Feedback and Reinforcement

A monitoring tool is effective if it has high specificity, sensitivity, validity, and reliability
as this reflects its potential usefulness and accuracy features (Vitrikas et al., 2017). Specificity
and sensitivity are helpful as they ensure that children are not misidentified as having delays.
There are no false-negatives as these are likely to lead to erroneous results, making children who
have delays ruled out. We decided to get a tool that meets these features for enhanced accuracy.
We also decided to settle on a tool embedded in electronic health records (EHRs) and still highly
reliable and provides valid results. We chose two tools; one that is directly administered and one
that is parent-completed.
The parent completed tool that we selected is the Parents’ Evaluation of Developmental
Status (PEDS). The PEDs tool will effectively measure the performance outcomes that we are
interested in in this evaluation. It is a tool that is used to evaluate children below the age of eight
years (Vitrikas et al., 2017). Chloe is four years, and thus she can effectively be assessed using
this tool. Further, the tool provides an online version that can be integrated into the EHR
(Vitrikas et al., 2017). This is important for our technicians as it makes it easy to record, store
and retrieve data. Also, all the technicians will have access to Chloe’s data by assessing it
through the EHR. The tool is also appropriate because it has a specificity rate of 74% and a
sensitivity rate of 75% (Vitrikas et al., 2017). Therefore, it is efficient in monitoring and tracking
progress made by Chloe as it is sensitive to slight changes in behavior, either their socialization
or communication.
Chloe’s caregiver will complete the PEDs questionnaire. It takes five or fewer minutes to
complete and has ten items. Responses from the questionnaire will be used to evaluate Chloe’s
progress. Depending on responses provided during the first visit, the items on the questionnaire

will be modified to capture the different development milestones achieved and to assess for
progress in higher levels of development. For instance, during the first visit, Chloe’s caregiver
will be asked to state whether Chloe utters words that are sensible. There will be three possible
choices to the question. The caregiver will select either “Yes”, “No”, or “A little”. If the comment
is a little, then the intervention plan will be created in such a way that it helps Chloe make
sensible words by asking the caregiver to get close to Chloe, ask them to talk more to the child,
be more talkative and the child will imitate the words and start uttering sensible words.
The plan will also include the technician listening to the child and identifying sounds that
she may be struggling to pronounce. This will help tailor support and ensure that the child is
helped to practice how to pronounce these sounds. Further, if the answer is yes, then the
intervention plan will be modified to support Chloe to make two-word sentences that are
actionable and meaningful as well. Thus, using this tool will help provide and modify the
intervention plan accordingly to ensure that it captures Chloe’s improvement.
Further, if a response to a question is “Yes”, then the item on the questionnaire is changed
to evaluate a higher ability task. For example, if the parent is asked, “Does Chloe make two-word
sentences that are meaningful?” if the answer to this question is “yes”, then, during the next visit,
the question will be upgraded to “does Chloe understand adjectives when used in sentences?”
performance is evaluated based on the number of tasks that a child is able to achieve during the
time when the intervention plan will be implemented. Further, the questionnaire has eight close-
ended questions and two open-ended questions. The open-ended questions are necessary to
capture any concerns that a caregiver may have concerning the child’s progress that has not been
captured by the close-ended questions (Vameghi et al., 2015). Thus, this tool is effective in

helping the technician get a comprehensive view of the child’s progress or lack of it and thus help
them act accordingly.
The Parent Questionnaire and a Child Development Chart will be used. This will help
specifically during discrete training. The caregiver will complete a questionnaire that will help
the technician tailor the training effectively. For example, a question such as “are you concerned
about your child’s aggressive behavior?” will help the technician understand the child’s
socialization skills and whether their level of aggression could negatively affect their
socialization. Thus, if a parent answer is “yes”, then training will be tailored towards ensuring
that Chloe is helped to control her emotions and interact with other children well without acting
aggressively towards them. Also, since the caregiver is able to interact and observe the child in
their natural setting and for prolonged periods of time, having them complete the questionnaire
provides the technician with a comprehensive view of the child’s progress. We agreed to use this
questionnaire because it also assesses the parent’s functioning. This is necessary because dealing
with a child who has developmental delays can affect a caregiver emotionally ((Vitrikas et al.,
2017). Thus, the technician is able to provide support whenever necessary to the caregiver and
advise them on how to respond accordingly.

References

Vameghi, R., Sajedi, F., Shahshahani, S., & Biglarian, A. (2015). Validity and reliability
determination of parents evaluation of developmental status (peds) in 4-60 months old
children in Tehran. Iranian Rehabilitation Journal, 13(2), 62-67.
Vitrikas, K., Savard, D., & Bucaj, M. (2017). Developmental delay: when and how to
screen. American family physician, 96(1), 36-43.