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Consider the following variables prior to making referrals for a mental health evaluation. Children begin, PLAY STIMULATION CASE STUDY AIMS Play stimulation work contributes towards the following 2003-2006 PSA targets: Improving social and emotional development, and Improving learning. Does your child let you know how she is feeling with gestures or words? Summary sheets can be printed easily by clicking on the appropriate bookmark, selecting Print, and typing in the corresponding page number. When you point at something, does your child look in the direction you are pointing? If all questions have been answered, go to Step 2. What did they say? hb```f` l@QM1_g.ww~0[(3cCMK'9FE7x0Yp4xurT\owg~\wN.?g+,w|^:MR6WV4wQ'5My%61Mgy[-&N5*XrpRh%@Y~+j'&kj^Q \3`j>g\*>:>Y,TCC:@ $P Q(((llJi.a`HbH(?YzBbL{&3t00$aaC4&@eX@s0z0McA!1**S*K2)031J3e~a&c=VFCV,?b6aT}fA!JBric2`(glg`d:`>:Fa0R(&C@0B 8kc`u8yH;0N pm Does your child hurt herself on purpose? 2. Objective The student will read high frequency words. 0000020164 00000 n Z V X TOTAL POINTS ON PAGE Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H. Brookes Publishing Co months/3 years, 42 MOST OF THE TIME RARELY OR NEVER CHECK IF THIS IS A CONCERN SOMETIMES 18. Does your baby let you know when she is hungry or sick? Problems with food are fairly common try not to panic. 0000132793 00000 n 1, 18 Ages & Stages Questionnaires : Social-Emotional A Parent-Completed, Child-Monitoring System for Social-Emotional Behaviors By Jane Squires, Diane Bricker, & Elizabeth Twombly with assistance from Suzanne Yockelson, Maura Schoen Davis, & Younghee Kim Copyright 2002 by Paul H. Brookes Publishing Co. 18 Month ASQ:SE Questionnaire (For children ages 15 through 20 months) Please provide the following information. Z V X 20. I do, and her name is Lucy. 0000010423 00000 n Z V X 21. Questionnaire interval 12 months/1 year Cutoff score 48 Child s ASQ:SE score 3. 0000010595 00000 n X V Z 26. Referral considerations It is always important to look at assessment information in the context of other factors influencing a child s life. trailer Make sure the parent has answered all questions and has checked the concern column as necessary. 0000005716 00000 n 1 Version 1.1 AGES & STAGES QUESTIONNAIRES : SOCIAL-EMOTIONAL A PARENT-COMPLETED, CHILD-MONITORING SYSTEM FOR SOCIAL-EMOTIONAL BEHAVIORS by Jane Squires, Ph.D. Diane Bricker, Ph.D. and Elizabeth Twombly, M.S. 0000019134 00000 n 0000006882 00000 n THE STORY FOR LITTLE ONES: Preschool LESSON GUIDE: Lesson 2 5 ABRAHAM FOLLOWS GOD Bible Basis: Genesis 12:1 9, 17; 21:1 7 Bible Verse: Abram believed the Lord. All parents review, Writing Our Journey: Poems and Essays by Family Caregivers Each meeting has a suggested prompt, or idea, for people to write about. Development factors (e.g., Is the child s behavior related to a developmental stage or a developmental delay?) Check the circle if this behavior is a concern MOST OF THE TIME SOMETIMES RARELY OR NEVER CHECK IF THIS IS A CONCERN 1. The 5 Love Languages Words of Affirmation Quality Time Receiving Gifts Acts of Service Physical Touch, Eyes on Aggressive behaviours. 0000135055 00000 n Z V X 18. Child s name: Child s date of birth: Today s date: Person filling out this questionnaire: What is your relationship to the child? 0000012661 00000 n Use black or blue ink only and print legibly when completing this, Parable of The Prodigal Son Teacher Pep Talk: Children need to know that they are loved unconditionally. X V Z 18. Use black or blue ink only and print legibly when completing this, Healthy Sleep Healthy Me What s Inside? You will find a brief questionnaire enclosed with this letter. Z V X 25. By 2 3 months, your baby s social smiles are signs that she knows who you are. Easy workouts for babies and toddlers RESPOND, Teaching Strategies GOLD Objectives for Development & Learning: Birth Through Kindergarten, Early. Does your baby stiffen and arch her back when picked up? Has anyone expressed concerns about your baby s behaviors? Does your baby get constipated or have diarrhea? 0000022402 00000 n Z V X TOTAL POINTS ON PAGE Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H. Brookes Publishing Co months/4 years. 0000005244 00000 n She called her friend, Purpose: To acquire language and the ability to communicate successfully with others The language development and communication domain involves the development of the ability to use language to communicate, Inspection report for early years provision Unique Reference Number EY300466 Inspection date 13 May 2005 Inspector Wendy Fitton Type of inspection Type of care Childcare Childminding ABOUT THIS INSPECTION, SPEECH AND LANGUAGE CASE HISTORY FORM Date Person filling out this questionnaire Relationship to child PLEASE ATTACH A RECENT PHOTO OF YOUR CHILD HERE IDENTIFYING INFORMATION Name of child Nickname Date, The Game The Relationship Game from LifeLearningToday.com Take turns asking and answering the questions below. When upset, can your child calm down within 15 minutes? X V Z 9. X V Z 23. 0000046317 00000 n X V Z 13. Z V X 8. For example, does he sit down when asked? If you checked sometimes or most of the time, please explain: X V Z 30. 3. Does your baby cry for long periods of time? Does your child cling to you more than you expect? Z V X 4. Whether you. What do you do to prepare? Does your child greet or say hello to familiar adults? Use black or blue ink only and print legibly when completing this form. One of activities James loves is to sit down on the. X V Z 22. Has anyone expressed concerns about your child s behaviors? If the child s score falls above the cutoff and the factors in Step 4 have been considered, refer the child for a mental health evaluation. 0000029892 00000 n Can your child settle himself down after periods of exciting activity? Does your child like to play near or be with family members and friends? You and I What will they do? Does your child look at you when you talk to him? There are no exact rules. 2. Review any parent comments. If not all questions have been answered, you should first try to contact the parent to obtain answers or, if necessary, calculate an average score (see pages 39 and 41 of The ASQ:SE User s Guide). If you have any questions or concerns about your child or about this questionnaire, please call:. If you have any questions or concerns about your child or about this questionnaire, please call:. Does your baby stiffen and arch her back when picked up? Extension of 1 st reason. Z V X TOTAL POINTS ON PAGE Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H. Brookes Publishing Co months, 35 MOST RARELY CHECK IF OF THE OR THIS IS A TIME SOMETIMES NEVER CONCERN 21. 13. X V Z 12. Childhood Indicators of Progress, Infant Development: The First Year of Life, AGES AND STAGES: BREASTFEEDING DURING YOUR BABY S FIRST YEAR, Behavior & Sensory Strategies for Individuals with ASD, It was late at night and Smartie the Penguin was WIDE awake He was supposed to be fast asleep but tomorrow was his birthday. Does your child seem more active than other children her age? If all questions have been answered, go to Step 2. Z V X 9. When you point at something, does your child look in the direction you are pointing? If there are no comments, go to Step 3. Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H. Brookes Publishing Co. 6 6 months, 10 Ages & Stages Questionnaires : Social-Emotional A Parent-Completed, Child-Monitoring System for Social-Emotional Behaviors By Jane Squires, Diane Bricker, & Elizabeth Twombly with assistance from Suzanne Yockelson, Maura Schoen Davis, & Younghee Kim Copyright 2002 by Paul H. Brookes Publishing Co. 12 Month/1 Year Questionnaire (For children ages 9 through 14 months) Important Points to Remember: Please return this questionnaire by. If not all questions have been answered, you should first try to contact the parent to obtain answers or, if necessary, calculate an average score (see pages 39 and 41 of The ASQ:SE User s Guide). 0000004844 00000 n Your telephone: Your mailing address: City: State: ZIP code: List people assisting in questionnaire completion: Administering program or provider: 2, 26 Please read each question carefully and 1. X V Z 27. Does your child do things over and over and can t seem to stop? Does your child look at you when you talk to him? Paul H. Brookes Publishing Co. Post Office Box Baltimore, Maryland Paul H. Brookes Publishing Co. is a registered trademark of Paul H. Brookes Publishing Co., Inc. Ages & Stages Questionnaires is a registered trademark and is a trademark of Paul H. Brookes Publishing Co., Inc. 2 About this CD-ROM This CD-ROM contains one PDF of the ASQ:SE questionnaires and summary sheets, which you are viewing now. Five to Thrive TALK PLAY CUDDLE RELAX. Z V X 8. Z V X 19. Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) TM Acknowledgement: We thank Joaquin Fuentes, M.D. Does your child seem more active than other children her age? If there are no comments, go to Step 3. Make sure the parent has answered all questions and has checked the concern column as necessary. Does your child look at you when you talk to him? Is your child interested in things around her, such as people, toys, and foods? X V Z 25. For example, does he let you know when he is hungry, hurt, or tired? 0000135682 00000 n Give special consideration to any individual questions that score 10 or 15 points and any written or verbal comments that the parent shares. Z V X 7. Animals Around Us. X V Z TOTAL POINTS ON PAGE Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H. Brookes Publishing Co months/2 years, 27 MOST RARELY CHECK IF OF THE OR THIS IS A TIME SOMETIMES NEVER CONCERN 10. Z V X 2. X V Z 22. Child s name: Child s date of birth: Today s date: Person filling out this questionnaire: What is your relationship to the child? Child s name: Child s date of birth: Today s date: Person filling out this questionnaire: What is your relationship to the child? Family/cultural factors (e.g., Is the child s behavior acceptable given cultural or family context?) Does your child like to hear stories and sing songs? Do you and your child enjoy mealtimes together? Use black or blue ink only and print legibly when completing this, Purpose: To approach the world with a sense of trust and emotional security The social and emotional domain includes the development of trust and emotional security, self-awareness, self-regulation and, INTRODUCTION THE NURSERY CLASS Purpose Letter to Parents The purpose of the nursery class is to help children learn the restored gospel of Jesus Christ and live it. Transfer child s total score In the table below, enter the child s total score (transfer total score from above). Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H. Brookes Publishing Co months/3 years, 45 36 Month/3 Year ASQ:SE Information Summary Child s name: Person filling out the ASQ:SE: Mailing address: Telephone: Today s date: Child s date of birth: Relationship to child: City: State: ZIP: Assisting in ASQ:SE completion: Administering program/provider: SCORING GUIDELINES 1. Does your child cling to you more than you expect? Your telephone: Your mailing address: City: State: ZIP code: List people assisting in questionnaire completion: Administering program or provider: 2, 6 Please read each question carefully and 1. Is your child interested in things around him, such as people, toys, and foods? 0000134898 00000 n Z V X 16. Did not ask according to instructions 2. Does your child cry, scream, or have tantrums for long periods of time? Offer guidance, support, and information to families, and refer if necessary, as indicated by score and referral considerations. Does your baby sleep at least 10 hours in a 24-hour period? The idea is to have fun mostly with just the conversation. Has anyone expressed concerns about your child s behaviors? What things do you enjoy most about your child? 0 If you checked sometimes or most of the time, please explain: X V Z 20. Health factors (e.g., Is the child s behavior related to health or biological factors?) Make sure the parent has answered all questions and has checked the concern column as necessary. Does your baby let you know when she is hungry, hurt, or tired? Cross Curriculum links: En1 3a-e; 4a, b, c En3 1b, 12 PSHCE 4a, c Learning Outcomes: What you need: Understand that there are different kinds of friendship Consider how we might, Patient Education Page 51 Caring for Yourself and Your New Baby Common Concerns About Breastfeeding Breastfeeding is healthy and natural. Questionnaire interval 30 months Cutoff score 57 Child s ASQ:SE score 3. In the Parable of the Prodigal Son, Jesus assures us that God will, Sample Issue ~ Late for School Again Sunshine Center s Parent Handbook clearly outlines the center s policy that parents must have their children to the center by 9am at the latest. 2. Z V X 28. (You may write in something else.) Activity Based Approach, 111 Book review by Onur zdemir 1 An Activity Based Approach to Developing Young Children s Social Emotional Competence Jane Squires & Diane Bricker Paul H. Brookes Publishing, I Miss My Pet. Z V X 25. Offer guidance, support, and information to families, and refer if necessary, as indicated by score and referral considerations. Give special consideration to any individual questions that score 10 or 15 points and any written or verbal comments that the parent shares. X V Z (You may write in another problem.) (You may write in another problem.) 0000009558 00000 n Does your child seem too friendly with strangers? Offer guidance, support, and information to families, and refer if necessary, as indicated by score and referral considerations. If all questions have been answered, go to Step 2. Health factors (e.g., Is the child s behavior related to health or biological factors?) Is your baby interested in things around her, such as people, toys, and foods? 0000008032 00000 n 6 What Can You Do To Help? X V Z TOTAL POINTS ON PAGE Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H. Brookes Publishing Co months/2 years, 29 MOST RARELY CHECK IF OF THE OR THIS IS A TIME SOMETIMES NEVER CONCERN 26. Female Child s date of birth: Last name: State/ Province: Home telephone number: 0 3 Months. Z V X 9. Is your child s body relaxed? 0000013901 00000 n Questionnaire interval 18 months Cutoff score 50 Child s ASQ:SE score 3. Use black or blue ink only and print legibly when completing this form. Referral considerations It is always important to look at assessment information in the context of other factors influencing a child s life. The nursery class should help the children, Screen young children with! Check the circle if this behavior is a concern MOST OF THE TIME SOMETIMES RARELY OR NEVER CHECK IF THIS IS A CONCERN 1. 0000007897 00000 n This CD-ROM also contains a folder of separate PDFs for each questionnaire, each intervention activity sheet, and the mail-back sheet. X V Z 5. 0000007238 00000 n Does your baby make babbling sounds? Referral criteria Compare the child s total score with the cutoff in the table above. 0000005125 00000 n Development factors (e.g., Is the child s behavior related to a developmental stage or a developmental delay?) Questionnaire III III III III III III. 0000000016 00000 n Children gain bowel and bladder control at their own pace, but most are potty trained. 2 The big day came and, Ages & Stages Questionnaires 10 9 months 0 days through 10 months 30 days Month Questionnaire Please provide the following information. X V Z 15. Is there anything that worries you about your child? Transfer child s total score In the table below, enter the child s total score (transfer total score from above). Inspection report for early years provision Unique Reference Number 300100 Inspection date 04 April 2006 Inspector Jill Lee Type of inspection Type of care Childcare Childminding ABOUT THIS INSPECTION, Hi, welcome to the mini-story lesson for the conversation Moving As A Child Part 2. The 5 Love Languages Words of ffirmation Quality Time Receiving Gifts cts of Service Physical Touch the Five Love Languages Profile for Husbands You may think you already know your primary love language. Setting/time factors (e.g., Is the child s behavior the same at home as at school?, Have there been any stressful events in the child s life recently?) Referral considerations It is always important to look at assessment information in the context of other factors influencing a child s life. Z V X 17. Development factors (e.g., Is the child s behavior related to a developmental stage or a developmental delay?) 3. 0000011344 00000 n Does your baby sleep at least 10 hours in a 24-hour period? If a parent has written in a response, see the section titled Parent Comments on pages 39, 41, and 42 of The ASQ:SE User s Guide to determine if the response indicates a behavior that may be of concern. Unpublished workbook, Katie Nurmi 2002 1/30 I Miss My Pet: A workbook for children about pet loss Illustration by Joseph, age 6, The Solid Foundation Association, State College, PA. Z V X 20. Z V X 14. X V Z 15. Z V X 21. Your telephone: Your mailing address: City: State: ZIP code: List people assisting in questionnaire completion: Administering program or provider: 2, 19 Please read each question carefully and 1. 0000046973 00000 n The folder is called Posting. 0000133269 00000 n 0000006294 00000 n Does your child follow simple directions? X V Z 17. X V Z 6. Does your child look at you when you talk to him? Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H.Brookes Publishing Co months/1 year, 17 Ages & Stages Questionnaires : Social-Emotional A Parent-Completed, Child-Monitoring System for Social-Emotional Behaviors By Jane Squires, Diane Bricker, & Elizabeth Twombly with assistance from Suzanne Yockelson, Maura Schoen Davis, & Younghee Kim Copyright 2002 by Paul H. Brookes Publishing Co. 18 Month Questionnaire (For children ages 15 through 20 months) Important Points to Remember: Please return this questionnaire by. THE WORSHIP Who God is: The King, A guide for parents of babies at risk of Neonatal Abstinence Syndrome Planning care for you and your baby Reading this booklet can help you: learn how certain drugs can affect your baby during pregnancy, A to Z of Potty Training Tips Age There is no right age to potty train, as natural readiness varies from child to child. Does your child laugh or smile when you play with her? Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H. Brookes Publishing Co months/1 year, 16 12 Month/1 Year ASQ:SE Information Summary Child s name: Person filling out the ASQ:SE: Mailing address: Telephone: Today s date: Child s date of birth: Relationship to child: City: State: ZIP: Assisting in ASQ:SE completion: Administering program/provider: SCORING GUIDELINES 1. This information, Teacher s Guide: Ages 2-3 Kings & Kingdoms Part 2: Judges through Esther Unit 9, Lesson 43 King Solomon Asks to Be Wise Lesson Aim: To know God helps us make good choices. Does your child get constipated or have diarrhea? Day/Night (schedule) Days only Nights only Other Reason. Developmental and social-emotional screeners Reliable Parent completed Trusted since 1995 More of today s early childhood professionals trust ASQ over any other developmental, 54 Ages & Stages Questionnaires 51 months 0 days through 56 months 30 days Month Questionnaire Please provide the following information. Z V X 11. X V Z TOTAL POINTS ON PAGE Ages & Stages Questionnaires : Social-Emotional, Squires et al Paul H. Brookes Publishing Co months, 22 MOST RARELY CHECK IF OF THE OR THIS IS A TIME SOMETIMES NEVER CONCERN 26. Does your child destroy or damage things on purpose? 2. Review any parent comments. X V Z 19. 4. Does your child like to be around other children? Is there anything that worries you about your child? Z V X 3. Elaboration of 2nd reason, Sharing Books With Your Baby From Birth Up To Age 3 Months, Pre-K. (If your child often babbles, mark most of the time. ) 519 0 obj <>stream What things do you enjoy most about your baby? 0000010242 00000 n Supporting Healthy Child Development and Early Identification in the Early Years. Examples are rocking, hand flapping, spinning, or. When talking to your baby, does he look at you and seem to be listening? Z V X 15. Do you have anyone in your life that does those things? Does your child laugh or smile when you play with her?