This Standard Operational Procedure (SOP) manual was
developed and written by the Health Content Area Staff of Head Start of Greater Dallas
This manual is comprised of the health staff job descriptions, responsibilities, duties, health information and procedures for the delivery of services for children and families enrolled in the agency.
This manual has incorporated health information and guidelines from a variety of resource materials. Some of the reference/resource materials include:
§ Head Start Program Performance Standard and Other Regulation 2004
§ Texas Minimum Standards 2003
§ Department of Human and Health Services 2005
§ American Red Cross 2001
§ Dallas Public School Health Services Policy 2001
§ The 5-minute Pediatric Consult 2000
§ Quality Nursing Intervention in the School Setting 1996
§ Current Pediatric Diagnosis & Treatment 1999
§ Mosby’s Medical , Nursing & Allied Health Dictionary 1994
§ Clinical Guidelines in Family Practice
§ Current Medical Diagnosis & Treatment 2000
§ The School Nurse’s Source Book of IHP 1992
This manual will be reviewed and updated annually by Health’s SOP Committee.
HEAD START of Greater Dallas, Inc.
TABLE OF CONTENTS
I. INTRODUCTION
II. HEALTH STAFF: JOB DESCRIPTION AND RESPONSIBILITIES
III. PRE-CENTER OPENING ACTIVITIES
IV. ENROLLMENT PROCEDURES
V. THSTEPS: MEDICAL/DENTAL RECOMMENDED GUIDELINES
VI. ORGANIZATION OF HEALTH SECTION IN CHILDREN’S NOTEBOOK
VII. SCREENING PROCEDURES
VIII. IMMUNIZATION RECORD AND SCHEDULE
IX. MONITORING AND TRACKING PROCEDURES
X. PHYSICAL EXAM PROCEDURES
XI. FOLLOW-UP/TREATMENT PROCEDURES
XII. DOCUMENTATION PROCEDURES
XIII. REFERRAL PROCEDURES
XIV. HEALTH POLICIES AND PROCEDURES
XV. SPECIAL NEED SERVICES
XVI. CHILD HEALTH AND SAFETY
XVII. BLOOD-BORNE PATHOGENS
XVIII. DAY-TO-DAY OPERATIONS
XIX. INTRA-RELATIONSHIPS WITH OTHER COMPONENTS
XX. HEALTH FORMS
XXI. RELATED EXTERNAL FORMS (HEAD START)
Table of Contents
I. Introduction 9
Content Area Summary 9-10
II. Health Staff: Job Description and Responsibilities 11
Nurse Practitioner/Nurse Coordinator 11
Health Specialist 12-13
Health Assistant 13-14
Early Head Start Health staff 14
Health Administrative Assistant 15
Orientation 15
Staffing Assignment of Health Content Area 16-17
Suggestions for the Health Office in New Centers 18
Internship in the Health Content Area 19
Health Specialist Intern 19-20
Health Assistant Intern 20
III. Pre-Center Opening Activities 21
Beginning of the Year Activities for Health Coordinator 21
Beginning of the Year Activities for Health Specialist 21-22
Beginning of the Year Activities for Health Assistant 22
Guideline for Planning Activities per Performance Standards 22-23
IV. Enrollment Procedures 24
Pre-Enrollment Procedure and Packet 24-26
Center Enrollment Packet 26
Services Permission Form 26-28
Medical Home Form 29-31
Health History Form 31
Consent to Release Form 31-32
Immunization Form 32-33
Lead Requirement/Questionnaire 33-34
Re-Enrollment for Lead Questionnaire 34
Lead Education/Referral Form 34
TB Questionnaire 34-35
Re-Enrollment for TB Questionnaire 35
TB Consent/Education Form 35
Statement of Physician Form 35-36
Check-In Procedure 36-37
Sign-In/Sign-Out Procedure 37
Vogel Alcove 38
Re-Enrollment Procedure 38-39
Data Base Input 39
Waiting List 39-40
Enrollment in Spanish 40-44
V. THSteps: Medical and Dental Recommended Guidelines 45
THSteps Periodicity Schedule 45-46A
VI. Organization of Health Section in Child’s Folder 47-48
Progress Notes/Family Contact Log 48
Data Entry Forms 48-49
VII. Screening Procedures 50
Introduction to Screenings 50
Timeline Calendar Procedure and Calendar 51-55
Growth Assessment 56-58
Growth Charts (Boys and Girls) 59-66
Growth Chart for Girls with Down Syndrome 67-68
Growth Chart for Boys with Down Syndrome 69-70
Head Circumference 71-72
Overweight/Underweight/Short Statue 73-77
Blood Pressure 77-79
Hypertension in Children 79-81
Vision Screening 82-93
EHS Vision Screening 93
Gross Vision Evaluation 94
Hearing Puretone/Impedance 94
Pure Tone Sweep Check Screening 95-97
Impedance/Tympanometry 97-101
Impedance Testing Chart 101
Referral Process for Failed Pure Tone/Impedance Screenings 102
Hearing Referral Process Screening Chart 103
Hearing Checklist for Parents 104
Anemia Testing Hemocue 104-108
Hemocue Hb201 108-110
Heel Stick 110-111
Dental Examination 112-115
Time & Services Report 115-116
Dental Treatment Procedure 116-118
Second Dental Screenings ` 119
Dentition Norms 120
Dental Screenings for Pregnant Moms in the EHS Program 121
Lead Testing 121-129
TB Skin Testing 129
TB Testing for Children 129-130
TB Screening Team 130-131
TB Testing for Employees 131-132
TB Testing for New Employees during Orientation 132-133
TB Testing for Volunteers 133-135
TDSHS TB Testing Guidelines 135-140
Monthly Mantoux Report 141
Screening for Special Services 141
Vogel Alcove 141-142
Pilot Programs 142
VIII. Immunization Record and Schedule 143 Immunization Requirements 143-146
EHS Immunization Requirements 146
Minimum Standards Requirements for Texas Children 147
Immunization Procedure 148
Special Remarks: Immunization Requirements 148
Medical Contraindications 149
Religious Conflicts 149
Exemptions 149
Conscientious Objection to Vaccinations 149-150
In-House Immunization Clinic 150
Recommended Immunization Schedule for Children 151
Texas Immunization Registry (ImmTrac) 152
Combination Doses 152
IX. Monitoring and Tracking Procedures 153-154
Health Content Monthly Report Checklist 154
Control Sheets 155-156
EHS Control Sheet 156-157
Nurse Practitioner Health Problems List 157
TB List of Names 158
Communicable Disease Category B Form 158
Monthly Reports 158-163
EHS Monthly Report 163-167
Supply Request 167-167
Forms for Health Staff 167-168
Health Specialist Monthly Report 168-170
Health Specialist Audit Reports/Forms 170-171
Directions/Instructions for Audit Form 171-174
Data Base Audit Form 174-175
Safety and ADA Checklist 175
First Aid/CPR Training List 175-176
Combined Health Tracking Record 176
EHS Anticipatory Guidance Checklist 176
EHS Prenatal Control Sheet 176-174
In-kind Monitoring 177
PIR Report 177-178
X. Physical Exam Procedures 179
Physical Examination 179-180
Appointment Schedule for Nurse Practitioner 180-181
Child Health Record 181-182
Employee Health Assessment 182
XI. Follow-up/Treatment Procedures 183
Health Screenings 184
Hearing 184
Hematocrit/Hemoglobin 185
Dental Treatment 185
General Undressed Physical Examination 186
Lead Test 186
Lead Questionnaire 186-187
TB Questionnaire 187
Overweight/Underweight 187
Medical Home Follow-up Form 188
Health Notice 188-189
Parental Satisfaction Services Survey 189
XII. Documentation Procedures 190
General Guidelines for Appropriate Documentation 190
Common Documentation Errors 191
Parent Contact Log 191
Parental Refusal of Health Services/Treatment 191-192
Consent to Release 192
Progress Notes 192-193
Drops/Transfers/Transitioning 193
Absences 193-194
Incomplete Screening 194
Referrals 194-195
Examples of Documentation 195
Examples of Completion with Referrals 195
Treatment Plan 195-197
Examples of Documentation via Health Assistant/Specialist 197
Notification of Child Enrollment 197
Confidentiality of Records 198-201
Center Visit Report 201
Corrective Plan of Action 201-202
Two-Week Postnatal Health Assessment Home Visit 202
Health Coordinator Center Visit Form 202
Early Head Start 202
Data Entry Procedure 202-204 Enrollment (Re-Enrollment) Forms on the Database 204-211
Data Entry Pointers/Conversion 211-212
XIII. Referral Procedures 213
Internal Referral 213-214
External Referral 213-214
Payment for Health Services 214-215
Payment of External Referrals 215-216
Procedure for Check Requisition 216-218
Medical Referral 218-219
Nurse Practitioner Health Problems List 219
Procedure for Recruitment of a Provider 219-220
XIV. Health Policies and Procedures 229
Hand Washing 229 - 227
Gloving Procedure 228 - 232
Check-In Procedure 233 - 234
Check-In Algorithm 235
Pediculosis Screening 236 - 237
Screening Procedure 237- 238
Cleaning Procedure 238-239
Common Communicable Diseases 239-240
Allergic Rhinitis (Sinus Congestion) 240-241
Conjunctivitis 241-242
Fever 242-243
Gastroenteritis 244
Hepatitis A 244-245
Impetigo 245
Meningococcal Meningitis (Bacterial) 245
Pediculosis Capitis (Head Lice) 246
Scabies 246
Streptococcal Sore Throat 247
Tinea Capitis (Ringworm of the Scalp) 247
Tinea Corporis (Body Wing Worm) 247
Tuberculosis 247- 248
Varicella (Chicken Pox) 248
Reporting Communicable Diseases 249-254
Dallas County Health and Human Services Helpful Numbers 255
Communicable Disease Chart for Schools/Child-Care Centers 256
Incubation Periods and Duration of Communicable Diseases 252-260
Medication Administration 261-262
Procedure for Medication Administration 263-264
Special Procedures performed by Staff 264-265
Medication Administration on a Field Trip 265-266
Medication/Special Procedure Log 266-267
Child Abuse Reporting 267-269
Violation of child Abuse and/or Neglect 269-270
Violation of Minimum Standards against a HSGD Employee 270-271
Actions/Results of Child Protective Services Findings 272-273
Procedure for Employee, Volunteer and/or Paid Parent who 273
are arrested for any criminal offense of the Penal Code
Poison Ingestion & Drug Overdose 273-274
Tooth Brushing Policy 274
EHS Tooth Brushing Policy 274-275
Sudden Infant Death Syndrome (SIDS) 275-276
Field Trip Safety 276
Ill Child on Field Trip 276
Injured Employee 276-277
Bottles, Pacifiers & Thumb Sucking 277-278
Tuberculosis Screening Procedure 279-283
TB Testing for Volunteers 283-285
Hepatitis B Guidelines 286-290
Hepatitis A Guidelines 291-293
XV. Special Needs Services 294
Policies and Procedures 294 - 298
Guidelines for Asthma 298-299
Guidelines for Hydrocephalus 299-300
Guidelines for Sickle Cell Disease & Beta Thalassemia 300-302
Guidelines for Hemophilia (Free Bleeder) 302
Children with HIV/AIDS 303-304
General questions and answers related to HIV/AIDS 304-305
Diaper Rash 305-306
Diapering Procedure 306-308
Catheterization 308
Female 309-310
Male 311-312
Crede’s Method 312
Ostomy Care 314-315
Nebulizer Treatment 316-317
Gastrostomy Feeding 317-318
Bolus Method A 319-320
Bolus Method B 321-322
Gastrostomy Feeding Button C 323
Gastrostomy Tube D 324
Glucose Monitoring 325
Trachea Re-Insertion 325-326
Epi-Pen/Epi-Pen Jr. Auto Injector 326-327
XVI. Child Health and Safety 328
First Aid Kit (Centers) 328
First Aid Kit (Main) 328-329
First Aid Kit/Fanny Packs (Classrooms) 329
First Aid Kit on the Bus 329-330
Acute Illness and First Aid Guidelines 330
Bites-Animal & Human 330-331
Bites & Stings (Insects) 331
Bleeding (Cuts & Abrasions) 332
Bleeding (Nose Bleed/Foreign Objects in the Nose) 332-333
Foreign Objects in the Nose 333
Blisters 333
Bruises 333-334
Burns 334
Convulsions 334-335
Earaches/Foreign Objects in the Ear 335
Foreign Objects in the Ear 335
Head Injury (Severe or Mild) 335-336
Sore Throat 336
Splinters 336
Stomach 337
Vomiting 337
Incident/Illness 338-340
Dental Emergency First Aid 340-342
Emergency Accident Procedures 343-344
Situations which Require Immediate Medical Attention 344
Health Special Risk, Inc. 345-346
Emergency Numbers 346-348
XVII. Blood Borne Pathogens 349-352
Exposure Determination 352
Methods of Minimizing Exposure 352-354
Engineering Controls 354
Work Practice Controls 354-357
Personal Protective Equipment 357-358
Housekeeping Controls 358-359
Hepatitis B Vaccine 359
Post-Exposure Vaccination 359-360
Post-Exposure Evaluation and Follow-up 361-362
Medical Recordkeeping 362
Signs and Labels 362-363
Information and Training 363-365
Program Management 365-366
Waste Management 366-367
XVIII. Day-to-Day Operations 368
Roles & Responsibilities 368
Team Format/Crossing Triads 368
Team Meetings 369
Transportation 370
Vehicle Check Out Purposes 370
Procedures in Reserving an Agency Vehicle 370-371
Health Staff Transporting Families and/or Children 371
Minimum Standards for Child-Care Centers for Field Trips 372
Transition Procedures 372
Health Summary 373
Trainings 373
Nurse Practitioner/Health Coordinator 373-374
Health Specialist 374
Health Assistant 374
Standardized Health Training Service 374-375
End of the Year Activities 375
Sub-Committees of the Health Content Area 376
Centers Open During the summer 376-377
XIX. Intra-Relationships with other Content Areas 378
Family Advocate/Parent Involvement Services 378
Case Management 378-379
Family Partnership (FPA) 379
Parental/Guardian Concerns 379-380
Head Start Concerns 380
Family Health Concerns 380-381
Refusal of Services 381
Nutrition 381
Special Services/Mental Health 381-385
Education 385-386
Early Head Start 386
Vogel Alcove 386-387
I. INTRODUCTION
Performance Standard 1304
There are several components within Head Start of Greater Dallas. These are: Health, Literacy, Education, Family Advocates/Parent Involvement, and Special Services. These components and their perspective disciplines work together to accomplish Head Start’s mission. Teamwork and integration are essential for effective planning and implementation of the agency’s mission statement. This integration involves each child, their family, the community, and the environment.
The major aspects of the health services program in HEAD START of Greater Dallas, Inc. include providing health education and performing health screenings. Ensuring physical exams, dental exams and treatment; mental health and special needs services, nutrition counseling is being provided for each child when indicated. Staff must monitor and track these services and involve the parent in every aspect of care for their child while enrolled in the agency.
The Head Start Performance Standards provide a framework by which staff members of the various components are to function in order to achieve the agency’s goals. This team approach is clearly stated in the Head Start philosophy.
The Head Start Health Content’s mission statement is “Working to Keep Children Healthier for a Brighter Future”. The main purpose is early identification and arrangement for treatment of health problems and/or concerns. The Health Content incorporates preventive measures such as, screenings and referrals, in order to assist children reach their optimal level of health, while encouraging families to obtain information in order to promote self reliance.
In recognizing the uniqueness of each individual child, the health staff forms a partnership with families, advocating for higher levels of wellness with emphasis on the concept of self-help. In addition, the Health Services Advisory Committee is a major contributor comprised of community providers and families which supports the Health Content concept.
A) CONTENT AREA SUMMARY
(Standard 1304.20)
1) IDENTIFICATION OF NEEDS AND/OR ASSESSMENT
Health staff will be able to determine the child’s health status during enrollment.
The health status is based on Performance Standard 1304.20. This includes ensuring a medical and dental home; physical exam; health screenings; immunizations; dental exams and treatments; and early identification of health problems.
All children (new and returning) enrolled are required to have health screenings within 45 days of entry into the center. Health screenings include a strabismus, vision, pure tone and impedance, hematocrit/hemoglobin, height, weight, blood pressure, TB questionnaire, lead test or Lead questionnaire. For abnormal results children will be referred to their PCP or the agency’s Nurse Practitioner/Health Service Manager for an evaluation. If a child fails his/her initial screening, re-screens for vision and hematocrit/hemoglobin are performed 4-6 weeks after the screening date. Re-screens for pure tone and impedance are performed 2-4 weeks after the screening date.