Traci Dalton
WV Head Start State
Collaboration Director
Rebecca J. King
Coordinator
WVDE-Office of Healthy Schools
2010/11 School Nurse Needs Assessment
Medical Diagnoses
In-School Specialized
Health Care Procedures
Asthma
Inhalers for Asthma
Behavioral Disorders
Emergency Medications
Anaphylactic Reaction
Long-Term Medications
Obesity
Special Diets per Federal Form
Mental Disorders (Depression, Bipolar,
Schizophrenic, Suicidal)
Seizure Management
Close 5th places…..
Ear, Nose and Throat/
Migraine or Severe Headache/Seizures
Diabetes Type II
2010/11
Student Medical Diagnoses
Diabetes Type I
16145
Seizures
18000
11491
16000
14000
12000
10000
8000
6000
4000
2000
0
238
852
2147
4213
Anaphylactic
Reaction
Behavioral
Disorders/ADD/AD
HD/OCD/Anxiety
Asthma
5.4. All children entering an approved participating WV PreK 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/PreK_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.

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.

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.

HealthCheck (EPSDT) Only
▪ No massive screenings
▪ Working closely with the child’s medial and dental
home

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.
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

§ 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:

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:

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



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

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 Medicaideligible 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

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

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

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

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
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

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

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
Get involved with your
Regional School Wellness
Committee by contacting
your
RESA-Regional School
Wellness Specialist (RSWS)
Contact Information:
Traci Dalton
Email: Traci.L.Dalton@wv.gov
Phone: 304-356-4604
THANK YOU!