BRIGANCE III

TRAINEE BOOKLET
MATERNAL AND CHILD HEALTH NURSES
 Outline

• Guidance for MCH use why, what, how and when

• What is different about Brigance III?
• Brigance in MCH practice
- 2016 survey results
- practice
- scoring options
- referral pathways
- resources
 Slides and Training Booklet
• Booklet in order of presentation but some
slides are not in booklet
• Yellow outline of slide indicates it is not in
training booklet
 Resources for MCH Nurses
Resources include: tip sheets with entry points, cut
off scores, colour coded data sheets, information
about interpreting results, discussing results with
parents and case studies for use with this training
presentation.
http://www.education.vic.gov.au/childhood/profes
sionals/health/Pages/mch.aspx#link43
BRIGANCE screens

Why?
 The key principles underpinning child
development

• development has age- related manifestations

• development is directional
• every child develops uniquely
• development is malleable
 Screening

• Purpose to identify problems as early as

possible

• A brief measure that sorts children who

possibly have problems from those who
probably don’t.
 Screening
• Brigance screen is a secondary screen after
PEDS path A or B
• Screening tests do not yield a diagnosis
• Assessment with more detailed measures is
usually indicated after score below cut off
on a screening test
Parents Evaluation of Development
Status (PEDS)
• PEDS is our primary developmental
screen
• Supports a comprehensive
developmental assessment
• We need accurate recording of PEDS
• Ensure you have completed the online
training for PEDs 2017
 PEDS
Expect:
• 10% Path A
• 20% Path B
• 20% Path C
• 50% Path D/E
 PEDS
• Ensure you have good understanding of the
paths, especially Path B
• If PEDS is Path B, Brigance should follow
(except in exceptional circumstances)
• If Path A, Brigance will support your referral
BRIGANCE Screens
What are they?
 Introduction to Brigance III
a short video

http://www.youtube.com/watch?v=2RLPnf1keg8

(2.5 min)
 BRIGANCE screens
• Series of developmental screens
7 screens across screen books, covering ages 1m to 7 years

• Uses direct observation of skills (in 2+ years )

• Can be administered by a range of
professionals (nurse/teacher)
• Administered and scored in 10-15 minutes
 3 Core Developmental Domains
• Physical Development
Gross and Fine Motor Skills
• Language Development
Receptive and Expressive Language Skills
• Academic Skills/Cognitive Development
adaptive skills for infants and toddlers
(self help and socioemotional)
 Infant skills (1-11 months)
Physical Language Adaptive-
Self help and socioemotional
Gross motor eg: Receptive eg: Self help eg:
• rolling  sitting • responds to name • holds bottle/cup
crawling walking • looks at named • feeds self
• transferring objects objects • cooperates in dressing
between hands • Responds to
commands Socio- emotional eg:
Fine motor eg: • waving • plays peek-a-boo
• holding objects • gives block on • gives affection
• squeaking toys command • initiates interaction with
• grasp and release of others
objects Expressive eg: • explores and returns to
• putting objects into a • vocalising caregiver
container • gesturing
• pretend talks
• says real words
 Toddler (12-23 months)
Physical Language Adaptive-
Self help/socioemotional
Gross motor eg: Receptive Self help eg:
• standing • waves, gestures • feeds self
• walking • responds to simple • assists in dressing
• jumping commands • holds cup
• running • points to body parts • removes shoes
• identifies pictures
Fine motor eg: • knows animal sounds Socioemotional eg:
• pincer grasp • gives affection
• grasp and release Expressive • initiates interactions
• pour/dumps • communicating  talking • opens doors
• scribble • names common objects • imitates other children
• repeats phrases • watches faces for
says 2-3 word phrases emotional clues
• wants to do things for
self
 2 year old skills
Physical Cognitive Language

Gross Motor Literacy Receptive

• Jumping • Repeats sentences • Identifies body parts by
• Walking backwards • Matches colours pointing
• Balance on one foot
(1sec)
• Walking on tiptoe
Numeracy Expressive
Understands concepts of: • Names common objects
Fine motor • number (one, one • Knows use of common
• Scribbling/drawing more) objects
• Building tower of blocks • and size ( big, little) • Verbal fluency and
articulation
 3 year old skills
Physical Cognitive Language
Gross motor Literacy Receptive
• Balancing on • Identifies self by first • points to named colours
one leg (5sec) and last name and age
• Repeats sentences • points to named body
• Walking heel parts
to toe 4 steps Numeracy
• understands concepts Expressive
Fine motor of number • identifies pictures by
• Drawing naming
copying lines
and circles • knows use of objects
• building tower
with blocks • knows prepositions and
irregular plurals
 4 year old skills
Physical Cognitive/Academic Language

Gross motor • Identifies self by first and Expressive

• Balancing on last name, age, address • names colours
one leg (10sec)
Literacy • names body parts
• Hopping both
feed (5 hops) • Visually discriminates • names pictures
shapes, letters
• Walking heel • Verbal fluency
to toe 5 steps Numeracy Sentences of 3+ words,
• Counts by rote 90% of speech is
Fine motor understandable
• Copy shapes • Recognises and names
circle, +,X, quantities of 3,5,8 Receptive
square, counting without touching • follows verbal
rectangle directions- 2 step, 3
step
 5 year old skills
Physical
Gross motor
• Balancing on one leg
(10sec)
• Balancing on one leg
with eyes closed (1sec)
• Walking backwards heel
to toe 4 steps
Fine motor
• Copy shapes X, square,
rectangle, triangle,
diamond
• Prints first and last name
Cognitive/Academic Language
• Identifies self by name, Expressive
age, birthday, phone
number, address • names body parts
Literacy • names pictures
• Recites alphabet
• Recognises letters of
alphabet
• Experience with books and
text- knows front and back
of a book, understands
progress text from L) to R),
top to bottom
Numeracy
• Counts by rote
• Sorts objects by size, shape
and colour
• Matches quantities with
numerals
• Adds 2 groups of numbers
 6 year old skills
Physical Cognitive/Academic Language
Fine motor Literacy Receptive
• Auditory discrimination
• Prints first and last • Knows personal for beginning and
name information ending of sounds
• Writes numbers in • Reads lower case letters
sequence • Visually discriminates Expressive
letters within words • Identifies initial letters
• Word recognition in words
• Identifies common
Numeracy themes among words
• Sorts objects by size,
colour, shape
• Addition and
subtraction sums
• Solves word problems
 Some useful BRIGANCE features
Located after the core assessments in screen books
Following slides discuss each of these in detail:
• Screening Information Forms (for all ages)
• Parent – Child Interaction forms ( Infant and Toddler)
• Parent Feedback form (for ages 2 and up)
• Self-help and Social-Emotional Scales (for ages 2 and up)
• Supplemental assessments (for ? “gifted” children)
 Screening information forms
• Available for all ages
see p 67-70 of 0-35 month screen book
and p 91 of 3-5 year screen book
• Used to assist your observation of child’s
behaviour during screening in following areas
• Vision
• Auditory
• Behaviour
• Speech
• Self reliance
• Motor skills
• Physical appearance
 Screening information forms
continued

• Copy and use with screening as needed

• Can use to help you record observations on
data sheet
• NOT scored
 Parent- Child interaction forms
• Only in infant and toddler screen
p 71-72 0-35 month screen book
• Observation of parent/child interaction
• Assessment of some psychosocial risk factors
• Can be scored
• Use precaution in making assumptions based
on a singe observation/situation
 Parent feedback form
See p75 and 76 of 0-35 month screen book (2yo)
p 97 and 98 of 3-5year screen book (3yo)
• Available for 2 year old and 3 year old screens
• To help parents understand skills
expected/being assessed for age group
• To help the nurse understand what child is
reported to be able to do at home
• NOT scored
 Parent feedback form continued
• Many items the same as what is in the core
screen as well as self help and socioemotional
screens
• Give to parent prior to coming in for Brigance
screen, or done with parent
• If information is not compatible with what you
observe, is helpful to know this (could be sent
with referral)
Self help and socio emotional domains
See p 77-84, 0-35 m screen book
P 102-112,3-5 y screen book
• For 2 year olds plus
• 0ption of adding Brigance self help and socio
emotional scales to the core assessments.
• Can be scored, which adds these two
important domains to your assessment
Self help and Socio emotional scales
Parent report of child’s:
• Eating, dressing toileting skills
• Relationship with adults and peers
• Play skills
• Self confidence and self regulatory skills
• Can be scored
• Can be done by parent at home prior, or with
nurse
 Supplemental Assessments
• For those children not challenged by core
assessments
• Useful if you want to gain more information
about the child’s skills
• Not scored
• Not anticipated will be used by MCH much
(The picture opposite p58 in 0-35 m screen book has
picture for use in general conversation with children)
Standardisation of Brigance III
 Glossary
Term Definition
Sensitivity Percentage of children with delay correctly identified
Specificity Percentage of children without delay correctly identified
Standardisation Score comparison of large nationally representative group
Norm Score measured against standardised group to compare
referenced performance
Reliability Extent to which test results are consistent when administered by
different examiners or test-retest with same examiner
Validity Extent to which a test measures what it claims to measure
Raw score Total number of points awarded for responses to all test items.
Total possible score = 100
Cut off score BRIGANCE screen raw score below which children with disabilities
or those at risk of academic difficulties are best identified
Psychosocial No one factor predicts risk but multiple factors compound effect
risk factors on the child’s development
 BRIGANCE screens
can be used either as

Criterion Referenced Norm-referenced

OR
Measures a
Measures a student’s student’s
performance based performance in
on mastery of a comparison to the
specific set of skills. performance of
same-age students
on the same
assessment.
 Brigance III Standardisation
(resulting in cut off scores)
• conducted over 12 months, published in 2013
• across 33 American states
• nearly 2000 children
Children Infant Toddler 2yo 3yo 4yo 5yo 6yo Total
Number 588 209 255 158 230 167 322 1929

• representative range of socioeconomic and demographic

characteristics
 Reliability

• Internal consistency .94 – .98

• Test/retest reliability .92 – .99
• Inter-examiner reliability .93 – .96

Figures relate to the correlation coefficient –

the closer to 1, the better the reliability
 Accuracy- Sensitivity
Correctly identified below cut off
screen/full assessment %

Infant 57 / 63 89
Toddler 19 / 22 86
Sensitivity is the
2yo 26 / 29 90 accuracy of cut off
17 / 18
scores
3yo 94
26 / 29
in predicting
4yo 90
14 / 15
developmental delay
5yo 93
6yo 26 / 28 93
TOTAL 185 / 204 91
Total children assessed=1929
 Accuracy- Specificity
Correctly identified above cut off
screen / full assessment %
Infant 451 / 522 86
154 / 187
Specificity is the
Toddler 82
200 / 226
accuracy of cut off
2yo 88
scores
3yo 130 / 140 93
in predicting
4yo 179 / 201 89
normal
5yo 136 / 152 89 development
6yo 238 / 294 81
TOTAL 1488 / 1722 86
Total children assessed=1929
BRIGANCE screens

How?
 First step
• Age calculated in years, months and days
and corrected for prematurity if 36 weeks
gestation or less up to age of 2 years
• Age needs to be exact to determine use of correct
screen as well as correct cut off score for age
CDIS will tell you child’s exact age in years, months and days
 If required (i.e. not on CDIS yet), there is a way
to avoid spending valuable time working out the
Brigance age..…
Hawker Brownlow website has a free age
calculator you can download onto your
computer,
Go to:
http://www.hbe.com.au/series-brigance/downloads-tools.html
 Preparing data sheet
• Record child details, your details, today’s date
• Record cut off score
Table is in screen book, or can be printed from
Brigance III resources on DET, MCH website
Brigance III 0-35m screen book, p xxi
Brigance III 3-5 year screen book p xviii
(ensure looking at cut off score for delay, not giftedness)
 Marking the data sheet
• Show mastery of skill with
• If incorrect or unable to demonstrate
mark with a slash
 Administration guidelines
• Simple explanation to parent
• Ensure child is well
• Ideally done without distraction of disruptive siblings
if possible
• MUST use interpreter if needed
• Some items are parent questions, some are direct
observation and some can be either check
instructions
 Administration guidelines
• Pleasant manner, establish rapport
• ‘games’ not ‘tests’
• Non committal encouragement - whether
response is correct or not!
• Want child to feel successful, no matter what
eg:“ you are doing a good job listening”
Screening directions
 Screening Directions
• Be familiar with all directions for each item/page
• Follow clear and prescriptive directions on each page
• Use script as written but in a natural way
• Incorporate questions/observations into
conversation and consultation eg gross motor/
drawing/ pictures can be part of “warm up time” but
these skills are observable and scorable
• Some items can be assessed together
eg: ask colours while building tower of blocks
Screening Directions (cont)
Assessments can be administered in any
order

But…….

within each assessment, questions/items

need to be asked from L) to R) as they are
listed in order of difficulty
 Screening Directions
• Take notice of discontinuation points
noted on screen page and data sheet
• Screen/cover parts of page if needed
• Record observations as you go
 Common errors

• Gazing at correct choice

• Excessive prompts
 Scoring
• Add across each row, then add total score
• Compare to cut off
• Observe domain scores (more about this
later)
• Make referral decisions
• Record “next steps”
How is Brigance III different?

It is similar enough to be familiar, yet

more effective and user friendly
 Brigance III
• Brigance III screen books and data sheets are all
new and NOT interchangeable with Brigance II

• Very DIFFERENT cut off scores

• Changes to many items- order and content

 Brigance III
• Screen book and data sheets are less busy
• Instructions are clearer
• No 2.5 year old screen
• For MCH 2 screen books instead of 3
(0-35 months and 3-5 years)
 Cut off scores
Infant
age vII v III
4m < 23 < 27
5m < 27 < 33
6m < 32 < 36
7m < 39 < 39
8m < 40 < 43
9m < 43 < 57
10m < 56 < 60
11m < 68 < 67
 Cut off scores
Toddler
age v II V III

12-13m < 22 < 32

14-15m < 35 < 39

16-17m < 40 < 49

18-19m < 55 < 56

20-21m < 60 < 66

22-23m < 65 < 70

 Cut off scores
2 year old
age V II V III

2-0 to 2-2 < 47 < 47

2-3 to 2-5 < 61 < 54

2-6 to 2-8 < 72 < 62

2-9 to 2-11 < 76 < 75

 Cut off scores
3 year old
age v11 v111

3 -0 to 3 -2 <52 3-0 to 3-3 < 42

3-3 to 3-5 <55

3-4 to 3-7 <45
3 -6 to 3-8 < 71

3 -9 to 3 -11 < 71 3-8 to 3-11 <49

 Cut off scores
4 year old

age v II v II

4 - 0 to 4 - 3 < 58 < 42

4 - 4 to 4 - 7 < 72 < 69

4 -8 to 4 - 11 < 80 < 71
 Cut off score
5 year old

age v II v III

5-0 to 5-5 <65 <61

5-6 to 5-11 <78 <70

Most importantly, Brigance III
reduces over referrals
 Important points to remember

• Prepare as much as possible

• Follow the instructions- they are clear and
comprehensive
• All screening needs practice
 Recall of Brigance II kits
Pack up all of your old Brigance II
kits and have them ready for
collection by the Department
 Brigance III Summary
• Will accurately identify children at risk of
developmental delay
• Quick and easy to use
• Can help to inform referral decisions
• Will support your referral
Maternal and Child Health Nurse
BRIGANCE III TRAINING
PART 2
PRACTICAL WORSHOP
GP knowledge of Brigance
Infant and toddler screens
some specific points to note
 Infant and toddler screens-
entry points
• Items in the infant and toddler screens have different entry
points depending on age of child
• If time permits, place a mark on the data sheet at entry points
for each item prior to screening
• Entry points are clearly marked on each page of the screen.
• Tip sheet with entry points for age group is available on MCH
DET website under Brigance Resources for MCHNs
 Basal Point (Infant and Toddler)
• Need three in a row to establish a “basal point”
• Once basal point achieved, give credit for all lower
skills
 Scoring (Infant and Toddler)
• If three in a row not achieved from entry
point, go to lower entry point
 Scoring (Infant and Toddler)
• If three in a row not achieved at all, give
credit for any items achieved.

eg: 1 and 3 correct but unable to demonstrate basal of 3 in a

row, still receives credit for
1 and 3
 2 and 3 year old screens
• Entry point is always item no 1
• Continue L)  R) until discontinuation point/end of
each item

4 8
Parent report vs examiner observation
• Most of infant and toddler skills are parent report
• Most of 2 year old skills are observed
• All of 3 year old are observed
• Instructions re this are clearly marked on each page
of the screen book
When asking the parent questions:

• Use the wording provided

• If parent answers “most of the time” 
• If the answer is “sometimes”, “if I let her” ,“ a little” or “she
hasn’t tried yet”, the skill is emerging and not yet mastered 
emerging skill not enough, looking for mastery
 12 min video of
22 month old Lily

http://www.curriculumassociates.com/professio
nal-development/professional-development-
brigance.aspx
 Interpreting the results
reasons for score below cut off
Psychosocial
• Potentially unreliable performance risk factors
(testing conditions, behaviour)

• Destabilised performance
unwell, untreated vision / hearing, language / cultural barrier, experiential

• Likely developmental delay / disability

see p 30-32 Brigance III Technical Manual
or handout supplied with training materials
As long as performance was not
destabilised or unreliable
The cut off
is the cut off!
Refer if below cut off
Domain scores need to be considered

• Score may be above cut off and all domains above average
no need for any action
• Score may be above cut off but below average in a particular
domain
• May be below cut off and need referral, but useful to know
which domains are below average
 3 options for scoring
to enable domains to be considered

1. Manual - with coloured data sheets to help

2. On line –free option
3. On line OMS, charge applies
 OPTION 1
Manual scoring
• MCH nurses are accustomed to previous
Brigance screen use
• Tip sheets available to assist in assessing domain
scores. Colour coded data sheets with table of
below average domain scores
• See www.education.vic.gov.au
(Brigance resources)
 OPTION 2
Free on line scoring tool
***USEFUL FOR MCH USE ONLY***

• NOT SUITABLE TO SHOW/GIVE PARENTS due to inclusion of

age equivalent scores
• Hawker Brownlow website www.hbe.com.au
• Go to Brigance
• Downloads and tools
• Screens III Scoring Tool
• Screens III Self-Help and Social-Emotional Scales Tool
 OPTION 3
On Line Management System (OMS)
may be introduced in the future
 Where to from here?
• Sharing the results with parents: Tip sheet
available with training resources or see p xxvi
Brigance 0-35 month screen book
• Does the child need referral? – hearing, vision,
speech path, playgroup, childcare, GP,
paediatrician, Early Childhood Intervention
Services
• Resources- readiness activities, books, websites,
library
• Follow up
Resources
Resources

• Standardisation details
• Interpreting results
• Discussing results with parents
• Appendix B has parenting tip sheets
• Building Speech and Language Skills
• Building preschool skills
• Social development resources for
parents
 Resources
• Department of Education website for resources developed for
Victorian MCH nurses for use with BRIGANCE screens III
http://www.education.vic.gov.au/childhood/professionals/health/Pag
es/mch.aspx#link43
• Hawker Brownlow Education website for FAQs, free scoring tool ,
on line training
http://www.hbe.com.au/series-brigance/downloads-tools.html
• Curriculum Associates- on line training and videos
www.curriculumassociates.com/professional-
development/professional-development-brigance.aspx

Scroll down to Early childhood and click on:

 Resources
• www.zerotothree.org
• www.raisingchildren.net.au
• www.cyh.com
• http://www.peds.org.au

• Recommended reading: Ajay Sharma and Helen Cockerill.

(2014) Mary Sheridan's From birth to five years. Children's
developmental progress 4th Edition. Routledge Oxon. AND
Ajay Sharma and Helen Cockerill. (2014) From birth to five
years. Practical Developmental Examination Routledge Oxon.
• ALL BRIGANCE resource enquiries to:
mch@edumail.vic.gov.au
 Resources from
Royal Children’s Hospital
Centre for Community Child Health
Monitoring the health, development, learning and wellbeing of
young children through the use of screening tools
files/Monitoring%20child%20health%20development%20
and%20wellbeing.pdf
Key principles underpinning children's development
files/Key%20principles%20underpinning%20children%27
s%20development.pdf
Risk and protective factors PDF
files/Early%20Years%20Key%20Risk%20and%20Protective
%20Factors.pdf
 References
• Centre for Community Child Health, Royal Children’s Hospital,
Melbourne,: Research Projects that have used Parent’s Evaluation
of Developmental Status (PEDS)
http://www.rch.org.au/uploadedFiles/Main/Content/ccch/PEDS_in_R
esearch(1).pdf
• Brigance® Screens III: Technical Manual • CA14300 • © 2014.
Hawker Brownlow Education
• Brigance® Early Childhood Screens III 0-35 months • CA14294 • ©
2014. Hawker Brownlow Education
• Brigance® Early Childhood Screens III 3-5 years • CA14296 • ©
2014. Hawker Brownlow Education