Region 10 & Alaska Native T/TA
PIR Health Conference Call
Transcript
Moderator: Allison Hertel, T/TA Health Specialist
May 25, 2006
11:00 am Pacific Time
Coordinator:
Excuse me, this is the conference coordinator.
At this time I'd like to inform the parties that today's call is being recorded. If anyone does have any objections, you may disconnect at this time.
If you do require any assistance during the conference, please press the star followed by 0. Thank you.
(Allison Hertel):
Okay. Good morning everybody. This is (Allison Hertel), I'm the T&TA Health Specialist in Seattle for all programs in Region 10 (unintelligible) programs. I also have (Julianne Crevatin) here who is a Region 10 Program Specialist.
Yesterday we had a representative from Xtria on this phone and Xtria is the contractor for the PIR, and unfortunately they could not join us today, but if there are questions that we are unable to answer, we will go ahead and forward them on to Xtria.
I want to begin the call; it took about 45 minutes yesterday to get through the health piece and then we spent another 15 minutes going over the mental health, and then there will be time for questions.
Yesterday it worked pretty well to just have people ask the question. There's also the option of the emailing the question into Renee Andrae. And if you want to do it that way, her email is renee.andrae@acf.hhs.gov.
As most of you probably are aware, the 2006 User's Guide for the PIR is not yet available online and so a lot of the information that I'm going to be sharing is from the 2005 guide. However, if you do have a copy of the 2006 PIR, the actual PIR report, you can go ahead and refer to that also, and I'll go back and forth, making sure we're all on the same page.
If you have a mute button your phone, I would recommend putting that on. If you don't have mute, you can mute your phone by pushing star-6, and then to get it off mute, you push star-6 again.
So at this point, I'll go ahead (unintelligible).
The question that we're going to start with is on Page 20 of the actual PIR, and it's on Page 43 of the User's Guide. So Page 20 on the PIR talks about health insurance and it asks for the number of children that have health insurance in your program and then it asks you to specify which type of health insurance they have.
Hopefully all of you received a breakdown by state of the different types of health insurance. I think it's titled, something like Children's Health Insurance Structure or Systems and it gives the state. That was sent out to all of the health coordinators in the programs and it was also sent out to all of the directors. So if you did not receive a copy of that, I would get in contact with either the health coordinator or your program director.
It asks for information at the beginning of the enrollment year, when they started the program, and also at the end of the enrollment year. So the kids, as they exited the program, whether it was in December or May, did they have health insurance.
The second question asks about pregnant women and this is for Early Head Start programs only, and it asks for the number of pregnant women with at least one type of health insurance, and then the second question asks about the number of pregnant women with no health insurance, and not just asking for at enrollment.
So those are the two health insurance questions, so about children and pregnant women. And I'll just give people a second if there are any questions on the health insurance.
The next section is getting into medical home and medical services.
Medical home is defined as an ongoing source of routine, preventive, and acute healthcare. And examples include family doctors, health clinics, and health maintenance organizations.
Again for this question they're asking at the beginning of the enrollment year for the child and at the end of the enrollment year, asking the number of children that have a medical home and then it asks specifically for the number that received their services through Indian Health Service or through a migrant community health center.
The next question is Number 9, and we're Page 21 of the PIR; if you're using the User's Guide, we're on Page 45. The question asks the number of children who are up-to-date on the schedule of age appropriate, preventive and primary healthcare including all appropriate tests and physical examinations during the current operating period or within the last 12 months.
In this you're to include any children that have dropped out of the program that re-enrolled or that enrolled later in the year.
A couple of questions that have come out, we've given people the opportunity to ask questions for the last couple of weeks and so we've had some sent in and we've forwarded these on to either the regional office or to Xtria which works with the Head Start Bureau to answer them.
One of the questions was, if a provider skips an exam such as a 15-month exam but then the child is brought up-to-datewith an 18-month exam, is that child considered up to date. And the question to that is yes. Count children that received their 18-month exams as up-to-date or it was something during their 2-year old exam, so those children would be considered up to date.
Another question that came out was if a child enrolled, how many of their prior EPSDT exams do you need? And you just need their most recent exam to show that they're up to date.
In Oregon, if you're an Oregon program, I get a lot of questions about the fact that Oregon does not have any EPSDT schedule, so what you'll want to use is the provider's schedule, or basically whatever your program has determined through their Health Services Advisory Committee. So if you follow the Omairican Academy of Pediatrics schedule, you'll want to make sure that they're up-to-date according to that schedule.
A couple of recommendations, first of all, I highly suggest that you use the comments section in - within this bigger question to clarify children that were enrolled in the program less than 90 days. So the number of - just to show some - why your percentages are the way they are.
In your comments I would say that x number of children were enrolled less than 90 days, and then I would also include the number of children who their parents refused the exam, so that you have that documentation and your regional office can see that.
The next part of that question is the 9A, and that asks of the children reported as of today, the number diagnosed within the current operating period or within the last 12 months as needing medical treatment.
One piece to clarify here is even if a child is enrolled in September, however, they had a medical diagnosis as needing treatment in June, include that child. As long as their up-to-dateon their schedule, include any diagnosis of treatment needs in your numbers.
And then the second part of that, B, asks of the number of the children that were diagnosed as needing medical treatment, the number of children who received or are receiving treatment. And to count in this number, a child needs to have had at least one follow up appointment, so they need to be in the process of receiving the treatment services.
And then Number 10 asks for the number of children who received medical treatment and it lists seven conditions. Maybe one child is receiving treatment for four different areas, you can include children in more than one, and then, it's just important to know that children need to have been diagnosed to be able to be included in this section.
If you use a licensed healthcare provider such as a dietician in your program or if you use an audiologist, and they have made that diagnosis that that child needs to follow up care or treatment for a vision problem or for a concern with being overweight, you can include those children.
One other question that came up from that is the question around anemia, and it asks if it was referring to a specific type of anemia. And the answer is that it can be any type of anemia as long as it's been diagnosed by a provider.
Man:
I see on F, high lead levels, and yet the State of Washington does not require monitoring for lead. Can you tell me how you can collect that data if the State of Washington is not recommending it?
(Allison Hertel):
If the state - EPSDT does not require a lead screening, the only way that you would include this information is if for some reason the provider did a lead test on a child and through that lead test they were diagnosed as needing treatment. But it is not an EPSDT requirement in Washington State. It is in other states though.
Man:
Thank you.
(Allison Hertel):
You're welcome.
Are there any other questions around medical services? We're kind of finishing up that section.
(Julianne):
I think the other question is because, you know, these categories are there does not mean you have to have a number for every category. It is about what the situation is in your own program. It isn't about an overall assessment of what's out in the community. This is your experience with the children you're having your own program.
So it's basically looking at the children and what are the greatest medical needs in those children that should help guide maybe the kinds of services or education you're providing the family. So this data is useful in terms of ongoing education for families, and hopefully programs look at this and look at the most commonly occurring concerns that you see in your own children.
(Allison Hertel):
The next section is immunization services, and again this question refers to at enrollment and at the end of the enrollment year, so again, you want to check this issue is up-to-date at the beginning of the enrollment year and is up-to-date at the end of their enrollment year.
And the first one asks the number of children who have been determined by a healthcare professional to be up-to-date on all immunizations appropriate for their age. And the User's Guide, it also clarifies that you want to include children who have legal exemptions. So in some states such as Washington State, you can have a personal exemption, a medical exemption, or a religious exemption. Those children would be considered in that category as up-to-date.
The second question asks the number of children who've been determined by healthcare professional to have received all of the immunizations possible at this time but who have not received all immunizations appropriate for their age. So it may be considered a conditional status in your program because they're on the schedule to get their immunizations up-to-date and they can't receive any more for a certain time period.
Woman:
I have a question on that.
(Allison Hertel):
Sure.
Woman:
So a child who needs their immunizations before kindergarten, and they could have them any time, from four years to six years of age, we call those - do we call them, if they've only had four DPT, and to go into kindergarten, they could have their fifth - they must have their fifth DPT, and they can get it between four and six. So if a child that receives a fifth DPT, we would call them complete, but a child who only have four DPTs, are they up-to-date or are they complete?
(Allison Hertel):
Those children would be - if the child has till age six to receive an immunization, they would be considered complete because for their age, age four, they have that two year window to get that final vaccine.
(Mark Campbell):
Hey, so up-to-date means current but not necessarily complete, correct?
(Allison Hertel):
Correct.
(Mark Campbell):
Okay. So like three year olds that are current obviously are not complete but they would be counted as...
(Allison Hertel):
Right, because for their age group, they are up-to-date for what's appropriate for their age.
(Mark Campbell):
Okay, thank you.
(Allison Hertel):
You're welcome.
In the User's Guide, it clarifies and encourages you to include in the comment section the number of kids that are not fully immunized and the reason for that. So it could be that parents are refusing to complete them if your state doesn't have certain exemptions, there may be reasons that the families are not completing those immunizations. That would be a place to include that information.
Are there any other questions around immunizations?
Woman:
(Ali)?
(Allison Hertel):
Yes.
Woman:
I'm still confused between the - between Question 11 and Question 12. They both seem to be saying the same thing; I don't get the difference.
(Allison Hertel):
Okay. So the difference is if they started their vaccination series and they are complete for their age group. The difference is that for Number 12, if a child does not receive any immunizations in their first year of life for whatever reason, and they begin all of the series at age one, then they can only receive shots within certain time periods because there has to be a leg between certain shots and when they're given.
So at age 1 they would start the series, so they're up-to-date- they received all the immunizations possible at that time, but they're not up-to-date for their age because at that age they should have received - a certain number Hib vaccines. But at this point they've only received one.
Does that make sense?
Woman:
I think so. Thank you.
(Julianne):
The difference really rests with the fact of - do you have a child that's on schedule for, you know, if you have a child that comes in and they routinely have gotten immunizations all along, they're going to be complete by the time they're done with you. Other kids come in later and they're really on a make-up schedule. And at this point in time they are - as completed, as they can be - but they still have more shots to receive, but you can't crowd more immunizations in because of the timeframe and the intervals that need to elapse before they can have the next immunization.
So it's really a differential between kids who are on schedule at the beginning versus kids that are on a make-up schedule and are up-to-date for as much that they can receive at this time, but they are still immunizations pending. That's really kind of the difference between the two questions.
(Allison Hertel):
Okay. Hopefully, that answers your question. And (Julianne) stated it better than I did.
Moving along, the next question refers to program services for pregnant women and these questions are for Early Head Start programs only and it asks you to indicate the number of pregnant women who received the following while enrolled in the Early Head Start program. It breaks it down into four areas, prenatal and postpartum healthcare, mental health interventions and follow-up including substance abuse prevention and treatment, prenatal education on fetal development, and information on the benefits of breastfeeding.
You can count women in more than one category, so if they received all four of those, they would be counted under each one of those categories, and also it's important to note that your count the services, whether your program directly provided the service or if the program connected them with an appropriate service provider in your community.
An example is given in the User's Guide that your Early Head Start program arranged for a local breastfeeding organization to conduct a workshop on the benefits of breastfeeding. So any pregnant woman that's enrolled in your program that attended out workshop, you could count in that question.
Question Number 14 asks which trimester those pregnant women were enrolled. And then Question Number 15 asks, of the total number of pregnant women, the number of pregnancies were identified as medically high risk by a physician or a healthcare provider. And that includes women whose pregnancies were determined to be high risk prior to their enrollment in their program.
Does anyone have any questions on those two?
(Julianne):
I just want to say on that in the program services for pregnant women, many programs in this region are home-based and many of these services such as the prenatal education, fetal development benefits the breastfeed may be something that is actually part of your home visit, you know, kinds of activities. Those are still accountable in this category. It doesn't have to be a specific class. It doesn't have to be a formalized training. But you must - it can't be just a brochure you hand in a pocket, if you actually provide information, go through the information and actually ensure that that's part of a visit, that's really part of the whole education of that pregnant woman, then you should add that in that count.
So that kind of educational questions are little (unintelligible) but I would -- certainly if you're doing home visits, and that is really one of the areas that you cover in the home visits, and it's an actual activity versus a pamphlet or brochure, that should be seen as a service provided to the pregnant woman.
(Allison Hertel):
Okay. We are moving on to dental.
The first question is around dental homes, and similar to medical homes, it has a definition and is defined as an ongoing source of routine preventive and acute dental care under the supervision of a dentist. Examples include family dentists and dental clinics.
(Julianne):
Some have asked about a mobile dental unit like a Smile Mobile, et cetera, if that is the ongoing source of care that's available in the community, and this is where the family gets their care, that, at this point, believe or not, would be considered their dental home.
(Allison Hertel):
So Number 16 is asking for children that had a dental home at enrollment and then at the end of their enrollment year. So that's another one where you want to talk about how throughout the year.
(Omair):
(Allie), this is (Omair). Can I ask...
About dental homes, dental district health which provides preventive services (unintelligible) area, do they consider as a - and they do work under the supervision of a dentist although a dentist is not there and they do not - if there is a child who needs dental intervention, that clinic does not do that and they refer them to the other clinic, but they do the routine screening by a dental hygienist who works under the supervision of the dentist and also they do provide varnish. Can we count them as a dental home?
(Allison Hertel):
(Julianne) is saying yes, you can count them as a dental home.
(Omair):
Okay, thank you very much.
(Allison Hertel):
You're welcome.
We are having a little side discussion and we'll get into this next. The problem is going to come when you need a dental exam. So I might as well just right get into that one.
So the next question is Number 17, and this one is for preschool programs only. So we're only talking three to five year olds. And it asks the number of children including those enrolled in Medicaid or SCHIP who have completed a professional dental examination during the current operating period or within the last 12 months. It says to include children if they were examined during the summer months, and the reason for that is that what we're trying to determine is if they're up-to-date on this schedule of EPSDT which includes dental care.
Then the User's Guide -- it defines dental examination as one completed by a dentist. And I just want to state that what you need to do is refer back to your State Practice Act, and I can give you the answer to it, in all four Region 10 states, dental examinations can only be completed by a dentist. Dental hygienists can do screenings but they're, within their scope of practice, it does not include all of the different aspects that make up a dental exam.
C17A is the next component of that question, and it asks, of the children that receive dental examinations, the number of who received preventive care, and preventive care includes fluoride application, cleaning, sealing application, et cetera.
B asks for the number of children who received the professional examination that were diagnosed as needing treatments.
And then the next part of that question asks for the number of children who have received or are in the process of receiving treatment. So, also similar to the medical question, children should have at least had one appointment completed and they're in the process of getting sealants or getting restorative care for their treatment needs. It can't just be that they have an appointment planned for six months out, because at that point you don't know that they've actually started the treatment. They have a plan but they're not actually receiving it currently.
Woman:
Can I ask a question on A, of the children examined, the number of children who received preventative care.
(Allison Hertel):
Uh-huh.
Woman:
You don't really want to know if we had children that didn't get the exam but did get fluoride or varnish treatment, you only want the number out of the number that have received an examination?
(Allison Hertel):
In that question, yes. But I would strongly, strongly, strongly encourage you to do is include that in your comment.
Woman:
Okay.
(Allison Hertel):
You have a dental hygienist who comes in three times a year and does fluoride varnish on all the kids, put that in the comment section.
Woman:
Okay.
(Julianne):
Yeah, because otherwise you're going to have all of these preventative services not reported and it looks like your program hasn't provided any kind of service to the families, which we all know, is not the situation. We do know that many programs have preventative services provided by hygienists who come in on very regular basis and there's lots of preventative services happening within the program, but this question, if you read it again, it says of the children from T17, so you have to go back to the upper - the post question, and everything after that is based on the number of kids that you report in the very first question.
And for you, you have to use that as your base to answer the regular questions in this section.
Woman:
Thank you. That helps a lot.
(Allison Hertel):
It helps staff in the regional office and T&TA really understand all the services that are being provided and - and so there is that documentation.
Question 17CI asks if T17C is less than 90% of children diagnosed as needing treatment, please specify the primary reason below. So what it's asking is if they did not get the follow-up treatment, what is the primary reason for that.
(Julianne):
And again, only in this case, you have to check one primary reason. And then again, in the comments section, you can talk about the other reasons, but please check one primary reason. You know, I first look at this and I would have wanted to check several because it's so varied by the children and by maybe where your center and sites are located that it only allows you to check one.
(Allison Hertel):
For all of the kids.
(Julianne):
Yes. And so it doesn't - it's not really there, I mean - I mean, you could have centers in four different counties and the reason might be different based on the make-up that county. So this question is a little difficult when you can't respond, but I think the other thing is many people want to check them all and then the question is not useful either.
So I think the real question is, what is the real reason why the kids in your community are not getting treatment? And we really would like to narrow that down to get a better sense of, what else can we do then to try to really improve the treatment outcome for kids?
(Vern):
This is (Vern) at - with (Chris). I have got a question on T17I, of the children who did not receive, the reasons why.
Last year, it was a scroll selection, this year, it's a checkbox, at least from what it looks like on the draft. Is - can we give multiple reasons?
(Julianne):
It says, check one primary reason. That's why I looked at that, because I - my original reaction was if when I check several boxes and it - and it says the in - italics primary, (Ali) is checking the User's Guide.
(Allison Hertel):
If you - I have a version of the 2006 User's Guide that I was given by Xtria and it looks like the screen for the Web-based reporting system, it's going to be a scroll down option where you will have to pick only one item.
(Vern):
There is no control select with that?
(Allison Hertel):
I don't know because I just have a print out of it and I'm not able to get online and access it since I'm not a grantee, but you could probably go in and try it.
(Allison Hertel):
...and you feel that all of those reasons are valid...
Man:
Yeah...
(Allison Hertel):
...then I would put it in the comment section. And if you even want to go further and specify the number of children for each of the...
(Julianne):
By category, yeah.
(Allison Hertel):
...you could do that. It's really your call on how detailed you want to get, but I think that's - I personally think that's interesting information.
(Vern):
Thank you very much.
(Allison Hertel):
Sure.
Man:
Just to add to that dental services 17I, the question is sub-optimally phrased, the least they could do is just say, pick the three most important reasons. It needs some work.
(Allison Hertel):
Thank you for that feedback. Just so you all know, part of the reason we're recording this call is so we can take some of the feedback back, and hopefully for next year, get some of these questions clarified or - to me some of the reasons seem a little repetitive. So we'll definitely take that feedback to the bureau and give them an opportunity to make changes. Thanks.
The next set of questions, 18 and 19, are preventive dental services, and these are for early Head Start programs only and migrant programs, but in our region we don't work with migrant programs. So in our case, it's Early Head Start programs.
C18 asks the number of children who received oral health screenings as part of the series of Well-Baby exams. In many states, up until age three, medical providers complete oral health screenings on children as part of the EPSDT well-child exam. If that is the case in your Early Head Start program and you know that the medical provider is completing that oral health screening, you can list those children there.
And let me go back to C16. One more time that dental home question has came up yesterday of if the child is between ages of 0 to 3 and they get their dental services through their medical provider, is that considered a dental home?
And we believe the answer is yes. If you're dealing with infant and toddlers and they get their general services through their medical provider, that provider is their dental home at that point. At age three they should have a dental home.
C19 asks the number of children who received a professional dental examination during the operating period or within the last 12 months. For some programs, some programs have had really good success at getting dentists to see children between ages of 0 to 3. If your child or if the children in your program have seen a dentist, it would go under professional dental exam.
Man:
Does professional include a licensed hygienist?
(Allison Hertel):
No, it does not. And that is based on the State Practice Act as defined by the state agency. In our four states, it has to be a dentist.
(Allison Hertel):
On the next page, we're on Page 24 of the actual PIR and Page 53 for the User's Guide, it asks about dental services for pregnant women, again this is for Early Head Start program only, and it asks for the number of pregnant women who received a dental examination and/or treatment within the last 12 months or during your operating period.
I'm going to pause for a moment and see if there are any questions around dental services.
Okay. We will move on to mental health and there are just a series of about three questions for mental health.
(Omair):
For medical services Question Number 9, I just want to go back, and you mentioned that those families who opted not to do a Well-Child examination, we - shall we include in this? And put the documentation or just put it in the comment section and provide the documentation?
(Allison Hertel):
In that case, if a family refuses to get a medical exam, I believe you will just put it in the comment section, because they're still not up to date.
(Omair):
Up to date.
(Allison Hertel):
It's not like immunizations where they're claiming an exemption, because they can't exactly claim an exemption for medical care. I would just encourage you to include it in the comments section that x number of parents refused exams for their children.
(Omair):
One more question around health insurance, and I'm sorry if you have covered it already, how - sometimes the families, even the families do not know that - under which program they are in.
(Allison Hertel):
Right. I sent out a little form a few days ago, I think it was Monday, to all health coordinators, and basically what it does is it breaks down whether it's Medicaid, SCHIP, a combination, and a lot of times the only way that tell that is based on the family's income.
(Omair):
Okay, I see, okay.
(Allison Hertel):
In most circumstances, if the family is eligible for Head Start based on being below 100% of the federal poverty level and they have legal status, then they should be eligible for the Medicaid program, listed under Medicaid.
(Omair):
Right, right. Okay, I see what you mean. Thanks, (Ali).
(Allison Hertel):
Sure.
Okay, mental health.
The first question asks the average total hours for operating months that a mental health professional spends on site. And you want to report the number of hours spent with children, parents and families within the program and in training your consultation with the staff.
In the User's Guide, it defines what a mental health professional is, and as programs you all have to have a mental health consultant or someone on staff. If you have questions around what a mental health professional is, I encourage you to look in the User's Guide. And just really quickly, it says that it's an individual trained to support the emotional and psychological well-being of Head Start or Early Head Start children and families, and it says that they - that mental health professionals represent a variety of disciplines including but not limited to - and it lists off a bunch of different areas.
The mental health professional, it does not need to be a staff member of Early Head Start or Head Start, it could be a consultant that that program uses.
Woman:
Can I ask you a question?
(Allison Hertel):
Uh-huh.
Woman:
Related to this item but not qualifications. Would services provided on a home visit account in this category?
(Julianne):
We had this question yesterday. This one is looking at the average number of hours onsite working in the program, and it talks about within or outside of the classroom training. This - I believe this question is really specific. It's not like you pick up the phone and talk to the mental health consultant about a child, it's actually onsite in the program.
So I think this is looking, trying to say, what is your - if you're contracting for a mental health (person) (unintelligible) onsite, what's the average number values really having that person provide the services directly onsite to your program staff, to the teaching staff, to the children, or in consultation with you, and it's looking at onsite time, so I would say, it is not looking at a home visit. (*** After this conference call, the Office of Head Start clarified this response and stated that it can include "the time a mental health professional provides in the program may include time he or she spends on a home visit". See the PIR 2006 Question and Answer document.)
Woman:
Okay, because I know mental health consultants do some direct service with children and families in the home.
(Allison Hertel):
Okay, and that is probably - would not be included in that one but would fall under some of the services provided.
Woman:
Okay, thank you.
(Allison Hertel):
You're welcome.
I think that's a really good question though, and that - we'll take that feedback back.
(Julianne):
Yeah, we asked - that came up yesterday and we, you know, we kind of paused there as well. But for whatever reason, this one talks about (unintelligible) onsite, and although the variants are within or outside of the classroom, but I believe they're just trying to get a sense of how much time has this person actually available to the program, and, you know.
Woman:
I just want to throw this into the fray, I mean, if it's a home-based program, wouldn't the home be the site? I just thought I'd throw that in for the definition.
(Allison Hertel):
Right. So we'll take that feedback back to the bureau, but at this point it sounds like it's specifically onsite in the program.
Woman:
Thank you.
(Julianne):
I just want - I think the reason they put the word onsite there is because they didn't want to have a record of how, you know, phone consultation, availability by phone to confer. They're trying to get actual direct service. And I - that's what - maybe the home visit will be counted. But I think in the past, programs would put a lot of hours but they really weren't available onsite to be - truly available in the program. And so they clarified it by putting onsite. And now they're questioning whether onsite, yeah, includes the home visit, a home-based model.
So we'll get an answer to that but this is clearly direct service onsite not by phone, not by, you know, distant email, not that kind of consultation. (*** After this conference call, the Office of Head Start clarified this response and stated that it can include "the time a mental health professional provides in the program may include time he or she spends on a home visit". See the PIR 2006 Question and Answer document.
Woman:
We have remote sites and we're really lucky if we get a mental health consultant to a site twice or three times a year and you divide that between nine months. That's not even one hour a month.
(Allison Hertel):
Right.
Woman:
I mean, that - what do you do? Point-zero, you know, how do I?
(Allison Hertel):
You know, at this point, if there's a comment section, I would include it in the comment section. If you have contract and they provide phone consultation or email or video conferencing, include it in your comment section.
And I think what (Julianne) and I will do is go back to the bureau and get some clarification as to what exactly it is they want in that question. At this point though, I would keep it the way that we're saying it and include it in the comment section.
And if there's not a comment section specific to mental health, there should be a general comment section in the Web-based PIR.
Woman:
Thank you.
(Julianne):
You're welcome.
(Allison Hertel):
Number 22 asks you to indicate the number of enrolled children who are served by the mental health professionals in the following ways during the operating period. And it has that little disclaimer that it says, do not include routine communication with staff or parents or routine child trainings and assessments in the counts above.
This isn't just the 45-day developmental social and emotional screening you're dealing on all the children. This is specific to children that you are - that it becomes individual, so it's beyond that first screening.
And the first one asks you to indicate the number of children for whom the mental health professionals consulted with program staff about the child's behavior or mental health.
Then under that is (Part I). And it says of those children, the number for whom the mental health professional provided three or more consultations with staff during your operating period. That question is specific to consulting with staff about children.
22B is specific to consulting with parents or guardians. This would be the one that, I'm not sure who mentioned the home visit, and as a mental health consultant was going on a home visit to work individually with the family, it would fall under this one. The question is the number of children for whom the mental health professional consulted with the parent and/or guardian about their child's behavior or mental health.
And of those children, the number for whom the mental health professional provided three or more consultations with the program, parents or guardians during the operating period.
C asks for the number children for whom the mental health professional provided an individual mental health assessment. And we had received a question about, what does individual mental health assessment mean? And I think this goes back to the question of it goes beyond that first screening or assessment that the program is doing. It's something specifically done for that child to assess their mental health needs beyond that initial screening.
D asks for the number of children for whom the mental health professional facilitated a referral for mental health services.
Man:
Can I ask a question about the previous one?
(Allison Hertel):
Yes.
Man:
I'm just curious. I've interpreted this very narrowly. I'm a full time mental health consultant for a program.
(Allison Hertel):
Okay.
Man:
And to me, a mental health assessment is the equivalent of a formal evaluation that you get when a child doesn't intake at a community mental health center. And that's not part of my job description so I always have submitted zero for this category. However, based on what you've just said, I do direct observations in classrooms and write up what we call consultant reports that then get considered by teams. It's not technically a mental health assessment the way the state would define it, but it is a service above and beyond you know, just routine screening. How should I think about this question when I'm reporting?
(Allison Hertel):
That's really a good question, and I think it's really hard when programs define things different ways. And what we're going to try to do is get an actual definition from Xtria and/or the Head Start Bureau on what the intent of this question was. Is it to find out children that actually have very specific mental health needs or is it just to find out how many additional kids were being received at that additional support?
So what we will do is get an answer.
Man:
Okay.
(Allison Hertel):
And try to get that out to all grantees. If you're a consultant and you work with a program, I would check in with both your director, and your health coordinator. Probably give us a couple of days to get that answer.
Man:
Thank you very much.
(Julianne):
Yeah. Both (Allie) and I were saying - to me, the word "assessment" is a much more defined term and would require a defined process. I think it's much more likely, you were describing, you know, it's a very interesting question. To me, as a mental health professional, if you're out in the field, you would leave that assessment to those children that I think that you would have some (unintelligible) really want to have embedded tool to make some kind of evaluation from.
So the fact that they're using the word assessment would require some specific tool to me. And so I'm betting that it's defined for a very limited use.
So we'll get a definition of what the term mental health assessment is.
Man:
If it would help to clarify my question, in my mind, a mental health assessment has multiple components including things like a five-access diagnosis, a psychosocial history, a mental status exam, you know, things beyond what I ordinarily will deal with at Head Start. And we usually just leave that to the clinicians to whom we refer to do that level of evaluation.
And I think the question isn't stating that it's a diagnostic assessment. I think that's a difference there.
(Allison Hertel):
Right, okay. Great. Thank you.
Okay, then D asks for the number of children for whom the mental health professional facilitated a referral for mental health services.
Lastly, Number 23 asks for the number of children who were referred for mental health services outside of the Head Start program during the operating period. And it says to include referrals made by the mental health professional or other Head Start or early Head Start (job). So if...
((Crosstalk))
(Allison Hertel):
...decided that child, this means a referral, you would include at that.
Man:
How does that differ from D right above it? Number of children who facilitated a referral?
(Julianne):
One requires that the mental health professional (unintelligible). The second one is the actual number of kids who will be referred to mental health services outside of - that could have been by the physician, it could be by staff. It's broader, okay? 23 is looking at this child should be referred to mental health services by CPS, by their provider, by Head Start. It's bigger than Head Start.
(Allison Hertel):
Bigger than the mental health...
Man:
So we're supposed to track what other community organizations are doing with our children?
(Allison Hertel):
Sorry. What was that?
Man:
So we are supposed to track then what the other agencies or community people are doing with our children as far as referring? I mean...
(Allison Hertel):
I would say that you may or may not know that information. If you get a medical exam back and the provider explicitly states on there that they referred for mental health, then you would know. If as Head Start you determined to just refer to an appropriate agency during a staffing or conference, then that's where it would happen.
So it just goes beyond what the mental health professionals are doing. But no, I wouldn't say...
(Julianne):
But not all referrals (unintelligible) professionals in the program. Some referrals are walks in and it's all ready or you, again, the program may have other folks - they may have a different health professional that might make a different kind of referral. So the referrals could come again broader than just the mental health professional making that referral for the child.
Man:
Okay. Now, does it include the mental health professionals referrals, meaning if you knew that your mental health professional, you know, made five referrals out of that service as well, we don't know - we have no information that anybody else did. Do I - would I put five down under Number 23 also?
(Allison Hertel):
Yeah.
(Julianne):
Yeah.
(Allison Hertel):
So it could be a little duplicative.
Man:
But it'd be at least the same number if not more.
(Allison Hertel):
Exactly, yes.
(Julianne):
That's correct.
Man:
Okay. Thanks.
(Allison Hertel):
I think what they're really getting to is the number of those children who received actual services. So that just goes into the follow-up -- did the children referred actually go on to receive the services?
Man:
Okay. Sounds good. Thanks.
Man:
I have one question on 23?
(Allison Hertel):
Uh-huh.
Man:
We have three mental health consultants, and two of them are contracted to the county and they decided to go into the consulting. They also provide direct services. I usually have counted them in that because they're, you know, providing services through the county not as part of Head Start even though they're mental health consultants. Does that makes sense?
(Allison Hertel):
Uh-huh.
Man:
So is that correct to continue to include them?
(Allison Hertel):
Yes.
Man:
Okay.
(Allison Hertel):
Okay. So that wraps up the health and mental section of the PIR for this year.
Woman:
Wait, all right.
(Allison Hertel):
I want to open it up if people have any questions that they want...
Woman:
Yes, I do. I have a question.
Woman:
Is that a heads-up that maybe I should be, you know, coming up with another document or another form where I can next year get a better idea of services provided by other professionals?
(Allison Hertel):
Well, it should be a part of your tracking system. If you're doing a referral for any type of health services, you want to track to show that there's progress and follow-up occurring. It should just fall into your current tracking system.
Woman:
Well, that's just it. Our tracking system does not document whether services have been provided after the referrals, unless it's just by accident, like you say, you know, some paperwork comes in from...
(Allison Hertel):
Okay. Well, what we could do is talk about this after the call. I can talk to you individually and we can kind of do some brainstorming around tracking system, if that would be helpful.
Woman:
Thank you.
(Allison Hertel):
Sure.
Are there other questions?
Well, then I will just say thank you to everyone for participating on the call. And we are going to have all of - oh, we have a question that came in via email. Okay. There are a few questions. I'm going to just read them off.
It says, when the question states, during the current operating period, and a child comes into the program at age three, does that include their time in the program after two years or only the current school year?
(Julianne):
Well, I think what you're asking, and both (Ali) and I are reading this -- when you're completing the PIR, you're doing it on (unintelligible). So when you have to answer the question during the current operating period or when a child comes into this program, you look at - if you have a child that comes in at three, they're going to be in your program to use. You have to report, what does that child look like in year one and what does that child look like in year two?
And a child at three is going to have a span of services and then when they turn four they're going to have a span of services. There's certainly a connection but you have to look at child year to year in reporting on the PIR.
I don't know if that makes sense or not.
(Allison Hertel):
And then the other thing I would add to that question is the current operating period. If a child -- and this came up yesterday also, if a child gets - three years old and gets their medical exam in July, they would be considered up-to-date until the following July based on the EPSDT or the schedule for your state, or if your state doesn't have schedule that whatever current recommendations you use. The operating period is actually defined in the PIR User's Guide. And it says to include the summer months before the enrollment year.
Hopefully that answers your question. If it doesn't, I can talk to you offline later or you can email me.
The next question says, on C10 it sounds like we do not count a child if our staff screened the child for vision and hearing. It was a referral and they ended up meeting and getting some type of treatment. Is that correct?
In C10, let's see -- C10 is referring to the number of children who received medical treatment for the following conditions, and it gives seven conditions. And so if a child was referred and received medical treatment for any of those seven reasons and it occurred through referral, as long as that treatment was provided by a healthcare professional, you can include those -- from what I understand.
The 2006 User's Guide clarifies it a little. It says, the intent of this item is to understand the incidents of the conditions listed among Head Start children. Include all children who received or were receiving medical treatment for these conditions regardless of whether they were included in C9A or C9B. So that's the one that were actually diagnosed and that were received.
So even if your program made that diagnosis and as a result of your referral they received follow-up care and treatment, they can be included in that count.
Man:
I have a question. We are both an Early Head Start and Head Start program out here. And some of the children transitioned during the program year. And so this would apply to a majority of the questions asked on the PIR. Do we count them only in their primary where they started the year or do we count them on both pieces?
(Allison Hertel):
That's a really good question. So the question was - so just like confirm. If you have an early Head Start and a Head Start. And for a lot of your kids there - they may have received it in the last year but they've transitioned into Head Start. And you're asking if you count them on both PIRs, is that correct?
Man:
Yes.
Man:
We have a question.
(Allison Hertel):
Okay hold on. What - let's - he's asking, do we (unintelligible) on the primary where they spent the majority...
(Julianne):
Yeah. I'm counting that. I mean - yeah, I would keep them where the bulk of the services, where we've seen. If the child is, you know, 2 years and 9 months and the bulk of services that are in Head Start, I'd count them over there. But if this child is primarily an Early Head Start child, I'd report them in Early Head Start only.
Man:
Okay. And then you get to that weird piece where we run our program, your 9/1 through 8/31 and we've got a kid like right after six months mark. Should we count them in Early Head Start side?
(Allison Hertel):
Yeah, I would go and make that determination for your program.
(Julianne):
Yeah.
Man:
Okay. All right, thank you very much.
(Allison Hertel):
You're welcome.
There is another question?
Man:
Yes. We were wondering if the children that get tubes in their ears have received treatment for their hearing problems.
(Allison Hertel):
Yes.
(Julianne):
Yes.
Man:
Thank you.
(Allison Hertel):
Because that's the course of treatment determined by their medical provider.
Okay, there are a few more questions that came through email.
Man:
Okay. I can wait.
Woman:
Did you have another question?
(Omair):
Yes, (Allie), this is (Omair).
And Question 9A, it says a number of children diagnosed within that current operating period or within the last 12 months as needing medical treatment. So for example, if we have a child in our Head Start program who was diagnosed a heart murmur when a child was one year of age and receiving treatment for asthma and receiving treatment, shall we include in this?
(Allison Hertel):
I believe it's always the last 12 months.
Man:
Okay.
(Allison Hertel):
That question also came up yesterday and I had to re-clarify that. If a child receives a diagnosis as needing or as having asthma at age one and you get that child at age four, you would not include them in that count, but you could include them in C10 that they're receiving or have received medical treatment for asthma.
Man:
Okay. So if a child who is diagnosed at the age of one with heart condition like Tetralogy of Fallot or something, other condition, so there is no other column here in Number 10, so where shall I include in that...
(Allison Hertel):
If you wanted to, you could include it your comment section, and that would give Xtria an opportunity to see maybe some other categories that they may want to add in the future.
Man:
Okay, thank you.
(Allison Hertel):
You're welcome.
Another email question came in. It says, immunization services referred to children that have been determined by a healthcare professional. And assuming that we can count the children that we have made the determination for us, since our state health department trains and requires us to assess them. Is this correct?
Great question. We had the same question yesterday, and we actually sent that question to the Head Start Bureau for clarification. At this moment I don't have an answer. And as soon as we get that answer, I sent the question yesterday, and haven't heard about yet, we will send out any clarification we receive.
(Julianne):
I think the important point in this question which all of us look at, the language in the PIR and actually the performance standards talk about immunization being determined by a healthcare professional, we know that many programs when children enter, and I'm looking at eligibility for Head Start, people ask to see immunization records. And in some cases, family service folks are looking at whether or not a child could be up-to-date on their immunizations.
This does not recognize that. It's talking of determination made by a healthcare professional on whether or not a child is up-to-date on immunizations. That's the why the question is out there. So again, we're going to get some clarity on this question.
I think that the fact that this goes on to qualify (unintelligible) because there's actually training that's been provided to whoever, you know, on this question, that you would count because you've been trained or the health department, that's different than staff just making a determination that have not been trained and have not have some kind of orientation to the immunization schedules to make an appropriate determination.
Again, in many programs, the reason you have a health coordinator or you contract for health services is the fact that you have professional expertise that is reviewing or making some determinations about the house of data. And that's what I think this question is getting to as well.
But we'll get you a better answer for this one.
(Allison Hertel):
And it also came up yesterday that in some states, I know in the state of Alaska there's a software program where you can type in the immunizations you get and determine if that child is up-to-date. There are a couple of different scenarios and we have sent them all on to the Head Start Bureau to get an answer. I apologize for not having it now but we will get it for you.
Man:
Can I have one more question?
(Allison Hertel):
Okay.
Man:
Number 9, what is the 12-month period? Is it based on when this PIR is sent in or the closing date on the - what we're looking at is how far back our exams - our physical exams are considered current? So if that child gets one during the summer and we send it in before summer starts, that within the 12-month period, if they got one in July and we don't send our PIR until August 1, are they now out of the 12-month period?
(Allison Hertel):
No, they're not, because it's still within your operating period. If your operating period ends in June, you just need to do it through June.
Man:
No. Well, okay, because our operating period starts July 1.
Woman:
But then if they - so if that - if your operating period starts July 1 and the child receives an exam July 2 and they're three, they're up-to-date until the following July 2.
Man:
But if they received it June?
(Allison Hertel):
If they received it in May...
Man:
Uh-huh, and our operating period started June 1 - or I mean, July...
(Allison Hertel):
Then they're up-to-date until the following May. And then as Head Start, you try to get that child in. You can keep them up-to-date on their schedule. If you know they had another exam in May, they would still be considered up to date.
Man:
So here's our problem. If they have one in June, they're up-to-date clear up till our program here finishes at the end of May, so they're still good no matter when I submit this PIR report.
(Allison Hertel):
Right.
(Julianne):
Yes.
Man:
Okay.
Woman:
Yeah.
Woman:
Can I ask and follow that up?
Is the operating period different than enrollment period?
Man:
Yes.
(Allison Hertel):
Yes. Your enrollment year is defined in the PIR User's Guide as the period of time when the program provided center or home-based services to enrolled children and families.
(Julianne):
Can I add? Your enrollment year would also be whatever - most programs submit to the region in their grant application, what their model and options are. And in that they talk about whether they're providing year-round services or nine-month services. What is it that you're doing to meet the number of days requirement? So that's your enrollment - I mean - I'm sorry, that's your operating period. I'm sorry that's your operating period.
(Allison Hertel):
So your operating period could include the summer months, holidays, if you take two-week breaks, that's your operating period. If this seems confusing, it's on Page 17 of the User's Guide. And I also think it's probably in the PIR.
We had a couple more questions via email that I want to touch on. It says for pregnant women Number 13B, is this only answered if the women needed intervention and follow-up? I had thought in the past it was regarding providing education on these topics. And I think - oh 13B (unintelligible) health interventions and follow-ups.
Now (unintelligible) it doesn't say education. I'm going to look in the User's Guide and see if I can find anything on that.
The User's Guide specifically state, count the number of 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 server providers.
Specifically asking mental health interventions and follow-up including substance abuse prevention - or substance abuse prevention and treatment. So it's specific to that. If you're doing education, I would include it in the comments again. But that seems pretty specific interventions and follow-up.
There's another question though -- I'll ask the Head Start Bureau.
Okay, one more question. Early Head Start Preventive Dental Number 18 and 19 -- can you count children in both if they received both? Yes.
That is all the email questions I have. Are there other questions?
If you do come up with other questions, please feel free to e-mail your program specialist or if you're not aware of who your program specialist is, you can email me, and I can forward them on, and get answers.
Like I said before, this call was recorded. And we will be getting a transcript from it and we will post all of that information online. And we're also just going to take all the questions that came up, compile them, and give them to the Bureau to provide some feedback on how in the PIR could be clarified a little further.
At this point, that's everything. There's one more call next week, it's basically the same call over. If you know someone that missed it, and that's interested, it is next Thursday at 11:00 so the same time. Thank you all very much for participating. And let me know if there's anything we can do to be supportive. And have a wonderful long weekend.
So that's it. Thank you.
END