Routines-Based Interview Checklist - Mount Sinai Hospital

Early InterventionTraining Centerfor Infants and Toddlers WithVisual ImpairmentsModule:Family-Centered Practicesfor Infants and Toddlers With Visual ImpairmentsSession 4: Eligibility and Routines-BasedAssessmentHandout ARoutines-Based Interview ChecklistProject INTEGRATE. (2001). Routines-based interview checklist. Chapel Hill, NC:Project INTEGRATE, Frank Porter Graham Child Development Institute, UNC–CH.Name: ______________________________ Date: _____________________________Did the interviewer1. Prepare the caregivers (i.e., parents, teachers, and other care providers) tothink about their routines?2. Attempt to schedule family members and any other important caregivers to bepresent for the interview?3. Place the parent who is likely to answer most of the questions at 90 degreesto the interviewer?4. Tell the family the purpose of the meeting and how long it will take? Yes No5. Ask family members if they have any main concerns? Yes NoFamily Routines6. Tell the family that the conversation will concentrate on daily routines? Yes No7. Ask the family how the day begins? Yes No8. Ask the family to set the agenda by following the family’s routine (i.e., “What Yes Nohappens next?”)?9. Ask what the family does for each routine? Yes No10. Ask what the child does for each routine? Yes No11. Ask family members how satisfied they are with this routine (i.e., “Is thereanything you would like to change about this time of the day?”)?YesYesYesYesNoNoNoNoFCP Module 9/22/04Session 4 Handout AEIVI-FPG Child Development Institute Page 1 of 2UNC-CH

Early InterventionTraining Centerfor Infants and Toddlers WithVisual Impairments12. Ask questions to determine the child’s social relationships during each Yes Noroutine?13. Ask questions to determine the child’s engagement during each routine? Yes No14. Ask questions to determine the child’s independence during each routine? Yes NoClassroom Routines(To be completed if child spends at least 15 hours/week in a classroomprogram)15. Ask what the class does during each routine? Yes No16. Ask what the child does during each routine? Yes No17. Ask the teacher how satisfied she is with this routine (i.e., “Is there anythingyou would like to change about this time of the day?”)?18. Ask questions to determine the child’s social relationships during each Yes Noroutine?19. Ask questions to determine the child’s engagement during each routine? Yes No20. Ask questions to determine the child’s independence during each routine? Yes NoGeneral21. Prompt to get enough information? Yes No22. Move on when appropriate? Yes No23. Focus on the parents’ routines as well as the child’s? Yes No24. Respond with appropriate sensitivity? Yes No25. Reassure and react positively to both the child and the parent? Yes No26. Maintain a conversational, friendly, interested tone? Yes No27. Avoid judgment about routines and child/family functioning? Yes No28. Avoid giving advice? Yes NoYesNoFCP Module 9/22/04Session 4 Handout AEIVI-FPG Child Development Institute Page 2 of 2UNC-CH