C. Health Services Objectives and Performance
Standards
1. Health Services General
Objectives
The general objectives of the health services component of
the Head Start program are to:
a
Provide a comprehensive health services program which Includes a broad range of
medical, dental, mental health and nutrition services to preschool children,
including handicapped children, to assist the child's physical, emotional,
cognitive and social development toward the overall goal of social
competence.
b Promote preventive
health services and early intervention.
c Provide the child's family with the
necessary skills and Insight and otherwise attempt to link the family to an
ongoing health care system to ensure that the child continues to receive
comprehensive health care even after leaving the Head Start program.
2. Health Services Advisory
Committee
The plan shall provide for the creation of a Health Services
Advisory Committee whose purpose shall be advising in the planning, operation
and evaluation of the health services program and which shall consist of Head
Start parents and health services providers in the community and other
specialists in the various health disciplines. Existing committees may be
modified or combined to carry out this function.
3. Medical and Dental History, Screening, and
Examinations
a The health services component
of the performance standards plan shall provide that for each child enrolled in
the Head Start program a complete medical, dental and developmental history
will be obtained and recorded, a thorough health screening will be given, and
medical and dental examinations will be performed. The plan will provide also
for advance parent or guardian authorization for all health services under this
subpart.
b Health screenings shall
include:
(1) Growth assessment (head
circumference up to two years old), height, weight and age.
(2) Vision testing.
(3) Hearing testing.
(4) Hemoglobin or hematocrit
determination.
(5) Based on
community health problems, other selected screenings where appropriate, e.g.,
sickle cell anemia, lead poisoning, and intestinal parasites.
(6) Assessment of current immunization
status.
(7) During the course of
health screening, procedures must be in effect for Identifying speech problems,
determining their cause, and providing services.
(8) Identification of the special needs of
handicapped children.
c
Medical examinations for children shall Include:
(1) Examination of all systems or regions
which are made suspect by the history or screening test.
(2) Search for certain defects In specific
regions common or important In this age group, i.e., skin, eye, ear, nose,
throat, heart, lungs, and groin (inguinal) area.
d The plan shall provide, also, In accordance
with local and state health regulations that employed program staff have
initial health examinations, periodic checkups, and are found to be free from
communicable disease; and, that voluntary staff be screened for
tuberculosis.
4. Medical
and Dental Treatment
a The plan shall provide
for treatment and follow-up services which Include:
(1) Obtaining or arranging for treatment of
all health problems detected. (Where funding is provided by non-Head Start
funding sources there must be written documentation that such funds are used to
the maximum feasible extent. Head Start funds may be used only when no other
source of funding Is available).
(2) Completion of all recommended
immunizations --diphtheria, pertussis, tetanus (DPT), polio, measles, German
measles. Mumps Immunization shall be provided where appropriate.
(3) Obtaining or arranging for basic dental
care services as follows:
(i) Dental
examination.
(ii) Services required
for the relief of pain or Infection.
(iii) Restoration of decayed primary and
permanent teeth.
(iv) Pulp therapy
for primary and permanent teeth as necessary.
(v) Extraction of non-restorable
teeth.
(vi) Dental prophylaxis and
instruction in self-care oral hygiene procedures.
(vii) Application of topical fluoride in
communities which lack adequate fluoride levels in the public water
supply.
b
There must be a plan of action for medical emergencies. (Indicated in OCD Head
Start Guidance Material.)
5. Medical and Dental Records
The plan shall provide for:
(a) The establishment and maintenance of
Individual health records which contain the child's medical and developmental
history, screening results, medical and dental examination date, and evaluation
of this material, and up-to-date information about treatment and
follow-up;
(b) forwarding, with
parent consent, the records to either the school or health delivery system or
both when the child leaves the program; and
(c) giving parents a summary of the record
which includes information on immunization and follow-up treatment;
and
(d) assurance that In all cases
parents will be told the nature of the data to be collected and the uses to
which the data will be put, and that the uses will be restricted to the stated
purposes.
6. Health
Education
a The plan shall provide for an
organized health education program for Program staff, parents and children
which ensures that:
(1) Parents are provided
with information about all available health resources;
(2) Parents are encouraged to become involved
In the health care process relating to their child. One or both parents should
be encouraged to accompany their child to medical and dental exams and
appointments.
(3) Staff are taught
and parents are provided the opportunity to learn the principles of preventive
health, emergency first-aid measures, and safety practices;
(4) Health education is integrated Into
ongoing classroom and other program activities.
(5) The children are familiarized with all
health services they will receive prior to the delivery of those
services.
7.
Mental Health Objectives
The objectives of the mental health part of the health
services component of the Head Start program are to:
a Assist all children participating in the
program In emotional, cognitive and social development toward the overall goal
of social competence In coordination with the education program and other
related component activities;
b
Provide handicapped children and children with special needs with the necessary
mental health services which will ensure that the child and family achieve the
full benefits of participation In the program;
c Provide staff and parents with an
understanding of child growth and development, an appreciation of individual
differences, and the need for a supportive environment;
d Provide for prevention, early
identification and early intervention In problems that interfere with a child's
development;
e Develop a positive
attitude toward mental health services and a recognition of the contribution of
psychology, medicine, social services, education and other disciplines to the
mental health program; and
f
Mobilize community resources to serve children with problems that prevent them
from coping with their environment.
8. Mental Health Services
a The mental health part of the plan shall
provide that a mental health. professional shall be available, at least on a
consultation basis, to the Head Start program and to the children. The mental
health professional shall:
(1) Assist In
planning mental health program activities;
(2) Train Head Start staff;
(3) Periodically observe children and consult
with teachers and other staff;
(4)
Advise and assist In developmental screening and assessment;
(5) Assist In providing special help for
children with atypical behavior or development, Including speech;
(6) Advise in the utilization of other
community resources and referrals;
(7) Orient parents and work with them to
achieve the objectives of the mental health program; and
(8) Take appropriate steps in conjunction
with health and education services to refer children for diagnostic examination
to determine whether their emotional or behavior problems have a physical
basis.
b The plan shall
also provide for:
(1) Attention to pertinent
medical and family history of each child so that mental health services can be
made readily available when needed;
(2) Use of existing community mental health
resources;
(3) Coordination with
the education services component to provide a program keyed to individual
developmental levels;
(4)
Confidentiality of records;
(5)
Regular group meetings of parents and program staff;
(6) Parental consent for special mental
health services;
(7) Opportunity
for parents to obtain individual assistance; and
(8) Active involvement of parents In planning
and Implementing the individual mental health needs of their
children.
9.
Nutrition Objectives
The objectives of the nutrition part of the health services
component of the Head Start program are to:
a Help provide food which will help meet the
child's daily nutritional needs in the child's home or In another clean and
pleasant environment, recognizing individual differences and cultural patterns,
and thereby promote sound physical, social, and emotional growth and
development;
b Provide an
environment for nutritional services which will support and promote the use of
the feeding situation as an opportunity for learning;
c Help staff, child and family to understand
the relationship of nutrition to health, factors which Influence food
practices, variety of ways to provide for nutritional needs and to apply this
knowledge In the development of sound food habits even after leaving the Head
Start program;
d Demonstrate the
interrelationships of nutrition to other activities of the Head Start program
and Its contribution to the overall child development goals; and
e Involve all staff, parents and other
community agencies as appropriate In meeting the child's nutritional needs so
that nutritional care provided by Head Start complements and supplements that
of the home and community.
10. Nutrition Services
a The nutrition services part of the health
services component of the performance standards plan must Identify the
nutritional needs and problems of the children In the Head Start program and
their families. In so doing, account must be taken of:
(1) The nutrition assessment data (height,
weight, hemoglobin hematocrit) obtained for each child;
(2) Information about family eating habits
and special dietary needs and feeding problems, especially of handicapped
children; and
(3) Information about
major community nutrition problems.
b The plan, designed to assist in meeting the
daily nutritional needs of the children, shall provide that:
(1) Every child In a part-day program will
receive a quantity of food In meals (preferably hot) and snacks which provides
at least 1/3 of daily nutritional needs, with consideration for meeting any
special needs of children, Including the child with a handicapping
condition;
(2) Every child In a
full-day program will receive snack(s), lunch, and other meals as appropriate
which will provide 1/2 to 2/3 of daily nutritional needs depending on the
length of the program;
(3) All
children in morning programs who have not received breakfast at the time they
arrive at the Head Start program will be served a nourishing
breakfast;
(4) The kinds of food
served conform to minimum standards for meal patterns Indicated in OCD Head
Start Guidance Material;
(5) The
quantities of food served conform to recommended amounts indicated in OCD Head
Start Guidance Materials; and
(6)
Meal and snack periods are scheduled appropriately to meet children's needs and
are posted along with menus; e.g., breakfast must be served at least 2 1/2
hours before lunch, and snacks must be served at least 1 1/2 hours before lunch
or supper.
c The plan
shall undertake to assure that the nutrition services contribute to the
development and socialization of the children by providing that:
(1) A variety of foods which broaden the
child's food experience in addition to those that consider cultural and ethnic
preferences is served;
(2) Food is
not used as punishment or reward, and that children are encouraged but not
forced to eat or taste;
(3) The
size and number of servings of food reflect consideration of Individual
children's needs;
(4) Sufficient
time Is allowed for children to eat;
(5) Chairs, tables, and eating utensils are
suitable for the size and developmental level of the children with special
consideration for meeting the needs of children with handicapping
conditions;
(6) Children and staff,
including volunteers, eat together sharing the same menu and a socializing
experience in a relaxed atmosphere; and
(7) Opportunity is provided for the
involvement of children In activities related to meal service. (For example:
family style service.)
d
The plan shall set forth an organized nutrition education program for staff,
parents, and children. This program shall assure that:
(1) Meal periods and food are planned to be
used as an integral part of the total education program;
(2) Children participate in learning
activities planned to effect the selection and enjoyment of a wide variety of
nutritious foods;
(3) Families
receive education In the selection and preparation of foods to meet family
needs, guidance in home and money management and help in consumer education so
that they can fulfill their major role and responsibility for the nutritional
health of the family;
(4) All
staff, including administrative, receive education in principles of nutrition
and their application to child development and family health, and ways to
create a good physical, social and emotional environment which supports and
promotes development of sound food habits and their role in helping the child
and family to achieve adequate nutrition.
e The plan shall make special provision for
the involvement of parents and appropriate community agencies In planning,
implementing, and evaluating the nutrition services. It shall provide that:
(1) The Policy Council or Committee and the
Health Services Advisory Committee have opportunity to review and comment on
the nutrition services;
(2) The
nutritional status of the children will be discussed with their
parents;
(3) Information about
menus and nutrition activities will be shared regularly with parents;
(4) Parents are informed of the benefits of
food assistance programs; and
(5)
Community agencies are enlisted to assist eligible families participate In food
assistance programs.
f
The plan shall provide for compliance with applicable local, State, and Federal
sanitation laws and regulations for food service operations including standards
for storage, preparation and service of food, and health of food handlers, and
for posting of evidence of such compliance. The plan shall provide, also, that
vendors and caterers supplying food and beverages comply with similar
applicable laws and regulations.
g
The plan shall provide for direction of the nutrition services by a qualified,
full-time staff nutritionist or for periodic and regularly scheduled
supervision by a qualified nutritionist or dietitian as defined In the Head
Start Guidance Material. Also, the plan shall provide that all nutrition
services staff will receive pre-service and in-service training as necessary to
demonstrate and maintain proficiency in menu planning, food purchasing, food
preparation and storage, and sanitation and personal hygiene.
h The plan shall provide for the
establishment and maintenance of records covering the nutrition services
budget, expenditures for food, menus utilized, numbers and types of meals
served daily with separate recordings for children and adults, inspection
reports made by health authorities, recipes and any other information deemed
necessary for efficient operation.