FAQ: HELP 0-3 Clinical Questions

Choose a Question...
Using HELP® for Program Eligibility
   Can we get needed information for eligibility from HELP®?
   Can I use HELP® to determine program eligibility?
   Is it possible to use HELP® to calculate a percentage of delay?
   How do we deal with half month increments on HELP® for DALs?
   Can I determine % delay for child 3 month old?
Cultural Sensitiity
   What is the cultural sensitiity of HELP®?
Staff Qualifications
   Who is qualified to give the HELP®?
Crediting skills
   What are "anticipatory guidance" items?
   Why is important to record "A" during the assessment process?
   HELP® covers so many items, where do I begin?
   Why are some ages different on the HELP® products?
   Why are some HELP® skills repeated in different Strands?
   I have a question about crediting "relational play".
Determining Approximate Developmental Age Levels (DALs)
--How do I report an approximate DAL when...
   ...child has two "-", but feel further into the strand he may have two "+"?
   ...child does not have 1st Strand skill that is within chronological age ?
   ...final + credit in a Strand has a several month age range?
   ...most skills are at one age level but one skill is at much higher level?
   ...child's CA is within Strand, but child can do one or less of the items?
   ...child has only one skill in a Strand which is not the first skill in Strand?
   ...child can only do the first item in a strand?
   Do I use clinical judgment to determine DALs in these examples?
   How do I get DAL for a domain that has many Strands?
   How do I report DAL if the child cannot complete any skills in Strand?
Adjusting for Prematurity
   Do the Strands use an adjusted age when determining skill level?
Adapting for Disabilities
   What are issues for using HELP® with students with visual impairments?
   How to find Assessment Adaptations for every Strand in Inside HELP®?
Assessment Materials
   Is there is a listing of items that should be used in the evaluation?
HELP® Background/Research/Use
   What is the theory behind the HELP® assessment?
   What normative data was used in HELP®?
   What research has been conducted using HELP® to establish validity?
   What scientifically valid research is available for HELP®?
   HELP® 0-3 Evidence-Based Practices?
   What is the definition of atypical development?
   What is definition of "curriculum based" for the HELP®?
HELP® at Home
   Who is target audience for HELP® at Home?
   Is the 2nd edition of HELP® at Home necessary if I have 1st?
Using HELP® for OSEP Reporting
   Can HELP® be used to monitor progress for OSEP child outcomes?
   If a child's DAL is close to [X] CA how is it reported for ECO rating?
   Are weighting factors applied to Strands to determine ECO rating?
   If a DAL and "A" is reported for a Strand, how ECO rating affected?
   When do I circle a credit on OSEP worksheets?
   Why aren't language strands included for OSEP Outcome 3?

Sample Developmental Report
   Do you have any sample reports from HELP® 0-3?


The development of HELP® as a curriculum-based family centered assessment process is itself an ongoing, multidisciplinary process. The following questions and responses were drawn from the numerous questions received during the past two decades on how to best use HELP® 0-3 materials in your important work with infants and families. They are being shared on this website to continue and enhance this process.

Using HELP® for Program Eligibility:

Question from: [Top]
Michelle, Pediatric Therapist
"Can we get needed information for eligibility from HELP®? I am a pediatric physical therapist who has used the HELP® for years. Our early intervention program (birth to 3 years of age) is looking for a new assessment tool but we need standard scores (scale score, age equivalent, standard deviations from mean). I realize the HELP® is a criterion-referenced assessment. Can we get the information we need from the HELP®? If so, please advise."

Author response:
My response assumes you are referring to needing standard scores for Part C eligibility. HELP® cannot provide standardized "scores" to determine eligibility. However, when appropriate HELP® can help inform and support eligibility under the Part C. "Informed clinical opinion" option for determining eligibility — for example in the assessment of atypical development and developmental concerns. However, HELP® is not a standardized test and should not be use to determine eligibility for "developmental delay".

Since Part C requires multiple methods and assessments and thus many programs and States are using a standardized test such as the Battelle or Bayley as their tool to establish eligibility, and love using HELP® as their on-going family-centered assessment for the development and implementation of their IFSP's. HELP® assists in the identification of approximate developmental age levels and quality concerns to develop statements of current functioning within and across developmental domains that guide individualized intervention plans (outcomes, services and strategies) for infants and their families.

If programs need "scores" or "ratings" to collect and track individual child and program progress, HELP® has developed a system for quantifying curriculum assessment data for progress tracking purposes — but not eligibility.

Question from: [Top]
FAQ's Inside HELP®, Administration and Reference Manual ©1997, 2006
"Can I use HELP® to determine program eligibility?"

Author response:
This will depend primarily on your program's policies and the individual needs of the child. It is your professional responsibility to use instruments and qualified personnel that meet local, state, and federal requirements.

HELP® is not standardized and thus should not be used if your program requires standardized instruments to determine developmental delay. In addition, since HELP® cannot provide a single score or definitive developmental age, HELP® should not be used to determine eligibility for children who may be experiencing mild developmental delays. In such cases, however, HELP® can be used to compliment standardized instruments to support "informed clinical opinion" requirements, and it can be used as an initial and ongoing assessment to help identify the child's unique strengths and needs, services appropriate to meet those needs, and the resources, priorities, and concerns of the family.

If your program does not require standardized instruments, HELP® can be used to help support your informed clinical opinion regarding eligibility for children with significant delays and atypical development. HELP® can also be used as an initial and ongoing assessment to identify the child's unique strengths and needs, services appropriate to meet those needs, and the resources, priorities, and concerns of the family. In addition, if a child is referred to your program with a previously diagnosed disability or special need that already meets program eligibility requirements, HELP® can be used as an initial and ongoing curriculum-based assessment.

Question from: [Top]
Part C Staff, Ohio
"Once a developmental age has been established by the team, is it possible to use the results of the HELP® to calculate a percentage of delay. This is the sole reason percent delay is being used (for eligibility into the state's birth—3 program). It does not need to be a standardized test (or a norm referenced one), as long as percent or standard deviation can be inferred from the existing tool."

Author response:
I understand that states are required to define "developmental delay" as part of their state's system for early intervention eligibility determination under Part C of IDEA. In response, many states have included as part of their definition a specific percent of delay in one or more areas of development, and, are developing methods to quantify curriculum-based assessments such as HELP® to meet this need.

I agree with your statement that one can mathematically compute % delay using developmental age (DA) and chronological age (CA) information, as well as prematurity information when applicable. However, if this process is used with HELP®, the findings should be viewed as "approximate" and used to help support informed clinical opinion rather than as definitive "score", "age equivalent" or the sole criterion[i] to determining eligibility. Like many curriculum-based assessments, HELP® is not standardized nor intended to provide an exact score or % of delay. The HELP® assessment process understands that typically developing children vary greatly in the accomplishment of developmental skills, and that it is difficult to assign an exact developmental age or percent delay for each developmental area.

HELP® can however be used to help determine eligibility by supporting informed clinical opinion regarding degree of developmental delay in all developmental areas as well as concerns about the quality a child's development. HELP® provides the qualitative and quantitative information to support team decisions needed to determine the need for early intervention services. This use is consistent with the current and proposed May 9, 2007 regulations of Part C.

With this background and understanding, while it is not necessary to derive % delay on HELP® for eligibility (because approximate developmental age levels can guide clinical opinion) and although HELP® was not developed to yield a single score or "age equivalent", some programs and states wish to quantify HELP® into developmental age levels to help support clinical opinion for eligibility, and/or help measure child progress. Guidelines to help multidisciplinary teams in that quantification effort are available for download on the VORT website here. Forms and procedures are available through VORT to measure and monitor progress for OSEP's Part C, Child Outcome Statements using HELP® and ECO's 7 point rating system.

Most importantly, in addition to using HELP® to support "informed clinical opinion" requirements for eligibility, HELP® is best used as an initial and ongoing multidisciplinary assessment to help identify the child's unique strengths and needs, and the resources, priorities, and concerns of the family related to their child as required by Part C, as well as identifying and providing curriculum interventions appropriate to meet those needs.

Question from: [Top]
Evaluator for 0-3 program Ohio
"I have a couple of questions about using HELP® and the 25% delay for Part C eligibility in our state. How specific are the HELP® requirements in determining the age for delay. For example, since a child at 17 months would need to show a 4.25 month delay, do we round that to 4 months and the child would then have to have skills below 13 months to qualify for Part C? What if the 25% corresponds to .5 months - such as 34 months would be 8.5 months for Part C? Any thoughts or additional information would be most helpful."

Author response:
The rounding up or down issue does not apply to HELP® because (1) we cannot determine an exact month level using HELP®, and, (2) HELP® should not be used to determine Part C eligibility for children who would only be eligible based upon a 25% delay.

HELP® was developed as a curriculum-based assessment process. It is not standardized and cannot yield exact developmental age levels. Any developmental age levels derived from the HELP® should be considered "approximate" and used to help support informed clinical opinion rather than used as a definitive "score", "age equivalent" or the sole criterion to determining eligibility. Therefore, if a child appears to display questionable or only mild delays on the HELP® Strands, these findings should not be used to determine eligibility based upon a 25% delay. However, If the child's approximate developmental age levels on the HELP® were more significantly delayed, e.g., more than 40% delay, and or if the child displayed many skills and behaviors that were atypical or dysfunctional "A" as assessed by credit criteria in Inside HELP®, this assessment information provides stronger evidence to help support Part C eligibility.

Example: A 15 month old would need to be assessed at 10.5 mo. or less in one area of development to be eligible in Ohio for Part C services. If this child's approximate DAL across strands for one domain on the HELP® Strands is assessed at 9-11 months, and the child does not display atypical or dysfunctional skills or behaviors, then HELP® does not provide strong evidence to support a 25% delay for eligibility. It would be important to use standardized tests and or other assessment procedures.

If however this child displayed most skills in at least one area of development at the 5-7 month level, and/or displayed atypical quality or dysfunctional skills such as atypical muscle tone and posturing, then this assessment information provides stronger evidence to help support Part C eligibility.

Question from: [Top]
OT in Franklin, Virginia
"Can I determine % delay for child 3 month old?"

Author response:
Although each baby and situation is different, you typically can not calculate a valid % delay using HELP® for a 0-3 mo.old, but you can use HELP® to identify developmental concerns. If you are trying to do this to determine eligibility or treatment planning, it would be more appropriate to use HELP® to support and inform clinical opinion, and review HELP®'s atypical development definitions for skills and Strands in Inside HELP® that are pertinent to 0-3months. Part C of IDEA understands the importance of using clinical opinion rather than specific percent delays, especially under 6 months.

Cultural Sensitivity:

Question from: [Top]
Stephanie, OTD Candidate
"Our program uses the HELP® in its 0-5 programming during assessment and ongoing progress monitoring. We have a very diverse population in our city and I am doing a research project examining cultural sensitivity of using the HELP® Family-Centered Interview in conjunction with the HELP® strands versus other family centered assessment tools. I am looking to gather more scholarly literature on the HELP®, but have had some difficulty finding much."

Author response:
I am very pleased to hear about your experience as an occupational therapist using HELP®® in your early intervention program, and, in your research project examining cultural sensitivity of using the HELP® Family-Centered Interview in conjunction with the HELP® Strands.

HELP®® was selected and featured as one of the top 30 "Authentic Assessment Measures" in the LINK Social Validity Study in LINKing Authentic Assessment & Early Childhood Intervention, Best Measures for Best Practices, 2nd edition. Bagnato, S.J., Neisworth, J.T., Pretti-Frotczak, K. (2010) Baltimore: Brookes. Selection of HELP® as a top assessment in this important work was based upon expert panel ratings across 19 standards and other features including 'Diversity features'. The HELP® 0-3 curriculum based assessment (CBA) process emphasizes the importance of understanding, respecting and incorporating each family’s beliefs, values and practices. Examples of how HELP® 0-3 materials reflects culturally responsive practices include:

1. Inside HELP® (administration manual for using HELP®) avoids using standardized materials and settings. HELP® recommends the use of the child’s own, or similar toys and materials familiar to the child.

2. HELP® recommends assessing children with familiar people in familiar settings using the child's own toys during typical routines. Inside HELP® lists "example observation opportunities" for each HELP® skill, and includes families in selecting meaningful materials and methods.

3. HELP® recommends assessing children using their primary language using culturally relevant toys, objects, foods, and pictures.

4. HELP® understands that each child develops skills at different times and can be impacted by cultural differences. HELP® does not assign specific ages to skills and provides supportive guidance for developing meaningful descriptive reports

5. HELP® understands that all skills are not applicable to all children and does not require all skills to be assessed or included in curriculum.

6. HELP® includes parents as central in every step of the assessment process so that children’s behaviors and abilities can be understood in the context of their family relationships and cultural beliefs. Examples of family centered interview questions are provided in Inside HELP® and the HELP® Family Centered Interview for each HELP® Strand.

I am not familiar with other scholarly works specific to comparing the HELP® Family Interview and the HELP® Strands with other tests regarding cultural diversity, however, there is much literature discussing the importance of using authentic assessments with culturally diverse populations and since HELP® is considered one of the top authentic assessments in early intervention perhaps this type of literature could be helpful in your project.

Please also see: HELP® 0-3, Embracing Evidenced Based Practices.

Personnel Qualifications:

Question from: [Top]
Speech Language Pathologist, Wisconsin
"I am interested to know which professionals are qualified to give the HELP®. After reviewing HELP®, there seems to be a lot of professional "lingo" used by different disciplines. As a speech language pathologist, I'm not sure if I'd feel comfortable completing for example, the Gross and Fine motor sections without extensive training."

Author response:
HELP® is a flexible curriculum-based assessment process that includes a variety of assessment and intervention materials. Since several materials are available as part of this process, I am not sure if you are asking about user qualifications for one product or for the entire curriculum-based assessment process. I will try to address various scenarios but in general a wide range of professionals and paraprofessionals, with a range of qualifications, can use HELP® with infants and families. Variables include:
  • Setting: HELP® is successfully used in various settings with a variety of children and families by personnel who have varied backgrounds, e.g., community day care, Early Start programs, hospitals, and Part C early intervention programs for infants and toddlers who have developmental concerns.
  • Purpose: e.g., Are you using HELP® as an assessment tool to support clinical opinion regarding program eligibility or identifying developmental concerns? Or, as a curriculum-based assessment tool identify activities and interventions that support a child's development in everyday activities? And, or to provide families with support and information about their child's special needs? And, or to design specialized treatment plans for a child with a significant disorder?
  • State or program definitions or requirements for "qualified personnel": If HELP® is being used in Part C programs, it should be used as part of the assessment process, and a multidisciplinary team should be involved who are considered "qualified personnel" according your State's definition under Federal regulations. In addition when using HELP®, if the child is identified with specific delays, atypical development or disabilities in a specific area of development, the professional whose background most closely matches that need should be included, e.g., a physical or occupational therapist if the child is identified as having abnormal muscle tone and movement, or, a speech language therapist if the child has disordered speech.
I understand that as a Speech Language therapist, if you have not had experience or training in all developmental areas that you could feel uncomfortable using HELP® in all areas of development. In some cases as described above, it would not be appropriate for you to "administer" HELP®, e.g., to make eligibility or treatment decisions for a child who is motor impaired. On the other hand, in other cases when the child's primary concerns are speech, language or feeding, it may be very appropriate for you to use all developmental areas of the HELP® to support you efforts to serve the "whole" child within the context of the family and everyday situations.

HELP® products lend themselves well to an interdisciplinary and transdisciplinary approach and extensive training is usually not required. Inside HELP® provides clear definitions, flexible contextually-based assessment guidelines, and credit criteria for each HELP® skill in all developmental domains. The preface section for each Strand within Inside HELP® also provides interdisciplinary training and information to help you learn about the conceptual issues regarding that area of development, how it is inter-related to others, and defines the "lingo" other disciplines may use. It also provides clear guidelines on when you should refer the child for further evaluation or intervention by another discipline. Examples: Strand Preface, Skill credit and definition.

Crediting skills:

Question from: [Top]
multi-state HELP® Trainer
"I receive questions about the anticipatory guidance items - why are they important? I also think it will be very important to explain when to record "A" during the assessment process."

Author response:
Anticipatory guidance items are those behaviors that you would not want to teach/encourage to the child, but, may want to provide information or support to families if their child displays them, e.g., skills 5.42 "Displays frequent tantrums", 5.27 "Struggles against supine", or, 3.49 "Crawls backwards". If these skills/behaviors are not present they should be recorded as "N/A" rather than "-" so that they are not targeted to "teach" nor included toward determining an approximate DAL because it could imply a delay. If they are present then they can be marked as "+" or "A" if extreme or dysfunctional. Anticipatory skills are identified in the HELP® Strands definitions in the HELP® Strands Assessment booklet, and in Inside HELP® with instruction about recording "N/A".

Importance of recording "A": I agree! Recording and considering "A"'s in the assessment process is an important training issues. It makes HELP® unique from many other 0-3 assessments. I encourage all clinicians to review the Strand's preface in Inside HELP® and the skill items for references to "A" whenever "things just don't seem right". The multidisciplinary expert contributors to Inside HELP® spent enormous time and effort researching and defining atypical/dysfunctional development. Crediting notes for using "A" are included for each skill when applicable in the HELP® Strands Assessment booklet, and in Inside HELP®.

Question from: [Top]
FAQs, Inside HELP® 1997
"HELP® covers so many items, where do I begin?"

Author response:
No other currently available 0-3 curricula include as many developmental skills, behaviors, and intervention strategies as the HELP®. The density and comprehensiveness of HELP® can at first glance appear overwhelming, especially to the new user. However, the comprehensiveness of HELP® offers the clinician more variety and options for assessment and curriculum planning, and enables families and clinicians to plan and monitor progress in small, incremental steps. The following tips can help make using HELP® more manageable.
  • Remember: HELP® is not a "one-time" tool
    HELP® is an ongoing curriculum-based assessment which is not intended to be completed in one assessment session. There are a large number of skills, but they span three years and are intended to be addressed over a long period of time.
  • Not all skills are pertinent
    All of the HELP® skills and behaviors listed are rarely pertinent to any one child. Many will not be pertinent due to the child's age and developmental level, some skills may not be functional due to a child's disability, some skills may not be culturally relevant, and other skills may not be necessary to assess because they are judged not to be important to assess for a particular child, e.g., ability to walk on a balance beam if the child displays no difficulty in motor planning or balance skills. As you consider these variables, the scope of skills appropriate to assess during initial observations and family interview can become narrower and more manageable.
  • Don't assess each skill, Strand, or domain separately
    Although each skill, strand, or domain has an underlying key concept or focus, it is typically unnecessary and inappropriate to assess each separately. Each observation of a child completing a task or involved in an interaction or daily activity yields information about a variety of skills and behaviors - simultaneously. For example, if you observe a parent asking the child to, "Throw the ball," and in response the child says, "ball" and throws the ball in a playful way to his parent, you could credit in receptive language his understanding of the words "ball" and "throw" in Strand 2-1, as well as his ability to follow a direction in Strand 2-2. In addition, you could credit his expressive vocabulary with the word "ball" in Strand 2-3, as well as his ability to produce single consonant vowel combinations in Strand 2-6. The gross motor and social interaction skills of throwing a ball can also be credited in the Gross Motor and Social-Emotional domains. Thus, a single response is likely to elicit information on several skills in several strands.
  • Get a general idea of where to begin before you begin
    Family and other caregivers can provide an enormous amount of information about their child to give you a general idea of level of functioning in most areas of development. This information can be gathered from family interviews over the phone, in person, and through application questionnaires. In addition to family interviews, additional developmental information may be available from previous screenings or formal evaluations. Since many of the items on the HELP® are similar to items contained in various screening and evaluation tools, this information is likely to be useful in identifying were to begin with the HELP®.

Question from: [Top]
FAQs, Inside HELP® 1997
"Why are some age ranges on the HELP® Checklist, Charts and Activity Guide different than the age ranges in Inside HELP® and HELP® Strands?"

Author response:
The original HELP® products, the HELP® Activity Guide and the HELP® Charts were developed in Hawaii in 1976-1979 by Setsu Furuno and her multidisciplinary team. Since that time, infant/toddler research has expanded and more information has become available. Although most of the original HELP® skill wording and age ranges remain the same, some skills needed to be revised to reflect current literature. These changes were made on the HELP® Strands and in Inside HELP® in 1992, and on the HELP® Charts and HELP® Checklist in 1994, and the HELP® Activity Guide in late 1997. Check the © date on your copies to see if you have the latest versions. Order the latest version of HELP® materials online here.

Question from: [Top]
FAQs, Inside HELP® 1997
"Why are some HELP® skills repeated in different Strands?"

Author response:
Some skills are repeated in more than one Strand because these skills involve more than one underlying key concept. For example, skill 4.29 "Reaches and grasps object" is listed in the Cognitive strand 1-5 "Spatial Relationships" and in Fine Motor Strand 4-3 "Reach/Approach." This skill is built upon the cognitive concepts related to depth perception and relationship of objects in space, as well as fine motor skills required for reaching. The definitions and credit criteria, therefore, will differ somewhat between strands for the same skill when it is repeated in different strands.

Question from: [Top]
Developmental Specialist, EI program, Nevada
"I have a question about what I would be looking for in simple relational play for skill 5.35 "Engages in simple relational play". If a child puts a spoon in a cup and "stirs" it around, does that act alone count or do I need to determine if the child is or is not simply wanting to make noise as she might if she were using the toys in a more sensory type schema? She also put a lid on a jar and attempted to screw it on, and, put pegs in a peg-board. Our team is seeking clarification as we have differing opinions."

Author response:
I am responding to your question about clarifying the credit criteria for relational play, i.e., skill 5.35 "Engages in simple relational play", which is part of Strand 1-1 Development of Symbolic Play. I applaud your team's efforts in exploring this question to help guide your work with infants and families.

Since I did not personally evaluate this child and I do not know what variables (e.g., disabilities, setting, assessment materials used) and other information the evaluation team used to assess this child's play, I am not able to provide a definitive answer. With that understanding, I hope my responses can assist you and your team during discussions about what makes sense for this particular child.

As noted for Skill 5.35 "Engages in simple relational play", on page 26 in Inside HELP®, the credit criteria for this skill is that the child "combines two different but related objects in any relational manner several times during play". The qualifier "several times during play" was included to help ensure that relational play is part of the child's repertoire rather than an "accident". In addition, as noted by the qualifier "simple" in the skill title, and in the skill's definition and credit criteria, relating two objects need only be "a crude approximation", and, she does not have to actually perform the exact social action; e.g., when presented with several objects during play the child takes a doll hair-brush and puts it with a doll in some way, but doesn't have to actually brush the doll's hair.

The example you gave in your question, playing with a cup and a spoon, therefore does appear to be relational play behavior especially if several other things were available and the child seemed to purposefully select those two items to play with them in a meaningful related way, even if the "related" way was to make sound. The act of stirring a spoon in a cup would be significant and an example of relational play as well as the next skill in the Strand 1-1 which focuses on functional play, i.e., 1.59 "Demonstrates drinking from a cup". Your other examples such as putting a lid on a jar, and pegs in a board can also be examples of relational and functional play.

On the other hand, I can also understand wondering if perhaps the child was simply making the sound without regard that the two objects relate together - especially if there were no other observations of the child combining other objects in play. So that is really one of the keys to explore - does this child "try-out" putting two things together, to see what she can make happen, or was it simply an accident that two objects were involved and instead she was "banging" a single object at a lower sensory exploratory level.

As noted in the "Professional FYI" section for this Strand, different play schemes appear to develop in a rather sequential order but there is also much overlap between stages of play, and some play schemes continue while others are replaced by more mature interactions. It is thus more important to identify the variety of play interactions the child has in his repertoire, and to observe which ones seem to predominate current play, than to be concerned with specific age levels.

Team consensus and discussions will be important to guide decisions for each individual child. The following pages in Inside HELP® may be helpful during discussions regarding Strand 1-1 and relational play, i.e.:
p. 21 Professional FYI
p. 24 Assessment Procedures and Credit notes
p. 26 Skill definition, credit criteria

Determining Approximate Developmental Age Levels (DALs):

Important reminder to all HELP® users: HELP® was developed as a curriculum-based assessment process. It is not standardized and cannot yield exact developmental age levels or "scores". Any developmental age levels derived from the HELP® should be considered "approximate" and used to help support informed clinical opinion rather than used as a definitive "score", "age equivalent" or the sole criterion to determining eligibility. A guidance packet is also available for download here.

Question from: [Top]
HELP® Trainer from Illinois
"What do we do when a child has scatter...namely the child has two minuses, but you know that further into the strand the child may once again have two pluses?"

Author response:
Since HELP® is a curriculum-based assessment process, there are no absolute rules—we need to do what makes sense for this child in this situation. In this situation it probably makes sense to assess higher skills in the Strand. Since most skills in Strands, but not all, are listed in hierarchical order, if the child misses two in a row, but is observed to do higher skills, we need to question why. Perhaps, the skills recorded as "-" were credited incorrectly, e.g., maybe they should have been recorded "N/A" because the skill is not appropriate to assess, or, should not have a credit value (e.g., tantrums), or, the child has a disability and the item was not adapted for the disability. Or, maybe this is just the way it is for this child - so we'd need to use clinical judgment, not rules, to determine an approximate DAL.

Question from: [Top]
HELP® Trainer in Ohio
"I don't know how to record a delay for a child who does not have the first skill in a Strand which has an age range that falls within the child's chronological age (CA). For example, if the child is 20 months old and in Strand 3-7E. "Stairs", he cannot do the first skill 3.90 "Walks upstairs with one hand held" (17-19mo), what developmental age would you assign?"

Author response:
Strand 3-7E. "Stairs", is one of eight sub-stands under Strand 3-7, "Advancing Postural Control". These strands require an integration of skills from earlier Gross Motor Strands i.e., Strands 3-1 though 3-6 (see page 149 Inside HELP®). With that in mind, depending upon individual circumstances and clinical opinion, there could be three possibilities:
  1. If child's approximate DAL in gross motor is more than 12-15 months in the earlier aged Strands (3-1 through 3-6) and child is 20 months, that Strand could be recorded as "less than 19 months".
  2. If this child has not had experience, has never been exposed to stairs, or has a specific disability which precludes using steps at this time- this Strand should probably recorded as "N/A" with an explanatory note, and not be included in determining an approximate DAL.
  3. If the child's approximate DAL in earlier Gross Motor Strands (3-1 through 3-6) is less than 15 months it would be appropriate to record, "N/A".

Question from: [Top]
Program Manager, 0-3 Program, Virginia
"I have a question about Rule 1. listed on page 2 in Guidelines for Determining Approximate DALs from the HELP®® Strands which says to (with some exceptions) "Report the last age range with a "+" credit after two consecutive "+" credits followed by two "-" credits, unless the Strand ends before two "- " can be observed'.

Let's say the final + credit for a skill, (before two consecutive "-"s), in a Strand has a several month range, e.g., skill 3.47 "Pulls to Standing" in Strand 3-5 has an age range of 6 to 10 months. The child is 16 months. If you had to choose a specific month level for data collection and could not record a range, what would you choose?"

Author response:
If you are determining an approximate DAL for quantification and data collection purposes, as a program you may want to come up with a general program rule such as "the highest in the range", "the lowest in the range", or, the "median". This could provide consistent progress data across children, but remember that you should only report this for quantification purposes, and, this may not be a good reflection of an individual child. HELP® does not yield valid single age levels.

On the other hand, if you are trying to determine an approximate DAL for clinical purposes and are using HELP® to guide clinical opinion regarding a DAL for e.g., eligibility and planning, then the team may go through some "item analysis", and use "what makes sense for this child" dependent upon variables related to this child.

Bottom line: When trying to quantify a curriculum-based assessment, we need to rely on the team's clinical opinion and use the "rules" as guidelines to help guide or support it.

Question from: [Top]
Service Coordinator, New York
"What is the correct way to report a child's functioning in a domain such as Cognition, if for instance, the child is able to master skills within the 18-24 month range in most cognitive Strands, some skills between the 24-30 level, but only one skill at the 30-36 month level? I do not think we should report 30-36 month level?"

Author response:
Since I did not personally evaluate this child and I do not know what variables (e.g., cultural issues, medical history, experiences) and other information the evaluation team used to evaluate and determine approximate developmental age levels for this child, nor how you will be using this data, I am not able to provide you a definitive answer.

However, from the information you provided, I can understand your concern about reporting a 30-36 month level for cognition and I recommend further discussion with the evaluation team to help clarify your question. It may be more meaningful to say something like, "the child displays many cognitive skills and behaviors expected for her age" since reporting "30-36 months" might imply she is developmentally advanced. As you know, no child is expected to display all HELP® skills so not displaying some earlier skills can be okay if the child does not show a pattern of atypical skills or delays -- but again this is dependant upon the evaluator's informed clinical opinion for each child considering many variables.

Question from: [Top]
Kentucky Early childhood Data System Trainer, Human Development Institute, University of Kentucky

(Author note: this is a multipart question. For clarity, author responses are embedded within each part of the question).

"In working with providers and trainers in KY who are using the HELP®, several questions have come up about determining approximate DALs. I would like your input on these example situations:

Question, part 1: A child's chronological age is within the age range of items in a strand, but the child is not able to do any or only one of the items.
1. a. For example, a 30-month old child cannot do the first 3 items in 4.0 Fine Motor II, 4-6, D. Paper Activities. Should the DAL be reported as "No DAL" or maybe just a dash?

Author response: , 1a:
The approximate DAL for Strand 4-6D. could be either: "N/A", and use other Strands in Fine Motor to help support an approximate DAL, or, record "< 24 months" , depending upon clinical opinion about what makes sense for the individual child and situation.

Things to consider:
Strand 4-6 D Paper Activities, is one of four Fine Motor - Spatial Perception and Planning sub-Strands. Are the foundational skills in the FM domain, i.e., Strands 4-1 through 4-5 developed and integrated? If so, was the child able to demonstrate skills in other sub-stands within Strand 4-6 A. Pre-writing, B. Block construction, C. Formboard? If so, and up to his age level- then this provides important information about what may be going on , e.g., the child may have tactile issues, memory or planning issues, or, not had experience with paper. If so, the approximate DAL for this Strand should be considered as less than 24 months. On the other hand, if the child has not had experience with paper, or, not accomplished foundational fine motor skills in Strands 4-1 through 4-5, his approximate DAL could be determined using those Strands and Strand 4-6D could be marked N/A or blank (clinical notes will be important).

Question continued:
1. b. An 18-month-old child is credited with Item 1.72 under 1.0 Cognitive, 1-7, B. Size at the 12-15 month level (fitting cup or can into a larger one), but cannot do 1.70, 1.109, or 2.76. Is this enough to report any approximate DAL?

Author response:
Demonstrating only one skill in a Strand which is not the first skill in a Strand can be enough to report an approximate DAL for the Strand. In your example, because "nesting two cups'', if done thoughtfully, demonstrates a key skill supporting the underlying Strand concept, i.e., Size discrimination, this skill is probably enough. But again, clinical judgment, opinion, and item analysis, must to come into play. Was skill 1.70 "Shows understanding of size" not credited only because the child could not stack blocks? If so, this could be a fine motor issue, not a cognitive (size concept) issue. If you look at the definition for this skill in Inside HELP®, putting a small cup into a larger one would qualify the item to be credited with +, so perhaps he should not have been credited as "-".

Question continued:
1. c. What if the child can only do the first item in a strand? For example, a 14-month-old child is credited with 4.58 under 4.0 Fine Motor II, 4-6, B. Block Construction, but not 4.61 or 4.69. Should the approximate DAL be reported as 11 or 11-12 or no DAL be reported?

Author response:
It is probably appropriate to record "OK" for this Strand. Although this child cannot do skill 4.61 which can emerge anytime between 12-16 months, he is only 14 months and can accomplish the prior skill. See Rule 2 on "Guidelines for Determining Approximate Developmental Age Levels". But, again, your informed clinical opinion "rules".

Question continued:
2. In the following examples, should the assessor use clinical judgment (including any additional information gathered about these children) to determine the approximate DAL? Please suggest approximate DALs.
2. a. Credits are as follows for 2.0 Language-Expressive, 2-4B Communicating with Others, Verbally for an 18-month-old:
  2.21 +
  2.27 +
  2.35 N/A
  2.38 -
  2.44 +/-
  2.46 -
  2.49 +
  2.59 -
  2.72 -

Author response:
If you need to assign an approximate DAL for quantification/data collection purposes, with the information you have provided, it may be appropriate to consider anapproximate DAL of 14-15 months (higher than the 11-15 mo. for skill 2.27 because 2.44 is emerging). But...clinical judgment considering variables and item analysis will be key. At first glance the Strand findings could indicate a child who may be comparatively a little slow expressively, but okay (i.e. not eligible for Part C. based on this Strand). But, it is crucial to look at this Strand within context of other Language Strands and cultural/environmental/medical issues, e.g., is family English speaking, does child have any hearing concerns, prematurity?

It is equally important to consider the language concept that this Strand is built upon, i.e., "vocalizing to initiate, regulate, or maintain a reciprocal language interaction". I'd probably explore more with the evaluator, skills 2.44, "Uses voice in conjunction with pointing or gesturing" and 2.46 "Vocalizes wishes and needs at the table" to get a good understanding on how this child is "vocalizing to initiate, regulate, or maintain a reciprocal language interaction".

Question continued:
2. b. These credits are for a 14-month-old child for 2.0 Language-Receptive, 2-1, A. Objects, Events, and Relationships - should the assessor use clinical judgment (including any additional information gathered about these children) to determine the approximate DAL? Please suggest approximate DALs for:
  1.12 +
  2.16 +/-
  1.38 +/-
  1.48 +/-
  1.55 +
  2.26 +/-
  1.93 -
  1.92 -

Author response:
Since there are so many +/- (i.e. skill emerging) credits, item analysis and clinical opinion will play a major role. If there are no hearing or middle ear fluid issues and no concerns or gut feeling issues about this child's "conectiveness with the environment", then it may be appropriate to record "OK" for this strand. Skill 2.16 "Looks and responds to own name (5-7 mo.)", should be explored/monitored closely. If that skill was credited as "-" or"A" do not report "OK".It may also be important to double check hearing and make sure this child is not only responding to visual clues.

In summary, when determining approximate DALs, there is not a single "rule"/answer that applies to all infants in all situations except that clinical opinion "rules". The answer will be dependent on a number of variables that the team needs to consider such as:
  • Purpose for formulating an approximate DAL- e.g., for OSEP outcomes? To quantify progress? To help support Part C Eligibility? Or, to help identify strengths and needs within broader domains that will help determine appropriate intervention strategies and 'next steps' (original purpose of HELP® as a curriculum-based assessment tool),
  • Cultural, environmental, or disability issues that influence the relevance of a particular Strand to this child
  • The HELP® Strand involved (e.g. are there foundational Strands? Is the Strand inappropriate for formulating a DAL e.g., 0.0 )
  • What skills and behaviors are present, atypical or absent in other Strands within the Domain.

Question from: [Top]
Educator, Hearing Impaired Program, Illinois
"I see a lot of variation out there on how findings are reported from the HELP®. For example, the Self-Help Domain has 7 Strands within it. How do you get a single developmental age range for Self-Help when there are so many skills and age ranges involved?"

Author response:
Since some children will display varying strengths and needs within and between major developmental domains (e.g. Self-HELP®, Gross Motor, Language), the strand format can yield a profile of approximate developmental levels within and between domains. This helps us understand and develop more individualized intervention plans. Therefore:

1. Sometimes you should not report a single age range for a domain. In cases where there are significant performance differences between Strands within a domain, it is important to report these differences rather than report one broad age range for the entire domain.

Example 1: Important to report strengths and needs within Strands
HELP® Strand Profile Six month old- Gross Motor Domain
  3-1 Prone      0-2 months
  3-2 Supine     0-2 months
  3-3 Sitting     5-6 months
  3-4 Weight-bearing/Standing   5-6 months

In Example 1. this six-month-old displayed skills in the Prone and Supine Strand at approximately the 0-2 month level, and in the Sitting and Weight-Bearing Strand at approximately the 5-6 month level. For this child it is important to report these age level differences within the Gross Motor domain rather than reporting "scattered skills up to 6 months." This type of break-out, although appearing cumbersome at first glance, will provide the clinician with valuable interpretive and planning information that can save time in the long run.

2. In other cases, see example 2., you may not find significant age level differences between Strand within a domain. In these cases and based on "informed clinical opinion," you can report one approximate age range for the entire domain.

Example 2: Okay (but not necessary) to report single age range for domain
HELP® Strand Profile Six month old- Gross Motor Domain
  3-1 Prone      3-5 months
  3-2 Supine     4-5 months
  3-3 Sitting     4-5 months
  3-4 Weight-bearing/Standing   3-5 months

In example 2, there does not appear to be significant differences between Strands, and the clinician could report one age range for this domain, i.e., 3-5 months (or, if child is 5 months old, report "age appropriate").

Special Notes/Exceptions: In some cases it is more appropriate to report descriptions about a child's behaviors and development rather than reporting developmental age levels.

Examples when to report descriptions:
  • When a child displays persistent atypical or dysfunctional skills and behaviors that are not typical or appropriate at any age, e.g., pervasive repetitive behaviors, self destructive behavior, obligatory abnormal posturing. A description of these patterns is usually more appropriate than reporting levels.
  • Some areas of development may be inappropriate to assess due to a child's disability, e.g. "Picture Concepts" for a child who is blind, or "Advancing Postural Control and Motor Planning" skills for a child who is non-ambulatory
  • Section 0.0 - Regulatory/Sensory Organization focuses upon the child's self-regulation capacities and his capacities to perceive and organize various sensory experiences. The purpose of this area is to look for patterns of preferences, capacities, and difficulties related to Regulatory/Sensory Organization. It is not appropriate to assign specific age ranges in this area. Instead, child responses can be described as "Typical," "Over-reactive" or "Under-reactive."
  • A delay can be "normal" for a child with a specific disability when compared to a child who does not have a disability. For example, a delay in self-initiated mobility is normal for a child who is blind. The developmental ranges listed in HELP® are based upon children who do not have disabilities. Be sure to review 'Adaptations' for every strand in the preface sections of Inside HELP® when assessing and reporting for children with disabilities. Example: page 62 from Inside HELP®.
Final Note:
Although HELP® was not developed to yield a single score or "age equivalent", some programs and states wish to use methods to quantify HELP® into developmental age levels that will help support clinical opinion for eligibility, and/or help measure progress. Guidelines to help multidisciplinary teams in that quantification effort are available here.

Question from: [Top]
Infant Specialist, Minnesota 0-3 Program
"If I am assessing a child who is 25 months old and she cannot complete tasks for a given strand that begin below her age level (i.e. 11 or 18 months), how do I score that strand? (i.e. 4-6 B Block Construction begins at 11 months and she cannot complete the first task, how do I score it?). This is the case for a large number of Strands (i.e. in the area of Gross Motor she cannot complete any of the tasks in 3-7 A-H which begin bet. 13 and 22 months so I am unsure as to how I should score each of these items). (It may be helpful to note that she has a diagnosis of Down Syndrome)."

Author response:
In general, you do not need to assign an approximate developmental age level for a Strand when the child cannot complete any skills within that strand. In these cases you could record "N/A" for the Strand (after recording "-" at the individual skill levels). Use other Strands that are applicable for the child within that domain to support clinical opinion regarding the child's developmental age level for that domain.

Sometimes however, dependent upon the Strand and the individual child, it may be appropriate to report a "less than" age, e.g., in Strand 4-6B, "less than 12 months". Reporting "Less than 12 months" could be appropriate if the child demonstrated higher age level skills in other fine motor Strands because it helps us understand and pinpoint needs for intervention

Since HELP® is a curriculum-based assessment, the value of breaking domains into Strands is to look at the child's overall Strand Profile. If there are significant variations between Strands, that variation provides us with good diagnostic information as outlined in the Strand's Preface for the Strand, "Identifying and Interpreting Needs for Intervention", e.g., p.257 in Inside HELP® for 4-6B "Block Construction".

In the child you referred to, you noted she could not complete any of the block construction items. Thoughts to consider: Strand 4-6 B "Block Construction" is one of four "Fine Motor - Spatial Perception and Planning" sub-Strands - are the foundational skills in the FM domain, i.e., Strands 4-1 through 4-5, developed and integrated? If not, the foundational skills in those Strands will probably be the targets for intervention rather than stacking blocks. On the other hand, if the child did demonstrate higher foundational skills in Strands 4-1 through 4-5, and, was able to demonstrate skills in other sub-stands within 4-6, A. Pre-writing, C. Formboard, D. Paper Activities, then this provides us with a different set of important diagnostic information about what's going on related to fine motor planning and perceptual (see Inside HELP®, page 257)

This information also applies to other domains. Since the 25 mo. little girl you referred to is not yet displaying gross motor skills in Strands under 3-7 "Advancing Postural Skills", it is not appropriate to assign approximate developmental age levels for those Strands. Instead, focus on the gross motor Strands within Section. I, Birth to 15 months, which are the foundational motor skills to support Section II Gross Motor skills, "Advancing Postural Control" - see page 149 Inside HELP®.

Question from: [Top]
OTR/L Connecticut 0-3 Program
"How do you report the approximate DAL if a child gets 2 negatives on the very first two skills listed. For example, child is 24 months CA. On 1-7A matching and sorting, 1-7B size and 1-7C associative, the child received 2 negatives for the first 2 skills listed in each strand. Do you write DAL is less than 12 months for matching and sorting, etc?"

Author response:
Since HELP® was developed as a flexible curriculum-based assessment process, there is not a definitive "rule" that fits all children or all Strands. The team needs to consider several variables, (e.g., pertinence of Strand to child, disabilities, cultural issues, age of child, DALs of other Strands in the domain) and then use clinical opinion to report what makes sense for each child in each situation.

With that understanding, it is generally unnecessary to report an approximate developmental age level (DAL) for a Strand when a child does not display any skills or behaviors listed in the Strand, even though the Strand includes skills that can typically occur during that child's chronological age. Instead, you could record "N/A" and not consider that Strand when determining the broader domain's approximate DAL.

On the other hand, in some situations such as Strand 1-7 Discrimination/Classification, if the child who is 24 months demonstrates many age expected skills/behaviors in the other cognitive Strands, i.e. 1-1 through 1-6, then it would be meaningful to point out the pattern identified and record an approximate DAL of "less than 18 months" *. That is because the most important part of this process is to look at patterns of strengths and needs reflected by approximate DALs between Strands and Domains. This can assist us in understanding individual child and family needs, and identify the best interventions to help. So, in this example situation, if a child shows significant delays in Strand 1-7, more so than in other cognitive Strands, we'd want to look at the underlying Strand concept, in this case "Discrimination/Classification", to help figure out what's going on and how to best help. Review the Strand preface more closely in Inside HELP®, in this case page 75-76, to assist in the process.

*Note: "less than 18 months" was suggested rather than "12 months" because skill 1.70 in Strand 1-7A. typically emerges anytime between 12-18 mo. Thus, it would probably be more appropriate to use 18 since 12 months could imply an inflated delay.

Adjusting for Prematurity:

Question from: [Top]
SLP, Arizona
"I used the HELP® Strands to assess an 11 1/2 month old child who was 11 weeks premature. Does the HELP® Strands use an adjusted age when determining skill level?"

Author response:
Yes, you can adjust for prematurity to assist in identifying and reporting approximate age levels. There is space on the cover of the HELP® Stands booklet to include prematurity assigned along with other identifying information. If you adjust for prematurity, be sure to note this on the HELP® Strands and any resulting records or reports for the child.

Clinically, although it is not specifically required by HELP®, adjusting a child's age for prematurity (i.e., subtracting the number of weeks/months prematurity of a child from the child's chronological age) can provide a better understanding of the child's development, strengths, and needs. If and how you adjust for prematurity will be dependent upon how you are using the HELP®, and, upon your individual program or state regulations. Some states or programs for example, recommend adjusting for prematurity up to 2 years chronological age (CA), if the child is more than 4 weeks premature when screening or evaluating for eligibility. As a child becomes older, this adjustment will be less significant for evaluation and programming. For example a 5 week prematurity adjustment for a two month old would be about a 50% adjustment of CA, whereas a 5 week adjustment for a 24 month old would be less than 5%.

Using the child in your question as an example, for an 11 1/2 month old who is 11 weeks premature, it would be appropriate to observe if this child is displaying HELP® skills and behaviors expected for children who are about 9 months old, being extra careful to observe quality as defined in Inside HELP® for relevant HELP® skills. Remember that the age range listed for skills and behaviors on the HELP® Strands is the range that the skill typically emerges according to the literature, and, that all HELP® Skills are not necessary for typical development. Thus if a HELP® skill is listed as 6-8 months and the child's adjusted age is 9 months, this child may not be delayed in that skill or area of development if the skill is not present. There is only a one-month difference between 8 months (upper age range when skill typically emerges) and child's adjusted age of 9 months.

Special note regarding prematurity and OSEP child outcome ratings: ECO has directed Part C programs and test developers not to use adjusted age to determine child outcome ratings. Therefore, prematurity adjustment does not occur on VORT's HELP® for OSEP online system.

Adapting for Disabilities:

Question from: [Top]
Educator, Texas
"What are the barriers/issues for administration of HELP® to students with visual impairments?"

Author response:
HELP® 0-3 is a flexible family centered, curriculum-based assessment (CBA) process that includes a variety of assessment and curriculum options such as Inside HELP® the administration and reference manual (0-3), HELP® Strands - a consumable booklet for recording assessment and progress notes, and HELP® at HOME - developmental hand-outs for families, each cross-referenced to the same HELP® skills/behaviors. The primary "barriers/issues" for using HELP® with infants who are visually impaired may be that HELP®, like most 0-3 CBA's, was not specifically developed for, or based upon, infants who are blind or visually impaired.

An important strength of HELP® is that although HELP® skills are based upon typical birth to three development, Inside HELP®, the administration manual does provide adaptations and considerations for specific disabilities, including visual impairment. Here is a sample, page 62 from Inside HELP® to illustrate these adaptations for Cognitive development, Strand 1-5 "Spatial relationships".

Question from: [Top]
Education Coordinator, Early Head Start, August, 2016
"How to find Assessment Adaptations for every Strand in Inside HELP®?"

Author response:
Every HELP® Strand has a preface section in Inside HELP®. Each preface include information that applies to all skills in the Strand, e.g., Family Friendly Definition of the Strand, Parent Questions, Assessment of environment/interactions, and Assessment Adaptions.

For example, you can find Assessment Adaptions for Strand 4-3 Reach/Approach in the preface section for that strand on page 233 in Inside HELP®. Look for the universal handicap logo!

Assessment Materials:

Question from: [Top]
Infant Program
"Is there is a listing of items that should be used in the evaluation?"

Author response:
I am responding to your question regarding the availability of materials list to use when using HELP® as a curriculum-based assessment. Since HELP® is not a standardized test, it does not require standardized materials. Instead, HELP® encourages the use of culturally relevant, meaningful materials available in natural environments. A "stand alone" materials list for HELP® is not currently available, however, suggested materials are embedded throughout Inside HELP®, the administration and reference manual for using HELP®.

Inside HELP® lists within each HELP® Strand preface, suggested materials and toys that are likely to elicit responses for assessment of skills. The materials listed are typically available in the child's natural environments and encourages families to suggest toys and other materials that are functional and meaningful to their child. For example, in the preface of Inside HELP® for Strand 1-1 Development of Symbolic Play, under the sub-heading Assessment Materials the following is listed:
  • Birth to approximately 1 year developmentally: Several easy-to-grasp toys that have different textures, sounds, and consistencies. Examples include: smooth plastic rattles; small blocks, some that have different pictures on the sides, such as alphabet blocks; soft textured squeak toy; crumpled piece of paper; dinner bell; plastic cup; toy cars; small doll.
  • Approximately 1 to 3 years: Objects that encourage combining objects in play: e.g., brush, doll bed and doll, stick and xylophone; blocks or spoon and cup or bowl; pegs and pegboard, toy person and car; telephone receiver and base of telephone;
  • Objects that encourage serial interactions and representational play; e.g., brush, two different cups, a few different-sized blocks, spoon, cloth, dowel, safe hand mirror, shoe box, doll with moveable parts, puppet, doctor's kit, housekeeping props (sponge, pans, tea set, small broom etc.).
Notes are also included throughout Inside HELP® that emphasizes the use of safe materials.  For example, in the introduction for the Fine Motor domain the following assessment materials safety note is included:
  • "Numerous fine motor activities involve manipulation or handling of small objects by the child. Be sure that all items are large enough to prevent the child from choking—locks should be at least 1.25 inches in size—preferably even larger; beads not too small. Always use careful supervision, and provide guidance to the caregiver. "Inch cubes" refer to cubes that are at least 1.25 inches on each side."
Notes are also included in the Strand Preface (under Assessment Adaptations) to adapt  assessment materials to accommodate specific disabilities. For example if the child is visually impaired the use of toys and objects that are reflective and/or have high color and texture contrast is suggested.

HELP® Background/Research/Use:

HELP® 0-3 Research Summaries
HELP® 0-3 Evidence-based Practices
HELP® 0-3 Interrater Reliability

Question from: [Top]
Graduate student, University of Texas
"Can you please give me some background information on the theory behind the assessment?"

Author response:
The HELP® process is based upon an integrative theoretical model that brings together the most effective assessment and intervention techniques from a variety of theoretical approaches: behavioral, cognitive, constructivist, ecological, developmental, transactional, dynamic and relationship-based models of practice. The HELP® 0-3 process was developed and continues to be updated according to evidenced based practices using the best available research with interdisciplinary knowledge, and, experiences and values of professionals and families.

Question from: [Top]
Student, UCLA
"I have used the HELP® for a several years while doing assessment for prospective early intervention consumers, and became interested in using it to do research on the possible causes of certain developmental delays. My questions have to do with HELP®'s initial development. Do you have the normative data, e.g., how many children were in the study and description of the sample population, etc."

Author response:
I am responding to your request for normative information regarding the age levels assigned for each of the HELP® skills. I was not part of the original team from Hawaii who developed the HELP® Activity Guide and HELP® Charts, including field-testing by numerous programs for infants and toddlers with disabilities where the materials were used and reviewed by programs in 35 states and 7 different countries for additional feedback. I became involved with HELP® in the early 80's and developed various complementary materials, i.e., Inside HELP®, HELP® Strands, HELP® at Home.

The age ranges, skills and behaviors, criterion referencing, example observation opportunities, and developmental activities in HELP® are based upon expert review and review of the literature, as well as normative data from existing standardized tests. These resources are listed in the "References" section of Inside HELP®, Administration and Reference Manuel. Since the HELP® skills and their respective age ranges are based on other developmental and standardized tests, there are no demographic "norms" specific to HELP®. HELP® was instead developed as a curriculum-based assessment process.

Question from: [Top]
Music Therapist, Florida State University
"I am looking for research that has been conducted using the Hawaii Early Learning Profile to establish the tool's validity. Can you offer any guidance on where to look for published articles?"

Author response:
Please see this page for the latest research.
HELP® is a family-centered, comprehensive, ongoing curriculum-based assessment process - not a single instrument. It is not intended to be used for diagnosis, and, it is not a norm-referenced, standardized test. As such, we are not aware of specific validity research.

HELP® is however intended to identify family and infant strengths and needs, assist in determining "next steps" for intervention and support, provide individualized family-centered information and support, and, to monitor progress. The age ranges, skills and behaviors, criterion referencing, example observation opportunities, and developmental activities are based upon expert review and review of the literature, as well as normative data from existing standardized tests. These resources are listed in the "References" section of Inside HELP®, Administration and Reference Manual.

There is also an expanding evidence base related to the benefits of using "curriculum-based Assessments" in general, as well as the benefits of delivering family-centered services. For example: Neisworth, J.T. & Bagnato, S. J. "The MisMeasure of Young Children: the Authentic Assessment Alternative". Infants and Young Children, 17( 3):198-212, 2004. Additional journal articles that address importance of family involvement and have included using HELP® in their studies include:
1. Mary Pat Moeller, M.P. "Early Intervention and Language Development in Children Who Are Deaf and Hard of Hearing" Pediatrics, Sep 2000; 106: 43.
2. Coplan, J. Jawad, A.F., "Modeling Clinical Outcomes of Children with Autistic Spectrum Disorders. Pediatrics 2005:116;117-122
3. Belcher, H., Butz, A. M., Wallace, P. et. al. "Spectrum of Early Intervention Services for Children With Intrauterine Drug Exposure." Infants & Young Children. 18(1):2-15, 2005.

Question from: [Top]
Early Head Start Program Director
"We are an Early Head Start program applying for expansion funding. The new Head Start Act requires programs to use curricula "based on scientifically valid research. We have been using HELP® since the inception of our Early Head Start program in 2000, and plan to name it as our curriculum on choice in our grant application. Is there a description such as mentioned that you can provide to us?"

Author response:
Please see this page for the latest research.
As you know, HELP® is a family-centered, comprehensive, ongoing curriculum-based assessment and intervention process. It includes various components that are flexible to use with a range of infants and families (including at-risk or mildly delayed infants and toddlers) in everyday natural settings.

HELP® 0-3 has been reported to be the most frequently used curriculum assessment among Part C programs, is listed as a "Child Development Instrument" under the Early Start Program Performance measures and, is listed in "Resources for Measuring services and outcomes in Head Start Programs serving Infants and toddlers" as one of the measures used in the National Early Head Start Research and Evaluation Project.

Face and content validity background for the development of the HELP® 0-3 process is detailed in Inside HELP®'s Introduction : History of HELP® and Development of Inside HELP® sections available online here.

However, because HELP® 0-3 is a family-centered, ongoing curriculum-based assessment and intervention process and not a single instrument, it is not intended to be used for diagnosis, and, is not a standardized test that has been researched as such.

The HELP® process was however, developed and continues to be updated, according to evidenced based practices using the best available research with interdisciplinary knowledge, experiences and values of professionals and families. There is an expanding evidence base related to the benefits of using authentic and "curriculum-based Assessments" and the importance of using evidence-based practices. For example: Neisworth, J.T. & Bagnato, S. J. "The MisMeasure of Young Children: the Authentic Assessment Alternative". Infants and Young Children, 17( 3):198-212, 2004.

The following are examples of how the HELP® 0-3 process embraces and reflects the seven key evidenced based practices for providing early intervention services in natural environments outlined by the Workgroup on Principles and Practices in Natural Environments (November, 2007).

Principle 1. Supporting sensitive parent-infant interactions and relationships. Examples of how HELP® does this:
• Inside HELP® includes guidelines for assessing supportive parent-infant interactions, and guidelines for understanding and interpreting the child's skills and behaviors within the context of caregiving relationships and environments.
• HELP® at Home is written from child's point of view--each hand-out provides empathetic statements and information from the baby's point of view, and helps 'reframe' challenging behaviors.

Principle 2. Supporting safe environments. Examples of how HELP® does this:
• HELP® at Home includes safety alerts when applicable on hand-outs related to the activities and materials suggested in the handout, and, includes specific hand-outs for "Keeping me safe at home"--based upon the Consumer Product Safety commission guidelines)
• Inside HELP® recommends using only safe materials during the assessment process, and, highlights opportunities to inform families about keeping their baby safe.

Principle 3. Providing assessment and interventions in the real world of everyday experiences and interactions with familiar people in familiar contexts. Examples of how HELP® does this:
• Inside HELP® has "observation opportunities" rather than strict assessment guidelines for each HELP® Skill;
• Inside HELP® includes Sample Functional Outcome Statements in the Preface for each Strand.
• HELP® at Home has activities that are tied to everyday routines such as mealtimes, play, and diapering.
• HELP® Family-Centered Interview: Provides interview questions that center around everyday meaningful activities (such as mealtimes, playtimes, sleeping), to help families identify concerns, priorities and resources.

Principle 4. Encouraging and supporting parents in decision-making at every step of the EI process. Inside HELP®, HELP® at Home, and the HELP® Family-Centered Interview provides families with clear, jargon-free information to help them make informed decisions, e.g.,
•  Inside HELP® provides guidelines for encouraging and supporting parents through every step of the assessment process in the "Instructions-General Guidelines and Precautions" section. • "Family-Friendly Interpretations of the Strand Concept, Assessment and Purpose" are included in the preface for each Strand in Inside HELP®
• HELP® at Home gives a clear explanation on each page describing what baby is "learning" and why it is important. Suggestions are also included for supporting each family's role in the assessment process in Inside HELP®'s instructions, "Conducting the Assessment"
• User instructions in HELP® at Home provide guidelines for using and selecting hand-outs to support family's preferences.

Principle 5. Including information and activities that are based upon research, and, integrated with expert opinion, experiences and professional wisdom about what makes sense.
• All HELP® at Home activities and Inside HELP® assessment information are based upon research and an integration of interdisciplinary experts' experience. E.g. sleep positions based upon American Academy of Pediatrics; how to respond to "crying" based on various reported research in journals and child development literature, encouraging motor development through dynamic approaches according to research findings in OT/PT journals, social-emotional behavioral interventions for challenging behaviors in accordance with http://challengingbehavior.org/do/resources/tacsei_resources_all.htm
• In addition, the way the activities are presented in HELP® at Home, (e.g., from child's point of view, emphasis on parent child interactions, suggesting activities rather than prescribing definitive 'treatments') reflect available evidence about how parents learn best.

Principle 6. It is important to assess and address the "quality" of the child's skills and behaviors, not just skills and behaviors.
• Inside HELP® provides clear definitions and examples of quality concerns to observe for individual HELP® skills and strands
• HELP® at Home hand-outs include applicable information to families and "when to seek more help".

In summary, HELP® follows and supports evidenced based practices but is not intended to provide standardized evaluation or diagnosis. HELP® should be considered a complement and supplement to a full range of resources and supports.


Question from: [Top]
multi-state HELP® trainer
"What is the definition of atypical development?"

Author response:
In the HELP®, "Atypical" refers to skills and behaviors that are "dysfunctional", "unusual", "disordered" or of "of poor quality". Inside HELP® provides specific definitions of "atypical" for individual skills in the Strand preface, and/or, "Credit criteria" section for each skill. Condensed definitions of "A" are also listed on the HELP® Strands. Skills/behaviors that are considered "atypical" should be record as "A" in the HELP® Strands Assessment booklet to document and provide important assessment and intervention information.

Question from: [Top]
Infant Specialist, California
"What would be the most descriptive, concise definition of "curriculum-based" as the adjective for the HELP® as an assessment tool? This term is all over the VORT website and in the books but it is not defined anywhere that I can see."

Author response:
In general, a curriculum-based assessment is the process of gathering information in order to plan individualized programs of intervention based upon those findings. Items listed on the curriculum-based assessment tool are available for possible targets for intervention.

HELP® provides a comprehensive, family centered frame-work for gathering information about the child's developmental skills and behaviors, the family's concerns, priorities, and resources, and, the environmental to develop individualized services and interventions. Examples of using HELP® skills to translate 'functional outcome statements' are listed in the Preface section for each Strand in Inside HELP®. Click here to see an outline of HELP®'s family-centered curriculum-based assessment process.

HELP® at Home:

Question from: [Top]
RN, MPH: Local Health Department, Oregon
"Can you tell more about the target audience that HELP® at Home was designed for? What is the reading level and what methods were used to determine reading level? Was there a focus group review?"

Author response:
HELP® at Home is a family centered, birth-to-three curriculum that is part of the broader HELP® 0-3 curriculum-based assessment process. It is a comprehensive collection of reproducible handouts for professionals and early intervention programs to individualize and distribute to the families of children who are developmentally birth to three years.

Target Population
Professionals: HELP® at Home can be used by any one who is involved in supporting families with young children, e.g., early childhood educators, assistant teachers/aides, speech pathologists, physical therapists, occupational therapists, nurses, counselors, physicians, and psychologists.

Families: Although professionals are the initial user/point of contact for HELP® at Home, the end target for handouts are families who have children, developmentally birth to three years, who may or may not be delayed, disabled, or at risk for developmental delays. HELP® at Home hand-outs should be distributed according to each family's preference for receiving information, e.g., families who express an interest in having print resource materials; who are interested in having developmental information and ideas to help their child at home.

Interdisciplinary training: Although HELP® at Home was developed for families as the primary end user, professionals have found them helpful to in learn about all areas of development, beyond their area of specialty.

Reading Level
The reading level of HELP® at Home handouts range from 5th to 7th+ grade level, as measured through Microsoft Word's Flesch-Kincaid Grade Level score.

The design and development of HELP® at Home reflects family support/ training literature, multidisciplinary expert review, and individual and group meeting feedback with families whose infants with special needs were enrolled in the Prince William County Parent-Infant Education Program in northern Virginia where I worked as program coordinator for 10 years.

Question from: [Top]
Developmental Therapist, Illinois
"I am new to HELP® and have one of the 1998 editions of HELP® at Home. I am just getting started and do not have a lot of funds to spend. Is there enough difference in the 1998 edition to the current edition to make it worth spending the extra funds, or could I use the older edition and use the money saved to purchase one of the other HELP® materials? How much difference is there between the older and newer edition?"

Author response:
The new (2nd) edition of HELP® at Home has updates and has been redesigned and updated in the following important ways:

1) New information and updated research in the field of early intervention, family support, and infant/toddler development has been added. These additions and changes include research on infant development, new safety guidelines, new toys, changes in terminology, and changes in technique when applicable. They are reflected in new and existing appendices, illustrations, and, on most handouts under the new subtitles:
•At this stage...
•Ideas to HELP®
•/!\ Safety Check

2) Handouts are more closely aligned with the HELP® Strands and Inside HELP®. The first edition of HELP® at Home was written prior to the development of the HELP® Strands and Inside HELP®. These two products include updated information and changes to the original HELP® Activity Guide (1983), such as age range for some skills, skill description, and skill placement in a strand format. HELP® at Home 2nd Edition reflects those changes, and is now more consistent with the HELP® Strands and Inside HELP®. These changes are reflected in the introductory behavior descriptions under, "At this stage...", and in the headers regarding age range and prerequisites.

3) Handouts are formatted to be more 'user-friendly' for the professional. Cross-referencing information is available in the lower right margin rather than the 'header' of each handout and is less obtrusive when copied. In the first edition, the handout needed to be repositioned on a copier to 'cut-off' the header. This is no longer necessary. In addition to skill ID numbers, the titles of "see also" handouts are now included with ID numbers for more meaningful cross-referencing.

4) Handouts have more emphasis on supporting the family's vital role as the 'expert' and decision maker, and, better addresses the realities of everyday stresses and busy schedules. Changes include adding empathetic statements, information to 'reframe' the child's behavior, information that shows how their interactions can make a difference during everyday routines, omitting activities which are unrealistic in a home setting, and, new wording to provide 'ideas' as options they can choose from rather than a list of prescriptive 'activities'.

If you have limited funds, provide services to the Part C population, and do not have other HELP® materials, I recommend putting funds toward, Inside HELP® and the HELP® Strands. They are integral toward understanding how to best use HELP®, understand the child's needs, and plan appropriate interventions for the child within the context of his family and everyday environment.

Using HELP® for OSEP Reporting:

Question from: [Top]
"Can HELP® be used to monitor progress for OSEP's child outcomes?"

Author response:
Yes. Forms and procedures are available on VORT's website to measure and monitor progress for OSEP's Part C, Child Outcome Statements. This system uses ECO's HELP® Crosswalk, supports COSF, and builds upon ECO's 7 point rating system.

Question (3-part) from:
0-3 Program Director, 2008
"I am attempting to calculate outcomes manually from the HELP® for OSEP Reporting System worksheets and have a few questions:

1. When determining an ECO value for an outcome rating, if a child's DAL is close to, but not at or above, the chronological age, how is it recorded? For example, if the CA is 20 and the DAL is 19, is the child given "partial credit" for attainment of the strand or none?

Author response, part 1:
Yes, if the child's DAL is close to (e.g. within 25%) his CA he'd probably receive and ECO rating as 6 or 7. In your example, the 7 rating would be appropriate as long as no one on the team has any concerns.

Question, part 2:

2. "Are weighting factors applied to any of the strands?"

Author response, part 2:
Yes there is some weighting of Strands depending upon the Outcome statement and Strand. This weighting is computed automatically if you enter the child's worksheets on the online system.

Question, part 3:

"I am attempting to calculate outcomes manually from the HELP® for OSEP Reporting System worksheets and have a few questions:
3. "If a DAL is given for a strand and "A" is marked also (due to atypical behavior), how is the ECO rating for the strand affected?"

Author response, part 3:
It depends upon how many Strands are reported as "A". One or two could lower the rating one point lower than if the "A" was not present. If several of the strands have "A", the outcome rating could be lowered by more points. The online system, can compute that for you.

Question from: [Top]
muti-state HELP® Trainer
"When using the HELP® for OSEP instructions there seems to be conflicting directions as to when to use the circle. I always say that it should be used when there is concern about the caregiver, compromising the environment, or when the caregiver asks for more information."

Author response:
That is correct at the individual SKILL level. But...because ECO's rating changes from a 7 to a 6 if child is okay but there is a concern, on the HELP® for OSEP Worksheets at the STRAND Level I had to add an additional instruction that only applies to those who are working on ECO ratings, i.e., if the child's DAL are ok but there are concerns, then circle the Strand (in contrast to circling a individual skill). During field testing of the HELP® for OSEP worksheets, I noticed, especially in the younger children (1-4 months) that they may have had a medical diagnosis, e.g., Down Syndrome, and their DALS were fine so they got rated 7 when everyone did have concerns. So this instruction was added to solve the problem with the Circling of the Strand. If the OK strand rating is circled, the ECO rating would be lowered from a 7 to 6. The HELP® for OSEP online system does this.

Question from: [Top]
0-3 Program Director, Virginia
"We have just started filling out the OSEP Outcome forms. We are crunching our way through it and we have color coded the HELP® to clue us in until we memorize it. I saw the Color-coded HELP® Strand Profile crosswalk on the VORT website after I did it by hand for the first several assessment packets we prepare in advance! Glad you have it posted.

Today at staff meeting the observation was made that no communication items from the HELP® Strands were included in Outcome 3: "Takes appropriate action to meet needs". I saw that the ECO crosswalks for the E-LAP, Battelle, and Carolina included language items for this Outcome. Was there a reason that HELP® Strands 2-4 A & B were not included for Outcome 3?"

Author response:
Your team made an important observation. I reported the HELP® Crosswalk outcome 3 inconsistency to the ECO team when they initially posted it, and will forward your concern on to them as well. Hopefully since there are many other Strands to support Outcome 3, this will not be a statistically significant difference when compared to other tools. Please keep the issue in mind however as your team confirms an ECO rating for Outcome 3. I am glad you found the color-coded Strand Profile available for download on the VORT website. It can save a lot of time.

Sample HELP® Developmental Report:

Question from: [Top]
Clinical Psychologist, Early Head Start Program, Los Angeles
"Do you have any sample reports from HELP® 0-3 that I may be able to view as I am somewhat unclear as to how to use all the materials and present it in a report format?"

Author response:
I have attached a sample developmental report for "Katy" who was assessed by a multidisciplinary team using HELP® Strands and Inside HELP®. It was drawn from one of the programs I directed several years ago and identifying information has been changed to ensure confidentiality of the child and family. I am also attaching Katy's HELP® Strand profile. As you may know, HELP® was developed as a curriculum based assessment tool rather than a standardized "test". The following link on the VORT website will also be helpful to you:
Guidelines for Determining Approximate DALs