Indicator of Parent-Child Interaction (IPCI) User`s Manual
Contents
1. No Opportunitv should be checked Examples lt Baby smiles and coos as mom shows book lt Baby wiggles arms and legs and vocalizes when dad leans over baby and smiles lt Child leans into parent giving a hug and smiling Non Examples Child focuses visually on a book but does not provide any positive feedback Scoring Hint With a toddler or slightly older child reserve a rating of 3 for frequent clear expressions of positive feedback For example occasional smiling interspersed with frequent whining crying and refusals should never be rated as a 3 35 2 Sustained Engagement Child engages in sustained activity Consider both social and non social engagement with toys or materials For older infants and young children the child must be actively engaged e g reaching for looking at turning pages of a book manipulating objects etc This item does not include an older infant or child sitting and passively watching others interact However for very young infants this item does include sustained visual attention to toys materials or face Watch for at least 30 seconds of sustained attention to parent s face or materials Simply looking around a room is not an example of this item Examples lt Baby focuses on board book for at least 30 seconds by reaching grasping intent focus or attempting to turn pages lt Child plays with toy house for2. misses opportunities to use stress reducing strategies in response to subtle signs of distress such as gaze aversion disinterest frustration do not assign a rating above a 2 During the observation use tally marks or write down key words next to Uses Stress Reducing Strategies on the rating sheet each time you hear an example It is helpful to write a key word the first time you see an example If following the child s lead is infrequent then continue to write key words If it is frequent use tallies Before you assign a rating count these examples 30 Parental Caregiver Interrupters 1 Uses criticism or harsh voice For this item as well as each of the Interrupter items consider both frequency as well as severity when rating Interrupters If there is a conflict between frequency and severity use severity to rate the item e g single episodes of a parent calling a child a name using a derogatory label or making emotional threats e g I m going to leave you don t want you anymore or using anything more than the most mild physical force should automatically be rated as a 3 Watch for name calling sarcastic tone of voice yelling raised voice critical statements about the child Avoid trying to interpret a parent s meaning with this item Enter a tally mark if you observe any of the behaviors listed It is possible for a parent to make a very demeaning statement while laughing or dismissing
3. at least 30 seconds before switching focus Non Examples The child watches parent while parent sits on couch while watching child without interacting Scoring Hint Use tally marks to note instances of 30 second or more intervals of sustained attention 36 3 Follow Through Examples lt gt lt gt lt gt lt gt When and if the parent attempts to engage the child or requests action the child follows through by vocalizing gesturing attempting task or for very young imitating a smile or vocalization of the parent This item gets at the extent to which the child follows through and responds to a parent s attempt to engage the child Watch for the child to follow a parent s instruction follow through with a verbal request or follow through with a clear non verbal cue after it has been paired with a request or instruction In response to a mom smiling and expanding on baby s vocalization baby smiles and vocalizes Mom puts a toy in a box and says Let s put them away and child begins to pick up toys Dad claps his hands and says You do it as he models clapping and child claps hands Auntie says You can do it get that bunny and child reaches for the bunny but doesn t quite grasp it Non Examples lt gt Mom says let s play Peek a boo and holds her hands up to her eyes as child watches Scoring Hint Use tallies i
4. at that particular time 10 What about parents and children with disabilities Vision hearing impairments Using sign language What about reading illiteracy c Remember instructions for the book activity do not involve asking the parent to read to the child For parents or children with visual impairments books are also available in Braille which will help with visually disabled parents and children 19 Overview of IPCI Items Parental Caregiver P C Domains P C Facilitators 1 Conveys acceptance warmth 2 Uses descriptive language 3 Follows child s lead 4 Introduces voice materials to maintain or extend child s interest 5 Uses stress reducing strategies P C Interrupters 1 Uses criticism harsh voice 2 Uses restrictions intrusions 3 Rejects child s bid for support Child Ch Domains Ch Engagement 1 Gives positive feedback 2 Shows sustained engagement 3 Follows through Ch Distress 1 Overwhelmed by negative affect fussing crying whining 2 Externalizing distress 3 Frozen watchful withdrawn 20 General Scoring Procedures Immediately following a live or video recorded administration of IPCI interaction activities the IPCI rating sheet including the Cover Sheet is completed Each item is rated on a 4 point scale of relative frequency i e 0 Never 1 Rarely Mild 2 Sometimes Inconsistent and 3 Often Consistently Severe Parental Caregiv
5. being changed a The key here is to make sure the child s privacy is protected Rather than pause the camera it is much better to shift the camera to focus on the parent and any unexposed area of the child This can usually be done quite easily by lifting the lens so that the child s exposed area is not in the picture This is far preferable to pausing the camera because it then allows the assessor and the parent to see what the parent is doing and how the child is responding which can be very important for intervention purposes should intervention be warranted 9 What about personal and cultural differences a Being sensitive to and aware of cultural differences is always best practice Parents may play with their child in many different ways There is no prejudgment about the types of activities they may choose to engage in with their children e g social play materials play etc However the IPCI focuses on specific behaviors that are associated with either more positive child outcomes or more negative child outcomes regardless of the child s cultural background b Scores should be scored based solely on the video tape and with careful attention to the behavioral definition not what you know about the family This should not result in parent child interactions looking worse than they are Rather you are simply recording what is occurring in the present moment which is likely to result in the most accurate picture
6. key words If it is frequent use tallies Before vou assign a rating count these examples 25 3 Follows Child Lead The adult follows the child s lead by noticing what the child is interested in and either commenting on the child s interest or joining in the same activity without interrupting the child However the parent does not interrupt the child or redirect child s behavior Following a child s lead can occur in the context of routines in which a parent may be taking a more active role than in play For example a parent who notices and comments on the child s focus and what is happening during dressing can be an indicator that the parent is following the child s lead However this must be done in a non intrusive manner to be exemplary of this item 2 The adult may introduce activity and make suggestions but parent follows child s lead through attending imitating joining turn taking and or commenting appropriately on child s interest The caregiver may use gestures words or actions consistent with child s focus which may slightly extend child s verbal or nonverbal behavior The parent may comment on what the child is doing If the comment is descriptive it would also be an example of Using Descriptive Language If in addition the comment is positive and affirming of the child it would also be an example of Acceptance Warmth Examples of Follows Child s Lead lt Child points t
7. name is ready to look ata book and introducing the activity 15 Common IPCI Administration Questions and Answers 1 If the family has 2 children do we need 2 separate IPCI sessions a Yes Also if siblings are around and in the video for the target child only score parent behavior directed toward the target child except in the case where a negative or harsh voice tone is directed to another child and the target child is exposed by virtue of proximity 2 What if the family is very resistant to being video taped Can you score in session a Remind the parent that the video is only to help the assessor and parent be able to learn together about how the child is relating to others at home Also if the assessor is nervous or embarrassed about videoing the family will be Advocates must be comfortable with the procedure b Often if the video recording is started early and the assessor provides a brief appropriate explanation parent s apprehensions can be alleviated and families will get used to the recorder and ignore it c If the parent caregiver continues to express reservations find out exactly what the parent is concerned about and help to alleviate the worry For example some parents are concerned that individuals other than the assessor might see the video Others have misperceptions about what it will be like to be videotaped and expect lots of lights and a big camera such as an in a photo shoot In this case par
8. or Extend the adult s behavior must be interesting and not disrupt the child s focus of attention Developmental appropriateness of the parent s behavior must be considered when rating this item In order to rate this item as present the behavior described herein must be novel or interesting and it must be developmentally appropriate Attempts to stimulate development that are far beyond the child s development level are Not examples of Introduces to Maintain or Extend Keep in mind for this item that what may be novel or interesting the first time it is introduced may not continue to be novel interesting when repeated Examples of Introduces to Maintain or Extend lt The child reaches for a toy phone and begins to vocalize Mom says Yes let s call grandma as she moves the phone with child s reach lt The child is engaging in pretend play with a toy barn As the child picks up one the duck figure the dad says quack quack let s feed the animals Non Examples lt The child is looking at or reaching for a toy ring and the adult places another toy in front of the child The child is playing with a toy barn and the parent sits beside the child quietly watching but does not engage with the child in play When mom says let s look at books the child picks up one book Mom says in reference to another book let s look at this one instead Scoring Hint During the observati
9. says in a firm but kind voice Oh you can t have that it s not safe as she leads child away and to a safe activity Scoring Hint Scoring Hint Remember for this item as well as for each Interrupter item consider both frequency as well as severity when rating interrupters If there is a conflict between frequency and severity use severity to rate the item e g single episodes of hitting a child or using anything more than the most mild physical force should automatically be coded as 3 For this item a single intrusion should be scored a 3 if it is severe e g slapping roughly yanking a child backward A rating of 3 would also be given if intrusions are frequent but mild To score a 1 the intrusion or restriction 33 should be mild and occur only once 3 Rejects child s bid This item includes words or gestures that the parent uses specifically in response to a child s seeking of support help or attention from the parent that explicitly convey that the child is not to interrupt parent or seek parent s attention or physical support e g motioning the child away to get away from the parent or pushing the child away saying Not now or I don t want to play with you pulling away from a child who is seeking a hug or blatantly ignoring a child s request for help or attention Remember to consider severity not simply frequency One severe rejection would be scored a 3 If t
10. sought for guidance in intervention decision making and planning IPCI Administration IPCI Interaction Activities The Indicator of Parent Child Interaction is completed following a series of brief interaction activities between a parent or other primary caregiver and their young child at home or in a child care setting during a 10 minute observation period IPCI activities include the following e Free Play e Book Activity e Distraction Task Only for children older than 1 year of age e Dressing IPCI Administration Materials The IPCI materials kit includes the following e Small carry case for all materials e Blanket plastic top table cloth at least 5 X 7 e Set of brightly colored keys and key ring attached to recorder e Books Brown Bear Touch and Feel Puppy Fiesta Available in English Spanish and Braille IPCI Administration Protocol e IPCI Rating Sheet e Timer Be sure time signal is soft and subtle Do not use timer with a loud or repetitive buzzer e Camcorder tripod videotape or memory stick if rating sheet can not be completed live e Video recording device for clinical use of video reflection IPCI Administration Steps Step 1 Cover the Pre Assessment Visit Introduction for Parents or Other Caregivers The Pre Assessment Visit Introduction for Parents should be discussed with parental caregivers prior to the assessment visit either during a home visit that precedes the assessment visit or by t
11. strategies brief breaks comfort 1 2 3 distraction Total ___ out of 3 orTotal __ outof 6 or Total out of 12 or Total __ out of 15 Total __ s out of 9 Caregiver Interruption Never Rarely Sometimes Often NA Child Reactivity Distress Never Rarely Sometimes Often NA Mildly Severe Mildly Severe ee 1 Overwhelmed by neg affect 0 1 2 3 1 Criticism harsh voice 0 1 2 3 Rapidly shifting signals whimpering crying 2 Restrictions intrusions 0 1 2 3 2 External distress tantrum 0 1 2 3 hitting kicking screaming 3 Rejects child s bid 0 1 2 3 3 Frozen watchful withdrawn 0 1 2 3 Total ___ out of 6 orTotal _ outof 9 Total ___ out of 9 42 INTEROBSERVER AGREEMENT CHECK CALCULATION Example enter ra Ery E ioa Interru ra Ery E eme Primary Coder PC Reliability Coder RC AToTAL Sum agreements for Sum agreements for 5 Facilitators amp Interrupters 6 Engage amp Distress 5 Overall Agreement Sum disagreements for Sum disagreements for Facilitators amp Interrupters 1 Engage amp Distress 1 Agree A A D 86 A A D 83 Calculation of Percentage Agreement Record Primary coder scores in first row Record Reliability coder scores in second row Record the number on which they agreed on the third row Record the number on which they disagreed on the fourth row Calculate Percent Agreement for each Key Behavior by column using
12. 1 IPCI Rating Cover Sheet IPCI Rating Sheet Inter rater Agreement Worksheet Introduction Why Another Measure for Assessing Parent Child Interaction Parental caregiver child interaction is the earliest and foremost mechanism for promoting positive social emotional behavior in very young children While infant mental health theory evidence based practices for supporting positive behavior in young children and routines based intervention in early childhood all emphasize the importance of parent child interaction in promoting children s early social emotional behavior few assessment tools exist for assisting practitioners in efficiently screening at risk parent child interactions and monitoring progress expected with intervention This gap is illustrated by a host of limitations of more commonly available measures which include administration requirements beyond the training and experience of most early intervention service providers measures that are too long and complicated for repeated use in authentic environments such as homes and child care settings and lack of readily available reports that can show progress toward important outcomes To advance effective practice for supporting early parental caregiver child interaction and young children s early social emotional development specific characteristics of parent child interaction measures are needed That is to be useful for practitioners providing early intervent
13. Grandma smiles and in a happy excited voice tone says Oh those are soft touches to that furry doggie lt Dad giggles and says Wow look at you go as child begins to crawl or walk Non Examples of Shows Acceptance and Warmth lt Mom says Yeah you finally did it in a flat voice tone as she rolls her eyes lt The child becomes frustrated during play and mom laughs lt Child throws a toy across the room and dad smile and then says how many times have I told you not to do that i Scoring Hint While you are observing make a tally mark on the rating sheet near Conveys acceptance warmth each time you observe an example that meets the definition above When you are ready to rate this item after the observation count the number of tally marks you have made and consider these before rating this item 23 2 Uses Descriptive Language This item includes adult descriptive comments that meet at least one of the following criteria The comment both labels and connects objects and actions the wheels go round not there they go see what the wheels do The comment labels and connects nouns and adjectives there s that furry brown bear The adult describes activities objects and or child s behavior or feelings This item does not refer to negative descriptive statements about the child or child s behavior e g That s mean Don t be a bad boy You re going
14. Indicator of Parent Child Interaction IPCI User s Manual Kathleen M Baggett Judith J Carta Juniper Gardens Children s Project Schiefelbusch Institute of Life Soan Studies University of Kansas Eva M Horn Department of Special Education University of Kansas With the Assistance of Rashida Banerjee Yumiko Saito Kiok Kim 2002 2003 All Rights Reserved Format Version September 25 2006 Baggett Carta amp Horn Table of Contents ERO GI CE ko g PAEA AEE ee eeno andes ec E es mac 3 PCT ACIIESEGLI ON is sarswesvuvan tales usavetc E EEE E EEEE RE ah 6 Interaction ACKIVITIOS se sesse vei eei Ee ai EEEE EEEE EEE 6 Materials sank nnn Qu eaaa a aa Na AAEE AAE AA N oaa 6 Pre Assessment Visit Introduction for Parents or Other Caregiver 8 Administration INStrUCtiIOnNS sssssssesserssrerrrre sarin sacdoniata na teeeans 9 Admi istration WiPSieicicsucernssesnereieesniereiaeients eee 15 Administration Questions and ANSWEIS cccccsceeceeeeeeueeeeeeuaueanes 18 Item Definitions and SCOPING cccccececececeeeeeeeeeeeeeeeeeeeeeeeaeaeaeaeneaeaeneaeas 23 Overview of IPCI Penis ciccsranciirderaeixeercsergarengndi van iuenteneneegecanes 23 General Scoring ProcedureS ssssssssrsrrerrerrrerrerrsrnsrrerrerrerrrerrrrre 24 Parental Caregiver DOMainS ssssssssrssresresrrsrrsrrsrrrrrerrerrrrrrere 25 Child DOMAIN Savas er EAEE 38 Appendices assanir eina IEEE EE EEES EEEE TETEE EE eoedetin eel E 4
15. ain what s important is parent and child comfort In taping hundreds of IPCI assessments with culturally diverse and many high risk families less than 1 of parents were unwilling to be video recorded after discussing their specific concerns In one case the parent was diagnosed with paranoid schizophrenia and had stopped taking her medication In the other case the parent had a disfiguring skin disorder and had removed mirrors from her home In such extreme and rare cases when video recording can not be done IPCI activities can be scored live A significant disadvantage is that video can not then be used for providing positive support interventions In addition to preparing parents for video recording by exploring and addressing concerns t s also important to watch for excessive parent or child reactivity to video recording Signs of reactivity in children will be obvious and may include staring into the camera or coming to look into the camera Watch for these signs and if you see them encourage child to return to interaction with parent If these behaviors are very brief and the child quickly returns to interaction with the parent then continue to record and make a note on the Rating Cover Sheet about the approximate duration of the reactivity and how it may have affected the assessment if relevant However if the child is not quickly redirected to the parent stop recording and stand in front of the camera Let the parent know that wh
16. der infants children parents may use distraction appropriately e g helping child become interested in another activity Simply introducing new toys or materials to a young infant under 6 months who is showing aversion or distress cues is not an example of appropriate distraction Similarly after attempting to introduce a new activity once or twice with an older infant or young child unless the parent uses another strategy listed herein repeating this behavior is not an example of appropriate distraction General words of affection or comfort without steps to comfort are not examples of Stress Reducing strategies If the child does not show any aversion frustration cues or distress then No Opportunity should be checked If the child shows aversion frustration cues but not overt distress such as crying then rate this item based on the parent s response to aversion frustration cues Follow the same principle if the child shows overt distress but not earlier signals of aversion frustration If the child shows both aversion frustration cues as well as distress and the parent engages in appropriate strategies to one of these e g distress crying but not the other e g aversion frustration cues and the child provided an opportunity for the parent to respond this item should be rated less than 4 Examples lt In response to an infant crying dad picks up the infant cradles the infant quietly provides a pacifier a
17. dministered The assessor should be thoroughly familiar with them prior to administration and should reference them while maintaining eye contact with the parental caregiver Avoid giving the appearance of reading the instructions The activities should be presented in the order that they occur in the protocol Always begin with Free Play and never end with the Distraction task While the IPCI is designed to be used for guiding intervention decision making intervention is a separate activity from assessment and should not enter into play during assessment Reliable and valid results depend on following the administration protocol and making individual accommodations as recommended for increasing parent and child comfort when warranted Always follow the instructions and use IPCI Administration Tips for making appropriate individual accommodations Pay close attention to the verbal and nonverbal messages that you send during the observation Focus on maintaining a relaxed and accepting stance It is appropriate to provide general encouragements and reminders about what is expected However it s important to avoid intervening during the observation by sending verbal or nonverbal messages of approval disapproval or behavioral expectations about what the parent or child should be doing Unless the child is at risk of injury during the assessment do not intervene Free Play Materials No materials are required for this activity Sett
18. either dangerous like electrical outlets or that may not necessarily be unsafe for children but that are important for children not to play with because they are breakable or otherwise not appropriate for a young child o For afew minutes we would like for you to keep child s name on this blanket and not allow him or her to get this recorder o Normally we would never intentionally place something in front of your child that s he can not have but because there are times when such materials may be unavoidable for your child such as in the car grocery store or at the doctor s office it s important to see how your child handles such situations when there is something in reach that is not appropriate to have Note It is fine for the parent to engage the child with any materials so long as the Parent introduces the materials Do not make any suggestions or give the parent alternate materials with which to engage the child If this activity is particularly stressful for the child or parent be prepared to help the parent and child calm at the end of this activity before moving on to the final activity Be empathetic and reflect that this was a difficult task and praise the parent for making it through 11 Dressing Task Materials No materials required if the parent wishes to take clothes off and put them back on shirt socks and shoes If parent wishes to put on a change of clothes that s fine too Setting up Remember
19. elephone It should also be reviewed again with the parent at the time of the assessment Step 2 Follow Administration Instructions Step 3 Be familiar with and prepared to use PC Assessment Tips for establishing rapport managing possible disruptions responding to parent and or child discomfort and facilitating smooth activity transitions and positive closure Pre Assessment Visit Introduction for Parents The ways in which young children interact with their parents or other important caregivers can be very different for individual children There are also many different types of activities that young children do with their parental caregivers such as eating bathing dressing and playing To better understand how your child is relating at home or at child care center with the most important adult s in their lives would like to spend some time observing some important and common activities for very young children These include 1 Whatever you and your child enjoy doing together 2 Looking at books 3 Seeing how your child handles frustration if he she is over 1 year old 4 Dressing putting on shoes socks and shirt Getting Ready for the visit There are a few things that you can do to help the visit go smoothly and to learn the most about how your child is relating These include preparing your child for the visit letting others know that you will be busy during the visit and having anything on hand that you would
20. en the child becomes less interested in the camera you ll continue with the next activity Wait and attend to another activity and minimize interaction with the child Signs of reactivity on the parent may be more subtle and may include behaviors such as looking into the camera instructing the child to behave or perform for the camera If you see these behaviors remind the parent that you are interested in what is usual for parent and child not putting on a show for the camera If you anticipate or observe reactivity that is not minimized by the approaches above be prepared to bring the video camera to visits and turn it on briefly over a session or two to help desensitize parent and child to the video camera Generally after several opportunities for recording sensitivity decreases If you see signs of reactivity be sure to record these on the Rating Cover Sheet and note their effect on the assessment 14 Attend Carefully to Administration Instructions and Modify ONLY when Warranted If you are creating a video for certification review begin video recording just before reviewing the Pre Visit Introduction for Parents and continuing video recording until the IPCI administration is completed Introduce each activity by using the protocol script provided in this manual Present activities in the listed order and do not modify the instructions initially If there is any concern about the parent s understanding of the instruction
21. ents can be shown the equipment and can be encouraged to do whatever they normally do and how things normally go this is not about putting on a show In other cases parents have initial discomfort with the assessor being across the room with the camera In this case the camera can be set up with the parent and child in the shot and then sit down beside the parent and let her know that you ll start out together on the video Let her know that you will need to check the camera but you ll stay with her at the beginning 3 Can we score live instead of from videotape a Scoring live requires the assessor to be certified in scoring live before this method can be used with families Becoming a certified scorer during live observation is more difficult than scoring afterward because the same person must both administer and score the IPCI while managing other challenges or distractions that may occur in the home 16 b There are pros and cons that should be weighed carefully in making the decision about whether or not to videotape Below are a list of pros and cons of videotaping Our experience has been that videotaping is preferable to live scoring in a variety of ways Pros Cons 1 Staff don t have to be certified as a 1 Video equipment must be purchased if scorer at the time of administration not on hand 2 Video can be a powerful intervention 2 Staff must be trained in sensitive use of tool for supporting positive interaction
22. er Interrupters and Child Distress are rated with regard to relative frequency as well as severity If there is a discrepancy between relative frequency and severity then the highest number possible is assigned For example if a Parental Caregiver Interrupter occurs once but is severe as specified in the item definition then a rating of 3 Often Consistently Severe is assigned If a Child Distress behavior occurs frequently but is mild in nature a rating 3 is assigned To enhance and maintain inter rater reliability the IPCI item definitions in this manual should always be referenced when scoring While the rating sheet includes brief item labels complete definitions are provided in the manual For each IPCI item a definition is provided examples and non examples are presented and a scoring hint is included To maximize rating accuracy it is helpful to use tally marks on the rating sheet next to each IPCI item when an IPCI item example is observed Criteria for obtaining IPCI scoring certification includes 2 consecutive IPCI sessions each scored to at least an 80 criteria overall with neither the Parental Caregiver nor Child sub domains below 70 Once certification is obtained inter rater reliability should be checked periodically to maintain reliability 21 Item Definitions and Scoring Parental Caregiver P C Domains P C Facilitators 1 Conveys Acceptance and Warmth The adult conveys acceptance and
23. f and when you observe follow through 37 Ch Distress 1 Overwhelmed by negative affect fuss cry or rapidly shifting signals Child is overwhelmed by negative affect Watch for fussing whining crying or rapidly shifting signals This item reflects both clear signals of fussiness and crying as well as unclear difficult to read signals Child s signals may shift rapidly to whimpering fussing or crying with little warning Consider how the child recovers from stressors Uncontrollable or inconsolable crying are examples of this item Difficulty calming after a stressor is also an example of this item If the child becomes overwhelmed by emotion even if it is due to a clear environmental stressor this should be reflected in the scoring Examples lt Dad is playing peek a boo and child begins to cry lt Mom is reading showing a book to child and child begins to fuss and whine lt During toy play it is difficult to tell if the child s vocalizations are signals of enjoyment or distress Non Examples Scoring Hint Make a tally mark next to this item each time you see an example during the observation 38 2 External distress Child engages in non compliance tantrum or aggressive behavior hitting biting kicking throwing objects spitting head banging screaming verbal or nonverbal social rejection name calling derogatory language or threats Non compl
24. fy areas of strengths or concerns that warrant intervention for addressing real needs and improving quality of life or for determining if intervention is working as intended for the child 17 Interactions with parents and other primary caregivers are of critical importance in the lives of very young children There is strong evidence that the quality of parent responsiveness is linked to important outcomes not only in early childhood but throughout the life span Parent child interactions are especially critical to early social emotional development Through daily interactions there are opportunities for parents to either directly support positive child social emotional behavior and development or to engage in behaviors sometimes completely unaware that either fail to support or actually interfere with positive social emotional skills In order to effectively support children s social emotional development we need quick reliable and valid tools for assessing the role of parent child interaction so that we can tell when interactions are risky and provide early support to help interactions get back on track before problems mount and become entrenched Using an indicator of parent child interaction can provide valuable information about where concrete strengths exist so that they can be celebrated with and encouraged in parents Such an indicator can also point out specific skill areas that need to be supported In this way informatio
25. he child does not seek the parent s attention or approval through gaze vocalization comment soft touch approach or smile hence providing No Opportunity for the parent to respond No Opportunity should be checked Examples lt gt Child tries to show mom a picture and mom pushes child away lt Child brings a cup to mom for water and mom says I told you no You re not getting any lt Child brings toy to dad and dad says Go away can t you see I m busy Non Examples lt The parent uses a harsh town and engages in very few facilitator behaviors The child does not make any attempts to seek parent s attention Scoring Hint Remember to score No Opportunity if the child does not seek out the parent s attention To score the presence of Rejects Child s Bid the child must make a bid Child CH Domains Ch Engagement 1 Positive Feedback Child provides positive feedback to parent through positive social signals such as appropriate smiling or laughing eye contact vocalizing words or gentle touch This item does not reflect a child passively looking at a parent who is not engaged with the child In rare cases a young infant may haves no opportunity to provide positive feedback to the parent because the parent is physically unavailable such as an infant laying on his or her back who can not see the parent s face due to parent positioning In such rare cases
26. hild startles and then freezes while intently watching mom Non Examples Mom says come here and child does not respond Mom attempts to engage child in play and child shows no interest and she continues to play with another toy Scoring Hint Make a tally mark beside this item for each example observed Remember to consider severity as well frequency Observation of a dramatic flinch response should be rated as a 3 40 Indicator of Parent Child Interaction IPCI Rating Cover Page Child s Name Test Date Language of Administration use existing dropdown list Test Duration dropdown with 1 10 minute range Interaction Activity s select all that apply Free Play Book Distraction Dressing Overall Assessment Location use existing dropdown list If at home please indicate the relationship of the parent caregiver to the child dropdown list with the following O Biological Mother Service Provider O Biological Father O None O Other Father Figure O Psychiatrist O Grandmother O Psychologist O Aunt O Social Worker O Foster Parent Oroua O Nurse O Other O Parent Aide Family Advocate O Early Intervention Home Visitor If at center please indicate the relationship of the O Speech Language Therapist caregiver to the child dropdown list with the following O Physical Therapist O Lead Teacher O Occupational Therapist O Teacher Aide AERTS O Other Paraprofessional Type of Interventio
27. hing more than the most mild physical force should automatically be coded as a 3 32 Uses restrictions intrusions Restrictions include statements such as No Don t Stop Quit They also include repeated vague warnings such as Watch out Be careful If you hear a vague warning once disregard it If you hear it more than once make a tally for each time thereafter Intrusions include taking things away unnecessarily unnecessarily controlling child s movement using physical discipline or pushing objects in front of a child s face Consider both frequency and severity A rating of 3 should be assigned if mild restrictions are used frequently A rating of 3 should also be assigned if only 1 restriction is observed but it is severe e g slapping a child s hand yanking a child away from a toy Examples lt gt lt gt lt gt lt gt lt gt A child is playing roughly and the parent says be careful on several occasions without providing any other support Mom pulls a clean toy ring out of baby s mouth Baby begins to mouth a baby board book and dad says get that out of your mouth and pulls the book away A child is reaching for an ashtray on the coffee table and mom slaps the child s hand A toddler reaches for a door knob and mom says No stop it Non Examples lt gt Child is reaching for something inappropriate and mom
28. ht show While this may happen spontaneously the instructions were designed to avoid stimulating such an effect If the parent gives verbal or nonverbal cues of discomfort with the task or tells you that s he can t read encourage the parent that however s he would like to use these books with the child is just fine and that you re really interested in the interaction with books not necessarily in reading If the parental caregiver appears uncomfortable and looks to you for support or confirmation as to what is expected paraphrase instructions and maintain a supportive stance but do not make any specific behavioral suggestions to the parent 10 Distraction Task Materials Blanket table cloth and recorder with tunes and key chain Setting up Lay down the blanket Then give the instructions As soon as the instructions have been given turn the recorder on and set it on the blanket in front of and within reach of the child Remember to set the timer for 2 minutes as soon as parent and child are on the blanket and the recorder has been placed on the blanket and turned on Special Accommodation if the parent has a physical disability making it difficult or impossible to get down on the floor this activity can be set up by placing the recorder and keys on the couch within reach of the child and asking the parent and child to stay on a couch rather than a blanket Instructions o Sometimes there are materials around that are
29. iance alone simply not following through is not an example of externalizing behavior Similarly saying No unless it is repeated and is combined with another behavior such as yelling or screaming is not an example of External distress This item does not include a child who simply turns eyes and or head away from interaction or fails to follow parent instruction without other signals Examples lt gt Mom tries to show child book and child throws book at mom lt Mom says It s time to get dressed and child screams No as she turns away Non Examples Mom says Let s put your shoes on and child pulls his foot away Scoring Hint If a child engages in biting or head banging these behaviors should be rated as 3 even if they occur only once 39 3 Frozen watchful withdrawn Child startles flinches pulls away from the parent or engages in frozen watchful behavior without joining in interaction A child who is simply not engaged in an activity or whose attention shifts to another activity other than what the parent may want the child to focus on is not_an example of this item Watch for behaviors such as flinching pulling away frozen watchful gaze The behavior should give a clear impression of fear uncertainty or avoidance Examples lt Mom reaches in front of child to pick up toy and child flinches and ducks lt Mom says come here and c
30. ing up Remember to set the timer for 4 minutes as soon as you give the instructions below Instructions o Let s get started by spending a few minutes with you and your child doing something together that you enjoy o This activity should be something that you and your child are both comfortable with and used to and something that your child loves to do o Please feel free to move around as is comfortable for you and your child You don t have to sit in one place but l Il need to know what room you d like to be in so that can move along with you o Sometimes parents talk or play games without toys sometimes parents just sit with their children and sometimes children like to play with a favorite toy o Whatever you and child s name normally do that makes child s name smile laugh or have fun is what want to see Feel free to stay with an activity or change activities as you would like Attend to any needs your child might have during this time just as you normally would Note The purpose of this activity is to be as non restrictive as possible and to encourage the parent and child to engage in whatever activity they enjoy It is important not to impose any structure on the parent above and beyond the instructions Therefore do not restrict the parent s and child s movement by asking them to stay in one place Instead encourage the parent to let you know if they would like to move simply so that you can s
31. ion services measures need to meet the following criteria They need to focus on key parent and child behaviors that signal or indicate quality of parent child interaction and that are predictive of social emotional outcomes in young children They need to focus on behaviors that occur in the context of natural settings where parents caregivers and children typically interact without the requirement of videotaping They need to be easy to administer for individuals across multiple disciplines with various levels of training e g Part C early intervention staff Early Head Start staff social workers counselors and nurses They need to be suitable for quick and frequently repeated administration What is the Indicator of Parent Child Interaction IPCI The Indicator of Parent Child Interaction IPCI is an Individual Growth and Development Indicator It is a means of checking growth toward the important general outcome of interactions in which parents and other primary caregivers respond to their child in ways that promote positive social emotional behaviors This General Outcome is directly related to social emotional competence another highly accepted and valued General Outcome in early childhood Performance is measured through repeated assessment of the same key skills using the same set of care giving activities and scoring procedure Unique features of the IPCI as compared to common limitations of many existing app
32. like e Preparing your Child You can help your child to be ready for the visit by making sure that he or she has eaten recently and is rested Please feel free to help your child feel as comfortable as possible If your child gets fussy please feel free to do whatever you would normally do to help your child feel comfortable We are not interested in you or your child putting on a show Instead we you and can learn best about how your child is relating by seeing what happens the way you usually interact together whatever it is that you and your child would normally do e Letting others know that You will be Busy It will help the visit go more smoothly if you let family and friends know that you will be busy during the time of the visit It is best to schedule a visit at a time when you think you won t be interrupted by visitors or phone calls e Things to have on hand While it s not necessary for you to have materials or toys available if there are any things that you and your child especially enjoy doing together it would be good to have any such materials out and ready For the dressing activity you may either take off and replace your child s shoes socks and shirt or if you wish to put on another set of clothes it would be good to have these ready at the time of the visit IPCI Administration Instructions After establishing rapport and reviewing the Pre Assessment Visit Introduction for Parents the IPCI may be a
33. ment Tips There are a variety of things that assessors can do to help ensure that IPCI results are reliable and valid These include e Setting the stage for administration e Careful attention to following the administration protocol e Fostering smooth transitions between activities Set the Stage for Administration Setting the stage for administration involves establishing rapport with the parental caregiver helping the parental caregiver to understand the purpose of the IPCI and what to expect and helping the parental caregiver to feel as comfortable as possible with video recording Establish rapport by spending a few minutes e g 5 10 at the beginning of the visit with the parent and help the parent to feel at ease Prepare parental caregiver for what to expect by reviewing the Pre Assessment Visit Introduction with the parent Answer any questions or address misperceptions that the parent may have about the IPCI assessment activities Help the parental caregiver to feel as comfortable as possible with the video recording process t s important that the assessor be as comfortable as possible with the video recording process so as not to contribute to any discomfort of the parent If the parent appears uncomfortable or expresses concern about video recording provide gentle reassurance explore the parent s concerns and address them In most cases reassurance can be provided to address concerns to permit video recording Di
34. n O Other Professional S noe Assessor Description dropdown list with the following O Farly Heed aa Home Visitor 9 O Information Sharing O Other EHS Staff Oe Necktie O Part C Home Visitor a O Other Part C Staff ideo Reflection O Early Childhood Mental Health Specialist O Other O Other Did any factors interfere with assessment O NO O If Yes please specify O Child illness O Parent illness O Interruption O Other Note 41 Note Rarely Once Sometimes Half the time Inconsistently Often given the opportunity the item almost always or always described the parent child dyad IPCI Keep in mind that a rating of Often should be reserved for clear frequent and consistent examples of the item lf uncertain about which anchor to select select the one that is closest Free Play Book Distraction Dressing Overall Caregiver Support Never Rarely Sometimes Often NA Child Engagement Never Rarely Sometimes Often NA 1 Acceptance Warmth 1 Positive feedback 0 1 2 3 encouraging comment 0 1 2 3 smiling vocalizing smile gentle touch 9 g 2 Descriptive language 0 1 2 3 2 Sustained engagement 0 1 2 3 n 3 Follow through 3 Follows child s lead 0 1 2 3 by turn taking vocalizing 0 1 2 3 gesturing attempting task 4 Introduces extends 0 1 2 3 5 Stress reducing
35. n about skills that are off track can highlight where support is needed and information about specific strengths can be used as a starting point to highlight existing skills and then begin building new skills 6 How often should the IPCI be done a Every 3 months for regular monitoring b During the intervention phase more frequent monitoring monthly or less would be appropriate if a possible concern is identified 7 Can you do the different tasks on different days for a single IPCI administration a It is important to complete the activities at one time because this gives the best overall picture of parent child interaction at a particular point in time When it is explained to the parent up front that all tasks take less than 15 minutes and parents have been prepared for the assessment through discussion about possible distractions and how these can be minimized it is very unlikely that it will not be possible to complete the entire assessment This is especially true if the home visitor introduces and conducts the assessment at the beginning of the meeting In over 350 observations with high risk families it has only been necessary to end the assessment prematurely and to re do it on another day in one or two cases If the assessment must be stopped for some 18 reason and it was not possible to observe each activity the assessment should be rescheduled for another day 8 Do we pause the camera if the baby s diaper is
36. nd begins rocking lt Atoddler turns away from the book that after an attempt to re engage the child in looking at the book by pointing and talking about a picture mom says Let s take a break and we can look at books later lt Achild begins to whine and cry when he becomes frustrated that auntie removed a phone that the child was attempting to play with and placed it out of reach Auntie says That s for grown ups let s find something for you to play with as she leads child gently by the hand to find an appropriate activity Non Examples lt An infant begins to cry and mom picks up baby and says What s wrong shh in a gentle voice without any other intervention lt After a few minutes of face to face play an older infant begins to fuss Mom quickly places a series of toys in front of the baby shaking each toy and talking in an animated voice as she attempts to interest child in the toys lt Atoddler is running falls down and skins his knee Mom says You re okay Scoring Hint Always consider opportunities for Stress Reducing Strategies Reserve a rating of 3 for situations in which the caregiver consistently recognizes signs of distress including subtle signals of frustration and disinterest and responds consistently with specific stress reducing strategies described above If the parent consistently responds to obvious signs of distress with stress reducing strategies but
37. o a dog and mom says Yes you see the doggie lt Child reaches for toy phone and dad says You want to talk on the phone as he pulls it closer to child lt Child is tapping a large ring toy and the parent picks up another ring and says tap tap tap as she taps her ring on the table lt Child puts a toy phone up to her mouth and mom says You like that phone Mom gets out a book to show child but child is not interested and turns toward another book Mom says Oh you want to look at that one as she pulls the book closer for the child She then says Let s read this one lt gt Non Examples lt The child is looking at or reaching for a toy ring and the adult places another toy in front of the child lt The child reaches for a toy and mom begins talking about or pointing to another toy 26 lt The child shows interest in a ball by squealing and gesturing for it the caregiver does not respond in any way Scoring Hint During the observation use tally marks or write down key words next to Follows Lead on the rating sheet each time you hear an example It is helpful to write a key word the first time you see an example If following the child s lead is infrequent then continue to write key words If it is frequent use tallies Before you assign a rating count these examples Remember in order to score this item as a 3 the adult must have consistentl
38. on use tally marks or write down key words next to Introduces to Maintain or Extend on the rating sheet each time you hear an example It is helpful to write a key word the first time you see an example If following the child s lead is infrequent then continue to write key words If it is frequent use tallies Before you assign a rating count these examples 5 Uses Stress Reducing Strategies If a child shows frustration or distress does the parent respond appropriately through the following strategies a If the child shows distress crying does the parent use soothing behaviors that include providing a pacifier cradling rocking With an older child parent behaviors would include gentle touch words acknowledging child s feelings and words of comfort support If the child does not exhibit any distress for the parent to respond to No Opportunity should be checked b If the child shows frustration aversion cues does the parent respond by providing one of the following strategies slowing pace using softer voice providing a brief pause in interaction or with older infants use appropriate distractions Early signs of distress include gaze aversion turning face or eyes away from when a parent is trying to get child to look at her face or a toy increased activity level rapid breathing and fussy sounds Watch for parent to respond immediately to these signals by slowing pace using a softer voice becoming quiet With ol
39. roaches include the following 1 focus is on key parent and child behaviors that signal or indicate quality of parent child interaction and that are predictive of social emotional outcomes in young children 2 focus is on activities that typically occur in authentic environments where parental caregivers and very young children interact such as in homes with parents or other caregivers or in child care settings 3 it can be administered within 10 minutes by a variety of practitioners that typically provide early intervention services e g Part C Early Intervention staff Early Head Start staff nurses counselors and social workers 4 it is designed for frequently repeated administration in family homes or center based settings and 5 reports can be generated automatically to guide intervention decision making What populations has the IPCI been used with The IPCI is designed for use with children between the ages of 2 and 42 months It has been used with children in this age range across several federally funded research studies including both descriptive and intervention studies Families participating in studies with the IPCI were referred from a variety of agencies including urban and rural Early Head Start programs alternative school programs for teen aged parents and inner urban WIC clinics and prenatal clinics Families were culturally and linguistically diverse and many were experiencing multiple risks including the follo
40. s ask the parent to paraphrase them Clarify any misperceptions by simplifying the instructions and or reminding the parental caregiver about what to expect Do nottell parents the time limit for each activity It is important that the parent does not feel rushed but that the assessor manages time well and helps the parent transition smoothly from one activity to the next If parents ask about the time let them know that it will just be a few minutes and that you ll let them know when it s time for the next activity As soon as the parent initiates the designated activity set the timer for the allotted time e g Free Play 4 minutes Book Activity 2 minutes Distraction Task 2 minutes and Dressing 2 minutes Foster Smooth Activity Transitions e Be sure to select a timer that signals time in a subtle manner Avoid loud or distracting buzzers or other distracting sounds e Remember the timer is for the assessor not the parent and child The role of the assessor is to facilitate smooth transitions from one activity to the next e Avoid abrupt transitions and use care to avoid disrupting the parent and child when the timer signals the end of an activity Instead if the parent and child are engaged in activity pause and watch for a moment to create a break by walking slowly toward the parent and child commenting on the activity just completed orienting the parent to the next activity e g use previewing Let s see if child s
41. scomfort may arise for various reasons such as concern about who will have access to the video how the video will be used unrealistic expectations about the video recording process or a cultural belief that video recording will cause harm to those who are recorded Try to identify the concerns and address them Below is a list of possible concerns and considerations for responding to them Possible concern Who will have access to the video Remind the parent that the video will be kept confidential Videos also make great gifts and can be given to the parent when the child matriculates from the program Possible concern How will the video be used If the videos will be used for intervention purposes explain that you will watch the video together with the parent and that it will be used an important tool for you and the parent to understand more about how the child is a relating at home 13 Misconceptions about the video process or expectations It s important to correct misconceptions or unrealistic expectations about the video recording process For example some parents envision a big camera or bright lights They may envision a movie shoot or having pictures taken for a family portrait In such cases show the camera to the parent Remind them that this video is very different from staged videos or pictures Instead we are only interested in usual activities This is not about dressing up or looking a particular way Ag
42. tay with them If the parent looks toward you during the assessment or engages in behavior that suggests s he is concerned with being in view of the camera or needing to look good for the camera e g pulling child s arm in an attempt to position child in front of camera or saying stay here so they can see you to the child remind the parent that is your job to move the camera around and that you need mom and child to do whatever they would like without worrying about the camera at all and to ignore the camera as much as possible Looking at Books Materials Books Brown Bear Touch and Feel Puppy Setting up Give the books to the parent Remember to set the timer for 2 minutes as soon as you give the instructions below Instructions o During the next few minutes you and your child can spend a few minutes with these books o However you want to use the books with your child is fine o Feel free to attend to whatever needs your child might have during this time Note Do Not ask the parental caregiver to read to his or her child This is very important for at least two reasons First parents who can not read or who are self conscious about their reading ability may shy away from interacting with their child because of the instruction to read Second some parents will interpret the instruction to read literally and will do so regardless of whatever conflicting signals for readiness the child mig
43. the formula below dividing agreements by agreements disagreements x 100 Sum the Key Behavior Element Agreements Atotai and Disagreements Dtota to find row totals for each use the third and fourth rows 7 Calculate the Overall Percent Agreement using Agreements Artota and Disagreements Dota in the formula below Percent Agreement Number of Agreements Number of Agreements Disagreements x 100 akRwWND O
44. the comment Avoid looking for reasons to dismiss criticism or harsh voice Instead refrain from making a judgment about intent or meaning behind such statements and simply make a tally to note that it occurred Using a flat or monotone voice without warmth is not an example of this item There must be a criticism in words and or a raised and harsh tone of voice Examples lt Achild care provider says in an angry tone How many times do have to tell you A mother says You re so rotten as she laughs A father says in a rough voice Look at me when talk to you A mother says Why can t you ever do what tell to you to gt gt Non Examples Amother maintains a flat voice tone devoid of warmth throughout the observation 31 Scoring Hint For this item a single critical statement should be scored a 3 if it is severe e g calling the child a name belittling the child threatening to abandon or withhold love To score a 1 the statement must be mild and occur only once Remember for this item as well as for each Interrupter item consider both frequency as well as severity when rating Interrupters If there is a conflict between frequency and severity use severity to rate the item e g single episodes of a parent calling a child a name using a derogatory label or making emotional threats e g I m going to leave you don t want you anymore or using anyt
45. to hurt yourself etc During the book activity this item should be rated based on the parent s use of descriptive language and imitation or expanding on the child s interests and vocalizations Simply reading without any other descriptive comments to the child is not an example of descriptive language Keep in mind that it is possible for adults to talk a lot but not use descriptive language This is sometimes referred to as impoverished talk Simply making sounds repeating words making brief statements that do not describe are not examples of Descriptive Language Simply naming colors counting or naming off objects in a room are not examples of Descriptive Language Examples of Uses Descriptive Language lt Child points to a dog and mom says Yes that s a doggie You see the brown doggie lt Child reaches for a cup and dad says You want a drink from your sippie cup lt Child is looking at a book and auntie says You see the duck The duck says quack quack Non Examples See it Do it lt Say one Put it there That one 24 lt The orange one Say red 6 Scoring Hint During the observation use tally marks or write down key words next to Descriptive Language on the rating sheet each time you hear an example It is helpful to write a key word the first time you hear an example If descriptive language is infrequent then continue to write
46. to set the timer for 2 minutes as soon as parent and child are on the blanket and the recorder has been placed on the blanket and turned on Instructions o Let s spend a few minutes now seeing what it s like to get child s name dressed in the morning with whatever clothes and or changing routine you use o Let s focus on changing shirt socks and shoes or a diaper if that s needed It s fine to simply remove and then replace the same clothing or if you d like to use a change of clothes that s fine too o However you two normally go about dressing is what I m interested in Note After the final activity dressing end on a positive note Point out something positive that you observed during the observation If something positive was captured on video replaying a brief section to point out the positive and encourage the parent s reflection can be helpful If the activities were particularly difficult or stressful for the parent or child acknowledge that and empathize with the parent If the child is distressed ask the parent what s he thinks might help to soothe the child If appropriate explore basic needs diaper change if this wasn t done during the session bottle food rest activity that child especially enjoys etc In rare cases the dressing task particularly with a young infant may not last for 2 minutes which is fine Simply note the time on the rating on the rating form 12 IPCI Assess
47. video w families to help families become and providing concrete examples of more comfortable with video parent and child growth 3 Video also offers advantages in 3 Staff will have to spend some time up reflective supervision allowing for home front visitors to receive concrete support in intervention planning 4 Videos returned to families as home movies at the end of the program make a a wonderful gift 4 What if the parent just doesn t want to do the assessment a Strongly encourage them as it is a normal if new part of the EHS protocol and does not require extra commitment on their part b Remind the parent that the assessment can provide important information to the home visitor and the parent about how the child is relating at home This is an opportunity to learn together 5 a It seems like the parent sections focus on the negative b Is this judging the parent a Actually the IPCI focuses on parent behaviors that are known to support more positive child outcomes This includes high rates of facilitative behaviors as well as low rates of interrupting behaviors Low scores on interrupting behaviors are a good thing b Practitioners need to be aware of both strengths and concerns if they are going to partner with parents to build on strengths in a meaningful way We know that the purpose of assessment of children in early intervention should never be to judge them Rather it is often to identi
48. warmth through approval in one of the following ways ro kS Smiling at the child Making a positive comment to or about the child Providing gentle affectionate touch Agreeing with something the child has said Indicating that the child s behavior is correct Confirming what the child has just said Thanking the child for something Stating the child made a good effort even if the task was not performed correctly ro kS ro KS ro kS gt re K gt 2e KS ro kS x KS Watch for clear and appropriate signals of acceptance and warmth If a parent gives a verbal and nonverbal message simultaneously these messages must match and be positive to be an example of this item A positive comment with a flat expression frowning or using negative voice tone is not an example of Conveying acceptance and warmth A negative comment while smiling or laughing is also not an example of conveying acceptance and warmth Smiling or laughing inappropriately such as when a child is hurt upset engaging in unsafe behavior or in a behavior that is not appropriate is not an example of conveying acceptance warmth Simply holding or touching a child in the context of a general routine does not necessarily convey acceptance or warmth and therefore is not be an example of this item Examples of Shows Acceptance and Warmth lt Mom smiles as she says Good job you did it all by yourself 22 lt
49. wing e Teenage parent status Children with or at risk for disabilities Extreme poverty Undocumented citizen status Functional homelessness Very low parent education level Parents at risk for child maltreatment Maternal depression and or anxiety Families with histories of substance disorders and domestic partner abuse What are the qualifications for IPC administration and scoring Any early childhood service provider may administer and score the IPCI after completing administration and scoring certification How can IPCI results be used IPCI reports can be automatically generated from the IGDI website to provide information about both parental caregiver and child behavior These reports are designed to be used in conjunction with other assessment data to guide intervention decision making The IPCI can be repeated as often as monthly for progress monitoring Parent Facilitator and Child Engagement domain reports can be interpreted by and shared with parents by an early childhood service provider who is certified on administration and scoring When should behavioral mental health consultation be sought Parent Interrupter and Child Distress domain reports are designed to be used with mental health consultation to understand specific interaction challenges that a parent and child may be facing When scores in these domains i e Parent Interrupters and Child Distress fall in to the concern range mental health consultation should be
50. y followed the child s lead without contrary examples in which s he interrupted the child or missed multiple opportunities to follow the child s lead If the parent followed the child s lead closer to half the time score a 2 if not score a T Following Child s Lead is a higher order skill than simply avoiding Intrusions and Restrictions Always consider Intrusions Restrictions before rating Follows Child s Lead Restrictions and Intrusions directly interfere with Following Child s lead If you observe Intrusions and Restrictions more than 1 time during the observation then it should be reflected in the rating for Follow s Child s Lead For example if you observed 2 examples of Intrusions Restrictions do not rate Following Child s Lead above a 2 sometimes inconsistent If you observed more than 2 examples of Intrusions or Restrictions do not rate Following Child s Lead above a 1 rarely 27 4 Introduces to Maintain or Extend Child s Focus The adult introduces materials or voice in a novel or interesting manner to maintain and or extend the child s focus Watch for the adult to use words voice tone facial expressions and gestures in an interesting way to engage the child in a manner that maintains the child s focus or slightly extends the child s focus Introduces to Maintain or Extend is a higher order skill than simply Following Child s Lead To meet the definition of Introduces to Maintain
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