Provider name:
Date: 7/3/2025
Workshop Date: (format: mm/dd/yyyy)

2015-16 Competency: Marcel's Completed ASQ

1. What is Marcel's age in months and days?
   months:
   days:
2. Total points on page 1:
3. Total points on page 2:
4. Total points on page 3:
5. Total points on page 4:
6. Total score:
7. Marcel's score falls within which area of the scoring graphic?
   No or low risk
   Monitor
   Refer
8. Were there any concerns marked on scored items? If so, what were the concerns?
   
9. Were there any eating/sleeping/toileting concerns?
   
10. Were there other worries no marked on scored items? If so, what were they?
    
11. FOLLOW UP REFERRAL CONSIDERATIONS
    
    1. What follow-up referral considerations would you discuss with the team? Consider the following factors: setting, developmental, health factors, and family/cultural factors.
       
    2. What activities would you carry out with Marcel to promote Tier 1 implementation?
       
12. Marcel's team deemed he was eligible for early intervention. Write a participation-based outcome related to social-emotional development for Marcel:
    

2015-16 Provider Competency: Application of Tier 1 strategies to promote infant and toddler social emotional development

Family 1

1. Family 1 Child's Initials:
2. Child's Date of Birth: (format: mm/dd/yyyy)
3. Why is this child receiving early intervention?
4. Child's diagnosis, if any:
5. Describe the social emotional development strategies you implemented:
   1. Promoting responsive interactions
      
   2. Structure environment to promote regulated behavior
      
   3. Individualized activities
      
6. What outcomes resulted:

What questions do you have about addressing infants' and toddlers' social emotional development?