Health Institute
May 21, 2013
Head Start Health Regulations
1304.20
Kristen Smith
Health Management Consultant
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Performance Standards 1304.20
Early Childhood Development and Health Services
Child Health and Developmental Services
(a) Determining child health status
(b) Developmental, sensory, and behavioral
screenings
(c) Extended follow-up and treatment
(d) Ongoing care
(e) Involving parents
(f) Individualization
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Performance Standards
30, 45 and 90 Day Timelines
30 Days
• Physical
Exam/WBC’s (CB)
• TB Clearance (risk
assessment or
TST if needed)
(CB)
45 Days
• Sensory
Vision
Hearing
• Developmental
• Social Emotional
90 Days
• Physical
Exam/WBC’s (HB)
• TB Clearance(HB)
• Growth
Assessment
• Hgb/Hct
• Lead Test
• LR Assessment
• Blood Pressure
(HS)
• Dental Assessment
(EHS) or Dental
Exam (HS)
101220.1 Immunizations(CB)
(a) Prior to admission to a child care center, children shall be immunized against diseases as required by
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the California Code of Regulations, Title 17, commencing with Section 6000.
Enrollment and Entry Requirements
Policy Clarification
OHS – PC – I – 057
Can a child be denied entry into Head Start if they are not up
to date on their physical or immunizations
No, there is no Head Start Program Performance Standard that
requires a child be up-to-date on their physical or immunizations
prior to entering the Head Start program. However, some states
prohibit a child from entering a child care center until they have a
physical and/or meet State immunization requirements and in
these situations a program would have no choice but to not enroll
the child until the child had received all required health services.
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30 Day Screenings
Title 22 Child Care Licensing Regulation
(101220) Child Medical Assessment
(d) If a medical assessment is not available for a
child and cannot be obtained within 30 days of
admission:


(1) A medical appointment date shall be obtained from
the authorized representative upon the child's
admission.
(2) A TB test shall be obtained on the child within 30
days of admission.
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45 Day Screenings
Developmental, Sensory & Behavioral
1304.20 (b)(1)
Within 45 calendar days of child’s entry, grantee
must perform or obtain linguistically and age
appropriate developmental, sensory, and behavioral
screenings.
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Policy Clarification
OHS – PC – C – 002
Must a Head Start child in the child’s second year of Head
Start be re-screened for developmental concerns?
No. A child must receive the initial screening for developmental,
sensory and behavioral concerns “within 45 days of the child’s
entry into the program”. Thereafter, the Head Start program must
conduct ongoing assessments of each child's development
throughout the child’s enrollment.
For sensory domains such as vision and hearing, screening
procedures should be re-administered on the periodicity
schedule required by State EPSDT schedule, or more frequently if
recommended by the Health Services Advisory Committee.
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90 Days Screenings
Determining Child Health Status
1304.20(a)(1)(ii)
In collaboration with the parents and as quickly as possible,
but no later than 90 calendar days …

Obtain from a health care professional a determination as
to whether the child is up-to-date on a schedule of age
appropriate preventive and primary health care which
includes medical, dental and mental health.

Such a schedule must incorporate the requirements for a
schedule of well child care utilized by the state’s EPSDT
program. (CA- CHDP)
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Health Services: Follow-up Care
Determining Child Health Status
1304.20(a)(1)(ii)
(1) In collaboration with the parents and as quickly as
possible, but no later than 90 calendar days …
(A) For children not up-to-date on an age
appropriate schedule of well child care, grantee and
delegate agencies must assist parents in making the
necessary arrangements to bring the child up-todate.
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Health Services: Follow-up Care
1304.20(a)(1)(iv)
Determining Child Health Status
(within 90 days…..)
“Develop and implement a follow-up plan for
any condition identified in 45 CFR
1304.20a(1)(ii) (iv) so that any needed
treatment has begun.”
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Health Services: Follow-up Care
1304.20(c)(1)
Extended Follow-up and Treatment
“Grantee and delegate agencies must
establish a system of ongoing
communication with the parents of children
with identified health needs to facilitate the
implementation of the follow-up plan.”
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Health Services: Follow-up Care
1304.20(d)
Ongoing Care
“Grantee and delegate agencies must
implement ongoing procedures by which
Early Head Start and Head Start staff can
identify any new or recurring medical, dental,
or developmental concerns so that they may
quickly make appropriate referrals.”
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Health Services: Follow-Up Care
1304.20(e)(1)
Involving Parents
“Consult with parents immediately when
child health or developmental problems are
suspected or identified.”
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Health Services: Follow-Up Care 1304.20(f)(1)
Individualization
“Grantee and delegate agencies must use the
information from the screening for developmental,
sensory, and behavioral concerns, the ongoing
observations, medical, and dental evaluations and
treatments, and insights from the child’s parents
to help staff and parents determine how the
program can best respond to each child’s
individual characteristics, strengths and needs.”
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Challenges with Follow-Up Care





No Targeted efforts to “assist” families
Lack of Documentation
Delayed-Not Timely
No Closed Loop- where services received?
Inconsistent system for monitoring
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Small Group Activity
Instructions:

Review case scenario

Discuss challenges with health follow-up

Develop strategies to address concern

Report out to large group
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