Form Structure: Brief Infant Toddler Social Emotional Assesment-Childcare provider form
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Brief Infant Toddler Social Emotional Assesment-Childcare provider form
Short Name:
BITSEAChildcareProvider
Description:
The Brief Infant Toddler Social Emotional Assesment (BITSEA) is a brief screener of children's social or emotional behavior problems and competencies based on the Infant Toddler Social Emotional Assessment (ITSEA). It was designed to identify children with deficits or delays in these areas, with positive screens to be followed by administration of the full ITSEA. The measure yields a Problem Total Score and a Competence Total Score. There are two versions, a Parent Form and a Childcare Provider Form. References: Briggs-Gowan, M. J., Carter, A. S., Irwin, J. R., Wachtel, K., & Cicchetti, D. V. (2002). Copyright 2006, 2016 Pearson Education, Inc or its affiliate(s). All rights reserved, http://www.pearsonclinical.com/. Copyright 2004, Society of Pediatric Psychology. All rights reserved. Copyright 2006 2002 by Yale University and the University of Massachusetts
Disease:
Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-11-01
Owner:
Number of Data Elements:
67
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Optional | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Vital status | Status of participant/subject as alive or dead | VitStatus | Optional | CDE |
| 5 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 6 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Language form administration ISO code | Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration | LangCRFAdministratISOCode | Recommended | CDE |
| 2 | Language form administration ISO code other text | The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. | LangCRFAdministratISOCodeOTH | Recommended | CDE |
| 3 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 4 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 5 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 6 | Data source other text | The free-text field related to Data source specifying other text. Source of the data provided on the case report form | DataSourceOTH | Recommended | CDE |
BITSEA (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Succeed pleasure scale | The scale of showing pleasure when the child succeeds, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEASucceedPleasScl | Recommended | CDE |
| 2 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hurt often scale | The scale of getting hurt that the parent/guardian/caregiver cannot take eyes off the child, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAHurtOftScl | Recommended | CDE |
| 3 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Nervous tense fearful scale | The scale of being nervous, tense, or fearful, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEANervTensFearfulScl | Recommended | CDE |
| 4 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Restlessness scale | The scale of being restless, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEARestlessScl | Recommended | CDE |
| 5 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Rule follow scale | The scale of following rules, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAFollowRulesScl | Recommended | CDE |
| 6 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Sleep difficulty scale | The scale of having difficulty in falling asleep again after waking up, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEASleepDiffScl | Recommended | CDE |
| 7 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Cries tantrum exhaust scale | The scale of having cries or tantrums until the child is exhausted, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEACriesTantrumExhaustScl | Recommended | CDE |
| 8 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Place animal thing fear scale | The scale of being afraid of certain places, animals or things, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAPlacAnimThingFearScl | Recommended | CDE |
| 9 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Place animal thing fear text | An example that a child is afraid of, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAPlacAnimThingFearTxt | Recommended | CDE |
| 10 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Less fun scale | The scale of having less fun than other children, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEALessFunScl | Recommended | CDE |
| 11 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Look for when upset scale | The scale of looking for parent/guardian/childcare provider, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEALookForWhenUpsetScl | Recommended | CDE |
| 12 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Cries hang onto care giver scale | The scale of crying or hanging onto a care giver when he or she tries to leave, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEACriesHangOntoCrGiverScl | Recommended | CDE |
| 13 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Worries a lot very serious scale | The scale of worrying a lot or being very serious, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAWorriesALotVySeriousScl | Recommended | CDE |
| 14 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Look right name called scale | The scale of looking right at parent/guardian/childcare provider when his/her name is called, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEALookRightNameCalledScl | Recommended | CDE |
| 15 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - No reaction when hurt scale | The scale of not reacting when hurting, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEANoReactnWhenHurtScl | Recommended | CDE |
| 16 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Affectionate with loved ones scale | The scale of being affectionate with loved ones, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAAffectionateWLvdOnesScl | Recommended | CDE |
| 17 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Won't touch some objects scale | The scale of not touching some objects because of how they feel, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAWontTouchSomeObjectsScl | Recommended | CDE |
| 18 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Trouble fall stay asleep scale | The scale of having trouble falling or staying asleep, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAToubleFallStayAsleepScl | Recommended | CDE |
| 19 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Run away public places scale | The scale of running away public places, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEARunAwayPublicPlcsScl | Recommended | CDE |
| 20 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Play well with other children scale | The scale of playing well with other children, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAPlayWellWOthrChldrnScl | Recommended | CDE |
| 21 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Long time attention scale | The scale of paying attention for a long time, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEALongTimeAttnScl | Recommended | CDE |
| 22 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Trouble adjusting to changes scale | The scale of having trouble adjusting to changes, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEATroubleAdjutToChangeScl | Recommended | CDE |
| 23 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Help when someone hurt scale | The scale of trying to help when someone is hurt, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAHelpWhenSomeoneHurtScl | Recommended | CDE |
| 24 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Often get upset scale | The scale of often getting upset, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAOftenGetUpsetScl | Recommended | CDE |
| 25 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Gags chokes scale | The scale of having gags and chokes on food, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAGagsChokesScl | Recommended | CDE |
| 26 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Imitates playful sounds scale | The scale of imitating playful sounds when you ask the child to, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAImitatesPlayfulSdsScl | Recommended | CDE |
| 27 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Refuse to eat scale | The scale of refusing to eat, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEARefuseToEatScl | Recommended | CDE |
| 28 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hit shove kick bite children scale | The scale of hitting, shoving, kicking and biting children, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAHitShoveKickBiteCdrnScl | Recommended | CDE |
| 29 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Destructive scale | The scale of being destructive, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEADestructiveScl | Recommended | CDE |
| 30 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Point to show things far away scale | The scale of pointing to show you something far away, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAPntToShowTgsFarAwayScl | Recommended | CDE |
| 31 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hit bite kick parent scale | The scale of hitting, biting, or kicking parents, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAHitBiteKickParntScl | Recommended | CDE |
| 32 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hit bite kick parent scale | The scale of hitting, biting, or kicking parents, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAHugFeedDollsScl | Recommended | CDE |
| 33 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Unhappy sad depressed withdrawn scale | The scale of being unhappy, sad, depressed or withdrawn, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAUnhapySdDpresWithdrnScl | Recommended | CDE |
| 34 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hit bite kick you scale | The scale of hitting, kicking or biting you (or other childcare provider), as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAHitBiteKickUScl | Recommended | CDE |
| 35 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Still freeze when upset scale | The scale of getting very still, freezing, or not moving when upset, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAStillFreezeWhenUpsetScl | Recommended | CDE |
| 36 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Still freeze when upset scale | The scale of putting things in a special order over and over and getting upset if the child is interrupted, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAPutTnsInSpeclOrdersScl | Recommended | CDE |
| 37 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Repeat same actions without enjoyment scale | The scale of repeating the same action or phrase over and over without enjoyment, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAReptSmActnWtEnjymntScl | Recommended | CDE |
| 38 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Repeat same actions without enjoyment text | An example describing how a child repeats the same action or phrase over and over without enjoyment, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAReptSmActnWtEnjymntTxt | Recommended | CDE |
| 39 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Repeat particular movement scale | The scale of repeating a particular movement over and over ( like rocking, spinning), as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAReptPrtcularMovemntScl | Recommended | CDE |
| 40 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Repeat particular movement text | An example describing how a child repeats a particular movement over and over ( like rocking, spinning), as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAReptPrtcularMovemntTxt | Recommended | CDE |
| 41 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Space out scale | The scale of spacing out, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEASpaceOutScl | Recommended | CDE |
| 42 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - No eye contact scale | The scale of not making eye contact, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEANoEyeContactScl | Recommended | CDE |
| 43 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Avoid physical contact scale | The scale of avoiding physical contact, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAAvoidPhysicalContactScl | Recommended | CDE |
| 44 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Self hurt on purpose scale | The scale of hurting himself or herself on purpose, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEASelfHurtOnPurposeScl | Recommended | CDE |
| 45 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Self hurt on purpose text | An example describing how a child hurts himself or herself on purpose, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEASelfHurtOnPurposeTxt | Recommended | CDE |
| 46 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Eat drink things non edible scale | The scale of eating or drinking things that are not edible, like paper or paint, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAEatDrinkTnsNonEdibleScl | Recommended | CDE |
| 47 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Eat drink things non edible text | An example describing how a child eats or drinks things that are not edible, like paper or paint, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAEatDrinkTnsNonEdibleTxt | Recommended | CDE |
| 48 | Brief Infant Toddler Social Emotional Assessment (BITSEA) -How worried about child behavior scale | The scale of worrying about the child's behavior, emotions, or relationships, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAHwWorrdAbtCdBehvrScl | Recommended | CDE |
| 49 | Brief Infant Toddler Social Emotional Assessment (BITSEA) -How worried about child language development scale | The scale of worrying about the child's language development, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAHwWorrdAbtCdLangDevScl | Recommended | CDE |
Score summary (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Brief Infant Toddler Social Emotional Assessment (BITSEA) -Problem total score | Problem total score, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEAProblemTtlScore | Recommended | CDE |
| 2 | Brief Infant Toddler Social Emotional Assessment (BITSEA) -Competence total score | Competence total score, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) | BITSEACompetenceTtlScore | Recommended | CDE |
| 3 | Brief Infant Toddler Social Emotional Assessment (BITSEA) - Follow up notes text | Description of follow-up notes, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA), Childcare Provider Form | BITSEAFollowUpNotesTxt | Recommended | CDE |
Keywords
