HEAD START®

Well-Child Health Care: Making It Happen

Training Guides for the Head Start Learning Community

Table of Contents | Preface | Introduction | Module 1 | Module 2 | Module 3
| Continuing Professional Development | Resources

MODULE 1: why is well-child health care and why is it important?

Outcomes | Key Concepts | Background Information | Activity 1 | Key to Activity 1 | Activity 2 | Activity 3 | Activity 4 | Activity 5 | Activity 6 | Activity 7 | Next Steps
download these pdf attachments: Handout A | Handout B | Handout C | Handout D-1 | Handout D-2 | Game Board for Activity 3 | Question & Answer Key

Well-Child Health Care: Making It Happen...

The challenge: Coordinating over 10 service agencies that spread over six countries and serve the Fort Berthold Reservation. The solution: Communication, cooperation, and an enrollment form that permits sharing of information between all the services.

Outcomes

After completing this module, participants will:

• be able to explain the importance of well-child health care to other staff, parents, and community members;
  
  
• understand the concept and benefits of a "medical home" and work in partnership with parents to link their families to a "medical home;" and
  
  
• gain skills in reviewing health records for completeness, following up on identified needs, and discussing results in records with parents.

Key Concepts

The cornerstone of well-child health care is establishing a partnership between children and families and a "medical home." The "medical home" provides an ongoing source of continuous accessible medical care.

Well-child health care consists of providing the child with regularly scheduled check-ups with a health care provider. It includes the following:

• Health history of the child
  
  
• Screening tests to identify health conditions that might need further assessment or treatment
  
  
• Examination of the child
  
  
• Treatments to prevent disease
  
  
• Education and counseling to promote health

Well-child health care helps to keep children healthy. The earlier a child's health needs are identified and met, the better it is for the child and family.

It is important to read and understand each child's complete health record since existing health problems are interrelated with screening and exam results. All results and follow-up should then be clearly explained to parents.

Background Information

A. Well-Child Health Care—What It Is and Why It's Important

The cornerstone of well-child health care is a partnership of children and families with a system of health care that ensures families have a continuous, ongoing source of accessible medical care. This source of health care is termed the "medical home." The health care provider might be a physician, nurse practitioner, or traditional healer; the "medical home" might be located in an office, clinic, or other setting. The health care provider works in a collaborative partnership with the parents and Head Start staff. She or he gets to know the family and coordinates the child's health care during healthy times, illnesses, injuries, and other health conditions. Through linkage to a medical home, a child can be put on a program of regularly scheduled immunizations and early and periodic screenings. The medical home is important for all children, especially for those with health problems. The relationship between families and the medical home will hopefully continue after the child leaves Head Start.

Well-child health care begins before the child is born by helping pregnant women access comprehensive prenatal care. Prenatal care can prevent low birth weights, premature labor, birth defects such as spina bifida and other neural tube defects, and increase the chances of a healthy baby for HIV-positive women. Prenatal education helps women make healthy choices for themselves and their babies regarding smoking, diet and exercise. At birth, health experts recommend that children begin regular examinations, screenings and immunizations. Since the first few years of life are critical for a child's health and development, early and frequent visits to the medical home are crucial. (See Appendix A: Recommendations for Well-Child Health Care.)

When health conditions are identified and treated early, the impact of many disabilities can be reduced. For example, lead poisoning can cause serious medical, behavioral, and learning problems in children. When lead screening identifies a child with lead poisoning, prompt intervention—removing the source of lead, educating the family, and getting medical therapy—can lessen the harmful effects of lead poisoning on the child. It may also help prevent poisoning of other family and community members.

B. The Components of Well-Child Health Care

Health History

A brief summary of the child's health history is made from discussion with the parents and review of medical records. It addresses the health of the child within the context of the family. It covers pregnancy and delivery, illnesses, hospitalizations, chronic health conditions, allergies, and the child's physical, emotional, and social development. It also includes a family history of health problems and a description of the child's home environment. The health history highlights any special concerns about the child.

The health history should include a list of the child's primary health care provider, specialists, and other services that the child and family receive, such as a developmental center or Children's Protective Services.

Documentation

Health records are essential for evaluating children's health needs and developing plans for intervention and follow-up. They are also important for communicating with families, health care professionals, and teachers/caregivers. Health records must be:

- Accurate: Observations and screening and exam results should be carefully documented in objective terms. Vague terms and judgments should be avoided. For example, instead of stating "Jimmie's behavior has been very bad since he started school," it would be better to state, "Jimmie has gotten into fights with his classmates three or four times a week. He frequently screams, punches, and bites."

- Complete: Results must be documented for all of the required screenings and exams. All "abnormal" screening and exam results must be followed up by further assessment and treatment, when needed. When children have specific health problems, it is important to get records of previous evaluations, diagnoses, and treatments. Ongoing consultation with the family and health care providers should also be carefully documented.

- Confidential: Children and families have a right to have their health records kept confidential. Information should not be shared with other parents. Only staff who need to know the information should have access to the family's health records.

- Shared Appropriately: The information can and should be shared with anyone who needs to know in order to care for the child, but only with the consent of the parent(s) or legal guardian. Key family members, health care providers, and staff need to be involved in family conferences to develop plans for intervention and follow-up to meet the child's needs. When the child changes programs or goes to kindergarten, the records should be forwarded, with the consent of the parent(s), in a complete, organized and confidential manner.

For specific follow-up for screenings and exams, see Appendix B: Well-Child Health Care Fact Sheets.

Screening

Screenings are standardized, often quick, procedures to identify health conditions that might need further assessment and treatment.

Screening procedures include gathering information from the family, observing the child's behavior and skills, and doing certain tests. They include both objective, standardized procedures (e.g., developmental tests), and subjective observations (e.g., "Tina seems to have difficulty with fine motor tasks").

While Head Start requires screenings be completed within certain time limits after enrollment, screening also includes daily observations of children's appearance, behavior, and skills throughout the year. It is important for Head Start staff to be able to read and understand each child's health record since existing health problems can be related to screening results. Head Start should not duplicate services that have been conducted by other health professionals. Instead, Head Start works in partnerships with health care professionals to make sure children are receiving needed health services.

The trained professionals at the child's medical home will do some screening (e.g., hematocrit, tuberculosis, hereditary/metabolic, lead, and intestinal parasite screening). Other screenings may be done by Head Start staff, parents, or volunteers who are properly trained in the procedures (e.g., growth, vision, hearing, nutritional assessment).

Within 45 days of enrollment, the Head Start staff will screen to identify developmental, sensory, and behavioral concerns. Many screenings can be completed in the classroom or in the family's home where the child is most comfortable.

The child's screening results are assessed according to the "typical" or "normal" range among children that age. "Atypical" or "abnormal" screening results mean that the child may have a special health need. The child needs further evaluation by a health professional to determine if he has a specific condition or diagnosis and what treatment or services might help.

A relationship with the medical home will offer consistency of care. Diagnosis, treatment and follow-up can be closely followed.

Examinations

Examinations are in-depth physical assessments of the child, such as the medical/physical exam and the dental exam. Licensed health care professionals, such as a physician, nurse practitioner, or physician's assistant perform the medical exam; a dentist performs the dental examination. Professional standards require specific procedures and equipment. Staff work with parents and mental health professionals to address concerns over a child's mental health.

Preventive Treatments

Public health research has shown that certain preventive treatments can reduce health problems among children. For example, immunizations can prevent many serious diseases such as polio and measles, and dental fluoride can help prevent dental cavities. The medical home will provide the child with regularly scheduled immunizations following the Centers for Disease Control and Prevention (CDC) guidelines.

Education and Counseling

Working in partnership, health care providers and parents discuss many issues to promote the health of the child. They review the results of the screenings and exams, and discuss what further assessment and treatment may be needed. Parents are given guidance about the child's development, nutrition, dental care, and preventing illnesses and injuries. The parents' concerns are addressed and support is provided.

C. Head Start Responsibilities

The Head Start program works in partnership with parents and health care providers to ensure that every child entering Head Start is assisted with:

• Identifying and accessing health care providers
  
  
• Linking to a medical home: a source of ongoing and continuous health care
  
  
• Receiving recommended screenings, examinations, and immunizations within specific time frames
  
  
• Receiving follow-up evaluation, diagnosis, and treatment of health conditions that are identified
  
  

Head Start programs also provide the following:

• Assistance to pregnant women in accessing comprehensive prenatal care, childbirth services and postpartum care
  
  
• Health education for children and parents
  
  

Head Start services complement the services provided by other practitioners. Head Start programs do not duplicate services already given unless there is an explicit need to do so.

(See Appendix B: Well-Child Health Care Fact Sheets.)

Questions for Discussion/Reflection

Preventive health care is not only important for children—it is also very important for adults. Thinking about your own health care practices can give you a greater understanding of some of the challenges Head Start families may face:

• Do you have a "medical home" or a consistent health care provider?
  
  
• Do you see your health care provider only when you are sick or also on a regular basis when you are well? Do you put off seeing your provider because you are anxious about what he or she may find?
  
  
• Have you gotten the screenings and exams (e.g., blood pressure, breast exam, PAP smear, blood cholesterol level, eye exam, dental exam, tuberculosis test) and the immunizations that you need?

Activity 1: What If There Were No Well-Child Health Care?

Purpose: This activity helps participants appreciate the importance of the many elements of well-child health care for Head Start. They will identify which elements are missing in this classroom. These may include screenings, accessibility to providers, education, or advocacy. This activity is especially helpful for teachers, aides, and other staff members involved in the classroom.

For this activity you will need:

• Key to Activity 1: What If There Were No Well-Child Health Care? (For Trainer Only)
  
  
• Flip chart and markers

Step 1: Ask participants to get into a comfortable position and close their eyes. Tell them that you are taking them on a guided tour of a new Head Start program where there might be something wrong.

Step 2: Read aloud, slowly and with expression, the following story:

"It's the middle of the morning, five months after enrollment of students, and we're going to visit a new Head Start center. The entire facility and grounds are beautifully designed. As you enter the building, you notice a clean and inviting lobby. There is a bulletin board with notices about field trips and children's art.

You walk into the classroom and see cubbies for 20 children, but only a dozen children are in class today. The teacher says, `This is a typical day. Our children miss a lot of school, but we try our best to keep the program going. We're having a mini-epidemic of measles right now, but I don't know who has and hasn't been immunized! Miguel's cubby is empty all the time. His parents have a hard time keeping him out of the hospital now that he has asthma. An overdose of medication sent him to the ER just last week. He wheezes a lot when he plays here too.'

You watch the teacher comfort a child who is crying because his mouth hurts. You cannot miss the blackened front teeth, but the teacher explains that there are no pediatric dentists taking Head Start students. Several children are standing by the kitchen area waiting. The aide explains that these children have had breakfast and are waiting for lunch. She says, `They never seem to get enough nutritious food over the weekend.' There are two children in the bathroom with a `tummy-ache'—their diarrhea and cramps have lasted for weeks off and on.

A pregnant mother drops her child off late, explaining she gets severe morning sickness after her job of cleaning floors with strong chemicals all night. She asks the teacher's aide if he knows of any doctors who might see her before the baby is born. The greeter politely explains, `I have no idea, the last obstetrician left the neighborhood two years ago.'

A little three-year-old girl approaches saying `mama mama'. The teacher says she missed a month of school with meningitis and doesn't know if she might have problems with hearing, vision or speech, or maybe a developmental delay.

The teacher rings a bell and starts calling the children over for circle time. In the circle area, two children are lying down looking pale and lethargic, others are fighting and biting each other. One boy will not leave the corner where he has been rocking back and forth all morning. The teacher and the aide decide to postpone circle time to take care of the children's other, more urgent needs."

Step 3: Ask the participants to open their eyes. Ask them:

• What elements of well-child health care are missing from this Head Start program?
  
  
• How did you feel in that classroom? How did the children feel? How did the teachers feel?

Step 4: Divide a flip chart paper into two columns. Label the left column "Health Concerns" and the right "Health Services Needed" (see Key to Activity 1: What If There Were No Well-Child Health Care?).

• Ask participants to list the health care concern that they observed in the classroom (e.g., tooth pain, pregnant mother).
  
  Do not list possible diagnoses (e.g., anemia or intestinal parasites). Diagnoses are made only by health care providers.
  
  
• Ask participants to list the elements of well-child health care services needed that might address each health concern.

Points to Consider:

Without the many aspects of well-child health care:

• children could experience numerous health, developmental and emotional problems, pain, and confusion.
  
  
• teachers would not know what the children's needs were or how to address them.

Trainer's Note:

For more information on mental health, see the guide Promoting Mental Health in the Health series of Training Guides for the Head Start Learning Community.

Key to Activity 1: What If There Were No Well-Child Health Care?
(For Trainer Only)

Health Concern	Health Services Needed
Many Absent Children	All Well-Child Health Care
Tooth Pain	Dental Screening and Examination Medical/Physical Examination Nutrition Assessment Advocacy for Dental Care Preventive Dental Education
Hunger	Nutrition Assessment Family Needs Assessment Medical/Physical Examination Growth Assessment Anemia Screening (hemoglobin/hematocrit)
Pale, Tired	Medical/Physical Examination Nutrition Assessment Growth Assessment Anemia Screening (hemoglobin/hematocrit) Lead Screening Intestinal Parasite Screening Tuberculin Testing
Fighting, Biting	Developmental Screening/Mental Health Assessment Soliciting Parental Information about Child's Mental Health
Measles Epidemic	Reviewing Records Timely Determination of Health Status Immunizations Tracking
Child with Asthma	Individualizing Program Parent Education regarding Asthma and Medication
Pregnant Mother	Prenatal Care and Education Staff keeping abreast of Community Services Medical Home
Stomach Cramps, Diarrhea	Medical/Physical Examination Intestinal Parasite Screening Nutrition Assessment
Saying "mama mama"	Medical/Physical Examination Hearing Testing Speech and Language Screening Vision Testing Developmental Screening/Mental Health Assessment Immunizations Ongoing Observations
Child Rocking in Corner	Ongoing Observation Soliciting Parental Information about Child's Mental Health Screening for Behavioral Concerns Mental Health Counseling

Activity 2: What, Why, and How of Screenings and Exams

Purpose: This activity allows participants to practice explaining specific screening and exam procedures to a parent or co-worker. It is especially helpful for staff that has direct contact with parents, including family service workers, health aides, and teachers.

For this activity you will need:

• Appendix B: Well-Child Health Care Fact Sheets
  Provide copies for all participants.

Step 1: This exercise allows you to practice explaining to parents or co-workers the "what, why, and how" of different screening procedures.

Step 2: If you are in pairs: One person will begin as the "teacher" and the other the "learner." The teacher will explain two different screening exams to the learner.

If you have a group of three: The third person will be the "observer." The observer will provide feedback to the role-players.

Everyone will have the chance to play every role.

Step 3: Identify the role that you will begin in. Take a few minutes to "get into" your role.

• For the teacher: You want to help the learner develop a firm understanding of the screening or exam—what it is, why it is important, and how it is done.
  
  
• For the learner: Make this activity a challenge for yourself and the teacher. Take the role of a learner who is not familiar with the screening or may have some reservations or concerns about it.
  
  
• For the observer: Pay careful attention to the communication between the teacher and learner. Note what worked and what didn't work.

Step 4: Take a few minutes to briefly review with participants Appendix B: Well-Child Health Care Fact Sheets after distributing it.

For the teacher: Choose one screening or exam that you feel comfortable explaining and then another that is more challenging for you to explain.

Take up to 10 minutes for the role-play.

Step 5: Change roles and repeat Step 4. Repeat the role-play, explaining two other screenings or exams.

Make sure that everyone has a chance to play every role.

Step 6: Discuss the role-plays:

• In the role of the learner:
  
  
  • Did you understand and feel comfortable with the explanations of the procedures?
    
    
  • Did the "teacher" use words that were too technical?
    
    
  • If there was something that you didn't understand, did you feel comfortable asking questions?
    
    
  • How do your feelings reflect how parents may feel about screenings and exams?
    
    
• In the role of the teacher:
  
  
  • Did you feel comfortable explaining the procedures?
    
    
  • Did you feel adequately prepared?
    
    
  • If you did not know something, did you feel comfortable acknowledging that?
    
    
  • In the future, how might you want to prepare better for explaining screenings and exams to other co-workers and parents?
    
    
• In the role of observer:
  
  
  • What did you notice was difficult in the communication?
    
    
  • What were some effective techniques that were used?

Points to Consider:

• Make sure that you review and understand the information before you try to explain it to someone else.
  
  
• Share the information that the other person wants to know and needs to know. Build on what he or she already knows.
  
  
• Make the explanation clear, simple, and brief. Try not to use highly technical terms.
  
  
• Continually ask and observe whether the person has any questions or concerns. Respond to these concerns directly.
  
  
• Recognize your own limitations. If you do not know the answer, say, "I don't know, but I will try to find out." Then follow-up with the information later.

Well-Child Health Care: Making It Happen...

Sharing information: Because they work in collaboration, the Health Coordinators from ABCD Head Start in Boston go directly out to the network of public health clinics and inform the staff exactly what medical information is needed for children, reducing misinformation and phone calls.

Activity 3: The Well-Child Health Care Fact Game

Purpose: This activity familiarizes participants with the common components of well-child health care required for Head Start. It is helpful for staff from different areas of Head Start.

For this activity you will need:

• Flip chart paper
  
  
• Paper and pens or pencils
  
  
• Game board
  
  
• Question & Answer Key (For Trainer Only)
  
  
• Prizes (e.g., stars, healthy snacks, pencils, etc.)
  
  
• Overhead projector and transparency (Optional)
  
  
• Stopwatch or Timer

Trainer Preparation Note:

Prepare the game board on a large piece of cardboard, flip chart paper, or overhead transparency.

Step 1: Explain that participants will play a team game with questions and answers about well-child health care and screening.

Step 2: Explain that the game will focus on the common components of well-child health care for Head Start.

Step 3: Divide participants into teams of four to six members. Ask each team to name itself. Write the teams' names on flip chart paper and post it as a scorecard.

Step 4: Display the Game Board, explaining the following rules:

• Teams will answer questions under four categories:
  
  
  • What It Is
    
    
  • Why You Do It
    
    
  • What You Might Observe
    
    
  • How You Do It
    
    
• Each category has questions that increase in value and difficulty, from $100, $200, $300, $400, to $500.
  
  
• Teams have 30 seconds to discuss the question and formulate their answer. When the time is up, the team that selected the question gives its answer. If the team has no answer or gives an incorrect answer, the next team gets the chance to answer.
  
  
• The team with the correct answer wins the dollar value for the question. No points are deducted for incorrect answers.

Step 5: Ask the first team to start by selecting a category and dollar value. Cross out the selection on the Game Board. Using the Question and Answer Key, read the question aloud.

Step 6: Follow your watch, set a timer, or play a musical tape for 30 seconds while the teams discuss their responses.

Step 7: Ask the team that selected the category for its answer. Proceed to the next team(s) until the correct answer is stated. Add the dollar value to the score of the team that answers correctly. If no team states the correct answer, read the answer aloud.

Step 8: Ask the next team to select the category and dollar value for the next question.

Continue playing the game as in Steps 5 to 7 until all the questions have been asked.

Step 9: At the end of the game, add up each team's money. The team(s) with the most money wins. You may give the winners a prize.

Points to Consider:

• It is helpful for staff to be familiar with the facts about well-child health care and screening. However, it is most important to be aware of what you do and don't know and where you can get the information that you need.
  
  
• Your key resources for health information are written materials and health professionals. Since health information advances rapidly, written material may become out-of-date. Programs need reliable health consultants to keep them informed about new information and to update the program's written materials (e.g., fact sheets) every year.

Well-Child Health Care: Making It Happen...

The Head Start in Vail, Colorado the Rotary Club, and the Eagle Valley Family Center are working in collaboration to set up a "dental committee" that will work with local dentists to set up and community wide system of indigent dental care.

Game Board for Activity 3 - download pdf version (PDF/14 KB)

The Well-Child Health Care Fact Game
What It Is	Why You Do It	What You Might Observe	How You Do It
$100	$100	$100	$100
$200	$200	$200	$200
$300	$300	$300	$300
$400	$400	$400	$400
$500	$500	$500	$500

Question & Answer Key for The Well-Child Health Care Fact Game - download pdf version (PDF/14 KB)

(For Trainer Only)

What It Is:
$100	Q: Which screening measures height, weight, and head circumference? A: Growth Assessment
$200	Q: What condition can be caused by low iron in the diet, lead poisoning, sickle cell disease, and other blood disorders? A: Anemia
$300	Q: Which screening checks understanding, thinking, communication, social skills, physical coordination, and self-help skills? A: Developmental Screening
$400	Q: Name ten diseases for which immunizations protect children. A: Chicken pox, polio, diphtheria, pertussis, tetanus, measles, mumps, rubella, hemophilus influenza B (HIB), and hepatitis B
$500	Q: Which screening checks for a problem that is rare in children which could lead to heart disease and stroke? A: Blood Pressure Screening
Why You Do It:
$100	Q: Which exam helps prevent tooth decay, pain, and tooth loss? A: Dental Screening and Examination
$200	Q: Which procedure helps identify and treat health problems, and provides families with guidance on child health and development? A: Medical/Physical Examination
$300	Q: Which screening can lead to antibiotic treatment to prevent severe pneumonia, weight loss, meningitis, bone disease, and death? A: Tuberculin Testing
$400	Q: What three problems can growth assessment identify? A: "Failure to thrive," obesity, and disproportionately large or small head growth
$500	Q: Which three screenings aim to prevent difficulties in communication, behavior, and relationships? A: Hearing, speech and language, and developmental/mental health assessment
What You Might Observe:
$100	Q: What might cause mild symptoms, such as pain at the injection site or fever, although the benefits are far greater than the risks? A: Immunizations
$200	Q: What condition might cause stomach cramps, diarrhea, anemia, fatigue, and delay in growth? A: Intestinal parasites
$300	Q: Name three possible signs of developmental delay at three years of age. A: (Any three): The child cannot follow simple directions, make two-word sentences, copy a circle, or take off her own clothes
$400	Q: What are three problems found through nutrition assessment? A: Dietary deficiencies, feeding difficulties, and food allergies
$500	Q: Name three possible signs of vision problems. A: (Any three): Eyes crossed or pointing out, squinting, short attention for visual tasks, holding materials very close to the face, difficulty catching balls, complaints of eye discomfort or headache
How You Do It:
$100	Q: Which screening requires a blood test usually done by pricking the finger? A: Anemia Screening
$200	Q: Which screening involves a skin test—Mantoux/PPD—to look for a reaction that indicates infection? A: Tuberculin Testing
$300	Q: Which screening involves a laboratory test of stool samples? A: Intestinal Parasite Screening
$400	Q: Which screening involves a special blood test and asking the family about the age of their home, construction, or peeling paint, as well as asking about the use of specific home remedies? A: Lead Screening
$500	Q: Which two screenings use a standardized screening test or skills checklist? A: Speech/language and developmental/mental health assessment

Activity 4: The Importance of Well-Child Health Care and a Medical Home

Purpose: This activity allows participants to develop skills in explaining the importance of well-child health care and linkage to a medical home to parents. Participants will develop strategies to help families overcome barriers to good medical care for their families. This activity is particularly helpful for family service workers and other staff members who are involved in enrolling children into Head Start.

For this activity you will need:

• Handout A: Carlos' Story, for each participant

Step 1: Divide participants into pairs. Instruct them to find a partner to work with and read Handout A: Carlos' Story together.

Step 2: Ask participants to take a minute to reflect on their own experiences:

• Have you ever put off getting health care for yourself or other family members? What were the reasons (e.g., you had other more important things on your mind, it was too expensive, or you were afraid)?
  
• Has anyone ever told you that you were not taking the best care of your health? How did it make you feel?

Step 3: Return to the story and discuss the following questions:

• What aspects of well-child health care and screening does Carlos need?
  
  
• What may be some of the reasons that Carlos has not gotten the health care that he needs?
  
  
• How might you encourage Carlos' family to complete the Head Start enrollment and health screening?
  
  
  • What might you say?
    
    
  • What else might you need to know?
    
    
  • Who else in the family, community, or program could help?
    
    
• Given the fact that Carlos may not have received adequate health care, what might be the implications for the health care of other family members? How might you address this issue?

Points to Consider:

• Well-child health care and screening are important for every child. They are especially important for children who have signs and symptoms that might indicate a health problem.
  
  
• Early screening, diagnosis, treatment, and education can prevent or reduce pain and disability from health problems.
  
  
• When working with the family, the health concerns should extend beyond the Head Start child to include siblings, parents, and other family members. For example:
  
  
  • Have the siblings received well-child health care and immunizations?
    
    
  • If the mother is pregnant, has she received pregnancy counseling and prenatal care?
    
    
• When we promote health care and screening for Head Start children and families, we must try to understand and be sensitive to the individual families' attitudes, practices, and concerns.
  
  
• Linking a family to a "medical home" best serves their needs by providing continuous, accessible medical care.

Activity 5: Sam's Story Part One—Assessing Need

Purpose: This activity helps participants develop skills in working with families to understand the importance of well-child health care. Different portions of Sam's story appear in Modules I, II and III. Part one focuses on assessing Sam's dental care needs.

For this activity you will need:

• Handout B: Sam's Story—Part One, for each participant

Step 1: Distribute and review with participants Handout B: Sam's Story—Part One.

Step 2: Discuss the following questions:

• How would you discuss the importance of oral health and well-child health care in general with the family?
  
  
  • Whom should you talk with?
    
    
  • What would you ask?
    
    
  • What would you say?
    
    
• What classroom intervention and education might be helpful?
  
  
  • Who should be involved?
    
    
  • What would the main messages be?
    
    
  • How might the Health Services Advisory Committee help?

Step 3: Discuss any experiences that you have had with educating families regarding well-child health care in any area of health.

• What techniques were effective?
  
  
• What techniques were not effective?
  
  
• What would you do differently?

Points to Consider:

It is important that the parents and key staff understand:

• What measures to take at home and at school to prevent the problem (e.g., how to use a bottle safely).
  
  
• When working with the family, the health concerns should extend beyond the Head Start child to include siblings, parents, and other family members. For example:
  
  
  • How is the baby bottle used with younger siblings?
    
    
  • Are the siblings linked to a medical home?
    
    
  • If the mother is pregnant, has she received pregnancy counseling and prenatal care?
    
    
• How to have discussions with families that are sensitive to:
  
  
  • their knowledge and level of understanding;
    
    
  • their beliefs and cultural practices;
    
    
  • their living situation; and
    
    
  • their available resources.

Activity 6: Reviewing Health Records

Purpose: This activity allows participants to practice reviewing screening and exam results. They will work in teams to review a health record, determine the follow-up needed, and discuss the results and follow-up plans with parents and staff.

For this activity you will need:

• Handouts C: Child Health Record Samples (Parts 1 - 5) or
  
  
• use your own agency's record or update the records using the handouts in Appendix C: Blank Records & Forms.
  
  
• Appendix B: Well-Child Health Care Fact Sheets
  
  
• Overhead projector and transparencies
  
  
• Flip chart paper and markers

Trainer Preparation Note:

• Make a copy and an overhead transparency of the Child Health Record. If you want to update the child health records so that they reflect current information and have current dates, you will find blank copies of these handouts that you can fill out in Appendix C: Blank Records & Forms.
  
  
• Separate the Child Health Record Samples into Parts 1, 2, 3, 4, and 5.
  
  
• Attach to each part the corresponding Fact Sheet(s) from Appendix B:

  Part 1—Medical/Physical Exam, Growth

  Part 2—Anemia, Lead, Tuberculin, Hearing, Vision, Immunizations

  Part 3—Developmental

  Part 4—Dental

  Part 5—Nutrition

• Write the questions from Step 4 on flip chart paper.

Step 1: Explain that this activity will give participants a chance to review screening and exam results and determine what follow-up is needed.

Step 2: Divide participants into five groups. Have each group identify a "recorder" to report back to the larger group.

Step 3: Ask participants to imagine they are the health coordinators responsible for reviewing health records and documenting and following up results for Janine, who is entering your Head Start program. Imagine that it is now September of the current year.

Step 4: Distribute one part of the Health Record and corresponding Fact Sheet(s) to each group.

Explain that each group has received a part of Janine's health record. Each group should take about 10 minutes to review its part of the record and discuss the following questions (posted on flip chart paper):

• Is this part of the record complete? What, if anything, is missing?
  
  
• Are the child's screening or exam results inside or outside of the "normal range?"
  
  
• What follow-up is needed?

Step 5: Bring the groups back together. Ask each recorder to display the health record on the overhead projector and explain the group's analysis of the record and approach to follow-up.

Encourage participants from the large group to add their comments.

Step 6: After all of the parts of the health record have been discussed, ask participants:

• When you were analyzing your part of the health record, was there other information that would have been helpful to know?
  
  
• What are some important relationships between the different screenings and exams?
  
  
• Now that you've reviewed the complete health record for this child...
  
  
  • what would you tell the parents about:
    
    
    • the child's strengths in the areas of health and development?
      
      
    • the health concerns and the follow-up needed?
      
      
  • what staff and health professionals should be involved?
    
    
  • what would you want the classroom teachers to know?
    
    
  • how would you document the process?

Points to Consider:

• Screening and exam results that are "outside the normal range," "abnormal," or "failed" mean that the child might have a health problem. Such results must be followed up by rescreening and further evaluation by the health care provider to determine if the child has a health problem and, if so, what treatment is necessary.
  
  
• Each child's complete health record should be assessed, since many health problems and screening and exam results are interrelated. For example, if a child is diagnosed with dental problems such as Baby Bottle Tooth Decay, it is important to identify possible causes in nutrition (e.g., use of bottle, sweets) and possible effects on growth (e.g., failure to thrive or overweight).
  
  
• The results of screenings, exams, assessments, diagnoses, and treatment recommendations must be explained to parents and key staff who care for the child. This should be done:
  
  
  • by a well-informed person;
    
    
  • in clear terms and language that the parent(s) understand; and
    
    
  • with sensitivity to the concerns of the parents and staff.
    
    
• Careful documentation is crucial for a comprehensive review and appropriate assessment, treatment, and follow-up to meet each child's health needs.

Activity 7: Explaining the Meaning of Screenings and Exams, and Ensuring Follow-up

Purpose: This activity helps participants develop skill in explaining screening and exam results to parents and then working in partnership with parents to ensure follow-up of services for the child's identified health needs.

For this activity you will need:

• Enough copies of Handouts D-1 and D-2: The Meaning of Screenings and Exams for half the participants to get one and half to get the other
  
  
• Enough copies of the Appendix B: Well-Child Health Care Fact Sheets to attach one to each corresponding Situation Card:
  
  
  • To D-1: The Meaning of Screenings and Exams, attach the Speech and Language, Growth, and Vision fact sheets
    
    
  • To D-2: The Meaning of Screenings and Exams, attach the Anemia, Hearing, and Developmental/Mental Health fact sheets

Step 1: Explain that this activity allows participants to practice explaining screening and exam results to parents.

Step 2: Divide the participants into groups of three.

Step 3: Distribute to each group Handout D-1 or D-2 with the fact sheet attachments from Appendix B that correspond to the situations.

Step 4: Ask each group to identify a "staff person," "parent," and "observer" for each of the three situations. These roles should rotate, so everyone has a chance to play every role.

Step 5: Give the groups about five minutes to prepare:

• Everyone should review all of their group's situations.
  
  
• Each person should also review the fact sheet relating to the situation in which she will play the staff person.

Step 6: Allow the groups 15 minutes to role-play the three situations. Each group should be sure to address the following:

• The meaning of the screening or exam results
  
  
• The parent's/guardian's concern or lack of concern about the screening or exam results
  
  
• What follow-up services are needed and how to ensure their delivery

Step 7: Bring the groups back together. Ask a group to volunteer to read Situation #1 aloud and summarize their discussion. Ask the other groups that role-played this situation to add any comments they might have about how their discussion was similar or different.

Proceed in the same manner to discuss Situations #2 to #6.

Step 8: Ask participants:

• What were some of your general feelings and perceptions in the role of staff person? In the role of parent? In the role of observer?
  
  
• What might be some reasons for the differences in interpretations of screening or exam results?
  
  
• What are some general communication skills that are effective in addressing all of these screening and exam results with parents?
  
  
• What are creative strategies you have used to ensure follow-up of needed services?
  
  
• How does parental education improve follow-up on identified health needs?

Step 9: Ask participants to relate any personal experiences that they have had with screenings or exams that resulted in differences in interpretation from the parents. How were these differences resolved?

Points to Consider:

• In discussing the results of screenings and exams, staff should be sure to:
  
  
  • Acknowledge the parent's concerns.
    
    
  • Provide basic information to explain the meaning of the screening or exam results.
    
    
  • Refer the parent to the health specialist and the family's health care provider for more detailed information and follow-up.
    
    
• To explain the meaning of a screening or exam, you may refer to the detailed information in the Well-Child Health Care Fact Sheets. However, it is not necessary to know all of the details. It is most important to stress the following general points:
  
  
  • A screening or exam result that is "normal" means that the child probably does not have a problem in this area.
    
    
  • A screening or exam result that is "outside the normal range" means a child might have a problem—more testing is needed to determine if there is a problem, what it is, and how the child might be helped.
    
    
• It is important to consider the parents' observations and concerns. Parents offer important information that can contribute to interpreting screenings and exams. They are also key partners in developing the follow-up plan.

Next Steps: Ideas to Extend Practice

Make the Most of the Well-Child Health Care Fact Sheets

Distribute the fact sheets to parents and staff to help them understand the relationship of screening to well-child health care. The fact sheets may be useful at orientation, enrollment, the beginning of the school year, and when the results of screening are explained to parents.

Make new fact sheets according to your local program needs. You may get assistance from members of your Health Services Advisory Committee, health consultants, and other community-based agencies. Be sure to review and update the fact sheets every year. The following are possible reasons to adapt your fact sheets:

• If there are special health issues for your population that were not addressed in the fact sheets, revise the information according to your needs.
  
  
• If there are other screenings that are usually done in your area, develop additional fact sheets.
  
  
• If your program serves families that speak languages other than English, you might translate the fact sheets into the other languages.
  
  
• If your program needs handouts at a lower literacy level, revise the fact sheets accordingly.

Revise and Replay the Well-Child Health Care Fact Game

Make new questions and answers for the game based on the fact sheets. You may choose to rewrite the categories to focus on your on-site screenings, your most challenging screenings, or those that have identified many children who need follow-up evaluation and treatment. If you develop new fact sheets, these can also be incorporated into the game.

Establish Regular Educational Workshops for Parents and Staff

Information on children's health is constantly advancing. Help spread the knowledge by inviting local health experts to regular, ongoing workshops for staff and parents at your program. The range of topics is diverse; it could include parenting skills, medical and dental health, nutrition, mental health concerns, safety, and environmental hazards in the community. As

Head Start reaches out to pregnant women, prenatal classes can assist women by educating them on the effects of diet, smoking, drugs, and alcohol on their baby. With this knowledge, mothers-to-be can best make healthy choices.

Establish a two-way exchange of information with the health experts. Share your observations and concerns about the health of children at your program. Find out more about health problems specific to your community—what they are, what causes them, how to identify children and families at risk, and how to prevent and treat the problems.

Assemble a Panel Representing Special Populations

Conduct a panel discussion—with families, community advocates, and professionals—focusing on special well-child health care needs. Examples include the needs of homeless families, families that do not speak English, migrant families, and parents with disabilities. Ask them to address the following challenges:

• Connecting to a "medical home"
  
  
• Health screenings and exams
  
  
• Assuring the delivery of well-child health care
  
  
• Tracking follow-up immunizations and services for identified needs

Ask panel members to serve as consultants to address questions that might arise. If gaps in services are identified, community advocates and families can work together to increase services. Health professionals can bring in information regarding who is available to provide services to the Head Start community, and advocate among their professional peers for additional coverage.