Region 10 & Alaska Native T/TA
PIR Health Conference Call
Transcript
Moderator: Allison Hertel, T/TA Health Specialist
June 1, 2006
11:00 am Pacific Time
Coordinator:
...the operator. I just need to let the parties know that today's call is being recorded.
Thank you.
(Allison Hertel):
Thank you.
Additionally, (Julianne Crevatin) who's the Program Specialist in the Regional Office will be joining me. She had another meeting - so she's going to be coming in a few minutes late.
Just to let everyone know, if you have questions in the past two times this works pretty well just to go ahead and ask your questions through the phone. If you prefer to remain a little anonymous, you can email them to Renee Andrae. And her email, in case you don't have it is renee.andrae@acf.hhs.gov.
To let everyone know, the PIR, the User's Guide for 2006 is now available on Xtria's Web site. So I am going to be referring to the 2005 User's Guide but it's pretty similar there's just been a couple of additions. And I'm also - I also have the PIR 2006 in front of me.
What we're trying to do with these calls is just to make sure that we increase the consistency of our reporting, and that we provide all of you with the necessary information and resources to ensure accuracy and consistency.
If - like I said, if you have questions throughout the call, go ahead and ask them. I'll be pausing after each of the major sections and I will give you an opportunity to ask them.
What we're going to do is start with the health services. And in the PIR, it's on Page 19, the User's Guide, it starts on Page 43. And the first question...
(Allison Hertel):
The first question asks for the number of all children with health insurance. And it breaks it down into the number of children at enrollment, and then also at the end of the enrollment year. The end of enrollment year refers to the last day of services for that individual child.
And it breaks it down into Medicaid, SCHIP, a combined SCHIP-Medicaid, state-only funded and hopefully you all received a copy I sent out a couple of weeks ago.
And it breaks down what the differences are in each individual state. And in most states, they - the Medicaid and SCHIP program are under the same name, and it comes down to the federal poverty level. That information was sent to all health coordinators and all program director.
If you are not one of those positions, I would encourage you to talk to if either your director or your health coordinator or manager to get that information.
Then it goes to the primary insurance and then it asks for that number of children with no health insurance.
The next question asked for the number of pregnant women with at least one type of health insurance at enrollment, and then the number of pregnant women with no health insurance. And that question is specific to early Head Start Program.
That's all of the questions for health insurance.
Woman:
I just have a question on the health insurance. We have a child that has IHS and I'd like to know (unintelligible); where do they want us to count them?
(Allison Hertel):
Unless they have dual health insurance, I believe it says - the category that best describes the type of insurance if a child has more than one type of insurance, count him or her under the primary insurance. It would be determining if they get - if they bill Medicaid more than IHS, it would fall under Medicaid.
Woman:
Okay. Thank you.
(Allison Hertel):
Okay. The (next question) falls under medical homes and medical services and we're (on Page) 21 of the PIR, and on Page 44 of the User's Guide.
And the first questions also are asking for the number of children at enrollment and the number of children at the end of their enrollment year.
The first question asks for the number of children with an ongoing source of continuous and accessible routine preventive and acute medical care which is the medical home. And then the next two questions, one asked for the number of children receiving medical services through Indian Health Service, and the second one asked for the number of children receiving medical services through migrant community health centers.
A medical home could be family doctors, health clinics, health maintenance organizations, anything that you consider as health medical home given the situation geographically on some, and we'll get into this a little more with dental but some children only home that they had is a dental van or logo clinic. So, that would be considered as health medical home.
(Jennifer):
Hi. This is (Jennifer) from (EPIC). I just had a question, we have here in the (ACAMA), the Farm Workers Clinic.
And if that through the child goes, do we count that as their ongoing continuous source of care or as the migrant community health center? Or would it be both?
(Allison Hertel):
That's a really good question, let's see. I'm guessing they're - what they're - this is a guess but I'm guessing what they're asking is the migrant community health centers probably received funding a little bit differently federally. So it would depend on that actual clinic.
(Jennifer):
Okay.
(Allison Hertel):
And it's considered a migrant community health center, federally speaking. I'd have to look into that a little bit more for you, (Jennifer).
(Jennifer):
Okay. Thank you.
(Kim Keating):
(Allison).
(Allison Hertel):
Uh huh.
(Kim Keating):
(Allison), hi. This is (Kim Keating). I was able to make it into the - I just joined.
(Allison Hertel):
Thank you for joining. And we're actually waiting - and (Julianne) is also going to join so she should be here momentarily.
(Kim Keating):
Okay. I just want to let you know I'm on the call.
(Allison Hertel):
(Kim), did you hear that last question about migrant community health centers?
(Kim Keating):
Uh huh. Yes. I heard and I agree to just what you said.
(Allison Hertel):
Okay.
(Kim Keating):
Yeah.
(Allison Hertel):
Okay.
The next set of questions is regarding medical services.
The next question asks the number of children who are up-to-date on a 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.
This is asking for the number of kids that are up-to-date on their EPSDT Well Child Schedule.
I have a couple of comments to make from questions that have come in previously. One of them is if you're an Early Head Start Program and a medical provider skips an exam such as I've heard in instances where the providers aren't doing 15-month exam. But then the child has been brought up-to-date with their 18-month exam, that child will be considered up-to-date. So if a child's most recent exam has been completed, they're up-to-date.
If a child enrolls in your program, you only need a copy of the most recent Well Child exam to show that they're up-to-date. You don't need - if a child enrolls at 18 months, you don't need all of the previous EPSDTs that they've had since birth. You only need their most recent copy.
Woman:
Hi, (Allison Hertel).
(Allison Hertel):
Yes.
Woman:
This is (unintelligible) and I'm also with (EPEC) and I - with the example that you just gave about the 15-month exam being skipped and then the 18-month exam, and then the child being brought up-to-date, is that 18-month exam doesn't occur within the first 90 days? Are they still considered up-to-date?
(Allison Hertel):
If the child has had their 18-month exam by their birthday, it's based on a schedule that the state provides. So, if they've had their 18-month exam in August and they're not due for another one until January, then technically they're up-to-date until January.
(Jennifer):
But (Allison), this is (Jennifer) again. The problem that we're having is doctors in our area are not following the schedule.
Woman:
So are we, we're having the same problem.
(Jennifer):
Yeah. And so like - I'll give you an example, we have a child that had - the three-year-old, you know, Well Child exam, went in for their four-year-old exam and the doctor said they wouldn't see them until they're five. So the three-year-old has expired, they now need there four-year-old one but they don't have it and we're getting close to 90 days.
(Allison Hertel):
And the providers are refusing to do them?
(Jennifer):
Yes. Because there are Medicaid, some have argued that because it's Medicaid.
(Allison Hertel):
Okay. Well, that's interesting because the state law says that they should have them at four, so obviously, that's probably an individual provider issue. But technically, they are not up-to-date.
(Jennifer):
Okay.
(Allison Hertel):
And (Kim), I don't know if you have anything you want to add to that.
(Jennifer):
Well, we've - because there is more than one provider here in the Yakima Valley, and we've been asking them to give us a note at least, you know, telling us that they're not going to do them. But the children are still not receiving their exam so we're having a big issue.
(Kim Keating):
I would just suggest that right technically, they're not up-to-date so you can't count them but I would put - note that in your comment section that the providers are doing that in your area.
(Jennifer):
Okay.
(Jennifer):
This has reported - completed all appropriate tests and physical examinations during the current operating period or within the last 12 months.
(Allison Hertel):
Uh-huh.
(Jennifer):
We have - safely have a child that received their physical and let's say June, and the first day of school doesn't start or excuse me, like in May or April or May. And the first day of school doesn't start until September. And, you know, (what's wrong with) PIR right now and it's showing that that child has not had one for the last 12 months. But they're technically, they've met the requirements and they're overdue but they won't get one until they start again next year.
(Allison Hertel):
Yes and we've had that question actually come up on...
(Jennifer):
So they've met the requirements and they are getting close to being - they are expiring but they're not within the 90 days from the time that they - that school end.
(Allison Hertel):
Right, right.
(Jennifer):
But they did get one for that year.
(Allison Hertel):
Right. (Kim), do you have any comments on that?
(Kim Keating):
When was the end of the program year?
(Woman):
For part day with the 18th of May and say we had a child, it expired in April or even March, you know, then they have another 90 days to get another one but then, they go on to summer months and they're not in school. They're not in class.
(Kim Keating):
Uh huh.
(Woman):
So then, they could get one during the summer but on this PIR when you pulled a calculation on there, it shows that they didn't get one at all.
(Kim Keating):
Right, because they had it - because it had expired during the enrollment year. I'll have to - we'll have to follow up more with (Robin) about that because I don't know about the 90-day period, how that rules into it. I think that probably what we're going to come back with is that there's still not going to be considered up-to-date since the exam expired.
Let me look at this, I think that the language that we added into the Users' Guide this year was that the time period is not based on the health status when you're completing the PIR but just that it has to be that the child is current throughout the enrollment year.
(Woman):
Okay.
(Kim Keating):
And we put a specific example in there of that so technically, that child would not be considered up-to-date unless they were brought up-to-date before the end of the enrollment year.
(Allison):
And just to clarify and that goes back to the performance standards which states that it's to ensure that the children are kept up-to-date on the schedule of Well Child care. So if the child's three in March and gets to examine March, and they turned four the following month - March, they would still need that four-year-old exam.
(Kim Keating):
Okay. We're talking about - I'm talking about Head Start.
(Jennifer):
Right. I understand that. So if a child turns three in March and receives an exam, and then they start Head Start that fall, that's how this considered up-to-date and they meet the 90-day deadline until the following March when they need a set - another four-year-old exam based on the state's EPSDT schedule.
(Kim Keating):
Uh huh.
(Jennifer):
And so in March, they would be due for another exam.
So is there - so you're saying if their physical exam - so you don't - and here the physical, they're called physical exam after three-year-old and if they expire within the year close to the end of the school year then we don't have that 90-day, then they don't count on the PIR? So it looks like we - these children have not had a physical exam at all.
Woman:
(Unintelligible).
(Allison Hertel):
Let me, you know, I want to - since I can't interpret all of the standards, I need (Julianne) to be here and help answer that question. I'm going to postpone it, and then also to let you know we did have a similar question, and we went back and forth on it. It was forwarded on to the Head Start Bureau.
(Jennifer):
Okay.
(Allison Hertel):
I haven't forgotten it. It's on the table, and currently, it does meet that 90-day deadline but I understand what you're asking is it's later in the year but it's still prior to the end of the enrollment year. Let me just table that question for a few minutes until we get a program specialist in here, if that's okay.
(Jennifer):
Thank you.
(Allison Hertel):
Other questions about number nine.
Just a couple other comments I wanted to make is one, there's not an EPSDT schedule in Oregon so they are based on the schedule determined either by your medical provider or the town's medical provider, or your Health Services Advisory Committee, or if you follow the American Academy of Pediatrics recommendation.
I know that Oregon is a bit unique because there isn't a schedule so it will be based on what your program has identified as appropriate schedule or the child's provider.
And lastly on that question, I want to make a comment about using the comment section, and I encourage you to include in the comments section the number of children that were enrolled in your program less than 90 days. And especially if they did not receive an exam include that number in the comment section, and then I also encourage you to include the number of children whose parents refused exams, or like was discussed earlier, the number of children who the provider refused the exam - it just provides a little bit more information as to why, first time it just may seem lower then because the PIR does include some of those numbers. And (Julianne) is here now so I'm going to push that question over to her and give her a minute to think about it. And if we can come up with an answer, we'll give it to you and if not, like I said that it has been sent to the Head Start Bureau.
(Jen):
This is (Jen) in Lane County Head Start.
(Allison Hertel):
Hi, (Jen).
(Jen):
Hi. What - a requirement of performance standard that we have 90 days to determine if a child have access to a medical care. Not that we have to have a Well Child exam in our (unintelligible), it was in 90 days. Is that correct?
(Julianne Crevatin):
(Unintelligible) that's how I read it all along, that you have to have a determination from a health professional; so basically what that means is that, you have to have something in your hand or your record that validated that some health professionals made a determination on the health status of the child.
Now, that is not - many people can't get that without a health exam. That's why this gives it, but if a child has had an exam, four months, six months prior and you have documentation that this child has got, you know, that the determination has been made around the health status of the child and you have a record of that, to me that counts.
But then the follow-up is whenever that determination was made, the child - when is the due date for the next exam? And you need to know when the due date in the next exam is based on where that child is in their schedule and then the follow up has - then you were responsible for the follow-up exam. Does that make sense?
(Jen):
Yes, okay.
Woman:
So (Julianne), the question came up which I think you're in the process of answering is, if the child received an exam in March, then they meet the 90 days deadline when they enroll in the fall, but then the child exam expires that following March.
(Julianne Crevatin):
Uh-huh.
Woman:
...and what the - somebody's comment was - is that in March, so they're not up to date anymore and the PIR is saying that they didn't receive an exam in the last 12 months.
Are they considered up to date and I said that that question was - we sent on to the Bureau, but I wasn't sure if you had...
(Julianne Crevatin):
Yes. We'll wait to see with how they weigh in on that; but that is how I would - if a child had an exam in March, then you need to have verification that that child is up-to-date. Basically, what you have is a child that's up-to-date. (They are current) when they walk in your program.
Now, a lot of people have asked also, "Then what about the 45-day screening for vision, hearing, and developmental?" You still need to do those. And once you're relying on it, all of your kids getting their screening somewhere else.
Kids, even though they are up-to-date, you're still going to want to put them to your ongoing screening for vision and hearing, height, weight, etcetera. So that you can have within that 45 days, so you get them and screened.
Woman:
I have another question.
(Allison Hertel):
Okay.
Woman:
That comment you made awhile back about technically not up-to-date when they don't meet an EPSDT schedule for a 15-month exam. They had a 12-month exam. The doctor didn't do a 15-month because we determined that he'd only needed to see the child again at 18 months.
And my interpretation of the performance standard based on the EPSDT requirement and then that additional comment as determined by a medical provider that in Washington State with our elaborate EPSDT schedule that a provider individualizes for each child and determining on the health of that child and how often he's been and he may say, "Yes. I need to see him in that 2 months, 4 months, 6 months. I don't need to see him at nine months and then I'll see him again at 12 to 15 months and maybe 18 to 24 and that's often how the Medicaid form is broken down also.
The form that they use if they choose to use the Medicaid form. So we have been counting those as current based on the doctor's recommendation of when he wants to see them again. Are we interpreting that correctly?
(Julianne Crevatin):
I would say yes, but I'm not, you know, I would be sure that on your record that you know - that the verification is when is the next scheduled appointment, you know, how do you know that that's the next scheduled time who, you know, this is based on the physician or healthcare professional the determination that the next exam is due at this timeframe versus, you know, if a child doesn't have one at 15, everybody doesn't have one and that's if, you're just going with that. You need to know that the next required - what is the next professional determination for that child?
Woman:
Yes. That's clear. Thank you.
(Julianne Crevatin):
Okay.
(Allison Hertel):
I'm going to move us on to C9A which is other children that are up-to-date on their schedule of exams; the number of children that were diagnosed within the current operating period or within the last twelve months as needing medical treatment.
And then in the user's guide in the PIR, it defines medical treatment as any service that is required to improve the physical condition of the child including all forms of medical follow up.
C9B asks of the children diagnosed within the current operating period or within the last 12 months; the number of children who have received or are receiving medical treatment.
And for those questions, you need - the child must have had at least one follow up appointment to be counted as received or receiving treatment and then within that it asks you to specify the number of children who received medical treatment for the following conditions and it lists seven conditions.
Just to clarify on this and this has been added to the 2006 guide. The intent of the item is to understand the incidence of the condition listed among Head Start children.
Regardless of whether or not they were included in C9A or 9B, you can still include them in C10. If for example, as a result, of a Head Start screening for hearing, or vision, or overweight, or anemia, it was determined that the child needed follow up in treatment and they actually receive it.
You can include those numbers in that question.
(Val):
Hi (Ali)...
(Allison Hertel):
Uh-huh?
(Val):
I have a question.
(Allison Hertel):
Okay.
(Val):
This is (Val) with Head Start of Lane County.
(Allison Hertel):
Hi (Val).
(Val):
Hi. I recall from last year and I don't know if it's been changed in the computer system, but last year, we had this issue come up and A would have to be as big as 10. 9A would have to be as big as 10 or for the, you know, would choke on it.
(Kim Keating):
Right.
(Val):
So, is that the way it still is
(Kim Keating):
No. This is (Kim).
The software has been modified so that it will allow you to enter any number of children in 10.
(Val):
Okay and - so 9A and 10 do not have to match?
(Kim Keating):
Right.
(Val):
Okay. Then my other question (Ali) for you, is around - when children are diagnosed, what I see particularly is children that when they're in our setting, they get diagnosed with ADHD. It wasn't necessarily at the time that the initial determination was made as often that we've sent them back in for more evaluation based on their behavior in the classroom.
(Val):
And then they get a diagnosis. So I've never been - do we count that in 9A and then there's not a place for ADHD. Is that in the middle health section or disabilities?
(Julianne Crevatin):
I think it would fall under - I'm trying to look under disabilities. But the fact is that their medical provider that is involved in there, you know, because often, well you know, for it to be as good as possibly you'd want the pediatrician involved in that.
(Allison Hertel):
Yes. (Julianne) and I are looking into that. I think would include this as a result in that last 12 months they received the diagnosis as needing medical treatment...
Woman:
Right.
(Allison Hertel):
...and as we go to that, they received treatment. I would include it.
(Val):
Okay and I think what's going to happen for us is that those numbers are going to increase if we do that, so it's going to look a little odd. It's going to look like, "Wow, what's happened all of a sudden all these kids got diagnosed?" because...
(Allison Hertel):
I would put it in the comment section. I'm really encouraging parents to use that comment section this year and if there's other conditions like ADHD or some other medical condition that has a higher incidence in your program, I would say then specify the number of children that were diagnosed with ADHD or other health conditions and that may help with the PIR for next year in adding some additional conditions.
(Val):
Okay and since the programmer is there, what I'm hoping for is at some point, if on number 10, there could in other category, if that's at all feasible.
Woman:
That's great.
(Julianne Crevatin):
We agree too. I mean there are other conditions that are unique to some communities that don't show up here and it's really helpful to track that and having programs have a better sense of what that might be than I do, but there are some areas where there are - we should know what they - there's a higher incidence in some areas with certain conditions.
Then, it'd be good for us to know what those are because that's how people plan their health program.
Woman:
Right. Okay.
(Cindy):
So I'm (Cindy). I'm also at Head Start of Lane County and I just want to know like in addition to ADHD, do you want other mental health diagnosis that they're getting treatment for, medication for to be included? So anything, they're getting medication for an ongoing treatment from the physician.
(Janice Henson):
Hi. This is (Janice Henson) with (unintelligible) and I think that's a great question too and we're just confused in what you're talking about there also with all of the other number of mental health services that some of our (kiddos) received.
Is this and would the ADHD be more of a mental or emotional disorder? Isn't that a part of mental health services? I mean there's a quite a detailed disability piece that's on Page 25 that goes into the different disabilities or learning disability and that is where I would think we would categorize a child with ADHD. Is that incorrect?
Woman:
Well, I mean basically, yes. You have the section on mental health and then you have the section on disability. The only place should we be able to record it on mental health is if the child was actually included for mental health services outside of Head Start and then that actually receives so little.
So you could put those children there. I mean some of these are overlapping categories. I mean health is the biggest umbrella and then under that, you can separate some children out under disabilities and some children under mental health.
I mean you get a medically (unintelligible) child under medical. You can have the disability, you know, so I don't think the categories are exclusive. I don't know (Kim). I mean with a thinking of there being totally, you can only be one of - can you be a class multiple category.
Hi. I haven't ever heard anybody say that they have to be exclusive that way and some things will overlap in different areas. It certainly will kick it out of their system if you're reporting children here who have medical diagnosis that are also mental health diagnosis, but programmatically, you will have to decide whether that is what you want to do.
(Irene):
This is (Irene) (unintelligible) and I have a question. I was under the (impression) as far as all these goes, you have to have an IEP to be counted in the - or an IFSP to be counted in the disability section.
(Allison):
That is correct and I just got – Dawn Williams, TA Disabilities Specialist just walked in I actually just stepped down after that question. And so with ADHD if they - as a result of that diagnosis, they're on an IEP. It would go into the disability section.
(Allison):
Just to clarify, medical treatment in the user's guide is defined as any service that is required to improve the physical condition of the child including all forms of follow-up medical care.
So I think in us, a child is on medication for a certain condition. That is done to improve the physical condition of the child.
Woman:
Is or is not, sorry. I couldn't understand. Did you say is or is not?
(Allison):
That is, medication is required to improve the physical condition of the child. Then it would be medical treatment.
Woman:
But I have a question for that (Ally). If it's diagnostic follow-up. Is that considered treatment or not?
You know, like I've got a child that's being followed up for whether or not diabetes might be a potential diagnosis. So they're not getting medications for it. They're being evaluated for that potential. Is that treatment?
I would consider that treatment because they require these follow up appointments to make sure the child is healthy. But it is at this point, it is only diagnostic.
Woman:
We're just reading some.
Woman:
Yes. We're looking at such any service that is required to improve the physical condition of the child including all forms of medical follow up. So follow up blood sugar test, you know, fasting blood sugar over the next couple of weeks or something would be considered treatment by that definition.
Woman:
It sounds like it. Yes. I already know.
Woman:
I mean they specifically define medical treatment as any service that is required to improve the physical condition of the child including all forms of medical follow up. So basically, this additional assessment or process is to close that loop basically and it's medical follow-up.
Woman:
Okay.
Woman:
That (unintelligible) is not done yet and so you're still following up on this concern.
Woman:
Okay.
(Jose):
I have a question. My name is (Jose) from Washington State (Migrant) Council. So to clarify; if a child has an IEP or ISSP, it should go in the disability section unless they're receiving treatment for some other health issue, correct?
Woman:
Yes.
(Jose):
Okay.
Woman:
I'm wondering how broad the health care provider definition is. For example, as a registered dietician, looking at highly charge to notice a child who's overweight and not really sort of our diagnosing them. Meaning counseling, but can they be counted?
(Allison):
Yes if it's a health care professional. If your program uses an (RD) to make that determination of overweight and as a result of that, they're getting treatment. You can include them.
Woman:
Hi. If a child has a health impairment and disability - we have a child who has epilepsy, but she has an IEP. So that would go under health impairment in the disability section?
(Allison):
Yes.
Woman:
Okay.
(Allison):
I'm going to move us along and just to keep us on track with time, the next section is immunization services and there's two questions and both of the questions are one information on the children at enrollment and at the end of their enrollment year.
The first question asks for the number of children who have been determined by a health care professional to be up to date on all immunizations appropriate for their age and the second question asks for the number of children determined by a health care professional to have received all immunizations possible at this time, but who have not received all immunizations appropriate for their age.
The next section is regarding program services for pregnant women and this is for Early Head Start program only and it asks programs to indicate the number of pregnant women who received the following while enrolled in the Head Start program and it goes through a list of prenatal and post partum health care, mental health interventions and follow up, prenatal education on fetal development, information on the benefits of breast feeding.
And the user's guide clarifies that you can count the women whether your program directly provides the services or whether the program connected the women with two appropriate service providers.
Say, the Early Head Start program arranged for, it's there on Page 22, a local breast feeding organization that conduct the workshop on the benefits of breast feeding for the pregnant women.
Even though your program didn't actually do it, you arrange for it happens. Those women can be included.
The next question asked about prenatal health and it asks for the trimester in which the women enrolled.
And then the next - the last question asked for the number of women whose pregnancies were identified as medically high risks by a physician or health care provider
Just want to pause for a minute and see if there's any questions before we move on to dental.
(Allison):
We will move on to dental. We are on Page 23 of the PIR and Page 50 of the user's guide.
The first question asked about dental homes and asked for the number of children with an ongoing source of continuous and accessible routine preventive and acute dental care at those enrollment and at the end if their enrollment year.
Like I stated earlier with medical homes, if a dental home on a mobile dental clinic is that child's source of dental care or the dentist that visits villages, that is the child's medical home if that's the only type of service they can get through the state.
The next question goes into dental services and this one is for preschool programs only and 17 asks for the number of all children including those enrolled in Medicaid or SCHIP to have completed a professional dental examination during the current operating period or within the last 12 months.
In this you want to include all children, regardless of whether or not they dropped out or they enrolled late.
To clarify on this; a professional dental examination is one that is completed via dentist based on how your state practice act and regulations define what an exam is.
In all Region 10 states, a dentist is the only professional who can complete an actual exam.
(Jose):
I've got a question; (Jose) (unintelligible) at the (Migrant) Council.
Woman:
Hi (Jose).
(Jose):
Just on question Number 16, for regular Head Start it's pretty easy and Early Head Start because their families are pretty stable. But we also have migrant children and when they're with us they have constant provider but as soon as they leave the program, it's kind of unknown because most of the times they leave the state. So would we count those children as not having one or how do other people do it out there? In the event that for example, they couldn't answer the question said, "No, they don't have a constant provider when we are not servicing them."
(Julianne):
Well I think at the time of enrollment then, they don't have a medical home at the end - when they leave you they have medical home during that period of time. And they're more likely going to a non-medical home situation again. So at the top you give both categories the number of children with an ongoing source to continue accessible routines more than likely when they come into your program they don't have that. You wouldn't count them there but at the end of the time that you have them, they have a home. Because in this is kind of - at the end is, did you connect - they're trying to find out by this question. Did you connect these children with - and always have dental care?
And so, when they came in, did they have it? When the left your program, did they have it? At the end of the year, I think my sense of that question is how did they look when they walked in? And during the time they were with you, did you connect them with a (source) of care?
I would hope that they look different during the time they were with you.
(Jose):
Would it be okay to answer that. We even know - we know that they're going to back to...
Woman:
Otherwise, you'd have more than likely to do on (zero).
(Jose):
Right, right.
Woman:
So yeah. At the end of their enrollment year with your program they had an ongoing source of care.
(Jose):
Okay.
(Allison):
Okay, so back to dental. 17A asks for, of the children examined the number who received preventive care. So preventive care includes fluoride application, cleaning, (saline) application.
(Val):
This is (Val) with Head Start of Lane County. You know, know I'm not thrilled about 17.
(Allison Hertel):
Right.
(Val):
What I'm really uncomfortable and concern about is 17A when all of our children get preventive services regardless of whether they've been examined by a dentist, the way the program works, we can only count the once that got - that we, you know.
(Allison Hertel):
Right.
(Val):
Got a dentist to see and that is absolutely maddening to me.
(Allison Hertel):
Right. And a couple comments, one is - this question came up last week and strongly encouraged all programs. If you have a dental hygienist that comes into your program and does screening on the children and provides fluoride varnish, include all of those numbers in your comments.
And what we're hoping is that, that can really encourage the bureau to look at - really look at this question and make some changes (to it) so that we can capture all of the services that are being provided to kids.
We - I recognize...
((Crosstalk))
(Allison Hertel):
...and we know what the reality is. So I think the more programs that can speak to the role of dental hygienist in providing that preventive care through your comment section, the better.
(Val):
Okay.
(Allison Hertel):
And then also, this will help capture what your program is doing for all the kids within the program.
(Val):
Okay. I mean, but the (unintelligible) that the numbers, so under 17-A, I mean, I really - I'm in a quandary as to how we're going to reflect it because we're going to have to find some way to tease out where the - I mean, it's going to be a nightmare. With the four managed care groups that we worked with, we're going to have to tease out how many have the, you know, dentist do whatever 17 is saying and we're going to lose.
So A is only going to reflect the once that we've been able to figure our how to classify in that way because we can't report a number higher than 17 under 17-A, right?
(Allison Hertel):
Right.
(Kim Keating):
This is Kim, we didn't alter this language this year but I'm looking at the guidance in the user's guide for C-17A and it says that you can include children who receive preventive care services from registered dental professionals within or outside of the program. Are you saying that it's not a by dental professionals that they're receiving the preventive care?
(Allison Hertel):
No, they're receiving it. It's the issue that with 17A, you can only count the ones who had a professional dental exam which they're defining as only done by a dentist.
(Kim Keating):
Right. I understand that part but I just wanted to clarify so I know what to take back...
(Val):
But 17 and 17 in our program, that's every child in the program gets preventive services. But every child, whether I can come up with, you know, what 17 is requiring on all 800 kids or 850 kids is that's the issue. And so, I can't report 820 under 17A when I only reported say 600 under 17.
(Kim Keating):
Right. I know that, that's just because of an (added) tech that's there but I'm looking at the language and it seems like it should be allowing that. What I'll do is I'll check back with the Head Start bureau - right - to see if that was their intent. Because we've never altered that item but it does - I can see what your saying that it's limiting that and at the same time the guidance that they wrote into the user's guide last year - not this year - specified that you can be including children who received services from professional within or outside of the program.
(Woman):
Well, right and they even changed...
(Kim Keating):
So, it's a double message.
(Woman):
And they change the language to say that you can have the hygienist part of the exam and then have a dentist sign off.
(Kim Keating):
Right.
(Woman):
And some of this could, you know, (unintelligible) a way to do that. I'm not sure that fixes the problem in the long term.
(Kim Keating):
No. What I wanted to see is if they're intent was at that time if we should have taken the edit check off that limits to just the total reported in C-17.
(Woman):
Uh-huh.
(Kim Keating):
So we might be able to - we can get back to you...
(Woman):
Okay, that would be perfect.
(Kim Keating):
...and tell you what to do because maybe we can make an exception and you can accurately report the number in 17A this year.
(Woman):
Okay. That'd be great.
(Kim Keating):
Okay.
Woman:
(Kim), thank you for doing that because I think that has come up and I noticed that last year without language change. It's still - isn't reflective of all of the preventive services that are going on in programs.
(Kim Keating):
Uh-huh. Okay.
(Carol Weaver):
Can I make a quick comment? This is (Carol Weaver) let's go back actually to the medical services. There's really the same problem there if you're going to look at the problem with the dental issue because there's a diminishing number again with Number 9...
(Allison Hertel):
Uh-huh.
(Carol Weaver):
...where you have to complete it all of the eight appropriate test when some our children may not have gotten physical exam but because of our screening, the health and or the hearing and vision screening, they were sent to somebody and receive treatment for either a hearing or vision problem...
(Allison Hertel):
Right.
(Carol Weaver):
...and you can't (unintelligible) those children either because they did not ever get a physical exam.
(Allison Hertel):
Great, thank you. And thanks (Kim) for looking in to that for us.
(Kim Keating):
Uh-huh.
(Carol Weaver):
Thank you.
(Janice Henson):
Hi. This is (Janice Henson) (unintelligible) I just have an additional question because of the current discussion and that is 417 - if we had 600 kids that we're putting in 17, of that 600 is - 500 of them receive preventive care but their preventive care is - like they all have a dentist, okay of the 600. But 500 of them received preventive care from a hygienist of even from, you know, some of our staff for instructional period or training. That can't be counted under the preventive unless it's only done by a dentist?
(Allison):
Well, that's what we're trying to see if we can get rectified.
(Janice Henson):
Well, I mean, I understand 17 has said - it's indicated so it has to be done by a dentist. But 17A does that...
(Allison):
If those children receive an exam and part of that exam included fluoride varnish by a hygienist, it would included there. The challenge is coming up for children that did not receive exam but they still receive fluoride varnish. At this point, that cannot be included in there. So it's only coming up for the children that did not receive an exam.
(Janice Henson):
Okay. Thank you.
(Allison):
If you need additional clarification you would want to talk later. Feel free to call me because I know this can be a little confusing.
17 B asks, of the children examined the number of children diagnosed within the current operating period or within the last 12 months is needing treatment. And then it states what treatment includes.
And of the children diagnosed as needing treatments, the number who have received or are receiving treatments.
And then 17-C-i ask you to - that if the number of children that were diagnosed as needing treatment is less than 90% - if the children that received treatment is less than 90% of the children that were diagnosed as needing treatment you'll find the primary reason below.
And what it asks for is one specific reason. And we recognize that there - maybe - all of those reasons as to why the children did not receive care.
And again use the comment section to specify if you want to even break it down into numbers, how many kids, for what reason and it's just another way that maybe next year that you can include multiple comments but - or multiple reasons. But at this point it's only asking for one reason.
Moving on to C18, this is for Early Head Start Programs and Migrant Programs and it asks for the number of children or received oral health screenings as a part of their well baby exams as mandated by Medicaid so oral health screenings may be conducted by the child pediatrician during a well child exam. You would include all of those children within the account.
And then it asks for the number of children who received a professional dental exam during the operating period or within the last 12 months so that - it would be again an exam from a dentist.
And a question was asked last week (that) if we had a child who received both of them and you can include that child in both categories.
And then the last dental question asked is, dental services for pregnant women. And it asks for the number of pregnant women served in your Early Head Start program who received a dental examination and or dental treatment within the last 12 months.
Just going to pause for a minute and see if there are any other questions around dental.
(Allison):
We're going to move into the mental health part and it is on Page 24 of the PIR and on Page 53 of the User's Guide.
And the first question is 21 and it asks for the average total hours for operating months that a mental health professional spends onsite.
Report the number of hours spent with the children, parents and families within or outside of the classroom, and/or and training or consultation with the staff.
(Cindy):
This is (Cindy) with Head Start of Lake County. I have just a quick question about mental health professional and your definition of that.
We have a behavior support team with our early intervention program that provides some support to our classrooms for all the kids that are on ISSP that they need behavior support but we also have them provide support when some kinds aren't on the ISSP - do we count them as a mental health professional or not? They're not licensed.
(Julianne Crevatin):
(Unintelligible) this is (Julianne), I'm - I'm going back to the definition of the mental health professional as defined by the Performance Standard, then (Ally's) point to - the guide to see if there's a definition in there.
(Allison):
It says that mental health professional's representative variety discipline including but not limited to psychiatry, psychology, psychiatric nursing, marriage and family therapy, clinical social work, behavioral and developmental pediatrics and mental health counseling.
And that is on Page 52 of the Users Guide.
Woman:
Yeah. I did see it...
Woman:
I think if you have a - because it also says, you know, in here she maybe a consultant to the program or served the program on a contractual basis.
Woman:
Do you have another person that (unintelligible) that you're actually hiring on a contract as a mental health consultant separate or an addition to this...
Woman:
Yes.
Woman:
...was this the source for your mental health...
Woman:
We have mental health providers that we've contract with and then there's also myself. So they're not the sole on mental health provider by any means but they do provide behavior support which overlaps with the mental health requirements or just recommendations quite a bit from time.
Woman:
Yeah.
Woman:
Uh-hum.
(Dawn):
I - this is (Dawn), I think that you could count that because you know they don't have licenses. They're trained professionals. Not where there are any ECSE in Oregon so I think that will count as part of your mental health...
(Dawn):
...(for all their) - support you get from them.
Woman:
Okay. Twenty-two asks...
(Veronica St Angelo):
Excuse me, this is (Veronica St Angelo) of the Behavior Mental Health, Program Manager at (EPIC). To - just to clarify, support staff that is employed with Head Start agencies as well as mental health consultants can be counted within the professional hours operating within a month in question 21?
Woman:
Are the staff in your program mental health qualified professionals.
(Veronica St Angelo):
Yes.
Woman:
Yeah.
Woman:
Then yeah.
Woman:
Yeah.
Woman:
Yeah.
Woman:
(Under that) - in their job description and the function that they perform?
(Veronica St Angelo):
Yes.
Woman:
Then I will count them.
(Veronica St Angelo):
Okay.
(Allison):
If some programs have their own in house staff and some contract point and some do both, so this is trying to get how much mental health consultation time is available within the program.
C22 asks you to indicate the number of enrolled children who were served by the mental health professional in the following ways during the operating period.
A asks for the number of children for whom the mental health professional consulted with program staff and of the child's behavior or mental health. And then under that (i) asks, for of those children the number for whom the mental health professional provided three or more consultations with program staff.
B asks for the number of children for whom the mental health professional consulted with parents or guardians about their child's mental or child's behavior or mental health. And (i) again asks for the number of those children for whom the mental health professional provided three or more complications with the parents or guardian.
C asks for the number of children for whom the mental health professional provided an individual mental health assessment.
And D asks for the number of children for whom the mental health professional facilitated a referral for mental health services.
Woman:
I have a question and I just wanted to clarify something I think I heard a little while ago.
Woman:
Okay.
Woman:
We have a mental health consultant that we contract with. We also - and they do meet the required qualifications from mental health professionals. We also have a behavior interventionist that we can (go with), who is a Masters in - at - and we contract with her to help with behavior intervention in the classroom as well.
She does not meet the mental health professional qualification but she does help with mental health in the sense of behavior in a classroom. So did I hear that you say earlier that I could count her numbers in the comments section maybe, and not as a mental health professional?
(Allison):
If she doesn't meet the qualifications for a mental health professional, then right, you could not include her in that count. But I would encourage you to put it in the comment section that you have a Masters of Behavioral Consultant that works X number of hours (with Ken).
Woman:
Okay, thank you.
(Julianne Crevatin):
I'm reading at the performance standard. And again, this is where it gets back to this definition that mental health services must be supported by staff to consultants who are licensed or certified mental health professionals with expert - with experience and expertise in serving young children and their families.
This is the definition I believe that's behind this question on mental health services. So again, the goal is just to find out how much time is available within a program to provide mental health services. There's no good, bad number. This is just the amount of the hours that actually are contracted with or available within the program. It can be either internal or external or both of that on a monthly basis.
And even if you look in that staff, you know, when I look at allocation of staff time, you know, if you're looking at it, you may have a person that does multiple functions within your agency those have to have the expertise and they have to actually have allocated time to do this function.
So, think of it in those terms. So you have somebody that is (putting) in their PD, their Physician Description, their allocated time to do this, and they have the qualification. Then you can count them in this category.
This doesn't have a minimum or a maximum requirement to it.
(Sandy):
But (Julianne), this is (Sandy) over here in Olympia.
(Julianne Crevatin):
Uh-huh.
(Sandy):
I think part of question for me is the licensed professional and I think there are models in which there's a licensed mental health professional who has a couple other mental health people working with them who are not licensed.
(Julianne Crevatin):
Uh-huh.
(Sandy):
Then I would want to be able to count all of those total hours.
(Julianne Crevatin):
And I would count them as long as they're working under the direction of that licensed mental health professional. They're not independently operating but they're working under the contract that you've set up. They're dedicated to a specific amount of time, that I would count.
(Sandy):
I agree with you. Thank you.
(Julianne Crevatin):
Okay, and then (23 asked about)...
(Allen):
Excuse me, this is (Allen) from (unintelligible) Childhood Program.
(Julianne Crevatin):
Hi (Allen).
(Allen):
Good morning - afternoon, whatever it is.
That I provide observations in a classroom, I am degreed but I am not licensed or certified. So from what (Julianne) is saying then I am not - I would not be counted, correct?
(Julianne Crevatin):
Do you have someone else in your program that you contract the mental health services or are you the sole provider of this expertise?
(Allen):
So we have agencies and an individual we contract with who also does that and we also have three individuals who are professionals either now or were with school districts and they do in kind mental health kinds of things; but - so that was - so that we all to varying degrees do the observations and then some are available for further consultation services; but they're all licensed and/or certified and I am not, I am degreed. And I have been counting myself as providing part of those hours.
And I'm - it sounds like from what you're talking about, that I should not be counting my hours.
(Julianne Crevatin):
And degreed in which field?
(Allen):
Masters in Counseling.
(Julianne Crevatin):
Well, it says mental health counseling is a mental health professional if you look in the user's guide, so.
(Allen):
Right, but then the other information I've seen it talks specifically to licensed or certified, like in Head Start performance standards.
Woman:
So, can I interject? This is (Val) from Lane County.
(Julianne Crevatin):
Go for it (Val).
(Val):
When the guidance in the (PIR) does not match with the performance...
Woman:
That's exactly (why).
(Val):
Which is what we are up against in dental as well, what are we supposed to do?
(Val):
Well...
(Julianne Crevatin):
Well, and this isn't a questioning about performance - I mean the issue of the (PIR) is not about meeting performance and a requirement. Like I said, there's no minimum or maximum scale on mental health services.
You know, I don't have an answer between, you know, what's required to and what's not. And I'm looking out here at the definition under the (PIR) guidance, that (unintelligible) talked about mental health counseling.
And it - but it does go back and it gives a much broader mental health professional representative, variety of discipline including but not limited to...
(Val):
In the guidance and the (PIR), right?
(Julianne Crevatin):
Yeah.
(Val):
Because - yeah, what we're looking at is not as rigid as in the standard. Which is opposite, in the dental...
(Julianne Crevatin):
Yes, it is.
(Val):
...it's actually turn the other direction where it's...
(Julianne Crevatin):
Yeah.
(Val):
...more rigid in the (PIR) guidance than it is in the standards.
(Julianne Crevatin):
Good point.
(Val):
So that - I mean, I think that that's really underlying all of this is why so many of us gets so frustrated with this process because we're told following your performance standards, follow your performance standards and then the (PIR) kind of says, "Oh, but not now."
Woman:
Well, this is...
(Julianne Crevatin):
So the purpose of the (PIR) is different than - I mean, you know, the bottom line is, it was not necessarily created for the same purpose, then I agree with the entire frustration with this that, you know...
(Val):
...I totally understand that (Julianne) I'm not - my purpose is not directed to you...
(Julianne Crevatin):
No, I know that.
(Val):
...any way.
(Julianne Crevatin):
And though what I'm saying is they have nothing really - the parallel kinds of thing then I go back to that - the performance standards.
Because when I go out and I look at mental health services, why are you contracting if you, you know, somehow, you know, you're not meeting that definition so you - in your own program of getting additional consultation.
So that committee says, "We know to meet this requirement will join in additional hours. That's what I'd be reporting."
I mean, and again, this one doesn't have a minimum or maximum. It's just trying to get a (sense) within a program, how much time do programs really dedicate to the mental health area? And I think collectively, it has an important statement to say that what kinds of services are available to kids? Whether you have 400 hours a month or 20 hours a month, this one doesn't weigh the burrow, one way or another, within a minimum or a maximum requirement within the program.
I would want to have it at closely reflect what kind of professional expertise you have available to provide services to children. And at this point, for me to try to decide this meets, you know, who meets that definition, I default to performance standards, that's all.
Woman:
Okay, okay. Thank you.
(Allison):
The last question asks about mental health referrals and the question states the number of children who were referred for mental health services outside of the Head Start program during the operating period.
And then, of those children that were referred, the number who received mental health services during the operating period. So that is outside of the program.
Woman:
Excuse me, I have a question on Number 23.
(Allison):
Okay.
Woman:
Can you explain the difference to me of question number 23 and questions 22D?
(Allison):
And 23A is asking for the number of children who received services outside of Head Start. This is asking who facilitated a referral. So facilitated is how it come together, how did that referral come together. It's not the actual receiving of services.
Woman:
Right, but she's asking for 23, the number of children who referred for mental health services outside of Head Start, not 23A.
So those children could also include...
Woman:
You know, this is what we figured out.
So 22D is actually the mental health professionals facilitated that referral; 23 is a little bit broader and that it could be that as a result of a staffing or as an - another staff member in the program made the referral or the medical...
(Julianne Crevatin):
Maybe the child's pediatrician made a referral for mental health services, 23 the referral to mental health, could it come from anyone? Could it come - both internal to Head Start or external?
This child might have been referred for mental health services from (CPS), this child might have been referred for mental health services from a variety of other providers and you may or may not know this, some children being referred for mental health, you know, have nothing to do with Head Start.
But (I always collect D as) whom within your system, the mental health professionals facilitated the referral, what 23 is, any referral, 2 mental health outside the Head Start. And it could include your own and more referral.
Woman:
Thank you.
(Julianne Crevatin):
And the other thing is - the child could come into your program and is already been referred or is in the process of being referred through another system or another agency so I'd ask that's kind of how we looked at it. That I would think of 23 as a bigger category possibly than D.
(Allison):
That wraps up all the health and mental health piece. Are there any other questions out there floating around?
(Allen):
Yes, please. This is (Allen) from (unintelligible) Childhood Program.
If I may go back to C21 on the mental health professional averaged total hours for operating month stands on site, a couple of questions, one, when the school psychologists are there, is that something that we would include here because, you know, they are a psychologist or is that something that we would more focus in the area and disability as far as including or counting their influence and their time spent in the program.
(Julianne Crevatin):
I think it's the school psychologist that's providing mental health services and - to all students, not only children on IEPs or ISSPs and that would be included in that.
(Allen):
Okay. I guess behavioral is becoming more and more a part of that...
(Julianne Crevatin):
Uh-huh.
(Allen):
...diagnosis in the intervention.
And the other question is, you know, looking at the average number or average total hours for operating month, I'm thinking across our sites. In some areas, we have a great deal of mental health intervention available from individuals in the community whether it's the school district, whether it's counseling agencies or whatever, and then in some other areas, we have very, very little.
So trying to calculate those numbers is somewhat difficult and then, you know, what those numbers actually represent when we get done I'm not sure is very accurate or very representative of the program, so it's almost like, you know, taking one and a hundred and averaging amount and you end up with, you know, 50.
(Julianne Crevatin):
Uh-huh.
(Allen):
So anyway, that's more an observation I don't know...
(Julianne Crevatin):
Right.
(Allen):
...if there's any guidance in terms of how to do that or other programs experience that kind of situation as well.
(Julianne Crevatin):
So it's not as your reflection of your program. And the (PIR) is asking for an average.
(Allen):
Right.
(Julianne Crevatin):
So for (PIR) purposes, calculating the average.
(Allen):
Right.
Because I'm thinking there for instance in our Grangeville site we've got incredible mental health services, I, you know, (unintelligible) get their - probably their 50% of the time and...
(Julianne Crevatin):
Oh.
(Allen):
...and other centers it's negligible, it may be only when I visit there a couple of times a year.
(Julianne Crevatin):
Right.
(Allen):
So there - tremendous experience.
(Julianne Crevatin):
Right. That's a good observation. We can take that feedback to the bureau. I don't know if we - I mean, I think it's good to have a better average and have that reflection for the whole program.
(Allen):
Certainly.
(Julianne Crevatin):
You could include those figures in the comment section as well, if you wanted.
Woman:
Actually what you're saying, your range, it looks different than your average...
(Julianne Crevatin):
Yes.
Woman:
...and, you know, an average doesn't tell the whole story and that's the problem with averages.
If - I think, again, whatever additional information you'd like to add to this, it would be helpful. I think all of us know that in many ways the (PIR) addition is a very (unintelligible) tool in the fact that there's a lot of kinds of services that may not even get reflected here.
So I encourage you again to use the comments, to add whatever you'd like, but again, this comes down to just the average. What does it look like on a average program wide basis in terms of the number of hours that you have mental health consultation available.
(Allen):
Excuse me - and so in answering that, when we're talking about on site, we're talking about on site across the program, not as opposed to one individual site?
Woman:
It's continuing to say the average total on that operating per month, it's across the - and you know, how much time do you think you give per month for mental health consultation.
Woman:
Yeah.
(Allen):
Right, so we're talking - we're talking - when we're saying on site, we're talking about sites across the program, not an individual site, correct?
Woman:
Yes.
(Allen):
Okay. Because obviously with individual sites, then it's even going to be a smaller number.
(Julianne Crevatin):
Right.
(Allen):
Okay, thank you.
(Allison):
It's a total.
Are there other questions?
(Allison):
Okay well, if there are not other questions, we will wrap up the call. If you think of questions this afternoon or in the next few days or in August, when you're finishing your (PIR), feel free to email myself or your program specialist if it's health-related, and if it's mental health, you can email myself or (Dawn) and for those of you - some of you had some questions there on disabilities, that call is going to be occurring at 1 o'clock.
Good luck with the (PIR) everyone and again, use those comment sections, I think they'll be helpful and we'll take all of these - all your questions and feedback to the bureau and give them all that information.
(Julianne):
Thanks a lot everybody and thanks for the effort in putting, you know, the (PIR) data together. It is used a lot. We know it's an imperfect tool at best but I will also continue to say that the data that's gathered from you has a lot of impact on what happens in Head Start. It is the one reporting tool that talks about the amount and scope of services provided to children. It doesn't talk about necessarily the outcome of that, but it is the one reporting mechanism that's out there.
It is important that we do it to the best that we can and again, I appreciate everybody's effort in making that a workable document. We all want to see it improved and I think that this effort by the region have the potential to change some of these questions and I think the questions that we're asking the bureau as a result of this call, again, for some clarity around some of the policy questions.
So, I really appreciate your input. I appreciate the questions that you asked and, you know, we have recorded the information. So, you know, I'm positive and hopeful that this will help us in the long run. So thanks for your effort.
END