1. Early Head Start – Child Care Partnerships Comprehensive Services Part II: Health, Mental Health, Nutrition, and Disabilities
NOTE TO PRESENTERS:
Ginny and/or Sharon will present this slide

2. Presenters Marco Beltran, DrPH Program Specialist,
Office of Head Start
Tatiana Tucker, MSA
Program Specialist,
Office of Child Care
NOTE TO PRESENTERS:
Ginny and/or Sharon will present this slide

3. Learning & School Readiness
Health & Safety
Learning & School Readiness
Sick children are away from program activities, leading to regression in cognitive & general knowledge
Time out due to illness will impact the amount of time needed to develop relationships and or form attachments

4. Objectives
To provide information to potential applicants on the Head Start health, mental health, nutrition and disabilities services
To identify the Program Performance Standards related to all of the Head Start health services
To identify resources that help support the Head Start health services
To provide background information about the Child Care and Development Fund (CCDF)
To identify the Health and Safety requirements for CCDF
To understand the key roles of Child Care Health Consultants

5. Head Start Program Performance Standards
Determine a child’s current health status
Screen for developmental, sensory, and behavioral concerns
Provide ongoing health care
Monitor health and safety issues
Provide nutrition services
Individualize to each child
Provide mental health consultation or disability services, if needed
Communicate between staff and parents

6. Health Services Set the Stage

7. Child Health Services Timeline

8. Screening Standards
(2)(b) Screening for developmental, sensory, and behavioral concerns
Within in 45 days…identify concerns regarding a child’s developmental, sensory (visual and auditory), behavioral, motor, language, social, cognitive, perceptual, and emotional skills

9. Why do we screen? 10-13% of all children have a developmental delay
1-3 children per every thousand are born with some hearing loss
5% of preschool children have visual problems that affect learning

10. A comprehensive screening approach …
Multiple sources of information
Family
Teacher/Caregiver/Home Visitor observations
Health, emotional state, and energy levels of the child
A standardized tool
Culturally and linguistically appropriate
Also check out:

12. Child’s Health Status Standards
(a)(1)(i)-(iii) Determine child health status
No later than 90 calendar days… from the child's entry
Determine if each child has an ongoing source of continuous, accessible health care
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…and the latest immunization recommendations…

13. Schedule of Well Child Care
An EPSDT well-child exam may include:
Screening (i.e., vision, hearing, medical and dental)
Immunizations
Laboratory tests
Diagnostic or treatment services
Vision and hearing services
Other health care
Remember: Each screen and each state has its own “periodicity schedule”

15. Follow-Up Plan and Tracking Standards
(a)(1)(C)(iii)(iv) …must establish procedures to track the provision of health care services
Obtain or arrange further diagnostic testing, examination, and treatment by an appropriate licensed or certified professional for each child with an observable, known or suspected health or developmental problem
Develop and implement a follow-up plan for any condition identified…so that any needed treatment has begun

17. Ongoing Care
Implement ongoing procedures by which staff can identify any new or recurring medical, dental, or developmental concerns
Procedures must include: periodic observations and recordings, as appropriate, of individual children's developmental progress, changes in physical appearance (e.g., signs of injury or illness) and emotional and behavioral patterns

18. Individualization of the Program
Determine how the program can best respond to each child's individual characteristics, strengths and needs using a variety of sources
Support individualization for children with disabilities through implementation of an IEP/IFSP
Children’s needs for early intervention, special education, or related services are identified promptly

19. Services for Children with Disabilities
Enrolled over 136,000 children with disabilities
Nearly 12% of Head Start’s enrollment
Over 21,000 were infants and toddlers enrolled in EHS and MSHS

20. Services for Infants and Toddlers with Disabilities
Language in the Head Start Program Performance Standards - 45 CFR (f) (1) (i) – requires that Head Start program serving infants and toddlers must provide services for infants and toddlers with disabilities and their families that support the attainment of the expected outcomes contained in the Individualized Family Service Plan (IFSP) for children identified under Part C of the Individuals with Disabilities Education Act (IDEA).
Language in the Head Start Act A (b) 11 – clearly states that programs ensure formal linkages with providers of early intervention services for infants and toddlers with disabilities with the State interagency coordinating council, as established in part C of the Individuals with Disabilities Education Act (20 U.S.C et seq.), and with the agency responsible for administering section 106 of the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106a).

21. Disabilities Services
At least 10% of Head Start enrollment is for children determined eligible for services under the Individuals with Disabilities Education Act (IDEA)
Children with disabilities and their families are included in the full range of Head Start program activities
Parents of children with disabilities are supported and engaged as decision-makers, receiving information and assistance to address their child’s special needs and to advocate for them

22. Mental Health Standards
Education and ECD
Child Mental Health
Family Partnerships

23. Mental Health Promote social and emotional development
Build trust, foster independence, encourage self-control
Support and respect home language, culture, family composition
Involve parents in mental health interventions
Provide mental health education for staff, parents, families
Facilitate opportunities for parent to participate in counseling programs

24. Mental Health 1304.24 (a)(2) and (3) Child Mental Health
…secure the services of mental health professional on a schedule of sufficient frequency to enable the timely and effective identification of and intervention in family and staff concerns about a child’s mental health . . .
Mental health program services must include a regular schedule of onsite mental health consultation…

25. Programs find mental health consultant/providers through…
Local mental health agencies/providers
State children’s mental health directors
Universities, colleges, and community colleges – departments of social work, child psychology, child psychiatry, special education, and their counseling centers

26. Nutrition Standards 1304.23 Child Nutrition
Staff and families must work together to identify each child’s nutritional needs
Use nutrition related assessment data
Use information about family eating patterns, cultural preferences, dietary requirements and feeding requirements
Feeding schedules
Use information about community nutritional issues

27. Nutrition Services
Design and implement a nutrition program that meets the nutritional needs and feeding requirements of each child
Use funds from USDA Food and Consumer Services Child Nutrition Programs as the primary source of payment
Funds may be used to cover those allowable costs not covered by the USDA
Also check out:

28. Nutrition Services
Serve a variety of foods - consider cultural and ethnic preferences
Promote effective dental hygiene among children in conjunction with meals
Include opportunities to assist individual families with food preparation and nutritional skills
Involve parents in planning, implementing, and evaluating the agencies' nutritional services

29. Meal Service
Ensure services contribute to child’s development and socialization
Serve foods that broadens food experiences
Food is not used as punishment or reward
Allow sufficient time for each child to eat
Family style dining - children and staff eat together family style and share the same menu to the extent possible
Hold infants while feeding; do not lay infant down to sleep with a bottle
Also check out:

30. Food Safety and Sanitation
Post evidence of compliance with all applicable Federal, State, Tribal, and local food safety and sanitation laws, including those related to the storage, preparation and service of food and the health of food handlers
Contract only with food service vendors that are licensed in accordance with State, Tribal or local laws
Facilities must be available for the proper storage and handling of breast milk and formula

31. Involving Parents in Health Services
Consult with parents immediately when child health or developmental problems are suspected or identified
Familiarize parents with health and developmental procedures; obtain advance authorization
Share diagnostic results and treatment procedures and ongoing care
Assist parents to enroll and participate in a system of ongoing family health care and encourage parents to be active partners in their children's health care process

32. Health and Safety Standards
Foundation for high quality care
Over 100 individual standards related to health and safety
Found in each section of HSPPS

33. Health and Safety Standards
Prevent illness by maintaining healthy environments
45 CFR (a); (c); (e); (e); (l)(3)(i); ;
Prevent childhood injuries
Identify and report child abuse and neglect
Implement injury prevention strategies
45 CFR (e); (a)(5); (b); (f); (e); (e)-(h); (i)(iii)-(iv); (l)(3)(i); (l)(4); ; ; ;

34. Health and Safety Standards
Provide education for children, families, staff and volunteers on injury prevention practices
45 CFR (d); f)(3)(iii); ;
Conduct inspections of any facility, equipment and materials used by the program
45 CFR (f); (c)
Develop, practice and use emergency plans CFR (a); (b)(1)(i); (b)(1)

36. Staff Qualifications

37. Health services must be supported by staff or consultants that have training and experience in public health, nursing, health education, maternal and child health, or health administration. In addition, when a health procedure must be performed only by a licensed/certified health professional, the agency must assure that the requirement is followed [HSPPS 45 CFR (d)(2)].
Nutrition services must be supported by staff or consultants that are registered dieticians or nutritionists [HSPPS 45 CFR (d)(3)].

38. Mental Health services must be supported by staff or consultants that are licensed or certified mental health professionals with experience and expertise in serving young children and their families [HSPPS 45 CFR (d)(4)].
Disabilities must be supported by staff or consultants that have training and experience in securing and individualizing needed services for children with disabilities [HSPPS 45 CFR (d)(7)].
Content area experts including managers, coordinators or consultants who work with infant and toddler staff need the capacity to assist them in appropriately implementing and adapting the services for children from birth to 36 months of age.

39. CCDF Overview
Grantees. 50 States, DC, Territories, and 260 Tribal entities
Funding. Jointly financed by Federal and State governments. CCDF program combined federal funding for FY $5.2 billion.
Flexibility. CCDF provides flexibility to States, Territories, and Tribes in establishing policies that support families’ access to child care through subsidies.
Children and Families Served. Approximately 1.6M low-income children and families receive child care subsidies per month
Coordination. CCDF allows States, Territories, and Tribes to serve families through a single, integrated child care subsidy program under the rules of the CCDBG Act. States coordinate CCDF with Head Start, pre-kindergarten, and other early childhood programs.

40. Child Care and Development Fund (CCDF)
OCC Vision
More children in low-income families able to access high quality care
CCDF Purpose
Assists low-income working families obtain child care so they can work or attend training/education
Improves quality of child care and promotes coordination among early childhood development and afterschool programs
CCDF Law
Child Care and Development Block Grant Act (CCDBG) of 1990
Section 418 of Social Security Act

41. OCC Quality Framework Health and Safety Pathways to Program Quality
Pathways to Professional Development
Children’s Healthy Development and School Readiness and Success
Health and Safety

42. CCDF Health and Safety Requirements
State, Territories, and Tribes have responsibility for ensuring the health and safety of children in child care through the licensing system and/or the establishment of health and safety standards for providers who care for children receiving CCDF funds.
CCDF Health and Safety Requirements
State Licensing Standards
Prevention and Control of Infectious Diseases
Building and physical premise safety
Minimum health and safety training
49 States have licensing standards that address care of infants/toddlers
43 address supervision
43 require programs/activities specific to infants/toddlers (including nutrition)
44 require equipment/materials specific to infants/toddlers
23 require primary caregiver for each infant
17 require specific qualifications for staff

43. CCDF Quality Investments
$1 billion a year spent on quality improvement activities.
Lead Agencies are required to spend at least 4% of CCDF allocation on these activities. Actual State spending was 12% in FY2010
Includes $100M specifically set-aside by Congress for infants and toddler care
Examples of Activities Supported by Quality Funds:
Scholarships for providers to obtain accreditation of continuing education and training
Grants or loans to help programs meet quality and health and safety standards
Health consultants working with early care and education programs
Enforcement of health and safety requirements
Infant and Toddler Specialists

44. Child Care Health Consultants
Child Care Health Consultants are health professionals who have received specialized training in child health, child development, and health and safety in child care settings
In 2012, approximately 30 States reported using health consultants in child care
CCHCs and child care staff work together to promote healthy and safe environments for young children

45. Role of a CCHC
A CCHC can help improve the health and safety of children in child care and head start programs by:
Meeting on-site with child care providers about health and safety
Reviewing health records of children and child care providers
Helping to manage the care of children with special health care needs
Identifying children with developmental delays
(Read Slide)

46. Other Resources to help providers meet Health and Safety Standards
Healthy Child Care America
Provides resources and online trainings to early care and education providers on the health and safety of children in out-of-home child care.
Medical administration
Preventing Infectious Diseases
Safe Sleep Practices/SIDS
Let’s Move Child Care
Help providers adopt best practices for physical activity and nutrition through interactive online tools
Let’s Move Child Care Training Modules

47. Where To Go for More Information and Resources

50. Resources http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health

51. Are You Planning To Apply?
Register with Grants.gov
Only the Applicant organization needs to register
The registration process can take one to three weeks depending on your organization, so start now!  
You will receive notifications based on Funding Opportunity Number (FON)
A FON is a number that a federal agency assigns to each specific grant announcement
Obtain Data Universal Numbering System (DUNS) Number
Register in System for Award Management (SAM) Eligibility Requirements
Visit:

52. Questions To:

53. STAY TUNED For the next webinar in the series:
Comprehensive Services Part III: Family and Community Engagement Friday, March 28, 2 p.m. EDT
Maximizing Resources and the Role of Governance Monday, March 31, 2 p.m. EDT

54. THANK YOU