Determinación del estado de salud del niño

(En inglés)

NCH Webinar: Health Issues in Head Start
Determining Child Health Status

Ann Schlesinger: Welcome. I'm Ann Schlesinger from the National Center on Health at Education Development Center. The National Center on Health has developed this webinar and a companion webinar and screening for Head Start grantees. In this webinar, my colleague Nancy Topping-Tailby and I will review some of the Head Start Program Performance Standards that all grantees and delegate agencies must follow regarding determining children's health status. During this time, we will review the Head Start Program Performance Standards related to determining child health status; we'll identify activities and timelines to meet this health requirement; we'll describe the connection between Head Start systems and services, and discuss ways to use planning resources to ensure that all enrolled children receive required health services. We know that when systems work well, that is, when everyone understands the program's policies and procedures and the roles and responsibilities associated with them, programs are better able to provide effective health services to meet the health and wellness needs of children and their families.

Since its beginnings, Head Start has recognized that health is the foundation for children's growth and development and that healthy children are better able to learn. Evidence suggests that when children receive preventive well-child care, early diagnosis, and effective treatment, they're more  likely to engage in learning. The first requirements in the Head Start Program Performance Standards for child health and development services is 1304.20(a), Determining Child Health Status, which describes activities that must be completed within 90 days of a child's entry into the program. Note that entry is defined as the first day the child enters the classroom or begins to participate in a home-based or family child care program. The activities to be completed within 90 days of entry could include screenings or immunizations at a health fair, an initial home visit by Head Start staff, or other pre-entry services. 

You may want to pause the webinar now while you refer to the handout Head Start Program Performance Standards on Child Health Status, one of the resource materials that accompany this webinar. It provides more detail about the regulations that we'll be discussing. We'll talk a little more about documenting and tracking children's health status in a few minutes, but first we'll review the Early and Periodic Screening, Diagnosis, and Treatment program, EPSDT, that outlines the health services that all Head Start and Early Head Start children must receive.

The Early and Periodic Screening, Diagnosis, and Treatment program, known as EPSDT, provides the federally required health care benefits and services for Medicaid-enrolled children. EPSDT allows families to access ongoing health care for their children that meets the special physical,  emotional, and developmental needs of low-income children, so that if children experience any medical, dental, vision, mental health, or developmental problems, these issues can be identified and treated as soon as possible. EPSDT defines the health services that all Head Start and Early Head Start children must receive. The Head Start Program Performance Standards require all grantees and delegate agencies to, quote, “obtain from a health care professional a determination as to whether the child is up-to-date on a schedule of age-appropriate preventive and primary health care which includes medical, dental, and mental health. This schedule must incorporate the requirements for a schedule of well-child care utilized by the EPSDT program of the Medicaid agency of the state in which they operate,” end quote.

EPSDT includes a mandatory set of comprehensive and preventive health care services and benefits as well as a schedule of well-child care for children who are enrolled in Medicaid. You may want to pause the webinar now while you refer to the handout What You Need to Know about EPSDT, which contains greater detail about the services that are covered under EPSDT. This chart describes each element of the  EPSDT, early, periodic, screening, diagnosis, and treatment. We know that early childhood is a time when children's brains are growing very quickly, and all the systems in their bodies need to be working well. For example, when children are able to hear sounds clearly and can see the letters written on
objects in the world around them, it'll be easier for them to learn.

These systems are built during children's early years and set the stage for lifelong health, wellness, and success in school and life. In fact, there's a growing body of research that demonstrates the connection between school readiness and children's healthy development. Some scientists have even compared children's healthy development to the launching of a rocket in which even small disruptions after takeoff can have a very big effect on how far the rocket can travel during its flight. This is why it's so important that health conditions are diagnosed and treated promptly so that children are able to learn and grow.

An EPSDT well-child exam may include screening, including a comprehensive health and developmental history, a review of height, weight, and other nutrition-related assessment data, an unclothed physical exam, also appropriate immunizations, laboratory tests, and health education. Laboratory tests based on the child's age include lead screening and hemoglobin hematocrit blood count. Immunizations are based on recommendations from the Centers for Disease Control and Prevention, CDC, as well as state and local authorities. You can refer to the handout CDC's Recommended Immunizations for Children from Birth through Six Years Old, which lists the recommended schedule for vaccines.

Now let's talk about how to document and track children's health status. In order to determine each child's health status within the timelines required by the Head Start Program Performance Standards, you'll need to collect specific information about whether the child is up-to-date on a  schedule of ageappropriate preventive and primary health care that includes medical, dental, and mental health, and incorporates EPSDT, the latest immunization recommendations, and any additional recommendations from your program's Health Services Advisory Committee. Be sure that you record the date of the exam, not the date the medical provider signed the form, and record the date the program receives the information. Then you can make a determination if the child is up-to-date based on the EPSDT and immunization schedules.

Whatever management information system your program uses, you'll want to establish procedures to track the provision of health care services. Make sure that the staff who are responsible for data entry and reporting are trained in how to use the software so they know which children have received a referral, whether and when these children receive the services to which they were referred, and if they need additional follow-up. You can use your Health Services Advisory Committee, or HSAC, to engage the provider community. Your HSAC can help you to review your health services plan, policies, and procedures, and make recommendations for improvements. A strong HSAC can be a powerful ally in making connections with the medical, dental, and mental health communities.

In order to attract HSAC members, consider these strategies. Think about meeting frequency and timing. 

Consider lunch or breakfast meetings to make it easier for providers to attend. Include family members, staff, managers, and providers who can facilitate decision-making including resource allocation. There are also opportunities to expand beyond your immediate community. Can you use technology to engage members who may want to work with you but are too far away to attend in-person meetings? You can also talk with your HSAC members to get their ideas about other creative ways to recruit and engage providers. Finally, consult with your HSAC to identify community-specific health issues. Head Start has a resource called Weaving Connections that contains guidance and suggestions on how to build a strong HSAC and the ways that you can utilize the expertise of your HSAC members. You can find Weaving Connections on the ECLKC. Next, Nancy will talk with you more about the relationship between systems  and services. Nancy?

Nancy Topping-Tailby: Thank you, Ann. A systems approach integrates health services and knowledge across your program. Staff recognize that health is everyone's business and understand their own roles and responsibilities in implementing the program's systems, policies, and procedures. To be successful, you will need the support and leadership of your program director and other members of your program's management team working together as health champions for the children in your Head Start or Early Head Start program. When Head Start programs design and implement an effective systems approach that is supported by all of these individuals, they are able to provide high-quality health services to children and families.

The National Center on Program Management and Fiscal Operations has developed this constellation to identify the ten management systems that Head Start programs use to deliver high-quality services to children and families. Programs need to make sure that each of their Head Start systems is working well and that they all work together effectively. A problem in any one of these systems is likely to have a negative effect on the quality of services that the program is able to offer. You can use this constellation to help you, other program managers, and your Health Services Advisory Committee to determine what is working well and whether any corrective actions are needed.

On the next slide, we will look at some questions you may want to consider to determine if any of your systems need to be strengthened. As you review this slide, refer to your handout General Questions to Consider, which examines how well your program's Head Start management systems support health services. The handout contains additional information that is not pictured here. As you can see, we have identified some sample questions in each management system that can help you to meet the EPSDT requirements for child health status as well as other EPSDT  requirements. For example, in the planning system, you may want to ask: Does our program have a comprehensive plan in place to meet the EPSDT health requirements? Or, do we need to provide any outreach to providers to make sure that children are up-to-date on their schedule of well-child care? Or in the facilities, materials, and equipment management system, we may ask: What additional materials or equipment, if any, will we need to ensure children receive required health screenings in order to be up-to-date on their schedule of wellchild care? 

Note that for each of the management systems we have included an "other" question so that you can adapt the questions for your own program. We have also included a Health Services Management Systems Worksheet handout that you may want to use during your Annual Self-Assessment and review of your health services plan. The systems your program puts in place to determine child health status are only part of meeting this requirement. Systems require the leadership of your health manager who must work with other managers, staff, HSAC members, and families to effectively plan, implement, and evaluate health services.

Every manager in a Head Start program is a support in the bridge between the program's management systems and its service delivery systems. Ultimately, health managers and the other members of your team can make sure that every child is healthy and ready to learn. The Head Start National Center on Health is available to answer your questions by email or by phone. You can find additional health-related resources on the National Center on Health pages of the ECLKC. This concludes our webinar on determining child health status. Thank you for listening.

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