LACOE Health Service Area Manual

Transcription

1 LACOE Health Service Area Manual Revised: July 1, 2017

2 LACOE Health Service Area Manual Table of Contents OVERVIEW... 4 Head Start Health Services... 4 THE ROLE AND RESPONSIBILITIES OF THE HEALTH COORDINATOR & HEALTH STAFF... 5 Program Planning & Service System Design... 6 Data & Evaluation... 6 Fiscal Management... 7 Community & Self-Assessment... 7 Facilities & Learning Environments... 8 Transportation... 8 Technology & Information Systems... 8 Training & Professional Development... 8 Communication... 9 Record-keeping & Reporting Ongoing Monitoring & Continuous Improvement Human Resources MINIMUM EXPECTATIONS FOR PROGRAM SERVICES Subpart D Health Program Services Purpose (a) Health Services Advisory Committee (b) Collaboration and Communication with Parents (a) Consent (b)(1) Health emergencies (b)(2) Child health status and care Ensuring up-to-date child health status (b) Health History (b)(i) Immunizations (b)(i) Follow-up for Children Not Up-to-date (b)(ii) Anticipatory Guidance (b)(i) Vision and Hearing Screenings (b)(2) LACOE Health Service Area Manual Page 2 of 64

3 Ongoing care (c) Extended follow-up care (d) Oral health practices Family support services for health Health and Well-being Education Opportunities (b)(1) Navigation through health systems (b)(2) Safety practices Facilities (b)(1) Equipment and materials (b)(2) Background Checks (b)(3) Safety Training (b)(4) Safety Practices (b)(5) Hygiene practices (b)(6) Hand washing, Diapering, Toileting (b)(6)(i) Safe Food Preparation (b)(6)(ii) Bloodborne Pathogens (b)(6)(iii) Administrative safety practices (b)(7) Emergencies (b)(7)(i) Fire Prevention and Response (b)(7)(ii) Illness Management (b)(7)(iii) Medication Administration (b)(7)(iv) Release of Children (b)(7)(v) Specific Health Care Needs and Food Allergies (b)(7)(vi) Disaster preparedness plan (b)(8) Reporting of Safety Incidents (c) Subpart H Services to Enrolled Pregnant Women Enrolled pregnant women Two-week postpartum/newborn home visit (d) Prenatal and postpartum information, education, and services APPENDIX LACOE Health Service Area Manual Page 3 of 64

4 OVERVIEW The Los Angeles County Office of Education (LACOE) administers Head Start (HS), Early Head Start (EHS), Early Head Start-Child Care Partnerships (EHS-CCP), California State Preschool (CSPP), and General Child Care and Development (CCTR) programs in designated areas of Los Angeles County. Within LACOE, the Head Start-State Preschool Division ensures delegate agencies and early childhood education providers (DA/ECEPs) operate these quality through four pillars of responsibility: 1) Program Leadership and Accountability, 2) Collaboration, Communication, and Outreach, 3) Assessment and Continuous Improvement, and 4) Workforce Development and Professional Learning. This manual focuses on the specific requirements related to management, planning, and oversight of health services and programs for quality service delivery. In addition, LACOE s focus on each of the pillars is embedded in this document with accountability expectations for LACOE as the grantee and for each DA/ECEP. Services are provided in a variety of program settings, including center-based, home-based, socializations, and family child care homes. Programs also offer several options, including partday and full-day services that operate from nine to 12 months a year. LACOE does not operate programs directly, but rather contracts direct services to non-profit organizations and public agencies. For the purposes of this manual, the term DA refers to delegate agencies and/or early childhood education providers. Head Start Health Services Head Start has maintained a strong commitment to promoting the overall health of Head Start and Early Head Start children and their families. Head Start was established on a philosophy that a child is not ready to learn unless they are first healthy, secure, and receiving adequate nutrition. Head Start has maintained this commitment to the importance of health as an integral part of school readiness since the program began in In 2016, the Office of Head Start (OHS) released revised Head Start Program Performance Standards (HSPPS), effective November 1, The performance standards were originally released in the 1970s and the last revision prior to 2016 was in The new format has been streamlined and reorganized to make the new HSPPS easier for programs to use, follow, and implement. Major changes related to health services include: The entire health section (now Subpart D) was reorganized; however, core health services were retained due to the strong connection between health, school readiness, and long-term outcomes Developmental and behavioral screenings were moved to Subpart C: Education and Child Development LACOE Health Service Area Manual Page 4 of 64

5 Language regarding individualization was moved to Subpart F: Disabilities Oral health is highlighted Parent education in health is emphasized Mental health was strengthened to reflect best practices Subpart H relates to services for pregnant women and expectant families THE ROLE AND RESPONSIBILITIES OF THE HEALTH COORDINATOR & HEALTH STAFF The Head Start Management Systems Wheel 1 illustrates the twelve Head Start program management, planning, and oversight systems (figure below). The following sections describe how the roles and responsibilities of the health coordinator and health staff are related to each of these systems. DAs can use the Head Start Management Systems: Guiding Questions to assess the system and health services within each of these management systems at their own agency. Refer to 1 Head Start Management Systems. U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, National Center on Program Management and Fiscal Operations LACOE Health Service Area Manual Page 5 of 64

6 Program Planning & Service System Design The health coordinator is usually responsible for developing the DA s health policies and procedures. This planning process must ensure the implementation of health services in a manner that is consistent with the following indicators: All federal, state, and local regulations Mandates in LACOE s grantee instructional memos (GIM) Information and trends in the annual community assessment Health-related goals and activities in the annual funding application Health-related goals and activities in the annual school readiness plan Results from the annual self-assessment Grantee monitoring results DA and grantee data Recommendations from the Health Services Advisory Committee (HSAC) To ensure all mandates are captured in the agency s policies and procedures, as well as to avoid duplication of services, it is recommended that DA service areas collaborate when developing their policies and procedures. This collaboration should include reviewing all relevant agency policies and procedures (beyond just health services), identifying activities where health staff have responsibilities in other service areas and where other service area staff are responsible for health activities, and cross-training where needed. The following are the minimum expectations for health services related to program planning and service design: 1. Since the Health GIM follows the same order and uses the same section headings as the HSPPS, the DA s health policies and procedures must then do the same, using the order and section headings in the Health GIM (also refer to table of contents). This consistency across programs ensures that all regulations and mandates are addressed and easy to reference. 2. Health policies and procedures must be reviewed and updated at least annually and at a minimum when updates or revisions of the LACOE Health GIM/Manual are received. Data & Evaluation The revised HSPPS emphasize using data throughout the program to drive planning and quality service delivery. Examples of health data sources include, but are not limited to, ongoing monitoring of required health services, timelines, and reasons that services are not at the 100% threshold; LACOE Health Service Area Manual Page 6 of 64

7 community assessment; self-assessment; and other ongoing monitoring results. Health coordinators are encouraged to use their health data for continuous program improvement and to share with LACOE and the appropriate governing and planning committees (e.g., policy council, HSAC, and board). Grantee-wide health data is also used to drive program improvement throughout the grantee. Fiscal Management (e) Use of funds (1) A program must use program funds for the provision of diapers and formula for enrolled children during the program day; (2) A program may use program funds for professional medical and oral health services when no other source of funding is available. When program funds are used for such services, grantee and delegate agencies must have written documentation of their efforts to access other available sources of funding. The health coordinator should contribute to the agency s budgeting process as it relates to health services and the mandate above. The following may contribute to fiscal planning and management, including non-federal share for health services: Purchasing supplies Funding required services Need for contracted health consultant services Previous program year health expenditures Medical and dental insurance coverage and service provider trends Availability of local medical and dental services and resources through other funded programs and sources (e.g., dental van, children s vision program) Mandatory health trainings and professional development Health Services Advisory Committee Community & Self-Assessment The health coordinator should participate in and provide content area expertise to the agency s annual self-assessment and community assessment. Data from both assessment activities should be used for ongoing program evaluation and program improvement planning. Results should be shared with the HSAC, especially for assistance with developing program improvement strategies. Results from the DA s self-assessment process and any noncompliance areas from LACOE monitoring must be included in the DA s final self-assessment report. DAs must submit a Program Improvement Plan (PIP) to address all noncompliances. The DA s health coordinator and LACOE staff will monitor implementation of the strategies in the PIP and verify final correction(s). LACOE Health Service Area Manual Page 7 of 64

8 Facilities & Learning Environments It is expected that the health coordinator will collaborate with other DA staff to support, monitor and ensure healthy and safe facilities and learning environments for all children, families, and staff in its programs. Health-related mandates are in this GIM. Refer also to the Safe Practices and Facility Management GIM. Transportation DAs that provide transportation should refer to the Transportation GIM. Technology & Information Systems ChildPlus is LACOE s record-keeping system. LACOE provides the DAs with the support, materials, and training needed to implement ChildPlus consistently throughout the grantee. The following are the minimum expectations for health services related to technology and information systems: 1. All DAs are required to enter health information into the ChildPlus system according to the instructions in the ChildPlus Health & Nutrition Services manual. 2. DAs must ensure that any staff responsible for health-related data entry have attended the comprehensive, introductory Health and Nutrition ChildPlus Training at LACOE. 3. The health coordinator must ensure that all health and other staff as needed have access to the most current ChildPlus Health & Nutrition Services manual. 4. The health coordinator must monitor data entry trends at their agency to determine any subsequent health-related ChildPlus training needed at their agency. 5. Ongoing ChildPlus training, technical assistance, and support at the agency should be provided primarily by the health coordinator, referring to the ChildPlus Health & Nutrition Manual for clarification. If the health coordinator or other agency staff person needs assistance, then a training and technical assistance request should be submitted to the grantee. Training & Professional Development LACOE health staff supports DAs operations and delivery of health services by providing professional training and staff development opportunities, expert technical assistance, leadership, and guidance in the field. LACOE Health Service Area Manual Page 8 of 64

9 At the DA, the health coordinator should collaborate with management staff on the agency s annual training plan for staff, parents, and volunteers. The health coordinator or designee will contribute health content area expertise when developing the plan. Refer to the Human Resources GIM for detailed mandates on staff orientation, professional development, and training. This includes how trainings are documented, tracked, and monitored. Subpart D, (b) of this manual addresses specific health-related parent training opportunities that the agency must offer and provides specific mandates for staff and volunteer trainings. Communication The following are the minimum expectations for health services related to communication: 1. DAs must have communication procedures related to health services which are culturally, linguistically, and developmentally appropriate. 2. DAs must have communication procedures which provide the opportunity for all service areas to come together and share necessary information about the children and families in their program, often referred to as case management, care coordination, multidisciplinary case management, or team meetings. These meetings also assist with coordinating between service areas to ensure all children have received required health services and follow-up. Refer to the Multidisciplinary Team Meetings GIM for additional expectations across service areas. 3. DAs must have communication procedures which plan for individualized, safe, and inclusive care for all children: Multidisciplinary team meeting (collaboration with internal and external services) Individualized health care planning Communication with parents/families Communication with health professionals and community providers 4. The agency s transition procedures must include the role of health services in transition and the transition of relevant health documents, including but not limited to: Immunizations Child health status Individualized health care planning, including medications LACOE Health Service Area Manual Page 9 of 64

10 The following mandates specifically address follow-up as part of communication: 1. DAs must initiate and maintain regular communication with families and/or health care providers until a problem or need for follow-up is resolved. 2. Regular follow-up must be individualized for each concern. Always document the planned date(s) and person responsible for subsequent follow-up. 3. Thorough documentation of follow-up also must include enough details to tell an adequate story (e.g., who, how, what, when, results of follow-up). 4. All follow-up must be clearly documented in ChildPlus according to the instructions in the ChildPlus Data Entry for Health and Nutrition Module and the DA s record-keeping procedures (d)(2) 5. The health coordinator must monitor follow-up activities, including timelines and documentation, according to the agency s ongoing monitoring procedures. 6. Timely, effective health follow-up requires purposeful communication and collaboration with all stakeholders, including the child s family, medical and dental care providers, and other staff at the agency. This includes, but is not limited to: Providing support and assistance to families where needed, including empowering them to be their child s primary health advocate. Case management or other similar staff communication procedures (refer to communication management system above). Facilitating and encouraging ongoing partnerships with medical and dental providers that serve the children in the program and community to support timely and complete medical and dental care. Assisting parents, as needed, in obtaining any prescribed medication, aids, or equipment for medical and oral health conditions (d)(3) Record-keeping & Reporting The following are the minimum expectations for health services related to record-keeping and reporting: 1. DAs must establish and maintain efficient and effective record-keeping systems for health services as part of the DA s record-keeping procedures. 2. ChildPlus is LACOE s standardized record-keeping and reporting system. All DAs are LACOE Health Service Area Manual Page 10 of 64

11 required to enter health information into the ChildPlus database according to the instructions in the ChildPlus Health & Nutrition Services Manual. 3. Health record-keeping (including, but not limited to, health files and ChildPlus data entry) must be complete, accurate, and up-to-date. 4. Use LACOE standardized forms where applicable. All standardized forms are accessible on the prekkid.org website. 5. DA record-keeping procedures must also ensure: Forms are complete and do not have sections that are incomplete or blank. When there is an area that is not applicable or the information is located on another form, this should be indicated on that form. The original integrity of the document is maintained (e.g., when updating with a phone order). Potential discrepancies between records are clarified. 6. Information in ChildPlus must be consistent with information in the child s files. 7. DAs must include the protection of health services and health information as part of their confidentiality policies, including procedures to ensure personally identifiable information is stored, released, and transferred in a way that protects the privacy of the child and family. 8. When requesting information from a medical or dental provider via mail or fax, a copy of the DA s general consent and/or LACOE s Authorization for Release and Exchange of Information form must be included with the request and the request marked Confidential. 9. DAs must establish and maintain efficient and effective reporting systems for health services as part of the DA s reporting procedures. 10. Minimum expectations for health reporting include: LACOE Monthly Health Services Report by the 10th of the month. The current report template is accessible on the prekkid.org website. Annual California Immunization report Annual Program Information Report (PIR) reporting Health-related unusual incident reporting (including outbreaks and epidemic reports) Refer to Unusual Incident Reporting GIM Other reports as needed or required by the LACOE Contract Exhibit E LACOE Health Service Area Manual Page 11 of 64

12 Ongoing Monitoring & Continuous Improvement Together, LACOE and the DAs are responsible for coordinated ongoing monitoring and continuous improvement activities that: Ensure quality services for all children and families Comply with all federal, state, and local regulations, grantee mandates, and the DA s own policies and procedures. LAOCE staff conduct regular monitoring activities to ensure continued compliance, sustainability, and delivery of quality services, and to validate the DA s own ongoing monitoring. Monitoring activities include on-site visits, observations, review of documents and reports, interviews, and discussions with DA staff. LACOE documents all monitoring and technical assistance activities and reports them to DAs using a monitoring and tracking system/database. The Monitoring for Successful Outcomes GIM provides additional details about LACOE s approach to monitoring. The following are the minimum expectations for health services related to ongoing monitoring and continuous improvement: 1. The DA must have procedures for its ongoing monitoring of health services as part of the agency s overall ongoing monitoring policies. 2. Ongoing monitoring should include health information in children s records and ChildPlus, health and safety practices, and other health-related activities. 3. The health-related ongoing monitoring procedure(s) must include at a minimum: What is being monitored Person(s) responsible Frequency/schedule Data collection and aggregation activities Data analysis Plan to respond to results and develop corrective action plans How the information is shared NOTE: DAs are required to have agency ongoing monitoring policies and procedures. DAs may also have specific ongoing monitoring activities and indicators with individual health procedures. LACOE Health Service Area Manual Page 12 of 64

13 Human Resources The health coordinator serves a vital role in program management, planning, and oversight for the agency s health services area. Health staffing will vary and is dependent on characteristics unique to each agency, including size, location, demographics of children and families, and program options. DAs are encouraged to use the following OHS tools to assist with planning and supporting professional development for health staff: Head Start Health Services Competencies: A Tool to Support Health Managers and Staff Head Start Health Services Competencies Professional Development Assessment These are located on ECKLC at Minimum expectations related to human resources for the agency to ensure quality health services are found in the Human Resources GIM. MINIMUM EXPECTATIONS FOR PROGRAM SERVICES Subpart D Health Program Services Purpose (a) The intent of the mandates in these sections of the GIM, along with the other LACOE GIMs, is to provide the DA and its health coordinator with the minimum expectations to ensure: High-quality health services Health services that are culturally, linguistically, and developmentally appropriate Each child s growth and school readiness are supported Health Services Advisory Committee (b) 1. DAs must establish a Health Services Advisory Committee (HSAC) and procedures to guide it. 2. The DA s HSAC must align with the health needs and trends of the children, families, and communities it serves. This includes using information from the following data sources: Community assessment Community partners LACOE Health Service Area Manual Page 13 of 64

14 DA s reports/trends (e.g., PIR, Self-Assessment, grantee reports) 3. Dependent on DA individual needs, the DAs approach to their HSAC meetings may include one or more of the following: Convening a DA HSAC Collaborating with other DAs in their assigned LACOE region to convene combined HSAC meetings Participating as a representative of their own agency at another local Head Start HSAC Convening health issue-specific HSACs (e.g., dental health HSAC) 4. DAs must attend at least two HSAC meetings per year and be responsible for planning and facilitating at least one of them. 5. DAs must recruit and select community health care professionals to participate as HSAC members and ensure there is representation that is diverse and has the expertise to address the DA s and community s unique health issues, trends, and challenges. 6. Policies for HSAC must include procedures for: Ensuring a structure that allows members the opportunity to drive the agenda, participate in discussions, and provide information and strategies to address the unique health issues of the DA and community Orientation and support for members to be knowledgeable about Head Start and their role as a member of HSAC Documentation, such as meeting invitations, sign-in sheets, in-kind tracking, meeting agendas, and minutes 7. DAs must have procedures to include parents in the HSAC meetings by: Addressing any needs or challenges parents have, such as transportation, child care, translation, etc. Encouraging parents who attend HSAC meetings to provide policy committee and parent committees with HSAC reports. DAs are encouraged to reference HSAC resources, including Weaving Connections on ECKLC. LACOE Health Service Area Manual Page 14 of 64

15 Collaboration and Communication with Parents (a) For all activities in Subpart D, DAs must work to: Collaborate with parents as partners in the health and well-being of their children in a linguistically and culturally appropriate manner. Communicate with parents about their child s health needs and developmental concerns in a timely and effective manner. Consent (b)(1) 1. All children must have the LACOE standardized General Consent form for routine services, signed by the child s legal guardian. The DA must have procedures to ensure that the purpose of these services are explained and to describe how all results will be provided to families. 2. The LACOE Authorization for Release and Exchange of Information form is also required if additional information beyond general consent is needed. 3. If at any time, a parent or guardian refuses to give authorization for health services, the DA must maintain written documentation of the refusal. Health emergencies (b)(2) 1. DAs must have procedures on how they ensure parents are aware of the DA s policies for health emergencies that require rapid response by the staff or other emergency medical attention. This can include, but is not limited to: Posting at the site, classroom, socialization, or family child care homes (FCCH) Including in the parent handbook Including in parent orientation Child health status and care Source of health care (a) 1. As part of the health history completed during the enrollment process and within 30 days from the start date, DAs must make a determination as to whether each child has medical and dental insurance and a medical and dental home, and record this information in the designated areas of the Health History and enter in ChildPlus. 2. If a family does not have medical insurance, dental insurance, a medical home, and/or a LACOE Health Service Area Manual Page 15 of 64

16 dental home for their child, DAs must provide resources, referrals, and/or additional assistance as needed to secure them as soon as possible. Evidence of follow-up to secure the medical/dental homes and insurance must be documented, at a minimum, in ChildPlus (b) 3. DAs must maintain a current list of local resources/referrals for medical and dental insurance and providers. Resources should focus on providers that can offer services to children and families eligible for Head Start services. Ensuring up-to-date child health status (b) Health History (b)(i) 1. A comprehensive health history must be completed on all children prior to the start date using LACOE s standardized Health History form. For children served in the home-based program option, the Health History must be completed by or during the first home visit. 2. Refer to the instructions for the Health History for completing, reviewing, and following up on information on the Health History, including completing the Health History with the parent or guardian in an interactive, interview style and not leaving any areas incomplete. Immunizations (b)(i) Documentation of Immunizations 1. Beginning during the time of application, DAs must ensure that they have documentation of all required immunizations for the child s age (including a catch-up schedule). Specific immunizations required to attend licensed child care in California are listed in the most current Guide to Immunizations Required for Child Care or Preschool (IMM-230) from the California Department of Public Health. 2. Proof of the child s immunization status must come from an official document. This is usually the California Immunization Record (CIR) or Yellow Card ; however, it can also be found on international immunization records, in the immunization registry, or on an official record or form from a medical provider. 3. Immunizations must be accurately entered into ChildPlus by the start date to ensure effective monitoring for licensing requirements. 4. Enrollment status is not affected by outstanding immunization requirements. In the event that a required immunization(s) is still outstanding at the start date, the child will require a medical exclusion from the classroom until the minimum immunizations needed per state LACOE Health Service Area Manual Page 16 of 64

17 requirements i.e., an immunization status of completed all for age or up-to-date all possible for age are verified: Work with families to obtain the immunizations as soon as possible. This includes supporting attendance of homeless children (c) Provide families with verbal and written communication that lists the outstanding vaccines still required to start in the classroom. Provide families with assistance and/or referrals to obtain the required vaccines as quickly as possible. Clearly document the status and follow-up in ChildPlus and share with key DA staff. Document the additional vaccines, once verified, prior to the child starting in the classroom and update the immunizations in ChildPlus. California School Immunization Record (CSIR) or Blue Card 1. LACOE has approval from the California Immunization Branch for DAs to generate the CSIR card electronically through ChildPlus. A copy of this approval can be accessed on the prekkid.org website in the event that California Community Care Licensing Division (CCLD) or the California Immunization Branch needs documentation of the approval. 2. DAs must print a CSIR card from ChildPlus for every enrolled child within 14 days from the start date (using blue paper if available). 3. Once printed, Section I. Documentation on the CSIR card must be completed, including the date, staff signature, and the record presented. Other sections in the documentation box should be left blank. Refer to the California Immunization Handbook for Schools and Child Care Programs. 4. All subsequent immunizations received after the CSIR card is printed must be entered in ChildPlus and the CSIR card updated. Personal Waiver or Medical Exemption 1. Prior to January 1, 2016, parents had the right to refuse or waive vaccinations for their child with documentation from a health care provider that they had been informed about vaccines and diseases. Effective January 1, 2016, SB 277: No longer permits immunization exemptions based on personal beliefs Permits personal belief exemptions that were submitted before January 1, 2016 to remain valid until a pupil reaches transitional kindergarten (TK) or kindergarten. Refer to LACOE Health Service Area Manual Page 17 of 64

18 California Immunization Handbook or the Shots for School website. 2. A medical exemption is still permitted with documentation from the health care provider. 3. DA must explain to the family that in the event of one or more suspected or confirmed cases of a disease that their child has not been vaccinated against, their child will need to be excluded from the classroom until cleared to return by a health care provider. 4. Indicate the waiver in the Status of Immunization box on the CSIR card. 5. Waiver information must be entered into ChildPlus per the data entry instructions. 6. For any children that still have a current personal beliefs exemption, DA staff must partner with families and the medical home to plan for immunizations for transition to TK or kindergarten. Recommended Vaccines 1. In addition to the required vaccines for licensed child care in California, DAs must also document in ChildPlus those recommended in the annual Recommended Immunization Schedule from the Center for Disease Control (CDC) Advisory Committee on Immunization Practices, American Academy of Pediatrics, and American Academy of Family Physicians. To ensure the CSIR is complete and all vaccines can be accurately tracked, all vaccines must be entered in ChildPlus according to the instructions in the ChildPlus Data Entry for Health and Nutrition Services. 2. Although children are not excluded for missing recommended vaccines, like required vaccines, the DA must have a procedure to both advise families in the event that additional recommended vaccines are due and to document these efforts. Screening for Tuberculosis (TB) 1. At a minimum, every child is required to have a TB risk assessment and/or a TB screening completed by a physician (or designee) within 30 days of the entry date. 2. The results of all TB risk assessments, TB screenings, associated strategies, and/or treatment must be documented in ChildPlus according to the instructions in the ChildPlus Health & Nutrition Services Manual. 3. DAs must have recommendations from local experts (e.g., Health Services Advisory Committee) to support a policy that requires universal TB screening of all children in the program, since this is stricter than the current CCLD regulations. LACOE Health Service Area Manual Page 18 of 64

19 4. DAs must ensure information and resources for TB screening are available for all family members and household contacts of children with a positive TB screening. Physical & Dental Examinations 1. Beginning at the time of application, the DA must work with families and provide assistance as needed to obtain documentation of California Child Health & Disability Program (CHDP) required screenings for all enrolling children. Refer to the AAP Bright Futures Recommendations for Preventive Pediatric Health Care and the CHDP Periodicity Schedule for Dental Referral by Age. 2. LACOE s Physical Exam and Dental Exam forms are the standardized forms that DAs must provide to families to take to their medical and dental providers. However, since Head Start programs are dependent on outside providers to complete the forms, agencies may accept other documents submitted by medical and dental providers. Examples include: CHDP form Bright Futures physical form Report of Health Examination for School Entry PM 171A (State of California form used for K-12 entry) California Child Care Licensing Physical Form LIC 701 Photocopy of the medical or dental provider s records Health Document Review Refer to the Health & Nutrition Services Timeline document. 1. Health documents including, but not limited to, the Health History, Physical Exam, and Dental Exam must be reviewed by designated DA health staff within required timelines. 2. All health-related documents should be initialed and dated at time of receipt. 3. The DA must have policies for conducting document review, including Which staff will be responsible for 45 and 90 review timelines How and when to initiate referrals to the content area expert(s) or others as needed Prioritizing files for review by the content area expert(s), to ensure timely planning and follow-up where needed LACOE Health Service Area Manual Page 19 of 64

20 Documenting the date of review, needed actions in ChildPlus, and responsibilities for follow-up related to the specific health event. Determination of Child Health Status 1. Completion of the 45-day review of health documents (at a minimum the Health History, Physical Exam, and Dental Exam) must occur by 45 calendar days from the child s start date (or 45 calendar days from the receipt of the form for physical or dental forms received after the start date). 2. The 90-day review of health documents must be completed by the DA s content area expert(s) for health services by 90 calendar days from the child s start date (or 90 calendar days from the receipt of each form, for physical or dental forms received after the start date). This ensures health documents are reviewed and a determination of health status is made by a health professional within 90 days. 3. The 90-day determination of health status must include a review of all health-related documents available at the time of the review, including but not limited to, the Health History, Nutrition Screening, Physical Exam, Dental Exam, immunizations, screening tests, medication forms, and additional medical or dental information and in-house or outside medical or dental referrals. All forms reviewed must be signed and dated. Documentation of the 90-day review in ChildPlus must include the outstanding health requirements at the time of the review and the next steps to obtain the information. Follow-up for Children Not Up-to-date (b)(ii) 1. To ensure compliance with CCLD s 30-day timeline, when the physical examination form is not available on the child s start date, DA staff must record the appointment date of the physical examination prior to or at the time the child starts in the classroom. Appointment date must be documented in ChildPlus according to the instructions in the Health & Nutrition ChildPlus Manual. 2. The DA must work with the family and the child s medical/dental homes to obtain any outstanding screenings, results, and follow-up services to ensure documentation of complete and up-to-date medical and dental examinations. For example, a physical form is not considered complete without a blood lead level. If missing, DA staff would then need to follow up with the family to ensure the child had blood drawn. If so, the agency should contact the health care provider by phone or fax to obtain the results. 3. There may be occasions where families encounter barriers to obtaining the mandated health LACOE Health Service Area Manual Page 20 of 64

21 care services described above and/or the DA may have challenges obtaining required documentation. To overcome challenges and ensure compliance, DAs are required to identify and document any barrier(s) and develop individualized and program-wide strategies to overcome them. 4. All strategies, including assistance, follow-up, scheduled appointments, and referrals, must be thoroughly documented (including in ChildPlus). Follow-up strategies with families and/or providers must be varied and ongoing until receipt of all the required documentation is achieved. For example, if a letter of notification given to a family is unsuccessful, a different strategy must then be identified. Regular meetings between staff and service areas (e.g., case management or multidisciplinary meetings) could be used to develop these alternative strategies. 5. Although DAs are required to comply with federal and state regulations and timelines, programs must never exclude children from the classroom or program as a strategy to obtain information, including: Enrollment status must not be affected by missing health documentation. Written or verbal information must not be given to families that states or infers that priority or enrollment is affected due to missing health documents. Incomplete Initial Screening for Tuberculosis per CCLD If a child does not have either a TB risk assessment, TB skin test, or a waiver from the parent or health care provider within 30 days of the start date, the child will need a short-term exclusion from the classroom until the DA receives the documentation. The DA must assist the family with obtaining the screening to minimize the length of the short-term exclusion. The status and followup must be documented and shared with key DA staff. Note: There may be extenuating circumstances or reasons why obtaining the TB screening within 30 days is not possible. For a child to remain in the classroom past 30 days and until the screening is obtained, it must be discussed and agreed upon with a LACOE health consultant. Both the reason and continued follow-up activities would need to be thoroughly documented in ChildPlus. Anticipatory Guidance (b)(i) 1. DAs must have procedures to ensure age-appropriate anticipatory guidance is provided at enrollment and subsequent intervals per the AAP Bright Futures Recommendations for Preventive Pediatric Health Care. LACOE Health Service Area Manual Page 21 of 64

22 2. At a minimum, DAs must use the age-appropriate Bright Futures Parent Handout, accessible on prekkid.org. Vision and Hearing Screenings (b)(2) 1. Vision screening: EHS vision screening = Instrument-based screening for refractive errors, i.e. SPOT, SureSight (6 months to 2 years, 11 months) HS vision screening = Recognition Visual Acuity (Optotype-based) screening i.e. LEA symbol eye chart/cards or instrument-based screening for refractive errors (3 5 years) 2. Hearing screenings: EHS hearing screening = Otoaccoustic Emissions (OAE) screening test (birth to 2 years, 11 months) HS hearing screening = Pure tone play audiometry or OAE screening test (3 5 years) 3. When sensory screening results are taken from the child s physical exam, DAs must ensure they are objective results that include either a numeric value or a specific indication of pass or fail. Within normal limits (WNL) would need to be verified with the health care provider office to ensure that an objective screening was completed. Unacceptable results would be those that are not measurable, i.e., grossly normal, too young to test, or uncooperative. 4. The method(s) of screening, results, and actions must be documented in ChildPlus. 5. If vision and hearing screening results are not entered at the point of service, the DA must ensure they have additional tracking tools to monitor compliance with sensory screening timelines (e.g., hearing and vision screening logs used in the classroom when screenings are performed). 6. The DA must ensure the agency has adequate procedures and staff certified in age-appropriate vision and hearing screening at the agency to ensure all newly enrolled children are able to receive vision and hearing screenings within the required 45-day timeline. 7. The health coordinator must track staff certifications in vision and hearing, including number currently certified and expiration dates. Tracking includes information on hearing and vision certification that is already required on the annual staff qualification matrix submitted to LACOE. Refer to the LACOE Human Resources GIM. 8. The DA must have procedures to support continued proficiency of staff conducting vision and hearing screenings between certification dates. LACOE Health Service Area Manual Page 22 of 64

23 Initial sensory screenings within 45 days 1. DAs must ensure that all new enrollees (i.e., children starting their first year), have developmentally appropriate sensory screenings (hearing and vision) within 45 days from the start date. 2. DAs can use sensory screening results from the child s physical exam, certified DA staff, or outside agencies to meet requirements for the 45-day sensory screenings. Note: The screening date must be within one year prior to the child s start date to meet the required 45-day sensory screening timeline. 3. For infants in EHS who enroll between birth and six months, DAs must obtain the following sensory screenings within 45 days: a. The DA must attempt to obtain the newborn hearing screening results. If the infant has failed the newborn hearing screening, the agency must collaborate with the parents, medical home, and/or the newborn hearing screening program to determine if adequate follow-up has occurred b. Hearing results from the physical exam c. For children without a physical exam within 45 days, DA must conduct an OAE for hearing d. Vision results from the physical exam form Note: Since instrument-based screening for vision is not indicated prior to six months, it is imperative that DAs obtain a physical exam within 45 days. 4. For infants and toddlers in EHS who enroll between six months and three years, DA must conduct instrument-based screenings for hearing and vision if a physical exam is not obtained within 45 days. Communication with parents 1. Since general consent is usually obtained early in the enrollment period, DAs must also have procedures to notify families of the actual screening date (or range of dates). 2. The agency must have procedures to ensure that all screening results are shared with parents, including rationale for any referrals for further evaluation and the importance of sharing the results with the child s medical home. LACOE Health Service Area Manual Page 23 of 64

24 Rescreens When a child does not pass the first screening conducted by Head Start staff, the result is recorded as a Rescreen and the rescreening must be completed within the following timelines: Vision rescreens must be within two to four weeks of the initial screening date. Hearing rescreens must be within four to six weeks of the initial screening date. Note: Absent on screening date does not stop the clock and does not meet the mandated 45- day screening timeline; therefore, DAs must ensure that staff return to conduct the screening within the 45-day timeline. Follow-up 1. A referral to the child s medical home is required when a child does not pass the second screening attempt and must be initiated within two weeks of the screening date using the standardized LACOE Head Start Health Referral and Follow-up form. 2. Follow-up must also occur when it is noted that the child failed a vision and/or hearing screening on the physical exam or newborn hearing exam. 3. When a child does not pass a professional screening conducted by an outside agency (e.g., UCLA Children s Vision Program), this typically results in a referral and/or further evaluation and a rescreen by the DA is not needed. DAs must refer to the timelines and procedures for further evaluation as specified in the memorandum of understanding (MOU) with that specific agency. 4. DAs must continue to follow up, including documentation in ChildPlus, until there is a status of complete achieved in ChildPlus for that sensory screening event. 5. For a child who is referred for not passing hearing screenings and it was determined that they were treated for an ear infection and/or a middle ear effusion, DAs must rescreen hearing four to six weeks after treatment is completed. Subsequent screenings Head Start (3 to 5 years) Once the initial screening requirements are met, DAs must ensure that subsequent screenings are documented and/or conducted according to the periodicity in the AAP Bright Futures Recommendations for Preventive Pediatric Health Care. LACOE Health Service Area Manual Page 24 of 64

25 Subsequent screenings EHS (0 to 3 years) 1. Developmentally appropriate vision and hearing assessments are documented as part of the regular physical exams per the AAP Bright Futures Recommendations for Preventive Pediatric Health Care completed by the medical provider. 2. DA must perform subsequent instrument-based screenings at 12 and 24 months of age or more often, if needed, based on parent or teacher concerns 3. DAs must have procedures to obtain vision and hearing concerns as per the AAP Bright Futures Recommendations for Preventive Pediatric Health Care. Refer to the ageappropriate questions on the Bright Futures Pre-visit Questionnaire. Ongoing care (c) Continue to Follow Recommended Schedule of Health Care (c)(1) DAs must help parents continue to follow recommended schedules of well-child and oral health care per the AAP Bright Futures Recommendations for Preventive Pediatric Health Care. Subsequent Immunizations Needed During the Program Year In certain cases, a child may start the program with All the immunizations possible for their age, but subsequent vaccines will be needed during the program year. Examples include Early Head Start children birth to 18 months or children that start with a conditional admittance because they are behind in their immunizations and are currently on a catch-up schedule. 1. DAs must ensure that these children receive the subsequent vaccines by monitoring ChildPlus reports (at least monthly) to identify which children are due for additional vaccines and when. 2. When an enrolled child s vaccines come due, the DA must follow the instructions, requirements, and timelines in the California Immunization Handbook for Schools and Child Care Programs. 3. Subsequent vaccines and follow-ups with families must be documented in ChildPlus and the CSIR card updated. Subsequent TB Screening Once the initial TB risk assessment or screening is obtained, DAs must ensure children receive subsequent TB risk assessments according to the AAP Bright Futures Recommendations for Preventive Pediatric Health Care. This information can be obtained from the pre-visit questionnaire and/or from the physical exam. LACOE Health Service Area Manual Page 25 of 64

26 Note: These subsequent TB risk assessments/screenings are not required by CCLD and therefore do not affect the child s ability to participate in the program (i.e., does not require a medical exclusion). For subsequent risk assessment results that are not available on a current physical exam, the assessment can be completed by DA staff and must be reviewed by the agency s health content area expert for referrals as needed. Subsequent Medical and Dental Care 1. Throughout the child s entire enrollment, DAs must continue to obtain documentation that the child remains up-to-date with the AAP Bright Futures Recommendations for Preventive Pediatric Health Care and CHDP Dental Periodicity, by obtaining documentation of any subsequent age-appropriate physical and dental examinations and screening tests once they expire. 2. Follow-up strategies with families and/or providers must be varied and ongoing until receipt of all the required documentation is achieved. Periodic Assessment (c)(2) DAs must implement periodic observations for parents and staff to collaborate and identify any new or reoccurring developmental, medical, oral, or mental health concerns. At a minimum, this must include an updated health history using either a Bright Futures questionnaire or Health History form: 1. Age-appropriate Bright Futures Previsit Questionnaires: Completed prior to the subsequent physical exam (2, 4, 6, 9, 12, 15, 18, 24, 30, and 36 months, 4 years, and 5 years). The questionnaires may be completed in an interview style or given to the parents to complete and return. Note: Use of this Bright Futures Toolkit assists DAs to meet multiple requirements stressed in the new Performance Standards. It empowers families to follow recommended schedules of well child and oral health care. Reviewing with and providing these materials to families educates and prepares them for expected screenings and immunizations, and encourages parental concerns and questions. 2. LACOE standardized Health History form: For returning children, the original enrollment Health History must be reviewed with the parent/guardian prior to the new program year. LACOE Health Service Area Manual Page 26 of 64