Excerpt is Chapter 1 of Manual for the Infant-Toddler and Family Instrument (ITFI), by Nancy H. Apfel, Ed.M., & Sally Provence, M.D.

Copyright © 2001 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Across the United States and abroad, many policy initiatives are directed at ensuring all children a healthy start in life and an opportunity to develop their full potential. Many of these initiatives focus on providing support to young children and their families through home visits and early intervention programs. The importance of programs in facilitating the development of children during their earliest years is being recognized more and more.

The initial task of such programs is to determine whether families and children need services and if so, which services are needed. It is not easy to do such evaluations well. Many programs depend on workers who have experience with families but are not necessarily trained in child development, medicine, counseling, or social work. The term for many family and child workers without such specific professional training is paraprofessional. These family workers are often the ones making key decisions about services for families, including whether there is a need for referral for a more extensive and costly professional evaluation. These workers could use a tool to help them to collect information, organize their impressions, and make reasoned decisions. Even those who have professional training may find such evaluations difficult because their training is in one area of expertise and not necessarily in the multiple domains of child development and family life.

Many instruments are available to assess child development, but these typically require advanced professional training to use. There are also measures of caregiver-child interaction and the quality of the home environment, but these also typically assume that the practitioner has advanced professional training. Other measures of family life may offer guidelines of topics that should be covered in a parent or caregiver interview, but they do not specifically show how to conduct such an interview effectively to gather this information.

To our knowledge, few comprehensive and accessible instruments are designed specifically for family practitioners, including paraprofessionals, with varying levels of training. By comprehensive and accessible, we mean an instrument that brings together, in an easy-to-follow format, elements that help in making a judgment about whether a child and family need further services and referrals. The necessary components of such an instrument include ways to conduct a comprehensive caregiver interview, screen for developmental issues that a child may have, and organize collected information. It would assist in decision making about how well the child and the family are doing and about whether specific aspects of caregiver and child behavior and the home environment are worthy of concern. To fill this need, we have designed the Infant-Toddler and Family Instrument (ITFI).

The ITFI is a relatively short survey of family and child functioning that can be used by family services, child care, and health care providers. It was designed with home visitors in mind but can be used by other individuals in different environments, such as by a child care worker in a child care center or by a nurse, a doctor, a psychologist, or another professional in a medical, community service, or mental health center. Such family services providers can use the ITFI in developing a collaborative plan with caregivers on how to serve the children and their families. In addition, when service providers are called on to determine whether a family or a child needs further in-depth evaluation by a doctor, psychologist, or other professional, this instrument can be helpful in making such a decision.

It is expected that this instrument will supplement other services provided by the agency or individual, increasing the scope of services. To clarify, once the ITFI is completed, the practitioner has a summary of the family's strengths and vulnerabilities, specific child symptoms and stressors, and how well the caregivers are meeting their child's basic needs. With information organized in such a way, the types of services that the family and child may need are clearer. The agency is then better able to collaborate with the family to construct a plan to meet its needs.

It would be unusual for one agency or individual to be able to provide all the services that a typical family at risk might require. For example, a family may need help connecting with a women and children's crisis center, a child psychologist, a pediatrician, a city housing authority, and a community legal aid office. In working with families to develop support plans, an agency could help families look for services already in existence in the community to supplement the agency's own services. Building such connections could enhance the services of a particular agency while also avoiding duplication of services. The ITFI could also inspire the development of new services in an agency, such as support groups or workshops for individuals with specific needs, such as teenage mothers or grandparents raising grandchildren.

The ITFI is not intended to be a definitive measure of whether a child or family should receive services or further evaluation but rather to be a tool to organize the service provider's impressions of family and child needs.

There are four sections to the ITFI:

1. The Caregiver Interview, divided into three parts — Home and Family Life, Child Health and Safety, and Family Issues and Concerns — to be given in one or more sessions with the parent(s) or primary caregiver(s)
   
   
2. The Developmental Map, a series of observations of spontaneous and elicited behavior of the infant-toddler in four domains — Gross and Fine Motor Development, Social and Emotional Development, Language Development, and Coping and Self-Help Development — plus a Summary Sheet
   
   
3. The Checklist for Evaluating Concern, divided into three parts — Home and Family Environment; Child Health, Development, and Safety; and Stressors in the Child's Life — that permit the interviewer to organize his or her impressions and concerns about the family and the child, plus a Summary Sheet
   
   
4. The Plan for the Child and Family, next steps to be taken, if necessary
   
   

Several preparation sessions are strongly recommended as orientation and instruction for the appropriate use of the ITFI.