03.02.01 - Screening, Examination, Treatment, & Follow-up Care Procedures

Screening, Examination, Treatment, & Follow-up Care Procedures Policy Number and Last Update (03.02.01/01-2019) SUBPART D - Health Program Services §1302.40 .41 .42

The goal is to coordinate and support the provision of a broad range of individualize health, dental, and developmental services to all enrolled migrant & seasonal children. The objectives of these procedures are:

1. All enrolled children have a source of accessible health care.
2. All enrolled children are up-to-date on a schedule of age-appropriate preventive and primary health care, as required by the Illinois EPSDT program.
3. New and recurring medical, dental, or developmental concerns are identified so that appropriate referrals can be made quickly.
4. Follow-up care is provided to all children requiring re-screening, assessment, diagnostic services, medical/dental treatment of therapy.
5. Children in need of further services at the time of their departure are transitioned to their next destination site. 
6. Parents are involved at all levels during the screening/exam, diagnostic, treatment, and follow-up processes, recognizing them as primary care givers and advocates of their children.

Community Partnerships

This process begins with building community partnerships to ensure services are available and accessible. Follow the action steps in the Community Partnership plan. In particular:

1. Assess the available resources in the community.
   1. Review the program's current resource file for health and dental providers.
   2. Discuss the resource file with Center Director, FSW, and HSAC to determine if they know other resources.
   3. Call all resources identified to ensure all information is current and up-to-date.
   4. Ensure all providers meet qualification to perform services.
   5. Update the center resource file with information identified.
   6. Submit an updated list of Health/Dental/Emergency resources that are appropriate for parental use to FSW for inclusion in the center's Parent Community Resource Directory.
2. Identify resources that provide each service required by the Head Start Performance Standards, the Illinois ESPDT program, and Illinois Licensing Standards.
   1. Identify resources that will provide the screenings, physical examinations, dental services, immunizations, and treatments, particularly those who will accept medical cards for payment.
   2. If possible, negotiate evening schedules for services to maximize parent participation.
   3. Determine fee schedule and willingness to accept medical card for payment.
   4. In collaboration with and approval of center director, complete interagency agreements and/or contracts for services with all service providers. (This is most important with Migrant Health Centers to ensure families have a "medical home" while in Illinois - Ref.: State Interagency Agreement between Migrant Health Grantee and IMSHS.)
3. Determine the water fluoride level for the center site. As exam and treatment dentists are identified, ensure that they are given this information to make informed decisions regarding recommendations of fluoride treatment and/or supplements.

Screening and Exams

1. Obtain from the Family Services Worker, the following, which were received from parents at the time of the child's enrollment:
   1. Medical card information;
   2. Health records, immunization card, and the health records that the parents may have brought with them, if available; and
   3. Signed release of information form to obtain records of most recent health services, and transition consent.
2. For children who do not have complete records, contact health service providers at previous location(s). Get a signed release of information from the parents.
3. Determine if the child has a source of accessible health care while in Illinois and/or a current Illinois medical card by reviewing child intake form. If needed, in collaboration with FSW, assist parents in identifying sources, including giving them the Community Resource Directory, and with determining medical card eligibility and applying to IDHS.
4. If a child is not up-to-date on the Illinois schedule of well child care and/or immunization schedule (see EPSDT schedules), work collaboratively with parents to arrange for the child to receive needed services within four weeks of the child's entry into the program. Always keep in mind parents' work hours when scheduling appointments. As services are provided track per COPA Data Entry Procedures.
5. If a child is up-to-date at the time of enrollment, note the date(s) the next services are due per COPA Data Entry Procedures and keep records per documentation requirements. If a child will need one or more of the necessary screenings, exams, or immunizations while enrolled, arrange for services so they are obtained by due date(s).
6. Ensure that parents are involved, participate and approve, of all needed screening/examination, immunization, and treatment procedures to be completed on their children. Give parents the IMSHS description of screening/exams handout that explains each screening and exam. Always obtain informed, signed, parent consent and release of information for all health services provided by the program or its contracted service providers.
7. If parents refuse to authorize any of these services, have them sign as documentation of that refusal. However, explain that some screenings and exams* are required by day care licensing and if they refuse those services, the child cannot attend the center. (*Physical exam, documented on required form, TB test by Mantoux method at age one or older, at least one lead blood test from age one, and up-to-date immunizations required by the Department of Public Health.
8. If a child's records do not contain a current health and nutrition history, interview parent to obtain an initial or updated health, dental, and developmental history.
9. If the program has scheduled services, ensure that parents are aware of screening/exam dates and that parents are provided with transportation (when needed) to screenings and translation services.
10. Inform parents of screening and examination results completed by the program, or contacted service provider by sending them the original Medical/Dental Screening and Exam Results form in their language.

Treatment and Follow-Up Care

1. When children enroll with continuing treatment needs or when conditions are identified, develop and carry out a written follow-up plan. Help parents to arrange further diagnostic testing, examination, and treatment for each child with an observable, known, or suspected medical/dental or developmental problem.
2. Again, ensure that parents are involved, participate, and approve of all needed services. Explain to parents the follow-up needs, consult with them on developing the follow-up plan, and obtain signed parent consent and release of information for all follow-up services provided by the program or its contracted service providers. If parents refuse to authorize any of these services, have them sign as documentation of that refusal. Inform parents of follow-up results provided by the program or its contracted service providers by sending them the Medical/Dental Re-screening, Evaluation, or Treatment Results form.
3. Prioritize treatment needs and schedule treatment appointments to ensure that children requiring extensive treatment will have sufficient time available to receive all needed care.
4. Dental Treatment: At times, the usual treatment dentist cannot meet a child's particular treatment needs (e.g. referred to a pedodontist). When this occurs, attempt to find a provider who will accept the medical card for payment or provide in-kind services. If unsuccessful, these services can be paid for, with the approval of the Grantee Health Services Manager, with part of the delegate's Quality Improvement Funds.
5. Arrange for fluoride treatment and dental cleaning upon recommendation of examining dentist.
6. Refer children suspected of having a disability immediately to the Disabilities Services Worker (DSW) for assessment referral. Collaborate with the DSW the provision of services to children with known or suspected health disability conditions.
7. Follow the bi-weekly staffing procedures to develop plans with the entire team for children with extraordinary follow-up needs.
8. Continue to track and document the child's services throughout enrollment, per required procedures.
9. Transition: Follow transition plan to ensure children in need of additional care at the time of their departure are connected to services at their next destination. In consultation with parents and other staff members, develop a plan for further follow-up before child departs.