[Code of Federal Regulations]
[Title 45, Volume 4]
[Revised as of October 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 45CFR1304.20]

[Page 121-124]
 
                        TITLE 45--PUBLIC WELFARE
 
CHAPTER XIII--OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH 
                           AND HUMAN SERVICES
 
PART 1304_PROGRAM PERFORMANCE STANDARDS FOR THE OPERATION OF HEAD START 
 
        Subpart B_Early Childhood Development and Health Services
 
Sec.  1304.20  Child health and developmental services.


    (a) Determining child health status. (1) In collaboration with the 
parents and as quickly as possible, but no later than 90 calendar days 
(with the exception noted in paragraph (a)(2) of this section) from the 
child's entry into the program (for the purposes of 45 CFR 
1304.20(a)(1), 45 CFR 1304.20(a)(2), and 45 CFR 1304.20(b)(1), ``entry'' 
means the first day that Early Head Start or Head Start services are 
provided to the child), grantee and delegate agencies must:
    (i) Make a determination as to whether or not each child has an 
ongoing source of continuous, accessible health care. If a child does 
not have a source of ongoing health care, grantee and delegate agencies 
must assist the parents in accessing a source of care;
    (ii) Obtain from a health care professional a determination as to 
whether the child is up-to-date on a schedule of

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age appropriate preventive and primary health care which includes 
medical, dental and mental health. Such a schedule must incorporate the 
requirements for a schedule of well child care utilized by the Early and 
Periodic Screening, Diagnosis, and Treatment (EPSDT) program of the 
Medicaid agency of the State in which they operate, and the latest 
immunization recommendations issued by the Centers for Disease Control 
and Prevention, as well as any additional recommendations from the local 
Health Services Advisory Committee that are based on prevalent community 
health problems:
    (A) For children who are not up-to-date on an age-appropriate 
schedule of well child care, grantee and delegate agencies must assist 
parents in making the necessary arrangements to bring the child up-to-
date;
    (B) For children who are up-to-date on an age-appropriate schedule 
of well child care, grantee and delegate agencies must ensure that they 
continue to follow the recommended schedule of well child care; and
    (C) Grantee and delegate agencies must establish procedures to track 
the provision of health care services.
    (iii) Obtain or arrange further diagnostic testing, examination, and 
treatment by an appropriate licensed or certified professional for each 
child with an observable, known or suspected health or developmental 
problem; and
    (iv) Develop and implement a follow-up plan for any condition 
identified in 45 CFR 1304.20(a)(1)(ii) and (iii) so that any needed 
treatment has begun.
    (2) Grantee and delegate agencies operating programs of shorter 
durations (90 days or less) must complete the above processes and those 
in 45 CFR 1304.20(b)(1) within 30 calendar days from the child's entry 
into the program.
    (b) Screening for developmental, sensory, and behavioral concerns. 
(1) In collaboration with each child's parent, and within 45 calendar 
days of the child's entry into the program, grantee and delegate 
agencies must perform or obtain linguistically and age appropriate 
screening procedures to identify concerns regarding a child's 
developmental, sensory (visual and auditory), behavioral, motor, 
language, social, cognitive, perceptual, and emotional skills (see 45 
CFR 1308.6(b)(3) for additional information). To the greatest extent 
possible, these screening procedures must be sensitive to the child's 
cultural background.
    (2) Grantee and delegate agencies must obtain direct guidance from a 
mental health or child development professional on how to use the 
findings to address identified needs.
    (3) Grantee and delegate agencies must utilize multiple sources of 
information on all aspects of each child's development and behavior, 
including input from family members, teachers, and other relevant staff 
who are familiar with the child's typical behavior.
    (c) Extended follow-up and treatment. (1) Grantee and delegate 
agencies must establish a system of ongoing communication with the 
parents of children with identified health needs to facilitate the 
implementation of the follow-up plan.
    (2) Grantee and delegate agencies must provide assistance to the 
parents, as needed, to enable them to learn how to obtain any prescribed 
medications, aids or equipment for medical and dental conditions.
    (3) Dental follow-up and treatment must include:
    (i) Fluoride supplements and topical fluoride treatments as 
recommended by dental professionals in communities where a lack of 
adequate fluoride levels has been determined or for every child with 
moderate to severe tooth decay; and
    (ii) Other necessary preventive measures and further dental 
treatment as recommended by the dental professional.
    (4) Grantee and delegate agencies must assist with the provision of 
related services addressing health concerns in accordance with the 
Individualized Education Program (IEP) and the Individualized Family 
Service Plan (IFSP).
    (5) Early Head Start and Head Start funds may be used for 
professional medical and dental services when no other source of funding 
is available. When Early Head Start or Head Start funds are used for 
such services, grantee and delegate agencies must have written 
documentation of their efforts

[[Page 123]]

to access other available sources of funding.
    (d) Ongoing care. In addition to assuring children's participation 
in a schedule of well child care, as described in Sec.  1304.20(a) of 
this part, grantee and delegate agencies must implement ongoing 
procedures by which Early Head Start and Head Start staff can identify 
any new or recurring medical, dental, or developmental concerns so that 
they may quickly make appropriate referrals. These procedures must 
include: periodic observations and recordings, as appropriate, of 
individual children's developmental progress, changes in physical 
appearance (e.g., signs of injury or illness) and emotional and 
behavioral patterns. In addition, these procedures must include 
observations from parents and staff.
    (e) Involving parents. In conducting the process, as described in 
Sec. Sec.  1304.20 (a), (b), and (c), and in making all possible efforts 
to ensure that each child is enrolled in and receiving appropriate 
health care services, grantee and delegate agencies must:
    (1) Consult with parents immediately when child health or 
developmental problems are suspected or identified;
    (2) Familiarize parents with the use of and rationale for all health 
and developmental procedures administered through the program or by 
contract or agreement, and obtain advance parent or guardian 
authorization for such procedures. Grantee and delegate agencies also 
must ensure that the results of diagnostic and treatment procedures and 
ongoing care are shared with and understood by the parents;
    (3) Talk with parents about how to familiarize their children in a 
developmentally appropriate way and in advance about all of the 
procedures they will receive while enrolled in the program;
    (4) Assist parents in accordance with 45 CFR 1304.40(f)(2) (i) and 
(ii) to enroll and participate in a system of ongoing family health care 
and encourage parents to be active partners in their children's health 
care process; and
    (5) If a parent or other legally responsible adult refuses to give 
authorization for health services, grantee and delegate agencies must 
maintain written documentation of the refusal.
    (f) Individualization of the program. (1) Grantee and delegate 
agencies must use the information from the screening for developmental, 
sensory, and behavioral concerns, the ongoing observations, medical and 
dental evaluations and treatments, and insights from the child's parents 
to help staff and parents determine how the program can best respond to 
each child's individual characteristics, strengths and needs.
    (2) To support individualization for children with disabilities in 
their programs, grantee and delegate agencies must assure that:
    (i) Services for infants and toddlers with disabilities and their 
families support the attainment of the expected outcomes contained in 
the Individualized Family Service Plan (IFSP) for children identified 
under the infants and toddlers with disabilities program (Part H) of the 
Individuals with Disabilities Education Act, as implemented by their 
State or Tribal government;
    (ii) Enrolled families with infants and toddlers suspected of having 
a disability are promptly referred to the local early intervention 
agency designated by the State Part H plan to coordinate any needed 
evaluations, determine eligibility for Part H services, and coordinate 
the development of an IFSP for children determined to be eligible under 
the guidelines of that State's program. Grantee and delegate agencies 
must support parent participation in the evaluation and IFSP development 
process for infants and toddlers enrolled in their program;
    (iii) They participate in and support efforts for a smooth and 
effective transition for children who, at age three, will need to be 
considered for services for preschool age children with disabilities; 
and
    (iv) They participate in the development and implementation of the 
Individualized Education Program (IEP)

[[Page 124]]

for preschool age children with disabilities, consistent with the 
requirements of 45 CFR 1308.19.

(The information and collection requirements are approved by the Office 
of Management and Budget (OMB) under OMB Control Number 0970-0148 for 
paragraphs (a), (c) and (d).)

[61 FR 57210, Nov. 5, 1996, as amended at 63 FR 2313, Jan. 15, 1998]