Contents
6.1 Overview of ADLs/IADLs
6.2 Describing "Help"
6.3 Adaptive Equipment
6.4 ADL/IADL One-Third Guideline
6.5 "Needs" versus "Safety"/
Fluctuating Needs
6.6 Age Specific ADL/IADL Answer Choices
6.7 Bathing
6.8 Grooming
6.9 Dressing
6.10 Eating
6.11 Toileting
6.12 Mobility
6.13 Transfers
6.14 Communication
6.15 Learning
6.16 Social Skills
(PDF)
6.17 Meal Preparation
(PDF)
6.18 Money Management
(PDF)
6.19 Duration of Needs
6.20 Expected Decline in Functioning
6.1 Overview of ADLs/IADLs
The computer application of the CLTS FS will calculate the child’s age and present only the ADL/IADL answer choices appropriate for the child’s age. Although the screener should not use the full paper screen, the screener may wish to take along a print-out of the ADL/IADL answer choices that match the child's age, and check the boxes. The screener can print this from the "Forms" link in the CLTS FS application.
These answer choices were developed by the screen workgroup using well-established child development guidelines. Modifications were made in order to meet our screen development goals:
- Accuracy (match current functional eligibility rules and clinical judgment)
- Brevity (unnecessary information was left out)
- Objectivity/ inter-rater reliability (i.e., reduce subjectivity as much as possible)
- Inclusiveness (able to describe various needs of children)
These four criteria can obviously conflict. The balancing between these goals is especially evident in the ADLs.
The wording of each answer choice was crafted to be as precise and objective as possible to promote inter-rater reliability. This can obviously be challenging when trying to be inclusive of all children with or without physical, cognitive, or emotional disabilities.
Similarly, brevity can conflict with inclusiveness and accuracy, since children’s abilities must be broken down by age groupings. If functional eligibility is not affected, brevity is chosen over inclusiveness. Since age-appropriate needs are not "necessary" information (they don’t help with determining program eligibilities) they are not included among the ADL/IADL answer choices. This means that screeners will not be able to describe every child’s needs, if the needs are "age-appropriate," i.e., similar to those of non-disabled children of the same age group. ("Similar" here means the same as, or too difficult to distinguish without subjectivity and excessive length of the CLTS FS)
Age-appropriate descriptions (such as complete cares for infants) were
left off the CLTS FS for brevity. Babies are properly determined eligible
even without checkmarks on some of the ADLs/IADLs.
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6.2 Describing "Help"
"Help" means assistance from another person. It includes
hands-on assistance, doing the task completely, verbal cueing, or close
supervision throughout the task. In this way, help needed due to physical,
cognitive or emotional disabilities or mental illness can be indicated.
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6.3 Adaptive Equipment
Some items specifically ask whether the child needs adaptive equipment.
Adaptive equipment includes "medical" equipment such as
wheelchairs or mechanical lifts; it can also include "low-tech"
equipment the parents use, such as strollers for a three year old who
cannot walk, or a baby seat to bathe a baby who cannot sit on her own.
Such low-tech or generic equipment count only if they are used to
compensate for a child's physical impairment. (See details under
"Bathing" and "Mobility.") Note the term is
"needs" equipment, whether or not the child currently has the
equipment.
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6.4 ADL/IADL One-Third Guideline
ADLs/IADLs are to be checked if the child needs help at least one third of the time. In many cases, a child’s need for help is fairly consistent: "She can’t do that," or "He always does this," or "Most of the time…" In other cases, the child’s needs arise only some of the time. Very infrequent needs cannot count toward functional eligibility for long-term support programs.
The one-third guideline applies to ADLs (Bathing, Grooming, Dressing, Eating, Toileting, Mobility, and Transfers) and relates to the day in/day out routine of the child. The fact that the child has been able to complete the specific task(s) on occasion is irrelevant. If they need assistance most of the time then the box is checked. If the family is providing hands on support to the child for a skill even though the child can do the task independently, then do not check the box. These needs cannot be determined from a single episode but need to reflect the child's typical or average functional need. This is particularly important when reviewing documentation about a child's abilities. A report that indicates that a child completed a specific task may not represent the typical needs of that child. Be certain to verify any statement or assessment of frequency with the care providers who spend the most time with the child.
When frequency is at question, screeners should use a simple one third guideline: If the child has a limitation one third of the time (or more often) then it counts as a checked box on the CLTS FS. If the child has a limitation less than one third of the time, the ADL/IADL answer choice should not be checked.
The "one third of the time" criterion does not mean that the screener tests the child or measures her needs or abilities only during the visit. If a parent says, "now and then," "every few weeks," or "a few times, not mostly," it’s probably less than a third of the time. The screener can ask the parent "In the past few months, would you say he’s needed help more than a third of the time?" In general, consider ADL/IADL function over a six-month timeframe, unless the child has new needs or has developed new skills.
Example A: Juan has cancer and gets very sick during chemotherapy and he needs help with his ADLs then; at other times he is independent with them. Juan gets chemotherapy one week each month. Screener does not indicate that Juan needs help with his ADLs because he needs help less than one third of the time – one week out of four.
Example B: Tia was potty-trained two months ago and is doing well with it. Screener does not check box for needs help with toileting (although she did, four out of the past six months), because Tia has developed this skill and now rarely needs any help.
Example C: Isabel is a 13- year-old girl with a serious mental illness. Her need for help varies widely as she cycles from depression to manic states. Overall, Isabel needs verbal cueing or supervision (sometimes even hands-on help) more than one third of the time.
Remember that "help" includes supervision, verbal cueing, and
partial or complete hands-on cares.
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6.5 "Needs" versus "Safety" / Fluctuating Needs
"Needs" and "safety" should not be over-interpreted or over-used to express screeners’ subjective opinions. The CLTS FS is intended to be an objective screen of children’s need for assistance. Thus, the screener should ask, "Would another screener of another discipline rank the child the same way?"
It is often difficult to distinguish a child’s needs from parents’ preferences. Sometimes parents may prefer to perform or help with tasks even though the child could do them. If a child can complete a task independently, but it takes them a long time, the screener needs to consider whether or not the child "needs any help to complete the task." Sometimes it takes a child so long that the parent must do the task so that the child gets to school on time. This is not just for convenience, and amounts to (on average) more than a third of the time (since it’s five days out of seven); it would be counted as help needed on the Functional Screen.
The screener will quite often
encounter different versions of the child’s abilities from different
parties. This is discussed in the first part of the instructions. Also,
there are instructions for how to deal with fluctuating needs, and with
the fact that a child may function differently, e.g., at home and at
school. Please review those earlier sections as needed under 1.12
Strategies to Minimize Screening Limitations (B. Different
Descriptions from Different People and C. Abilities Fluctuate).
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6.6 Age Specific ADL/IADL Answer Choices
The following tables provide information and guidance about the ADL/IADL questions on the CLTS FS. The table is organized by ADL/IADL (Bathing, Dressing, etc.). The columns to the left side of the table indicate the age at which the specific answer choice appears on the CLTS FS. The answer choices are listed in Bold. Following the specific answer choice is an explanation of the question and/or relevant examples. Always consider the answer choice itself first; the examples are only intended to supplement that.
In the following tables, the symbol 
is
used to indicate that if the information listed here is true for the
child, the screener would check that box on the CLTS FS.
The symbol 
is used to indicate that if the information listed here is true for the
child, the screener would not check that box on the CLTS FS.
This is not an
inclusive or exclusive list of information. The children for whom a CLTS FS
is completed for are complicated individuals, and every situation has not
been represented on the screen or in these instructions. The information
provided is meant to offer guidance to the screener. For most of the
questions, the answers should be relatively clear once the screener has met the
child and reviewed the available documentation. For further clarification,
e.g. means "for example" and i.e. means "that is, or
"in other words."
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6.7 Bathing
The ability to shower, bathe or take sponge baths for the purpose of maintaining adequate hygiene (does not include hair care). For older children, this also includes the ability to get in and out of the tub, turn faucets on and off, regulate water temperature, wash and dry fully.
Bathing Table (PDF)
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6.8 Grooming
Brushing teeth, washing hands and face. Due to variations in hair care by culture, length of hair, etc, hair care is not considered for the purposes of this screen.
Grooming Table (PDF)
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6.9 Dressing
The ability to dress as necessary. This does not include the fine motor coordination for buttons and zippers.
Dressing Table (PDF)
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6.10 Eating
The ability to eat and drink using routine or adaptive utensils. This also includes the ability to cut, chew, and swallow food.
Eating Table (PDF)
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6.11 Toileting
The ability to use the toilet, commode, bedpan, or urinal. This includes transferring on/off the toilet, cleansing of self, changing of pads, managing an ostomy or catheter, and adjusting clothes.
Toileting Table (PDF)
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6.12 Mobility
The ability to move between locations in the individual's living environment. For children, this includes home and school. Mobility includes walking, crawling, or wheeling oneself around at home or at school. For functional eligibility purposes, mobility does not include transporting oneself between buildings or moving long distances outdoors.
Mobility Table (PDF)
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6.13 Transfers
Does not include bathtub or shower. The physical ability to move between surfaces: e.g., from bed/chair to wheelchair, walker or standing position. This excludes transfers into bathtub or shower or on and off the toilet, because those are captured in bathing and toileting ADLs.
Transfers Table (PDF)
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6.14 Communication
Hearing Impairments
Many of the questions in this category are related to auditory/verbal
communication. If a child has a known hearing impairment some
interpretation will be required to answer the questions correctly. Please
consider the child's primary method of communication. If they communicate
through sign language due to a hearing impairment, then complete the
questions with that understanding. For example, for a child who is deaf,
when asked "Does not use more than 10 meaningful words or word
approximations," the screener would inquire if they can sign 10
words. That would not be the case for example for a child with Down
syndrome who has a speech delay and is enhancing their communication with
sign language. For that child, their primary method of communication is
still verbal.
Non-Verbal / Use of Communication Devices
Many of the questions in this category are related to auditory/verbal
communication. If a child has a known significant language disorder that
has resulted in the use of an alternative communication system, some
interpretation will be required to answer the questions correctly. Please
consider the child's primary method of communication. If they communicate
using a communication devise, then complete the questions with that
understanding. For example, for a child who is non-verbal and uses a
Dynamite to express themselves, when asked "Does not join familiar
words into phrases (e.g., "me drink," "red
truck")," the screener would inquire if they are combining words
on their Dynamite.
Emerging Skills
The CLTS FS is trying to capture mastered skills. If a skill listed has
been mastered then check accordingly. If the skill is starting to emerge
and parents/caregivers can report that they have witnessed the skill but
only a few times, do not consider the skill mastered. This is especially
evident in Communication and Learning.
Assessment of 35% delay or two standard deviations
The following is a list of tools that are norm referenced for receptive
and expressive language. Select the correct tool from the pull down
menu on the CLTS FS. Indicate the date (MM/YYYY) that the assessment was
completed.
[ ] indicates child's age at which this tool can be used and considered accurate. Any numbers written with decimal points indicates the age in [years.months]. The latest editions of the test should always be used when available.
Acceptable tools for Expressive and Receptive Communication:
- Clinical Evaluation of Language Fundamentals - Preschool (CELF-P) [3 - 6.11]
- Clinical Evaluation of Language Fundamentals (CELF) [5 - 21]
- Comprehensive Assessment of Spoken Language (CASL) [3 - 21]
- Comprehensive Receptive and Expressive Vocabulary Test (CREVT) [4 - 89]
- Early Language Milestone Scale (ELMS) [Birth - 36 months]
- Fullerton Language Test for Adolescents (FLTA) [11 - 18]
- MacArthur Communicative Developmental Inventories (CDIs) [8 - 30 months]
- Miller Assessment for Preschoolers (MAP) [2.9 - 5.8]
- Oral and Written Language Scales (OWLS) [3 - 21] - Only use Listening Comprehension Scale and Oral Expression Scale results
- Preschool Language Scale (PLS) [Birth - 6]
- Reynell Developmental Language Scales [1 - 6.11]
- Sequenced Inventory for Communication Development (SICD) [4 months - 4]
- Test of Adolescent and Adult Language (TOAL) [12 - 24]
- Test of Early Language Development (TELD) [2 - 7.11]
- Test of Language Competence (TLC) [5 - 18.11]
- Test of Language Development - Primary (TOLD-P) [4 - 8.11]
- Test of Language Development - Intermediate (TOLD-I) [8 - 12]
Acceptable tools for Expressive Communication only:
- Expressive One-Word Picture Vocabulary Test (EOWPVT) [2 - 18.11]
Acceptable tools for Receptive Communication only:
- Receptive One-Word Picture Vocabulary Test (ROWPVT-2) [2 - 18]
- Test of Auditory Comprehension of Language (TACL) [2 - 9.11]
- Test of Auditory Perceptual Skills (TAPS) [4 - 13]
- The Token test for Children [4 - 12.5]
The following are commonly used assessments that DO NOT qualify as norm-referenced tools of Expressive and Receptive Communication:
1.) Not Norm-Referenced, Standardized Tools:
- Assessment of Basic Language and Learning Skills
- Brigance Diagnostic Inventory
- Carolina Curriculum for Infants/Toddlers with Special Needs
- Child Curriculum Inventory Profile
- Denver Developmental Screen
- Developmental Assessment for Individuals with Severe Disabilities
- Developmental Assessment of Young Children
- Developmental Observation Checklist System (DOCS)
- Early Learning Accomplishment Profile (E-LAP)
- Measurement of Language Utterance (MLU)
- Non Speech Test for Expressive and Receptive Language
- Portage Guide to Early Education
- Receptive Expressive Emergent Language Scale (REEL)
- Rosetti Infant Toddler Language Scale
- Transdiciplinary Play Based Assessment
2.) Communication Assessments that do not measure Expressive or Receptive Communication:
- Braken Basic Concept Scale
- Communication Abilities Diagnostic Test (CADeT)
- Gard Gillman and Gorman Pragmatic Language Scale
- Goldman Fristoe Test of Articulation
- Greenspan-Lewis Affect Basic Language Curriculum
- Language Processing Test (LPT)
- Northwestern Syntax Screening Test
- Peabody Picture Vocabulary Test (PPVT)
- Test of Early Reading Ability (TERA)
- Test of Pragmatic Language (TOPL)
- Test of Word Finding (TWF)
3.) Tools that measure something other than Expressive and Receptive Language but contain sub-categories regarding Communication skills. These are not accepted because the purpose of the tool is not to measure Expressive and Receptive Language. There is a communication subtest that measures the influence that communication has on behavior or intelligence or achievement or development but cannot stand alone as an assessment of communication. These often fall into the category of screening tools rather than full assessments.
- Adaptive Behavior Assessment System
- Adaptive Behavior Scale
- Adolescent Test of Problem Solving
- Autism Rating Scale
- Battelle Developmental Inventory (BDI)
- Bayley Scales of Infant Development
- Behavioral Language Assessment Form
- Differential Ability Scale (DAS)
- Early Learning Measure (ELM)
- Eau Claire Child Observation Recording Tool (EC-CORT)
- Kaufman Assessment Battery for Children
- Kaufman Brief Intelligence Test
- Kaufman Survey of Early Academic and Language Skills
- Mullen Scales of Early Learning
- Psychoeducational Profile Revised
- Scales of Independent Behavior
- Vineland Adaptive Behavior Scales
- Wechsler Individual Achievement Test (WIAT)
- Wechsler Intelligence Scale for Children (WISC)
- Wechsler Preschool and Primary Scales of Intelligence
- Wisconsin Knowledge and Concepts Examination
- Woodcock-Johnson Test of Achievement
- Woodcock-McGrew-Weder Mini-Battery of Achievement
- WRAT
When to consider the assessment results as valid?
The only assessments that should be considered when answering this question are assessments in which the evaluator is confident in the accuracy of the test results. There are many circumstances in which the test results are not accurate or are not useable. For example:
- If the results are listed with qualifiers such as "child was unable to focus on the tasks of the tests" or "child's behaviors' interfered with accurate test results" or any other indication that the results may not be a true reflection of the child's abilities.
- If the child was considered "un-testable" do not assume that they would meet a 35% delay or 2 standard deviations below the mean.
- If the child being tested was of a different age than the range that is measured by a particular tool, do not consider those results to be an accurate reflection of the child's abilities.
- If the test results you have do not list the results in percentages or by standard deviations, do not try to estimate whether or not they would fall into the required range of delay.
- The test is not a "norm referenced" tool. Whether or not a test is norm referenced can often be checked by learning more about the particular test on the internet or by asking the professional who completed the evaluation.
Screeners do not always have documentation to substantiate this item. Even when a child's delays are obviously significant, they are not usually documented in these precise terms. This item is available for those situations when the screener sees documentation in these terms. Do not worry if the screener cannot check this item. It is essentially superfluous to all the other IADL descriptions of a child's functioning. Make special note of the number of months associated with each question (it varies based on the age of the child).
Communication Table (PDF)
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6.15 Learning
Compromising Impairments
Under the category of Learning, the CLTS FS is capturing cognitive
development. The questions have been stated in broad terms to try to
account for different developmental issues affecting children. If a child
has limitations that mask their cognitive development, try to determine
the actual cognitive ability. If a child has a significant vision
impairment, has a significant hearing impairment, or has a complex
physical disability that compromises the child's ability to demonstrate
their intelligence, consider the question in light of that impairment. For
example, "Does not seek objects that were hidden" is a question
asked for a 13-18 month old child. If a child is blind, this skill may not
be possible to measure. If a child has a physical disability that limits
their movement, we may still be able to tell that the child understands
object permanence by seeing if they continue to look in the direction of a
toy that was hidden or start looking away as if the toy disappeared. When
the child's compromising impairments result in not being able to
adequately measure their cognitive impairment, make note of the situation
in the notes section on that page and contact State Clinical Staff for
further assistance.
Emerging Skills
The CLTS FS is trying to capture mastered skills. If a skill listed has
been mastered then check accordingly. If the skill is starting to emerge
and parents/caregivers can report that they have witnessed the skill but
only a few times, do not consider the skill mastered. This is especially
evident in Communication and Learning.
Assessment of 35% delay or two standard deviations
The following is a list of tools that are norm referenced for cognitive
development. Select the correct tool from the pull down menu on the
CLTS FS. The screener may also select "Other" and write in the
name of the tool used for this assessment. Be certain that the tool used
is norm referenced for cognitive development. Indicate the date (MM/YYYY)
that the assessment was completed.
[ ] indicates child's age at which this tool can be used and considered
accurate. Any numbers written with decimal points indicates the age in
years.months.
* indicates an IQ test
- Battelle Developmental Inventory - Second Edition only [Birth - 8]
- Bayley Scales of Infant Development - Second Edition [1 month - 42 months]
- Cognitive Abilities Scale - Second Edition (CAS-2) [3 months - 3]
Comprehensive Test of Nonverbal Intelligence (CTONI) [6 - 18.11] - Kauffman Adolescent & Adult Intelligence Test (KAIT) [11 - 85]*
- Kaufman Assessment Battery for Children - Second Edition (KABC) [2.5 - 12.5]*
- Leiter International Performance Scale - Revised (Leiter-R) [2 - adult]
- McCarthy Scales of Children's Abilities [2.5 - 8.5]
- Merrill-Palmer Revised Scales of Development (M-P-R) [Birth - 6.6]
- Miller Assessment for Preschoolers (MAP) [2.9 - 5.8]
- Mullen Scales of Early Learning (MSEL) [Birth - 42]
- Primary Test of Cognitive Skills (PTCS) [Grades K-1]
- Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI) [adolescence - adult]
- Slosson Full-Range Intelligence Test (S-FRIT) [5 - 65]
- Slosson Intelligence Test - Primary (SIT-P) [2.7 - 11]
- Slosson Intelligence Test - Revised (SIT-R3) [4 - 65]
- Stanford Achievement Test Series - Tenth Edition (SAT-10), [Grades K-12]
- Stanford-Binet Intelligence Scales (SB) [2 - Adult]*
- Test of Nonverbal Intelligence - Third Edition (TONI-3) [6 - 89.11]
- Wechsler Adult Intelligence Scale - Third Edition (WAIS-III) [16 - 74.11]*
- Wechsler Intelligence Scale for Children - Third or Forth Edition (WISC-III or WISC-IV) [6 - 16] *
- Wechsler Preschool Primary Scale of Intelligence - Third Edition (WPPSI-III) [2 - 6] *
- Other - If you use another tool, be certain it is norm-referenced and measures cognitive development.
The following are commonly used assessments that DO NOT qualify as norm-referenced tools of Cognition:
- Infant/Toddler Sensory Profile [Birth - 36 months] Measures a child's sensory processing abilities and to profile the effect of sensory processing on functional performance in the child's daily life.
- Behavioral Style Questionnaire (BSQ) [3 - 7] Measures behavior/temperament based on parental report.
- Carolina Curricula (CCITSN or CCPSN) [Birth - 24 months or 2 - 5] Not norm-referenced. A Curriculum-Based/Criterion Referenced assessment of cognition, communication, social/adaptation, fine motor and gross motor skills.
- Test of Cognitive Skills - Second Edition (TCS-2) [Grades 2-12] Not norm-referenced. Obtains an accurate assessment of academic aptitude.
- Transdisciplinary Play-Based Assessment (TBA) [Birth - 6] Not norm-referenced. Assess a child's development in cognitive, social-emotional, communication and language, and sensorimotor domains through observation of play.
- Vineland Adaptive Behavior Scales [Birth - 18] A measurement of personal and social skills not communication or learning.
- Hawaii Early Learning Profile (HELP) [1 - 14] Not norm referenced. A Curriculum-Based/Criterion Referenced profile of six developmental domains: gross motor, fine motor, cognition, language, social and self help.
- Infant Toddler Developmental Assessment (IDA) [Birth - 36 months] Not norm referenced. A developmental assessment of adaptive behavior.
When to consider the assessment results as valid?
The only assessments that should be considered when answering this
question are assessments in which the evaluator is confident in the
accuracy of the test results. There are many circumstances in which the
test results are not accurate or are not useable. For example:
- If the results are listed with qualifiers such as "child was unable to focus on the tasks of the tests" or "child's behaviors' interfered with accurate test results" or any other indication that the results may not be a true reflection of the child's abilities.
- If the child was considered "un-testable" do not assume that they would meet a 35% delay or 2 standard deviations below the mean.
- If the child being tested was of a different age than the range that is measured by a particular tool, do not consider those results to be an accurate reflection of the child's abilities.
- If the test results you have do not list the results in percentages or by standard deviations, do not try to estimate whether or not they would fall into the required range of delay.
- The test is not a "norm referenced" tool. Whether or not a test is norm referenced can often be checked by learning more about the particular test on the internet or by asking the professional who completed the evaluation.
Screeners do not always have documentation to substantiate this item. Even when a child's delays are obviously significant, they are not usually documented in these precise terms. This item is available for those situations when the screener sees documentation in these terms. Do not worry if the screener cannot check this item. It is essentially superfluous to all the other IADL descriptions of a child's functioning. Make special note of the number of months associated with each question (it varies based on the age of the child).
IQ Test Scores
We are forced to use full-scale IQ scores as a way to address the over-use
and under-use of the diagnosis of mental retardation (MR). We are aware of
the limitations of IQ testing. The federal definition of MR is a
full-scale IQ below 70. Federal guidelines do acknowledge an IQ score
error range of 5 points. We have chosen to use 75 as a "cut-off"
point instead of 70 in recognition of that error range.
If the clinician conducting the IQ test expressed concern about the results due to the child's ability to participate in the testing process, don't use the results of that test. The screener will want to consider the results from the most recent IQ test a child has if they have had multiple tests done. It does not matter how old the IQ test is as long as it is the most current one on record for that child.
Learning Table (PDF)
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6. 16 Social Skills
Social Skills Table (PDF)
6.17 Meal Preparation
Meal Preparation Table (PDF)
6.18 Money Management
Money Management Table (PDF)
6.19 Duration of Needs
*Is at least one of the bathing functional impairments checked expected to last for at least one year from the date of screening?
For functional eligibility for long-term support programs, the child's need for help (i.e., her functional impairments) must be long-term. For every ADL/IADL item checked, screeners are asked to indicate whether any of the functional impairments are expected to last for at least one year from date of screening. Health care providers regularly make such predictions. If some of the functional impairments are not expected to last but one or more is, then check "yes" for this question. If the screener is not clear about the duration, the screener can seek additional information. When the expected duration is not clear, the screener should check "Yes."
Please take your time answering these questions. It is imperative that screeners accurately record the duration of any specific functional limitation. On the ADL and IADL page, consider the specific check marks in each category (Bathing, Dressing, etc) and check that the limitation is expected to last if any of the items checked are expected to last a year from the date of screening.
Example:
Brandon a 5 year old child. Under Toileting the screener has checked both
Incontinent during the day and Needs physical help, step-by-step cues or a
toileting schedule, consider if either one is going to last for a year. If
Brandon is not likely to be incontinent for another full year, but will
continue to need physical help in the bathroom, the screener would select
"Yes" to the duration question because there is at least one
impairment under toileting that is expected to last a year.
If a child is nearing a change in age cohort (0-6 months, 6-12 months, 12-18 months, 18-24 months, 24-36 months, 3-4 years, 4-6 years, 6-9 years, 9-14 years, 14-18 years, 18+years) and it is likely that the child will master the task you have checked but will not be able to complete the tasks listed for the next age cohort within the year, then answer "Yes" to the duration question.
The screener should check "No" if the child has cancer, an illness or surgery that resulted in higher needs than normal. This is especially true if the child had typical functional skills before this acute episode.
Example:
Carlos is a 2-month old with congenital heart defects. He is expected to
have surgery next month and is expected to recover and regain full
functioning within three months after that. Carlos is not eligible for
long-term support programs.
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6.20 Expected Decline in Functioning
The following question appears on the CLTS FS to capture rare situations where the screener knows that the child is not exhibiting nearly the amount or severity of delays at the time of the screen but will have significant changes in their functioning over the next 12 months. It is intended for children who are functioning near or at their age level now but within the next year are going to demonstrate significant limitations requiring help from others. It is not intended for children who are currently demonstrating needs or limitations and who will continue to have limitations over time as is expected given their condition.
Child has a verified diagnosis that is expected to cause more substantial long-term functional impairments within one year: (Check all that apply.)
- Self-Care
- Mobility
- Learning
- Communication
This is an important question on the Functional Screen that is intended to work for the following situations only:
- Serious conditions diagnosed in young infants:
In all of these cases, the impairments should be expected to occur within a year from the date of screening. Also, the expected impairments should be "long-term" that is, they should be expected to last for more than six months once they do appear. For example, if a child will have surgery and then a body-cast for three months, the screener should not check this box because the expected impairments will last less than six months and is considered an acute episode.
Screeners are not expected to make clinical or nursing judgment about whether a child’s functioning will deteriorate. Screeners would check that child has a "verified diagnosis that is expected to cause more substantial long-term functional impairments within one year" only if:
- Medical records indicate or health professionals report that the criterion
is true.
- The parents report that MDs have informed them that the criterion is true.
As with diagnoses, parents’ own opinions are not recorded, but
parents’ reports of what qualified professionals have told them can be
recorded.
- A screener’s expertise allows them to know, based on child’s age and diagnosis, that the child will have substantial functional decline in the next year.
Many screeners do not have the expertise to know if a particular condition will cause lasting impairments within a year. The screener will want to review the case with a physician or a nurse who will be better able to predict the child's functional impairments over the next year.