The following is an excerpt from WIC and Head Start: Partners in Promoting Health and Nutrition for Young Children and Families.
Health and Nutrition Screening/Assessment
WIC Program Requirements
Head Start Requirements
Health and Nutrition Screening/Assessment
WIC Requirements
Head Start Requirements
Opportunities for WIC and Head Start Collaboration
Survey Findings: Collaboration Strategies at Work
Coordination Strategies at Work
“Focus on your successes, not your setbacks in collaboration efforts. Remember that successes can be very, very small. Appreciate them.”
-- Survey respondent from Newport, Vermont WIC-Head Start Coordination
WIC and Head Start Programs are both required to complete health and nutrition screening /assessment procedures or assure that participants receive these services from another appropriate health professional. As a result, families participating in both programs may be asked to provide similar information to each program at different times. Coordinating the health and nutrition screening/assessment processes between programs may minimize duplicative efforts for families and staff.
WIC Program Requirements
As part of the eligibility process, applicants must be individually determined to be at nutritional risk by a competent health professional. To determine risk, at minimum, a current height, weight and blood test for
anemia must be obtained and evaluated. This data must be obtained prior to or at the time of certification for eligibility and may be obtained directly or by referral to an appropriate health care provider. Examples of nutrition risk criteria are anemia, underweight, overweight, a medical condition with nutritional impact such as diabetes, or inadequate dietary patterns as assessed by a 24-hour dietary recall, dietary history or food frequency. WIC also provides referrals for health care, including Medicaid and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, to assist families in accessing appropriate ongoing health services.
Head Start Requirements
As quickly as possible, but no later than 90 days after enrollment, Head Start and Early Head Start Programs are required to assure that participants are enrolled in a system of ongoing preventive healthcare. Programs must obtain from a health care professional a determination that each child is up-to-date on a schedule of age-appropriate preventive and primary health care, including medical, dental, and mental health. The schedule must incorporate the schedule of well-child care required by EPSDT and the latest immunizations schedule recommended by the Centers for Disease Control and Prevention, State, tribal, and local authorities. An EPSDT well-child exam includes height, weight, and blood tests for anemia at regular intervals based on age. In addition, information about child and family eating patterns, including current feeding schedules for infants, must be collected and assessed. Although programs have 90 days to obtain health assessment information from a health care provider, many Head Start Programs choose to perform some health screenings on-site including, height, weight, vision, and hearing screenings. Providing screenings on-site prevents delays in obtaining health data that may be used as a part of the developmental screening that must be completed for each child within 45 days of enrollment. The developmental screening identifies concerns regarding a child’s developmental, visual, auditory, behavioral, motor, language, social, cognitive, perceptual, and emotional skills.
HEALTH AND NUTRITION SCREENING/ASSESSMENT
WIC Requirements
- Nutrition risk must be demonstrated prior
to or at the time of certification. At minimum, height, weight and
a blood test for anemia must be assessed. Assessment may be based
on data collected directly or from another appropriate healthcare
professional. A poor diet may also be included as a nutrition
risk.
- Programs provide participants with referrals to on-going health care as needed.
Head Start Requirements
- Nutritional needs must be identified,
taking into account information about child/family eating patterns
and relevant health exam/screening data (height, weight, and blood
tests for anemia). Health exam data is obtained within 90 days of
enrollment - see below.
- Within 90 days of enrollment, programs must assure that children and pregnant woman are up-to-date on a schedule of preventive health care used by EPSDT for children or prenatal care for pregnant woman. Programs may choose to conduct some health and nutrition screening activities directly to aid in identifying health/nutrition needs as quickly as possible.
Early Head Start Programs must ensure that pregnant women are receiving comprehensive prenatal and postpartum care immediately after enrollment into the program. This care must include early and continuing risk assessments, including an assessment of nutritional status as well as nutrition counseling and food assistance. The care must also include dental and mental health assessments and interventions as deemed appropriate by the attending health care provider.
Health and Nutrition Screening/Assessment Opportunities for WIC and Head Start Coordination
Although both Head Start and WIC Programs conduct health and nutrition screening/assessment activities, WIC utilizes assessment data to determine program eligibility while Head Start does not. Instead, within 90 days of enrollment, Head Start programs must assure that children and pregnant women are up-to-date on a schedule of preventative health care, including appropriate screenings. Programs may choose to complete some of these activities as part of enrollment, although this is not required. Thus, the timelines required for completing these activities may differ, making collaboration efforts in this area more challenging. Nevertheless, coordination of health and nutrition screening/assessment activities can be successful in minimizing duplicative services and assuring that families have access to on-going preventive healthcare.
Opportunities for wic and head start coordination:
Health and nutrition screening/assessment
- Both Head Start and WIC require that similar health/nutrition assessment data be obtained for children and pregnant women, including and assessment of dietary patterns/eating habits.
- Head Start requires that information be collected within 90 days of enrollment into the program, while WIC requires that the information be collected prior to or at the time of WIC certification of eligibility.
- Both programs work to assure that children and families are enrolled in a system of on-going preventive health care such as Medicaid and EPSDT. Information from a health care provider may be used to determine health/nutrition status and risk.
Survey Findings: Collaboration Strategies at Work
Although somewhat limited by the barriers posed by the confidentiality of participant records, a substantial number of programs have developed the means through which assessment data can be shared between WIC and Head Start Programs. The following are specific examples of collaborative efforts in the area of health and nutrition screening/assessment as shared by study respondents:
- Joint medical assessments and screenings;
- Joint data collection forms which contain
a signed release authorizing information sharing between WIC and
Head Start;
- WIC performing all the health-related
testing and screening functions for Head Start with both programs
utilizing the information gathered;
- WIC performing selected health-related
functions, the most common being hematocrits and anthropometrics
measures; less common are immunizations and lead testing by health
department-funded individuals assigned to work with WIC;
- Head Start performing all or selected
health screening functions for both programs;
- Each program gathering its own
information utilizing forms with a release so information can be
shared;
- One program completes dietary intake
assessments for the other;
- Shared medical equipment for use in
testing and screening;
- Shared staff who complete
screening/assessment procedures for both programs; _ WIC
monitoring and follow-up on clients referred by Head Start for
specific medical or nutritional needs;
- Staff in-service training by WIC for Head Start staff on nutrition assessment procedures (e.g., to perform height and weight measurements and plot growth charts); and _ Head Start provides transportation to WIC appointments.
The Jackson, Tennessee Collaboration reports significant benefit from WIC conducting medical and nutrition screenings for both programs, stating that:
“This makes more efficient use of time resources for both staff and clients.”
The ability to bring WIC services to the Head Start sites allows families to get both services at one site. The Oklahoma City WIC-Head Start Collaboration, for example, involves WIC bringing its mobile services to the Head Start sites on a regular basis.
“Our van travels to eight separate Head Start sites, with clinics on Monday through Thursday of each week and half-day on Friday. Each site is visited at least once per month and the larger ones are visitedvonce each week. This enables WIC to serve 1,000 clients at Head Start. Because this is a Community Action Program as well, the mobile unit also sees other WIC clients at the Head Start site from time to time. Services provided include: certifications, dietary assessments, heights, weights, and hematocrits, along with issuance of vouchers.”
WIC mobile-unit collaborations were reported by several programs as providing excellent benefits, particularly in rural areas with widely dispersed client populations. The Community Action Programs in Spartanburg, South Carolina and Owego, New York where WIC and Head Start are colocated reported this benefit:
“Parents don’t have to take off work to come to the health department for physicals for their children.”
Haverhill, Massachusetts’s Collaboration said of its van program:
“The Department of Public Health gave us a WIC van with a nurse practitioner whose time is donated by a local hospital one day each week. She does wellness care, immunizations, and physical exams at the rural Head Start center and all around the city at Head Start sites as well.”
In addition, a number of programs reported cooperative use of vans or buses for transporting clients for services. The Head Start Program in Macon County, North Carolina reported how they work with WIC:
“Head Start helps provide transportation, reminds people of their appointments and provides a list of children who aren’t up-to-date on their shots. Head Start provides health and medical information to WIC. Head Start does their own screenings for dental, height and weight. WIC does hemoglobin.”
The Child Development, Inc. Head Start Program in Russellville, Arkansas also collects health information for both Head Start and WIC with many reported benefits:
“When parents and children come to Head Start for enrollment, Head Start does EPSDT, height, weight and hemoglobin. Then [families] go to the WIC person who enrolls them because they are qualified for WIC if they meet the income guidelines for Head Start. Then WIC gives them the vouchers on the spot and does their nutrition assessment. Parents have loved it and look forward to it. It cuts down on transportation.”
At Cherokee Tribal Child Care Services in North Carolina, WIC does all medical screening and the information is shared, authorized by a joint release form. The benefits of collaborations in the medical testing area can be obvious. Program after program offered some variation on the following comment:
“Kids don’t like to get stuck. It hurts! If we can figure out a way to only have to stick them once it’s a lot better than having to do it twice. Collaboration cuts down on pain.”
COORDINATION STRATEGIES AT WORK:
HEALTH AND NUTRITION ASSESSMENT/SCREENING
- Joint screenings for both programs can
contribute to:
- greater efficiency;
- less time off from work for parents; and
- fewer duplicative screening procedures
for children.
- Joint release forms and shared forms
facilitate information sharing and minimizes duplication.
- Shared staff allow similar functions in both programs to be efficiently accomplished so families do not have to provide duplicative information.
