PERFORMANCE STANDARD

STRATEGIES

INDIVIDUAL (S)

RESPONSIBLE

TIMELINE

DOCUMENTATION/ MONITORING

1304.20 (a) (1)  

Determining child health status.

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, grantee and 

delegate agencies must: 

(1) 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.

At the time of enrollment, the Generalists will ensure that each family has a medical home.  If a family does not have a medical home, the Generalists will work with the family to ensure one.

Generalists

Ongoing

Application

Emergency Cards

MHP

1304.20 (a) (1) (ii)

(ii) Obtain from a health care 

professional a determination as to 

whether the child is up-to-date on a 

schedule of age appropriate 

preventative 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.

At the time of enrollment, the Generalist ensures that all immunizations are current and up-to-date.

The Generalist continues to ensure that immunizations are completed in a timely fashion when due.

The Health Coordinator trains the Generalist 3X a year on immunizations through Health Advisory Committee members from Public Health.

Health Coordinator

Generalists

Public Health

Time of Enrollment

Ongoing

California Blue Immunization Card

Immunization report due October 10^th of each year

1304.20 (a) (1) (ii) (A) 

(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,

Generalists work in conjunction with the Health Coordinator to ensure that children who have not received up-to-date immunizations are given proper and timely referrals to low cost/no cost clinics or a local CHDP provider for services.

Generalists

Health Coordinator

Ongoing

Resource Referral

Immunization Schedules

TB Clinic Schedules

1304.20 (a) (1) (ii) (B)

(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.

Center staff will continue to work with parents, to discuss the importance of maintaining up-to-date immunizations and Health checks.

.

Teachers

Generalists

Health Coordinator

Ongoing

Physical immunization record

1304.20 (a) (1) (ii) (C)

(C) Grantee and delegate agencies 

must establish procedures to track 

the provision of health care services.

Generalist will track children’s’ health examinations and ensure that medical and dental examinations have occurred in a timely manner.  All health examinations are recorded and kept confidential in the children’s’ files.

Generalist

Ongoing

Excel tracking

Genesis

1304.20 (a) (1) (iii) &(iv) 

(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.

When a staff member suspects a child has a health or developmental problem, he/she will immediately begin a referral to the appropriate entity, in conjunction with the Health Coordinator and/or the Disabilities Coordinator. 

Monthly service delivery team meetings will be conducted to discuss the implementation and follow up of all referrals made. 

Teachers

Health Coordinator

Disabilities Coordinator

Generalists

HS Director

Parents

Ongoing

Referrals

Health Plans

Service Delivery documentation

1304.20 (a) (2)  

(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.

N/A

N/A

N/A

N/A

1304.20 (b) (1) 

(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.  To the greatest extent 

possible, these screening procedures 

must be sensitive to the child’s cultural 

background.

PSD staff use various screenings for developmental, sensory and behavioral concerns.  Consents for the screenings are completed by the parents at the time of enrollment.  If a screening discloses concern, parents are immediately made aware, and further follow up action, such as a referral to the appropriate entity is made.

Teachers

Health Coordinator

Parents

Within 45 calendar days after enrollment.

As needed

Acuscreen, Speech Screen, DRDP plus, Ages and Stages Social/Emotional

MHP

Hearing/Vision

Physicals

1304.20 (b) (2) 

(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.

Mental Health and Disabilities Staff advises staff and provides guidance on how to make referrals to the appropriate entity. 

Mental Health and Disabilities Staff also assist staff in determining the appropriate procedures for developmental screenings.

Teachers

Mental Health and Disabilities Staff

Ongoing

Referrals

1304.20 (c) (1) & (2) 

(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.

Generalist will establish a system of ongoing communication with Parents of children with identified health needs, via telephone calls, home visits, written correspondence, and/or parent conferences.

The Health Coordinator and Generalists assist parents to obtain resources, including prescription medications.

Health Coordinator

Teachers

Generalists

Ongoing

Service Activity Documentation

Genesis case notes

1304.20 (c) (3) (i) & (ii) 

(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.

At the time of enrollment consent forms are signed by parents. Parents also sign First 5 Dental form.

The Health Coordinator/Generalists will work with local dentist collaboratives to ensure that dental screenings are conducted throughout the year to ensure proper dental care.

Teachers will practice daily toothbrushing with the children to instill the importance of daily dental care.

Teachers

Health Coordinator

Generalists

At the time of enrollment

Ongoing

Dental Consent Form

Consent Form

First 5 Dental Form

1304.20 (c) (4) 

(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)

Teachers will incorporate Individualized Education Program (IEP) goals into the Child’s Individual Plan and also into the lesson plans.

 Disabilities Coordinator will in conjunction with Teacher and Parent write HS IEP.

Teachers

Disabilities Coordinator

Parents

Ongoing

IEP/IFSP

Child’s Individual Plan

Lesson Plan

1304.20 (c) (5) 

(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 to access other available sources 

of funding.

The grantee agency will provide treatment for medical and dental care, when no other source of funding is available.

PSD will work with other agencies to obtain services, including the CHDP program.

PSD will also utilize the Health Services Advisory Committee as a link to other outside resources.

Teachers

Generalists

Health Coordinator

Health Services Advisory Committee

Ongoing

Health Services Advisory minutes

1304.20 (d)

(d) Ongoing Care

In addition to assuring children’s participation 

in a schedule of well child care, as described 

in section 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 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.

All Teachers conduct a Daily Health Inspection of the child, prior to the parent leaving the Center.  This will ensure that if a child is sick, he/she is taken to the doctor immediately by the parent.

Observed changes will be brought to the Service Delivery Team and shared with Program Supervisor, Health/Ed Specialist, Teacher, and Site Supervisor as needed.

Teachers

Health Coordinator

Ongoing

Daily Health Check Form

Service Delivery Team

Referrals

SAD Sheet

Child’s Individual Service Record

1304.20 (e) (1) 

(e) Involving Parents
In conducting the process, as described i

n sections 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:

Teachers, Generalist, and Site Supervisors will work with parents, and ensure that timely referrals are given, as needed.

Health Coordinator

Parents

Teachers

Site Supervisor

Ongoing

Referrals

1304.20 (e) (2) 

(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:

Screening Consent Forms are signed by parents upon enrollment into the program.

All results of screenings are shared during parent conferences, home visits, or as needed by the Teachers and/or the Health Coordinator, Generalist, and Area Content Specialists.

Teachers

Health Coordinator

Teachers

Site Supervisor

At the time of enrollment

Ongoing

Screening Consent Form

1304.20 (e) (3)

(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.

During the enrollment process, staff will discuss with parents the importance of demonstrating procedures ahead of time.  Teachers will discuss program setting and provide staff introductions with parents at time of the facility tour.  Parent Handbooks are discussed with parents at time of enrollment.   

Generalists

Parents

Teachers

At the time of enrollment

Parent Handbooks

1304.20 (e) (4) 

(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; 

Center staff help to assist parents with obtaining medical and health resources. Center staff encourage parents to attend medical and developmental appointments.

Interest Survey forms are given to parents.

Parents are encouraged to participate in the Health Service Advisory Committee.

Generalists provide resource lists to parents.

Teachers

Generalists

Parents

Ongoing

Referral

Resource List

Lesson Plans

Interest Service form

1304.20 (e) (5) 

(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.

The Generalist obtain timely written parental consent for authorization of health services.  If a parent declines, written documentation is maintained to document refusal of services.

Health Coordinator

Parents

Generalist

At time of referral

Permission to Refer for Individual Assessment

Consent Form

1304.20 (f) (1) 

(f) Individualization of the program.

(1) Grantee and delegate agencies must 

use the information from the screenings 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.

Teachers and HS Director use the Child’s Individual Plan with Creative Curriculum to individualize each child’s learning needs, in addition to the results of the screenings, observations and assessments.

Teachers

Site Supervisor

Ongoing

Lesson Plans

Child’s Individual Plan