Head Start Health Regulations Health Institute May 21, 2013 Head Start Health Regulations 1304.20 Kristen Smith Health Management Consultant

Performance Standards 1304 Performance Standards 1304.20 Early Childhood Development and Health Services Child Health and Developmental Services (a) Determining child health status (b) Developmental, sensory, and behavioral screenings (c) Extended follow-up and treatment (d) Ongoing care (e) Involving parents (f) Individualization

Performance Standards 30, 45 and 90 Day Timelines 30 Days Physical Exam/WBC’s (CB) TB Clearance (risk assessment or TST if needed) (CB) 45 Days Sensory Vision Hearing Developmental Social Emotional 90 Days Physical Exam/WBC’s (HB) TB Clearance(HB) Growth Assessment Hgb/Hct Lead Test LR Assessment Blood Pressure (HS) Dental Assessment (EHS) or Dental Exam (HS) 101220.1 Immunizations(CB) (a) Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, commencing with Section 6000.

Enrollment and Entry Requirements Policy Clarification OHS – PC – I – 057 Can a child be denied entry into Head Start if they are not up to date on their physical or immunizations No, there is no Head Start Program Performance Standard that requires a child be up-to-date on their physical or immunizations prior to entering the Head Start program. However, some states prohibit a child from entering a child care center until they have a physical and/or meet State immunization requirements and in these situations a program would have no choice but to not enroll the child until the child had received all required health services.

30 Day Screenings Title 22 Child Care Licensing Regulation (101220) Child Medical Assessment (d) If a medical assessment is not available for a child and cannot be obtained within 30 days of admission: (1) A medical appointment date shall be obtained from the authorized representative upon the child's admission. (2) A TB test shall be obtained on the child within 30 days of admission.

45 Day Screenings Developmental, Sensory & Behavioral 1304 45 Day Screenings Developmental, Sensory & Behavioral 1304.20 (b)(1) Within 45 calendar days of child’s entry, grantee must perform or obtain linguistically and age appropriate developmental, sensory, and behavioral screenings.

Policy Clarification OHS – PC – C – 002 Must a Head Start child in the child’s second year of Head Start be re-screened for developmental concerns? No. A child must receive the initial screening for developmental, sensory and behavioral concerns “within 45 days of the child’s entry into the program”. Thereafter, the Head Start program must conduct ongoing assessments of each child's development throughout the child’s enrollment. For sensory domains such as vision and hearing, screening procedures should be re-administered on the periodicity schedule required by State EPSDT schedule, or more frequently if recommended by the Health Services Advisory Committee. Policy Clarification

90 Days Screenings Determining Child Health Status 1304.20(a)(1)(ii) In collaboration with the parents and as quickly as possible, but no later than 90 calendar days … Obtain from a health care professional a determination as to whether the child is up-to-date on a schedule of age appropriate preventive and primary health care which includes medical, dental and mental health. Such a schedule must incorporate the requirements for a schedule of well child care utilized by the state’s EPSDT program. (CA- CHDP)

Health Services: Follow-up Care Determining Child Health Status 1304.20(a)(1)(ii) (1) In collaboration with the parents and as quickly as possible, but no later than 90 calendar days … (A) For children not up-to-date on an age appropriate schedule of well child care, grantee and delegate agencies must assist parents in making the necessary arrangements to bring the child up-to-date.

Health Services: Follow-up Care 1304.20(a)(1)(iv) Determining Child Health Status (within 90 days…..) “Develop and implement a follow-up plan for any condition identified in 45 CFR 1304.20a(1)(ii) (iv) so that any needed treatment has begun.”

Health Services: Follow-up Care 1304.20(c)(1) Extended Follow-up and Treatment “Grantee and delegate agencies must establish a system of ongoing communication with the parents of children with identified health needs to facilitate the implementation of the follow-up plan.”

Health Services: Follow-up Care 1304.20(d) Ongoing Care “Grantee and delegate agencies must implement ongoing procedures by which Early Head Start and Head Start staff can identify any new or recurring medical, dental, or developmental concerns so that they may quickly make appropriate referrals.”

Health Services: Follow-Up Care 1304.20(e)(1) Involving Parents “Consult with parents immediately when child health or developmental problems are suspected or identified.”

Health Services: Follow-Up Care 1304.20(f)(1) Individualization “Grantee and delegate agencies must use the information from the screening for developmental, sensory, and behavioral concerns, the ongoing observations, medical, and dental evaluations and treatments, and insights from the child’s parents to help staff and parents determine how the program can best respond to each child’s individual characteristics, strengths and needs.”

Challenges with Follow-Up Care No Targeted efforts to “assist” families Lack of Documentation Delayed-Not Timely No Closed Loop- where services received? Inconsistent system for monitoring

Discuss challenges with health follow-up Small Group Activity Instructions: Review case scenario Discuss challenges with health follow-up Develop strategies to address concern Report out to large group