ERIC ED493429: Physically Healthy and Ready to Learn. Technical Assistance Paper No. 1

2006·0.58 MB·English

by  ERIC

Physically Healthy
and Ready to Learn
National Head Start Training and Technical
Assistance Resource Center
Technical Assistance Paper No. 1
U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES
Administration for Children and Families
Administration on Children, Youth and Families
® Head Start Bureau
Physically Healthy and Ready to Learn
Technical Assistance Paper No.1
This document was developed by the National Head Start Training and Technical Assistance Resource
Center (HSNRC) at Pal-Tech, Inc. in collaboration with the Head Start Bureau. The contents of this paper
are not intended to be an interpretation of policy.
Developed for the Head Start Bureau by the National Head Start Training and Technical Assistance
Resource Center at Pal-Tech, Inc., under contract No. 233-02-0002.
Cover photos:(top) Photo by T. Summers. Mooresville Family Resource Center and (bottom) photo by J. Brough Schamp. SECO HS.
Technical Assistance Paper No. 1
Physically Healthy and
Ready to Learn
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TABLE OF CONTENTS
Introduction ......................................................................................................................................3
An Ounce of Prevention: Building a Healthy Foundation for Learning............................5
Making a Determination About Current Health Status......................................................................5
Let’s Take a Peek: Screening for Developmental, Sensory, and Behavioral Concerns..........................6
Keeping Kids Healthy: Ongoing Care........................................................................................8
Establishing Staff and Parent Communication ........................................................................8
Promoting Child Health and Safety............................................................................................9
Emergencies ......................................................................................................................................10
Injury Prevention ..............................................................................................................................10
Child Abuse and Neglect ..................................................................................................................11
First Aid Kits ....................................................................................................................................13
Short-Term Exclusion and Admittance: Communicable Diseases......................................................14
Wash Your Hands: Hygiene Procedures............................................................................................15
Administration, Handling, and Storage of Medication......................................................................16
Providing Nutrition Services ........................................................................................................17
Family Meal Service ........................................................................................................................17
Child and Adult Care Food Program................................................................................................18
Food Safety and Sanitation ..............................................................................................................18
Nutrition Assessment........................................................................................................................18
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Individualizing Health and Education Services........................................................................19
Involving Parents: It’s a Process!..................................................................................................19
Family Partnership Agreement............................................................................................................19
Building Community Partnerships ..............................................................................................20
The Health Services Advisory Committee ..........................................................................................20
Establishing Health Systems..........................................................................................................21
Planning..............................................................................................................................................21
Community Assessment......................................................................................................................21
Record Keeping..................................................................................................................................23
Reporting Systems..............................................................................................................................24
Special Issues ....................................................................................................................................24
Establishing a Medical Home and Dental Home................................................................................24
Oral Health........................................................................................................................................25
Obesity and Physical Activity ............................................................................................................26
Let’s Celebrate Diversity! Cultural Competence in Health..................................................................28
Conclusion ........................................................................................................................................30
References ..........................................................................................................................................31
Head Start Resources......................................................................................................................33
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Technical Assistance Paper No. 1
Physically Healthy and
Ready to Learn
Technical Assistance Paper No. 1
INTRODUCTION
Alejandro Gutierrez and his family recently immigrated to the United States from a small village
in Mexico to a densely populated urban community. The family does not speak English, nor do
they have access to close friends or family who can serve as translators. Alejandro and his family
share an apartment with another immigrant family. One of the adults in the home is a smoker,
which is a new experience for Alejandro and his family. Prior to moving, Alejandro seemed
healthy, but his mother has begun noticing that his breathing is accompanied by a stuffy and
runny nose, coughing, sneezing, and restless sleep. Alejandro’s mother is hesitant to visit a doctor
because of the language barrier. She tries a few traditional home remedies to make her son
comfortable, but his difficulty breathing is persistent.
When Alejandro’s mother finds out about the local Head Start program, she enrolls him. The
health staff immediately suspect his breathing troubles as possible early signs of asthma. They
refer Alejandro’s parents to a local community clinic that provides services to Spanish-speaking
immigrants. The doctor at the clinic diagnoses Alejandro with asthma and prescribes the medicine
he needs for his breathing problem. After Alejandro’s visit to the clinic, his mother notices
immediate improvement in his breathing and sleeping. He seems his usual self again.
Left untreated, Alejandro’s condition would have worsened, possibly leading to costly emergency services.
And saddled with his condition, his overall development might have been impaired. But now that he is
healthy again, Alejandro can get back to learning and growing. Children must be physically healthy to
learn and Head Start helps make that happen. The comprehensive health services provided by Head Start
identify urgent health needs, as in the case of Alejandro Gutierrez, and ensure follow-up treatment as well
as ongoing well-child care.
Head Start’s overall mission is to help children from low-income families start school ready to learn. To
be ready to learn, young children need to be healthy. But, what is meant by health? The World Health
Organization defines health as “a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity” (Preamble to the Constitution of the World Health Organization as
adopted by the International Health Conference, 1946). The Head Start Program Performance Standards,
which all programs are required to implement, support and promote this holistic view of health. Head
Start’s commitment to wellness embraces a comprehensive vision of health as the foundation for cognitive,
social, and emotional development for each child.
Head Start has a long history of providing comprehensive health services to young children and their
families. Project Head Start began in 1965 as a summer program designed to break the cycle of poverty
for pre-kindergarteners by providing school readiness support. Dr. Robert Cooke, Professor and Chairman
of Pediatrics at Johns Hopkins University, was appointed by the Office of Economic Opportunity to chair
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an advisory committee to establish the framework for Project Head Start. The committee’s final report,
known as the Cooke Report (1965), recommended that a comprehensive early care and education
program promote optimal physical health, emotional and social development, cognitive development, and
a sense of responsibility, dignity, and self-worth for each child and family. These recommendations have
provided the foundation for Head Start’s comprehensive health care approach with its focus on preventive
health care and parental involvement.
This Technical Assistance Paper offers guidance to programs regarding the implementation of the Head
Start Program Performance Standards on child health and developmental services, child health and safety,
and child nutrition. The paper examines how physical health influences children’s development and how
child health and development are integrated with parent engagement, community support, and systems
planning. The paper also discusses how Head Start programs can promote a culture of healthy lifestyles in
every classroom and home so that young children will embrace lifelong healthy practices. Finally, the
paper explores specific health-related concerns of many Head Start programs, including establishing a
medical and dental home, promoting oral health, addressing obesity and physical activity, and embracing
cultural considerations in health. The paper is divided into these major sections:
(cid:122) An Ounce of Prevention: Building a Healthy Foundation for Learning
(cid:122) Keeping Kids Healthy: Ongoing Health Monitoring
(cid:122) Establishing Staff and Parent Communication
(cid:122) Promoting Child Health and Safety
(cid:122) Providing Nutrition Services
(cid:122) Individualizing Health and Education Services
(cid:122) Building Community Partnerships
(cid:122) Establishing Health Systems
(cid:122) Special Issues
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Technical Assistance Paper No. 1
AN OUNCE OF PREVENTION: (cid:122) consideration of health and safety issues
Building a Healthy Foundation for (cid:122) provision of nutrition services
(cid:122) provision of individualized health services
Learning
MAKING A DETERMINATION ABOUT CURRENT
Young children grow, change, and develop quickly.
HEALTH STATUS
Therefore, Head Start has only a brief opportunity
The Head Start Program Performance Standards
to address threats to their health and development
require that all programs collaborate with parents
and promote wellness and healthy practices. The
to determine if each child in Head Start has an
Head Start Program Performance Standards
ongoing, continuous, accessible source of health
require that programs provide comprehensive
care, also known as a medical home or dental
health services that include a medical evaluation,
home [45 CFR 1304.20(a)(1)(i-iii & iv)]. To pro-
dental examination, and a screening for
mote healthy development and to ensure optimal
developmental, sensory and behavioral concerns.
learning, every child needs a medical and dental
The Head Start Program Performance Standards
home that is available after the child leaves
also require that the comprehensive health services
Head Start. (Refer to Special Issues section for
program be individualized to address the unique
more information on a medical home and
needs of each child and family.
dental home).
Results from screenings, information from parents,
The first step to ensuring comprehensive health
and ongoing observations are used to assess the spe-
services is to collaborate with families within 90
cific health needs of children and families. These
days from the child’s date of entry into the pro-
results might also indicate the need to individualize
gram to determine if the child has access to ongo-
health services for children with disabilities. In pro-
ing health care. Review local program policy to
viding comprehensive health services, Head Start
determine the timing of entry into a Head Start
connects children with a medical and dental home
Program. If the family does not have an estab-
to provide ongoing well-child care including immu-
lished medical home for both health and dental
nizations and appropriate well-child check-ups that
services, then the grantee must assist families in
include treatment for medical, behavioral, and oral
accessing a source of health care [45 CFR
health concerns.
1304.20(a)(1)(i)]. To ensure that children receive
prompt medical and dental evaluation and/or
The Head Start Program Performance Standards
treatment, Head Start staff assist families to
mandate that Head Start staff collaborate with
obtain a source of funding for health services,
families on early identification of health and
such as Medicaid’s Early Periodic Screening,
developmental concerns [45 CFR 1304.20]. Head
Diagnostic, and Treatment program (EPSDT). If
Start health staff is required to put into action the
funds are not available to families, then Head
critical concepts of prevention and early interven-
Start funds may be used [45 CFR 1304.20(c)(5)].
tion by connecting families to a medical/dental
home and ongoing care; supporting parent involve-
EPSDT service is Medicaid’s comprehensive and
ment in health care; developing an individualized
preventive child health program for individuals
health plan; and ensuring tracking and follow-up
under the age of 21. EPSDT includes periodic
health care. Also, Head Start staff implement
health, vision, dental, and hearing screening and
other preventive measures such as proper nutrition
treatment services. Once a medical or dental
and a safe environment.
home is established, each child visits the health
care provider on a schedule of preventive and pri-
The Head Start Program Performance Standards
mary health care as required in the EPSDT perio-
require a comprehensive health program that
dicity schedules developed by each state [45 CFR
includes these components:
1304.20(a)(1)(ii)].
(cid:122) a determination of current health status Under EPSDT periodicity schedules, health and
(cid:122) screening for developmental, sensory, and dental services must be provided at intervals deter-
behavioral concerns
mined to meet reasonable standards of medical and
(cid:122) ongoing health care dental practice. If children are up-to-date on a
(cid:122) communication between staff and parents schedule of well-child care, Head Start programs
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National Head Start Training and Technical Assistance Resource Center
ensure that they continue to follow the recom- begun [45 CFR 1304.20(a)(1)(iii) & (iv)]. If a
mended schedule for well-child care [45 CFR medical home is in place, then follow-up care can
1304.20(1)(ii)(B)]. If a child is not up-to-date on be initiated without significant delay.
well-child care, then Head Start programs assist
the family in accessing health services to bring the LET’S TAKE A PEEK: SCREENING FOR
child up-to-date [45 CFR 1304.20(a)(1)(ii)(A)]. It DEVELOPMENTAL, SENSORY, AND BEHAVIORAL
is possible that children are up-to-date on well- CONCERNS
child care but do not have a continuous source of The screening process allows for early detection of
available health care. In this case, staff and parents health and developmental concerns. The Head
work together to plan strategies to ensure that the Start Program Performance Standards mandate
family acquires a continuous source of care or a that within 45 days of a child entering Head Start,
medical home. (Refer to the Special Issues section appropriate screening procedures must be conduct-
for more information on a medical home.) ed to determine if developmental skills (e.g., walk-
ing and talking), sensory abilities (hearing and
For children with observable, known, or suspected vision), and behavioral skills (social and
health or developmental problems, Head Start pro- emotional), are progressing as expected [45 CFR
grams obtain or arrange for further diagnostic test- 1304.20(a)(b)(1)]. This screening process must be
ing, examination, and treatment, which may be carried out in coordination with parents, staff, and
accessed through EPSDT programs [45 CFR community partners.
1304.20(a)(1)(iii) & (iv)]. Programs also develop
and implement a follow-up plan for any condition Head Start does not require the use of specific
identified to ensure that any needed treatment has screening instruments [45 CFR 1304.20(b)
Guidance]. However, the Head Start Program
Performance StandardsGuidance specifies that
EPSDT
screenings must be reliable, valid, and comprehen-
sive [45 CFR 1308.6(b)(3)]. Appropriate standard-
Early: Assessing a child's health early in life so
ized measures must be used whenever available.
that potential diseases and disabilities can be
Screenings should be conducted using multiple
prevented or detected in the early stages, when sources of information including information from
they can be treated most effectively; family and staff observations, child and family med-
ical history, and other information such as EPSDT
Periodic: Assessing children's health at key reports. Furthermore, screenings must be culturally
points to assure continued healthy development; sensitive to language and cultural values and must
be age-appropriate. (Refer to the Head Start Bulletin
on Screening and Assessment Issue 2001 No. 70 for
Screening: Using tests and procedures to
detailed information on screening).
determine if children screened have conditions
requiring closer medical or dental attention,
The three kinds of screenings required are:
including attention to mental health problems;
Developmental screenings. Developmental screen-
Diagnostic: Determining the nature and cause ings provide a composite picture of a child’s devel-
of conditions identified by screenings and those opmental status including physical, social, emotion-
al, and intellectual functioning. Acquisition of age-
requiring further attention; and
appropriate developmental skills depends, in part,
on a child’s health status. All children grow sequen-
Treatment: Providing services needed to con-
tially through patterned and predictable milestones,
trol, correct, or reduce physical and mental
and each child develops at his or her own rate,
health problems.
which contributes to individuality. If the initial
screening in Head Start uses a standardized meas-
Head Start, Medicaid, & CHIP: Partners for Healthy ure, a child’s developmental status can be compared
Children. A Guide for Head Start Programs. Administration
to norms for his/her age. This information can be
for Children and Families and Health Care Finance
used effectively by Head Start parents and staff to
Administration, September 1999.
determine how programs can best respond to each
child’s individual characteristics and needs.
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Technical Assistance Paper No. 1
Sensory screenings. Sensory screenings involve result of the behavioral screening, programs
vision and hearing. These screenings can often be should consult with a mental health provider to
conducted during well-child visits as specified in a address a child’s identified mental health needs [45
state’s EPSDT program or by licensed professionals CRF 1304.20(b)(2)]. Most importantly, Head Start
such as an audiologist or ophthalmologist. A staff, families and mental health providers work
state’s EPSDT periodicity schedule determines together to identify early signs of emotional and
when vision and hearing screenings are appropri- behavioral concerns. If necessary, a mental health
ate. The American Academy of Ophthalmology provider will develop an appropriate treatment
recommends that preschoolers be screened for plan for children and families.
common eye problems during their regular pedi-
atric appointments and vision testing should be Head Start programs assess the availability of men-
conducted for all children starting at around 3 tal health resources for families in need and pro-
years of age. mote successful partnerships with families/care-
givers, community support systems and local
Parents and staff work together to watch for signs resources. Head Start programs also support
of potential vision problems. Young children with family/caregiver strengths and cultural values and
vision problems usually do not squint, but they beliefs about mental health.
may cover one eye when looking at things close up
or complain about headaches. Often, children who Screenings do not determine a diagnosis or need
have difficulty learning may actually have for early intervention services. However, the
undetected vision problems. Preschoolers typically results may suggest the need for an in-depth for-
develop visually guided eye-hand-body coordina- mal evaluation by a professional [45 CFR
tion, fine motor skills, and the visual motor skills 1304.20(b) Guidance]. The formal evaluation
necessary to learn to read. more fully assesses the child’s status and deter-
mines what intervention may be needed (e.g., spe-
The goal of screening for hearing loss in cial education or related services). (Refer to the
preschoolers is to identify children whose hearing Head Start Bulletin on Screening and Assessment
loss may interfere with speech and language Issue 2001 No. 70).
development, overall health and well-being, or
future school performance. In addition, because It is important to note that programs may find it
hearing loss of preschoolers is so often associated challenging to complete all screenings within the
with middle ear disease or ear infections, it is also required 45 days. Some strategies to help facilitate
recommended that preschoolers be screened for the screening process include:
middle ear disorders. Frequent or untreated ear
infections also can lead to speech and language (cid:122) conducting pre-enrollment meetings for parents
delays. Parents and staff work in partnership to to inform them about necessary screenings and
monitor for symptoms of an ear infection such as to help them identify providers to conduct the
pulling on the ears, drainage, fever, and/or irri- screening;
tability. Some children may pass an initial hear- (cid:122) communicating with parents about the
ing screening, but still be at risk for hearing loss importance of maintaining an individual child
that is inherited, fluctuates or is progressive (gets health record to reduce duplication of services;
worse over time), or is manifested later in devel- (cid:122) establishing relationships with local health care
opment. Therefore, it is important to obtain a providers who understand and support Head
family history and to monitor children’s hearing Start’s requirements for timely screening and
status on a regular basis. assessment;
(cid:122) developing collaborations with colleges and
Behavioral screenings. Behavioral screenings universities with professional schools so that
focus on social-emotional development. Head students in nutrition, nursing, speech pathology,
Start staff and families look for signs of increasing audiology, and other allied health fields can help
self-regulation, self-help, and self-control in young with screenings; and
children as well as positive interactions with family (cid:122) empowering parents to be peer advocates for
and peers. This information on social-emotional health care services.
functioning can be incorporated into the behav-
ioral screening. When concerns are raised as a
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National Head Start Training and Technical Assistance Resource Center
Screenings are not one-time events. To ensure
In completing a daily health check, observe
positive outcomes for preschoolers served in Head
Start, it is essential to identify concerns early, keep- or learn through discussion with home
ing in mind that problems may be identified any- caregivers whether any signs of illness
time during the program year. If a child is suspect- are present such as:
ed of having a health concern after the initial
screening period has passed, a referral must be
made for a formal evaluation.
(cid:122) elevated temperature, pale or flushed coloring
(cid:122) repeated severe coughing
KEEPING KIDS HEALTHY: (cid:122) stomach ache, vomiting and/or diarrhea
(cid:122) red and/or draining eyes or ears
Ongoing Health Monitoring
(cid:122) undiagnosed skin rashes, sores, bruises,
and/or swellings
In a quality early care and education program,
ongoing assessment is the basis for individualizing (cid:122) unusual activity levels such as irritability or
fussy listless behavior
all services. That is why it is important for staff to
periodically observe, document, and record chil-
dren’s progress and to discuss with parents what In addition, staff can be alert to signs of:
they notice about their child’s development. Head
Start Program Performance Standard [45 CFR (cid:122) tooth discoloration or bleeding gums during tooth
1304.20(d)] mandates that programs implement brushing activities
procedures by which Head Start children are
(cid:122) signs of injury such as bruising or
observed throughout the day as they participate in
abnormal swelling
indoor and outdoor experiences, routines, transi-
(cid:122) abnormal emotional or behavioral patterns
tions, arrivals, and departures. These observations
different from the previous day's attendance
help staff to identify any new or recurring medical,
(i.e., timid, fearful, or aggressive behavior)
dental, or developmental concerns so that appro-
priate referrals can be made as soon as possible. (cid:122) unusual changes in eating, sleeping, and
toileting patterns
As part of ongoing health monitoring, daily health (cid:122) unusual changes in physical activity
checks of each child can be conducted at the begin- such as frequent falling
ning of each day. If a parent or guardian accompa- (cid:122) lack of response to verbal commands
nies the child to Head Start, then they can (cid:122) decreased talking
exchange information with staff and specific signs
or symptoms of illness can be identified in time to
(American Academy of Pediatrics 2002)
prevent the spread of infection. Staff are not
expected to be able to diagnose illness, but be sen-
sitive to a child’s condition. On occasion, this
health check may lead to a decision that the child is
children and staff from illness and to respond to
not well enough to attend Head Start. In those
children’s health needs.
instances, appropriate action is taken (e.g., isolate
the child from other children) until a parent can
come to take the child home or to the primary
medical provider. (Refer to page 14 for more infor- ESTABLISHING STAFF AND PARENT
mation on Short-Term Exclusion and Admittance.) COMMUNICATION
It is important that parents and staff form strong
The Head Start Program Performance Standards
partnerships in order to promote the child’s health
mandate that programs establish and implement
and to address health concerns. Strong partner-
communication systems to ensure that timely and
ships enable staff and parents to maintain an open
accurate information is provided to parents, policy
line of communication regarding the ongoing
groups, staff, and the general community [45 CFR
health status of children in order to protect all
1304.20(e)(1-5)]. A key responsibility of health
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