1. Rebecca J. King Coordinator WVDE-Office of Healthy Schools Traci Dalton WV Head Start State Collaboration Director

4. 2010/11 School Nurse Needs Assessment Medical DiagnosesIn-School Specialized Health Care Procedures AsthmaInhalers for Asthma Behavioral DisordersEmergency Medications Anaphylactic ReactionLong-Term Medications ObesitySpecial Diets per Federal Form Mental Disorders (Depression, Bipolar, Schizophrenic, Suicidal) Seizure Management Close 5 th places….. Ear, Nose and Throat/ Migraine or Severe Headache/Seizures

7. 5.4. All children entering an approved participating WV Pre- K classroom must have age appropriate immunizations upon enrollment as defined by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) and recommended by WVDHHR, located at http://www.wvdhhr.org/immunizations/pdf/Pre- K_Vacc_Chart_final.pdf. Children that are not fully immunized may be provisionally enrolled providing a plan has been developed to assure full immunization, but may not enter WV Pre-K classrooms until they have received the first dose of each required vaccine. http://www.wvdhhr.org/immunizations/pdf/Pre- K_Vacc_Chart_final.pdf

8.  5.5. A WV Pre-K classroom should have on file within 45 days of enrollment or prior to the first day of school attendance a record of a HealthCheck screening, or other comprehensive health screening comparable to the HealthCheck protocol. All screening forms shall be signed and dated by the child’s licensed health care provider and completed within the past 12 calendar months. Counties can retain the right to conduct follow-up screening.

9.  20.15. HealthCheck is the screening/surveillance protocol recommended for the licensed health care providers to be used for all children entering WV Pre-K. HealthCheck meets the requirements for vision, hearing, developmental, including speech and language, and oral health. The HealthCheck screening form is the preferred documentation method of licensed health care providers to record screenings.

10.  HealthCheck (EPSDT) Only ▪ No massive screenings ▪ Working closely with the child’s medial and dental home

11.  5.6. W.Va. Code §16-3D-3 requires tuberculosis screening test for students transferring from an out-of-state school or enrolling for the first time from outside the state.  5.6.1. Staff, volunteers and student teachers shall follow the required communicable disease educational in-services, tuberculosis skin testing for new employees and W.Va. 64CSR7, WVDHHR Reportable Disease, Events and Conditions Rule.

12. School Health Services:  W.Va. Code 18-5-22-School Nurses and Specialized Health Care Procedures  WBE Policy 2422.7 Standards for Basic and Specialized Health Care  WVBE Policy 2422.8 Medication Administration  WVBE Policy 2423 Communicable Disease Control

13.  § 1304.20 (a)(1) In collaboration with the parents and as quickly as possible, but no later than 90 calendar days (with the exception noted in paragraph (a)(2) of this section) from the child's entry into the program (for the purposes of 45 CFR 1304.20(a)(1), 45 CFR 1304.20(a)(2), and 45 CFR 1304.20(b)(1), "entry" means the first day that Early Head Start or Head Start services are provided to the child), grantee and delegate agencies must:  (ii) 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 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program of the Medicaid agency of the State in which they operate, and the latest immunization recommendations issued by the Centers for Disease Control and Prevention, as well as any additional recommendations from the local Health Services Advisory Committee that are based on prevalent community health problems:

14.  Annual proof of HealthCheck/EPSDT is required.  (ii) Obtain from a health care professional a determination as to whether the child is up-to-date on a schedule ofage 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 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program of the Medicaid agency of the State in which they operate, and the latest immunization recommendations issued by the Centers for Disease Control and Prevention, as well as any additional recommendations from the local Health Services Advisory Committee that are based on prevalent community health problems:

15.  OHS – PC – B – 006 What immunization requirements should be followed?  Children in Head Start and Early Head Start programs must be immunized according to their State Medicaid EPSDT schedule for immunizations, not according to each child’s doctor’s recommendations. In many instances, State Medicaid EPSDT immunization requirements are the same as the recommendations for childhood immunizations outlined by the Centers for Disease Control and Prevention (CDC). For Head Start programs located in a state where state Medicaid EPSDT requirements differ from the CDC recommendations, the program’s Health Services Advisory Committee may, in accordance with 1304.20(a)(1)(ii), require children receive the additional immunizations as recommended by the CDC.  Each state determines the guidelines for exemptions from immunizations due to medical, religious or other reasons. If a child in Head Start has a medical exemption that meets all the requirements of the State immunization exemption guidelines, they do not need to be immunized according to the State immunization schedule.  Requirement 45 CFR 1304.20(a)(1)(ii)  June 12, 2007

16.  Dental Examination  Dental Preventive Care  Establishing a Dental Home  OHS – PC – B – 003 Head Start children are expected to receive both a dental exam and dental preventive care. Can the preventive care include just one of the following: dental cleaning or the application of fluoride or the application of sealants?  Preventive care may include a dental cleaning or fluoride application or the application of sealants. However, it may also be determined that a particular child needs more than one type of preventive care.  Requirement 45 CFR 1304.20(a)(1)(ii)(A)–(B); 1304 CFR 1304.20(c)(3)(i)–(ii) June 12, 2007

17.  The Head Start Program Performance Standard 45 CFR 1304.20(a)(1)(ii) requires a determination of whether a child is up-to-date on a schedule of age appropriate preventive and primary health care. This schedule must incorporate the requirements for well child care utilized by the State’s Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. The EPSDT Program of the Centers for Medicare and Medicaid Services (CMS) requires a screening blood lead test be performed to determine the blood lead level for all Medicaid eligible children at 12 and 24 months of age. Children between the ages of 36 months and 72 months of age must receive a screening blood lead test if they have not been previously screened for lead poisoning. At this time, States may not adopt a statewide plan for screening children for lead poisoning that does not require lead screening for all Medicaid- eligible children. State Medicaid programs (and therefore Head Start programs) must comply with this requirement. A “risk assessment” (i.e. a paper and pencil questionnaire or parent interview) DOES NOT meet this requirement. A local program’s Health Services Advisory Committee can not determine whether or not a child should receive a lead screening.

18.  If a parent can not provide written documentation from their child’s medical provider that their child received a screening blood lead test at ages 12 months and at 24 months, it is a CMS requirement that the child receive a screening blood lead test between the ages of 36 and 72 months. Head Start programs must work in partnership with parents to make sure every enrolled child receives this screening.  If a child’s provider will not perform this screening, the Head Start program is required to assist the family in seeking this screening from other sources within the community in accordance with 45 CFR 1304.20(a)(1)(ii)(A). If there are no other sources in the community that can provide this service, then Head Start can provide it. If a Head Start program provides this screening, they must comply with the Head Start Program Performance Standards requirement 45 CFR 1304.52(d)(2) that health procedures be performed only by a licensed certified health professional. Requirement 45 CFR 1304.20(a)(1)(ii); 45 CFR 1304.20(a)(1)(ii)(A); 45 CFR 1304.52(d)(2) November 20, 2007

19.  OHS – PC – B – 014 Are all Head Start and Early Head Start children required to receive a hemoglobin/hematocrit screening?  The requirements for all screenings, including hematocrit and hemoglobin, are determined by each State’s Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. Which is 12 months of age in WV. Requirement 45 CFR 1304.20(a)(1)(ii) July 3, 2007

20.  OHS – PC – B – 038 If a child receives sensory screenings during a well child visit, is the Head Start program required to screen the child within 45 days of their entry into the Head Start program?  45 CFR 1304.20(b) requires Head Start grantee and delegate agencies to perform or obtain linguistically and age appropriate screening procedures to identify concerns regarding a child’s developmental, sensory (visual and auditory), behavioral, motor, language, social, cognitive, perceptual, and emotional skills within 45 days of entry into the program. If a parent provides the Head Start program with documentation that a linguistically and age appropriate sensory screening took place during the well child visit, it is NOT necessary to repeat this screening within 45 days of the child’s entry into the program.  Head Start programs should consider, however, that the population they serve is considered to be high risk, and that it may be more efficient and effective for them to provide for the uniform screening of all children’s hearing and vision using objective screening instruments. Programs may consult with their Health Services Advisory Committee for assistance in identifying linguistically and age appropriate objective screening instruments that would be most appropriate for use in their program, given the children they are serving.  Requirement 45 CFR 1304.20(b) November 20, 2007

21.  OHS – PC – B – 039 What is a Head Start program’s responsibility if a parent provides documentation from the child’s most recent well child examination and there is no information about whether the child received sensory screenings during the visit?  45 CFR 1304.20(a)(ii)(A) requires Head Start programs to assist the parent in bringing their child up-to-date on a schedule of well child care according to the state Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. If there is no evidence that the child received sensory screenings during the well child visit, the program must work with the parent to obtain the necessary documentation from their child’s health care provider. In some instances, the Head Start program and the parent may call the provider’s office to see if there is additional documentation that can be sent showing the child received sensory screenings. If it is determined that the screenings did not take place, the Head Start program may decide it is more efficient for them to provide the sensory screenings at the Head Start program rather than sending the child back to the health care provider’s office. The program’s Health Services Advisory Committee may assist the program in developing program policies on screening Head Start children. The Head Start program may also meet with local health care providers to explain to them the Head Start Program Performance Standards requirements and the state EPSDT requirements for well child care in their state.  Requirement 45 CFR 1304.20(a)(ii)(A) November 20, 2007

22.  OHS – PC – B – 040 What are the requirements for lead screening for Head Start and Early Head Start children?  The Head Start Program Performance Standard 45 CFR 1304.20(a)(1)(ii) requires a determination of whether a child is up-to-date on a schedule of age appropriate preventive and primary health care. This schedule must incorporate the requirements for well child care utilized by the State’s Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. The EPSDT Program of the Centers for Medicare and Medicaid Services (CMS) requires a screening blood lead test be performed to determine the blood lead level for all Medicaid eligible children at 12 and 24 months of age. Children between the ages of 36 months and 72 months of age must receive a screening blood lead test if they have not been previously screened for lead poisoning. At this time, States may not adopt a statewide plan for screening children for lead poisoning that does not require lead screening for all Medicaid-eligible children. State Medicaid programs (and therefore Head Start programs) must comply with this requirement. A “risk assessment” (i.e. a paper and pencil questionnaire or parent interview) does not meet this requirement. A local program’s Health Services Advisory Committee can not determine whether or not a child should receive a lead screening.  If a parent can not provide written documentation from their child’s medical provider that their child received a screening blood lead test at ages 12 months and at 24 months, it is a CMS requirement that the child receive a screening blood lead test between the ages of 36 and 72 months. Head Start programs must work in partnership with parents to make sure every enrolled child receives this screening.  If a child’s provider will not perform this screening, the Head Start program is required to assist the family in seeking this screening from other sources within the community in accordance with 45 CFR 1304.20(a)(1)(ii)(A). If there are no other sources in the community that can provide this service, then Head Start can provide it. If a Head Start program provides this screening, they must comply with the Head Start Program Performance Standards requirement 45 CFR 1304.52(d)(2) that health procedures be performed only by a licensed certified health professional.  Requirement 45 CFR 1304.20(a)(1)(ii); 45 CFR 1304.20(a)(1)(ii)(A); 45 CFR 1304.52(d)(2) November 20, 2007

23. OHS – PC – B – 029 If a Head Start child does not receive their physical examination within one year of their last physical (as required by Medicaid/EPSDT), can the child be expelled from Head Start? No, a program should not disenroll any child because the child has not had a recent physical examination. Rather, as required by 45 CFR 1304.20(a)(1)(ii)(A), the program should assist the parents of any such child to bring their children up-to-date on a schedule of well child care as determined by the State Medicaid\EPSDT program. Requirement 45 CFR 1304.20(a)(1)(ii)(A) July 31, 2007

24.  OHS – PC – B – 028 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. Requirement 45 CFR 1304.22(b) July 31, 2007

25.  To reference the Improving Head Start for School Readiness Act of 2007, Head Start Performance Standards or Policy Clarifications visit:  http://eclkc.ohs.acf.hhs.gov/hslc/standards http://eclkc.ohs.acf.hhs.gov/hslc/standards

27. Get involved with your Regional School Wellness Committee by contacting your RESA-Regional School Wellness Specialist (RSWS)

30. THANK YOU! Contact Information: Traci Dalton Email: Traci.L.Dalton@wv.govTraci.L.Dalton@wv.gov Phone: 304-356-4604