MEISR sample form.pdf

Measure of Engagement, Independence, and Social Relationships

The MEISR™ is a list of skills that infants and toddlers (birth to 3 years of age) typically display in everyday routines within the home and community. To complete the MEISR, caregivers assess a child’s level of functional participation in 14 different routines. For the purposes of the MEISR, a caregiver is defined as someone who has observed the child often in the home. The MEISR has many benefits within the context of early intervention. Prior to administration, professionals should discuss the specific purpose and benefits as they apply to each child within each routine, including items with a typical starting age beyond the child’s age. Follow instructions at the bottom of each routine to determine scoring. Scores indicate a child’s level of mastery by age (relative to typical starting age for skills) and by routine (relative to all skills for that routine up to 36 months of age). Once completed, transfer scores for all routines to the MEISR Scoring Summary page. See the manual for complete administration instructions (Chapters 4 and 6). On a scale from 1 to 3 (Not yet, Sometimes, Often or Beyond this), rate your child’s level of functioning in performing activities. Circle 1, 2, or 3 for each skill. Depending on the child’s age, some activities may be beyond your child’s capability. This is expected. The MEISR takes about 45 minutes to complete.

Child's Details

Child's Name Amber Brook
Child's DOB June 1, 2015
Child's Age (months) 25 months
Date of Evaluation July 1, 2017
Caregiver(s) Name Lomita and Evan Brook
Professional(s) Name Viola Jackson and Ben Larsen

MEISR Routines

MEISR Routines (number of items in routine) A. Total Number of 35 B1. Total Number of Items Scored for Child's Age B2. Percentage of Items Mastered by Child's Age (A/B1 * 100 = %) C1. Total Number of Items Scored for Routine C2. Percentage of Items Mastered by Routine (A/C1 * 100 = %)
01. Waking Up (25) 21 23 91 % 25 84 %
02. Toileting/Diapering (20) 6 12 50 % 20 30 %
03. Meal Times (47) 24 37 65 % 47 51 %
04. Dressing Time (29) 11 21 52 % 29 38 %
05. Hangout – TV – Books (38) 16 24 67 % 38 42 %
06. Play With Others (38) 18 27 67 % 38 47 %
07. Nap Time (14) 9 11 82 % 14 64 %
08. Outside Time (26) 13 14 93 % 26 50 %
09. Play by Him- or Herself (35) 21 29 72 % 35 60 %
10. Bath Time (30) 20 25 76 % 30 63 %
11. Bedtime (16) 10 12 83 % 16 63 %
12. Going Out (35) 15 26 58 % 35 43 %
13. Grocery Shopping (18) 6 13 46 % 18 33 %
14. Transition Time (15) 5 9 56 % 15 33 %
TOTALS 145 283 69 % 386 51 %

Sample Scoring for Routines

1. Waking Up

Skill Typical Age (months) Not yet Sometimes Often or Beyond Time Func Dev Out
1.01 Making vocal sounds 0 1 2 3 S CM K
... ... ... ... ... ... ... ...

6. Play With Others

Skill Typical Age (months) Not yet Sometimes Often or Beyond Time Func Dev Out
6.01 Reacting to sounds (e.g., startling) 0 1 2 3 E CG K
... ... ... ... ... ... ... ...

13. Grocery Shopping

Skill Typical Age (months) Not yet Sometimes Often or Beyond Time Func Dev Out
13.01 Attending to sound of caregiver's voice 0 1 2 3 S S S
... ... ... ... ... ... ... ...