1. A Review of the Revised Head Start Program Performance Standards Relevant to Oral Health
November 18, 2016
Presented by: Marco Beltran, Dr.P.H., and Harry Goodman, D.M.D., M.P.H
Moderated by: Michelle Landrum, RDH, MEd

2. General Reminders
This webinar will be recorded and archived on the ASTDD website
Questions will be addressed after the speakers are finished. Please click on the icon at the top of your screen that looks like a person with their hand in the air. The moderator will recognize and “un-mute” you so you can ask your question.

3. Learning Objectives
Value the significance of the revised Head Start Program Performance Standards (HSPPS)
Understand the expanded visibility of oral health in the revised HSPPS
Understand the changes in the revised HSPPS as they relate to oral health
Understanding of the current Head Start Program Information Report (PIR) oral health elements as they relate to oral health

4. Important Reminder!
DHLs should not provide direct guidance on or interpretation of the HSPPS to HS programs or staff
The Office of Head start would like to respond to questions through the Contact Us link ( on the ECLKC website to maintain consistency
DHLs role is to provide support and evidence-based resources to programs so they can make informed decisions
e.g., providing information on the benefits and appropriate use of fluoride, or assisting programs find dental providers in their area that will provide age 1 dental exams

5. Overview of Head Start Program Performance Standards Final Rule
Presented by: Marco Beltran

6. Office of Head Start Administration for Children and Families
Head Start Program Performance Standards Final RULE
______________________
An Overview

7. Paradigm Shift Focusing on outcomes over processes and plans
Eliminating Head Start-specific requirements where government- or HHS-wide procedures exist
Giving grantees more flexibility in how to meet the requirements
Increasing transparency with simplified and streamlined standards
Reduced the prior Head Start regulations by 30%

8. Guiding Principles The new Head Start Program Performance Standards:
Provide research-based program service requirements.
Are written in plain language and presented clearly to support better program delivery for current and prospective grantees.
Strengthen Education requirements and ensure all children will get the exposure to early learning they need to leave Head Start ready for school.

9. Guiding Principles The new Head Start Program Performance Standards:
Maintain core Head Start principles, including comprehensive services, parent engagement, enrolling the highest need children and valuing diversity.
Requires using data for continuous quality improvement.

10. Major Changes in Response to Comments
The NPRM proposed specific requirements for length of day and year, for all programs by 2017.
The final rule sets an annual hour requirement for duration and phases the requirement in over five years (by 2021).
The NPRM proposed to eliminate home-based as a standard option for preschoolers.
The final rule allows home-based as a standard option as long as it isn’t the only option available to preschoolers.
The NPRM proposed to eliminate the requirement for parent committees and articulated impasse procedures that could become imbalanced.
The final rule retains the parent committee requirement and ensures impasse procedures lead to an equitable process for both parties.

11. Overall Structure of the HSPPS
The new HSPPS has five clearly defined parts:
Program Governance (1301)
Program Operations (1302)
Administrative & Financial Requirements (1303)
Federal Administrative Procedures (1304)
Definitions (1305)

12. Questions about the HSPPS?
All questions should be sent to ECLKC -Contact Us
OHS staff will be answering the questions based on the following:
Reflect the Standard
Paradigm Shift
Clarification of Intent
Deferred for Future Answer
Implementation Tips

13. Supporting implementation
Resources and supports will be provided, including:
OHS Webinar series every third Wednesday!
The Performance Standards Showcase- a series of videos that examine highlights and major changes to the regulations and standards.
Federal Sessions at national and regional events
Region 9 conference in Hawaii
CHSA conferences
Cluster meetings
Training by National Centers and Regional TTA
OHS Birth to Five Leadership Institute
Spring 2017

14. Head Start Program Performance Relevant to Oral Health
Presented by: Harry Goodman

15. Relevant Revised Head Start Program Performance Standards Themes
The core health services from the previous program performance standards were maintained
Strengthened requirements with an emphasis on oral health and parent education in health issues
Updated mental health requirements
Streamlined program performance standards

16. HSPPS Sections of Importance to Oral Health Five (5) Revisions of Note
In general—Revision
Collaboration and communication with parents
Child health status and care—Revision (3)
Oral Health practices—Revision
Child nutrition (changes of note with indirect impact on oral health)
Child mental health and social and emotional well-being
Family support services for health, nutrition, and mental health
Safety practices (changes of note with indirect impact on oral health)
Community partnerships and coordination with other early childhood and education programs
Enrolled pregnant women
Prenatal and postpartum information, education, and services

17. Sections of Importance for Oral Health 1302.40 In General
Goal of the health section is to ensure programs provide high-quality health, oral health, mental health, and nutrition services that support each child’s growth and school readiness

18. Sections of Importance for Oral Health 1302.40 In General
The term “oral” replaced the term “dental” throughout the revised regulation (REVISED)
Rationale
Reflects current scientific and clinical terminology
Agreement oral health is an important element of overall health
If it had remained as “dental” health, it might not automatically have been recognized by programs as included under health

19. Sections of Importance for Oral Health 1302
Sections of Importance for Oral Health Child Health Status and Care
Determine children’s source of care
Support parents in ensuring children are up-to-date and ensure children receive ongoing necessary care
Determine if children have health insurance and support families in accessing health insurance if they do not
Requirements for extended follow-up care and clarifies use of program funds for medical and oral health services
Use of funds for the provision of diapers and formula

20. HSPPS: Oral Health 1302.42 Child Health Status and Care
Now includes “oral health care professional” in addition to “health care professional” throughout the regulation (REVISED)
Rationale
Needed clarity about the meaning of “health care professional” as it relates to oral health since previously confusing
Now specifies “oral health care professional”
Doesn’t specify the qualifications of oral health care professionals leaving it instead to individual states

21. HSPPS: Oral Health 1302.42 Child Health Status and Care
Now includes the language “…dental periodicity schedule as prescribed by the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program of the Medicaid agency of the state in which they operate” (REVISED)
Rationale
Needed more clarity to ensure that being “up to date” on health care services included oral health care services
This now clarifies that programs must determine whether the child is up-to-date on both medical health and oral health care

22. HSPPS: Oral Health 1302.42 Child Health Status and Care
Key points regarding the revised reference to the “dental periodicity schedule”:
Not every state Medicaid program has a specific “dental periodicity schedule”
While all states are required to submit “dental periodicity schedules” to the Centers for Medicare and Medicaid Services (CMS), not all have done so to-date

23. EPSDT Dental Periodicity Schedules References
EPSDT Dental Periodicity Schedules References
American Academy of Pediatric Dentistry (AAPD)
States with EPSDT Dental Periodicity Schedules
y_schedules/
Hom JM, Lee JY, Silverman J, Casamassimo PS. State Medicaid Early and Periodic Screening, Diagnosis, and Treatment guidelines: adherence to professionally recommended best oral health practices. J Am Dent Assoc; 2013 Mar 144(3):
Discussion of EPSDT Dental Periodicity Schedules
I am not sure I did justice to explaining EPSDT and the implications for 1) states that do not have yet dental periodicity schedules; 2) states that use different resources and guidelines to determine their dental schedule. It is really a topic that we could devote its own session to. But to drill this down to a few simple statements, you will need to 1) refer to a state’s Medicaid program to determine what source is used for their EPSDT periodicity schedule, whether they have a dental periodicity schedule or not; and essentially what it covers and at what age does it provide these services. And 2) be familiar with a state’s dental practice act, which I am sure most of you are, to determine the extent to what a dental hygienist can do by law in a Head Start program’s compliance with EPSDT.
But let me say this about the latter point – and something I have said ever since I got involved with Head Start – regardless of whether a dental hygienist can legally do an exam and bill for it, there is so much dental hygienists can still do for HS programs. Of course, provide needed anticipatory guidance and preventive services but even doing a simple assessment that, depending on your state, may not count toward a program’s PIR can still go so far in giving the HS program an idea of how many children and who are at high risk for oral disease. And of course, you as our Dental Hygienist Liaisons on a more global scale do so much, through your knowledge, experience and local contacts, in helping HS kids find dental homes.

24. Additional Key Points Regarding State EPSDT Schedules:
State Medicaid programs use different sources to determine their EPSDT schedules (e.g., AAP’s “Bright Futures”, AAPD Guidelines, other)
Refer to individual state’s Medicaid program for the source
The EPSDT periodicity schedule impacts the following oral health services/actions, among others:
Oral health risk assessment/screening by health care professional
Clinical oral examination by an oral health care professional
Referral to a dental home
Prevention services such as prophylaxis and fluoride treatment
Anticipatory guidance
State EPSDT schedules still depend on state dental practice acts regardless of the existence of a state dental periodicity schedule or from where it is derived

25. HSPPS: Oral Health 1302.42(a) Child Health Status and Care
Ongoing care
“Program must facilitate and monitor necessary oral health preventive care, treatment and follow-up, including topical fluoride treatments. In communities where there is a lack of adequate fluoride available through the water supply and for every child with moderate to severe tooth decay, a program must also facilitate fluoride supplements and other necessary preventive measures, and further oral health treatment as recommended by the oral health professional” (REVISED)
Rationale
Programs must provide preventive oral health care for all children including, access to topical fluoride treatments (in areas with and without fluoridated water systems) and, as indicated, where there is a lack of a fluoridated water system, facilitate the provision of fluoride supplements

26. Sections of Importance for Oral Health 1302.43 Oral Health Practices
Promote effective oral health hygiene with daily tooth brushing
More direct/clear from previous instruction where we said that staff must promote effective dental hygiene among children in conjunction with meals

27. Sections of Importance for Oral Health 1302.43 Oral Health Practices
The title of this section has been changed from “toothbrushing” to “oral health practices” (REVISED)
Rationale
Better reflects the connection between toothbrushing and overall oral health status
Titling a section as “toothbrushing” was too limiting and tended to undermine the importance of overall evidenced-based oral health practice
Clarifies the requirement that all children with teeth have their teeth brushed at least once per day with toothpaste that contains fluoride to better reflect scientific evidence

28. Sections of Importance for Oral Health 1302.44 Nutrition
A program must:
Serve 3 to 5 year-olds meals and snacks that conform to USDA requirements
Meals and snacks must be high in nutrients and low in fat, sugar, and salt
Ensure bottle-fed infants are never laid down to sleep with a bottle
Make safe drinking water available to children during the program day

29. Sections of Importance for Oral Health: 1302.44 Nutrition
A new requirement to “make safe drinking water available to children during the program day” was added
Rationale
An indirect revision relevant to oral health
While not specifically mentioned since Head Start programs already comply with Child and Adult Food Care Program guidelines, consuming safe drinking water during the day may make children less likely to consume large amounts of sugar-sweetened beverages

30. Sections of Importance for Oral Health: 1302.47 Safety
All staff systematically and routinely implement hygiene practices that at a minimum ensure exposure to blood and body fluids are handled consistent with standards of the Occupational Safety Health Administration

31. Sections of Importance for Oral Health 1302.47 Safety
Language changed in hygiene practices from “spills of bodily fluids” to “exposure to blood and bodily fluids”
Rationale
An indirect revision relative to oral health given oral disease prevention practice is a component of “hygiene practices”
Language more aligned with language used by OSHA, CDC, and other agencies that address infection control for employees and patients

32. What is the Head Start Program Information Report?
The PIR provides comprehensive data on the services, staff, children, and families served by Early Head Start/Head Start programs nationwide
All grantees and delegates are required to submit PIR reports to the Office of Head Start annually
Self-reported data
PIR data are compiled for use at the federal, regional, state, and local levels
eclkc.ohs.acf.hhs.gov/hslc/mr/pir

33. What is the Impact of the HSPPS Changes on the PIR?
There are NO changes on the PIR
Unlike the Program Performance Standards, PIR is NOT federal law/regulations
New monitoring guidelines will be forthcoming
eclkc.ohs.acf.hhs.gov/hslc/data/pir/ pdf/ hs-pir-form.pdf

34. Current PIR Oral Health Requirements
PIR #C.17 The number of children with continuous, accessible dental care provided by a dentist:
# at enrollment
# at the end of enrollment year
Dental home (as defined in the PIR):
An ongoing source of continuous, accessible dental care provided by a dentist
PIR #C.18 The number of children who received preventive care since last year’s PIR was reported:
Preventive care (as defined in the PIR):
Includes fluoride application, cleaning, sealant application, etc.

35. Current PIR Oral Health Requirements
PIR #C.19: The number of children…who have completed a professional dental exam since last year’s PIR was reported:
# at the end of enrollment year
Professional dental exam (as defined in the Program Performance Standards)
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

36. Current PIR Oral Health Requirements
PIR #C.19.a.: Of the number of children in C.19, the number of children diagnosed as needing dental treatment since last year’s PIR was reported; and, of these children the number who received or are receiving dental treatment:
# at the end of enrollment year
Dental treatment (as defined by PIR)
Includes restoration, pulp therapy, or extraction
Does not include fluoride application or cleaning

37. Current Early Head Start PIR Oral Health Requirements
Infant & toddlers
PIR #C.20: Number of all children who are up-to-date on a schedule of age-appropriate preventive and primary oral health care according to the relevant state’s EPSDT schedule
at the end of the enrollment year
Pregnant women
PIR #C.21: Number of all pregnant women who received a professional dental examination(s) and/or treatment since last year’s PIR was reported
# of pregnant women

38. Important Reminders for DHLs
Quarterly reports
Thanks to all the DHLs that completed their quarterly reports in October!
It is very important that we receive reports from all DHLs each quarter. The deadlines are:
January 7 (Quarter 1)
April 7 (Quarter 2)
July 7 (Quarter 3)
October 7 (Quarter 4)

39. Important Reminders for DHLs (con’t)
New DHL orientation PPT now available!
Posted on the DHL webpage right under the DHL contact list
Good review for even “seasoned” DHLs
Make sure to read the notes section on each slide
If you have any questions, please ask your RDHL or Michelle Landrum

40. Presenters’ Contact Information
Marco Beltran:
Harry Goodman:
Michelle Landrum:

41. National Center on Early Childhood Health and Wellness
Toll-Free: (866)
Website:

42. Questions?
Please click on the icon at the top of your screen that looks like a person with their hand in the air. The moderator will recognize and “un-mute” you so you can ask your question.