**FTS-HHS ACF**

**Moderator: Mr. Eugene Gousie**

**June 18, 2008**

**1:00 pm CT**

Coordinator: Good afternoon and thank you for standing by. All lines
will be in a listen-only mode until the question and answer session. To
ask a question, please press star 1.

Today's conference is being recorded if anyone has any objections you
may disconnect at this time.

Now I'll turn the meeting over to your host for today's call, Mr. Eugene
Gousie. You may begin.

Eugene Gousie: Good morning to some of you and good afternoon to others.
This is Gene Gousie and I'm with the Head Start T&TA network here in
Region 10, joined by my colleague Louise Gill.

This is one of our monthly training and technical assistance regional
conference calls. And we're pleased that today several members of the
regional office staff can join us.

Julianne Crevitan is here, Dorothy Shields, Laura Bocchetti and Leslie
Jenkins. Our topic today is around the PIR, the changes in the PIR as
you look at completing that in the upcoming months.

And also to frame this in a larger way to talk about the data collection
and analysis that accompanies not just the PIR, but all of the outcomes
driven data or the data that your program does and could collect.

So we'll be talking today about the PIR update and entries to data
entry, data collection, data analysis and use of that information.

We will be taking questions at the end of the presentation and as the
operator noted you will have an opportunity to ask those on the phone.
If you care to email them in or call them in to Annelle Bogus prior to
that time you can do so by calling her at 206-615-3648 or emailing her
at Annelle, A-N-N-E-L-L-E, dot Bogus, B-O-G-U-S at A-C-F dot H-H-S dot
G-O-V.

And we're going to start this morning by turning this over to Louise.

Louise Gill: Okay. Well good morning everyone, this is Louise Gill and
if you're following along in the slide presentation, we're on the second
slide. I want to briefly talk about the PIR update for the 2008 PIR.

We put the information that you can print the PIR off of the Early
Childhood Learning and Knowledge Center and the web pages there and also
you can go on the PIR web page at Xtria and print the summary of
changes.

So really for 2008 there are not many changes. There are just
clarifications basically to questions, there are clarifications to
enrollment and program option questions, program staff and
qualifications.

There are some more clarification and then in the section Child and
Family Services, there are clarifications regarding questions there. So
if you look at your PIR in some of the sections, they will have the
clarification at the bottom of the question section.

And it's usually under if there's place for comments, there will be some
type of clarification there. Now in transportation and facilities, there
are some new questions. If you were to look at that section, question
C56, last year it was just one broad question.

This year they've broken it into C56 A and they've added a new question,
C57 and C57A.

And then they've also added some information under C58, center names. So
that is where you have the option of reporting the different centers in
which there is a federal interest.

So basically that is really all the changes so really the only change
has been in transportation and facilities, and further clarification is
in the explanation of words in the question in the other section.

So if we move to the next slide, understanding PIR questions, I can't
stress enough to just read the questions. Read the instruction out of
the user's guide which you can get off the PIR web page.

Read those, read the question and then just answer the question. Don't
agonize over fine distinctions. Don't read something into the question
that is not there, because that will just create more stress for you and
it really just adds a lot of time to trying to answer these questions,
so please just read the question and use your user guide and answer it
to the best of your knowledge.

Okay, now I'm going to turn it back over to Gene.

Eugene Gousie: Thank you, Louise. As I mentioned earlier we will be
talking about collecting and entering data in this part, and we're
talking not just about PIR data but all data that you deal with.

The overall guidance when we're dealing with data of any kind is to
develop systems that will provide us with valid and reliable data.

Valid data means data that is indeed measuring what you intend it to.
For example, if you're measuring something like services to parents, you
need to know how it is that the PIR directions are defining that term,
because you want to measure something that is indeed the services for
parents and not something that's outside that scope.

Otherwise you're setting yourself up for some invalid data. And on the
reliable end, you want to be checking your systems on a regular basis to
make sure that the data collection and the information you're getting
from the data is not dependent on one person's perspective on this, but
that indeed different people in the organization could pull up the same
results.

> So let's turn to the next one where we look at parts of the process of
> collecting and entering data, for instance the definition, the
> collection point, the collection entity, the collection means, the
> mechanism or data base and the extraction.

What you'll want to do is check your systems to see that you have
developed procedures around each of these points and that you review
them periodically. We've already talked about the importance of the
definition.

And sometimes the terms that you will be collecting data around are used
more broadly than the PIR does. Or they may not be defined by an outside
group such as a funder but are left to you to define, in which case
you're looking for a definition that makes practical sense, something
that's fairly intuitive, so that when you use that term everybody will
have a pretty good idea of what you're talking about. And something that
can be easily explained and lends itself to measurement.

The collection points are the times of the year when you collect data.
It may make sense to collect data on a given variable or question on a
monthly basis or a quarterly basis or a yearly basis depending when the
data is available, how easy or difficult is it to collect the data, what
other data is being collected that you can collect at the same time, and
other factors such as the cost or the resources used by the program to
collect the data and the availability of the staff and complexity of the
data.

When we talk about the collection entity, we're talking about who it is
that collects that and to some extent this will depend on the means of
collection or how the data is collected. Are you collecting data
directly from individuals who are basically responding to you in an
interview format? That would dictate who it is that's collecting the
data, the person doing the interviewing.

Are you collecting data by reviewing forms? Well, that would indicate
perhaps someone else is doing the data collection. Who is doing the data
collection will depend upon the ways in which you are collecting the
data.

Are you doing it from observations? Are you doing it with the person who
is closest to the activity?

> When we talk about the collection mechanism or the database, that is
> the program's means of storing and also slicing and dicing the data.
> You can invest in a more complex and expensive database which will
> give you many more opportunities to slice and dice that data and pull
> up more sophisticated analysis. Now on the other hand that will also
> cost you more. It will require more training and on the whole it will
> use up more program resources.
>
> The collection extraction part of the process also includes that
> slicing and dicing and the questions that come with it, as well as
> determining in the organization who is the best person to be doing
> that collection extraction.

Louise Gill: Before we move on I just want to say that I think the key
here is that the person who is collecting this information not only for
the PIR but anything else, your self assessment, your community
assessment, has to understand what they're collecting, what do these
questions mean and what is the intention of this report? I think that's
why we get a lot of skewed information sometimes, especially on the PIR,
it's because the person who's collecting the data doesn't really
understand its use.

Eugene Gousie: Right, it's not just a person who is filling out the PIR,
it's people at each step of the process that we're talking about: who's
entering the data, do they have an idea of why work's being done there?
Who is collecting the data and who is reviewing it?

Louise Gill: Let's move over to slide number nine, monitoring the
process. This is the key. This is the key with everything I think in
Head Start is the monitoring process.

In your reviews this is where we find a lot of findings in the PIR. This
is why your numbers don't add up sometimes, because for whatever reason
we don't monitor this information on a regular basis.

There are steps in monitoring. You need to know who is overseeing the
process. Everybody can't oversee the PIR monitoring. There's got to be
one main person on your staff who truly loves the PIR and is willing to
take this on.

When and how often, Gene mentioned a while ago that you could collect
data on a monthly basis, a quarterly basis or yearly basis. For the
PIR's purposes, I would recommend that you don't wait for the yearly
collection of this.

This needs to be monitored all year long and so therefore you need to
look at how you're collecting this data and what are you collecting. But
it needs to be done if not on a monthly basis I would recommend a
quarterly basis, definitely.

I know your staff goes crazy when some programs say okay we've got the
PIR, we've got to get this information and nobody has been collecting
this information. And I know, I've heard we don't know what the
questions are until we get the PIR.

But you can see for the past couple of years, the PIR pretty much stays
the same. So I would just go with what you've had this year to collect
for next year.

And then in what ways are you collecting it? What are you doing to get
this data? What tools are you using? I've had recent discussion with
some of my grantees that says, well, you know this software does good to
a certain point and then it's not good after that.

Really look at the software you're using to compilate all this data.
What's being recorded as you document, know the questions of the source
that you're trying to gather information from.

What's being reported? What are you asking? What's your final outcome?
Who are you sending this information to? It shouldn't just be the data
entry person that gets this information.

Everybody on your management team should have this information because
it's so important, this drives your whole program. So this is a very key
part, monitoring the process and it's an ongoing part, as we all know.

Gene?

Eugene Gousie: We turn to analyzing the PIR numbers. First thing you
want to do is check for reliability and validity, check your process.
Have you assured yourself that you're measuring what you wanted to be
measuring, and as a result it's reliable?

Check each of the data points. Where is it that you're collecting the
data and who's doing that collection and how can you check to see one
more time that the data is being collected properly and entered
properly?

Look for fluctuations in key variables. This becomes part of the bigger
piece that we'll talk about in a couple minutes about telling the story
of your PIR numbers, the contextual elements that affect the PIR numbers
for the year.

Were there some major environmental factors that skewed the data this
year and if so, you want to recognize that and you want to enter that
information in some of the content boxes where you have the opportunity
to explain that.

Again, as you're thinking about analyzing this data and beginning to
apply it to changes in the program, what other data do you have that you
can compare your program's data with?

For a start you have your own in house historical data. What changes are
you seeing, what trends? What variables are fluctuating?

You can pull data or access data on similar kinds of grantees, again to
give you a sense of where your program falls in the bigger scheme; you
can look at regional data numbers and same thing with national numbers,
again to give you a sense, some reality testing of where your data fits
and what you might use that for.

Louise Gill: And I just want to say for the national and the states or
the regional information, if you wanted to compare your program to the
other programs in the region, we here at the regional office will be
glad to assist you with that.

Don't hesitate to ask us for that information.

Eugene Gousie: In using data to develop action plans, you'll want to use
not just the PIR numbers but, as you develop action plans based on the
data, consider other data sources.

What are your community partners collecting? What information is
contained in your community assessment? Use the data to identify
strategies that seem to be working and those that you'd like to take a
closer look at.

This is using some of those rising numbers and the falling numbers to
trigger your attention to the specific strategies you use. You may have
strategies that are very successful but don't actually impact your
outcome, so you want to look for places where the changes in the
strategies link to the changes in your outcomes, in this case the PIR
numbers.

So don't think of those strategies in isolation either but realize they
impact each other as well as link to the outcomes.

Keep your focus on your outcomes even as you consider strategies to
change. And remember strategies will produce unintended consequences and
keep these in mind as you review the strategies that you're using to
produce the changes in your outcomes. Those strategies also have costs
as well as benefits associated with them.

> So what are some common challenges to the whole data collection
> process and analysis?

One is certainly around training. Training is usually not a one time
event even if it involves the same individuals over time. As staff leave
or change responsibilities you'll need to do more training and how much
training you do will depend on the sophistication and complexity of your
data system and of your data collection system.

Now finding the right software is a frequent challenge. Don't choose one
just because it worked for someone else. You'll have to try it out in
your own program, evaluate your own needs and your resources and the
capacity of your program to implement a new software package.

And give it some time to play itself out so that you begin to get a feel
for the accuracy, the reliability, the validity of the numbers in the
information that you're getting from that package.

Trust the data collection process. Sometimes new coordinators or
directors make changes in the process because they don't like the
analysis of the data done by their predecessor. Separate the person
doing the analysis or separate the analysis from the data collection
process. Is the data good is your first question, then what can we do in
terms of analysis of that data and moving forward on that.

And then owning the data collection process. It's a dangerous thing to
put a process such as this in the hands of one person or make one person
responsible for this, because then again you can't really trust it,
really test the reliability of it. And it puts an incredible burden on
one person, to say nothing of the bind that the program finds itself in
if that person is no longer available.

On the next slide, a few more challenges, balancing centralization and
decentralization. Some aspects of the data collection process typically
take place at a central office. And other parts, usually the data
collection part, often take place in the field in numerous locations
done with numerous staff. Now sometimes programs change the process to
become more centralized or more decentralized without really looking at
the ramifications of that. And they are around training, they are around
reliability of the data, they are around the forms you use, all of those
kinds of things.

> The leadership at the top level really is necessary to make some
> changes when you're changing your data collection process or even
> ensuring that it's a robust and reliable system.

And for any new and increased effort, there's a price to pay. The
program may use more resources, staff take on new responsibilities.
Parents may be involved in new ways or more intense ways. Get as clear
as you can toward the program about what it will take to make changes in
your data collection process and make sure the program is willing and
able to make that commitment.

Finally, this data, the PIR data like other data that your program
collects, does not exist in isolation. So the PIR is telling a
particular story about your organization, a very data driven story.

Again use those comment boxes to provide the kind of context that helps
make sense of the information you've collected, particularly if it's
something unusual, you have a real drop in some way, or something has
spiked one way or another.

And the PIR data is part of a bigger set of data about program outcomes
as a whole, child outcomes, that is available for you to use to tell the
bigger story about the success and value of the work that your
organization does.

A future TA call will be focusing on the annual reports and outcome
measures and reporting to help tell that bigger picture.

At this point we are going to open up our lines, operator, to take
questions from participants and we have a room full of folks here to
respond to them.

Coordinator: Thank you at this time if you would like to ask a question
please press star 1. You will be announced prior to asking your
question. To withdraw your question press star 2.

Once again to ask you question please press star 1.

Eugene Gousie: Great, and while we're waiting for the first to come in
we have one that has come in from email and I'm going to ask Julianne to
read that.

Julianne Crevitan: Good afternoon everybody or good morning. This is
Julianne Crevitan and I do have the first question that came in to
Annelle via email. Before I answer this question I want people to know
and I think, I'm not sure who's on the phone so it's a little hard to
know if you are the direct service person who's actually doing a lot of
data entry.

If you're a manager, if you're a program specialist, if you're a content
specialist, I will give a little bit of background because I'm not sure
who all sees which level of reports.

The question that I'm being asked, the question that's on the table
right now is about the program indicator report. "When my program
completes the PIR data report, this is a summary of raw data. When this
data goes into Xtria which is the contractor who manages the PIR, they
actually perform and produce summary data reports for the regional
office. And out of that we get a performance indicator report and we get
a summary report that we can pull down and take a look at.

And often times that is the one that should much more broadly and may be
used to look at the progress of Head Start across the country. In that
report all the data comes out in percentages. It doesn't come out in raw
data, and so the question that's being asked is how do the percents get
calculated?

> There are formulas embedded behind many of the PIR questions. The
> formulas are drawing the data from maybe two different places and
> producing a percent. So it is absolutely critical when you enter data
> to really respond to the question. If it's talking about total
> enrollment, you need to be sure you're counting all the children.

When you calculate a percent your denominator number is an important
number because that's the population that the percent is basing its
assessment on.

The question is, "How is the following performance indicator computed?"
This must be coming from someone who I'm guessing is a manager, where in
the PIR report does the data come from to compute the percentage in the
following area?

On the PIR performance indicator report, there's a question. Children up
to date on a schedule of preventative and primary care, when we received
the indicator report, which is what we usually talk to programs about,
we're looking to have programs at 90% or higher on all of the indicator
reports.

In the question, this is the formula. To get the percent you take the
question that asks the number of children who have received medical
exams, that's the numerator.

The denominator is the total actual enrollment of children, minus the
children that were enrolled for less than 45 days. So it is those two
questions that are put together in the data analysis when they produce
the report that give us the percent of children that are up to date on
the schedule of preventative and primary care.

So it is two questions and that's how we get a percent. Behind what you
all see is how are these calculations done and how do these percents get
produced in the indicator reports.

And so there are formulas for many of the questions that are on the
summary reports. Anyway, that answers that one but it's a long way to
get there and that's more likely more data than you wanted.

Louise Gill: So then, Julianne, it's very important that they understand
what they're answering, the difference between actual enrollment numbers
and funded enrollment. You've got to understand those definitions and
all of that is in your user guide.

Julianne Crevitan: Absolutely.

Eugene Gousie: All right, we're ready for a question.

Coordinator: Our first question comes from Jose De Leon.

(Jose De Leon): Actually (Jenessa), but\...

(Jenessa): Hi, good afternoon, just a quick question. Based off that
formula example that was just given, would it be possible for Xtria to
post a formula sheet based off those formula indicators?

Julianne Crevitan: Yes, I actually have the formula sheet and will make
it available after the call.

Louise Gill: We can post that on our website. Also there will be minutes
from this phone call and a recording on the Region 10 web page, at
<http://www.acf.hhs.gov/programs/region10/programs/head_start_tta/region_10_fcp.html>.

Julianne Crevitan: Contact Louise or Gene if you have questions or
problems in accessing that.

Coordinator: Our next question comes from Kim Steiner.

(Angie Hanson): Hi, it's actually Angie Hanson from Head Start of Lane
County. I have a question regarding Section B, program staff and
qualifications.

My question is when we have staff that will fill two roles. For example,
we have a position that is called community childcare specialist. And
they act in both the capacity of a teacher and a family services staff
person. And I would say roughly they do 50% ed and 50% family services.

I'm assuming we don't count them twice when we're filling out the data
regarding their educational qualifications, but how should we decide
where we put those people on the - as far as the data?

Julianne Crevitan: If you truly believe that they're 50/50, I'd say pick
one or the other, I'd say pick where they are most qualified and put
them in the area that they have the greatest degreed background for the
position.

If you have them in a combined position and they have more expertise in
training in a certain field, I would put them there.

(Angie Hanson): Okay, thank you.

Coordinator: Thank you, once again to ask a question please press
star 1. Jolene Connor.

(Jolene Connor): Hi this is Jolene from Head Start in Wenatchee,
Washington. We have a question on the family service question number 47,
C47.

Do we count the number of referrals made or only the referrals that
we're certain the family received? And perhaps they are getting that
service from the community. But we're referring them somewhere.

Louise Gill: Okay, this is Louise and the program specialists help me
here. That question is asking for services received. So there is a
difference between a referral and a service.

So what you have to do is you've got to follow up. Once you refer them
to an agency or whatever, then you've got to find out from the family if
they actually received a service?

So a referral would not count by itself. Say you referred them to the
mental health agency and you never followed up with them, you don't know
if they received services or not, you can't count that.

That's the referral. But if you referred them, you followed through, you
caught up with them, they said oh yes, we're going for appointments,
that's services.

They actually received something. Does that make - is that clear?

(Jolene Connor): Yes, thank you so much.

Louise Gill: We used to ask for referrals and my gosh we do thousands of
referrals. What they truly want to know now is are our families actually
receiving something from all these referrals we're giving our families.

(Jolene Connor): Awesome, thank you.

Julianne Crevitan: That's a really good clarification when you say you
know that statement says that received services, they have to have some
outcome as a result of the referral. That's a really nice distinction.

Louise Gill: I go back to my very first slide, do not read so much into
these questions, just really look at what is service and what is the
referral, and you're answering for service.

Cindy Johnson: Hello, this is Cindy Johnson, from NeighborImpact Head
Start and my question is regarding the table of the PIR on page 15 that
talks about the qualifications of child development staff.

Our program has an educational specialist and we also have center
coordinators. Would I use both of those personnel in the child
development supervisors category?

Julianne Crevitan: Are your site supervisors all ed managers, education
trained? There's a lot of programs that have site managers who are not
background degreed in education.

Cindy Johnson: Our site supervisors are trained to be in the classroom
as a lead teacher, so they can fill that role. So they all have an
educational background, yes.

Louise Gill: Do they supervisor the teachers?

Cindy Johnson: Yes.

Julianne Crevitan: If your site managers are basically performing the
roles and ed supervisor, then they are at supervisor/site manager.

Eugene Gousie: Let me do a little reminder here while we're waiting.
Sometimes we get calls from programs or we get them or Xtria gets them
part way through the year looking to revise the data that they have sent
in from the previous year.

Which is not possible, once it's finalized, entered into the national
database, Xtria does not take your data and backtrack the whole thing to
perform some operations on it.

It's a reminder to double check that data before it gets sent on its way
and make sure it's as accurate as possible.

Coordinator: Lorenzo Garza, you may ask your question.

(Lorenzo Garza): I had a question on page 16 regarding the average
salary of direct child development staff.

The average annual salary in comparison to average hourly rate, is there
a simple easy process to calculate that? I always struggle with that
every year.

Louise Gill: Okay, so you're looking at question number B13 through 15?

(Lorenzo Garza): Correct.

Louise Gill: I'm going to read to you what it says in the user guide. It
says "report the average annual salary of teachers, assistance teachers
and home based visitors regardless of the qualifications. Report the
full salary even if part or all of the salary is funded by a non-ACF
source or if the position is split between programs. Do not annualize
the salary to 12 months, enter the actual dollar amount paid to the
staff member even if they work less than 12 months of the year."

Julianne Crevitan: You take all of the salaries, sum all the salaries
and divide by the number of teachers, by the number of staff, and that
comes up with the annual salary. And they show you in the guide if you
print that out, it shows you an actual formula and they give you an
example. So you could get your one, two, three, four, five, six, add up
all these salaries and divide by the total number and that will give you
the average annual teacher's salary.

(Lorenzo Garza): All right thank you.

Louise Gill: And then when you're gathering each individual teacher make
sure you only gather for the number of months they worked.

(Lorenzo Garza): Right, correct.

Louise Gill: Not for 12 months.

(Lorenzo Garza): All right, thank you both.

Coordinator: Joyce Painter, you may ask your question.

(Joyce Painter): Hi. This is Joyce Painter with Lower Columbia College,
Head Start ECEAP in Longview.

My question is back on family services 47, and just wondering if a
family for instance needs information or wants some assistance with
their child with toilet training, and our direct service staff gives
them that information.

I'm assuming that would count as a referral met? Or service rendered,
or - am I correct on that? That's a big question for our staff.

Louise Gill: What category would you put that under? Let me ask you that
first.

(Joyce Painter): Well I think it could either go under parent education
or health education. Parenting education.

Louise Gill: Say it's parenting education, I agree with that. And do you
think your parents received a service by your staff giving them
information on potty training?

(Joyce Painter): Yes.

Louise Gill: Okay.

(Joyce Painter): Okay, great thank you.

Eugene Gousie: However, it should be clear to everybody in the program
that that's the definition of the service and so everybody will be
making the same kind of determination.

Louise Gill: Exactly, so make sure everybody's counting information that
they give to parents on potty training.

(Joyce Painter): Right, right.

Coordinator: We have one other question. Sarah Kuenzli.

(Sarah Kuenzli): I have a little bit of a concern in the section C
around medical documentation - it seems as though in the guide this year
it's real explicit around an EPSDT well child exam is required. And that
if sections of that exam according to what's supposed to be happening
don't happen then you don't get the count back.

Is that right?

Louise Gill: Well we're going to have a little discussion on that
(Sarah), hold on. Okay, you program specialists?

Leslie Jenkins: It does seem to be very extreme. This is something that
we need to go get further clarification on from the office of Head
Start. Right now I would advise you just to answer the question as it is
written.

If we have further clarification we'll put it through in a regional
letter, but right now answer the question as it is written.

Louise Gill: Okay, so for that - for further clarification on that, on
that question C9, answer the question as it's written and read the
clarification in your user guide and that same clarification is right
there on the question.

And so if your child does not meet all of the EPSDT exams, you won't
count them as up to date until we get further notice.

Coordinator: Maureen Short, you may ask your question.

(Maureen Short): Good morning Leslie.

Leslie Jenkins: Hi there.

(Maureen Short): My question is regarding your answer. In the state of
Oregon with the EPSDT schedule that we have a waiver for, explain to me
how we might go about that, answering that question as how it's written
if they're not required to follow that table.

We assume that they're making, that they're following the guidelines
that are out there, but we have no way to assure that. So how do we
answer that in Oregon?

(Terry Elofson): I think we need to get back to the group with these -
this is (Terri Elofson). I think we need to get back to this group with
some of these issues because there's just too much at stake in terms of
program problems if we get the answers wrong.

And I think it probably is going to entail talking to the Xtria people
and Office of Head Start people

Louise Gill: Office of Head Start is going to have to have the final
answer on this one.

(Terry Elofson): I think that would be a better way to go so that -
especially with a waiver, what does that waiver mean. I mean I don't
honestly know what it means but what does that mean to the state so that
the state can respond in the most appropriate, correct way that they
can.

Leslie Jenkins: I think one way that you can persist forward is if
there's an opportunity in ECLKC to forward questions and this is one way
to surface it directly from the program position.

(Maureen Short): To surface questions through the ECLKC?

Louise Gill: The Early Childhood Learning and Knowledge Center.

(Maureen Short): Right, I thought we were supposed to send our questions
to the region and not directly do that?

Terry Elofson: Because we don't have a definite answer, the answer is
going to have to come from OHS. And probably you would get a faster
response in putting it on the ECLKC than sending it to us, because we
would then have to forward it to the office of Head Start.

(Maureen Short): Okay.

Terry Elofson: The Office of Head Start has been notified that there is
a problem with the lead screening in our region and with the Oregon
waiver. However, we have not received a response back on how to address
that issue.

Leslie Jenkins: If memory serves me correct I believe that the state of
Oregon has been in communication with Julianne. This is an issue that
they've been in discussion on.

Louise Gill: Leslie, I know that they're talking to the Oregon health
plan administrators about that as well and we're just waiting to hear,
we should hear something after the director's meeting occurring this
week in the State of Oregon.

(Maureen Short): But you know my concern is that we just had our Risk
Management Meeting with you all just recently, and I'm looking at my PIR
numbers and they're going to be right at 90%, and so - and this is the
first year that it's been that way.

But if I'm asked to recalculate them based on an EPSDT schedule, I can't
even do that for you at this point. That would take a lot of going back
and speaking with physicians about whether - what their well child exam
entailed.

If it's something other than what their guidance is in the state of
Oregon, so I don't even know if I could meet an August deadline with
that. So I'm more than willing to put that question out on the ECLKC.

(Terry Elofson): I would think that Nancy Hutchins would really want to
see this question, too, because she has been working with the
pediatrician at the national office and they have been talking about
this in Region 10.

Nancy Hutchins has been talking to everyone about this out in DC. And I
think it might actually help for her to take that question forward.

If I remember correctly the director's meeting is next week, or is it
the week after in Oregon?

(Maureen Short): It's Friday.

(Terry Elofson): It's this Friday. She is planning to talk to them, so
that could come up then and I will be carry it and all these program
specialists can carry it down to her, too.

Leslie Jenkins: (Maureen), why don't you send me an email what you just
discussed. We frankly expected this question to come up first.

Not that we have a really good answer as you can see, but we anticipated
it and go ahead and send me the email, I'll forward it both to (Terry)
and to Nancy. And we'll keep it real high on our radar.

(Maureen Short): So let me ask for clarification, so you don't want me
to put it on the ECLKC website, just send a question to three\...

Leslie Jenkins: Yeah, start with sending it to me, I'll forward it and
we'll see where we go.

Louise Gill: Well I just want to throw something else into the mix, so
what are you going to do if you've got an exam and the doctor marks that
they're up to date.

(Maureen Short): If they complete that and say that they're up to date,
I assume he knows what the guidance is for well child exam and what all
that entails, and when I do my PIR that child is considered up to date.

I, as a nurse, I look to him to be able to provide a well child exam
check that meets the requirements put out by the American Pediatrics
Association.

I do not question them although I will be speaking to all the physicians
that will attend a meeting about what the requirement is of Head Start
and how we can work together to provide a well child exam that meets the
needs of Head Start as well as physicians.

And if we can do that in a way that doesn't deplete their resources.

Louise Gill: Great answer. Great answer. So I hope everybody else heard
that. If the doctor is marked that this child is up to date, you know
the doctor's aware of all this stuff coming down through the state, so
what do you think. Are they up to date or not?

(Maureen Short): They're up to date.

Louise Gill: And then we'll have further clarification as soon as we
can. But that may be after August, after you have to submit these
reports. We just don't know how quickly we're going to get this
resolved.

(Maureen Short): Thank you, that answers my question wonderfully.

(Terry Elofson): I'd just like to this is not just a western issue,
either. It's across the country issue.

Louise Gill: Yes, I recognize that in speaking to my cohorts across the
nation.

Eugene Gousie: All right, other questions?

Coordinator: At this time I'm not showing any further questions.

Eugene Gousie: Great. We will take the opportunity then to thank you all
for your participation today. The information from this call will be up
on our website and any further questions you may have, feel free to send
them in and we'll address them as they come in.

Thanks to all our guests.

END