Assessment and evaluation for early intervention services
by Robin Balbernie

(This page is an edited extract from a paper written by Robin Balbernie on Assessment and evaluation measures / tools that can be used in early intervention services. See the full paper here. Robin divides the tools he describes into the nine areas listed below, each of the nine areas has a separate page on this wiki, this page gives an overview of the whole area of assessment /routine outcome measurement)

These are collected ideas on what can be evaluated and monitored during the process of the work of a multidisciplinary infant mental health service, or for
that matter any team working with children in the early years such as a children’s centre or health visitors. They are originally based on a working
group held at the Anna Freud Centre for PIP UK and what has been found since then in the literature. A recent paper provides an overview from a
slightly different perspective. - Eduardo Szaniecki and Jacqueline Barnes (2015) Measurement issues: measures of infant mental health. Child and
Adolescent Mental Health, published online 23rd April. It has a comparison table of structured questionnaires and mentions a few observational methods.
The CORC website also has a plethora of measures for all age groups

I have made a division into nine domains (there is a lot of common ground), and in the appendix are some more early years assessment measures where
either further information is hard to find or they do not seem quite so potentially appropriate for a PIP team. These might fit a specific bill for a
different setting. Feedback and further information would be welcome on all measures. There is little point in doing any sort of evaluation / assessment
unless it helps the caregiver understand their infant, and can be communicated in everyday language.

These are the slightly overlapping areas of assessment considered:

1) parenting skills and actual interactions between parent and infant;

2) the parent’s perception of the infant, or of their own parenting;

3) the stresses that the care-giving relationship is under;

4) the quality of the care-giving relationship, including attachment;

5) pre-birth assessments;

6) the child’s social and emotional development as well as his or herglobal development;

7) the state of mind of the parent;

8) some more public health oriented indices which might interestcommissioners;

9) and client feedback at end of contact.

Measures need to be appropriate for children under the age of two for a PIP team, but this will not apply to many other early years services. They might
sometimes duplicate or overlap with those used by heath visitors, community paediatricians or adult mental health services. Any measure should not
dominate a session when it is being applied, and should preferably produce clinically useful information that will be understandable by the client and
relevant to partner agencies and commissioners. They should also be moderately less likely to generate fake, or false positive, responses. Evidence
shows that collecting outcome measures improves actual outcomes. There are three different levels to consider here: clinical practice, routine outcome
measures and finally those for research and RCT purposes.

A massive list of tools for evaluating home visiting has been published by DOHVE - and also on Updated.pdf Handy for a quick and extensive overview. Also, CORC have
already made some suggestions in this field, and I can send them if you are interested, email me at:

Head Start in America has developed a range of evaluation tools for looking at outcomes in the early years. See:
family/assessing and explore the links that follow for many examples.

The Social and Emotional Assessment Group that contributed to the recent report from the DoE and WAVE, ‘Conception to Age 2 - The Age of
Opportunity’ (see: ) listed the principles behind the selection of methods for assessment in the early years.

They were:

1. The purpose with all assessments of a child’s social and emotional well-being should be to establish the level of social and emotional
functioning of the infant in addition to the sensitivity/responsiveness of relevant carers in order to guide the family and the practitioner towards
the most appropriate support and intervention for the family within the context of a gradient of need.
2. Assessment tools should be practical as well as valid and reliable, based not only on sound research and evaluation but also on a high
likelihood of it being implementable as part of a busy practice.
3. All assessment tools need therefore to make sense to parents and carers, and to be seen as supportive rather than judgemental; this
requires that such tools be implemented as part of a promotional and partnership model of working.
4. Measures and methods must be usable across the whole spectrum of ability including social disadvantage, disability, culture and language
5. Finally training in any proposed assessments must be easily accessible and not prohibitively time consuming or expensive.

Beyond validity, there may be other questions to answer to see if a parenting assessment tool will be useful, the following are based on ideas from KIPS:

1. Does it document outcomes that match agreed service goals? i.e. Will it make sense to clinicians, parents and commissioners?
2. Is it clinically useful, identifying the parent's individual strengths as well as any areas needing improvement? Are the assessed behaviours
potentially changeable and the changes measurable?
3. Will it provide information relevant to quality of parenting?
4. Can the answers / behaviours being measured be easily simulated? This applies to the child as well, as by 15 months a toddler is capable
of faking false positive behaviours and affect
5. Is it sensitive enough to note parents’ progress, or where further work needs to be done? Is the assessment information useful in planning
and promoting services?
6. Is it designed so the information makes sense to a parent and can be used to reinforce a parent's progress and build their confidence?
7. Does it highlight parent-child interaction?
8. Does it provide easy to understand language that can be shared with parents, team members, and other agencies alike?
9. Does the assessment information support reflective practice, promoting both ‘mind-mindedness’ for the caregiver and the process of reflective
supervision for the clinician?
10. Does it provide information and data that will be helpful in continuous improvement of both the staff and the service?

Conclusions so far
There is currently no completely satisfactory single assessment tool for a clinical situation involving children under age two, with all those listed having
disadvantages (and advantages) of one sort or another. It was decided that the measures that would initially be recommended to new
PIPs, to ensure consistency, would be: KIPS, PIRGAS (with great reservations and in conjunction with a structured observation); both the Ages

and Stages Questionnaires when useful, with ASQ:SE2 at least giving some idea of whether or not the infant is on course in terms of social and emotional
development and the standard ASQ available for screening for developmental delay / difficulties and the need for a further specialist referral. All, except the
PIR-GAS, have the advantage of being shareable with the parent. In terms of the parental states of mind the GAD-7 and PHQ-9 can be used, or
else the HADS which has the advantage of assessing both anxiety and depression with one measure and so takes up less time for both parent and
clinician. This last measure was suggested by the panel. The risk factor checklist provides anonymous records of the difficulties impacting the caregiver-baby relationship that some families contend with. In terms of evaluation and feedback to other services and commissioners, this can be used to give an anonymous profile of the families worked with. It also is a rough indicator of both complexity and other, more distal, targets for intervention. (Psychological work may not begin until certain practical issues,
such as safety, have been resolved.) Plus, it would be important to include a parent evaluation at end of service contact (PIP UK has an example). More
measures may be developed in the future; but for now each PIP could also explore other ways of assessing their work as well and share information as
services develop.