Welcome to the 

Head Start Self-Assessment:

Your Foundation for Building 

Program Excellence

Head Start Self-Assessment: 

Your Foundation for Building Program Excellence

Table of Contents

Page

Introduction . . . . . . . . . Intro-1

Stage 1: Preparing Your Self-Assessment . . . . 1-1

Stage 2: Collecting and Synthesizing the Information . . . 2-1

Booklets on:

Program Governance . . . . . . . 2-1-1

Planning . . . . . . . . 2-2-1

Communication . . . . . . . 2-3-1

Recordkeeping and Reporting . . . . . 2-4-1

Ongoing Monitoring . . . . . . . 2-5-1

Human Resources . . . . . . . 2-6-1

Fiscal Management . . . . . . . 2-7-1

Prevention and Early Intervention . . . . . 2-8-1

Tracking and Follow-up . . . . . . 2-9-1

Individualization . . . . . . . 2-10-1

Disabilities Services . . . . . . . 2-11-1

Curriculum and Assessment . . . . . . 2-12-1

Family Partnership Building . . . . . . 2-13-1

Parent Involvement . . . . . . . 2-14-1

Community and Child Care Partnerships . . . . 2-15-1

Eligibility, Recruitment, Selection, Enrollment and Attendance . 2-16-1

Facilities, Materials, Equipment and Transportation . . 2-17-1

Using Child Outcomes in Program Self-Assessment . . 2-18-1

Stage 3: Interpreting the Information . . . . . 3-1

Stage 4: Strengthening Your Program . . . . . 4-1

Introduction — 1

Introduction

What is a Self-Assessment and why should we do it? 

Continuous quality improvement is a central tenet of the Head Start program, with the 

goal of meeting Performance Standards and moving toward program excellence for serving 

children and families throughout the country. As part of this process, the annual SelfAssessment provides programs with the means to regularly assess their own management 

systems and program operations in order to continually strengthen the program and the 

services delivered to children and families.

Head Start Performance Standards clearly state that at least once each program year, 

with the consultation and participation of the policy groups and, as appropriate, other 

community members, grantee and delegate agencies must conduct a Self-Assessment 

of their effectiveness and progress in meeting program goals and objectives and in 

implementing Federal regulations. 

The objectives of Head Start and Early Head Start are clear:

■ Enhance children’s growth and development

■ Strengthen families as the primary nurturers of their children

■ Provide children with educational, health and nutritional services

■ Link children and families to needed community services

■ Ensure well-managed programs that involve parents in decision-making

How can Head Start programs be sure that the services they provide meet these objectives 

as well as strive to continuously improve the quality of services?

By using the Self-Assessment process described here, grantees can annually assess how 

specifi c aspects of their program’s operations impact services delivered to children and 

families. Self-Assessment is not an isolated event, but along with ongoing monitoring, is 

an integral part of a program’s planning cycle. Programs seeking continuous improvement 

should constantly ask the questions:

■ Is the program meeting all national Head Start Performance Standards?

■ Are our services responding effectively to the changing needs of children and 

families?

■ Are we doing what we need to, or are we just doing it the way we have always done it?

■ Can we refi ne our program design and management systems to further improve 

outcomes for children and families?

The Self-Assessment process involves the collection of information from a variety of 

sources to determine if systems and services have been implemented and are working 

effectively. In the Self-Assessment process we encourage programs to analyze, review and 

incorporate information from multiple sources, such as ongoing monitoring reports, the 

Program Information Report (PIR), child outcome data, Community Assessment, and the 
2 — Introduction

Program Review Instrument for Systems Monitoring (PRISM) report. In total this information 

is used to identify program strengths, determine areas to strengthen, and plan appropriate 

strategies to effectively address the identifi ed weaknesses of the program.

Who is responsible for the Self-Assessment?

Section 1304.50, Appendix A (Governance and Management Responsibilities), of the 

Head Start Program Performance Standards designates the Head Start program director as 

having operational responsibility for carrying out the Self-Assessment. Most Head Start 

directors engage a team of program managers and leaders in outlining a process and 

timeline for conducting the Self-Assessment and analyzing the results. The results of the 

Self-Assessment serve as a driving force in determining needs for program improvement. 

The Self-Assessment portion of the Governance and Management Responsibilities chart is 

provided below:

Grantee Agency Delegate Agency Grantee or Delegate 

Management Staff

Governing Body 

has general 

responsibility

Policy Council 

must approve or 

disapprove

Governing Body 

has general 

responsibility

Policy Committee 

must approve or 

disapprove

Head Start 

program director 

has operating 

responsibility

Agency director’s 

responsibility is 

determined locally

How do we ensure shared decision-making?

The Head Start director does not pursue this process alone. The Self-Assessment process 

provides an opportunity for involving program leaders, such as parents, Policy Council 

members, governing body members, and community stakeholders, and for making staff 

more aware of how the program operates and is viewed by its consumers. Through 

Self-Assessment, Head Start programs reinforce how program leaders engage in shared 

decision-making. 

How does a Self-Assessment differ from the Federal monitoring that occurs 

every three years? 

The primary purpose of Federal monitoring is described in Section 641A(c)(1) of the Head 

Start Act:

...to determine whether Head Start agencies meet standards...and results-based educational 

performance measures developed by the Secretary...with respect to program, administrative, 

fi nancial management, and other requirements...

The purpose of Self-Assessment is explained in section 1304.51(i)(1) of the Head Start 

Performance Standards as a method of measuring agency accomplishments, strengths, and 

weaknesses. Self-Assessment promotes continuous improvement of program service 
Introduction — 3

delivery and quality, as well as focuses attention on issues that arise in the community, 

the program, and among enrolled families. The processes of Self-Assessment and Federal 

monitoring complement each other and both are intended to ensure quality. The following 

table Comparing Self-Assessment and Federal Monitoring distinguishes the features of 

the two forms of review.

Comparing Self-Assessment and Federal Monitoring

Review Process Schedule ResponsibleEntity Instrument Perspective How Results are Used

Self-Assessment At least once 

a year

Head Start Grantee Self-Assessment 

Guide that is 

comprehensive and 

based on Head 

Start Program 

Performance 

Standards 

Self-critique Shared with managers, 

staff and governing bodies; 

used to develop Program 

Improvement Plans to reach 

and exceed compliance

Federal 

Monitoring

At least 

every three 

years

Federal Regional 

Offi ce

Standardized; 

Program Review 

Instrument for 

Systems Monitoring 

of Head Start and 

Early Head Start 

Grantees (PRISM)

Outside 

Experts

Shared with managers, staff 

and governing bodies; used 

to ensure program compliance

Although these two forms of review and quality assurance are similar, Self-Assessment is 

the annual opportunity for programs to obtain objective and refl ective feedback about their 

ability to meet Head Start Program Performance Standards and ensure the delivery of quality 

services each year. 

How long should a Self-Assessment take?

The time required to perform a Self-Assessment will vary with each program. While 

many programs have thought that the Self-Assessment is extra work, well-managed Head 

Start programs view the time and effort needed to complete the annual Self-Assessment 

as an important, integral part of the program year. The Self-Assessment process should 

allow for the continuation of Head Start services without interruption, yet provide time 

for staff participating in the process to both gather and contribute information through 

observations, document reviews, and interviews.
4 — Introduction

How will this Guide be useful?

This Guide is intended to be a workbook that will help you:

■ Review your program’s operations and program’s management systems

■ Analyze the results of the Self-Assessment 

■ Assess your program’s progress in meeting its own goals and objectives

■ Identify program strengths

■ Identify areas where improvement is needed

■ Develop and implement strategies for program improvement

■ Identify training and technical assistance needs

■ Prepare for a Federal monitoring review

■ Ensure quality Head Start services are delivered each year
Introduction — 5

About this Guide

One of the key management responsibilities of all Head Start programs is to:

conduct a Self-Assessment of their effectiveness and progress in meeting program goals 

and objectives and in implementing Federal regulations...at least once each program year 

(1304.51(i)(1) Head Start Performance Standards).

Programs are also required to incorporate child outcome data into their Self-Assessment 

process (ACYF-IM-HS-00-18).

Each Head Start program is required to develop a comprehensive process for SelfAssessment that addresses all of the management systems and service areas that are part of 

every well-run Head Start program. Head Start Self-Assessment: Your Foundation for Building 

Program Excellence supports programs with their Self-Assessment process.

Historically, many Head Start programs have struggled to develop a system for SelfAssessment. Consequently, many programs have used the existing Federal monitoring 

instrument, PRISM, as a basis for creating their own system because it addresses all of the 

Federal requirements that Head Start programs must meet. 

This Guide, Head Start Self Assessment: Your Foundation for Building Program Excellence,

assists programs to create a system that provides an in-depth assessment of all Head Start 

service areas and management systems, yet remains user-friendly and manageable for 

staff, parents and other participants. This Guide incorporates the essential ingredients of 

the PRISM, as well as feedback received from experienced Head Start directors, program 

managers, parent leaders, Head Start Bureau and Regional Offi ce staff, the Regional 

Technical Assistance (TA) Network, and program review team members. 

Principles 

The workgroup that originally convened to create a vision for this resource developed four 

key principles to guide the work. They determined that local programs will benefi t from a 

Self-Assessment instrument that: 

■ Adequately addresses all areas of the Head Start Performance Standards

■ Can be administered by a diverse Self-Assessment team that includes not only child 

development and family services professionals, but also governing body members, 

parents and community representatives

■ Promotes an effi cient use of time and resources

■ Provides valuable information to inform program leaders about ways to strengthen 

and improve the program
6 — Introduction

Four Stages of Self-Assessment

This Guide outlines four distinct stages of the Self-Assessment process. Each stage is 

critical and supports programs in meeting Head Start Performance Standards and in building 

programs of excellence. While it requires programs to devote signifi cant time and energy, 

this process will culminate in the development and implementation of a plan to meet and 

exceed standards and promote continuous program improvement.

The Guide is divided into four sections representing the stages of the Self-Assessment 

process:

Stage 1: Preparing

Stage 2: Collecting and Synthesizing

Stage 3: Interpreting

Stage 4: Strengthening 

The fi rst stage is Preparing Your Self-Assessment 

The Head Start director must take steps to prepare for Self-Assessment by convening a 

team to lead the process, determining how the program will use the Guide, informing the 

Policy Council and governing body, selecting and recruiting qualifi ed participants to serve 

on the various Self-Assessment teams, and informing others who will be affected. Team 

members need to receive training on the regulations as well as the process they will use to 

complete the Self-Assessment booklets assigned to their team. 

The second stage is Collecting and Synthesizing the Information

Once the program has identifi ed the Self-Assessment teams and recruited and trained 

the members, the teams engage in the actual assessment process. Team members observe 

activities, review documents, interview people, and record and summarize their fi ndings 

according to the instructions provided in the eighteen individual Self-Assessment booklets. 

Using this information, which is based on the eighteen Core Questions in the PRISM, team 

members begin the analysis process by synthesizing the data from multiple sources and 

consolidating this information into a Booklet Analysis. This Booklet Analysis identifi es 

program strengths, specifi c weaknesses and areas to strengthen.

The third stage is Interpreting the Information 

Once the Self-Assessment teams have completed their assigned booklets and the team 

leaders have analyzed the results, their work is then forwarded to the Self-Assessment 

leadership team. The Self-Assessment leadership team closely examines the booklet 

analyses. This information is further analyzed by displaying the data in a useful manner; 

establishing patterns of identifi ed needs; uncovering underlying causes and systemic 

issues; and determining priorities for change and improvement. At this stage, programs 

should ask for clarifi cations on regulations or policy from Federal staff, if needed. 
Introduction — 7

The fourth stage is Strengthening Your Program

The Self-Assessment has little value unless the program uses the information to drive 

program improvements. In this fi nal stage, leaders use Self-Assessment results as a driving 

force to develop program improvement goals, desired outcomes, and action plans. 

Both the results of the Self-Assessment and the plan for program improvement should 

be communicated widely to the governing body, staff, Policy Council, parents, and 

community partners. Both the Regional Offi ce staff and the TA Network staff can provide 

assistance and support to Head Start programs as they develop and implement Program 

Improvement Plans.
8 — Introduction

Self-Assessment is a Cyclical Process

As indicated below, Self-Assessment is a cyclical process founded on the principles 

of Continuous Quality Improvement. This process requires continually monitoring, 

evaluating, and improving program quality and outcomes for children and families. 

Strengthening

the program

Preparing Your

Self-Assessment

Collecting and

Synthesizing the

Information

Interpreting the

Information

The impact of Quality Self-Assessment

As a result of using Head Start Self-Assessment: Your Foundation for Building Program 

Excellence, programs benefi t from: 

■ Obtaining objective, reliable information about Head Start services and systems

■ Promoting shared understanding and appreciation of Head Start goals and 

Performance Standards among the governing body, program stakeholders, and 

community partners 

■ Integrating multiple sources of data 

■ Conducting a thorough analysis of program data

■ Creating effective Program Improvement Plans

■ Designing meaningful training and technical assistance plans

Together these elements strengthen the program’s foundation, support program excellence 

and lead to the ultimate goal —improved outcomes for children and families. 

(See chart on the following page).
Introduction — 9

Community

Assessment

Results of Federal 

monitoring (PRISM)

Summaries of ongoing 

monitoring 

PIR data PIR

Summary of Child 

Outcome data

Other data sources

Self -Assessment

Information

Interpreting the Data

Analysis of: Strengths 

Weaknesses Patterns

Underlying Causes

Priorities

Program 

Improvement Plan

Goals Outcomes

Action Steps 

Timelines Resources

Training and Technical 

Assistance Plan

Strengthening 

Your Program

Improved Outcomes for Children and Families

SELF-ASSESSMENT
10 — Introduction
Introduction — 11

Team Team Team Team

FOUR STAGES OF SELF-ASSESSMENT

Stage 1: Preparing Your Self-Assessment 

The Self-Assessment leadership team consists of a team of managers who work together to design the 

Self-Assessment process. The team is led by the Head Start director and may include program managers, 

representatives from the governing board and policy groups, and community partners.

Helpful Tools:

 ■ Team Assignment Worksheet ■ Team Leader Worksheet

 ■ Team Participant Worksheet ■ Self-Assessment Training Worksheet

 ■ Focusing the Assessment Worksheet 

 ■ Self-Assessment Timeline Worksheet

Stage 2: Collecting and Synthesizing the Information

Team leaders recruit staff, parents, and community volunteers to serve on their individual assessment 

teams. Each team is responsible for collecting the information for their assigned Self-Assessment booklets. 

This information is consolidated and synthesized into Booklet Analyses.

Helpful Tools:

 ■ 18 Self-Assessment Booklets, which include sample observation tools, charts, 

 checklists, and interview questions

Stage 3: Interpreting the Information

The Self-Assessment leadership team reconvenes to review the summary reports prepared during Stage 2. 

These summaries are reviewed to: identify contained areas of weaknesses, patterns of identifi ed needs and 

systemic issues; reveal underlying causes; and determine priorities for change and improvement. 

Helpful Tools:

 ■ Program Strengths Worksheet 

■ PRISM Framework ■ Priorities Worksheet

Stage 4: Strengthening Your Program

In this fi nal stage, members of the Self-Assessment leadership team design and oversee plans for program 

improvement and establish a time frame for monitoring and assessing progress.

Helpful Tools: 

 ■ Identifying Resources Worksheet ■ Program Improvement Plan 

 ■ Evaluating Your Self-Assessment System ■ Regional Offi ce Summary Report
12 — Introduction

Format

Overview of Stages 1, 2, 3 and 4

The fi rst page of each stage of the Guide begins with an overview. The overview identifi es 

key participants and outlines the specifi c activities that will take place. 

Booklets

The largest of the four sections is Stage 2, Collecting and Synthesizing the Information, 

which contains 18 booklets. The booklets correspond to the PRISM core questions and 

each addresses a critical Head Start management system or service area. The PRISM core 

question on Health is made up of two parts, (a) Prevention and Early Intervention and 

(b) Tracking and Follow-Up. They have been divided into two separate booklets in the 

Guide. In addition, unlike the PRISM, the Guide does not contain a booklet to address SelfAssessment. Instead, you are encouraged to evaluate your Self-Assessment process after 

completing all four stages. An evaluation form follows in Stage 4 of this Guide. 

Sample observation tools, charts, checklists, and interview questions are included as 

helpful tools in each booklet. Team members may use these tools or modify them as needed 

to support the Self-Assessment process. Some of these tools have been adapted from the 

PRISM instrument. 

All 18 booklets follow a similar format. Each booklet opens with a core question describing 

the system or service area to be assessed. Next is a compilation of related performance 

standards and a number of bullets that capture the essence of each section in user-friendly 

terms. Assessment team members are instructed to pay close attention to this bulleted 

description to gain a better understanding of the critical elements of each section. Team 

members are encouraged to review all related Performance Standards and to refer to them 

repeatedly during the assessment process. 

Team members are expected to use the following data collection methods to gather 

information to complete their booklets:

■ Observe (e.g., observing classrooms, Policy Council meetings) 

■ Review (e.g., various data sources, such as PRISM, PIR, Community Assessment, 

as well as ongoing monitoring reports, written plans, documents, records) 

■ Interview (e.g., interviewing managers, direct service staff, parents) 

Individual team members summarize their work and submit these summaries to their 

team leaders. Team leaders review these summaries and consolidate and synthesize the 

information into a Booklet Analysis. These 18 separate Booklet Analyses provide the basis 

for further distillation and analysis in Stage 3. The Self-Assessment leadership team works 

to: display the data in a useful manner through the PRISM Framework; establish patterns 

of identifi ed needs; reveal underlying causes and systemic issues; and prioritize goals for 

strengthening the program. 
Introduction — 13

Assistance is Available

You are not alone in conducting your Self-Assessment. The Regional Offi ce staff, the 

Regional TA Network, and your colleagues in other Head Start programs are available 

to support you. In particular, the members of the Head Start TA Network can serve as 

coaches and facilitators throughout the continuous quality improvement process. The TA 

staff is trained in the use of the Self-Assessment Guide and can support you through all 

four stages of the process. We encourage you to fully utilize these resources as you work 

through the Self-Assessment process to build your program of excellence.

Self-Assessment and the Technical Assistance Network 

The TA Network is available to support you throughout your Self-Assessment process. 

While the TA specialist is not to be assigned to a particular Self-Assessment team, your TA 

specialist can work with you as you design how the Self-Assessment process will look in 

your program and assist you in the synthesis and analysis of information, as well as in the 

development of the Program Improvement and T/TA Plans. 

To obtain or download copies of this document... 

Head Start Self-Assessment: Your Foundation for Building Program Excellence, is available in 

electronic format at:

www.HeadStartInfo.org 
14 — Introduction
Stage 1: Preparing Your Self-Assessment — 1

Stage 1: Preparing Your Self-Assessment

Overview

Key participants in Stage 1 include:

The Self-Assessment leadership team, which is made up of the Head Start director (or 

designee) and a team of managers and program leaders. The leadership team designs 

and leads the Self-Assessment process, analyzes the results, and incorporates the results 

into program improvement efforts. Your assigned TA specialist can work with you as you 

design how the Self-Assessment process will look in your program.

In this stage you will:

Determine how the Self-Assessment process will look in your program by:

■ Introducing Head Start Self-Assessment: Your Foundation for Building Program Excellence

to Self-Assessment leaders

■ Dividing and assigning the responsibilities to make the process more manageable

■ Selecting team leaders

■ Recruiting participants to serve on your Self-Assessment teams

■ Training Self-Assessment teams

■ Focusing your assessment

■ Establishing a timeline

Consult with the Policy Council in order to:

■ Meet the regulatory requirement

■ Ensure meaningful participation
2 — Stage 1: Preparing Your Self-Assessment

Stage 1: Preparing Your Self-Assessment

Determine How the Self-Assessment Process Will Look in Your Program 

The Head Start Self-Assessment: Your Foundation for Building Program Excellence is a guide 

to be adapted to meet the individual needs of your program. Stage 1 provides you with 

helpful tools to assist you as you plan how the Self-Assessment process will look in 

your program. This planning is essential for the development and implementation of a 

comprehensive Self-Assessment that yields valuable information for continuous program 

improvement.

To plan your Self-Assessment, you will need to:

■ Convene the Self-Assessment leadership team and introduce them to the SelfAssessment Guide

■ Divide the responsibilities among various teams

■ Designate Self-Assessment team leaders

■ Recruit participants to serve on the Self-Assessment teams

■ Provide training for participants

■ Focus your Self-Assessment by selecting representative child and family records, 

centers, classrooms, program options, child care partners, and delegate agencies

■ Establish a timeline for completion of Self-Assessment activities

■ Present this plan to the Policy Council for review

These steps are described in detail on the following pages, along with examples and helpful 

worksheets to support the planning process.

Introduce Head Start Self-Assessment: Your Foundation for Building Program 

Excellence to Self-Assessment Leaders 

One of the fi rst responsibilities of the Head Start director is to provide Self-Assessment 

leaders with an understanding and appreciation of the role that Self-Assessment plays in 

maintaining program quality and fostering positive change and continuous improvement. 

The director, who by Head Start regulation has operating responsibility for the SelfAssessment process, may choose to facilitate the work of the Self-Assessment leadership 

team or designate that responsibility to one of its members.

When recruiting members to join the Self-Assessment leadership team, directors need to 

consider the role of governing bodies, delegates and child care partners on that team. As 

stated in 1304.51(i)(1) of the Head Start Program Performance Standards, the Self-Assessment 

is conducted “...with the consultation and participation of the policy groups and, as appropriate, 

other community members.” Directors should recruit these partners to the table. 
Stage 1: Preparing Your Self-Assessment — 3

The group leader should then share the Guide with the membership. Team members 

should become familiar with all of the materials, including the instructions, booklets, 

and data collection instruments. They should discuss why the Self-Assessment is being 

conducted, who should be involved as team leaders and team members, and whose 

cooperation is needed in order for it to be successful. 

Dividing and Assigning the Responsibilities to Make the Process 

More Manageable 

A quality Self-Assessment takes considerable time and effort. The process of assessing all 

program services and systems may be more manageable if you divide the responsibilities 

among various teams, designating program managers and other key decision makers as 

team leaders. Creating teams will have several advantages:

■ The work will be spread among a larger group of individuals to lessen the burden 

and add depth, knowledge and valuable perspectives of many individuals to the 

experience

■ Staff, parents, Policy Council members, participants, community partners and others 

serving on Self-Assessment teams will have greater access to team leaders who can 

provide support and guidance throughout the process

■ Individual teams can focus on particular areas or systems that are more appropriate 

to their experience (e.g. members with expertise in fi scal matters should be on the 

team which covers this system)

■ By recruiting managers and staff representing delegates and child care partners, you 

are fully investing delegates and partners in the Self-Assessment process. They will 

gain a fuller understanding of the Head Start Program Performance Standards and their 

importance to a quality program

Programs can determine team assignments by dividing the 18 booklets in a way that makes 

sense for your program. Factors that can help you determine the number and composition 

of each group might be:

■ Your program’s organizational structure and the manner in which responsibilities are 

assigned to management staff

■ The size of your program

■ The time it will take to adequately complete each booklet

■ Suffi cient expertise of members
4 — Stage 1: Preparing Your Self-Assessment

The following chart illustrates just two examples of ways that the Self-Assessment 

responsibilities can be divided among various teams. Use these examples to come up with 

your own confi guration and record your decisions on the Team Assignment Worksheet

provided on page 5. 

Sample Team Assignment Worksheet

Example A

TEAM 1: Management Systems

■ Governance 

■ Communication

■ Ongoing Monitoring

■ Fiscal Management

■ Planning

■ Record-Keeping & Reporting

■ Human Resources

■ Child Outcomes

TEAM 2: Child Development and Health Services

■ Prevention & Early Intervention

■ Disabilities Services

■ Tracking and Follow-up

■ Individualization

■ Curriculum

TEAM 3: Family and Community Partnerships: 

■ Family Partnership Building

■ Community and Child Care Partnerships

■ Parent Involvement

TEAM 4: Program Design

■ Eligibility, Recruitment, Selection, Enrollment, and Attendance 

(ERSEA) 

■ Facilities, Materials, Equipment & 

Transportation

Example B

TEAM 1: Management 

■ Community and Child Care Partnerships 

■ Communication

■ Ongoing Monitoring

■ Fiscal Management

■ Planning

■ Record-Keeping & Reporting

■ Human Resources

■ Facilities, Materials , Equipment & 

Transportation

TEAM 2: Education and Disabilities

■ Individualization 

■ Disabilities Services

■ Curriculum

■ Child Outcomes

TEAM 3: Health, Nutrition, and Mental Health

■ Prevention and Early Intervention ■ Tracking and Follow-up

TEAM 4: Family Partnerships and ERSEA

■ Family Partnership Building

■ Governance

■ Parent Involvement,

■ Eligibility, Recruitment, Selection, 

Enrollment, and Attendance (ERSEA)
Stage 1: Preparing Your Self-Assessment — 5

Team Assignment Worksheet

Record your decisions about how the Self-Assessment responsibilities should be divided. 

List the booklets that will be used by each of the teams. 

TEAM __ : 

TEAM __ : 

TEAM __ : 

TEAM __ :

TEAM __ :
6 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 7

Selecting Team Leaders

Persons who serve as leaders for each Self-Assessment team are responsible for:

■ Recruiting a diverse group of team members to engage in the assessment process

■ Training members of the Self-Assessment team on the content of the regulations and 

the process they will use to assess the program

■ Describing the program structure and layout to members, pointing out key locations 

they will visit, and introducing them to members of the staff and Head Start 

community who they may need to speak with

■ Assisting team members in distributing the work load, assigning tasks that 

correspond to the skills and abilities of members, and pairing team members, as 

appropriate

■ Establishing a time frame for completing the assignments

■ Arranging to check in with members at certain intervals to assess their progress and 

assist with any problems that arise 

■ Providing on-going support to team members

■ Assisting members in summarizing the data and information they have collected and 

drawing conclusions

■ Synthesizing information into a Booklet Analysis that identifi es program strengths 

and areas to strengthen 

■ Recognizing team members for their contributions to the program

Many programs choose leaders with experience and expertise in the service or 

management areas to which they are assigned. Other programs choose leaders from 

different content areas in order to enhance the objectivity of the process.
8 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 9

Team Leader Worksheet

Use the following Team Leader Worksheet to help you make decisions about what kinds 

of skills your team leaders should have and who would be the best candidate to assume a 

team leadership position.

Title Skills/Perspectives Team Leader 

(name, position)

Team 1:

Team 2:

Team 3:

Team 4:

Team 5:
10 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 11

Recruiting Participants to Serve on your Self-Assessment Teams

Although the Self-Assessment process will be heavily supported by program staff, it 

provides a wonderful opportunity to involve others. The guidance attached to Regulation 

1304.51(i)(1), program Self-Assessment and monitoring, reads: “consider including staff, 

policy group members, parents, representatives from community organizations, governing body 

members, and staff from other Head Start agencies on the Self-Assessment team.” To the extent 

possible, it is desirable to recruit a team that is representative of the diversity of enrolled 

children, families and the local community. 

Serving on a Self-Assessment team provides parents with an opportunity to learn 

important new skills that can be applied to their goals for personal or professional 

development. Including individuals from outside your program can offer a tremendous 

learning opportunity for both parties. You may want to contact peers from nearby Head 

Start programs and offer to assist with their assessment if they will assist with yours. 

Consider inviting early childhood development programs in the local area that would be 

willing to lend a hand. Affi rmatively recruit team members who have the right skills and 

will contribute to the team. When recruiting, be sure your candidates have the time to 

engage in the process. 

In selecting potential team members, take into consideration the different skills and 

qualities that the task requires. In addition to having an interest and/or expertise relating 

to Head Start services or systems, participants serving on the assessment team should have 

the following skills and qualities: 

■ Objectivity

■ Professional conduct

■ An appreciation for confi dentiality

■ One or more of the following:

✓ Observation skills

✓ Interview skills

✓ Reading and documentation skills

Use the following Team Participant Worksheet to record your ideas for staff and 

volunteers who might serve on each of the Self-Assessment teams. We recommend that you 

list more persons than are actually needed, in the event that some volunteers have limited 

availability.
12 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 13

Team Participant Worksheet

List the positions, titles, or specifi c names (e.g., parent, board member, education content 

expert, Mary Jones, etc.) of staff and volunteers who you would like to recruit to serve on 

each of the Self-Assessment teams. 

Team 1 — Title:

Team 2 — Title:

Team 3 — Title:

Team 4 — Title:

Team 5 — Title:
14 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 15

Training Self-Assessment Teams

Team leaders should give careful thought to the training that they provide to team 

members so their team will be fully prepared to engage in the assessment process. The 

quality of the initial orientation and training as well as on-going support have a direct 

impact on the quality and usefulness of the results. Key elements of the training should 

include:

■ Discussion of the purpose of Self-Assessment and how the results are an integral 

part of the planning process

■ Overview of the program’s organizational structure and description of program 

services and options

■ Distribution of Head Start regulations and booklets relating to team assignments 

(duplicate the booklets as needed to provide everyone with a copy)

■ Overview of regulations and discussion of their intent

■ Review of the booklets and the three methods of collecting information: review, 

observe, and interview

■ Distribution of written plans describing services in each of the content areas 

■ Review of important data sources that may be relevant to your work such as the 

PRISM Report, PIR data, Community Assessment, child outcome information, 

strategic plan, short and long term program goals, ongoing monitoring reports, 

and summaries of staff development plans

■ Discussion of the qualities that make for a good team member (e.g. they are 

objective, honest, respectful of staff) and review of professional conduct expected 

of the team

■ Sharing of the skills, expertise, and qualities of each member of the team

There are a number of different approaches to training staff and volunteers who serve on 

Self-Assessment teams. You may choose to:

■ Keep all participants together for the entire training 

■ Provide an orientation to the full group followed by individual team training

■ Conduct all training in individual teams

Use the following Self-Assessment Training Worksheet to assist you in designing the 

orientation and training session(s) for your Self-Assessment teams. 
16 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 17

Self-Assessment Training Worksheet

FFull Group

Training Content Trainer(s)

Training Content Trainer(s)

Team 1 — Title:

Team 2 — Title:

Team 3 — Title:

Team 4 — Title:

Team 5 — Title:

Individual Teams
18 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 19

Focusing Your Assessment

Many programs enroll large numbers of children and families and operate classrooms 

in more than one location. Your Self-Assessment leadership team may determine that 

including every classroom and every child’s fi le in the Self-Assessment process will be too 

time-consuming. Decide if the Self-Assessment team will look at the entire program or 

focus their efforts on a representative sample.

A sample should be chosen which represents a cross-section of children, families, program 

options and services. Your sample should be large enough to establish whether quality is 

consistent throughout the program.

For grantees with delegate agencies and child care partnerships, it is important to make 

sure that these segments of your program are fully included in the Self-Assessment 

process. Determine if your Self-Assessment teams are responsible for assessing delegate 

programs and child care partners at this time, or if the delegate or partner will engage in an 

independent assessment.

Use the following Focusing the Assessment Worksheet to record your decisions.
20 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 21

Focusing the Assessment Worksheet

Select centers, classrooms, program options and records that will give you a full picture of 

the effectiveness of systems and services. Determine the approach you will take to assess 

partners and delegates. Record your decisions in the space provided.

Centers 

Classrooms 

Program Options

Child and Family 

Records

Child Care Partners 

Delegate Agencies
22 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 23

Establishing a Timeline

Develop a timeline for teams to begin and end the process. Programs may wish to conduct 

Self-Assessment in phases. Others may choose to focus their efforts so that the SelfAssessment takes place over a number of weeks. Since Self-Assessment is an integral part 

of program planning, be sure to coordinate your Self-Assessment with your planning 

calendar. It is important that you adapt the process to best meet the needs of your 

particular program. Think about scheduling your own Self-Assessment at a time during the 

program year when:

■ The Policy Council has enough experience to be full participants in the process

■ Services are well underway 

■ Time remains before the end of the program year to correct any issues that arise, 

to maximize outcomes for children and families currently participating in the 

program

■ The results can be used to support the development of the program’s Training 

and Technical Assistance Plan and annual grant application

Many programs prefer to stagger their schedule so that the assessment of program services 

precedes the assessment of management systems. Teams assigned to assess Head Start 

management systems may benefi t from the information gathered during the assessment of 

program services. They can use the information to draw conclusions about the relationship 

between systems and services and determine how systems are affecting services to children 

and families. Staggering the schedule also permits staff and volunteers to serve on more 

than one assessment team. 

The following Month-At-A-Glance Chart shows, as an example, how the Self-Assessment 

might look in a program that chooses to complete Stage 2 of the process within one month. 

Month-At-A-Glance

1st Week st 2nd Week 3rd Week 4th Week

u Self-Assessment Teams 

 receive orientation and 

 training

u Team conducts 

 Self-Assessment

u Team conducts 

 Self-Assessment

u Team Leaders check in 

 with team’s progress

u Team summarizes 

 results

Use the following Self-Assessment Timeline Worksheet to set target dates for steps in the 

Self-Assessment process.
24 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 25

Self-Assessment Timeline Worksheet

Activity Date

Stage 1

Preparing

Recruit and convene the Self-Assessment leadership team

Convene the Self-Assessment leadership team to design the Self-Assessment process 

Present process to Policy Council for consultation 

Recruit participants to serve on Self-Assessment teams

Convene teams for orientation and training

Stage 2

Collecting and Synthesizing

Draw on multiple data sources to complete service area booklets

Draw on multiple data sources to complete management system booklets 

Summarize booklet information for Individual Team Member Summary

Consolidate information from individual team members into Team Leader Booklet 

Analysis

Stage 3

Interpreting

Reconvene Self-Assessment leadership team to review and analyze results 

Identify program strengths

Display information from the 18 Booklet Analyses in a useful manner

Establish patterns of identifi ed needs

Reveal underlying causes and systemic issues

Classify and prioritize the identifi ed weaknesses and areas to strengthen

Stage 4

Strengthening

Develop a program improvement plan by identifying goals, desired outcomes, and 

specifi c action steps

Develop and implement a Training and Technical Assistance (T/TA) Plan 

Monitor and assess progress in implementing the Program Improvement Plan and T/TA 

Plan 
26 — Stage 1: Preparing Your Self-Assessment
Stage 1: Preparing Your Self-Assessment — 27

Including the Policy Council

Once you have completed the worksheets in Stage 1, present your completed package to 

the Policy Council for review. Ask members of your Self-Assessment leadership team who 

serve on the Policy Council to assist you in making the presentation. 

Section 1304.51(i)(1) of the Head Start Performance Standards requires the consultation 

and participation of the Policy Council in the Self-Assessment process. Section 

1304.50(d)(1)(viii) provides the following guidance: 

As active participants in the ongoing process of annual Self-Assessment . . . 

the Policy Council and Policy Committee consider the extent to which:

■ The time schedule for Self-Assessment is reasonable

■ An appropriate assessment team has been formed, which includes parents and 

adequate representation from the community

■ The Self-Assessment team receives training on how to conduct an assessment

■ All team members are fully aware of the results of the last Self-Assessment, as well as 

of the Federal monitoring review

■ The measures used to conduct the Self-Assessment adequately evaluate the program

■ Findings from the Self-Assessment are reported to the Policy Council, Policy 

Committee, Parent Committees and governing bodies

■ Improvement Plans are appropriate and feasible in terms of resources and timeframes
28 — Stage 1: Preparing Your Self-Assessment
Stage 2: Collecting and Synthesizing the Information

Overview

Key participants in Stage 2 include:

Team leaders and the team members they have recruited to serve on the various SelfAssessment teams. 

In this stage:

Team members engage in the collection of information and data to assess if the program is 

meeting the Head Start Performance Standards. Team members use the helpful tools provided 

in each booklet to collect information. Methods for gathering information include:

■ Reviewing documents

■ Interviewing people

■ Observing activities

■ Incorporating relevant data sources

Team members summarize their fi ndings. 

Team leaders begin the analysis process by consolidating and synthesizing the information 

they have collected. 

Team leaders will produce a succinct and focused Booklet Analysis that identifi es program 

strengths, specifi c weaknesses and areas to strengthen.

Stage 2: Collecting and Synthesizing the Information — 1
Stage 2: Collecting and Synthesizing the Information — Booklet 1 ■ 1

Program Self-Assessment Booklet 1

Management Systems: Program Governance

Core Question to be answered by Self-Assessment team:

How effective is your system of shared governance in supporting the implementation of quality 

services to children and families?

Purpose:

The objective is to ensure that programs have a policy group and governing body that share 

responsibility for overseeing the delivery of high quality services to children and families. 

Parents and community representatives should be empowered to actively participate in 

the shared decision-making process. (Introduction to 1304.50, p. 158, Head Start Program 

Performance Standards, hereafter referred to as “Performance Standards”.) 

This booklet will help the Self-Assessment team determine if the program meets Federal 

Performance Standards relating to Program Governance. Related Performance Standards:

1304.50, including Appendix A; 1304.52 (k). 

As you conduct your Self-Assessment of program governance systems, pay close attention 

to the following:

■ Do the governing body, the Policy Council and the staff have a formal structure 

of shared decision-making which supports the delivery of high quality services to 

children and families?

■ Do the governing body, Policy Council, and program managers work in partnership 

to lead the Head Start program?

■ Do program leaders (governing body, Policy Council, and program managers) 

embrace the spirit and intent of the Head Start regulations and help to ensure that 

parents have direct participation in program planning and operations?

■ Do governing body members successfully carry out their fi duciary (legal and fi scal) 

responsibilities and ensure effective and appropriate expenditures of Head Start 

dollars? 

■ Is the Policy Council actively involved in informed decision making?

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 1 ■ 2

Observe:

The Self-Assessment team member(s) should sit in and observe a meeting of the Policy 

Council and the governing body. During your observations, look for evidence that 

members are engaged in informed decision-making and have the opportunity to review 

and discuss information prior to making a decision to approve or disapprove.

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Organizational chart

■ Grant application

■ Written policies or procedures that describe the Head Start program’s system for 

program governance and shared decision-making

■ Governing body and Policy Council by-laws

■ Evidence of ongoing training for the governing body and Policy Council 

■ Agendas, minutes, handouts and materials from the governing body, Policy Council, 

Policy Committee and Parent Committee meetings 

■ Ongoing monitoring reports

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals
Stage 2: Collecting and Synthesizing the Information — Booklet 1 ■ 3

Use the checklist below to assist you in your document review:

Does the organizational chart accurately refl ect all decision-making bodies? 

❏ Yes ❏ No Comment: _________________________________________________________

Is there any documentation of ongoing training of governing body and Policy Council 

members (e.g. memos, invitations, sign-up sheets, training materials)? Does the training 

plan include orientation to the Performance Standards and support in carrying out roles and 

responsibilities in relation to the Head Start program? 

❏ Yes ❏ No Comment: _________________________________________________________

Do governing body members receive training specifi c to their oversight responsibilities in 

fi nancial and legal matters? 

❏ Yes ❏ No Comment: _________________________________________________________

Do minutes and records from governing body and Policy Council meetings provide an 

accurate account of decisions and establish accountability? 

❏ Yes ❏ No Comment: _________________________________________________________

Do the minutes refl ect that the governing body and policy groups have the opportunity to 

review and discuss issues prior to approval? 

❏ Yes ❏ No Comment: _________________________________________________________

Do agendas, minutes and records show evidence that the governing body and Policy 

Council review ongoing monitoring reports, including child outcome data and assessment 

information, to help determine the direction of program improvement efforts? 

❏ Yes ❏ No Comment: _________________________________________________________

Is there documentation that shows that parent members of the Policy Council or Policy 

Committee are elected once a year? 

❏ Yes ❏ No Comment: _________________________________________________________

Are all parents encouraged and given an opportunity to participate and serve as Policy 

Council members? 

❏ Yes ❏ No Comment: _________________________________________________________

Are any parent members of the Policy Council or Policy Committee serving for more than 

three years? (Check old meeting minutes, membership lists, ask Policy Council members 

and staff.) 

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 1 ■ 4

Is there a handbook or letter that explains Head Start parents’ rights and responsibilities? 

❏ Yes ❏ No Comment: _________________________________________________________

Are there written procedures approved by the governing body and Policy Council to help 

resolve community complaints about the program? 

❏ Yes ❏ No Comment: _________________________________________________________

Are there written procedures to resolve disputes between the governing body and Policy 

Council? 

❏ Yes ❏ No Comment: _________________________________________________________

Is there documentation that shows that community representatives of the Policy Council or 

Policy Committee are elected once a year? 

❏ Yes ❏ No Comment: _________________________________________________________

Are any community representatives of the Policy Council or Policy Committee serving for 

more than three years? (Check old meeting minutes, membership lists, ask Policy Council 

members and staff.) 

❏ Yes ❏ No Comment: _________________________________________________________

Is there evidence that the grant and budgets have been approved and signed by the Policy 

Council prior to submission to the regional offi ce? 

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 1 ■ 5

Interview:

A Self-Assessment team member should speak with at least two members of the governing 

body and Policy Council. 

Questions for the governing body: 

How would you describe the role you play in leading and supporting the Head Start 

program?

_________________________________________________________________________________

_________________________________________________________________________________

Can you describe for us some of the goals and issues facing the Head Start program at this time?

_________________________________________________________________________________

_________________________________________________________________________________

Relevant to your stewardship responsibilities, what types of Head Start fi nancial reports 

do you routinely review? What is your understanding of the program’s current fi nancial 

situation? Is it on target, under budget, over budget?

_________________________________________________________________________________

_________________________________________________________________________________

Does the governing body engage in a self-evaluation process to determine their level of 

effectiveness and ways they can improve? 

_________________________________________________________________________________

_________________________________________________________________________________

Is the governing body involved in the annual review and evaluation of the Head Start 

director? Can you describe that process?

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 1 ■ 6

Questions for the Policy Council: 

How does the Policy Council participate in the hiring and termination process?

_________________________________________________________________________________

_________________________________________________________________________________

Describe the ways parents are involved at the parent committee level. How regularly 

do they meet? How are parents supported fi nancially to carry out their activities (i.e., 

reimbursements)? Are all parents encouraged to participate?

_________________________________________________________________________________

_________________________________________________________________________________

If your program has both Head Start and Early Head Start, are both represented adequately 

and proportionately on the Policy Council?

_________________________________________________________________________________

_________________________________________________________________________________

Questions to ask members of the governing body and Policy Council: 

Many programs have exceeded Head Start Performance Standards by improving 

communication between the governing body and the Policy Council by appointing a 

liaison or providing for cross-membership within the governance structure. How does your 

program achieve two-way communication between the two groups?

_________________________________________________________________________________

_________________________________________________________________________________

Describe the ways in which the Policy Council receives information on how the program 

is progressing so that the Policy Council can make decisions that will be of benefi t to the 

program.

_________________________________________________________________________________

_________________________________________________________________________________

What specifi c kinds of documents and reports do you receive to help inform you about the 

Head Start/Early Head Start program? (Listen for information about fi nancial reports and 

child outcome data.)

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 1 ■ 7

Questions to ask members of the governing body and Policy Council:

Describe the training and support you have received from Head Start to assist you in your role.

_________________________________________________________________________________

_________________________________________________________________________________

Describe the governing body’s (or Policy Council’s) involvement in the Head Start grant 

application process. 

_________________________________________________________________________________

_________________________________________________________________________________

Describe the annual Self-Assessment process. Who is involved in evaluating the program? 

How are the results reported to the governing body and the Policy Council? How are the 

results used to make improvements in the program?

_________________________________________________________________________________

_________________________________________________________________________________

Can you provide examples of how child outcome data has been used to plan for changes in 

the program?

_________________________________________________________________________________

_________________________________________________________________________________

How does the program recruit volunteers in the community?

_________________________________________________________________________________

_________________________________________________________________________________

Ask Policy Council and governing body members if the Policy Council and/or Policy 

Committee develop, review, approve/disapprove program policies and procedures. How 

do they accomplish this?

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 1 ■ 8

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 1 ■ 9

Team Member Summary Worksheet

Summary of Results for Governance

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 1 

■ 10

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 2 ■ 1

Program Self-Assessment Booklet 2

Management Systems: Planning 

Core Question to be answered by the Self-Assessment team:

How effective is the grantee’s ongoing system of program planning in supporting the 

implementation of quality services to children and families?

Purpose:

Planning is a multi-faceted, dynamic, and ongoing activity that involves key members 

of the Head Start community. Agencies that plan well are better equipped to meet the 

unexpected and create a vision for the future. 

This booklet will help you to assess if the program meets Federal Performance Standards

relating to planning, which includes such activities as developing the Community 

Assessment, formulating program goals and objectives, selection of program options, and 

development of written plans for implementing services. Related Performance Standards

include: 1304.51(a); 1305.3; 1306.30(a); 1306.30(d); 1306.31-1306.36; 1308.4.

As you conduct your assessment of the program’s planning process, pay close attention to 

how the:

■ Community Assessment is used for program planning

■ Program consults with the governing body, policy groups, staff and other community 

organizations in the process

■ Program develops and revisits long-range goals and short-term program and 

fi nancial objectives

■ Conclusions drawn from the Community Assessment affect program plans

■ Results of the Self-Assessment impact plans for program improvement 

■ Program’s analysis of outcomes for children affects the planning process

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 2 ■ 2

Review: 

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Community Assessment 

■ Statement of long-range goals and short-term objectives

■ Service plans for each program area (Early Childhood Development and Health 

Services, Family and Community Partnerships, and Program Design and 

Management)

■ Timelines depicting the yearly planning calendar

■ Results of the most recent Self-Assessment

■ Results of the most recent child outcome data

■ Ongoing monitoring reports

■ Results of staff, parent, and community surveys 

■ Important data sources relevant to this area such as the PRISM report and PIR data 
Stage 2: Collecting and Synthesizing the Information — Booklet 2 ■ 3

Use the checklist below to assist your document review:

Has the Community Assessment been completed within the last three years?

❏ Yes ❏ No Comment: _________________________________________________________

Has this document been updated within the last year?

❏ Yes ❏ No Comment: _________________________________________________________

Does the Community Assessment include some description of the community’s strengths, 

needs, and resources? 

❏ Yes ❏ No Comment: _________________________________________________________

Is there a strategic plan or other document that includes the program’s long-term goals and 

short-term objectives?

❏ Yes ❏ No Comment: _________________________________________________________

Do long-range goals and short-term objectives logically follow from the Community 

Assessment?

❏ Yes ❏ No Comment: _________________________________________________________

Are they consistent with the philosophy of Head Start? 

❏ Yes ❏ No Comment: _________________________________________________________

Is information from ongoing monitoring and Self-Assessments feeding into planning 

activities?

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 2 ■ 4

Interview: 

The Self-Assessment team members should gather information about planning by 

interviewing:

■ Head Start director and program planner

■ Members of the governing body and Policy Council

Questions to ask: 

What process is used to develop the Community Assessment, and how do you utilize the 

results? (i.e., Is the Community Assessment used for making plans, determining program 

options, and deciding how and where services will be delivered?) 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What were some of the key fi ndings from last year’s Self-Assessment? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How did these fi ndings impact your program improvement plans? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 2 ■ 5

What progress has been made in achieving goals from last year’s Self-Assessment?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Can you describe how your analysis of child outcome data has impacted program 

improvement planning?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How would you describe your program planning process? Who is involved? What data 

sources and information do you use to determine what your goals and objectives should be?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How are the governing body, policy groups, staff, and other community organizations 

consulted while plans are being made?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 2 ■ 6

What process do you use to develop written plans? How are the plans utilized once they 

are written? (i.e., Do plans “sit on the shelf” or are they dynamic documents that are 

constantly referred to, reviewed, revised and updated as needed?)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What progress has your program made in achieving the goals and objectives contained in your 

strategic plan? What challenges have you faced? Have you revised any of your initial goals? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Answer if applicable to your program: If your Community Assessment indicates needs 

such as full day/full year or Early Head Start for children from birth to three, how does this 

infl uence the planning process?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

In planning for parent involvement, does your program collect information about fathers in 

addition to mothers? (i.e., Do your intake forms prompt staff to include this information?)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 2 ■ 7

To support transitions for young children and families, how does your Community 

Assessment collect information about continuity of services from pregnancy through age 

fi ve?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

In conducting your Community Assessment, how do you gather information on youth 

services to benefi t siblings of Head Start children? Does your Community Assessment 

process include identifying marriage strengthening or marriage preparation services for 

couples who choose to participate?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 2 ■ 8

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 2 ■ 9

Team Member Summary Worksheet

Summary of Results for Planning

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 2 

■ 10

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 3 ■ 1

Program Self-Assessment Booklet 3

Management Systems: Communication 

Core Question to be answered by the Self-Assessment team: 

How effective is the grantee’s communication system in supporting the implementation of quality 

services to children and families? 

Purpose:

Communication ensures the exchange of information that allows individuals to become 

fully involved in program activities and to make group decisions that promote a quality 

program (Rationale for 1304.51(b), p.181).

This booklet will help you to assess if the program is meeting Federal Performance Standards

relating to communications involving governing bodies, parents, policy groups, staff, 

partners in the community, and the community in general. Related Performance Standards

include: 1304.22(a)(4); 1304.20(c)(1); 1304.22(b)(3); 1304.41(a)(1); 1304.51(b)-1304.51(f); 

1308.4(l).

As you conduct your assessment of this program’s communication system, pay close 

attention to how information is shared:

■ Among staff, governing bodies, and policy groups

■ Between staff and parents

■ With community partners and child care partners

■ With delegate agency governing bodies, Policy Committees, and staff (where 

appropriate)

■ With the public and news media

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 3 ■ 2

Review: 

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Policies and procedures pertaining to communication systems

■ Written communication among staff

■ Meeting minutes

■ Sample communications with families

■ Policies and procedures pertaining to communication

■ Communications with the governing body and policy groups

■ Ongoing monitoring reports

■ Sample communications with community partners

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals
Stage 2: Collecting and Synthesizing the Information — Booklet 3 ■ 3

Use the checklist below to assist your document review: 

Does the program have written policies and procedures pertaining to communication 

systems?

❏ Yes ❏ No Comment: _________________________________________________________

Are communications with families provided in their primary language?

❏ Yes ❏ No Comment: _________________________________________________________

Is an orientation packet provided to new members of governing bodies and policy groups 

which explains their role and participation in shared decision-making?

❏ Yes ❏ No Comment: _________________________________________________________

Does the program have a way to communicate with staff such as memos, bulletins or 

electronic means such as e-mail or bulletin boards?

❏ Yes ❏ No Comment: _________________________________________________________

Does the program have a regular schedule of meetings:

For staff? ❏ Yes ❏ No 

For parents? ❏ Yes ❏ No

For policy groups? ❏ Yes ❏ No

Do governing body members and policy groups receive pertinent information in a timely 

manner in order to make informed decisions?

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 3 ■ 4

Interview:

The Self-Assessment team member(s) may want to interview members of the Head Start 

management team, staff, members of the governing body or Policy Council, and Head Start 

families.

Questions to ask staff:

How do you fi nd out what’s happening in the program?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What opportunities do you have on a regular basis to communicate with other staff, 

including supervisors?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you foster effective two-way communication with families? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are you able to communicate with families in their primary or preferred language?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 3 ■ 5

How does the program obtain information from each family in order to plan services for 

their child?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Does the program communicate with both parents when they live in separate households?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Questions for policy group and governing body members:

How are you oriented to your roles and responsibilities as a policy group or governing 

body member?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Is required information such as reports, federal policies, guidelines, program plans, policies 

and procedures and grant applications, shared with you? Is information received in a 

timely manner?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 3 ■ 6

Questions for Managers:

Is there a system in place for staff to communicate regularly about services to children and 

families so that services become integrated and coordinated? Describe the system.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

In what ways does the program seek information from families to plan opportunities 

within the program that meet their needs and desires?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How is good communication ensured between the program and its community partners? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe the system for orienting new employees.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 3 ■ 7

What is the process for parent orientation to your program and services?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Questions for Families: 

How do you fi nd out about what’s happening in the program?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Did you participate in an orientation to the program? Describe that experience.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 3 ■ 8

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 3 ■ 9

Team Member Summary Worksheet

Summary of Results for Communication

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 3 

■ 10

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 1

Program Self-Assessment Booklet 4

Management Systems: Record-Keeping and Reporting

Core Question to be answered by the Self-Assessment team: 

How effi cient and effective are the record-keeping and reporting systems in providing accurate, 

confi dential, and timely information regarding children, families, and staff and in supporting quality 

services?

Purpose:

Effective record-keeping and reporting systems provide the information needed to 

individualize programs for children and families, to monitor the quality of program 

services, to assist in program planning and management, and to ensure the delivery of 

quality services (Rationale for 1304.51(g), p. 184).

This booklet will help you to assess if the program meets Federal Performance Standards

relating to maintaining publicly accessible records, records on refusals of health services, 

records relating to the dispensing of medication, etc. Performance Standards: 1301.30; 

1304.20(e)(5); 1304.22(c)(3)-1304.22(c)(5); 1304.51(g)-1304.51(h); 1304.52(k)(3)(i); 1308.4(l); 

1308.6(e)(4).

Note: At least one staff person should sit on this review team so they can access and 

review child/family fi les. Other team members may not have access to these fi les based 

on the program’s confi dentiality policy.

As you conduct your assessment of the program’s record-keeping and reporting systems, 

pay close attention to:

■ The way that child/family fi les are maintained and the contents of each fi le

■ The reports that are used by program managers to maintain program accountability 

and keep them advised of the program’s progress in delivering services to children 

and families

■ The reports that are generated on child outcomes for children three to fi ve years 

old that provide information on progress on the required domains, elements, and 

indicators when they enter the program, at a mid-point in the year, and at the end of 

the year

The Child/Family Audit Checklist has been included in this booklet as an optional 

instrument. Team members may fi nd it to be a helpful tool in assessing the effectiveness of 

the program’s record-keeping and reporting systems

Other helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 2

Review: 

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Program policies and procedures pertaining to confi dentiality

■ A sample number of child/family records to review. Team members may choose 

to use the attached Child/Family Audit Checklist, modify it to meet the individual 

needs of your program, or develop your own data collection tool to record the 

results of record reviews (In order to comply with policies pertaining to the 

confi dentiality of records, these fi les should be reviewed by staff participating on the 

assessment team.)

■ A selection of reports used by supervisors and managers to determine the status of 

program operations and services (e.g., ongoing monitoring reports, weekly activity 

reports, computerized tracking reports, and child outcome reports)

■ The program’s most recent Program Information Report (PIR)

■ Important data sources relevant to this area such as the PRISM report, Community 

Assessment, strategic plan or short and long term program goals

Parents serving on this team may choose to review their own child and family fi le and 

compare the format and contents with Head Start regulations pertaining to record-keeping.

File Audit (Child/Family Files):

After completing your audit, summarize the strengths and identify any patterns that 

emerge that point to weaknesses in the system.

Summary comments:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 3

Interview and questionnaire:

Ask your team leader to identify who within the organization is in charge of maintaining 

child/family records. Interview that individual and ask the following:

Describe the system you use to maintain records for children and families.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Who has access to child/family records?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe the safeguards in place to keep information on families and children confi dential.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What procedures do you follow when a parent asks to see his/her child’s fi le?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 4

With the assistance of the person(s) in charge of maintaining child/family 

records, complete the following questionnaire:

Are standardized forms used for record-keeping throughout the program?

❏ Yes ❏ No 

Comment: _______________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are there documents that record when parents refuse permission for health services for 

their children?

❏ Yes ❏ No 

Comment: _______________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are there physician instructions and written parent authorizations for all medications 

administered by staff ?

❏ Yes ❏ No 

Comment: _______________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

When medication is given to the child, is the amount, time, date and person giving it 

recorded?

❏ Yes ❏ No 

Comment: _______________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 5

Do fi les on enrolled children indicate that follow-up occurred when health needs 

were identifi ed? Were parents contacted? If necessary, was assistance provided with 

transportation or payment for medication?

❏ Yes ❏ No 

Comment: _______________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Is there a method for staff to report observations of child abuse and neglect in accordance 

with local laws?

❏ Yes ❏ No 

Comment: _______________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Do you seek parents’ permission to transfer fi le information when a child leaves Head Start?

❏ Yes ❏ No 

Comment: _______________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 6

Reporting Systems:

Interview:

Interview members of the program management team and ask: 

What kinds of data are collected and what kinds of reports are generated to inform you 

about program operations? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What procedures are in place for producing and disseminating status reports, including 

those related to child outcomes?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you use these reports to manage the program? Are reports shared with other 

managers and the program director?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

To what extent is your program engaged in using automated information systems?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 7

Do you seek parents’ permission to transfer fi le information when a child moves from Early 

Head Start to Head Start?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Interview the Head Start director and ask:

Are there record-keeping and reporting systems that help decision-makers track the 

program’s progress in achieving goals and objectives?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

When you determine that services need to change to better meet the needs of children and 

families, are these changes refl ected in your written plans? What is the process you use to 

make this happen?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How is information regarding this Head Start program made available to the public? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 8

Specifi c questions for the program director about the Head Start Program Information Report 

(PIR):

How is the information needed for the PIR collected across the program?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Is the information analyzed for accuracy and correctness in any way? For example, is 

the information compared to the same data contained in other management information 

reports for the same time period to see if it is in agreement?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Is the information in the PIR used by managers and staff to identify possible performance 

problems and make improvements? Give examples. Is the information integrated with the 

program’s annual planning process? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 9

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 10

CHILD/FAMILY FILE AUDIT 

Instructions:

For each fi le you review, place the child’s name and identifying information in the space 

provided across the top of the instrument. Review each fi le and mark (X) if you fi nd 

verifi cation of the Head Start requirement within the fi le. Mark (0) if no evidence is found.

Before starting, ask a staff member to show you how the fi les are organized and where each 

piece of information is typically located.

While conducting your audit, note patterns that emerge which point to a potential 

weakness in the program’s overall record-keeping system, such as lack of documentation, 

incorrect documentation by new staff, etc. Include the information in your summary.
Stage 2: Collecting and Synthesizing the Information — Booklet 4 

■ 11

CHILD/FAMILY FILE AUDIT CHILD/FAMILY FILE AUDIT

Child’s name or identifying information Duplicate this form as needed.

Information/Service Total

Income verifi cation signed by staffMeets income eligibility? (yes/no)Meets age eligibility?Enrollment formsIncome verifi cation (not required for 2nd year enrollees)Regular interaction with families (some in the home)Pre-existing family plans Family Partnership Agreement (FPA)

Information/Service Total
Stage 2: Collecting and Synthesizing the Information — Booklet 4 

■ 12

CHILD/FAMILY FILE AUDIT CHILD/FAMILY FILE AUDIT

Child’s name or identifying information

Information/Service Total

Referrals to community resources? (yes/no)

Follow-up on referrals (yes/no)

Individual child developmental screening

Individual child developmental assessment (at 3 points during year)

Center-based:# education staff home visits

Center-based:#staff/parent conferences (2 required)

Home-based:# home-based visits

Information/Service Total
Stage 2: Collecting and Synthesizing the Information — Booklet 4 

■ 13

CHILD/FAMILY FILE AUDIT CHECKLIST

Child’s name or identifying information

Information/Service Total

Emergency contact informationChild’s medical, dental and developmental historyMedical home established within 90 daysHEALTH SCREENINGS:Growth assessmentImmunization statusVisionHearingOther EPSDT screenings:(individual programs complete)

Information/Service Total
Stage 2: Collecting and Synthesizing the Information — Booklet 4 

■ 14

CHILD/FAMILY FILE AUDIT CHECKLIST

Child’s name or identifying information

Information/Service Total

Developmental/sen-sory screening completed within 45 days?SIGNED MEDICAL EXAMMedical treatment needed? (yes/no)Treatment completed, if neededCOMPLETED DENTAL EXAMDental treatment needed? (yes/no)Treatment completed, if needed

Information/Service Total

For HS 3 to 5 yr. olds only
Stage 2: Collecting and Synthesizing the Information — Booklet 4 

■ 15

CHILD/FAMILY FILE AUDIT

Child’s name or identifying information

Information/Service Total

Documentation of well-baby visitsMedical treatment needed?Treatment completedForwarding of records at end of HS/EHSIEPs (HS children w/ disabilities only) IFSP (EHS children w/ disabilities only)

Information/Service Total

For EHS only
Stage 2: Collecting and Synthesizing the Information — Booklet 4 ■ 16

Team Member Summary Worksheet

Summary of Results for Record-Keeping and Reporting

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 4 

■ 17

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 5 ■ 1

Program Self-Assessment Booklet 5

Management Systems: Ongoing Monitoring 

Core Question to guide the Self-Assessment team: 

How effective is the grantee’s ongoing monitoring system in supporting the implementation of 

quality services to children and families?

Purpose:

Ongoing Monitoring helps to ensure that Federal regulations and local goals and objectives 

are being achieved, and to ensure that appropriate interventions are being taken in a timely 

manner (Rationale to 1304.51(i)(2), p. 188).

This booklet will help the team assess if the program meets Federal Performance Standards

relating to monitoring program operations and those of delegate agencies (if applicable). 

Related Performance Standards include: 1304.51(i)(2)-1304.51(i)(3); 1308.4(d); Part 74.51; Part 

92.40

As you conduct your assessment of the program’s ongoing monitoring systems, look for 

evidence that managers:

■ Analyze Early Head Start and Head Start data and information contained in 

tracking systems and written reports

■ Engage in on-site observation and supervision of Early Head Start and Head 

Start staff

■ Have a system in place for tracking family and community partnerships

■ Have a system in place for tracking patterns of progress and accomplishments 

for groups of three to fi ve year old children in the eight domains of learning in 

addition to health and disabilities services. The eight domains of learning and 

development for three to fi ve year old children are:

✓ Language Development

✓ Literacy

✓ Mathematics

✓ Science

✓ Creative Arts

✓ Social & Emotional Development

✓ Approaches Toward Learning

✓ Physical Health and Development

■ Use information from reports, observations, etc. to take corrective action and 

make program changes

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 5 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Program policies and procedures relating to ongoing monitoring

■ Sample tracking reports

■ Ongoing monitoring reports

■ Written documentation of periodic monitoring activities, including reports to any 

delegate agencies

■ Important data sources relevant to this area such as the PRISM report, PIR

data, Community Assessment, strategic plan or short and long term program 

goals
Stage 2: Collecting and Synthesizing the Information — Booklet 5 ■ 3

Use the checklist below to assist your document review:

Are there tracking/reporting systems in place and regular monitoring activities occurring 

in each of the following service areas? Identify who is receiving such reports and describe 

how they are being used.

EHS HS

Yes No Yes No Describe

Child Development

Health 

Mental Health

Disabilities

Nutrition

Family Partnerships

Transition

Community Partnerships

Parent Involvement
Stage 2: Collecting and Synthesizing the Information — Booklet 5 ■ 4

Interview:

Interview program management staff and ask them to describe their system for ensuring 

that program operations are being implemented properly and according to plan. Questions 

may include:

In what ways are staff supervised and observed on-site to assure that services are delivered 

with consistent quality? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How are services to children with disabilities tracked and monitored?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you use program tracking reports and other reports?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does the program check on the quality and completeness of ongoing child assessment 

data?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 5 ■ 5

Can you share an example of how your analysis of child outcome information for three-tofi ve year old children has resulted in program change?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

For programs with child care partnerships: 

What is your system for monitoring partnership classrooms to assure quality services are 

implemented? What have your recent monitoring efforts revealed? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

For programs with delegate agencies:

What is your system for monitoring your delegate agencies to assure quality services are 

implemented? What have your recent monitoring efforts revealed?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 5 ■ 6

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 5 ■ 7

Team Member Summary Worksheet

Summary of Results for Ongoing Monitoring

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 5 

■

8

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 1

Program Self-Assessment Booklet 6

Management Systems: Human Resources

Core Question to be answered by the Self-Assessment team:

How effective is the grantee’s human resources management system in supporting the 

implementation of quality services to children and families?

Purpose:

The objective is to ensure that programs recruit and select dynamic, qualifi ed staff 

who possess the knowledge, skills and experience needed to provide high quality, 

comprehensive and culturally sensitive services to children and families in the program. 

Staff should be regarded as one of the program’s greatest assets. 

This booklet will help you to assess if the program meets Federal Performance Standards

relating to personnel, staff qualifi cations, hiring, performance appraisals, etc. Performance 

Standards: 1301.31, including Appendix A; 1304.24(a)(2)-1304.24(a)(3); 1304.52; 1306.20-

1306.23; 1308.4(e); 1308.4(k); 1310.16-1310.17.

As you conduct your assessment of human resources management, pay close attention to:

■ How staff are organized to support the program

■ How staff are oriented to their positions and supervised

■ The program’s system to support training and professional development, especially 

in the area of teacher qualifi cations

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Organizational chart of staff or list of staff and their functions

■ Program personnel policies

■ Professional development/training plans for staff (individual and agency-wide)

■ Child abuse reporting policy

■ Sample of staff fi les from all areas of the organization plus sample performance 

appraisals (to maintain confi dentiality, personnel fi les should be reviewed by a 

manager or staff member who has access to these fi les) 

■ Ongoing monitoring reports

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 3

Use the checklist below to assist your document review:

Are there job descriptions of each staff position, including qualifi cations and roles and 

responsibilities?

❏ Yes ❏ No Comment: _________________________________________________________

Are there formal procedures for the recruitment, selection and termination of staff?

❏ Yes ❏ No Comment: _________________________________________________________

Are references verifi ed and background checks conducted in accordance with state law and 

administrative requirements before hiring job applicants?

❏ Yes ❏ No Comment: _________________________________________________________

Does the program have in place standards of conduct by which all employees must abide?

❏ Yes ❏ No Comment: _________________________________________________________

Is there evidence that regular volunteers are asked and required to have tuberculosis 

testing? 

❏ Yes ❏ No Comment: _________________________________________________________

Are there procedures for conducting staff performance appraisals? Is there evidence that 

procedures are being followed? Are appraisals conducted at least once each year?

❏ Yes ❏ No Comment: _________________________________________________________

Is there an assurance that the program is an equal opportunity employer and does not 

discriminate on the basis of gender, race, ethnicity, religion or disability?

❏ Yes ❏ No Comment: _________________________________________________________

Are there procedures for managing employee grievances and adverse actions? 

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 4

Checklist for reviewing personnel fi les:

Content Area Expert Qualifi cations:

Is there evidence that lead teachers have proper qualifi cations? 

Classroom (lead) teacher qualifi cations: 

50% of teachers have Associate, Baccalaureate, or advanced degree in early childhood 

education or Associate, Baccalaureate, or advanced degree in a fi eld related to early 

childhood education, with experience in teaching preschool children.

❏ Yes ❏ No Comment: _____________________________________________________

Or

Child Development Associate (CDA) state certifi cate for preschool teachers or degree 

in a fi eld related to early childhood education, with experience in teaching preschool 

children and a state certifi cate to teach preschool.

❏ Yes ❏ No Comment: _____________________________________________________

Or

If the teacher does not have the above qualifi cation, enrollment in a 2 or 4-year degree or 

CDA program that will grant degree or credential to the individual within 180 days of 

employment.

❏ Yes ❏ No Comment: _____________________________________________________

Note: For programs that use consultants to provide content area expertise, consultants must also 

meet qualifi cations outlined in Performance Standards. 

Are health services supported by a content area expert with experience and training 

in public health, nursing, health education, maternal and child health, or health 

administration?

❏ Yes ❏ No Comment: ___________________________________________________________

Are nutrition services supported by a content area expert who is a registered or licensed 

dietitian or nutritionist?

❏ Yes ❏ No Comment: ___________________________________________________________

Are mental health services supported by a content area expert who is a licensed or certifi ed 

mental health professional with experience and expertise in serving young children and 

their families?

❏ Yes ❏ No Comment: ___________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 5

Are family and community partnership services supported by a content area expert who 

has training or experience in fi elds related to social, human or family services?

❏ Yes ❏ No Comment: ___________________________________________________________

Are parent involvement services supported by a content area expert who has training, 

experience and skills in assisting the parents of young children in advocating and decisionmaking for their families?

❏ Yes ❏ No Comment: ___________________________________________________________

Are disability services supported by a content area expert who has training or experience in 

securing and individualizing needed services for children with disabilities?

❏ Yes ❏ No Comment: ___________________________________________________________

Do home visitor staff have knowledge and experience in child development and early 

childhood education, the principles of child health, safety, and nutrition, adult learning 

principles and family dynamics? Are they skilled in communicating with and motivating 

people? Do they have knowledge of community resources and the skills to link families 

with appropriate agencies and services?

❏ Yes ❏ No Comment: ___________________________________________________________

Do transportation services staff have the proper qualifi cations (including licenses)?

❏ Yes ❏ No Comment: ___________________________________________________________

 Do transportation services staff receive ongoing training to increase knowledge and skills?

❏ Yes ❏ No Comment: ___________________________________________________________

Do Early Head Start staff have training and experience necessary to develop supportive 

relationships with very young children and their families?

❏ Yes ❏ No Comment: ___________________________________________________________

Are professional development plans created and implemented?

❏ Yes ❏ No Comment: ___________________________________________________________

Is there evidence that employees are in good health and have been screened for tuberculosis?

❏ Yes ❏ No Comment: ___________________________________________________________

Does the program’s child abuse policy comply with state law?

❏ Yes ❏ No Comment: ___________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 6

Interview: 

Interview the Head Start director, managers and staff from all segments of your 

organization (e.g., food service, transportation, etc.).

Guiding questions:

Tell me about how you learn what is expected of you in your position and the kinds of 

support you get to help you do a better job.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How did you learn about the Head Start philosophy and Performance Standards?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe your agency’s plan and ongoing efforts to support continuing education for 

teachers in need of early childhood degrees.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 7

Who has the responsibility for the following tasks associated with child outcomes and how 

were these staff persons trained?

■ Summarizing child assessment information

■ Analyzing and interpreting results

■ Planning

■ Data collection and tracking

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe the performance appraisal process. How often does it occur?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are you provided opportunities for professional development? Do any of these 

opportunities afford course credit or lead to higher degrees?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 8

Are you aware of the program’s policies regarding the reporting of child abuse and 

neglect? Can you briefl y describe the process?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

For programs with child care partnerships: 

What is your system for monitoring partnership classrooms to assure quality services are 

implemented? What have your recent monitoring efforts revealed? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

For programs with delegate agencies:

What is your system for monitoring your delegate agencies to assure quality services are 

implemented? What have your recent monitoring efforts revealed?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 9

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 6 ■ 10

Team Member Summary Worksheet

Summary of Results for Human Resources

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 6 

■ 11

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 1

Program Self-Assessment Booklet 7

Management Systems: Fiscal Management 

Core Question to be answered by the Self-Assessment team: 

How effective is the fi scal management system in supporting the implementation of quality services 

to children and families?

Purpose:

Fiscal Management means having a system of administering resources including funds, 

property and equipment. A fi scal management system is necessary to ensure that limited 

resources, allocated carefully and accountably, support the program’s delivery of quality 

services. 

This booklet will help you to assess if the program meets Federal Performance Standards

relating to fi scal management, budgeting, and expenditures. Related Performance 

Standards include: 1301.10-1301.13, Subpart B; 1301.20-1301.21, Subpart C; 1301.32-

1301.33; 1304.20(c)(5); 1304.23(b)(1)(i); 1304.50(f); 1304.50(g)(2); 1304.51(h)(1)-1304.51(h)(2); 

1304.52(d)(8); 1305.9; 1308.4(m)-1308.4(o); 1310.23(b); Part 74, Subpart C; Part 92, Subpart C; 

OMB Circular A-21; OMB Circular A-87; OMB Circular A-110; OMB Circular A-122; OMB 

Circular A-133.

As you conduct your assessment of the program’s fi scal management systems, pay close 

attention to:

■ How Federal regulations regarding fi scal management are met

■ How the budget is developed and approved

■ How expenditures are monitored

■ What fi scal reports are produced and how they are used

■ How the grantee maintains accountability

■ How investment choices are made

Given the increased emphasis on fi scal management and oversight, the offi cial PRISM

Fiscal Checklist has been included in this booklet. It will provide you with a useful tool to 

ensure that the program is meeting its fi scal oversight and management responsibilities.

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 2

Interview:

The Self-Assessment team member should interview the program’s fi scal offi cer and Head 

Start director. Use the questions below to assist you with the interview:

Describe the fi scal system and how the management team and the fi scal offi cers work 

together to support the delivery of Head Start services. How do they interact during the 

year to support the Head Start program?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How is the budget developed and approved? Describe the involvement of the governing 

body and Policy Council. Are there written procedures describing this process? Is there a 

timeline?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How are expenditures monitored? What reports are produced and how are they used?

(Find out who receives regular fi nancial reports, how often, and how the budget is 

compared to actual expenditures.)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 3

Has the program conducted a cost analysis of providing transportation services? If so, does 

your cost analysis refl ect the true cost of providing transportation services? Do the results 

suggest any changes to these services?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Review: 

Review salary information for the grantee’s executive and staff positions. Are salaries in 

general and teacher salaries in particular, suffi cient to recruit and retain qualifi ed staff? Is 

the level of compensation consistent with the mission and goals of an anti-poverty agency 

and reasonable by community standards?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Use your interview with the director and chief fi nancial offi cer to obtain copies of 

documents and other information to complete the attached fi scal checklist.
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 4

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 5

Fiscal Checklist 

Instructions for completing the Fiscal Checklist:

This checklist is designed to assist you in monitoring the fi scal health of the grantee and 

any delegate agencies (as applicable). The checklist is divided into three sections (with all 

questions receiving either a “Yes” or “No” answer). The answers to the questions in the 

fi rst two sections will help you, in the third section, assess fi scal health in each of two major 

areas: 

1. Internal Controls [45 CFR Parts 74.21(b)(3), 92.20(b)(3)]; and 

2. Governance [45 CFR Part 1304.50(g)(2)].

These two major areas receive substantial emphasis because, together, effective internal 

controls and governance help grantees ensure successful and effi cient operations of their 

own programs (and those of their delegates), reliable fi nancial reporting, and compliance 

with applicable laws and regulations.

The fi rst section of this checklist (Section I) includes 24 questions that serve as indicators 

(i.e., “fl ags”) designed to help identify underlying fi scal problems. Circle “Y” (yes) or “N” 

(no) when answering each question. Responses with fl ags immediately below them might 

indicate an underlying fi scal problem. (For several of the questions, one or more follow-up 

questions appear that are related to the main question. Answer these questions as directed.) 

After completing the fi rst section, refer back to the questions with “fl ag” responses to gain 

a preliminary sense of the fi scal health of the grantee (and/or its delegates) and to identify 

areas that may need additional attention. 

The second section of this checklist (Section II) includes 28 questions that directly assess 

compliance with specifi c program requirements (i.e., each question contains citations to the 

regulation(s) and/or Offi ce of Management and Budget (OMB) Circulars that are applicable 

to the respective question). Circle “Y” (yes) or “N” (no) when answering each question. (For 

several of the questions, one or more follow-up questions appear that are related to the main 

question. Answer these questions as directed.) If a fl ag appears under the response that you 

circled, and if the weight of the answers to the main and follow-up questions (if applicable) 

suggest the grantee/delegate is not in compliance with the specifi ed requirement(s), place a 

check in the box under the “Potential Area of Noncompliance” heading. 

Toward the end of the fi scal review (i.e., after you have completed Sections I and II of the 

checklist, gathered all relevant information from document reviews and interviews, and 

followed up on all outstanding issues), turn your attention to the two major areas identifi ed 

above (i.e., internal controls and governance). These items also appear in question form in 

Section III (page 20). For each of these items on page 20, place a check in the box under the 

heading “Potential Area of Noncompliance” if the weight of the evidence you have collected 

(including the answers to the questions in Sections I and II of the checklist) suggests that the 

grantee/delegate is not in compliance with the specifi ed requirement.
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 6

Under the “Documents Reviewed” column, list the evidence, in the form of documents, 

you gathered and reviewed to support your conclusion. Under the “People Interviewed” 

column, list the individuals you interviewed when answering the checklist questions, and 

in the “Additional Comments” column, write any additional remarks that pertain to the 

question.

In answering the questions on this checklist, some of the documents you might fi nd useful 

to review include:

■ current and prior fi nancial statements from the audit report,

■ most recent fi nancial reports as delivered to the governing bodies,

■ Policies and Procedures manual(s) covering fi scal operations (e.g., written accounting 

procedures and procurement procedures),

■ detailed general ledger or accounts payable (AP) disbursements journal,

■ monthly trial balances,

■ bank reconciliations,

■ administrative costs documentation,

■ program budget planning documents (e.g., forms, memorandums, work papers, 

GABI, and grant proposals),

■ chart of accounts,

■ property inventory and fi les for recent major purchases,

■ audit reports and the management letter that accompanies the audit report (including 

the most recent), 

■ current and prior year Financial Assistance Award (FAA), 

■ notice of grant award,

■ indirect cost agreement and/or cost allocation plan,

■ lease agreements,

■ codes of conduct from personnel policies,

■ organizational chart or list of staff and function of each staff person, including any 

vacancies,

■ payroll journal and/or payroll service summary,

■ most recent SF-269, with supporting documentation

■ PMS-272 with supporting documentation from the past four quarters,

■ insurance policies (e.g., liability, vehicles, child accident),

■ interagency agreements,

■ Non-Federal share documentation,

■ Department of Agriculture (USDA) accounting records and source documents (e.g. 

meal counts, etc.),

■ Vendor contracts,

■ grantee charter document,

■ delegate agencies and other partnership contracts as required.

*Please note that questions 12, 27, 40, and 50 apply to grantees only, and question 45 is only applicable to private non-profi ts.
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 7

Fiscal Checklist

Section I

Documents 

Reviewed

People 

Interviewed

Additional 

Comments

1 Y N Is the ratio of current assets to current liabilities 

less than 1 (i.e., are there insuffi cient funds to pay debts due within a year)? [If yes, please answer the question below. If no, go to question 2.]Y N Has the ratio decreased over the past three years?

2

Y N Has the grantee borrowed money within the last 

12 months?

3

Y N Has the amount of cash reported on the balance 

sheet (per audit report) decreased over the past three years? 

4

Y N Have vendor payments been late? 

5

Y N Does the most recent audit contain a disclosure 

(footnote) regarding cash fl ow status?
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 8

Documents

Reviewed

People

Interviewed

Additional 

Comments

6

Y N Does the most recent audit show any programs 

with negative operating balances?

7

Y N Are there large unfunded liabilities (e.g., annual 

and sick leave accruals, taxes payable, 401(k) payments outstanding; large mortgage or large line-of-credit payments) or recent signifi cant cost increases? 

8

Y N Have the grantee and/or delegates provided 

adequate documentation to demonstrate timely payment of employee benefi ts (i.e., Federal and state taxes, health and retirement contributions)?

9

Y N Are the grantee and/or delegate named in 

pending or recent litigation? Are there pending or current disallowances from any funding source such as USDA, CSBG, or child care? [Obtain this information through interviews with staff.]

10

Y N Is there any indication the agency may lose one or 

more major programs and/or funding sources? 
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 9

Documents

Reviewed

People

Interviewed

Additional 

Comments

11

Y N Does the Federal tax information reported agree 

with other fi nancial reports? (Specifi cally, is the tax information on the IRS 990 in agreement with the audit report?)

12

Y N [THIS QUESTION APPLIES TO THE GRANTEE 

ONLY] Does the fi nal SF-269 reconcile with the appropriate quarterly PMS-272 for the same period? 

13

Y N Do bank statements refl ect any negative cash 

balances, overdraft, or fi nance charges?

14

Y N Has there been a recent reduction of program 

staff or services, a shift towards outsourcing, excessive turnover of supervisory staff, or have key personnel quit unexpectedly?

15

Y N Does the agency maintain a complete and up-todate list of all employees? 

16

Y N Are separation/termination of employment 

instances immediately reported to the payroll department? 
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 10

Documents

Reviewed

People

Interviewed

Additional 

Comments

17

Y N Have positions been vacant for a signifi cant period 

of time (i.e., more than 90 days)? 

18

Y N Are original time records properly prepared and 

properly approved by supervisors? 

19

Y N Are payroll records regularly compared with the 

records of the personnel department? 

20

Y N Are there written accounting procedures?

21

Y N Are there specifi c procedures for maintaining 

checks and balances for cash management and other fi scal functions? [To assist in answering this question, consider the questions below.] Y N Are cash and negotiable securities 

under lock and key, and is access to them strictly controlled?
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 11

Documents

Reviewed

People

Interviewed

Additional 

Comments

Y N Are forms such as blank 

checks and purchase orders sequentially pre-numbered, physically secured, and is access to them strictly controlled?

Y N Are mechanical check signers and

signature plates physically protected, and is access to them strictly controlled?

Y N Is one individual allowed to

control all key aspects of a transaction or event?

Y N Are duties assigned 

systematically to a number of individuals to ensure that effective checks and balances exist?

Y N Does the grantee have

internal controls for mail processing, 

cash receipts, and cash disbursements?

Y N Are all grantee bank

statements reconciled on a monthly basis?
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 12

Documents

Reviewed

People

Interviewed

Additional 

Comments

Y N Are there safeguards in place

for fi nancial data systems in the event 

of data failure?

Y N Are changes in payroll 

properly authorized? 

22

Y N Are there compliance fi ndings over internal 

controls in the current audit? [If yes, please answer the question below. If no, go to question 23.]Y N Have the fi ndings been 

corrected or is there a corrective action plan in place?

23

Y N Did a review of year-end payments disclose any 

unusual or irregular items (e.g., large purchases of supplies or equipment or pay out of end-of-year “bonuses”)?

24

Y N Do the grantee and/or delegate agencies have 

policies and procedures for the use of credit cards (e.g., require documentation for expenditures, regularly monitor expenditures, and impose other clear spending limits)? 
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 13

Section II

Potential

Area of 

Noncompliance 

(✓)

Documents 

Reviewed

People

Interviewed

Additional 

Comments

25

Y N Have Head Start funds been drawn down in 

excess of documented cash requirements? [45 CFR Parts 74.22(b)(2), 92.21(c)]

26

Y N Have prior year salaries or other prior year costs 

been charged to the current budget year? [45 CFR Parts 74.28, 92.23(a)]

27

Y N [THIS QUESTION APPLIES TO THE GRANTEE 

ONLY] Has the grantee submitted timely and accurate SF-269s and PMS-272s? [45 CFR Parts 1304.51(h)(2), 74.52(a)(1)&(2), 92.41(b)&(c)]

28

Y N Have Head Start funds been used to cover costs 

normally paid by other funding streams (i.e., interfund borrowing)? [45 CFR Parts 74.27(a), 92.22(a)(1)&(2), 92.22(b)]

29

Y N Does the grantee have a qualifi ed fi scal offi cer? 

[45 CFR Part 1304.52(d)(8)]
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 14

Potential

Area of 

Noncompliance 

(✓)

Documents 

Reviewed

People

Interviewed

Additional 

Comments

30

Y N Are any staff making in excess of $100,000? 

[Consider gross pay from all funding sources.]

31

Y N Are the wages of staff (including those identifi ed 

in question 30 above) reasonable and supported by appropriate wage comparability data? [OMB Circulars A-122 (Attachment B, Item 8 (c)), A-87 (Attachment B, Item 8 (b))

32

Y N Did the grantee award COLA/Quality funds 

in compliance with the terms of its grant application? [45 CFR Parts 74.21(b)(3), 92.20(b)(3)]

33

Y N Are there appropriate internal controls for payroll 

checks distributed to employees? [45 CFR Parts 74.21(b)(3), 92.20(b)(3)&(6)]

34

Y N If the grantee has shared costs, has the grantee 

used an allocation base that best measures the relative degree of benefi t for all benefi ting functions? [45 CFR Part 92.20(b)(5), OMB Circulars A-122 (Attachment A, subsection D.1b), A-87 (Attachment A, subsection C.3), and A-21 (Section C, subpart 4)]
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 15

Potential

Area of 

Noncompliance 

(✓)

Documents 

Reviewed

People

Interviewed

Additional 

Comments

35

Y N Does the grantee regularly compare budgeted 

costs to actual costs? [45 CFR Parts 74.21(b)(4), 92.20(b)(4)] 

36

Y N Do the Policy Council and Policy Committees 

work in partnership with key management staff and the governing body to develop, review, and approve or disapprove all procedures for refunding applications and amendments to refunding applications for Early Head Start and Head Start, including administrative services, prior to the submission of such applications? [45 CFR Part 1304.50(d)(1)(i)]

37

Y N Are fi nancial reports current and available upon 

request? [45 CFR Parts 1304.51(h)(1)&(2), 74.21(b)(1)&(2), 74.53(b), 92.20(b)(1)&(2)]

38

Y N Have the grantee and delegate agencies failed 

to submit timely and accurate IRS 941, IRS 990 and other offi cial reports as required? [45 CFR Part 1304.51(h)(2)]
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 16

Potential

Area of 

Noncompliance 

(✓)

Documents 

Reviewed

People 

Interviewed

Additional 

Comments

39

Y N Has there been a failure to disseminate timely and 

accurate fi scal information to the management staff, governing body, and policy groups? [45 CFR Parts 1304.51(d)(3), 1304.51(h)(1)]

40

Y N [THIS QUESTION APPLIES TO THE GRANTEE ONLY] 

Has the grantee implemented procedures for programmatic and fi scal monitoring of its own operations and each of its delegates? [45 CFR Part 1304.51(i)(2)]

41

Y N Have the grantee and/or delegate agencies made 

changes to the budget that required prior approval before receiving such approval in writing? [45 CFR Parts 74.25, 92.30][Select subsection(s) of 45 CFR Parts 74.25 and/or 92.30 that are appropriate to the circumstance.]

42

Y N Was the last required annual audit not completed 

and/or not submitted timely and/or unavailable? [OMB Circular A-133 (Subpart B.220), 45 CFR Parts 1301.12(a), 74.53(b), 92.42] 
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 17

Potential

Area of 

Noncompliance 

(✓)

Documents 

Reviewed

People 

Interviewed

Additional 

Comments

43

Y N Has the grantee corrected previous audit fi ndings? 

[OMB Circular A-133 (Subpart C.315, Paragraphs (a) & (b))]

44

Y N Has the grantee implemented procedures 

to determine allowability, allocability, and reasonableness of costs as required? [45 CFR Parts 74.21(b)(6), 92.20(b)(5)]

45

Y N [THIS QUESTION APPLIES TO PRIVATE NON-PROFITS 

ONLY] Does the grantee fail to have the required insurance coverage? [45 CFR Parts 1301.11, 74.31. (Not applicable for grantees subject to Part 92, who are generally self-insured.)] [Select subsection(s) of 45 CFR Part 1301.11 that are appropriate to the circumstance.]

46

Y N Does the grantee meet property management 

standards for nonexpendable personal property, including conducting a physical inventory at least once every 2 years and having all vehicle titles available? [To assist in answering this question, fi rst consider the questions below.] [45 CFR Parts 74.30, 74.33(a)(1), 74.34(f)(1)(ix)(3), 92.31-92.32]
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 18

Potential

Area of 

Noncompliance 

(✓)

Documents 

Reviewed

People 

Interviewed

Additional 

Comments

Y N Is equipment vulnerable to theft, securely

fastened or protected in some other manner?

Y N Are identifi cation plates and

numbers affi xed to offi cefurniture and fi xtures,equipment, and other portable assets?

47

Y N Does the grantee have inadequate supplies or 

materials or outdated equipment? [45 CFR Part 1304.53(b)(1)] 

48

Y N Are costs for development and administration 

necessary and of benefi t to the program, properly allocated and documented, and not in excess of 15% of total costs unless a waiver has been granted? [45 CFR Part 1301.32] [Select subsection(s) of 45 CFR Part 1301.32 that are appropriate to the circumstance.]
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 19

Potential

Area of 

Noncompliance 

(✓)

Documents 

Reviewed

People 

Interviewed

Additional 

Comments

49

Y N If the grantee and/or delegate agencies charge 

indirect costs, are these costs supported by a current negotiated indirect cost rate? [OMB Circulars A-122 (Attachment A, Paragraph E.2.c. & g.), A-87 (Attachment A, Paragraph H), and A-21 (Section G, subpart 11.g)]

50

Y N [THIS QUESTION APPLIES TO THE GRANTEE ONLY] 

Did the use of Federal funds in the grantee’s last budget exceed 80% of the total cost without a waiver? [45 CFR Parts 1301.20(a), 1301.21(a)&(b)]

51

Y N Do the source, use, and accounting of non-Federal 

funds meet the same requirements as Federal funds, and is the accounting of funds supported by proper source documents? [45 CFR Parts 74.23, 92.24][Select subsection(s) of 45 CFR Parts 74.23 and/or 92.24 that are appropriate to the circumstance.]

52

Y N Are any of the procurement transactions conducted 

in a manner that does not provide for open and free competition? [45 CFR Parts 74.43, 92.36(c)]
Stage 2: Collecting and Synthesizing the Information — Booklet 7 

■ 20

Section III

Potential

Area of 

Noncompliance 

(✓)

Documents 

Reviewed

People 

Interviewed

Additional 

Comments

Place a check in the box under the “Potential Area of Noncompliance” heading if the weight of the evidence you have collected during this review (including the answers to the questions in Sections I and II of the checklist) suggests that the grantee/delegate is not in compliance with the specifi ed requirement:

53 Grantee lacks effective control over and accountability for all 

grantee and/or delegate funds, property, and other assets. [45 CFR Parts 74.21(b)(3), 92.20(b)(3)]

54 Governing body does not ensure that appropriate internal 

controls are established and implemented to safeguard funds. [45 CFR Part 1304.50(g)(2)]
Stage 2: Collecting and Synthesizing the Information — Booklet 7 ■ 21

Team Member Summary Worksheet 

Summary of Results for Fiscal Management

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 7 

■ 22

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 8 ■ 1

Program Self-Assessment Booklet 8

Child Development and Health Services: Prevention & Early Intervention

Core Question to be answered by the Self-Assessment team:

How does the grantee implement a comprehensive system of services for preventing health problems 

and intervening promptly when they exist? 

Purpose:

The objective is to support healthy physical development by encouraging practices that 

prevent illness or injury, and by promoting positive, culturally relevant health behaviors 

that enhance life-long well-being (Introduction to 1304.22, p. 83).

This booklet will help you assess if the program meets Federal Performance Standards

relating to Prevention & Early Intervention. Related Performance Standards include: 

1304.20; 1304.21(c)(1)(iii); 1304.22-1304.24; 1304.40(c)(2)(3); 1304.40(f); 1304.41(a)(2); 

1304.41(b); 1304.53(a)(6); 1304.53(a)(8); 1304.53(a)(10)(i)-1304.53(a)(10)(iii); 1304.53(a)(10)(v)-

1304.53(a)(10)(xvii); 1306.30(c); 1306.33(c)(3); 1308.6; 1308.20; 1304.40(c)(1)(i)-

1304.40(c)(1)(iii); 1310.21.

As you conduct your assessment of the program’s prevention and early intervention 

activities, pay close attention to how the program ensures that:

■ Parents are involved as full partners in prevention and early intervention

■ Children and families are linked to an ongoing source of continuous, accessible 

health care and children are kept up-to-date on a schedule of well-child care

■ Preventive health practices are taught to children and parents

■ Nutrition and mental health services are provided to children and families that are 

responsive to their needs

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 8 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Community Assessment

■ The results of the child/family record audit conducted by the team assessing record 

keeping and reporting and/or a sample of children’s records

■ Written plans describing health, nutrition, and mental health services

■ Health and safety policies and procedures

■ Sample menus

■ Health and Safety Checklists completed by program staff 

■ Transportation Services Checklist completed by program staff

■ PIR information

■ Evidence of pedestrian safety training

■ Ongoing monitoring reports

■ Other important data sources relevant to this area such as the PRISM report, 

strategic plan or short and long term program goals

In addition, obtain the results of the Health and Safety Checklist and the Transportation 

Services Checklist administered by the team responsible for the Facilities, Materials, 

Equipment and Transportation booklet. 

Note: The team reviewing record-keeping and reporting systems is responsible for 

completing an audit of children/family records as a part of their assessment. Review the 

results of their audit and ask team members if they discovered answers to the following 

questions. You may want to supplement this information by reviewing a number of sample 

fi les on your own. 

Do children’s fi les indicate that the program assessed whether the child has an ongoing, 

continuous source of health care within 90 days of entry into the program?

❏ Yes ❏ No Comment: _________________________________________________________

Do fi les contain the information necessary to assess if children are up-to-date with wellchild care visits and have received recommended immunizations and screenings?

❏ Yes ❏ No Comment: _________________________________________________________

Do fi les for infants and toddlers indicate that screenings for developmental, sensory, and 

behavioral concerns are completed within 45 days of entry into the program? 

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 8 ■ 3

Do fi les for 3-5 year olds indicate that screenings for developmental, sensory, and 

behavioral concerns are completed within 45 days of entry into the program?

❏ Yes ❏ No Comment: _________________________________________________________

Are the 45 day screenings done in collaboration with each child’s parent and are they 

linguistically and age appropriate for the following areas: developmental, sensory 

(auditory and visual), behavioral, motor, language, social, cognitive, perceptual and 

emotional skills?

❏ Yes ❏ No Comment: _________________________________________________________

If the program did not identify a source of health care, is there evidence of assistance 

provided to the parents to fi nd one?

❏ Yes ❏ No Comment: _________________________________________________________

Is there evidence in the fi le that parents are informed and made aware of the various 

screenings as they occur (permission forms, contact notes, home visit reports, notifi cation of 

results)?

❏ Yes ❏ No Comment: _________________________________________________________

Review written plans describing health, nutrition, and mental health 

services to answer the following:

Is there evidence that these plans have been updated so that services respond to 

Community Assessment data and meet the current needs of children and families?

❏ Yes ❏ No Comment: _________________________________________________________

Do plans describe the use of early intervention and education strategies so that services are 

preventive in nature?

❏ Yes ❏ No Comment: _________________________________________________________

Is there evidence that parents and children have received training on pedestrian safety and 

bus safety practices?

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 8 ■ 4

Review sample menus to answer the following:

Are there a variety of foods made available to children, taking into account cultural and 

ethnic preferences?

❏ Yes ❏ No Comment: _________________________________________________________

Do the menus contain nutritious well-balanced meals that are age-appropriate?

❏ Yes ❏ No Comment: _________________________________________________________

Interview:

Make arrangements to meet and interview health, nutrition, mental health, and 

transportation services staff. Sample questions for the manager of health and nutrition 

services and/or the nutrition consultant:

Describe your approach to providing preventive health services to children and families at 

Head Start.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you go about accessing medical services for families who are not connected to a 

regular system of health care? (i.e., Does the program assist families in accessing their State 

Children’s Health Insurance Program (CHIP)?)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What do you do when families do not have dental services?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 8 ■ 5

Describe how nutrition services are provided to children and families in this program.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you ensure that the meals served to children meet all USDA regulations?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you accommodate special dietary needs for individual children?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe how health and nutrition education is provided to children. Are these services 

integrated into child development experiences?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 8 ■ 6

How do you share information with families that promotes nutrition, health, and safety at 

home?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Sample questions for the manager of mental health services and/or the 

mental health consultant:

Is there a regular schedule of visits by a mental health professional?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe how the mental health consultant works with staff.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe how the mental health consultant works with children and families.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 8 ■ 7

Sample Questions for Early Head Start Managers:

How does this team make sure there is a comprehensive system for preventing health 

problems and for intervening when problems exist, especially with regard to pregnant 

women and children from birth to three years of age?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

If your Early Head Start program serves pregnant women, describe how you assist women 

to access comprehensive prenatal and postpartum health care.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

If your Early Head Start program serves expectant families, how do you provide prenatal 

education about fetal development, including the risks from smoking and alcohol, labor 

and delivery, postpartum recovery, including information on maternal depression and the 

benefi ts of breastfeeding?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Sample Question for Person Responsible for Transportation Services:

How does the program ensure that all parents and children are trained on pedestrian safety 

and bus safety practices?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 8 ■ 8

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 8 ■ 9

Team Member Summary Worksheet 

Summary of Results for Prevention and Early Intervention

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 8 

■ 10

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 9 ■ 1

Program Self-Assessment Booklet 9

Child Development and Health Services: Tracking and Follow-up

Core Question to be answered by the Self-Assessment team: 

How does the grantee track the provision of all child health and developmental services and ensure 

that follow-up services are received in a timely manner? 

Purpose:

The objective is to ensure that all child health and developmental concerns are identifi ed, 

and children and families are linked to an ongoing source of continuous, accessible care to 

meet their basic needs (Introduction to 1304.20, p. 41).

This booklet will help you assess if the program meets Federal Performance Standards

relating to monitoring and necessary follow-up of all child health and developmental 

services. Related Performance Standards include: 1304.20(c)-1304.20(f); 1304.41(a)(1); 

1304.51(g); 1308.18. 

As you conduct your assessment of the program’s health care tracking and follow-up, pay 

close attention to how the program:

■ Utilizes a system for tracking health and developmental services to provide a safety 

net for children to ensure that they receive all necessary services

■ Promotes communication between and among managers and staff to plan and 

coordinate follow-up services in an integrated way

■ Accesses community resources to connect children and families with follow-up 

services

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 9 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to: 

■ Sample child/family fi les

■ Written plans and procedures describing health services

■ Sample tracking reports

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals

Are there procedures to track the provision of health care services?

❏ Yes ❏ No Comment: _________________________________________________________

Are there written procedures on the handling, storage and administration of medications?

❏ Yes ❏ No Comment: _________________________________________________________

Are there procedures by which staff can identify any new or recurring medical, dental or 

developmental concerns so that they may quickly make appropriate referrals?

❏ Yes ❏ No Comment: _________________________________________________________

Note: At least one staff person should sit on this review team so they can access and 

review child/family fi les. Other team members may not have access to these fi les based on 

the program’s confi dentiality policy.

Ask your team leader to provide you with a number of children’s records that represent 

children with identifi ed health and nutritional needs. Review these records to answer the 

following:

Are parents requested to inform the program of a child’s particular health needs and 

dietary considerations (allergies, medications) upon enrollment?

❏ Yes ❏ No Comment: _________________________________________________________

Do the fi les indicate that follow-up plans have been developed and implemented for health 

conditions that have been identifi ed?

❏ Yes ❏ No Comment: _________________________________________________________

Are doctor’s instructions and parental consent obtained before medication is administered?

❏ Yes ❏ No Comment: _________________________________________________________

Is there a record maintained of all medications dispensed?

❏ Yes ❏ No Comment: _________________________________________________________

Is the record reviewed regularly with parents?

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 9 ■ 3

Interview:

The Self-Assessment team member should interview the health manager. Use the questions 

below to assist you with interviews: 

What are your procedures for tracking child health services?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you make sure follow-up treatments are provided in a timely manner?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe the system that you use within your own program to integrate and coordinate 

services to children and families. Do managers meet regularly to communicate about and 

coordinate services? Describe that process.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Do direct service staff (e.g., teachers and family service workers) meet to coordinate 

services? Describe that process.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 9 ■ 4

Describe the role that the parent plays in arranging and providing for follow-up services to 

children.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe the role that direct service staff (e.g., teachers, family service workers) have in 

implementing follow-up services to children.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How has the program reached out to partner with health care providers and other 

providers in the community to link children and families with needed services?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 9 ■ 5

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 9 ■ 6

Team Member Summary Worksheet

Summary of Results for Tracking and Follow-Up

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 9 

■

7

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 10 ■ 1

Program Self-Assessment Booklet 10

Child Development and Health Services: Individualization

Core Question to be answered by the Self-Assessment team: 

How does the grantee, in consultation with the family, individualize the program of child 

development and health services to meet each child’s unique characteristics, strengths and needs?

Purpose:

Individualization assures that the program recognizes the uniqueness of each child and 

staff respond by individualizing approaches to child development, education and family 

partnership. 

This booklet will help the team assess if the program meets Federal Performance Standards

relating to how services are responsive to each child. Related Performance Standards include: 

1304.20(d); 1304.20(f); 1301.21(a); 1304.21(b); 1304.21(c)(1)(i); 1304.23(b)(1); 1304.40(a)(2); 

1308.19.

As you conduct your assessment of the program’s ability to individualize child 

development and health services for children, look for evidence that:

■ Families are involved in establishing goals for their children to meet their social/

emotional, language and academic needs in order to be prepared for school

■ The system used by the program to assess children is ongoing

■ Individualization addresses:

✓ Child interests

✓ The eight domains of learning and development 

✓ Temperament

✓ Language

✓ Cultural background

✓ Learning style

■ Teaching staff tie individual children’s goals into the overall curriculum

Helpful tools to support data collection in this area follow. 
Stage 2: Collecting and Synthesizing the Information — Booklet 10 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Evidence of individualized planning 

■ Evidence that plans address child interests, developmental strengths, temperament, 

needs, oral language and early literacy skills, cultural background and learning style

■ Ongoing monitoring reports

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals

Reminder: a member of the staff serving on the Self-Assessment team must conduct fi le 

reviews.

Record your results below:

My review of ____(fi ll in number) child fi les revealed that:

___ all fi les show evidence of individualized planning 

___ a substantial number of fi les show evidence of individualized planning 

___ very few fi les show evidence of individualized planning

Comments:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 10 ■ 3

Early Head Start

(Please check appropriate column) Most of the 

time

Some of the 

time Rarely

Files show that individualization addresses:

■ Child interests

■ Developmental strengths

■ Temperament

■ Needs

■ Learning styles

■ Languages

■ Early literacy skills (e.g., book knowledge, book language, 

phonological awareness, print awareness) phonological awareness, print awareness)

Early literacy skills (e.g., book knowledge, book language, 

■ Math and science concepts

■ Cultural background

■ Health/nutrition considerations

Information in the child fi les shows that parents provide input into 

the education and child development services that are planned for the education and child development services that are planned for

Information in the child fi les shows that parents provide input into 

their child 

Classroom curriculum plans refl ect individualization and are based 

on information contained in the child fi les on information contained in the child files

Classroom curriculum plans refl ect individualization and are based 

Planning for socializations indicates evidence of individualization

Socializations include parents and their infants and toddlers

Head Start

(Please check appropriate column) Most of the 

time

Some of the 

time Rarely

Files show that individualization addresses:

■ Child interests

■ Developmental strengths

■ Temperament

■ Needs

■ Learning styles

■ Languages

■ Early literacy skills (e.g., book knowledge, book language, 

phonological awareness, print awareness) phonological awareness, print awareness)

Early literacy skills (e.g., book knowledge, book language, 

■ Math and science concepts

■ Cultural background

■ Health/nutrition considerations

Information in the child fi les shows that parents provide input into 

the education and child development services that are planned for the education and child development services that are planned for

Information in the child fi les shows that parents provide input into 

their child 

Classroom curriculum plans refl ect individualization and are based 

on information contained in the child fi les on information contained in the child files

Classroom curriculum plans refl ect individualization and are based 
Stage 2: Collecting and Synthesizing the Information — Booklet 10 ■ 4

Observe:

Two members of the assessment team, one staff person with a child development 

background and another staff person or parent, should select a specifi c number of 

children to observe. The “observation team” might have two or three “focus” children. 

In conducting an observation, team members should focus on one child at a time for an 

extended period (typically no less than 30 minutes).

The following questions are adapted from the PRISM Classroom Observation and PRISM

Home Visit Observation tools and the National Institute for Child Health and Development 

Caregiver Language Checklist. Use your observations of children to answer the following 

and record your comments: 

Is there evidence that the teacher or caregiver responds to the child’s vocalizations or bids 

for attention? (e.g. the caregiver responds verbally by repeating a sound or naming the 

object the infant/toddler is pointing to or comments on what the child said to expand the 

conversation.)

❏ Yes ❏ No Comment: _________________________________________________________

_________________________________________________________________________________

Is there evidence that the teacher or caregiver supports the learning of the child? (e.g., 

notices what the child is working on, takes out a special puzzle or helps a child with a 

disability participate in a physical game by holding hands or going slowly.)

❏ Yes ❏ No Comment: _________________________________________________________

_________________________________________________________________________________

Is there evidence that the teacher or caregiver adjusts the activity to refl ect the needs of the 

child? (e.g., accepts non-verbal response to a question or offers adaptive equipment like 

larger crayons or double-handled scissors to the child.)

❏ Yes ❏ No Comment: _________________________________________________________

_________________________________________________________________________________

Is there evidence that the teacher or caregiver provides a supportive learning environment? 

(e.g., offers a hand to a new walker, moves furniture to accommodate a child with motor 

planning problems.)

❏ Yes ❏ No Comment: _________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 10 ■ 5

Interview:

A member of the assessment team should interview teachers and/or home visitors, family 

child care providers, and a sample of parents. Use the following questions to assist you 

with interviews: 

Questions for education managers, teaching staff and home visitors:

How does the curriculum support individual needs, abilities and learning styles of 

children?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does the curriculum support individual needs in the areas of oral language, literacy, 

and school readiness?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What information is taken into account to individualize planning for each child?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Talk about three children you currently work with. What have assessments revealed? 

How have you used this information to design activities and experiences to support these 

children in attaining new goals?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 10 ■ 6

Describe the practices within your program that ensure a continuity of services and care for 

children as they enter and exit the program.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does the program involve parents in supporting individualized child development?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does the program involve parents in supporting individualization based on oral 

language, early literacy and academic skills?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

For Early Head Start: 

Are there adequate transitions from Early Head Start to Head Start or another setting in 

the community? Does transition planning for Early Head Start children begin six months 

before the child’s third birthday?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 10 ■ 7

Questions for parents include:

What kinds of things is your child learning by participating in Head Start?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are there other things that you would like to see your child learning? If yes, have you 

discussed this with your child’s teacher/home visitor?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Have you participated in home visits with the teaching staff as well as staff/parent 

conferences? Tell me about those visits and conferences.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Do you work together with your child’s teacher/home visitor to plan activities that you can 

do with your child in your home?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 10 ■ 8

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 10 ■ 9

Team Member Summary Worksheet

Summary of Results for Individualization

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 10 

■ 10

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 11 ■ 1

Program Self-Assessment Booklet 11

Child Development and Health Services: Disabilities Services

Core Question to be answered by Self-Assessment team: 

How does the grantee ensure that individual services are effectively provided to children with 

diagnosed or suspected disabilities?

Purpose:

The purpose is to ensure that children with disabilities enrolled in the program receive all 

of the services to which they are entitled in the least restrictive environment. (Purpose and 

application of Part 1308, p. 255.)

This booklet will help the Self-Assessment team determine if the program meets Federal 

Performance Standards relating to disabilities services. Related Performance Standards include: 

1304.20(c)(4); 1304.20(f); 1304.21(a)(1)(ii); 1304.23(a)(2); 1304.24(a)(3)(iii); 1304.41(a)(4); 

1304.53(a)(10)(xvii); 1304.53(b)(1)(iii); 1308; 1310.22(b).

As you conduct your Self-Assessment of program services to children with disabilities, pay 

close attention to:

■ The process used by the program to assess children’s needs for special services

■ How the program engages parents as partners when planning special services for 

children

■ Evidence of the inclusion of children with disabilities in the Head Start program

■ Evidence of Individualized Family Service Plans (IFSPs) in Early Head Start 

programs and Individualized Education Plans (IEPs) for Head Start programs

Note: Individual programs may wish to substitute terms used in this booklet with terms used by 

your local school district (e.g., special needs, disabilities, special services, disabilities services). 

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 11 ■ 2

Observe:

Check in with Self-Assessment team members assigned to curriculum and individualization. 

Ask them to summarize for you what they discovered about the program’s approach to 

serving children with disabilities during their assessment process. In particular, review 

with them the results of the Curriculum Observation Instrument pertaining to serving 

children with disabilities. 

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Written plans describing how disabilities services will be delivered

■ Copies of all Interagency Agreements with Local Education Agencies (LEAs), Part C, 

and other programs serving children with disabilities and their families

■ A sample of records for children with disabilities (Note: assign this task to 

someone on your team who can review children’s records without breaching the 

confi dentiality policy of the program.)

■ Ongoing monitoring reports

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals

As you review the above documents and records answer the following:

Is there evidence that the disabilities services plan has been updated annually?

❏ Yes ❏ No Comment: _________________________________________________________

Are there interagency agreements between the program and LEAs that provide services to 

enable the effective participation of children with disabilities?

❏ Yes ❏ No Comment: _________________________________________________________

Do fi les demonstrate a timely process for assessing children with suspected disabilities, 

engaging parents, and arranging for services, as needed? (Note: A meeting to develop the 

IEP must be held within thirty calendar days of a determination that the child needs special 

education and related services.)

❏ Yes ❏ No Comment: _________________________________________________________

If you have an Early Head Start program, is there evidence of a formal partnership with the 

local Part C agency (provider of early intervention services)? 

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 11 ■ 3

If you have an Early Head Start program, is there an agreement that describes the process 

for coordinating services for infants and toddlers?

❏ Yes ❏ No Comment: _________________________________________________________

Is there evidence of the family’s involvement in the development of IEPs and IFSPs?

❏ Yes ❏ No Comment: _________________________________________________________

Do IEPs and IFSPs identify persons responsible for planning, delivering, and supervising 

services and projected dates for services to begin?

❏ Yes ❏ No Comment: _________________________________________________________

Are transition plans developed for children that provide continuity of care as children with 

disabilities move from one program to the next?

❏ Yes ❏ No Comment: _________________________________________________________

Interview:

The Self-Assessment team member should interview the:

■ Manager of disabilities services

■ Teachers, home visitors, family child care providers, family service workers

■ Parents of children with disabilities

■ If possible, a representative from the local LEA (Head Start) and/or Part C agency 

(Early Head Start)
Stage 2: Collecting and Synthesizing the Information — Booklet 11 ■ 4

Use the questions below to assist you with interviews: 

Questions for the disabilities services manager:

What efforts are taken to recruit children with disabilities (including children with severe 

disabilities)?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Is there a system in place to track the provision of disabilities services? Describe the followup that occurs when timeframes are not met.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How are children with disabilities included in ongoing assessment? Are all children 

included? Give examples of how appropriate accommodations were made for their special 

needs.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What types of modifi cations has the program made to meet the specifi c needs of children 

with disabilities over the past year?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 11 ■ 5

How does the program provide parents with information and assistance in understanding 

and advocating for services and supports needed to address their child’s special needs?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Has the program been successful in accessing the additional resources (including 

transportation) that may be outlined in the IEPs and IFSPs of the children you serve?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Questions for education staff:

Provide us with some examples of how you have modifi ed the program and individualized 

services to ensure the inclusion of children with disabilities in the full range of program 

activities.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 11 ■ 6

Questions for education/family services staff:

Provide us with some examples of the information, support, and guidance available to 

assist you in providing services to children with disabilities and their families. 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Questions for families: 

Describe how the Head Start program involved you in planning services for your child.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What resources in the community have you heard about through Head Start that can offer 

you assistance?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Have you participated in any training that specifi cally prepares you to advocate for your child?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 11 ■ 7

Questions for Program Partners:

Describe your relationship with the Head Start program.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Do you have an interagency agreement in place that describes the process you and Head 

Start will follow to provide services to children with disabilities? If yes, describe the major 

components of the interagency agreement.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are there challenges or barriers you face in providing services to Head Start children?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How are you working with Head Start to overcome these barriers?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 11 ■ 8

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 11 ■ 9

Team Member Summary Worksheet 

Summary of Results for Disabilities Services

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 11 

■ 10

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 1

Program Self-Assessment Booklet 12

Child Development and Health Services: Curriculum and Assessment

Core Question to be answered by the Self-Assessment team: 

How has the grantee engaged in a process of curriculum selection and/or development, 

implementation, and evaluation resulting in a written plan that supports the growth of children’s 

social competence, including school readiness, for each identifi ed program option?

Purpose:

The objective is to provide all children with a safe, nurturing, engaging, and secure learning 

environment, in order to help them gain the awareness, skills, and confi dence necessary to 

succeed in their present environment, and to deal with later responsibilities in school and 

in life. (Introduction to 1304.21, p. 58.) 

This booklet will help the team assess if the program meets Federal Performance Standards

relating to curriculum development and implementation. Related Performance Standards

include: 1304.21; 1304.23(b)-1304.23(c); 1304.3(a)(5); 1304.40(e)-1304.40(f); 1306.30(b); 

1308.4(c); 1310.21.

As you conduct your assessment of the program’s ability to develop an appropriate 

curriculum, see if you can confi rm that:

■ Families have been given the opportunity to be involved in curriculum development 

that meets the social/emotional, language and literacy, and academic needs of their 

children in order to be prepared for school

■ The written curriculum contains core elements of sound child development and 

learning principles and developmentally appropriate practices 

■ The implementation of the curriculum is evident in classrooms, family child care 

homes, or in other program options offered by the program

Included are adapted tools from the PRISM: the Classroom, Family Child Care or 

Socialization Experience Observation Instrument (page 8); the Early Head Start Classroom, 

Family Child Care or Socialization Experience Observation Instrument (page 15) and; the 

Head Start Home Visit Observation Instrument (page 22). These are optional tools that 

team members may fi nd helpful in assessing the program’s curriculum. Other helpful tools 

to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 2

Observe: 

The team member should observe a sample of classrooms, socialization settings, and/or 

family child care homes (depending on the options offered by your program). Use the 

attached curriculum observation instrument or your own data collection tool. Duplicate 

the instrument as necessary to complete a good sampling of the child development services 

offered by the program. 

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents. (In order to maintain confi dentiality, only a staff member serving on 

your Self-Assessment team can review these fi les.) 

■ The written curriculum

■ The written plan describing child development services

■ Daily and weekly classroom plans

■ Child progress records 

■ Documentation of parent involvement

■ Ongoing monitoring reports

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals

Use the checklist below to assist your document review:

Does the Early Head Start written curriculum include:

Goals for children’s development, learning and school readiness? ❏ Yes ❏ No

The experiences through which they will achieve these goals? ❏ Yes ❏ No

What staff and parents do to help children achieve these goals? ❏ Yes ❏ No

The materials needed to support the implementation of the curriculum? ❏ Yes ❏ No

Does the Head Start written curriculum include:

Goals for children’s development, learning and school readiness? ❏ Yes ❏ No

The experiences through which they will achieve these goals? ❏ Yes ❏ No

What staff and parents do to help children achieve these goals? ❏ Yes ❏ No

The materials needed to support the implementation of the curriculum? ❏ Yes ❏ No
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 3

Is the curriculum consistent with the Performance Standards and based on

sound child development and learning principles? ❏ Yes ❏ No

Does it provide appropriate and comprehensive programming for the oral 

language, early literacy, social-emotional, cognitive, and physical development

of children of all ages served by the program? ❏ Yes ❏ No

For preschool children, does the curriculum include experiences in the eight

domains (language, literacy, mathematics, science, creative arts, social and 

emotional development, approaches to learning, and physical development 

and health)? ❏ Yes ❏ No

Does the curriculum and assessment process support the inclusion of children

with disabilities? ❏ Yes ❏ No

Does the curriculum and assessment process support the inclusion of the home

language of the children? ❏ Yes ❏ No

Are health, nutrition, mental health, and safety education integrated into

the curriculum? ❏ Yes ❏ No

Does the curriculum include transition issues? ❏ Yes ❏ No

Does curriculum implementation, including assessment, provide appropriate

environments and comprehensive programming for children, from birth to 

fi ve years old? ❏ Yes ❏ No

Is there a written plan describing child development services that gets updated

annually to refl ect the changing needs of children? ❏ Yes ❏ No

Do the ongoing assessment tools address the eight domains and thirteen

mandated elements and indicators? ❏ Yes ❏ No

Is the tool appropriate to children’s ages, home languages, cultures, and special

needs? ❏ Yes ❏ No

Comments: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 4

Interview:

A Self-Assessment team member should interview the education manager and ask: 

How does your team engage with parents to select, develop, implement and evaluate the

curriculum for each program option? How do you ensure that the curriculum supports 

the oral language development, literacy skills, and the growth of the social competence of 

children?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How have you incorporated outcome-based measures into curriculum development and 

implementation?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you ensure that the curriculum supports children whose home language is 

different than English?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Does ongoing assessment align with the curriculum and cover all the major goals and 

objectives?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 5

Are teachers and other staff members well-trained in using the ongoing assessment tools to 

provide accurate and consistent information on children’s progress?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are teachers and other staff members provided adequate time and support to record 

and review ongoing assessment information so that they can understand it and use it 

appropriately in adjusting teaching strategies, materials and learning opportunities for 

groups of children and for individual children?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

For children who are transported to the program, how is the time spent riding the bus used 

to reinforce the curriculum and otherwise foster healthy child development?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

A Self-Assessment team member should interview teachers and/or home visitors and 

family child care providers and ask: 

How is the curriculum consistent with the Performance Standards and sound child 

development and learning principles?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 6

How are parents involved in curriculum development and reporting child progress?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Tell me how your classroom environment and daily schedule supports the curriculum.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Tell me how your classroom environment supports an enriched language and early literacy 

environment.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What process do you use for curriculum planning?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you evaluate children’s progress? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 7

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■

8

CLASSROOM, FAMILY CHILD CARE, or SOCIALIZATION EXPERIENCE

OBSERVATION INSTRUMENT

(Adapted from PRISM)

Instructions: Make arrangements to visit a cross-section of classrooms, family child care homes, and/or socializations. Be sure to include child care partnership classrooms in your selection. Spend some time sitting and observing the setting to gather enough information to complete the instrument. You may want to pair with another Self-Assessment team member. You can then work together to reach consensus regarding your interpretations of the activity you observe. Team members engaged in this process should have knowledge of appropriate early childhood practice.Use this observation tool to observe classrooms, family child care and socializations. Duplicate this form for each site the SelfAssessment team visits. 

1. Teacher Interaction and Strategies■ Adults using a variety of intentional strategies that vary in complexity■ Supervision of all indoor and outdoor activities■ Positive child guidance and appropriate limits■ Materials are accessible for childrenObserve: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:

■ Child-initiated and adult-directed activities

■ Individual and small group experiences■ Children exploring and making choices■ Timely, predictable, and unhurried routines and transitions■ Talking to children, singing and playing with them during transitions,

mealtimes, and other routines

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 9

2. Facilitating Children’s Language and Early Literacy Development■ Language use and interaction among and between children and adults■ Adults fostering children’s communication, including home language■ Experiences that develop auditory and visual discrimination■ Experiences that support creative expression■ Experiences that develop school-readiness skills in early literacy■ Books that are accessibleObserve: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Alphabet posters, puzzles and books■ Examples of functional print and other materials in appropriate places: 

mailboxes, sign-in charts, maps, helper charts and schedules

■ Opportunities for children to scribble, write and dictate stories and messages■ Art, music, rhyming songs and movement■ Learning activities such as games, puzzles and books that promote 

knowledge of letters (alphabet) and sounds

■ Adults reading and discussing stories one-on-one and in small groups■ Books that are accessible for children to choose, to look at alone, to share 

with a friend, or to take home

■ Adults and children asking questions and engaged in meaningful 

conversations

■ Experiences, materials, conversation and activities that support the language 

used at home and English as a second language

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 10

3. Facilitating Children’s Math and Science Development■ Experiences that develop skills in mathematics and science understanding■ Experiences that develop auditory and visual discrimination■ Opportunities for children to discover how numerical concepts relate to other conceptsObserve: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Puzzles, games, unit blocks, and manipulatives that range in complexity■ Materials and experiences that develop counting, sequencing and one-to-one 

correspondence

■ Materials and experiences that encourage understanding of cause and effect 

and spatial relationships such as Legos®, sand/water table

■ Opportunities for children to discover how mathematical concepts relate to 

other concepts, e.g., measuring or weighing

■ Opportunities for children to count, classify, sequence, sort and match■ Children experiment, describe and make predictions■ Children using recipes for making snacks■ Children caring for plants and animals and learning about science in their 

surroundings

■ Adults asking open-ended questions in ways that extend children’s thinking

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 11

4. Facilitating Children’s Social and Emotional Development■ Experiences that foster trust, independence and self-esteem■ Age-appropriate expectations of children■ Adults interacting in supportive ways■ Experiences that help children develop social skills, competence, respect for others and positive attitudes towards learningObserve: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Self-portraits and family pictures■ Books, stories, puppets, and other dramatic play experiences■ Interactive games and activities■ Familiar routines and transitions■ Clear, consistent age-appropriate rules developed with child input■ Children accessing materials independently■ Adults timely response to children’s cries and other cues■ Adults encouraging and modeling problem solving, behaviors and language■ Singing or talking during routines and transitions

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 12

5. Facilitating Children’s Physical Development■ Experiences that develop sensory and motor skills■ Experiences that develop fi ne and gross motor skills■ Children using and coordinating small muscles, including eyes, hands and eye-hand coordination■ Suffi cient safe indoor and outdoor space with age-appropriate equipment and materialsObserve: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Tools such as blocks, beads, scissors, stapler and writing or drawing tools,

pencils and brushes, as appropriate

■ Opportunities and suffi cient space for children to walk, run, jump and climb■ Age and ability-appropriate equipment and materials■ Children using motor skills in daily routines such as pouring juice or milk, 

serving themselves, buttoning and zipping

■ Children manipulate materials such as sand, water and clay

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 13

6. Prevention and Early Intervention-Integrating Health, Nutrition, Mental Health, Safety, and Wellness■ Health, nutrition and mental health integrated into routines and children’s learning experiences.Observe: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Toothbrushing and handwashing■ Children using tissues and throwing them in the wastebasket after use■ Suffi cient time for meals■ Adults and pre-school children sharing family-style meals and meaningful 

conversations

■ Children involved in food experiences■ Topical books, songs, games, and fi ngerplays■ Materials available for socio-dramatic play ■ Adults and children talking about visits to the dentist and doctor■ Experiences representative of children’s cultures ■ Children instructed in pedestrian safety

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 14

7. Individualizing and Disabilities Services■ Respect for the culture, language, ethnicity, family and ability of each child■ Facilities that ensure children’s safety, comfort and participation■ Environment and curriculum that refl ect the IEP■ Adults observing and assessing children’s behavior and progressObserve: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Books, music, posters, and games in different languages and representing 

different cultures

■ Dolls, posters, pictures and books that represent children with disabilities■ Special furniture, equipment, and materials, if needed, to accommodate a 

child with disabilities

■ Experiences required in the IEP■ Adults working with individual children and with small groups of children■ Use of post- its, notebooks, folders, cameras, or other tools used to record 

observations

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 15

EARLY HEAD START CLASSROOM, FAMILY CHILD CARE, or 

SOCIALIZATION EXPERIENCE

OBSERVATION INSTRUMEN

T

(Adapted from PRISM)

Instructions: Make arrangements to visit a cross-section of classrooms, family child care homes and/or socializations. Be sure to include child care partnership classrooms in your selection. Spend some time sitting and observing the setting to gather enough information to complete the instrument. You may want to pair with another Self-Assessment team member. You can then work together to reach consensus regarding your interpretations of the activity you observe. Team members engaged in this process should have knowledge of appropriate early childhood practice.Use this observation tool to observe classrooms, family child care and socializations. Duplicate this form for each site the SelfAssessment team visits. 

1. Teacher Interaction and Strategies■ Adults using a variety of intentional strategies that vary in complexity■ Supervision of all indoor and outdoor activities ■ Positive child guidance, e.g. infants and toddlers able to explore and play safely with teachers naming and supporting the exploration■ Materials accessible to infants and toddlers■ Environment arranged so infants and toddlers have places to snuggle and safely be “alone” and play “peek-a-boo”.Observe: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Child-initiated and adult-directed activities■ Individual and small group experiences■ Children exploring and making choices■ Timely, predictable and unhurried routines and transitions ■ Talking, singing, playing with babies and toddlers during diaper changes, 

mealtimes and other routines

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 16

2. Facilitating Children’s Language and Literacy Development■ Infants and toddlers vocalizing and talking to each other and to adults■ Adults talking to infants and toddlers■ Experiences that develop auditory and visual discrimination■ Experiences that support creative expression ■ Early literacy experiences that develop school-readiness skillsObserve: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Pictures, puzzles and books■ Examples of functional print and other materials in appropriate places: pictures 

of infants and toddlers with their names, pictures of family members with names

■ Opportunities for toddlers to scribble, draw and dictate stories and messages■ Music, rhyming songs and movement■ Books that promote games (peek-a boo), activities (patting), and 

sounds (“the cow says”)

■ Adults reading or telling stories to infants and toddlers in their lap or close by■ Infants and toddlers choosing books to look at alone or to share with a friend, or 

to take home

■ Adults naming activities and feelings, asking questions and engaging in 

conversations with infants and toddlers 

■ Experiences, materials, conversation and activities that support the language 

used at home and English as a second language

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 17

3. Facilitating Children’s Math and Science Development■ Experiences that develop skills in mathematics and science■ Experiences that develop auditory and visual discrimination Observe: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Puzzles, games, unit blocks and manipulatives that range in complexity■ Materials and experiences that develop sequencing, e.g. enough toys so 

toddlers can create “line ups” 

■ Materials and experiences that encourage understanding of cause and effect 

and spatial relationship, e.g. busy boxes, push and pull toys

■ Opportunities for toddlers to classify, sequence, sort and match■ Infants and toddlers experiment, describe and make predictions■ Toddlers helping with snacks■ Infants and toddlers learning about their surroundings, e.g. experiencing sand, 

water 

■ Adults asking toddlers open-ended questions 

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 18

4. Facilitating Children’s Social and Emotional Development■ Experiences that foster independence and trust and self-esteem■ Age-appropriate expectations of children ■ Adults interacting in supportive ways ■ Experiences that help children develop social skills, competence, respect for others, and positive attitudes towards learningObserve: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:

■ Pictures of the infants, toddlers and their families, self portraits of toddlers 

(body outline drawings)

■ Books, stories, puppets and other dramatic play opportunities■ Interactive games and activities■ Familiar routines and transitions■ An environment that supports exploration and does not require adult prohibitions 

to ensure safety

■ Infants and toddlers accessing materials independently■ Adults timely response to infants’ and toddlers’ non-verbal cues such as 

vocalizing, pointing, crying, smiling and talking

■ Adults encouraging and modeling problem solving, behaviors and language ■ Singing or talking during routines and transitions

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 19

5. Facilitating Children’s Physical Development■ Experiences that develop sensory and motor skills■ Experiences that develop fi ne and gross motor skills ■ Children using and coordinating small muscles, including eyes, hands and eye-hand coordination■ Suffi cient safe indoor and outdoor space with age-appropriate equipment and materialsObserve: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Opportunities and suffi cient space for infants and toddlers to crawl, sit, walk, 

run, jump and climb safely 

■ Age and ability-appropriate equipment and materials■ Infants and toddlers using motor skills in daily routines as they develop, such as 

self feeding and using utensils 

■ Infants and toddlers manipulating materials such as sand and water

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 20

6. Prevention and Early Intervention-Integrating Health, Nutrition, Mental Health, Safety, and Wellness■ Health, nutrition, and mental health integrated into routines and children’s learning experiences.Observe: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:■ Adults swabbing infants’ gums, toddlers using toothbrushes and washing hands■ Toddlers using tissues and throwing them in the wastebasket after use■ Suffi cient time for meals■ Adults and toddlers sharing family-style meals and talking■ Infants held while being fed■ Songs and books that name feelings■ Opportunities for toddlers to dress up and pretend ■ Adults and children talking about visits to the dentist and doctor ■ Experiences representative of children’s cultures ■ Toddlers instructed in pedestrian safety

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 21

7. Individualizing and Disabilities Services■ Respect for the culture, language, ethnicity, family, and ability of each child■ Facilities that ensure children’s safety, comfort, and participation ■ Environment and curriculum that refl ect the IFSP or IEP ■ Adults observing and assessing children’s behavior and progress.Observe: What are the children doing? What are the teachers and adults doing? What is the environment like?Examples you might look for include:

■ Books, music, posters and games in different languages and representing different 

cultures

■ Dolls, posters, pictures and books that represent children with disabilities■ Special furniture, equipment and materials, if needed, to accommodate a child with 

disabilities

■ Experiences and adaptations required in the IFSP■ Adults sitting on the fl oor with individual infants and toddlers and with small groups 

of infants and toddlers 

■ Use of photos to document observations of interactions between and among infants 

and toddlers and adults

Yes No Comments
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■ 22

HEAD START HOME VISIT OBSERVATION INSTRUMENT

(Adapted from PRISM)

Instructions: Make arrangements to visit a cross-section of family child care homes. Spend some time sitting and observing the setting to gather enough information to complete the instrument. You may want to pair with another Self-Assessment team member. You can then work together to reach consensus regarding your interpretations of the activity you observe. Team members engaged in this process should have knowledge of appropriate early childhood practice.Use this observation tool to observe home visits. Duplicate this form for each site the Self-Assessment team visits. 

1. Home Visit Interactions and StrategiesHow does the home visitor:■ Demonstrate a friendly, cooperative relationship with the family?■ Encourage parents to take leadership of the home visit?■ Communicate in the family’s preferred language?■ Use the home as a learning environment and as a resource for curriculum experiences?■ Understand the link between home visits and socialization experiences?

■ (For preschool children) help parents plan experiences that foster their child’s 

development and learning in the 8 domains?

■ Help parents improve their parenting skills?■ Plan home visits with parents to incorporate all services of the Head Start program?■ Evaluate the home visit with parents?

Observe: What are the adults doing? What is the child doing?Issues, Questions and Follow-up:
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■ 23

2. Facilitating Children’s Language and Literacy DevelopmentHow does the home visitor help parents:■ Understand how children learn?■ Provide age-appropriate experiences that support child language and literacy learning and development?■ Provide school-readiness experiences through home visits and group socializations that refl ect the program’s curriculum?■ Value creative expression?■ Foster communication, including communication in the language spoken in the home?■ Develop auditory and visual discrimination?Observe: What are the adults doing? What is the child doing?Issues, Questions, and Follow-up:
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■ 24

3. Facilitating Children’s Math and Science DevelopmentHow does the home visitor help parents provide:■ Experiences that develop skills in mathematics?■ Experiences that develop skills in science?■ Experiences that develop auditory and visual discrimination?■ Opportunities for children to discover how numerical concepts relate to other concepts?Observe: What are the adults doing? What is the environment like? Issues, Questions, and Follow-up:
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■ 25

4. Facilitating Children’s Social and Emotional DevelopmentHow do the home visits help parents:■ Provide experiences that foster independence?■ Develop age-appropriate expectations of children?■ Interact in supportive ways?■ Help children develop social skills, respect for others, and friendships?■ Help children feel successful, competent and positive toward learning?Observe: What are the adults doing? What is the child doing? Issues, Questions, and Follow-up:
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■ 26

5. Facilitating Children’s Physical DevelopmentHow does the home visitor help parents:■ Provide experiences that develop sensory and motor skills?■ Provide experiences that develop fi ne and gross motor skills?■ Assist children in using and coordinating small muscles including eyes, hands and eye-hand coordination?■ Provide suffi cient safe age-appropriate equipment and materials?■ Supervise their child during physical activities?Observe: What are the adults doing? What is the child doing?Issues, Questions, and Follow-up:
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■ 27

6. Curriculum: Prevention and Early Intervention-Integrating Health, Nutrition, Mental Health, Safety and WellnessHow does the home visitor help parents:■ Ensure a safe environment?■ Promote health, nutrition and wellness?■ Understand and use health and hygiene practice?Observe: What are the adults doing? What is the child doing?Issues, Questions, and Follow-up:
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■ 28

7. Curriculum: Individualizing and Disabilities ServicesHow do the home visitor and the parent demonstrate:■ Planning and implementation of experiences that match the child’s current developmental level?■ Understanding of ways to adapt or change activities for the child?■ Understanding and use of health and hygiene practice?Observe: What are the adults doing? What is the child doing?Issues, Questions, and Follow-up:
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■ 29

8. Family PartnershipsHow does the home visitor:■ Support positive relationships?

■ Respect the home language and culture?■ Encourage parents to get involved in other areas of the Head Start program?■ Support parents in progress towards their goals?Observe: What are the adults doing? What is the child doing?Issues, Questions, and Follow-up:
Stage 2: Collecting and Synthesizing the Information — Booklet 12 ■ 30

Team Member Summary Worksheet 

Summary of Results for Curriculum and Assessment

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 12 

■ 31

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 1

Program Self-Assessment Booklet 13

Family and Community Partnerships: Family Partnership Building

Core Question to guide the Self-Assessment team: 

How does the grantee engage in a process of collaborative partnership-building with families?

Purpose:

The objective is to support mothers and fathers as they identify and meet their own goals, 

nurture the development of their children in the context of the family and culture, and 

advocate for communities that are supportive of children and families of all cultures 

(Introduction to 1304.40, p. 125).

This booklet will help the Self-Assessment team determine if the program meets Federal 

Performance Standards relating to working with parents. Related Performance Standards

include: 1304.20(e); 1304.21(a)(2); 1304.23(b)(4); 1304.40; 1304.50(a)(1); 1306.30(b); 1308.19(j); 

1308.21.

As you conduct your assessment of the program’s services in the area of family 

partnerships, pay close attention to:

■ The approach that the program uses to build a partnership relationship with families

■ How staff works with families to identify family goals, strengths, necessary services 

and supports to formulate a family partnership agreement

■ The program staff’s knowledge of community resources

■ The system the program uses for tracking and follow-up with families

■ How the program provides assistance to pregnant women so they can obtain 

comprehensive prenatal and postpartum care (for Early Head Start programs)

■ If the program adopts a broad and inclusive defi nition of family

■ The inclusion of mothers and fathers in meaningful ways

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ A family partnership written plan

■ A sample number of family records (In order to maintain confi dentiality, only a staff 

member serving on your Self-Assessment team can review these fi les) 

■ A listing of the community resources most commonly used to support families

■ Ongoing monitoring reports

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals

Use the questions below to assist your document review.

Has the written plan been updated within the past year to refl ect how the program will 

respond to any new needs of families?

❏ Yes ❏ No Comment: _________________________________________________________

Is there evidence of the family partnership agreement process in the majority of family fi les 

that describe: 

⇒ individualized developmental approach ❏ Yes ❏ No

⇒ family goals ❏ Yes ❏ No

⇒ strength-based ❏ Yes ❏ No

⇒ timetables ❏ Yes ❏ No

⇒ strategies for achieving the goals ❏ Yes ❏ No

⇒ progress in achieving goals ❏ Yes ❏ No

⇒ inclusion of fathers ❏ Yes ❏ No

⇒ family driven approach ❏ Yes ❏ No

Do fi le notes and reports indicate that families are being referred to appropriate resources 

in the community?

❏ Yes ❏ No Comment: _________________________________________________________

Do family services staff conduct follow-up with families to determine the quality of 

services received through Head Start referrals?

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 3

Is there evidence of family involvement in identifying and participating in appropriate 

community resources?

❏ Yes ❏ No Comment: _________________________________________________________

Do community resource listings include resources for:

⇒ emergency or crisis assistance ❏ Yes ❏ No

⇒ counseling services ❏ Yes ❏ No

⇒ education and employment training ❏ Yes ❏ No

⇒ prenatal health services (Early Head Start) ❏ Yes ❏ No

Interview:

The Self-Assessment team member should interview:

■ The manager of family partnership services and members of his/her staff

■ A number of families

■ The Early Head Start manager and staff (if appropriate)

Use the questions below to assist you with interviews: 

Questions for managers:

How do you document and monitor family partnership activity to ensure that services are 

being delivered according to the written plan?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Where do you think you should focus your attention and resources to further improve 

family partnership services in the program?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 4

Questions for family partnership staff:

How do you build partnerships with families? What are the fi rst things you do?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Can you describe the process you use for obtaining information on pre-existing plans so 

that they can be integrated into the Family Partnership Agreement?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How often do you meet one-on-one with families to review the Family Partnership 

Agreement, assess progress in attaining goals, and make adjustments?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Can you describe any goals you have with families that are related to family literacy? How 

about goals related to school readiness?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 5

Can you talk about some of the resources that work best for families in this community? 

How do you fi nd out when resources are not working? Can you name any that are not 

working? What are you doing about it?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What are some of the new or emerging needs of the low-income families that you work 

with? Describe how you are able to assist families in meeting goals in this area.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you help families transition from Early Head Start and other early care and 

education programs into Head Start or from Head Start to public school?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 6

Questions for staff providing Early Head Start services to expectant 

families:

Describe how you assist pregnant women to access comprehensive prenatal and 

postpartum health care. Provide one or two examples.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does your program provide for prenatal education? What does that education 

include? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does your program include expectant mothers and fathers in services?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

The Performance Standards require programs to provide early and continuing risk 

assessments. How is that done in this program?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 7

How does the program educate pregnant women about the benefi ts of breastfeeding?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe your procedures for transitioning families into a program option after the birth of 

the child.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Questions for Head Start and Early Head Start families:

Tell me how you fi rst learned about the family services that Head Start provides.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Can you describe how you have worked with family services staff throughout the year? 

What goals have you been working on? How have staff supported you in reaching those 

goals?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 8

Questions for Early Head Start expectant families:

Briefl y describe the types of services you have received from the Early Head Start program. 

(Listen for evidence that that the program is honoring family input and providing for risk 

assessments, timely referrals to community resources for prenatal and postpartum health 

care as well as mental health services, as appropriate.)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Other Family Service Considerations

Interview

Ask the manager responsible for coordinating family services:

Are some of your program’s families considering marriage or having diffi culty with their 

marriage? If so, what services, either offered directly or by referral, are available? For those 

families that wish to participate, how do you connect them to these resources?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you talk with parents about issues and concerns that are affecting older siblings of 

their Head Start children? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 9

Have you identifi ed supportive services for youth in your community? How do you link 

older siblings of Head Start children to these resources?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you provide opportunities for young children to get involved with your Head 

Start program (e.g., reading books to children, volunteering in classroom)?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 10

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 ■ 11

Team Member Summary Worksheet

Summary of Results for Family Partnership Building

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 13 

■ 12

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 1

Program Self-Assessment Booklet 14

Family and Community Partnerships: Parent Involvement 

Core Question to guide the Self-Assessment team:

How does the grantee provide parent involvement opportunities in all aspects of the Head Start 

program?

Purpose:

The objective is to ensure that parents are provided opportunities for growth that refl ect 

their needs, desires and input so they become strong partners in the education of their 

child. 

This booklet will help the Self-Assessment team determine if the program meets Federal 

Performance Standards relating to parent involvement. Related Performance Standards

include: 1304.20(e)(4); 1304.23(d); 1304.24(a)(1); 1304.40(b)-1304.40(h); 1304.50; 1308.19(j); 

1308.21.

As you conduct your assessment of the program’s services in the area of parent 

involvement, pay close attention to:

■ How the program promotes parent involvement in each of the service areas: 

education, mental health, health, nutrition, disabilities, transition and family 

partnerships

■ Information pertaining to opportunities in the program for parent leadership (e.g., 

Advisory Committee meetings, Policy Council, community partnership activity, etc.)

■ The different opportunities that the program offers for families and whether or not 

they are responsive to the expressed needs of the families they serve

■ How the program reaches out to both mothers and fathers whether or not they live 

together 

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 2

Observe:

As you spend time in the Head Start program during the Self-Assessment process, take 

note how parents are involved in the program.

As you enter each center, is the atmosphere warm and inviting to families, including fathers?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are current or former parents serving as volunteers and paid staff?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are parents engaged in group meetings? What are the meetings about? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 3

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Sample fi les to review for documentation of home visits and parent/teacher 

conferences (only staff serving on Self-Assessment teams are permitted to review fi les) 

■ Records of parent involvement activities 

■ Parent training records and training calendars 

■ Plan for parent involvement (this may be integrated into other program plans)

■ Participation records or referrals for family literacy services

■ Community resource directory

■ Parent surveys, including identifi ed areas of interest

■ Ongoing monitoring reports

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals

Use the questions below to assist you in your review:

Is there evidence in child/family records of at least two staff-parent conferences conducted 

per program year?

❏ Yes ❏ No Comment: _________________________________________________________

Do you see evidence that the information obtained from families during home visits and 

parent/teacher conferences infl uences the services that are provided to children and 

families? 

❏ Yes ❏ No Comment: _________________________________________________________

In fi les pertaining to children with disabilities, is there evidence that parents are involved in 

the process of developing an Individualized Education Plan (IEP)? 

❏ Yes ❏ No Comment: _________________________________________________________

Early Head Start:

In fi les pertaining to children with disabilities, is there evidence that parents are involved in 

the process of developing an Individualized Family Services Plan (IFSP)? 

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 4

Does the program provide the following opportunities for mothers and fathers: Yes No

Opportunities to enhance parenting skills?

Opportunities for children and families to participate in family literacy services?

Medical, dental, nutrition and mental health education programs?

Opportunities to participate in community advocacy?

Parent involvement and education and employment opportunities responsive to the needs 

expressed by families?

Parent involvement in curriculum development?

Opportunities for families of children with disabilities to recognize their role in advocating for 

their child?

Opportunities for parents to learn about rights and responsibilities concerning the education of 

the child in the school they attend after Head Start?

Opportunities to participate in Early Head Start to improve skills and knowledge in prenatal 

education on fetal development, labor and delivery and post-partum recovery?

Interview:

The Self-Assessment team should attempt to speak with as many program managers as 

possible, asking each manager how he/she promotes parent involvement in the service 

areas they manage. Another strategy you may use is to check in with the other SelfAssessment teams charged with reviewing child development, health, nutrition, education, 

mental health, disabilities and transition services. You can ask for their assistance in 

assessing the extent to which parent involvement is an integral part of each of these service 

areas. 

As part of your assessment, interview some families, teachers and members of the family 

services staff. Use the following questions to assist you with interviews: 
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 5

Questions for each content area specialist (manager):

In what ways are mothers and fathers involved in services for children in the content 

area that you manage? (Answers should address home visits, health care, curriculum 

development, nutrition services, disabilities services and transition to/from Head Start.)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe current practices which ensure that parents have a strong voice in planning for 

the transition of their child into Head Start from Early Head Start or other child care/child 

development arrangements or from Head Start into elementary school.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does the program ensure that parents have opportunities for community advocacy 

so they can infl uence services in this community? Can you give me a few examples of 

community advocacy efforts being supported by this program?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 6

How does the program ensure that opportunities for involvement are responsive to the 

needs and interests of individual parents (e.g., parents with disabilities, parents whose 

primary language is not English, working parents, homebound parents, incarcerated 

parents, non-custodial parents, grandparents, etc.)? Can you share a few examples of the 

ways you have changed or enhanced the opportunities you offer to families to respond to 

their changing needs?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What procedure do you follow if parents refuse health care services offered through Head 

Start?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What procedure do you follow if parents choose not to follow up with recommended 

treatment or services proposed by the Head Start program (e.g., mental health, health, 

Individualized Education Plan (IEP))?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 7

Questions for staff working directly with families:

How do parents fi nd out about the different ways they can get involved?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What are some of the different opportunities (e.g., learning, community involvement, etc.) 

that this program offers families?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe your role in connecting families to these different opportunities.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Questions for mothers and fathers:

Tell me how you learned about some of the various opportunities that Head Start offers to 

families. Can you name some of them?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 8

How have you chosen to be involved in Head Start and how has the program benefi ted 

your family?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Have you participated in an end of the year staff-parent meeting to understand the 

progress your child has made while in Head Start? Did it better prepare you to advocate for 

your child in public school? If so, how?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Do you know what to do if you have a complaint?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 9

Other Parent Involvement Considerations

The following questions are adapted from Building Block 2, First Thoughts on Getting Dads 

Involved in Head Start and Building Block 3, Building Your Foundation to Work with Fathers, 

Department of Health and Human Services, ACF, ACYF, Head Start Bureau, 2004.

In what ways are fathers an asset to the program?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Do staff members have an understanding and appreciation for the important role that 

fathers play in child development? Describe any training and technical assistance they have 

received regarding father involvement.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Can you talk about the ways that this program has helped fathers to appreciate the 

important roles they play in their child’s development? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 10

What steps are being taken to fully involve fathers in the enrollment process? How is 

information gathered on fathers who do not live with their children?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are fathers personally invited and encouraged to participate in the program and given 

practical ideas for how to participate?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What are the most common services provided to fathers during the family partnership 

process? How are these services working?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Describe some of the key community resources for fathers and the community partnerships 

that help you to improve services to fathers.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 11

Question for fathers:

Describe the services that this program offers to you and other fathers.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Document review:

Can you fi nd evidence that staff involve fathers in the family partnership process? Are 

there specifi c goals established with fathers?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 12

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 ■ 13

Team Member Summary Worksheet

Summary of Results for Parent Involvement

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 14 

■ 14

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 1

Program Self-Assessment Booklet 15

Family and Community Partnerships: Community and Child Care 

Partnerships

Core Question to guide the Self-Assessment team:

How does the grantee take an active role in community planning and advocacy to improve the 

delivery of services to children and families? Is this program engaged in effective child care 

partnerships?

Purpose:

The objective is to ensure that programs collaborate with partners in their communities 

in order to provide the highest level of services to children and families, to foster a 

continuum of family centered services and to advocate for a community that shares 

responsibility for the healthy development of children and families of all cultures 

(Introduction to 1304.41, p. 147).

This booklet will help the team assess if the program meets Federal Performance 

Standards relating to developing and maintaining community and child care 

partnerships. Related Performance Standards include: 1304.23(b)(4); 1304.24(a)(3)(iv); 

1304.40(e)(4); 1304.41; 1308.4(l)(1)-1308.41(l)(7); 1310.23.

As you conduct your assessment of this program’s approach to community 

partnerships and child care partnerships, pay close attention to:

■ How the program goes about developing a plan to guide their partnership 

activity

■ How partnership responsibilities are shared among the managers and staff

■ The program’s progress in formulating interagency agreements

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Interagency agreements

■ Child care partnership agreements

■ The program’s plan for community involvement

■ Documentation of the program’s partnership efforts 

■ Copies of the program’s transition plan

■ Ongoing monitoring reports

■ Advisory committee rosters and minutes

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals

Use the questions below to assist your document review:

Does the program document their community partnership efforts? ❏ Yes ❏ No

Is there an interagency agreement with local education agencies? ❏ Yes ❏ No

If no interagency agreement exists, is there documentation of efforts to establish such an 

agreement? ❏ Yes ❏ No

Is there evidence that the program has on-going collaborative relationships with the 

following community agencies: Yes No

Health care providers?

Mental health providers?

Nutritional service providers?

Providers of services to children with disabilities?

Family preservation and support services?

Child protective services?

Local elementary schools?

Other educational and cultural institutions (libraries, museums, etc.)?

Providers of child care services?

Organizations and businesses that provide transportation services?

Other organizations and businesses that provide support and resources to mothers, 

fathers and families?

Are there procedures in place to facilitate transitions to/from other child care programs 

and Early Head Start or Head Start, and from Head Start to elementary school?

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 3

Interview:

Ask your team leader to assist you to connect with:

■ Members of the management team who have primary responsibility for overseeing 

community partnerships

■ Community partners 

■ Child care partners

When interviewing Head Start managers, ask:

How does the program establish and maintain advisory committees to address program 

issues and to help the program respond to family and community needs?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does the program coordinate services to children with disabilities and their families 

with community agencies?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Does the program have relationships with the following community agencies:

Health care providers ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Mental health providers ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Nutritional service providers ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 4

Providers of services to children with disabilities ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Family preservation and support services ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Child protective services ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Local elementary schools ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Other educational and cultural institutions (libraries, museums, etc.) ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Providers of child care services ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Organizations and businesses that provide transportation services ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Organizations that provide job readiness and employment services ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________

Other organizations and businesses that provide support and resources to families

 ❏ Yes ❏ No

Describe the benefi ts to children and families:

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 5

How does the program encourage volunteers to participate in Head Start?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Can you provide examples of how Head Start parents work with staff to improve the 

quality of services available to children and families?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Do you have practices in place to coordinate services between this program and other 

programs that children attend before, after and during their Head Start experience? Please 

describe.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 6

Do you coordinate joint training with early childhood programs in this community?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Is there a group in your community working to coordinate transportation and do you 

participate in it? If not, have you explored the possibility of creating one?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

For Early Head Start:

How does the program promote the access of children, families and expectant parents to 

community services that are responsive to their needs? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 7

Questions for Community Partners:

If possible, see if you can meet and speak with several of the program’s community 

partners (all programs must engage in community partnerships). Four sample interview 

questions follow:

Could you briefl y describe your agency and the services it provides to the community?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How and why did your agency’s partnership with Head Start develop?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What activities and initiatives are underway as a result of this partnership?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What do you see as the major effects of this partnership?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 8

Questions for others: 

For members of the Health Services Advisory Committee or other Head Start Advisory 

Committees: How long have you been a member of the Advisory Committee? What sort of 

issues has the committee addressed during that time?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

For Local Education Agencies (LEAs) or early intervention programs funded by Part C 

of the Individuals with Disabilities Education Act (Part C agencies): How do you work with 

Head Start to support children with disabilities? What arrangements do you have to assist 

children and families in their transition from Head Start?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 9

Questions for child care partners:

Tell me about your partnership with Head Start. How did it begin and how is it working?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does your partnership with Head Start assist in meeting the needs of children and 

families in this community?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What do you bring to the partnership? What does Head Start bring?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How was the division of responsibilities decided? Is there a written agreement?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 10

How is information shared between agencies? What records are shared? How do you 

handle confi dentiality?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you ensure that you are meeting all of the Head Start Performance Standards? What 

kinds of oversight and training does Head Start provide? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Other Community Partnership Considerations 

Do you work with faith-based organizations in your community? Describe the nature of 

any partnership you may have developed.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 11

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 ■ 12

Team Member Summary Worksheet

Summary of Results for Community and Child Care Partnerships

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 15 

■ 13

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 1

Program Self-Assessment Booklet 16

Program Design: Eligibility, Recruitment, Selection, Enrollment and Attendance

Core Question to guide the Self-Assessment team:

How does the grantee approach eligibility, recruitment, selection, enrollment and attendance in 

an attempt to meet the needs of Head Start-eligible families and in response to the Community 

Assessment?

Purpose: 

The purpose is to ensure that the program is abiding by Federal requirements and 

procedures for determining eligibility, recruitment, selection, enrollment, and attendance of 

children. 

This booklet will help you to assess if the program meets Federal Performance Standards

relating to eligibility, recruitment, selection, enrollment and attendance. Related 

Performance Standards include: 1305.3-1305.8; 1308.5

As you conduct your assessment of the program’s approach to eligibility, recruitment, 

selection, enrollment and attendance, pay close attention to:

■ How the program determines who in their community is most in need of Head Start 

services

■ The strategies used to recruit children and families who are most in need

■ The process used to select children for the program

■ How the program ensures full enrollment

■ How the program responds to children who are absent

An adapted version of the PRISM Income Eligibility Data Collection Form (and its 

instructions) has been included. Team members may fi nd it to be a helpful tool in assessing 

the program’s selection of eligible children and families. Other helpful tools to support data 

collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

■ Community Assessment

■ Eligibility and selection criteria 

■ Written information on the recruitment process and the recruitment areas

■ Prioritized waiting list of eligible children (Caution: in order to maintain 

confi dentiality, only staff persons serving on your assessment team are able to view 

this information)

■ Attendance records 

■ Ongoing monitoring reports

■ Class lists and home visitor assignments

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

strategic plan or short and long term program goals

Use the questions below to assist your document review:

Does the Community Assessment include the following information about the Early Head Start 

and/or Head Start geographic area? Yes No

Demographic makeup of eligible children (number, where they live, race, ethnicity)

Community strengths and assets

Other child care and child development programs that are serving Head Start eligible children 

(include publicly funded programs)

Estimated number of children with disabilities (birth to 4 years old), including types and relevant 

services available

Data regarding the education, health, nutrition and social service needs of 

Head Start eligible children and their families

The education, health, nutrition, and social service needs of Head Start eligible 

children and their families as defi ned by families and by institutions in the community that serve 

young children

Resources in the community that could be used to address the needs of Head Start eligible children 

and families, including an assessment of their availability and accessibility

Summary and analysis of the data collected for the Community Assessment
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 3

Is there evidence that the program uses the information from the Community Assessment 

to determine the following:

A plan for recruiting eligible families? ❏ Yes ❏ No

Determining selection criteria? ❏ Yes ❏ No

Are there procedures for selecting children based on:

Family income? ❏ Yes ❏ No

Age of the child? ❏ Yes ❏ No

The extent to which a child or family meets 

program-specifi c selection criteria? ❏ Yes ❏ No

Are at least 90% of your currently enrolled families living below the poverty guideline?

❏ Yes ❏ No Comment: _________________________________________________________

If a vacancy occurs more than 60 days before the end of the program year, is it fi lled with 

another child within 30 days?

❏ Yes ❏ No Comment: _________________________________________________________

Does the program regularly calculate average daily attendance? Does the program analyze 

the causes for absenteeism when the monthly average daily attendance falls below 85%?

❏ Yes ❏ No Comment: _________________________________________________________

Is there a waiting list that ranks children according to selection criteria? 

❏ Yes ❏ No Comment: _________________________________________________________

In cases where children have four or more unexcused absences, has the program 

documented its attempt to intervene with family support procedures? 

❏ Yes ❏ No Comment: _________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 4

Interview:

One or two members of the Self-Assessment team should interview a number of Head Start 

families as well as staff persons responsible for the recruitment, selection, and enrollment 

of Head Start families. In many programs, this responsibility rests with the family services 

manager and his/her staff.

Questions for families:

How did you fi nd out about Head Start and what was it like for you to get into the 

program?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Questions for staff:

How do families in your community fi nd out about Head Start? (See if the program uses 

a variety of strategies to reach out to families; see if the program staff is willing to assist 

families through the application process.)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Tell me how the decision is made to accept a particular child into the program. (Listen to 

be sure that there are established criteria used to evaluate applications and that a consistent 

process is used to make decisions.) 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 5

What is the current average daily attendance of your program? What are you doing to 

address the low attendance if it is below 85%?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does the program recruit those most in need of Head Start services, including 

previously underserved populations?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How does your program ensure that at least 10% of those served are children with 

disabilities? What is your progress in meeting this goal?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you assign children to program options offered by your program? (Listen to be 

sure that options are offered to families in accordance with their needs.) 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 6

What is your funded enrollment for children? How many children are currently in the 

program? How do you maintain the funded enrollment level? Do you fi ll vacancies as they 

occur? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 7

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 8

Instructions for Completing the Income Eligibility Data Collection Form

(Adapted from PRISM 2005)

The Income Eligibility Data Collection Form is included to support the Head Start Bureau’s 

efforts to identify potential income eligibility-related areas of non-compliance. An adapted 

version of this form is included here to help the Self-Assessment team conduct a thorough 

review of a sample of income eligibility determination records. 

Note: The Income Eligibility Data Collection form requires the reviewer to examine 

children’s fi les. Only a staff person may access and review these fi les based on the program’s 

confi dentiality policy.

Data Collection Form Completion:

1. Column A: To facilitate this process, programs should select an appropriate sample of 

fi les to review. Programs with actual enrollment of less than 20 should review all of the 

children’s fi les (e.g., a program with 17 enrolled children should review all 17 fi les). For 

actual enrollment of 20-37 children, programs should review a sample of 20 fi les; for 

actual enrollment of 38-77 children, programs should review a sample of 25 fi les; for 

actual enrollment of 78-597 children, programs should review 30 fi les; and for actual 

enrollment of 598 children or more, programs should review a sample of 35 fi les.

2. Column B: For each child, determine if the program identifi ed the child as income 

eligible or as part of the program’s enrollment from “over-income” families.

a. For all children identifi ed by the program as income eligible (i.e., from a 

household that meets the low-income guidelines), enter a Y in column B and 

proceed to step 3 (column C).

b. If the child was enrolled as an “over-income” child, note that on the attached form 

by entering an N in column B. If you enter an N in column B, your work for that 

specifi c child’s fi le has been completed and you should proceed to the next fi le.

3. Column C: Determine if there is a signed statement by a Head Start program employee 

stating that the child was determined to be income eligible to participate in the 

program.

a. If the fi le contains a signed determination statement, enter a Y in column C and 

proceed to step 4 (column D).

b. If the fi le does not contain a signed determination statement, enter an N in column 

C. If you enter an N in column C, your work for that specifi c child’s fi le has been 

completed and you should proceed to the next fi le.

4. Column D: Determine if there is additional documentation that was used in verifying 

and determining the child’s income eligibility.

a. If the fi le contains additional documentation used to verify the child’s income 

eligibility status, enter a Y in column D and proceed to step 5 (column E).

b. If the fi le does not contain additional documentation used to verify the child’s 
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 9

income eligibility status, enter an N in column D. If you enter an N in column D, 

your work for that specifi c child’s fi le has been completed and you should proceed 

to the next fi le.

5. Column E: Review the documentation used to determine eligibility and make your 

own determination about the child’s eligibility.

a. If you concur with the program that the child is income eligible (i.e., from a 

household that meets the low-income guidelines), enter a Y in column E.

b. If you conclude that the child is not income eligible (i.e., “over-income”), enter an 

N in column E.

Below are correct and incorrect examples of form completion. Please review these examples 

before beginning your work.

Example of Correct Data Collection Form Completion:

A B C D E

File Number

Program has enrolled the 

child as an income eligible 

(from a low-income 

household) child

(Y or N)

Reviewer fi nds a signed 

statement in folder 

identifying that eligibility 

has been verifi ed

(Y or N)

Reviewer fi nds in folder 

documentation used by the 

program for determining 

eligibility

(Y or N)

Reviewer supports 

grantee’s determination of 

income eligibility

(Y or N)

1 Y N

2 N

3 Y Y Y Y

In the above example, the reviewer correctly stopped working on File Number 1 after 

entering N in column C. Also, the reviewer correctly fi lled out the form by leaving the rest 

of the columns blank after writing N in column B for File Number 2. For File Number 3, 

the reviewer fi lled in all four columns because every column had a Y in them. This example 

demonstrates the correct completion of the form because once an N is entered into a column, 

the reviewer should stop work for that fi le and move on to begin work on the next fi le. 

Example of Incorrect Data Collection Form Completion:

A B C D E

File Number

Program has enrolled the 

child as an income eligible 

(from a low-income 

household) child

(Y or N)

Reviewer fi nds a signed 

statement in folder 

identifying that eligibility 

has been verifi ed

(Y or N)

Reviewer fi nds in folder 

documentation used by the 

program for determining 

eligibility

(Y or N)

Reviewer supports 

grantee’s determination of 

income eligibility

(Y or N)

1 Y Y N Y

In the above example, the reviewer should have stopped work on File Number 1 after 

entering N in column D. Since there is no additional documentation verifying income 

eligibility, it would be impossible for the reviewer to make a determination of support for the 

grantee’s initial determination of income eligibility. Therefore, column E should have been 

left blank and the reviewer would begin work on File Number 2.
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 10

Income Eligibility Data Collection Form

Actual enrollment: ____________________________

Number of fi les to be reviewed: _______________________________

A B C D E

File Number

Program has enrolled the 

child as an income eligible 

(from a low-income 

household) child

(Y or N)

Reviewer fi nds a signed 

statement in folder 

identifying that eligibility 

has been verifi ed

(Y or N)

Reviewer fi nds in folder 

documentation used by the 

program for determining 

eligibility

(Y or N)

Reviewer supports 

grantee’s determination of 

income eligibility

(Y or N)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 11

A B C D E

File Number

Program has enrolled the 

child as an income eligible 

(from a low-income 

household) child

(Y or N)

Reviewer fi nds a signed 

statement in folder 

identifying that eligibility 

has been verifi ed

(Y or N)

Reviewer fi nds in folder 

documentation used by the 

program for determining 

eligibility

(Y or N)

Reviewer supports 

grantee’s determination of 

income eligibility

(Y or N)

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35
Stage 2: Collecting and Synthesizing the Information — Booklet 16 ■ 12

Team Member Summary Worksheet

Summary of Results for Eligibility, Recruitment, Selection, Enrollment and 

Attendance

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 16 

■ 13

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 17 ■ 1

Program Self-Assessment Booklet 17

Program Design: Facilities, Materials, Equipment, and Transportation

Core Question to guide the Self-Assessment team:

How does the grantee ensure that the facilities, materials, equipment and transportation services 

are supportive of learning and refl ective of different ages and stages of development of each child 

including children with disabilities, and that appropriate space is provided for the conduct of all 

program activities?

Purpose: 

The objective is to ensure that Head Start’s physical environment and transportation 

services supports the delivery of high quality services to all children and families. This 

booklet will help the Self-Assessment team to determine if the program meets Federal 

Performance Standards relating to facilities, materials, equipment and transportation. 

Related Performance Standards include: 1304.21(a)(4)(iv); 1304.21(a)(5)-1304.21(a)(6); 1304.2

2(e)(7);1304.23(e); 1304.53(a)(1)-1304.53(a)(5); 1304.53(a)(7)-1304.53(a)(9); 1304.53(a)(10)(iv); 

1304.53(a)(10)(xiv)-1304.53(a)(10)(xv); 1304.53(a)(10)(xvii); 1304.53(b); 1306.30(c); 

1308.4(o)(4)-1308.4(o)(6); 1310.10; 1310.12(b); 1310.13-1310.15(b); 1310.15(d); 1310.20; 

1310.22(b); 1310.23; 45 CFR 84.5

As you conduct your assessment of the program’s facilities, materials, equipment, and 

transportation, pay close attention to how:

■ Inspections, maintenance and repairs are carried out 

■ The need for materials and equipment is determined and how they are ordered

■ Programs comply with all relevant Federal, state, and local requirements regarding 

facilities and transportation vehicles

Adapted versions of the PRISM Health and Safety Checklist, and Transportation Services 

Checklist have been included. Team members may fi nd them to be helpful tools in 

assessing the program’s facilities, materials, equipment and transportation services. Other 

helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 17 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following licenses, inspections and other documents: 

■ Child care

■ Sanitation

■ Fire/safety

■ Food handlers 

■ Other locally required licenses 

■ Ongoing monitoring reports

■ Vehicle maintenance logs

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals

In addition, ask your team leader to provide you with copies of the following policies and 

procedures and check the appropriate box:

Available 

and current

Not 

available Comment

Medication administration

Short-term exclusion for health reasons

Emergency procedures

Child abuse/neglect reporting procedures

Equipment and vehicle maintenance logs
Stage 2: Collecting and Synthesizing the Information — Booklet 17 ■ 3

Observe:

The Self-Assessment team member should visit a number of centers and classrooms 

(including family child care homes) and complete the attached Health and Safety Checklist 

and the Transportation Services Checklist. Share your results with the team administering 

the booklet on Prevention and Early Intervention. The checklist results will also assist them 

in their work. 

Interview:

The Self-Assessment team member should interview management staff responsible for 

facilities and materials. Use the questions below to assist you with interviews: 

How do you make sure that the program’s facilities, materials, equipment, and 

transportation services are appropriate for the children you serve?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you make sure that the program’s facilities, materials, equipment and 

transportation services are appropriate for children with disabilities? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

When choosing a facility, what things do you consider? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 17 ■ 4

How do you ensure that the facilities, materials and equipment are accessible and useful to 

persons with disabilities?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Besides classroom space, what are the other uses for space in your Head Start facilities?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you ensure that arrangements and space, as well as types and uses of materials 

and equipment support the curriculum?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you ensure that facilities are free of toxins such as smoke, lead, pesticides and 

herbicides?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 17 ■ 5

How do you ensure that required inspections, maintenance and repairs are taking place 

and the facility is in compliance with all other relevant Federal, state, tribal and local 

requirements?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 17 ■ 6

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■

7

Health and Safety ChecklistPlace a check in the box when you observe evidence of each of the items listed. Describe any problems or concerns you witness in the comment section.Note: duplicate this page if your team is assessing more than four classrooms.For Early Head Start Infant/Toddler classrooms only:

1. Sanitation and hygiene procedures for diapering have been adopted that adequately protect health and safety of children served by the program and staff. [1304.22(e)(5)]2. The diaper-changing area is located away from areas used for cooking, eating, or children’s activities.  [1304.53(a)(10)(xiv)]3. Diapers are disposed of in a safe and sanitary manner. [1304.53(a)(10)(xvi)]4. Infant sleeping arrangements use fi rm mattresses and avoid soft bedding materials such as comforters, pillows, fl uffy  blankets or stuffed toys. [1304.53(b)(3)]5. Cribs are at least three feet apart from each other. [1304.22(e)(7)]6. Infant toys are made of non-toxic materials and are sanitized regularly. [1304.53(b)(2)]7. Toilet training equipment is available for children being toilet trained. [1304.53(a)(10)(xv)]

Comments:

Classrooms
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■

8

All Classrooms

1. Nonporous gloves are available for use when dealing with bloody bodily fl uids. [1304.22(e)(3)]2. Staff promote effective dental hygiene among children in conjunction with meals. [1304.23(b)(3)]3. Toys are stored in a “safe and orderly fashion” (e.g., in their assigned places, not out where people can trip over them).  [1304.53(b)(1)(vii)]4. The indoor and outdoor space for infants and toddlers is separated from general walkways and  areas used by preschoolers. [1304.53(a)(4)]5. Toys, materials and furniture are safe, durable, and kept in good condition (e.g., materials free of sharp edges and loose pieces, balloons and/or plastic bags not used; no choking hazards. Cribs are at least three feet apart from each other).  [1304.53(b)(1)(vi)] [1304.22(e)(7)]6. Center space is organized into functional areas that can be recognized by children and that allow  for individual activities and social interactions. [1304.53(a)(3)]7. Staffi ng patterns support regulations regarding class size and number of adults per class. [1306.20]8. Staff, volunteers and children wash their hands with soap and running water after diapering or toilet use, before food-related 

activities, whenever hands are contaminated with blood or other bodily fl uids, after handling pets or other animals. Staff and volunteers wash their hands with soap and running water before and after giving medications, before and after treating or bandaging a wound and after assisting a child with toilet use. [1304.22(e)(1)-(2)]

Comments:

Classrooms
Stage 2: Collecting and Synthesizing the Information — Booklet 17 ■ 9

Indoor Facilities

1. Facilities are available for the proper storage and handling of breast milk and formula.  [1304.23(e)(2)]2. Bathroom facilities are clean, in good repair and easily reached by children. [1304.53(a)(10)(xiv)]3. Bathroom facilities are separated from areas used for cooking, eating or children’s activities.  [1304.53(a)(10)(xiv)]4. Indoor and outdoor premises are cleaned daily and kept free of undesirable and hazardous  materials and conditions. [1304.53(a)(10)(viii)]5. Garbage and trash are stored and disposed of in a safe, sanitary manner. [1304.53(a)(10)(xvi)]6. A separate utility sink is specifi cally used to clean potties. [1304.22(e)(6)]7. For EHS, cribs are spaced at least three feet apart. [1304.22(e)(7)]8. Accommodations for nursing mothers who visit classrooms/participate in activities. [1304.40(c)(3)] 

Comments:

Classrooms
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 10

Safety

1. The facility has approved, working fi re extinguishers and an appropriate number of smoke detectors that are tested regularly. 

[1304.53(a)(10)(v), 1304.53(a)(10)(vi)]

2. Windows and glass doors are constructed, adapted or adjusted to prevent injury to children. [1304.53(a)(10)(xii)]3. Electrical outlets accessible to children are covered. [1304.53(a)(10)(xi)]4. The heating/cooling system is insulated to protect children and staff from potential burns. [1304.53(a)(10)(i)]5. There is an absence of highly fl ammable furnishings, decorations, or materials that emit toxic fumes. 

[1304.53(a)(10)(ii)]

6. Flammable and other dangerous materials/poisons are stored in locked cabinets or facilities separate from medications and  food and accessible only to authorized persons. [1304.53(a)(10)(iii)]7. Appropriate licenses (water/sewage, food/sanitation, fi re codes, transportation, and vendor/contractor licenses) are seen. 

[1304.53(a)(6) and (10)(xiii), 1304.23(e)(1), 1306.30(c)]

Comments:

Classrooms
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 11

Facility Layout and Environment

1. If necessary, there is a safe and effective heating and cooling system. [1304.53(a)(10)(i)]2. There is at least 35 sq. ft. of usable indoor space (i.e., not including bathrooms, halls, kitchens, staff rooms, and storage 

places) per child. [1304.53(a)(5]

3. Facilities enable the safe and effective participation of children with disabilities. [1308.4(o)(4)]4. Rooms are well lit. [1304.53(a)(10)(iv)]5. Garbage and trash are stored and disposed of in a safe, sanitary manner. [1304.53(a)(10)(xvi)]

Comments:

Classrooms
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 12

Provision for Emergencies

1. Exits and/or evacuation routes are clearly marked. [1304.22(a)(3), 1304.53(a)(10)(vii)]2. Emergency lighting is available. [1304.53(a)(10)(iv)]3. Emergency telephone numbers (e.g., EMS, Fire, Police, Poison Control) are clearly posted. [1304.22(a)(2)]4. Policies and plans of action that require rapid response for emergencies on the part of staff (e.g., a child choking) or 

immediate medical or dental attention are clearly posted. [1304.22(a)(1)]

5. A well-supplied fi rst-aid kit is available, accessible to staff, and out of reach of children. [1304.22(f)(1)]

Comments:

Classrooms
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 13

Medication Administration

1. All medications are properly labeled (i.e., name of child/staff, name of medication, dosage, name/number of 

pharmacy/physician). [1304.22(c)(1)]

2. Medications are under lock and key and out of reach of children. [1304.53(a)(10)(iii), 1304.22(c)(1)]3. Medications in need of refrigeration are refrigerated. [1304.22(c)(1)]

Comments:Outdoors

1. There is at least 75 sq. ft. of usable outdoor space per child. [1304.53(a)(5)]2. The playground equipment is in good repair and safe condition (e.g., adequately secured to the ground, free of sharp  edges and/or splinters, soft falling surface). [1304.53(a)(7) 1304.53(a)(10)(viii) 1304.53(a)(10)(x)]3. The outdoor play area is arranged such that no child can leave the premises or get into unsafe or unsupervised areas.  [1304.53(a)(9)]

Comments:

ClassroomsClassrooms
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 14

Instructions for Completing theTransportation Services Checklist The information gathered will be based on busride(s), interviews, observations, and documentreviews.The checklist has been numbered for easy reference and separated into four categories:

• Facilities, Materials, Equipment and

Transportation (Questions 1-13)

• Early Childhood Development and 

Health Services (Questions 14-22)

• Family and Community Partnerships

(Questions 23-27)

• Program Design and Management

(Questions 28-40)

The questions marked with � apply to all

Head Start grantees and their delegates,whether they provide transportation services or not. These items appear in questions 13-15, 17, and 26-30.

The questions marked withmay be observed on bus ride(s).

Transportation Services Checklist

(Adapted form PRISM ‘05)

Reviewer _________________________________________________________________ Date/Time _________________________Other Sources of Information Used ___________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 15

Facilities, Materials, Equipment, and TransportationYes No____ ____ 1. Each vehicle used in providing transportation services has:

• a communication system to call for assistance;• emergency safety equipment, including a charged fire extinguisher properly mounted near the driver's 

seat and a sign indicating its location;

• a first aid kit and a sign indicating its location; and • a seat belt cutter and a sign indicating its location. [1310.10(d)(1-4)]

____ ____ 2. Any auxiliary seating used in vehicles providing transportation services has been built into the vehicle by the manufacturer acturer ____ ____ 2. Any auxiliary seating used in vehicles providing transportation services has been built into the vehicle by the manuf

as part of its standard design, maintained in proper working order, and inspected annually. [1310.10(e)]

____ ____ 3. Baggage and other items transported in the passenger compartment are properly stored and secured, aisles remain 

clear, and doors and emergency exits are unobstructed at all times. [1310.15(b)]

____ ____ 4. There are procedures in place to ensure that the bus or alternative allowable vehicle is maintained in safe operating

condition. The organization operating the vehicle has established and implemented procedures for:• an annual safety inspection through an inspection program licensed or operated by the State;• systematic preventive maintenance; and • a daily pre-trip inspection by the driver. [1304.53(a)(7), 1310.13] 

____ ____ 5. Each vehicle is not required to back up or make "U" turns, except if necessary for safety reasons or because of

physical barriers. [1310.20(b)(3)]

____ ____ 6. Trip stops minimize traffic disruptions and afford the driver a good field of view in front and behind the vehicle.

[1310.20(b)(4)]

TRANSPORTATION SERVICES CHECKLIST
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 16

____ ____ 7. There are specific procedures for use of alternate routes in the case of hazardous conditions that could affect the safety of ____ ____ 7. There are specific procedures for use of alternate routes in the case of hazardous conditions that could affect the saf

the children who are being transported. [1310.20(b)(7)]

____ ____ 8. Transit times for children going to and from the program do not exceed one hour each way unless there is no shorter 

route available or any alternative shorter route is either unsafe or impractical. [1310.20(b)(1)]

____ ____ 9. When possible, stops do not require children to cross the street or highway when boarding or exiting the vehicle.

[1310.20(b)(5)]

____ ____ 10. If children must cross the street before boarding or after leaving the vehicle, the children are escorted across the street

by the bus monitor or another adult. [1310.20(b)(6)] 

____ ____ 11. The number of occupants in the vehicle does not exceed maximum passenger capacity at any time. [1310.20(b)(2)] ____ ____ 12. All vehicle occupants (except for the bus monitors who are assisting children) are seated in height- and weightappropriate restraint systems while the vehicle is in motion. [1310.15(a), 1310.15(d)] 

Exception: Approval letter from the Head Start Bureau is required for an extension of the effective date of the portion ofthe Head Start regulation relating to child safety restraint systems up to January 20, 2006.

____ ____ 13. � Children are only released to a parent, legal guardian, or other individual as designated in writing by the parent or legal 

guardian. The agency maintains lists of the persons, including alternates in case of emergency, and up-to-date child rosters are maintained at all times to ensure that no child is left behind, either at the classroom or on the vehicle at the end of the route. [1310.10(g)]

Comments:

TRANSPORTATION SERVICES CHECKLIST

Facilities, Materials, Equipment, and Transportation (cont.)Yes No
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 17

____ ____ 14. � Children receive developmentally appropriate safety training within 30 days of the start of the program year on:

• safe riding practices;• safety procedures for boarding and leaving the vehicle;• safety procedures in crossing the streets to and from the vehicle at stops;• recognition of danger zones around the vehicle; and• emergency evacuation procedures, including participation in an emergency evacuation drill conducted on the vehicle the

child will be riding. [1310.21(a), 1310.21(b)(1)-(5)]

____ ____ 15. � Children's safety training reminder activities have been developed and are developmentally appropriate, individualized, and

an integral part of program activities. [1310.21(e)]

____ ____ 16. At least two bus evacuation drills in addition to the one required to be provided within the first thirty days of service have 

been conducted during each program year. [1310.21(b)(5), 1310.21(d)]

____ ____ 17. � Grantee and delegate agencies have arranged for or provide transportation for children with disabilities to and from the

program and to special clinics or other service providers when the special education and related services cannot be provided on-site. [1308.4(h)(6), 1310.22(b)]

____ ____ 18. Up-to-date family contact information and authorization for emergency care for each child is readily available.

[1304.22(a)(2), 1304.51(g)]

____ ____ 19. Appropriate staff is informed of any health or safety accommodations or adaptations needed for children in accordance 

with the program's confidentiality policy. [1304.22(b)(3)]

TRANSPORTATION SERVICES CHECKLIST

Early Childhood Development and Health ServicesYes No
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 18

Early Childhood Development and Health Services (cont.)Yes No____ ____ 20. The agency must establish, maintain, and implement written procedures regarding the administration, handling,

and storage of medication for every child. [1304.22(c)]

____ ____ 21. Bus drivers and monitors encourage self-control by using positive methods of child guidance by setting clear,

consistent limits. [1304.21(a)(3)(i)(C), 1304.52(h)(1)(iv)] 

____ ____ 22. Routines and transitions occur in a timely, predictable, and unrushed manner according to each child's needs.

[1304.21(a)(3)(ii)]

Comments::

TRANSPORTATION SERVICES CHECKLIST
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 19

____ ____ 23. Effective two-way communication between staff and parents is facilitated on a regular basis throughout the program 

year. [1304.51(c)(1)] 

____ ____ 24. Interactions with families are respectful. [1304.40(a)(5)] ____ ____ 25. Communication with parents is conducted in the parents' primary or preferred language or through an interpreter,

to the extent feasible. [1304.40(a)(5)] 

____ ____ 26. � Parents receive safety training within 30 days of the start of the program year that:

• emphasizes the importance of escorting their children to the vehicle stop and reinforcing the vehicle safety training.• complements the training provided to their children so that safety practices can be reinforced both in the program and at 

home by the parent. [1310.21(a), 1310.21(c)] 

____ ____ 27. � Reasonable efforts are made to coordinate transportation resources with other human services agencies in the community.

[1310.23(a)]

Comments:

TRANSPORTATION SERVICES CHECKLIST

Family and Community PartnershipsYes No
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 20

Program Design and ManagementYes No____ ____ 28. � The agency assists as many families as possible who need transportation in order for their children to attend the program 

in obtaining that transportation. [1310.10(a)] 

____ ____ 29. � The specific types of transportation assistance being offered are made clear to all prospective families in the program's 

recruitment announcements. [1310.10(b)] 

____ ____ 30. � If the agency has decided not to provide transportation services, either for all or a portion of the children, the agency 

provides reasonable assistance to the families of such children to arrange transportation to and from its activities.[1310.10(b)]

____ ____ 31. If the agency provides transportation through an arrangement with another organization or individual, the agency has 

ensured compliance of the transportation provider with the Head Start regulations. [1310.10(c)]

____ ____ 32. Each vehicle purchased after February 20, 2001 is a school bus or an allowable alternate vehicle equipped for use of heightand weight-appropriate child safety restraint systems and with a reverse beeper. [1310.10(c)]

____ ____ 33. All accidents involving transportation services are reported in accordance with applicable State requirements. [1310.10(f)]

____ ____ 34. Where available in the State or jurisdiction, each driver has a valid Commercial Driver's License (CDL) for vehicles in the 

same class as the vehicle the driver operates. [1310.16(a)(1)]

____ ____ 35. In accordance with the applicant review procedures, bus drivers' driving records have been checked through the appropriate 

State agency, including the National Driver Register, if available in the State. [1310.16(b)(2)]

TRANSPORTATION SERVICES CHECKLIST
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 21

TRANSPORTATION SERVICES CHECKLIST

Program Design and Management (cont.)Yes No

____ ____ 36. Each bus driver has received a combination of classroom and behind-the-wheel training prior to transporting any child

enrolled in the agency's program, and refresher training annually, on how to:• operate the vehicle safely and efficiently;• safely run a fixed route, including loading and unloading children, stopping at railroad crossings and performing 

other specialized driving maneuvers;

• administer basic first aid;• handle emergency situations, including vehicle evacuation procedures;• operate any special equipment, such as wheelchair lifts, assistance devices or special occupant restraints;• conduct routine vehicle maintenance and safety checks; and• maintain accurate records as necessary. [1310.17(a), 1310.17(b)(1)-(7)]

____ ____ 37. Bus drivers receive annual evaluations, which must include an on-board observation of road performance. [1310.17(f)(1)]____ ____ 38. At least one bus monitor is on board at all times. [1310.15(c)]

Exception: Approval letter from the Head Start Bureau is required for an extension of the effective date of the portion ofthe Head Start regulation relating to bus monitors up to January 20, 2006.
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 22

TRANSPORTATION SERVICES CHECKLIST

___ ____ 39. Each bus monitor has been trained prior to duty on:

• child boarding and exiting procedures;• use of child restraint systems;• any required paperwork;• responses to emergencies;• emergency evacuation procedures;• use of special equipment;• child pick-up and release procedures;• pre- and post-trip vehicle check. [1310.17(f)(2)] Exception: Approval letter from the Head Start Bureau is required for an extension of the effective date of the portion ofthe Head Start regulation relating to bus monitors up to January 20, 2006.

____ ____ 40. Each agency has identified the true cost of providing transportation in order to knowledgeably compare the costs

of providing transportation directly versus contracting for the service. [1310.23(b)(1)]

Program Design and Management (cont.)Yes No

Comments:
Stage 2: Collecting and Synthesizing the Information — Booklet 17 ■ 23

Team Member Summary Worksheet

Summary of Results for Facilities, Materials, Equipment, and 

Transportation

Areas where the program is working well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 17 

■ 24

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 2: Collecting and Synthesizing the Information — Booklet 18 ■ 1

Program Self-Assessment Booklet 18

Using Child Outcomes in Program Self-Assessment

Core Question to guide the Self-Assessment team:

Does the program have an effective system for measuring child outcomes that informs program 

leaders of patterns of progress for three to fi ve year old children and how the program might be 

improved?

Purpose:

The purpose is to ensure that programs have a system for measuring child outcomes and 

using the results to plan for continuous program improvements. 

This booklet will help the Self-Assessment team determine if the program has responded 

to program outcomes as outlined in Section 641A(b) of the Head Start Reauthorization Act of 

1998 and related guidance that appears in ACYF-IM-HS-00-03 and ACYF-IM-00-18. These 

IM’s address:

■ Head Start Child Outcomes Framework

■ Timelines for Implementation and Program Monitoring

Related Performance Standards include: 1304.21(a)(1)(i); 1304.40(e)(5); 1304.51(a)(1)(ii)-

1304.51(a)(1)(iii); 1304.51(g); 1304.51(i)(1)-1304.51(i)(2); Head Start Act, Sections: 

641A(a)(1)(B); 641A(b)(4); 642(e); 648A(a)(1)(A).

As you conduct your assessment of the program’s outcome measurement system, pay close 

attention to the:

■ Effectiveness of the system in demonstrating patterns of progress for three to fi ve 

year old children participating in the program

■ Conclusions and results of the program’s analysis of information on child outcomes 

Helpful tools to support data collection in this area follow.
Stage 2: Collecting and Synthesizing the Information — Booklet 18 ■ 2

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the 

following documents: 

The Self-Assessment team member should review:

■ Child assessment instruments

■ Written plans that have been revised to include information on measuring child 

outcomes

■ Written procedures describing methods for data collection, data analysis and how 

child outcome information will be used in program planning

■ Sample data collection reports

■ Report of child outcome data analysis

■ Ongoing monitoring reports

■ Staff training and development plans 

■ Important data sources relevant to this area such as the PRISM report, PIR data, 

Community Assessment, strategic plan or short and long term program goals

Use the following checklist to guide your document review:

Do written plans refl ect responsibilities associated with collecting, analyzing and utilizing 

child outcome data?

❏ Yes ❏ No

Comment: _______________________________________________________________________

_________________________________________________________________________________

Are child outcome responsibilities refl ected in management systems such as program 

planning, record keeping and reporting, Self-Assessment, ongoing monitoring and human 

resources as well as in service areas?

❏ Yes ❏ No

Comment: _______________________________________________________________________

_________________________________________________________________________________

Do child assessment procedures and the instruments used by the program address, at a 

minimum, the eight domain areas and the thirteen required indicators listed in the Child 

Outcomes Framework?

❏ Yes ❏ No

Comment: _______________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 18 ■ 3

Is there evidence that the program staff measure children’s progress, at a minimum, in the 

beginning, middle, and end of the year?

❏ Yes ❏ No

Comment: _______________________________________________________________________

_________________________________________________________________________________

Does the program have a system for recording the results of child outcome measurement so 

they can be analyzed effectively? Can the reports be used to identify patterns of progress 

for children?

❏ Yes ❏ No

Comment: _______________________________________________________________________

_________________________________________________________________________________

Do program long-range goals and short-term objectives refl ect the fi ndings of ongoing 

monitoring and the Self-Assessment, including analysis and use of child outcome data?

❏ Yes ❏ No

Comment: _______________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 18 ■ 4

Interview:

The Self-Assessment team member should interview the Head Start director, members 

of the management team, and other program leaders involved in the child outcome 

measurement system. 

Questions you may use to guide your interview:

Describe your systems for collecting child outcome data and ongoing monitoring to track 

patterns of progress and accomplishments.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What process is used by program managers and leaders to analyze data collected during 

outcome measurement?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How is the child outcome data analysis information shared with the governing body, Policy 

Council and other stakeholders?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 18 ■ 5

How has the program used the child outcome data analysis information in planning for 

continuous improvement in the following areas:

Services for individual children?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Strengthening individual classrooms?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Identifying staff training and professional development needs?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Program planning? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 18 ■ 6

Does analysis and use of ongoing assessment data include attention to the progress of 

different groups of children such as English language learners and children who enter 

Head Start with different levels of knowledge and skills? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Are there examples of “mid-course corrections” in curriculum, teaching and other child 

development services occurring based on review of ongoing assessment information at the 

beginning and mid-points of the program year? 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Does analysis of child outcomes information incorporate comparison of trends from 

past years to highlight patterns of continuity, new areas of need or concern, or enhanced 

progress of children?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

How do you include all children in your process, including children with disabilities?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 18 ■ 7

Is your program measuring outcomes in areas other than those that are mandated (e.g., 

family outcomes)? Describe which ones.

❏ Yes ❏ No

Comment: _______________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Special Instructions: 

Review the results of the program’s outcome data analysis. Include this information 

with your booklet summary so that the Self-Assessment leadership team can use this 

information in planning program improvements.
Stage 2: Collecting and Synthesizing the Information — Booklet 18 ■ 8

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may 

choose to add:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources 

such as the PRISM report, PIR data, Community Assessment, strategic plan or short and 

long term program goals: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 18 ■ 9

Team Member Summary Worksheet

Summary of Results for Using Child Outcomes in Program Self-Assessment

Areas where the program is doing well. Provide examples of program strengths or areas 

where the program exceeds Performance Standards: 

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Areas where the program needs improvement:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional areas of concern:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Stage 2: Collecting and Synthesizing the Information — Booklet 18 

■ 10

TEAM LEADER BOOKLET ANALYSIS

Booklet # 

____________________________________________________________

Booklet Name: _______________________________________________________

Program Strengths Data Source

Specifi c Program Weaknesses and Areas to Strengthen Data Source
Stage 3: Interpreting the Information — 1

Stage 3: Interpreting the Information

Overview

Key participants in Stage 3 include:

Your designated team of managers and program leaders who are charged with leading 

the process, analyzing the information, and incorporating the results into program 

improvement efforts. In addition, your assigned TA specialist is available to support the 

work of the team as you interpret the information collected through your Self-Assessment. 

You may also want to seek input from and share key fi ndings with program leaders, staff 

and other Head Start stakeholders.

In this stage you will:

■ Review and further analyze all of the summary materials generated by each of the 

Self-Assessment teams

■ Examine program strengths and accomplishments

■ Analyze and interpret areas to strengthen

■ Display the data in a useful manner

■ Identify underlying causes and systemic issues

■ Classify and prioritize health and safety concerns

■ Classify and prioritize short-term improvements

■ Classify and prioritize long-term improvements
2 — Stage 3: Interpreting the Information 

Stage 3: Interpreting the Information

Interpreting the Information You Have Collected

After completing Stage 2, Collecting and Synthesizing the Information, you will fi nd that your 

Self-Assessment teams have generated a great deal of information and data. A signifi cant 

amount of effort went into completing each booklet, with notes refl ecting the results of 

observations, document reviews, surveys, and interviews. 

In this stage, the Self-Assessment leadership team will review, process and make sense 

of this information. This is one of the most challenging, yet critical, steps in the SelfAssessment process. This information analysis is necessary to draw meaning from the 

data that was gathered and compare existing program practice with Head Start Performance 

Standards.

Analysis of information requires: 

■ consolidating the data into a more manageable size 

■ displaying the data in a useful manner 

■ uncovering underlying causes, including systemic issues

■ classifying and prioritizing the information 

You have already begun the process of analysis in Stage 2 by having Self- Assessment team 

leaders consolidate the information into Booklet Analyses. At this point, it is necessary 

to further consolidate the data and display it in a way that enables you to identify 

weaknesses, and determine underlying causes and systemic issues. This process will enable 

you to gain insight and draw reasonable conclusions from the data, which is necessary for 

the development of your Program Improvement Plan and your Training and Technical 

Assistance Plan in Stage 4.
Stage 3: Interpreting the Information — 3

Examining Strengths

Before turning your attention to the concerns and needs that emerged from the SelfAssessment process, take time to identify and document the key strengths and 

accomplishments of the program. Take stock of the information regarding strengths that 

appears in the Booklet Analyses prepared by team leaders. Focus on new accomplishments, 

exceptional strengths or other areas that exceed the Head Start Program Performance 

Standards, and record the information on the following Program Strengths Worksheet.

The information you record will inform your work in Stage 4 by providing a broader 

program context. To support continuous quality improvement, you will need to draw upon 

the strengths of the program in order to develop and support new strategies to improve 

outcomes for children and families. This information should also be included in any SelfAssessment summary reports you prepare for the staff, families, Policy Council, governing 

body, and the greater community. These reports will provide a balanced program 

perspective so that others are aware of the good work you do. 
4 — Stage 3: Interpreting the Information 
Stage 3: Interpreting the Information — 5

Program Strengths Worksheet

Record the key strengths and signifi cant achievements that you want to share with others 

and build upon in the future.

Key Strengths and Achievements
6 — Stage 3: Interpreting the Information 
Stage 3: Interpreting the Information — 7

Analysis and Interpretation 

Analyzing information is a complex process. Analysis of data needs to be conducted in 

a systematic and logical way so that information can be reviewed and processed, and 

reasonable and reliable conclusions can be drawn. While some problems are readily 

identifi able, others may not be as obvious. In addition, while some issues may be limited to 

specifi c program functions or segments, others may be more overarching. The identifi cation 

of problems, the determination as to whether they are contained or systemic, and the 

formation of conclusions about their underlying causes, will form the basis for developing 

the Program Improvement Plan and the T/TA Plan.

Displaying the Data

There are many different methods for the analysis of Self-Assessment information and 

data. As the purpose of the Head Start Self-Assessment process is to assure consistency 

with the Performance Standards and help programs strive for excellence, a method that has 

proven especially effective for Head Start programs is the use of the PRISM Framework. 

This framework, a matrix of all eighteen systems and services contained in the Head Start 

Program Performance Standards, provides a tool to display the information from the Booklet 

Analyses and identify systems and services needing improvement. 

The PRISM Framework: Analysis of Areas to Strengthen is included on page 11 to assist 

programs in organizing and displaying their Self-Assessment data to determine areas of 

contained weaknesses, patterns of identifi ed needs and systemic issues. 

Take each of the specifi c program weaknesses and areas to strengthen that appear in the 

Booklet Analyses and use the PRISM Framework to determine the relevant service and 

system. Once you have made your decision, record the information in the corresponding 

square. Some programs use sticky notes to physically place each item onto the 

corresponding square on the grid. This will provide a picture or map of all the identifi ed 

weaknesses and can assist you to identify any patterns within or across individual systems 

and service areas.

The sample PRISM Framework on page 13 shows examples of specifi c areas to be 

strengthened that are mapped onto the grid. For example, the Self-Assessment data may 

have demonstrated a lack of follow-up on recorded changes in children’s behavior while on 

medication. This need would be mapped onto the grid along the system of Record-Keeping 

and Reporting and under the services of Prevention and Early Intervention.

Issues that have been identifi ed through the Self-Assessment process may refl ect contained 

areas of weaknesses, or they may refl ect larger systemic problems. The PRISM Framework 

is a useful tool to help you visually display both isolated areas of weaknesses as well as 

systemic issues within or across particular systems and service areas.
8 — Stage 3: Interpreting the Information 

Underlying Causes

Once you have displayed all the information onto the PRISM Framework, take time to 

review the weaknesses that you have identifi ed. For each area to strengthen, you will need 

to uncover the underlying cause(s). Identifying these underlying causes will facilitate the 

development of appropriate and effective strategies to strengthen program systems and 

services. 

To uncover underlying causes, it may be necessary to refer back to the information 

collected in each of the 18 Self-Assessment booklets. In addition, members of the SelfAssessment teams may be able to provide insight and clarifi cation based on their review 

of particular program and service areas. Examples of common underlying causes include: 

lack of knowledge in a particular area; inadequate supervision and support for staff; and 

inadequate documentation systems (forms, communication mechanisms, tracking systems, 

etc) in place to facilitate and record the process or service. 

Contained Areas of Weaknesses

Some items displayed on the PRISM Framework are contained problems that do not refl ect 

larger systemic issues. For each of these items, the leadership team should review the 

information collected in Stage 2, as well as other relevant program documents and records 

to uncover the underlying causes. 

In Example A on page 15, the issue of under-enrollment has been identifi ed as a contained 

area of weakness. In order to develop effective strategies to address this issue, it is essential 

to uncover the underlying problems that have caused the under-enrollment. Underlying 

causes may include, but are not limited to: changes in community demographics, problems 

in the program’s recruitment system, lack of transportation, lack of availability and 

accessibility of services, inappropriate program options to meet families’ needs, or poor 

program reputation within the community. 

Patterns and Systemic Issues

The PRISM Framework display may also demonstrate an underlying systemic problem 

within specifi c management systems and service areas. As your program’s management 

systems exist to support program services, a breakdown in a key management system 

may result in negative effects in a particular program area or across multiple program 

service areas. A pattern of multiple issues within a particular system (along one row of the 

grid) often points to an underlying systemic issue. Similarly, multiple weaknesses within 

one service area (within one column of the grid) may indicate a signifi cant problem in 

that particular service area. Identifying such patterns will help programs plan effective 

strategies to improve and strengthen management systems and program service areas. 
Stage 3: Interpreting the Information — 9

In the sample PRISM Framework grid provided on page 13, multiple weaknesses have 

been mapped onto the system of Record-Keeping and Reporting and the service area of Parent 

Involvement. When patterns such as these emerge, programs must investigate these areas to 

uncover underlying causes of these systemic issues. 

In Example B on page 16, Program XYZ has identifi ed weaknesses within their system of 

Record-Keeping and Reporting. Underlying causes may include, but are not limited to: lack of 

understanding of the purpose and procedures for record-keeping; inadequate supervision 

to ensure staff follow-through; ineffective forms or tracking systems; and inadequate time 

allowed to complete records and reports. 

Similarly, Example C on page 17 shows a weakness within the service area of Parent 

Involvement. Underlying causes may include, but are not limited to: staff not understanding 

the value of parent involvement or not knowing how to promote it; inadequate supervision 

to assist staff to support parent involvement; and ineffective tracking systems to promptly 

identify any problems. 

Identifying underlying causes is critical for the development of effective strategies to 

promote continuous quality improvement. In Stage 4, you will apply the information you 

have uncovered about underlying causes to the development of a Program Improvement 

Plan and a T/TA Plan.
10 — Stage 3: Interpreting the Information 
Stage 3: Interpreting the Information — 11

PRISM Framework: Analysis of Areas to Strengthen

Systems

Services and Partnerships

Child Development and Health Services Family and Community Partnerships Program Design

Prevention 

and Early 

Intervention

Individualization Disabilities Services Curriculum and Assessment Child Outcomes Family Partnership Parent Involvement Community Partnerships Facilities, Materials., Equip, Transp

Program 

Governance

Planning

Communication

Record-Keeping 

and Reporting

Ongoing 

Monitoring 

Self-Assessment

Human 

Resources

Fiscal 

Management

ERSEA
12 — Stage 3: Interpreting the Information 
Stage 3: Interpreting the Information — 13

PRISM Framework: Analysis of Areas to Strengthen

SAMPL

E

Systems

Services and Partnerships

Child Development and Health Services Family and Community Partnerships Program Design

Prevention 

and Early 

Intervention

Individualization Disabilities Services Curriculum and Assessment Child Outcomes Family Partnership Parent Involvement Community Partnerships Facilities, Materials., Equip, Transp

Program 

Governance

Parents on Policy Council 

rarely attend meetings

No community 

representatives on Policy 

Council

Planning

No evidence of 

child outcome data 

being used for 

program planning

Parents were not 

involved in development 

of program plans and 

policies

Communication

Limited materials for 

parents in languages 

other than English

Record-Keeping 

and Reporting

Lack of follow-up on 

recorded changes in 

children’s behaviors while 

on medication

Twenty-fi ve percent of 

lesson plans reviewed 

lacked documentation of 

individualization

Interagency 

agreements with 

LEA’s are outdated 

Inconsistent 

Family Partnership 

Agreements—some 

missing information

Inconsistent 

documentation of 

parent involvement in 

classroom curriculum

No work order system for maintenance issues

Ongoing 

Monitoring 

Self-Assessment

Parents were not 

provided an opportunity 

to participate in last 

year’s self-assessment

Human 

Resources

Parents did not 

participate in the 

recruitment and 

screening of Head Start 

employees

Fiscal 

Management

ERSEA Program is under-enrolled 

by more than 20%
14 — Stage 3: Interpreting the Information 
Stage 3: Interpreting the Information — 15

 Example A Identifying underlying causes for a contained area of weakness

Issue: Program XYZ is more than 20% under-enrolled.

 What are the underlying causes of under-enrollment for this program? 

In addition to the Self-Assessment Booklets, it would be helpful to review:

■ Community Assessment

■ Staff surveys

■ Parent surveys

■ Community partnership agreements

■ Enrollment data from past years

■ Program recruitment policies and procedures

■ Program waitlists

■ Other sources identifi ed by the Self-Assessment leadership team

Questions to consider:

■ Has the community population changed in the past year?

■ How are program options meeting the community’s needs?

■ How does the program ensure services are available and accessible to families?

■ Is the under-enrollment program-wide or limited to some sites?

■ Is there a waitlist? Is this list program-wide or limited to some sites?

■ How does the program know the extent to which parents are satisfi ed with services?

■ What is the reputation of the Head Start program within the community?

Underlying causes:

A review of the Community Assessment shows that program options are meeting the 

needs of families in the community, but that there has been a change in the community 

population over the past few years; many families have had to relocate in response to 

increasing housing costs in the northern part of the city. A review of enrollment and wait 

list documents reveals that under-enrollment is limited to sites in the northern part of the 

city. Sites in the southern part of the city have long waiting lists. It appears that the services 

provided by Program XYZ are not available for many eligible families in the southern part 

of the city, while classrooms are under-enrolled in the northern part of the city where fewer 

eligible families reside.

Developing strategies:

Plans to address under-enrollment in Program XYZ will need to focus on these underlying 

causes, and consider issues related to program design, site locations, transportation, waitlist policies and procedures, recruitment strategies, resources, and facilities, as well as other 

relevant management systems and service areas.
16 — Stage 3: Interpreting the Information 

 Example B Identifying underlying causes of a systemic issue

Issue: Program XYZ has demonstrated signifi cant problems in its system of record- 

 keeping and reporting across program service areas.

 What are the underlying causes of systemic record keeping issues?

In addition to the Self-Assessment Booklets, it would be helpful to review:

■ Child records

■ Family partnership agreements

■ Lesson plans

■ Home visit and parent teacher conference forms

■ Policies and procedures manual

■ Staff Training logs

■ Staff surveys

■ Staff evaluations

■ Supervision documentation

■ LEAs

■ Work order system

■ Program plans

Questions to consider:

■ Do program plans, procedures and policies clearly refl ect record-keeping and 

reporting responsibilities and requirements?

■ Are staff receiving adequate and ongoing training regarding their record-keeping and 

reporting roles and responsibilities?

■ Are current forms and tracking systems effi cient and effective?

■ Does the supervision system include regular review and discussion of record-keeping 

and reporting documentation?

■ Do staff work schedules allow time for record-keeping?

Underlying causes: 

A review of staff surveys and evaluations reveals a lack of staff understanding of the 

purpose and procedures of record-keeping and reporting. In addition, supervision 

documentation does not address record-keeping and reporting responsibilities, and the 

tracking mechanism is unreliable. 

Developing strategies:

Plans for improving the record-keeping and reporting system will need to focus on these 

underlying causes and address: ongoing staff development and competence; tracking 

systems that monitor services and ensure program compliance; supervisory systems; 

program policies and procedures regarding record-keeping and reporting; as well as other 

management areas to ensure strong and comprehensive systems that will support quality 

services.
Stage 3: Interpreting the Information — 17

 Example C Identifying underlying causes of a pattern of weaknesses in a service area

Issue: Program XYZ has demonstrated a signifi cant lack of parent involvement in 

 the program.

 What are the underlying causes for the lack of parent involvement for this program?

In addition to the Self-Assessment Booklets, it would be helpful to review:

■ Policy Council roster and minutes

■ Bylaws, in particular sections on maintaining membership

■ Program plans

■ Annual Self-Assessment and minutes from planning meetings 

■ Child/family records

■ Parent surveys and program evaluations

■ Staff/parent training records

■ Hiring procedures and documentation of interviews

■ Parent Committee minutes and notices

■ Notices for parent meetings and program activities

Questions to consider:

■ Does the program philosophy and culture promote parent involvement?

■ Is there an expectation that parents are partners in all aspects of program planning 

and policy development? 

■ Are parent involvement and education activities responsive to the ongoing expressed 

needs of parents?

■ Are there opportunities to include parents in the development of the program’s 

curriculum and approach to child development and education? 

■ What methods are used to communicate with non-English speaking families?

■ What role does staff play in supporting parent involvement?

■ Does the supervision system include regular review and discussion of parent 

involvement?

Underlying causes: 

The review of the Policy Council materials revealed a well-defi ned process for establishing 

a Council but lacked a process for maintaining membership. Bylaws did not include a 

process to monitor Policy Council attendance or replace members who have not attended. 

Written program plans include a separate section dedicated to parent involvement but do 

not indicate how parents would be active participants in program operations, planning 

and development. A monthly calendar of parent activities is distributed to parents the last 

week of every month. It is the only method used to notify parents of upcoming events and 

is printed in English only.
18 — Stage 3: Interpreting the Information 

 Example C Identifying underlying causes of a pattern of weaknesses in a service area ...continued

Developing strategies:

Plans for increasing parent involvement in Program XYZ will need to focus on these 

underlying causes, and consider ways in which the program’s mission statement, 

philosophy and culture are aligned with program practices and how policies and 

procedures integrate parent involvement throughout the program. In addition, plans to 

encourage parent involvement will need to address the program’s communication systems 

and support effective staff and parent leadership.
Stage 3: Interpreting the Information — 19

Classifying and Prioritizing Areas to Strengthen 

Use the information collected through the Self-Assessment process to classify the areas to 

strengthen. Complete the following Priorities Worksheets as you identify three types of 

concerns you want to address in your fi nal Program Improvement Plan:

Section 1: Health and Safety. The team should determine if there are areas of concern 

that affect the health and safety of children, families and staff. The team will need to 

resolve these issues immediately. All health and safety issues should be considered high 

priority.

Section 2: Short-Term Improvements. The team should identify any service area or 

operational issues that managers and content area experts can address in a quick and 

effi cient manner.

Section 3: Long-Term Improvements. The team should also identify any major areas 

of concern that require prolonged effort. Often, these are systemic issues that cut across 

program areas and services. These may necessitate major program improvement. Long 

term improvements typically require an action plan that entails a focused effort by key 

staff and program leaders, creative strategies, time commitment and the shift or addition 

of program resources through expansion or development of community partnerships.

Frequently, a team will need to prioritize multiple program improvement goals to ensure 

that it does not jeopardize its chance of success by spreading resources too thin. 

As you prioritize the areas you want to strengthen, you may want to have the team revisit 

the core objectives of Head Start found at the beginning of the Guide:

■ Enhance children’s growth and development

■ Strengthen families as the primary nurturers of their children

■ Provide children with educational, health and nutritional services

■ Link children and families to needed community services

■ Ensure well-managed programs that involve parents in decision-making

Program managers will want to give priority to areas where they are not meeting these core 

objectives. Goals that address weaknesses in management systems or service areas also 

deserve top priority. For example, teams may place a priority on the following issues:

■ Lack of an active Policy Council

■ Signifi cant under-enrollment

■ Failure to conduct behavioral screenings

■ Inadequate ongoing monitoring systems
20 — Stage 3: Interpreting the Information 
Stage 3: Interpreting the Information — 21

PRIORITIES WORKSHEET

Section 1: Health and Safety

Health and SafetyHealth and Safety issues are considered high priority and must be resolved immediately.(List in order of importance)

Areas to Strengthen Data Sources Timeframe Need for T/TA?

Use the last column of this worksheet to note the area where training and/or technical assistance may be needed.
22 — Stage 3: Interpreting the Information 
Stage 3: Interpreting the Information — 23

PRIORITIES WORKSHEET

Section 2: Short-Term Improvements

Short-Term ImprovementsOperational issues that managers and content area experts can address in a quick and effi cient manner.(List in order of importance)

Areas to Strengthen Data Sources Timeframe Need for T/TA?

Use the last column of this worksheet to note the area where training and/or technical assistance may be needed.
24 — Stage 3: Interpreting the Information 
Stage 3: Interpreting the Information — 25

PRIORITIES WORKSHEET

Section 3: Long-Term Improvements

Long-Term Improvements Systemic issues and major areas of change that take signifi cant time, resources and commitment of program leaders.(List in order of importance)

Areas to Strengthen Data Sources Timeframe Need for T/TA?

Use the last column of this worksheet to note the area where training and/or technical assistance may be needed.
26 — Stage 3: Interpreting the Information 
Stage 4: Strengthening Your Program — 1

Stage 4: Strengthening Your Program

Overview

Key participants in Stage 4 include:

Your team of managers and program leaders designated to coordinate the process, as 

well as analyze and incorporate the results into program improvement efforts. Again, 

you may want to include your TA specialist as you incorporate your results into program 

improvement efforts.

In this stage you will:

■ Recall the areas to strengthen that you identifi ed in Stage 3 and develop plans for 

program improvement by:

➤ Identifying resources available to you that can support your program 

improvement effort such as: 

✓ Expertise within your program 

✓ Regional Offi ce staff

✓ Other Head Start programs

✓ Outside consultants, trainers and technical assistance providers 

✓ Head Start Technical Assistance Network

➤ Designing specifi c plans to achieve your goals that include:

✓ Goal identifi cation

✓ Desired outcomes

✓ Action steps

✓ Persons responsible

✓ Resources

✓ Timelines

■ Develop your Training and Technical Assistance Plan

■ Determine how you will evaluate your progress toward completing your Program 

Improvement Plan

■ Refl ect on your experience with the Self-Assessment process and determine ways 

that it can be improved for the following year

■ Provide your Head Start program specialist with a brief summary of your SelfAssessment including program strengths identifi ed by the Self-Assessment team and 

your plans for addressing areas that need improvement
2 — Stage 4: Strengthening Your Program

Stage 4: Strengthening Your Program

Developing Plans for Program Improvement

Now it is time to develop the goals for program improvement with members of the 

leadership team and make concrete plans to move the program forward in its quality 

improvement efforts. Leadership team members may choose to use the attached Program 

Improvement Plan on page 7 or use a format more familiar to the program for this 

purpose. The team begins this process by identifying all of the available resources that can 

be applied to the plan. Your TA specialist is available to assist you in this regard.

Identifying Resources 

Engage members of the team in a discussion to generate a complete list of resources that 

can be incorporated into your plan for strengthening the program. Record their ideas in the

Identifying Resources Worksheet that is attached on the following page. As you compile 

your list of resources, include resources that are available within the program, external to 

the program and within the TA Network.

Resources available within the program might include:

■ Members of the governing body, Policy Council parents and community 

representatives, and members of your various advisory groups who have expertise in 

a variety of different areas

■ Staff members who hold expertise in specifi c areas

■ Other professionals within the grantee agency

External sources include:

■ Community Partners

■ Peers in other Head Start programs

■ Workshops, conferences, and seminars

■ Academic institutions and courses 

■ Consultants and trainers

Resources within the TA Network include:

■ Your locally-based TA specialist who is available to support your improvement effort, 

can link you to TA content specialists, and help you to identify and access other 

resources both within and outside the TA Network 

If you are seeking clarifi cation on Federal policy or Head Start regulations, you should 

contact your Head Start program specialist at the Regional Offi ce.
Stage 4: Strengthening Your Program — 3

Identifying Resources Worksheet

The following resources are available to assist in program improvement efforts. These resources should be incorporated, as 

needed, into the action plans developed for each goal area.

Resources Comments
4 — Stage 4: Strengthening Your Program
Stage 4: Strengthening Your Program — 5

Developing Your Program Improvement Plan

In Stage 3 you determined the specifi c health and safety, short-term, and long-term 

improvements you would like to see in your program. Your next step is to involve team 

members and staff with distinct expertise in designing specifi c action plans to serve as your 

roadmap for change. 

Goals

Revisit the priorities you identifi ed during Stage 3 and determine how they can be 

translated into goals that will strengthen the program and improve outcomes for children 

and families. Examples of goals might include:

■ Redesigning Head Start management systems such as communication, recordkeeping, or ongoing monitoring

■ Improving services in a particular content area

■ Strengthening professional development of staff

Outcomes

The team should identify the desired outcomes relative to each goal. A desired outcome 

should be stated as an end-result that will demonstrate improvement. For example, if the 

Self-Assessment or other data sources indicate that there is a lack of documented follow-up 

in child/family health fi les, a desired outcome might be: “All identifi ed child/family health 

issues are tracked and appropriate follow-up action taken.” However, if the issue is actually 

that the health issues are being tracked and follow-up actions taken, but not documented, 

then the desired outcome statement might be: “All follow-up actions taken are documented 

in children’s health fi les”. 

You may want to divide your leadership team into small groups, assigning members to 

work on one or two goals most aligned with their area of interest and expertise. Assign 

managers and your program’s content area specialists to address goals related to the 

service areas in which they work. 

Action Steps

For each of your goals, you must identify the necessary steps to reach the desired outcome 

successfully. As you work through this process, consider ways in which the program can 

build upon its existing strengths. 

Action steps might include:

■ Modifying policies and procedures

■ Shifting resources from one program area to another 

■ Securing new resources 

■ Developing new partnerships

■ Obtaining training or technical assistance
6 — Stage 4: Strengthening Your Program

Provide each team with copies of the Program Improvement Plan on the following page. 

The plan provides space for team members to identify:

■ Goals

■ Outcomes

■ Action steps 

■ Person(s) responsible

■ Resources that will be applied to the effort

■ Expected dates of completion

As a fi nal step, program leaders should coordinate the new Program Improvement Plan

with other plans that address program improvement efforts such as a Quality Improvement 

Plan or strategic plan. This will help you to:

■ Reexamine and identify the goals that are most critical to the program

■ Avoid moving in too many different directions and spreading resources too thin

■ Improve the likelihood of attaining goals and reaching higher outcomes for children 

and families

■ Use the results to develop a comprehensive T/TA Plan for your program
Stage 4: Strengthening Your Program — 7

Program Improvement Plan 

GOAL:DESIRED OUTCOMES:

ACTION STEP PERSON(s) RESPONSIBLE RESOURCES DATES
8 — Stage 4: Strengthening Your Program
Stage 4: Strengthening Your Program — 9

Training and Technical Assistance Plan

One strategy related to the overall continuous quality improvement process will be 

the development and implementation of a Training and Technical Assistance Plan. The 

development of this plan should be a natural progression from the Self-Assessment process 

and the development of the Program Improvement Plan. The Regional Offi ce and the TA 

Network will work with you as you develop and implement your T/TA Plan. This plan 

will need to be submitted with your annual grant application. 

Your Regional Offi ce and the TA Network will work together to support you through this 

process and help you implement the specifi c activities outlined in your T/TA Plan. 

Monitoring and Assessing Progress in Reaching Goals and Improving 

Outcomes

To ensure that programs achieve the goals they have established, it is critical to identify a 

process for monitoring and assessing implementation of the Program Improvement Plan. 

When following up on the Program Improvement Plan it is important to ask:

■ Have we completed the action steps as outlined in the plan? If not, why not?

■ What barriers do we face in implementing change? How can they be overcome?

■ Do we need to make adjustments to our plan?

■ Are we making substantial and timely progress towards reaching our goal?

■ Are we likely to attain our anticipated outcome at our present rate of progress? 

By conducting routine follow-ups, the team can identify barriers to change and make 

necessary adjustments to the original plan. You may discover during a follow-up review 

that you need to institute new strategies and action steps to achieve your intended outcome 

or that you may want to apply new and different resources to the plan.

Evaluating Your Self-Assessment System

Before adjourning your Self-Assessment leadership team, while memories are still fresh, 

you should solicit their assistance in evaluating the entire Self-Assessment process. The 

feedback they provide will give you valuable information that can be used to refi ne and 

improve the process for subsequent years. The following Evaluating Your Self-Assessment 

System Worksheet can help you in that evaluation.
10 — Stage 4: Strengthening Your Program
Stage 4: Strengthening Your Program — 11

Evaluating Your Self-Assessment System Worksheet

Think about the process that you recently used to conduct your Self-Assessment. What 

worked well for team members, staff, parents, etc.?

______________________________________________________________________________

______________________________________________________________________________

What aspects of the Self-Assessment did not work well?

______________________________________________________________________________

______________________________________________________________________________

Were there enough participants so that the team was inclusive and able to spread the work 

out appropriately?

______________________________________________________________________________

______________________________________________________________________________

Was adequate time allowed for team members to complete their work? Did the time 

frame cause undue interruptions for staff or others who had to be responsive to the SelfAssessment team’s need for information?

______________________________________________________________________________

______________________________________________________________________________

How do the results of the Self-Assessment compare with your most recent Federal 

monitoring review?

______________________________________________________________________________

______________________________________________________________________________

What would you do differently next year? Make specifi c recommendations that can be 

considered for next year’s Self-Assessment.

______________________________________________________________________________

______________________________________________________________________________
12 — Stage 4: Strengthening Your Program
Stage 4: Strengthening Your Program — 13

Sharing Your Results with the Regional Offi ce

The Head Start Bureau views Self-Assessment as a critical management and evaluation 

tool. Strong, well-managed programs conduct comprehensive Self-Assessments based on 

Head Start Program Performance Standards and use the results to guide continuous quality 

improvement towards program excellence. The following Regional Offi ce Summary 

Report should be used to summarize the results of the Self-Assessment. 

The following information should be submitted with your annual grant reapplication: 

summary of the annual Self-Assessment, Program Improvement Plan, and T/TA Plan. 

Celebration

Now that you have completed this year’s Self-Assessment process, it is time to celebrate 

this important team accomplishment and to acknowledge and thank all who have 

participated. 
14 — Stage 4: Strengthening Your Program
Stage 4: Strengthening Your Program — 15

Program Self-Assessment Results

Regional Offi ce Summary Report

Program Year 20___

Program Name:_________________________________________________________________

Dates of Self-Assessment:________________________________________________________

Participants in the Self-Assessment Process: Provide the positions or titles of the various 

stakeholders who participated in the Self-Assessment process such as staff, parents, Policy 

Council, governing body, community partners (no need to list specifi c names).

Program strengths identifi ed:

Strength Description

1.

2.

3.

4.

5.

Other
16 — Stage 4: Strengthening Your Program
Stage 4: Strengthening Your Program — 17

Goals for program improvement:

Goals for Improvement Description

1.

2.

3.

4.

5.

Other

Head Start Director Date Policy Council Chair Date 

Attach your Training and Technical Assistance Plan here.