1. HEALTH ENROLLMENT TRAINING APRIL 7,2014 MATILDA ELIZONDO

2. Health Services Timelines and Process Diagram Illustrates the Health processes that we must conduct during the Head Start year. ◦ Which includes the: Initial developmental, sensory (vision, strabismus, hearing)behavioral, motor, language, social, cognitive, perceptual and emotional skills screenings (Articulation Screening, ASQ/SE) Establishment of medical and dental homes Identification of additional health concerns during the child’s enrollment

3. Health Timelines

4. This Timeline was part of earlier guidance, when the Performance Standards were first introduced

5. Screening for Development, Sensory, and Behavioral Concerns within 45 days of child’s entry into the program.

6. Why we do screening Approach to screening includes getting information from the people who know the child best—the family, the teacher, the caregiver—or whoever has been working with the child. If a child has not slept well, has health conditions, takes medications that may impact her energy level, or is hungry or in pain, she may not demonstrate her full range of skills, abilities, and knowledge. Screening can help us catch problems early so we can refer children for further assessments and possibly special services, treatment, or other resources that can help children overcome problems.

7. 90 Day Timelines Child Health Status Standards ◦ 1304.20(a)(1)(i)-(iii) No later than 90 calendar days… from the child’s entry ◦ Determine if each child has an on-going source of continuous, accessible health care (both medical and dental )

8. FY 2014 CHS: Health Determinations NEW: Date of health determination should be the date the program obtained the determination from the health care professional More accurately reflects the standard FY 2013 language “has a determination been made” FY 2014 language “on what date was the determination obtained” 13

9. FY 2014 language “on what date was the determination obtained” Site will be issued 2 date stamps FSW- when a physical comes in or parent hands to you, it will be stamped dated as soon as you receive it. Monitors- Under event date- will enter date of physical and Under scheduled date- date received (what is stamped on physical)

10. Medicaid’s Early Periodic Screening Diagnostic, and Treatment program To ensure that children receive prompt medical and dental evaluation and/or treatment, Head Start staff assist families to obtain a source of funding for health services, such as Medicaid’s Early Periodic Screening, Diagnostic, and Treatment program (EPSDT). If funds are not available to families, then Head Start funds may be used [45 CFR 1304.20(c)(5)].

11. EPSDT Early: Assessing a child's health early in life so that potential diseases and disabilities can be prevented or detected in the early stages, when they can be treated most effectively; Periodic: Assessing children's health at key points to assure continued healthy development; Screening: Using tests and procedures to determine if children screened have conditions requiring closer medical or dental attention, including attention to mental health problems; Diagnostic: Determining the nature and cause of conditions identified by screenings and those requiring further attention; and Treatment: Providing services needed to control, correct, or reduce physical and mental health problems.

12. THSteps Medical Check-ups Periodicity Schedule for Infants, and Children, (Birth Through 10 Years of Age)

13. Recommended Immunization Schedule for 2014

14. Memorandum Of Understanding (Mou’s) Federally funded clinics to be used for physicals and dentals of Head Start children. Four(4) clinics will have Mou’s with Head Start. ◦ Community Health Center of Lubbock  1318 Broadway, Lubbock, Texas 79401-3206  806-765-2611 extension 1029

15. Mou’s Mou’s Larry Combest Community Health and Wellness Center  301 E. 40 th Street, Lubbock, Texas 79404- 2811  806-743-9355 South Plains Rural Health Services, Inc.  1000 Fm 300, Levelland, Texas 79336-6235  806-894-7842 extension 154 Regence Health Network  2801 W. 8 th Street, Plainview, Texas 79072-6737  806-293-8561 extension 318

16. Resources Texas Health Steps providers are on-line! Up-to date list of Region 1 THSteps providers can be found at: Medical providers www.dshs.state.tx.us/region1/thstepsmedical.shtm Dental providers www.dshs.state.tx.us/region1/thstepsdental.shtm Case Management providers www.dshs.state.tx.us/region1/thstepscaseman.shtm

17. Physical Letter Do not leave any blanks. Section 1. – complete Center/Partner Name, date, and child’s name. Section 2. - review section #2 with the parent or guardian at time of enrollment. Section 3. - all of these items must be completed on the physical exam form to be considered complete. Section 4.- Explanation to provider /parents on action plans and bloodwork. Section 5. - contact information for the parent.

19. Physical Exam SPCAA/Head Start will no longer be giving parents a physical form at enrollment. We will use the THSteps forms or any other form that a provider uses as long as it has all the areas required for a THSteps exam.(example attached) Make sure that the child’s information is at the top of form indentifying that the physical is for that child and that it is completed. According to the TMPPM (Texas Medicaid Provider Procedures Manual 2011) it does not say that a provider has to sign his/her name in handwriting. They can sign a checkup form electronically, but prohibited to submit a claim and other documents with a stamped signature. Form will be entered into Child Plus by Monitor’s and filed in the child’s brown folder under Flap #4 Acceptable: Not Acceptable: Stamped

22. Oral Health Form- Children Make sure all the information that is required in number1, 2, 3, 4 and 12 is complete before child is to see the Dentist Number1. - Complete child’s name Number 2. – Complete center name or partner site name Number3. – Complete child’s date of birth Number 4. – Dental home select YES or NO Number 5, 6 and 7, - Dentist will complete these section. Number 8. - If dentist selects YES them the name of the specialist will be documented. Number 9. – If OTHER is seleceted then the dentist will specify what other treatment is needed. Number 10. – Dentist will complete this section. All items in this section have to be complete if child needs treatment and the treatment has not been completed.

23. Oral Health Form- Children Number 11. – This section will be completed for recall appointment. Number 12.- Person completing enrollment forms will circle what dental plan the child is on and document the plan number. If Child does not have dental insurance this section will be left blank. Number 19.- Dentist will print name Number 20 and 21- The phone number and fax number of the dentist office will be documented here. Number 16 and 17 the dentist office name and address will be documented here Number 18.- The dentist will sign the form Number 19 – The date the service (exam, treatment, preventive care) was completed would be place here. Form will be entered into Child Plus by Monitor’s, and filed in the child’s brown folder under flap #4.

25. Parent Consent for Services Make sure that all the questions have been answered by the parent Section 1. - Put child’s full name Section 2.- We prefer all answers be YES, however if parent answers NO, FSW’s will need to re-ask to clarify answer if still NO document and let SM/TL know. Number 11. In Section 2. Is permission for children’s pictures to be taken, Make sure that teachers know who those children are who have NO answers! Section 3. - Must be signed and dated by staff person completing form. Ensure that Parent or Guardian have also signed and dated. Form will be entered into Child Plus by FSW’s and then filed in the child’s brown folder under flap #5.

27. Consent for Lead and/or Hematocrit Testing using a Finger Stick Method Instructions All parents’ sign a Consent for Lead and/or Hematocrit Testing using a Finger Stick Method at the time they enroll into the program unless they refuse for blood work to be completed. This consent will be used if we can not get the needed results from the provider.

28. 14-15

29. Consent for Lead and/or Hematocrit Testing using a Finger Stick Method This information is used in reporting data to the state of Texas, as all lead results have to be reported to Austin. Section #1, To be completed at time of enrollment as part of the enrollment process. This form is good for one (1) year from date signed. Parent will be notified before it is utilized. ◦ Do not leave any blanks. ◦ Please fill in Medicaid or insurance information. Section #2, To be completed at time of enrollment as part of the enrollment process. ◦ All blanks need to be completed. ◦ Please have parent complete address with City and Zip Code. ◦ Ethnicity and Race must be checked as this is used in reporting to the state of Texas. ◦ Please include the child’s primary physician and location. Section #3, To be completed by SPCAA Nurse at the time the blood work is completed. The Consent for Lead and/or Hematocrit will be filed in the child’s brown folder under flap #5 after completed with family to be used if needed. When completed by SPCAA Nurse, form will be filed in the brown folder under flap #4 under the physical exam form.

30. Refused- Consent for Lead and/or Hematocrit Testing using a Finger Stick Method Instructions This form is only used at enrollment if parent refuses for blood work to be completed. Section #1, To be completed at time of enrollment as part of the enrollment process. Section # 2, Parent signature and date form was completed. The Refusal for Consent for Lead and/or Hematocrit will be filed in the child’s brown folder under flap #5 after completed with family. The form will be filed in the brown folder under flap #5.

31. 1. 2.

32. Tuberculosis (TB) Screening Parent Questionnaire Do not leave any blanks. Section 1. – Complete with Center/Partner name, child’s name, and date. Section 2. – An ‘X’ will be placed under the section parent indicates. ◦ If any answers are “Yes” or “I Don’t Know” except question # 1, the parent will need to provide TB skin test results OR a Dr.’s note stating why the child may or may not need an additional TB skin test. Form will be entered into ChildPlus by FSW’s, and filed in the child’s brown folder under flap #4.

34. Lead Risk Questionnaire Do not leave any blanks. Section 1. – Complete with Center/Partner name, Child’s name, and Date. Section 2. – An ‘X’ will be placed under the section parent indicates. ◦ If ‘Yes or I Don’t Know’ is marked, then you will need to let the SPCAA Nurse know so it can be determined if child needs an additional lead test completed. ◦ When a ‘Yes or I Don’t Know’ is noted on the form the Lead Risk Questionnaire will be entered into ChildPlus as a failed event. ◦ If child fails Lead Risk Questionnaire after a Lead test has been completed, the child may need an additional Lead test completed. Contact the SPCAA Nurse. Form will be entered into ChildPlus by FSW’s and filed in the child’s brown folder under flap #4.

36. Medical and Dental Emergency Consent/History Form Do not leave any blanks if question asks for information Section 1. – Complete Parent name, Child’s name, and Center name are completed at top of form. Section 2-4. – Print physician name, address with city, state, zip code and telephone number Section 5-7. – Print name of facility, address with city, state, zip code and telephone number Section 8. – Complete all portions. ◦ If box marked ‘No Problems’ is checked, nothing else is needed. ◦ If any other box is marked, please have parent explain. ◦ If child is receiving services from another agency, please complete what agency is providing services. ◦ If any finding is noted, complete a contact note in ChildPlus detailing information parent provides. Do not complete Health History part 2 for abnormal findings in this section. Section 9. – Complete this section with parent. ◦ If yes to any of the questions (4-6)in the black box, you must complete Health History part 2. ◦ Parent must provide supporting documentation for all items marked abnormal in this section. For no documentation complete a contact note under Medical/Dental Emergency Consent History Form in ChildPlus. ◦ If child will be receiving medication at the center, please refer parent to assigned personnel to complete medication administration forms. Section 10. – Must be signed and dated by parent and staff Form will be entered into ChildPlus by FSW’s and filed in the child’s brown folder under Flap #5. Copy of the form is to go on field trips.

38. Health History Part 2 Form Sections 1-5. – Please complete appropriate section according to which area parent provides documentation for. If the section does not apply to the child, mark the ‘Not Applicable’ box. ◦ For child with asthma, parent will need to bring an asthma action plan from the Dr at time of enrollment ◦ For child with diabetes taking insulin at the center, parent will need to bring in documentation from Dr detailing exact dosing information and times to be given. Section 6. – If child will be taking medication at the center, explain medication procedure and let them know the designated personnel at the center they will give medication to when they bring it to the center. If child takes medication daily, a Health Management Plan will need to be completed by SPCAA Nurse. Section 7. – Must be signed and dated by parent and staff Form will be entered into ChildPlus by FSW’s and filed in the child’s brown folder under Flap #4.

40. Questions?????? Answers…..