Monitoring Protocol Comparison: January 10, 2009 and February 27, 2009 Versions Compared
by Teresa Wickstrom, Center for Community Futures
1) Abbreviation key:
EECD / Education and Early Childhood Development
ERSEA / Eligibility, Recruitment, Selection, Enrollment and Attendance
FCS / Family and Community Services
FM / Fiscal Management
HL / Health Services
MH / Mental Health Services
NS / Nutrition Services
PDM / Program Design and Management
SE / Safe Environments
TR / Transportation Services
2) Quick Look at the Changes between the January 10, 2009 Monitoring Protocol and the February 27, 2009 version.
Where the Changes Are (from January version) /HL2A / Document Review: Child Files
Interview: Health Staff, Parent (Policies and Procedures)
HL2F / Document Review: Child Files
Document Review: Health Tracking System
NS2D / Document Review: Staff Files
SE1B / Safe Environments Checklist
SE1K / Special study on its grantees’ emergency preparedness
SE2D / Interview: Family Child Care Provider, Teaching Staff-EHS (Diapering Practices)
MH2A / Interview (list re-ordered)
MH2B / Interview (list re-ordered)
MH2C / Interview (list re-ordered)
FCS4B / Interviews (lists re-ordered)
Interview deleted
EECD1G / Interview (list re-ordered)
Interview added
EECD2B / Interview (list re-ordered)
Interviews switched
EECD2D / Interviews (lists re-ordered)
EECD2F / Interviews (lists re-ordered)
EECD3B / Interview (list re-ordered)
EECD4B / Interview (list re-ordered)
EECD4C / Interview (list re-ordered)
FM1A / Document Review: Governing Body Meeting Minutes
Interview: Governing Body Members, Head Start Director (Internal Controls)
FM1B / Interview: Governing Body Members (Conflict of Interest)
FM1E / Interview: Financial Officer (Control Environment)
FM1F / Document Review: Code of Conduct
Interview: Financial Officer (Code of Conduct)
FM1G / Interview: Financial Officer (Staffing)
FM1H / Document Review: Physical Controls
FM2A / Document Review: Bank Reconciliations & General Ledger
Interview: Financial Officer (Allowable Costs)
FM2C / Document Review: Financial Reports
Document Review: SF-269 Financial Reports
FM2D / Review Question
FM2H / Document Review: Non-Federal Share
FM2K / Document Review: Bank Reconciliations & General Ledger
FM2L / Document Review: Grant Application Budget Instrument (GABI)
Document Review: SF-424
Interview: Financial Officer (Accounting System)
FM2M / Document Review: Contracts, Payments, and Reimbursements
FM2N / Document Review: Inventory and Equipment Records
FM3A / Interview: Financial Officer (Purchasing Facilities)
FM4B / Review Question
Interview: Financial Officer (Compensation)
PDM1A / Review Question Note
Document Review: Governing Body Membership Roster
Interview: Governing Body Members (Conflict of Interest)
PDM2F / Document Review: Newsletters, Calendars, Etc.
PDM3B / Interview: Head Start Director (Planning - Community Assessment)
PDM7C / Document Review: Staff Files
PDM7E / Document Review: Staff Files
PDM7H / Document Review: Policies and Procedures
No changes to review questions in Disabilities Services, Transportation Services, ERSEA.
3) Detailed look at the changes in Monitoring Protocols.
January 10, 2009 / Feb. 27, 2009 /Health Services / Health Services /
HL1A / 1304.52 d 2 Link: PDM7B / Same
Do the content area experts assigned to oversee health services have training and experience in public health, nursing, health education, maternal and child health, or health administration? Does the program assure that health procedures are performed only by a licensed or certified health professional? / Same
Document Review: Staff Files / Same
Before conducting your interviews, review the job description for the content area expert who oversees health services. Describe the required license or certification for health professionals with experience and expertise in serving young children and their families. / Same
Review the personnel file, contract, or resume of the health content area expert to determine whether he or she has documentation of a license or certification, as well as experience serving young children and their families. List the degree or degrees, training, experience and qualifications documented. Note the accrediting body for the license or certification. / Same
Interview: Health Staff (Staffing) / Same
Describe how hired staff or consultants provide regularly scheduled and ongoing content area expertise and oversight. / Same
Does the program administer health procedures? If so, are procedures performed by licensed and certified professionals? / Same
What training or experience do you have in public health, nursing, health education, maternal and child health, or health administration? / Same
HL2A / 1304.20 a 1 ii C, 1304.20 d, 1304.22 a 4, 1304.20 e 1, 1306.35 c Link: PDM6A / Same
Has the program established procedures for tracking, documenting, and reporting health care services? / Same
Document Review: Child Files / Same
Review child files for documentation (e.g., case notes, family contact logs) of the program's attempts to help parents bring their child up-to-date. Describe how the program works with parents to bring their child up-to-date on a schedule of primary preventive health care. / Same but re-ordered
Review the program's health tracking system and identify a sample of children from the tracking system for record review. Have the grantee staff guide you through the actual records of the selected children, and compare them to the tracking system for accuracy. Have the grantee print a tracking system report for you to compare them to information in child files. Is it accurate? If not, please describe. / Changed:
If not, please describe any discrepancies. Be sure to include in your notes the number of files reviewed, the number of files with discrepancies, which files had discrepancies, and the type of discrepancies identified.
Document Review: Health Tracking System / Same
Please describe the Health Tracking System used by the program. / Same
Review child files for completion of all screenings within 45 days (30 days for Migrant and Seasonal programs). Indicate the date that screenings were completed and the date for any screenings completed beyond 45 days (or 30 days) or screenings that were not completed at all. Also indicate if there were any concerns identified in the screenings requiring follow-up.
1304.20 b 1, 1304.20 a 2 / Same
Interview: Family Child Care Provider, Health Staff, Parent (Policies and Procedures) / Same
How are parents notified in the event of an emergency involving their child?
1304.22 a 4 / Relocated
What is the system for notifying parents of emergencies or unplanned interruptions in service? Describe the contingency plans you have developed with parents for these emergencies (e.g., alternative providers or substitutes)? How do you inform parents of an emergency or the need to pick up a child who has become ill?
1306.35 c / Same
Interview: Health Staff (Providing Health Services) / Same
What is your ongoing procedure for identifying new or recurring medical, dental, or developmental concerns? When noted or observed by staff or parents, how do you record physical changes in a child's appearance or signs of illness or injury? How often do you make referrals based on these observations?
1304.20 d / Same
What is your system for tracking children's health care? How do you keep the system effective and accurate? How do you use the system to communicate child health needs with parents and staff? Can you show me your program's health tracking system?
1304.20 a 1 ii C / Same
Interview: Health Staff, Parent (Policies and Procedures) / Same
Relocated:
How are parents notified in the event of an emergency involving their child?
1304.22 a 4
How do consultations with parents occur when health problems are suspected or identified for children?
1304.20 e 1 / Same
HL2B / 1304.20 a 1 i, 1304.20 a 2 / Same
Does the program employ a process to determine whether each child has an ongoing source of continuous, accessible health care?
Note: 1304.20 a 2 applies only to Migrant and Seasonal programs and should be cited in conjunction with 1304.20 a 1 i for such programs. / Same
Document Review: Child Files / Same
Review child files to determine whether children's ongoing source of health care is addressed during enrollment activities, before their entry into the program, or within 90 days of entry into the program (30 days for Migrant and Seasonal programs). Is the source of ongoing health care documented in the child's record? / Same
Document Review: Policies and Procedures / Same
Review the program's procedure on determining children's access to ongoing healthcare. Does the program maintain a list of provider offices? / Same
Interview: Health Staff (Providing Health Services) / Same
How do you determine whether enrolled children have an ongoing source of continuous, accessible health care with in 30 days of entry? / Same
How do you determine whether enrolled children have an ongoing source of continuous, accessible health care within 90 days of entry? / Same
Interview: Parent (Providing Health Services) / Same
How does the program support you to ensure that your child has access to health care (e.g., your child has a primary care physician and dentist)? / Same
HL2C / 1304.20 a 1 i, 1304.20 a 1 ii, 1304.20 a 1 ii A, 1304.20 a 1 ii B, 1304.20 a 2 / Same
Has the program obtained from a health care professional a determination of whether each child is up-to-date on a schedule of primary and preventive health care, helped parents bring children up-to-date when necessary, and kept children up-to-date, as required?
Notes: 1304.20 a 2 applies only to Migrant and Seasonal programs and should be cited in conjunction with 1304.20 a 1 ii for such programs. The program is required to know which children are not current on the required primary and preventive health care, help parents bring their children up-to-date, and have a system to ensure that children who are current stay current. / Same
Document Review: Child Files / Same
Review child files for documentation (e.g., case notes, family contact logs) of the program's attempts to help parents bring their child up-to-date. Describe how the program works with parents to bring their child up-to-date on a schedule of primary preventive health care. / Same
Review child files for up-to-date determinations that incorporate the requirements of the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) schedule for each child and check dates of determinations to ensure the 90-day requirement (30 days for Migrant and Seasonal programs) is met. Does documentation include a breakout of blood lead and hemoglobin/hematocrit?
1304.20 a 1 ii, 1304.20 a 2 / Same
Interview: Health Staff (Providing Health Services) / Same
How do you ensure that children who are up-to-date with primary and preventive health care stay up-to-date?
1304.20 a 1 ii B / Same
How do you obtain a determination of each child's health status from a health care professional and ensure that each child is up-to-date with the EPSDT requirements of your State, within 90 days of his or her entry into the program (30 days for Migrant and Seasonal programs)?
1304.20 a 1 ii, 1304.20 a 2 / Same
If a child is not up-to-date on her or his schedule of primary and preventive health care, how do you help the parents bring their child up-to-date? Do you have documentation of your attempts to help parents bring their child up-to-date?
1304.20 a 1 ii A / Same
What are the State EPSDT requirements for well child care? / Same
What do you do if parents are having difficulty making appointments or keeping their children up-to-date in primary and preventive health care? / Same
Interview: Parent (Providing Health Services) / Same
Has the program helped you keep your child up-to-date on primary and preventive health care? Has the program helped you make and keep appointments? Has the program helped you understand the importance of staying up-to-date? / Same
HL2D / 1304.20 b 1, 1304.20 b 2, 1304.20 b 3, 1304.20 a 2 / Same
Has the program, in collaboration with each child's parent, performed or obtained the required linguistically and age-appropriate screening procedures to identify concerns regarding children within 45 days of entry into the program, obtained guidance on how to use screening findings, and used multiple sources of information to make appropriate referrals?
Note: 1304.20 a 2 applies only to Migrant and Seasonal programs and should be cited in conjunction with 1304.20 b for such programs. / Same
Document Review: Child Files / Same
Use the health tracking system to identify files of children whose parents have refused to give authorization for health services. Sample the files of these children. Check for written documentation of their refusal.
1304.20 e 5 / Same
Interview: Health Staff (Providing Health Services) / Same
Do you obtain guidance from the mental health or child development specialist on how to use screening findings? How do you receive information? How do you use this information?
1304.20 b 2 / Same
How and when do you ensure each child receives the following screenings: developmental, sensory (hearing and vision), behavioral, motor (gross and fine), language, social, cognitive, perceptual, and emotional skills? How do you ensure that the screenings are sensitive to the child's cultural background?
1304.20 b 1 / Same
What other sources of information do you use to help you understand screening findings (e.g., parent, teacher, and other staff feedback)? How do you use this information to make referrals?
1304.20 b 3 / Same
HL2E / 1304.20 a 1 iii, 1304.20 a 1 iv, 1304.20 c 3 ii, 1304.20 c 1, 1304.20 c 2 Link: PDM6A / Same
Does the program ensure that each child with a known or suspected health, dental, or developmental problem receives further testing, examination, and treatment from a licensed or certified health care professional? Does the program ensure that appropriate follow-up actions are taken? / Same
Document Review: Child Files / Same
Use the health tracking system to identify children with known or suspected health or developmental problems. Check the files of these children to determine whether further testing, examination, or treatment was obtained. Check whether a follow-up plan is in place and implemented, if appropriate. / Same
Interview: Health Staff (Follow-up Care) / Same
How do you communicate with parents to ensure implementation of medical and dental follow-up plans?
1304.20 c 1, 1304.20 c 2 / Same
How do you ensure that children receive preventive measures and further dental treatment recommended by dental professionals?
1304.20 c 3 ii / Same
What is the process for obtaining further testing, examinations, or treatment for children with known or suspected health or developmental problems? How long does it take to receive care after problems are identified?