Region 10 & Alaska Native T/TA
PIR Health Conference Call
Transcript
Moderator: Allison Hertel, T/TA Health Specialist
May 24, 2006
11:00 am Pacific Time
Coordinator:
This is the conference coordinator. I would like to inform all participants that today's call is being recorded.
If any one has any objections, you may disconnect at this time.
And Ms. (Hertel), you may begin.
(Allison Hertel):
Great. Thank you very much.
I just wanted to take (unintelligible) (opportunity) to welcome everyone.
And I'm not quite sure how many of you are all in the call. But if you could all put your phones on mute, it's star-6, and then when you want to take it off-mute, it is also star-6.
And I just wanted to check and see if (Kim Keating) is on from (Xtria)?
(Kim Keating):
Yes, I am.
(Allison Hertel):
Okay, great. Thanks, (Kim).
And just so, (Kim), from - you're only available for about 30 minutes?
(Kim Keating):
Yes, uh-huh.
(Allison Hertel):
Okay.
So, first of all, I'm going to describe the purpose of the call and then since (Kim) is only on for 30 minutes, (Kim) is with (Xtria), who's the contractor that does the PIR, so if there's specific questions about reporting, she can answer those prior.
And hopefully, if you do have questions you all have the information to email Renee Andrae. I will just give you her email address in case you don't have it, and she's in the office right now so she will be bringing the questions here. Her email address is renee.andrae@acf.hhs.gov.
Also in the room, we have TA staff that who are going to be facilitating the call and then (Julianne Crevatin), who is an ACF Region 10 Program Specialist is also here to help answer questions.
So with that, we're going to go ahead and begin. The emails that were sent out referred everyone to the 2005 PIR Users Guide.
At this point, as of about 10 minutes ago, the 2006 Users Guide was not yet online, so that is what I'm going to be referring to. However, if you do have the 2006 PIR with you, the health section starts on Page 19. So I'm going to be referring back and forth, but what I'm reading off of is the Users Guide from 2005, which starts on Page 43 of the Users Guide.
(Allison Hertel):
What we're going to start with is the first question .We're basically just going to go through it and answer questions as they come up if you have them, and we're going to go through the health section, and then we're going to go through the mental health section. Some programs had asked questions, and we've given people the opportunity to ask questions in the last couple of weeks. Some of those questions will be answered and hopefully, your questions will be answered.
If you have specific individual questions that are very specific to your program, I would encourage you to email your program specialist or myself and we can talk offline individually about your specific needs.
The first question discusses health insurance and it talks about the number of kids that are enrolled that have health insurance and the number of kids that don't.
And what I do want to make sure everyone is aware of is a couple of days ago, I sent out to all the directors information on the health insurance systems for each dates and I think the title of this page is, Children's Health Insurance System for Alaska. There's one for Idaho, Oregon and Washington.
And what it does is it breaks down the number of families that are enrolled on each of the different health insurance options. So a lot of states call their insurance programs the same name and the difference comes in the federal poverty level of families that can enroll.
Hopefully, that will help answer those questions. I just asked for the number of kids at the beginning of their enrollment that had insurance on the number of children at the end of their enrollment year. So if a child withdraws from the program in December, it's the end of their enrollment year. We want to make sure that you include all children in those counts.
And then it asked about the number of - or pregnant woman with health insurance and the number without health insurance.
I'm going to move on to the next question. If you're looking in the Users Guide, it's on Page 44. If you're looking at the PIR for 2006, it's on Page 21.
And the first question talks about medical homes. And medical homes are the ongoing source of routine preventative and acute healthcare, so family doctors, health (clinics), health maintenance organizations, some programs in Alaska use public health nurses to provide the EPSDT services out in the villages that's your medical home.
So again, the question is the number of kids who have an ongoing source of continuous accessible healthcare. And then those that received services through Indian Health Service, through the migrant community health centers, and again the answers are going to be at the beginning of the enrollment year. So once that child starts their program and then at the end of their enrollment year.
The next question is the hard one. It's the number of children who are up-to-date on a schedule as age appropriate, preventive and primary healthcare.
And from my understanding, there have been a couple of questions that have come up around these questions. I'm just going to read a few things off.
What it is asking is you want to make sure that children are up-to-date on their schedule of well-child exams during the current operating period or it within the last 12 months. You want to include dropout children that reenrolled, children that enrolled late so anytime throughout the year.
(Allison Hertel):
A couple of comments from questions that we received previously is if a provider gets an exam such as the 15-month and then the child was brought back up-to-date with the 18-month exam, is the child considered up-to-date and the answer to that question is yes.
And then another question has come up is if a child enrolled, you only need a copy of their most recent well-child exam according to the EPSDT schedule of the state. So the child enrolled at 22 months, you don't need exams from two months, four months, six months of age. You just need the copy of their most recent well-child exam.
Other questions that have come up is that there is not an EPSDT schedule in Oregon, and so that's based on the schedule that your health services advisory committee decide or if you follow the AAP's recommendation or if the provider has determined their own schedule you would use that..
(Allison Hertel):
I encourage you to use the comment section to explain why children are not receiving their medical services. I would include the number kids that were enrolled less than 90 days in your program. And I would also encourage you to include the number of kids whose parents refused exam.
And while those numbers may not come out in the report, they'll come out in your individual PIR report, which helps clarify some of the reasons those numbers are at certain percentages.
(Allison Hertel):
The next question talks about the number of children diagnosed by a healthcare provider as needing medical treatment.
A couple of clarifications on this question is that you want to include children who have been previously diagnosed and are receiving treatment. So if a child has been diagnosed as having asthma, however, it was prior to their enrollment in their program, you still want to count that child as needing medical treatment so that you can later show that they are getting treatment.
(Betty):
Back on No. 9 - Question No. 9 .
(Allison Hertel):
Yes.
(Betty):
And of course, this is an Oregon question. When there is no EPSDT period for this schedule, and you're going by the healthcare providers own schedule. That's the decision your (HSAC) has made...
(Allison Hertel):
Uh-huh.
(Betty):
...to use that provider's schedule.
How do we determine what - it says that you can only count them if they have completed all required tests. And what is the PIR really looking for there? And if that provider - we have a group of providers who don't do certain tests that are required in other states, (DPS), (DT) period (at least).
(Allison Hertel):
Right.
(Betty):
How do we handle that?
(Julianne Crevatin):
(Betty), this is (Julianne).
When you have providers that have their own schedules, what do you receive from them and what do they have on their exam form? I would expect to see that they complete their own exam form.
(Betty):
We do not infer - I think reason that many people on the call including you guys are aware of. We do not request the exam form.
What we request is the health appraisal form asking if the child is up-to-date, when the last well-child exam was, where there any health concerns that needed follow up and we do ask for specific things such as we ask for a current hematocrit or hemoglobin, we asked if blood screening was completed. Is there anything else, (Julianne) (ask for)?
(Julianne Crevatin):
No.
(Betty):
No.
(Betty):
And a number of programs in Oregon use that system. It's called the Health Appraisal System. There's lot of reasons we do not want that well-child exam form in our office, so when the provider is determining are they up-to-date and they are saying they completed the exam and when?
Woman:
Then I - makes you on your form that you have the statement says, the child has been examined, is complete at this time, or something to that effect is the provider verifies completion of exam.
(Betty):
Okay.
And then we don't have to worry about individual tests because our state doesn't have a list of test that are required on EPSDT physical.
(Julianne):
And I would make sure you have that in your file that verifies that for reviewing.
(Betty):
Okay. Thank you.
(Kim Keating):
This is (Kim). I just wanted to comment.
First, I apologize that the Users Guide isn't up yet. When we converted it over to PDF a little bit earlier this afternoon, it (unintelligible) the screen up, so somebody is fixing that right now and hopefully you'll have it by the end of the day each of you that's on the call to be able to download.
In terms of the language in that about appropriate test in physical exam, it does say to answer your question that you can go with the recommendations of your HSAC for your specific community about what is required in terms of tests in physical exam just to determine if – the determination in your area is to go with what the doctors require as complete and that's what the PIR will allow for.
(Allison Hertel):
Kim, this is (Allison).
Just to clarify that's in the 2006 Users Guide?
(Kim Keating):
Yes, it is.
(Allison Hertel):
Okay.
So for everyone on the call, look for that this afternoon. And if we do - when we do clarify that it is out, we'll also send out an email.
Woman:
On Question No. 9, could I just clarify? Do we include the screening - hearing and vision screenings in that? Are you expecting those numbers included in No. 9?
(Allison Hertel):
The hearing and vision screenings at the program complete?
Are you relying on that information to show that the EPSDT has been completed as part of this - as the EPSDT exam?
Woman:
Well, we're in Oregon also, so we don't have the EPSDT requirement. But we were told to include that, our No. 9 question, so we have been including it...
Woman:
But it - sorry. We're just - but if they haven't - don't have an exam, we can't just have...
(Kim Keating):
Who's completing the hearing and vision screening? The doctor or people within the programs (receiving that)?
Woman:
(Doctors). We have an audiologist doing the hearing screenings.
(Kim Keating):
Uh-huh.
Woman:
Doctors doing vision screenings also.
(Kim Keating):
Okay. All right.
Woman:
So that information can be used if that child had an exam, so that's one component of the exam that you're relying on another health professional to complete it, you can include those children.
(Kim Keating):
Okay.
Woman:
But it's not going to take the place of an exam.
(Kim Keating):
Right. Thank you.
Woman:
You're welcome.
(Caroline):
(Allison), this is (Caroline) from EWU.
I missed the comment that you made at the end of No. 9, which I thought was something about - were you saying something about we should put in comment if we have people who aren't today on their EPSDT? Did you say something like that?
(Alison):
Yes. I encourage you to include comments for those children that have not been enrolled for 90 days or that may have withdrawn prior to the 90 day deadline.
(Caroline):
Oh, okay.
(Allison Hertel):
And also those children whose families refused the exam.
(Caroline):
Okay, thank you.
(Allison Hertel):
You're welcome.
That way we have something to understand, why the number is different - I mean basically this percentage is calculated against, the actual enrollment numbers. And so if this percent is lower, then what some of the reasons for this can - clearly, some of the reason is one of the children weren't there long enough and the other reason is parents who refuse medical exams.
So that accounts to some of the variation in the number between, what should be expected in completion and the reason why we don't see 100%.
(Allison Hertel):
Okay. I'm going to go ahead and move this on.
The next question is referring to the number of the children diagnosed by healthcare provider, the number who have received or are receiving medical treatment.
(Allison Hertel):
So, of those kids, the one clarification on this is that the kids need to have at least one follow-up appointment to be counted as having received or receiving treatment. It's not just an appointment has been made for the summer; it's that you actually know that they have started the treatment process.
The other clarification on that, some programs have asked about treatment provide aside from their medical provider. You can also include treatments that's been done by a licensed healthcare provider. So if a child is having an intervention with a dietician or an audiologist or another provider, that is considered treatment. Education is not considered treatment.
Woman:
...education is not (unintelligible).
Woman:
I heard that. But what does that mean?
Woman:
Let's say a home visitor gives information...
(Allison Hertel):
So there is a question - I think I heard the question of what does that mean. So, yes, they had staff that's just providing a resource to a family that would not be considered treatment. It's actually a medical intervention.
Woman:
What if that treatment is performed by a registered dietician?
(Allison Hertel):
Then it would be - okay.
Woman:
Is that in the contract of your (nutritionist)? Are you talking about like a nutrition follow-up on an overweight or underweight child and you refer to your own nutritionist?
Woman:
Yes.
Woman:
And that individual is a practicing provider in the community?
Woman:
Oh, that person is on staff at the start. Registered dietician is an employee...
Woman:
Then they're licensed to provide that?
Woman:
Yes.
Woman:
I think what the question that is (Kim), the education we've provided through our home visitors or family advocates be considered treatment.
Woman:
And then (unintelligible) should be made to you (own in-house). So what we send with you is an actual record of the follow-up treatment (unintelligible) it is an educational activity with the parent. You can actually see it's scheduled like an appointment, where there's actually a dedicated time and activity that supports the effort.
Woman:
Okay.
(Linda):
Several times when a child has a (unintelligible) hemoglobin, the doctor or healthcare provider will start them on vitamins with iron or iron drops or something like that so that's a treatment that's received at the time of the exam. So would that count as a service?
(Allison Hertel):
Yes.
(Linda):
Okay. (I don't) like to say have an ear infection, they received antibiotics. That would be a treatment (also).
(Allison Hertel):
Yeah. They're on a course of treatment.
Woman:
Treatment, uh huh.
(Linda):
Okay. Thank you.
(Allison Hertel):
You're welcome.
The next question talks about the number of children who received medical treatment for the following conditions. So it asks specifically, I think there are seven different areas: anemia, asthma, hearing difficulties, overweight, vision problems, high blood levels, and diabetes.
First off, there has been one question that came in about anemia, and whether it includes all types of anemia. And that answer is yes.
The second piece for this question is if it's been - and, (Kim), correct me if I'm - if it's been diagnosed through the program, through a licensed healthcare professional the program uses so determining if a child is overweight, that can also be used.
Is that correct, (Kim)?
(Kim Keating):
That's correct, uh-huh.
(Allison Hertel):
Okay. And that also includes the vision and hearing or any of those, but I know most frequently, programs are doing the hearing and vision screenings and the overweight. And so if through that a child has received medical treatment, you can count that.
(Kim Keating):
Yeah.
(Allison Hertel):
The next question moves us into immunizations. And this one also is looking at the beginning of the enrollment year and at the end of the enrollment year.
And the first question is, the number of children who have been determined by healthcare professional to be up-to-date on all immunizations appropriate for their age? And then in the definition of terms in the Users Guide, it also says to include as up-to-date those children who have legal exemptions.
The second question refers to the number of children who's been determined to have received all immunizations possible at that time, but they are not up-to-date for their age.
In the Users Guide it says, do not include children who are not up-to-date or who have missing immunizations. Specify in the comment section the number of children who are not fully immunized and the reason, for example, parent's refusal that does not include in the exemption.
So just another place to use the comment section to help explain some of the reasons.
Woman:
Excuse me. On No. 11.
(Allison Hertel):
Uh huh.
Woman:
Did I hear you say that you would consider a child that has a legal exemption? You would count them in that.
(Allison Hertel):
You would count them as up-to-date.
Woman:
Okay. So when you say a legal exemption, you're also talking personal?
(Allison Hertel):
It's different in different states, but I know in Washington State, there's a religious exemption, a personal exemption, and a medical exemption.
Woman:
Okay.
(Allison Hertel):
I'm not sure what - how other states have it.
(Allison Hertel):
And it requires documentation on their certificate of immunization status form or whatever form the state uses..
Woman:
Right. Okay, thank you.
(Allison Hertel):
You're welcome.
(Terry):
(Allison), this is (Terry) in Seattle.
(Allison Hertel):
Hi, (Terry).
(Terry):
Hi.
You said that immunizations needed to be evaluated by a healthcare professional to determine whether or not they're up-to-date on all immunizations. Does that mean a licensed person have to do that within the program? Or is that -- I mean because I know there's a lot of health coordinators that are not licensed.
(Allison Hertel):
I'm sorry to have a discussion. I think we're going to come back to your question.
(Terry):
Okay.
(Allison Hertel):
So I will just hold on to that because it's being discussed and it won't be forgotten.
(Terry):
Okay.
Woman:
(Unintelligible) will that information go out to all?
(Allison Hertel):
Yes, it will.
Woman:
Thank you.
(Theresa):
(Ali), it's (Therese) in Fairbanks. How are you?
(Allison Hertel):
Good, thanks.
(Theresa):
If a program is using the SelfIMMage program that we use because that makes a determination, is that considered an acceptable means of getting that information?
(Allison Hertel):
That's what - we're going to confirm all of that for you.
(Therese):
I just want to make sure that that part was added to the question.
(Allison Hertel):
Right, because there's a lot of states that have a similar program.
(Therese):
Okay, thank you.
(Allison Hertel):
Okay. The next question refers to services for pregnant women. And so this is for Early Head Start programs only, talks about - to indicate the number of pregnant women who received the following while enrolled in the Early Head Start program.
So you're just supposed to give information for the number of women who received prenatal and postpartum healthcare. The number who received the mental health interventions and follow-up including substance abuse, prevention and treatment, prenatal education on fetal development and information on the benefits of breastfeeding.
So, you can - in the Users Guide it says you count these women who received one or more of the listed services while enrolled in the program, whether your program directly provided the services or the program connected the women to the appropriate service providers.
And women can be counted under more than one service type if multiple services were received. So the example given is that Early Head Start program arranged for a local breastfeeding organization to conduct the workshop on the benefits of breastfeeding for the pregnant women. So you would report the total number of women who received that service.
And then the second question asks the trimester in which the pregnant women enrolled in the program, so the first, second or third trimester.
And then lastly, it asks the number of women served whose pregnancies were identified by their medical provider as high risk. Report only the number of women whose pregnancies were identified by a physician or healthcare provider as high risk.
Include those women whose pregnancies were determined to be high risk prior to their enrollment in the program.
Okay. Going to move on to dental, our favorite topic out there.
Okay. First question and just to clarify, it says the dental home is an ongoing source of routine, preventive and acute dental care under the supervision of a dentist. Examples include family dentists and dental clinics.
The first question is the number of children with an ongoing source of continuous and accessible routine, preventive and acute dental care, though similar to the medical question, it's what you consider the dental home and what's available in your community.
So thinking about at enrollment, who has accessible dental care and then at the end of the enrollment year.
(Allison Hertel):
The next few questions are for preschool programs only. And it starts with the dental services.
Woman:
Excuse me. Can I ask a question? We have Early Head Start program. And the dentists in our area do not see our children, and that's according to (EPSDT). And so what we do is we have the parents fill out a dental form telling us if there's any, you know, concern or a problem that their children have. Is that considered that there's - that we're meeting that? On Question No. 16.
(Allison Hertel):
On Question No. 16, in most states that EPSDT schedule states that a medical provider can do the dental component during those first few years.
Woman:
But they don't. They will again unless if they're having a distinct problem. They don't see our children routinely before (three).
(Allison Hertel):
The medical provider is doing it...
Woman:
They'll look at the child's mouth, right?
(Allison Hertel):
Okay.
So that - so they are doing that visual - that oral health screening for infants and toddlers.
Woman:
Okay.
So if we - so if it's marked on their health appraisal that they have no concerns about their oral health, then we're covered, right?
(Allison Hertel):
Yes.
Woman:
That would be their - considered at that time their dental home, right?
(Allison Hertel):
Yes, the medical provider would be considered their dental home.
Woman:
Okay, thank you.
Woman:
I have a question on No. 16.
(Allison Hertel):
Okay.
Woman:
We, in our community, have two community dental clinics that are available to those families without dental providers that take sliding fee. If at the time of enrollment, if they don't have an ongoing source of dental care, but we refer them to these dental clinics, which will not turn them away, would that meet that criteria?
(Allison Hertel):
That would mean that at enrollment, they did not have a provider and as a result of the program, at the end of the enrollment year they did have one.
Woman:
Right. Yeah.
(Allison Hertel):
So, yes.
the next question which is No. 17, asks the number of children including those enrolled in Medicaid or EPSDT who have completed a professional dental examination during the current operating period or within the last 12 months, including dropouts, re-enrollees and late enrollees if they have completed the professional dental exam.
In the PIR Users Guide, it states that a - and I believe - It says that a professional dental exam is when completed by a dentist, the signature of the dentist is required on the dental exam record even if a dental hygienist performed part of the exam.
And what I'm going to say here is that your programs need to look at your State Dental Practice Act to determine the definition of an exam. And the purpose of an exam is to make a diagnosis for the purpose of developing a treatment plan. And Region 10 states; in all four states, dental hygienist cannot do exams.
A dental hygienist can do screenings but that does not make a child - that is not a professional dental exam.
(Madeleine):
This is (Nathalene) at (Kid Co).
And I wondered even if the dental hygienist has a limited access permit. Can she - would that make a difference?
(Allison Hertel):
No, because in Oregon, the limited access permit if you look at the state regulation, it still does not allow them to develop a treatment to do treatment plan.
(Madeleine):
Okay, thank you.
(Allison Hertel):
Secondly, you want to include dropouts from the program, re-enrollees and late enrollees and you want to include any child who had a dental exam within the last 12 months regardless of whether the service was arranged by Head Start.
(Terry):
(Allison), it's (Terry) in Seattle, again.
I'm looking - this is - I've never thought of this before. But the - within the last 12 months, when do you start counting that? So, for instance, you have a child that enrolled in September. They have a dental exam in March of that year. Is that counted to 12 months or does it have to be - can you clarify the 12 months for me?
(Allison Hertel):
Sure.
It's 12 months for the child. It'd be similar to the EPSDT schedule. If a three-year-old had an exam in May, they would be up-to-date until the following May.
(Terry):
Okay.
(Allison Hertel):
So if it - so it's similar for dental exams.
(Terry):
So kids who were up-to-date when they started, you put them out of up-to-date in your database, once they hit that anniversary that...
(Allison Hertel):
Correct.
(Terry):
Okay.
(Allison Hertel):
The next question asks of the actual children that were examined, the number of children who received preventive care, which includes fluoride application, cleaning or filling application.
And then the next one is the number that were diagnosed as needing treatment within the current operating period or within the last 12 months. So a treatment includes restoration, full therapy extraction. It does not include fluoride application or cleaning.
Woman:
Hi. I have to go back to Question 17 and back to the 12 months question.
(Allison Hertel):
Okay.
Woman:
If I have a child that started school on 9/14/2005 and they have a dental exam on 9/14/2004 or later, am I not allowed to count them as having had a dental exam within the past 12 months when I do the PIR at the end of the year?
(Kim Keating):
This is (Kim).
No, and I think that we added some clarification in about that. I just don't know if it linked specifically to the dental item. It might be at the beginning of the medical services section entirely in the 2006 Users Guide.
But the 12-month should be referring back to - for that type of situation should be referring back to the entire enrollment year. It should not be based on when you're doing the PIR because you'll be doing that during the summer, and so that won't be related to the enrollment year. So at the very latest, it should be the last day of the enrollment year that you're counting back from.
In the example that you gave, the child would have to have been brought up-to-date during the enrollment year for you to count them as up-to-date in (T17) for the example that you just gave.
Woman:
Okay.
(Kim Keating):
Does that make sense?
Woman:
Right.
So if I - if my last student day is June 9...
(Kim Keating):
Uh-huh.
Woman:
Then it has to - have been June 9, 2005, or later in order for me to count it?
(Kim Keating):
That's right. Uh-huh.
Woman:
Okay, thank you.
(Allison Hertel):
The next question is (C17c), which builds off the previous question; which of the children that were diagnosed as needing treatment, the number who received or were receiving or are receiving treatments.
So that then again - that again is a child needs to have received at least one follow-up exam or have started the intervention to be considered received or receiving.
The next question talks about the number or the percentage of diagnosed children who receives treatment. And it say if this person is less than 90% of the children diagnosed as requiring treatment, please specify the primary reason. And then you can include stuff in the comment section.
The next question moves into Early Head Start programs, and it's around preventive dental services for infants and toddlers, so 0 to 3.
And (C18) asks the number of children who received oral health screenings as part of the series of well-baby visits mandated by Medicaid, EPSDT.
In the Users Guide, it defines oral health screening. They are conducted by a health professional such as the pediatrician and do not involve making diagnoses that lead to treatment plan.
So this is what medical providers do as part of EPSDT or their well-child exam. It's two to three minutes screenings, including both visual and manual screening of the entire mouth and teeth to identify oral disease or other oral conditions that require management.
So you want to include dropouts from the program, re-enrollees and late enrollees if they received oral health screenings within the last 12 months. And you want to include all children ages 0 to 3.
The next question is the number of children in Early Head Start who received a professional dental examination within the last 12 months. So of the children in your program, ages birth to 3, the number that received an exam conducted by a dentist who is qualified to perform the exam based on your State Practice Acts and Regulation.
And it says that oral examinations include a complete clinical oral health assessment appropriate, diagnostic testing, assessment of risk for developing disease, establishing a prevention plan or planning for treatment. Again, the signature of a dentist is required.
The next question is on dental services for pregnant women. So this is for pregnant women in Early Head Start program only. Of the number of pregnant women served in your Early Head Start program, the number who received a dental examination and/or treatment within the last 12 months.
We're going to kind of close out this section. I just wanted to check in and see if there are any questions.
(Jill Carpenter):
Hello, this is (Jill Carpenter) with Northeast Washington Early Childhood Program.
(Allison Hertel):
Hi, (Jill).
(Jill Carpenter):
I have two questions. I thought I heard you say back on 9A and 9B to count a child if they were - had a documented health condition like asthma even before coming to Head Start, did I hear you say that?
(Allison Hertel):
Yes.
(Jill Carpenter):
Because that - is that in the Users Guide for 2006, that clarification, because right now, the Users Guide says just account child if they were - you know, if they have the condition and it was diagnosed during the operating period.
(Allison Hertel):
Right.
(Jill Carpenter):
They were in Head Start. You're saying to count them if they came into our program and were diagnosed before they came to us.
(Allison Hertel):
Right. (Kim)...
(Allison Hertel):
Kim, Can you clarify that in the 2006 Users Guide?
(Kim Keating):
No, it hasn't changed. Let me think here.
Well, the part of the phrasing that says or within the last 12 months...
(Jill Carpenter):
Uh-huh.
(Kim Keating):
...account for any type of diagnosis that may have made prior to the actual enrollment year.
So, if the child was examined and diagnosed in the summer month before the school year began, you know, that's certainly coming before the year began, that's...
(Jill Carpenter):
Yeah, I'm taking about a child that comes in as a medically fragile child and they've been diagnosed maybe when they were two years old, and they're coming to us and they're continuing to get treatment.
(Kim Keating):
Okay. Well, that wouldn't have been within the last 12 months...
(Jill Carpenter):
...that was I trying to get - I thought I had heard something about make sure you count children here that were diagnosed even - I just didn't hear - okay, I understand then.
So that question hasn't changed. We're still looking at children that were diagnosed in the previous - right before coming to us. Not necessarily, diagnosed when they were one or two years old.
(Jill Carpenter):
That's my understanding. Is that yours, (Ali)?
(Allison Hertel):
Yes.
(Jill Carpenter):
Okay. And the other thing was I thought I heard you also say something about in No. 10, something about Head Start staff as treatment providers and I was confused about that because there was a lot of conversation, it's hard to hear sometimes when everybody is talking, something about you can have a licensed, you know, nutritionist that does treatment with your families on an appointment basis, but then someone else said when we have some Head Start staff that do hearing and vision. But I guess I'm kind of mixed up about what you're talking about as far as Head Start staff being treatment providers on No. 10.
(Allison Hertel):
Right. And just to clarify, that's licensed healthcare provider, so yes, if you're a dietician who was on contract and through referrals did that type of treatment you can include those.
(Jill Carpenter):
A licensed provider, you're talking about?
(Allison Hertel):
Yeah, I think the confusion may have come and I said that often Head Start staff do the hearing and vision screenings, but really what it comes down to is as a result of that screening, it's the treatment.
(Jill Carpenter):
A treatment, okay. All right, thank you very much.
Woman:
We have a lot of staff who do screenings, but they're not licensed to provide any kind of treatment. This question focused on treatment. You have to have a professional that's certified to provide treatment to be able to count them in this question.
(Allison Hertel):
Thank you for those questions.
(Dawn Williams):
Hi, (Alli). This is (Dawn).
(Allison Hertel):
Hi, (Dawn).
(Dawn Williams):
Hi.
(Allison Hertel):
(Dawn Williams) is our (TA) Disabilities Specialist and she takes the lead on the mental health piece. We work in coordination to do mental health (since that really) encompasses all areas, so she's on this part of the call.
Perfect timing because we are moving into mental health.
The mental health piece, if you are in the PIR, it starts on Page 24. If you are in the Users Guide, it starts on Page 53.
And the first part of the Users Guide defines what a mental health professional is and it states that it's an individual trained to support the emotional and psychological well-being of Head Start or Early Head Start children and families. They represent a variety of disciplines including, but not limited to psychiatry, psychology, psychiatric nursing, marriage and family therapy, clinical social work, behavioral and developmental pediatrics and mental health counseling.
The mental health professionals do not have to be on the staff of the Head Start or Early Head Start. He or she maybe a consultant to the program or served the program on a contractual basis.
So if you have questions about the mental health professional, I encourage you to look in the Users Guide.
The first question is 21, and it talks about the average total hours for operating month that a mental health professional spends on site.
You are to report the number of hours spent with children, parents and families within or outside of the classroom and in training or consultation with the Head Start staff, and you are to use whole members only, no fractions. It's on the Users Guide.
(Betty):
(Ali), I have a question on that one.
(Allison Hertel):
Uh-huh.
(Betty):
Hi. That - it seems contradictory because we had just recently received what we believe to be quite clear clarification from the Bureau that onsite means on classroom site not any services that consultation or anything that's provided other than in a classroom site.
And so I guess - so basically, in this - for the PIR what's your saying is that if a service is provided on a home visit that's still a Head Start service. If it's provide on a head service, you want those hours captured for PIR, but even though - so the definition of onsite is different?
(Julianne Crevatin):
(Betty), I'm reading right on the PIR. It says, for example, with children (unintelligible) family within or outside that classroom and in training or consultation with the staff, so it does not say specifically if that that outside is outside the building or outside...
(Julianne Crevatin):
The PIR (unintelligible) I would count it.
Woman:
Okay.
(Kim Keating):
Yeah. I would, too. This is (Kim).
I would count it because I haven't heard this come up as an a point of debate when I've talked with the people in the bureau and would assume since there's also home-based models that they're not really intentionally limiting it to physically, you know, only in the building.
Woman:
Okay, that's great because apparently they are considering that.
Woman:
The bureau does consider that to be true for...
Woman:
Even for the home base?
Woman:
Well, you know, I don't know about a home base. If you have a center base model, they - we just received clarification. They only consider onsite to actually be in your center base site.
(Allison Hertel):
Okay. The next question is mental health services and it is number 22.
Indicate the number of children, enrolled children who are served by the mental health professional in the following ways during the operating period.
So the first one is the number of children for whom the mental health professional consulted with program staff about the child's behavior or mental health.
The next question is the number of children - or of those children, the number for whom the mental health professional provide a three or more consultation with program staff.
Woman:
On No. 22A, the number of children for whom they consulted with program staff on behavioral mental health. My question is, when they do a classroom observation, we consult on all children. If some children re-consult specifically on and we do work on behaviors, et cetera, on specific children, do those children count there?
(Allison Hertel):
Well, if you look there's a little No. 1 at the top end, it says do not include routine communication with staff or parents or routine child screening and assessment in those counts.
Woman:
Exactly. So the routine is that they sit down and they cover the children, but the out of routine part would be that they specifically talked about the children's behaviors and what to do.
(Allison Hertel):
Well, if that goes beyond that routine piece, if that's the next step, and the follow-up is to discuss that individual child then yes, that child would be included.
Woman:
So would they need to have an individual observation written up for that child accounted or can it be part of our classroom report where we report on each child?
(Kim Keating):
This is (Kim). But in the Users Guide for 2006, we specify as well as being - along with routine communication, routine observations or screenings do not include those. So, I would think that there would have to be an additional observation for that particular child.
Woman:
Because that makes a huge difference in the numbers.
(Kim Keating):
Yeah.
Woman:
Okay.
(Allison Hertel):
The next question is specific to the number of children for whom the mental health professional consulted with the parents and/or the guardian about the child's behavior in mental health.
And of those children, the number for whom the mental health professional provided three or more consultations with the parent or guardian during the operating period.
The next question asks for the number of children for whom the mental health professional provided an individual mental health assessment.
There was a question that came in earlier about what is considered to be mental health assessment. And it's more than just that routine child screening or assessment. Something that's not routine, and I would say that would be determined by your program of that additional level of assessment of the mental health professional is doing for that individual child.
And then the next question is the number of children for whom the mental health professional facilitated a referral for mental health services.
Woman:
Question on these.
Woman:
Facilitating the mental health, are those was that they recommend for a mental health referral? Is that what - you would consider that where the mental health consultant, they come in and do an individual observation or during the classroom observation, they recommend that this child has a mental health referral, is that what you would mean by that?
(Allison Hertel):
Well, does the actual referral occur?
Woman:
It would occur - we would pursue that referral then with the parents to see if they're willing to do the referrals.
(Allison Hertel):
So if that mental health professional helps facilitate the referrals, then yes.
Woman:
Okay.
(Allison Hertel):
The last question is the number of children who were referred for mental health services outside of the Head Start program during the operating year. This includes referrals made by the mental health professional or other Head Start, Early Head Start, and that is in the Users Guide.
And then the next question asks of the children referred, the number who received the mental health services during the operating period, you want to include all children referred during holiday breaks and summer months also.
We have a little more time. Are there questions that have come up?
Woman:
I do have a question. I did send in an email question, so it apparently didn't make it into your room. So can I ask it then?
It goes - actually it's two. It goes back to Question No. 17, see if I can get this clear.
So we have a child that we enroll in August of this year of 2006 for the next program year. We go back one year, but, you know, child enrolled in August. The child has a dental exam from May of that year. We're going to consider that child in our data system to be up-to-date on dental care within 90 days as soon as we have the paperwork in with a signed dental form.
So once that's in, we're going to consider them up-to-date, but my understanding of what you said on Question 17 was we would be able to count that child in the numbers on No. 17 unless we ensure that they got another dental exam in May of that next year and got the paper working on it too with the signature of a dentist on it. Is that - did we hear that correctly?
(Allison Hertel):
That's how - you know, basically, you're saying that child walks in the door and is up-to-date for a dental exam. The next annual exam is the next May, so the program should be ensuing that that child receives the exam in May, and at that point the child is up-to-date in May, again.
Woman:
The question for one of those is, then we can't count them until we have the signature of the dentist on a form and the program year closes and, you know, we - a lot of times it's getting the signature of the dentist on the form.
So we just wanted to be clear about do we count this kid or do not and sounds like for PIR purposes, no.
(Kim Keating):
This is (Kim).
When is the actual date that your enrollment year would end?
Woman:
It would end the first week of June.
(Kim Keating):
Okay. So then they would not be - they unless they had an exam in May, they had not...
Woman:
And we had the paperwork in with the signature on it.
(Kim Keating):
Right.
Woman:
So I guess what we would probably want to do then is include - would you recommend that in some of those positions were we believe they've gotten the exam, but we weren't able to get the paperwork in before the end of the program year, that we would include that in the comments?
Woman:
Oh, it was completed by a dentist. And just to ensure that we don't just ask the parent, did you get the exam, we want to make sure that it actually - there was a form that, you know, the dentist signed that they did it.
(Allison Hertel):
Uh-huh.
Woman:
So we could just accept it if the parent said that they went in and got the exam. If that would - if we could count them that way, that would be great.
(Allison Hertel):
That would - that's not...
Woman:
(Unintelligible).
(Allison Hertel):
(My call), I guess it's the program specialist that would have to determine that.
Woman:
Thank you, (Alli)?
Woman:
...clarification in your files to show that somehow you verify that that child received that exam.
Woman:
...for whatever.
Woman:
Yeah.
Woman:
...there was an exam at that point.
Woman:
That would be great, okay.
Woman:
Yeah.
Woman:
It'd be unfortunate if you couldn't count that.
Woman:
Well, yeah then - and so it's - a lot of times it's, you know, the challenge is getting the pieces of paper.
(Allison Hertel):
At the end of the year.
Woman:
At the end of the year.
Woman:
Yes.
Woman:
And that really becomes a huge challenge and, you know, it is a systems issue.
And then on the next question we have with on mental health 23A, we heard you say - I just want to clarify that it says clearly on there during the operating period.
(Allison Hertel):
Uh-huh.
Woman:
And I heard - we thought we heard you say summer, and we were just assuming that that meant programs that operate in the summer, but...
(Allison Hertel):
It says in the Users Guide, it says including during holiday breaks and the summer months preceding the enrollment year.
Woman:
Preceding. Oh, that's good that was exactly our question. If we pick up a child that needs mental health, can we - okay, that's good, we can. If we provide the service, we count that one.
(Allison Hertel):
Yeah.
Woman:
Great, thank you.
Woman:
Can I go back to Question No. 17?
Woman:
Sure.
Woman:
The question asked who have - a professional dental exam during the current operating period or within the last 12 months. So the question is not asking whether the child is up-to-date. It's whether they've had a professional exam. So that child that has an exam on (5-6) would count - on May of '06 would count because they've had a professional exam within the last 12 months and of the...
Woman:
Great.
Woman:
...the last 12 months, the operating period started in August. It was only three months prior to the operating period.
Woman:
Well, the - let me look at this.
(Allison Hertel):
I mean the wording maybe different from the medical, but it's the intent as I understand it from the bureau has always been that the children are kept current on their dental as well as their physical examinations.
Woman:
Well, I mean I understand the performance standards required to determine that children are up-to-date and we're to keep them up-to-date, but that's not actually the question on the PIR.
So if you have us counting only children who are up-to-date and this information is not going out to everyone. Then whether it's the intent or not, it's going to affect our numbers terribly.
Woman:
Actually been a lot of the problem with the PIRs, it does not match the language of the performance standard. So were - programs are often trying to meet performance standards, and then when we try and do the PIR, it's very difficult to make that match because the language does not much.
(Allison Hertel):
And the language for these items comes directly from the health people at the bureau and I have never them interpret it as if that there have been an exam, but that the child was not current in their examinations. So we probably need to work with them and re-word that item next year.
Man:
Yeah.
Woman:
For this year, we need to count that one in May or because everyone is doing that, we're intent to look, you know, and then we've got to try and be as consistent as possible with everyone.
Woman:
And what's the big deal?
Woman:
I would look at this question, you're looking at what is doable within like an (insurance) period. I mean basically, that's how you look at these questions.
In a 12-month span of time, my child is eligible for an exam, in that 12-month time has the child received an exam. And so I would include the children who have had an exam whether it was over the summer or during the operating period of your program as number of children who were enrolled, who have received, who have completed the demo exam. These children whether they gotten exam in June, July or August, they had an exam.
Woman:
Right.
Woman:
And those children should be counted.
(Don't) say on which had (start) - got them the exam it says, do this child have a completed dental exam in the last 12 months?
Woman:
Right.
Woman:
So those children should be counted in that number.
Woman:
The example was made though for the month of May, so I'm - it'd be good if this could be (typed) up and sent out with the final (question) is.
Woman:
Another problem with the dental fees is that we often get kids in that have received a lot of extensive dental treatment or are in the process of treatment. And because of that, if there is an extensive...
Woman:
...full treatment plan, it draws the preventative schedule off for those children. The dentists are working to try and get their treatment done. And for those children especially whether they're identified prior to entering our program or they're identified during our program, their preventative schedule is completely null and void because they're in the treatment process.
And technically should also be counted because they are in the process and they will not receive another examine until they're completely done with their treatment. And with some children it is taking a year to get their treatment done especially those on (OHP) and dealing with pediatric dentists and hospital surgery and that sort of thing.
So. I think, you know, this - the dental piece really is very problematic for, I think, a lot of our program and how to count this children.
Woman:
Going back to - I completely agree with that. We run into that that situation all the time as well, and you wouldn't be able to get another exam in there.
The other question, going back to that issue of data, I understood that part of the - purposes of these calls was to ensure consistency of data. I think it will work well, you know, for within the region. But I am concerned that the state - that this question says during the current operating period or within the last 12 months that if that's interpreted differently in other regions, we'll still look in consistent with other regions.
So somebody could follow up on that, you know, and so that we're consistent with other regions, that would be great.
Woman:
Sure...
Woman:
And that's why I think (Kim) was on the phone. It will help - I mean she certainly needs to hear this information back.
(Kim Keating):
Right. Also with (Robin Brocato) and the bureau and see what they want to do because the language hasn't changed here in the last several years then the numbers look consistent across the region.
But if there's clarification that needs to be made, I mean obviously, there is. So we'll figure out the best way to communicate that to everybody so it's consistent nationally.
(Allison Hertel):
I really want to encourage everyone to use the PIR comment section as much as possible to explain things because that also helps the bureau recognize where some of the - maybe questions that need clarified could come up.
(Julianne) and I will work on the answer to that immunization question. That's one I haven't heard of before, so thank you very much for posting that and we will get an answer and I will send it out to all of the directors and all of the health coordinators. If you're not one of those people and you're on the call, please check in with them in the next couple of days, and we'll try to get you those answers.
(Allison Hertel):
Also, we're doing these calls again tomorrow and next Thursday. And we're going to take all the information and we are having the call transcribed and recorded, and so we will make sure we get everyone's questions and get those answers and post it then to our Web site in the next couple of weeks.
And as soon as that happens, we'll send out another email so that you have that information on the - on how to access it.
Woman:
Can I make one more comment?
(Allison Hertel):
Sure.
Woman:
In discussing the number of children who are up-to-date on the medical, on the physical exam...The question clearly asked for children who are up-to-date on physical exams. My concern is that when you report it back under the performance indicators, the percentage is reported back, the question then read, children who have received a physical examination.
So the reporting back doesn't reflect the question that you're asking.
Woman:
Right. We have - we changed the language on the indicators because it was inconsistent the way that we had it worded.
(Allison Hertel):
Okay. Well, thank you everyone. And again, we will keep you updated how to get this information, and we'll follow up on that immunization question.
(Julianne):
Thanks for all your hard work on actually completing this data. I really want to say once again whether people like doing this form or not, this form has a lot of use. And it's really more important to us that the data is accurate.
It is really, really important that we understand your numbers and that you provide as good of the information as you can. So I'm more inclined to say please provide - like (Alli) is saying, (if these things and) the comment that you people to understand from your data, please let us know that.
This data is used a lot to report on what and how children receives services and Head Start and the data is used all the time, and we'll ask to report on the regional result of PIR data. So, we get asked questions a lot of about this data.
So it's a valuable piece of information, and it's only as good as the people putting in the data. So I thank you upfront for all the work in putting the information into the system and I know it's not a science. It's certainly - that's why we're trying really hard in this region to try to get better reliability and consistency in the way people enter this data because this is all over the board and we know that.
But this is certainly an attempt to try that help get better consistency for us that (wait), so that when we report and when we talk about program, we feel confident that information that we have is as good as it can be.
So thanks for all you work in this effort.
END