Informed Clinincal Opinion
Informed clinical opinion is a necessary safeguard against eligibility determination based upon isolated information or test scores alone, and must be included in evaluation and assessment procedures.
This page covers four issues:
- Part C Regulations on informed clinical opinion
- What does informed clinical opinion mean for Part C?
- How does informed clinical opinion affect eligibility determination?
- Why document informed clinical opinion?
Part C Regulations on informed clinical opinion
IDEA Part C regulations on informed clinical opinion are intended ensure a dynamic assessment approach, support and encourage the acquisition and interpretation of multiple sources of information during evaluation and assessment process, and create alignment of a child and family's needs with the services provided.
- 34 CFR §303.24 — Multidisciplinary
- 34 CFR §303.111 — State definition of developmental delay
- 34 CFR §303.113 — Evaluation, assessment, and nondiscriminatory procedures
- 34 CFR §303.321 — Evaluation of the child and assessment of the child and family
- 34 CFR §303.409 — Fees for records
See also: Evaluation and Assessment — Federal Requirements
What does informed clinical opinion mean for Part C?
Informed clinical opinion makes use of qualitative and quantitative information to assist in forming a determination regarding difficult-to-measure aspects of a child's development and the potential need for early intervention.
Early intervention professionals use informed clinical opinion to:
- Inform recommendations eligibility for services under Part C as part of evaluation and assessment (both initial or continuing eligibility)
- Plan services that meet child and family needs
The knowledge and skill of the early intervention multidisciplinary evaluation team—including information obtained from the parents—create the foundation for becoming "informed" about a child's developmental status within a socially valid context, answering the question "What are the child's abilities and needs within their natural environment?"
Elements of Informed Clinical Opinion
- Training
- Previous experience with evaluation and assessment
- Sensitivity to family beliefs, values, and needs
- Ability to gather and include information from family members
Examples of Informed Clinical Opinion
- A physical therapist makes judgments about muscle tone abnormality, based on their training and experience with other children.
- A psychologist observes a playing child, who performs tasks in adaptive ways not permitted during the administration of a standardized cognitive assessment.
- An early interventionist observes a child engaging in self-stimulating behaviors (rocking, hand waving) when playing with toys, which leads them to conclude the child exhibits atypical development, a diagnosed condition, or developmental delay.
- An occupational therapist observes a premature infant's oral sensitivity to bottles and other objects.
How does informed clinical opinion affect eligibility determination?
The individuals, teams, and agencies responsible for implementing Part C programs must consider the following questions:
- Who has an informed clinical opinion, and about what?
- How will we integrate informed clinical opinion into the evaluation and assessment process?
Individuals
Early intervention professionals use qualitative and quantitative information to shape informed clinical opinion about a child's development and need for early intervention services.
The professional must know about:
- Multiple developmental domains characteristic of infants and toddlers
- The typical sequence of development
- The range of individual variations in typically developing infants and toddlers
Multiple procedures and sources of information must be used to reach an informed clinical opinion about the development of a particular infant or toddler.
Early intervention professionals synthesize the information into an informed clinical opinion of an individual child, which should reflect a meaningful assessment of the child's development and functioning, as well as the family's resources, priorities, and concerns. It can also suggest further evaluation or assessment.
Example Sources of Information for Informed Clinical Opinion
- Reviewing a child's developmental history
- Reviewing medical records, educational records, or other psychometric and diagnostic data
- Performing neurodevelopmental or other physical examinations
- Using an evaluation instrument
- Interviewing family members, caregivers, medical providers, social workers, and educators about the child's participation in everyday routines and activities
- Observing parent-child interaction
- Observing the child at play and in various settings
- Identifying a child's level of functioning and needs across developmental domains
Team Level
The team includes family members when synthesizing and interpreting the qualitative and quantitative information about a child. Integrating observations, impressions, and evaluation findings of the entire team creates a "whole child" approach to evaluation and assessment, which goes beyond the reporting of test scores.
When determining eligibility, and when developing an Individualized Family Service Plan (IFSP), the team discusses and considers the impact of observed delays or differences in development of child functioning. Knowing about available services is useful in formulating an IFSP, but shouldn't limit the team's recommendations.
Why document informed clinical opinion?
Documentating the sources and use of informed clinical opinion is important.
Changing Needs
Documentation provides a baseline for the progress and changing needs of the child and family. The team's initial recommendations only reflect the needs of the child and family at a specific point in time. In Part C, assessment and eligibility determination is an ongoing process, which often requires modifications to the IFSP. The perceptions and impressions of individual early intervention professionals can change. Documenting individual and team findings facilitates transition if a family moves, service providers change, new services are initiated, or other service delivery systems are accessed.
Procedural Safeguards
Documenting the sources and use of informed clinical opinion also assures procedural safeguards were provided during the evaluation and assessment process and eligibility determination (initial or ongoing). Documentation should be maintained by designated team members, for example, a service coordinator and a parent.
Examples of Documention for Informed Clinical Opinion
- People involved in the team and in gathering information
- Procedures used
- Settings observed
- A summary describing the child's functioning in each developmental domain
- Team decision and rationale for eligibility determination
References
- Bagnato, S. J., McKeating-Esterle, E., Fevola, A., Bortolamasi, P., & Neisworth, J. T. (2008). Valid use of clinical judgment (informed opinion) for early intervention eligibility. Infants & Young Children, 21(4), 334–349. https://doi.org/10.1097/01.iyc.0000336545.90744.b0