9.2.3.4: Written Policy for Obtaining Preventive Health Service Information

Each facility should develop and follow a written policy for obtaining necessary medical information including immunizations (see Appendix G: Recommended Childhood Immunization Schedule) and periodic preventive health assessments (see Appendix I: Recommendations for Preventive Pediatric Health Care) as recommended by the American Academy of Pediatrics (AAP) in Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents (1-3). Facility staff should encourage parents/guardians to schedule these preventive health services in a timely fashion.

Documentation of an age-appropriate health assessment that includes current immunizations and health screenings should be filed in the child’s record at the facility. Immunization records should be provided at the time of enrollment. The health assessment should be provided within two weeks of admission or indication that an appointment has been made with the health care provider. Updates of the health record should be maintained according to the American Academy of Pediatrics’ (AAP’s) periodicity schedule, Appendix I: Recommendations for Preventive Pediatric Health Care. Health record information should be reviewed by the staff of the facility and information sharing between the staff, the parents/guardians, and the child’s health care professional should be encouraged and facilitated in order to provide better care for the child in the child care setting.

Centers should have written procedures for the verification of compliance with recommended immunizations and periodic health assessments of children. Centers should maintain confidential records of immunizations, periodic health assessments, including Body Mass Index (BMI) for children age two and older, and any special health considerations.

RATIONALE

Health assessments are important to ensure prevention, early detection of remediable problems, and planning for adaptations needed so that all children can reach their potential. When age-appropriate health assessments and use of health insurance benefits are promoted by caregivers/teachers, children enrolled in child care will have increased access to immunizations and other preventive services (4). With the expansion of eligibility for medical assistance and the federal subsidy of state child health insurance plans (SCHIP), the numbers of children who lack insurance for routine preventive health care should lessen.

Requiring facilities to maintain a current health record encourages and supports discussion of a child’s health needs between parents/guardians, caregivers/teachers, and the child’s primary care provider. It also encourages parents/guardians to seek preventive and primary care services in a timely fashion for their child.

The facility should have accurate, current information regarding the medical status and treatment of each child so it will be able to determine and adjust its capability to provide needed services. This documentation should consist of more than a statement from the child’s primary care provider that the child is up-to-date. Because of the administrative burden posed by requests to fill out forms, unless the specifics of services rendered are requested, the information may not reflect the child’s actual receipt of services according to the nationally recommended schedule. Instead, it may only represent that the child has a current health record in the primary care provider’s office. Until tracking systems become more widespread and effective in health care settings, a joint effort by the education system, family and primary care provider is required to ensure that children receive the preventive health services that ensure they are healthy and ready to learn.

COMMENTS

Assistance for caregivers/teachers and low income parents/guardians can be obtained through the Medicaid Early Periodic Screening and Diagnostic Treatment (EPSDT) program (Title XIX) and the state’s version of the federal Child Health Insurance Program (SCHIP) (5).

Most states require that caregivers/teachers document that the child’s health records are up-to-date to protect the child and other children whom the unimmunized child would expose to increased risk of vaccine-preventable disease. State regulations regarding immunization requirements for children may differ, but the child care facility should strive to comply with the national, annually published, “Recommended Childhood Immunization Schedule,” available at http://www.cispimmunize.org from the AAP, Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians (AAFP).

A child’s entrance into the facility need not be delayed if an appointment for health supervision is scheduled. Often appointments for well-child care must be scheduled several weeks in advance. In such cases, the child care facility should obtain a health history report from the parents/guardians and documentation of an appointment for routine health supervision, as a minimum requirement for the child to attend the facility on a routine basis. The child should receive immunizations on admission or provide evidence of an immunization plan to prevent an increased exposure to vaccine-preventable diseases.

Local public health staff (such as the staff of immunization units, EPSDT programs) should provide assistance to caregivers/teachers in the form of record-keeping materials, educational materials, and on-site visits for education and help with surveillance activities. A copy of a form to use for documentation of routine health supervision services is available from Model Child Care Health Policies at http://www.ecelshealthychildcarepa.org/content/MHP4thEd Total.pdf.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

2.1.1.4 Monitoring Children’s Development/Obtaining Consent for Screening
9.4.1.3 Written Policy on Confidentiality of Records
Appendix I: Recommendations for Preventive Pediatric Health Care
Appendix FF: Child Health Assessment

REFERENCES

1. American Academy of Pediatrics. 2008. Recommendations for preventive pediatric health care. http://practice.aap.org/content
   .aspx?aid=1599&nodeID=4000.
2. Hagan, J. F., J. S. Shaw, P. M. Duncan, eds. 2008. Bright futures: Guidelines for health supervision of infants, children, and adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics.
3. Haskins, R., J. Kotch. 1986. Day care and illness: Evidence, costs, and public policy. Pediatrics 77:951-82.
4. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid. Children’s health insurance program. http://www.cms.hhs.gov/home/chip.asp.
5. American Academy of Pediatrics. Recomended childhood immunization schedules. http://www2.aap.org/immunization/izschedule.html.