Module 2

Partnerships in Ongoing Well-Child Health Care

Outcomes After completing this module, participants will be able to:

* prepare a strategy for assuring the delivery of well-child health care
to Head Start children, based on community assessment;

* evaluate the quality of their program's screenings, exams,
observations, and communication with parents regarding
procedures and results;

* support parents in providing follow-up services to address identified
health needs and track the provision of well-child health care
services; and

* evaluate and improve their ability to individualize the Head Start
plogram to match a child’s identified needs.

Key Concepts Well-child health care is the concern of all Head Start staff. The role
that each staff member takes will vary, depending on the needs of
their Head Start children and the services available in their
community.

High quality screenings and exams are characterized by:

* Establishing partnerships with parents, Head Start staff, the
“medical home,” and the Health Services Advisory Committee

+ Employing qualified individuals to perform the tests

. Utilizing standardized methods appropriate for the child’s age
and background

. Using creativity to solve challenges to accurate screenings and
exams

Staff members individualize the Head Start program by responding

to information they gather from each child’s screening and from in-

sights from the child’s parents,

Head Start staff provides education for parents, as needed, so they

can learn to obtain and administer medication and implement the

follow-up plan after health needs are identified.

Partnerships in Ongoing Well-Child Health Care 51

>)

Ww



Module 3

Points to Consider:

+ Parent who has reason to be frightened of “authorities”
history within the legal system, problems with immigration,
etc.

Give each pair a few moments to work out how they would
explain in this circumstance.

Step 9: Ask each pair to explain the term to the group. Ask the group

members to think about the special situation given to this pair,
and suggest ways that understanding might be improved.

Step 10: Again congratulate the group on their abilities to expiain ab-

stract or confusing terms or concepts.
Encourage them to read medical brochures and mailings from

health insurance companies critically, and to think about how to
explain the system to families.

Jargon is pervasive within health care. It is a special skill to be able
to cut through it.

— What are the consequences of not understanding some of these
terms?

— Why is it important to be able to explain?
People may not understand and may not ask. What are some cues to

“not understanding” that you can pick up from those you work
with?

BEST COPY AVA ILABLE

pa
po
co

Advocacy, Action, and Access



Module 1

Points to Consider:

Do not list possible diagnoses (e.g.. anemia or intestinal
parasites). Diagnoses are made only by health care
providers.

Ask participants to list the elements of well-child health
care services necded that might address each health concern.

Without the many aspects of well-child health care:

+ children could experience numerous health, developmental and emo-
tional problems. pain, and confusion.

+ teachers would not know what the children’s needs were or how to
address them.

Trainer's Note:

For more information on mental health, see the guide
Promoting Mental Health in the Health series of Training
Guides for the Head Start Learning Community.

What Is Well-Child Health Care and Why Is It Important? 17



Appendix

roa

Well-Child Health Care:
Making It Happen...

On the Fort Berthold Reservation,
collaboration has brought
medical and dental examinations,

mental health information,

WIC enrollment, Healthy Start enrollment

(for pregnant women), health education,

together all in one place for the
well-child health care clinic
three times a month.

16°

146 “US Goverment Prnung Oice, 1999 — 715-092/68212 Well-Child Health Care: Making It Happen



Appendix B: Well-Child Health Care Fact Sheets

Medical/Physical Examination

What is the medical examination?

The medical exam is a thorough checkup of the
child’s overall health and development. It is done
by a licensed physician, nurse practitioner, or
physician’s assistant.

How is the medical exam done?

The medical professional:

+ Discusses with the parent the child’s medical
history, development, pertinent family history,
and any special concerns

+ Measures the child’s height, weight, and head circumference (for infants)

* Measures biood pressure with an arm cuff

* Observes the child’s appearance, behavior, speech, and motor skills

* Examines the child closely from head to toe: skin, eyes, ears, nose, mouth, teeth, heart, lungs,
abdomen, genitalia, and limbs

* Conducts and/or assesses other screening tests (e.g., development, vision, hearing, hemoglobin,
tuberculosis, urine)

What might I notice?

You might not notice any signs or symptoms, or you might notice a child who:
+ Appears pale, fatigued, feverish, or in pain

* Coughs or has problems breathing

« Has vomiting, diarrhea, or little appetite

« Has difficulty doing things expected of most children at a given age

ee SR Follow-up to the medical exam
The medical/physical If the medical exam identifies any problems, the health care
exam assesses overall provider might recommend further evaluation, treatment, and
health and follow-up.
development. It can lead This might include:
to early identification + Laboratory tests or X-rays
and treatment of health + Referral for evaluation by a health or
problems. educational specialist

* Medication or other therapy
+ Education and counseling for the family and staff

Well-Child Health Care: Making It Happen ann 141
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ED 435 468

Happen

HEAD START]

Training Guides for the
Head Start Learning Community

Well-Child
Health Care:
Making It —

NT OF HEALTH AND HUMAN SERVICES
Children and Families -
Children, Youth’'and Families

>» BEST COPY AVAILABLE



Module 3

care for a child in need.

Activity 3: { oO Purpose: This activity-challenges a staff person to plan a way to access

Services for RA}
Children }

For this activity you will need:

@ = = Handout O: Children in Need

Step I:

Step 2:

Step 3:

Step 4:

Ask the participant to imagine that she is going to write an
example for a new staff person in Head Start, in order to help
the new person understand the health care system in this
community.

Ask the participant to think about a child that has recently been
enrolled in Head Start and had a need for specialized health
services. (If a situation does not come easily to mind, use a
sample story from Handout O: Children in Need.)

Ask the participant to think about the steps that she went
through in order to help the family access care.

+ Who was the first person she talked with?

+ Where did they go from there?

Think about the path that was taken to get the care needed.

Ask the participant to write or draw an illustration of the care
pathway. Label each step on the way, and indicate which people

had to be involved.

Also make note of barriers or pitfalls that were encountered, and
how you handled them.

Ask the participant to share the story with you and/or present the
scenario at a staff meeting for feedback and additional ideas.

Advocacy, Action, and Access

ied i



Module 2

Points to Consider:

What can program managers do to assure services in the long-
term? Can they...

* work with local state or tribal officials to recruit more
providers to the area?

* contact a nearby university to help educate providers about
quality services?

+ other...?

Head Start’s commitment to wellness embraces a comprehensive
vision of health for children and families. To achieve wellness a
variety of health services are necessary. Head Start staff face chal-
lenges as they help families access quality, comprehensive health
services.

Head Start’s role is different in different communities. Some Head
Start programs may find a need to carry out some screenings on site.
Others may find that the community providers’ services fit nicely
with the Performance Standards.

How do we determine Head Start’s role in the provision or tracking
of services?

— What aspects of the community situation contribute to quality?
What aspects of the situation may reduce the quality?

~ Some strategies to support the strengths are...

-- Some strategies to overcome the quality problems are...

It is important to realize that short-term and long-term strategies can

be carried out simultaneously. Both are essential in achieving the
goal of high quality, comprehensive services.

me

Ce

60

Well-Child Health Care: Making It Happen



Appendix B: Well-Child Health Care Fact Sheets
Tuberculin (TB) Testing

What is tuberculosis?

Tuberculosis (TB) is a serious disease caused by a
bacteria. Young children, elderly people, and people with
health problems are especially at risk.

TB can spread by coughing. The infection can enter the
lungs and cause no symptoms for a long time. But it can

progress to cause pneumonia, fevers, and weight loss. It ———. iw
can spread to the brain, heart, kidneys, bones, and even . SX
cause death. x

How do you test for TB?

TB testing is done by a skin test. The recommended test, called ““Mantoux” or “PPD,” involves a small
bubble of fluid injected under the skin on the forearm. It is done by a health professional. Two to three
days after the skin test, a trained person inspects the site for swelling.

What might I observe?

Most children with TB have no symptoms. You might notice:
* Chronic cough
+ Pneumonia

Follow-up to TB testing

If the TB test causes swelling of more than S—10 mm diameter, it is “positive” and indicates possible
infection with TB. The child should be referred to his health care provider for further evaluation. This
might involve repeat skin testing and chest x-ray.

Treatment might include:

* Oral medication for six to 12 months (hospitalization for

When TB is identified severe cases), with close medical follow-up

early, treatment can + Reporting, investigation, and follow-up by the local health
prevent serious health departmei.
complications and the + Testing and possible treatment for family and school contacts

+ Recommendations that the child may return to school when
the healih care provider certifies that he is no longer
contagious

spread of the disease.

5
J

Cot

4
7

144 Well-Child Health Care: Making It Happen
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Module 2

Activity 6:
Sam’s Story
Part Two—
Supporting
Parents

Purpose: This activity helps participants develop skills in supporting
parents in accessing well-child health care and services to follow-up on
needs identified in screenings and examinations.

For this activity you will need:

= One copy of Handout J: Sam’s Story—Part Two

Step 1: Distribute and review with participants Handout J: Sam's
Story—Part Two

Step 2: Discuss the following questions:

+ What follow-up would be helpful with the famiiy?

— When would you want to follow up?
— Who should be involved?

- Who would you ask?

— What would you say?

+  Inyour Head Start community, how would you support
parents in accessing well-child health care (including dental
care)?

— Who would you talk to?

- Who would help?

~ Are there logistical barriers? (Transportation? Office
hours that are difficult for working parents?)

— Are there cultural barriers? (A different belief system
regarding cures? Language barriers?)

+ Hew would you document the interventions in the child's
health record?

+ How are recent changes in legislature preventing or
promoting access for your families?

Partnerships in Ongoing Well-Child Health Care n

71

w



Introduction

[Modules | Activity | Time | Handouts |

Activity 1: Sam’s Story Part | 60-90 | Handout N
Three—Advocating for minutes'
Services (C)

Module 3: Activity 2: Pathways to Care | 45-60 | Handout O

Advocacy, Action, avid Access WwW minutes
Activity 3: Services for 30-60 | Handout O
Children (C) minutes
Activity 4: JUMP: Jargon —| 30-60 | Handout P
Used by Medical Providers |minutes| Handout Q
(7)

(C) = Coaching Activity

(W) = Workshop Activity

BEST COPY AVAILABLE

Introduction



oo
OI
g

For use with A

Module 3: Advocacy, Action, and Access

Handout O: Children in Need

Story #1

Mrs. Johnson has been courageously living with AIDS for the past two years. When her daughter
Tameka (2% years old) was first enrolled in Early Head Start last fall, she would attend school daily in
crisply pressed cotton dresses, her hair a beautiful rainbow of colored barrettes. The teacher's aide has
noticed lately that she attends school in the same clothes for days on end—sometimes smelling of urine.
Her ankles are covered with infected fleabites and she has begun hoarding food in her cubby, Mrs.
Johnson had always kept her properly nourished, even though the AIDS food delivery program misses
their neighborhood. The Home Visitor and social worker stop by Tameka’s home on Friday night. They

find the house in disarray, overrun by cats. Mrs. Johnson, unable to lift herself off the couch, has slipped
into the early stages of AIDS dementia.

ea eae tena nm a SS Ne Hn SR PaO US SC PG

Story #2

Christina has been totally insulin dependent since her pancreas was removed in infancy. Now, at the age
of four, she has moved from her grandparents’ home in another city. Her mother will be caring for her
and is unfamiliar with the needs of a diabetic child. There is no diabetic education program at the local
county hospital. The staff is aware that she is totally dependent on the injected insulin and proper
glucose monitoring for her health. It has been usual for the Emergency Medical Technician (EMT) unit
to be called to her home on a monthly basis due to dangerously low or high glucose levels. Her
grandmother wants to know where the nearest EMT unit is stationed relative to the school. She will be
arriving for school in two weeks and it is your job to set up the staffing to meet her needs.

Story #3

Jessie spent the second year of his life living in a car in Kentucky with his parents. Medical care during
those years consisted of desperate trips to the emergency room in the middle of the night for
antibiotics—that were stopped as soon as he looked better. He now lives with his aunt and five cousins
and attends Head Start with her children. He has not seen his parents for one year. He has failed his
hearing test twice and his speech is difficult to understand. Previous inquiries have shown that the
nearest speech therapist willing to accept Medicaid children is 1% hours away. He seems shy and
withdrawn, and would sit and play for hours by twirling a rubber band if you did not redirect him to the

boisterous play of those around him. His aunt says, “Oh that boy is no problem, it’s like he’s not even
here!”

wan
sud

120 Well-Child Health Care: Making It Happen



Continuing Protessional Development

+ Maintaining connections with local health professionals

Invite community health providers to staff and parent meetings to
answer questions about health care, screening, and local health
issues of concern.

+ Advocating for improved health care and building collaborative
relationships with existing service providers to increase access

What are the common health issues in your community? Lead
poisoning, obesity, violent behavior, contaminated water, or lack of
access to health care providers serving low-income families? Seek
out those people capable of making change and actively advocate to
improve the health of your community. This guide provides many
models of this strategy. Form collaborative partnerships with
existing service agencies to truly streamline the delivery of services.

126 Well-Child Health Care: Making It Happen



Module 2

Sample Copy: Everyone’s Role in Screening

Identitication & treatment
of child's dental problems

Prepare children
for dental exam

Health
Screening

Talk with teachers & parents
‘about dental screening

Conduct dental
screenings

Examine chiidren
for dental problems

1. Few private dentists participate and
Dr. Jimenez is cverloaded with patients.

=1
Challenges Strategies

1.

Advocate for more dentists to serve Head
Start children.

i
|
i
i

long waiting lists for appointments and
cannot complete exams withing 45 days.

2. Managed care assigns dentists that may not | 2. Ask dentist if they have colleagues or
be trained or set-up for caring for children. partners who specialize in working with
children.
3. Managed care assigns dentists that may be | 3. See if the Family Service Worker can
far away. assist parents with transportation.
4. Managed care assigns dentist that may not | 4. Arrange for a translator to accompany the
| speak the language that families do. parents to the dentist.
5. Managed care assigns dentists that have 5. Schedule dental appointments for the

summer prior to September admission.

66

Well-Child Health Care: Making It Happen

73



Module 1

Step 4: Display the Game Board, explaining the following rules:

Step 5:

Step 6:

Step 7:

Step 8:

Step 9:

+ Teams will answer questions under four categories:
~ What It Is
— Why You Do lt
- What You Might Observe
— How You Do It

+ Each category has questions that increase in value and
difficulty, from $100, $200, $300, $400, to $500.

+ Teams have 30 seconds to discuss the question and

formulate their answer. When the time is up, the team that
selected the question gives its answer. If the team has no
answer or gives an incorrect answer, the next team gets the
chance to answer.

+ The team with the correct answer wins the dollar value for
the question. No points are deducted for incorrect answers.

Ask the first team to start by selecting a category and dollar
value. Cross out the selection on the Game Board. Using the
Question and Answer Key, read the question aloud.

Follow your watch, set a timer, or play a musical tape for 30
seconds while the teams discuss their responses.

Ask the (eam that selected the category for its answer. Proceed
to the next team(s) until the correct answer is stated. Add the
dollar value to the score of the team that answess correctly, If no
team states the correct answer, read the answer aloud.

Ask the next team to select the category and dollar value for the
next question.

Continue playing the game as in Steps 5 to 7 until all the
questions have been asked,

At the end of the game, add up each team’s money. The team(s)
with the most money wins. You may give the winners a prize.

fap

3

24

Well-Child Health Care: Making lt Happen



Module 2: Partnerships in Ongoing Well-Child Health Care

Handout M: Trackviile Head Start Tracking Instrument (continued)

» eT POLIO
a R 8 Bal BR a #2 B Bal BR
 lafotaa jalalas | rifiehas| teller stolas ala aat ithielaa
> | Shed 931741 fa3| 4]a0!s2| 6 w/t sleofaa) tel e4fao}a3
* | pla}qaito}a|a3) talsopa} tacit gjak|tela|as|iafofs
* | aula |@IS 43 | Balas |ailat 14): /43|celo143\ 9/2/43
* | alaciaat]a}aa| lao |ialoe}44 ajcofa| fa} |1faohe
* |sfaelaa} sheel43} tice} alaelaaishieies |tieelas
” lahohs lajio/a3
* 1A H43 | afted43| Shela bali] 4H] faokat| «514 | 3]h4/43| 5] o}42 | joojau
® |alio}4| yfoola3 thtolay| sbulas a }olad| loot iio}
lula faa) tta2| ale ]aa)afoctetlalistat| wilz}al 12/93 lafisfa3! alis/2e
1 | 4l5i43 | efort}as) olel43 lp as" ols )a3 | laa fasio| ola
aha aie) faa na.abs| 4 tial? alist ahs fs |otet/a}ae
* ltoliohs| alah toleHt3| hasta
| slau! la fia as | ufteA3ofoo} 44 atoslea 4] 9/43 ues
15.
Well-Child Health Care: Making It Happen +93 95

BEST COPY AVAILABLE

Of

UO 6 AIEAHOE NIA ASN 4

maddy asa

Oxf WP Spaovay Yury 31

“mopweny sigs ayopde o7 stat


Module 1

Purpose: This activity helps participants develop skills in working with
families to understand the importance of well-child health care. Different
portions of Sam’s story appear in Modules I, II and III. Part one focuses
on assessing Sam’s dental care needs.

Activity 5:
Sam’s Story
Part One—
Assessing Need

For this activity you will need:

@ = Handout B: Sam’s Story—Part One, for each participant

Step 1: Distribute and review with participants Handout B: Sam's
Story—Part One.

Step 2: Discuss the following questions:

+ How would you discuss the importance of ora! health and
well-child health care in general with the family?

6 — Whom should you talk with?
— What would you ask?
— What would you say?

+ What classroom intervention and education might be
helpful?

~ Who should be involved?
— What would the main messages be?

-- How might the Health Services Advisory Committee
help?

Step 3: Discuss any experiences that you have had with educating
families regarding well-child health care in any area of health.

+ What techniques were effective?
+ What techniques were not effective?

) + What would you do differently?

What Is Well-Child Health Care and Why Is It Important? é al



Appendix C: Blank Records & Forms

Handout M: Trackville Head Start Tracking Instrumenit (continued)

HEALTH DATA PART [Ll-srmre | Cl sogeagonnerme
TRACKING INSTRUMENT | 8 Ee Sama [71 recesreo sac
performed, follow-up
HEAD START CENTER - Treatment oarine. corerral, or
ADDRESS : Dents! Cleaning a Srocedure oF service
|= Oertat Fioride | Pe procedure or ses
YEAR CLASS SHEET oF —_| fF} = immunization completed
iD. TESTS AS APPROPRIATE, rane Dental
No. TB Lead Sickte Ceil Exam Services.
ru
ese D De eT eo eaTo Te eel AnGn
PELE tedel febfel bePeTele | befell slodeye wey PIES ia KI
; teTetetePelele | Pedoleleleyetet lee] sfoq aye ep Jete Anon
Telateblel tele] alt} lolol plat Teledaqe Tele Anne
=
lpeTelelelelel blo] e[o]elt elle] fed aye «pejelt elites
Cs
; Mela ledali be fedelteledelelsledeL tole] aye tedaye niin
; See eleb bblebbebael eb beled qe Fish eh
L. WTlalbed sh teleleld ede Pedal ley ale wefe[ ooon
SS OOO OOO EO co eiefaye ret
z tele feT-To ete] of] fo] ole] +P] e] fof] aye ePesele eetele
= Teele edeleedolaleteled ee lel ele led oele wPelehe ine
3 spelt} sede] dspelele] led alte e] i] [ed ole wPToye “Leet
3 is
=
é slo oP tf efor] alt] elon] a] et] sled alt) fod a] ty slot ale ellolt aftie|r
> i
& = tredaleledel ble] Pedals bdeltdedal wledele ailele
3 “Telit Ppl tele] op [ede] ded] ft egaye *P[ote wept
é cry
156 afl Well-Child Health Care: Making It Happen

BEST COPY AVAILABLE



Module 2

. Children: Some chiidren may have difficulty cooperating with
screenings and exams. It can be particularly difficult for younger
children to complete complex procedures with unfamiliar examiners
at the beginning of the school year.

+ Families: Some families may not understand the importance of well-
child health care, or they may have other issues that take priority
over health care. They may have difficulty taking time off from
work, getting transportation, or securing childcare for medical home
appointments. Ensuring follow-up may be difficult for some
families.

Note to Trainer/Coach:

For more information on communication with parents, see the
guide Communicating With Parents in the Parent
Involvement series of Training Guides for the Head Start
Learning Community .

C. The Individualized Health Plan

When medical, developmental, or dental needs are identified, Head Start
staff can best meet the needs of children by developing an Individualized
Health Plan (IHP). The IHP is a written reference developed in partner-
ship with parents, medical professionals, classroom staff and relevant
members of the Head Start management team (dieticians, health coordina-

tors). This plan guides the staff and parents in supporting the health of the
student.

[

Note to Trainer/Coach:

For information on individualized health plans, see the guide
Caring for Children with Chronic Conditions in the Health
series of Training Guides for the Head Start Learning
Community.

56

Well-Child Health Care: Making It Happen



Appendix B: Well-Child Health Care Fact Sheets

Lead Screening

What is lead screening?

Lead screening measures the level of lead in the blood. Lead is a poison that is very dangerous for young
children because of their small size and rapid growth and development. It can cause anemia, learning
difficulties, and other medical problems.

Children can be exposed to lead through:
* Home or child care environment:
- built before 1960 with peeling paint or renovation
- located near a highway or lead industry
» Family member who works with lead or treated for lead poisoning
+ Imported ceramic pottery for cooking, storing, or serving food
+ Home remedies with lead

How is lead screening done?

Lead screening involves:
+ Asking the family questions about the child’s exposure to lead
+ A blood lead test, from the finger or vein, done by a health professional

What might I observe?

Most children with lead poisoning show no symptoms. You might notice:
« Irritability, headache

* Poor appetite, stomachache

« Pale skin, tiredness

* Slow growth and development

+ Acchild who eats paint chips or dirt

Follow-up to lead screening

Lead poisoning can cause If screening indicates a lead level of above 10 ug/dl,
serious health and the child should be referred to a health professional for

evaluation and treatment.
developmental problems in

young children. Eliminating Treatment may include:
the source of lead and + Removing the source of lead
treating the child can + Nutrition counseling, iron supplements
improve the health and * Medication to remove the lead from the blood

« Follow-up testing of child’s blood
+ Referral for developmental testing

AUD

developmental outcomes.
a

140 Well-Child Health Care: Making It Happen
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Module 1

© Question & Answer Key for The Well-Chiid Health Care Fact Game

(For Trainer Only)

What It Is:

$100 Q:

A

$200 Q:

A:

$300 Q:

A:

$400 Q:

AL

$500 Q:

6 AL

Why You Do it:

$100 Q:

A:

$260 Q:

AL

$300 Q:

A

$400 Qa

A:

$500 Q:

@ nN

Which screening measures height, weight, and head circumference?

Growth Assessment

What condition can be caused by low iron in the diet, lead poisoning. sickle
cell disease, and other blood disorders?

Anemia

Which screening checks understanding, thinking, communication, social
skills, physical coordination, and self-help skills?

Developmental Screening
Name ten diseases for which immunizations protect children.

Chicken pox, polio, diphtheria, pertussis, tetanus, measles, mumps, rubella,
hemophilus influenza B (HIB), and hepatitis B

Which screening checks for a problem that is rare in children which could
lead to heart disease and stroke?

Blood Pressure Screening,

Which exam helps prevent tooth decay, pain, and tooth loss?
Dental Screening and Examination

Which procedure helps identify and treat health problems, and provides
families with guidance on child health and development?

Medical/Physical Examination

Which screening can lead to antibiotic treatment to prevent severe
pneumonia, weight loss, meningitis, bone disease, and death?

Tuberculin Testing
What three problems can growth assessment identify?

“Failure to thrive,” obesity, and disproportionately large or small head
growth

Which three screenings aim to prevent difficulties in communication,
behavior, and relationships?

Hearing, speech and language, and developmental/mental health assessment

What Is Well-Child Health Care and Why Is It Importar23 27


Module 2

Step 3:

Step 4:

Step 5:

Step 6:

+ Are most families enrolled in a Health Maintenance
Organization (HMO) to cover their health care? If so, what
well-child health care is part of the benefits package?

+ For migrant families, are clinics open during times when
parents are not engaged in fieldwork?

Using Handout E and the state's EPSDT schedule, instruct the
partners to rate each aspect of care according to its accessibility
and quality: high quality, easily accessible, medium quality,
some access, or low quality, not accessible.

Ask participants to highlight those services on Handout E which
they don’t believe are available from the health care community
in their locale.

Give the group about |5 minutes to fill out their handouts.

Ask each pair to choose one service that is easily accessible and
of high quality, and share with the group. ask them to describe
how they assure that children receive this service.

Ask each manager to use the materials from this workshop in
planning the health care services in her own program. Lead a
discussion with the participants that explores gaps in services in
their community.

What does each manager do to ensure that services which are
not currently available become available?

Are there things she can do in the short-term, such as:

» have staff members assist parents in transporting children to
providers out of the area?

+ hold some screenings on-site at Head Start?
+ have meetings with local providers’ organizations to
advocate for more appointment times for Head Start

children?

«hook up with a public health program like Women, Infant,
and Children (WIC) to jointly publicize services?

* other.

oJ

be

Partnerships in Ongoing Well-Child Health Care 59



Module 2: Partnerships in Ongoing Well-Child Health Care

Handout M: Trackville Head Start Tracking Instrument (continued)

HEALTH DATA PART [Gj Score  ]CD team
TRACKING INSTRUMENT A [a] = Ciagnosis (21 Procedure or serice
HEAD START CENTER cl mackuille Headsrecte | ]+ treatment (re testing, referral, or
" = Exam reat
ADDRESS * Dental Cleaning wi . Procedure or service
= Dental Fluonde | guy » Procedure or service
YEAR SZ_cisss 21S 7 ears suet or —_] De] = immunization completed.
1D. [oedienc STANDARD TESTS
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96 Well-Child Health Care: Making It Happen
BEST COPY AVAILABLE



Module 3

Spread the good word!
Head Siart programs in Greene and Miami
counties send staff members to private
child care centers and home day cares
to do screenings, exams,
mental health counseling,
and speech therapy;
share information on social services

and parent involvement;
and provide startup

. NS educational materials.
SQN

AS

118 Well-Child Health Care: Making It Happen



Module I

| Step 6:

Step 7:

Step 8:

Step 9:

Allow the groups 15 minutes to role-play the three situations.
Each group should be sure to address the following:

+ The meaning of the screening or exam results

* The parent's/guardian’s concem or lack of concern about
the screening or exam results

+ What follow-up services are needed and how to ensure their
delivery

Bring the groups back together. Ask a group to volunteer to read
Situation #1 aloud and summarize their discussion. Ask the
other groups that role-played this situation to add any comments
they might have about how their discussion was similar or
different.

Proceed in the same manner to discuss Situations #2 to #6.
Ask participants:

+ What were some of your general feelings and perceptions in
the role of staff person? In the role of parent? In the role of
observer?

+ What might be some reasons for the differences in
interpretations of screening or exam results?

+ What are some general communication skills that are
effective in addressing all of these screening and exam
results with parents?

+ What are creative strategies you have used to ensure follow-
up of needed services?

« How does parental education improve follow-up on
identified health needs?

Ask participants to relate any personal experiences that they
have had with screenings or exams that resulted in differences in
interpretation from the parents. How were these differences
resolved?

43

What Is Well-Child Health Care and Why Is It Important?

37



Module 2

Activity 9:
Keeping Up—
Tracking
Health Services

Purpose: This coaching activity helps participants assess their
program's health tracking system and develop skills in tracking and deter-
mining what and when health follow-up is needed.

For this activity you will need:

Handout C: Child Health Records (from Module 1) or your own
agency records

Handout M: Trackville Head Start Tracking Instrument

Appendix A; Recommendations for Well-Child Health Care
or your own state EPSDT guidelines

Key to Activity 9: Keeping Up—Tracking Health Services
(For Trainer Only)

Trainer Preparation Note:

Ifyou want to update the child health records and tracking
instrument so that they reflect current information and have
current dates, you will find blank copies of these handouts that
you can fill out in Appendix C: Blank Records & Forms.

Step 1: Explain that this activity will help assess your program's health

tracking system and develop skills in reviewing tracking
records.

Step 2: Ask the participant(s):

+ What is the current system that you use to track children's
health services in your program? How has it been working
for you? What are your system’s strengths? What are its”
weaknesses?

+ Are you considering upgrading to a new computerized
system or an improved version of an cxisting system? What
have been your sources of information? What have you
learned? What else do you need to find out? (Make plans te
get the additional information needed.)

Partnerships in Ongoing Well-Child Health Care yy

QW



Well-Child Health Care:
Making It Happen...

A meeting of the minds:
Starting with a $5,000 seed grant from
Healthy Child Care America Campaign, the
Region VIl Head Start Quality Improvement Center
helped host a planning summit attended by
Head Start, Healthy Child Care America,
Bureau of Maternal and Child Health,
Administration of Children and Families,
pediatricians, child care providers, and families.
The goal?
Bringing people together
to make a state plan for the
goal of child health.

xii Well-Child Health Care: Making It Happen


Contents

Preface ix
Introduction I
Overview .

Purpose ..

Audience...

Performance Standard:

Orientation to Guide
Module Sections

Definition of Icons
At A GIAMCE oe ecccecssessseessesssesseesectessnenseesersneresseesecsussessesseenseeseess

DAwWwaw NH

Module I 9
What Is Well-Chiid Health Care and Why Is It Important?

Outcomes .. 9
Key Concepts 9
Background Information - 10
Activity 1; What If There Were No Well-Child Health Care? ...... 15
Activity 2: What, Why, and How of Screenings and Exams 20
Activity 3: The Well-Child Health Care Fact Game . 23

Activity 4; The Importance of Well-Child Health Care and a
Medical Home

Activity 5: Sam's Story Part One—Assessing Need 31
Activity 6: Reviewing t/ealth Records . 33

Activity 7: Explaining the Meaning of Screenings and Exams, and
Ensuring Follow-up «0.0.0.0 . 36

Next Steps: Ideas to Extend Practice 39
Handout A: Carlos’ Story......... 41
Handout B: Sam’s Story—Part One sesssaseasenearensssesseseeesees 42.
Handouts C: Child Health Record Samples (Parts 1 - 5) svaveaveene 43,

Handout D-1: The Meaning of Screenings and Exams
(Situation Cards #1 - #3) ..csecssees

Handout D-2: The Meaning of Screenings and Exams
(Situation Cards #4 - #6).

29

soe AD

.- 50

Well-Child Health Care: Making It Happen - v


Appendix B: Well-Child Health Care Fact Sheets

Nutrition Assessment

What is nutrition assessment?

The nutrition assessment reviews the chiid’s eating and
growth patterns. A child’s diet can affect how she grows,
develops, looks, and feels.

How is nutrition assessment done?

Nutrition assessment is usually done by trained Head
Start staff with consultation from a nutritionist. It in-
cludes:

+ Discussion with the family about the child’s eating habits, food allergies, feeding problems, and
special dietary needs

¢ Review of the child’s growth—height, weight, and head circumference (for infants)

* Review of other screening res. !ts—medical/physical exam, hemoglobin/hematocrit, lead, sickle cell,
intestinal parasites

What might I observe?

You might notice a child who:

* Looks very short, thin, large, or overweight

* Looks pale or tired

+ Eats very little, too much, or prefers non-nutritious foods like sweets, candy, and junk food
« Has chronic illnesses such as allergies, diabetes, HIV/AIDS, or intestinal parasites

How a child eats can
affect how she

Follow-up to nutrition assessment

If nutrition assessment finds inadequate diet (e.g., too little, too
much, or unhealthy foods), growth problems (e.g., failure to

grows, develops, thrive or overweight), or anemia, the child should be referred to
looks, and feels. a health care provider for evaluation and treatment.
Nutrition assessment
and counseling can Treatment may include:

+ Referral to a nutritionist
promote healthy * Counseling for parents and Head Start staff on the types and
growth and amounts of food the child should eat and recommended
development. amount of physical activity
Tron supplements or iron-erviched vitamins
Treatment of medical conditions causing nutritional and
growth problems ao?

142 Well-Child Health Care: Making It Happen
BEST COPY AVAILABLE



Module 1

Step 2:

Step 3:

Step 4:

Step 5:

Step 6:

Divide participants into five groups. Have each group identify a
“recorder” to report back to the larger group.

Ask participants to imagine they are the health coordinators
responsible for reviewing health records and documenting and
following up results for Janine, who is entering your Head Start
program. Imagine that it is now September of the current year.

Distribute one part of the Health Record and corresponding Fact
Sheet(s) to each group.

Explain that each group has received a part of Janine’s health
record. Each group should take about 10 minutes to review its
part of the record and discuss the following questions (posted on
flip chart paper):

+ Is this part of the record complete? What, if anything, is
missing?

+ Are the child’s screening or exam results inside or outside
of the “normal range?”

+ What follow-up is needed?
Bring the groups back together. Ask each recorder to display the
health record on the overhead projector and explain the group’s

analysis of the record and approach to follow-up.

Encourage participants from the large group to add their
comments.

After all of the parts of the health record have been discussed,
ask participants:

+ When you were analyzing your part of the health record.
was there other information that would have been helpful to

know?

» What are some important relationships between the different
screenings and exams?

+ Now that you’ve reviewed the complete health record for
this child...

— what would you tell the parents about:

- the child's strengths in the areas of health and
development?

34

Well-Child Health Care: Making It Happen
45



Appendix C: Blank Records & Forms

Handout M: Trackville Head Start Tracking Instrument

Ne HIB HepB MMR

# RQ B #4 # w ®B

Well-Child Health Care: Making It Happen 153

Lu8

Zampowy ut 6 diiauoy yim asn soy


Module 2

Points to Consider:

Important screening activities include:

~ Working as a team among staff to complete health screening and
exams

— Ensuring that the Health Services Advisory Committee plans
and reviews the screening program

— Training people conducting screenings and exams

— Preparing children for screenings

— Informing and involving parents in all aspects of screenings

— Explaining screenings and exam results to parents

— Supporting parents with follow-up with health care providers

-- Ensuring confidentiality of screening results

- Involving community partners in screenings

— Completing required screenings within the required time limit
The challenges to screening tend to involve and affect more than one

of the partners in screening. Therefore, the partners must work to-
gether to develop effective strategies to overcome the challenges.

Partnerships in Ongoing Well-Child Health Care 65



Module 2

Look at one feature that is checked for both children. Were
the children the same, or did they both appear “normal” but
in different ways?

Consider the other children in the program. How much
variation do you see in this feature among the children?

What does this tell you about the range of normal
appearance, behavior, and skills among children at a given
age?

Step 6: Next, focus on the circled “questions” or “concerns” features:

What made you feel concerned about this observation’?

What does it mean that you have circled some features?
How is the meaning of your observations similar to the
meaning of screening?

Who would you want to discuss these observations with?
What would you want to tell them about your observations
and what would you ask them about your observations?

What further evaluation or follow-up might be helpful to
address your questions or concerns?

Step 7: Take one of your circled items. State what further evaluation
(i.e., screening test, exam, assessment, or evaluation) might be
needed.

Imagine that the results of this further assessment were normal.

What does this imply about the role of your observations in
screening?

How would you plan to be alert to further developments
with this child?

Would you want to repeat the screening or exam to be sure
there are no probletis?

Step 8: Take another one of your circled items. State what further

evaluation (i.

creening test, exaim, assessment, or evaluation)

might be needed.

Imagine that this further assessment indicated that the child had
a special health condition or disability.

GO

74

Well-Child Health Care: Making It Happen



DOCUMENT RESUME

ED 435 468 PS 028 039
TITLE Well-Child Health Care: Making It Happen. Training Guides
for the Head Start Learning Community.

INSTITUTION Bowman (James) Associates, San Francisco, CA.

SPONS AGENCY Administration for Children, Youth, and Families (DHHS),
Washington, DC. Head Start Bureau.

PUB DATE 1998-00-00

NOTE 172p.; For related Training Guide on "Infant and Toddler
Transitions," see PS 028 041.

CONTRACT 105-93-1578

AVAILABLE FROM U.S. Government Printing Office, Mail Stop: SsoP,
Washington, DC 20402-9328.

PUB TYPE Guides - Classroom - Teacher (052)
EDRS PRICE MFO1/PCO7 Pius Postage.
DESCRIPTORS Child Advocacy; Child Development; *Child Health; Child

Welfare; Childhood Needs; *Health Programs; Health Services;
Preschool Education; *Preventive Medicine; Professional
Development; *Training; Workshops

IDENTIFIERS *Project Head Start; Training Materials; *Well Child Care

ABSTRACT

Noting that by assuring well-child health care, screening,
assessment, and follow-up for every child, Head Start can make a significant
difference in children's lives, this training guide is intended to provide
support to enhance the quality of Head Start well-child health care. The
three training modules of the guide are organized to provide learning
opportunities in workshops or smaller sessions. Each module contains: (1)
outcomes; (2) key concepts; (3) background information; (4) questions for
discussion and reflection; (5) learning activities; (6) points to consider;
(7) next step ideas to extend practice; and (8) handouts. Module one, “What
Is Well-Child Health Care and Why Is It Important?" addresses the importance
of well-child health care and linking a family to a medical home. Module two,
"Partnerships in Ongoing Well-Child Health Care," addresses the importance of
supporting parents as health care consumers by accessing the available
services in their communities. Module three, "Advocacy, Action, and Access,"
addresses the importance of reaching out into the community for
collaborations that could improve delivery of services to children and
families, and advocating for change where services are missing. The guide
concludes with sections on continuing professional development for Head Start
staff and additional resources. Appendices include recommendations for
well-child health care, well-child health care fact sheets, and blank records
and forms for use by participants. (Contains an annotated bibliography and
contact information for national organizations. (SD)

Reproductions supplicd by EDRS are the best that can be made
from the original document.



Module 3

Background Information

A. Parents as Community Advocates

Parents play a vital role in the community as advocates for the health of
their children. The Head Start staff can support and encourage parents as
they influence the goals and character of community services and make
them more responsive to the needs of their particular community. Con-
sider Mrs. Huey’s story...

Mrs. Huey, her husband and three daughters recently emigrated from
Hong Kong. They live in the top floor of a 90-year-old Victorian house.
The two older girls participate in Head Start and the family includes a
six month old baby. Upon enrollment in Head Start, the girls were
linked to a medical home for routine examinations and blood work. It
was discovered that they both had borderline “high” lead levels in
their blood. The Head Start health coordinator explained the meaning
of the test results to Mrs. Huey and strongly recommended the baby be
tested. The baby had even higher lead levels than her sisters.

Mrs. Huey and the Head Start Family Service Worker found many
health violations in the tiny apartment--most notably chipping paint
and crumbling asbestos covered duct work. With this knowledge and
the support of a Head Start advocate for translation, Mrs, Huey notified
the landlord of the problem. He ignored her completely. Mrs. Huey then
approached the Health Department with letters of support from her
medical doctor and the Lead Poisoning Prevention Program.

The Health Department visited her home and made the landlord clean
up the lead problem and asbestos in all five of his units.

Knowing her neighbors must be in similar danger of lead poisoning, Mrs.
Huey and her neighbors convinced the community health center to hold a
free clinic for lead testing of children. Of the 45 children tested, five chil-
dren had elevated levels. A health educator from Head Start held a work-
shop in the evening for the community to attend and learn how to safely
deal with lead paint. Mrs. Huey pointed out to the Lead Poisoning Pre-
vention Program that most people on her stree:_ ould not read the En-
glish-only lead prevention pamphlets. Literature in English, Spanish, and
Chinese is now distributed throughout the community.

Mrs. Huey’s story shows the power that one advocate can have in a com-
munity. Head Start staff members can help empower parents by support-

449

100

Lad
Well-Child Health Care: Making It Happen



Module 3: Advocacy, Action, and Access

Handout P: Insurance and Medical Jargon Cards

Preferred Health
os . Managed
Provider Maintenance 5
soot er Medical
Organization Plan Organization } Care
(PPO) (HMO)
Open Child Health
Enrollment Insurance Program COBRA
Period (CHIP)
Share Prior Authorization
of a
or Beneficiary
Cost Prior Approval
(SOC) pp
Medicaid
vs. Co-Payment Verification
Medicare
Deductible Premium Referral

petnanoy yn asn soy

Well-Child Health Care: Making It Happen

Be
t2
Loe)

123


Appendix C: Blank Records & Forms
Handout C: Child Health Record Sample (Part 4)

CHILD HEALTH RECORD: FORM 5, DENTAL HEALTH
CHILD'S NAME: mx: @INTHDATE:
| ead staat canrer: PHONE:
ADORES:
7. 18 THE CHILD. "yor," Inoluds Tengih of tre | 2 DOES THE CHILD HAVE ANY TROUBLE WITH TEETH,
NOW RECEIVING: receiving fluoride GUMS, OR MOUTH THAN THE PARENT KNOWS
Topical Fivorkie Apptication? — Ho__Unknown__Yea_ ABOUT?
& Fluoridated waver? Wo___Unknown Yee
‘Supplement chet? No___Unknown Yea
ue tal —, Fquid___)
'SGHILD (HAS, ——HAS NOT PREVIOUSLY SEEN A DENTIST. |'7. SOURCE OF REIMBURSEMENT OF SERVICES
E Date last vielt O EPEDT/Medicald
Gada oniL B (s8, —J8 NOT) UNDER A PHYSICIAN'S GARE. © Federal, State, or toca! Agency
a Physician's name. —
[5] & CHILD (__J8, 38 NOT) RECEIVING MEDICATION. O Heed Stadt
Type. C In-tund Provider.
5 @. CHILD 16 REPORTED TO HAVE (Give detalis or attach Health O Parentaxsuardiane
g History, Form 2A). YER NO YES NO 0) Other (rd Party)
oa Attorgios — — _ Uver dis. — —— | & Priontry anoup
e Aathma —— —— RheumaticFever . —_ 1D A. Needs Attention immediatety
Peal FA Bleeding — — Sickle Cell Dis. — CB. Nesds Attention Soon
x Diabetes == = Other st Bow) “| 0 C. Neede Routine Care
B Epitepey =
HeartiVeaouler Die,
~— TO-EXAMINATION AND TREATMENT RECORD (List recommended services in order).
fe Daan Trocsent | Spe een | AA Renal
hanieaal Arment Lacvoarin| “womme | em”

tod L

W1 SENTAL NEEDS (Cheat one or more and return 3 conten | $0 Heed Start affarfrst vit
CA. TREATMENT (resioration, (8. CLEANING OG. FLUORIDE
Burp therapy, extraction)
Co. OTHER NO PROBLEMS

Approximate number of visitta________ approximate cost

TE.CHILD ORAL HEALTH SUMMARY (Comptore and ratur 2 copive fo Head Start afte final visi.
‘All planned treatmunt (je, __je not) complete. if not, explain here, as weil as Items cheoked.

Da. Routine recall visits De. Dietary probleme) De.  Harmtfut oral habits
o Species home empnesia, Od. Developmental problem(s) Cf. Needs fluoride supplement
oral hygiene

PART IL TO BE COMPLETED BY DENTA!. CARE PROVIDER

\ gectity that | have gompiated the wervica(s) lated In Part Il, tem 10, end thet Itemized charges do not
exceed my usual and customary
Signature, Date.

Well-Child Health Care: Making It He fi
LILLE DPE BESTCOPYAVAILABLE

ra
a)
hep)

amipopy ut 6 auanay 3) | ANpow wi g AiANDP Ys Asn 40y

if


This national training guide was developed by James Bowman Associates, San Francisco,
California, under contract #105-93-1578 of the Head Start Bureau, Administration for
Children and Families, Department of Health and Human Services.

Photograph courtesy of Steve Caulfield and the Mahube Community Council, Detroit Lakes, @

Minnesota.
1998



Module 3

ing their efforts with education, logistical support (translation, transporta-
tion), and information regarding existing community resources.

Mrs. Huey’s neighborhood has a special need for lead poisoning aware-
ness. By building partnerships between existing community services, she
was able to improve the delivery of community services in her neighbor-
hood. When agencies share information and collaborate, the delivery of
services to children and families is improved. Through Head Start's edu-
cational workshops and the Lead Prevention Organization's literature in
three languages, the public is now becoming informed. When the health
center expanded its services to provide a special screening clinic for lead,
those already poisoned could be identified and treated. The Lead Poison-
ing Prevention Organization and the doctor at Mrs. Huey’s clinic commu-
nicated with the Health Department to ensure a swift response.

B. Community Partnership

Head Start is a central community institution for low-income families and
children. The Advisory Committee on Head Start Quality and Expansion
(1993) asked how this institution should function in the 21st Century.
Head Start staff members play pivotal roles in reaching out to the greater
community and forming alliances between community services and link-
ing children into this network of resources. For families to be stable and
thriving they need services from a broader community and they also need
to be involved in that community.

An important link to the broader community lies in the Health Services
Advisory Committee (HSAC). This body within Head Start is made up of
local health care providers, experts in relevant fields, and parents. It may
include an official from the Public Health Department, physician, school
administrator, dentist and experts in mental health and disabilities, and
Head Start staff members. Medical professionals on the committee often
agree to treat Head Start students in their offices. The Health Services
Advisory Committee looks at available community health services and
advises on how to handle health issues. Head Start staff members are ad-
vised of important health issues in the community (e.g., increases in tuber-
culosis or environmental pollutants) and advised how to best protect the
health of their children with this knowledge (e.g., yearly tuberculosis test-
ing). The HSAC devises a working health plan that responds to current
information regarding the community. With guidance from the HSAC, the
Head Start health plan will not be static and outdated, but change with
current needs. Through contact with the members of the community on
the HSAC, Head Start staff can acquaint the community at large with their
vision that “parents are the primary educators, nurturers and advocates for
their children”, and must be respected in that role.

Advocacy, Action, and Access

Bal
fa
ee

101



Module 1

Points to Consider: ° Make sure that you review and understand the information before
you try to explain it to someone else.

+ Share the information that the other person wants to know and needs
to know. Build on what he or she already knows.

+ Make the explanation clear, simple, and brief. Try not to use highly
technical terms.

e Continually ask and observe whether the person has any questions
or concerns. Respond to these concems directly.

+ Recognize your own limitations. If you do not know the answer. say,
“I don’t know, but I will try to find out.” Then follow-up with the
information later.

Well-Child Health Care:
Making it Happen...

Sharing information:
Because they work in collaboration,
the Health Coordinators from
ABCD Head Start in Boston
go directly out to the network of
public health clinics and inform the staff

exactly what medical information is
needed for children,

reducing misinformation

and phone calls.

2 Well-Child Health Care: Making It Happen



Module 2

+ How has your system been working for you? What are your
system’s strengths? What are its weaknesses?

* Do you need to improve your reminder system? What have
been your sources of information? What have you learned?
What else do you need to find out? (Make plans to get the
additional information needed.)

Step 7: Have participants look at the entire class of children on the
Tracking instrument. Ask:

+ Are there any common problems that are apparent? (For
example, are many children missing growth measurements
or vision screening? Are many children not up-to-date on
their immunizations? Do many children have anemia?)
What plans might you make to address these concerns?

+ How are you using his information to plan services with
your Health Services Advisory Committee, Policy Council,
and health care providers in your community?

Points to Consider: ¢ Tracking invoives systematic documentation and review of
children’s health records. Effective tracking tools help identify the
health services that children have received and children who require
follow-up.

+ The program’s tracking system must facilitate the sharing of neces-
sary information among staff including the program director, com-
ponent coordinators and other designated staff.

+ — Specific staff must be designated, trained and monitored in entering
and reviewing tracking data.

+ The program’s tracking system must be reviewed regularly to ensure
that the information is current and relevant to the program.

Partnerships in Ongoing Well-Child Health Care 81



Module 2

Activity 8: Purpose: This activity illustrates how information from screenings,
Pro, exams, and assessments can affect plans for classroom interventions and
gram :
. parent education.
Planning
For this activity you will need:
@ = = Handout L: Program Planning Stories (Separate the stories and
attach to each story the corresponding fact sheet from Appendix B)
fi = Appendix B: Well-Child Health Care Fact Sheets that correspond to
the Program Planning Stories:
* Story #1: Anemia Screening
+ Story #2: Immunizations
¢ Story #3: Developmental Screening
+ Story #4: Nutrition Assessment
Step 1; Explain that participants will be part of an interdisciplinary
team conference to review screening and assessment results and
develop program plans.
Step 2: Divide participants into four groups: #1, #2, #3, and #4. Instruct
each group to begin by...
+ having each participant identify his role and function within
the interdisciplinary team conference.
~ Each group should have a representative of health,
disabilities, social service, education, and family
involvement functions.
~ Participants may or may not choose to play their actual
roles.
* assigning a “recorder” who will report back to the large
group.
a
o3
16 Well-Child Health Care: Making It Happen



Introduction

Module Sections

Each module is organized to provide leaming opportunities for workshop
(12-25 people) or for coaching (two-three people) sessions. Each has the
following segments:

Outcomes: The skills to be acquired by staff who participate in a
module’s activities.

Key Concepts: The main ideas the module covers. These sections
can be used as handouts or overheads.

Background Information: Elaborates on the Key Concepts. This
section can be used as a coaching resource or as an outline for a
presentation to a group. Background Information sections can also
be used for handouts or as overheads in workshop sessions.

Questions for Discussion/Reflection: Listed at the end of each
Background Information section. These questions can be used to
initiate discussion in workshops and coaching sessions, or serve as
prompts for staff journals.

Learning Activities: Build the skills needed to achieve the
module’s outcomes. Managers can choose to use workshop
activities, coaching activities, or a combination. Activities should be
adapted to a group’s size and composition: the management team,
staff from one component area, or staff and board members together.

Points to Consider: Issues listed at the end of each activity to keep
in mind or to use as discussion prompts while working through the
activity.

Next Steps: Ideas to Extend Practice: Additional activities to
reinforce the expected outcomes and help to transfer skills from the
training sessions to the work setting.

Handouts: Included at the end of each module. Trainers should
reproduce the handouts as needed for participants.



se Appendix C: Blank Records & Forms to update this Handout.

For use with Activity 6 (& Activity 9 in Module 2). Or.

Module 1: What Is Well-Child Health Care and Why Is It Important?

Handout C: Child Health Record Sampie (Part 3)

CHILD HEALTH RECORD:

FORM 28, HEALTH HISTORY (Continued)

PERSON INTEAVIEWED:_-S EAN) WZOWA) pate: 7!-% pevationsii: Notned_
NAME OF INTERVIEWER: TITLE:

PHYSICAL, PSYCHOLOGICAL, AND SOCIAL DEVELOPMENT

THESE QUESTIONS WILL HELP US UNDERSTAND YOUR CHILD BETTER AND KNOW WHAT [S USUAL FOR HIM/HER AND WHAT.
MIGHT NOT BE USUAL THAT WE SHOULD BE CONCERNED ABOUT:
27.CAN YOU TELL ME ONE OR a ties THINGS YOUR CHILD IS INTERESTED IN OR DOES ESPECIALLY WELL?

Cites Chmorag poak.

tikes Deesgiag. cs up 2 active
28. D0£S YOUR CHILD TAKE A NAi NO; _W”_Yes. IF “VES” DESCRIBE WHEN AND HOW LONG. lhe

- pm

29. 00ES YOUR CHILD SLEEP LESS THAN 8 HOURS A DAY OR HAVE TROUBLE SLEEPING (SUCH AS BEING FRETFUL, HAVING
NIGHTMARES, WANTING TO STAY UP LATE)? NO, YES. IF "YES" DESCRIBE ARRANGEMENTS (OWN ROOM, OWN.
BED, AND SO _FCHTH).

HOW DOES YOUT CHILD TELL YOU HE/SHE HAS TO GO TO THE TOILET?. oon Cie Sette
1. DOES ¥ HILD NEED HELP IN GOING TO THE TOILET DURING THE DAY OR NIGHT, OR DOES YOUR CHILD WET HIS/HER

PANTS? NO, YES. IF "YES" PLEASE DESCRIBE.

32, HOW DOES YOUR CHILD ACT WiTH ADULTS THAT HEISHE DOESN'T KNOW? | -Htle, Thuy

‘33. HOW DOES YOUR CHILD ACT WITH A FEW CHILDREN HIS/HER OWN AGE?

likes to plag-

34, HOW DOES YOUR CHILD ACT WHEN PLAYING WITH A GROUP OF OTHER CHILDREN? @  / ¢-FE fey

38. DOES YOUA CHILD WORRY A LOT, OA IS HE/SHE VERY AFRAID OF ANYTHING? —__NO, 37 _YES. IF "YES", WHAT THINGS
SEEM TO CAUSE HIM OR HER TO WORRY OR TO BE AFRAID? VE@Y BaD un Pode sts
Fi Gantt pg setete up

36. CHILDREN LEARN 10 DO THINGS AT DIFFERENT AGES. WE NEED TOKNOW inet EACH CHILD ALREADY CAN DO OR IS
LEARNING TO DO EASILY, AND WHERE THEY MIGHT BE SLOW OR NEED HELP SO WE CAN FIT OUR PROGRAM TO EACH CHILD.
I'4 GOING TO LIST SOME THINGS CHILDREN LEARN TO DO AT DIFFERENT AGES AND ASK WHEN YOUR CHILD STARTED TO DO
THEM 4S BEST YOU CAN REMEMBER. (INTERVIEWER: Read question for each item fiated below, and check off the parent's anawer
in the wpproprlate space).

HEN
canuen |pirepteo| water | ace
* WoULD YOUSAY YouR CHILD | [aTSiTUR WITROUT HELE smo
BEGAN TO _____EARLIERTHAN = [(b) CRAWi vs 9 AAD
YOU EXPECTED ABOUT WHEN [WALK i wie
YOU EXPECTED, OR LATER (a) TALK, Z C02.
THAN YOU EXPECTED? lle) FEED AND DRESS SELF Ete
[(Q LEARN TO USE THE TOILET w
>. WHEN DID HE/SHE BEGIN Kg RESPOND TO CIRECTIONS: Y a.
To? [()) PLAY WITH TOYS A
(Q.USE CRAYONS Z 7m
‘W)UNDERSTAND WHAT IS SAID TO HIMIHER Zz Lye.
37.D0ES YOUR CHILD HAVE ANY DIFFICULTIES SAYING WHAT HE/SHE WANTS TO DO OR DO YOU HAVE ANY TROUBLE

UNDERSTANDING YOUR CHILD? NO, YES, IF "YES" PLEASE DESCRIBE.

38. CHILDREN SOMETIMES GET CRANKY OR CRY WHEN THEY'RE TIRED, HUNGRY, SIC} }]D SO FORTH. DOES YOUR CHILD
OFTEN GET CRANKY OR CRY AT OTHER TIMES, WHEN YOU CAN'T FIGURE OUT WHY? NO, YES. IF "YES" CAN YOU
TELL ME ABOUT THAT?

WHEN THIS HAPPENS, WHAT DO YOU DO ABOUT IT TO HELP THE CHILD FEEL BETTER?

39.HAVE THERE BEEN ANY BIG CHANGES IN YOUR CHILO'S LIFE IN THE LAST SIX MONTHS?
PLEASE DESCRIBE. «5 el rt-up wit husbouwck

New buty at home

NO, 7 YES. IF “YES”

TC BE COMPLETED BY HEAD START STAFF WITH PARENT GUARDIAN EARLY IN PROGRAM YEAR AFTER CHILD IS ENROLLED.

40. ARE YOU OR YOUR FAMILY HAVING ANYPROBLEMS NOW THAT MIGHT AFFECT YOUR CHILD? ____NO, _¥_YES. IF “YES"
PLEASE DESCRIBE. aniy4— ug Ut
fimonces
41.1S THERE ANYTHING ELSE YOU WOULD LIKE US TO KNOW ABOUT YOUR CHILD? his: YES. IF “YES” PLEASE
DESCRIBE?
me
03
46 Well-Child Health Care

STCOPV AVAI ARLE



§
=

Module 2: Partnerships in Ongoing Well-Child Health Care
Handout G: Health Screening at Twin Oaks Head Start

Janey is the Health Coordinator at Twin Oaks Head Start, and she has her hands full. Her county
is large, rural, and medically underserved. Transportation is a huge problem. Beginning in
September, she sets up a mass child health clinic at the elementary school for vision, hearing,
and dental screens. Seeing 50 children in one long day is chaos! There are tears and frustrations
among the younger children waiting in long lines, and sometimes the noise level is deafening in
the big gymnasium. Local medical students volunteer their time for one day before heading back
to school.

The classroom teachers help prepare the children for their dental screenings and exams by
inviting a hygienist to the classroom to role-play a visit to the dentist. Parents are invited in on
this day so they too can learn about preventive dental care and know what to expect the day of
the examination. The children also go through mock vision testing to get comfortable with this
screen.

Although Janey has trained many parents in the vision and hearing screenings, it is a major
challenge to find dentists to examine and treat Head Start children. During the chaos of the mass
screening clinic, some parents complained to Janey that the dentist did not complete the exam
when the child cried or had difficulty cooperating. Other parents were concerned when told that
their child’s mouth was fine after the dental screening when Head Start staff had said there may
be problems.

Janey has tried to recruit dentists to work with her Head Start students, but the few she called
turned her down, stating that Medicaid only reimburses 40% of their customary fees. She does
have one dentist, Dr. Jimenez, on the Health Services Advisory Committee and he is overloaded
with Medicaid patients already. Dental access seems to be a problem throughout the state. The
Medicaid policy covering Janey’s children often assigns the most serious cases to a dentist over
an hour away, and it’s still a good three months before he can schedule them. The parents
complain that no one at his office speaks their language.

Parent education is also an important part of Janey’s job. She teaches about preventing Baby
Bottle Tooth Decay, but few parents attend her noon workshops. The workshops are presented in
English and Spanish, but she is concerned about language and cultural barriers in trying to
educate parents speaking the five other languages represented in her Head Start Program.

Janey knows that there needs to be changes in her Head Start screening program and the existing
health care system in general. She plans to better use her Health Services Advisory Committee
and be more active in advocating for increased dental access. How would you advise her to

\? 4
proceed? iat

88 Well-Child Health Care: Making It Happen



Module 2

Activity 4:
Exploring the
Challenges

io
le}

&

,

u

Purpose: This activity helps staff identify the challenges and develop
strategies for ensuring well-child health care for Head Start children.

For this activity you will need:

= Handout H: Exploring the Challenges, for each participant

Step 1:

Step 2:

Step 3:

Step 4:

Step 5:

Step 6:

This exercise allows participants to discuss the challenges to
well-child health care from different perspectives.

Take a few minutes to review Handout H: Exploring the
Challenges.

The group will discuss each situation with each participant
taking a different perspective. Beginning with situation #1, have
each participant identify the role that he or she will play: one
person will be the staff person, another the parent, and the third
a health care provider.

Take a moment to get into the perspective of your role. Reread
the situation and focus on your feelings and the difficulties from
your perspective.

Take five or 10 minutes to play out the situation. Begin by
trying to understand everyone’s perspective. Try to move the
discussion toward strategies that will help overcome the
difficulties.

Change roles and proceed to the next situation. Discuss all of
the situations in the same manner. Continue to change roles to
ensure that everyone has the chance to play every role.

Discuss how this activity felt from the perspective of the staff,
parent, and health care provider.

+ What are some differences in perspective that can get in the
way of the partnership in well-child health care and
screening?

Partnerships in Ongoing Well-Child Health Care 67



Module 1

Question & Answer Key for The Well-Child Health Care Fact Game
(For Trainer Only, continued)

What You Might Observe:

$100 Q: What might cause mild symptoms, such as pain at the injection site or fever,
although the benefits are far greater than the risks?

A: Immunizations
$206 Q: What condition might cause stomach cramps, diarrhea, anemia, fatigue, and
delay in growth?

A: Intestinal parasites

$300 Q: Name three possible signs cf developmental delay at three years of age.

A: (Any three): The child cannot follow simple directions, make two-word

sentences, copy a circle, or take off her own clothes
$400 Q What are three problems found through nutrition assessment?

A: Dietary deficiencies, feeding difficulties, and food allergies

$500 Q: Name three possible signs of vision problems.

A: (Any three): Eyes crossed or pointing out, squinting, short attention for
visual tasks, holding materials very close to the face, difficulty catching
balls, complaints of eye discomfort or headache

Hew You Do tt:
$100 Q: Which screening requires a blood test usually done by pricking the finger?
A: Anemia Screening
$200 a: Which screening involves a skin test—Mantoux/PPD—to look for a
reaction that indicates infection?
A: Tubercutin Testing
$300 Q: Which screening involves a laboratory test of stoo] samples?
A: Intestinal Parasite Screening
$400 Q Which screening involves a special blood test and asking the family about
the age of their home, construction, or peeling paint, as well as asking about
the use of specific home remedies?
A: Lead Screening
$500 Q: Which two screenings use a standardized screening test or skills checklist?
A: Speech/language and developmental/mental health assessment

40

28 Well-Child Health Care: Making It Happen



Module 1

Head Start reaches out to pregnant women, prenatal classes can assist
women by educating them on the effects of diet, smoking, drugs, and alco-
hol on their baby. With this knowledge, mothers-to-be can best make
healthy choices.

Establish a two-way exchange of information with the health experts.
Share your observations and concems about the health of children at your
program, Find out more about health problems specific to your commu-
nity—what they are, what causes them, how to identify children and fami-
lies at risk, and how tc prevent and treat the problems.

Assemble a Panel Representing Special Populations

Conduct a panel discussion—with families, community advocates, and
professionals—focusing on special well-child health care needs. Ex-
amples include the needs of homeless families, families that do not speak
English, migrant families, and parents with disabilities. Ask them to ad-
dress the following challenges:

. Connecting to a “medical home”

. Health screenings and exams

+ Assuring the delivery of well-child health care

+ Tracking follow-up immunizations and services for identified needs
Ask panel members to serve as consultants to address questions that might
arise. If gaps in services are identified, community advocates and families
can work together to increase services. Health professionals can bring in
information regarding who is available to provide services to the Head

Start community, and advocate among their professional peers for addi-
tional coverage.

40



Module 3

Step 3:

Step 4:

Step 5:

Step 6:

Step 7:

Tell participants that they are going to create a game—a maze—
that a family would need to go through in order to get services
for this child,

Give them each a poster board. Show them the sample maze you
have drawn. Ask them tc create a pathway from start to finish,
making blank squares for each step. They should just outline the
squares, not label them.

TTT

a - bo
i | Finish
i

Now ask each team to read its story aloud.

After each team has read its story, ask each team to pass its game
board and yellow squares to the team on its left.

Each team now is asked to place the step to accessing services
for the child on the game board in the order that they should be
taken.

Paste them on the board, and be ready to explain why you are
proceeding in the way that you are.

Each team has ten red papers. On the red papers, write up to 10
barriers or pitfalls that a family might face in accessing care.
Write the challenges that advocates for change in the system
might face.

Place those along the pathway to care also.

Advocacy, Action, and Access


Module 1: What Is Well-Child Health Care and Why Is It Important?
Handout C: Child Health Record Sample (Part 2)

CHILD HEALTH RECORD: FORM 3, SCREENINGS, PHYSICAL EXAMINATIONJASSESSMENT
cuore name JANINE BOUIN oex_E piatHpate: 3 “10-42

HEAD START CENTER: PHONE:
ADDRESS:

1. RELEVANT INFORMATION (from Health History, Parent/Teacher Observations):

Allekay + Ppeasuts (Peanut butree.

2. SCREENING TESTS. Starred items (*) are required by Head Start and recommended by the Amorics
children 35 years. Enter dates It do viously. When recording results, enter at a minimum "N",

my of Pediatrics for
or "A" for NORMAL,

be

&

5 a S

Or

gus

zr2s

a SWL__ suspect. on ATVPICALABNORMAL, respectively. _

ang TEST [pate | RESULTS T Test DATE RESULTS
ows @ VISION Ciype of Tea, Sree E al
h=o AGUITY, FUL B24 20 / zs By
a Ge RESCREENING

22 STRABISMUS i ve

ore COMMENTS

5 1 =

wih SPS rewatocnior ROTHER TESTS it indicated)

or HEMOGLOBIN: 32446) IG m7 IS-2446| NEG.

QS Ae Hearn ctype of Ten PASM EET (2) Sickie Call fi
= OG} RESULTS, AL = Ni (3) Lag ZEIT Bsnansool i] 19¥Ag
Ze ES)  rescrcenne (@) Ova & Parnaites

Zz] comments (5) Unasiyais 7 =

ibe

© Other

Immunizations | Birth to | Month 2 Months 4 Months 6 Months 12-18 Months 4-6 Years

prp 6-11-42 | 8-28-42 | Il- 3-42 [8-1-4943 [3-24-96
Polo 5-19-42 |¥-29-942 1-43 |a-24-4ee
HIB 5-17-92 [8-28-92 |il- 3-92, 1B-1-93

Hep B

st 971-43 [3-24-40

Other

Note: Ages and number of boosters may vary when immuntzations start at older ages,

BEST COPY AVAILABLE

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Well-Child Health Care: Making It Happen 45



Resources

+ American Academy of Pediatrics

Contact: 141 Northwest Point Blvd.,
EIk Grove Village, IL 60007
Telephone: 847/228-5005
Fax: 847/228-5097

+ American Dietetic Association

Contact: 216 West Jackson Blvd., Suite 800
Chicago, IL 60606
_ Telephone: 312/899-0040

+ American Optometric Association

Contact: 243 N. Lindbergh Blvd.
St. Louis, MO 63141
Telephone: 314/991-4100
Fax: 314/991-4101

+ American Orthopsychiatric Association, Inc.

Contact: 330 Seventh Avenue, 18th Floor
New York, NY 10001
Telephone: 212/564-5930
Fax: 212/564-6180

+ American Speech Language and Hearing Association

Contact: 10801 Rockville Pike
Rockville, MD 20852
Telephone: 301/897-5700
Fax: 301/571-0457

+ Medicaid/EPSDT (Early and Periodic Screening. Diagnosis, &
Treatment)

Contact: 7500 Security Blvd., 4th Floor—Central Bldg.
Baltimore, MD 21244-1850
Telephone: 800/638-6833

+ National Association for the Education of Young Children
Contact: 1509 16th St.,. NW

Washington, D.C. 20036-1426
Telephone: 800/424-2460 or 202/232-8777

ton:
133

130 Well-Child Health Care: Making It Happen



Module 1: What Is Well-Child Health Care and Why Is It Important?
Handout A: Carlos’ Story

Carlos is a three-and-a-half year old who is enrolling in your Head Start program. Carlos lives with his
19-year-old mother and 18-month-old sister. Carlos’ father, also a teenager, visits occasionally.

You are the Home Visitor enrolling Carlos in Head Start. During your visit with Carlos’ mother, Maria,
the following conversation takes place:

Maria: “I’m kind of nervous; it’s the first ime Carlos is going to school.”
Home Visitox: “So, you have some concems?”
Maria: “Yeah. Carlos...he’s sort of slow. He doesn’t talk or seem (o understand much. We

just kind of accept him that way.”
Home Visitor: “Hmmm...”

Maria: “I’ve been reaching the end of my rope dealing with his temper tantrums, especially
being pregnant and all.”

Home Visitor: “I didn’t know you were pregnant. Boy I’m sure that can be exhausting. Head Start
may be able to help you with some of your concerns for Carlos. Does your family
have a regular physician?

Maria: “No, I just take him to the emergency room for all his earaches—-he gets them all
winter.”
Home Visitor: “Carlos will get the chance for a full medical check-up before school. There are

some wonderful doctors at the local clinic who can see his little sister and give you
prenatal care too.

Maria: “Yeah, but the kids aren’t sick now—why do they need to go?”

Home Visitor: “By seeing a doctor on a regular basis, many illnesses can be prevented. Carlos may
need special help for speaking and hearing and they can give it.”

Maria: “But doctors scare me. All those shots wil! make my kids cry and they talk real fast
at me in English. I get too embarrassed to say I can’t understand them.”

Home Visitor: “We can call the clinic and schedule the family with a Spanish-speaking doctor. Dr.
Alma Hernandez can follow your children throughout their childhood and help you
with your pregnancy. She has three children of her own and understands. Ill help
you find the phone number in the phone book if you'd like...”

Well-Child Health Care: Making It Happen 33 41
uv

fp AnaMOp yrs asn so



Module 2

+ Some strategies to support the strengths are...

* Some strategies to overcome the quality problems are...

Step 4: Reconvene the group and discuss cach dilemma with cach small

group reporting back about the strengths, problems, and
strategies they identified. List the strategies on flip chart paper.

Step 5: Ask participants to think about these dilemmas and their

experiences with assuring all the elements of well-child health
care in their own programs. Ask participants to discuss some of
the advantages and disadvantages of:

« Having Head Start staff instead of parents take children to
their dental appointments?

+ Holding a child health screening clinic instead of sending
children to their “medical home” for screenings and
examinations?

+ Using screeners who are teachers, parents, and volunteers
rather than heaith professionals?

Step 6: Ask participants to briefly describe any other creative and

Points to Consider: .

successful strategies that programs have used to ensure well-
child health care, including the completion of screenings and
exams, tracking services, and education. Have you heard about
any interesting methods that you might like to try in your
program?

The goal of well-child health care is best served when there is a part-
nership between parents, staff, and health care providers.

Screenings and exams alone do not ensure well-child health care-—a
tracking system must be in place to ensure follow-up to meet
identified needs and the delivery of routine immunizations and
examinations.

There are many challenges to quality screenings and exams, such as
time limits and the lack of resources. Programs should aim to pre-
serve quality, since a poor quality screening or exam is of no benefit
and may be harmful. If compromises must be made, they should be
made with the advice of health consultants and the Health Services
Advisory committee. 0

Gee

70

Well-Child Health Care: Making It Happen



Medule 2

Step 3:

Step 4:

Step 5:

Step 6:

Distribute Handout C: Child Health Records (from Medule 1).
Explain that this child, Janine, is attending Trackville Head
Start. Distribute Handout M: Trackville Head Start Tracking
Instrument. Explain that this tracking instrument includes the
health records of Janine’s class in the program.

Ask participants to enter Janine’s health record into the
Trackville Head Start Tracking Instrument in space #15.

Distribute Appendix A: Recommendations for Well-Child
Health Care or your own state EPSDT guidelines.

Ask participants to use the preventive care guidelines and
review the Trackville Head Start Tracking Instrument to identify
children or records that need follow-up for any reason. For
example:

+ Is any data entered incorrectly?

«Are any records or health services not up-to-date with the
EPSDT guidelines?

+ Are there children with abnormal resuits who need repeat
screening, follow-up evaluation or treatment?

+ Are more than the usual number of children failing a
screening? Is there a problem with its administration?

Instruct participants to circle elements that need follow-up and
note what follow-up is needed for each. Allow 10-20 minutes.

Review with participants the Trackville Head Start Tracking
Instrument. Beginning with Janine, identify any elements in the
health records that need follow-up. Then proceed with each of
the children, identifying the follow-up needed. (See Key to
Activity 9: Keeping Up—Tracking Heaith Services.)

Explain that, once a need for follow-up and a timeframe has
been determined, programs need a “tickler file” or reminder
system. Ask:

+ What system do you have to remind you of follow-up
needed to complete missing health services, further
evaluation or treatment, and follow-up for children to stay
up-to-date on age-appropriate preventive health care and

- atin)
immunizations? a0
Vee

80

‘Vell-Child Health Care: Making It Happen



Module I

Points to Consider: :

- the health concerns and the follow-up needed?
— what staff and health professionals should be involved?
~  ‘vhat would you want the classroom teachers to know?

— how would you document the process?

Screening and exam results that are “outside the normal range,”
“abnormal,” or “failed” mean that the child might have a health
problem. Such results must be followed up by rescreening and fur-
ther evaluation by the health care provider to determine if the child
has a health problem and, if so, what treatment is necessary.

Each child’s complete health record should be assessed, since many
health problems and screening and exam results are interrelated. For
example, if a child is diagnosed with dental problems such as Baby
Bottle Tooth Decay, it is important to identify possible causes in
nutrition (e.g., use of bottle, sweets) and possible effects on growth
(e.g., failure to thrive or overweight).

The results of screenings, exams, assessments, diagnoses, and treat-
ment recommendations must be explained to parents and key staff
who care for the child. This should be done:

— bya well-informed person;

— in clear terms and language that the parent(s) understand; and
— with sensitivity to the concerns of the parents and staff.

Careful documentation is crucial for a comprehensive review and

appropriate assessment, treatment, and follow-up to meet each
child’s health needs.

What Is Well-Child Health Care and Why Is It Important? 35

pla
-



Module 3: Advocacy, Action, and Access
Handout O: Children in Need (continued)

Story #4

The Health Coordinator at Tall Pines Indian Reservation has always been relieved to see low lead levels
in her Head Start children. This fall however she notices an increase in the number of children with
borderline high levels and even has three children with high levels. Because there is no communication
between services on the reservation, she cannot check with the other early childhood program to see if
they also have increased levels. There are no lead testing clinics available to test the siblings of her Head
Start students. A community member does remember a lot of scraping and painting going on last
summer at the re tion center.

Story #5

Marcus’ epilepsy had been kept under control since his diagnosis last summer. Now you notice him
staring off into space at very frequent intervals during activities that used to engage him. His father, a
hard-working brick layer, has had custody of the children since Christmas. You remember that Marcus
missed a week of school at that time due to a medication overdose. When you gave the father literature
on epilepsy after that incident, he thanked you kindly but said he would have to have his older daughter
read it to him. With no other relatives in town for support, he often seeras overwhelmed and stressed at
drop off in the morning. Marcus seems to devour his food on Monday mornings and he has started
trying to eat clay during art class.

Story #6

Pierre is a bubbly, impish boy with boundless energy. He lost a good deal of his hearing due to a severe
illness while living in Haiti and his speech is hard to understand, The doctor says he should have tubes
put into his ears. He also has amblyopia or “lazy eye”. He has been fitted for glasses with a patch over
the good eye, but there is no one in the town who will make the hearing aid for those on public
assistance. Upon arrival at school, if he is wearing his glasses he whips them off and hides them in his
cubby. His mother explains that “He’s embarrassed to look different from the other kids. Why not wait
until he’s older and he can read. And there’s nothing wrong with the way he talks. I can understand what
he’s saying, Can’t you? He’s still young, he’ll catch up.”

eal
Cad
=

Well-Child Health Care: Making It Happen

EPC SaNIANIY YIM asn 40-4


Module 3

Questions for Discussion’

Reflection

Think about your own personal experiences in advocating for change. It
can range from being as simple as changing the lunch times at school so
your kindergartner does not collide with 5" graders, to creating a public
campaign to clean-up the toxic landfill in your community.

* What obstacles did you have to overcome? (Fear of public speaking?
Persons in authority ignoring you?)

+ Did you lear any skills that can apply to advocating for change to
benefit your Head Start community?

e Did you work alone or organize a group of people to work toward
the same goal? What is most effective?

Well-Child Health Care:
Making It Haopen...

A model of advocacy in action,
the Health Coordinator in
Olympia, Washington

serves on health committees or task forces
for the Thurston County Health Department,
state Department of Social and Health Services,
state Health Department,

local schools and other organizations.
Six dentist volunteered their office
for exam clinics (some on days off!}
after hearing a presentation by the
Health Coordinator at the
dental society meeting.

Advocacy, Action, and Access

a6 105


Module 3

Step 4:

Step 5:

Step 6:

Step 7:

Step 8:

It is the responsibility of Head Start staff, in assuring that fami-
lies are hooked up with a medical home, to help the families to
be comfortable with the terminology they will encounter.

Shuffle all of your jargon and definition cards. Give half of the
participants a jargon ard, and the other half a definition card.
Be sure that each card has a match in the group.

Now encourage participants to get up, move about the room, and
find their “partners,” the person whose card matches the one
they hold.

When they have all found their partners, ask them to confer for a
moment together.

After they have conferred, ask each pair to tell the group which
word they have and then to describe the meaning of it, using
both the written definition and any additional information they
would like to include in order to make the definition more clear.

Congratulate the group on their skills in finding definitions and
explaining them.

Now shuffle the rest of your cards and distribute them again.
Ask the group members to again find their partners. This time,
tell them that they will be asked to explain their term, but to
pretend that they are explaining it to a Head Start family with a
specific challenge.

Give each pair a chance to talk about their word together. Then
assign each pair a special circumstance. You may make up
special challenges based on the families in your own Head Start
program. Some ideas follow:

+ Low literacy

+ Non-English speaking

* Teenage parent

+ Cultural health beliefs and practices

+ Parent who does not believe in mainstream (“western”)
medicine

14

Well-Child Health Care: Making It Happen



Module 3: Advocacy, Action, and Access

Handout N: Sam’s Story—Part Three*

Unfortunately, Dr. Martinez’s office is in the wrong county for Sam’s Medicaid program
to cover services. The Health Coordinator sits down with his parents and calls five, then
10 dentists in Sam’s county—no one is taking any more public assistance patients.
Sam’s front teeth are now literally breaking off. The Health Coordinator decides that this
problem is bigger than her own county. She knows, from state and national Head Start
meetings, that other Health Coordinators share her frustration.

With the support of her agency’s Health Services Advisory Committee, she organizes a

letter-writing campaign. Several staff members write to state and national officials, and

receive responses. A parent volunteer, who also works part-time at the local newspaper,
writes an article about the lack of dental access. She praises Dr. Martinez for serving so
many children in her county. All who are involved in the letter-writing campaign realize
the importance of raising awareness of a problem, and commit to following up with the

officials they contacted.

In addition to putting pen to paper, the Health Coordinator gets out on Saturdays and
volunteers to scrub surgical instruments at the free adult dental surgery clinic. As a
result of volunteering her time, the oral surgeons now provide free dental surgeries for
the Head Start children. Pediatric dentists are volunteering their time at the public health
department to provide services for the children on public aid due to the increased
awareness of the access problem. The Health Coordinator is also working on a grant
with the county dental association and the health department to get the beautiful new—
but unfunded—county dental clinic up and running.

And Sam? He has the biggest, pain-free smile of them all! He was able to get his worst
teeth extracted and his salvageable teeth filled in December. Now all he wants for
Christmas is his two front teeth!

* Adapted from a truc story from Heartland Head Start in Bloomington, Hlinois.

9
te

q

Well-Child Health Care: Making It Happen ‘ 119



Appendix B: Well-Child Health Care Fact Sheets

Speech and Language Screening

Aa Bb Ge Dd Ee-Fi Gg Hh fi Ji

What is speech and language screening?

Speech and language screening assesses a child’s abilities in the areas of:
* Voice (tone, loudness)

¢ Articulation (pronouncing sounds)

+ Fluency (stuttering)

+ Language (understanding and using words)

How is speech and language screening done?

Speech and language screening is done by a health professional or trained staff, parent, or volunteer.
Children should be screened in their primary language. A standardized screening tool should be used.
The screening asks questions and gives the child things to observe, think about, and then respond to
verbally.

What might I observe?

« Speech that is:
- limited compared to other children at tht age
- not easily understood
~ very loud or soft, or sounds unusual
« Difficulty understanding instructions, following directions, and communicating with other children
and adults
¢ Frequent ear infections or allergies

Follow-up to speech and language screening
Ifachild’s speech and language skills fall below the

“normal range” for his age, he should be rescreened.
If ee “fails” a second time, he should be referred to a

Speech and language are
important for learning and
communicating with others.

Early assessment and
treatment of speech problems
can help promote a child’s
development and

relationships.
el

health care provider for further evaluation and treat-
ment. Evaluation should also consider the results of
the hearing test, developmental screening, medical
and dental exams. Treatment may include:

+ Medications ¢ Hearing aid devices
+ Speech therapy + Sign language instruction
+ Dental work ¢ Special education services
+ Lip reading instruction
+ Surgery such as “ear tubes” to help prevent

ear infections
+ Mental health counseling,consultation for the

child, family, and staff

Well-Child Health Care: Making It Happen

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138



Appendix C: Blank Records & Forms

Handout C: Child Health Record Sample (Part 1)

CHILD HEALTH RECORD:

FORM 2A, HEALTH HISTORY

TO BE COMPLETED BY HERD START STAFF DURING PARENTIGUARDIAN INTERVIEW.

PERSON INTERVIEWED:

NAME OF INTEAVIEWER:

Te:

PREGNANCY/BIRTH HISTORY

EXPLAIN “YES” ANSWaRe

1. DID MOTHER HAVE ANY HEALTH PROBLEMS DURING
THIS PREGNANCY OR DURING DELIVERY?

2 DID MOTHER VISIT PHYSICIAN FEWER THAN TWO TIMES:
DURING PREGNANCY?

‘SL_WAS CHILD BORN OUTSIDE OF A HOSPITAL?

‘4. WAS CHILD BOWN MORE THAN 3 WEEKS EARLY OR LATE?

G_WHAT WAS CHILD'S BIRTH WEIGHT?

6. WAS ANYTHING WRONG WITH CHILD AT SIRTH?:

7. WAS ANYTHING WRONG WITH CHILD IN THE NURSERY?

& DXD CHILD OR MOTHER STAY IN HOSPITAL FOR MEDICAL
ER THAN USUAL?

‘©. 1@ MOTHER PREGNANT NOW?

(if yee, ask about prenatal care, or schedule tims to
Gavuse prenatal are arrenpemente.)

‘TION! 1D ILL 133
40. HAS CHILD EVER BEEN HOGSITALIZED OR OPERATED ON?

mad

{______ EXPLAIN "YES" ANSWERS

V1.HAS CHILD EVER HAD A SERIOUS ACCIDENT (broxen
bones, head Injuries, faifa, bu 2

12. HAS CHILD EVER HAD A SERIOUS ILLNESS?

HEALTH PROBLEMS:

EXPLAIN (Ue additional sheets If needec)

43, DOES CHILD HAVE FREQUENT ___SORE THROAT;
COUGH; _URSARY INFECTIONS OR TROUBLE
URINATING; 9. STOMACH PAIN, VOMITING, OUARAHEAT

14,.D0€8 CHILD HAVE CIFFICULTY SEHING
| _seauint, crocs eyes, kok olvesiy at Books)?

18.16 CHILD WEARING (or eupposed to wear} GLASSES?

48.0028 CHILD HAVE PROBIEMS WITH EARS/HEARING
(Pain fn eer, frequent esraches, disoharge, rubbing or favor-
ing one ear)?

(it yoo") WAR LAST CHECKUP MORE THAN ONE YEAR
aac?

17.HAVE YOU EVER NOTICED CHILD SCRATCHING HIS/HER
BEHIND (Rear end, anus, butt) WHILE ASLEEP?

‘18, HAS CHILD EVER HAD A CONVULSION OR SEIZURE?
38 CHILD TAKING MEDICINE FOR SEIZURER?

If "yea" esk: WHEN DiD [T LAST HAPFEN?.
WHAT _MEDICINE?,

10.18 CHILD TAKING ANY OTHER MEDICINE NOW?
(Special consent form inuat be signed for Head Stort
fo administer any medication).

WHAT MEDICINE?.
(it "yee" WILL IT NEED TO BE GIVEN WHILE
CHILD [8 AT HEAD START? HOW GETEN?,

30,58 CHILD NOW BEING TREATED BY A PHYSICIAN OF A
DENTIST?

(PHYSICIAN'S NAME, )

21. HAS CHILD HAD: —__ncits, ___caicKENPOx,
_——-ROZIMA, __ GERMAN MEASLES,
FEvER,

a EASED,
WHOORING COUGH?

HAS MAD:
23, HAS CHILD HAD: ___ASTHMA, ___BUREDING TEMOENCIRS
——_AABETES, _SPILEPBY, 'VORRCL

——_HEART/BLOOD-
C¥OSABE, ___LIVER DISEASE, __PHEUMATIC FEVER,
CELL DISEASE?

It "yea", trenator information to Forma 1 and 6.

24, DOBBS CHILD HAVE ANY ALLERGY PROBLEMS (Rash,
Honing, awelling, diftlaulty breathing, eneezing)?
& WHEN EATING ANY POOD8?.
1b. WHIN TAKING ANY MEDICATION?,
co. WHEN NEAR ANIMALS, FURS, INSECTS, DUST, ETC.7.

if “yea”, traneter Information to Forma 1 and &
WHAT FOO06?

WHAT MEDICINE?

WHAT THINGS?

HOW DOE8 CHILD REACT?

2B. (any "Yea anawora to questions 14 16 18, 22, 23, of 24
Sek) DO ANY Of THE CONDITIONS WE'VE TALKED ABOUT
‘AR GET IN THE WAY OF THE CHILD'S EVERYDAY
ACTIVITIES?

DID A DOCTOR OR OTHER HEALTH PROFESSIONAL TELL
ILD HAS THIS. PI iM?

‘DESCRIBE HOW:

WHEN?

@B. ARE THERE ANY CONDITIONS WE HAVENT TALKED:
ABOUT THAT GET IN THE WAY OF THE CHILD'S EVERY.
AY ACTIVITIES?

1D A DOCTCA OR OTHER HEALTH PROFESSIONAL TELL
YOU THE CHILD HAD THIS PROBLEM?

DESCRIBE:

Well-Child Health Care: Making It Happen

he
©

147
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IANO’ YIM 397 104

a
5

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=
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&
>
2

5
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2


HEAD START* ff

Well-Child Health Care:
Making It Happen

Training Guides for the Head
Start Learning Community

aH,
< U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
2 Administration for Children and Families
3 Administration on Cildren, Youth and Families
% Head Start Bureau
Niaay



Appendix B: Well-Child Health Care Fact Sheets

Hearing Testing

What is hearing testing?

Hearing testing checks whether children can hear different kinds
of sounds.

How is hearing testing done?

Hearing testing or “audiometry” is done by a health care
professional or trained staff person or volunteer. The child
indicates when he hears tones through earphones.

Ear exams are done by a health professional using a small instrument inserted into the child’s ear canal.
*“Otoscopy” looks at the child’s ear canal and ear drum
¢“Tympanometry” tests how well the child’s ear drum moves

What might I observe?

¢ An infant does not startle at noises, tum to voices, or babble at seven to 12 months of age
+ Achild has difficulty with listening activities
* A child’s speech is:
— limited compared to children at that age
— not easily understood
— very loud or soft or sounds unusual
«A child has frequent earaches

Follow-up to hearing screening

A child “fails” the hearing test if she fails to respond
at 1,000, 2,000 or 4,000 Hz in either ear. She should
be rescreened. If she fails again, she should be re-
ferred to her health care provider for evaluation and

Hearing is important for
learning and communicating
with others. Early identification

and treatment of hearing treatment. Children with ear infections should be
problems can help improve a retested after treatment.
child’s development and . oa .
relationships. Causes of hearing loss might include prenatal condi-
ace EREERENOSENETRTETNSRSNESNNERE tions, ear infections, other serious illnesses, and head
injuries.

Treatment might include:

+ Medications + Lip reading instructions + Speech therapy

+ Sign language instruction + Hearing aid devices ¢ Special education services
+ Surgery such as “ear tubes” to help prevent ear infection

Well-Child Health Care: Making It Happen 137

so)

7
ade

z

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For use with Activity 9. Or, use Appendix C: Blank Records & Forms to update this Handout.

Module 2: Partnerships in Ongoing Well-Child Health Care

Handout M: Trackville Head Start Tracking Instrument (continued)

HEALTH DATA
TRACKING INSTRUMENT

HEAD START CENTER
ADORESS

Trackuoille.

year (44.7 ciass

AtS Years seer

PART ADDITIONAL CHILD-SPECIFIC INFORMATION
(Include any other information about health status
dD that will heip with case management.)
OF

1D. TEST RESULTS (Screening, blood OTHER IMPORTANT INFORMATION (Critical dates, atypical/abnormal
No. pressure, Hct., Hgb.) findings, allergies, nutrition deficiencies, recommendations )
T.
redo “Denver
2.
z : 7
Spine abnoemalt hes need ve Served J pes. Scoliosis
CA ITE DentaQ treatment needecl
4.
Chores teed rel +e clevtist
5
Quit Vision KQ gor alasses romney
6.
Polmonary exer Abronpel ping of aethma pec Da Speen
ca BR Nead pecan Giemed Goonslet paces, non red Hea VER Dept
ves ° Samilu lest aet/ reeie in G mos.
Quo ries Liltsags Sracted %/i2
z.
g,
pie Denvee Dev, abaoemal
abnormal heart sourds
i Qa iled hearing ¥ 2
redo Denver ~ chill iM [that dag
12. BR leak Qounsled PATENTS, Stop TeNsvatimys Apt,
Denvoe~ abnor maQ_ re a. <s mos,
fo Oo ries
8 VL tea . JU weight re Servet bo De Spencen SISO
Denver abnormak, Aiag ness. Severely ma (nooris heal,
14

aca

abn

98

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Well-Child Health Care: Making It Happen



Module 2

Activity 1: Purpose: Management staff will consider the well-child health care

Locating components required within the Head Start Program Performance Stan-

Services in dards and determine how their own Head Start program can assure that all
children receive the services.

Your

Community

For this activity you will neéd:
@ = Handout E: Planning for Services

® = Section 1304.20: Child Health and Developmental Services of the
Head Start Program Performance Standards for each participant

@ Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT)
State Schedule

Step 1: Review with participants the section of 1304.20: Child Health @
and Developmental Services of the standards that describe
essential well-child health care.

Distribute to each participant a copy of Handout E: Planning for
Services, and your state’s EPSDT schedule.

Step 2: Ask each participant to find a partner. Together, have them
discuss the ways that children receive each aspect of well-child
care in their community. Have participants consider the EPSDT
requirements in their state.

Ask participants to think about the various types of well-child
health care providers in their area. For example:

+ Is there a sufficient number of dentists in the area? Do these
dentist have expertise in treating young children?

+ Are there adequate facilities at the community clinic for
hearing evaluations?

+ Are the majority of families covered by Medicaid? If so, are
providers willing to accept this payment method for
screenings? Do the providers spend enough time on e
screenings to achieve valid results?

70

58 Well-Child Health Care: Making It Happen



ny 6 (& Activity 9 in Module 2). Or, use Appendix C: Blank Records & Forms to update this Handout.

For use with Acti

Module 1: What Is Well-Child Health Care and Why Is It Important?

Handout C: Child Health

Record Sample (Part 1, continued)

CHILD HEALTH RECORD:

FORM 3, SCREENINGS, PHYSICAL EXAMINATION/ASSESSMENT

CHILD'S ame:_=TAN INE KQ@OUWN SEK: pintHpaTe: 3-10-42,
HEAD START CENTER: PHONE:
appress:

1. RELEVANT INFORMATION (from Health History, Parant/Teacher Observations):

AlleRay +o Peasduts /Peaout butte

2. SCREENING TESTS. Starred items (+) are required by Head Start and recommended by the Am
children 3-5 years. Enter dates If done previously. When recording resutts, enter at a minimum
SUSPECT, OR ATYPICAL/ABNORMAL, respectively.

Pediatrics for
tor NORMAL,

bE
&
eee
©
383
=e
5o8
org Test ‘DATE RESULTS. Test DATE AESULTS
wy S| = PRESENT AGE 3-245 D. VISION (Type of Test)® Salete Eat
{i ES] vb. HEIGHT (no shoes, to ACUITY, PUL. S2y-4d zo/ze ko
FEEL resreat tiny RESCREENING
: Ne
& x S| = wera ont ciotning STRABISMUS n
BEZL tonsarat v4 10.3" COMMENTS
6 FA [21000 PRESSURE |
ez HEMOGLOBIN B26] ML S246] NEG.
REAP C HEARING ype 3 Te Bio ETIOT A
EOS resutrs, ae cto Ne BEAVER CHT TEIL |
Bl RESCREENING
BEST comments
<ez|
aoa]
‘3. PHYSICAL EXAMINATION/ASSESSMENT, Complete and ratura top three Coples 10 Head Start.
MORMAL| ABNOR. | NOT
Iromage| WAL” | EVAL | COMMENTS (Use Addinonat sneet It neces:
3. GENERAL APPEARANCE WA
b. POSTURE. GAIT a
¢_SPEECH NoT &BLE TO ABSESS
6. HEAD ZZ
«SKIN ms
1. EYES: (i) External Aspecte —
(2) Optic Fungiscople an ol
{(H Cover Test
GEARS: (1) External & Canale
(2) Tympenic Membranes |W”

NOSE, MOUTH, PHARYNX

TEETH

UPPER FeonT TEETH DECAYED

HEART

LUNGS

‘ABDOMEN (Include hernta)

GENITALIA

BONES, JOINTS, MUSCLES.

ele la|-ler il

NEUROLOGIGAUSOCIAL
(1) Gross Motor,

(2 Fine Motor

@ Communteation Skiits,

DENvER Dewel. Test — vi.

(4) Cognitive,

© Salt-telp. Skills,

©) Social Skills

2. GLANDS (LymphaticsThyroig)

MUSCULAR GOORDINAT“N.

le

NASA mas
Ky

OTHER

. GENERAL STATEMENT ON CHILD'S PHYSICAL STATUS:

ee

4. FINDINGS, TREATMENTS, AND RECOMMENDATIONS

ABNORMAL FINDINGS/DIAGNOSIS.
7 iY

RECOMMENDED FOLLOW-UP OR RESULTS

(initial when complete DATE

TREATMENT PLAN,
-. ID St

DURING AND AFTER PHYSICAL EXAMINATION/ASSESSMENT

PART Il. TO BE COMPLETED BY HEALTH CARE PROVIDER

ja |e l>

oOo

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Well-Child Health Care: Making It Happen



Module 2: Partnerships in Ongoing Well-Child Health Care

Handout L: Program Planning Stories

Story #1: Six children in your Early Head Start program were diagnosed with anemia,
some of which are fairly severe cases. All six were found to have iron-
deficiency anemia, and four were found to have lead poisoning.

Story #2: Seven children on your Family Service Worker’s caseload are not up-to-
date on their immunizations. Mary of the families have immigrated from
other countries.

Story #3: Four children in your preschool classroom have difficulty engaging in
activities and relationships. During circle time, they tend to stare off into
the air and not participate in the songs or discussions. They frequently
wander from one activity to another without getting involved. They also
haven’t seemed to form friendships with other children or teachers.

Story #4: — Six three- to five-year-olds in your center were found to be significantly
overweight on their physical exam. The parents tell you that most of what
they eat is “fast food,” chips, cookies, and soda.

Well-Child Health Care: Making It Happen 93

gp anauay ysim asn 404


Module 1

Key to Activity 1: What If There Were No Well-Child Health Care?

(For Trainer Only)

Health
I Concern

Health Services
Needed

|Many Absent Children

All Well-Child Health Care

Tooth Pain

Dental Screening and Examination
Medical/Physical Examination
Nutrition Assessment

Advocacy for Dental Care
Preventive Dental Education

Hunger

Nutrition Assessment

Family Needs Assessment
Medical/Physical Examination

Growth Assessment

Anemia Screening (hemoglobin/hematocrit)

Pale, Tired

Medical/Physical Examination

Nutrition Assessment

Growth Assessment

Anemia Screening (hemoglobin/hematocrit)
Lead Screening

Intestinal Parasite Screening

Tuberculin Testing

Fighting, Biting

Developmental Screening/Mental Health Assessment
Soliciting Parental Information about Child's Mental Health

30

Well-Child Health Care: Making It Happen

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Module I

Questions for Discussion/
Reflection

Receiving follow-up evaluation, diagnosis, and treatment of health
conditions that are identified

Head Start programs also provide the following:

Assistance to pregnant women in accessing comprehensive prenatal
care, childbirth services and postpartum care

Health education for children and parents

Head Start services complement the services provided by other practitio-
ners. Head Start programs do not duplicate services already given unless
there is an explicit need to do so.

(See Appendix B: Well-Child Health Care Fact Sheets.)

Note to Trainer/Coach:

As medical information advances, health recommendations and
requirements may change. Head Start programs must stay cur-
rent on state and local recommendations of health authorities
and state licensing requirements to determine the compieie list
of screenings, exams, and immunizations needed. For informa-
tion about local recommendations for well-child health care

and screening, contact your local or state Medicaid/Early and
Periodic Screening, Diagnosis & Treatment program, your
local Health Services Advisory Committee, and your local
chapter of the American Academy of Pediatrics.

Preventive health care is not only important for children—it is also very
important for adults. Thinking about your own health care practices can
give you a greater understanding of some of the challenges Head Start
families may face:

Do you have a “medical home” or a consistent healtli care provider?

Do you sce your health care provider only when you are sick or also
on a regular basis when you are well? Do you put off seeing your
provider because you are anxious about what he or she may find?

Have you gotten the screenings and exams (e.g., blood pressure,
breast exam, PAP smear, blood cholesterol level, eye exam, dental
exam, tuberculosis test) and the immunizations that you need?

Well-Child Health Care: Making It Happen

25



Module 2: Partnerships in Ongoing Well-Child Health Care

Handout M: Trackville Head Start Tracking Instrument (continued)

HEALTH DATA PART [Le-semme | (> teggaunarsoncera
P "
TRACKING INSTRUMENT | 8 febiem Referral | procedure or serace
performad, follow
HEAD START cenTeR __ etek wi lle a = Treatment treatment fee
» Exam
ADDRESS CE1= conte cleaning = Procedure or service
[le] Dentat Fluoride ae 7
year (227 cass Y*S yaar obser OF [2] = tmmunization a completed we
10. TESTS AS APPROPRIATE. Medical Dental
No. 18 tea | Sickie cell | thistory [Mateo caver. Exam Services
T B-7-% Aigcos,
8 -B-9s° 602 $-15-9¢ | P-20-%0| F -20-Fe I-IP-F 6 7-¥- Fe
5 PR Pe olols Mer| ale AenTaTe Weel Mole
oe 95 Len | Pere | Stee] R207 7-30 Fe
5 onl 6] < igerTo [|e To] s] MT] BR] oT We Toe Bok
"| e-vesr| eos ay B-1¥- Fe} B-20-70| B-20-5t| TRIE
we EN. ORSAY. PS Oo BLT
4) eI -F5 | o.5- 90 7-a?-Fe,
LS Pree
Mel Blond ef teled Pedal bel eD eToys 7
5. reer) go -724 S-15-5¢| B-2e-5e] F-20-7e 7-3/-Fe
6
ied 2 -O-%e PYS -Fe| B-20-%| F-20-Fe! P-19-P ee
| PON elo] a] Woo] Reo] MB To]
7. “8 -:
B27 | & 255 Bs | S20 Psore @a7-3e
; CES 7. a
- 5 -2-791 B-1y- a | P20-%0| B-2)-9¢ B-27- 9 $-20- SI °
es
Wer ol | lL] Mel] aL Miele] BT aT] pTel g
9g. =
8-25%¢ Bvs-%| 8-2-9721 B-2/- 52) P-AP- Fe 8
~ ea
TOO. Con: cn on elayo 3
10, g
9-7-4} 9-30-92] B-2/-Fe] Boz, “Fe 9-O7-Fe &
ST Ee 7 a 4
il.
9-2-76 4 — Be! ~ J
-2 576 Bys-s¢| 9-23-92} P-3/-Fe e27-90 z
) es. Sa: Sa Se ent o]t
12.
“$-5' - ~, 2) -. =
SEPT | % 2 Fl BV4-9e| P-2/-9e| P-2/-Fe F-19-92
Caan. RO Con ed So tale
13. 38 -Es -7-
iad 3-7 B91 Io| 9-2-5 e| P-27- 456 B-29- He =
g
x Mae Bell elon] 3] Won] | RRR OME] oT 3
ss as Re-s | Sey —-Ie | 9-2/-Fe 7-17 -Fe s
oe) er] [| lon) a] on) BB] o] « MBo] oe emt ele &
15. &
@ eT eat pep fs popel floaty pep aye tp TsTe
Well-Child Health Care: Making It Happen 97

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Activity 9 in Module 2

Appendix C: Blank Records & Forms

Handout M: Trackville Head Start Tracking Instrument (continued)

#1

#1

POLIO

154

Well-Child Health Care: Making It Huppen


Appendix C: Blank Records & Forms

Handout M: Trackville Head Start Tracking Instrument (continued)

REALTH DATA PART | ACDITIONAL CHILD-SPECIFIC INFORMATION
include any other infurmation about hesth status
TRACKING INSTRUMENT D ‘that will help with case mansgemsrt.)
HEAD START CENTER
ADDRESS
YEAR CLASS SHEET —
10. TEST RESULTS (Screening, blood OTHER IMPORTANT INFORMATION (Critical dates, stypical/ abnormal
No. pressure, Hct, Hgb) findings, allergies, nutrition les, recommendations.)
L
2.
Es
4
= -
6.
7
8.
9
10.
ih
Tz —
13.
14
1s

Well-Child Health Care: Making It Happen

72 BEST COPY AVAILABLE

157

Oppopy ut 6 AnaNOE yn 2517 40g



Module I

Game Board for Activity 3
The Weil-Child Health Care Fact Game
What You
What itts | By You Might How You
Do It Do It
Observe
$100 $100 $100 $100
$200 $200 $200 $200
$300 $300 $300 $300
$400 $400 $400 $400
$500 $500 $500 $500
38

BEST COPY AVAILABLE

Well-Child Health Care: Making It Happen



Module 3

Points to Consider: + Review the three levels of advocacy. Through this activity, we are
exploring the third level of advocacy to make changes in the system
if services offered do not meet the needs of families,

+ Collaboration is essential in working for these big changes. Collabo-
rators can apply joint pressure to decision makers. They can also
offer moral support to each other over the long-term effort. This kind
of change is tough!

Well-Child Health Care:
Making It Happen...

Tne goal:
Close to 100% success rate
in linking children to a permanent
medical home at Tri-County Head Start
program in Colorado!
The key?
A strong commitment
on the part of the health departments
and local physicians.

Advocacy, Action, and Access ays
aeu

107


Resources

environment, sanitation, emergencies and first aid, child health
screening, dental health, nutrition, children with special needs,
child abuse and neglect, lead poisoning, chronic health con-
ditions, infectious diseases, and staff health issues. It contains a
large amount of information on each of these topics, practical
charts, forms, and handouts, as well as educational exercises and
strategies for teaching children about health.

Contact: National Association for the Education of Young
Children. 1509 Sixteenth Street, NW, Washington, D.C. 20036.
Telephone: 800/424-2460 or 202/232-8777. Fax: 202/328-1846.
$15; no shipping & handling fee for prepaid orders.

Meisels, Samuel. Developmental Screening in Early Childhood: A
Guide. Washington, D.C.: National Association for the Education of
Young Children (NAEYC), 1989.

This manual demonstrates how to organize an exemplary early
childhood screening program. It includes advice on selecting an
appropriate screening instrument, sample screening forms, and
NAEYC’s position statement on standardized testing.

Contact: National Association for the Education of Young
Children. 1509 Sixteenth Street, NW, Washington, D.C. 20036.
Telephone: 800/424-2460 or 202/232-8777. Fax: 202/328-1846.
$4.50; no shipping & handling fee for prepaid orders.

Seattle-King County Dept. of Public Health. Child Care Health
Handbook. Seattle, WA: Author, 1990.

This is a comprehensive, concise, and very user-friendly manual
on health and safety issues in childcare. It covers mental health

and developmental topics such as partnership; child growth and
development; encouraging emotional health and good behavior;

- helping children cope with stress, child abuse, and neglect; and

children with special needs. It also covers health and safety
topics such as child health screening, immunizations, nutrition,
dental health, injury prevention, emergencies, infection control,
illnesses, reporting communicable diseases, and staff health
issues.

Contact: Child Care Health Program, Seattle-King County De-
partment of Public Health, 400 Yesler Ave., 3rd Floor, Seattle,
WA 98104, Telephone: 206/296-4902. Fax: 206/205-5281. $10
each; $8.50 for orders of two to nine copies; $7.50 for orders of
10 or more; 10% shipping & handling fee on all orders.

hay

128

Well-Child Health Care: Making It Happen



For use wuh Acuvity 7

Module 1: What Is Well-Child Health Care and Why Is It Important?

Handout D-2: The Meaning of Screenings and Exams

Situation #4: Anemia

Rosa is 18-months-old. When Rosa had her physical exam for Head Start, she had a blood test for
anemia (hemoglobin/hematocrit). The results showed that she had mild anemia. The nurse practioner
told Rosa’s mom that she needed to cut back on milk—drinking five 8-ounce bottles a day was too
much for Rosa and didn’t leave space for her to eat iron-rich foods. She also needed to take iron
medication. Rosa’s mom spoke with Head Start staff and asked how the school could help.

Situation #5: Hearing

Daniel is three years old. He had frequent ear infections in his first two years of life. Daniel’s hearing
was screened with two different tests, and he failed the hearing tests both times. The health coordinator
discussed the screening results with Daniel’s mother and referred him back to his pediatrician for further
evaluation. A few weeks later, the health coordinator asked Daniel’s mom if he had seen the doctor. The
mom said, “Since Daniel got over his cold, he’s been fine and doesn’t need to see the doctor.”

Situation #6: Development/Mental Health

Maria is four years old. Maria’s developmental screening was impossible to complete. On the develop-
mental history, Maria's mother said that she was able to speak in full sentences, dress and feed herself,
and play games with other children. However, in the month since Maria enrolled in the program, she has
mostly sat in the corner with her thumb in her mouth. She refuses to play with other children and only
talks minimally in baby talk to the teachers. Maria’s mom says that it might have to do with the fact that
the grandmother who raised Maria just died last month of a heart attack in front of Maria.

rome)
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50 Well-Child Health Care: Making It Happen



Module 3

D. The Links for Families Program

An example of a working collaboration is the Links for Families program
operating in Boston, Massachusetts. This program combines the ABCD
Head Start program, Boston Medical Center, and the network of commu-
nity health cer. rs in Boston. This program was initiated in 1996 because
the same population of children used, or were eligible for, both services
and there was no formal mode of communication between the two ser-
vices. The collaboration allows Head Start and the medical providers to
work most efficiently together. The collaboration works on three levels.
These are as follows:

. Strategic Planning: Solutions to challenges to communication and
service delivery are explored. One example is the development of a
consent form to enable teachers and physicians to communicate
directly about the children while respecting confidentiality and
parental consent. Another example is the development of a referral
system where physicians can directly link eligible children to their
local Head Start center through a central office.

. Cross-training: This area permits the Head Start program and the
medical providers to share knowledge. A Health Manager from
Head Start now visits the clinics personally to inform the medical
staff which examinations and forms Head Start needs to be sure that
children are up-to-date with their care. This decreases misinforma-
tion and unnecessary services. Phone calls between the two agencies
decreased, and when there are questions, the medical staff now have
a personal contact to call for answers. Physicians or early childhood
specialists go out to the Head Start sites to teach the staff about rel-
evant topics. These include substance abuse, reading behavioral
cues, handling aggressive behavior or lead poisoning. Valuable
knowledge is shared by all members of the collaboration to the ben-
efit of the children.

. Information Dissemination: This area allows the staff from both
institutions to understand the other’s organizational structure. With
this knowledge, the proper person or department is easily accessed
when an answer to a specific question is needed.

Note to Trainer/Coach:

For more information on collaboration building, see the guides
Community Partnerships: Working Together in the Social
Services series, and Sustaining a Healthy Environment in the
Health series of Training Guides for the Head Start Learning
Community.

444

104

Weil-Child Health Care: Making It Happen



Module 2

Points to Consider:

+ What is the “common ground” to emphasize in order to
promote the partnership in well-child health care and
screening?

+ How might you incorporate “taking a different perspective”
into your daily work experience?

In order to empower parents in well-child health care we must be
sensitive to families’ beliefs and challenges. We should provide
basic information and work together to try to overcome the
difficulties.

The challenges to well-child health care tend to involve more than
one of the partners. Therefore, Head Start staff, parents, and health
care providers must all work together to develop effective strategies
to overcome the challenges.

We can facilitate communication and cooperation by standing firmly
on our “common ground”—everyone's concern for the best interests
of the child.

68

Well-Child Health Care: Making It Happen



Module 1

Activity 2: (ome) Purpose:

This activity allows participants to practice explaining specific

What, Why, 05} screening and exam procedures to a parent or co-worker. It is especially

and How of
Screenings and = ="
Exams

helpful for staff that has direct contact with parents, including family ser-
os vice workers, health aides, and teachers.

For this activity you will need:

= = Appendix B: Well-Child Health Care Fact Sheets
Provide copies for all participants.

Step 1:

Step 2:

Step 3:

Step 4:

This exercise allows you to practice explaining to parents or co-
workers the “what, why, and how” of different screening
procedures.

If you are in pairs: One person will begin as the “teacher” and
the other the “learner.” The teacher will explain two different
screening exams to the learner.

If you have a group of three: The third person will be the
“observer.” The observer will provide-feedback to the role-
players.

Everyone will have the chance to play every role.

Identify the role that you will begin in. Take a few minutes to
“pet into” your role.

+ For the teacher: You want to help the learner develop a firm
understanding of the screening or exam-—what it is, why it
is important, and how it is done.

«For the learner: Make this activity a challenge for yourself
and the teacher. Take the role of a learner who is not
familiar with the screening or may have some reservations
or concems about it.

+ For the observer: Pay careful attention to the communica-
tion between the teacher and learner. Note what worked and
what didn’t work.

Take a few minutes to briefly review with participants Appendix

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Well-Child Health Care: Making It Happen



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Introduction

Overview

Purpose Many of us think of health care as something we need only when we are
sick. But “well-care” can keep children and adults healthier by preventing
disease and catching health problems sooner. Everyone in Head Start-—
families, staff, and health care providers—plays an important role in
promoting health. Through advocacy and collaboration building, the
health care system can be changed to best meet the needs of the commu-
nity it serves.

Well-Child Health Care: Making It Happen can help Head Start staff:

+ Develop a partnership between families and providers at a “medical
home,” where children have a continuous, ongoing source of
accessible medical care.

. Evaluate the quality of their program’s screening and exam practices
and communication with parents, and thereby develop strategies for
improvement.

¢ Understand and explain the importance of well-child health care to
other staff, parents, and the community.

+ Support parents in obtaining follow-up services for identified health
needs and track provision of well-child services.

+ Develop strategies to work with parents to advocate for needed
health services and build collaborations among existing service
providers to improve access for children and families.

Audience This guide can be used by ali staff, with a special importance for those
staff members with responsibility for health services or building commu-
nity partnerships around health issues.

Note:
Trainings should be conducted by staff or consultants who are
well-trained and experienced in health education, medicine,
nursing, dentistry, or another area of public health or clinical
care. The trainer or coach must be well-versed in the Early and
Periodic, Screening, Diagnostic, and Treatment (EPSDT} re-
quirements of your state. He or she should be provided with
background materials such as the appendices, fact sheets, and
publications listed in the Resources section.

Introduction 13 1


Module 2

Activity 5: Purpose: This activity allows participants to evaluate different scenarios

Well-Child for aspects that support or reduce quality well-child health care. Partici-

Health Care pants will brainstorm strategies for improving their ability to make well-
child health care “happen.”

Dilemmas

For this activity you will need:

@ = Handout I: Dilemmas in Assuring Well-Child Health Care
for each participant.

@ = Flip chart paper and markers

Trainer Preparation Note:

Before the training, write down the discussion questions from
Step 3 on flip chart paper. .

Step 1: Explain to participants that this activity will give them the
chance to assess the strengths and problems in various scenarios
dealing with the provision of well-child health care.

Step 2: Divide participants into small groups of three to five people.
Ask them to imagine they are consultants to help Head Start
programs improve the quality of delivering well-child health

care.

Step 3: Distribute Handout I: Dilemmas in Assuring Well-Child Health
Care to each participant. Explain that each program’s dilemma
has both quality problems and strengths.

Instruct each group to review each scenario and discuss the
following questions (posted on flip chart paper):

« What aspects of the situation contribute to quality?

+ What aspects of the situation may reduce the quality?

Partnerships in Ongoing Well-Child Health Care a4 69



Module 2

Points to Consider:

+ What does this imply about the role of your observations in
screening?

+ What might you want to find out about the cause, treatment,
and outcome for the health condition?

+ Are there any possible implications for screening for other
family members (e.g., younger siblings) or classmates?

Both parents and teachers have the opportunity to observe children
in various activities. Careful observations of each child over time are
important elements of screening.

Most of children’s appearance, behavior, and skills fall within the
broad range of “normal or typical” for children that age.

Observations of concem include signs of physical or emotional pain,
difficulty participating in activities, and difficulties in social
interactions.

Observations should be discussed with other individuals who have
observed the child over time and know the child best, such as
parents and teachers. If teachers and parents agree that there are
concerns, they need to be carefully documented and assessed along
with other history ar screening information. It means that the child
might have a special ne: d, and further observation, discussion, and/
or evaluation may be necessary.

Note to Trainer:

For more \iformation on developing observation skills, see the
guide Observing and Recording: Tools for Decision Making
in the Education series of Training Guides for the Head Start
Learning Community.

Partnerships in Ongoing Well-Child Health Care 8



Preface

By assuring wet! :hild health care, screening, assessment, and follow-up
for every child, Head Start can make a real difference in the lives of
children and families, Latrice tells us her story:

"My son Jamal began Head Start when he was four years old. Through

my Family Service Worker, i found out that he had not received his state
recommended shots. Our Family Service Worker also asked about
Jamat's baby sister. She needed her shots too. Upan realizing that we had
no regular health care providers, we sat down together and found the

phone nanber for the nea

clinic, I got my family enrolled in a
program of well-child exams and regular immunizations, So 1 taok both of
the children to the clinic for their checkups and shots. I found out it was a

good thing, too, because that winter when our neighbors’ babies were
really sick with whooping cough, my children were fine. I feel very much
at home at this clinic--1 recommended it to my sister for her prenatal

care.

Three months into the Head Start program, a teacher's aide noticed

Jamal was always thirsty and needed to go to the bathroom often, [ took

him back to Dr. Spencer and a blood test showed he has diahetes- -the

same disease his grandpa has. | felt overwhelmed and scared. / didn’t
know how to give insulin or cook for him now.

With the help of the Head Start staff, my clinic set me up with a dietician
and together we came up with menus using a lot of our family recipes.
The nurse taught me all about giving shots and testing Jamal's sugar
levels. There’s even a Diabetes Support Group I attend to ‘get things off
my chest'——my fears and all. | don't worry about him at school because
the staff knows when to give Jamal his snacks and the right types of food
to give him. I feel like I have a whole team of people behind me to keep
my baby healthy.”

The cornerstone of well-child health care is establishing a linkage and
partnership between children and families and a “medical home.” The |
“medical home” provides an ongoing source of continuous, accessible

medical care, even after the child has left Head Start. Health care begins
before a child is born by pregnant women’s entrance into comprehensive 1
prenatal care.

>

Well-Child Health Care: Making It Happen ix



Module 3

C. Children’s Health Insurance Program (CHIP)

The Balanced Budget Act of 1997 included a comprehensive children’s
health initiative under Title XXI of the Social Security Act, the State
Children’s Health Insurance Program (CHIP). This new program enables
states to initiate and expand health insurance coverage for uninsured chil-
dren. The law allows states the option to expand coverage for children
through a separate child health insurance program, through expanding
Medicaid coverage, or developing a program that combines features of
both Medicaid and CHIP. CHIP is a valuable resource for those Head
Start families who make too much money to qualify for Medicaid, yet
cannot afford to purchase private health insurance.

Head Start State Collaboration Offices should be working with State
CHIP planning committees about developing outreach strategies and en-
rollment plans for children and families to ensure Head Start is included
in a states Child Health Plan. Specific strategies for outreach that can be
conducted by Head Start programs include:

. informing families about Medicaid and CHIP as part of their
enrollment process;

* contacting their State Medicaid office to see if presumptive
eligibility is being offered to children enrolled in Head Start;

+ assisting families with completing the application for Medicaid and
CHIP—some states may have a developed a joint application;

° inviting a representative from Medicaid or CHIP to become
members of the HSAC; and

. linking with community partners who are also involved in Medicaid
and CHIP to share ideas about how to coordinate education and
outreach activities.

Note to Trainer/Coach:

Other sources of information about Medicaid and CHIP is
either the ACF Home Page or Web Site (www.acf.dhhs.gov)
or the Health Financing Administration Home Page
(www.hefa.gov). The Head Start State Collaboration Offices
and the Head Start Quality Improvement Centers (HSQICs) are
also resources for programs wanting state specific information.

Advocacy, Action, and Access

103

ay
po
[op]


Module 2

Activity 7: 60 Purpose: This activity helps participants appreciate the role of daily
Observing is Q5) observations in screening.
Screening

For this activity you will need:

@ = One copy of Handouc K: Observation Worksheet, for each
participant

Step 1: Take 30 minutes to observe two children playing. It can be ina
center or home-based setting. Select a boy and a girl who are
approximately the same age.

Step 2: Using Handout K: Observation Worksheet, jot down your
observations of each child’s physical appearance, emotions,
behavior, and skills. Write any additional observations in the
“Other” section.

Be sure to document your observations in specific, descriptive
terms. For example, under “Emotional State” you might write
“playing and laughing with other children” rather than “okay.”

Step 3: Take 30 to 40 minutes to discuss your observations with your
coach or partner(s). Begin your discussion by giving a brief
description of each child.

Step 4: Based on your experience with children:

+ Make acheck on your worksheet next to each of your
observations that you think falls “within the normal or
typical range” for children that age.

* Circle any item that you have concerns or questions about
possibly being “outside of the normal or typical range” for
children that age.

Step 5: Use your worksheets to discuss the following questions. First,
focus on the checked “normal” or “typical” features:

+ Did you have mostly “typical” checks for these two
children? If so, what does this mean?

Partnerships in Ongoing Well-Child Health Care B



Module 3

@ Advocacy, Action, and Access

Outcomes After completing this module, participants will:

* assess which community institutions significantly affect the health
care of Head Start families;

. develop strategies to advocate for needed health services; and

° assist parents through education and consultation to become
effective health care consumers and strong advocates for their
families’ health care needs.

Key Concepts Head Start offers a key link to introducing young children and their
parents into a broader network of community support. As a central
@ community institution, Head Start can notice gaps in service and ad-
vocate for change.

Staff members fully understand the ins and outs of the health care
system in their community can facilitate the efforts of parents to re-
ceive the best care for their families.

Receiving the best care requires three levels of advocacy:

. Advocacy on a personal level with an individual health care
provider to assure the delivery of needed services (for oneself or
for a child)

. Advocacy with a health care system to assure that the benefits
promised are delivered as described in contracts

. Advocacy to make changes in the system if offered services do
not meet the needs of families

As Head Start assists parents in understanding and receiving
services, it can also help community providers to understand and
effectively serve Head Start familics.

Advocacy, Action, and Access 99


Module 2

Next Steps:
Ideas to
Extend Practice

Review Your Program's Screenings and Exams

As part of your annual program self-assessment, conduct a “Quality Re-
view” of your program’s screening instruments and procedures. Interview
children and parents to find out if the screenings and exams were ad-
equately explained to them, if they were made to feel comfortable and
involved, and how the process could be improved. Collaborate with other
Head Start programs to learn creative approaches to solving screening
challenges.

Discuss screenings at a meeting with staff members, jarents, Health Se:-
vices Advisory Committee, Parent Council, and health care providers.
You may wish to discuss the following issues:

+ Do the screenings and exams effectively identify children’s health
needs and involve the parents in their child’s health care?

. Do they involve cooperation of staff, parents, and health care
providers?

+ How can the screening process be improved?

Keep Health Care Follow-up on the Agenda

Penodicall:;, reserve time to share information about the families’ chal-
lenges in following through on their children’s health care. Gather ideas
about how best to support the parents. Develop methods to track the deliv-
ery of services io Head Start students.

This system could include a master calendar shared by parents and staff
stating when the child is due for services, or an organized system of trans-
portation to and from appointments. Health professionals could be
brought on-site to facilitate delivery of services. Screening alone will not
ensure well-child health care; following through with preventive services
and services to meet special needs is essential.

Assemble a Multicultural Health Panel

When Head Start screenings and exams identify health problems and rec-
ommend treatment, the family might not complete the follow-up if their
health beliefs are very different from the recommendations.

35
vu

84

Well-Child Health Care: Making It Happen



Module 2

Background Information

The Elements of High Qu...ity Screenings and Exams
Qualified and Trained Examiners

The initial screening and exam period around enrollment is the ideal
time to link a child and family to their “medical home.” The medical
home provides the entire family with ongoing accessible health care.
Once linked to a medical home, the parents can develop a long-term
relationship with the health care provider. Medical and dental exams
must be done by licensed health professionals—the medical exam
by a physician, nurse practitioner, or physician’s assistant, the dental
exam by a dentist. Professional standards require specific
procedures and equipment. In addition to the physical and dental
exams, properly trained professionals at the medical home will test
for anemia, tuberculosis, lead, metabolic disorders, or parasites.

To ensure the provision of well-child health care for each Head Start
student, it is essential that Head Start staff assess the community of
their families. For example:

~ Is there a provider who can perform good developmental
screens?

— Are pediatric dentists available?
— Do office hours accommodate working parents?

The Head Start program can then tailor its services to dovetail with
existing services. Since well-child health care is a long-term goal,
and children may spend only one or two years in Head Start, work-
ing towards continuity is important. Head Start’s efforts are twofold:
to assist families in accessing health services during their time with
Head Start, and assuring that families are able to continue with their
care in the future. Head Start works with health professional in the
local community without duplicating their services.

In some instances, screenings for height/weight, vision, and hearing
are performed by properly trained Head Start staff, parents, or
volunteers—not the medical home. The Head Start staff does screen
to identify concerns regarding a child’s developmental, sensory,
behavioral, motor, language, social, cognitive, perceptual and
emotional skills. The screens are age and language appropriate for
the child. Since information and techniques may change, training
should be updated regularly.

64

$2

Well-Child Health Care: Making It Happen



For use with Activity 6 (& Activity 9 in Module 2). Or, use Appendix C: Blank Records & Forms to update this Handout

Module 1: What Is Well-Child Health Care and Why Is It Important?
Handout C: Child Health Record Sample (Part 5)

CHILD HEALTH RECORD: FORM &, NUTRITION

cHiLo’s NAME: STAN INE “RZOWN sex: minTHDATE:D“10-92,
DIETARY HABITS

1. WHAT FOODS DOES YOUR CHILD ESPECIALLY ukerHtmwluegete, Fests, juice, 30k

ILD Dist
2. ARE THERE ANY FOODS YOUR Ci URES? QQeeA) Vegetaties , MINE.

9g
<=
=
= -
3 Yea] No! 12,.AB0UT HOW OFTEN Approximate Number of Times
& DOES YOUR CHILD EAT 8 Week (circle the number(s)
3. DOES YOUR CHILD TAKE VITAMINS AND. res
5 MINERAL SUPPLEMENTS? V | Sette cottowing
2 (a) It “yes, what kind are they? (a) Milk, cheese, oor 2s 4 Oe 7 74
= (©) Do they contain tron? yoourt. ©
5 (©) Do they contain fluoride? ov rwaea 4 G6 7 7H
a {d) Were they prescribed? Dried beans/ceas,
S [+S THERE A YOUR CHILD SHOULD NOT | beanut butter.
EAT FORCMEDIGALS RELIGIOUS, OR PERSONAL // (c) Rice, grit ov 283 4 5 8 7 ©
= REASONS? ekay Peet S bread, cereal,
B z 6. IS YOUR CHILD ON A SPECIAL DIET? 52 fortis
=| __{o) What king? ( Growns, carats, 0% 34567 74
i |e. Has THERE BEEN 4 BIG CHANGE IN YOUR . egueen pumniin,
ty & | -GHILD'S APPETITE IN THE LAST MONTH sweet potatoes.
2 Z[ 7. DOES YOUR CHILD TAKE A BOTTLE?MIARY INAD |7*) @ Oranges, yrapes «0 1* 23 4 5 6 7 ©
= | 8. DOES YOUR CHILD EAT OR CHEW THINGS THAT 7 w4 i.
& Z| nent Foon? trates
© B| @. DOES YOUR CHILD HAVE TROUBLE CHEWING 7 of @ 34567 7
ui Z| "OR SWALLOWING? veg
© 3 |19.D0ES YOUR CHILD OFTEN HAVE: ra ovis 2 3 4 Oe 2 74*
28] ‘woiannes?
7 |__@) Constipation? + (h) Cakes, cookien, 890 1 2 3 4 5 6 7 &>
Gi] 17-00 YOu HAVE ANY CONCERNS ABOUT WHAT WV Sodas, fruit
 @|__‘Your CHILD EATS? drinks, candy,
& <[PSterved answers may require follow-up. Explain datalle or give additional comments here.
oa

13.GROWTH. 14, ANEMIA SCREEN
DATE AGE HEIGHT (no WEIGHT (ight DATE IHEMOGLOBINTM On,
shoes, to clothing, to HEMATOCRIT *
nearest 1/8 in.) | neerest 1/4 1b..)

Tafel rm Ine [25° C5OP)| 24 le (25% Dlecname [SJaulau | Ie
By mo. [37 a" C504] 2616. Crser) [neocreenins

(ft nO mo. | 40" (som) [24 te. Csr nishinatian saute oe

18.CRITERIA FOR REFERRAL OR FURTHER INVESTIGATION

(Review Items 2 through 13. ¢t the: ewere In starred (*) areas, of If growth /s not within the typical range, check the
‘appropriate box(es) below and consult # nutritionist or physician.)

ans

G_ Suspect dietary problem or inadequate food Overweight (weight greater than typical, from
intake (from Questions 2 ta 12) Growth Chart 1 or 4)

CO Hgb. less than 11 gm. or Het. less than 24% OD Short tor Age (height lesa than typical, trom
(rom Question 14) Growth Chart 2 or 5)

Underweight (weight jess than typical, from Cl Wt. for Ht. (greater or leas than typical, from
Growth Chart 1 or 4) Growth Chart 3 or 6)

COMMENTS (use additional page If needed)

¢
cs

PART !l. TO BE COMPLETED BY HEAD START STAFF,

HEALTH CARE PROVIDER, OR NUTRITIONIST

Signature_ Title, Date.

4

oS

Well-Child Health Care: Making It Happen
BFST COPY AVAILABLE



Module 1

Background Information

A. Well-Child Health Care—What It Is and Why It’s Iraportant

The comerstone of well-child health care is a partnership of children and
families with a system of health care that ensures families have a continu-
ous, ongoing source of accessible medical care. This source of health care
is termed the “medical home.” The health care provider might be a physi-
cian, nurse practitioner, or traditional healer; the “medical home” might
be located in an office, clinic, or other setting. The health care provider
works in a collaborative partnership with the parents and Head Start staff.
She or he gets to know the family and coordinates the child’s health care
during healthy times, illnesses, injuries, and other health conditions.
Through linkage to a medical home, a child can be put on a program of
regularly scheduled immunizations and early and periodic screenings. The
medical home is important for all children, especially for those with
health problems. The relationship between families and the medical home
will hopefully continue after the child leaves Head Start.

Well-child health care begins before the child is born by helping pregnant
women access comprehensive prenatal care. Prenatal care can prevent low
birth weights, premature labor, birth defects such as spina bifida and other
neural tube defects, and increase the chances of a healthy baby for HIV-
Positive women. Prenatal education helps women make healthy choices
for themselves and their babies regarding smoking, diet and exercise. At
birth, health experts recommend that children begin regular examinations,
screenings and immunizations. Since the first few years of life are critical
for a child’s health and development, early and frequent visits to the
medical home are crucial. (See Appendix A: Recommendations for Well-
Child Health Care.)

When health conditions are identified and treated early, the impact of
many disabilities can be reduced. For example, lead poisoning can cause
serious medical, behavioral, and learning problems in children. When lead
screening identifies a child with lead poisoning, prompt intervention—
removing the source of lead, educating the family, and getting medical
therapy—can lessen the harmful effects of lead poisoning on the child. It
may also help prevent poisoning of other family and community members.

B. The Components of Well-Child Health Care
. Health History

A brief summary of the child’s health history is made from discus-
sion with the parents and review of medical records, It addresses the
health of the child within the context of the family. It covers preg-
nancy and delivery. illnesses, hospitalizations, chronic health condi-
tions, allergies, and the child's physical, emotional, and social
development. It also includes a family history of health problems

Well-Child Health Care: Making It Happen

4
e2



Module 1

Next Steps:
Ideas to
Extend Practice

Make the Most of the Well-Child Health Care Fact Sheets

Distribute the fact shects to parents and staff to help them understand the
relationship of screening to well-child health care. The fact sheets may be
useful at orientation, enrollment, the beginning of the school year, and
when the results of screening are explained to parents.

Make new fact sheets according to your local program needs. You may
get assistance from members of your Health Services Advisory Commit-
tee, health consultants, and other community-based agencies. Be sure to
review and update the fact sheets every year. The following are possible
reasons to adapt your fact sheets:

. If there are special health issues for your population that were not
addressed in the fact sheets, revise the information according to your
needs.

. If there are other screenings that are usually done in your area,
develop additional fact sheets.

° If your program serves families that speak languages other than
English, you might translate the fact sheets into the other languages.

. If your program needs handouts at a lower literacy level, revise the
fact sheets accordingly.

Revise and Replay the Well-Child Health Care Fact Game

Make new questions and answers for the game based on the fact sheets.
You may choose to rewrite the categories to focus on your on-site sereen-
ings, your most challenging screenings, or those that have identified many
children who need follow-up evaluation and treatment. If you develop
new fact sheets, these can also be incorporated into the game.

Establish Regular Educational Workshops for Parents and Staff

Information on children’s health is constantly advancing. Help spread the
knowledge by inviting local health experts to regular, ongoing workshops
for staff and parents at your program. The range of topics is diverse: it
could include parenting skills, medical and dental health, nutrition, mental
heaith concerns, safety, and environmental hazards in the community. As

TM4

What Is Well-Child Health Care and Why Is It Important? 39



Module 1: What Is Well-Child Health Care and Why Is It Important?

Handout C: Child Health Record Sample (Part 1)

CHILD HEALTH RECORD:

FORM 2A, HEALTH HISTORY

PERSON INTERVIEWED: VEMrN  “BZOWN

oate:3-)-4@ neLaTionsHiPMVOTHES

NAME OF INTERVIEWER:.

TITLE:

PREGNANCY/BIRTH HISTORY.

EXPLAIN “YES” ANSWERS

1. DID MOTHER HAVE ANY HEALTH PROBLEMS DURING
THIS PREGNANCY OR DURING DELIVERY?

Huypeetessioat

2. DID MOTHER VISIT PHYSICIAN FEWER THAN TWO TIMES
DURING PREGNANCY?

3. WAS CHILD BORN OUTSIDE OF A HOSPITAL?

‘4. WAS CHILD BORN MORE THAN 3 WEEKS EARLY OR LATE?

5. WHAT WAS CHILD'S BIRTH WEIGHT?

6._WAS ANYTHING WRONG WITH CHILO AT BIRTH?

7. WAS ANYTHING WRONG WITH CHILD IN THE NURSERY?

8. DID CHILD OR MOTHER STAY IN HOSPITAL FOR MEDICAL
REASONS LONGER THAN USUAL?.

9. IS MOTHER PREGNANT NOW?

(i yes, ask about prenatal care, or schedule time to
discuss prenatal care arrangements.)

HOSPITALIZATIONS AND ILLNESSES.

BISINAN [VN

EXPLAIN "YES" ANSWERS

10. HAS CHILD EVER BEEN HOSPITALIZED OR OPERATED ON?

AG? 2y¢@5 — ASTHMA

11.HAS CHILD EVER HAD A SERIOUS ACCIDENT (broken
bones, head Injuries, falls, burns, polsoning)?

aN

12. HAS CHILD EVER HAD A SERIOUS ILLNESS?

Oatimo

HEALTH PROBLEMS:

EXPLAIN (Use additional sheets /f needed)

13, DOES CHILD HAVE FREQUENT ____SORE THROAT;
‘COUGH; ___URINARY INFEGTIONS OR TROUBLE Foequesst Cough IA Winter.
URINATING: STOMACH PAIN, VOMITING, DIARRHEA?

14. DOES CHILD HAVE DIFFICULTY SEEING
(Squint, cross eyes, look closely at books)?

15.S CHILD WEARING (or supposed to wear) GLASSES?

16.D0ES GHILD HAVE PROBLEMS WITH EARS/HEARING
(Pain in ear, frequent earaches, dischsrge, rubbing or favor-
Jag one ear)?

WAS LAST CHECKUP MORE THAN ONE YEAR,

€ac rafecthons as Lary

17. HAVE YOU EVER NOTICED CHILD SGRATGHING HIS/HER
BEHIND (Rear end, anus, butt) WHILE ASLEEP?

18.HAS CHILD EVER HAD A CONVULSION OR SEIZURE?
IS CHILD TAKING MEDICINE FOR SEIZURES?

it "yas" avk: WHEN DID IT LAST HAPPEN?,
WHAT_MEDICINE?,

19.15 CHILD TAKING ANY OTHER MEDICINE NOW?
(Special consent torm must be signed for Head Stsrt
to administer any medication).

WHAT MEDICINE?.
(it yen") WILL IT NEED TO BE GIVEN WHILE
CHILD 1S AT HEAD START?. HOW OFTEN?,

20.15 CHILD NOW BEING TREATED BY A PHYSICIAN OR A
DENTIST?

wnysicans name. MAay Smart)

21. HAS CHILD HAD: Bois, 7" CHICKENPOX,
TD Sozeaa n “azmnan enna eases,
== MUMPS, ___SCABLET FEVER, ____WHOOPING COUGH?
‘22. HAS CHILD HAD: _W7_ Hives, POLIO? When) ote peosnat (netics
23,HAS CHILO HAD: STHMA, __BLEEDING TENCENCIES It "yes", transter intormation to Forms 1 and 5.
——__DIABETES, EPILEPSY, HEART/SLOOD VESSEL Since age 2- mostty TN
DISEASE, ___LIVER DISEASE, ____ RHEUMATIC FEVER.

SICKLE CELL DISEASE?

Winted, some with avimals

24. DOES CHILO HAVE ANY ALLERGY PROBLEMS (Rai
itching, swelling. difficulty bi
4 WHEN EATING ANY FOODS?.
b. WHEN TAKING ANY MEDICATION?.
©. WHEN NEAR ANIMALS, FURS, INSECTS, DUST, ETC.

WHAT FOODS?

WHAT MEDICINE?

WHAT THINGS? QLaly~nrAols

HOW DOES CHILD REACT?ROSH, “LTeH, Cougn.

it “yas”, transfer information to Forms t and 5.
COMUTS

25. (if any “yes” answers to questions 14, 16, 18, 22, 29, or 24
23k:) DO ANY OF THE CONDITIONS WE'VE TALKED ABOUT
SO FAR GET IN THE WAY OF THE CHILD'S EVERYDAY.
ACTIVITIES?

BID A DOCTOR OR OTHER HEALTH PROFESSIONAL TELL
YOU THE GHILD HAS THIS PROBLEM’

SES

DESCRIBE HOW: ,
Cougs 2g £ Colds TA Widtee.

WHEN? AQe 2- Qethmon

TO BE COMPLETED BY HEAD START STAFF DURING PARENT/GUARDIAN INTERVIEW.

26. ABE THERE ANY CONDITIONS WE RAVEN TALKED
ABOUT THAT GET IN THE WAY OF THE CHILD'S EVERY-
BAY ACTIVITIES?

DID A DOCTOR OR OTHER HEALTH PROFESSIONAL TELL
YOU THE CHILD HAD THIS PROBLEM

DESCRIBE:

WHEN?

Well-Child Health Care: Making It Happen

35  BESTCOPY AVAILABLE

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Module 2

Points to Consider:

Step 3: Discuss any experience that you have had with supporting

parents in accessing well-child health care and follow-up
services.

+ What was successful?

+ What was not successful?

Step 4: Discuss the following:

+ What if there were several children in the classroom who
were diagnosed with the same problem?

~ What additional classroom or family interventions
might be helpful?

— What might be done as a group to access health care and
deliver follow-up services?

It is important that the parents and key staff understand the results of
screenings and exams, the diagnoses, and the recommended treat-
ment and follow-up.

Careful documentation is crucial to facilitate comprehensive review
and appropriate assessment, treatment, and follow-up to meet each
child’s health needs.

For common health problems, programs should determine which
classroom, multifamily, and community interventions might help.
This might involve more extensive public education and advocacy.

7

72

Well-Child Health Care: Making It Happen



Appendix B: Well-Child Health Care Fact Sheets

Dental Screening and Examination

What is dental screening?

Dental screening is a quick check of a child’s mouth to find out if
she needs a prompt exam and treatment. It can be done by a dental
professional or trained Head Stact staff or volunteer. Whether or not
it is done, all Head Start children need a complete dental
examination.

What is the dental examination?

The dental examination is a full checkup by a dental professional. It includes:

* Discussion of diet, toothbrushing, use of bottles, and thumb-sucking.

+ Exam of the mouth for tooth decay, bite, and gum infections. Dental equipment such as mouth
mirrors, dental picks, and high intensity lights are used. X-rays may be taken.

* Information on good oral hygiene and nutrition.

* Fluoride may be applied to the child’s teeth and/or prescribed in liquid or tablets to prevent tooth
decay.

What might I observe?

* Mouth pain and sensitivity to hot, cold, or sweets
+ Discolored, broken, or missing teeth

¢ Red, swollen, or bleeding gums

* Swollen face

* Bad breath

Foilow-up to dental screening
Dental problems can

, If dental problems are found, the child needs follow-up
cause pain and

evaluation and treatment by a dentist.

difficulty eating and

speaking. Treatment Treatment might include:

for dental problems -_ 7 , ;

can improve a child's « Filling cavities, capping, or pulling teeth

+ Education on improved diet, bottle use, toothbrushing,
flossing, and fluoride
* Referral to an orthodontist or other specialist

health and well-being.

aor
tad

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Resources

Books & Manuals Colgate-Palmolive Company. Colgute Bright Smiles, Bright Futures: A
multi-cultural oral health program for Head Start and Early
Childhood Programs. New York, NY: 1991.

This is a comprehensive, school-based package of teaching ma-
terials to help incorporate oral health activities into the class-
room and home. The package addresses the following goals:
promoting individual responsibility for oral health; easing fear
about visiting the dentist; and showing parents, guardians, and
teachers the basics of preventive oral health care, emergency
first-aid and safety practices, and good nutrition. Included with
activities are a “big book” showing healthy smiles, audiocas-
settes, wall posters, and video tapes.

Contact: Colgate-Palmolive Company, 1133 Broadway, Suite
1123, New York, NY 10010, Telephone: 800/334-7734.
Fax: 212/924-3052. Free to Head Start Programs.

Green, M., Ed. Bright Futures: Guidelines for health supervision of
infants, children, and adolescents. Arlington, VA: National Center
for Education in Maternal and Child Health, 1994.

This book is a clear and comprehensive guide to preventive
health care and screening for children from birth through
adolescence. It was designed to help health professionals,
families, and community members promote the health of
children. The book presents an overview of children’s
development and special health issues for discussion and
screening at different ages. The recommendations were
developed through the collaboration of numerous child health
agencies and experts, and sponsored by the Maternal and Child
Health Bureau, U.S. Department of Health and Human Services.

Contact: National Maternal and Child Health Clearinghouse,
2070 Chain Bridge Rd., Suite 450, Vienna, VA 22182-2536.
Telephone: 703/821-8955. Fax: 703/821-2098. $22.35 for one;
$18 for orders of two to 10 copies; $15 for 11 - 49 copies; and
$14 for orders of 50 or more. All prices include shipping &
handling.

Kendrick, A.S., R. Kaufmann, & K.P. Messenger, Eds. Healthy Young
Children: A manual for programs. Washington, D.C.: National
Association for the Education of Young Children, 1995.

This is a comprehensive book on health in childcare and early
childhood programs. It addresses a wide range of health topics
including: health promotion and education, creating a safe

Resources 127

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Introduction

Definition of Icons

Coaching

A training strategy that fosters the development of skills
through tailored instruction, demonstrations, practice, and
feedback. The activities are written for a coach to work
closely with one to three participants.

Workshops

A facilitated group training strategy that fosters the
development of skills through activities which build on
learning through group interaction. These activities are
written for up to 25 participants working in small or large
groups with one or two trainers.

Next Steps:
Ideas to Extend Practice

Activities assigned by the trainer immediately following
the completion of the module to help participants review
key information, practice skills, and examine their progress
toward expected outcomes of the module.

Continuing
Professional Development

Follow-up activities for the program to support continued
staff development in the regular use of the skills addressed
in a particular training guide. It includes:

1) opportunities tailored to the participant to continue
building on the skills learned in the training; and

2) ways to identify new skills and knowledge needed to
expand and/or complement these skills through
Opportunities in such areas as higher education,
credentialing, or community educational programs.

Introduction



Resources

Videos

National Organizations

U.S. Department of Health and Human Services. EPSDT: A Guide for
Head Start Programs. Washington, D.C.: 1995.

This guide, developed jointly by the Head Start and Medicaid
bureaus, helps Head Start programs to navigate access to
preventive and treatment services for their Medicaid-eligible
children. It focuses on Medicaid’s Early and Periodic,
Screening, Diagnostic and Treatment (EPSDT) program. The
guide includes contact organizations and telephone numbers.

Contact: Head Start Publications Center, P.O. Box 26417,
Alexandria, VA, 22313-0417. Telephone: 202/205-8560.
Fax: 703/683-5769. Free to Head Start Programs. Catalog #117.

Bright Smiles, Bright Futures: An oral health parent education video.
Colgate-Palmolive Company. New York, NY: 1991.

This is a comprehensive video developed to educate parents
about how to improve the oral health of their children by
teaching them good oral health habits at an early age. It
addresses Baby Bottle Tooth Decay (BBTD) and the adverse
effects of sleeping with a bottle (i.e., advance tooth decay, space
loss, tooth loss, crooked teeth, etc.). The video is fun to watch,
shows children dancing, rapping, and singing about a healthy
mouth.

Contact: Colgate-Palmolive Company, 1133 Broadway, Suite
1123, New York, NY 10010. Telephone: 800/334-7734.
Fax: 212/924-3052. Free to Head Start Programs.

Note: For any of the following organizations listed, you can also contact
your local chapter/affiliate for further information.

+ American Academy of Pediatric Dentistry

Contact: 211 E. Chicago Avenue, Suite 700
Chicago, IL 60611-2616
Telephone: 312/337-2169
Fax: 312/337-6329

Resources

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Module 1: What Is Well-Child Health Care and Why Is It Important?

Handout C: Child Health Record Sample ‘Part 4)

CHILD HEALTH RECORD:

FORM 5, DENTAL HEALTH

CHILO'S NAME TANASE: “B@ouda) 0 sex FO aintupate B-10-9 2
__| weap start CENTER: PHONE: .
Hs
ti By] AOORESs:
a BI © ISTHE CHILD i “yes,” Include length of time ‘2. DOES THE CHILD HAVE ANY TROUBLE WITH TEETH,
ih} Nowneceivina: recelvipg fluoride GUMS, OR MOUTH THAN THE PARENT KNOWS
8 z Topica Fluoride Application? —_—No. Unknown___Yes. ABOUT?
QE] Fiuorigated water? No. nknown, 2

Fluoride Supplement diet? No_sZ“Unknown_——ve Caps
(tablets, .Mquig,___)
TS. CHILD CHAS, @ HAS NOT) PREVIOUSLY SEEN A DENTIST, J 7. SOPACE OF REIMBURSEMENT OR SERVICES
w Dentiat’s pame_ Date iast visit. EPSOT/Medicald
G Je] 4. CHILD (IS, IS NOT) UNDER A PHYSICIAN'S CARE. O Federal, State, or local Agency
Bz] Physician's name,
= 5] § CHILO (__ts, 71s NOT) RECEIVING MEDICATION, O Head Start
OPI type O inking Provider.
© Ee] 6. CHILD iS REPORTED TO HAVE (Give details or altach Health O Parents/Guardians
Sy History, Form 2A). YS NO YES NO, © Other (3rd Party) -
0 Allergies —. Liver Dis, — 8. PAJORITY GROUP
2a Asthma ra Rheumatic Fever x ‘A. Needs Attention immediately
=3 Bleeding = Sickiecettois. = DB. Nesds Attention Soon
EE Diabetes —_ g Other (List Below) OC. Needs Routine Care
Epilepsy

aa Heart/VascularDis.

9. ORAL CONDITIONS BEFORE
TREATMENT: missing (TRY).
decayed (QB), or filled
(Gap): Indigate restorations

10. EXAMINATION AND TREATMENT REGOAD (List recommended services in order)

Foon

worm Ii 0. For] Surfaces eee” Kostowea | “eaticenes® | procedtre caroes
@ you pertorm In ltem 10. [Fe] weniained | Pigeaaen a
(Stra) leer, Steel ofou, 19 [201% H
a oteel GMPPICTTM i
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ron
5
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mh uNgUAL a
2 %
.
® :
11. DENTAL NEEDS (Check one or more turn 3 copies 10 Mead Start after srst visit).
TREATMENT (restoration, B. CLEANING FLUORIDE

pulp therapy, extraction)
OTHER

Approximate number of visit:

Oo

O& NO PROBLEMS

~. Approximate cost

12.CHILD ORAL HEALTH SUMMARY,
All planned treatment (|

mplete and raturn 2 coplas 10 Head Start alter final visit).
1ot) complete. If not, explain here, as well as items checked

Routine recail visite
Special home emphasis,
orat hygiene

mw

PART il. TO BE COMPLETED BY DENTAL CARE PROVIDER

that | have completed the service(s) listed in Part Il, Iterp 10,
my id customary fees. wa

Be.
Og.

We

Dietary problem(s)
Dovelopmental propiem|

Harmtul ore! habits
Nees fluoride supplement

‘ized Gharges do not

a vate T= £6- Ip

Signatury

Well-Child Health Care: Making

Tt Happen 47

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Contents

Module 2 5]
Partnerships in Ongoing Well-Child Health Care

Outcomes ....
Key Concepts .
Background Information .
Activity 1: Locating Services in Your Communit
Activity 2: Taking Inventory of Screenings and Exams
Activity 3: Everyone's Role in Well-Child Health Care
Activity 4: Exploring the Challenges
Activity 5: Well-Child Health Care Dilemmas ..
Activity 6: Sam’s Story Part Two—Supporting Parents.
Activity 7: Observing is Screening
Activity 8: Program Planning ....
Activity 9: Keeping Up—Tracking Health Services
Next Steps: Ideas to Extend Practice ...s.cccscse

Handout E: Planning for Services..........scssecsessesererserseseseessnseeene 86

Handout F: Taking Inventory

Handout G: Health Screening at Twin Oaks Head Start........... 88
Handout H: Exploring the Challenges ....

Handout I: Dilemmas in Assuring Well-Child Health Care ...... 90
Handout J: Sam’s Story—Part Two ......ssssccsscssssssersseessesensessesees 91
Handout K: Observation Worksheet...

Handout L: Program Planning Stories.....

Handout M: Trackville Head Start Tracking Instrument ......... 94

vi

Well-Child Health Care: Making It Happen



Appendix C: Blank Records & Forms

Handout M: Trackville Head Start Tracking Instrument (continued)

HEALTH DATA PART [[G]- screening T= Procedure or service not

fev] = Problem Reterral performed.
TRACKING INSTRUMENT A ae [A> Procedura oF service

[<] = Olagnosis performed, follow-up
HEAD START CENTER Se Taatment) newsers
ADoRess FEY, cen ciesine | B2Y> featur ean

[1] = Dental Fiuoride Big = Procedure or service
YEAR CLASS SHEET OF FP] = tmmunizetion complated.

10. [secicsial STANDARD TESTS

NAME No. [Enoted{ “Hearing | Visual Acu. | Strabismus | Het.or Hgb ] Ht & we, 1 [At a wt 2

r [Birth Date:
2. Birth Date:
3 [sirth Date: !

Wels pede ede lol dele eye dele

tedalele Poli felTolt ts baleleys belts pa]ale

seatels bePol |e ble] efebelalils poe] s fafa]

[Birth Date:

Wedel eli eel pe falets dette eles

5. [girth Date:
6 ben F923 Ca de
5. Bir th Date:
7 Birth Date:
8. [sicth Date:
8. Birth Date:

10. Leirtn Dare:

tPeTele|ebeLelefeperletets belaqi ls fod atipepmyepe

2

Well blel ble lel be bedeledebe]ate

leh fede bedal tele edele

tetet ie ble tebe] [spelt te plelite payee

i Teirth Date:

Tele leh bal] Toledeb]al|spaqaye

12. Tairth date:

33. Teirth Date

4 [ainth date

Weta bdap be ielel be edalle lel de b-yal

OS Pd

ynM asn 404

EO A

18. Birth Date: 5

©

e ED MN OC OC od =
Well-Child Health Care: Making It Happen 155

471) BESTCOPY AVAILABLE


Module 2

Step 4:

Step 5:

Step 6:

Step 7:

Step 8:

« Community Volunteers
+ Health Services Advisory Committee

Have participants list activities for each role that support
screening, Write down the activities as smaller spokes off the
“role” circles (e.g., Dentist: conduct dental exams).

Point to a specific role (e.g., Parents) and ask participants:
+ Why is this role important?

+ What would happen if this partner were not involved in
screening?

Point to an activity (e.g., Family Service Worker: arrange for an
interpreter for non-English speaking parents) and ask
participants;

+ Why is this activity important?
» What would happen if this activity were not completed?

On the flip chart paper or blackboard, write a heading
“Challenges” on the left. Have participants brainstorm a list of
the major difficulties in this program's screening story. Write
them down in this column.

To the right of the column for Challenges, write a heading
“Strategies.” Have participants brainstorm some strategies by
which the key partners can work together to overcome the
challenges to screening. Write them down in this column.

Ask participants to think beyond this example of dental
screening and exams:

+ Give examples of other screenings that involve many
partners and activities.

+ Give examples of other challenges to screening that you've

experienced, and strategies that were developed among the
partners to overcome the difficulties.

aed
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64

Well-Child Health Care: Making It Happen



Module 1

Key to Activity 1: What If There Were No Well-Child Health Care?
(For Trainer Only, continued)

|
|
i

Health Health Services
Concern Needed
Measles Epidemic Reviewing Records
| Timely Determination of Health Status
Immunizations
Tracking |
Child with Asthma Individualizing Program
Parent Education regarding Asthma and Medication
[Pregnant Mother Prenatal Care and Education 1

Staff keeping abreast of Community Services
Medical Home

Stomach Cramps,
Diarrhea

Medical/Physical Examination
Intestinal Parasite Screening
Nutrition Assessment

Saying "mama mama"

Medical/Physical Examination

Hearing Testing

Speech and Language Screening

Vision Testing

Developmental Screening/Mental Health Assessment
Immunizations

Ongoing Observations

Child Rocking in Comer

Cngoing Observations

Soliciting Parental Information about Child's Mental Health
Screening for Behavioral Concerns

Mental Health Counseling

What Is Well-Child Health Care and Why Is It Important?

a+
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Module 2

Step 5:

Ask participants to identify for themselves one aspect of screen-
ing that they would like to improve over the course of the school
year. Write it down, sign it, and give it to your supervisor or
partner. Ask the supervisor or partner to put a reminder on the
calendar for the month of May to discuss how progress is going
with screening.

Points to Consider: + Head Start programs are required to document certain screening
procedures in order to comply with the Performance Standards (e.g.,
completing screenings and exams within the time limit).

+ Programs should also strive for the highest quality in well-child
health care for Head Start children and families. Attention should be
paid, for example, to truly preparing children, involving parents,
supporting families’ relationships with their “medical homes,” and
making best use of the Health Services Advisory Committee.

Well-Child Health Care:

Baby Bottle Tooth Decay
is decreasing in Alaskan communities!

Parent dental health advocates
trained in oral-wellness curriculum are
dispensing parental support, toothbrushes,
and good information throughout

Making It Happen...

The solution?

the community,

62

Well-Child Health Care: Making It Happen



Appendix B: Well-Child Health Care Fact Sheets

Immunizations

What are immunizations?

Immunizations are vaccines or “shots” that protect children from serious
illnesses. The illnesses can cause pneumonia, liver cancer, brain damage,
and death. A child should receive immunizations for ten diseases:

Immunization Disease ¢
DTP Diphtheria, tetanus, pertussis (whooping cough)
OPV or IPV Polio

MMR Measles, mumps, rubella (German measles)
HIB Hemophilus influenza B

HBV Hepatitis B

VZV Varicella (chicken pox)

How are immunizations given?

Immunizations are injections or shots, except the polio vaccine which is usually a syrup given by mouth.
They are given by a health professional at a doctor’s office, clinic, or Head Start site. They require one
or more doses. They should be given at the following ages:

° Birth

* 2,4, %, 12, and 15 to 18 months of age

¢ Before kindergarten (4 to 6 years of age)

Are immunizations safe?

Health experts agree that immunizations are far safer than the diseases they cause. A child may have
soreness, low-grade fever, or fussiness for one or two days. Complications like high fever and seizures
are very rare. Parents should call their health care provider for any serious reaction.

eee! Are ail the immunizations necessary?
Imraunizations Children entering Head Start must be up-to-date with the immu-
protect chiidren from nizations required by Head Start and Jocal/state child care
severe diseases. We regulations. As new vaccines are developed, requirements may
still have deadly change.

epidemics because
many children are not

immunized on time.
Del

Ifa child is behind on immunizations, he should be referred to a
health care provider to catch up. Rarely, exemptions may be

given for medical reasons gr the family’s personal beliefs.
LUD

138 Well-Child Health Care: Making Jt Happen
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Module 2

education services for a leaming disability. Parents and staff in
partnership are responsible to see that follow-up plans are
developed and implemented.

- Follow-up involves re-evaluation of the child's progress by the
parents, staff, and health care providers. How soon, how often,
and with whom follow-up is needed depends upon the health
condition and the treatment. For example, a child with a simple
health problem (e.g., an uncomplicated ear infection) might need
a single follow-up visit with one health care provider. A child
with a more complex health problem (e.g., failure to thrive
resulting from severe child neglect) might need frequent follow-
up visits and evaluations over a jonger period of time with many
different health specialists.

Procedures need to be in place to track both well-child health
care and treatment for medical needs. Jt is important to work
with parents to ensure follow-up treatments for diagnosed medi-
cal needs found during the screening process. When there are
difficulties in following up, it is crucial that program staff, par-
ents, and health care providers re-evaluate the situation and
work collaboratively to develop strategies to address the chal-
lenges. Health screening, exams, assessments, and diagnoses are
only valuable when they are followed by appropriate treatment.

B. The Challenges to Quality Screenings and Exams

Head Start staff have many responsibilities in ensuring that screenings,
exams, and immunizations are completed within the time frame specified
by the Head Start Program Performance Standards. There are many details
to coordinate, document, review, and follow up. All this can be very chal-
lenging because the process depends on the cooperation of all of the part-
ners~-staff, parents, health care providers, and children. Each partner has
her own perspective, needs, and particular difficulties. Some of the chal-
lenges include:

. The Health Care System: In some areas, it can be difficult to find
health care providers who are accessible, accept Medicaid/EPSDT,
speak the families’ languages, and are sensitive to families’ diverse
backgrounds. Some health care systems may restrict access to
desired services or may not offer services of highest quality.

. The Head Start Program: Programs may have limitations in staffing
and resources for screenings, exams and follow-up.

Partnerships in Ongoing Well-Child Health Care — 55



Module 1

Screening

Screenings are standardized, often quick, procedures to identify
health conditions that might necd further assessment and treatment.

Screening procedures include gathering information from the family,
observing the child’s behavior and skills, and doing certain tests.
They include both objective. standardized procedures (¢.g.. develop-
mental tests), and subjective observations (¢.g.. “Tina seems to have
difficulty with fine motor tasks”).

While Head Start requires screenings be completed within certain
time limits after enrollment, screening also includes daily observa-
tions of children’s appearance, behavior, and skills throughout the
year. It is important for Head Start staff to be able to read and under-
stand each child’s health record since existing health problems can
be related to screening results. Head Start should not duplicate ser-
vices that have been conducted by other health professionals.
Instead, Head Start works in partnerships with health care profes-
sionals to make sure children are receiving needed health services.

The trained professionals at the child's medical home will do some
screening (e.g., hematocrit, tuberculosis, hereditary/metabolic, lead.
and intestinal parasite screening). Other screenings may be done by
Head Start staff, parents, or volunteers who are properly trained in
the procedures (e.g.. growth, vision, hearing. nutritional
assessment).

Within 45 days of enrollment, the Head Start staff will screen to
identify developmental, sensory, and behavioral concems. Many
screenings can be completed in the classroom or in the family’s

home where the child is most comfortable.

The child’s screening results are assessed according to the “typical”
or “normal” range among children that age. ‘‘Atypical” or “abnor-
mal” screening results mean that the child may have a special health
necd. The child needs further evaluation by a health professional to
determine if he has a specific condition or diagnosis and what treat-
ment or services might help.

Arelationship with the medical home will offer consistency of care.
Diagnosis, treatment and follow-up can be closely followed.

Examinations
Examinations are in-depth physical assessments of the child, such as

the medical physical exam and the dental exam. Licensed health
care professionals, such as a physician, nurse practitioner, or

Vell-Child Health Care: Making It Happen
y,
a4



Module I

Activity 4: 00 Purpose: This activity allows participants to develop skills in explain-
The Importance ing the importance of well-child health care and linkage to a medical
of Well-Child eH} home to parents. Participants will develop strategies to help families over-
Health C d ‘sf come barriers to good medical care for their families. This activity is

ea . are an particularly helpful for family service workers and other staff members
a Medical Home who are involved in enrolling children into Head Start.

For this activity you will need:

@ = Handout A: Carlos’ Story, for each participant

Step 1: Divide participants into pairs. Instruct them to find a partner to
work with and read Handout A: Carlos’ Story together.

Step 2: Ask participants to take a minute to reflect on their own
experiences:

+ Have you ever put off getting health care for yourself or
other family members? What were the reasons (e.g., you had
other more important things on your mind, it was too
expensive, or you were afraid)?

+ Has anyone ever told you that you were not taking the best
care of your health? How did it make you feel?

Step 3: Return to the story and discuss the following questions:

+ What aspects of well-child health care and screening does
Carlos need?

+ What may be some of the reasons that Carlos has not gotten
the health care that he needs?

+ How might you encourage Carlos’ family to complete the
Head Start enrollment and health screening?

— What might you say?
— What else might you need to know?

— Who else in the family, community, or program could
help?

nt
eee

What Is Well-Child Health Care and Why Is It Important? 29



Appendix C: Blank Records & Forms

Handout C: Child Health Record Sample (Part 2)

CHILD HEALTH RECORD: FORM 3, SCREENINGS, PHYSICAL EXAMINATION/ASSESSMENT

CHILD'S MARE:

mx:

@aTHOATE:

HEAD START CENTER:

PHONE:

ADDANSS:.

1, RELEVANT INFORMATION (from Health Hietory, Parent/Teacher Obeervatione):

2 SCREENING TESTS. Sterred /deme (*) aro
children 3-6 years. Enter dates if done

SUSPECT, OR ATYPICALIABNORMAL, reepoctiely.

red by Heed Stari and recommended by the American Avsdemy of Padictriex for

reeuite, enter at a minimums “N", "S", or "A" tor NORMAL,

ast,

\TIONASSESSMENT.

AT &. TO BE COMPLETED BY HEAD ST&AT
AFF OR HEALTH CARE PROVIDER BEFORE

DATE RESULTS rast DATE RECS.
(s_PREBENT AGE" re, Moe. |g. ViGlON (Type of Test)®
1b. HEIGHT {no shoes, to ACUTE, AL
rarect 178 1n)* REACREENING
WRIGHT (ight clothing ‘STRABIEMUS
Bl] 10 nasreat 14 th.9° COMMENTS,
f._BLOOD PRESSURE
‘© HEMATOCRIT or OTHER TERTS (ii Incicaled)
HEMOGLORIN® nts
HEARING (Type of Tet 2) Bionte Catt
AESULTE, AL Meee
FA RESCREENING (Ove & Parasines
COMMENTS A Urinstyele,
bE m Omer
@ Immunizations | Birth to 1 Month 2 Months 4 Months 6 Months 12-18 Months 46 Years
bie
Polio
HIB
Hep B
MMR
Other Note: Ages und number of boosters may vary when immunizations start at older ages.

BEST COPY AVAILABLE

Well-Child Health Care; Making It Happen

149

Nov 7p) [ BINPORY UO AEIANDY YRS 997 40

©
>
&
&

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ita



Module 1: What Is Well-Child Health Care and Why Is It Important?

Handout D-1: The Meaning of Screenings and Exams

Situation #1: Speech and Language

Holly is four years old. When the teacher gives Holly’s parents the results of the speech and language
screening, Holly’s mother asks the teacher what it means. The results show that Holly’s speech and
language are “within normal limits,” yet Holly’s mother still has concerns about her daughter. Her
mother’s boyfriend has told her that he thinks Holly doesn’t speak very well.

Situation #2: Growth

Jamal is nine months old. The results of Jamal’s physical exam indicate that he is significantly
underweight for his height and age. The doctor indicated that Jamal has “failure to thrive” and
recommended more tests to determine the possible causes and intervention needed. The health staff
spoke with the grandmother (his legal guardian) about what the program can do and what she can do to
help Jamal. The grandmother feels that he is fine and doesn’t need any help. She said, ““He’s come such
a long way since I’ve had him.”

Situation #3: Vision

Devon is three-and-a-half years old. The community volunteer who screened Devon's vision mentioned
that he might have a “lazy eye” and need to wear a patch over the good eye. Devon’s father didn’t
understand what that meant and why you would want to cover up a good eye. But he was concerned that
Devon has trouble throwing and catching balls.

Well-Child Health Care: Making It Happen 49

Z Ananoy yim asn 404


Module 1

Activity 1:
What If There
Were No
Well-Child
Health Care?

Purpose: This activity helps participants appreciate the importance of
the many elements of well-child health care for Head Start. They will
identify which elements are missing in this classroom. These may include
screenings, accessibility to providers, education, or advocacy. This activ-
ity is especially helpful for teachers, aides, and other staff members
involved in the classroom.

For this activity you will need:

M = Key to Activity 1: What If There Were No Well-Child Health Care?
(For Trainer Only)

@ Flip chart and markers

Step 1: Ask participants to get into a comfortable position and close
their eyes. Tell them that you are taking them on a guided tour
of a new Head Start program where there might be something
wrong.

Step 2: Read aloud, slowly and with expression. the following story:

“It’s the middle of the morning, five months after enrollment of
students, and we're going to visit a new Head Start center. The
entire facility and grounds are beautifully designed. As you
enter the building, vou notice a clean and inviting lobby. There
is a bulletin board with notices about field trips and children's
art.

You walk into the classroom and see cubbies for 20 children,
but only a dozen children are in class today. The teacher says,
‘This is a typical day. Our children miss a lot of school, but we
try our best to keep the program going. We're having a mini-
epidemic of measles right now, but I don't know who has and
hasn't been immunized! Miguel's cubby is empty all the time.
His parents kave a hard time keeping him out of the hospital
now that he has asthma. An overdose of medication sent him to
the ER just last week. He wheezes a lot when he plays here too.’

You watch the teacher comfort a child who is crving because his
mouth hurts. You cannot miss the blackened front teeth, but the

What Is Well-Child Health Care and Why Is It Important? 15

a4)



Appendix B: Well-Child Health Care Fact Sheets

Growth Assessment

What is growth assessment?

Growth assessment measures a child’s height, weight, and head circumfer-
ence (for infants). Growth is a sign of a child’s overall physical and emotional
health.

How is growth assessment done?

Growth is measured by a health care provider or Head Start staff. A wall-
mounted height measure, balance-beam scale, and tape measure are used.

The child’s measurements are recorded on a standardized growth chart.
Measurements are:

« Compared to other children the same age and sex to give a “percentile”
+ Followed over time to give a “growth curve”

What might I observe?

A child may appear...

+ Very short, thin, large, or overweight

¢ Too thin or too heavy for his height

+ To have his head too large or small for his body

Follow-up to growth assessment

The parents’ height/weight and race are taken into account to determine the child’s “normal” growth. A
child should be referred to his health care provider for further evaluation for:

° Height or weight below 5th or above 95th percentile

SS . .
+ Head circumference below 2nd or above 98th percentile

When growth problems + Failure to grow along the growth curve
are identified and
treated early, the child's Causes of growth problems might include:
health and well-being + Improper nutrition—not enough, too much, or unhealthy
are improved. foods
al + Serious medical illness

+ Severe family problems

Treatment might include:

* Nutritional counseling and dietary supplements

« Treatment of medical conditions causing the growth problem

+ Mental health counseling/consultation for the child, family, and staff

404
2

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Module 2

Key to Activity ¥: Keeping Up—Tracking Health Services (For Trainer Only)

Note to Trainer: Tracking Instruments must often be assessed several times to properly catch all of a
child's health needs. Proper documentation and dating of services is essential and must be double-
checked. The health records in this activity reflect the errors and omissions that can occur.

Heaith Records

Health Tracking Plan

1 abnormal development test

2 normal

3 abnormal spinal exam: r/o scoliosis
dental caries

4 missing history, nutritional
assessment and development test;
dental caries

5 overweight, poor nutrition; failed
vision test 2x; abnormal development
test

6 abnormal pulmonary exam, diagnosis
of asthma per Dr. Spencer; missing
immunizations

7 low hemoglobin, increased blood
lead level; dental caries; missing
immunizations

8 failed vision test

9 normal

10 abnormal development test; abnormal
heart exar.., missing lead result

repeat development test
usual follow-up

refer to primary care provider/orthopedist for
evaluation and treatment
refer to dentist for treatment

perform missing tests and assessments
refer to dentist for treatment

refer to primary care provider/nutritionist for
evaluation/treatment

eyeglasses prescribed 10/96; repeat development test
with glasses

treatment and health plan for asthma
refer to primary care provider for immunizations

counseled family regarding lead/notified health dept.
recheck hemoglobin and lead in 6 months

refer to dentist for treatment

refer to primary care provider/nutritionist for
evaluation/treatment

repeat vision test

usual follow-up

refer for development assessment/treatment

34

Well-Child Health Care: Making It Happen



Module 1

Activity 7:
Explaining the
Meaning of
Screenings and
Exams, and Ensuring
Follow-up

Purpose: This activity helps participants develop skill in explaining
screening and exam results to parents and then working in partnership with
parents to ensure follow-up of services for {..2 child’s identified health
needs.

For this activity you will need:

@ Enough copies of Handouts D-1 and D-2: The Meaning of
Screenings and Exams for half the participants to get one and half to
get the other

@ Enough copies of the Appendix B: Well-Child Health Care Fact
Sheets to attach one to each corresponding Situation Card:

+ To D-1: The Meaning of Screenings and Exams, attach the
Speech and Language, Growth, and Vision fact sheets

+ To D-2: The Meaning of Screenings and Exams, attach the
Anemia, Hearing, and Developmental/Mental Health fact sheets

Step 1: Explain that this activity allows participants to practice
explaining screening and exam results to parents.

Step 2: Divide the participants into groups of three.

Step 3: Distribute to each group Handout D-1 or D-2 with the fact sheet
attachments from Appendix B that correspond to the situations.

Step 4: Ask each group to identify a “staff person,” “parent,” and
“observer” for each of the three situations. These roles should
rotate, so everyone has a chance to play every role.

Step 5: Give the groups about five minutes to prepare:

+ Everyone should review all of their group's situations.

« Each person should also review the fact sheet relating to the
situation in which she will play the staff person.

36

Well-Child Health Care: Making It Happen

48



Module 2

Step 3:

Step 4:

Step 5:

Step 6:

Distribute to Group #1 the Program Planning Story #1 with its
attached fact sheet (Anemia) that corresponds to that story.
Distribute the handouts in the same manner to Groups #2, #3,
and #4.

Allow the groups 15 minutes to review their stories and the fact
sheets and then develop a program plan to meet the needs of the
situation. Address the following questions:

+ What else might you need to know?

+ What are some sources of information among the families,
community, and health professionals?

+ What is the role of the parents? What parent education
would you provide?

+ What is the role of Head Start staff? What classroom
interventions might you make?

+ How would you document and follow up your program
plan?

Bring the groups back together. Have each recorder read the
story aloud and summarize that group’s plan.

Encourage other participants to add their comments.

Ask participants to describe some health problems that many
children in your program have experienced.

* Have you done interdisciplinary team conferences to discuss
the problems?

« What kinds of classroom-wide, multifamily, and/or
community interventions have you tried to address these
common health problems?

» Who has been helpful within the program and outside the
program?

+ Has this activity given you any ideas about new strategies
that you might like ts try to address common health
problems?

Partnerships in Ongoing Well-Child Health Care

71



Module 2

undergo, give their consent, and understand the meaning of the
results. Head Start staff should be able to explain all procedures
and test results, even those they do not perform. Parents should
be encouraged to ask questions about the procedures and results.
Parents know their child best and can provide valuable informa-
tion for screening. They should be encouraged to serve on advi-
sery committees, to review procedures, assist in classroom-
based screening, and accompany their children to the medical
home for clinic-based screenings and exams.

Following Up On Screenings and Exams

Assessment or diagnostic evaluation provides more in-depth
testing or examination to determine whether, in fact, a child has
a special health or developmental need. It is done by specialists
in child health and development such as a physician, dentist. or
psychologist. It also involves the parents, staff, and often other
agencies such as schools, developmental centers, and the medi-
cal home. Assessment might include standardized developmen-
tal tests, specialized physical exams (e.g., neurological or
occupational therapy evaluation), and laboratory tests (e.g.,
blood tests, urine tests, or X-rays).

The assessment might indicate that the child has:
- no specific problem and no follow-up is needed

- no specific diagnosis but some concerns; further observation
and follow-up testing may be recommended

- a diagnosis of a health condition and recommendations for
treatment and follow-up

Diagnosis is the specific medical or developmental condition
determined by a health professional. For example, a physician
might diagnose anemia, and a psychologist might diagnose a
learning disability.

A diagnosis helps to understand the child’s condition and make
specific recommendations for treatment and follow-up. It must
not be used to label or stigmatize a child.

Treatment, therapy, or intervention is the process of caring for
any condition that the health professional diagnoses. The
treatment aims to cure a health problem or reduce the impact of
a disability. For example, a doctor might prescribe medication
for anemia, and a psychologist might recommend special

[exe]

54

Well-Child Health Care: Making It Happen



Module 2

Points to Consider:

When several children and families in the program have the same
health problem, programs should consider what classroom,
multifamily, and community interventions could help. These might
include education and advocacy.

To address health problems, programs should obtain all of the
necessary information about the causes and possible interventions
for the problem. .

Sources of information on health issues include program staff,
parents, local health care providers, departments of public health,

health consultants, and regional/national health agencies.

It is important that the parents and key staff understand:

— the results of the screenings and exams, the diagnoses, and the

recommended treatment and follow-up;

— the measures to take at home and school to treat and prevent the
problem; and

— the importance of comprehensive well-child health care, beyond

addressing the identified health problem.

Discussions with families should be sensitive to their knowledge,
beliefs, practices, living situation, and resources.

Careful documentation is crucial to facilitate comprehensive review

and appropriate assessment, treatment, and follow-up to meet each
child's health needs.

Jo

Well-Child Health Care: Making It Happen



Module 3

Activity 4:
JUMP:
Jargon
Used by
Medical
Providers

Purpose: Participants will learn the definitions of some common terms
used by health care providers and health care systerns, and will practice
explaining the definitions to others. For the purposes of this activity we
will refer to these with the acronym “J.U.M.P.” meaning: the Jargon Used
by Medical Providers.

For this activity you will need:
M = = Handciuit P: Insurance and Medical Jargon Cards

Mi Handout Q: Insurance and Medical Jargon Definition Cards

Note to Trainer/Coach:

Prepare the jargon cards prior to the workshop session by
copying Handouts P and Q onto cardstock paper and cutting
them into equal size cards.

Step I: Ask the participants how many of them have encountered an
unusual term, word, or acronym recently in their reading or
conversations with health care providers—something that they
didn’t understand at first.

Write the terms/words on the board. Ifno one thinks of a term
readily, you might write a few from your own experience.

Step 2: Lead a discussion on the challenges with J.U.M.P. (the Jargon
Used by Medical Providers) in the health care system—both the
traditional challenge of medical terms and the newer challenge
of terms related to the “‘system”—the variety of different health
care plans, mechanisms for payment and explanations of
exclusions in medical coverage.

Step 3: Acknowledge that, while Head Start staff might come to under-
stand the J.U.M.P. in the health care system/setting, this
understanding might come much more slowly to parents in-
volved in accessing care for their children.

Advocacy, Action, and Access

13



Module 3

‘Next Steps:
Ideas to
Extend Practice

Become an Advocate

When screenings and exams discover health problems that are common to
many children and families in the program, these health concerns should
be discussed among the program management team and the Health Ser-
vices Advisory Committee. By convening or joining a task force about the
problem, Head Start can be a powerful advocate for change.

For example, if many children were diagnosed with intestinal parasites,
Head Start might want to work with the local public health department to
do the following:

. Investigate the local water supply

, Screen other children, family members, and staff for intestinal
parasites

. Review hand washing, diapering, toileting, and food preparation
procedures for home and schoo!

Build and Utilize a Dynamic Health Services Advisory Committee

By building a strong Health Services Advisory Committee (HSAC) that is
truly participatory, Head Start staff can gain access to the stakeholders in
making change in the existing health care system.

One Head Start site in Washington has included a State Senator and State
Representative on its HSAC. When changes were needed to increase ac-
cess to dental care for the children, the Health Coordinator knew who to
call—and got an appointment with the legislators within five minutes. As
a result of effective advocacy, the governor has now proposed a budget
with provisions that could have a significant impact on improving dental
access for children in Washington. Close connections with the County and
State Health Department can be developed through the HSAC, as can
relationships with dentists or pediatricians willing to advocate for change.

In addition to going out into the community to represent your needs for
change, the HSAC will bring important information into the Head Start
community. This information includes changes in immunization sched-
ules, methods of reimbursement, available providers and environmental
issues unique to their community.

QS

a4
ror

116

Well-Child Health Care: Making It Happen



Module I

Activity 3:

The Well-Child
Health Care
Fact Gaine

Purpose: This activity familiarizes participants with the common com-
ponents of well-child health care required for Head Start. It is helpful for
staff from different areas of Head Start.

For this activity you will need:

Flip chart paper

Paper and pens or pencils

Game beard

Question & Answer Key (For Trainer Only)
Prizes (e.g., stars, healthy snacks, pencils, etc.)
Overhead projector and transparency (Optional)

Stopwatch or Timer

Trainer Preparation Note.

Prepare the game board on a large piece of cardboard, flip
chart paper, or overhead transparency.

Step 1; Explain that participants will play a team game with questions

and answers about well-child health care and screening.

Step 2: Explain that the game will focus on the common components of

well-child health care for Head Start.

Step 3: Divide participants into teams of four to six members. Ask each

team to name itself. Write the teams’ names on flip chart paper
and post it as a scorecard.

an

es

What Is Well-Child Health Care and Why Is It Important? 23



Appendix C: Blank Records & Forms
Handout C: Child Health Record Sample (Part 1, continued)

CHILD HEALTH RECORD: FORM 3, SCREENINGS, PHYSICAL EXAMINATION/ASSEGSMENT

CHILD'S NAME: ox SUNTHOATE:
HEAD START CENTER: PHONE:
ADDRESS:
58 1. RELEVANT INFORMATION (from Health History, Perent/Teeokw Observations):
& & 5
3 2 SCREENING TEBTS, Starred itame () are requtmed by Heed Start and recommended 2y the Arwerican Academy of Pediatrics for
onikiren 35 years. Enter Oates If done When recording resutts, enter et a minimum “N", “S", of “A” for NORMAL,
a ‘SUSPECT, OR ATYPICALIABNORMAL, respectively.
TET. DATE. RESTS Tes CATE RESTS
&_PRESENT AGE” re, moe. |g. VIBION (Type of Tesi)TM
B HEIGHT (ne shees, 10 ACUITY, ML
fearest 178 10) RESCHEENING
% WRONT (Han STRABIOMUS
= 12. 114 th.9* COMMENTS
Z “2 K.000 PREseUnE.
8 '@ HEMATOCRIT or 4. OTHER TESTS (it Indicate
= HEMOOLOBIN’ ome
QE aT heanna Chyge ot ean Gy Bionie Cont
= nesults, ®
& fescheenina Ove & Paresites
§ s COMMENTS  Urinatyale
=& | mower

3. PHYBICAL EXAMINATION/ASSERSMENT. Complete and retum top three copies to Head Start.
jamwon.| HoT

(ron aged “tant | €VA. | commmnre vee Agetveng ener! ioneceenee |

GENERAL APPEARANCE
POSTURE, GATT

HAD
Co}
t. VES: (1) Boe
o
acorn Tet
@ BARS: (1) Extornat & Coneie
{2 Tymeenie
NOME, MOUTH, PHARYHX
a
L
te
o

rn
ny
S_ BPRECH
cy
ry
t

NATION,

GENERAL STATEMENT OM CHILD'S PHYBICAL STATUR:

6 in Module { (& Activity 9 in Module 2)

DURING AND AFTER PHYSICAL EXAMINATICNIASSESSMENT
as: ,
i
F

PANT 8. TO BE COMPLETED BY HEALTH CARE PROVIDER

Begnaturs Dete:

; 7 FINDINGS, TREATMENTS, AND RECOMMENDATIONS
= RECOMMENDED FOLLOW-UP o AESULTS |
g ABNORMAL PNDINGEDIAANORIE TMATIMENT PUAN (nite! een pare
s =
= ry
2 @ vi
2 tuo
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148 Well-Child Health Care: Making It Happen

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Preface

Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements of
your state. Provide any trainer or coach with background materials such as
the appendices, fact sheets, and publications listed in Resources.

The Training Guides for the Head Start Learning Community are de-
signed to help programs support and enhance quality. The Foundation
guides are for all staff and set forth the core principles and practices that
comprise the Head Start approach. Subsequent guides may be used by the
management team to plan and implement staff development activities.
Together, they make up a comprehensive staff development library cover-
ing all aspects of Head Start.

The concepts in this guide build on each other. For a comprehensive ap-
proach, users should proceed from the beginning to the end. However, the
learning activities in this guide can be adapted to your own situation. For
example, you may adapt a workshop activity to use with a smaller group
or insert stories from your own program.

Training materials are cffective only when they can be applied to the ev-
eryday work setting. Knowledge and skills that are developed in training
must be supported by follow-up activities. The guide contains sections
titled “Next Steps: Ideas to Extend Practice” and “Continuing Profes-
sional Development,” which help users design long-term learning plans.

This guide was developed with the assistance of many Head Start pro-
grams across the country. We would like to thank the Head Start staff and
parents who discussed the challenges they faced in dealing with well-child
health care and screening, shared their stories, participated in trainings,
and provided feedback on the activities. We appreciate the feedback pro-
vided by the Head Start Bureau, Regional Offices, and Head Start’s na-
tionwide training and technical assistance network. We especially value
the detailed review and input provided by the guide’s development team
of Head Start staff members and health professionals.

Throughout the guide, Well-Child Health Care: Making It Happen, we
have inserted true stories from Head Start programs across the United
States. These stories illustrate the many different ways that creative Head
Start staff and families are forging the linkages needed for well-child
health care. They are “making it happen” and we hope this guide will help
you in your efforts, too.

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Appendix B: Well-Child Health Care Fact Sheets

Intestinal Parasite Screening

What are intestinal parasites?

Intestinal parasites are infections of the intestines and stool.
Common intestinal parasites include giardia lamblia, pinworms,
ameba, roundworms, and ascaris. They may cause no symptoms or
stomach cramps, diarrhea, growth problems, and anemia.

Intestinal parasites spread when stool gets onto hands, objects,
food, and water. They commonly spread from not washing hands
well after diapering and toileting and before food preparation. They
can spread through untreated drinking water, wading pools, water
play tables, and living in conditions with inadequate sanitation.

How is intestinal parasite screening done?

Stool samples are collected and sent to a laboratory for analysis.

What might I observe?

Most children with intestinal parasites have no symptoms at all.
You might notice:

+ Nausea, low appetite, stomach cramps, gas

« Diarrhea—loose, watery, foul-smelling, bloody or mucous stools
« Rectal itching and scratching

+ Pale skin, tiredness

* Slow growth

Intestinal parasites can
cause diarrhea and
growth problems, They

can be successfully Treatment might include:
treated with medication * Medication
and education on
handwashing and safe
food preparation.

department

and disinfection

Follow-up to intestinal parasite screening

* Notification of staff, parents, and the public health

« Education on handwashing, food preparation, cleaning,

The screening results are evaluated by a health care provider
to determine the treatment.

Well-Child Health Care: Making It Happen

BEST COPY AVAILABLE

139



Appendix B: Well-Child Health Care Fact Sheets

Vision Testing

What is vision testing?

Vision testing checks how well a child can see and how well the eyes
move together.

How is vision testing done?

Vision testing is done by a health professional or trained staff, parent,

or volunteer. It involves:

+ Having the child identify letters, shapes, or figures on a standard
eye chart

* Observing the child’s eye movements (“strabismus testing”)

+ Observing for other eye abnormalities (e.g., redness, swelling,
discharge)

What might I observe?

¢ Eyes that cross or paint outward
« Frequent blinking, squinting, or rubbing eyes

o-oo

+ Difficulty picking up small objects, catching balls, or seeing distant objects

¢ Holding books and objects unusually close
+ Short attention for visual activities
+ Frequent complaints of eye discomfort, headaches, or dizziness

Vision is important
for development,
physical activity,

and social
interactions. Early
identification and
treatment of vision
problems can help
promote a child's
development.

Follow-up to vision testing:

A child “fails” the vision test if:

+ She is unable to identify more than half the symbols on the 20/
40 line

« There is more than a two-line difference in vision between one
eye and the other, even if the worse eye is 20/40 or better.

The child should be retested. If she fails again, she should be
referred to her health care provider for evaluation and treatment.
Children with eye infections should be retested after treatment.

Treatment may include:

+ Antibiotics to treat eye infections

+ Eyepatch

+ Eyeglasses

« Eye muscle surgery

* Special education or early intervention services

Well-Child Health Care: Making It Happen 145

$69 BEsTcopy AVAILABLE


Module 1

Points to Consider:

In discussing the results of screenings and exams, staff should be
sure to:

- Acknowledge the parent's concerns.

— Provide basic information to explain the meaning of the
screening or exam results.

— Refer the parent to the health specialist and the family’s health
care provider for more detailed information and follow-up.

To explain the meaning of a screening or exam, you may refer to the
detailed information in the Well-Child Health Care Fact Sheets.
However, it is not necessary to know all of the details. It is most
important to stress the following general points:

- A screening or exam result that is “normal” means that the child
probably does not have a problem in this area.

—  Ascreening or exam result that is “outside the normal range”
means a child might have a problem—more testing is needed to
determine if there is a problem, what it is, and how the child
might be helped.

It is important to consider the parents’ observations and concerns.
Parents offer important information that can contribute to interpret-
ing screenings and exams, They are also key partners in developing
the follow-up plan.

38

Well-Child Health Care: Making It Happen



Preface

Jamal’s story shows the importance of well-child heaith care and the vital
role of Head Start staff as key players in a broader network of community
support for children and their families. Without the observations of an
astute aide, Jamal’s diabetes may have gone undetected. Well-child health
care is everyone's role; not just those with “health” in their job title.
Ongoing observations throughout the year can pick up new or recurring
health problems,

Latrice’s comments show us how Head Start is most effective when it
works in active partnership with parents: parents empowered by skills and
knowledge. Latrice initially faced Jamal's chronic illness with anxiety and
fear. But with the partnership of a dietician teaching her to adapt old reci-
pes and a nurse teaching her to administer his medication, she can now
face his illness with competence and confidence.

As a Head Start staff member, you have a key role in making a difference

ina child’s health—both now and in the long term. Who else has regular

daily contact with children and families? Who better to link the children

into a broader network of community services including medical, dental,

vision, speech therapy, physical therapy, mental health, and counseling

services? You can open the door to better health care for a family by first

linking them to a “medical home” and then supporting follow-up for any

identified medical needs. Through prenatal education, well-child health 6
care begins before the child is born-—a time when many health ailments

can still be prevented. Ongoing health education helps the entire family.

Finally, working in partnership with families and community services,
you have the opportunity to advocate for change—change that will im-
prove services for families and meet the unique needs of your Head Start
community.

The activities in this guide explore the challenges to assuring well-child
health care and services for families, while enhancing skills to meet these
challenges. The activities emphasize that a partnership between families,
health-care providers, and all Head Start staff members is needed to pro-
mote well-child health care. Given the many challenges and changes in
the Head Start population and health resources, each program: must peri-
odically re-evaluate how well it is doing in screening, linking families
with health care, and advocating for better services with and for families.

One note of caution about using this guide—leading the activities in
this guide can be challenging. It is best to use staff or consultants who
are well-trained and experienced in health education, medicine, nursing,
dentistry, or another area of public health or clinical care. Be sure that any
trainer or coach understands both the facts of and the philosophy behind

well-child health care. He or she must be well-versed in the Early and eS
4

x Well-Child Health Care: Making It Happen


Module 1

Points to Consider:

It is important that the parents and key staff understand:

What measures to take at home and at school to prevent the problem
(e.g., how to use a bottle safely).

When working with the family, the health concems should extend
beyond the Head Start child to include siblings, parents, and other
family members. For example:

— Howis the baby bottle used with younger siblings?

— Are the siblings linked to a medical home?

— Ifthe mother is pregnant, has she received pregnancy counseling
and prenatal care?

How to have discussions with families that are sensitive to:
— their knowledge and level of understanding;

— their beliefs and cultural practices:

— their living situation; and

— their available resources.

32

Well-Child Health Care: Making It Happen



Module 3

Points ic Consider: + Barriers occur at expected and unexpected points and require de-
tours or alternative routes. However, there are usually logical ways
to proceed in order to access care.

+ Head Start staff members can help families in a number of ways, but
cannot lead the families all the way. We can only guide them to the
pathways to health care. The goal is to empower them to be able to
stay on path or to create pathways for themselves.

+ Advocacy is necessary to make needed services available when an
assessment of the community indicates that these services are miss-
ing.

* Collaboration and communication between existing service agencies
will greatly improve the delivery of services to children.

Well-Child Health Care:
Making It Happen...

The Heatth Coordinator
from Olympia, Washington
sums it up this way:

“If the work | do can affect a change
in the bigger system, then
health services are improved for
all children in the community,
not just the percentage that comes
to Head Start.”

aed

112 Well-Child Health Care: Making It Happen



Module 1

and a deseri:.tion of the child's home environment. The health his-
tory highlights any special concerns about the child.

The health history should include a list of the child’s primary health
care provider, specialists, and other services that the child and fam-
ily receive, such as a developmental center or Children’s Protective
Services.

. Documentation

Health records are essential for evaluating children's health needs
and developing plans for intervention and follow-up. They are also
important for communicating with families, health care profession-
als, and teachers/caregivers. Health records must be:

— Accurate: Observations and screening and exam results should
be carefully documented in objective terms. Vague terms and
judgements should be avoided. For example, instead of stating
“Jimmie’s behavior has been very bad since he started school,”
it would be better to state, “Jimmie has gotten into fights with
his classmates three or four times a week. He frequently
screams, punches, and bites.”

— Complete: Results must be documented for all of the required
screenings and exams. All “abnormal” screening and exam
results must be followed up by further assessment and treatment,
when needed. When children have specific health problems, it is
important to get records of previous evaluations, diagnoses, and
treatments. Ongoing consultation with the family and health
care providers should also be carefully documented.

— Confidential: Children and families have a right to have their
health records kept confidential. Information should not be
shared with other parents. Only staff who need to know the
information should have access to the family’s health records.

— Shared Appropriately: The information can and should be
shared with anyone who needs to know in order to care for the
child, but only with the consent of the parent(s) or legal
guardian. Key family members, health care providers, and staff
need to be involved in family conferences to develop plans for
intervention and follow-up to meet the child’s needs. When the
child changes programs or goes to kindergarten, the records
should be forwarded, with the consent of the parent(s), ina
complete, organized and confidential manner.

For specific follow-up for screenings and exams, see Appendix B: Well-
Child Health Care Fact Sheets.

What Is Well-Child Health Care and Why Is It Important? ul
a4
me



Introduction

At A Glance
| Modules | Activity | Time | Handouts
Activity 1: What If There 20-30 Key to Activity 1
Were No Well-Child Health | minutes} (For Trainer Only)
Care? (W)
Activity 2; What, Why, and 45-90 | Appendix B
How of Screenings and minutes
Module I: Exams (C)
What Is Well-Child Health Care |” xcrivity 3: The Well-Child | 30-45 | Question & Answer Key
and Why Is It Important? Health Care Fact Game (W) |minutes| (For Trainer Only)
Activity 4: The Importance of | 30-45 | Handout A
Well-Child Health Care and | minutes
a Medical Home (C)
Activity 5: Sam’s Story Part | 20-30 | Handout B
One—Assessing Need (W) minutes|
Activity 6: Reviewing Health | 30-60 | Handouts C: Parts | - 5
Records (W) minutes; Appendix B
Activity 7: Explaining the 45-60 | Handouts D-1 and D-2
Meaning of Screenings and | minutes} Appendix B
Exams, and Ensuring
Follow-up (W)
Activity 1: Locating Services | 30-45 | Handout E; Performance
in Your Community (W) minutes] Standards Section 1304.20
Activity 2: Taking Inventory | 20-30 | Handout F
of Screenings and Exams (C) | minutes!
Activity 3: Everyone’s Role 30-60 | Handout G
in Well-Child Health Care (W)| minutes|
Module 2: ~— 7
Partnerships in Ongoing acuity ego the heunel Handout H
Well-Child Health Care ee i
| Activity 5: Well-Child Health | 30-60 | Handout 1
Care Dilemmas (W) minutes,
Activity 6: Sam’s Story Part | 30-60 | Handout J
Two-Supporting Parents (W) | minutes}
Activity 7: Observing is 60-90 | Handout K
Screening (C) minutes|
\ Activity 8: Program Planning | 30-60 | Handout L
i (W) minutes| Appendix B
Activity 9: Keeping Up— 60-90 | Handout C (from Module 1)
Tracking Health Services minutes} Handout M; Appendix A
WW) Key to Activity 9
(For Trainer Only)
6 Well-Child Health Care: Making It Happen

BEST COPY AVAILABLE 18


Contents

Module 3 99

Advocacy, Action, and Access
Outcomes ..
Key Concepts
Background Information ........
Activity 1: Sam's Story Part Thr ee—Advocating for Service:
Activity 2: Pathways to Care...
Activity 3; Services for Chiletren
Activity 4: J.U.M.P.—Jargon Used ay Medical Providers
Next Steps: Ideas to Extend Practice

Handout N: Sam’s Story—Part Three
Handout O: Children in Need
Handout P: Insurance and Medical Jargon Cards...

Handout Q: Insurance and Medical Jargon Definition Cards..... 124

Continuing Professional

Development 125
Resources 127
Books & Manuals 127

Videos 129
National Organizati : 129

~t

Well-Child Health Care: Making It Happen vii


For use with Activity 4

Module 3: Advocacy, Action, and Access

Handout Q: Insurance and Medical Jargon Definition Cards

Traditional insurance where you
receive services, pay the
provider directly, and submit a
claim to the insurance company.
You may choose the provider.

An organized system of health care
providers offering a wide range of
health care services, usually
provided by a primary care
physician who treats you or refers
you to other physicians within the
HMO network. HMO Members
receive health care at a fixed,
prepaid monthly premium.

A system in which there is a
gatekeeper, usually a physician,
who is responsible for a child's
or family's primary care. The
gatekeeper determines the need
for any specialized care and
must authorize use of
specialized services.

Period of time when eligible
individuals may change benefit
plans or add eligible family
members.

A program that enables States to
initiate and expand child health
assistance to uninsured,
low-income children. States have
the option of establishing a
seperate program, expanding their
Medicaid program, or developing a
combinded program.

Consolidated Omnibus Budget
Act of 1986. Employees who
have terminated employment are
entitled to continue group
coverage for a period of up to 18
months.

The amount you must pay or
promise to pay each month toward
the cost of health care services
before Medicaid will pay. The
share changes with monthly
income and is only paid in a month
when you receive services.

An OK from Medicaid or
private insurance for medical
services or equipment before
they are received.

A person who has been
determined eligible for Medicaid
or insurance.

Medicaid is the federal and state
program of medical assistance for
needy and low-income people.
Medicare is a federal health
insurance program administered by
Social Security Administration that
is available regardless of income. It
covers most persons 65 or older
and certain disabled or blind
persons regardless of age.

The amount of money a patient
pays the doctor at an office visit.
The co-payment amount is either
a set amount (i.e., $5) or a
percentage of the total charges
(i.c., insurance covers 80% of
the cost and the patient pays
20%).

Acceptable evidence, such as
documents, which gives proof of,
statements made by an applicant
or beneficiary.

The amount of money the
patient must first pay a provider
for a service before the
insurance company begins
coverage.

The amount of money a patient
must pay to an insurance
company for coverage.

rae
qi)

When the primary care provider
(gatekeeper) requests a specialist
for a patient.

124

Well-Child Health Care: Making It Happen



Module 3

For parents, entering the broad network of services can be quite daunting.
Staff members can first assist parents in applying for Medicaid if eligible.
If parents are informed that a needed service is “uncovered”, the staff can
assist them in confirming this. Parents and staff members can then advo-
cate for a change in policy that would provide coverage in the future. In
most cases funds for uncovered services will be provided by Head Start.
By working in partnership with Medicaid providers, Head Start can open
the door to a wealth of services to meet well-child health care needs and
special needs. These special services include occupational therapy, physi-
cal therapy, speech therapy, and mental health counseling.

When staff member keep abreast of health care information in the com-
munity, they are most effective in assisting parents. Funding cuts, state
immunization requirements, new funding sources and eligibility require-
ments are all changing elements in the dynamic field of health care. An
active Health Services Advisory Committee can be very helpful by pro-
viding current information.

When parents and Head Start staff members take an active role in commu-
nity planning, they provide a powerful force in the development of
broader community resources that reflects the needs of parents and fami-
lies. Proactive steps need to be taken to establish ongoing relationships
with community organizations. After identifying recurring concerns of
Head Start families, alliances can be formed between families, the staff,
and services to meet those needs. Examples of collaborations could be a
large medical center, Head Start and the local clinic.

Through this partnership, seminars and workshops dealing with relevant
topics can be held for parents and the staff. A wealth of health care
knowledge can come to the Head Start center. Other community partners
could include local Park and Recreation departments, the health clinic
serving local children, and a representative of the police station to help
ensure safe recreation for the children when they leave Head Start. Strong
communication, cooperation aid sharing of information among agencies
and community partners will build collaborations that can truly meet the
needs of the Head Start community into the 21st century.

Note to Trainer/Coach:

For more information on forming a supportive community, see
the guides A Design for Family Support and Building Sup-
portive Communities in the Social Services series of Training
Guides for the Head Start Learning Community.

ato

abv

102

Well-Child Health Care: Making It Happen



Module 2

Activity 2:
Taking
Inventory of
Screenings and
Exams

Purpose: This activity helps participants assess how well they, as indi-
viduals and as part of the total program, promote well-child health care.
They will discuss the strengths and weaknesses of their program's screen-
ings and exams, and identify areas for improvement. This activity is
helpful for staff from all service areas.

For this activity you will need:

@ == Handout F: Taking Inventory, for each participant

Step 1: Distribute Handout F: Taking Inventory. This worksheet will
help determine how well you are doing in well-child health care
and screening. Take a few minutes to answer the questions.

Step 2: For each question on Handout F: Taking Inventory. ask a
participant to briefly explain what it means and why it’s
important.

Step 3: Discuss the following questions, citing examples from specific
screening and exam procedures (e.g., hearing test, screening for
developmental concerns, etc.).

* Based upon the results of your worksheet, what screening
activity do you do best? Which do you need the most help
on?

+ What does your program do best? What does your program
need to work on?

Step 4: Discuss the following questions, again citing examples from
specific screening and exam procedures:

+ How do you think the children feel about the screenings and
exams Head Start is required to complete? What could you
do to make them ready?

« How do you think the parents feel about the screenings and
exams? What could you do to make them feel more
comfortable and involved?

28

Partnerships in Ongoing Well-Child Health Care 61



Module 1

Step 3:

Step 4:

teacher explains that there are no pediatric dentists taking Head
Start students, Several children are standing by the kitchen area
waiting. The aide explains that these children hove had break-
fast and are waiting for lunch, She says, ‘They nv er seem to get
enough nutritious food over the weekend.’ There are two chil-
dren in the bathroom with a ‘tummy-ache'—their diarrhea and
cramps have lasted for weeks off and on,

A pregnant mother drops her child off late, explaining she gets
severe morning sickness after her job of cleaning floors with
strong chemicals all night. She asks the teacher's aide if he
knows of any doctors who might see her before the baby is born.
The greeter politely explains, ‘I have no idea, the last obstetri-
cian left the neighborhood two years ago.'

A little three-year-old girl approaches saying ‘mama mama’.
The teacher savs she missed a month of school with meningitis
and doesn't know if she might have problems with hearing,
vision or speech, or maybe a developmental delay.

The teacher rings a bell and starts calling the children over for
circle time. In the circle area, two children are lying down
looking pale and lethargic, others are fighting and hiting each
other. One boy will not leave the corner where he has been
rocking back and forth all morning. The teacher and the aide
decide to postpone circle time to take care of the children’s
other, more urgent needs.”

Ask the participants to open their eyes. Ask them:

+ What elements of well-child health care are missing from
this Head Start program?

+ How did you feel in that classroom? How did the children
feel? How did the teachers feel?

Divide a flip chart paper into two columns. Label the left
column “Health Concems” and the right “Health Services
Needed” (see Key to Activity 1: What If There Were No Well-
Child Health Care?).

«Ask participants to list the health care concern that they
observed in the classroom (e.g., tooth pain, pregnant
mother).

8

ras)

Well-Child Health Care: Making It Happen



Appendix B: Well-Child Health Care Fact Sheets

Developmental Screening

What is developmental screening?

Developmental screening helps identify a child’s strengths and
needs in development and mental health. It assesses a child’s
temperament, behavior and skills such as:

* Understanding and thinking
+ Emotional, social, and communicatica skills
¢ Physical coordination and self-help skills

SB
s

How is developmental screening done?

Developmental screening may be done by a mental health professional, health care provider, or trained Head
Start staff. Standardized developmental checklists and tests may be used. Information is gathered by:

¢ Talking with parents and teachers
+ Observing the child
¢ Having the child answer questions and complete tasks

What might I observe?

* Difficulty understanding, communicating, or doing things expected at that age
« Extreme moods: anger, sadness, lethargy, restlessness, anxiety
+ Difficulty with social behavior: fighting, biting, not interacting with other children or adults

Fellow-up to developmental screening

If screening results are outside “normal range” for her age, the child needs follow-up evaluation by her

health care provider. Evaluation may involve a mental health consultant, developmental center, or local
education agency (LEA).

Intervention might include:
LT

Early intervention * Special education or early intervention services
for developmental . ppeech herapy ional th
and mental health . sical and occupational therapy
+ Mental health counseling/consuitation for the child, family,

concerns can help

improve a child’s and staff
skills and well-
being.
BEST COPY AVAILABLE

Well-Child Health Care: Making It Happen +50 135
tui


Introduction

Performance Standards The Head Start Program Performance Standards require grantees and
delegate agencies to altend to well-child health care in many ways. These
include:

. Following a timeline for screenings and examinations, linking a
child to a “medical home,” and bringing a child up-to-date on im-
munizations.

. Providing link-ups with prenatal care, delivery services, and
postpartum care for pregnant women.

* Tracking each child to ensure that immunizations and regular well-
child exams are kept up-to-date and that follow-up plans for
identified conditions are carried through.

. Providing mental health services for Head Start children and
supporting mental wellness by providing staff and parents with
education on mental health issues.

. Encouraging and supporting the active leadership of parents in their
children’s health care.

+ Providing families with comprehensive information on available @
community resources and assisting parents through education to
become well-informed, effective health care consumers.

. Supporting and encouraging parents to advocate for change in the
health care system where needed—making it more responsive to
their needs.

. Taking active steps—as Head Start staff members—in forming
collaborative alliances among existing community resources to
streamline delivery of services and promote access for families.

Ne

Well-Child Health Care: Making It Happen



Appendix B: Well-Child Health Care Fact Sheets

Anemia Screening (Hemogiobin/Hematocrit)

What is anemia?

Our bodies need oxygen for energy and growth. Red blood cells, hemoglo-

bin, and iron carry oxygen through the blood to the body. Anemia is when 7)
the body does not have enough red blood cells, iron, or hemoglobin. It can a -
slow a child's energy, growth, and development. H ¢

How do you screen for anemia?

Anemia screening is a blood test, usually a finger-prick, to check the amount of hemoglobin (or hemat-
ocrit) in the blood. It is done by a trained health professional at a clinic, doctor’s office, health depart-
ment, lab, or Head Start.

What might I observe?

Many children with anemia have no symptoms at all. You might notice:
+ Pale skin

+ Tiredness

+ Lack of appetite

+ Frequent illness
¢ Slow growth and development

Follow-up to anemia screening

If screening shows a hemoglobin level less than 11 or a hematocrit less than 34, the child needs follow-
up evaluation and treatment by a health care provider. Causes of anemia might include:

« Not eating enough iron-rich foods

TT ¢ Drinking too much milk in place of iron-rich foods
Anemia can delay a + Sickle cell disease
child’s growth and + Intestinal parasites
development. Early * Lead Polsoning
. . + Severe illness
diagnosis and treatment * Loss of blood
of anemia can help
improve the child’s Treatment might include:
health and
development. * Nutrition counseling and diet changes
ésmesaresneemenonenensemncene, + Iron supplements or iron-enriched vitamins
+ Treatment of other conditions causing anemia
Well-Child Health Care: Making It Happen 133

29

3G BESTCOPY AVAILABLE


Module I

B: Well-Child Health Care Fact Sheets after distributing it.

For the teacher: Choose one screening or exam that you feel
comfortable explaining and then another that is more
challenging for you to explain.

Take up to 10 minutes for the role-play.

Step 5: Change roles and repeat Step 4. Repeat the role-play, explaining
two other screenings or exams.

Make sure that everyone has a chance to play every role.
Step 6: Discuss the role-plays:
+ Inthe role of the leamer:

— Did you understand and feel comfortable with the expla-
nations of the procedures?

-- Did the “teacher” use words that were too technical?

— If there was something that you didn’t understand, did
you feel comfortable asking questions?

~ How do your feelings reflect how parents may feel
about screenings and exams?

+ Inthe role of the teacher:
— Did you feel comfortable explaining the procedures?
~ Did you feel adequately prepared?

— Ifyou did not know something, did you feel comfortable
acknowledging that?

-- Inthe future, how might you want to prepare better for
explaining screenings and exams to other co-workers
and parents?

+ Inthe role of observer:

~ What did you notice was difficult in the communica-
tion?

— What were some effective techniques that were used?

What Is Well-Child Health Care and Why Is It Important? 21

G2
w



For use with Activity 3

Module 2: Partnerships in Ongoing Well-Child Health Care

Handout I: Dilemmas in Assuring Well-Child Health Care

“We've finally been able to get our screenings and exams done on time by doing a
big screening day in the gym during orientation week. Parents and children also
get to meet the staff before school starts. We are a little worried though, about

how many of our children need repeat screening because they failed the hearing
test.”

“This year we have a few families whose primary language is Croatian. We can’t
find any health care providers who speak the language. Some of the kids are
picking up some English and communicating through gestures. One little girl
seems very quiet and withdrawn. We’re worried about her, but can’t communicate
with her parents to find out what might be wrong. Doing a screening for
development, mental health or language just wouldn’t be fair.”

“Many of the children are very overweight, yet they are always hungry. I know it’s

hard to stretch a tight food budget, but it seems they must be eating a lot of fatty

foods and snacks. Nobody showed up for my nutrition workshop last Monday @
morning. I’l] just send home a note asking the mothers to cut out the junk food.”

“On our Tall Pines Indian Reservation there are over 10 services that children can
plug into. These include; Indian Health Services, WIC, Healthy Start, EPSDT for
Medicaid, Early Childhood Tracking, and our own Head Start program. It’s next
to impossible to try to figure out who is covered by what program or if we’re
duplicating services. One little girl moved so-much she was completely missed
last year. The WIC outreach worker tells me there are many families in the far
northern area that don’t know Head Start exists.”

“Nairna’s Individual Educational Plan (IEP) meeting is scheduled for January.
That’ll be a good time to talk with her dad and other service providers working
with her family. We'll find out which assessments have already been completed
and whether he has followed through with her immunizations. We’re having a
mini-measles epidemic here and I don’t know who has been immunized. I’m also
concerned that we need to have all of Naima’s screening results on file within 45
days, so maybe I’ll just go ahead and do the ones we can do here.”

+

44
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Well-Child Health Care: Making It Happen



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Module 2

Key to Activity 9: Keeping Up—Tracking Health Services (continued)

Note to Trainer: Tracking Instruments must often be assessed several times to properly catch all of a
child's health needs. Proper documentation and dating of services is essential and must be double-
checked. The health records in this activity reflect the errors and omissions that can occur.

Health Records

Health Tracking Plan

failed hearing 2x; low hemoglobin
(NOTE: Information in Parts B & D
are inconsistent)

increased blood lead level; dental
caries; missing vision result
(NOTE: Information in Parts B & D
are inconsistent)

low hemoglobin; underweight; poor

nutrition; severe malnutrition per Dr.
Spencer; abnormal development test;
dental caries; missing immunizations

normal

missing hep B immunization: asthma,
allergies; underweight, poor

nutrition; no speech evaluation;
increased blood tead; dental caries

refer to primary care provider/audiology for
evaluation/treatment

refer to primary care provider/nutritionist for
evaluation/treatment

counseled parents/repeat lead level in 6 months
refer to primary care provider/nutritionist for
evaluation/treatment

refer to dentist for treatment

repeat vision test

refer to primary care provider/nutritionist for
treatment

refer to dentist for treatment

repeat development test after well-fed

refer to primary care provider for immunizations
tefer to Social Services/Child Protective Services

usual follow-up

refer to primary care provider for immunizations and
treatment plan for asthma and allergies

check results of lead retest

perform speech evaluation

refer to dentist for treatment

refer to primary care provider/nutritionist for
evaluation/treatment

an
vO

Parterships in Ongoing Well-Child Health Care

83



Introduction

Orientation to the Guide

This guide, Well-Child Health Care: Making It Happen has eight
sections:

@ = = Module 1: What Is Well-Child Health Care and Why Is It
Important?

This module covers the importance of well-child health care and
linking a family to a “medical home.” It also teaches participants
skills in reviewing health records and communicating identified
needs to parents.

@ Module 2: Partnerships in Ongoing Well-Child Health Care
This module covers the importance of supporting parents as health
care consumers by accessing the available services in their commu-
nities. Screening skills will be sharpened for Head Start programs
that have decided to perform screenings on-site.

= = Module 3: Advocacy, Action, and Access
This module covers the importance of reaching out into the commu-
nity for collaborations that could improve delivery of services to
children and families, and advocating for change where services are

missing. Participants will also leam the jargon of the health care
system,

E Continuing Professional Development

HB Resources

= = Appendix A: Recommendations for Well-Child Health Care

@ > =Appendix B: Well-Child Health Care Fact Sheets

@ = Appendix C: Blank Records & Forms

Introduction



Module 2: Partnerships in Ongoing Well-Child Health Care

Handout H: Exploring the Chalienges

1, Juana and several other parents in the Head Start program are very upset about the
screenings and exams. Juana explains to the health coordinator that she and the
other parents work together in the packing shed, and they can’t take their children
to the clinic because they would lose their jobs if they took time off from work.
Juana asks if the health coordinator could take the children to the clinic all at once
or if the clinic staff could come to the Head Start program to do the screenings
and exams. She also adds, “Can’t it be done later? The kids seem pretty healthy.”

When the health coordinator calls the local clinic to discuss the possibilities, the
medical director says, “We feel that it’s very important for our clinic staff to estab-
lish a relationship directly with the family. They should get used to coming to the
clinic for their health care, when they’re well and when they re sick.”

2. Robert is a mental! health consultant who is asked to observe the Head Start class-
6 room. The teachers are particularly concerned about four-year-old Jimmie who is
fre. uently aggressive and hurts himself and others. When Robert observes the
Head Start class, he is very concerned about Jimmie’s aggression, especially to-
ward younger and smaller children. Robert recommends mental health follow-up
with Jimmie’s grandmother, Florence.

When the health coordinator talks with Florence and encourages her to make an
appointment with a mental health professional, Florence says, “The child is just
bad—he doesn’t need any so-called professional attention.”

3. Sheila is a Head Start health coordinator. Parents complain to her that they can’t
find a doctor or dentist who will accept Medicaid. When Sheila talks with the lo-
cal doctors and dentists, they complain to her that it’s not worth it for them to take
Medicaid patients and deal with the excessive paperwork, long waiting periods for
payment, and low pay. One doctor and one dentist agree to see the Head Start chil-
dren, but only on the condition that the Head Start staff bring the children for their
exams to ensure that the appointments are kept.

Well-Child Health Care: Making It Happen 89

p anAnoy yriM asn soy


o update this Handout.

use Appendix C- Blank Records & Forms t

iy 9. Or,

with Activil

For use

Module 2: Partnerships in Ongoing Well-Child Health Care

Handout M: Trackville Head Start Tracking Instrument

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BEST COPY AVAILABLE

Well-Child Health Care: Making It Happen



Module 3

Points to Consider:

Step 8: Have each team share its pathways to care, demonstrating the

steps and the barriers.

Step 9: Discuss the pathways as a large group:

+ Were there similarities in the pathways to care among the
four different stories? What were the differences?

+ How did the pathway created by the “receiving” team
compare to the pathway developed by the “creating” team?

Explain to participants that barriers occur at expected and
unexpected points and require detours or alternative routes.
However, there are usually logical ways to proceed in order to
access care.

Head Start staff members can help families in a number of ways, but
cannot lead the families all the way. We can only guide them to the
pathways to health care. The goal is to empower them to be able to
stay on path or to create pathways for themselves.

Advocacy is necessary to make needed services available when an
assessment of the community indicates that these services are miss-
ing.

Collaboration and communication between existing service agencies
will greatly improve the delivery of services to children.

110

Well-Child Health Care: Making It Happen

e



Module 2

Questions for Discussion/
Reflection

D. Everyone’s Role in Well-Child Health Care

Well-child health care is an important part of everyone’s job. No one per-

son can—or should——be expected to be the only one “responsible” for the

health of Head Start children. The responsibility must be shared among all
staff.

Through everyday observations, any member of the staff can note a
change in the child’s health. It may be the dietician who notices the first
signs of high blood sugar in a child or the bus driver who observes the
first signs of a sickle cell crisis on the long ride to school. An administra-
tor who is spending some time in a classroom can give some individual
attention to a child who needs a bit of “TLC” (tender loving care) while
recovering from a cold. A home visitor can work with a parent to plan
meals high in iron for a child at risk for anemia, or suggest activities for a
child whose behavior is challenging.

Think about a time when you, a family member, or friend reccived a
screening test or exam. It might have been a physical exam, dental exam,
hearing test, cholesterol test, mammogram, PAP smear, or other test.

. How would you rate the overall quality of the experience for you?

+ What made it either a good or bad experience for you? For example:

~ Was the procedure explained to you in advance?

~ Were you made to feel respected and comfortable during the
procedure?

— Were the results thoroughly explained to you afterwards?
. Did you follow-through with what the physician suggested?
As you reflect on what made the experience pleasant or unpleasant for

you, consider the features of screenings and exams that parents and chil-
dren experience in your Head Start program.

Partnerships in Ongoing Well-Child Health Care



Module 2

Activity 3:
Everyone's Role
in Well-Child
Health Care

Purpose: This activity give participants the opportunity to review a
story of one Head Start program’s experience with screening and identify
the roles and responsibilities of all the partners: Head Start staff, parents,
children, and health care providers. Participants will identify the chal-
lenges to good screenings and develop strategies, including advocacy and
collaboration building, to overcome the difficulties.

For this activity you will need:

@ = Handout G: Health Screening at Twin Oaks Head Start,
for each participant

@ Flip chart paper and markers, or blackboard and chalk

Step i: Explain that this exercise will illustrate the importance of
everyone’s role in screenings, identify challenges to good
screenings, and develop strategies to overcome them.

Step 2: Distribute Handout G: Health Screening at Twin Oaks Head
Start. Read the story aloud or ask a participant to volunteer to
read it aloud.

Step 3: Explain that we will diagram the Screening Story. Staff, parents
and health care providers all support health screening like
spokes support a wheel.

Following the sample copy of Everyone’s Role in Screening as
your guide, draw a circle with the word “health screening” in the
middle on flip chart paper or on a blackboard. Draw and link at
least five smaller “role” circles to the “health screening” circle.

In each role circle, have participants list a partner in screening:

+ Staff (e.g., Teacher, Health Coordinator, Family Service

Worker)
+ Parents
«Children

+ Health Care Providers

od

3

Partnerships in Ongoing Well-Child Health Care 63



Well-Child Health Care:
Making It Happen...

Tne challenge:
Coordinating over 10 service agencies
that spread over six counties and serve the
Fort Berthold Reservation,

Tne solution:
Communication, cooperation, and
an enroliment form that permits
sharing of information
between all the services.

8 Well-Child Health Care: Making It Happen



For use with Activity 6 in Module 1 (& Activity 9 in Module 2)

Appendix C: Blank Records & Forms

Handout C: Child Health Record Sample (Part 5)

CHILD HEALTH RECORD:

*Gtarred anaweve may require follow-up, Explain Gatarie or give addivional comments here.

FORM 6, NUTRITION
CHLO’S NAME ex: BIRTHDATE:
DIETARY HA®TS
1, WHAT FOODS DOEB YOUR CHILD E®PECIALLY LIKE?
Z @ ARE THERE ANY FOODS YOUR CHILD DISLIKES?
3 Yas] No] 12. ABOUT HOW OFTEN. r
it PSPS] © ATS Sra Ua ames
2 2 eter CHRD TARE NITAMING ANG OF THE FOLLOWING to parent's anawor)
5 (a) It yee", what hind are they? (a) Mike, cheese, owes 4 5 Oo 7 7H
§ be aut contain sluccian? ©) Megat, poultry, orie2e3 4 8 87 TH
° Ores
¢ ‘4 18 THERE ANY FOOD YOUR CHILD SHOULD NOT *| Peacut
rd GAT FOR MEDICAL, RELIGIOUS, OR PERSONAL 0) Rios, orite, owas 4 5 8 7 74
Ss 6. 1S YOUR CHILD ON A SMMHOIAL DIET? 4 tortities. ;
ae fa) What king? © Greeny, canoe, 0172 9 4 6 6 7 7+
©. HAR THERE "A BIG CHANGE IM YOUR 3 Paes
CHILD'S A WTAE EARL MONTH? +, squash 7
7. ve 7
() Oranges, or1s2e3 4 6 6 7 74
& GER YOUR GFL EAT OM CHEW THINS THAT > fru
3 Tt FOOD? fruition.
3 Renn YOUR CHILD WAVE TROUBLE CHEWING * Other fruits anc ow2 346 77
4 OF BWALLCAVING?, ® . . *
3] 49) Olt, butter, or2 34 .
2 10. DOES YOUR GHILD OFTEN HAVE: BN eee teed. B86 7 T+
J 0) Cekes, cookies, 8901022 :5 4 6 6 7 THe
= x 7 codes, fruit
ef 17.00 YOU HAVE ANY CONCEANS ABOUT WHAT socea, fruit
aa

HEALTH CARE PROVIDER, OF NUTRITIONIST

PART &@ TO NE COMPLETED BY HEAD START STAFF,

13. GROWTH 14. ANEMIA SCREEN.
DATE AGE HERR (no WERE (ight DATE [HEMOGLOBIN® OF
shoes, to otothi to HEMATOCRIT *
nearest 1@ in) | nearest 118 1b}
— leoneenita
—— Yn ____ me. | PEOCHEENI NGS
“= Higp tooe than 11 07 Hot fess
yre____ mo. shan 34 require Kitowee
1. ete ee 2 i teen srw In aterred MW growth Ie not within the
Laval “) tt
bd ats are anewers inp rere ¢ pareye or growth is typical range, oheck [he

a Suspect amtey potion r racecints food TD Ovarweight (weight greater than typical, from
intake (insen Questions 2 to 12) Growth Chart 1 or 4)
CF Hb. 1900 than 11 gm. or Hat. teen then 34% CD _ Short for Age (height fees than tyaical, from
(trom Quection 14) Growth Chawt 2 oF 5)
C1 Underweight (eeigit lees then typical, from Wt for Ht. (gewatar or tees than typioal, from
Groerth Ohart 1 0f 4) Growth Chest 3 oF 8)
COMMENTS (use adaitional pege 1! needed)
BEST COPY AVAILABLE “ov
au
Signature. Tite Date.

152

Well-Child Health Care: Making It Happen



Module 2: Partnerships in Ongoing Well-Child Health Care

Handout J: Sam’s Story—Part Two

Sam has been in Head Start for three months now. Although he completed his dental
examination during enrollment, nothing has been done to remedy his 12 cavities.
His front teeth are crumbling.

Sam’s parents are definitely working toward preventing more painful cavities, but
they are still reluctant to bring the children in for fillings and extractions.

The Health Coordinator schedules Sam’s parents to volunteer in the classroom the
day the dentist comes dressed as the “tooth fairy” to teach about preventive dentistry
and dental procedures. It is a day filled with balloons, pixie dust and laughter.

Sam’s mother and father meet Dr. Lina Martinez and their fears seem to melt.
Through a translator, she explains that the first visit is just to get acquainted, ride the
chair and collect prizes. She never uses restraints to tie or hold children down and
modern methods enable her to work on the children without pain. Due tu information
from Head Start, she has changed her hours to accommodate working parents. Sam’s
parents schedule the entire family for an appointment on the spot.

The Health Coordinator helps them locate Dr. Martinez’s office on the bus line and
the dental health advocate agrees to accompany them to translate. Sam is on his way
to a pain free mouth!

re
C5
>

Well-Child Health Care: Making It Happen 91

9 dnanay yntn asn 407


Module I

physician's assistant perform the medical exam; a dentist performs
the dental examination. Professional standards require specific pro-
cedures and equipment. Staff work with parents and mental health

professionals to address concerns over a child's mental health.

. Preventive Treatments

Public health research has shown that certain preventive treatments
can reduce health problems among children. For example,
immunizations can prevent many serious diseases such as polio and
measles, and dental Muoride can help prevent dental cavities. The
medical home will provide the child with regularly scheduled
immunizations following the Centers for Disease Control and
Prevention (CDC) guidelines.

. Education and Counseling

Working in partnership, health care providers and parents discuss
many issues to promiuie the health of the child. They review the
1.sults of the screenings and exams, and discuss what further
assessment and treatment may be needed. Parents are given
guidance about the child's development, nutrition, dental care. and
preventing illnesses and injuries. The parents’ concerns are
addressed and support is provided.

Note to Trainer/Coach:

For information on developing partnerships with parents, seg
the guide Partners in Decision Making in the Parent Involve-
ment series of Training Guides for the Head Start Learning
Community.

C. Head Start Responsibilities

The Head Start program works in partnership with parents and health care
providers to ensure that every child entering Head Start is assisted with:

. Identifying and accessing health care providers

. Linking to a medical home: a source of ongoing and continuous
health care

+ Receiving recommended screenings, examinations, and
immunizations within specific time frames

What Is Well-Child Health Care and Why Is It Important? 13

an

a)



For use with Activity 5

Module 1; What Is Well-Child Health Care and Why Is It Important?
Handout B: Sam’s Story—Part One

Sam is a three-year-old who is enrolling in your Head Start program. Sam's family
emigrated from Cambodia two years ago. He has five older and two younger siblings.
Sam is cared for by his mother and father.

You are the staff person enrolling Sam in Head Start. When you greet Sam and his
father, you notice that Sam’s teeth appear blackened and jagged. Sam’s father tells you
that Sam frequently complains of mouth pain and keeps the family up at night with his
crying. He explains that the family gives Sam bottles of milk or juice to help him fall
asleep, as they do for the other babies. “I know those tecth look bad,” he says, “but
they’re just baby teeth—they’ll fall out.”

You explain that Sam will have the chance for a full health check-up for Head Start,
including a dental examination. You tell him that Sam’s tecth are decayed and causing
him pain—making eating difficult. His father confides that the last time he took a child
to the dentist it was for an extraction and the child was terrified. He'd never want to put
his children through that again and still regrets being talked into it. You ask if one of the
Head Start parent dental health advocates can visit his home. She is well trained in an
oral wellness curriculum and speaks Cambodian. The children will get free tooth-
brushes, toothpaste and a little toy. Sam’s father reluctantly agrees.

The dental health advocate visits Sam’s family and educates them regarding Baby Bottle
Tooth Decay. Upon her visit she notices Sam’s siblings also have decayed front teeth. In
a maniner sensitive to the stresses of comforting many children in a cramped living
space, she gives alternative suggestions for putting the children to sleep without a bottle
and teaches proper brushing and flossing techniques. Sam will be enrolling in Head
Start in two weeks and is scheduled for a dental examination.

Gt
ha

42 Well-Child Health Care: Making It Happen



©

Module 2: Partnerships in Ongoing Well-Child Health Care
Handout F: Taking Inventory

Check your response to the following questions, on a scale of | - 4:

1 = not well 2 =a little 3 = pretty well 4 = very well

Answer these questions about yourself:

important.

i
I can explain what well-child health care and screening means and why it is |
|

I have been adequately trained to do certain Head Start screenings and exams. |
!

I can prepare the children and make them comfortable for screenings and
exams.

Tam skilled at explaining the results of screenings and exams to parents.

Tam comfortable asking parents to follow up with health care providers.

I ensure confidentiality with all aspects of screenings and exams.

Answer these questions about your program’s on-site
Screenings and exams: 1 2 3 4

The screening instruments and procedures are appropriate for the children and
families.

Staff members work as a team to complete health screenings and exams.

The people who do the screenings and exams are well trained and skilled.

i}

Parents are involved in all aspects: helping to do screenings and exams, being |
informed of the results, participating in follow-up. |
{

|

Community partners (e.g., clinics, service groups, health departments) assist
with screenings and exams.

The Health Services Advisory Committee helps plan and review the screening
program.

ee : |

Staff ensures the confidentiality of screening and exam results. ut
1

\

|

Our program assures completion of screenings and exams within the required
time limit.

Well-Child Health Care: Making It Happen 87
wJd

>
§
g

wl


Module 1

Points to Consider: . It is helpful for staff to be familiar with the facts about well-
child health care and screening. However, it is most important
to be aware of what you do and don’t know and where you can
get the information that you need.

. Your key resources for health information are written materials
and health professionals. Since health information advances
rapidly, written material may become out-of-date. Programs
need reliable health consultants to keep them informed about
new information and to update the program’s written materials
(e.g., fact sheets) every year.

Weil-Child Health Care:
Making Ht Happen...

The Head Start in Vail, Colorado
the Rotary Club, and
the Eagle Valley Family Center
are working in collaboration to set up a
“dental committee”
that will work with local dentist to
set up a community wide system
of indigent dental care,

What Is Well-Child Health Care and Why Is It Important? 25



Continuing Professional Development

This

guide helps Head Start staff recognize the value of comprehensive
child health care and screening in promoting health. Head Start staff

V7 well-
il members should continue to learn about health care and screenings by:

tt

Reassessing their personal knowledge and skills in screening

Give staff members the opportunity to identify at least one aspect of
screening they would like to explore further. For example, a teacher
may want to learn more about sickle cell anemia or gain skills in
explaining the results of developmental screening to parents.
Develop a personal action plan for improvement.

Investigating other Head Start programs that are effective in areas
you would like to improve

Use meetings (e.g., local and regional health coordinators, Head
Start Association, health conference) as opportunities for discussing
strategies for promoting well-care, successfully completing
screening, tracking services, building a strong, participatory HSAC
or collaboration building.

Subscribing to public heatth journals to stay updated on current
recommendations

Keep a library of books and videos on health screening topics. Make
sure that the Well-Child Health Care Fact Sheets are reviewed and
revised every year by the Health Services Advisory Committee
members and/or health consultant.

Encouraging staff to participate in classes and conferences on
child health

Courses may be available through the local community college,
child care resource and referral agency, hospitals, and other
community-based agencies such as the American Red Cross. Allow
staff to attend local, regional, and national conferenc .s on health
sponsored by Head Start, child care associations, public health
associations, and health maintenance organizations.

492
NES)

Continuing Professional Development

125

BEST COPY AVAILABLE


Module 1

© What Is Well-Child Health Care and Why Is It Important?

Outcomes After completing this module, participants will:

. be able tow “lain the importance of well-child health care to other
Staff, parents, and community members:

. understand the concept and benefits ofa “medical home" and work
in partnership with parents to link their families to a “medical
home;" and

. gain skills in reviewing health records for completeness, following
up on identified needs, and discussing results in records with
paren ts,

Key Concepts The cornerstone of well-child health care is establishing a partnership
between children and families and a “medical home.” The “medical

home” provides an ongoing source of continuous accessible medical
care,

Well-child health care consists of providing the child with regularly
scheduled check-ups with a health care provider. It includes the fol-
lowing:

. Health history of the child

. Screening tests to identify health conditions that might need
further assessment or treatment

. Examination of the child

. Treatments to prevent disease

. Education and counseling to promote health

Well-child health care helps to keep children healthy, The earlier a
child’s health needs are identified and met, the better it is for the
child and family.

It is important to read and understand each child’s complete health
record since existing health problems are interrelated with screening

and exam results. All results and follow-up should then be clearly
e explained to parents.

What Is Well-Child Health Care and Why Is It Important? 9



Module 2

. Standardized and Appropriate Instruments

Instruments are the tools or methods that are used in screening such
as the developmental checklist, nutrition questionnaire, and vision
charts. High quality instruments are:

— Standardized: The screening instruments should be developed
by experts and tested on large numbers of children. They must
be “reliable” and “valid”—-accurately assessing the child's
capabilities when trained examiners perform them correctly.
They must also be “normed” to determine the “normal range” of
test results around the average that includes 95% of the healthy
children tested.

— Appropriate: Screening instruments should be appropriate to the
program’s needs and resources. Programs should identify
screening methods that are comfortable for the children. The
time for screening should be short enough for a child to
maintain concentration. Ideally, programs should use screening
instruments normed on children of similar age, gender, culture,
language, and economic background.

Note to Trainer/Coach:

If programs use screening instruments that they have developed
on their own, they may not be reliable, valid, or normed. This
may lead to lower quality screening results.

frective Procedures

Evaluating the quality of screening and exam procedures can be
subjective. Programs must aim to provide the best experience
possible for all participants. The process should:

— Allow children to perform at their best. Children should be
prepared in advance. L uring screenings and exams they should
be made to feel comfortable, and the surroundings should help
them concentrate.

— Involve the parents. Throughout all exams, screenings, and
observations, parents play an important collaborative role. It is
important that they understand the procedures their children will

Partnerships in Ongoing Well-Child Health Care ere) 53



For use with Activities 2 & 3

Module 3: Advocacy, Action, and Access

Handout O: Children im Need (continued)

Story #7

This winter has been one of the coldest in Wisconsin history, When Mr. Jackson lost his job at the
machine shop he also lost his health insurance. Although probably eligible for funds, he left the welfare
office in embarrassment when given a stack of papers he could not read. Lack of money led to the shut-
off of his gas and electric at the house and Janetta (14-months-old) lost three weeks of school with
pneumonia. Since the pneumonia, it seems like one illness after another takes Janetta from school. The
home visitor that comes to check on the family notices Janetta coughing hard. The Jacksc.ns are giving
her half doses of antibiotics from her last illness; hoping she will get better before needing another run
to the emergency room. Her father tells you the ER doctor mentioned something about putting tubes into
her ears at her last visit. Mr. Jackson sighs in desperation, “I've brought home a paycheck to my family
every Friday since | was 17.1 got no other job skills. Now I’ve let everybody down—especially Jancita.”

Story #8

When Tabitha’s great-grandinother died last Spring, she and her | 8-year-old mother lost their small
farmhouse in West Virginia. An uncle in Chicago reluctantly offered to take them in for “one month and
not a minute more,” Now seven people reside in a one bedroom flat in the city. Although her medical
exam results indicate no problems, you notice Tabitha wheezing during strenuous play. Her mother is
five months pregnant and looks pale and exhausted during conferences. She says she knows all the
smoking in the house isn’t good, “but they won't listen to me.” Used to growing her own food, she is
unaware that WIC exists and she and Tabitha live on a lot of snack foods from the corner store, She has
no prenatal care, fearing she could never afford a city doctor. Her dream is to become a teacher while in
Chicago and return to the clean, open spaces of West Virginia.

Story #9

The Faith Bible Church sponsored the emigration of the Song family from Cambodia last summer.
Upon request from the pastor, the Home Visitor comes to the apartment to enroll the twin boys Ritha
and Sok. Although four years old, they are the size of most two-year-olds due to severe malnutrition
while in Cambodia. They do not speak yet. Their two-year-old brother still cannot walk and the five-
month-old is the size of most newborns. There are four older siblings in the home, including the 20-
year-old who lost one leg ini a landmine injury. He has never had physical therapy. Mr. Song was a
farmer in Cambodia, but is eager to learn English and then a new trade as soon as possible. Like the
Songs, the 10 other Cambodian families at the Head Start center have survived a war and witnessed
many atrocities, but there is not one mental health counselor who speaks Cambodian taking public

assistance cases in the entire county. 497

aod

122 Well-Child Health Care: Making It Happen



Module 3

Purpose: This activity helps participants develop skill in advocating for
services needed in their community. It also sharpens skills in building
collaborative relationships with the services already available in their

community.

For this activity you will need:

@ = Handout N: Sam's Story—Part Three, for cach participant.

Step 1: Distribute and review Handout N: Sam's Story-—Parl Three
with the participant(s)

Step 2: Discuss the following questions:

Where do you see a need to build collaborative relationships in
your community and how would you go about doing it?

How could your current Health Services Advisory
Committee (HSAC) help?

Who could you add to your HSAC to help?

What state and county health committee ortask force could
Head Start staff join to increase influence in policy making?

How do you keep abreast of all the services available in
your community? How do you assess which ones will be of
help to your Head Start community?

Where does advocacy for change in the existing system need to
take place in your community?

Who would you ialk to? What would you say?

Does the staff understand the ins and outs of the health care
system in your community? How are gaps in services
addressed?

Who is currently on the HSAC to help advocate for change?

Who could you add to the HSAC to help advocate for
change?

aL

Activity 1: Yo]
Sam’s Story

Part Three— CA
Advocating for ~
Services

106

Well-Child Health Care: Making It Happen



Module 3

Activity 2: rT Purpose: Parlicipants review their understanding of how to access the
‘ a . ara :
Pathways to i ‘ health care delivery system in their own community, and share their
Care QS knowledge and experiences with others in the group.
0 3oo St
For this activity you will need:
> Handout O: Children in Need
M ~~ Four large pieces of poster board
markers
@ glue for each team
MA sample poster board with a puzzle drawn on it. with large spaces
(see Step 3)

B= Construction paper squares: ten pieces for each team approximately
4" by 4" in yellow and 10 picces for each team of the same size but
in red.

Step 1: Explain the purpose of the activity, and divide the participants
into four or more groups, with four to five participants in each
group.

Give each group a story from Handout O: Children in Need,
describing a child in need of health services. If you have a very
large group, prepare additional stories from your own
experience.

Step 2: Let each group review the story of their child. Give them 10
minutes to discuss the steps that they would take in order to
access health services for this child and family.

Also discuss any collaborations that would make sense.
Encourage participants to make notes. At the end of their
discussion, ask them to write each step in the process to
accessing care on one piece of yellow construction paper.
a4
he
108 Well-Child Health Care: Making It Happen



Contents

Appendix A 131

Recommendations for Well-Child Health Care
Recommendations for Preventive Pediatric Health Care

(AAP) 131
Health Assessm ups
(EPSDT)... 132

Appendix B 133
Well-Chiid Health Care Fact Sheets

Anemia Screening (Hemoglobin/Hematocrit) .
Dental Screening and Examination
Developmental Screening .
Growth Assessment ....
Hearing Testing
Immunizations .
Intestinal Parasite S
Lead Screening...
Medical/Physical Examination
Nutrition Assessment
Speech and Language Screenin
Tuberculin (TB) Testing
Vision Testing...

Appendix C 147

Blank Records & Forms
Handouts C: Child Health Record Samples (Parts ! - 5).
Handout M: Trackville Head Start Tracking Instrument...

viii Well-Child Health Care: Making It Happen


Module 2

Invite health experts, families, and community members from different
cultural backgrounds to discuss health beliefs and practices of different
cultures represented in your Head Start program. Topics of discussion
may include the following:

. How to maintain good health

¢ What causes illness

. Who are the health care providers
. What are appropriate treatments

+ The importance of establishing a “medical home,” screenings,
exams, and follow-up treatment for identified needs

. The importance of well-child health care

Well-Child Health Care:
Making It Happen...

The Health Coordinator
from Heartland Head Start in
Bloomington, Illinois
volunteered to scrub surgical instruments
at the monthly adult free dental surgery clinic.
As a result of this volunteer work,
the oral surgeons now provide dental
surgeries free for Head Start children
without insurance or accept
what Medicaid pays.

Partnerships in Ongoing Well-Child Health Care RS



Medule I

Points to Consider:

+ Given the fact that Carlos may not have received adequate
health care, what might be the implications for the health
care of other family members? How might you address this
issue?

Well-child health care and screening are important for every child.
They are especially important for children who have signs and
symptoms that might indicate a health problem.

Early screening, diagnosis, treatment, and education can prevent or
reduce pain and disability from health problems.

When working with the family, the health concems should extend
beyond the Head Start child to include siblings, parents, and other
family members. For example:

— Have the siblings received well-child health care and
immunizations?

—- Ifthe mother is pregnant, has she received pregnancy
counseling and prenatal care?

When we promote health care and screening for Head Start children
and families, we must try to understand and be sensitive to the indi-
vidual families’ attitudes, practices, and concems.

Linking a family to a “medical home” best serves their needs by
providing continuous, accessible medical care.

30

Well-Child Health Care: Making It Happen



Module 1 (& Activity 9 in Module 2)

bin

For use with Acti

Appendix C: Blank Records & Forms

Handout C: Child Health Record Sample (Part 3)

CHILD HEALTH RECORD:

FORM 25, HEALTH HISTORY (Continued)

PERSON WITERVIEWED: DATE: RELATIONSHIP:
[LAME OF INTE Te:
| PHYSICAL, PBYCHOLOGICAL, AND SOCIAL DEVELOPMENT

THESE QUESTIONS WILL HELP US UNDERSTAND YOUR CHILD BETTER AND KNOW WHAT 18 USUAL FOR HIM/HER AND WHAT
MIGHT NOT BE USUAL THAT WE SHOULD BE CONCERNED ABOUT:
27.CAN YOU TELL ME ONE OR TWO THINGS YOUR CHILD 18 INTERESTED IN OR DOSS ESPECIALLY WELL?

'28.DOES YOUR CHILO TAKE A NAP? ___NO, ___VES. IF “YE8" DESCRIBE WHEN AND HOW LONG.

29.008 YOUR CHILD SLEEP LE&S THAN 8 HOURS A DAY OR HAVE TROUSLE SLEEPING (6UCH AS BEING FRETFUL, HAVING
NIGHTMARES, WANTING TO STAY UP LATE)? ___NO, ___YES. IF “‘VES" DESCAIBE ARRANGEMENTS (OWN ROOM, OWN
BED, AND

[ SE. HOW DOES YOUR CHILD TELL YOU HE/SHE HAB TO GO TO THE TOILET?,

31.D0E8 YOUR CHILG NEED HELP IN GOING TO THE TOILET DURING THE DAY OR NIGHT, OR DOES YOUR CHILD WET HIG/HER

| PANTS? HO, ea VER. IF “YES” PLEASE DECOR ene ne aren |
SZHOW DOES YOUR CHILD ACT WITH ADULTS THAT HE/SHE CORSN'T KNOW?

‘SR. HOW DOES YOUR CHILD ACT WITH A FEW CHILOREN HI8/HER OWN AGE?

‘34. HOW DOES YOUR CHILD ACT WHEN PLAYING WITH A GROUP OF OTHER GHILOREN?

| "33. DOES YOUR CHILO WORRY A LOT, OR IS HE/SHE VERY AFRAID OF ANYTHING? NO, ____VES. IF “YES", WHAT THINGS
‘SEEM TO CAUSE HIM OR HER TO WORAY OF TO BE AFRAIO?

‘S4.CHILDREN LEARN TO DO THINGS AT DIFFERENT AGES. WE NEED TO KNOW WHAT EACH CHILD ALREADY CAN DO OR 18
LEARWING TO DO EASILY, AND WHERE THEY MIGHT BE Si.GW OR NEED HELP 50 WE CAN FIT OUR PROGRAM TO EACH CHILD.
I'M GOING TO LIST SOME THINGS CHILDREN LEARN TO 00 AT DIFFERENT AGES AND ASK WHEN YOUR CHILD STARTED TO 00
‘THEM, AS BEST VOU CAN REMEMBER. (INTERVIEWER: Reed queation for each Kem Nsied below, and cheok off the parent's anawer
In the appropriate apace).

wen
wanes [eos] waren [aoe

@. WOULD YOU SAY YOUA CHILD: ia)

BEQAN TO____SARUER THAN [i

YOU EXPECTED, ABOUT WHEN (c) WALK :

YOU EXPECTED, OR LATER: (d) TALE

‘THAM YOU EXPECTED? (e} FEED AND OAERS SEL

LEABR TG USE THE TOULET

b. WHEN O10 HE/SHE GEGIN:

To 7 Y With TOYS:

[in Owe CRAVE
[AND WHAT 1 SAID TO HiMHER

37.D0E8 YOUR CHILD HAVE ANY DIFFICULTIES SAYING WHAT HE/SHE WANTS TO 05 OR DO YOU HAVE ANY TROUBLE
UNDERSTANDING YOUR CHILD? ___NO, ___YES. IF “YES” PLEASE DESCRIBE.

‘34. CHILDREN SOMETIMES GET CRANKY OR CRY WHEN THEY'RE TIRED, HUNGRY, SICK, AND 80 FORTH. DOES YOUR CHILD
OFTEN GET CRANKY CF GRY AT OTHER TIMES, WHEN YGU CAN'T FIGUAE OUT WHY? ____NO, __YES. IF “VE8" CAN YOU
‘TELL ME ABOUT THAT?

WHEN THIS HAPPENS, WHAT DO YOU DO ABOUT IT TO HELP THE CHILD FEEL BETTER?

TO BE COMPLETED BY HEAD START STAFF WITH PARENT GUARDIAN EARLY IN PROGRAM YEAR AFTER CHILO 1S ENROLLED.

BEHAVE THERE DESH ANY BIG CHANGES IN YOUR CHILO'S LIFE IN THE LAST 8X MONTHS? NO, ___ YE. IF "YER"
PLEASE DESCRIBE.
10. ARE YOU OR YOUR FAMILY HAVING ANY PROBLEMS NOW THAT MIGHT AFFECT YOUR CHILO? NO, ___YeS. IF "YES"
PLEASE DESCAVRE.
41.06 THERE ANYTHING ELSE YOU WOULD LIKE US TO KNOW ABOUT YOUR CHILD? ___NO, VES, IF "VES" PLEASE
DESCRIBE?
150 Well-Child Health Care: Making It Happen

BEST COPY AVAILABLE



Module 3

Support Parent Empowerment

Parents empowered by knowledge that will help them navigate the health
care and reimbursement systems are best able to become effective health
care consumers. The ability to advocate for change when available ser-
vices and benefits fall short also arises from this knowledge. Regular
workshops on the health care system and day-to-day contact with an in-
formed staff person who can answer questions wiil help parents get the
best health care for their children.

Build on Success

Look at the guide Building on Success in the Parent Involvement series
of Training Guides for the Head Learning Community. Adapt Activity 3-
3: “The Impact of Policies in Your Community” regarding social services
to the health care system.

Hold an “Explaining” Meeting for Staff Members

Schedule a meeting for staff to come and ask questions about their health
insurance. Ask each person to bring in his or her “evidence of coverage”
for health insurance. Some might also bring in descriptions of coverage
from family members or friends. Spend some time examining the docu-
ments and discussing the meaning of various terms or conditions. Be sure
that everyone understands the ins and outs of coverage.

Encourage Assertive Communication

Consider the importance of assertive communication (by a parent or a
Head Start staff member) in receiving needed services from a provider.
An activity entitled “Assert Yourself” can be found in Module 2: Essen-
tial Principles of Care of the guide Caring for Children with Chronic
Conditions in the Health series of Training Guides for the Head Start
Learning Community.

BEST COPY AVAILABLE

495
ay

Advocacy, Action, and Access

117



Module 2: Partnerships in Ongoing Well-Child Health Care

Handout K: Observation Worksheet

Observations Child #1 Child #2

Physical Comfort

Emotional State

Activity Level

Body Build

Skin

Smile and Teeth

Speech, Language,
and Hearing

Piay Activity:

-Large Motor

-Fine Motor

Social Activity

T7Y
Lud

Other

»
3
s
€

92 Well-Child Health Care: Making It Happen



Module 1

Purpose: This activity allows participants to practice reviewing screen-
ing and exam results. They will work in teams to review a health record,
determine the follow-up needed, and discuss the results and follow-up
plans with parents and staff.

Activity 6:
Reviewing
Health Records

For this activity you will need:

@ = Handouts C: Child Health Record Samples (Parts | - 5) or
use your own agency’s record or update the records using the
handouts in Appendix C: Blank Records & Forms.

Ms Appendix B: Well-Child Health Care Fact Sheets

@ = Overhead projector aad transparencies

@ Flip chart paper and markers

Trainer Preparation Note:

+ Make a copy and an overhead transparency of the Child Health
Record. If you want to update the child health records so that
they reflect current information and have current dates, |
will find blank copies of these handouts that you can fill out in
Appendix C: Blank Records & Forms.

* Separate the Child Health Record Samples into Parts 1, 2, 3. 4.
and 5.

+ Attach.to each part the corresponding Fact Sheet(s) from Ap- }
pendix B:

Part 1—Medical/Physical Exam, Growth
Part 2—Anemia, Lead, Tuberculin, Hearing, Vision, Immunizations
Part 3—Developmental
Part 4—Dental
Part 5—Nutrition
* Write the questions from Step 4 on flip chart paper.

Step 1: Explain that this activity will give participants a chance to
review screening and exam results and determine what follow-
up is needed.

What Is Well-Child Health Care and Why Is It Important? 33

a7
ee)