Head Start and Oral Health in Iowa

1. Head Start and Oral Health in Iowa

2. Overview • What is Head Start? • Services Provided • Eligibility • Organization • State Collaboration Offices • Head Start Performance Standards • Head Start in Iowa • Head Start Oral Health Work

3. What is Head Start? • Early Head Start and Head Start are comprehensive child development programs which serve children from birth to five, pregnant women, and their families.

4. Goals of Head Start • Promote school readiness by enhancing the social and cognitive development of low-income children • Support parents in their role as primary educators of their children and empower families • Provide a supportive learning environment for children, staff and parents • Meet basic health needs including prevention • Respect children & adults • As individuals • With roots in many cultures and languages • As members of a community

5. Head Start is unique… • Involves parents in all aspects of decision making • Parent volunteering and community representation on the policy council are part of the Head Start budget • Community partnering is a requirement • Parent preference in hiring

6. Head Start Services Child development and education Determination of child’s health status Disabilities Nutritious meals Mental wellness Parent education Home visits Staff development Community connections Parent involvement in decision-making Socialization Tracking and Referrals

7. Birth to 3 (EHS) Ages 3-5 Meet family income guidelines Grantees may serve up to 35% of their enrollment with children whose incomes are between 100-130% of poverty. (This is in addition to the current 10% over-income.) Children in foster care regardless of income Children who are homeless Families receiving public assistance (TANF or SSI) regardless of income 10% of enrolled children must be for children with disabilities Eligibility

8. 2009 HHS Poverty Guidelines Source:Federal Register, Vol. 74, No. 14, January 23, 2009, pp. 4199-4201

9. Lyon Winnebago Mitchell Worth Howard Emmet Osceola Dickinson Kossuth Winneshiek Allamakee Hancock Clay Cerro Gordo Sioux Palo Alto Floyd Chickasaw O’Brien Clayton Fayette Bremer Plymouth Buena Vista Humboldt Cherokee Pocahontas Wright Franklin Butler Webster Woodbury Ida Delaware Dubuque Sac Buchanan Calhoun Black Hawk Hamilton Grundy Hardin Jackson Jones Benton Tama Monona Linn Crawford Greene Boone Story Carroll Marshall Clinton Cedar Audubon Johnson Iowa Jasper Shelby Dallas Poweshiek Guthrie Polk Harrison Scott Muscatine Adair Keokuk Madison Marion Washington Cass Mahaska Pottawattamie Warren Louisa Lucas Monroe Clarke Wapello Jefferson Mills Union Montgomery Adams Henry Des Moines Fremont Page Van Buren Taylor Wayne Ringgold Davis Decatur Appanoose Lee

10. Department of Health and Human Services Administration for Children and Families Office of Head Start Regional Offices (12) Head Start State Collaboration Offices Head Start Grantees Head Start Delegate Agencies Head Start Organization Chart Federal Local

11. Head StartState Collaboration Offices • Create a visible partnership at the state level to support the development of multi-agency and public/private partnerships. • Help build early childhood systems • Encourage widespread collaboration among Head Start and other appropriate programs, services, and initiatives, • Facilitate the involvement of Head Start in state policies, plans, processes, and decisions

12. Head StartProgram Performance Standards • The code of Federal regulations- 45 CFR PART 1304 — contains the program performance standards for the operation of Head Start programs by grantee and delegate agencies. • Mandatory regulations that grantees and delegate agencies must implement in order to operate a Early Head Start and/or Head Start program.

13. Head StartProgram Performance Standards Provide Head Start grantee regulations for… • early childhood education • health and safety • nutrition • transition • social and emotional development • disabilities • parent involvement • family partnerships • community partnerships • administrative and financial management, and facilities

15. Head Start and Oral Health Head Start requires every program to: • Provide ongoing training to staff who provide health services, including oral health services. • Determine whether each child has an ongoing source of continuous, accessible health care, including dental care. • Identify which children are not up-to-date on the required schedule of primary and preventive care.

16. Head Start and Oral Health(continued) Head Start requires every program to: • Ensure children who are up-to-date remain up-to-date. • Help parents obtain health services for children who are not up-to-date. • Ensure children with an observable, known or suspected health problem receives further testing, examination and treatment from a licensed/certified professional. • Develop a system to implement ongoing procedures to identify new or recurring dental concerns to facilitate timely referrals.

17. Head Start and Oral Health(continued) Head Start requires every program to: • Obtain written documentation if a parent refuses to give authorization for health services. • Consult with parents immediately when children's health problems are suspected or identified. • Obtain advanced authorizations for health procedures. • Help parents familiarize their children , in a developmentally appropriate way, to any health procedures they undergo.

18. Head Start and Oral Health(continued) Head Start requires every program to: • In Early Head Start, assist pregnant women immediately after enrollment to access prenatal/postpartum care, including dental care. • Promote effective dental hygiene in conjunction with meals. • Provide parents and children with education about oral hygiene.

19. Oral Health Protocol (example) Determine child’s oral health status. Is child up-to-date (EPSDT)? Yes/No Ensure child continues to be up-to-date. Yes No Refer to services Does child have a dental home? Yes/No No Ensure services are received Obtain written refusal Yes Ongoing determination of dental needs. Ensure child continues to be up-to-date.

20. How is Iowa Doing?

28. Health Services Advisory Committee • Required by performance standards • The HSAC comprised of community health professionals (such as physicians, dentists, DHs) Head Start staff, and Head Start parents. • Assists programs in identifying resources, developing policies and procedures and other activities.

29. Head Start Oral Health Forum2003 Dental Care Access • Dentists aren’t there • Dentists won’t serve low income families • Dentist won’t serve young children • KEY ISSUES Prevalence of Early Childhood Caries • Most common infectious disease • Invisible illness

30. What can we do?Five goals • Raise awareness. • Promote better linkages at a local level among early childhood health services, Head Start and other stakeholders. • Use linkages to promote new practices • Strengthen the Head Start Head Services Advisory Committees. • Develop a parent curriculum

31. Raise awareness Promote linkagesStrengthen the HSACs Develop a parent curriculum Results • legislators • child care providers • county public health • Iowa Community • Empowerment • Shared lists • Distributed information re toothbrushing, fluoride varnish, dental issues for pregnant women • Ensured Dentist and/or DH on each HSAC (16/18) • Conducted HSAC training • Now extended to I-Smile • Created “Healthy Smiles” Curriculum & Flip Charts • 18 workshops, 610 trained

32. “Healthy Smiles” Results(Percentage saying “yes”)

33. Next StepsIdentified in Sept. 2008 KEY WORK ITEMS: • Strengthen linkages with I-Smile • Healthy Smiles (new round of train the trainers) • Develop toolkits on setting up incentive systems to motivate families • Support TOSS Grant: Public awareness around oral health. • Improving Access Strategies

34. AAPD Dental Home Initiative Goals 2010 • To put together a Leadership Team • To educate and bring on board Dentist to serve these low income children and families as a dental home. • To have a motivational interview training for professionals to address families • To develop a tool kit for this