[Code of Federal Regulations]

[Title 45, Volume 4]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 45CFR1304.20]



[Page 121-124]

 

                        TITLE 45--PUBLIC WELFARE

 

CHAPTER XIII--OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH 

                           AND HUMAN SERVICES

 

PART 1304_PROGRAM PERFORMANCE STANDARDS FOR THE OPERATION OF HEAD 

START PROGRAMS BY GRANTEE AND DELEGATE AGENCIES--Table of Contents

 

        Subpart B_Early Childhood Development and Health Services

 

Sec. 1304.20  Child health and developmental services.





    (a) Determining child health status. (1) In collaboration with the 

parents and as quickly as possible, but no later than 90 calendar days 

(with the exception noted in paragraph (a)(2) of this section) from the 

child's entry into the program (for the purposes of 45 CFR 

1304.20(a)(1), 45 CFR 1304.20(a)(2), and 45 CFR 1304.20(b)(1), ``entry'' 

means the first day that Early Head Start or Head Start services are 

provided to the child), grantee and delegate agencies must:

    (i) Make a determination as to whether or not each child has an 

ongoing source of continuous, accessible health care. If a child does 

not have a source of ongoing health care, grantee and delegate agencies 

must assist the parents in accessing a source of care;

    (ii) Obtain from a health care professional a determination as to 

whether the child is up-to-date on a schedule of



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age appropriate preventive and primary health care which includes 

medical, dental and mental health. Such a schedule must incorporate the 

requirements for a schedule of well child care utilized by the Early and 

Periodic Screening, Diagnosis, and Treatment (EPSDT) program of the 

Medicaid agency of the State in which they operate, and the latest 

immunization recommendations issued by the Centers for Disease Control 

and Prevention, as well as any additional recommendations from the local 

Health Services Advisory Committee that are based on prevalent community 

health problems:

    (A) For children who are not up-to-date on an age-appropriate 

schedule of well child care, grantee and delegate agencies must assist 

parents in making the necessary arrangements to bring the child up-to-

date;

    (B) For children who are up-to-date on an age-appropriate schedule 

of well child care, grantee and delegate agencies must ensure that they 

continue to follow the recommended schedule of well child care; and

    (C) Grantee and delegate agencies must establish procedures to track 

the provision of health care services.

    (iii) Obtain or arrange further diagnostic testing, examination, and 

treatment by an appropriate licensed or certified professional for each 

child with an observable, known or suspected health or developmental 

problem; and

    (iv) Develop and implement a follow-up plan for any condition 

identified in 45 CFR 1304.20(a)(1)(ii) and (iii) so that any needed 

treatment has begun.

    (2) Grantee and delegate agencies operating programs of shorter 

durations (90 days or less) must complete the above processes and those 

in 45 CFR 1304.20(b)(1) within 30 calendar days from the child's entry 

into the program.

    (b) Screening for developmental, sensory, and behavioral concerns. 

(1) In collaboration with each child's parent, and within 45 calendar 

days of the child's entry into the program, grantee and delegate 

agencies must perform or obtain linguistically and age appropriate 

screening procedures to identify concerns regarding a child's 

developmental, sensory (visual and auditory), behavioral, motor, 

language, social, cognitive, perceptual, and emotional skills (see 45 

CFR 1308.6(b)(3) for additional information). To the greatest extent 

possible, these screening procedures must be sensitive to the child's 

cultural background.

    (2) Grantee and delegate agencies must obtain direct guidance from a 

mental health or child development professional on how to use the 

findings to address identified needs.

    (3) Grantee and delegate agencies must utilize multiple sources of 

information on all aspects of each child's development and behavior, 

including input from family members, teachers, and other relevant staff 

who are familiar with the child's typical behavior.

    (c) Extended follow-up and treatment. (1) Grantee and delegate 

agencies must establish a system of ongoing communication with the 

parents of children with identified health needs to facilitate the 

implementation of the follow-up plan.

    (2) Grantee and delegate agencies must provide assistance to the 

parents, as needed, to enable them to learn how to obtain any prescribed 

medications, aids or equipment for medical and dental conditions.

    (3) Dental follow-up and treatment must include:

    (i) Fluoride supplements and topical fluoride treatments as 

recommended by dental professionals in communities where a lack of 

adequate fluoride levels has been determined or for every child with 

moderate to severe tooth decay; and

    (ii) Other necessary preventive measures and further dental 

treatment as recommended by the dental professional.

    (4) Grantee and delegate agencies must assist with the provision of 

related services addressing health concerns in accordance with the 

Individualized Education Program (IEP) and the Individualized Family 

Service Plan (IFSP).

    (5) Early Head Start and Head Start funds may be used for 

professional medical and dental services when no other source of funding 

is available. When Early Head Start or Head Start funds are used for 

such services, grantee and delegate agencies must have written 

documentation of their efforts



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to access other available sources of funding.

    (d) Ongoing care. In addition to assuring children's participation 

in a schedule of well child care, as described in Sec. 1304.20(a) of 

this part, grantee and delegate agencies must implement ongoing 

procedures by which Early Head Start and Head Start staff can identify 

any new or recurring medical, dental, or developmental concerns so that 

they may quickly make appropriate referrals. These procedures must 

include: periodic observations and recordings, as appropriate, of 

individual children's developmental progress, changes in physical 

appearance (e.g., signs of injury or illness) and emotional and 

behavioral patterns. In addition, these procedures must include 

observations from parents and staff.

    (e) Involving parents. In conducting the process, as described in 

Sec. Sec. 1304.20 (a), (b), and (c), and in making all possible efforts 

to ensure that each child is enrolled in and receiving appropriate 

health care services, grantee and delegate agencies must:

    (1) Consult with parents immediately when child health or 

developmental problems are suspected or identified;

    (2) Familiarize parents with the use of and rationale for all health 

and developmental procedures administered through the program or by 

contract or agreement, and obtain advance parent or guardian 

authorization for such procedures. Grantee and delegate agencies also 

must ensure that the results of diagnostic and treatment procedures and 

ongoing care are shared with and understood by the parents;

    (3) Talk with parents about how to familiarize their children in a 

developmentally appropriate way and in advance about all of the 

procedures they will receive while enrolled in the program;

    (4) Assist parents in accordance with 45 CFR 1304.40(f)(2) (i) and 

(ii) to enroll and participate in a system of ongoing family health care 

and encourage parents to be active partners in their children's health 

care process; and

    (5) If a parent or other legally responsible adult refuses to give 

authorization for health services, grantee and delegate agencies must 

maintain written documentation of the refusal.

    (f) Individualization of the program. (1) Grantee and delegate 

agencies must use the information from the screening for developmental, 

sensory, and behavioral concerns, the ongoing observations, medical and 

dental evaluations and treatments, and insights from the child's parents 

to help staff and parents determine how the program can best respond to 

each child's individual characteristics, strengths and needs.

    (2) To support individualization for children with disabilities in 

their programs, grantee and delegate agencies must assure that:

    (i) Services for infants and toddlers with disabilities and their 

families support the attainment of the expected outcomes contained in 

the Individualized Family Service Plan (IFSP) for children identified 

under the infants and toddlers with disabilities program (Part H) of the 

Individuals with Disabilities Education Act, as implemented by their 

State or Tribal government;

    (ii) Enrolled families with infants and toddlers suspected of having 

a disability are promptly referred to the local early intervention 

agency designated by the State Part H plan to coordinate any needed 

evaluations, determine eligibility for Part H services, and coordinate 

the development of an IFSP for children determined to be eligible under 

the guidelines of that State's program. Grantee and delegate agencies 

must support parent participation in the evaluation and IFSP development 

process for infants and toddlers enrolled in their program;

    (iii) They participate in and support efforts for a smooth and 

effective transition for children who, at age three, will need to be 

considered for services for preschool age children with disabilities; 

and

    (iv) They participate in the development and implementation of the 

Individualized Education Program (IEP)



[[Page 124]]



for preschool age children with disabilities, consistent with the 

requirements of 45 CFR 1308.19.



(The information and collection requirements are approved by the Office 

of Management and Budget (OMB) under OMB Control Number 0970-0148 for 

paragraphs (a), (c) and (d).)



[61 FR 57210, Nov. 5, 1996, as amended at 63 FR 2313, Jan. 15, 1998]