DOCUMENT RESUME ED 262 895 PS 015 409 Head Start Program ... · DOCUMENT RESUME ED 262 895 PS 015...

DOCUMENT RESUME

ED 262 895 PS 015 409

TITLE Head Start Program Performance Standards (45-CFR1304).

INSTITUTION Administration for Children, Youth, and Families(DHHS), Washington, DC. Head Start Bureau.

REPORT NO DHHS-OHDS-84-31131PUB DATE Nov 84NOTE 67p.PUB TYPE Legal/Legislative/Regulatory Materials (090)

EDRS PRICE MF01/PC03 Plus Postage.DESCRIPTORS Dental Health; *Early Childhood Education;

Educational Facilities; Educational Objectives;Educational Planning; Educational Policy; HealthEducation; *Health Services; Medical Services; MentalHealth; Nutrition; *Parent Participation; ProgramImplementation; *Social Services; *Standards

IDENTIFIERS *Program Objectives; *Project Head Start

ABSTRACTHead Start program performance standards set by

Administration for Children, Youth, and Families are presented infive sections. Subpart A sets out the goals of the Head Startprogram, emphasizing the implementation and enforcement ofperformance standards. Subpart B sets out education servicesobjectives and performance standards concerning program content,operations, and facilities. Subpart C consists of health servicesobjectives and performance standards dealing with health servicesgenerally; the Health Services Advisory Committee; and medical,dental,- health education, mental health, and nutrition objectivesand/or services. Subpart D presents information about social servicesobjectives and performance standards and the content of the socialservices plan. Subpart E focuses on parent involvement objectives andperformance standards concerning parent participation policy;enhancing development of parenting skills; communications amongprogram management, staff and parents; and the content of the parentinvolvement plan. Subparts B through E provide non-mandatory,specific, and detailed directions and guidance for interpreting andimplementing the standards. Appended are rules and regulations fromthe Federal Register, Vol. 40,- No. 126 of June 30,- 1975 concerningprogram options for Project Head Start.- (RH)

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U.S. DEPARTMENT.OF HEALTH AND HUMAN SERVICESOffice of Human Development ServicesAdministration for Children, Youth and FamiliesHead Start Bureau

U.S. DEPARTMENT Of EDUCATIONNATIONAL INSTITUTE OF EDUCATION

EDUCATIONAL RESOURCES INFORMATION

CENTER IERICIL This document has -been reproduced as

received from the Person or coiMnilaflonoriginating it,

changes kayo bean mad* rn imptfm

reproduction quelnY-

Points of view of open ons stated in this docu-ment do not necessarily represent ofkul NIE

position or POSCY.

HEAD START

PROGRAM PERFORMANCE STANDARDS

(45CFR 1304)

November 1984

hdshumandevelemopment.servs

ADMINISTRATION FOR CHILDREN, YOUTH & FAMILIESPROGRAM PERFORMANCE STANDARDS

SUBPART AGENERAL

Section1304.1-1 Purpose and application.1304.1-2 Definitions.1304.1-3 Head Start program goals.1304.1-4 Performance standards plan development.1304.1-5 Performance standards implementation and enforcement.

SUBPART BEDUCATION SERVICES OBJECTIVES AND PERFORMANCE STANDARDS

1304.2-1 Education services objectives.1304.2-2 Education services plan content: operations.1304.2-3 Education services plan content: facilities.

SUBPART CHEALTH SERVICES OBJECTIVES AND PERFORMANCE STANDARDS

1304.3-1 Health services general objectives.1304.3-2 Health Services Advisory Committee.1304.3-3 Medical and dental history, screening, and examination.1304.3-4 Medical and dental treatment.1304.3-5 Medical and dental records.1304.3-6 Health education.1304.3-7 Mental health objectives.1304.3-8 Mental health services.1304.3-9 Nutrition objectives.1304.3-10Nutrition services.

SUBPART DSOCIAL SERVICES OBJECTIVES AND PERFORMANCE STANDARDS

1304.4-1 Social services objectives.1304.4-2 Social services plan content.

SUBPART EPARENT INVOLVEMENT OBJECTIVES AND PERFORMANCE STANDARDS

1304.5-1 Parent involvement objectives.1304.5-2 Parent involvement plan content: parent participation policy.1304.5-3 Parent involvement plan content: enhancing development of parenting skills.1304.5-4 Parent involvement plan content: communications among program management,program

staff, and parents.1304.5-5 Parent involvement plan content. parents, area residents, and the program.

Subpart A Genera!Sec. 1304.1-1 PURPOSE AND APPLICATION

This part sets out the goals of the Head Start program as they may be achieved by the combined attain-ment of the objectives of the basic components of the program, with emphasis on the program perform-ance standards necessary and required to attain those objectives. With the required development of planscovering the implementation of the performance standards, grantees and delegate agencies will have firmbases for operations most likely to lead to demonstrable benefits to children and their families. While com-pliance with the performance standards is required as a condition of Federal Head Start funding, it is ex-pected that the standards will be largely -self- enforcing. This part applies to all Head Start grantees anddelegate agencies.

Sec. 1304.1-2 DEFINITIONS

As used in this part:(a) The term "ACYF" means the Administration for Children, Youth and Families, Office of-Human Devel-opment Services, U.S. Department of Health and Human Servi;es, and includes appropriate regional of-fice staff.(b) The term "responsible HHS official" means the official -who is authorized to make the grant of assist-ance in question, or his designee.(c) The term "Commissioner" means the Commissioner of the Administration for Children, Youth- andFamilies.(d) The term "grantee" means the public or private nonprofit agency which has been granted assistanceby ACYF to carry on a Head Start program.(e) The term "delegate agency" means -a public or private nonprofit_ organization_or agency to which agrantee has delegated the carrying on-of-all-or part of its:Head Start program.(f) The term-"goal"-means-the ultimate purpose or interest toward which total Head Start-program effortsare- directed:(g) The term "objective" means the ultimate purpose or interest toward which_Head Start program compo-nent-efforts are directed.(h) The_term "program-performance standards" or "performance standards" means the Head Start pro-gram functions, activities and facilities required and necessary to meet the objectives and goals -of -the-Head Start- program -as they relate directly to children and-their families.(i) The term "handicapped children" means mentally-retarded, hard of hearing, deaf, speech impaired,visually handicapped, seriously emotionally disturbed, crippled, or other health impaired children who byreason thereof require special education and related services.

Sec. 1304.1-3 HEAD START-PROGRAM GOALS

(a) The Head -Start Program is based on the premise that all children share certain needs, and that chil-dren of low-income families, in particular, can benotit from a comprehensive developmental program tomeet those needs. The Head Start Program approach is based on the philosophy that.

(1) A child can benefit most from a comprehensive, interdisciplinary program to foster development andremedy problems as expressed in a broad range of services, and that

(2)- The child's entire family, as well as the community must be involved. The program should maximizethe strengths and unique experiences of each child. The family, which is perceived as the principal influ-ence on the child's development, must be a direct participant in the program. Local communities are al-:owed latitude in developing creative program designs so long a.. the basic goats, objectives and stand-ards of a comprehensive program are adhered to.(b) The overall goal of the Head Start program is to bring about a greater degree of social competence inchildren of low-income families. By social competence is meant the child's everyday-effectiveness in deal-ing with both present environment -and later responsibilities in school and life. Social competence takesinto account the interrelatedness of cognitive and intellectual development, physical and mental health,nutritional needs, and other factors that enable a developmental approach to helping children achieve so-

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cial competence. To the accomplishment of this goal, Head Start objectives and performance standardsprovide for:

(1) The improvement of the child's health and physical abilities, including appropriate steps to correctpresent physical and mental problems and to enhance every child's access to an adequate diet. The im-provement of the family's attitude toward future health care and physical abilities.

(2) The encouragement of self- confidence,- spontaneity, curiousity, and self-discipline which will assistin the development of the child's social and emotional health.

(3) The enhancement of the child's mental processes and skills with particular attention to conceptualand communications skills.

(4) The establishment of patterns and expectations of success for the child, which will create a climateof confidence for present and future learning efforts and overall development.

(5)- An increase in the ability of the child and the family to relate to each other and to others.(6) The enhancement of the sense of dignity and self-worth within-the child and -his- family.

Sec. 1304.1-4 PERFORMANCE STANDARDS PLAN DEVELOPMENT

Each grantee and delegate agency shall develop a plan for implementing the performance standards pre-scribed in Subpa. ts B, C, D, and E of this part for use in the operation of its Head Start program (hereinaf-ter called "plan" ir "performance standards plan"). The plan shall provide that the Head Start program cov-ered thereby shall meet or exceed the performance standards. The plan shall be in writing and shall be de-veloped by the appropriate professional Head Start staff of the grantee or delegate agency with coopera-tion from other Head Start staff, with technical assistance and advice as needed from personnel of the Re-gional Office and professional consultants, and with the advice and concurrence of the policy council orpolicy committee. The plan must be reviewed by grantee or delegate agency staff and the policy council orpolicy committee at least annually and revised and updated as may be necessary.

Sec. 1304.1-5 PERFORMANCE STANDARDS IMPLEMENTATION AND ENFORCEMENT

-(a) Granteesrandrdelegateragencies-must te=in-compliance-with-or exceed=the-performance =standardsprescribed in Subparts B, C, D, and-E of this -part at the commencement of -the grantee's_program yearnext following July 1, 1975, effective date of the regulations in this part, -or 6 months after that date, which-

-ever is later, and thereafter,, unless the period= for full compliance is extended -in- accordance with para-graph (f) of this:section.(b) If the responsible HHS-official -as a result of information obtained from program self-evaluation, pre-review, or routine monitoring, is aware of has reason to believe that a Head-Start program, -with respect-to-performancerstandards other than those for which the time for compliance has been extended in accord-ance with paragraph (f) of this section, is-not in compliance with performance stancards,:he shall notify thegrantee promptly in writing of-the deficiencies and inform the grantee that it, or if the deficiencies are in aHead Start program operated by a delegate agency, the delegate agency has a period stated-in the noticenot-to exceed 90-days-to come -into- compliance. If the -notice_is- with respect to a-delegate_ agency,_thegrantee shall immediately_ notify the - delegate agency and inform it of the time_within_which the-deficienciesmust be corrected. Upon rect.iving the-notice the grantee or delegate agency shall immediately_ analyze its_operations to determine-now it might best comply wiih the performance standards. In this process it shall

-review, among otherzthings, its-utilization of-all-available-local-resources, and whether -ins receiving thebenefits-of State -and other Federal programs for which it is eligible and which-are available. It shall reviewand realign -where feasible, program priorities, operations, and financial and manpower allocations. -It shallalso consider the possibility of choosing an alternate program option for the delivery of Head Start servicesin accordance with Notice N-30-334-1-, Program Options for Project-Head Start, attached hereto as Appen-dix A,_which the grantee, with ACYF-concurrence, determines that it would be able-to operate as a-qualityprogram in compliance with performance standards.(c) The grantee or delegate agency shall report in wi...ng in detail its- efforts to meet the performancestandards within the time given in the notice to the responsible -HHS official. A delegate agency shall re-port through the grantee. If the reporting agency, grantee or delegate agency determines that it is unable

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to comply with the performance standards, the responsible HHS official shall be notified promptly in writ-ing by the grantee, which notice shall contain a description of the deficiencies not able to be corrected andthe reasons therefor. If insufficient funding is included-as a principal reason for inability to comply with per-formance standards, the notice shall specify the exact amount, and basis for the funding deficit and effortsmade to obtain funding from other sources.(d) The responsible- HHS official -on the -basis of -the reports- submitted pursuant -to paragraph (c) of -thissection, will undertake to assist grantees, and delegate agencies through their grantees, to comply withthe performance standards, including by-furnishing or by recommending technical assistance.(e) If the grantee or deiegate agency has not complied with the performance standards, other than thosefor which the time for compliance-has been extended in accordance with paragraph (f)-of-this section,within the period stated in the notice issued under paragraph (b) of this section, the grantee shall be noti-fied promptly by the responsible HHS official of the commencement of suspension or termination proceed-ings or of the intention-to deny refunding as may be appropriate, under Part 1303 (appeals procedures) ofthis- chapter.(f) The time within which a grantee or delegate agency shall be required to correct deficiencies in imple-mentation of the performance standards may be extended by the responsible HHS official to a maximumof one year, only with respect to the following deficiencies:

(1) The space per child provided by the Head Start program does not comply with the Education Ser-vices performance standard but there is no risk to the health or safety of the children,

(2) The Head Start program is unable to provide Medical or Dental Treatment Services as required byHealth Services Performance Standards because funding is insufficient and there are no community orother resources available;

(3) The-services of a-mental health professional are not available or accessible to the program as re-quired by the Health Services Performance Standards; -or

(4) The deficient serviceis not able to be-corrected _within_the 90 days notice period, notvo..Istanding fulleffort at compliance, because of lack of funds and outside community resources, but it is .eascnable to ex-pect- that -the services _will be_brought _into compliance -within _the_ extended period, and-the overall=highquality-of the Head Start program otherwise will be-maintained during the extension.

INTRODUCTION

The Performance Standards presented in the following pages are accompanied by guidance materialwhich elaborates upon their intent and provides methods and procedures for implementing them. Thestandard is found in the left hand column and the appropriate guidance material in the right hand column.The standards in the left hand column constitute Head Start policy-with which all grantees and delegateagencies are required to conform. They are taken verbatim from the Federal Register dated June 30, 1975,Volume 40, Number 126, Part II, that contains the Head Start Program Performance Standards for operatun of Head Start programs by grantees and delegate agencies. The guidance in the right -hand column isprovided-for the assistance of Head Start programs in interpreting and implementing the standards and isnot-in-itself mandatory.

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PERFORMANCE STANDARDS

Subpart B-- Education Services Objectives andPerformance Standards

§ 1304.2-1 Education services objectives.

The objectives of the Education Service com-ponent of the Head Start program are to:

(a) Provide children with a learning- environ-ment and the varied experiences which will helpthem develop socially, intellectually, physically,and emotionally in a manner appropriate to theirage and stage of development toward the over-all goal of social competence.

(b) Integrate -the educational aspects of thevarious Head Start components in the daily pro-gram of activities.

(c) Involve parents in educational activitiesof the program to enhance their role as the prin-cipal influence on the Child's education and de-velopment.

(d) Assist parents to increase knowledge, un-derstanding, skills, and experience in childgrowth and development.

(e) Identify and reinforce experiences whichoccur in the home that parents can utilize aseducational activities for their children.

§ 1304.2-2 Education services plan content:operations.

(a) The education services component of theperformance standards plan shall provide strat-egies for achieving the education objectives. Inso doing it shall provide for program activitiesthat include an organized series of experiencesdesigned to meet the individual differences andneeds of- participating children, -the specialneeds of handicapped children, the needs ofspecific educational priorities of the local popu-lation and thecommunity. Program activitiesmust be carried out in a manner to avoid sexrole stereotyping.In addition, the plan shall provide methods forassisting parents in understanding and using al-ternative ways to foster learning and develop-ment of their children.

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GUIDANCE

(a) The education plan should be prepared bythe educational staff with cooperation from otherHead Start staff, parents and policy group mem-bers. Professional consultants may be called uponas needed.

Before the education plan is vvritten, parents,staff and policy group members should meet to dis-cuss the education service objectives and perform-ance standards. The staff has-the responsibility toinform parents and policy group members about al-ternative strategies for achieving the education ob-jectives. The staff should recommend those strate-gies (curriculum approaches. teaching methods,classroom- activities. etc.) most appropriate to theindividual needs of the population served andbased on performance standard requirements.With the- concurrence of- the parents and policygroup members, the educational staff will thenwrite the plan. The education plan must be specifi-cally designed to meet children's needs as deter-mined through assessment procedures.

The education plan must specify strategies forimplementing each of the education services ob-jectives of the Head Start program.

EDUCATION


(b)- The education services component of theplan shall provide for:

(1) A supportive social and emotional climatewhich:

(i) Enhances children's understanding ofthemselves as individuals, and in relation toothers, by providing for individual, small group,and large group activities;

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GUIDANCE

Tha education plan should indicate:

How the education program will provide chil-dren with a learning environment and variedexperiences appropriate to their age andstage of development which will help them de-velop:

sociallyintellectuallyphysicallyemotionally

How the education program will integrate theeducational aspects of the various Head Startcomponents in the daily program of activities.

How the education program will involve par-ents in educational activities to enhance theirrole as the principal influence on tha child'seducation and development.

How the education program will assist parentsto increase knowledge, understanding, skills,and experience in child growth and develop-ment.

How the education program will identify andreinforce- experiences which occur in- thehome that parents can utilize as educationalactivities for their children.

The plan should be accompanied by brief de-scriptive information regarding:

Geographical settingPhysical setting (available facilities)Population- to be served-(ethnicity, race, lan-guage, age, prevelance of handicapping con-ditions, health factors, family situations)Education staff (staffing patterns, experience,training)VolunteersCommunity resourcesProgram philosophy/curriculum approachAssessment procedures (individual child, totalprogram)

(1) The following suggestions may be useful be-ginning steps:

() Encourage awareness of self through the useof full-length mirrors, photos and drawings of childand family, tape recordings of voices, etc

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EDUCATION


(6) Gives children many opportunities forsuccess through program activities;

(iii) Provides an environment- of- acceptancewhich helps each child build ethnic- pride, de-velop a positive -self- concept, enhance his indi-vidual strengths, and develop facility in socialrelationships.

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Use child's name on his/her work and belong-ings.Arrange activity settings to invite group partic-ipation (block and doll corners, dramatic play).Include active and quiet periods, child-initi-ated and adult - initiated activities, and use ofspecial areas for quiet and individual play orrest.

(ii) Here are some examples:

Make sure that activities are suited to the de-velopmental level of each child;Allow the child to do as much for himself as hecan;Help the child learn "self-help" skills (pouringmilk, putting on coat);Recognize and praise honest effort and notjust results;Support efforts and intervene when helpful tothe child;Help the child accept failure without defeat ("Iwill help you try again.");Help the child learn to wait ("You will have aturn in five minutes.");Break tasks down into_manageable parts sothat children can see how much progress theyare making.

(iii) This can be accomplished by adult behaviorsuch as:

showing respect for each child;listening and responding to children;showing affection and personal regard (greet-ing by name, one-to-one contact);giving attention to what the child considers im-portant (looking at a block structure, locating alost mitten);expressing appreciation, recognizing effortand accomplishments of each child, followingthrough on promises;respecting and protecting individual rightsand personal belongings (a "cubby" or box forstorage, name printed on work in large, clearletters);acknowledging and accepting unique quali-ties of each child;avoiding situations which stereotype sex rolesor racial/ethnic backgrounds;providing ample opportunity for each child toexperience success, to earn praise, to de-velop an "I can," "Let me try," attitude:accepting each child's language, whether it bestandard English, a dialect or a foreign Ian-

EDUCATION


(2) Development of intellectual skills by:

(i) Encouraging children to solve problems,initiate activities, explore, experiment, ques-tion, and gain mastery through learning by do-ing;

(ii) Promoting- language understanding anduse in an atmosphere that encourages easycommunication among children and betweenchildren and adults;

(iii) Working toward recognition of the sym-bols for letters and numbers according to the in-dividual developmental level ,.: the children,

(iv) Encouraging children to organize theirexperiences and understand concepts, and

(v) Providing a balance program of staff di-rected and child initiated activities.

(3) Promotion of physical growth by:

(i) Providing adequate indoor and outdoorspace, materials, equipment, and time for chil-

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GUIDANCE

guage; fostering the child's comfort in usingthe primary language;providing opportunities to talk about feelings,to share responsibilities, to share humor.

(2) Intellectual skills can be enhanced by provid-ing a learning climate in which staff guide childrento foster cognitive functioning (i.e., understanding,reasoning, conceptualizing, etc.).

(I) Provide materials and time appropriate to thechild's age and level of development in the areasof:

science; concepts of size, shape, texture,weight, color. etc.;dramatic play;art;music;numerical concepts; spatial, locational andother relationships.

(ii) Some examples are;

Give children ample time to talk to each otherand ask questions in the language of the rchoice;Encourage free discussion and conversationbetween children and adults;Provide games, songs, stories, poems whichoffer new and interesting vocabulary;Encourage children to tell and listen to stories.

(iii) Make use of information that is relevant tothe child's interests, such as his name, telephonenumber, address and age. Make ample use of writ-ten language within the context of the child's un-derstanding, for example, experience stones, lab-els, signs.

(iv) The sequence of classroom activities shouldprogress from simple to more complex tasks, andfrom concrete to abstract concepts. Activities canbe organized around concepts to be :warned.

(v) Although each day's activities should- beplanned by the staff, the schedule should allowample time -for both spontaneous activity by chil-dren and blocks of time for teacher-directed activi-ties.

(i) This can be accomplished through regularperiods for physical activity (both indoor and out).

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EDUCATION


dren to use large and small muscles to increasetheir physical skills; and

(ii) Providing appropriate guidance whilechildren are using equipment and materials inorder to promote children's physical growth.

(c) The education services component of theplan shall provide for a program which is indi-vidualized to meet the special needs of childrenfrom various populations by:

(1) Having a curriculum which is relevant andreflective of the needs of the population served(bilingual/bicultural, multicultural, rural, urban,reservation, migrant, etc.).

(2) Having- staff and program resources re-flective of the racial and ethnic population ofthe children in the program.

(i) including persons who speak the primarylanguage of the children and are knowledgeableabout their heritage; and, at a minimum, when amajority of the children speak a language otherthan English, at least one teacher or aide inter-acting regularly with the children must speaktheir language; and

GUIDANCE

Physical activities should include materials and ex-periences designed to develop:

large muscles (wheel toys, climbing appa-ratus, blocks);small muscles (scissors, clay, puzzles, smallblocks);eye-hand coordination (puzzles, balls, lotto);body awareness;rhythm and movement (dancing, musical in-struments).

(ii) Staff should be actively involved with chil-dren during periods of physical activity. Duringsuch activities, staffshould take opportunities- toincrease their contact with individual children. Toensure safety, activities should be adequately su-pervised.

(1) This can be accomplished by including ineach classroom materials and activities which re-flect the cultural background of the children. Ex-amples of materials include:

books;records;posters, maps, charts;dolls, clothing.

Activities may include:

celebration of cultural events and holidays;serving foods related to other cultures;stories, music, and games representative ofchildren's backgrouno,inviting persons who speak the child's nativelanguage to assist with activities.

(i) This adult may be:

a teacher or aide;other member of the center staff,a parent or family member,a volunteer who speaks the chlids language,

(11) Where only a few children, or a single (ii) In some cases where a single child is af-child, speak a language different from the rest, fected A may not be possible for the center to pro-

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EDUCATION


one adult In the center should be available tocommunicate in the native language.

(3) Including pumas In curriculum develop-ment and having them serve as resource per-sons (e.g., for bilingual/bicultural activities).

(d) The education services component of thepan shall provide procedures for on-going ob-servation, recording and evaluation of eachchild's growth and development for the purposeof planning activities to suit individual needs. Itshall provide, also, for integrating the educa-tional aspects of other Head Start componentsinto the daily education services program.

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GUIDANCE

vide an adult speaking the c'nild's language on aregular basis.

(3) Parents can be valuable resources in plan-ning activities which reflect the cioldren's heritage.Teachers may request suggestions from parentson ways to integrate cultural activities into the pro-gram. For example, parents may wish to:

plan holiday celebrations;prepare foods unique to various cultures;re,: ,mmend books, records, or other materialsfor the classroom;act as classroom volur:teers;suggest games, songs and art projects whichreflect cultural customs.

td) The education plan should specify how HeadStart staff will assess the individu. Jevelopmenta::instructional- needs of children. Some ways thismay be accomplished include.

discussions with parents during recruitment,enrollment, home visits, parent -staff Lor.fer-ences and meetinos;review of child's medical and developmentalrecords;conferences with medical or psychologicalconsultants where indicated;teacher observations documenting develop-mental progress used as guidance in planningfor and/or mod., 'ng individual children's ac-tivities;use of specific assessment instruments orscales.

Planning should take into account the agegroups and abilities of the children. For example,activities will differ for three and five year olds.Children with handicaps, like all children, shouldhave specific goals set for them according to theirability.

The plan should also include the following:

long-range plans based on evaluation of eachchild's current needs, interests and abilities;specific activities and responsibilities of staffmembers;consistent methods for observing and record-ing the progress of each child;procedures to be used for reviewing- eachchild's progress and modifying the programwhen indicated.

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(e) The plan shall provide methods for en-hancing the knowledge and understanding ofboth staff and parents of the educational anddevelopmental needs and activities of childrenin the program. These shall include:

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GUIDANCE

Activities to integrate educational aspects ofother components into the daily education programcould include:

Health Education built into the schedulethrough:

time to talk about physical and dental exam-inations in order to increase understandingand reduce fears;

books and pictures about doctors and den-tists;

materials for dramatic play (stethoscope,nurse's uniform, flashlight);

role playing before and after visits to doc-tors, dentists, hospitals, clinics, etc.

Nutrition Education as part of the daily sched-ule:assistance in meal preparation, setting ta-

ble;learning experiences through food prepara-

tion (adding liquids to solids, seasoning,freezing, melting, heating, cooling, cookingsimple foods):

books, pictures, films, trips related to thesource of foods, (farm, garden, warehouse,market, grocery store).

(e) The plan should indicate some of the waysparents and staff will work together to understandeach child and provide for his learning experi-ences. The plan should include details of ways thehome and center will attempt to supplement eachother in providing positive experiences for thechild.

There should be an early orientation to the Edu-cation Services Objectives. Special emphasisshould be given to the significance of the materi-als, equipment and experiences provided in aHead Start Child-Development program. Interpre-ters should be available to facilitate full participa-tion of non - English speaking parents.

Procedures should be established to facilitatemaximum-communication between staff and par-ents, for example:

newslettersparent/teacher conferencesgroup meetingsphone callshome visitsposters, bulletin boards, radio/TV announce-ments.

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(1) Parent participation in planning the edu-cation program, and in center, classroom andhome program activities;

(2) Parent training in activities that can beused in the home to reinforce the learning anddevelopment of their children in the center;

(3) Parent training in the observation ofgrowth and development of their children in thehome- environment and identification of andhandling special developmental needs;

(4) Participation in staff and staff-parent con-ferences and the making of periodic home visits(no less than two) by members of the educationstaff;

(5) Staff and parent training, under a programjointly developed with all components of theHead Start program, in child development andbehavioral developmental problems of pre-school children; and

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(1) Meeting with staff to provide for the overallwritten education plan (see item 1304.2 -2(a) for fur-th2r guidance).

(2) Some examples are:

orientation and training sessionsdesigning activities for children at homeparticipation in classroom/center activities.

(3) Provide parents with films, workshops, publi-cations, specialists, professionals, etc., in childgrowth and development. Arrange for films, publi-cations and specialists to provide training.

(4) Areas of mutual concern to be discussedcould include:

child's developmental progress;child rearing issues;discussion of possible home activities to ex-pand the Head Start experience;discussion of health problems or handicap-ping conditions of the Head Start child.

Although only two home visits are required, wesuggest- that consideration be given to visitingeach child's home at the beginning, middle andend of -the year. Arrangements for such visitsshould respect- parent's wishes-and convenienceand should be coordinated with the visits of othercomponent staff. At least one of these visits shouldbe devoted- to discussion with parents aroundareas of mutual interest and concern- in order toidentify home activities and other ways to expandthe Head Start experience.

(5) An orientation and training program shouldbe planned in cooperation with other componentstaff members and parents. The training programshould- provide for periodic formal and informalsessions. The content, organization, staffing andscheduling will depend on the individual programneeds as determined in the planning stage. Train-ing should focus on the normal child as well as thechild with special needs. Emphasis should be onmental, physical, social, and emotional growth anddevelopment.

There should be identification of opportunitiesfor training or continuing education to contribute tostaff competence. In some locations, CDA trainingcan be an appropriate means for achieving this;many Head Start staff members are receiving CDAtraining- through the Head Start SupplementaryTraining program.

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(6) Staff training in identification of and hand-ling children with special needs and workingwith the parents of such children, and in coordi-nating relevant referral resources.

§ 1304.2-3 Education services plan content:facilities.

(a) The education services component of theplan shall provide for a physical environment,conducive to learning and reflective of the dif-ferent stages of development of the children.Home-based projects must make affirmative ef-forts to achieve this environment. For center-based programs, space shall be organized intofunctional areas recognized by the children,and space, light, ventilation, heat, and otherphysical arrangements must be consistent withthe health, safety and developmental needs ofthe children. To comply with this standard:

(1) There shall be a safe and effective heatingsystem;

(2) No highly flammable furnishings or -deco-rations shall be used.

(3) Flammable and other dangerous materialsand potential poisons shall be stored in lockedcabinets or storage facilities accessible only toauthorized persons;

(4) Emergency lighting shall be available incase of power failure;

(5)- Approved, working fire extinguishersshall be readily available;

(6) Indoor and outdoor premises shall be keptclean and free, on -a daily basis, of undesirableand hazardous material and conditions,

(7) Outdoor play areas shall be made so as toprevent children from leaving the premises andgetting into unsafe and unsupervised areas,

12

GUIDANCE

(6) Training should also familiarize staff and par-ents with appropriate referral resources in the com-munity. (Refer to 1304.3-3(b)(10)).

(a) Indoor and outdoor space should be sufficientand appropriate for necessary program activitiesand for support functions (offices, food prepara-tion, custodial services) if they are conducted onthe premises. In addition, rest/nap facilities andspace for isolation of sick children should be avail-able.

(1) Radiatuis. stoves, hot water pipes, portableheating units, an similar potential hazards areadequately screened or insulated to prevent burns.

(2) Flammable materials can be fireproofed withcommercial preparations.

(3)- Cleaning supplies and potentially dangerousmaterials should be stored- separately from foodand out of reach -ofchildren.

(4) High powered flashlights may be used. Can-dles are fire hazards.

(5) Adults in the program_should be able to lu-cate and properly operate fire extinguishers.

(6) If evidence of rodents or vermin is found, thelocal health or sanitation department may provideassistance or referral for extermination. At regularintervals programs should check for and correctsplintered surfaces, extremely sharp or protrudingcorners or edges, loose or broken parts. All clearglass doors should be clearly marked with opaquetape to avoid accidents.

(7) Where outdoor space borders on unsafeareas (traffic, streets, ponds, swimming areas)adults shculd always be positioned to supervisethe children. If possible such areas should be en-closed.

15

EDUCATION

fiERFORMANCE STANDARDS

(8) Paint coatings on premises used for careof children shall be determined to assure the ab-sence of a hazardous quantity of lead,

(9) Rooms shall be well lighted;

(10) A source of water approved by the ap-propriate local authority shall be available in thefacility; adequate toilets and handwashing facil-ities shall be available and easily reached bychildren;

(11) All sewage and liquid waste shall be dis-posed of through a sewer system approved byan_ appropriate responsible authority, and gar-bage and trash shall be stored in a safe and san-itary manner until collected;

(12) There shall be at least 35 square feet ofindoor space per child available for the care ofchildren (i.e., exclusive of bathrooms, halls,kitchen, and storage places). There shall be atleast 75 square feet per child outdoors, and

(13) Adequate provisions shall be made -forhandicapped children to ensure their safety andcomfort.

Evidence that the center meets or exceedsState or local licensing requirements for similarkinds of facilities for fire, health, and safetyshall be accepted as prima -facie compliancewith the fire, health and safety requirements ofthis section.

(b) The plan shall provide for appropriate andsufficient furniture, equipment and materials tomeet the needs of the program, and for their ar-

GUIDANCE

(8) Old buildings may be dangerous, be sure tocheck for lead contamination.

The local public health department can be con-tacted to provide information on lead poisoningand to detect hazardous quantities of lead in thefacility.

(9) Fixtures which have a low glare surface tosufficiently diffuse and reflect light may be useful.Use bulbs with sufficient wattage. Check and re-place burned-out bulbs regularly.

(10) Verify State and local licensing require-ments in these areas. Stepstools or low platformsmay be useful where toilets or handwashing facili-ties are too high.

(11) Disposal problems can be referred to the lo-cal sanitation- and public work department. Keepall waste materials away from children's activityareas and from areas used- for storage and forpreparation of food.

(12) Where minimum space is not avilable, vari-ous alternatives can be considered. For example, avariation in program design (See Notice N-30-334-1on Program Options for Project Head Start), stag-ger the program day, the program week, outdoorplay periods. In this manner, all children will not bepresent at the same time. In some cases, outdoorspace requirements may be met by arranging fordaily use of an adjoining or nearby school yard,park, playground, vacant lot, or other space. Besure that these areas are easily accessible and ful-fill the necessary safety requirements.

In some- cases, it may be necessary to locatemore suitable facilities.

(13) Ramps, railings, and special materials andequipment may be needed in order to allow suchchildren maximum possible mobility. Communityresources may =be used to acquire needed specialmaterials and services.

Confirm compliance with local licensing require-ments. Where no licensing is required, the granteeand Policy Council should request advice fromlocal fire and health departments in determiningsafety standards.

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EDUCATION


rangement in such a way as to facilitate learn-ing, assure a balanced program of spontaneousand structured activities, and encourage self-reliance in the children. The equipment and ma-terials shall be:

(1) Consistent with the specific educationalobjectives of the local program;

(2) Consistent with the cultural and ethnicbackground of the children;

(3) Geared to- the age, ability, and develop-mental needs of the children;

(4) Safe, durable, and kept in good condition,

(5) Stored in a safe and orderly fashion whennot in use;

(6) Accessible, attractive, and inviting to thechildren; and

(7) Designed to provide a variety of learningexperiences and to encourage experimentationand exploration.

14

GUIDANCE

(1) Make use of the written plan when select-ing materials and equipment.

(2) Many books, pictures, re .-ds, and othermaterials reflect ethnic and cul.. heritage andbackground.

(3) For instance, chairs and tables are childsize, toys, books, and other materials and equip-ment are interesting and challenging to the chil-dren.

(4) Contact U.S. Consumer Product SafetyCommission, Washington, D. C. 20207 for informa-tion. Repair broken equipment and materials pro-mptly.

*(5) (6) Securely-fastened, well-organized closetsand cabinets are needed for many supplies whichshould be stored out of reach and sight of smallchildren. Classroom materials and equipment,stored on low shelves and/or in open bins shouldbe located -near the area where they are to be usedand arranged in orderly convenient fashion so thatchildren may be responsible for their use and re-turn to storage.

(7) Materials that can be used in a number ofways rather than single-purpose items are gener-ally more useful.

HEALTH


Subpart C Health Services Objectives andPerformance Standards

§ 1304.3-1 Health services general objectives.

The general objectives of the health servicescomponent of the Head Start program are to:

(a) Provide a comprehensive health servicesprogram which includes a -broad range of medi-cal, dental, mental health and nutrition servicesto preschool children, including handicappedchildren, to assist the child's physical, emo-tional, cognitive and social development towardthe overall goal of social competence.

(b) Promote preventive health services andearly intervention.

(c) Provide the child's family with the neces-sary skills and insight and otherwise attempt tolink the family to an ongoing health care systemto ensure that the child continues to receivecomprehensive- health care even after leavingthe Head Start program.

§ 1304.3-2 health= Services Advisory Commit-tee.

The plan shall provide -for the creation of aHealth Services Advisory Committee whosepurpose shall be advising in the planning, oper-ation and evaluation of the health services pro-gram and which shall consist of Head Start par-ents and health services providers in the -com-munity and other specialists in the varioushealth disciplines. (Existing committees may bemodified or combined to carry out this func-tion.)

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GUIDANCE

(a), (b), & (c) These are the aims toward whichthe program efforts should be directed.

In order to achieve the comprehensive goals, thehealth program shouldbe- planned by profes-sionally competent people. Planning must takeplace early and should involve a wide cross sectionof the professional health talent available in thecommunity. The committee should be representedby all four areas of health professionals, i.e., medi-cal, dental, mental health and nutrition.

The committee si,ould meet at least twice a yearto advise on the development of the health ser-vices and health education program and must ap-prove the health plan.

Examples of people who could be involved inplanning the health program of the Head Start pro-gram include:

a. Pediatricians and pediatric societies.b. General practitioners and the Academy of

General Practice.c. Other physicians and the county and State

medical societies.d. Local, regional, and State health offices.e. Child and general psychiatrists and their as-

sociations.f. Hospital administrators and their associa-

tions.Dentists and Dental Hygienists and their as-sociations.Public health nurses, school nurses, andnursing organizations.

g.

h.

18

HEALTH


§ 1304.3-3 Medical and dental history, screen-ing, and examinations.

(a) The health services component of theperformance standards plan shall provide thatfor each child enrolled in the Head Start pro-gram a complete medical, dental and develop-mental history will be obtained and recorded, athorough health screening- will= be given, andmedical and dental examinations- will be per-formed. The plan will provide also for advanceparent or guardian authorization for all healthservices under this subpart.

16

GUIDANCE

i. Nutritionists and their associations.j. Optometrists and their associations.k. Psychologists and their associations.I. Medical technologists and their associations.m. Speech and hearing personnel and their as-

sociations.

The plan should indicate the number of parents,and specific health professionals on the health ad-visory committee; goals and objectives; and pro-jected number of meetings.

Involving parents, health professionals and theirorganizations in planning will ensure that thehealth program is tailored to the needs of the chil-dren, and that it utilizes fully the resources avail-able in the community without duplicating alreadyexisting services. The health professionals shouldbe aware of common health practices in their com-munity. The health advisory committee should de-velop guidelines to deal with health practices thatmay be potentially harmful to a child. Organiza-tions and individuals who are involved in the earlyplanning of a program are likely to cooperate fullyin the implementation of the program.

a) As much pertinent health information as pos-sible should be accumulated and recorded foeach child. This should be performed as soon afterthe child is enrolled as is feasible. There are threemain sources for such information. records of pastmedical and dental care, teachers' observations.and interviews with parents or guardians.

Every effort should be made to obtain records orsummaries of the significant medical and dentalcare and immunizations that each child has re-ceived in the past. This information may be- avail-able from hospital clinics, private physicians anddentists, or health department-sponsored well-child clinics. In special cases, it may be desirableto obtain the mother's and infant's delivery andbirth history from the hospital where the child wasborn, especially if the child now shows evidence ofneurologic impairment. Written records of import-ant health events are important supplements to themother's recollection of such events. By acquiringsuch records before the physician performs thecomplete health evaluation, a great deal of repeti-tion, wasted time, and unnecessary concern maybe avoided.

9

HEALTH

PERFORMANCE STANDARDS GUIDANCE

Health providers should be informed of programrequirements for health services. An example ofthe type of information required is contained in theCHILD HEALTH RECORD available from the HeadStart Bureau, P.O. Box 1182, Washington, DC20013.

(b) Health screenings shall include:

17

Timely informed written parental consent shouldbe obtained for authorization of all health servicesprovided/arranged.

The teacher is in an unusually good position tonotice those children who may have health prob-lems. The teacher observes the children for 15 to30 hours a week, whereas the physician can onlyobserve the child for 20 minutes to an hour. Poorcoordination, hyperactivity, unintelligible speech,excessive tiredness, or withdrawal from othersmay be noted much more readily by a teacher thanby either the parent, who usually has little basis forcomparison, or thephysician, who has a- limitedtime of observation. The teacher may observe den-tal problems when children eat. Some formal provi-sion should be made to ensure that teachers' ob-servations of the children's health and behavior areavailable to the physician at the time of the medicalevaluation.

An example of the type of form and informationthe teacher- should record is containedin theCHILD HEALTH RECORD.

(b) Screening tests should be carried out for allthe Head Start children. These are tests some ofwhich may be performed by- non - professional work-ers. They do not represent a complete evaluation,but they identify-a group of children who requiremore complete professional evaluation. Health co-ordinators are encouraged to schedule screeningfor children who appear to have health problems orhandicaps early in- the year (the spring beforewhere possible) so that valuable- time will notelapse before their health conditions or handicapscan be addressed. Screenings- should be com-pleted within 90 days after the child is enrolled orentered into the program.

It is important that the results of the screening aswell as the complete medical and development his-tory are available to the physician at the time ofmedical examination. The purpose of this is -toidentify children with needs and to alert the physi-cian to problems requiring a more complete profes-sional evaluation.

A diagnostic evaluation should be arranged foreach child with atypical/abnormal findings result-ing from screenings.

20

HEALTH


If a child has had a diagnostic evaluation with anatypical/abnormal finding within the past 12months or is currently under treatment for that find-ing, the diagnostic evaluation need not be re-peated.

(1) Growth assessment (head circumferenceup to two years old) height, weight, and age.

(2) Vision testing.

18

(1) Head circumference measurement is notnecessary after the child reaches one year of age.(A health professional should teach this procedureto para-professionals.)

The results of careful height and weight meas-urements for each child should be recorded onstandardized growth charts in the beginning andapproximately two months prior to the end of theschool year so that a failure to gain weight or toorapid a gain in weight will allow for follow-up.

A beam balance scale should be used forweights since ordinary bathroom scales may be in-accurate.

Heights should be measured- with the- childstanding straight with the back to a wall on which ismounted a paper, wooden, or metal measure. Astraight-edged device rested on the child's head isheld at right angle to the measure.

In interpreting height and weight measurements,one must remember that many normal, wellnour-ished children are small for their age. In evaluatingpoor nutrition and poor growth, the rate of growthof a child between two measurements separated intime is more important than a single measurement.For this purpose, and whenever available, weightsand measurements which were obtained in previ-ous health examinations, should be recorded on agraphic recording sheet. The small child who isgrowing at a normal rate is likely to be wellnour-ished and free from serious disease. Even a muchlarger child who is growing at an unusually slowrate may have some significant adverse conditionaffecting the child's health.

(2) Visual acuity and strabismus testing shouldbe performed every two years beginning at agethree. The most appropriate visual screening testto be applied in any community can usually best bedetermined by the health services directo. in con-sultation with the group of health practitioners-ophthalmologists/optometrists, who_ will be respon-sible for the complete evaluation and treatment ofthe children. These specialists can determine thetype of tests and the criteria for passing or- failingwhich they feel are most appropriate. Healthdepartments and school health programs oftenhave well-established visual screening programs

21

HEALTH


which can be applied readily to Head Startchildren.

When there is no established screening programand consultation from eye specialists is not avail-able to a community, the National Society for thePrevention of Blindness* or its State or local chap-ters, or the Volunteers for Vi6ion may assist in set-ting up a screening program.

If none of these resources is available, the fol-lowing vision screening method may be used,which will generally identify most of the childrenwho are in need of further eye care. The test maybe performed by nurses, by health aides, or volun-teers trained in the method.

A Snellen E illiterate visual testing chart (obtain-able from any hospital supply company or from theNational Society for the Prevention of- Blindness)should be placed on a bare wall without windows.There should be no bright light or glare within thechild's field of vision. The child should be seatedcomfortably with the head 20 feet away from thechart A goose-neck lamp with a metal shade and a75 watt bulb placed _5 feet from the chart will pro-vide adequate standard illumination.

Children should be instructed in the Head Startclassroom, or in small groups before testing, in"how to play the E game," The child is told to indi-cate with his own fingers the direction in which thelingers" of the E point. After he has learned to dothis, each= child is tested individually, a black "pi-rate's patch" may be a more acceptable way of cov-ering one eye than simply holding a card in front ofthat eye. To avoid possible transfer of infection, aseparate patch or card should be used for eachchild. The card or patch should not put any pres-sure on the eye, and the child should keep the cov-ered eye open. First, the child's vision with botheyes is tested. Then, with his left eye covered, thechild is asked to indicate which direction the E ispointing as the examiner uses a pencil or pointer toindicate specific- symbols on -the= chart. An exam-iner may point first to the first Eon the 20/60 line. Ifthis is passed successfully, go on to the first twosymbols on the 20/40 line. If these are passed suc-cessfully, go on to the first three symbols on the20/30 line, and if these are passed successfully, go-on to the 20/20 line. Whenever a child fails to -iden-tify the position correctly, the tester should con-tinue across the same line on the E chart. Mine isconsidered "passed" if more than one half of thefigures on the line are correctly identified.

19

*Address: 79 Madison Avenue, New York, NewYork 10016,

22

HEALTH


The same procedure is repeated with the righteye covered. A child fails the test if, with either eye,more than half of the symbols on the 20/40 linecannot be identified, or if there is more than a twoline difference in vision between one eye and theother, even if the worse eye is 20/40 or better.

A child who is unable to learn to "play the Egame" should be reported as "non-testable" andmay be given further instruction in the "E game."either in the classroom or by the parents at home,and_retested_at a later-date,

Children already wearing glasses should betested while wearing their glasses. If they pass thetest while wearing glasses, there is no need for fur-ther testing.

Children failing the test who appear acutely ill orparticularly fatigued should be retested before theyare referred to an eye specialist. Other childrenwho fail the screening test should be referred to aneye specialist for further evaluation. The results ofthe screening test should be recorded on thechild's health form and should be brought to the at-tention of the physician-at the time-of the healthevaluation. At this time, the physician should ex-amine the optic fundi with an ophthalmoscope andshould note any deviation in extra-ocular move-ments.

Strabismus testing can be performed= by welltrained- staff or volunteers. The common-tests forstrabismus are the Cover Test and the HirschbergTest. Frequently, strabismus- testing- is performedduring the physical examination.

(3) Hearing testing.

20

(3) Audiometric testing should be done everytwo years beginning at age three. Children will bebetter prepared for testing if the procedure is dem-onstrated in the classroom, where the whole classcan be made familiar with the sounds and taught tomake the desired response.

Children who cannot learn to respond to the testproperly, or who give grossly inconsistent re-sponses to sounds of any intensity, should be des-ignated as "non-testable," A child is generally con-sidered to have failed the screening test if he failsto- respond -at the recommended level at any -fre-quency in either ear. The frequencies generallyused in a limited hearing screening test are 1000.2000, and 4000 Hz.

Although audiometric testings are-effective andnecessary, they do not always identify middle earproblems. Therefore. programs may wish to sup-plement information to the pure-tone testing withacoustic impedence screening.

HEALTH


The acoustic impedence bridge instrument ob-jectively evaluates the- middle ear conductivemechanisms and is paiJicularly valuable in identify-ing children with otitis media. The test is quick anddoes not require active participation of the child.

A large proportion of children who fail a hearingscreening test have only temporary hearing impair-ment associated with upper respiratory conditions.Such children should be retested after a few weeksbefore they are referred for special medical oraudiology care. For this reason, it is important toinstitute the hearing screening program as early aspossible in the Head Start program or even beforethe Head Start classrooms begin to meet formally.Head Start officials may encourage school person-nel to include hearing screening tests at part of theroutine pre-school interview which many schoolsystems conduct in spring before students will en-ter school.

Results of the preliminary hearing screening testshould be recorded on the health form and beavailable to the physician at the time of the com-plete health evaluation.

The person performing a hearing screening testmust have special training in the use of the equip-ment and in the interpretation of the various re-sponses which children may make to the-test. Mostschool health programs and health departmentshave both testing equipment and personnel trainedin its use. If equipment and personnel are not avail-able locally, help may be obtained from: (1) Anaudiologist in a neighboring community, (2) the re-gional and State health or- education department,(3) the State speech and hearing associations, (4)the American Speech and Hearing Association(10801 Rockville Pike, Rockville, Maryland 20852).It will usually be more economical for a Head Startprogram in a smaller community to obtain servicesfrom a trained technician in a nearby larger com-munity than to purchase its own equipment andtrain its own personnel,

(4) Hemoglobin or hematocrit determination.

21

(4) A hemoglobin- or hen latocrit determinationshould be made at the beginning of the first year ofthe child's enrollment. An= accurate test of hemo-globin concentration is the best screening test foranemia. However, accurate tests require trainedtechnicians and equipment that is moderately -ex-pensive.

The microhematocrit testis- somewhat less -pre-cise as an indicator of anemia. However, the labo-ratory determination itself is so simple and accu-rate that this test could often be more- practicalthan a hemoglobin test. Most community hospitals

24

HEALTH


will have equipment to- perform this test, as willmany health department clinics.

In using either of these tests, blood samples maybe obtained at the Head Start center or at anotherconvenient place by a technician or nurse. Theblood samples can then be transported and testedin a central location.

Children with anemia and similar medical/nutri-tion problems need specific diagnoses and follow-up. A child with- a hemoglobin of less than 11 orhematocrit of less than 34 is considered to be ane-mic. This is consistent with the standards of PublicHealth Service, Maternal and Child- Health andwith CDC National Nutrition Status Survey as wellas EPSDT guidance material.

(5) Tuberculin testing where indicated.

22

(5) Tuberculin testing and reading of resultsshould be performed in accordance with Statehealth department policy and/or the health ser-vices advisory committee recommendations. MostHead Start programs will be able to obtain both testmaterials and personnel trained in their usethrough their school health program, the localhealth department, or thelocal, county, or Statetuberculosis association. Initial tuberculin testingis usually done at approximately one -year of age.

Routine periodic tuberculosis testing is =pan ofscreening only if (1) the child has had contact witha known case of tuberculosis or is a member of afamily with a history of tuberculosis, (2) the_child isliving in a neighborhood or commun::y in which theprevalence of tuberculin sensitivity in the school-age children is known to exceed 1010, or (3) the childpresents symptoms consistent with tuberculosis.

A Head Start-program conducting its own tuber-culosis testing program will usually find the tuber-culin tine test to be the most economical and con-venient. Materials for this test are availablethrough many health departments and through anypharmacy. Complete instructions for administeringand reading this test are packed with the test mate-rials. The test should be scheduled at such a timethat the children will be in-a class three days laterto have the test read. Any swelling or indurationsurrounding any of the four needle puncturesshould be considered a positive reaction.

Children- who-react positively to the tuberculintine test should have a Mantoux intracutaneoustest performed using either intermediate strength,PPD 0.1- mil., or OT 1/1000 0.1 ml. The Mantouxtest must be performed by a- physician or a spe-cially trained nurse or technician. It should be readon the second or- third day.

Since children who are known to have been ex-posed to an active case of pulmonary tuberculosis

25

HEALTH


(6) Urinalysis.

(7) Based on community health problems,other selected screenings where appropriate,e.g., sickle cell anemia, lead poisoning, and in-testinal parasites.

(8) Assessment of current immunizationstatus.

(9) During the course of health screening,procedures mustbe in effect for identifyingspeech problems, determining their cause, andproviding services.

23

GUIDANCE

may have large, uncomfortable reactions to thestandard screening test, they should be referred toa physician for testing with a more dilute perpara-tion of PPD or OT. Certain viral infections (such asmeasles, influenza, mumps), some viral vaccines(such as measles and influenza), administration ofcorticosteroids, and extreme malnutrition may alldepress or suppress the tuberculin reaction for aslong as four to six weeks. Children with a history ofsuch conditions should be retested at a later date.

The results of the test should be recorded andavailable to the physician at the time of the exami-nation.

(6) A urinalysis need not be routinely performedas part of the health screening package unless re-quired by State health department policy and/orthe health services advisory committee. A simpleand inexpensive screening test that may detectsome urinary tract abnormalities is the use of a testpaper which detects albumin, sugar, blood, anddetermines the-pH of the urine. Urine can be ob-tained at the center or in- the home using deanglass bottles or paper cups. The test paper isdipped in the urine and color changes on the paperare interpreted according to a chart enclosed onthe -test papers. Children whose test shows- thepresence of sugar, blood, more than 1 + albumin,or pH of- more than 7.0 should have a completeurinalysis. Most children with abnormal screeningurine tests will be found normal on careful retest-ing.

(7) The State health department, local board ofhealth, the pediatric consultant, and the health aavisury committee provide information to ascertainwhether sickle cell anemia, lead poisoning, and in-testinal parasites are community health problemsor specific health problems in the population youserve. Problems such as head lice can also bedealt with in this manner.

(8) Staff should check medical records and con-sult- with parents on child's current immunizationstatus regarding diphtheria, pertussis, tetanus,measles, polio, German measles, and mumps.

(9) Many children talk very little during a medical examination, and the physician is in a poorposition to judge the adequacy of their speech.

Efficient screening of very young children can bedone quickly and informally by having children talkabout stimulus pictures, repeat key words contain-ing a variety of speech sounds, and relate oral in-

26

HEALTH


formation spontaneously. In general, remedialspeech services should be provided only whereconditions exist which suggest that, without atten-tion, a handicapping disorder will continue into latechildhood.

The teachers in the Head Start center shouldmake note of any children in their class whosespeech is substantially different from that of theaverage Head Start child. These observationsshould be available to the physician at the time ofthe examination. The physician then makes spe-cial evaluations of the ears, palate, and larynx, andmay be able to give advice as to whether thespeech pattern is normally immature or is patho-logical for the child. Whenever speech and hearingprofessionals are available to the Head Start pro-gram, they should work in cooperation with thephysician and teacher in detecting, examining,and evaluating speech abnormalities.

Every language community or geographic areahas certain differences from so-called standardspeech in pronunciation, vocabulary, and gram-mar. It should be recognized that a sizeable num-ber of pre-schoolers have unclear speech due toimmature articulation patterns and will mature anddevelop normally if they receive the necessary de-velopmental services. Therefore, a child who mayspeak a language other than English or ethnic col-loquialisms should not be regarded as speech im-paired.

The health advisory committee should= developthis procedure including the utilization of speechand hearing professionals and outlining a schedulefor checking suspect speech abnormalities.

Services include speech and language develop-ment, clinical services, and parent counseling ser-vices.

(10) Identification of the special needs of (10) Special needs of handicapped children canhandicapped children. be identified from the screening- and physical

examination results, parent interviews, and teach-ers' and mental health professionals' observations.

When screening identifies a child who may re-quire a more complete professional evaluation forhandicapping-conditions, the Health Coordinatorshould refer the child to the Handicap Coordinatorwho is responsible -for arranging- for diagnosticevaluations. Cooperation between the Health andhandicap Coordinators is essential to the identifi-cation of the special needs of handicapped chil-dren.

The plan to provide for these special needscould include modification of the physical facility,modification of the curriculum, development of

24

21

HEALTH


(c) Medical examinations for children shall in-clude:

(1) Examination of all systems or regionswhich are made suspect by the history orscreening test.

(2) Search for certain defects in specific re-gions common or important in this age group,i.e., skin, eye, ear, nose, throat, heart, lungs,and groir.. (inguinal) area.

(d) The plan shall provide, also, in accord-ance with local and State health regulations thatemployed program staff have initial healthexaminations, periodic check-ups, and arefound to be free from communicable disease;and that volunteer staff be screened for tuber-culosis.

§ 1304.3-4 Medical and dental treatment.

(a) The plan shall provide for treatment andfollow-up services which include:

25

GUIDANCE

new or different feeding skills, and continuation ofspecial medical care.

A number of children may be receiving a prede-termined set of screening services through publichealth clinics, neighborhood health centers, or Ti-tle XIX Medicaid Early and Periodic Screening,Diagnosis and Treatment, etc. If this set of screen-ing services does not include all of those screen-ings herein required in the Performance Stan-dards, Head Start must see that these screeningsare provided.

(c) An undressed physical- examination /assess-ment which includes blood pressure readingshould be performed every two years beginning atage three.

NOTE: Physical examinations, hearing and visiontests need not be performed for enrolled childrenwho have had these screenings with;n the requiredperiodicity schedule and the program has recordsof the results.

(d) Staff- and volunteers with respiratory infec-tions, skin infections, or other types of communic-able diseases should not have contact with -thechildren.

Depending on conditions in -thecommunity,tuberculin testing, miniature chest X-rays or full-size chest films may be the most economical formsof screening.

Tuberculin screening is not necessary for the oc-casional volunteer.

(a) The purpose of all examinations and screen-ing tests is to identify children in need of treatment.Examinations which do not lead to needed reme-dial or rehabilitative treatment represents a wastbof time and money.

A person on the staff should assume responsibil-ity for assuring that all health defects discoveredactually receive competent and continuing- careuntil they are remedied or until a pattern of continu-ing care -for them has been well established. Thisshould include:

Aid for the parent to find the necessary servicesand to find funds to pay for the services.

Assistance so that the parent and child actuallyhave transportation to the physician or clinic, andthat other children in the family can be cared forduring the visit. Community resources should beused for these services.

23

HEALTH


(1) Obtaining or arranging for treatment of allhealth problems detected. (Where funding isprovided by non-Head Start funding sourcesthere must be written documentation that suchfunds are used to the maximum feasible extent.Head Starts funds may be used only when noother source of funding is available).

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BEST COPY AVAILABLE

GUIDANCE

Careful and repeated review of health records toassure that recommended treatment is actuallytaking place and plans are developed to ensurenecessary treatment and follow-up.

(1) Medical and dental treatment should becompleted at the end of the operating year. If com-pletion is not possible, a system must be in placefor continuing the treatment after the child leavesthe program.

The program should coordinate and supplementexisting resources for health care of children, itshould not duplicate them. When existing serviceprograms do not meet the standards because of in-accessibility, unacceptability, or poor professionalquality, funds may be used to supplement the ex-isting services and bring them to standard.

Head Start funds should be used only after allcommunity resources and third party payments forwhich each child is eligible have been used. Only ifexisting services cannot be modified should newservices be arranged or purchased.

Every community will have available many of the resources listed in thefollowing table The program may contract with existing agencies to provide some or all of the health services

1 Private Practitioners of Medi 1 May provide all types oftine. Dentistry. Optometry. Psy- health services (consultation andchologyindividual or group planning, administrative, examina-

lions and screening tests. treat-ment, immunization. health educa-tion. and continuing health super-vision) on a volunteer, contract, orleeforservice basis

2 Health Departmentscity. 2 May provide all types ofhealth services. Some may be freeor contracted for all or some HeadStart children May provide-fundSto purchase services from othersources

county regional or State

3 School Health Programs 3 Same possibilities as HealthDepartment

4 Clinicsrun bf nospitaismedical schools or other agen-cies

5 Prepaid Medical Groups

6 Armed Forces Medical Suvices

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4 May provide all types ofhealth services usually on con-tract or feeforservice. but someservices may be free for ail orsome Head Start children

5 May provide complete rangeof services to children of membersof group

6 May provide medical preven-live diagnostic. and treatment services to cnildren of Armed ForcesPersonnel Dental services avail,able only at remote posts


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GUIDANCE

7. Community Health Centers.

8. Comprehensive Child HealthCenters (Example: Children andYouth Programs).

9. Dental Service Corporations.

10. Special Voluntary Agenciesand Public Agencies,

11. State Crippled Children's Programs.

12. Local and State Welfare orPublic Assistance Programs.

13. Insurance and PrePaymentPlans.

14. Medical Assistance under TitleXIX- "Medicaid Early and PeriodicScreening. Diagnosis and Treat-ment (EPSDT)."

7. May provide comprehensivehealth services at no cost to HeadStart for children living in geo-graphically defined neighborhoodsserved by centers.

8, May provide comprehensivehealth services at no cost to HeadStart children who are in the defined population served by the center.

9, May provide planning and administration of dental services forHead Start children on a contractfee.

10. May provide funds or servicesfor screening or treatment and re-habilitation of certain health prob.lems. Each is usually concernedwith a single category of illness.

11. May provide funds for ser-vices for screening or treatmentand rehabilitation of certain healthproblems. Limited to certain cate-gories of_illness which vary fromState to State and within States.

12. May provide funds for any orall health services for childrenwhose families receive or are eligi-ble for public assistance. Eligibilityand type of service paid for vary byState and locality.

13. Provide payment for certainkinds of health services for chil-dren of families covered by poll-des.

14. The majority of Head Startchildren are eligible for-MedicaidEPSDT. This provides preventivehealth services for eligible Medi-caid children -through screening,diagnosing and treating childrenwith health problems, Exact-ser-vices provided and paid for andrules for eligibility vary from Stateto State. At this time. Arizona doesnot participate in Title XIX.

SOME SPECIAL HEALTH AGENCIES WHICH MAY HELP WITHHEAD START HEALTH SERVICES

Catholic, Protestant, Jewish Wel Money for health and social ser-fare Associations. vices.

Family Service Associations. Psychological, psychiatric and social services.

Lions Club. Eyeglasses for needy children.

Money or volunteer help for spe-cial projects.

Other fraternal organizations, CivicClubs, Women's Clubs, and Par-entTeachers Associations.

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(2) Completion of all recommended immuni-zationsdiphtheria, pertussis, tetanus (DPT),polio, measles, German measles. Mumps immu-nization shall be provided where appropriate.

(3) Obtaining or arranging for basic dental careservices as follows:

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GUIDANCE

Associations for the blind or forprevention of blindness.

Associations for retarded children.cerebral palsy, crippled childrenand for children with special di.seases.

Tuberculosis Associations,

Mental Health Associations.

Vision screening, special servicesfor visionimpaired children

Special-services for retarded andhandicapped children

Tuberculin testing and followup

Psychological and social services.mental health consultations.

Resources need not be utilized solely because they are free The utiliza.lion -of community resources should be consistent with the Head Startgoal of enhancing the sense of dignity and selfworth within the child andhis/her-family.

Ideally, each child should be examined by-a private physician or byhealth facility staff who will institute corrective treatment for all detectsdiscovered and who will also provide continuing health supervision for thechild during the time that he/she is in Head Start and over the years to fol.low One of the central goals of the Head Start program is to introduce thechildren and parents to a physician or health facility that will be able tomeet all of their health needs over an extended period of time.

(2) Immunization instructions.(a) "complete" immunization is defined as fol-

lows:(i) DPT five doses of DPT (Diphtheria, Pertus-

sis, Tetanus) vaccine.(ii) Polioat least four doses of trivalent oral

vaccine or three doses of monovalent oral vaccineplus one dose of trivalent vaccine.

(iii) Rubeola/Measles one dose of live measlesvaccine. Naturally occuring measles provides com-plete immunity.

(iv) Rubella/German Measles one dose of liveRubella- vaccine or serologically documented im-munity.

(v) Mumps where mumps vaccine is part of acombined vaccine- it is appropriate for use in- theimmunization program. Naturally occurringmumps provides complete immunity.

Refer to ACYF Information Memorandum 84-5for the ages at which children should receive eachdose.

(3) Dental providers should be made aw.me ofthe basic dental care services required by HeadStart.

Arrange for basic dental care services with den-tists who are accessible and available. Choose adentist who is sensitive to the dental needs of HeadStart families. ''Fear of the dentist" is a commonphenomenon that may be prevalent in Head Startchildren and families who have not received regu-lar dental care. A considerate dental provider canhelp alleviate anxieties associated with visits to thedental provider.

A dental screening should be performed. Thepurpose of the dental screening is to check the

HEALTH


(I) Dental examination.

(ii) Services required for the relief of pain or in-fection.

(iii) Restoration of decayed- primary and per-manent teeth.

(iv) Pulp therapy -for primary and permanentteeth as necessary.

(v) Extraction of non - restorable- teeth.

(vi) Dental prophylaxis and instruction in self-care oral hygiene procedures.

GUIDANCE

child's mouth for readily observable oral healthproblems in order to establish priorities/categoriesfor the subsequently required dental examinationand dental treatment as needed. A dental screen-ing is a general cursory inspection of the mouth. Itmay be performed by a dentist, dental student,dental hygienist, dental assistant or trained staffmember.

Priorities/categories are as follows:(1) Children who have special needs requiring

immediate attention, i.e. painful teeth and/orgums, badly decayed- teeth /obvious large cavities,swelling and bleeding or pus formation around thegums.

(2) Children with observable dlcayed teeth/cav-ities.

(3) Children with no observable disease who re-quire a dental examination and any necessary pre-ventive dental care services.

(i) The annual dental examination by a dentist isan oral diagnostic procedure which should includediagnostic radiographs (x -rays) -only if the dentistdetermines that -they are- absolutely necessary.This examination should be performed within 90days of the child's entrance into the program.

on) Self care oral- hygiene procedures shouldbe emphasized daily as part of the classroom experience. Supervised toothbrushing should bepart of classroom teaching. This may take placeafter meals or at any appropriate time during theclass day. A child-sized toothbrush with soft,nylon bristles should be available for each child.A pea-sized dab of fluoridated toothpaste shouldbe used on the toothbrush. Dental flossingshould be done by a parent or Head Start staffwho has been shown how to correctly floss thechild's teeth. It is also appropriate and necessaryfor the parent to brush the child's teeth at homeduring the preschool years. Parental involvementand example is essential for the child to form pro-per self-care oral hygiene habits.

Not all children will need a professional dentalprophylaxis.

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(vii) Application of topical fluoride in commu-nities which lack adequate fluoride levels in thepublic water supply.

(b) There must be a plan of action for medicaland dental emergencies.

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(vii) All children should receive the proven den-tal health benefits of fluoride. Fluoridation benefitsoccur most ideally if the community water supply isfluoridated adoquately. The local, county, or Statehealth department; or local, county, or State dentalassociation; or the U.S. Public Health Service den-tal- consuitacit should be contacted- to determinethe adequacy of community water fluoride levels. Itis important to know if fluoride is or is not presentnaturally in the community water supply or in wellwater. If the community water supply lacks optimalfluoride levels, a fluoride supplement programshould be implemented. A fluoride supplementprogram is usually a daily regimen of prescriptionfluoride tablets for the children. You can receiveneeded professional assistance in the fluoridationeffort from the dentist who serves the program, orfrom: the U.S. Public Health Service dental con-sultant, the dental or medical professional on thehealth services advisory committee, the local pedi-atrician, or the health departments and dental as-sociations mentioned above.

Application of topical fluoride is also appropriatein communities which do- not- have adequatelyfluoridated water supplies. In addition, even inthose communities with adequately fluoridated wa-ter, children with rampant caries will benefit fromtopical application. The dentist can best make thisdetermination.

Another beneficial dental health measure is theselective -use and application of dental sealants,particularly for the older children in the program. Adental sealant is a- plastic adhesive film materialwhich is applied by the dental professional to thechewing surfaces of selected molar teeth to pre-vent dental decay. The dentist can best determineduring the dental examination if dental sealantsare indicated for a particular child. Programs areencouraged to ask the dentist and/or the dentalconsultants listed above, for information in regardto dental sealants.

(b) A plan should be developed with the parentsto provide for emergency medical and dental carefor their child. Written policy should deal withissues such as parental permission and consentforms to secure emergency care, transportationand available physicians/dentists, clinics and -hos-pitals. A- community physician/dentists, clinic ornurse should be available for telephone consulta-tion at all times.

At least one member of the full-time staff shouldbe knowledgeable or become trained in first aid.

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§ 1304.3-5 Medical and dental records.

The plan shall provide for; (a) the establish-ment and maintenance of individual health rec-ords which contain the child's medical and de-velopmental history, screening results, medicaland dental examination data, and evaluation ofthis material, and up-to-date Information abouttreatment and follow-up; (b) forwarding, withparental consent, the records to either theschool or-health delivery system or both whenthe child leaves the program; and (c) giving par-ents a summary of the record which includes in-formation on immunization and follow-up treat-ment; and (d) assaance that in all cases parentswill be told the nature of the data to be collectedand the uses to which the data will be put, andthat the uses will be restricted to the stated pur-poses.

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GUIDANCE

The health records should be used for. (1) identitying needed preventive and corrective case, (2) ar-ranging for such care, and (3) providing an educa-tional program suited to the individual child.

To aid the individual child, the record must com-pletely and concisely, summarize health findingsas determined from the history, screening tests,and medical and dental evaluation and must record all preventive measures in a way that clearlyshows which recommended preventive measureshave not yet taken place.

Whenever a child is referred for consultation ortreatment, all of the information in the health rec-ord should be made available to the consulting ortreating professional. If this is not done, the con-sultant must either obtain and record his own infor-mation, an unnecessary waste of time and effort,or proceed without such information, with possibleill- effects for the child.

To aid physicians, dentists and health workers inproviding needed health care, the record must -pro-vide a sufficient background of social, medical,and educational information of a general nature sothat each health professional dealing with the childneed not accumulate his own record and history.

To serve the educational- needs of- the child,health findings must be translated into classroomrecommendations. This process should begin atthe time the original health diagnoses are made. Itmust then be elaborated both by further writtenrecommendations and by conferences betweenphysicians, teachers, nurses, and other health per-sonnel.

Following medical and dental examinations, acopy of the treatment plan, if needed, should bepart of the child's health record. In addition, rec-ords should indicate the progress in completingtreatment for all conditions in need of follow -up -asa result of screenings, medical and dental exami-nations.

Thc Health Data Tracking Instrument (HDTI)should be used in the programs to see the individu-al child's health status. It is useful in identifyinghealth services performed or yet to be done,- follow-up (referral or treatment) needed- and/or com-pleted. The HDTI is available from the Head StartBureau, Box 1182, Washington, -D.C. 20013.

Records should indicate the progress in com-pleting treatment for all conditions in need of fol-low-up as a result of screenings and medical exam-inations.

In order to be useful to health workers and indi-vidual children, the health records must contain a

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§ 1304.3-6 Health education.

(a) The plan shall provide for- an organizedhealth education program for program- staff,parents and children which ensures that.

(1)- Parents are provided with informationabout all available health resources,

(2) Parents are encouraged to become in-volved in the health care process relating totheir child. One or- both parents should be en-couraged to accompany their child to medicaland dental exams and appointments;

(3) Staff are taught and parents are providedthe opportunity to learn the principles of pre-ventive health, emergency first-aid measures,and safety practices;

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large amount of information of a confidential na-ture. The privacy and confidence of this informa-tion must be respected. The records- should bekept in a place that is not accessible to unauthor-ized persons. Such information should not beavailable routinely to teachers, administrators, orother non-medical personnel. Those portions of thehealth information which are pertinent and usefulto teachers and to administrative personnel shouldbe shared with them through reports and throughconferences which translate the confidential healthinformation into useful educational and administra-tive recommendations. Health information mustnot be released to insurance companies or otherinquiring agencies without written consent of thechild's parents or guardian.

Staff should review all health records with theparents. The summary should be given to parentsso they have a written account of their currenthealth status annually. In addition, a child's healthrecord should be transferred to the school in orderto ensure continuity of health services.

(a) Health personnel should devote a substan-tial amount of time in helping the Head Start staffand= parents understand the implications of healthfindings for individual children, and for the pro-gram in- general. Regularly scheduled consulta-tions between the physician and the teachers aresuggested for this purpose.

(1) A local health resource booklet or pamphletshook'. be prepared for distribution to parents. Theinformation ought to be categorized by services.

(2) Parents can learn about health as a continu-ing process and not just as a physical and dentalexamination d they accompany the child to the ex-amination.

(3) Procedures- should outline measures to betaken in medical and dental emergencies at- thecenter and in home. Preventive health topics caninclude prenatal and postnatal health, immuniza-tions, sanitation, accident prevention, hazards oftoxic lead paint, first -aid- for cuts, bruises, insectbites, burns, prevention of dental cavities, use offluorides and other specific community healthproblems.

Staff should be aware of common health -prac-tices in their community.

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HEALTH


(4) Health education is integrated into ongo-ing classroom and other program activities.

(4) The most important health education activityof a program is the example it sets by providingeach child with pleasant, dignified, individualizedcare within the health program. Parents learn fromthe emphasis placed on careful examinations, im-munizations, dental care, and other health -meas-ures that such health activities are important fortheir children.

Parents' participation in classroom activities andin the health care process related to the child(screening, examinations) can be an effectivemethod of health education for the entire family.

Teachers should integrate health into the curric-ulum and daily activities of the children.

(5) The children are familiarized with all (5) Health education can bud on the health ser-health services they will receive prior to the de- vices program in another way. Each screeninglivery of those services. test, immunization, and examination can be dis-

cussed in the classroom. This will serve both toprepare the children for an unusual experienceand to give them a new knowledge about how eachof these measures can contribute to their health.Children love to act out the experiences they havehad with the doctor or nurse.

§ 1304.3-7 Mental health objectives.

The objectives of the mental health part of the These are the outcomes toward which the pro-health services component of the Head Start gram efforts should be directed.program are to:

(a) Assist all children participating in the pro-gram in emotional; cognitive and social devel-opment toward the overall goal of social compe-tence- in- coordination -with the education pro-gram and other related component activities;

(b) Provide handicapped children and chil-dren with special needs with the necessarymental health services which will ensure thatthe child and family achieve the full benefits ofparticipation in the program;

(c) Provide staff and parents with an under-standing of child growth and development, anappreciation of individual differences, and theneed for a supportive environment;

(d) Provide for prevention, early identifica-tion and early intervention in problems that -in-terfere with a child's development;

(e) Develop a positive attitude toward mentalhealth services and a recognition of the contri-bution of psychology, medicine, social ser-vices, education and other disciplines to themental health program; and

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(f) Mobilize community resources to servechildren with problems that prevent them fromcoping with their environment.

§ 1304.3-8 Mental health services.

(a) The mental health part of the plan shallprovide that a mental health professional shallbe available, at least on a consultation basis, tothe Head Start program and to the children. Themental health professional shall.

(1) Assist in planning mental health programactivities;

(2) Train Head Start staff;

GUIDANCE

(a) A mental health professional is a child psy-chiatrist, a licensed psychologist, or a psychiatricnurse or psychiatrit. social worker. Both the psychi-atric nurse and psychiatric social worker shouldhave experience in working with young children. Amental health aide may be a member of the mentalhealth team provided the aide is under the supervi-sion of one of the above professionals.

A mental health professional may be securedfrom a mental health- center in the geographicalareas, the school system, a university, or other ap-propriate vendors capable of providing compre-hensive mental health services.

(1) The mental health professional should meetwith -the Head Start Director, -the coordinator re-sponsible for mental healthservices, and repre-sentative parents to assist in developing a plan fordelivery of mental health services.

The planning should focus on the setting of pri-orities according to program needs and availabilityof trained personnel and resources.

Mental health program activities include:pre-service and in-service training of teachersand aides;consultation with teachers and teachers' aides;work with parents;screening, evaluation, and recommendations forintervention for children with special needs.The mental health professional should meet an-

nually with appropriate staff and parents to assistin evaluation of objectives of the plan and to assistin revision of objectives for the following year.

(2) Be involved in the assessment of mentalhealth training needs, in designing -the mentalhealth training program, in the selection of train-ers, and evaluating staff members' progress.

Provide information which will help staff mem-bers better understand normal development aswell as the more common behavior problems seenin children.

Training should include observation techniquesand methods in meeting the assessed needs of thechild.

(3) Periodically observe children and consult (3) The mental health professional can providewith teachers and other staff, practical advice and help to the teaching staff by

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observing the children in their physical surround-ings at least semi-annually.

Teachers can share their information, ideas, andsuggestions about the children.

(4) Advise and assist in developmental (4) Advise and assist staff in devising a processfor screening children with atypical behavior, andin evaluating children needing further assessment.In addition, the mental health professional will trainor assist in obtaining training for teachers in use ofbehavior checklists and other screening instru-ments.

Classroom observation and screening should beinitiated within the early weeks of class attendanceand then continued on a periodic basisas consid-ered necessary by staff and/or mental health pro-fessional.

Included in screening and evaluation are:

Physical coordination and development;Intellectual development;Sensory development with special emphasis onsensory discrimination;Emotional development;Social development.

screening and assessment;

(5) Assist in providing special help-for chit- (5) Advise and assist in provision of special ser-dren with atypical behavior or development, in- vices for children with atypical behavior or develop-chiding speech; ment, including language and speech.

Through staff conferences, practical recommen-dations may be generated when working with thechild with special needs. For example, the use ofgames- aimed- at increasing the child's verbal ex-pression, how the staff may work with the overlyshy or overly aggressive child, and how -to curb im-pulsive behavior.

(6) Advise in the utilization of other commu- t6)= The mental health professional should havepity- resources and referrals, a working knowledge of mental health resources in

the community in order to assist in development ofa file of community resources, including referralprocedures and documentation of their use. -Exam-ples of such resource agencies include child guid-ance clinics, community mental health centers,psycho-educational clinics, and State or countychildren's services.

(7) Orient parents and work with them to- (7) Orient parents and work with them toachieve the objectives of the mental health pro- achieve the objectives of the mental health pro-gram; and gram, including advising parents on how to secure

assistance on individual problems, assisting centerstaff in developing an ongoing education in mentalhealth for parents, and evaluating the effective-ness of the parent mental health education pro-gram.

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HEALTH


(8) Take appropriate steps in conjunctionwith health and education services to refer chil-dren for diagnostic examination to confirm thattheir emotional or behavior problems do nothave a physical basis.

(b) The plan shall also provide

(1) attention to pertinent medical and familyhistory of each child so that mental health ser-vices can be made readily available when need-ed;

(2) use of existing community mental healthresources;

(3) coordination with the education servicescomponent to provide a program keyed to indi-vidual developmental levels,

(4) confidentiality of records;

(5) regular group meetings of parents andprogram staff;

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GUIDANCE

The mental health professional should help par-ents to recognize a variety of ways in which theycan further their children's intellectual, emotional,and social development at home. This may be ac-complished through individual or group meetings.

(8) When a child is referred for emotional or be-havioral problems, a physical examination shouldbe included in the assessment in order to rule out aphysical cause for the mental health problemwhich can be treated.

0) The assessment of each child's medical rec-ords, family history and home visits by appropriatecuordinators and teachers, for information, will in-dicate if the child or his family may need additionalassistance from the mental health program. A planfor follow-through will be written for each childwhose medical and/or family history and/or homevisit suggests a potential for emotional or be-havioral problems. The plan should include objec-tives to be evaluated monthly.

(2) Procedures -for utilizing existing communitymental health resources- including- specified- con-tact- persons. These procedures should be devel-oped in conjunction with the mental health profes-sional for identifying and contacting resources.

t3) The mental health professional and the edu-cational coordinator should work closely with eachteacher and the parents in designing an educationprogram for each child based on his developmen-tal level and in training teachers to be able to dosuch program planning.

Conferences should be held periodically with thestaff to discuss particular children who have beenidentified as needing special help. The mentalhealth professional should share ideas and sug-gestions with staff on helping the child benefit fromthe program.

(4) Only authorized persons should be permit-ted to see the records. Parents and staff shouldjointly decide if such records are forwarded to theschool system.

(5) Periodic group meetings at least quarterly,between parents and staff can be used for identify-ing and discussing child development, discipline,childhood fears, complex family problems, andother parental and staff concerns. A mental healthprofessional should be present at these sessionsperiodically

HEALTH


(6) parental consent for special mental healthservices;

(7) opportunity for parents to obtain individ-ual assistance; and,

(8) active involvement of parents in planningand implementing the individual mental healthneeds of their children.

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GUIDANCE

(6) There must be a written consent from theparent for special mental health service. A stand-ard Informed consent" form should be used andshould include the following: the name of the child,the name of the service provider, a description ofthe services to be provided, and the date the formwas signed.

(7) Opportunities should be provided for parentsto discuss individual problems of the child or thefamily with the mental health professional. Thiscan be done on an appointment basis.

(8) There should be a parent orientation meet-ing to explain the mental health program and theavailable services. Ideally, the mental health pro-fessional should conduct this meeting. Parentsshould be involved in developing and evaluatingthe mental health program.

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NUTRITION


§ 1304.3-9 Nutrition objectives.

The objectives of the nutrition part of thehealth services component of the- Head Startprogram are to:

(a) Help provide food which will- help meetthe child's daily nutritional needs in the child'shome or in another clean and pleasant environ-ment, recognizing individual differences andcultural patterns, and thereby promote soundphysical, social, and emotional growth and de-velopment.

(b) Provide an environment for nutritionalservices which -will support and promote theuse of the feeding situation as an opportunityfor learning;

(c) Help staff, child and family to understandthe relationship of nutrition to health, factorswhich influence food practices, variety of waysto provide for nutritional needs and to apply thisknowledge in the development of sound foodhabits even after leaving the Head Start pro-gram;

(d) Demonstrate the interrelationships of nu-trition to other activities of the Head Start pro-gram and its contribution to the overall child de-velopment goals; and

(e) involve all staff, parents and other com-munity agencies as appropriate in meeting thechild's nutritional needs so that nutritional careprovided by Head Start complements and sup-plements that of the home and community.

§ 1304.3-10 Nutrition services.

(a) The nutrition services= part of the healthservices component of the performance stand-ards plan must identify the nutritional needsand problems of the children In the Head Startprogram and their families. In so doing accountmust be taken of:

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GUIDANCE

(a) The intended purpose of the written plan is todevelop a system to:

identify the problem areas and needs thatmust be addressed related to nutrition,

meet total needs including providing the over-all high .quality feeding and nutrition education pro-gram expected for children, and

bring parents and staff to a level of under-standing and involvement in the area of nutrition toenable them to meet their various appropriate re-sponsibilities.

It should be designed for the agency to use todevelop and provide a high quality nutrition com-ponent and does not have to be elaborate.

The ACYF Handbook for Local Head Start Nutri-tion Specialists can provide additional guidance tothe professional staff responsible for developingthe written plan.

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NUTRITION


The Handbook is available from the Head StartBureau, P.O. Box 1182, Washington, D.C. 20013.

(1) The nutrition assessment data (height, (1) These data should be available from theweight, hemoglobin/hematocrit) obtained for child's current health evaluation record or his meth-each child; cal history record. Height and weight measure-

ments should be plotted on growth charts. Meas-urements should be taken twice, at the beginningand the second time toward the end of the year.Other pertinent information can be obtained fromthe medical and dental records.

Underheight/underweight children may need ad-ditional food provided at the center along with fol-low-up at -home.

Overweight children need follow-up to identifythe specific factors involved in the weight problemand realistic interventions consistent with goodchild growth and development practices both atthe center and at home.

Children with anemia and similar medical nutri-tion problems need specific diagnoses and follow-up. A child with a hemoblobin of less than 1 -1 orhematocrit of less than 34 is considered to be ane-mic. This is consistent with the standards of PublicHealth Service, Maternal- and Child Health andwith CDC National Nutrition Status Survey as wellas EPSDT guidance material.

Children with unresolved nutrition-related needsshould be referred to appropriate agencies whohave continuing contact with the child for follow-upafter the child leaves Head Start.

(2) Information about family eating habits (2) This information should be obtained by -talk-and special dietary needs and feeding prob- inn with parents early in the year. The interviewerlems, especially of handicapped children, and, should receive orientation and training on how to

conduct such interviews from a nutritionist.The information will be used to assure that the

many good aspects of= the family eating patternsare reinforced through food served in the center;that special dietary needs are met at the center;and that this information will be considered in de-veloping a nutrition plan with families.

(3) Information about major community nutri-tion problems.

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(3) Information about major community nutritionrelated problems may be obtained from the demo-graphic characteristics of the target group such asfamily income, educational level, racial and ethniccomposition, and from the quality of the local foodand water supply such as availability of fluoridatedwater, etc. The State and local health departmentnutritionists are helpful in obtaining such informa-tion. The information should be used for develop.ing the applied aspects of the nutrition program bydetermining the need for food supplementation,fluoridation of water, iodized salt, control of sale of

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NUTRITION


(b) The plan, designed to assist in meetingthe daily nutritional needs of the children, shallprovide that:

(1) Every child in a part-day program will re-ceive a quantity cf food in meals (preferablyhot) and snacks which provides at least 1/3 ofdaily nutritional needs with consideration formeeting any special needs of children, includ-ing the child with a handicapping condition,

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GUIDANCE

uncertified raw milk, more effective method of dis-tribution and utilization of food stamps, a systemfor making food available, i.e. transportation, foodoutlets, coops, etc.

(b) The child's total daily nutritional needsshould be supplied by the food served in the home,complemented by the food served at the center.

(1) The Recommended Dietary Allowance of theNational Research Council, National Academy ofSciences are used as the basis for establishing thenutritional needs of the child. Calculations of nutri-ents in food served can be compared to the Rec-ommended Dietary Allowances as a cross-check inassuring that one-third of the nutrient needs aremet.

To meet one-third of the daily nutritional needs,use the lunch or supper pattern or a breakfast plusa snack pattern. If breakfast is served rather than alunch it should contain a protein food in addition tomilk, bread or cereal. In addition, the snack servedmust also be carefully planned to add fruit or vege-table and probably milk in order to meet the re-maining nutrient needs.

Use of cycle menus (3 weeks or longer) are help-ful in formulating balanced and varied menus andin planning purchasing orders and work sched-ules. Include hot and cold foods and variety in col-ors, flavors and textures. Seasonal foods andUSDA donated commodities should be fully util-ized to keep food costs down. Check children's ac-ceptance of food items on menu periodically andmake changes accordingly.

Menus should be dated and posted in the foodpreparation area as well as in the dining area. Thefood items should be identified by the kind of foodnot just the category of food group; for example,specify orange juice rather than fruit juice. All sub-stitutions must be indicated on the menus.

Choose foods for meals and snacks that .-n-tribute not only to the child's nutrient needs butalso to good dental health and support the dentaleducation program. Do not serve overly sweet andsticky foods especially those- high in refinedsugars.

Children do not need salt added to their food.Reduce the salt in cooking and at the table. It willbe beneficial to adults as well as children in help-ing to prevent hypertension.

Wherever possible reduce the amount of fat inrecipes, and in food preparation.

The nutrient needs of handicapped children arethe same as for other children. However, due to dif-ficulties in chewing or swallowing or lack of feeding

43

NUTRITION


(2) Every child in a full-day program will re-ceive snack(s), lunch, and other meals as appro-priate which will provide 1/2 to 1/4 of daily nutri-tional needs depending on the length of the pro-gram;

(3) All children in morning programs whohave not received breakfast at the time they ar-rive at the Head Start program will be served anourishing breakfast;

(4) The kinds of food served conform to mini-mum- standards for -meal patterns;

41

GUIDANCE

skills the texture and consistency of the foods mayneed to be modified. In other conditions which re-quire modification of the menu such as in food al-lergies, digestive or- metabolic disturbances, etc.,this information should be part of the child's healthrecord rind a physician's prescription must be kepton file at the center and at the food preparation siteand updated periodically. A qualified nutritionistshould help plan for meeting these needs.

General use of special dietary foods such asvitamin fortified modified milk products either assnacks or as meal supplements are not allowed.They are not in keeping with Head Start nutritionprogram goals of (1) providing needed nutrientsthrough well planned meals, (2) providing a varietyof food and eating experiences, and (3) providingopportunities for children to participate in menuplanning and wherever possible in simple foodpreparation and selection, (4) reinforcing culturaland ethnic practices found in the children's homes.

(2) To meet 2/3 of the child's nutrient needs willnecessitate the use of the lunch or supper patternplus breakfast and a snack or plus two wellplanned snacks, one of which contains milk.

(3) Since it is virtually impossible for small chil-dren to meet their nutrient needs without having 3meals a day, breakfast is required to be availableat the center forchildren who have not had it athome. Breakfast should be served immediatelyupon arrival of the child at the center. If only asmall number of the children arrive without break-fast, concentrate on supplementing the snack withsimple additional foods to meet the breakfast -pat-tern and serve the snack early. All children shouldthen have access to this. If a majority of the chil-dren come without breakfast, it may be simpler toserve breakfast to all children. Cake rolls, pastries,doughnuts, sugar-coated cereals, etc., because oftheir high sugar content, are not recommended.

(4) Meal Patterns

Snacks should be planned to supplement nutri-ent needs not met in the meals.

Menus developed from the pattern can includecultural foods. For example, at lunch the meat sub-stitute, vegetable and bread could be made into anenchilada, taco or burrito using the meat or cheeseor bean, tomatoes or tomato sauce and onion andan enriched corn or flour tortilla.

Protein-rich foods are meat, poultry, fish, eggs,cheese, peanut butter, dried peas and beans.

44


NUTRITION

42

GUIDANCE

Meal Patterns*

BreakfastChildren Children1 up to 3 years 3 up to 6 years

Milk, fluidJuice or fruit or vegetableBread and/or cereal,

enriched or whole grain

Bread orCereal: Cold dry or

Hot cooked

Midmorning ormidafternoon snack(supplement)

1/2 cup 3/4 cup

1/4 cup 1/2 cup

1/: slice 1/2 slice

1/4 cup' 1/3 cups

1/4 cup 1/4 cup

(Select 2 of these 4 components)Milk, fluidMeat or meat alternateJuice or fruit or vegetableBread and/or cereal,

enriched or whole grainBread orCereal: Cold dry or

Hot cooked

Lunch or supper

1/2 cup 1/2 cup1/2 ounce 1/2 ounce1/2 cup 1/2 cup

1/2 slice 1/2 slice1/4 cup' 1/3 cup'1/4 cup 1/4 cup

Milk, fluidMeat or meat alternate

Meat, poultry, or fish. cooked(lean meat without bone)CheeseEgg

Cooked dry beans and peasPeanut butter

Vegetable and/or fruit (two orBread or bread alternative,

enriched or whole grain

1/2 cup

1 ounce1 ounce1

1/4 cup2 tablespoons

more) 1/4 cup

1/2 slice

3/4 cup

1 1/2 ouncesF 1/2 ounces1

3/8 cup3 tablespoons1/2 cup

1/2 slice

1 1/4-cup (volume) or 1/3 ounce (weight), whichever is less.2 1/3 cup (volume) or 1/2 ounce (weight), whichever is less.3 3/4 cup (volumes or 1 ounce (weight), whichever is less,

A Planning Guide for Food Service in Child Care Centers,Food and Nutrition Service, United States Department ofAgriculture, 3101 Park Center Drive, Alexandria, Virginia22302.

Fruit drinks and beverages made from fruit-flavored powders or syrups should not be usedroutinely They do not contain many of the vitaminsand minerals found in natural juices, and are highin sugar.

Bread includes tortillas, cornbread, rolls, muf-fins, bagel, fried bread, flat bread, etc., made ofwhole grain or enriched flour. Use- whole grainbreads and cereals often.

"Milk" should meet State and local standards.For the preschool child milk may be whole milk,buttermilk, or skim milk, if the child is gaining toomuch weight.

45

NUTRITION


(5) The quantities of food served conform torecommended amounts indicated in ACYF HeadStart guidance materials; and,

(6) Meal and snack periods are scheduled zp-propriately to meet children's needs and areposted along with menus, e.g., breakfast mustbe served at least 212 hours before lunch, andsnacks must be served at least 1 112 hours beforelunch or supper.

(c) The pan shall undertake to ensure thatthe nutrition services contribute to the develop-ment and socialization of the children by provid-ing that:

43

GUIDANCE

For the infant the use of skim milk or reduced fatmilk isn't recommended. The calories from fat areneeded by the infant to help provide the highenergy needs and to maintain a desirable rate ofweight gain.

Raw vegetables contain larger amounts of vita-min C than cooked vegetables. Include both rawand cooked fruits and vegetables in the menu.

A good to excellent source of vitamin C shouldbe served daily. Fruits and vegetables that aregood to excellent sources of vitamin C are listedbelow:

Excellent: Orange, orange juice, grapefruit, grape-fruit juice, broccoli, collards, cantaloupe, rawtomato and raw strawberries.

Very Good: Mustard, beet and turnip greens, kale,cauliflower, chard, tangerine, and tomato juice.

Good: Spinach, raw green pepper, dandeliongreens, raw cabbage.

A dark yellow or leafy green vegetable should beserved every other day to provide vitamin A. Fruitsand vegetables that are good to excellent sourcesof vitamin A are:

Sweet potatoes, carrots, pumpkin, broccoli, wintersquash, apricots, peaches, tomatoes, cantaloupe,dark green leafy vegetables: beet and turnipgreens, spinach, kale, collard, etc.

(5) See page 42 for suggested size servings.

(6) Quiet time should be scheduled before themeal so the children come to the table relaxed andeady to eat. Regularity in times of serving meals

and snacks and the following of a daily routine helpyoung children to establish good habits. Properspacing of meals allows time for the child to behungry enough to eat. Time should be allowed af-ter meals for activities such as toothbrushing,handwashing, etc. This is especially importantwhen the meal is served just before the children gohome.

(c) Mealtimes should promote the physical, so-cial and emotional development of children. Thisneeds to take place c a quiet, well-lighted andventilated area.

4 6

NUTRITION


(1) A variety of foods which broaden thechild's food experience in addition to those thatconsider cultural and ethnic preferences isserved;

(2) Food is not used as punishment or re-ward, and that children are encouraged but notforced to eat or taste;

(3) The size and number of servings of foodreflect consideration of individual children'sneeds;

44

GUIDANCE

Meal-related activities provide opportunities fordecision making, learning to take responsibility,sharing, communicating with others, muscle con-trol and eye-hand coordination. Family style foodservice supports these efforts.

Food-related activities should be planned withinthe child's range of abilities. If food is not preparedon-site, special efforts will need to be made to as-sure that opportunities are available for foodpreparation activities in the classroom. These willneed to be closely coordinated with the plannedmenus, and food service personnel.

(1) Start with familiar foods which make a childfeel comfortable and promote good self-concept.Introduce new foods gradually. Offer a smallamount of one new food along with a meal of famil-iar foods. Children should be prepared for the newfood through classroom activities such as readingstories about the food, shopping for the food andhelping in its preparation, growing the food or see-ing it grow on a farm, etc. Snack time can be usedto introduce a =new food.

Explore various ways one food item is served indifferent cultures. For example, the many differenttypes of breads used: tortillas, biscuits, pita (flatbread), bagels, soda bread, etc.

Explore the many ways one food can be pre-pared. For example: hard and soft cooked egg,fried, poached, coddled, egg salad, deviled, mer-ingue, egg nog, etc.

(2) If a child refuses a food, offer it again atsome future time, don't keep pestering the child.Forcing children to eat or using desserts or otherfood as reward or punishment may create problemeaters and unpleasant or undesirable associationswith the food. Remember that all foods offeredshould contribute to the child's needs, includingthe dessert. "Clean plate" clubs, stars and othergimmicks to encourage children to eat are not ap-propriate.

(3) Appetites vary among children and in thesame child from day to day. Start vvith small por-tions allowing -for additional portions as desired.Permitting children to serve themselves gives themlatitude to make decisions on the- quantity theywant and prevents waste. Family style food serviceis preferred.

Use of preplated meals does not allow opportu-nity for individualization of serving size, and usu-ally allows title variety, especially in cultural foods.

Serve food in a form that is easy for the youngchild to manage. Bite-size pieces and finger foodare well-liked and suitable for small hands. Meat

4/

NUTRITION


(4) Sufficient time is allowed for childreneat;

GUIDANCE

cut in bite-size pieces, bread, and raw vegetablescut in strips and fruit in sections are easy for chil-dren to handle.

to (4) Serve children as soon as they come to thetable. Slow eaters should be allowed sufficient timeto finish their food (about 30 minutes). If childrenbecome restless before the meal period is over al-low them to get up and move around, i.e., the chil-dren can take their plate to a cleaning area awayfrom the table when finished. A leisurely meal timepace should be encouraged.

Some handicapped children may be eating at adifferent developmental level than the other chil-dren. For example, if the 3-year-old child is eatingwith skills of a- 2- year -old, start where the child isand plan with a nutritionist or other therapist forhelping the child reach an adequate level of self-feeding skill.

(5) Chairs, tables, and eating utensils aresuitable for the size and developmental level ofthe children withspecial consideration formeeting the- need_ s of children with handicap-ping- conditions;

(6) Children and staff, including volunteers,eat together sharing the same menu and a so-cializing experience in a relaxed atmosphere,and

(7) Opportunity is provided for the involve-ment of children in activities related to meal ser-vice. (For example: family style service)

(5) Chairs should be of a size to allow the child'sfeet to rest on the floor or support should be pro-vided in some way.

Plastic dishes and stainless steel flatware arepractical for use with small children. Small plasticglasses or cups (4 oz.) are easy to hold and helpavoid spills. Small pitchers can be handled by -chil-dren for refills.

Children need experience using- knives. Theseshould have rounded tips.

If paper plates must be used they should be ofsturdy weight so that they do not slide around andso juice- does not soak through the surface andmake eating difficult.

Use washable tabletops, covers or mats for easycleaning of spills.

(6) Small groups of 5-7 persons- are conduciveto conversation and interaction. Interesting andpleasant table conversation centered about chil-dren's total experiendes (not limited to food and nu-trition) should be- encouraged. Discourage talkabout personal dislike of food. Teachers and otheradults should set a good example by their attitudetoward acceptance of food served. If the teachermust be on a special diet and cannot eat the samefoods as the children, this should be explained tothem. Good food habits are "caught rather thantaught."

(7) Activities related to meal service includeshopping for food, setting the table, serving thefood to others or self, cleaning up, making placemats and table centerpieces, etc. Children shouldbe allowed to help with all of these activities.

45 48

NUTRITION


(d) The plan shall set forth an organized nu-trition education program for staff, parents andchildren. This program shall assure that.

(1) Meal periods and food are planned to beused as an integral part of the total educationprogram;

(2) Children participate in learning activitiesplanned to effect the selection and enjoymentof a wide variety of nutritious foods,

(3) Families receive education in the selec-tion and preparation of foods to meet familyneeds, guidance in home and money manage-ment and help in consumer education so thatthey can fulfill their major role and responsibil-ity for the nutritional health of the family;

(4) All staff, including administrative, receiveeducation in principles of nutrition and their ap-plication to child development and familyhealth, and ways to create a good physical, so-cial and emotional environment which supportsand promotes development of sound food hab-its and their role in helping the child and familyto achieve adequate nutrition.

46

GUIDANCE

(d) An organized program is based on identifiedneeds and consists of planned activities to meetthese needs. Nutrition education helps staff, chil-dren and parents increase knowledge, under-standing and skills to achieve good nutrition.

(1) Meal periods are part of the flow of the day'sactivities. Foods serve as objects of observationand conversation for conceptual, sensory, andvocabulary development of children. Food relatedactivities can be used as a means for teaching lan-guage arts, color, texture, arithmetic, science, so-cial skills and hygienic practices; however, the pri-mary purpose of these activities is to establish longterm sound food habits and attitudes, and the foodshould be eaten.

There also may be a special nutrition focus in theeducation program with carry over into the menuand meal time activities. For example, if a trip isplanned to an orchard, related emphasis should beplaced on the fruit in the menus, meal time conver-sation, and classroom food preparation experi-ences.

(2) Examples of learning activities are field trips,tasting parties, food preparation, planting andgrowing food, reading stories about food, role play-ing as parents, grocer, making scrap books andexhibits, feeding classroom pets, planning menusto share with parents, etc.

(3) Staff should talk with parents to identify thenutrition information and food needs and developthe plan in response to their specific needs. Par-ents have much to offer each other.

Many ways can be used for parent involvementin education such as formal and informal presenta-tions, individual counseling by nutritionist, nurseand other staff, attendance at local adult educationprograms and cook training sessions. Also, par-ents can participate in menu planning committeesand staff can distribute pamphlets, newslettersand employ audio-visual aids.

(4) This education must be appropriate to thespecific, nutrition-related responsibilities of eachstaff memuer. For example, nutrition education forthe classroom staff should have a different focusfrom that of the food service staff or that of the -di-rector. The staff training program should be coordi-nated and integrated with the total staff trainingand orientation program.

49

NUTRITION


(e) The plan shall make special provision forthe involvement of parents- and appropriatecommunity agencies 4n planning, implement-ing, and evaluating the nutrition services. Itshall provide that:

(1) The Policy Council or Committee and theHealth Services Advisory Committee have op-portunity to review and comment on the nutri-tion services;

GUIDANCE

(e) Parents should be encouraged to participatein nutrition program activities such as planningmenus and wol icing in classroom nutrition activi-ties, to serve as volunteers or in jobs in food ser-vice and in on-going monitoring of the nutritioncomponent.

Parents or members of the community who meetthe following requirements should be encouragedto apply for food service positions:

know how to prepare good foodare willing to try out new foodsmeet health standardshave good attitudes toward foodlike being and working with and around childrenare eager and flexible to learn the necessarycompetencies to carry out the functions re-quired.

Appropriate agencies can provide professionalinput and resources for training teachers, staff andfood service personnel as well as meeting needs ofparents. It is important that these agencies under-stand the Head Start philosophy. Some agenciesmay be resources for additional funding- equip-ment, food, etc. Examples are local health depart-ments, schools, colleges, hospitals, county Exten-sion Service, USDA, professional and trade organi-zations (The- American- Dietetic Association, DairyCouncil, American Home Economics Associationand Society for Nutrition Education).

(1) The health advisory committee and policycouncil should review the nutrition program planand advise on specific needs of the program withspecial reference to addressing identified commu-nity nutrition needs.

(2) The nutritional status of the children will (2) Any problem related to nutritional statusidentified by teachers' observations of feedingskills and habits should be discussed with parents.A plan to solve the problems should be developedwith the parents. Opportunity should be taken toreinforce the positive food habits and good growthpattern of the child.

be discussed with their parents,

(3) Information about menus and nutrition ac-tivities will be shared regularly with parents,

(4) Parents are informed of the benefits offood assistance programs; and

47

(3) Information can be shared by sendingmenus to the home, periodic group meetings, par-ent-staff discussions, home visits, and periodicnewsletters. Frequency of these activities will varyfrom agency to agency

(4) Food assistanc.a programs include foodstamps, -free or reduced price school breakfast,lunch, and food programs for high risk categories(pregnant mothers, infants, children, the elderly).

50

NUTRITION


(5) Community agencies are enlisted to as-sist eligible families participate in food assist-ance programs.

(f) The plan shall provide for compliance withapplicable local, State and Federal sanitationlaws and regulations for food service opera-tions including standards for storage, prepara-tion and service of food, and health of foodhandlers, and for posting of evidence of suchcompliance. The plan shall provide, also, thatvendors and caterers supplying food and bever-ages comply with similar applicable laws andregulations.

48

GUIDANCE

Contact USDA Child Nutrition Division for mate-rials and information on these programs.

Child Nutrition DivisionFood & Nutrition ServiceU.S. Dept. of Agriculture3101 Park Center DriveAlexandria, Virginia 22302

(5) It is important to assure that families havefood. This may involve utilization of emergencyfood banks, providing transportation to buy foodstamps or food, etc.; but it should be rememberedthat the long term goal is to help families becomeindependent. Work with the social service compo-nent on this.

(f) These are established to protect the healthand safety of children being fed.

All food service personnel should possess aHealth Card or Statement of Health from me localHealth Department or physician.

Some States do not- send inspectors to checkHead Start facilities for compliance with local anaState standards. In such a situation, designatedprogram personnel with knowledge of applicablesanitation laws and regulations or sanitation stand-ards that- assure provision- of a safe food- serviceshould check annually for compliance with theseregulations and be responsible for the correction ofexisting violations. Written evidence of this mustbe available.

Self-inspection reports should be completedquarterly to assure maintenance of standards.

The following areas should be addressed:

Cleanliness and safety of food before, duringand after preparation including maintenance ofcorrect temperature

Cleanliness and maintenance of food_prepara-tion, service, storage and delivery areas andequipment

Insect and rodent controlGarbage disposal methodsDishwashing procedures and equipmentFood handling practicesHealth of food service personnelWater supply

Local or State sanitarians in health agencies canbe most helpful in providing ideas on ways to meetsanitation standards.

Evidence must be available that food caterershave met codes. Vehicles used for transportingand holding food must be insulated so food meetstemperature standards and transportation equip-ment must be able to be sanitized.

51

NUTRITION


(g) The plan shall provide for direction of thenutrition services by a qualified full-time staffnutritionist or for periodic and regularly sched-uled supervision by a qualified nutritionist ordietician as defined in the Head Start Guidancematerial. Also, the plan shall provide that all nu-trition services staff will receive preservice andin-service training as necessary to demonstrateand maintain proficiency in menu planning,food purchasing, food preparation and storage,and sanitation and personal hygiene.

49

GUIDANCE

(g) The services that a nutritionist iS expected toprovide in developing, implementing and supervising a high quality feeding and nutrition program re-quire a person with at least the minimal amount ofnutrition training and experience as follows.

A qualified nutritionist or dietitian is one who (1)meets the educatior...., and training requirementsfor membership dilti registration in the AmericanDietetic Association plus one year of experience incommunity nutrition nicluding services to children0-6 or (2) has a baccalaureate degree with a majorin foods and nutrition, dietetics or equivalent hoursof food and nutrition course work plus two years ofexperience in community nutrition including ser-vices to children -0 -6. Required experience couldhave been concurrent with or a part of training.

A home economist who meets the requirementsin item (2) above would also be qualified.

It is important that the same nutritionist be usedto establish consistency and continuity in the ser-vices. The amount and frequency of supervisionneeded will depend on the size of the program andthe help it needs in coming into compliance withthe performance standards. A minimum of 8 hoursof services per week per center is suggested. Fieldexperience indicates that grantees with on-sitefood preparation facilities can effectively use theservices of one full time nutritionist for every 5sites. Grantees providing food from a centralizedfood preparation facility, including catered or con-tract services, can use one full time nutritionist forevery 10 centers served. Nutritionists, even thosemeeting the qualifications outlined above shouldbe oriented to the Head Start Performance Stand-ards. Every nutritionist should be provided with theHandbook for Local Head Start Nutrition Specialistswhich- is available from- the Head Start Bureau.P.O. Box 1182, Washington, D.C. 20013.

The nutritionist provides the following types ofservices:

(1) Assesses the nutritional status and specialneeds of children and their families from informa-tion provided by the family and from the health rec-ords, discussions with nurse, physician, dentist,and from knowledge of community nutrition -prob-lems; helps parents and staff in formulating plansfor the nutrition program from this information.

(2) Provides necessary counseling for parents.

(3) Plans the nutrition education program withstaff, parents and children. Participates in stafftraining.

(4) Observes performance of food service per-sonnel and provides for an ongoing training pro-

NUTRITION


gram that will improve or develop competencies toinsure proficiency.

(5) Helps teaching staff plan and provide nutri-tion-related learning experiences in classroom.

(6) Utilizes community resources in carrying outthe total nutrition program.

(7) Participates in menu planning and reviewand takes other steps to assure a high quality feed-ing program.

(8) Provides the food service unit with directionin food budgeting, purchasing, storage, prepara-tion, service, and setting up of efficient record sys-tems.

50

(9) Assists in interpreting and meeting health,sanitation, and safety standards related to nutri-tion.

(10) Interprets Head Start nutrition service phi-losophy to peers in other agencies and enlistsskills of such personnel.

(11) Assists in preparation of job descriptionsand schedules in food preparation facility to assurean efficient food service operation.

(12) Assists in preparation of the budget andany written plans for the nutrition component.

(13) Participates in the self-assessment pro-cess.

The nutritionist should work at the grantee ordelegate agency level so that she can coordinateall nutrition efforts across the board. She can func-tion in several modesusing local resources ineach program independently, setting up a clusterof model centers at which training of personnel canbe conducted. scheduling her own time to make amonthly visit to each on-site facility (or however fre-quently this is feasible depending on the need_ incenters).

Training for food service staff must focus onknowledge, skills and attitudes needed to do thejob as well as career development plans for thoseinterested. The training program can-be designedto meet the qualifications for a dietary technician orassistant as defined by the American Dietetic As-sociation and provide opportunity for career lad-ders into hospital dietary- departments and othertypes of institutions.

Examples of duties which food service personnelmay be expected to perform and therefore needtraining-are:

Plan menus with staff and parentsProcure and store food, supplies, equipment

53

NUTRITION


(h) The plan shall provide for the establish-ment and maintenance of records covering thenutrition services budget, expenditures forfood, menus utilized, numbers and types ofmeals served daily with separate recordings forchildren and adults, inspection reports made byhealth authorities, recipes and any other infor-mation deemed necessary for efficient opera-tion.

GUIDANCE

Prepare or supervise the preparation and ser-vice of nutritious meals and snacksArrange work schedules for aides and volun-teersMaintain established standards of sanitation,safety and food preparationPrepare budget data and maintain cost controlsystemIdentify equipment needsMaintain records pertaining to food service oper-ationDevelop and test recipes and productsCooperate and participate in nutrition educationactivities for children, parents and staffPrepare simple written reports

Adequate numbers of staff and-time are requiredto do this. What constitutes an adequate number offood service personnel depends on the size of thefood operation (the number of children being fed),the type of equipment available, the level of com-petency of the employees, and the available aux-iliary help such as janitorial service and volunteers.One full time cook on basis of-past Head Start ex-perience is suggested- for centers serving- 30-40-children supplemented by one full time aide forcenters serving up to 80 children. For centers -serv-ing 15-30 children, a -minimum of 6 hours-per dayof cook's time is needed.

Sufficient paid time- should- be allotted- to foodservice personnel to-attend staff meetings, trainingand for-planning.

(h) Thci nutrition services budget includes costsof fund, food service and nutrition staff, equipmentand nutrition education materials and supplies forchildren and parent activities and staff training,

Records should be kept on hie for a minimum ofZ sears and should be-available to monitors, audi-tors and other-agency personnel as needed.

AO food program costs should be recorded.quantity and cost of food, purchased or donated,labor including volunteers, expenditures for equip-ment. utilities and transportation.

Programs under the Child Care Food Programmust supply_ reports according to the requirementsof the agency administering the-program.

A daily count of meals served to children andadults is a requirement of USDA as a condition forreimbursement.

All-menus-should reflect-any-changes made.Written inspection reports should be- posted -and

Indicate any sanitation- violations and date of-com-pliance or expected compliance.

51

54


NUTRITION

52

GUIDANCE

Suggested source of menus and recipes:

Child Nutrition DivisionFood and Nutrition Service, USDA3101 Park Center DriveAlexandria, Virginia 22302

Tested recipes are recommended to insure uni-form quality, prevent waste and serve as a guide topurchasing.

Other needed records include food and equip-ment inventories, personnel evaluation and train-ing records.

55

SOCIAL SERVICES


Subpart D-Social Services Objectives and Per-formance Standards

§ 1304.4-1 Social services objectives.

The objectives of the social cervices compo-nent of the performance standards plan are to:

(a) Establish and maintain an outreach and re-cruitment process which systematically insuresenrollment of eligible children.

(b)- Provide enrollment of eligible children re-gardless of race, sex, creed, color, nationalorigin, or handicapping condition.

(c) Achieve parent participation in- the centerand home program and related activities.

(d) Assist the family in its own efforts to im-prove the condition and quality of family life.

(e) Make parents aware of community servicesand resources and facilitate their use.

§ 1304.4-2 Social services plan content.

(a) The social services plan shall provide pro-cedures for:

(1) Recruitment of children, taking into ac-count the demographic make-up of the commu-nity and the needs of the children and families,

(2) Recruitment of handicapped children;

GUIDANCE

In order to accomplish the comprehensive objec-tives of the Social Services component, the HeadStart program should use some form of familyneeds assessment (FNA) with every family havinga child enrolled in the program. The purpose of theFamily Needs Assessment (FNA) is to develop a to-tal profile or picture of the individual families beingserved by the Head Start program. The FNA willidentify the interests, desires, goals, needs andstrengths of the family, and will help the Social Ser-vices staff determine how Head Start can bestwork with the family to maximize and maintain itsstrengths, while strengthening areas of needand/or concern. This assessment process, begin-ning at the time of enrollment, and culminatingwhen the family leaves the program, should resultin the development of a family profile and assist-ance plan (FAP) which should be geared towardassisting families to reach their goals and- aspira-tions. Reference is made to the Head Start Bureau/ACYF publication, A Handbook For Providing So-cial Services in Head Start, as a resource for staff indeveloping the FNA and FAP - available from theHead Start Bureau, P.O. Box 1182, Washington,D.C. 20013.

(a) Input into the plan should oe made by staffand parents.

(1) The recruitment process should systematic-ally seek out children from the most disadvantagedhomes. Recruitment techniques include door -todoor contact, use of income eligibility lists, and useof recruitment staff who can identify with the -com-munity.

Special emphasis should be placed on recruitingand enrolling from and coordinating with otheragencies which are serving only some of the chil-dren's needs.

(2) The following factors will be taken into ac-count:

Number of handicapped children in the targetpopulation, including types of handicaps andtheir severity.Services provided by other community agen-cies.

(3) Providing or referral for appropriate coun- (3) (4) Preferably, these services should bes.silng; available directly from the local Head Start pro-

53

56

SOCIAL SERVICES


(4) Emergency assistance or crisis interven-tion;

(5) Furnishing information about availablecommunity services and how to use them;

(6) Follow-up to assure delivery of neededassistance;

(7) Establishing a role of advocacy andspokesman for Head Stan families;

(8) Contacting of parent or guardian with re-spect to an enrolled child whose participation Inthe Head Start program is irregular or who hasbeen absent four consecutive days; and

(9) Identification of the social service needsof- Head Start families and working with othercommunity agencies to develop programs tomeet those needs.

(b) The plan shall provide for close coopera-tion with existing community resources includ-ing:

(1) Helping Head Start parent groups workwith other neighborhood and communitygroups with similar concerns;

(2) Communicating to other communityagencies the needs of Head Start families, andways of meeting these needs;

(3) Helping to assure better coordination,cooperation and information sharing with com-munity agencies;

54

GUIDANCE

gram If unavailable directly, provision should bemade for obtaining appropriate services from out-side resources.

(5) The procedure should ensure that all avail-able community resources are used to the maxi-mum extent possible.

(6) Agencies to whom children or other familymembers were referred should be contacted to as-sure the services were satisfactorily provided.

(7) Heed Start staff should, in a prudent andpositive way, represent the best interests of HeadStart families to the community and other commu-nity agencies, especially if the family has any prob-lems in receiving benefits from local resources.

(8) Soc;a1 services staff should make regularlyscheduled family contacts (preferably home visits)and should assess and re-assess family needs ona continuing basis. These contacts should be coor-dinated with other component staff.

(9) The procedure should specify those serviceswhich will be provided directly by the local HeadStart program, i.e., counseling and those serviceswhich will be provided by resource agencies otherthan the local Head Start program. Head Start staffshould make every effort to involve parents in iden-tifying individual family needs and in planningways to meet those needs. Head Start staff shouldbe provided training in how to identify families andchildren in need of social services.

(1) (2) Some form of official communicationcould be established through designated liaison tomaintain contact with public service agencies. Let-ters of intent should be sought from agencies co-operating with Head Start where possible. Staffshould initiate the effort of finding out- (inventory-ing) what services these agencies currently do of-fer and have the potential for offering in the future.

(3) Ways of facilitating communication withother social service providers in the community In-clude visiting those providers, inviting those pro-viders to visit the Head Start program, placing pro-viders on a special Head Start mailing list toreceive pertinent information, being placed on theproviders' mailing list to keep abreast of the provid-ers' activities, and developing a media relationsprogram with local press, radio stations, and TVstations.

SOCIAL SERVICES


(4) Calling attention to the inadequacies ofexisting community services, or to the need foradditional services, and assisting in improving.ne available services, or bringing in new ser-vices; and

(5) Preparing and making available a commu-nity resource list to Head Start staff and fami-lies.

(c) The plan shall provide for the establish-ment, maintenance, and confidentiality of rec-ords of up-to-date, pertinent family data, includ-ing completed enrollment forms, referral andfollow-up reports, reports of contacts with otheragencies, and reports of contacts with families.

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GUIDANCE

(4) A Social Services Advisory Committee cornprised of Head Start staff, staff frum other community agencies, and Head Start parents could beformed to provide input concerning needed socialservices and to act as an advocacy group in obtain-ing these services.

(5) In communities where another agency pre .pares a community resource list, the Head Startprogram might update the list and make it more rel-evant for Head Start purposes.

(c) Adequate records should be kept and re-viewed periodically at the center level. Social ser-vice staff can coordinate with teaching staff onclass attendance and follow-up. Parents and staffshould be involved in determining criteria for ,,onfi-dentiality.

PARENT INVOLVEMENT


Subpart E-Parent Involvement Objectives andPerformance Standards

§ 1304.5-1 Parent Involvement objectives.

The objectives of the parent involvementcomponent of the performance standards areto:

(a) Provide a planned program of experi-ences and activities which support and enhancethe parental role as the principal influence intheir child's education and development.

(b) Provide a program that recognizes theparent as:

(1) Responsible guardians of their children'swell being.

(2) Prime educators of their children.(3) Contributors to the Head Start program

and to their communities.

(c)- Provide the following kinds of opportuni-ties for parent participation:

(1) Direct involvement in decision making inthe program planning and operations.

(2) Participation in classroom and other pro-gram activities as paid employees, volunteersor observors.

(3) Activities for parents which they havehelped to develop.

(4) Working with their own children in coop-eration with Head Start staff.

§ 1304.5-2 Parent Involvement plan content:parent participation.

(a) The basic parent participation policy ofthe Head Start program, with which ail HeadStart programs must comply as a condition ofbeing granted financial assistance, is containedin Head Start 'Policy Manual, Instruction 1-31Section B2, The Parents (ACYF Transmittal No-tice 70.2, dated August 10, 1970). This policymanual instruction is set forth in Appendix B tothis part.

(b) The plan shall describe in detail the imple-mentation of Head Start Policy Manual, instruc-tion 1-31Section B2. The Parents (AppendixB). The plan shall assure that participation ofHead Start parents is voluntary and shall not berequired as a condition of the child's enroll-ment.

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GUIDANCE

(b) The written plan should include a generalstatement of objectives for the Parent Involvementcomponent, a listing of specific goals, and the ap-propriate methodology for achieving these goals.An example of a goal might be Involving Parents inthe Education Program and one technique of themethodology for achieving this goal could be Re-cruiting Parents to Serve as Classroom Volunteers.Emphasis should be placed on maintaining theHead Start philosophy in the home so that parents'lives are enriched and the objectives of Head Start

59

PARENT INVOLVEMENT


§ 1304.5-3 Parent Involvement plan content:enhancing development of parenting skills.

The plan shall provide methods and opportu-nities for involving parents in:

(a) Experiences and activities which lead toenhancing the development of their skills, self-confidence, and sense of independence in fos-gering an environment in which their own chil-dren can develop to their full potential.

(b) Experiences in child growth and develop-ment which will strengthen their role as the pri-mary influence in their children's lives.

(c) Ways of providing educational and develop-mental activities for children in the home andcommunity.

(d) Health, mental health, dental and nutri-tional education.

(e) identification, and use, of family and com-munity resources to meet the basic life supportneeds of the family.

57

GUIDANCE

are continued by the child and the child's parentsin the home or community.

(a) Parents should be encouraged to participatein Head Start policy groups and on communityboards of directors and committees. Parentsshould be given the opportunity arid encouraged toconduct sessions for staff, children, and other par-ents in relevant activities for which they have spe-cial skills. Parents should be encouraged to partici-pate as volunteers in social service activities mak-ing contact with community social agencies andmaking home visits as well as volunteering in theclassrooms.

(b) Parents should be provided with guidance,information and training in the enhancement oftheir parenting skills, personal development, andchild development concepts through such meansas films, brochures, discussion groups, rap-ses-sions, courses, books and parent-child interactionactivities in the home or center. An excellent re-source -for accomplishing this goal would be theuse of the twenty session Exploring Parenting cur-riculum, a parent education curriculum developedby the Head Start Bureau/ACYF in 1976 for usewith Head Start parents.

(c) Parents could be exposed to specific ac-tivities which foster learning in children on thehome, e.g., the use of common household items toteach the names of colors, as in "Bring me the bluetowel," and in the community, e.g., planning a tripto the store.

(d) Training could be made available to parents,either in conjunction with staff training in theseareas or as a unit by itself. To facilitate parental at-tendance at training sessions, parents should re-ceive adequate notice and babysitting servicesshould be provided.

(e) Parents should be provided or made awareof available, community resources, such as adultclasses in consumer education, financial assist-ance programs, and family and employment coun-seling. This ought to be coordinated with the socialservices component to avoid duplication of effortand to strengthen the family-centered approach ofHead Start.

G

PARENT INVOLVEMENT


(f) Identification of opportunities for continu-ing education which may lead towards self-enrichment and employment.

(g) Meeting with the Head Start teachers andother appropriate staff for discussion- and as-sessment of their children's individual needsand progress.

§ 1304.5-4 Parent Involvement plan content:communications among program manage-ment, program staff, and parents.

(a) The plan shall provide for two-way com-munication between staff and parents carriedout on a regular basis throughout the programyear which provides information about the pro-gram and its services; program activities for thechildren; the policy groups; and resourceswithin the program and the community.

Communications must be designed and car-ried out in a way which reaches parents andstaff effectively. Policy groups, staff and par-ents must participate in the planning and devel-opment of the communication system used.

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GUIDANCE

(f) Educational opportunities might includebasic adult education issues, continuing educationprograms, vocational training or child developmentassociate (CDA) training, and self-enrichment pro-grams. Resources in the local community and itsimmediate environs which offer programs in theseand other educational areas should be identifiedand arrangements made -for the participation ofHead Start parents. Where these resources are in-adequate or do not exist in close physical proxim-ity, Head Start staff should seek assistance fromthe ACYF Regional Office. Many Head Start staffmembers are receiving training through the HeadStart Supplementary Training Program.

(g) Head Start staff should encourage parentalinterest in their child's development. Parentsshould be given the opportunity to meet with teach-ers on a scheduled and as-needed basis through-out the year (e.g., three home visits are recom-mended, although only two are required, at the be-ginning, middle, and end of the school year).

At these meetings parents and teachers shoulddiscuss the child's physical, social /emotional, -andintellectual development and review the child'sprogress. Such meetings can be used to arrive atagreement regarding desirable short-range goalsand some discussion of specific activities and ex-periences which may contribute to the child's prog-ress toward these goals.

Home visits should be planned to enable staff toacquire a fuller understanding of each child's abili-ties and experiences. Such visits may also be usedto help parents consider the child's current needs,interests and ability in order to plan home activitiesand interactions which will contribute to the child'sprogress. In addition to regularly scheduled teacherconferences, parents should meet with other HeadStart staff on an as-needed basis.

(a)- Examples of specific communication tech-niques include newsletters, home visits, trainingsessions, and policy group meetings. Those tech-niques should be programmed to occur on a regu-lar and continuous basise.g., monthly newslet-ter, and bimonthly group meetings.

PARENT INVOLVEMENT


(b) The plan shall provide a system for theregular provision of information to members ofPolicy Groups. The purpose of such communi-cation is to enable the policy group to make in-formed decisions in a timely and effective man-ner, to share professional expertise, and gener-ally to be provided with staff support. At a mini-mum, information provided will include:

(1) Timetable for planning, development, andsubmission of proposals;

(2) Head Start policies, guidelines, and othercommunications from ACYF.

(3) Financial reports and statement of fundsexpended in the Head Start account; and

(4) Work plans, grant applications, and per-sonnel policies for Head Start.

(c) The entire Head Start staff shall share re-sponsibility for providing assistance in the con-duct of the above activities. In addition, HealthServices, Education, and Social Services staffshall contribute their direct services -to assistthe Parent Involvement staff. If staff resourcesare not available, the necessary resources shallbe sought within the community.

§ 1304.5-5 Parent involvement plan content:parents, area residents, and the program.

The plan shall provide for:

(1) The establishment of effective proce-dures by which parents and area residents con-cerned will be enabled to influence the charac-ter of programs affecting their interests,

(2) Their regular participation in the imple-mentation of such programs and,

(3) Technical and other support needed toenable parents and area residents to secure ontheir own behalf available assistance from pub-lic and private sources.

GUIDANCE

(b) Examples of ways in which this informationmay be transmitted include written handouts, writ-ten minutes of meetings, official correspondence,and oral presentations at policy group meetingsand training sessions. Policy groups should havethe opportunity to comment within a reasonabletime.

(1) (2) (3) Content of the program should in-clude:

Training in all program components, in a waywhich allows parents to understand the HeadStart program as an interrelated whole and tofacilitate parent participation in the preparationof the work plan and budget.

Ways in which parents can assist staff in settingthe goals of the local program and the goals ofother community institutions concerned withchildren and families, allowing parents and staffto see these goals as an interrelated system.

Training that occurs in a planned and continu-ous fashion, beginning with and continuingthrough the grantee's funding cycle, with ade-quate provision for parental input in the designand evaluation of the program.

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62

ArreNoix AFlOGRAM OPTIONS rol PROJECTHEAD START

This appendix sets forth policy governingthe development and Implementation ofvariations in program design by local HeadStart programs.

N-30-334-1-00 PurposeThis chapter sets forth the policy govern-

ing the development and implementation ofvariations in program design by local HeadStart programs.

N-30-3.14-1-10 ScopeThis policy applies to all Head Start

grantees and delegate agencies that operateor propose to operate a full year programwhich provides set of services to the samechild or the tame group of children for leesthan tlx hours a day. The policy will be ap-plied to all applications submitted by suchgrantees or delegate agencies on or afterApril i. 1973.

N-30-334-1-20 PolicyA. CZNERAL novuume

Beginning in the fourth quarter of FY1973 (April 1973;. Head Start programs willbe permitted and encouraged to considerseveral progrhm models in addition to thestandard Head Start model and select theprogram option best suite-- to the needs ofthe children served and the capabilities andresources of the program staff. The programoptions that are to be available for localselection are as follows:

The standard Head Start model.Variations in center attendance.Double sessions.Home-based models.Locally designed variations.

In principle, the Office of Child Develop-ment will support any option or design modelprovided- a community can demonstrate inan acceptable proposal that it will result Ina quality child development program at rea-sonable cost and meet Head Start guidelines.Any program option proposed must demon-strate that It meets each of the followingconditions:

1. All policies stated In the Head StartManual for Head Start components mustbe adhered to, with the exception of thosepoints detailed in the descriptions of eachof the options under Special Provitions. Thispolicy Is not to be interpreted in any waywhich would lessen the force of the presentHeed Start policy which states that. "Pro-grams in which enrollment does not reflectthe sextet or ethnic composition of disad-vantaged families In the area may not befunded . . ." (Head Start Manual 6106-1,Page 8)

2 The design and selection of program op-tions 1.2 to be based on an assessment of thechild development needs and resources of theprosder community as well as the needs ofthe current enrollees and their families.

3, The assignment of children to programsIs' to be determined by assessing such fie-tors as age -or developmental level, familysituation, handicaps, health or learningproblems, and previoui school experience.Discussion with all parents -about specificneeds of their children and how but to

meet those needs must be a priority in suchan assessment.

4. Proposed options must be Justified asconsistent with good developmental prac-tices.

parent. whose children participatein any option must be represented in theirparent-group organizations In accordancewith the revised parent involvement guide-linu of the Head Start Policy Manual ofAugust 10, 1970.

6. Program options must receive the ap-proval of the Head Start Policy Council priorto submission to OCD.

7. There must be a specific training planfor staff and volunteers for any optionchosen. It should address itself to the re-quirement. and goals of the specific programvariations being implemented.

9. The number of hours spent in the HeadStart center will vary depending on the op-tion chosen. In all eases. the center activitiesare to maximize opportunities for meetingthe child's developmental needs.

9. The application must demonstrate theability to conduct the program option withinthe limits of the current funding level unlessfunds are added to the program from othersources. However, some options may enableprograms to serve more children within thesame funding level. Careful planning andanalysis will be necessary to determine thetotal cost associated with serving additionalchildren. In such planning, the followingareas should be considered:

a. Additional medical-dental coot!:b. Increased coats due to separate sched-

uling and operating practices in thearea of pupil and staff transporta-tion;

c. Additional staff for home visits andsimilar supportive activities;

d. Need for additional recruitmenteffort;

e. Increased insurance coat.;f. Additions to parent activity funds.

s. srzersi. rrioneroms1. The Standard Head Start Model

Continuation of the present fin- day -per-week, center-based claseroom format will beoptional. Communities electing to oontinuethis format are free to do so provided thatthey demonstrate through a careful assess-ment of their needs and capabilities thatcontinuing the present program Is In thebest interesta of the individual childrtn andfamilies served. If this assessment Indicatesthat the present format is not adequatelymeeting local needs. the groin= it to -con-sider whether these needs could be met motseffectively by one or more of the otheroptions.

2. Variations in- Center- Attendancea. Head Start programs may elect to serve

some or all children on a less than five -day-per -week basis. All children who attendHead Start on a partial basis mtfst receivethe same comprehensive developmentalservices as children attending the 5-day sea-alon, except as otherwise Indicated. Short-ened hours in the classroom may be supple-mented by a parent education program oranother option which would 'assist parent.In developing their role as the first -and mostinfluential educators of their own children.-In planning _ for less than -a five -flay -week

classroom schedule, careful conelderaUonmust be given to the underlying :reasons forthe attendance variations. Prografn planningmust specifically address the followingqtiestions:

(1) What are the developmental needs ofthe child? Can they be met as effectively ormore effectively by test Ufa a five-dayschedule?

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(2) What are the needs and desires of thefamily? Would adjustment factors dictateconsecutive -days attendance as opposed to,say, an every- other -day schedule?

(3) How does the curriculum plan fit theage and developmental needs of the children?Does the plan take into account differingneeds of children of different ages, and vary-ing needs of the same child over time?

(4) What kind of staffing pattern is re-quired to obtain the program objectives?

b In all situations where the children areIn the center less than five days a week. theprogram must specify how they will receivecomprehensive services The following exam-ples are illustrative of what this requires.

(1) One-third to one-half of the child'sdaily nutritional needs must be met each dayhe attends the center Parents must, on request, be provided with simple, economicalWeekly menus and counseling on budgeting,food preparation and sanitation, as well ason how to involve children in food-relatedactivities in the home.

('J) Provisions for complete medical anddental services must be made for all childrenin accordance with Head Start policies.

(3) Staff-family interaction, as central tothe Head Start concept, must be includedin any variation plan. Varied scheduling Isto provide staff with new and additional op-portunities for such interaction.

c. Staff utilization should contribute no-ticeably to program quality by maximizingstaff talent, potential and expertise. Stafftraining goals must be identified and a train-ing plan devised which will facilitate the im-plementation of the option. Such trainingshould enable the emit to incorporate cur-riculum modifications neoessary to accom-modate the shorter week and to allow for thedevelopmental differences between three-year-olds and five -year -olds,

d. Several attendance variation models arepossible -in planning the delivery of HeadStart services. Attendance schedules must bedevised for the children in accordance withtheir assessed needa. Proposals must describethe methods by which children are assignedto their schedules. The following examplesindicate possible scheduling variations. Thelist is not meant to be exhaustive.

(1) The- four - day -week schedule provide'four days for center -based activities plus anadditional day for center staff to performspecial activities, such as:

In-service training for staff, parents andvolunteers.

Special experiences for children.Home Visits.Two days in small groups in homes with

parent training by the staff.(2) Split-session schedules: Two regularly

enrolled groups, each meeting two days perWeek, with the fifth day set aside for suchthings as in-service training or working withsmall groups of parents or children with spe-cial needs.

3. Double SessionsHead Start programa are permitted to oper-

ate double sessions as an option. In no caseshall the addition of other children resultin fewer services for children currently inthe program. A program shall not be re-quired, nor shall it be permitted, to conductdouble sessions solely as a cost-saving device.In addition to the policies which apply tofull-year, part-day program, the followingconditions must be met when the doublesessions option is utilized:

a. Provisions must be made for a one-hourbreak between doube-sesslon classes when asingle teaching staff conducts both halvesof double session. In addition, at leastthirty minute. must be allotted prior toeach sessionwhether or not a different

tes.ohing staff Is used to prepare for thesession and set up the ci, ssroom environ-ment, as well as to give individual attentionto children entering and leaving the center.In some instances where- schools serve ascenter alien, variations in scheduling doublesessions may have to be considered.

b. The scheduling of children to attendmorning or afternoon sessions must attemptto meet Individual children s needs such asretcptivity, necessity fur naps, and otherfri.tors that might prevent full programbenefit to some children.

c. Adequate time for staff consultation,planning tariff must plan for each sessionto meet the needs of particular children en-rolled), in-service training and career de-velopment must be provided during theworking schedule. In some 'cases, this canonly be achieved by a variation in centerattendance (e.g.. four-day-week forchildren).

d. Staff teaching both halves of a doublesession are not to have the primary responsi-bility for home visits unleis some provisionIs made for substitute staff. In such cases,special provisions must be made for homev !sits.

e. Provisions must be made for an increaseIn supportive personnel and services in rela-tion to the anticipated requirements of ad-ditional children and their families.

f. Provisions must be made for custodiaiservices between sessions, including thecleaning of indoor and outdoor spaces.

g. Provisions must be made to maintainhigh food quality for both sessions. Allchildren should have an opportunity to joinin cooking and other food-related activities,preferably with the participation of thecook-manager.

4. Home -Based ModelsHead Start grantees may elect to develop

and incorporate a home-based model intotheir current program Such models wouldfocus on the parent as the primary factorin the child's development and the home asthe central facility. These models may bedesigned along the lines of the Home Startdemonstration programs initiated in fifteencommunities in FY 1972 or on a model de-veloped by the local community. The fol-lowing conditions must be met by thesegrantees in implementing their programs.a. Comprehensive Services

The same kinds of services which are avail-able to children served in a center-basedHead Start program will be available tochildren served by a home-based program.As in center-based programs, the home-basedprogram must make every possible effort toidentify, coordinate, integrate and utilizeexisting community resources and service;(public, reduced-fee, or no-fee) in providingnutritional, health, social and psychologicalservices for its children and their families.

(1) Nub-Mon.In home-based programs,whenever feasible children should receivethe same nutrition services as in center-based programs with priority emphasis onnutrition education aimed at helping par-ents learn to make the beat use of existingfood resources through food planning, buy-ing and cooking. If periodic, regular or in-cidental group sessions for children are held,every effort should be made to prepare andserve nutritious snack or meal. When foodis not available to a family, the home-basedprogram must make every effort to put thefamily in touch with whatever communityorganization can help supply food. In addi-tion, parents should be informed of all avail-able family assistance programs and shouldbe enoouraged-to participate in them.

Nutrition education must recognize cul-tural variations in food preferences and sup-plement and build- upon these preferences

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rather than attempt to replace them. Thus,;ova items that are a regular part of a fam-ily s diet win be a major focai point of nu-trition education.

(2) 'lei:Ult.Every effort must be made toprovide health services through existing re-sources. Children to nome t. -d programsare to receive the same heaii.ra services 11.8

children in center-based programs.As with the standard Head Start program,

home -based programs shah provide linkage.with existing health services for the entirefamily unit on an as-needed basis. However,Head Start funds may be used to providehealth services only for the pre - school mem-bers of the family.

(3) Psychological and Social Services.Home -based programs shall provide neededservices through existing community re-sources or within the sponsoring Head, Startprogram in accordance with existing HeadStart policies.b. Curriculum for Children

A major emphasis of the tirogram must beto help parents enhance the total develop-ment (including cognitive, language, so-cial, emotional and physical) of all theirchildren.

Whatever the educational program orphilosophy of a home - based program, it musthave plan or system for developing indi-vidualized" or ' personalized" education pro-grams for its children.

In addition, programs must provide ma-terial, supplies and equipment ouch .s tri-cycles. wagons, blocks, manipulative toysand bOults, to foster the children's develop-ment In their homes as needed. Provision forsuch materials may be made through lend-ing, cooperative or purchase systems.

Group socialization experiences must beprovided on a periodic basis for all childrenin home-based programs. The proposal mustspecify what kind of developmental activi-ties will take place in the group setting.

Furthermore, the education componentas well as all program components mustmeet the needs of the locale by taking intoaccount appropriate local, ethnic, culturaland language characteristics6. Parent Program

Home-based programs reflect the conceptthat the parent is the first and most in-fluential "educator" and "enabler" of his orher own children. Thus, home-based pro-grams are to place emphasis on developingand expanding the "parenting" role of HeadStart parents,

Home - based program: must give both -par-ents (or parent subatitt.tes and other appro-priate family members) an opportunity tolearn about such things as various ap-proaches to child rearing, ways to stimulateand enhance their children's total develop-ment, ways to turn everyday experiencesinto constructive learning experiences forchildren, and specific information abouthealth, nutrition and community resources.d. Evening and Weekend Services

It is suggested that the program makeprovision for evening and weekend servicesto families when needed.e. Career Development

Programs must pro dde career develop-ment opportunities fo- staff. For example,training of staff shous qualify for academiccredit or other appropriate credentials when-ever possible./ Service Delivery System

In then. propvaaLs, grantees most describeMau system fur deuiering health, nutrition,psychological and other services that arenot provided prirriaroy by the in -homeCaregiver.

p Staff SelectionProposals most desciinc the program a

system for selecting staff In accord with theresponsibuities as.siglicd by ale program tothe staff member Fvz- csainnie. vie stallvisiling homes must be.

(1) Fluent In the language used by thefamilies they serve:

121 Responsive listeners:(3) Knowledgeable about human devel-

opment. family dynamics, end needsof children:

(11 Knowledgeable about ail programcomponents:

(5) Knowledgeable -about communityresources.

h Sian DevelopmentPrograms must submit a staff and volun-

teer recruitment plan and a training plan,IncludIng content of proposed pre- and in-service training programs. teaching method,descriptions of training start or consultants,and provisions fur continued in-servicetraining. The career development plan mustbe designed to develop or increase staff mem-ber a knowledge about.

(1) Approaches to and techniques ofworking with parents:

(2) Other home-based or Home Start-like programs:

(3) All Head Start component areas.i. Volunteers

M in all other Head Start programs. thehome-based programs must encourage andprovide opportunity for the use of volun-teers.

5. Locally Designed OptionsIn addition to the above rriodela. local pro-

grams may elect to design and propose otherprogram options which they And well suitedto meet the needs of individual children andthe families in their communities. Proposalsfor local program options must adhere tothe following guidelines:

a. They must be derived from an analysisof the present standard Head Start modeland must represent more effectiVe ap-proach to meeting the needs of children inthe community.

b. They must be 4.Arnsisiehl with good de-velopmental practices.

c. They must be consistent with SeenStart pettvrmance standards and :twat en-sure that an cumpvnente of Head start. areeffectively delivered, unless they are operatedas an- adjunct to -a program Which deliversthe full range of Head Start services. or un-less they represent special program thrustor circumscribed effort such ste.

(1) Health Start-type program or otheraervicea such all sickle cell or -leadpaint screening.

(2) Summer follow-on services forhandicapped high risk or other chil-dren with special needs.

APPENDIX SHEAD START

POLICY MANIYAL. THE PARENTS

This appendix sets forth poetry g-,terningthe trvo'vement nt parenta of Head Startth"dren " 'n the devet-pment, c, r_ductand evens" rr grarr. d',e-:vn At ',Lelevel "

130 2 The ParentsA. INTRODUCTION

11,40 0.101 be.evte t, at the ger! madeby the chtid '-. Head Start rr.ust be under-stood and but upon by the farr.11y nd-thecommurlity To achieve this goal. Head Startprovides for the Involtement of the child'sParente and other members of the family inthe experter.ces he receives In the child de-velopment :enter by gibing them many op-

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RULES AND REGULATIONS

portunities for richer appreciation of theyt,,ing child's needs and how to satiety them.

Many of the benefita of Head Start arerouted in -change". These changes must takeplace In the family Itself, In the community.and in the attitudes of people and institu-tions that have an impact on both.

It is clear that the success of Head Startin bringing about substantial changes de-mands the fullest involvement of the parents,parental-substitutes. and families of chil-dren enrolled in its programs. This involve-ment begins when a Head Start programbegins and should gain vigor and vitality asplanning and activities go forward.

Successful parental involvement entersinto every part of Head Start, influencesother anti-poverty programs, helps bringabout changes In institutions In the com-munity. and works toward altering the socialconditions that have formed the system' thatTtirrnund the economically disadvantagedchild and his family

Project Head Start must continue to dis-c,ver new ways for parenta to become deeplyinvioved in decision-- making about the pro-gram and in the development of activitiesthat they deem helpful and important Inmeeting their particular needs and condi-tions. For some parenta, participation maybegin on a simple level and move to morecomplex levels. For other parents the move-ment will be Immediate. because of put ex-periences, Into complex levels of sharing andgiving Every Head Start program is obligatedto provide the channels through which suchparticipation and involvement can be pro-vided for and enriched.

Unless this happens, the goals of HeadStart will not be achieved and the programItself will remain a creative experience forthe preschool child in setting that Is notreinforced by needed changes In social sys-tems Into which the child will move- afterhis Head Start experience.

This sharing in- decisions for the futureis ono of the primary alms of parent partici-pation and Involvement In Project HeadStart.

D. THE ROLE OF THE PARENT*

Every Head Start Program Must Have Ef-fective Parent Participation. There are atleast four major kinds of parent participa-tion in local Head Start programs.

I PARTICIPATION IN THE PROCESS OFMAKING DECISIONS ABOUT THE NATUREAND OPERATION OF THE PROGRAM.

2. PARTICIPATION IN THE CLASSROOMA8 PAID EMPLOYEES, VOLUNTEERS OROBSERVERS.

3. ACTIVITIES FOR THE PARENTSWHICH THEY HAVE HELPED TO DEVELOP.

4. WORKING WITH THEIR CHILDREN INCOOPZRATION WITH THE STAFF OF THECENTER.

Each of these is essential to in effectiveHead Start program both at the grantee level:.nd the delegate agency level. Every HeadStart program must hire/designate Co-ordinator of Parent Activities to help bringabout appropriate parent participation. Thisstaff member may be volunteer in smallercommunities.1 Parent Participation in the Protege of

Making Decisions About the Nature andOperation of the Program

Head .Start Policy Grenipsa. Structure.Tho formal structure by

which parenta can participate In policy mak-ing and operation of the program will varywith the local administrative structure of theprogram.

Noarmny, however, the Head Start policygroups will consist of the following:

1. Head .Start Center Committee. Thiscommittee must be set up at the canter level.Where centers have several classes. It Is rec-ommended that there also be parent cluecommittees.

2. Head Start Policy Committee. This com-mittee must be set up at the delegate agencylevel when the program is administered Inwhole or in part by such agencies.

3. Head Start Policy Council. This Councilmust be set up at the grantee level.

When grantee has delegated the entireHead Start program to one Delegate Agency,It is not necessary to have a Policy Councilin addition to Delegate Agency Policy Com-mittee. Instead one policy group serves boththe Grantee Board and the Delegate AgencyBoard.

b. Composition.--Chart A describes thecomposition of each of these groups.

Representatives of the Community (Dele-gate Agency level)! A representative ofneighborhood community groups (publicand private) and of local neighborhood com-munity or professlod organizations, whichhave concern for children of low incomefamilies and pin contribute to the devel-opment of the program. The number of suchrepresentatives will vary depending OD the

Organization:: Head Start Center Committee

2 Head Start_Policy Committee (dele-gate agency).

3, Head Start Policy Council (grantee) -

number of organizations whichshould ap-propriately be represented. The DelegateAgency determines the composition of theircommittee (within the above guidelines) andmethods LO be used In selecting representa-tives of the community. Parents of formerHead Start children may serve as repre-sentatives of the community on delegateagency policy groups. All representative's ofthe comniunIty selected by the agency mustbe approved by elected parent members ofthe committee. In no case. however, 'houndrepresentatives of the community exceed 807.of the total committee.

Representatives of the Community (Gran-tee Agency level). A representative of major

Chart AComposition

1, Parents whose children are enrolled in thatcenter.

2. At least 50% parents of Head Start childrenpresently enrolled in that delegate agencyprogram plus representatives of the com-munity.

3. At least 50% parents of Head Start childrenpresently enrolled in that grantee's programplus representatives of the community.

agencies (public and private) and majorcommunity civic or professional organiza-tions which have a concern for children oflow income families and Can contribute tothe program. The number of such repre-sentatives will yaiy, depending on the num-ber of organizations which should appro-priately be represented. The applicant agencydetermines the composition of the council(within the above guidelines) and the meth-ods to be used in selecting representativesof the community. Parents of former MadStart children may serve Ai representativesof the community on grant** agency policygroups. All representatives of the ocmmunityselected by the agency must be approved by

FEDERAL REGISTER, VOL 40, NO. 126MONDAY, INE0, it TS

65

elected parent members of the committee. Inno case, however, should representatives ofthe community exceed 50% of the totalcommittee or council.Special Notes

1. All ',vents serving on policy groupsmust be elected by parents of Head Startchildren currently enrolled_In the program.

2. It is strongly recommended that thecommunity action agency board have repre-sentation from the Head Start Policy Councilto assure coordination of Head Start ac-tivities with other CAA programs Converse-ly, community action agency board repie-Dentition on the Policy Council Ls alsorecommended.

3. It is Important that the membership ofpolicy groups be rotated to assure a regularinflux of new ideas into the program. Forthis purpose, terms of membership must belimited to no more than three years.

4. No staff member (nor members of theirfamilies as defined in CAP Memo 23A) of theapplicant or delegate agencies shill serve onthe council or committee in a voting ca-pacity. Staff members may attend the meet-ing at councils or committees in a con-sultative non-voting capacity upon requestof the council or committee.

5. Every corporate board operating a HeadStart program mutt have a Policy Commit-tee or Council as defined by HEW. The cor-j.'.orato body and the Policy Committee orCouncil must not be one and the same '

O. Policy groups for summer programs pre-sent a ipeciel problem because of the dif-Acuity of electing parent representatives inadvance. Therefore. the policy group for onesummer program must remain in office untilits successors have been elected and takenoffice. The group- from the former programshould meet frequently between the end ofthe program and the election of new mem-bers to assure some measure of programcontinuity. These meetings should be for thepurpose of (a)- assuring appropriate followup of- the children (b) aiding the devel-opment of the upcoming summer HeadStart program, (c) writing of the applica-tion, (d) hiring of the director and estab-lishment of criteria for hiring staff and.when necessary (e) orientation of the newmembers. In short, the policy group from aformer program must not be dissolved untila new group is elected. The expertise of thoseparents who have previously served- shouldbe used whenever possible.

o. FunctionsThe following paragraphsand -charts describe the minimum functfonsand degrees of responsibility for the variouspolicy groups involved in administration oflocal Head Start programs Local groups maynegotiate for additional functions and agreater share of responsibility if all partiesscree. All such igreemebta are subject tosuch limitations as may be called for byHEW policy. Questions about this shouldbe referred to your HEW regional office

(1) The Head Start Center Committeeshill carry out at least the following mini-mum responsibilities.

(a) Assists teacher, center director, andall other persona responsible for the de-velopment and operation of every componentincluding curriculum in the Head Startprogram.

(b) Works closely with cliasTOOm teachersand all other component staff to carry outthe daily activities program

(c) Plana, conducts, and participates ininformal is Well as formal programs andactivities for center patents and 'tiff.

(d) Participates In recruiting and screen-ing of °enter employees within guidelinesestablished by HEW, the Drantee Collo-di and Board. and Dolepto Agency Coinm_ itt** and Board.

(2) The Head Start Policy Committee.Chart B outline' the major mans,gesnent

RULES AND REGULATIONS

functions connected with local Head Startprogram administered by delegate agenciesand the degree of responsibility assigned toeach participating group.

In addition to those listed functions, thecommittee shall:

(a) Serve as a link between public andprivate organizations, the grantee PolicyCouncil. the Delepte Agency Board of Di-rectors, and the community it serves.

(b) Have the opportunity to initiate sug-gestions and Ideas for program improve-ments and to receive a report on actiontaken by the administering agency with re-gard to its recommendations.

(c) Plan, coordinate and organize agency-wide activities for parents with the assist-ance of staff.

(d) Assist in communicating with parentsand encouraging their participation in theprogram.

(e) Aid in recruiting volunteer servicesfrom parents, community residents and com-munity organizations, and assist in the mo-bilization of community resources to meetidentified needs.

(f) Administer the Parent Activity funds.(3) The Head Start Policy Council. Chart

C outlines the major management functionsconnected with the Head Start program atthe grantee level. whether it be a communityaction or limited purpose agency, and thedegree of responsibility assigned to each par-ticipating group.

In addition to those listed functions. theCouncil shall:

(a) Serve as a link between public andprivate organizations, the Delegate AgencyPolicy Committees. Neighborhood councils.the Grantee Board of Directors end the com-munity it serves.

(b) Have the opportunity to initiate sug-gestions and ideas for program improve-ments and to receive a report on action takenby the administering agency with regard toIts recommendations.

tci Plan. coordinate and organize agency -wide- activities for parents with the assist-ance of staff.

td) Approve the selection of DelegateAgencies.

te) Recruit volunteer services from par-ents, community residents and communityorganizations, and mobilizes community re-sources to meet identified needs.

(f) Distribute Parent Activity funds toPolicy Committees.

It may not be easy for Head Start direc-tors and professional staff to share respon-sibility when decisions must be made. Evenwhen they are committed to involving par-ents, the Heed Start staff must take care toavoid dominating meetings by force of theirgreater training and experience in the proc-ess of decisionmaking. At these meetings,professionals may be tempted to do most ofthe talking. They must learn to ask parentsfor their ideas, and listen- with attention,patience and understanding. Self-don:Memoand self-respect are powerful motivatingforces. Activities which bring out these qual-ities in parents can prove Invaluable in im-proving family life of young children fromlow income homes.

Members of Head Start Policy Groupswhose family income falls below the "povertyline index" may receive meeting allowancesor be reimbursed for travel. per diem, mealand baby sitting expenses incurred becauseof Policy Group meetings. The proceduresnecessary to secure reimbursement fundsand their regulations are detailed in 0E0Instruction 416803 -1.2 Participation in the Classroom as Paid

Employees, Volunteers or ObserversHead Start classes must be open to parents

at times reasonable and convenient to them.There are very few occasions when the pres-ence of a limited number of parents would

present any problem in operation of theprogram.

Having parents in the classroom has threeadvantages. It:

a. Gives the parents a better understand-ing of what the center is doing for the chil-dren and the kinds of home assistance theymay require.

b. Shows the child the depth of his parentsconcern.

c. Gives the staff an opportunity to knowthe parents better and to learn from them.

There are, of course, many center activi-ties outside the classroom (e.g., field trips,clinic visits, social occasions) in which thepresence of parents Is equally desirable.

Parents are one of the categories of per-sons who must receive preference for em-ployment as non-professionals. Participa-tion as volunteers may also be possible formany parents Experience obtained as avolunteer may be helpful in qualifying fornon-professional employment At a minimumparents should be encouraged to observeclasses several times In order to permitfathers to observe 1t might be a good ideato have some parts of the program in theevening or on weekends.

Head Start Centers are encouraged to sataside space within the Center which can beused by parents for meetings and staffconferences.

3. Activities for Parents Which They HaveHelped To Develop

Head Start programs must develop a planfor parent education programs which are re-sponsive to needs expressed by the parentsthemselves. Other community agenciesshould be encouraged to assist in the plan-ning and implementation of these programs.

Parents may also wish to work together oncommunity problems of common concernsuch as health, housing, education and wel-fare and to sponsor activities and programsaround interests expressed by the group.Policy Committees must anticipate suchneeds when developing program proposalsand include parent activity funds to coverthe cost of parent sponsored activities.4 Working With Their Children in Their

Own Home in Connection with the Staffof the CenterHEW requires that each grantee mike

home visits a part of its program when par-ents permit such visits. Teschers shouldvisit parents of summer children a minimumof once; in full year programs there shouldbe at least three visits, if the wents haveconsented to such home visits. (Educationstaff are now required -to make no less thantwo home visits during a given program yearin accordance with 1304.2-2(e) (4).) In thoserare cases where a double shift has been ap-proved for teachers it may be necessary touse other types of personnel to make homevisits Personnel, such as teacher aides, healthaides and social workers may alsa make homevisits with. or independently of, the teachingstaff but coordinated through the parent pro-gram staff in order to eliminate uncoordi-nated visits.

Head Start staff should develop activitiesto be used at home 14 other family membersthat will reinforce and support the child'stotal Head Start experience.

Staff, parents and children will all benefitfront home visits and activities. Granteesshall not require that parents permit homevisits as a condition of the child's participa-tion in Head Start. However, every effort mustbea madeparents.

to explain the advantages of visits to

FEDERAL REGISTER, VOL 404 NO. 125--MONOAY, JUNE 30, 1475

66BEST COPY AVAILABLE

Definitions as used or charts B and CA. General Responsibility.The individual

or group with legal and fiscal responsibilityguides and directs tho carrying out of thefunction described through the person orgroup given operating responsibility.

D. Operating Responsibility,The Individ-ual or group that is directly responsible forcarrying otit or performing the function, con-sistent with the general guidance and direc-tion of the individual or group holding gen-eral responsibility.

C. Must Approve or Disapprove.The in-dividual or group (other than persons orgroups holding general and operating respon-sibility. A and B above) must approve beforethe decision is finalized or action taken. The

Individual or group must also hare been con-sulted in the decision tusking proceu prior tothe point of seeking approval.

If they do not approve. the proposal cannotbe adopted, or the proposed action taken.until agreement Is ruched between the dis-agreeing groups or individuals.

D. 'flirt be Consulted. The individual orgroup must be called upon before any de-cision is made or approval is granted to giveadvice or information bat not to make thedecision or grant approval.

Z. May be Consulted.The individual orgroup may be called upon for information,advice or recommendations by those individ-uals or groups baying general responsibilityor operating responsibility.

A .-General responsibilityB.-Operating responsibility[,Must approve or disapprove1)>Mtla be consultedE.-Mow be committed

Chart B Chut C

Delegate /goner Or an tee agency

Function

at§4

rarig

pa

I. Planning;(a) Identify child development needs in the area to

be served (by CAA' If not delegated).(W Establish goals of Bead Start programs and

develop ways to meet them within 11SWguidelines.

(c) Determine delegete &rendes and areas In thecommunity in which Head Start programswill operate.

fell Determine lee.atton of =tenor classes(e) Develop plans to use all available community

resources in head Start.(1) Establish criteria for selection of children within

applicebie laws and HEW guideline..(r) Develop plan for recruitment of children

II. Central Administration:(a) Determine the toroPOSitton of the appropriate

policy group and the method for setting It up(within HEW guidelines).

(1.) Determine what services should be provided toHead Start from the CAA' central Mike andthe neighborhood centers.

(c) Determine whit sturfees should be provided toIf rad Start from delegate agency.

(dl Establish method of hearing and resolvingcommunity complaints about the Head Startprogram.

(e) Direct the CAA' Had Start staff in day-to-dayoperations.

(f) Direct the delegate agency Bead Start star indaytoday operations.

(g) Insure that standerds for acquiring spice. equip-ment. and iruPPnra ate net.

HI Personnel administration:(a) Determine Head Start personnel policies (Includ-

ing establishment of Wring and taring criteriafor Head Stut start. career derelOpraent plans,and employes grievance procedures).

(grantee agency..Delegate agency

Illre and ars Bead Start Director of granteeagency.

(c) Biro and Aro read Start gaff of grantee agency(d) titre and Are Iled Start Director of delegate

agency.(e) Ilire and Are Head Start ate of delegate nester.

Pl. Orem application process:(a) Prepare request for funds and proposed work

Meru].Prior to sending to CAA'Prior to sending to HEW

(b) Mska major change. In budget and work programwhile program is In operation.

(c) Provide information needed reerevlow topoUey council.

(d) Provide intonation needed isr pee:Ivies,' toHEW.

V. Evaluation: Conduct selferaltiation of agency's HeadStart isrcgrun.

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DHHS Publication No. (OHDS) 84.31131 67U.S. GOVERNMENT PRINTING OFFICE!' 19135-461-207134926

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