[Code of Federal Regulations]
[Title 45, Volume 4]
[Revised as of October 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 45CFR1308.21]

[Page 170-186]
 
                        TITLE 45--PUBLIC WELFARE
 
CHAPTER XIII--OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH 
                           AND HUMAN SERVICES
 
PART 1308_HEAD START PROGRAM PERFORMANCE STANDARDS ON SERVICES FOR CHILDREN 
 
           Subpart G_Parent Involvement Performance Standards
 
Sec.  1308.21  Parent participation and transition of children into Head Start 


and from Head Start to public school.

    (a) In addition to the many references to working with parents 
throughout these standards, the staff must carry out the following 
tasks:

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    (1) Support parents of children with disabilities entering from 
infant/toddler programs.
    (2) Provide information to parents on how to foster the development 
of their child with disabilities.
    (3) Provide opportunities for parents to observe large group, small 
group and individual activities describe in their child's IEP.
    (4) Provide follow-up assistance and activities to reinforce program 
activities at home.
    (5) Refer parents to groups of parents of children with similar 
disabilities who can provide helpful peer support.
    (6) Inform parents of their rights under IDEA.
    (7) Inform parents of resources which may be available to them from 
the Supplemental Security Income (SSI) Program, the Early and Periodic 
Screening, Diagnosis and Treatment (EPSDT) Program and other sources and 
assist them with initial efforts to access such resources.
    (8) Identify needs (caused by the disability) of siblings and other 
family members.
    (9) Provide information in order to prevent disabilities among 
younger siblings.
    (10) build parent confidence, skill and knowledge in accessing 
resources and advocating to meet the special needs of their children.
    (b) Grantees must plan to assist parents in the transition of 
children from Head Start to public school or other placement, beginning 
early in the program year.
    (c) Head Start grantees, in cooperation with the child's parents, 
must notify the school of the child's planned enrollment prior to the 
date of enrollment.

   Appendix to Part 1308--Head Start Program Performance Standards on 
                 Services to Children With Disabilities

    This appendix sets forth guidance for the implementation of the 
requirements in part 1308. This guidance provides explanatory material 
and includes recommendations and suggestions for meeting the 
requirements. This guidance is not binding on Head Start grantees or 
delegate agencies. It provides assistance and possible strategies which 
a grantee may wish to consider. In instances where a permissible course 
of action is provided, the grantee or delegate agency may rely upon this 
guidance or may take another course of action that meets the applicable 
requirement. This programmatic guidance is included as an aid to 
grantees because of the complexity of providing special services to meet 
the needs of children with various disabilities.

      Section 1308.4 Purpose and scope of disabilities service plan

                       Guidance for Paragraph (a)

    In order to develop an effective disabilities service plan the 
responsible staff members need to understand the context in which a 
grantee operates. The Head Start program has operated under a 
Congressional mandate, since 1972, to make available, at a minimum, ten 
percent of its enrollment opportunities to children with disabilities. 
Head Start has exceeded this mandate and serves children in integrated, 
developmentally appropriate programs. The passage of the Individuals 
With Disabilities Education Act, formerly the Education of the 
Handicapped Act, and its amendments, affects Head Start, causing a shift 
in the nature of Head Start's responsibilities for providing services 
for children with disabilities relative to the responsibilities of State 
Education Agencies (SEA) and Local Education Agencies (LEA).
    Grantees need to be aware that under the IDEA the State Education 
Agency has the responsibility for assuring the availability of a free 
appropriate public education for all children with disabilities within 
the legally required age range in the State. This responsibility 
includes general supervision of educational programs in all agencies, 
including monitoring and evaluating the special education and related 
services to insure that they meet State standards, developing a 
comprehensive State plan for services for children with disabilities 
(including a description of interagency coordination among these 
agencies), and providing a Comprehensive System for Personnel 
Development related to training needs of all special education and 
related service personnel involved in the education of children with 
disabilities served by these agencies, including Head Start programs.
    Each State has in effect under IDEA a policy assuring all children 
with disabilities beginning at least at age three, including those in 
public or private institutions or other care facilities, the right to a 
free appropriate education and to an evaluation meeting established 
procedures. Head Start is either:
     The agency through which the Local Education 
Agency can meet its obligation to make a free appropriate public 
education available through a contract, State or local collaborative 
agreement, or other arrangement; or

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     The agency in which the family chooses to have 
the child served rather than using LEA services.
    Regardless of how a child is placed in Head Start, the LEA is 
responsible for the identification, evaluation and provision of a free 
appropriate public education for a child found to be in need of special 
education and related services which are mandated in the State. The LEA 
is responsible for ensuring that these services are provided, but not 
for providing them all. IDEA stresses the role of multiple agencies and 
requires their maintenance of effort.
    The Head Start responsibility is to make available directly or in 
cooperation with other agencies services in the least restrictive 
environment in accordance with an individualized education program (IEP) 
for at least ten percent of enrolled children who meet the disabilities 
eligibility criteria. In addition, Head Start continues to provide or 
arrange for the full range of health, dental, nutritional, 
developmental, parent involvement and social services provided to all 
enrolled children. Head Start has a mandate to recruit and enroll 
income-eligible children and children with disabilities who are most in 
need of services and to coordinate with the LEA and other groups to 
benefit children with disabilities and their families. Serving children 
with disabilities has strengthened Head Start's ability to individualize 
for all children. Head Start is fully committed to the maintenance of 
effort as required for all agencies by the IDEA and by the Head Start 
Act (Section 640(a)(2)(A)). Head Start is committed to fiscal support to 
assure that the services which children with disabilities need to meet 
their special needs will be provided in full, either directly or by a 
combination of Head Start funds and other resources.
    These Head Start regulations facilitate coordination with the IDEA 
by utilizing identical terms for eligibility criteria for the most part. 
However, Head Start has elected to use the term ``emotional/behavioral 
disorder'' in lieu of ``serious emotional disturbance,'' which is used 
in the IDEA, in response to comments and concerns of parents and 
professionals. Children who meet State-developed criteria under IDEA 
will be eligible for services from Head Start in that State.
    In order to organize activities and resources to help children with 
disabilities overcome or lessen their disabilities and develop their 
potential, it is essential to involve the education, health, social 
services, parent involvement, mental health and nutrition components of 
Head Start. Parents, staff and policy group members should discuss the 
various strategies for ensuring that the disabilities service plan 
integrates needs and activities which cut across the Head Start 
component areas before the plan is completed.
    Advance planning and scheduling of arrangements with other agencies 
is a key factor in assuring timely, efficient services. Local level 
interagency agreements can greatly facilitate the difficult tasks of 
locating related service providers, for example, and joint community 
screening programs can reduce delays and costs to each of the 
participating agencies.

                       Guidance for Paragraph (b)

    The plan and the annual updates need to be specific, but not 
lengthy. As changes occur in the community, the plan needs to reflect 
the changes which affect services.

                       Guidance for Paragraph (c)

    Grantees should ensure that the practices they use to provide 
special services do not result in undue attention to a child with a 
disability. For example, providing names and schedules of special 
services for children with disabilities in the classroom is useful for 
staff or volunteers coming into that classroom but posting them would 
publicize the disability of the individual children.

                       Guidance for Paragraph (d)

    Staff should work for the children's greater independence by 
encouraging them to try new things and to meet appropriate goals by 
small steps. Grantees should help children with disabilities develop 
initiative by including them in opportunities to explore, to create, and 
to ask rather than to answer questions. The children need opportunities 
to use a wide variety of materials including science tools, art media 
and costumes in order to develop skills, imagination and originality. 
They should be included on field trips, as their experience may have 
been limited, for example, by an orthopedic impairment.
    Just as a program makes available pictures and books showing 
children and adults from representative cultural, ethnic and 
occupational groups, it should provide pictures and books which show 
children and adults with disabilities, including those in active roles.
    Staff should plan to answer questions children and adults may have 
about disabilities. This promotes acceptance of a child with 
disabilities for him or herself and leads to treating the child more 
normally. Effective curricula are available at low cost for helping 
children and adults understand disabilities and for improving attitudes 
and increasing knowledge about disabilities. Information on these and 
other materials can be obtained from resource access projects 
contractors, which offer training and technical assistance to Head Start 
programs.
    There are a number of useful guides for including children with 
disabilities in regular group activities while providing successful 
experiences for children who differ widely in

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developmental levels and skills. Some of these describe activities 
around a unit theme with suggestions for activities suitable for 
children with different skill levels. Staff need to help some children 
with disabilities move into developmentally appropriate play with other 
children.
    Research has shown the effectiveness of work in small groups for 
appropriately selected children with disabilities. This plan allows for 
coordinating efforts to meet the needs of individual children as listed 
in their IEPs and can help focus resources efficiently.
    If a deaf child who uses or needs sign language or another 
communication mode is enrolled, a parent, volunteer or aide who can use 
that mode of communication should be provided to help the child benefit 
from the program.
    In order to build the language and speech capabilities of many 
children with disabilities who have communication problems, it has been 
found helpful to enlist aides, volunteers, cooks, bus drivers and 
parents, showing them how to provide extra repetition and model 
gradually more advanced language as children improve in their ability to 
understand and use language. Small group activities for children with 
similar language development needs should be provided regularly as well 
as large group language and listening games and individual help. Helping 
children with intellectual delays or emotional problems or those whose 
experiences have been limited by other disabilities to express their own 
ideas and to communicate during play and throughout the daily activities 
is motivating and can contribute greatly to their progress.

                       Guidance for Paragraph (e)

    The Disabilities Service Coordinator should possess a basic 
understanding of the scope of the Head Start effort and skills adequate 
to manage the agency to serve children with disabilities including 
coordination with other program components and community agencies and 
work with parents.

                       Guidance for Paragraph (f)

    For non-verbal children, communication boards, computers and other 
assistive technology devices may be helpful. Technical assistance 
providers have information on the Technology Related Assistance for 
Individuals with Disabilities Act of 1988, 29 U.S.C. 2201 et seq. States 
are funded through this legislation to plan Statewide assistive 
technology services, which should include services for young children. 
Parents should be helped to understand the necessity of including 
assistive technology services and devices in their child's IEP in order 
to obtain them.
    The plan should include any renovation of space and facilities which 
may be necessary to ensure the safety of the children or promote 
learning. For example, rugs or other sound-absorbing surfaces make it 
easier for some children to hear stories or conversation. Different 
surfaces on floors and play areas affect some children's mobility.
    45 CFR Part 84, Nondiscrimination on the Basis of Handicap in 
Programs and Activities Receiving or Benefiting from Federal Financial 
Assistance which implements the Rehabilitation Act of 1973 and the 
Americans with Disabilities Act require that all Federally assisted 
programs, including Head Start, be accessible to persons with 
disabilities including staff, parents and children. This does not mean 
that every building or part of a building must be physically accessible, 
but the program services as a whole must be accessible. Structural 
changes to make the program services available are required if 
alternatives such as reassignment of classes or moving to different 
rooms are not possible. Information on the accessibility standards is 
available from RAPs or the U.S. Department of Justice, Civil Rights 
Division, Coordination and Review Section, P.O. Box 66118, Washington, 
DC 20035-6115.
    Staff should ensure that children with physical disabilities have 
chairs and other pieces of furniture of the correct size and type for 
their individual needs as they grow. Agencies such as United Cerebral 
Palsy, Easter Seal Societies or SEAs can provide consultation on 
adapting or purchasing the appropriate furniture. The correct 
positioning of certain children is essential and requires expert advice. 
As the children grow, the furniture and equipment should be checked by 
an expert, such as a physical therapist, because the wrong fit can be 
harmful. Efforts should be made to use furniture sized and shaped to 
place children at the same level as their classmates whenever possible.

                       Guidance for Paragraph (h)

    The plan should specify:
     Overall goals of the disability effort.
     Specific objectives and activities of the 
disability effort.
     How and when specific activities will be carried 
out and goals attained.
     Who will be responsible for the conduct of each 
element of the plan.
     How individual activities will be evaluated.
    The plan should address:
     Enrollment information, including numbers of 
children and types of disabilities, known and estimated.
     Identification and recruitment of children with 
disabilities. Participation in Child Find and list of major specialized 
agencies approached.
     Screening.
     Developmental Assessment.
     Evaluation.
     The multidisciplinary team and its work.

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     The process for developing IEPs.
     The provision of program services and related 
services.
     Program accessibility.
     Recordkeeping and reporting.
     Confidentiality of information.
     Any special safety needs.
     Medications.
     Transportation.
     The process for identifying and meeting training 
and technical assistance needs.
     Special parent involvement needs.
     Planned actions to increase the ability of staff 
to serve children with more severe disabilities and the number of 
children with more severe disabilities served.
     Transitioning of children in and out to the next 
program.
    Particular attention should be given to addressing ways to:
     Involve parents throughout the disability effort, 
and
     Work with other agencies in serving children with 
disabilities. It should be possible for a reader to visualize how and by 
whom services will be delivered. Coordination with other agencies should 
be described, as well as the process for developing local agreements 
with other agencies. The RAPs can provide samples and models for the 
process of developing agreements with LEAs.

                       Guidance for Paragraph (j)

    Children may spend part of the program hours in Head Start for a 
mainstreaming experience and part in a specialized program such as an 
Easter Seal Society or a local mental health center. The amount of time 
spent in either program should be flexible, according to the needs of 
the individual child. All services to be provided, including those 
provided by collaborating agencies, should be described in the IEP. 
Staff of both programs should observe each other's work with the child 
who is enrolled and maintain good communication.
    Individual services such as occupational, physical or speech 
therapy, staff training, transportation, services to families or 
counseling may be shared by Head Start and other agencies. For example, 
Head Start might provide equipment and transportation while a 
development center might provide a facility and physical therapy for a 
Head Start child. Some LEAs provide resource teachers while Head Start 
provides a developmentally appropriate program in an integrated setting.
    Hiring additional staff may be necessary to meet the needs of 
children with severe disabilities. Hiring an aide may be necessary on a 
full-time, part-time, temporary or as needed basis to assist with the 
increased demands of a child with a severe disability. However, aides 
should not be assigned the major responsibility for providing direct 
services. Aides and volunteers should be guided and supervised by the 
disabilities service coordinator or someone with special training. It is 
desirable to have the services of a nurse, physical therapist or 
licensed practical nurse available for children with severe health or 
physical disabilities.
    Volunteers trained by professionals to work specifically with 
children with disabilities can provide valuable individualized support. 
For example, a volunteer might be trained by a physical therapist to 
carry out specific follow-up activities with individual children.

                       Guidance for Paragraph (k)

    State standards for qualifications of staff to provide special 
education and related services affect Head Start's acceptance as a 
placement site for children who have been evaluated by an LEA. Head 
Start grantees, like LEAs, are affected by shortages of staff meeting 
State qualifications and are to work toward the goal of meeting the 
highest State standards for personnel by developing plans to train 
current staff and to hire new staff so that eventually the staff will 
meet the qualifications. Grantees should discuss their needs for pre-
service and in-service training with SEAs during annual updates of 
interagency agreements for use in the planning of joint State level 
conferences and for use in preparation of Comprehensive State Personnel 
Development plans. They should also discuss these needs with LEAs which 
provide in-service training.
    The program should provide training for the regular teachers on how 
to modify large group, small group or individual activities to meet the 
needs of children with disabilities. Specific training for staff should 
be provided when Head Start enrolls a child whose disability or 
condition requires a special skill or knowledge of special techniques or 
equipment. Examples are structuring a language activity, performing 
intermittent nonsterile catheterization, changing collection bags, 
suctioning, or operating leg braces. Joint training with other agencies 
is recommended to stretch resources and exchange expertise.
    Staff should have access to regular ongoing training events which 
keep them abreast of new materials, equipment and practices related to 
serving children with disabilities and to preventing disabilities. 
Ongoing training and technical assistance in support of the disabilities 
effort should be planned to complement other training available to meet 
staff needs. Each grantee has the responsibility to identify or arrange 
the necessary support to carry out training for parents and staff.
    The best use of training funds has resulted when programs carry out 
a staff training needs assessment and relate current year training plans 
to previous staff training with the goal of building core capability. 
Staff

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who receive special training should share new knowledge with the rest of 
the staff.
    The core capability of the program is enhanced when speech, language 
and other therapy is provided in the regular site whenever possible. 
This allows for the specialist to demonstrate to regular staff and plan 
for their follow through. It also reduces costs and time spent 
transporting children to clinics and other settings. When university 
graduate students are utilized to provide special services as part of 
their training, it is helpful to arrange for their supervisors to 
monitor their work. Grantees arranging for such assistance are providing 
a valuable internship site and it is to the university's advantage to 
have their students become familiar with programs on-site. Grantees 
should negotiate when developing interagency agreements to have services 
provided on-site to the greatest extent possible.
    The Head Start Act, Section 648 (42 U.S.C. 9843) (a)(2), calls for 
training and technical assistance to be offered to all Head Start 
programs with respect to services for children with disabilities without 
cost through resource access projects which serve each region of the 
country. The technical assistance contractors contact each grantee for a 
needs assessment and offer training. While their staffs are small and 
their budgets limited, they are experienced and committed to meeting as 
many needs as they can and welcome inquiries. A brochure with names and 
addresses of the technical assistance providers is available from ACYF/
HS, P.O. Box 1182, Washington, DC 20013.
    The SEA is responsible for developing a Comprehensive System of 
Personnel Development. It is important that Head Start training needs be 
conveyed to this group for planning purposes so that all available 
resources can be brought to bear for staff training in Head Start. 
Grantees should take advantage of free or low-cost training provided by 
SEAs, LEAs, community colleges and other agencies to augment staff 
training.
    Many agencies offer free training for staff and parents. An example 
is the Epilepsy Foundation of America with trained volunteers throughout 
the country. The Lighthouse of New York City has developed a training 
program on early childhood and vision which was field-tested in Head 
Start and is suitable for community agencies. Head Start and the 
American Optometric Association have signed a memorandum of 
understanding under which member optometrists offer eye health education 
and screening. State-funded adult education and training programs or 
community colleges make available parenting, child development and other 
courses at low or no cost. Grantees should consider the need for 
training in working with parents, in developing working collaborative 
relationships and in networking when planning training.
    The disabilities coordinator needs to work closely with the 
education and health coordinators to provide or arrange training for 
staff and parents early in each program year on the prevention of 
disabilities. This should include the importance of observing signs that 
some children may have mild or fluctuating hearing losses due to middle 
ear infections. Such losses are often undetected and can cause problems 
in learning speech and language. Many children with hearing losses 
benefit from amplification and auditory training in how to use their 
remaining hearing most efficiently.
    The disabilities coordinator should also work with the education 
coordinator to provide timely staff training on recognizing signs that 
some children may be at high risk for later learning problems as well as 
emotional problems resulting from failure and frustration. This training 
should address ways to help children develop the skills necessary for 
later academic learning, such as following directions calling for more 
than one action, sequencing, sustaining attention, and making auditory 
and visual discriminations.

                       Guidance for Paragraph (l)

    The RAPS can provide information on agreements which have been 
developed between Head Start and SEAs and between Head Start and LEAs 
and other agencies. Such agreements offer possibilities to share 
training, equipment and other resources, smoothing the transition from 
Head Start to public or private school for children and their parents. 
Some of these agreements specify cost- and resource-sharing practices. 
Tribal Government Head Start programs should maximize use of Bureau of 
Indian Affairs, LEA and Head Start funds through cooperative agreements. 
Indian grantees should contact ACYF for referral to technical assistance 
in this regard. Grantees should bear in mind that migrant children are 
served in the majority of States and include consideration of their 
special needs, including the necessity for rapid provision of special 
education and related services, in agreements with LEAs and other 
agencies.

                       Guidance for Paragraph (m)

    In developing the plan and the budget which is a part of the grant 
application process, it is important to budget adequately for the number 
of children with disabilities to be served and the types and severity of 
their disabilities. The budget should reflect resources available from 
other agencies as well as the special costs to be paid for from Head 
Start funds. The Head Start legislation requires Head Start to access 
resources to

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meet the needs of all the children enrolled, including those with 
disabilities.
    An effective plan calls for the careful use of funds. The 
Disabilities Services Coordinator needs to keep current with the 
provisions of Part B of the IDEA and the services which may be available 
for three through five year-old children under this Act. Coordinators 
also need to utilize the expanded services under the Early and Periodic 
Screening, Diagnosis and Treatment (EPSDT) program and Supplemental 
Security Income program.
    To assist in the development of the plan, it may be helpful to 
establish an advisory committee for the disability effort or to expand 
the scope of the health advisory committee.

                       Guidance for Paragraph (o)

    Examples of evaluation costs which can be covered include 
professional assessment by the multidisciplinary evaluation team, 
instruments, professional observation and professional consultation. If 
consultation fees for multidisciplinary evaluation team members to 
participate in IEP meetings are not available from another source, they 
are allowable expenditures and need to be provided to meet the 
performance standards.
    Many children with disabilities enrolled in Head Start already 
receive services from other agencies, and grantees should encourage 
these agencies to continue to provide services. Grantees should use 
other community agencies and resources to supplement services for 
children with disabilities and their families.
    By planning ahead, grantees can pool resources to schedule the 
periodic use of experts and consultants. Grantees can time-share, 
reducing travel charges and assuring the availability of scarce 
expertise. Some LEAs and other agencies have enabling legislation and 
funds to contract for education, health, and developmental services of 
the type Head Start can provide. Grantees can also help increase the 
amount of preschool funding available to their State under the 
Individuals With Disabilities Education Act. The amount of the 
allocation to each SEA and to the public schools is affected by the 
number of three through five year old children with IEPs in place by 
December 1 of each year. By establishing good working relationships with 
State Public Health personnel and including them on advisory committees, 
health resources can be more easily utilized.
    It may be helpful to explore the possibility of a cooperative 
agreement with the public school system to provide transportation. If 
the lack of transportation would prevent a child with disabilities from 
participating in Head Start, program funds are to be used to provide 
this related service before a delay occurs which would have a negative 
effect on the child's progress. The major emphasis is on providing the 
needed special help so that the child can develop to the maximum during 
the brief time in Head Start.
    The Americans with Disabilities Act of 1990 (42 U.S.C. 12101) 
requires that new buses (ordered after August 26, 1990) by public bus 
systems must be accessible to individuals with disabilities. New over-
the-road buses ordered by privately operated bus and van companies (on 
or after July 26, 1996 or July 26, 1997 for small companies) must be 
accessible. Other new vehicles, such as vans, must be accessible, unless 
the transportation company provides service to individuals with 
disabilities that is equivalent to that operated for the general public. 
The Justice Department enforces these requirements.
    Efforts should be made to obtain expensive items such as wheelchairs 
or audiometers through resources such as Title V (formerly Crippled 
Children's Services). Cooperative arrangements can be made with LEAs and 
other agencies to share equipment such as tympanometers. Special 
equipment such as hearing aids may be obtained through EPSDT or from SSI 
funds for those children who have been found eligible. Some States have 
established libraries of assistive technology devices and rosters of 
expert consultants.

 Section 1308.5 Recruitment and Enrollment of Children With Disabilities

                       Guidance for Paragraph (a)

    Head Start can play an important role in Child Find by helping to 
locate children in need and hardest to reach, such as immigrants and 
non-English speakers. In cooperation with other community groups and 
agencies serving children with disabilities, Head Start programs should 
incorporate in their outreach and recruitment procedures efforts to 
identify and enroll children with disabilities who meet eligibility 
requirements and whose parents desire the child's participation.
    Integrating children with severe disabilities for whom Head Start is 
an appropriate placement is a goal of ACYF. Grantees should bear in mind 
that 45 CFR part 84, Nondiscrimination on the Basis of Handicap in 
Programs and Activities Receiving or Benefiting from Federal Financial 
Assistance or the Rehabilitation Act of 1973 (20 U.S.C. 794) states that 
any program receiving Federal funds may not deny admission to a child 
solely on the basis of the nature or extent of a disabling condition and 
shall take into account the needs of the child in determining the aid, 
benefits, or services to be provided. Many children who appear to have 
serious impairments are nevertheless able to make greater gains in an 
integrated setting than in a segregated classroom for children with 
disabilities.

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    The key factor in selecting an appropriate placement is the IEP. The 
need of the individual child and the ability of the child to benefit are 
determining factors. Likewise, the amount of time per day or week to be 
spent in the regular setting and/or in other settings is determined by 
the IEP. The IEP of a child with a severe emotional/behavioral disorder, 
for example, might realistically call for less than full day attendance 
or for dual placement. Another factor to consider is that according to 
the PIR, the majority of children with severe impairments are provided 
special services by both Head State staff and staff of other agencies, 
sharing the responsibility. Many grantees have successfully served 
children with moderate and severe disabilities.
    The disabilities coordinator's responsibility includes providing 
current names of appropriate specialized agencies serving young children 
with disabilities and the names of LEA Child Find contact persons to the 
director to facilitate joint identification of children with 
disabilities. It also includes learning what resources other agencies 
have available and the eligibility criteria for support from State 
agencies, Supplemental Security Income (SSI), Title V, Maternal and 
Child Health Block Grants, Title XIX (EPSDT/Medicaid), Migrant Health 
Centers, Developmental Disabilities programs, Bureau of Indian Affairs, 
third party payers such as insurance companies and other sources.
    Grantees need to develop lists of appropriate referral sources. 
These include hospital child life programs, SSI, early intervention 
programs funded by Part H of the IDEA or other sources, EPSDT providers, 
infant stimulation programs, Easter Seal and United Cerebral Palsy 
agencies, mental health agencies, Association for Retarded Citizens 
chapters, Developmental Disabilities Planning Councils, Protection and 
Advocacy Systems, University Affiliated Programs, the LEA Child Find, 
and the medical community.
    Head Start programs are encouraged to increase the visibility of the 
Head Start mainstreaming effort within the community by:
     Including community child service providers on 
policy council health and disability advisory boards and in other 
relevant Head Start activities.
     Making presentations on Head Start mainstreaming 
experiences at local, State and Regional meetings and conferences, such 
as the National Association for the Education of Young Children, Council 
for Exceptional Children, and the Association for the Care of Children's 
Health.
     Participating in interagency planning activities 
for preschool infant and toddler programs such as the State Interagency 
Coordinating Councils supported under the IDEA.

                       Guidance for Paragraph (b)

    Grantees should maintain records of outreach, recruitment, and 
service activities for children with disabilities and their families.
    Each grantee should develop a policy on what types of information 
are to be included in a comprehensive file for each disabled child. The 
policy should outline the locations where a copy of each record will be 
sent. For example, while a comprehensive file will be maintained at the 
Head Start program central office (where the disability services 
coordinator and component coordinators may be based), a teacher must 
have access to a child's IEP and progress notes in order to plan 
effectively. Confidentiality needs to be maintained in a manner which 
allows for access to information by appropriate staff while meeting 
applicable Head Start and State requirements.

                       Guidance for Paragraph (d)

    Staff should assist families who need help in obtaining 
immunizations before the program year begins, bearing in mind that a 
goal of parent involvement and social service activities is to encourage 
independence and develop skills in meeting timelines when seeking 
services for children. Care should be taken that children are not denied 
enrollment, but that their families receive the necessary assistance to 
meet entrance requirements. ``Healthy Young Children: A Manual for 
Programs,'' (a cooperative effort of the Administration for Children, 
Youth and Families, the American Academy of Pediatrics; the Division of 
Maternal and Child Health, U.S. Department of Health and Human Services; 
Georgetown University Child Development Center; Massachusetts Department 
of Public Health, and the National Association for the Education of 
Young Children, 1988, copyright, NAEYC) contains best practice guidance.

                  Section 1308.6 Assessment of Children

                       Guidance for Paragraph (b)

    Early screening is essential because of the time required for the 
steps necessary before special services can begin. It has been very 
difficult for some grantees to complete health screenings in a timely 
manner for several reasons including the lack of resources, especially 
in rural areas; the need to rely on donated services from agencies whose 
schedules have been especially overloaded during September and October 
after the start of the Head Start program year; lack of summer staff in 
most programs; and the difficulty in reaching some families. Lack of 
coordination among agencies with legislative responsibility for 
identifying children

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with disabilities has resulted in duplication and unacceptable delays in 
providing required services for many grantees. Other grantees, however, 
have demonstrated the ability to complete screenings early in the 
program year without difficulty. Many programs already complete 
screening by 45 days after the first day of program operation. Some 
participate in spring or summer screening programs in their areas before 
the fall opening. Grantees are encouraged to schedule well in advance 
with clinics and with such providers as EPSDT and the Indian Health 
Service for timely screening and any subsequent evaluations that may be 
needed.
    Recently, a number of legislative and legal requirements have 
increased the resources available for the screening and evaluation of 
children. Title XIX, EPDST/Medicaid, has new requirements for screening 
and evaluation, as well as treatment; the Social Security Administration 
has modified eligibility requirements for children with disabilities so 
that more services will be available; and all States have assured that 
services will be provided from at least age three under IDEA so that 
LEAs in more States will be engaged in identifying and evaluating 
children from birth to age six.
    In response to these changes, the Department of Health and Human 
Services and the Department of Education, through the Federal 
Interagency Coordinating Council, have developed a cooperative agreement 
for coordinated screening. Head Start is one of the participating 
agencies which will work together to plan and implement community 
screenings, assisting the LEAs which have the major responsibility for 
identifying every child with a disability under the IDEA. In addition, 
programs may elect to make some summer staff available for activities to 
close out program work in the spring and prepare for the fall.
    These developments make timely screening feasible. They also make it 
possible to expedite immunizations. State-of-the-art coordinated 
screening programs make immunizations available.
    This coordination can focus staff energy on assisting families to 
have their children immunized during the screening phase rather than 
making repeated follow-up efforts after the program for children has 
begun. Coordinated screening also provides an excellent parent education 
opportunity. Information on child development, realistic expectations 
for preschoolers and such services as WIC can be provided during the 
screening. Some communities have combined screening with well-received 
health fairs.
    The staff should be involved in the planning of screening to assure 
that screening requirements are selected or adapted with the specific 
Head Start population and goals of the screening process in mind. 
Instruments with age-appropriate norms should be used. Children should 
be screened in their native language. Universities, civic organizations 
or organizations to aid recent immigrants may be able to locate native 
speakers to assist. The RAPs can provide information on the 
characteristics of screening instruments.
    Current best practice indicates that individual pure tone audiometry 
be used as the first part of a screening program with children as young 
as three. The purpose is to identify children with hearing impairments 
that interfere with, or have the potential to interfere with 
communication. The recommended procedure is audiometric screening at 20 
dB HL (re ANSI-1969) at the frequencies of 1000, 2000, and 4000 Hz, (and 
at 500 Hz unless acoustic immittance audiometry is included as the 
second part of the screening program and if the noise level in the room 
permits testing at that frequency.) Acoustic immittance audiometry (or 
impedance audiometry) is recommended as the second part of the program 
to identify children who have middle-ear disorders.
    The audiometric screening program should be conducted or supervised 
by an audiologist. Nonprofessional support staff have successfully 
carried out audiometric screening with appropriate training and 
supervision.
    When a child fails the initial screening, an audiometric rescreening 
should be administered the same day or no later than within 2 weeks. A 
child who fails the rescreening should be referred for an evaluation by 
an audiologist.
    Current best practice calls for annual hearing tests. Frequent 
rescreening is needed for children with recurrent ear infections. 
Grantees who contract or arrange for hearing testing should check to 
assure that the testing covers the three specified frequencies and that 
other quality features are present. Speech, hearing and language 
problems are the most widespread disabilities in preschool programs and 
quality testing is vital for early detection and remediation.
    Playing listening games prior to testing and getting use to 
earphones can help children learn to respond to a tone and improve the 
quality of the testing.
    Some grantees have found it strengthens the skills of their staff to 
have all members learn to do developmental screening. This can be a 
valuable in-service activity especially for teachers. State requirements 
for qualifications should be checked and non-professional screeners 
should be trained.
    Some programs have involved trained students from schools of 
nursing, child development or special education graduate students, or 
medical students who must carry out screening work as part of their 
required experience.

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                       Guidance for Paragraph (d)

    Parents should be provided assistance if necessary, so that they can 
participate in the developmental assessment.
    Grantees should offer parents assistance in understanding the 
implications of developmental assessments as well as medical, dental or 
other conditions which can affect their child's development and 
learning.
    Development assessment is an ongoing process and information from 
observations in the Head Start center and at home should be recorded 
periodically and updated in each developmental area in order to document 
progress and plan activities.
    Disabilities coordinators, as well as education staff, need to be 
thoroughly familiar with developmental assessment activities such as 
objective observation, time sampling and obtaining parent information 
and the use of formal assessment instruments. Knowledge of normal child 
development and understanding of the culture of the child are also 
important.

                       Guidance for Paragraph (e)

    While the LEA is responsible for assuring that each child who is 
referred is evaluated in accordance with the provisions of IDEA and 
usually provides the evaluation, grantees may sometimes provide for the 
evaluation. In that event, grantees need to assure that evaluation 
specialists in appropriate areas such as psychology, special education, 
speech pathology and physical therapy coordinate their activities so 
that the child's total functioning is considered and the team's findings 
and recommendations are integrated.
    Grantees should select members of the multidisciplinary evaluation 
team who are familiar with the specific Head Start population, taking 
into account the age of the children and their cultural and ethnic 
background as they relate to the overall diagnostic process and the use 
of specific tests.
    Grantees should be certain that team members understand that Head 
Start programs are funded to provide preschool developmental experiences 
for all eligible children, some of whom also need special education and 
related services. The intent of the evaluation procedures is to provide 
information to identify children who have disabling conditions so they 
can receive appropriate assistance. It is also the intent to avoid 
mislabeling children for whom basic Head Start programming is designed 
and who may show developmental delays which can be overcome by a regular 
comprehensive program meeting the Head Start Performance Standards.
    When a grantee provides for the evaluation of a child, it is 
important that the Head Start eligibility criteria be explained to the 
evaluation team members and that they be informed as to how the results 
will be used.
    Grantees should require specific findings in writing from the 
evaluation team, and recommendations for intervention when the team 
believes the child has a disability. The findings will be used in 
developing the child's IEP to ensure that parents, teachers and others 
can best work with the child. Some grantees have obtained useful 
functional information by asking team members to complete a brief form 
describing the child's strengths and weaknesses and the effects of the 
disability along with suggestions for special equipment, treatment or 
services. The evaluators should be asked in advance to provide their 
findings promptly in easily understood terms. They should provide 
separate findings and, when they agree, consensus professional opinions. 
When planning in advance for evaluation services from other agencies, 
grantees should try to obtain agreements on prompt timing for delivery 
of reports which are necessary to plan services.
    To assist the evaluation team, Head Start should provide the child's 
screening results, pertinent observations, and the results of any 
developmental assessment information which may be available.
    It is important that programs ensure that no individual child or 
family is labeled, mislabeled, or stigmatized with reference to a 
disabling condition. Head Start must exercise care to ensure that no 
child is misidentified because of economic circumstances, ethnic or 
cultural factors or developmental lags not caused by a disability, 
bilingual or dialectical differences, or because of being non-English 
speaking.
    If Head Start is arranging for the evaluation, it is important to 
understand that a child whose problem has been corrected (e.g., a child 
wearing glasses whose vision is corrected and who does not need special 
education and related services) does not qualify as a child with a 
disability. A short-term medical problem such as post-operative recovery 
or a problem requiring only medical care and health monitoring when the 
evaluation specialists have not stated that special education and 
related services are needed does not qualify as a disability.
    The evaluation team should include consideration of the way the 
disability affects the child's ability to function as well as the cause 
of the condition.
    Some children may have a recent evaluation from a clinic, hospital 
or other agency (other than the LEAs) prior to enrolling in Head Start. 
If that evaluation did not include needed functional information or a 
professional opinion as to whether the child meets one of the Head Start 
eligibility criteria, the grantee should contact the agency to try to 
obtain that information.
    Some children, prior to enrolling in Head Start, already have been 
diagnosed as having

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severe disabilities and a serious need for services. Some of these 
children already may be receiving some special assistance from other 
agencies for their disabilities but lack developmental services in a 
setting with other children. Head Start programs may best meet their 
needs by serving them jointly, i.e., providing developmental services 
while disability services are provided from another source. It is 
important in such situations that regular communication take place 
between the two sites.
    Beginning in 1990, State EPSDT/Medicaid programs must, by law, 
evaluate and provide services for young children whose families meet 
eligibility criteria at 133 percent of the poverty levels. This is a 
resource for Head Start and it is important to become aware of EPSDT 
provisions.

     Section 1308.7 Eligibility Criteria: Health Impairment Guidance

                       Guidance for Paragraph (c)

    Many health impairments manifest themselves in other disabling 
conditions. Because of this, particular care should be taken when 
classifying a health impaired child.

                       Guidance for Paragraph (b)

    Because AIDS is a health impairment, grantees will continue to 
enroll children with AIDS on an individual basis. Staff need to be 
familiar with the Head Start Information Memorandum on Enrollment in 
Head Start Programs of Infants and Young Children with Human 
Immunodeficiency Virus (HIV), AIDS Related Complex (ARC), or Acquired 
Immunodeficiency Syndrome (AIDS) dated June 22, 1988. This guidance 
includes material from the Centers for Disease Control which stresses 
the need for a team, including a physician, to make informed decisions 
on enrollment on an individual basis. It provides guidance in the event 
that a child with disabilities presents a problem involving biting or 
bodily fluids. The guidance also discusses methods for control of all 
infectious diseases through stringent cleanliness standards and includes 
lists of Federal, State and national agencies and organizations that can 
provide additional information as more is learned. Staff should be aware 
that there is a high incidence of visual impairment among children with 
HIV and AIDS.

                       Guidance for Paragraph (c)

    Teachers or others in the program setting are in the best position 
to note the following kinds of indications that a child may need to be 
evaluated to determine whether an attention deficit disorder exists:
    (1) Inability of a child who is trying to participate in classroom 
activities to be able to orient attention, for example to choose an 
activity for free time or to attend to simple instructions;
    (2) Inability to maintain attention, as in trying to complete a 
selected activity, to carry out simple requests or attend to telling of 
an interesting story; or
    (3) Inability to focus attention on recent activities, for example 
on telling the teacher about a selected activity, inability to tell 
about simple requests after carrying them out, or inability to tell 
about a story after hearing it.
    These indicators should only be used after the children have had 
sufficient time to become familiar with preschool procedures and after 
most of the children are able easily to carry out typical preschool 
activities.
    Culturally competent staff recognize and appreciate cultural 
differences, and this awareness needs to include understanding that some 
cultural groups may promote behavior that may be misinterpreted as 
inattention. Care must be taken that any deviations in attention 
behavior which are within the cultural norms of the child's group are 
not used as indicators of possible attention deficit disorder.
    A period of careful observation over three months can assure that 
adequate documentation is available for the difficult task of 
evaluation. It also provides opportunity to provide extra assistance to 
the child, perhaps through an aide or special education student under 
the teacher's direction, which might improve the child's functioning and 
eliminate the behavior taken as evidence of possible attention deficit 
disorder.
    Attention deficit disorders are not the result of learning 
disabilities, emotional/behavioral disabilities, autism or mental 
retardation. A comprehensive psychological evaluation may be carried out 
in some cases to rule out learning disability or mental retardation. It 
is possible, however, in some instances for this disability to coexist 
with another disability. Children who meet the criteria for multiple 
disabilities (e.g., attention deficient disorder and learning 
disability, or emotional/behavioral disorder, or mental retardation) 
would be eligible for services as children with multiple disabilities or 
under their primary disability.
    Teacher and parent reports have been found to provide the most 
useful information for assessment of children suspected of having 
attention deficit disorder. They are also useful in planning and 
providing special education intervention. The most successful approach 
may be a positive behavior modification program in the classroom, 
combined with a carryover program in the home. Prompt and clear response 
should be provided consistently. Positive reinforcement for appropriate 
behavior, based on rewards such as stickers or small items desired by

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the child has been found effective for children with this disorder, 
along with occasional withholding of rewards or postponing of desired 
activities in the face of inappropriate behavior. Effective programs 
suggest that positive interactions with the child after appropriate 
behavior are needed at least three times as often as any negative 
response interactions after inappropriate behavior. Consultants familiar 
with behavior modification should be used to assist teachers in planning 
and carrying out intervention which can maintain this positive to 
negative ratio while shaping behaviors. These behavior interventions can 
be provided in mainstream placements with sufficient personnel.
    Suggested Primary Members of A Head Start Evaluation Team for Health 
Impaired Children:
    Physician.
    Pediatrician.
    Psychologist.
    Other specialists related to specific disabilities.
    Possible Related Services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Family counseling.
    Genetic counseling.
    Nutrition counseling.
    Recreational therapy.
    Supervision of physical activities.
    Transportation.
    Assistive technology devices or services

   Section 1308.8 Eligibility Criteria: Emotional/Behavioral Disorders

                       Guidance for Paragraph (a)

    Staff should insure that behavior which may be typical of some 
cultures or ethnic groups, such as not making eye contact with teachers 
or other adults or not volunteering comments or initiating conversations 
are not misinterpreted.
    The disability, social service and parent involvement coordinators 
should consider providing extra attention to children at-risk for 
emotional/behavioral disorders and their parents to help prevent a 
disability. Members of the Council of One Hundred, Kiwanis, Urban 
League, Jaycees, Rotary, Foster Grandparents, etc. may be able to 
provide mentoring and individual attention.
    Suggested Primary Members of a Head Start Evaluation Team for 
Emotional/behavioral Disorders:
    Psychologist, psychiatrist or other clinically trained and State 
qualified mental health professionals.
    Pediatrician.
    Possible Related Services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Behavior management.
    Environmental adjustments.
    Family counseling.
    Psychotherapy.
    Transportation.
    Assistive technology.

   Section 1308.9 Eligibility Criteria: Speech or Language Impairment

                       Guidance for Paragraph (a)

    Staff familiar with the child should consider whether shyness, lack 
of familiarity with vocabulary which might be used by testers, 
unfamiliar settings, or linguistic or cultural factors are negatively 
influencing screening and assessment results. Whenever possible, 
consultants trained in assessing the speech and language skills of young 
children should be selected. The child's ability to communicate at home, 
on the playground and in the neighborhood should be determined for an 
accurate assessment. Review of the developmentally appropriate age 
ranges for the production of difficult speech sounds can also help 
reduce over-referral for evaluation.
    Suggested Primary Members of a Head Start Evaluation Team for Speech 
or Language Impairment:
    Speech Pathologist.
    Language Pathologist.
    Audiologist.
    Otolaryngologist.
    Psychologist.
    Possible Related Services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Environmental adjustments.
    Family counseling.
    Language therapy.
    Speech therapy.
    Transportation.
    Assistive technology devices or services.

        Section 1308.10 Eligibility Criteria: Mental Retardation

                       Guidance for Paragraph (a)

    Evaluation instruments with age-appropriate norms should be used. 
These should be administered and interpreted by professionals sensitive 
to racial, ethnic and linguistic differences. The diagnosticians must be 
aware of sensory or perceptual impairments that the child may have 
(e.g., a child who is visually impaired should not be tested with 
instruments that rely heavily on visual information as this could 
produce a depressed score from which erroneous diagnostic conclusions 
might be drawn).

[[Page 182]]

    Suggested primary members of a Head Start evaluation team for mental 
retardation:
    Psychologist.
    Pediatrician.
    Possible related services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Environmental adjustments.
    Family counseling.
    Genetic counseling.
    Language therapy.
    Recreational therapy.
    Speech therapy.
    Transportation.
    Nutrition counseling.

   Section 1308.11 Eligibility Criteria: Hearing Impairment Including 
                                Deafness

                       Guidance for Paragraph (a)

    An audiologist should evaluate a child who has failed rescreening or 
who does not respond to more than one effort to test the child's 
hearing. If the evaluation team determines that the child has a 
disability, the team should make recommendations to meet the child's 
needs for education and medical care or habilitation, including auditory 
training to learn to use hearing more effectively.
    Suggested Primary Members of a Head Start Evaluation Team for 
Hearing Impairment:
    Audiologist.
    Otolaryngologist.
    Possible Related Services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Auditory training.
    Aural habilitation.
    Environmental adjustments.
    Family counseling.
    Genetic counseling.
    Language therapy.
    Medical treatment.
    Speech therapy.
    Total communication, speechreading or manual communication.
    Transportation.
    Use of amplification.
    Assistive technology devices or services.

       Section 1308.12 Eligibility Criteria: Orthopedic Impairment

                       Guidance for Paragraph (a)

    Suggested Primary Members of a Head Start Evaluation Team for 
Orthopedic Impairment:
    Pediatrician.
    Orthopedist.
    Neurologist.
    Occupational Therapist.
    Physical Therapist.
    Rehabilitation professional.
    Possible Related Services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Environmental adjustments.
    Family counseling.
    Language therapy.
    Medical treatment.
    Occupational therapy.
    Physical therapy.
    Assistive technology.
    Recreational therapy.
    Speech therapy.
    Transportation.
    Nutrition counseling.

   Section 1308.13 Eligibility Criteria: Visual Impairment Including 
                                Blindness

                       Guidance for Paragraph (a)

    Primary Members of an Evaluation Team for Visual Impairment 
including Blindness:
    Ophthalmologist.
    Optometrist.
    Possible Related Services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Environmental adjustments.
    Family counseling.
    Occupational therapy.
    Orientation and mobility training.
    Pre-Braille training.
    Recreational therapy.
    Sensory training.
    Transportation.
    Functional vision assessment and therapy.

                  Section 1308.14 Learning Disabilities

                       Guidance for Paragraph (a)

    When a four or five-year-old child shows signs of possible learning 
disabilities, thorough documentation should be gathered. For example, 
specific anecdotal information and samples of the child's drawings, if 
appropriate, should be included in the material given to the evaluation 
team.
    A Master's degree level professional with a background in learning 
disabilities should be a member of the evaluation team.
    Possible Related Services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Vision evaluation.
    Neurology.
    Psychology.
    Motor development.
    Hearing evaluation.
    Child psychiatry.

[[Page 183]]

    Pediatric evaluation.

                         Section 1308.15 Autism

    A child who manifests characteristics of the condition after age 
three can still be diagnosed as having autism. Autism does not include 
children with characteristics of serious emotional disturbance.
    Suggested possible members of a Head Start evaluation team:
    Psychologist.
    Pediatrician.
    Audiologist.
    Psychiatrist.
    Language pathologist.
    Possible related services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Family support services.
    Language therapy.
    Transportation.

                 Section 1308.16 Traumatic Brain Injury

    Traumatic brain injury does not include congenital brain injury.
    Suggested possible members of an evaluation team included:
    Psychologist.
    Physical therapist.
    Speech or language pathologist.
    Possible related services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Rehabilitation professional.
    Occupational therapy.
    Speech or language therapy.
    Assistive technology.

                    Section 1308.17 Other Impairments

    This category was included to ensure that any Head Start child who 
meets the State eligibility criteria as developmentally delayed or 
State-specific criteria for services to preschool children with 
disabilities is eligible for needed special services either within Head 
Start or the State program.
    Suggested primary members of an evaluation team for other 
impairments meeting State eligibility criteria for services to preschool 
children with disabilities.
    Pediatrician.
    Psychologist.
    Other specialists with expertise in the appropriate area(s).
    Possible Related Services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Occupational therapy.
    Speech or language therapy.
    Family Counseling.
    Transportation.

                             Deaf-blindness

    Information on assistance or joint services for deaf-blind children 
can be obtained through SEAs.

                          Multiple Disabilities

    A child who is deaf and has speech and language impairments would 
not be considered to have multiple disabilities, as it could be expected 
that these impairments were caused by the hearing loss.
    Suggested primary members of a Head Start evaluation team:
    Audiologists.
    Special educators.
    Speech, language or physical therapists.
    Psychologists or psychiatrists.
    Rehabilitation professional.
    Possible related services:
    (Related services are determined by individual need. These 
``possible related services'' are merely examples and are not intended 
to be limiting.)
    Speech, language, occupational or physical therapists as needed.
    Assistive technology devices or services.
    Mental health services.
    Transportation.

        Section 1308.18 Disabilities/Health Services Coordination

                       Guidance for Paragraph (a)

    It is important for staff to maintain close communication concerning 
children with health impairments. Health and disability services 
coordinators need to schedule frequent re-tests of children with 
recurrent middle ear infections and to ensure that they receive ongoing 
medical treatment to prevent speech and language delay. They should 
ensure that audiometers are calibrated annually for accurate testing of 
hearing. Speech and hearing centers, the manufacturer, or public school 
education services districts should be able to perform this service. In 
addition, a daily check when an audiometer is in use and a check of the 
acoustics in the testing site are needed for accurate testing.
    Approximately 17 percent of Down Syndrome children have a condition 
of the spine (atlanto-axial instability) and should not engage in 
somersaults, trampoline exercises, or other activities which could lead 
to spinal injury without first having a cervical spine x-ray.

                       Guidance for Paragraph (b)

    The disabilities services coordinator needs to assure that best use 
is made of mental health consultants when a child appears to have a 
problem which may be symptomatic of a disability in the social/emotional 
area. Teachers, aides and volunteers should keep

[[Page 184]]

anecdotal records of the child's activities, tantrums, the events which 
appear to precipitate the tantrums, language use, etc. These can provide 
valuable information to a mental health consultant, who should be used 
primarily to make specific recommendations and assist the staff rather 
than to document the problem.
    The mental health coordinator can cooperate in setting up group 
meetings for parents of children with disabilities which provide needed 
support and a forum for talking over mutual concerns. Parents needing 
community mental health services may need direct assistance in accessing 
services, especially at first.
    The disability services coordinator needs to work closely with staff 
across components to help parents of children who do not have 
disabilities become more understanding and knowledgeable about 
disabilities and ways to lessen their effects. This can help reduce the 
isolation which some families with children with disabilities 
experience.

                   Guidance for Paragraphs (c) and (d)

    Arrangements should be made with the family and the physician to 
schedule the administration of medication during times when the child is 
most likely to be under parental supervision.
    Awareness of possible side effects is of particular importance when 
treatment for a disability requires administration of potentially 
harmful drugs (e.g., anti-convulsants, amphetamines).

     Section 1308.19 Developing Individual Education Programs (IEPs)

                       Guidance for Paragraph (a)

    The IEP determines the type of placement and the specific 
programming which are appropriate for a child. The least restrictive 
environment must be provided and staff need to understand that this 
means the most appropriate placement in a regular program to the maximum 
extent possible based on the IEP. Because it is individually determined, 
the least restrictive environment varies for different children. 
Likewise, the least restrictive environment for a given child can vary 
over time as the disability is remediated or worsens. A mainstreamed 
placement, in a regular program with services delivered by regular or 
special staff, is one type of integrated placement on the continuum of 
possible options. It represents the least restrictive environment for 
many children.
    Following screening, evaluation and the determination that a child 
meets the eligibility criteria and has a disability, a plan to meet the 
child's individual needs for special education and related services is 
developed. In order to facilitate communication with other agencies 
which may cooperate in providing services and especially with LEAs or 
private schools which the children will eventually enter, it is 
recommended that programs become familiar with the format of the IEP 
used by the LEAs and use that format to foster coordination. However, 
the format of the IEP to be developed for children in Head Start can 
vary according to local option. It should be developed to serve as a 
working document for teachers and others providing services for a child.
    It is recommended that the staff review the IEP of each child with a 
disability more frequently than the minimum once a year to keep the 
objectives and activities current.
    It is ideal if a child can be mainstreamed in the full program with 
modifications of some of the small group, large group or individual 
program activities to meet his or her special needs and this should be 
the first option considered. However, this is not possible or realistic 
in some cases on a full-time basis. The IEP team needs to consider the 
findings and recommendations of the multi-disciplinary evaluation team, 
observation and developmental assessment information from the Head Start 
staff and parents, parental information and desires, and the IEP to plan 
for the best situation for each child. Periodic reviews can change the 
degree to which a child can be mainstreamed during the program year. For 
example, a child with autism whose IEP called for part-time services in 
Head Start in the fall might improve so that by spring the hours could 
be extended.
    If Head Start is not an appropriate placement to meet the child's 
needs according to the IEP, referral should be made to another agency.
    Helpful specific information based on experience in Head Start is 
provided in manuals and resource materials on serving children with 
disabilities developed by ACYF and by technical assistance providers. 
They cover such aspects of developing and implementing the IEP as:
     Gathering data needed to develop the IEP;
     Preparing parents for the IEP conference;
     Writing IEPs useful to teachers; and
     Developing appropriate curriculum activities and 
home follow-up activities.

                       Guidance for Paragraph (j)

    Programs are encouraged to offer parents assistance in noting how 
their child functions at home and in the neighborhood. Parents should be 
encouraged to contribute this valuable information to the staff for use 
in ongoing planning. Care should be taken to put parents at ease and to 
eliminate or explain specialized terminology. Comfortable settings, 
familiar meeting rooms and ample preparation can help lessen anxiety. 
The main purpose is to involve parents actively, not just to obtain 
their signature on the IEP.

[[Page 185]]

    It is important to involve the parents of children with disabilities 
in activities related to their child's unique needs, including the 
procurement and coordination of specialized services and follow-through 
on the child's treatment plan, to the extent possible. It is especially 
helpful for Head Start to assist parents in developing confidence, 
strategies and techniques to become effective advocates for their 
children and to negotiate complicated systems. Under IDEA, a federally-
funded Parent Training and Information Program exists whereby parent 
training centers in each State provide information, support and 
assistance to parents enabling them to advocate for their child. 
Information regarding these centers should be given to parents of a 
child determined to have a disability. Because some parents will need to 
advocate for their children over a number of years, they need to gain 
the confidence and skills to access resources and negotiate systems with 
increasing independence.
    Some parents of children with disabilities are also disabled. Staff 
may need to adjust procedures for assisting parents who have 
disabilities to participate in their children's programs. Materials to 
assist in this effort are available from technical assistance providers.

                   Section 1308.20 Nutrition Services

                       Guidance for Paragraph (a)

    Vocabulary and concept building, counting, learning place settings, 
social skills such as conversation and acceptable manners can be 
naturally developed at meal or snack time, thus enhancing children's 
skills. Children with disabilities often need planned attention to these 
areas.
    The staff person who is responsible for nutrition and the 
disabilities services coordinator should work with the social services 
coordinator to help families access nutrition resources and services for 
children who are not able to learn or develop normally because of 
malnutrition.
    The staff person who is responsible for nutrition and the 
disabilities services coordinator should alert staff to watch for 
practices leading to baby bottle caries. This is severe tooth decay 
caused by putting a baby or toddler to bed with a nursing bottle 
containing milk, juice or sugar water or letting the child carry around 
a bottle for long periods of time. The serious dental and speech 
problems this can cause are completely preventable.
    In cases of severe allergies, staff should work closely with the 
child's physician or a medical consultant.

  Section 1308.21 Parent Participation and Transition of Children From 
                       Head Start to Public School

                       Guidance for Paragraph (a)

    Grantees should help parents understand the value of special early 
assistance for a child with a disability and reassure those parents who 
may fear that if their child receives special education services the 
child may always need them. This is not the experience in Head Start and 
most other preschool programs where the majority of children no longer 
receive special education after the preschool years. The disabilities 
coordinator needs to help parents understand that their active 
participation is of great importance in helping their children overcome 
or lessen the effects of disabilities and develop to their full 
potential.
    The disabilities coordinator should help program staff deal 
realistically with parents of children who have unfamiliar disabilities 
by providing the needed information, training and contact with 
consultants or specialized agencies. The coordinator should ensure that 
staff carrying out family needs assessment or home visits do not 
overlook possible disabilities among younger siblings who should be 
referred for early evaluation and preventive actions.

                   Guidance for Paragraphs (b) and (c)

    As most Head Start children will move into the public school system, 
disabilities coordinators need to work with the Head Start staff for 
early and ongoing activities designed to minimize discontinuity and 
stress for children and families as they move into a different system. 
As the ongoing advocates, parents will need to be informed and confident 
in communicating with school personnel and staff of social service and 
medical agencies. Disabilities coordinators need to ensure that the Head 
Start program:
     Provides information on services available for 
LEAs and other sources of services parents will have to access on their 
own, such as dental treatment;
     Informs parents of the differences between the 
two systems in role, staffing patterns, schedules, and focus;
     Provides opportunities for mutual visits by staff 
to one another's facilities to help plan appropriate placement;
     Familiarizes parents and staff of the receiving 
program's characteristics and expections;
     Provides early and mutually planned transfer of 
records with parent consent at times convenient for both systems;
     Provides information on services available under 
the Individuals With Disabilities Education Act, the federally-funded 
parent training centers and provisions for parent involvement and due 
process; and

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     Provides opportunities for parents to confer with 
staff to express their ideas and needs so they have experience in 
participating in IEP and other conferences in an active, confident 
manner. Role playing has been found helpful.
    It is strongly recommended that programs develop activities for 
smooth transition into Head Start from Part H infant/toddler programs 
funded under IDEA and from Head Start to kindergarten or other 
placement. In order to be effective, such plans must be developed 
jointly. They are advantageous for the children, parents, Part H 
programs, Head Start and LEAs. ACYF has developed materials useful for 
transition. American Indian programs whose children move into several 
systems, such as Bureau of Indian Affairs schools and public schools, 
need to prepare children and families in advance for the new situation. 
Plans should be used as working documents and reviewed for annual 
update, so that the foundation laid in Head Start is maintained and 
strengthened.