development. So, let's take for example in the fine motor section from zero to 3 months of age. You'll have one of the skills as grasping reflexively. So, of course, in the beginning, children grasp reflexively but then at about the age of three to six months, they start to learn to grasp on purpose, and it's not reflexive anymore. So, if you have a child who's actually grasping on purpose, then you're going to say 'no' to reflexively. [ Slide end: ] So that's actually a good thing. And when you're doing your percentages, you're going to count that 'n'o as a 'yes.' But also be aware, although it's appropriate for some skills to disappear in the course of typical development, [ Slide start: ] Description Start: Title: Be Aware! Content: Although appropriate for some skills to "disappear" -- some children have completely missed participating in skill due to impact of a disability • Example: F001 in Fine Motor (0-3mo.) sucks fist • If you never see child bring fist to mouth, you may think this is a good thing. • However -- if a child cannot bring a spoon to mouth, then possibly this is a skill the child should be exposed to Description End: some other children may have completely missed the ability to participate in their skill, due to their disability. So for example, in the fine motor section, again, zero to three months, one of the questions is can a child suck their own hand? Now, if you never see the child bring their hand to their mouth, you may think this is a good thing, because eventually all children learn to not really chew on their hands as they get older. However, what happens if you have a child who can't bring their spoon to their mouth, because they have cerebral palsy? This may be a skill that they actually missed, and through activities you might want to be encouraging them to somehow learn to bring their hand to their mouth. [ Slide start: ] Table from assessment described by speaker So what I'm showing you here is an example of a child's completed assessment, and their ranges. What I've done is I've highlighted certain sections in yellow, so that you can see that this child is in about an 80 to 90 to 100 percent in anything in yellow. And anything below is just left as a clear color. So you get an overall picture of this child's development. This child is at about a 3 to 6-month-old level in gross motor and fine motor skills, but they're way down at a zero to 3-month-old, in mouth movements and visual perception. Their auditory and tactile perception is way up at the 6 to 9-month-old level. [ Slide start: ] Table from assessment described by speaker In the smell and taste section, they have some skills at a 3 to 6-month-old level, and a 6 to 9-month-old level, but they don't have any skills at the 0 to 3-month-old level. Now, someone might question why do I have a zero here? This happens to be a child who has a special diet, and we're not allowed to give him different types of foods, so it's very difficult to assess that section. But however later in life, if that diet changes, we may be able to evaluate that section. So we went ahead and assessed it, but right now he got nothing out of that section as a 'yes.' Now, in spatial relations, he's 80 percent in the 0 to 3-month-old range, but in object perception, he has 100 percent at 0 to 3, so he has skills all the way up to a 6 to 9-month-old level. His language is down at a 3 to 6 or a 0 to 3 level. [ Slide start: ] Table from assessment described by speaker His social level is at a 0 to 3-month-old, and look at his emotional perception. It's way, way down at the 0 to 3-month-old, and he's only got a 25 percent in that category, and a zero from 3 to 6 and 6 to 9. He can play with activities at a 3-month-old, and he has skills up to a 6 to 9. His toileting skills are at a 0 to 3, undressing a 0 to 3. His personal hygiene is a 0 to 3, and his eating skills are a 0 to 3. [ Slide start: ] Description Start: left-side text: Example of percentages for assessment levels of functions right-side graphic: Table from assessment described by speaker Description End: So, this child overall has a range of functions between a zero to 9-month-old level. Just when looking at this slide, if you notice his strengths are going to be auditory perception and tactile perception. His weaknesses are going to be his mouth movements, his visual perception, his smell and taste, his spatial relations, and most of his personal hygiene, or ADL activities. [ Slide start: ] Description Start: Title: Assessing Levels of Function Content: • If a child can complete all of the functions in a segment -- they should be considered developed to that level • If a child has completed only some of the functions in a segment -- they should be considered as learning has begun to that level • Children with special needs can show great discrepancy between levels of development in different fields Description End: If a child has completed all of the functions in a segment, then they should be considered to be developed to that level. [ Slide end: ] So if you're in the 0 to 3 range, and you say, 'yes' to everything, then that child is at the level of a 3-month-old. [ Slide start: ] repeat previous slide If a child has completed only some of the functions in a segment, let's say maybe 50 percent, then they should be considered that 'learning has begun' at that level. So, if you're at the 3 to 6-month-old range, and they have about 50 percent that they can do, they are still learning those activities, and they need to repeat and practice that section even more. Children with multiple special needs can show great discrepancies between levels of development and different fields. [ Slide end: ] One of the most notable is you'll happen to notice a lot of children have a very low emotional level, and they'll have high tactile or auditory levels. Chapter 5: Importance of Re-Assessment The nice thing about the Functional Scheme is it's one book. That book should go with that child throughout their entire life. You use the same Functional Scheme no matter where they go so when they leave-- for example, where I work at Penrickton Center, that Functional Scheme can go with them. The nice thing is the next person, who works with that child, can look back at the Functional Scheme and they can find out at one time did that child first learn to roll over, or when did that child first learn to bring their hand to their mouth. [ Slide start: ] Description Start: Title: The Importance of Re-Assessment Content: • Use the functional scheme throughout a child's lifetime • As new skills are added, leave old documentation in place. • The evaluator will be able to "see" progress over long periods of time. Description End: As new skills are evaluated, you can add that information to the Functional Scheme. You leave the old documentation in place. Over time, the evaluator will be able to see the progress that the child is making over long periods of time. [ Slide start: ] Table from assessment described by speaker In this slide, you can kind of see-- if you look at the last item, 'pushes feet against objects to give resistance,' I said back in June of 2015 that the answer was 'no.' Even before that, I said in February of 2015 that I didn't know the answer, so I evaluated it and then found out that the answer was 'no' but now in February of 2016, the answer is 'yes.' So, you can see that that child from six months learned a new skill. [ Slide end: ] When developing a learning program, every improvement, or lack of improvement, in one field will influence the development in all other fields. [ Slide start: ] Description Start: Title: The Learning Program Content: • Every improvement or lack of improvement in one filed will influence development in all other fields. • consider any discrepancy in the various fields, so program provides enough appropriate opportunities to foster developmental lagging fields • Gradually achieve better development equally among the different fields -- foundation for future learning. Description End: In developing a learning program, any discrepancy in the various fields should be considered, so that the program will provide enough and appropriate opportunities to foster development in the lagging fields, and gradually achieve better development equality among the different fields, which is the foundation for all future learning. [ Slide start: ] Description Start: Title: The Learning Program Content: • As small but distinct developmental successes follow and increase in the various fields, display of positive energy in the learner follows naturally. • This is both the result of and encouragement for ego development. Description End: As small but distinctive developmental successes follow, and increase in various fields display of positive energy in the learner usually follows. This is both the result of and the encouragement of ego development. [ Slide end: ] So the learning program must provide opportunities for the learner to use skills that they've already achieved. [ Slide start: ] Description Start: Title: The Learning Program Content: • Program must provide opportunities for the learner to use the skills already achieved • Apply knowledge about existing functional patterns (skills) to learn and progressively develop skills at a higher level in next segment of development. Description End: Thereby, they're applying their knowledge about existing patterns to learn and progress and develop patterns at higher levels and the next segments of development. [ Title Slide start: ] Description Start: Title: Active Learning Space Content: www.activelearningspace.org December 2016 Description End: Audio Description: A slide reads: Active Learning Space; www.activelearningspace.org; December 2016. At the bottom are logos for Pentrickton Center for Blind Children, Texas School for the Blind & Visually Impaired, and Perkins School for the Blind. Fade to black.