Lower Columbia College Head Start/EHS/ECEAP Family Service/Parent Involvement Table of Contents

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1 Lower Columbia College Head Start/EHS/ECEAP Family Service/Parent Involvement Table of Contents 1. Family Partnership Activities a. Family Partnership Activities Outline (Revised 08/15) b. Family Partnership Development Cycle (Revised 08/15) 2. Bus Pass Acquisition a. Bus Pass Acquisition for Parents (Revised 08/15) b. Monthly Bus Pass Order Form (Revised 09/10) 3. Case Management a. Case Management Policy and Procedure (Revised 03/15) b. Case Management Report Form (Revised 08/14) c. Children and Family Staffing Meetings Policy and Procedure (Revised 03/15) d. Notes Home Form (English & Spanish) (Revised 07/02) e. Classroom Family Tracking Form Policy and Procedure (Revised 08/15) f. Classroom Family Tracking Form End of Month for FA/Teacher (Revised 08/15) f1. Classroom Family Tracking Form End of Month for CFDS (Created 08/15) 4. Child Abuse and Neglect a. Child Abuse and Neglect Reporting Policy and Procedure (Revised 08/13) a1. Child Abuse and Neglect Signature Form (Revised 08/12) b. Child Abuse and Neglect Report Form (Revised 11/12) c. Anecdotal Form (Revised 09/10) d. Possible Abuse Indicators (Revised 06/10) e. Notification of Pickup by Child Protective Services (CPS) Form (Revised 09/10) e1. Procedure for On-Site Interview of Alleged Victims of Child Abuse (Revised 09/10) 5. Family Literacy a. Family Literacy Policy and Procedure (Revised 08/15) 6. End of the Month Family Advocate Report a. End of Month (EOM) Family Advocate Report Policy and Procedure (Revised 08/15) b. Family Advocate End of Month Report Form (Revised 08/15) 7. Family Advocate Home Visit # 1 a. First Home Visit Policy and Procedure (Revised 08/15) b. Family Picture (Revised 07/15) b1. Family Outcomes Report (Access Report 4210 in ChildPlus) c. Parent Involvement Brochure (English & Spanish) (Revised 08/15) d. Family Advocate Appointment Schedule (Revised 08/15) e. Health History/Nutrition Intake (1-5 years of age) (Revised 08/15) e1. Health/Nutrition Intake (Birth 12 months) (Revised 03/14) f. PIR Enrollment Questionnaire (Revised 02/15) g. Parent Agreement Contract (English & Spanish) (Revised 10/14) g1. Parent Agreement Exclusion List (Revised 12/13) h. LCC HOFL Enrollment Form (English & Spanish) (Revised E: 06/10; S: 08/10) i. HOFL Class Requirements (English & Spanish) (Revised 02/12) j. Vacant j1. Start-Up for Enrolled Families (Revised 06/14) k. Child/Family File Transfer or Withdrawal Checklist (Revised 08/14) k1. EHS Child/Family File Transfer or Withdrawal Checklist (Revised 06/15) l. Family Interest Survey Policy and Procedure (Revised 08/15) m. Family Interest Survey Form (English & Spanish) (Revised 05/14) 1 Revised 08/15

2 n. Family Interest Survey Volunteer Areas of Interest (Revised 06/12) 8. Family Advocate Home Visit # 2 a. Second Home Visit Policy and Procedure (Revised 06/12) b. Vacant c. Vacant c1. Family Partnership Agreement Policy & Procedure (Revised 08/15) c1(a). Family Partnership Map for Success (English & Spanish) (Revised 02/12) c1(b). Family Partnership for Success Puzzle Pieces (English & Spanish) (Revised 06/13) c1(c). Family Partnership for Success Steps (English & Spanish) (Revised 06/13) d. Home Emergency Information (English & Spanish) (Revised 06/11) e. Home Safety Checklist (English & Spanish) (Created 07/14) 9. Family Advocate Home Visit # 3 a. Third Home Visit Policy and Procedure (Revised 06/12) 10. Vacant 11. Family Advocate Home Visit General Information a. Home Visit Plan Form Procedure (Revised 08/12) b. Welcome Home Visit Form (English & Spanish) (Revised 07/15) b1. Second Family Involvement Home Visit Form (Revised 05/14) b2. Third Family Involvement Home Visit Form (English/Spanish) (Rev. E: 05/14; S: 03/15) c. Home Visit Schedule Reminder (English & Spanish) (Revised 09/10) d. Process for Shared Family Services (Revised 08/15) 12. Family Emergency Crisis Information a. Family Emergency and Crisis Intervention Policy (Revised 09/10) 13. Open House/Orientation a. Parent/Guardian/Child Orientation/Open House Policy and Procedure (Revised 07/15) b. Parent/Guardian/Child Orientation/Open House Checklist (English & Spanish) (Revised 06/14) b1. Parent/Guardian Orientation to Classroom Sign-In/Sign-Out Form & Volunteer Inkind Procedures (English & Spanish) (Revised 06/09) c. Vacant d. Vacant e. Volunteer Experiences with Children (English & Spanish) (Revised 06/10) f. Orientation Planning Form (Revised 07/15) g. Classroom Scavenger Hunt (English/Spanish) (Revised 06/09) 14. Parent Meetings a. Parent Committee/Parent Education Meetings Policy and Procedure (Revised 08/15) a1. Mandatory Information and/or Training Topics (Revised 10/10) b. Family Nights Policy and Procedure (Revised 08/14) c. Support Group Proposal Form (Revised 09/10) d. Parent Program Sign-In Sheet (English & Spanish) (Revised 08/15) e. Parent Education Plan (Revised 09/10) f. Parent Center Committee Responsibilities (English & Spanish) (Revised 09/10) g. Parent Committee Center Guidelines (English & Spanish) (Revised: 09/10) h. Center Officers and Their Duties (English & Spanish) (Revised E: 09/10, S: 10/10) i. Job Description for Classroom Representatives (English & Spanish) (Revised 06/12) j. Parent Committee Meeting Agenda Form (English & Spanish) (Revised 08/15) k. Parent/Community Written Concern/Feedback Form (English & Spanish) (R: 09/10) k1. Parent/Community Written Concern/Feedback Policy and Procedure (Revised E: 08/10, S: 10/10) 2 Revised 08/15

3 l. Parent Committee Minutes Form (English & Spanish) (Revised 09/10) m. Parent Training Evaluation Form (English & Spanish (Revised 05/14) 15. Policy Council a. Policy Council Bylaws (See PGOV 1d) b. Policy Council Officers Job Descriptions (English & Spanish) (Revised 09/10) -- Policy Council Handbook (See Administration Handbook/Program Governance 1a) 16. Early Head Start Prenatal/Newborn a. Prenatal Health/Dental/Nutrition History (Revised 03/15) b. Prenatal Home Visit Procedure (Revised 12/14) c. Home Visit Plan form Prenatal Families (Revised 05/15) c1. Supplemental Prenatal Client Questions (Created 07/10) d. Prenatal Emergency Information (Revised 12/14) e. Post Partum Assessment/Newborn Health Home Visit Purpose (Revised 08/14) f. Post Partum Assessment/Newborn Home Visit Home (Created 07/10) g. Vacant h. EHS Maternal Depression Screening & Referral Procedure (Revised 08/14) 17. Early Head Start a. EHS Home Visit Plan Form (Revised 05/14) a1. EHS Home Visiting Notes (Revised 11/12) b. Early Head Start Parent Agreement Contract (English & Spanish) (Revised 06/15) b1. EHS Parent Agreement Exclusion List (Revised 12/14) c. EHS Child & Family Development Specialist EOM Report (Revised 12/14) c1. Child and Family Development Specialist EOM Policy & Procedure (Created 10/10) d. Parent/Guardian/Child Orientation/Open House (English & Spanish) (Created 07/14) e. Tracking Form (EOM) (Revised 12/13) f. Family Partnership Agreement/Family Goals Index (Created 11/11) g1. EHS Home Base Intake/Home Visit Process (Revised 04/12) g2. EHS Combination Classroom Intake/Home Visit Process (Revised 04/12) g3. EHS Even Start Intake/Home Visit Process (Revised 06/11) 3 Revised 08/15

4 Activities: Forms: Welcome Home Visit #1 Benchmark: Before orientation Length: minutes Welcome parents to Head Start/ECEAP. Inform about upcoming events, slow start dates. Inform about upcoming dates for orientation and screenings. Distribute folders containing parent involvement brochure and other pertinent information. Explain the role of family advocacy in the partnership (home visits or parent/teacher conferences) (FPA). Follow-up on Health History information (new students only) Review Family Partnership Goal/Child Education Goals with returning families. Start Family Outcomes Assessment Make referrals as needed. Welcome Home Visit Form Parent Agreement Contract Update Contact Information Form Family Picture Health History (returning children only) Parent Involvement Brochure Dial 4 Parent Questionnaire Complete all needed releases (school district, doctor, dentist, specialist) Change of Status USDA food program enrollment LCC registration form (ELC class requirements) Family Interest Survey Home Language Survey Handouts: Welcome Folder Containing: Community Resource Directory Home Learning Nutrition Handouts Food Assistance Dental Provider Information Recalled Products Ways to Say Goodbye Calendar LOWER COLUMBIA COLLEGE HEAD START/ECEAP Family Partnership Activities Outline Parent Orientation Benchmark: In conjunction with slow start or within 2 weeks of enrollment Length: 1 2 hours Activities: Review sign in/out procedure and form. Orient parents to Head Start/ECEAP with an explanation of our philosophy, including all component areas and parent opportunities. Use parent handbook to cover required content pieces. Review importance of home learning/in-kind. Provide tour of classroom/site. Give date for first parent meeting. Educate and recruit parents for Policy Council. Dates for ESL, GED, POP. Forms: Orientation Checklist Activities: First Parent Meeting Benchmark: Two weeks prior to October Policy Council Meeting FS-PI 1a ***Staff to bring Community Resource Directory to home visit.*** (C: 06/06; R: 08/15) Social Time/Ice Breaker Elect Classroom Representatives and Alternates for Policy Council Elect Parent Committee Officers. Ask for parent curriculum input. Review Home Learning Forms: Parent Committee Meeting Agenda (FS/PI 14j) Handouts: Job description for classroom reps, committee officers and Policy Council officers. Class Representative and Committee Officer training dates Documentation Ongoing Documentation of Family Contact Should be Recorded in Case Management Who/When/Where/What/Plan of Action Forms completed/forms turned in Action Plans/FLUP Referral/FLUP

5 LOWER COLUMBIA COLLEGE HEAD START/ECEAP Family Partnership Activities Outline FS-PI 1a Second Family Involvement Home Visit Benchmark: November/December/January Length: 1 2 Hours Third Family Involvement Home Visit Benchmark: March/April/May Length: 1 2 Hours Activities: Forms: Handouts: Update Contact Information Form. Education Check-in: child goals, IEP status, review Home Learning/In-Kind. Follow-up on child s attendance. Establish or follow-up on Family Partnership Agreement. Make referrals as needed. Follow-up on previous referrals. Update Family Picture. Update Family Outcomes Assessment Discuss parent education opportunities and support groups. Encourage male involvement. Follow-up on information on Family Interest Survey. Review physical status, dental status, nutrition status and specialist status and any need for follow up and check-ups that are coming in the next year Follow-up on Health History information as needed. Follow-up on Nutrition Assessment/Handouts. Home Safety Checklist Updated Contact Information Form Release of Information Change of Status Family Picture (update existing) Family Ourcomes Assessment Family Partnership Agreement Home Safety Checklist LCC Registration Form Relevant brochures/articles will be given at visit and documented within 10 working days. Home safety card. Fire Drill Sheet. Activities: Forms: Documentation Ongoing Documentation of Family Contact Should be Recorded in Case Management Who/When/Where/What/Plan of Action Forms completed/forms turned in Action Plans/FLUP Referral/FLUP Update Contact Information Form. Education Check-in: child goals, IEP status, review Home Learning/In-Kind. Follow-up on child s attendance Review and/or follow-up on Family Partnership Agreement Make referrals as needed. Follow-up on previous referrals. Update Family Picture. Update Family Outcomes Assessment Discuss parent education opportunities and support groups. Encourage male involvement. Follow-up on information on Family Interest Survey. Review physical status, dental status, nutrition status and specialist status and any need for follow up and check-ups that are coming in the next year Follow-up on Nutrition Assessment/Handouts. Home Safety Checklist Review Sibling Application Transitions/Summer Information Update Contact Information Form Release of Information Change of Status Family Picture (update existing) Family Outcomes Assessment Family Partnership Agreement (update existing) Applications for siblings Home Safety Checklist (update) Handouts: Relevant brochures/articles will be sent following visit and documented within 10 working days. ***Staff to bring Community Resource Directory to home visit.*** (C: 06/06; R: 08/15)

6 LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP The Family Partnership Development Cycle FS/PI 1b Family Picture Extended Family/Friends/Support System Education Basic Needs Community Resources/Family Support Family/Pets Work/Past Work Experience Family Routines/Traditions/Language Mental/Family Relationships Family Health/Medical/Dental Temperament Legal Assistance Parenting/Child Development Transitions Family Interest Survey Parenting Family/Adult Ed and Employment Health/Nutrition Program Parent Leadership Program Activities Record/Monitor/Evaluate Families Progress Review progress with family Update Family Picture, Family Outcomes Assessment, FPA at home visit Follow-up within 10 days of service requested Monthly case management staffing with teacher (PI, Health/Nutrition, MH, Attendance, ED, SS) Significant contacts documented Family Outcomes Assessment Family Well Being Positive Parent/Child Relationships Family as Lifelong Educators Families as Learners Family Engagement in Transitions Family Connections to Peers and Community Families as Advocates and Leaders Family Partnership Agreement Goal (previous family goal) Small achievable steps What parent is responsible for What staff is responsible for Timeline (C: 02/09; R: 08/15)

7 FS/PI 2a Lower Columbia College Head Start/EHS/ECEAP Bus Pass Acquisition for Parents Procedures: Listed below are the steps for acquiring bus passes for the entire program for the month you are assigned as the designated staff member: 1. Staff will be assigned a month to be responsible for acquiring bus passes at pre-service. Staff will generate a list(s) of parents needing bus passes by utilizing the bus pass form for the following reasons: Head Start/EHS/ECEAP related functions and/or appointments. 2. The list will also include the parent s name, child's name and Loc ID. 3. The list needs to be submitted to the designated staff member no later than three (3) working days prior to the end of the month to process for the next month. If the lists are not received, staff is responsible for pursuing the passes for their parents. 4. The designated staff member will the bus pass list to the cashier s office at Sherri Akesson, sakesson@lcc.ctc.edu. The cashier s office will notify the staff member when the bus passes are ready for pick-up. 5. The designated staff member will then pick up the bus passes at the LCC Cashier s Office located on campus in the LCC Admissions Center. 6. The designated staff member or cashier will fill out the names of the parents on the bus passes. 7. The designated staff member will make copies of each bus pass after the parent's name has been inserted on the pass, then the designated staff member will write the name of the parent's child and LOC ID on the copy. 8. The copies are forwarded to the Fiscal Specialist at the LCC Head Start Center. 9. The designated staff member will distribute the bus passes by placing them in the appropriate staff mailbox with a copy of the monthly bus pass form. 10. Staff will also be responsible for providing a list of Foster Grandparents who need bus passes to the designated staff member. The center name should be written on the copy of the bus pass provided to the Fiscal Specialist. If you have any questions regarding the above procedure, contact your supervisor. (C: 08/99: R: 08/15)

8 FS/PI 2b LOWER COLUMBIA COLLEGE HEAD START / EHS / ECEAP Monthly Bus Pass Form Advocate: Center: Teacher: Month Needed: Parent Child Loc ID Foster Grandparents (C: 03/05; R: 09/10)

9 FS/PI 3a Lower Columbia College Head Start/EHS/ECEAP Case Management Policy The goal of Case Management is to build on strengths of children and families, provide support, services and resources as interest and need are determined. Case Management is documented in the ChildPlus.net and will be used to document the information gathered and contacts made with parents and significant family members of direct and indirect services. ChildPlus.net will be the central system component that is used for the systematic documentation that captures the picture of the entire family s strengths, needs, interests, concerns, goals, initial referrals, follow-up, referral outcomes, barriers, and satisfaction in the areas of all services provided by the staff within the program. Procedure Document on-going significant contacts with families in the ChildPlus.net with the first initial contact of the family. The person, who has the contact, should make the entry. The intake date initiates the process. ChildPlus.net will be kept up to date and will be utilized by all members of the team. See Family Services Data Guide for ChildPlus.net instructions. ChildPlus.net will be utilized for ongoing documentation and monthly staffings to review, summarize, share on-going information (absences, etc.) and update team members on family events, progress, changes, etc. (see Children and Family Staffing Meetings/On-going Assessment and Evaluation Policy and Procedure) FS/PI 3c. All progress and activities that are related to goal achievement will be documented. Policy complies with Head Start Performance Standard (C: 11/00; R: 03/15)

10 FS/PI 3c LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Children & Family Staffing Meetings (On-Going Assessment and Evaluation) Policy The integration of services within all components will occur in an on-going planning process for children and families throughout the year. Staff, parents, other service providers and professional agencies that are involved in the lives of the children and family will collaboratively plan and deliver services for all children and families. Procedure 1. Each child/family will be staffed at least once monthly. 2. Enter into ChildPlus.net to document and summarize the discussion at staffings in the areas listed under Staffing Guidelines below. 3. Head Start/ECEAP staff will use the Classroom Family Tracking Form to fill in dates, etc. of areas completed. 4. Review the events and actions in ChildPlus.net Family Services and cross check with the Health module. Address and update any follow-up items and discussion of new information on the child and family. 5. Head Start/ECEAP staffings will include: Teacher and Family Advocate. The Teacher Assistant, Area Manager and/or appropriate service providers/consultants may also attend as needed or required. 6. Complete staffings for families in crisis first. 7. Staffings of families include the following: Create an event for the monthly staffing. In the action notes, document any strengths and acknowledge accomplishments. Celebrate the family! Look at the big picture of the family s strengths, interests, un-met needs and goals. A new event and/or action is entered documenting decisions including actions to be taken, persons responsible, and timelines to be followed/met. Staff should document and refer to the appropriate form and location of the form. During the Monthly staffings, ensure all of the following service areas are addressed: Staffing Guidelines (Review and Discuss) Social Service Family Picture Family Partnership Agreement (FPA) Family Interest Survey Family Outcomes Assessment Additional Home Visits On-going Observations Follow-up and/or Referral status Crisis Intervention Inquiry of existing plans/steps in working with other agencies Bus Pass, if needed 1 (C: 11/00; R: 03/15)

11 FS/PI 3c Discuss each of the above- report the strengths, interests, concerns, and goals of the family. Discuss if a plan in any of these areas need to be developed, by whom, when, and if follow-up is needed. Tools: Family Picture, Family Partnership Agreement, Notes Home Form, Home Visit Plan Form, Anecdotal Form, Mental Health Request for Observation Form, Classroom Family Tracking Form, Family Outcome Assessment and Family Interest Survey. Mental Health On-Going Observation Discuss Social/Emotional Behavior Plan for Classroom, Home, and Plan & Learn (PAL) Transition Activities (Discuss any timely transition issues. Develop a plan if not already in place.) Follow-Up and/or Referral Status Crisis Interventions Physical Intervention Form ASQSE TS Gold EHS Health Consultant Forms Edinburgh Depressing Screening Discuss if a plan for behavior intervention needs to be developed, by whom, when, and if followup is needed and contact Mental Health Specialist as appropriate. Refer to and follow up on mental health recommendations. Tools: Application Form, Enrollment Form, FPA, Health Module, , Health Memo Form, Mental Health Request for Observation Form, Anecdotal Form, Notes Home Form, Classroom Family Tracking Form (Head Start/ECEAP), Parent Guardian Permission for Mental Health Observation, Parent Interview for Mental Health Observation, Mental Health Observation Report, DECA, Positive Behavior Support Plan, and Plan & Learn Socialization Form. Attendance To determine number of days child is absent and reasons for absence Barriers and/or strengths to attending Head Start/EHS/ECEAP and Play & Learn groups. Discuss if an attendance plan in this area needs to be developed. Document any changes and any progress, concerns or barriers to the child s attendance and write an action plan if necessary. Document who, when and if follow-up is necessary or needed. If the child is on an IEP/IFSP, ask the LEA/Part C specialist working with your child for feedback on the situation. Tools: Attendance and Meal Count Form, Attendance Tracking, and Attendance Agreement Plan with Parent/Guardian, Absence Form, EHS Home Visit Plan Forms, EHS Family Partnership Agreement Parent Involvement Parent/Guardian Program Involvement Status (i.e. classroom/pal attendance, classroom volunteer; policy council; parent meeting attendance/support groups; community meetings; curriculum planning; home visits) Home Learning 2 (C: 11/00; R: 03/15)

12 Follow-up status Discuss plan of action to acknowledge or to encourage parent involvement. FS/PI 3c Tools: Inkind/Sign-In Form, Parent Education Plan, Home Learning Form, Notes Home Form; Parent Meetings, Parent Committee Meetings, and Family Night Sign-In Forms; Policy Council Sign-In Form, IEP/IFSP Attendance and Family Interest Survey. Health/Nutrition Review Health Module events and actions. Family Health Insurance Status Ensure Children follow a Schedule of Well Child care Prenatal Health Status Child Health Status On-going observations Follow-up and/or Referral Status Medications taken by children in class/appropriate documentation in place Program Financial Assistance for Child/Prenatal Mom Health Services Assistance to parents to enable them to learn how to obtain any prescribed medications, aids or equipment for medical/dental conditions. Communicate to Disabilities/Health Nutrition Coordinator and Health Specialist, via or health memo, action scheduled or completed on health and/or dental follow-up and treatment. WIC Discuss if a plan in this area needs to be developed, plan of action, persons responsible, and timeline. Tools: Application Form, Enrollment Form, FPA, Medicaid & Basic Health Plan Application Forms, Health Module, , Health Memo Form, Health Documentation Request Form, Disabilities Database Reports, Anecdotal form, Notes Home Form, Classroom Family Tracking Form (Head Start/ECEAP), Student Accident Report Form, Adult Accident Report Form Education Learning Styles and Temperament Education Goals IEP/IFSP Goals Education Goals Status (updates, reviews) IEP/IFSP Status (review goals and update what is learned, determine next objective) TS Gold/On-Going Observation Strategies (Are they struggling in a domain or dimension, have you seen growth, have new skills been learned?) Vision, Hearing & Developmental or any other health concerns about the individual child that would affect the child s learning in a classroom. Include special accommodations for the classroom. Transition Activities (Discuss any timely transition such as school district busing, childcare, 2 ½ Year Transition Conference, or other situations. Develop a plan if not already in place.) Behavior Plan- classroom strategies and progress. Parent input for classroom planning and activities specific to the individual child. 3 (C: 11/00; R: 03/15)

13 Parent Involvement/Engagement ASQ/ASQSE Identify barriers to reaching goals. Other items pertinent to the child. FS/PI 3c Document the child s developmental progress, classroom strategies and individualization, and any changes, growth, concerns, barriers and write an action plan if necessary including persons responsible, and timeline. Tools: DIAL-4 Screening Tool, Teacher and Parent Questionnaire, Teaching Strategies Gold, ASQ/ASQ/SE Lesson Plan Form, Parent/Teacher Conference Form, Home Visit Plan Form, Child Profile, parent input, Kindergarten Transition, School Readiness Tool, Health Memo Form, Notes Home Form, Mental Health Request for Observation Form, Health Module, Disabilities Module, Classroom Family Tracking Form (Head Start/ECEAP), IEP/IFSP, Mental Health Observation Report and additional tools. Policy complies with Head Start Performance Standard ; (a) (d); ; ; (C: 11/00; R: 03/15)

14 NOTES HOME/AVISO FS/PI 3d TO/PARA: DATE/FECHA: FROM/DE: Teacher/Advocate Signature/Firma de la trabajadora Send White Copy Home If box is checked, please sign and return with requested information. Si este marcada la caja, firmalo y mandalo a la escuela. (C:08/98;R:07/02) NOTES HOME/AVISO FS/PI 3d TO/PARA: DATE/FECHA: FROM/DE: Teacher/Advocate Signature/Firma de la trabajadora Send White Copy Home If box is checked, please sign and return with requested information. Si este marcada la caja, firmalo y mandalo a la escuela. (C:08/98;R:07/02)

15 FS/PI 3e LOWER COLUMBIA COLLEGE HEAD START/ECEAP Classroom Family Tracking Form Policy Staff will document progress and information regarding families on the Classroom Family Tracking Form. This form will be ongoing, copied monthly and submitted with the End of the Month Report. Procedure 1. Staff will fill in the children's names, teacher name and location identification number on both pages of the Classroom Family Tracking Form. 2. This form is to be utilized as a tool for ongoing documentation. a. FS/PI 3f is for Family Advocate and Teacher model. b. FS/PI 3f1 is for Chile/Family Development Specialist model. 3. a. A blank box indicates that an item is not done or is pending. b. If there is an item that is not applicable, place an N/A in the box. 4. At monthly staffings, staff will review additions corresponding to events transpired and/or information received during the month and documented on the Classroom Family Tracking Form. 5. Staff will document all progress and dates under Events and Actions in ChildPlus.net. 6. Staff will use Classroom Family Tracking Form to verify that ChildPlus.net health information tab has most current and accurate information. 7. At the end of each month, the Classroom Family Tracking Form will be reviewed for completeness and accuracy, copied and submitted with the End of Month Report by the Family Advocate. 8. The Classroom Family Tracking Form is to be kept in the front of the classroom site files in a labeled folder. 9. If a child withdraws or transfers from the classroom, then a pencil line is to be drawn across the child's row on. a. DO NOT white out or blacken out the Child's information. b. See also Transition within Head Start/ECEAP Policy and Procedure (DISA 3b1) in the Education/Disabilities/Transportation Staff Handbook (Volume 3). (C: 07/02; R: 08/15)

16 FS/PI 3f1 Staff LOWER COLUMBIA COLLEGE HEAD START/ECEAP Classroom Family Tracking Form (EOM) Head Start Child/Family Development Specialist LOC ID Child's Name Entry Date W/D Date or Trsfr Date 45- day Date 90- day Date Dial 4 Date LEA Ref. Y or N Date IEP Date Parent/ Teacher Conference Date (Length) F S LCC ELC Enrollment () F W S FA 1st HV (Welcome Visit) Date (Length) FA 2nd HV Date (Length) FPA Date or O (Offered Date) FA 3rd HV Date (Length) Any Add. HV Date (Length) 1 (C: 08/15)

17 FS/PI 3f Teacher/Advocate LOWER COLUMBIA COLLEGE HEAD START/ECEAP Classroom Family Tracking Form (EOM) Family Advocate/Teacher LOC ID Child's Name Entry Date W/D Date or Trsfr Date 45- day Date 90- day Date Dial 4 Date LEA Ref. Y or N Date IEP Date Parent/Teacher Conference Date (Length) F W S Ed. Home Visit Date (Length) #1 #2 LCC ELC Enroll. () F W S FA 1st HV (Welcome Visit) Date (Length) FA 2nd HV Date (Length) FPA Date or O (Offered Date) FA 3rd HV Date (Length) Any Add. HV Date (Length) 1 (C: 07/02; R: 08/15)

18 FS-PI 4a1 Lower Columbia College Head Start/EHS/ECEAP Child Abuse & Neglect Signature Form I have received training on Child Abuse & Neglect and understand my responsibility to report Child Abuse and Neglect. Name (Please Print) Date Signature (C: 08/09; R: 08/12)

19 LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Child Abuse and Neglect Reporting Policy and Procedure FS/PI 4a Policy The mandatory reporting of Child Abuse Act (Section through 350-5) as amended (Supp. 1975) requires that school personnel must report suspected child abuse or neglect. State law (RCW ) requires all professional school personnel to report child abuse and neglect at the first opportunity, but within 48 hours of having reason to believe that child abuse or neglect has occurred. Reporting Procedure I. Who must report: All staff members; assistant teachers, teachers, family advocate staff, kitchen staff, office staff, bus drivers, bus monitors, etc. II. III. When to report: Anytime it is suspected that a child's physical or mental health or welfare may be affected by abuse or neglect. How to report: 1. Discuss concerns with Area Manager/EHS Supervisor or available member from the Leadership Team. 2. A decision will be made whether an official report needs to be completed. a. If the decision is to make a report: a written report will be completed and followed up with a telephone report to CPS. A copy of the written report will be kept in a separate confidential notebook in a locked file drawer behind the child/family site files. b. Document in Case Management that a report was made to CPS with a log entry stating, Community Referral Made. If more information is needed to be written, use an anecdotal and place it with the written report in the confidential notebook. c. If child transfers within the program, or at the end of the school year, the original CPS report(s) will be removed from the confidential notebook and will be placed in a sealed envelope labeled confidential. d. If the decision is not to report, detailed case management notes must be documented. 3. The written report original is to be given to your Area Manager/EHS Supervisor who will send the original to CPS, one copy to the Assistant Director, one copy to the Mental Health Consultant and one copy to be placed in the Confidential Notebook. 4. It is the responsibility of the CPS caseworker to notify the family of the referral unless assistance in doing so is requested by CPS staff. IV. Before you make the report, organize your information: The child's name, address, birthdate, parent's name, address, telephone, others living in the home (siblings/adults) and date of incident. 1. What causes you to suspect that abuse has occurred? Write: It appears it is physical, emotional, etc., abuse. 2. What exactly did the child say and under what circumstances? 3. Exactly where are any bruises or injuries, what do they look like and when did you first notice them? 4. What has the child said about the injuries? 5. Has the child's behavior changed recently? In what way? Has there been a chronic pattern of behavior? pg. 1 (C: 06/97; R: 08/13)

20 FS/PI 4a 6. What other signs and symptoms of abuse does the child exhibit? 7. What do you know about the child's family and home life? Extended family members? Race and ethnicity Family strengths that can help the parent(s) care for and protect the child(ren) Parent s socio-economic status Parents resources Previous history of mental health disorder History of substance use Parent s response to intervention, etc. 8. Is there any information about previous incidences of abuse or neglect? 9. Is there information on whether the mother or father is of American Native ancestry? V. What to report: 1. Infliction of physical injury on a child by other than accidental means, causing death, disfigurement, skin bruising, impairment of physical or emotional health or loss of impairment of any bodily function, and/or; 2. Creating a substantial risk of physical harm to a child's bodily functioning, and/or; 3. Committing or allowing to be committed any sexual offense against a child as defined in the criminal code, or intentionally touching, either directly or through clothing, the genitals, anus or breasts of a child for other than hygiene or child care purposes, and/or; 4. Allowing, permitting, encouraging, or engaging in the obscene or pornographic photographing, filming, or depicting of a child by any person. 5. Allowing, permitting, or encouraging a child to engage in prostitution by any person. 6. Committing acts that are cruel or inhumane regardless of observable injury. Such acts may include, but are not limited to, instances of extreme discipline demonstrating a disregard of a child's pain and/or mental suffering, and/or; 7. Assaulting or criminally mistreating a child as defined by the criminal code, and/or; 8. Failing to provide food, shelter, clothing, supervision, or health care necessary to a child's health or safety; 9. Engaging in actions or omissions resulting in injury to, or creating a substantial risk to the physical or mental health or development of a child; 10. Failing to take reasonable steps to prevent the occurrence of a) through g); 11. For any other reporting concerns, contact your Area Manager or other Leadership Team member. VI. Staff is available as advocates for parents. VII. Failure to pick up a child or be available for after school delivery: 1. In the event that no one is home at either the child's house or the alternate drop-off address, the child will be returned to the Head Start/EHS/ECEAP Center. The bus monitor or driver will notify the parent that the child has returned to the Center. It will be the parents' responsibility to pick the child up at the Center. Staff will try to contact all alternate care numbers listed. A member of the Leadership Team or their designee will call CPS one hour after the end of class, followed by a call to local law enforcement (Dispatch ). Staff will problem solve with parents so the problem does not reoccur 2. If the child is a drive-in and the parent fails to pick up the child, staff will try to contact all family information numbers. A member of the Leadership Team or their designee will call CPS one hour after the end of class, followed by a call to local law enforcement (Dispatch ). pg. 2 (C: 06/97; R: 08/13)

21 VIII. IX. FS/PI 4a Allegations against Head Start/EHS/ECEAP Staff: In the event that a Head Start/EHS/ECEAP employee is suspected of an act of abuse or neglect, a report shall immediately be made to the Area Manager, EHS Supervisor, Director, and/or Assistant Director. The Area Manager, EHS Supervisor, Director, and/or Assistant Director will take appropriate action according to the current Child Abuse Policy. A report will be filed with Child Protective Services. The Area Manager, EHS Supervisor, Director, and/or Assistant Director may take whatever action is necessary to ensure that children are safe until Child Protective Services and/or law enforcement (Dispatch ) has completed the investigation. If at a licensed center, the DEL licensor will be notified. Where to report: If the incident happened in the home involving a family member or if a parent was aware of the situation but failed to intervene in the child's behalf, it must be reported to CPS. Department of Social & Health Services Child Protective Services (CPS) P.O. Box Vine Street Kelso, WA During Business Hours: After Hours: FAX: (360) You have a legal responsibility to report child abuse when you have reasonable cause to believe abuse has occurred. Simply reporting this abuse to your supervisor does not fulfill your legal responsibility unless a report is made. pg. 3 (C: 06/97; R: 08/13)

22 LOC ID LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP CONFIDENTIAL Report of Child Abuse/Neglect FS/PI 4b NOTICE: Staff shall contact the appropriate community agency immediately and no later than 48 hours from the date and time the reporting staff member became aware of suspected abuse or neglect. A written report shall be submitted promptly to the agency to which a phone report was made. Child Protective Services (CPS) Business Hours: P.O. Box 330 Kelso, WA After Hours: FAX: Date and time of situation Date and time of call to CPS Spoke with Date and time of call to Law Enforcement Spoke with Name of Student Age DOB Address Phone Parent/Guardian Phone Primary Language Race/Ethnicity Names and ages of siblings (if known) Others in household and relationship to student (if known) Type of Suspected Abuse/Neglect (check all that apply) Physical Abuse Neglect Sexual Abuse Medical Neglect Emotional Neglect Sexual Exploitation Other Alleged Perpetrator Relationship to Victim(s) Specific Allegations (Describe specific behaviors, conditions, and symptoms of abuse/neglect. Include when and where incident(s) occurred and evidence of previous abuse or neglect.) Reporting staff member Signature of Reporter Leadership Team Member Contacted Leadership Team Member Signature Date & Time report completed Date & Time Date & Time All school personnel attending children and having reasonable cause to believe that children are suffering from physical, emotional, or sexual abuse or neglect, MUST report this fact to the Department of Social and Health Services or law enforcement. Staff need not verify that a child has in fact been abused or neglected. Verification is the responsibility of the agency to which the repot has been made. Parental notification is not required. The law permits photographing of the child to provide evidence of physical condition. Law against civil liability grants immunity. (RCW ) Original to: CPS/DSHS Copies to: Confidential Notebook, Area Manager, MH Consultant, Assistant Director (C: 06/97; R: 11/12)

23 FS/PI 4c LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Anecdotal Child's Name Teachers/Advocates Parent's Name Date Type of Contact TYPE OF CONTACT: C = Classroom HV = Home Visit T = Telephone O = Office (C: 03/94; R: 09/10)

24 Possible Abuse Indicators Indicators of Physical Abuse a) Unexplained bruises and welts on any part of the body; b) Bruises of different ages (various colors); c) Injuries reflecting shape of article used (electrical cord, belt buckle, ping pong paddle); d) Injuries that regularly appear after absence or vacation; e) Unexplained burns, especially to soles, palms, back or buttocks; f) Burns with a pattern from an electric burner, iron or cigarette; g) Robe burns on arms, legs, neck or torso; h) Injuries consistent with information offered by the child; i) Immersion burns with a distinct boundary line; j) Unexplained lacerations, abrasions or fractures. Indicators of Emotional Abuse a) Lags in physical development; b) Extreme behavior disorder; c) Fearfulness of adults or authority figures; d) Revelations of highly inappropriate adult behavior, i.e., being enclosed in a dark closet, forced to drink or eat inedible items. Indicators of Sexual Abuse a) Venereal disease in a child of any age; b) Evidence of physical trauma or bleeding to the oral, genital or anal areas; c) Difficulty in walking or sitting; d) Refusing to change into gym clothes; e) Child running away from home and not giving any specific complaint; f) Pregnancy at 11 or 12 with no history of peer socialization; g) Sexual knowledge, behavior, or use of language not appropriate to age level. Indicators of Sexual Exploitation a) Allowing, permitting, encouraging, or engaging in the obscene or pornographic photographing, filming, or depicting of a child by any person; b) Allowing, permitting, or encouraging a child to engage in prostitution by any person. Indicators of Physical Neglect a) Lack of basic needs (housing, clothing, food); b) Lack of essential health care and high incidence of illness; c) Poor hygiene on a regular basis; d) Inappropriate clothing in inclement weather on a consistent basis; e) Consistent lack of supervision, especially for long periods; f) Abandonment. FS/PI 4d Behavioral Indicators of Abuse and Neglect a) Wary of adult contact; b) Frightened of parents; c) Afraid to go home; d) Habitually truant or late to school; e) Arrives at school early and remains after school later than other students; f) Wary of physical contact by adults; g) Shows evidence of overall poor care; h) Parents describe child as "difficult" or "bad"; i) Inappropriately dressed for the weather - no coat or shoes in cold weather or long sleeves and high necklines in hot weather (possible hiding marks of abuse); j) Exhibit behavioral extremes: crying often or never, unusually aggressive or withdrawn and fearful. (C: 08/02; R: 06/10)

25 FS-PI 4e1 Lower Columbia College Head Start / EHS / ECEAP Procedure for On-Site Interview of Alleged Victims of Child Abuse Procedure The following guidelines should be observed when a victim or alleged victim of child abuse or neglect is to be interviewed by Child Protective Services (CPS) social worker and/or law enforcement officer at any site of Lower Columbia College Head Start / EHS / ECEAP. It is the responsibility of the CPS social worker or law enforcement, not Head Start / EHS / ECEAP staff, to notify parents of allegations and any other activity associated with the referral. Head Start / EHS / ECEAP staff shall refrain from informing parents of a referral or any activity associated the referral unless decided by specific consultation with the CPS social worker. It is the responsibility of the CPS social worker and/or law enforcement officer to inform the child s parent/guardian in a timely manner that: (a) A site interview has occurred; (b) The specifics of the allegations of abuse and neglect; and, (c) Disposition of the investigation. If the parent/guardian has any questions or concerns, the Head Start / ECEAP Area Manager or EHS Supervisor may refer the parent/guardian to CPS and/or the law enforcement officer. The CPS social worker or law enforcement officer must contact the Head Start / ECEAP Area Manager, EHS Supervisor or designee, present proper identification, and make known the name of the child to be interviewed. The Head Start / ECEAP Area Manager, EHS Supervisor or designee will provide a nonthreatening setting for the interview in which the child feels comfortable. The Head Start / ECEAP Area Manager, EHS Supervisor or designee, whose role is to observe in a neutral manner, may be invited to attend the interview. The Head Start / ECEAP Area Manager, EHS Supervisor or designee recognizes that in sensitive interviews depending on the age of the child and nature of the child abuse/neglect referral (such as child sexual abuse referrals), the involvement of a staff member may interfere with the investigation. The CPS social worker and/or law enforcement officer and/or team member will conduct the interview. In the event the CPS social worker has a Court order, or the law enforcement officer determines the need to remove the child from the Head Start / EHS / ECEAP program site, law enforcement will complete the necessary custody form and notify parents as per RCW Head Start / EHS / ECEAP will request that the CPS social worker and/or law enforcement officer sign acknowledgment that they are taking custody of the child. Per RCW the law enforcement agency or the Department of Social and Health Services (DSHS DCFS) investigating a report is hereby authorized to photograph such a child for the purpose of providing documentary evidence of the physical condition of the child. It is not appropriate for Head Start / EHS / ECEAP Programs and staff to substantiate abuse or neglect by photographs of the alleged child victim. (C: 09/03; R: 06/13)

26 FS/PI 4e Lower Columbia College Head Start/EHS/ECEAP Notification of Pick-up by Child Protective Services Police Officer's Name: Name of CPS Staff: Child's Name: Parent / Guardian Name: Date: Time: (C: 01/01; R: 09/10) FS/PI4e Lower Columbia College Head Start/EHS/ECEAP Notification of Pick-up by Child Protective Services Police Officer's Name: Name of CPS Staff: Child's Name: Parent / Guardian Name: Date: Time: (C: 01/01; R: 09/10)

27 Lower Columbia College Head Start/EHS/ECEAP Family Literacy Policy & Procedure FS/PI 5a Policy The goal of family literacy is to enable Head Start/EHS/ECEAP parents to develop and use literacy skills which enable them to become more active and effective participants in the community, in the workplace, in their child s education and development, and in their efforts to obtain economic and social selfsufficiency. Procedure 1. Offer parent literacy training that leads to economic and financial self-sufficiency through: Onsite ELL classes. Refer to GED programs. Onsite Parent Opportunity Program (POP) class. Early Learning Center (ELC) college credits to 3-5 program parents quarterly. Assist families to attend Lower Columbia College. Development of Family Literacy goals as appropriate in the Family Partnership Agreement (FPA) process. Development of family finance and/or budgeting goals as appropriate in the Family Partnership Agreement (FPA) process. Parent(s)/Guardian(s) in the 3-5 program participate in the Dial screenings, and the Teaching Strategies Gold Assessment. For the EHS program, parents/guardians participate in the ASQ/ASQSE, and the Teaching Strategies Gold Assessment. Parents attending and participating in the RIF readings in the classroom. From these events, fliers are sent home regarding the importance of reading to children. All Head Start/EHS/ECEAP children will receive a book at least 2 times per year. 2. Educate parents on how to be the primary teacher for their children and full partners in their child s education through: Home visiting activities with parent, child and teacher regarding early literacy and activities to build these skills. Parents and children are encouraged to practice these educational activities often in the home. Staff presenting Developmentally Appropriate Practice (DAP) at parent meetings. Education and support groups that help to educate parents on how to be the primary teacher for their children. Play and Learn (PAL) groups (EHS). 3. Provide interactive literacy activities between parents and their children through: Head Start/EHS/ECEAP s library is available for parents to check out literacy packs, books and videos. Encourage parents to create verbal or written books and stories in their home language. Providing a parent and child literacy event for centers at least one time per year. The literacy focused event topics may include free books, a Zoo-phonics activity, financial literacy information and GED/college information. 4. Provide age appropriate education to prepare children for success in school and life experiences through: Provide daily planned literacy activities in the Head Start/EHS/ECEAP classroom. Individual child learning plans developed around child literacy goals. Dial screenings and the ASQ/ASQSE. Invite guest readers from the community, parents and staff to read to the children in the classroom. Participating with the local library to: provide guest readers/puppet shows; coordinate field trips to local libraries; and to collaborate on providing families with library information (library cards for children and adults). Policy complies with Head Start Performance Standard (e)(4)(i) and (e)(4)(ii) (C: 11/06; R: 08/15)

28 LOWER COLUMBIA COLLEGE HEAD START/ECEAP End of Month Family Advocate Report FS/PI 6a Policy Family Advocates will track and submit reports of direct services, information, and referrals to all families in their caseload on a monthly basis. Procedure Attachments: Family Advocates submit one form monthly. Attachments indicated are to be submitted with the EOM report form. Copy of the Classroom Family Tracking Form Copy of completed Site File Review Forms Copy of Children Receiving Counseling Form (MH 8a) Copy of Parent Agreement Exclusion List (if changes) ECEAP ELMS Information: o Indicate that all parent activities and fliers have been placed in Center Notebook. o Indicate the date the Emergency Notebook was reviewed and current. Family Services: o Number of referrals to made to date: (from ChildPlus) o Number of child abuse/neglect reports made during the month. o Indicate revised and made current attendance tracking event o Indicate initiated attendance analyzing Parent Involvement: o List the number of adults by classroom attending activities. In the other space, write in additional activities such as family nights, etc. List information for each classroom on separate lines. Things that went well for me this month: o List the successes and accomplishments you have had which could include committees you ve served, program meetings, IEP meetings, etc. o Document your community involvement where you represented the program. My ideas, goals and plans for next month: o Under suggestions or ideas, include the thoughts or concerns you have for the program feedback regarding community referrals. I have attended and/or would like: o Under attended and/or would like, include the trainings you would like to attend. Please include any topics you would like any more information on. All reports are due by the 5 th of the month. Area Mangers then must compile information and submit their reports by the 10 th, so it is imperative that all reports are submitted on time. Policy complies with Head Start Performance Standards 45CFR Section , (a)(5), (a)(3)(iii), (a)(2), (b)(1), (b)(1)(i-iii), (d)(1), (f)(1), (h)(2), (h)(1). (C: 08/01; R: 08/15)

29 LOWER COLUMBIA COLLEGE HEAD START/ECEAP Family Advocate EOM Report FS/PI 6b NAME MONTH YEAR TEACHER NAME: AM PM Attachments: Copy of Classroom Family Tracking Form Completed Site File Review Forms Mental Health Report Form Parent Agreement Exclusion List Copy (if changes) ECEAP ELMS AM PM Information: Parent Meeting Agendas/Minutes/Flyers placed in your Center Notebook Yes No Emergency Notebook reviewed and current Date (i.e. medical concerns, medication side effects sheet, parent agreement contract, etc.) Family Services: Total number of referrals made to date: (from ChildPlus): Number of Child Abuse/Neglect reports made this month: Attendance tracking event reviewed and current Initiate attendance analyzing AM PM Date Date Parent Involvement: List the attendance of the following Parent Activities: HEAD START List by Classroom Parent Center Meeting Business Meeting Kids n Moms Kids n Dads POP ELL GED HS 21 Other Other ECEAP List by Classroom Report Due by the 5 th of the Month to your Area Manager. (C: 08/00; R: 08/15)

30 FS/PI 6b Things that went well for me this month: My ideas, goals and plans for next month: I have attended and/or would like: Report Due by the 5 th of the Month to your Area Manager. (C: 08/00; R: 08/15)

31 FS/PI 7a LOWER COLUMBIA COLLEGE HEAD START/ECEAP First Home Visit (Welcoming the Family) Gaining a Picture of the Child and Family (Social Service Home Visit #1) Policy Staff initiates the partnership process with parents to establish mutual trust and begin the process of getting a picture of the family in order to discover: the family s strengths, identify goals and identify needed or wanted services and other support. Procedure I. In order to welcome families to Head Start/ECEAP and share vital information about their child s transition into the Head Start/ECEAP program, the staff will conduct 1 st home visits with all families enrolled for the current year. II. The staff will review the child s file and ChildPlus.net prior to the home visit to familiarize themselves with the information already shared by the parent and/or agency that may have referred the family. III. The staff will call families to set up a schedule for welcome visits. This visit must be scheduled prior to parent orientation. The visit will be done in the home unless specifically requested otherwise by the parent. Staff will bring a welcome folder that will contain information referenced on FS/PI 1a: IV. The process for the visit is as follows: 1. Welcome the family to Head Start/ECEAP Program and explain the role of the Family Advocate, Teacher, and/or Child/Family Development Specialist. 2. Discuss important site information and dates and distribute any information requested at intake. 3. Communicate the importance of parent attendance at the Parent/Child Orientation/Open House. 4. Verify Contact Information Form, complete Change of Status form as applicable, parent and staff sign and date form. 5. Complete the Family Picture and Family Interest Survey with the family. When completing the Family Picture, use the topics in the boxes on the Family Picture to guide your discussion and to gather information. Briefly document shared information in the appropriate boxes. When completed, the Family Picture should give you a clear overview of the areas impacting the family s functioning, family s strengths, and any immediate needs. Use this to guide your Family Outcomes Assessment in ChildPlus.net. Basic needs are to be followed up on within ten working days. All referrals should be documented in Case Management. 6. Explain the goal-setting process to prepare families for developing partnership agreements. If this is the second year for the family, review the Family Partnership Agreement goal and update progress. 7. Discuss Health Items Physical: WCE, lead screening, treatment follow-up Dental: exam, treatment appointments, six month appointment Nutrition: food allergies, need for substitutions, WIC, dietary patterns, SNAP Specialist: vision, hearing, ENT, counselor 1 (C: 08/01; R: 08/15)

32 FS/PI 7a 8. Family Transportation Plan Discuss important of regular attendance and ask what the families plan is to get their child to school daily. 9. Completed Items Check as item is provided. 10. Things To Do Write one or two next items of action for the family and staff. 11. All families will be given the date and time of their Parent Orientation to attend with their enrolled child. V. As high needs families are identified, schedule their second Home Visits in order of urgency of needs. VI. Families coming into the program after September will receive their First Home Visit and orientation at the same time. This visit is to take place in the home setting in order to establish initial rapport and build trust with the family. Following initial intake, it is the responsibility of staff to schedule First Home Visits within two days after initial intake. Following the Home Visit I. Following the Home Visit, using a confidential envelope, the staff will send resource information in the areas the family indicated a need for assistance. If there is a problem with literacy level of the parent/guardian, staff will hand deliver and review the information with the parent. Document the date the information was sent in Case Management. II. Guidelines for documenting the visit in Case Management: Date of visit, brief description of the visit, any concerns, barriers, referrals, action plan and follow-up. Document completion in the outcome/follow-up section and make entry of outcome. Document visit on the Classroom Family Tracking Form. Record all attempts made by staff to contact the family. List all follow-up that is needed and who will do it. Share any concern or information that came up at the visit with other staff members as appropriate. Policy complies with Head Start Performance Standard (C: 08/01; R: 08/15)

33 Lower Columbia College Head Start/EHS/ECEAP Family Picture FS/PI 7b Child s Name: Parent s Name: LOC ID: What do you enjoy doing as a family? Basic Needs (food banks, SNAP, winter clothing, energy assistance) Education (parent) What are your child s favorite things to do? What is your child good at? Family Health/Medical/Dental Why did you choose this program for your child? What skills were you hoping your child would gain? Community Resources/Family Support Work Past/Work Experiences Family/Pets Mental Health/Family Relationships What are your family routines/customs/traditions/ special events? What comforts your child? Original to be placed in site file. Copy to be placed in lesson plan. (C: 06/00; R: 07/15)

34 Please share some stories that your family feels proud about: 1. FS/PI 7b Parenting/Child Development and Child Social Emotional Development What is your child s learning style? Legal Assistance Transitions (school, family, life) Temperament What information about your child would be helpful to the teacher? Easy Slow to warm Fiesty Date: Family Partnership Goal Existing plan with another agency? If yes, what is existing plan? Yes or No Original to be placed in site file. Copy to be placed in lesson plan. (C: 06/00; R: 07/15)

35 P A R E N T I N V O L V E M E N T You are your child s first and most important teacher every day. When you support learning at home, your child learns faster and more easily at school When you show your child you care enough about education to be involved, they care too. Your support and encouragement gives your child confidence in their abilities in and out of school. I m p o r t a n t I n f o r m a t i o n Your Teacher: Your Teacher s Classroom Phone: _ Classroom #/Building: Your Family Advocate: Your Advocate s Advocate s Phone: _ Main Office Phone: (360) W e l c o m e t o L o w e r C o l u m b i a C o l l e g e H e a d S t a r t / E H S / E C E A P Orientation: Your involvement throughout your child s education is the biggest contribution that you can make to help him or her achieve success and happiness in life. Slow Start Date: Child s School Schedule: PARENT INVOLVEMENT FS/PI 7c (C: 06/10; R:08/15)

36 HOME You might be surprised how many important life skills you can teach at home. Simple, inexpensive activities are great learning opportunities for your child. Here are a few ideas. Reading 20 minutes a day makes a big difference in literacy. Play Games Almost anything can be a game. Sort the laundry, look for numbers at the store, play cards, have fun. Keep A Routine Have a daily schedule of mealtime, bath time, bed time, etc. Take Good Care Exercise (be active), eat healthy, brush teeth, get plenty of sleep. Home Learning Remember to fill out and turn in your Home Learning forms at the end of each month! SCHOOL Volunteering in the program is one of the most important components. We encourage you to get involved; the benefits to your child are huge. Here are ways you can volunteer: Help in the Classroom Assist with classroom activities, have lunch with your child, work on a special project, share a unique talent with the class. Parent Meetings Mark your calendar every month to attend! There are always fun activities, good food and great speakers. Parent Opportunities Parent Meetings, Support Groups, Health Care Institute (HCI), etc. Parent Leadership Policy Council, Parent Center Committees, Room Representatives and State Representatives Volunteering is great on-the-job training. Many activities you participate in can help you develop important job skills like organizing people and tasks, operating office equipment, meeting schedules, and teaching children. COMMUNITY We will help you connect with resources in your community to improve the education, health and well-being of your child, family, and YOU. Adult Educational Opportunities GED, POP (Parent Opportunity Program/Transitions), ELL, and college opportunities are available. Health Care Remember immunizations, physical and dental exams are required. A healthy family is a happy family. Personal Support Community agencies and programs are available to assist when needed. It is your right and privilege to access services the community has to offer.

37 P A R T I C I P A C I Ó N D E P A D R E S Todos los días usted es el maestro mas importante de su niño. Cuando usted apoya el aprendizaje en casa y en la escuela, su niño aprende mas rápido y con mayor facilidad. Cuando le demuestra a su niño que a usted le interesa su educación lo suficiente para participar, a el también le interesará. Su apoyo y respaldo le da al niño confianza en sus habilidades dentro y fuera de la escuela. La mayor contribución que usted puede hacer para ayudar a su hijo a alcanzar el éxito y la felicidad, es participar en su educación. I n f o r m a c i ó n i m p o r t a n t e Su Maestra: Correo electrónico de su maestra: Teléfono del Salón: _ # de Salón/Edificio: Su Trabajadora Social: Correo electrónico de su T. Social: Teléfono de la T. Social: Interprete: Teléfono de la Interprete: Teléfono de la Oficina: (360) Orientación: Primeros Días de Clases: B i e n v e n i d o s a L o w e r C o l u m b i a C o l l e g e H e a d S t a r t / E H S / E C E A P PARTICIPACIÓN DE PADRES FS/PI 7c (C: 06/10; R: 08/15)

38 CASA Usted puede sorprenderse de cuantas habilidades importantes de la vida diaria puede enseñar en su casa. Actividades simples, sin costos son oportunidades de aprendizaje para su niño. Aquí hay algunas ideas. Leer 20 minutos al día hacen una gran diferencia en el aprendizaje. Juegos Casi todo puede ser un juego. Separar la ropa, buscar números en la tienda, jugar cartas, tener diversión. Mantener una Rutina Tener un horario fijo para las comidas, para bañarse, para acostarse, etc. Cuidarse Hacer ejercicio (estar activo), comer saludable, cepillarse los dientes, dormir lo suficiente. Aprendizaje en Casa Recuerde llenar las forma del Aprendizaje en Casa y entregarlas al final de cada mes! ESCUELA Ser voluntario en el programa es uno de los componentes más importantes. Nosotros lo invitan a que participe; los beneficios para su niño son inmensos. Estas son algunas maneras de cómo usted puede participar: Ayuda en el Salón Ayudar con las actividades del salón, comer con su niño, trabajar en un proyecto especial, compartir un talento único con la clase. Reunión de Padres Marque su calendario cada mes para asistir! Siempre hay actividades divertidas, buena comida e invitados especiales. Oportunidades para los Padres Reuniones de Padres, Amor y Lógica, Como Hablar Para Que Sus Niños Escuchen, Health Care Institute (HCI), etc. Representación de Padres Mesa Directiva, Comités de Padres de los Centros, Representantes de los Salones y Representantes del Estado. Ser voluntario es buen aprendizaje para-un trabajo. Muchas actividades en las cuales usted participa le pueden ayudar a desarrollar habilidades importantes para un trabajo, como organizar personas y actividades, utilizar aparatos de oficina, programar reuniones y enseñar a los niños. COMUNIDAD Nosotros le ayudará a conectarse con los recursos en su comunidad para mejorar la educación, salud y bienestar de su niño, familia y la de USTED. Oportunidades de Educación para Adultos GED, POP (Programa de Oportunidades para Padres/Transiciones), ELL, y oportunidades disponibles para el colegio. Cuidado de la Salud Recuerde que las vacunas, exámenes físicos y dentales son necesarios. Una familia sana es una familia feliz. Apoyo Personal Programas y agencias de la comunidad están disponibles para ayudarle cuando lo necesite. Es su derecho y privilegio tener acceso a los servicios que la comunidad ofrece.

39 Date LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Health/Nutrition Intake (Birth 12 months) Child's Name Birth Date / / Male Female FS/PI 7e1 Loc ID # HEALTH COVERAGE: 1. Date of last Well Child Exam Date of next Well Child Exam 2. Does your child have medical coverage? Yes No 3. Please check type of medical coverage: Medicaid/DSHS (Healthy Options) WA Basic Health Plus CHIP Private Insurance 4. Does parent have medical coverage? Yes No Type BIRTH INFORMATION: 1. Type of Delivery: Vaginal C-Section 2. Birth Weight: lbs. oz. Birth Length: inches Head Circumference: 3. Gestational Age weeks 4. Did mother receive prenatal care? Yes No If yes, when did care begin? 5. What type of facility was your baby born at? Hospital Home Other 6. Name of facility: Length of stay: 7. Did the mother have any health problems during this pregnancy/delivery? 8. Did the baby have any problems at birth? 9. Was caffeine used during your pregnancy? 10. Were drugs/alcohol or cigarettes part of family life during pregnancy? Yes No CHILD S HEALTH INFORMATION: Allergy Anemia Bruising Colic Constipation Diabetes Diarrhea Ear Problems/Infections Eczema Heart Problems Low Birth Weight Respiratory Problems Seizures Sickle Cell Yellow Jaundice Other Cerebral Palsy Downs Syndrome Exposure to Lead Exposure to TB Fetal Alcohol Surgery Past Yes Current No 1 Explain All Current Conditions (including medications) & State Follow-Up Plans: Explain All Current Conditions (including medications) & State Follow-Up Plans: (C: 04/10; R: 03/14)

40 HEALTH/NUTRITION INTAKE - Page 2 of 3 Child's Name FS/PI 7e1 Loc ID # MEDICATION: 1. Does your child take medication on a regular basis? Yes No If yes, what? 2. Will your child need this medication while in care? Yes No 3. Does your child have medication for emergency use? Yes No If yes, what? DEVELOPMENTAL HISTORY: 1. Does your child sleep on his/her? stomach back side 2. How do you put your child to sleep? 3. How many hours does your child sleep in a 24-hour period? Most of Time Some Times Rarely Never Does your child arch/stiffen when picked up? Does your child make eye contact when being fed or held? Do you have concerns about your child s sleep pattern? Does your child look at objects and follow them with his/her eyes? Does your child make sounds like ah, eh, uh? Does your child respond to your voice by looking at you? Does your child have different cries when he/she is upset, uncomfortable, happy? Does your child suck her/his hand or thumb? Does your baby hold her/his head steady when being held? Do you need assistance getting a car seat for your baby? Do you have any concerns about your child s development? ENVIRONMENTAL INFORMATION: 1. Does anyone in your household smoke inside the home? Yes No If yes, handout: 2. Does anyone smoke when in a car with your child? Yes No If yes, handout: DENTAL INFORMATION: 3. Does your child have dental coverage? Yes No 4. Do you clean your child s gums and/or teeth? Yes No 5. Do you have any family dental concerns? Yes No 6. Is there fluoride in your water? Yes No Unknown 7. Do you have a dentist for your child? Yes No 8. Does your child take a fluoride supplement? (6 mos./over) Yes No FEEDING/NUTRITION: 1. Do you breast feed your child? Yes No How often? times/24 hrs 2. Does your child drink from a bottle? Yes No How often? times/24 hrs 3. Do you feed your child formula? Yes No How much per feeding? oz/bottle If yes, what brand? 4. What kind of bottle do you use? Nipple type? 5. What do you put in the bottle? 6. Does your baby drink a bottle in bed? Yes No 7. Does your child take a vitamin supplement? Yes No 8. Does your child take a prescribed iron supplement? Yes No 9. Do you give your child milk? Yes No If yes, what kind? 2 (C: 04/10; R: 03/14)

41 HEALTH HISTORY - Page 3 of 3 Child's Name FS/PI 7e1 Loc ID # 10. Which of these foods do you offer your child? (circle) Eggs Poultry Vegetables Bread Fruit Fish Meat Cereal Rice Juice 11. Any known food allergies? 12. Do you have any questions/concerns about feeding your baby? Yes No If yes, what? 13. Do you have any concerns about your child s growth? Yes No If yes, what? 14. Is your child on WIC? Yes No 15. What concerns do you have about your family s nutritional health? Weight Issues Child Adult Appetite Child Adult Having enough food for each month. ESH staff provided resource info: Budgeting (EHS staff initials & date) Meal Planning Shopping Tips Healthy Eating Child Adult Cultural/Religious Preferences? (Please list) Special Diet? (Please list) Other I would like to discuss my concerns with the nutritionist. List Health And Nutrition Education Resources Shared With Parents: Lead and Your Kids Nutritional Information Oral Health Information Fluoride Information Other (please list) I would like to participate on the Nutrition/Food Service Committee. I would like to participate on the Health Services Advisory Committee. Parent/Guardian Signature Staff Signature Interpreter Health Specialist or Health Consultant Date Date Reviewed with Parent Date Date 3 (C: 04/10; R: 03/14)

42 Child's Name Loc ID # Lower Columbia College Head Start//EHS/ECEAP Health History/Nutrition Intake (1 to 5 years of age) Date HEALTH INSURANCE STATUS: 1. Head Start/EHS/ECEAP Child? Yes No Type 2. Parent/Guardian? Yes No Type 3. Siblings? Yes No Type Birthdate FS/PI 7e AM/PM RETURNING CHILDREN ONLY: Child s Primary Health Insurance Coverage (PIR) Please check only one box: Medicaid/Apple Health and/or CHIP (CHPW, Molina, ProviderOne) (Open Medical Coupon, Health Options & BHP-Plus) Private Health Insurance Other Health Insurance: (Military Health, Tri Care, CHAMPUS, etc.) No Health Insurance Child s Continuous and Accessible Medical and Dental Care (PIR) Please check each applicable box: Child has an ongoing source of continuous, accessible health care. Child received medical services through the Indian Health Service. Child received medical services through a migrant community health center. Child has an ongoing source of continuous, accessible dental care provided by a dentist. PREGNANCY: 1. Were you told that your child was born early or premature? How early? 2. Were there significant complications during pregnancy? 3. Were drugs, alcohol or cigarettes part of family life during pregnancy? 4. Is there any additional information that you would like to share regarding your pregnancy? PHYSICAL, PSYCHOLOGICAL & SOCIAL DEVELOPMENT 1. Please explain any problems, worries or fears your child may have such as separation anxiety, difficulty with transitioning from one activity to the next, nightmares, sleepwalking, aggression towards others, etc. 2. Do you have any concerns regarding your child's interactions with other adults and children? Yes No If yes, please explain: 3. My child naps during the day: Sometimes Always Never 4. In a 24-hour period, how many hours does your child sleep? 5. Has your child received counseling? Yes No Currently Counselor s Name 6. Does anyone in your household smoke inside the home? Yes No 7. Does anyone smoke in a car with your child? Yes No (C: 06/99; R: 08/15)

43 HEALTH HISTORY - Page 2 of 6 Child's Name Loc ID # FS/PI 7e AM/PM DISEASES OR CONDITIONS IN FAMILY 1. Please explain any current major health concerns for any member of your family: 2. Please give any diseases or conditions which seem to run in your family that are pertinent to your child's development. HOSPITALIZATIONS AND ILLNESSES: 1. Please explain if your child has been hospitalized, seriously ill, required surgery, has had a serious accident, or been chronically ill since birth. VISION AND HEARING: 1. My child... (indicate those which apply) has trouble hearing has or has had ear tubes history of ear infections has trouble seeing wears or is supposed to wear glasses HEALTH PROBLEMS Explain All Current Conditions (including Past Current medications) & State Follow-Up Plans: 1. Chicken Pox 2. Strep Throat/Tonsilitis 3. Bronchitis 4. Pneumonia 5. Fevers 6. Headaches 7. Tiredness 8. Joint Pain 9. Dizziness 10. Bruising 11. Vomiting 12. Diarrhea 13. Constipation 14. Stomach Aches 15. Hepatitis 16. Eczema 17. Urination/Bedwetting Discussed with PCP? Yes No FA Recommended Informing PCP 18. Child Wears: Diapers Pull-ups Underwear CONDITIONS REQUIRING A SPECIFIC PLAN OF ACTION AT THIS TIME: 1. My child has a life threatening illness: No Yes If yes, please explain: (C: 06/99; R: 08/15)

44 HEALTH HISTORY - Page 3 of 6 Child's Name Loc ID # FS/PI 7e AM/PM 2. Please check all applicable diagnosed conditions and complete a specific plan for each: Asthma Seizure/Convulsions Cerebral Palsy Diabetes Anemia Bee Stings Cystic Fibrosis Heart Problems Immuno Compromised None Allergies (i.e., food, medication, latex) explain: Other Condition(s) Name of Condition: Past Current* (*Please answer the following if this is a current condition and/or concern.) a. Known Causes: b. Signs & Symptoms: c. Date of Last Occurrence: d. Current Action Plan (Plan of Care): e. Emergency Action Plan: (A copy of a written plan of action, from the child's Primary Health Care Provider is required. Fax for plan.) f. Medication: Name: Dosage: Frequency: Additional Information: g. Specialist Name (complete a release): h. Child Last Seen for Condition: Date: Provider Name: Name of Condition: Past Current* (*Please answer the following if this is a current condition and/or concern.) a. Known Causes: b. Signs & Symptoms: c. Date of Last Occurence: d. Current Action Plan (Plan of Care): e. Emergency Action Plan: (A copy of a written plan of action, from the child's Primary Health Care Provider is required. Fax for plan.) f. Medication: Name: Dosage: Frequency: Additional Information: g. Specialist Name (complete a release): h. Child Last Seen for Condition: Date: Provider Name: DENTAL: 1. Has child complained of pain in teeth or gums? Past Present No 2. Have you noticed cavities in your child's teeth? Past Present No 3. Does your child suck his/her thumb? Use a pacifier? Yes No 4. Is there fluoride in the water at home? Yes No If no, receiving fluoride supplement? Yes No TUBERCULOSIS SURVEY: 1. Has your child ever received a PPD (TB Skin Test)? Yes No 2. Is your child in regular contact with anyone who has had a positive PPD (TB Skin Test) or has ever been treated for tuberculosis (latent or active)? Yes No Comments If answer to question 2 is yes, staff recommend further follow-up with child's Primary Health Care Provider: (staff initials & date) OTHER: PLEASE LIST ANY SPECIALIST THAT MAY HAVE SEEN YOUR CHILD DURING THE PAST TWO YEARS AND THE REASON THEY WERE EXAMINED, ASSESSED OR EVALUATED: (C: 06/99; R: 08/15)

45 HEALTH HISTORY - Page 4 of 6 Child's Name Loc ID # FS/PI 7e AM/PM Name: Reason: Name: Reason: (Please complete release forms for specialists listed above) PHYSICAL ACTIVITY: 1. Did your child participate in physical activity (ex: walking or riding a bike) in the past week? Yes No If yes, how many days and how long? Number of days Total hours per day 2. Does your child spend more than 2 hours per day with screen time (tablets, phones, computer games, etc.)? Yes No If yes, how many hours per day? (2-5 years old: If more than 2 hours per day, give limit screen time handout.) (staff initials) (If any screen time under the age of 2, give limit screen time handout. (staff initials) NUTRITION INTAKE FOR 12 TO 36 MONTHS (EHS): Estimate how many servings your child eats of these food groups EACH DAY: Milk, Yogurt & Cheese Group GOAL: 4-6 servings / day Milk or breast milk: ½ cup or 120 ml Cheese: ¾ oz or 20g Cottage cheese: ¾ cup or 180 ml Yogurt, pudding, custard made with milk: ½ cup or 120 ml 2 3* 4 5 more Fruit Group Fresh: ¼ - ½ small Canned or frozen: 2-3 tbsp Juice: 1/8 cup or 30 ml 1* more Bread, Cereal, Rice & Pasta Group GOAL: 2-4 servings / day GOAL: 6-11 servings / day ¼ - ½ slice of bread, tortilla, roll, muffin, pancake or waffle Dry cereal: ¼ cup to ½ cup Noodles, rice, cooked cereal: 1/8 cup to ¼ cup Crackers: 1-2 small 1 2 4* 6 8 more Meat, Poultry, Fish, Dry Beans, Eggs & Nut Group GOAL: 2-3 servings / day Animal Protein: Meat, chicken turkey, fish: 1 tbsp or 15 ml Eggs: ½ egg Vegetable protein: Cooked dry beans, lentils: ¼ cup or 60 ml Peanut Butter: 1 tbsp or 15 ml Tofu: ¼ cup or 60 ml 1* more Vegetable Group Cooked/Raw: 2-3 tbsp 1 2* 3 4 more NUTRITION INTAKE FOR 3 TO 5 YEARS OLD: Estimate how many servings your child eats of these food groups EACH DAY: Milk, Yogurt & Cheese Group ½ cup or 1 oz. servings: 2 3* 4 5 more Fruit Group ½ piece or 2 oz. juice servings 1* more GOAL: 3-5 servings / day GOAL: 4-6 servings / day GOAL: 2-4 servings / day (C: 06/99; R: 08/15)

46 HEALTH HISTORY - Page 5 of 6 Child's Name Loc ID # FS/PI 7e AM/PM Bread, Cereal, Rice & Pasta Group GOAL: 6-11 servings / day ½ slice or ¼ cup servings 2 4* 6 8 more Meat, Poultry, Fish, Dry Beans, Eggs & Nut Group GOAL: 2-3 servings / day 2 slices lunch meat or 2 tablespoons peanut butter or 2 fish sticks or 2 ounces (1/2 deck of cards) meat/poultry 1* more Vegetable Group GOAL: 3-5 servings / day ¼ cup cooked or ½ cup raw servings 1 2* 3 4 more Does your child have food allergies or food intolerances? Yes No If yes, What food(s)? What is reaction? If reaction is life threatening, faxed Anaphylaxis Emergency Plan form to Primary Health Care Provider. What does parent/guardian substitute? Cow s Milk Substitution: If parent/guardian wants our program to provide child Soy Milk, Lactose Reduced or Lactose Free Milk or if parent/guardian wants to provide Organic Milk, then have the parent/guardian complete a Request for Fluid Milk Substitution form. Completed Request for Fluid Milk Substitution Form Parent Requests Substitute Soy Milk Lactose Free Milk Lactose Reduced Milk If a parent/guardian wants our program to provide their child water, Almond Milk, Rice Milk or another Fluid Food as a substitute for cow s milk, then a Medical Disability Statement for Food Substitutions must be faxed to the child s doctor for completion. Parent requests substitute other (Almond, Rice, etc.) Faxed request letter to Health Care Provider with Medical Disability Statement for Food Substitutions. Food Substitution Food Other Than Milk: If a parent/guardian does not want a food offered to their child (for other than religious reasons) then a Medical Disability Statement for Food Substitutions and a Non-Disabling Medical Condition Statement are to be faxed to the child s Primary Care Provider for completion. Faxed request letter to Health Care Provider with Medical Disability Statement for Food Substitutions and Medical Non-Disabling Statement for Food Substitutions. What does your child eat for snacks? What does your child drink for snacks? *Note on database (*snacks are sugar and fat) (*sugared beverages) Does your child take vitamins? Yes No What kind? Do they contain iron? Yes No Were they prescribed? Yes No Is the enrolled child receiving WIC services? Yes No (C: 06/99; R: 08/15)

47 HEALTH HISTORY - Page 6 of 6 Child's Name Loc ID # FS/PI 7e AM/PM What concerns do you have about your family's nutritional health? Weight Issues Child Adult Appetite Child Adult Having enough food for each month. DST Provided Resource Information: Budgeting (DST initials & date) Meal Planning Shopping Tips Healthy Eating Child Adult Cultural/Religious Preferences? (Please list) Special Diet? (Please list) Other I would like to discuss my concerns with the nutritionist. I would like to participate on the Nutrition/Food Service Committee. I would like to participate on the Health Services Advisory Committee. Parent/Guardian Signature Staff Member Signature (C: 06/99; R: 08/15)

48 FS PI 7f Lower Columbia College Head Start/EHS/ECEAP PIR Enrollment Questionnaire Child s Name: Date: Loc ID: Child s Race Please check all that apply. Asian Black White Other: American Indian/Alaska Native Hawaiian/Pacific Islander Multi-Racial Hispanic Yes No Child s Primary Health Insurance Coverage Please check only one box. Medicaid and/or CHIP (CHPW, Molina, ProviderOne) (Open Medical Coupon, Healthy Options & BHP-Plus) Private Health Insurance Other Health Insurance: (Military Health, Tri Care, CHAMPUS, etc.) No Health Insurance Child s Continuous & Accessible Medical & Dental Care Please check each applicable box. Child has an ongoing source of continuous, accessible health care? Child received medical services through the Indian Health Service? Child received medical services through a migrant community health center? Child has an ongoing source of continuous, accessible dental care provided by a dentist? If child is currently in Child Care, Name of Provider Phone Is family approved for child care through Child Protective Services (CPS), including Family Assessment Response (FAR)? No Yes If yes, enter number of approved hours per week. Do you receive WCCC? Yes No Past participation in Head Start/EHS/ECEAP? No Yes If yes, Within past 3 years? Transferred from another Head Start/ECEAP? How did you hear about Head Start? Family Information Please check each applicable box. Homeless Family Active Military Receiving SNAP Receiving WIC (child and/or family) Referred by Child Welfare Agency Primary Parent/Guardian s Race Please check all that apply. Asian Black White Other: American Indian/Alaska Native Hawaiian/Pacific Islander Multi-Racial Hispanic Yes No Routing: Original: Administration Office, enter on ChildPlus Site File (C: 08/03; R: 02/15)

49 Primary Parent/Guardian Education Level Please check highest level. Grade 9 or less Grade 10 Grade 11 Grade 11 Grade 12 High School Graduate GED College or Advanced Training FS PI 7f College Degree/Trng. Associate s Bachelor s Master s Are you currently working? No Yes Full Time (35 hours or more each week) Part Time (Less than 35 hours each week) Seasonally Employed Retired Unemployed Disabled Name of Employer: Phone: Number of hours per week in paid work plus work-related travel: Are you currently in school? No Yes, where? Goal or Major: Full Time Part Time Number of hours per week in class and related travel when school is in session: Is parent/guardian in an approved WorkFirst activity other than employment, education or job training mentioned above? No Yes, describe activity and number of hours per week in approved activity and related travel: Secondary Parent/Guardian s Race Please check all that apply. Asian Black White Other: American Indian/Alaska Native Hawaiian/Pacific Islander Multi-Racial Hispanic Yes No Secondary Parent/Guardian Education Level Please check highest level. Grade 9 or less Grade 10 Grade 11 Grade 11 Grade 12 High School Graduate GED College or Advanced Training College Degree/Trng. Associate s Bachelor s Master s Are you currently working? No Yes Full Time (35 hours or more each week) Part Time (Less than 35 hours each week) Seasonally Employed Retired Unemployed Disabled Name of Employer: Phone: Number of hours per week in paid work plus work-related travel: Are you currently in school? No Yes, where? Goal or Major: Full Time Part Time Number of hours per week in class and related travel when school is in session: Is parent/guardian in an approved WorkFirst activity other than employment, education or job training mentioned above? No Yes, describe activity and number of hours per week in approved activity and related travel: Routing: Original: Administration Office, enter on ChildPlus Site File (C: 08/03; R: 02/15)

50 Additional Child (in the home) Name: Gender: Female Male Race Please check all that apply. Asian Black White Other: Additional Child (in the home) Name: Gender: Female Male Race Please check all that apply. Asian Black White Other: Additional Child (in the home) Name: Gender: Female Male Race Please check all that apply. Asian Black White Other: Additional Child (in the home) Name: Gender: Female Male Race Please check all that apply. Asian Black White Other: Date of Birth: American Indian/Alaska Native Hawaiian/Pacific Islander Multi-Racial Date of Birth: Date of Birth: Date of Birth: Hispanic Yes No FS PI 7f Emergency Contact Name: (First, Last) (Relationship) Address: City: State: Zip: Telephone: (Cell) (Home) (Work) Routing: Original: Administration Office, enter on ChildPlus Site File (C: 08/03; R: 02/15)

51 Lower Columbia College Head Start/ECEAP Parent Agreement Exclusion List FS/PI 7g1 Teacher LOC ID Child's Name Screenings Fluoride Varnish Assessments Photos/ Videos in Classroom to be Used in Classroom Activities Photos/ Videos Public Use Social Media Field Trips Name, Address, Phone to PC Rep. Transportation Release Dental and Medical Treatment OK to Provide Bus Transportation Distribution: Area Manager Front of File Drawer Emergency Notebook Inside Cupboard Door (C: 02/03; R: 12/13)

52 LOWER COLUMBIA COLLEGE HEAD START/ECEAP Parent Agreement Contract FS/PI 7g Child s Name: (Last) (First) (MI) I understand and agree to the following: 1. My child is to have a well child physical exam (within 90 days), a dental exam (within 90 days), and be immunized according to Washington State law before attending class. In addition, I agree to complete any needed medical or dental follow-up in a timely manner. If I have no financial resources, the program will arrange for these services as needed. 2. My child s records are available for me to review. The information is confidential and will not be released to anyone outside of this program without my written permission. 3. I am responsible for my child s daily attendance. My child will attend every program day he/she is able. I will call and give a note to the teacher if my child is absent, which states the reason and date(s) for absence. 4. If transportation is provided, I or an authorized person, need to put my child on the bus and take him/her off at scheduled times. 5. I will contact my Teacher/Family Advocate to add/delete persons from my authorized persons and emergency contact list in order to keep information current. 6. I will be available for scheduled Teacher/Family Advocate home visits, Parent/Teacher Conferences and will attend a classroom orientation on my child s first day of class. 7. There is not a fee for this program, but I understand the importance of contributing my time as a volunteer, i.e., in the classroom, special projects, home activities, etc. 8. Head Start/ECEAP staff are mandatory reporters and report any suspected incidents of child neglect or abuse as required by Washington State law. 9. I understand as an enrolled parent in the program I am expected not to use or be under the influence of drugs, alcohol or tobacco during my scheduled home visit or parent/teacher conference. 10. I understand that Head Start/ECEAP participates in Early Achievers and uses Teaching Strategies Gold to assess children s growth and development. I have been advised and give my permission for the following: Yes No 11. Head Start/ECEAP to perform the following screenings: Hearing, Visual Acuity Strabismus, Height/Weight, Dental and Developmental. 12. Photographs or videos may be taken of my child: In the classroom to be used in classroom activities To be used on social media, in newspaper, television, community bulletin boards, educational publications, or displays (we will attempt to give prior notification). 13. My child may go on program field trips, provided I have received prior notification which includes: destination, date, time, method of transportation, and educational objectives. 14. My name, address, and telephone number may be listed in the parent roster to be used by Policy Council members or Area Manager(s) so that I can be kept informed of up-coming program events (not to be released to anyone outside of the program without my prior written permission). 15. I give permission for LCC Head Start/ECEAP to transport and release or obtain medical/surgical treatment for my child. 16. If transportation is provided, I give permission for LCC Head Start/ECEAP to provide bus transportation for my child. Parent/Guardian Date Staff Date Parent/Guardian Date Interpreter Date Distribution: Original Site File Copies 1) Emergency Response Notebook & 2) Parent (C: 07/98; R: 10/14)

53 Parent Agreement Contract LOWER COLUMBIA COLLEGE HEAD START/ECEAP Acuerdo con los Padres de Familia FS/PI 7g Nombre del niño: (Apellido) (Nombre) (Inicial de Segundo Nombre) Como padre, entiendo y estoy de acuerdo con lo siguiente: 1. Antes de asistir a clases, mi niño tendrá un examen físico y uno dental (deberán realizarse dentro de los primeros 90 días), así como todas las vacunas conforme a las leyes del Estado de Washington. Además, estoy de acuerdo en realizar a tiempo, cualquier seguimiento médico o dental necesario. Si no tengo recursos económicos, el Programa hará los arreglos necesarios para estos servicios según sea necesario. 2. Los reportes de mi niño estarán disponibles para que yo los pueda revisar. La información será confidencial y sin mi permiso por escrito no será proporcionada a nadie fuera del Programa. 3. Soy responsable por la asistencia diaria de mi niño. Mi niño asistirá al Programa todos los días. Si mi niño va a estar ausente, llamaré y enviaré una nota a la maestra, informando la razón y fecha de la ausencia. 4. Si se proporciona transporte, yo o una persona autorizada, necesitamos subir y bajar a mi hijo del camión en los horarios programados. 5. Para mantener mi información actualizada, contactaré a la maestra o a la trabajadora social en caso de agregar o remover a las personas autorizadas de mi lista de contactos de emergencia. 6. Estaré disponible para las visitas en el hogar programadas con la Maestra/Trabajadora Social, para las Conferencias de Padres/Maestras y asistiré a una orientación del salón de clases el primer día de clases de mi niño. 7. No se requieren pagos para el programa, pero entiendo la importancia de contribuir como voluntario con mi tiempo, por ejemplo, en el salón de clases, en proyectos especiales, en actividades en el hogar, etc. 8. El personal de Head Start/ECEAP está obligado a reportar y reporta cualquier incidente en el que se sospeche de abuso o negligencia infantil de acuerdo con la Ley del Estado de Washington. 9. Entiendo que como padre de un niño inscrito en el Programa, se espera que yo no use ni esté bajo la influencia de drogas, alcohol o tabaco durante las visitas programadas al hogar o en las conferencias padres/maestras. 10. Entiendo que el Head Start/ECEAP participa en Early Achievers y usa Teaching Strategies Gold (estrategias de enseñanza oro) para evaluar el crecimiento y desarrollo de los niños. He sido notificado y doy mi autorización para lo siguiente: SI NO 11. El Head Start/ECEAP podrá hacer los siguientes exámenes: de Oído, de Agudeza Visual, Estrabismo, Estatura/Peso, Dental y de Desarrollo. 12. Que se tomen fotografías o videos de mi niño: En el salón de clases para ser usadas en actividades. Para ser usadas en los medios de comunicación, en el periódico, televisión, folletos de información a la comunidad, publicaciones educativas o en exhibiciones (nosotros intentaremos primeramente darle una notificación por adelantado). 13. Mi niño podría ir a excursiones, siempre y cuando yo haya recibido notificación anticipada la cual incluirá: destino, fecha, horario, método de transportación y objetivos educacionales. 14. Para que pueda ser informado de los futuros eventos del Programa, mi nombre, dirección y número de teléfono pueden estar registrados en la guía de padres y con los miembros de la Mesa Directiva o los Administradores de Area (no deberán proporcionárseles a nadie fuera del programa sin mi previo permiso por escrito). 15. Yo autorizo al Head Start/ECEAP de LCC para transportar y entregar u obtener tratamiento médico/quirúrgico para mi niño. 16. Si se proporciona transporte, doy permiso para que LCC Head Start/ECEAP transporte a mi niño. Padre/Tutor Fecha Personal Fecha Padre/Tutor Fecha Interprete Fecha Distribution: Original Site File Copies 1) Emergency Response Notebook & 2) Parent (C: 9/98; R: 10/14)

54 FS/PI 7h LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP 1600 Maple St. P.O. Box 3010 Longview, WA (360) HOFL Quarter-Year Section Credits New [ ] Returning [ ] INSTRUCTIONS: Please fill in both sides of this form with PARENT information, sign and return to child's teacher or office. MALE FEMALE Social Security Number Birthdate NAME Last First Middle/Maiden MAILING ADDRESS Street or Box # City State Zip Code HOME PHONE NUMBER ( ) MESSAGE/WORK PHONE ( ) ARE YOU A U.S. CITIZEN? YES NO ETHNIC ORIGIN (optional) * * * * * * RESIDENCY INFORMATION: REQUIRED BY WASHINGTON STATE LAW * * * * * * How long have you resided in the state of Washington? YEARS MONTHS Are you financially independent of your parents and were you financially independent during the last calendar year? YES NO If "no" to the question above, how long have your parents or legal guardians resided in the state of Washington? YEARS MONTHS * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ARE YOU A HIGH SCHOOL GRADUATE? YES NO HIGH SCHOOL ATTENDED CITY STATE LAST YEAR COMPLETED YEAR GRADUATED HAVE YOU TAKEN CLASSES AT LOWER COLUMBIA COLLEGE BEFORE? NO YES YEAR I certify that to the best of my knowledge all statements on this form are true. PARENT/GUARDIAN'S SIGNATURE CHILD'S NAME DATE M T W TH F CHILD'S TEACHER DAYS (circle) TIME (C: 09/01; R: 06/10)

55 1. What race do you consider yourself to be? White (800) Black/African-American (870) Indian (Amer.) (597): Name of the enrolled or principal tribe Eskimo (935) Aleut (941) Asian or Pacific Islander (API): Chinese (605) Filipino (608) Hawaiian (653) Korean (612) Vietnamese (619) Japanese (611) Asian Indian (600) Samoan (655) Guamanian (660) Other API (Please Print) Other Race (Please Print) 2. Are you or are you not of Spanish/Hispanic Origin? No (not Spanish/Hispanic) (999) Yes, Mexican, Mexican-Am., Chicano (722) Yes, Puerto Rican (727) Yes, Cuban (709) Yes, other Spanish/Hispanic (print one group, for example: Argentinean, Colombian, Domincan, Nicaraguan, Spaniard, and so on) 3. How will your course work relate to your current or future work? (11) Gain skills for a new job or career (12) Gain skills for my current job or career (13) Improve skills for a career change (14) Does not apply (90) Other 4. What is your main long term goal for attending this community college? (11) Take courses related to current or future work (12) Transfer to a four-year college (13) High school diploma or GED (14) Explore career direction (15) Personal enrichment (90) Other 5. How long do you plan to attend Lower Columbia College? (11) One quarter (12) Two quarters (13) One year (14) Up to two year, no degree planned (15) Long enough to complete a degree (16) Don't know (90) Other 6. What is your current work status while attending college? (11) Full-time homemaker (12) Full-time employment (including self-employed and military) (13) Part-time off-campus (14) Part-time on-campus (15) Not employed, but seeking employment (16) Not employed, not seeking employment (90) Other 7. What is your prior level of education at entry to Lower Columbia College? (11) Less than high school graduation (12) GED (13) High School Graduate (14) Some post high school, but no degree or certificate (15) Certificate (less than two years) (16) Associate Degree (17) Bachelor's Degree or above (90) Other 8. What was your family status when you started at Lower Columbia College? Were you... (select only one best response) (11) A single parent with children or other dependents in your care (12) A couple with children or other dependents in your care (13) Without children or other dependents in your care (90) Other 9. Do you have any of the physical or mental impairments listed below? YES (Developmentally disabled, seriously emotionally disturbed, hard of hearing, orthopedically impaired, NO speech impaired, visually handicapped, or other health impaired.) FS/PI 7h (C: 09/01; R: 06/10)

56 LCC Registration Form FS/PI 7h HOFL LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP 1600 Maple St. P.O. Box 3010 Longview, WA (360) Cuarto - Año Sección Créditos Nuevo(a) [ ] De Regreso [ ] INSTRUCCIONES: Por favor llene los dos lados de esta forma con la información de los PADRES, fírmela y entréguela a la maestra de su niño o en la oficina. MASCULINO FEMENINO Número de Seguro Social Fecha de Nacimiento NOMBRE DIRECCIÓN Apellido Calle o P.O. Box Nombre Ciudad Estado Código Postal TELEFONO DE CASA ( ) TELEFONO DEL TRABAJO/MENSAJE ( ) ES USTED CIUDADANO DE U.S? SI NO ORIGEN ETNICO (opcional) * * * INFORMACION DE RESIDENCIA: REQUIRDA POR LA LEY DEL ESTADO DE WASHINGTON * * * Cuánto tiempo ha vivido en el estado de Washington? AÑOS MESES Es usted económicamente independiente de sus padres y fue usted económicamente independiente durante el calendario del año pasado? SI NO Si contesto "no" a la pregunta de arriba, por cuanto tiempo sus padres o tutores legales residieron en el estado de Washington? AÑOS MESES * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * SE GRADUO DE LA SECUNDARIA? SI NO SECUNDARIA A LA QUE ASISTIO CIUDAD ESTADO ULTIMO AÑO QUE TERMINO AÑO EN QUE SE GRADUO ALGUNAVEZ HA TOMADO CLASES EN LOWER COLUMBIA COLLEGE? SI NO AÑO Certifico que de acuerdo a mi conocimiento que todos los datos en esta forma son verdaderos. FIRMA DEL PADRE/TUTOR NOMBRE DEL NINO(A) FECHA L M M J V NOMBRE DE LA MAESTRA(O) DIAS (circule) HORARIO (C: 09/01; R: 08/10)

57 LCC Registration Form 1. Qué raza se considera usted? Blanco (800) Negro/Africano Americano (870) Indio (Amer.) (597): Nombre de la tribu que pertenece Esquimal (935) Aleut (941) Asiático o Islandés Pacifico (API): Chino (605) Filipino (608) Hawaiano (653) Coreano (612) Vietnamés (619) Japonés (611) Indio Asiático (600) Samoano (655) Guamanian (660) Otros API (Por favor escriba) Otras razas (Por favor escriba) 2. Es o no de Origen Español/Hispano? No (no Español/Hispano) (999) Si, Mexicano, Mexicano-Americano., Chicano (722) Si, Puerto Riqueño (727) Si, Cubano (709) Si, Otros Español/Hispano (Escriba un grupo por ejemplo: Argentino, Colombiano, Dominicano, Nicaragüense, Español, etc.) 3. Cómo se relacionará su curso de trabajo a su actual o futuro trabajo? (11) Obtener habilidades para un nuevo trabajo o carrera (12) Obtener habilidades para mi actual trabajo o carrera (13) Mejorar mis habilidades para un cambio de carrera (14) No aplicable (90) Otros 4. Cual es su meta al largo plazo al asistir a este Colegio de la Comunidad? (11) Tomar cursos relacionados al trabajo actual o futuro (12) Transferirse a un colegio de cuatro años (13) Diploma de secundaria o GED (14) Explorar una dirección de carrera (15) Enriquecimiento personal (90) Otros 5. Cuánto tiempo piensa usted asistir a Lower Columbia College? (11) Un semestre (12) Dos semestres (13) Un año (14) Tal vez dos años, no título planeado (15) El tiempo necesario para terminar mi título (16) No se (90) Otros 6. Cuales es su estatus de su trabajo actual mientras asiste al colegio? (11) Ama de casa de tiempo completo (12) Trabajo de tiempo completo (incluyendo empleo personal y militar) (13) Medio tiempo fuera del colegio (14) Medio tiempo en el colegio (15) No estoy empleado(a), pero busco trabajo (16) No trabajo, no busco trabajo (90) Otros 7. Cual es su nivel de educación anterior al entrar a Lower Columbia College? (11) Menos que la graduación de la secundaria (12) GED (13) Graduado de la Secundaria (14) Asistí a la secundaria, pero no tengo un título o certificado (15) Certificado (menos de dos años) (16) Certificado de dos años (17) Título en licenciatura o más (90) Otros FS/PI 7h 8. Cuales fueron los estatutos de su familia cuando empezó en Lower Columbia College? Fue usted... (seleccione su mejor respuesta) (11) Un padre soltero con niños y otros dependientes a su cuidado (12) Una pareja con niños y otros dependientes a su cuidado (13) Sin niños u otros dependientes a su cuidado (90) Otros 9. Tiene algunos de estos impedimentos físicos o mentales anotados abajo? SI (Discapacidades de desarrollo, emocionalmente incapacitado, dificultad para oír, ortopédicamente discapacitado, NO discapacitado para hablar, visualmente discapacitado, u otro impedimento medico.) (C: 09/01; R: 08/10)

58 LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP HOME AND FAMILY LIFE (HOFL) 131, 132, 133 Class Requirements FS/PI 7i Instructor: Sandy Junker Phone: Course Description This course is designed to offer training, support, and education for improving self-sufficiency, parenting skills, and knowledge of child development. Method The class format includes parent support groups with sharing of personal experiences, parent/teacher conferences, educational home visits, HOFL parent seminars, classroom observation and participation, access to audio-visual and reading materials. It also includes small group sessions and guest speakers. Grade Evaluations Each student will receive a letter grade based on the following: "A" "B" "C" Have child in school 100% of the time, unless excused; Participate in parent activities (i.e., GED, ESL, Parent Meetings, Family Partnership Agreement, support groups, HOFL parent seminars, Family Night, Policy Council, etc.); Be present for home visits; Assist with classroom activities; Participate in development of your child s Individual Education Plan; Complete the DIAL-4 Parent Questionnaire; Complete the DECA Behavioral Assessment for Fall/Spring; Complete Home Learning; Participate in parent/teacher conferences. Have child in school 100% of the time, unless excused; Participate in parent activities (i.e., GED, ESL, Parent Meetings, Family Partnership Agreement, support groups, HOFL parent seminars, Family Night, Policy Council, etc.); Be present for home visits; Complete the DIAL-4 Parent Questionnaire; Complete the DECA Behavioral Assessment for Fall/Spring; Complete Home Learning; Participate in parent/teacher conferences. Have child in school 100% of the time, unless excused; Be present for home visits; Complete the DIAL-4 Parent Questionnaire; Complete the DECA Behavioral Assessment for Fall/Spring; Participate in parent/teacher conferences. If mid-term grade is below a "C", problem solve situation with parent. "D" Have child in school 100% of the time, unless excused. Any grades below a "C" for parents, student teachers, co-op students, or any question regarding student teachers performance should be brought to the Director before the grade is given. The mission of Lower Columbia College is to ensure each learner s personal and professional success, and influence lives in ways that are local, global, traditional, and innovative. a. Academic Honesty: Students are expected to be honest and forthright in their academic endeavors. To incorporate the words or ideas of another without giving credit to the source or to cheat on an examination corrupts the essential process by which knowledge is advanced. Refer to the Student Handbook for more details and potential consequences for engaging in academic dishonesty. b. Accommodations (ADA) Statement: If you have a disability, LCC s Special Services Office may be able to help you with reasonable accommodation. If you need assistance, please stop by the Special Services Office, located in the Admissions Building. (C: 07/96; R: 02/12)

59 LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP HOME AND FAMILY LIFE (HOFL) 131, 132, 133 Requisitos para las clases Instructora: Sandy Junker Teléfono: Correo Electrónico: FS/PI 7i Descripción del curso Este curso es diseñado para ofrecer capacitación, apoyo y educación para mejorar la auto-suficiencia personal, habilidades para ser mejores padres de familia y conocimiento acerca del desarrollo infantil. Método El formato de la clase incluye grupos de apoyo para los padres de familia para compartir experiencias personales, conferencias de padres de familia/maestras, visitas educacionales al hogar, seminarios de HOFL para padres de familia, observaciones y participación en el salón de clases y acceso a materiales audio-visuales y de lectura. También incluye sesiones en grupos pequeños e invitados especiales. Evaluaciones de Calificaciones Cada estudiante recibirá una letra de calificación basada en lo siguiente: "A" "B" Tener al niño en la escuela 100 por ciento del tiempo, a menos que tenga justificación; Participar en actividades para padres de familia (por ejemplo, GED, ESL, Reuniones de Padres, Acuerdo de Asociación Familiar, clases de apoyo de HOFL, Noches Familiares, Mesa Directiva, etc.); Estar presente para las Visitas en el Hogar; Ayudar con las actividades del salón de clases; Participar en el desarrollo del Plan Educativo Individual de su niño; Llenar el Cuestionario de Padres DIAL-4; Llenar la Evaluación del Comportamiento DECA de Otoño/Primavera; Llenar la forma del Aprendizaje en Casa; Participar en las conferencias de padres/maestra; Tener al niño en la escuela 100 por ciento del tiempo, a menos que tenga justificación; Participar en actividades para padres de familia (por ejemplo, GED, ESL, Reuniones de Padres, Acuerdo de Asociación Familiar, clases de apoyo de HOFL, Noches Familiares, Mesa Directiva, etc.); Estar presente para las Visitas en el Hogar; Llenar el Cuestionario de Padres DIAL-4; Llenar la Evaluación del Comportamiento DECA de Otoño/Primavera; Llenar la forma del Aprendizaje en Casa; Participar en las conferencias de padres/maestra; "C Tener al niño en la escuela 100 por ciento del tiempo, a menos que tenga justificación; Estar presente para las Visitas en el Hogar; Llenar el Cuestionario de Padres DIAL-4; Llenar la Evaluación del Comportamiento DECA de Otoño/Primavera; Llenar la forma del Aprendizaje en Casa; Participar en las conferencias de padres/maestra; Si la calificación de medio semestre es más baja a una "C", resolveremos el problema de la situación con el padre de familia. "D" Tener al niño en la escuela 100 por ciento del tiempo, a menos que esté exento Para los padres de familia, maestros estudiantes, estudiantes cooperativos con calificación más baja a una "C", o cualquier pregunta referente al desarrollo de los maestros estudiantes deberá ser dirigida a la Directora antes de que se dé la calificación. La misión de Lower Columbia College es garantizar el éxito personal y profesional de cada alumno e influenciar vidas en formas que son locales, globales, tradicionales e innovadoras. a. Honestidad Académica: Se espera que los estudiantes sean honestos y rectos en sus emprendimientos académicos. Incorporar las palabras o ideas de otros sin darle crédito a la fuente o hacer trampa en un examen daña el proceso fundamental para que el aprendizaje puede avanzar. Consulte el Manuel de Estudiantes para obtener más detalles y posibles consecuencias si su participación académica es deshonesta. b. Declaración para Necesidades Especiales (ADA): Si usted tiene una discapacidad, la Oficina de Servicios Especiales de LCC puede ayudarle con un acomodo razonable. Si necesita ayuda, por favor vaya a la Oficina de Servicios Especiales, ubicada en Departamento de Admisiones. (C: 07/96; R: 02/12)

60 LOWER COLUMBIA COLLEGE EARLY HEAD START Start-Up for Enrolled and Returning Families FS/PI 7j1 Child s Name: LOC ID #: Parent(s) Name: Forms/Date Change of Status Form* (sent to Admin) Child Profile Contact Information Form* (updated) Diaper Offer Form Family Interest Survey* Family Picture* Formula Offer Form Home Language Survey Other Forms for Returning Children/Date Carries Risk Assessment Health History Home Learning Inkind Form* Parent Agreement Contract PIR Update Releases USDA Prenatal/Date Prenatal Emergency Form Prenatal Dental Hist. Questionnaire Prenatal Health History Form PIR Above Starred * Items Releases/Date (update and send for records) Dental Medical Progress Center School District WIC Other Other Information Given/Date Book Family Resource Directory Food Assistance Flyer Parent Calendar/Handbook Other Other 45-Day Screenings/Date ASQ ASQ SE Hear/Vision 3 prong questionnaire Screening Summary (copy to Admin) 90-Day Forms Completed/Date Family Partnership Agreement Education Goals Health Safety Checklist (C: 06/14)

61 FS/PI 7k1 LOWER COLUMBIA COLLEGE EARLY HEAD START Child/Family File Transfer or Withdrawal Checklist Child s Name: Parent s Name: Date: From: LOC ID # To: LOC ID # or Withdrawal Place back on waitlist Initials Emergency Notebook Information (including Parent Agreement Contract/Medication List Forms/Health Care Provider Allergy Document/Dietary Restrictions Information) Classroom Sign-In/Out Forms (Teen Program/PAL) Medication (see medication HLTH 5a) Pictures Confidential Notebook Contents Change of Status (place on top of file) Computer Specialist for TS Gold Changes Refer to Site File Policy & Procedure (MSYS 7b) for further instructions regarding return of site files if needed Transportation Request (If applicable, to incoming center transportation liaison) Send to Early Head Start Supervisor that closeout procedure has been completed and family has withdrawn/transferred. Follow ChildPlus close-out procedure. Include: Reason for withdrawal Summary of family services (FPA goal) Education summary (progress on education goals) Other (C: 12/12; R: 06/15)

62 LOWER COLUMBIA COLLEGE HEAD START/ECEAP Child/Family File Transfer or Withdrawal Checklist FS/PI 7k Child s Name: Parent s Name: Date: From: LOC ID # To: LOC ID # or Withdrawal All items must be completed prior to returning file to office. File must be returned no longer than 3 days for a transfer and 5 days for a withdrawal. Site File Initials Other Initials Classroom Sign-In/Out Forms Tracking Form Update and Attach Copy to Checklist (transfer only) IEP Consultant Log Confidential Notebook Contents Change of Status (place on top of file) Medication (see medication HLTH 5a) Portfolio Items/Pictures/Artwork Classroom Transitional Object Additional Information Initials Emergency Notebook Information (including Parent Agreement Contract/Medication List Forms/Health Care Provider Allergy Document/Dietary Restrictions Information) (please highlight those that apply) Case Management Entry, i.e. summary of family services (FPA goal), education summary (progress on education goals), where file transferring to and reason for file transferring. Refer to Site File Policy & Procedure (MSYS 7b) for further instructions regarding return of site files if needed. Transportation Request (If applicable, to incoming center transportation liaison) Plan to communicate with other staff in the event of a transfer. Transfer any portfolio items/pictures. Take emergency information off the bus if applicable; remove any personal items. Teaching Strategies Gold 1. For withdraw of child from classroom, timeline for completion is 2 weeks. 2. For transfer, you should receive an stating transfer complete as soon as child is moved in ChildPlus. Other Area Manager Signature Date (C: 06/07; R: 08/14)

63 FS/PI 7l Lower Columbia College Head Start/EHS/ECEAP Family Interest Survey Policy In order to have more meaningful family engagement and involvement, staff will use a Family Interest Survey during the Welcome Visit. The Family Interest Survey will be used to determine what subjects parents would like information about and what areas of interest parents have for volunteer activities. Approved by Policy Council August 21, 2001 Procedure 1. Head Start/ECEAP staff will have parents and/or guardians fill out the Family Interest Survey during the Welcome Visit. EHS staff will have all parents and/or guardians complete the Family Interest Survey by the fourth home visit. 2. Track information given and follow-up in case management. 3. Staff will work with parents and community agencies to assist in planning and implementing activities and programs that meet parents needs and interests, and reflect the cultural and linguistic diversity of the family. 4. Family Interest Surveys will be tallied by classroom and by center and placed into the center notebook. This will be used as a reference tool and guide when planning for Parent Meeting topics. 5. Follow up on topics of interest will be conducted at subsequent home visits or family contacts. 6. Staff will contact each parent who had an interest in Policy Council and/or Center Officer to answer any questions they may have, and to see if they would consent to run for a position at the first Parent Meeting. 7. Staff will problem solve any barriers to volunteering in regards to child care and/or bus pass with the parent. (See Bus Pass Procedure) This policy complies with Performance Standard (d)(1); (d)(3); (e) (1); (e) (3); (a) (5). (C: 08/01; R: 08/15)

64 FS/PI 7m LOC ID LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Family Interest Survey Child's Name: Parent/Guardian's Name: Date: Please check any of the items that you would like more information and it will be provided to you: Parenting 1. Infant/Toddler/Child Development 2. Discipline Strategies 3. Communicating with Children 4. Literacy/Reading Activities 5. Fathers/Male s Role 6. Fun Family Activities 7. Encouraging Your Child s Self Esteem 8. Single Parent/Shared Parenting Issues 9. Toileting Strategies 10. Grandparents/Relatives Raising Child 11. Tantrums/Tears/Anger 12. Swearing/Bad Language 13. Fighting Among Children Family/Adult Education and Employment Health/Nutrition 27. Prenatal Care 28. Post-Partum Care 29. Family Planning (birth control) 30. SIDS 31. Breastfeeding 32. Introducing New Foods 33. CPR/First Aid 34. Stress Management/Self-Care 35. Domestic Violence Resources 36. Quit Smoking/Quit Tobacco/e-tobacco 37. Exercise/Physical Family Activity 38. Nutrition Education 39. Substance Abuse Prevention 40. Substance Abuse Treatment Custody/Legal Issues 15. Anger Management 16. Clothing 17. GED Classes/High School ELL Classes 19. Getting a New Job/Career 20. Attend College 21. Personal Budgeting 22. Marriage Education/Relationship 23. DSHS Programs (TANF, food, child care, Medicaid, WorkFirst) 24. Driver s License/Insurance 25. Child Abuse 26. Grief/Loss Please tell us what ways you would want to learn. Personal Conversation Parent Meeting Text carrier: Books/Written Materials Internet/ (C: 05/00; R: 05/14)

65 FS/PI 7m LOC ID In which of the following offices might you be interested: Chairperson - Conduct monthly meeting in center Vice Chairperson - Advise and fill in for chairperson when necessary Secretary -Take minutes at monthly meetings Room Representative for Policy Council - The governing board of the Head Start/EHS/ECEAP Program Alternate Room Representative for Policy Council fill in for Room Representative at the governing board of the Head Start/EHS/ECEAP Program What day of the week and time of day would be the most convenient for you for Parent Meetings and Program Activities? DAY: TIME: The items you check below will help us plan family fun nights and parenting classes throughout the school year. Please check all items you may be interest in: Ages & Stages of Development Activities to do at Home Home Safety & Injury Prevention I am Moving/I am Learning Stress Management First Aid/CPR Dinner and a Book Other Other Make & Take Learning Materials Literacy Activities Wellness/Weight Management Nutrition Activities Community Resources Sexual Abuse Prevention Budgeting & Money Management Other (C: 05/00; R: 05/14)

66 Family Interest Survey FS/PI 7m LOC ID LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Cuestionario de Intereses de la Familia Nombre del Niño: Nombre del Padre/Tutor: Fecha: Por favor marque todos los temas de los cuales quisiera recibir más información y ésta le será proveída: Educación de Padres 1. Desarrollo en Distintas Etapas de la Niñez 2. Estrategias de Disciplina 3. Comunicación con los Niños 4. Actividades de Alfabetización o Lectura 5. El Papel de Padres y Hombres 6. Actividades Divertidas para Familias 7. Promover la Auto-Estima de Su Hijo 8. Problemas de Padres/Madres Solteros o de Compartir la Responsabilidad de Crianza 9. Estrategias de Baño 10. Abuelos o Parientes que Crían al Niño 11. Rabietas/Lágrimas/Enojo 12. Palabrotas/Groserías 13. Peleas Entre Niños Educación/Empleo para la Familia/Adultos Salud/Nutrición 27. Control Prenatal 28. Atención Postparto 29. Planificación Familiar (anticonceptivos) 30. SMSL (Síndrome de muerte súbita del lactante) 31. Amamantar 32. Introducir Nuevos Alimentos en la Dieta 33. RCP/Primeros Auxilios 34. Manejar el Stress/Autocuidado 35. Recursos de la Violencia Familiar 36. Dejar de Fumar/Dejar el Tabaco/E-cigarrillos 37. Ejercicio/Actividad Física de la Familia 38. Educación de la Nutrición 39. Prevención del Abuso de Sustancias Adictivas 40. Tratamiento del Abuso de Sustancias Adictivas Custodia/Asuntos Legales 15. Manejar el Enojo 16. Ropa 17. Clases de GED o de High School 21+ (la preparatoria para personas mayores de 21 años) 18. Clases de Inglés 19. Obtener un Nuevo Trabajo o Carrera 20. Asistir a la Escuela o Universidad 21. Presupuestos Personales 22. Educación o Relaciones Interpersonales del Matrimonio 23. Programas de DSHS (efectivo de TANF o WorkFirst, alimentos, guardería, seguro médico) 24. Licencia de Manejar y Seguro 25. Abuso de Niños 26. Duelo y Pérdida Por favor háganos saber de qué manera desea usted aprender. Conversar con el personal Reuniones de Padres Texto compañía de servicio: Libros/Material por Escrito Internet/ (C: 05/00; R: 05/14)

67 Family Interest Survey FS/PI 7m LOC ID Cuáles de las siguientes puestos posiblemente le interesan?: Presidente Conducir una reunión mensual en el centro Vicepresidente - Aconsejar y sustituirse por el moderador cuando sea necesario Secretario Hacer las actas de las reuniones mensuales Representante del Salón a la Mesa Directiva El consejo directivo del programa Head Start/EHS/ECEAP Representante Sustituto del Salón a la Mesa Directiva sustituirse por el Representante del Salón a la Mesa Directiva del programa Head Start/EHS/ECEAP Qué día de la semana y qué hora del día le convendría más para las reuniones de padres y las actividades del programa? DÍA: HORA: Las cosas que marque abajo nos ayudarán a planear las noches de diversión familiar y las clases para padres de este año escolar. Por favor marque todas las cosas que le interesen. Edades y Etapas de Desarrollo Materiales de Aprendizaje de Hacer y Llevarse Actividades que Hacer en Casa Actividades de Alfabetización Seguridad de Casa y Prevención de Heridas Bienestar/Control del Peso Me Muevo y Aprendo Actividades de Nutrición Manejar el Stress Recursos de Comunidad Primeros Auxilios/RCP Prevención del Abuso Sexual Una Comida y un Libro Presupuestos y el Manejo del Dinero Otro Otro Otro (C: 05/00; R: 05/14)

68 FAMILY INTEREST SURVEY VOLUNTEER AREAS OF INTEREST FS/PI 7n Parent Name Reading to Children RIF Days Field Trips Toy Mending/ Repair Share a Hobby, Culture, Occupation Art Work/ Bulletin Board Preparing Classroom Materials (coloring, cutting, gluing) At-Home Classroom Projects Cooking with Children Carpentry Sewing Music Science/ Nature Projects Policy Council Officer Parent Leadership Center Officer Parent Leadership Class Rep. Parent Leadership State Rep. (C: 12/03; R: 06/12)

69 Lower Columbia College Head Start/ECEAP Second Home Visit (Family Service Assessment/Family Partnership October/November/December) Policy The staff and family partnership will focus and build upon the family s strengths by setting realistic goals developed by family members. In collaboration with other agencies, staff will support families in their efforts to reach these goals in an on-going, evolving process that continues throughout the family s participation in Head Start/ECEAP. FS/PI 8a Procedure I. Home visits are to be conducted in the child s home. When the family requests visits be conducted outside the home or in cases where a significant safety hazard exists for staff, the home visit may take place on site or at another safe and confidential place. The Family Advocate will discuss these situations with their Area Manager. II. Prior to the home visit, the Family Advocate and Teacher will examine the contents of the file for pertinent information related to the following areas: Social Service/Mental Health Attendance Education Parent Involvement Health/Nutrition The Family Advocate will document that curriculum/classroom ideas were discussed and solicited from the parent. III. Review the Contact Information Form and update any emergency information or address/phone number changes. Complete the Change of Status form and distribute copies accordingly. IV. Using the Home Visit Plan as a guide, the Family Advocate will discuss each area with the family. Reference Home Visit Plan Procedure (FS/PI 11a). The Family Advocate will discuss and review the following at each home visit: Review and update Family Picture Volunteer opportunities Parent curriculum input Parent meetings/parent enrichment opportunities (POP, ESL, GED) Policy Council and program committees Community activities Importance of Home Learning and In-kind Discuss HOFL registration Family Interest Survey and interest areas selected by parent Information requested on Health History Any health or nutrition information distributed Child s education goals DECA and home strategies Family Service Assessment; refer to procedure FS/PI 8b1. All requests for immediate needs must be fulfilled within 10 working days. V. The Family Advocate will check on the current status of the child s physical exam, dental exam, lead level screening and follow-ups services (six month dental recall visit or treatment). Staff will provide support to complete outstanding exams and any treatment 1 (C: 10/00; R: 06/12)

70 FS/PI 8a needed. All efforts will be documented in Case Management and include follow-up services, barriers and plan of action. (See Case Management Procedure) VI. Through conversation and discussion with the family, continue the Family Service Assessment. Refer to procedure FS/PI 8b1. VII. In the areas where the family has identified needs, the Family Advocate will utilize the Resource Directory to make appropriate referrals. VIII. The Family Advocate will discuss, with the family, the importance of having emergency information and a fire evacuation plan in place for the home. In addition, parents will be given a home emergency card. (See Home Emergency Card, FS/PI 8d) IX. Using information gathered from conversations, the parent and Family Advocate will identify an obtainable goal using the Family Partnership Agreement Form. Reference Family Partnership Agreement Policy and Procedure (FS/PI 8c1). Following the Home Visit I. Following the Home Visit, using a confidential envelope, the Family Advocate may send resource information in the areas the family indicated a need for assistance. If there is a problem with literacy level of the parent/guardian, the Family Advocate will hand deliver and review the information with the parent. Document the date the information was sent in Case Management. II. Guidelines for documenting the visit in Case Management: Date of visit, brief description of the visit, any concerns, barriers, referrals, action plan and follow-up. Document completion in the outcome/follow-up section and make entry of outcome. Document visit on the Classroom Family Tracking Form. Record all attempts made by the Family Advocate to contact the family. List all follow-up that is needed and who will do it. Share any concern or information that came up at the visit with other staff members as appropriate. Policy complies with Performance Standard (a) 1-5; (g) (1) (2); (b) (1) (2); (b) (1) (i) (iii); (i) (1) (5). 2 (C: 10/00; R: 06/12)

71 FS/PI 8c1(a) LOWER COLUMBIA COLLEGE HEAD START/ECEAP Family Partnership Map for Success / Mapa de Asociación para el Éxito Name(s) / Nombre(s): My Journey will start on / Mi travesía iniciará I am good at / Mis cualidades son I m already working on / Estoy trabajando Date / Fecha: with / con (C: 08/10; R: 06/13)

72 FS/PI 8c1(a) On or before / Durante o antes de Steps I will take Pasos que yo voy a tomar I will need support Voy a necesitar apoyo I will do it by Lo hare para I did it in Lo hice Progress / Progreso I DID IT!!! I Feel / Lo Logre!!! Me Siento (C: 08/10; R: 06/13)

73 LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Family Partnership Piecing It Together FS/PI 8c1(b) LOC ID Name (s): I will start piecing it together on: I am good at: I m already working on: with: I want to: Date: Putting the pieces together Piece 1 Piece 2 I will By Support I will By Support Piece 3 Piece 4 I will By Support I will By Support I DID IT!!! I FEEL (C: 03/11; R: 06/13)

74 Family Partnership for Success-Puzzle Pieces LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Asociación con la Familia Uniendo las Piezas FS/PI 8c1(b) LOC ID Nombre (s): Empezare a unir las piezas en: Mis cualidades son: Estoy trabajando en: con: Yo quiero: Fecha: Uniendo las piezas Pieza 1 Pieza 2 Yo Para Apoyo Yo Para Apoyo Pieza 3 Pieza 4 Yo Para Apoyo Yo Para Apoyo LO LOGRE! ME SIENTO (C: 10/11; R: 06/13)

75 LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Family Partnership Steps to Success FS/PI 8c1(c) LOC ID Name(s): My journey will start on: I am good at: I m already working on: with: My goal is: Date: Step 4: I will: By: Support: Step 3: I will: By: Support: Step 2: I will: By: Support: Step 1: I will: By: Support: I accomplished and learned about myself. I DID IT!!!! I FEEL (C: 04/11; R: 06/13)

76 Family Partnership for Success-Steps LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Asociación con la Familia Pasos para el Éxito FS/PI 8c1(c) LOC ID Nombre(s): Mi travesía iniciará: Mis cualidades son: Estoy trabajando: con: Mi meta es : Fecha: Paso 4: Yo: Para: Apoyo: Paso 3: Yo: Para: Apoyo: Paso 2: Yo: Para: Apoyo: Paso 1: Yo: Para: Apoyo: Logré Y aprendí LO LOGRE! ME SIENTO (C: 10/11; R: 06/13)

77 Lower Columbia College Head Start/EHS/ECEAP Family Partnership Agreement Policy & Procedure FS/PI 8c1 Policy Staff will engage parents/guardians in a process of collaborative partnership building with parents to establish mutual trust and to identify family goals and strengths. Staff will sustain the collaborative partnership building. Procedure I. Gather information noted from Home Visit, the Family Picture, Family Interest Survey and from the Family Outcomes Assessment. Using this information, Head Start/ECEAP will assist the parents/guardian to identify a goal they would like to work on using the Family Partnership Agreement. EHS staff will use the FPA Family Goal Index form to identify the goals the family would like to work on. At least one goal should be set during the school year. II. III. IV. If the family is working with another agency and has established goals or has a preexisting plan, these goals should be incorporated, or be the same as, the FPA. Guidelines for completing the Family Partnership Agreement for Head Start/ECEAP are as follows: a. Staff will assist the parent/guardian in documenting their goal. While the parent/guardian is developing their goal, staff will also complete a copy of the Family Partnership Agreement to take back with them to document the visit and progress. Staff will assist the parent in breaking down the goal into achievable steps. b. While discussing the goals with the parent, ask the parent to share the strengths of their family/self. The parent/guardian will document those strengths c. Address barriers in the action steps on the goal plan. As needed, make appropriate referrals. d. Develop specific steps and timelines for parent/guardian and staff to support reaching their goal. e. Leave the copy that the parent has completed with the parent at the end of the home visit. f. On the Classroom Family Tracking form, mark the date the Family Partnership Agreement was made. Guidelines for completing the Family Partnership Agreement/Family Goals Index for Early Head Start are as follows: a. Before beginning the process of goal setting, discuss strengths parents see in their family/self. b. Collaboratively with the parent, identify the goal that needs to be worked on and document the goal on the form. c. Complete, with parent, the steps to completion of the goals, appropriate supports, and the anticipated date of completion. d. It is assumed that the goal established during the goal setting process will become priority. However, if a more urgent need becomes apparent, then that need will be identified as a separate goal and take priority. e. Upon completion of the more urgent goals, the EHS staff will resume placing emphasis on the previously established goal. f. Upon completion of any established goal, staff will document the completion date under Date Achieved column of the form (C: 06/09; R: 08/15)

78 FS/PI 8c1 g. EHS staff will document established goals and steps on the Home Visiting Notes (FS/PI 17a1) to leave with parents. h. EHS staff will document on the monthly attendance tracking when the goal setting process was initiated and each time it is updated. V. If the parent/guardian chooses not to enter into a Family Partnership Agreement with LCC Head Start/ECEAP staff at this time, mark the FPA box with an O (offered) on the Classroom Family Tracking form. Document in Case Management that the Family Partnership Agreement is in process. The Family Partnership Agreement will be offered again at subsequent contacts with the family. VI. VII. Following the visit, staff will contact the family monthly by phone and/or personal contact to determine if each need has been met or if additional resources, referrals or advocacy efforts need to be initiated. All significant contact with families must be documented in Case Management. Family Partnership Agreements will be reviewed at subsequent home visits by staff. The progress of outcomes will be noted in Case Management and on the Family Partnership Agreement. At the family s request, Family Partnership Agreements can be altered, changed or replaced. Policy complies with Performance Standard (a)(1), (a)(2), (a)(3). (C: 06/09; R: 08/15)

79 FS/PI 8d EMERGENCY EMERGENCY 911 Police Fire Ambulance 911 Police Fire Ambulance Poison Control My Address Poison Control My Address Emergency Mental Health Services or Parent/Guardian at Work Emergency Mental Health Services or Parent/Guardian at Work Other Phone Number Other Phone Number School School School School Doctor Dentist Landlord Doctor Dentist Landlord (C: 01/07; R: 06/11)

80 FS/PI 8d EMERGENCIA EMERGENCIA 911 Policia Fuego Ambulancia 911 Policia Fuego Ambulancia Control de Veneno Mi Domicilio Control de Veneno Mi Domicilio Servicios de Emergencia de Salud Mental or Padre/Tutor en el Trabajo Servicios de Emergencia de Salud Mental or Padre/Tutor en el Trabajo Otro Número de Teléfono Otro Número de Teléfono Escuela Escuela Escuela Escuela Doctor Dentista Arrendador Doctor Dentista Arrendador (C: 01/07; R: 06/11)

81 FS/PI 8e Home Safety Checklist Do you know how safe your home is for your baby or young children? Use this checklist to help spot what parts of your home are safe and where you can make it safer. 1 Safe Sleep Is your baby always placed on his/her back to sleep? Is your baby sleeping alone in a crib-type bed for nightime and naps at home and away from home? Have you checked your baby s bed to make sure the crib sides are stationary and there are no broken or missing crib slats? Crib slats must be no more than 2 3/8 inches apart. Crib does not have drop sides. Is the crib mattress firm and fitted snugly inside the crib (no extra room around edges)? Is your baby s crib empty of pillows, comforters, stuffed toys, bumper pads, and other soft items? 3 Safe Storage Are there safety latches or locks on cabinets and drawers that contain potentially dangerous items? These items include: Vitamins Cigarettes Plastic bags Matches and lighters Knives, scissors, razor blades, and other sharp objects Cleaning supplies, pesticides, and other poisonous materials keep these in their original containers. Guns and ammunition must be stored separately Medications, including over-the-counter medicines Energy drinks or alcoholic beverages Remember: Child-resistant packaging is not child proof. Is your baby s crib away from the window and is not near a window or curtain/blinds? 2 Bathroom When your child is in the bathtub, is an adult always present? Is your hot water heater set to never go above 120 F? When you run your child s bathwater, do you test the temperature first with your wrist or elbow? Are there non-skid strips or a mat on the bottom of the bathtub? 4 Kitchen Are small appliances in the kitchen (coffee maker, toaster) and bathroom (hairdryer, curling iron) unplugged and put away? If they cannot be stored in a cabinet or drawer, push them to the back of the counter. Are only back burners on the stovetop used for cooking? Are pot handles turned toward the back of the stove? (C: 07/14)

82 FS/PI 8e 5 Around the House Is the Poison Center phone number ( ) and other emergency contacts posted near all of your telephones, programmed in your cell phone or in an obvious location in your home? It is not necessary to keep syrup of ipecac in your home. In case of poisoning, always call the poison center and the experts there will advise you on what to do. I have a list of emergency telephone numbers near my phone. Are small toys and objects that your baby could choke on out of reach and picked up off the floor? It is important that objects containing button batteries (TV remotes, clocks) have a screw0secured battery cover, and toys with small magnets are out of reach of children. Are working smoke detectors placed in each sleeping room as well as in the hallways outside the sleeping rooms? Smoke detectors should be tested monthly and batteries changed every year. Is everyone living in your home aware of an emergency exit plan in case of a fire? Are garage door openers kept out of reach of children? Is your home smoke-free (no one smokes inside your home)? Are heavy or unstable pieces of furniture, such as TVs, entertainment centers, and bookshelves anchored to the floor or secured to the wall? Are safety/baby gated installed at the top and bottom of all stairs? My child does not wear a pacifier or jewelry around his/her neck. I do not ever drink or carry hot liquids when holding my baby. Are stationary activity centers used instead of infant walkers? My babysitter is older than 13 and mature enough to handle common emergencies. Are the windows in your house or apartment child-safe? Things to do: Move furniture away from windows. Keep windows, especially those reachable by children, locked or have window guards or stops to prevent them from being open more than 4 inches. I keep fans and air conditioners our of my child s reach. Are electrical cords in good condition (not frayed)? Arrange the cords so they are out of your child s reach. Furniture and large toys are placed away from walkways. Are there shock prevention plugs or covers on all unused electrical outlets? My child does not play with objects that are small enough to fit through a paper towel roll. Are you keeping your child safe from lead poisoning? Peeling paint or paint dust on walls and windows can have lead if your home was built before Certain fold remedies may contain lead. I check my child s toys for safety hazards. Are the cords for windows, blinds, draperies, or baby monitors out or your child s reach? If cords for blinds or draperies are looped, cut them to create two short cords. I know how to prevent my child from choking. 6 In the Car Are age-appropriate child safety seats properly installed and used when children are riding in motor vehicles? Does everyone wear seatbelts (or ride in an ageappropriate, properly installed child safety seat) while riding in motor vehicles? I never leave my child unattended in a motor vehicle. What are your safety concerns? My family s home safety action plan is: (C: 07/14)

83 FS/PI 8e Lista de comprobación de la seguridad en el hogar Sabe qué tan segura es su casa para su bebé o los niños pequeños? Utilice esta lista de comprobación para ayudarle a determinar qué partes de su casa son seguras y dónde Ud. puede mejorar la seguridad. 1 Lugar seguro para dormir Siempre se le acuesta a su bebé de boca arriba para dormir? Duerme su bebé solo en una cama de tipo cuna, durante la noche y las siestas, en casa y fuera de casa? Ha revisado la cama de su bebé para asegurarse de que las barandas de la cuna estén fijas y que no haya tablillas rotas o faltantes? La distancia entre las tablillas de la cuna no debe ser de más de 2 y 3/8 pulgadas (3.5 centímetros). Está firme el colchón de la cuna y encaja perfectamente dentro de esta (no queda lugar alrededor de los bordes)? Hay almohadas, edredones, juguetes de peluche, protectores para cunas y otros artículos blandos? Está la cuna de su bebé lejos de la ventana, las cortinas y las persianas? 3 Almacenamiento seguro Hay pestillos de seguridad o cerraduras en los armarios y los cajones que contienen artículos potencialmente peligrosos? Estos artículos incluyen los siguientes: Vitaminas Cigarrillos Bolsas plásticas Cerillos y encendedores Cuchillos, tijeras, hojas de afeitar y otros objetos filosos Productos de limpieza, pesticidas y otros materiales tóxicos (debe mantenerlos en sus envases originales) Armas de fuego y municiones (se deben guardar por separado) Medicamentos, incluso los de venta libre Bebidas energizantes o bebidas con alcohol Recuerde: Los envases con mecanismos de seguridad para niños no son a prueba de niños. 2 El baño Cuando su hijo está en la bañera, siempre hay un adulto presente? Está el calentador de agua regulado para no superar nunca los 120 F (49 C)? Cuando prepara el baño de agua caliente para su hijo, prueba la temperatura primero en la muñeca o el codo? Hay bandas antideslizantes o un tapete en el fondo de la bañera? 4 La cocina Los pequeños electrodomésticos de la cocina (cafetera, tostadora) y el baño (secador de cabello, rizador), están desenchufados y guardados? Si no es posible guardarlos en un armario o un cajón, aléjelos hasta el fondo de la encimera. Para cocinar, se utilizan sólo los quemadores posteriores de la estufa? Están volteadas las asas de las cacerolas hacia la parte posterior de la estufa? (C: 07/14)

84 5 Alrededor de la casa El número de teléfono del Centro de Envenenamiento ( ) y otros contactos de emergencia, están anotados cerca de todos sus teléfonos, programados en su teléfono móvil o colocados en un lugar lógico de su casa? No es necesario que guarde en casa jarabe de ipecacuana. En caso de envenenamiento, llame siempre al centro de envenenamiento, y los expertos del lugar le aconsejarán qué hacer. Cerca del teléfono, he colocado una lista de números de teléfono de emergencia. Los juguetes y objetos pequeños con los que su bebé podría ahogarse, están fuera de su alcance y se han recogido del suelo? Es importante que los objetos que tienen pilas tipo botón (controles remotos de televisores, relojes) tengan una tapa para las pilas que sea asegurada con tornillos, y que los juguetes con imanes pequeños estén fuera del alcance de los niños. Hay detectores de humo en funcionamiento colocados en cada dormitorio, así como en los pasillos fuera de los dormitorios? Los detectores de humo deben probarse mensualmente, y las pilas deben cambiarse todos los años. Todas las personas que viven en su casa conocen el plan de salida de emergencia en caso de incendio? Guardan las abridoras de puertas de garaje fuera del alcance de niños? Es su casa libre de humo (nadie fuma dentro de la casa)? Los muebles pesados o inestables, como televisores, centros de entretenimiento y estantes para libros, están asegurados al piso o a la pared? Se han instalado puertas de seguridad para bebés a lo alto y al pie de todas las escaleras? Mi hijo no lleva ni chupete ni joyería alrededor del cuello. Nunca bebo ni llevo líquidos calientes cuando tengo a mi bebé en los brazos. Se utilizan centros inmóviles de actividades en lugar de caminadores para niños? Cuáles son sus inquietudes sobre la seguridad? FS/PI 8e Mi niñera tiene más de 13 años y es suficientemente responsable para responder a las emergencias comunes. Las ventanas de su casa o apartamento, tienen protección para los niños? Cosas para hacer: Alejar los muebles de las ventanas. Mantener cerradas las ventanas, especialmente aquellas a las que los niños tienen acceso, o colocar defensas o topes en las ventanas para evitar que se abran más de 4 pulgadas (10 centímetros). Mantengo los ventiladores y aparatos de aire acondicionado fuera del alcance de mi niño. Están en buenas condiciones los cables de la electricidad, (no están pelados)? Ordene los cables de modo que estén fuera del alcance de su hijo. Los muebles y juguetes grandes no están cerca de las áreas donde la familia camina con frecuencia. Hay tapones o tapas para la prevención de descargas eléctricas en todos los tomacorrientes que no se usan? Mi niño no juega con objetos pequeños que puedan pasar por un tubo de toallas de papel. Mantiene protegido a su hijo contra la intoxicación por plomo? La pintura descascarada o las partículas de pintura de las paredes y las ventanas pueden contener plomo si su casa fue construida antes de Ciertos remedios caseros pueden contener plomo. Reviso los juguetes de mi niño para asegurar que no tienen ningún riesgo para su seguridad. Están los cordones de las ventanas, las persianas, los cortinados o los dispositivos de control de bebés fuera del alcance de su hijo? Si las cortinas o persianas tienen un lazo de tiro continuo, córtelo para formar dos cordones cortos. Sé cómo prevenir que mi niño se atragante. 6 En el automóvil Cuando los niños van en automóvil, se utilizan asientos de seguridad para niños que son adecuados para su edad e instalados correctamente? Todos usan cinturones de seguridad (o van en un asiento de seguridad para niños adecuado para la edad y correctamente instalado) mientras van en automóvil? Nunca dejo a mi hijo sin supervisión en un automóvil. Nuestro plan de acción para la seguridad en el hogar es: (C: 07/14)

85 Lower Columbia College Head Start/ECEAP Third Home Visit (Family Goal Sheet Update) FS/PI 9a Policy The progress of identified goals and the level of family satisfaction with the services received will be assessed by staff and parents at the third Home Visit. Procedure I. Update Contact Information Form. If there are any changes, use the Change of Status Form and turn into the Program Coordinator. II. Review the Family Picture and the Family Service Assessment with the parent/guardian. III. Discuss changes, new information, referrals to agencies and record these updates. IV. Follow-up with families about requested handouts or referrals. Discuss how the information or referral met their needs. If there were any problems with referrals that were made, problem-solve with the parent/guardian or agency any barriers to those services. Some questions that might be asked are: 1. Did the services match your family s individual needs and expectations? 2. Did the service agency treat you with understanding and respect? 3. What problems, if any, did you encounter at the agency? 4. Do you have suggestions for what Head Start/ECEAP staff could do to improve the process of referring families to services? V. Review the Family Partnership Agreement. If the family was not ready to identify a goal at the previous home visit, offer one now and continue discussion. Evaluate where they are at in their steps to complete each goal. Note progress in the Progress Update section. Problem-solve any barriers to completing steps. Family Partnership Agreement will be noted on the Home Visit Plan form. Celebrate Accomplishments! VI. If FPA goals is completed, assist family in setting a new goal if desired. Reference Family Partnership Agreement Policy and Procedure (FS/PI 8c1). VII. Discuss and document any follow-up that may be needed on the child s physical, dental, mental health, screenings, immunizations or family and child health insurance status utilizing the Home Visit Form. (Review Health database prior to visit.) VIII. Ask for parent curriculum/classroom input. IX. Complete application for eligible siblings. X. Review HOFL Registration. XI. Have parent update any Releases of Information. XII. Review child s education goals. XIII. Discuss volunteer opportunities within the program and community. XIV. Discuss plans to transition any child who may be going into kindergarten: 1. Advise the parent/guardian of the transition activity and information such as kindergarten registration dates and required information needed to register their child at their neighborhood school. 2. Discuss with the parent/guardian any needed support to complete the transition process to elementary schools. (C: 10/00; R: 06/13)

86 FS/PI 9a Following the Home Visit I. Following the Home Visit, using a confidential envelope, the Family Advocate may send resource information in the areas the family indicated a need for assistance. If there is a problem with literacy level of the parent/guardian, the Family Advocate will hand deliver and review the information with the parent. Document the date the information was sent in Case Management. II. Guidelines for documenting the visit in Case Management: Date of visit, brief description of the visit, any concerns, barriers, referrals, action plan and follow-up. Document completion in the outcome/follow-up section and make entry of outcome. Document visit on the Classroom Family Tracking Form. Record all attempts made by the Family Advocate to contact the family. List all follow-up that is needed and who will do it. Share any concern or information that came up at the visit with other staff members as appropriate. Policy complies with Head Start Performance Standard (a) 1-5; (g) (1) (2); (b) (1) (2); 1304 (40) (i) (iii); (i) (1) (5). (C: 10/00; R: 06/13)

87 FS/PI 11a LOWER COLUMBIA COLLEGE HEAD START/ECEAP Home Visit Plan Form Procedure 1. Prior to each home visit, the family advocate and/or teacher will examine the contents of the file for pertinent information related to the following areas: Home Visit #1 (Welcome Visit) What is your child interested in: Strengths and interests of the child, projects for the classroom, ideas for classroom curriculum, provide home learning sheets and discuss the value of inkind. Complete the child profile with parent/guardian. Family Goal: Create and/or update on the Family Partnership Agreement (FPA). Family Involvement/Needs: Ensure the Family Interest Survey, Family Service Assessment, Family Picture, Contact information Form reflect the current status of the family. Discuss upcoming family involvement activities (family gatherings, picnics, etc.) If giving a referral, check the box and list the referral given on the line provided. Health: Review information on child plus health tab prior to the home visit, review and/or complete the health history, discuss barriers in each section as indicated (physical, dental, nutrition), any appointments/treatment, discuss any needed health referrals for family. Family Transportation Plan: List plan of transportation for child to arrive and depart from school daily and on time. Check the transportation box request completed if a transportation request is being submitted to the appropriate transportation liaison. Things to Do: List any plans of action needed, indicating who is responsible, timeline and plan for follow up. Completed Items: Check mark what items have been completed on the home visit. Home Visit #2 Follow Up: Items that need follow up since last visit or point of contact can be placed here. Education Check-In: Gather strengths and interests of the child from family, projects for the classroom, ideas for classroom curriculum, provide home learning sheets and discuss value of in-kind, education goals check-in and/or IEP check-in. Attendance: Review child s attendance with family. Discuss benefits of regular attendance and address any barriers. Applaud strengths in this area! Family Goals/Update: (C: 03/98; R: 06/13)

88 FS/PI 11a Create and/or update on the Family Partnership Agreement (FPA). Family Involvement/Needs: Ensure the Family Interest Survey, Family Service Assessment, Family Picture, Contact information Form reflect the current status of the family. Discuss upcoming family involvement activities (family gatherings, picnics, etc.). If giving a referral, check the box and list the referral given on the line provided. Health: Review information on child plus health tab prior to the home visit, discuss barriers in each section as indicated (physical, dental, nutrition), any appointments/treatment, discuss any needed health referrals for family. Safety Checklist: Document what safety information tools have been provided to the family. Review the HS/EHS/ECEAP Home Safety Checklist with the parent. Things to Do: List any plans of action needed, indicating who is responsible, timeline and plan for follow up. Completed Items: Check mark what items have been completed on the home visit. Home Visit #3 Follow Up: Items that need follow up since last visit or point of contact can be placed here. Education Check-In: Gather strengths and interests of the child from family, projects for the classroom, ideas for classroom curriculum, provide home learning sheets and discuss value of in-kind, education goals check-in and/or IEP check-in. Attendance: Review child s attendance with family. Discuss benefits of regular attendance and address any barriers. Applaud strengths in this area! Family Goals/Update: Create and/or update on the Family Partnership Agreement (FPA) Family Involvement/Needs: Ensure the Family Interest Survey, Family Service Assessment, Family Picture, Contact information Form reflect the current status of the family. Discuss upcoming family involvement activities (family gatherings, picnics, etc.) If giving a referral, check the box and list the referral given on the line provided. Health: Review information on child plus health tab prior to the home visit, discuss barriers in each section as indicated (physical, dental, nutrition), any appointments/treatment, discuss any needed health referrals for family. Safety Checklist: Review the HS/EHS/ECEAP Home Safety Checklist with the parent. Things to Do: (C: 03/98; R: 06/13)

89 FS/PI 11a List any plans of action needed, indicating who is responsible, timeline and plan for follow up Completed Items: Check mark what items have been completed on the home visit. 2. Home visits provide opportunities for family/child goal setting and discussion of each child/families individual development and progress. Additional home visits may be added on an individual basis. Home visits should be well planned for with all family information viewed ahead of time. Location and time options should be available to best meet the needs of individual parents most appropriately. Tips for a successful visit include: Be punctual and prepared. Confirm with the parent upon arrival the length of the visit (1 1/2 hours) to determine any barriers, which may interfere with the visit. If you are not sure of the parent s response, ask... Acknowledge his/her response by restating what you think it is: Sounds like..., You agree something needs to happen... So you think... Keep good eye contact, look at and relate to parents and acknowledge others who may be in the home. Clearly state the purpose of the visit. Get to know the family. Ask questions. Be a good model when you interact with them by being willing to share about yourself in an appropriate manner. Use family friendly language. Do not assume all parents can read and write. Show enthusiasm and acceptance. Make sure to leave your home visiting schedule at your site, including the family s name, the date and time of your visit and when you expect to return. 3. If your home visit has been cancelled or was a no show, document this in case management with your plan for follow-up. (C: 03/98; R: 06/13)

90 Lower Columbia College Head Start/ECEAP 2nd Family Involvement Home Visit Form Loc ID FS/PI 11b1 Child s name: Who was present at Home Visit? Date: Location: Follow Up: Education Check-in: Attendance: Family Information/Needs: Referrals: Family Goal/update: Health Physical: Dental: Nutrition: Specialist: Home Safety Checklist: Completed Items: Update Contact Information Form Current HOFL Registration Form Family Interest Survey Fire Drill Sheet Next Family Gathering: Things To Do: Home Learning Family Picture Dental/Physical In-kind (HS) Home Safety Card Parent Signature: Date: Staff Signature: Date: Length of Home Visit: Distribution: White Parent Yellow Site File (C: 06/13; R: 05/14)

91 Second Family Involvement Home Visit Lower Columbia College Head Start/ECEAP Segunda Visita de Participación de los Padres Loc ID FS/PI 11b1 Nombre del Niño: Quienes estuvieron presentes en la Visita? Fecha: Lugar: Seguimiento: Revisión de la información de Educación: Asistencia: Información de la Familia/Necesidades: Remisiones: Metas de la Familia/Actualización: Salud Físico: Dental: Nutrición: Especialista: Lista de Seguridad de Casa: Temas Revisados: Revisión de la forma de los Contactos Forma de Registración en HOFL Encuesta de Intereses de la Familia Información de Seguridad en Incendios Próxima Visita: Plan: Aprendizaje en Casa Foto de la Familia Tiempo Voluntario Dental/Físico (HS) Tarjeta de Seguridad en el Hogar Forma del Padre: Firma del Personal: Fecha: Fecha: Duración de la Visita: Distribution: White Parent Yellow Site File (C: 06/13: R: 05/14)

92 FS/PI 11b2 Lower Columbia College Head Start/ECEAP 3rd Family Involvement Home Visit Form Loc ID Child s name: Who was present at Home Visit? Date: Location: Follow Up: Education Check-in: Attendance: Family Information/Needs: Referrals: Family Goal/update: Health Physical: Dental: Nutrition: Specialist: Home Safety Checklist: Completed Items: Update Contact Information Form Sibling Application Current HOFL Registration Form Transitions/Summer Information Reviewed Next Family Gathering: Things To Do: Home Learning Family Picture Family Interest Survey Parent Signature: Date: Staff Signature: Date: Length of Home Visit: Distribution: White Parent Yellow Site File (C: 06/13; R: 05/14)

93 Third Family Involvement Home Visit Lower Columbia College Head Start/ECEAP Tercera Visita de Participación de los Padres Loc ID FS/PI 11b2 Nombre del Niño: Quiénes estuvieron presentes en la visita? Fecha: Lugar: Seguimiento: Revisión de asuntos de educación: Asistencia: Información de la Familia/Necesidades: Remisiones: Meta de la Familia/Actualización: Salud Físico: Dental: Nutrición: Especialista: Lista de Verificación de Seguridad de Casa: Temas Revisados: Actualización del Formulario de Contactos Solicitud para Hermanos Aprendizaje en Casa Formulario de Inscripción en HOFL Bosquejo de la Familia Transiciones/Revisión de Información de Encuesta de Intereses de la Familia Verano Próxima Reunión Familiar: Plan: Firma del Padre: Fecha: Firma del Personal: Fecha: Duración de la Visita: Distribution: White Parent Yellow Site File (C: 06/13; R: 03/15)

94 FS/PI 11b Lower Columbia College Head Start/ECEAP Welcome Home Visit Form Loc ID Child s name: Who was present at Home Visit? Date: Location: Family Information/Needs: Referrals: Family Goal (returning): Health Physical: Dental: Nutrition: Specialist: Health Organizer Food Assistance Flyer Nutrition Handouts Family Transportation Plan: Transportation Request Completed Completed Items: Update Contact Information Form ROIs Change of Status Parent Agreement Contract Home Language Survey Dial 4 Parent Questionnaire Family Picture Family Interest Survey Health History (returning) USDA In-Kind (Med/Dent) (HS) Current HOFL Registration Form Parent Involvement Brochure Ways to Say Goodbye Home Learning Recalls Community Resource Directory Parent Handbook/ Calendar Temperaments/Learning Style Things To Do: Parent Signature: Date: Staff Signature: Date: Length of Home Visit: Distribution: White Parent Yellow Site File (C: 03/98; R: 07/15)

95 Welcome Home Visit FS/PI 11b Lower Columbia College Head Start/ECEAP Visita de Bienvenida Loc ID Nombre del Niño: Quiénes estuvieron presentes en la visita? Fecha: Lugar: Información de la Familia/Necesidades: Remisiones: Meta de la Familia (2do. año): Salud Físico: Dental: Nutrición: Especialista: Folder de Salud Volante de Información de Apoyo con Comida Folletos de Nutrición Plan de Transportación: Forma de solicitud de transporte Temas Revisados: Actualización de la forma de Contactos (ROIs) Cambios de Información Acuerdo con los Padres de Familia Encuesta del Idioma en el Hogar Cuestionario Dial 4 para los Padres Cosas que hacer: Foto de la Familia Encuesta de Intereses de la Familia Historial de Salud (2do. año) USDA Tiempo Voluntario (Médico/Dental) (HS) Forma de Inscripción en HOFL Folleto de Participación de los Padres Maneras de Despedirse Aprendizaje en Casa Retiro de Productos Directorio de Recursos de la Comunidad Parent Handbook/Calendar Temperamento/Estilo de Aprendizaje Firma del Padre: Fecha: Firma del Personal: Fecha: Duración de la Visita: Distribution: White Parent Yellow Site File (C: 03/98; R: 07/15)

96 FS/PI 11c Lower Columbia College Head Start/EHS/ECEAP Home Visit Schedule Plan de visita domiciliaria Name/Nombre I will be at your home/estaré en su casa on/el, (day of week) (address) (date) at/a las. If this is not a convenient time, please call me at/si esta hora no es conveniente, hable por favor al No. I look forward to meeting with you./espero verle pronto. (Telephone Number) (Staff Signature) White: Parent Yellow: Teacher/Advocate (C: 09/00; R: 09/10) Name/Nombre Lower Columbia College Head Start/EHS/ECEAP Home Visit Schedule Plan de visita domiciliaria FS/PI 11c I will be at your home/estaré en su casa on/el, (day of week) (address) (date) at/a las. If this is not a convenient time, please call me at/si esta hora no es conveniente, hable por favor al No. I look forward to meeting with you./espero verle pronto. (Telephone Number) (Staff Signature) White: Parent Yellow: Teacher/Advocate (C: 09/00; R: 09/10)

97 FS/PI 11d Lower Columbia College Head Start/EHS/ECEAP Process for Shared Family Services In order to provide unduplicated, meaningful and quality services to our program families enrolled in both Early Head Start and Head Start/ECEAP, the below process will be followed with the EHS staff taking the lead. Parent Agreement Contracts EHS staff has parent complete an EHS Parent Agreement Contract. Head Start/ECEAP staff has parent complete a Head Start/ECEAP Parent Agreement Contract Family Services: Family Picture, Family Partnership Agreement (FPA), Family Interest Survey EHS staff will take the lead and provide Head Start/ECEAP with copy. Family Outcomes Assessment entry EHS staff will take the lead. Shared Family Staffings Held: October, January and April Attendants: EHS staff, HS/ECEAP FA or CFDS, Disabilities Specialist, Health Specialist, Appropriate Area Manager, EHS Supervisor, Mental Health Consultant Communication If the staff become aware of a major family need or crisis, they will communicate with one another to discuss and determine plan of action. Communication between EHS and HS/ECEAP staff shall occur at least monthly to establish a plan for the family. Family Involvement 2 nd and 3 rd Home Visits EHS staff and HS/ECEAP staff communicate to discuss strategies for 2 nd /3 rd home visit. HS/ECEAP worker to accompany EHS staff on their regular scheduled home visit (as appropriate). Teacher Home Visits & Parent/Teacher Conferences Teachers/EHS staff will conduct their own home visits and Parent/Teacher conferences. (C: 09/10; R: 08/15)

98 FS/PI 12a LOWER COLUMBIA COLLEGE HEAD START / EHS / ECEAP Family Emergency and Crisis Intervention Policy All Staff having knowledge of emergency or crisis situations involving LOWER COLUMBIA COLLEGE HEAD START / EHS / ECEAP families should refer the situation, as soon as possible, to the Family Advocate, Area Manager, EHS Supervisor or member of Leadership Team. They will deal directly with the problem or assist the family in obtaining appropriate services. Dependent on the situation refer to the appropriate policy or procedure. Should the situation warrant immediate assistance, call 911 or depending on your Center location. (C:08/99;R:09/10)

99 FS/PI 13a LOWER COLUMBIA COLLEGE HEAD START/ECEAP Parent/Guardian/Child Orientation/Open House Policy Parents are given opportunities to learn about the program structure and philosophy of Head Start/ECEAP and how they are implemented in their child s classroom and throughout the program. Procedure 1. Staff will work together to provide Parent/Guardian/Child Orientation before/during slow start begins in the fall and/or first day of school. Parent Orientation will be held at various times to not exclude parents. 2. Staff will inform the parent/guardian of the time at the first home visit/welcome visit. Staff will make a reminder phone call before the Open House/Parent/Guardian Orientation. When parents/guardians leave the child s classroom orientation to attend the Parent Orientation the Head Start/ECEAP children will stay in their classrooms with the teaching staff. 3. Open House: a. In order to accommodate program families, each classroom/center will conduct two Open Houses; one in the day and one in the evening. b. Staff will use this opportunity to introduce the classroom to children/families c. Classroom scavenger hunt game will be used to orient all children and families to areas of the classroom d. PIC and Full Day models will combine the open house and orientation activities into one event 4. The Direct Service Team will plan and organize a welcoming, fun, and informative Classroom and Parent/Guardian Orientation utilizing the Parent/Guardian/Child Orientation form and providing the following information: A. Classroom Orientation: Have areas set up for children to explore. 1. Introduce classroom staff. 2. Parent/child activities planned to orient the families to classroom environment. 3. Activities available in each interest area. B. Parent/Guardian Orientation/Open House: a. Plan how to provide information in content areas listed on Parent Orientation Checklist. b. Designate individual roles/responsibilities. c. Utilize content area experts. Policy complies with Head Start Performance Standard (a) (4) & (5); (g)(1)(ii) (C: 08/01; R: 07/15)

100 FS/PI 13b1 Lower Columbia College Head Start/ECEAP Parent/Guardian Orientation to Classroom Sign-In/Sign-Out Form & Volunteer Inkind Procedures Signing Your Child In and Earning Inkind 1. Upon arrival, you sign your child in, on his/her Classroom Sign-In/Sign-Out form by writing down: The Date The Time Your Child Entered the Classroom The Phone Number, Where You Can Be Reached That Day Your Signature 2. When you volunteer at the classroom and/or center, fill in the Volunteer Time In/Out. Signing Your Child Out Upon pick-up, you sign your child out, on his/her Classroom Sign-In/Sign Out form by writing down: The Time Your Signature Your Family Information Form Please remember that no minor (anyone under the age of 18), other than the parent/guardian, is allowed to sign out a child in a licensed facility. Your child can be released to adults, you have designated, on your Family Information Form. (C: 08/03; R: 06/09)

101 Parent/Guardian Orientation to Classroom Sign-In/ Sign-Out Form & Volunteer Inkind Procedures FS/PI 13b1 Lower Columbia College Head Start/ECEAP Orientación para Padres/Tutores Formatos para Firmar Entrada/Salida del Salón de Clases y Procedimientos para Trabajo Voluntario Firme la entrada de su niño y gane puntos en Inkind 1. Al momento de llegar, usted firmará la llegada de su hijo, en la forma de Registro de Entrada/Salida en el Salón de Clases, anotando: La fecha La hora en que su niño entró al salón de clases El número de teléfono donde usted puede ser localizado ese día Su firm 2. Cuando usted hace trabajo voluntario en el salón de clases y/o en el Centro, registre su hora de entrada y salida. Firme la salida de su niño Al momento de recoger a su niño, firme su salida escribiendo la hora de salida y firmando la forma de Entrada/Salida de su salón de clases, registrando: La hora Su firma Formato de Información Familiar Por favor, recuerde que ningún menor (nadie menor de 18 años), u otro que no sea el padre/tutor, están autorizados para firmar la entrada o salida de un niño de ningún centro. Su niño puede ser entregado a los adultos, que usted haya designado en su Formato de Información Familiar. (C: 08/03; R: 06/09)

102 Lower Columbia College Head Start/ECEAP Parent/Guardian/Child Orientation/Open House FS-PI 13b Classroom Orientation/Open House/Child & Parents Tour of Classroom, using Interest Area Signs/Outdoor Play Area Sign-In/Sign Out Form/Location Where to Check for Child s Mail Review Schedule/Lesson Plans/Parent Board Disaster Preparedness Plan (classroom/off campus) Classroom and Outside Rules Bathroom (adult/child) Daily Schedule/Arrival/Departure Parent Orientation/Parents Only Teacher Curriculum Input/Curriculum Information (introduce curriculum/parent ideas, input/lesson plan developed, holiday policy) School Readiness In-kind Guidance and Discipline Policy Attendance Daily Schedule Arrival/Departure Nutrition, Meals, Snacks Transportation (Bus Safety) (curriculum/safety Sam) (sign-in sheets) (field trips) Pet Policy/Procedure Family Advocate Parent Meetings/Family Nights Classroom Reps/Policy Council Parent Enrichment Opportunities (POP, GED, ELL, HS 21, etc.) Questions/Issues/Concerns Procedure Smoke/Drug/Weapon Free Environment Pesticide Application Policy & Procedure Discussed at Welcome Visit (Parent Handbook) Child Abuse and Neglect Disabilities Services Mental Health Services Confidentiality Sibling Policy Clothing, Outdoor Weather Policy Child's Name Parent's Signature Date (C: 07/02; R: 06/14)

103 Parent Guardian Open House Orientation Lower Columbia College Head Start/ECEAP Reunión General de Orientación para Padres/Tutores y Niños FS-PI 13b Orientación en el Salón de Clases/Visita al Salón de Clases/Niños y Padres Recorrido por el salón de clases, usar las señales en las áreas de interés/áreas exteriores de juegos Lugar para firmar la entrada y salida Donde revisar el correo de su niño Revisión de Horarios/Plan de Lecciones/Pizarrón de Información para Padres Plan de Preparación para Desastres (del salón de clases/fuera del Colegio) Reglas para dentro y fuera del salón de clases Baño (adulto/niño) Horario diario/entrada/salida Orientación únicamente para Padres Maestra Ideas/Información para el Programa de Clases (presentar el programa de estudios/ideas de los padres, aportación/plan de lecciones desarrollado, política para días festivos) Preparación para la Escuela Trabajo Voluntario Política de Disciplina y Orientación Asistencia Horario diario Entrada/Salida Nutrición, Comidas, Bocadillos Transportación (Seguridad del Camión) (currículo/sam Seguridad) (forma para firmar la entrada) (excursiones) Política/Procedimientos de Mascotas Trabajadora Social Reuniones de Padres/Noches Familiares Representante de Salón de Clases/Mesa Directiva Oportunidades de Enriquecimiento para los Padres (POP, GED, ELL, HS 21, etc.) Procedimiento para Preguntas, Problemas, Preocupaciones Ambiente Libre de Cigarros/Drogas/Armas Política/Procedimientos para Aplicación de Pesticidas Comentarios en la Visita de Bienvenida (Manual de Padres) Abuso y Abandono de Niños Servicios de Incapacidades Servicios de Salud Mental Confidencialidad Política de Hermanos Política de Ropa, Clima Exterior Nombre del Niño Nombre del Padre Fecha (C: 08/02; R: 06/14)

104 Lower Columbia College Head Start/EHS/ECEAP Volunteer Experiences with Children FS/PI 13e When working with children, be positive, offer choices and model appropriate behaviors. An attitude and atmosphere of calmness is best. Safety is of the utmost importance. To help with children s comfort, use indoor voice, make eye contact and connect at their level, even if you have to kneel or bend down. Each classroom has a variety of learning/interest centers. Below are a few suggestions for each area. ART: Be aware of what you say Tell me about your picture, Make sure there are enough materials: paper, paint, etc. Talk about colors. BLOCKS: Enhance play by asking the child questions about what they have built. Be a narrator i.e. I see you are making a tall tower. You are being very careful with the blocks. Play sorting games by color, shape, number, etc. Take dictation as the child describes what they are creating. Help children respect building space (not knock down other work) CIRCLE TIME: Join circle time activities. Reinforce being quiet during circle time. Give praise for sitting appropriately and paying attention. DRAMATIC PLAY: Pretend with the children. Talk with and encourage conversation. Offer helpful instruction tailored around what the children are doing. LIBRARY: Read to a child. Let child tell you a story from the pictures. Ask questions: What happened to? What happens next? MUSIC: Model movement and expression. Participate with the children: sing, play instruments, dance, etc. SAND AND WATER: Talk about cause and effect (i.e. how many cups does it take to fill the?) Talk about measuring and comparing. Help children play cooperatively. SCIENCE: Encourage children to feel objects. Expand on a child s knowledge base of the topic. Model and guide discussion. TABLE GAMES: Assist and/or demonstrate fine motor skills. Assist and/or demonstrate hand-eye coordination. Encourage conversation talking about colors, shapes, sizes, game rules, etc. (C: 08/02; R: 06/10)

105 Lower Columbia College Head Start/EHS/ECEAP Experiencias Voluntarias con los Niños FS/PI 13e Cuando trabaje con los niños, sea positivo, ofrezca opciones y demuestre comportamiento apropiado. Tener una actitud y una atmosfera tranquila es lo mejor. La seguridad es de suma importancia. Para ayudar al niño a sentirse mejor utilice una voz suave, tenga contacto visual a su nivel, aun cuando tenga que arrodillarse o agacharse. Cada salón de clases tiene una variedad de centros de aprendizaje/interés aquí hay algunas sugerencias. ARTE: Este consciente de lo que diga Platícame acerca de tu dibujo, Asegurarse de que haya suficiente materiales: papel, pintura, etc. Platique acerca de los colores. BLOQUES: Extienda el juego, hágale preguntas al niño acerca de lo que construyo. Sea el narrador, por ejemplo Veo que estas construyendo una torre alta. Estas siendo muy cuidadoso con los bloques. Juegue juegos donde clasifiquen colores, figures, números, etc. Tome notas cuando el niño le describa lo que está creando. Ayude al niño en el área de bloques (no destruir el trabajo de otros) TIEMPO EN CÍRCULO: Únase a las actividades de círculo. Recuérdeles aguardar silencio durante el círculo. Deles elogios cuando estén sentados y escuchando apropiadamente. JUEGO DRAMATICO: Simule con los niños. Hable y anime la conversación con los niños. Ofrézcales instrucciones que les ayuden acerca de lo que está haciendo. BIBLIOTECA: Léale al niño. Deje que el niño le platique la historia de su dibujo. Haga preguntas: Que le paso a? Qué paso después? MÚSICA: Modele movimiento y expresión. Participe con los niños: cante, toque instrumentos, baile, etc. ARENA Y AGUA: Hable sobre causa y efecto ( Cuantas tazas necesitamos para llenar?) Hable sobre medidas y comparaciones. Ayude a los niños a jugar en cooperación. SCIENCIAS: Anime a los niños a sentir los objetos. Extienda la base del conocimiento de los niños según el tema. Modele y guie la conversación. JUEGOS DE MESA: Ayude y/o demuestre las habilidades motoras. Ayude y/o demuestre la coordinación de manos y ojos. Anime a tener conversación sobre colores, figures, tamaños, y reglas del juego, etc. (C: 08/02; R: 06/10)

106 FS-PI 13f LOWER COLUMBIA COLLEGE HEAD START/ECEAP Orientation Planning Form Orientation/Slow Start Date: What is the location of the parent portion? How will the room be set up? Classroom: Materials Needed: Sign-in sheets (FS-PI 14d) Snack/coffee set up Name tags Pens/Markers Chart paper/smart board set up/etc. Parent Orientation Form (FS-PI 13b) Who is responsible? Time parents will be using the parent room? Who will be calling to remind Parents of orientation date and that there is no childcare available? Classroom Orientation (Name tags for children and adults should be available.) Prepare your lesson plans to orient children and parents into the classroom for the 1 st day of slow start. How will you create a system to help parents explore the classroom with their child? How will parents transition from Classroom to Information session? Information Curriculum Input/Curriculum Information (introduce curriculum/parent ideas, input/lesson plan developed, holiday policy) School Readiness In-kind Guidance and Discipline Policy Attendance Who is Delivering the information? How will information be presented? Materials needed? (C: 06/07; R: 07/15)

107 FS-PI 13f Daily Schedule Arrival/Departure Nutrition, Meals, Snacks Transportation (Bus Safety) (curriculum/safety Sam) (sign-in sheets) (field trips) Pet Policy/Procedure Parent Meetings/Family Nights Classroom Reps/Policy Council Parent Enrichment Opportunities (POP, GED, ELL, HS 21, etc.) Questions/Issues/Concerns Procedure Smoke/Drug/Weapon Free Environment Pesticide Application Policy & Procedure Questions about Welcome Visit Discussion Items listed on orientation form Other: Other: What icebreaker will you use to help parents get to know one another? Who will facilitate? Any other ideas to implement? (C: 06/07; R: 07/15)

108 FS-PI 13g Classroom Scavenger Hunt Busqueda de objetos en el salón de Clases Circle items as you find them / Circule los objetos que encuentre My Cubby Mi Cubo Computer Computadora Bathroom Baño Books/Library Libros/Librería Dramatic Play Area Área de dramatización Parent Mail Correo para los Padres Block Area Área de bloques Art Area Área de arte Child Sign-In Firma de entrada del niño Parent Board Pizarón para los padres Writing Center Centro de escritura (C: 06/07; R: 06/09)

109 FS/PI 14a1 LOWER COLUMBIA COLLEGE HEAD START/ECEAP Mandatory Information and/or Training Topics TOPICS Orientation Chemical Dependence Child Growth & Development Child Abuse & Neglect Prevention Mental Health Nutrition (including selection and preparation of foods, budgeting and info on food assistance programs) Health Safety (First Aid/Practices/Occupational) Discipline/Behavior Management Dental Domestic Violence Parents as Volunteers Services for Children w/disabilities Confidentiality Curriculum Literacy TANF/Working Connections Class Representative Training Policy Council Training Parent Committee Meetings/ Officer Training Transitions (Kindergarten) Maternal Depression SIDS Memo/ Flier/ Letter Orientation Home Visit Family Night Monthly Classroom Newsletter Parent Bulletin Board Handout Health History Arena Screenings Other (C: 09/06; R: 10/10)

110 FS/PI 14a Lower Columbia College Head Start/EHS/ECEAP Parent Committee Meetings Policy Parent Meetings provide an effective and meaningful way for parents to be involved in on-site decision-making, parent education, curriculum planning and two-way communication with staff members. Procedure 1. At a minimum, a parent committee meeting will be held five times per year with the business portion of the Parent Committee Meeting occurring on the alternate months. Parents may vote to have additional meetings as desired providing childcare funds are available. These meetings may include a second parent committee meeting, a family night (see policy), additional parent education meetings, or socialization times. Topics will be selected from parent input and mandatory topics as written in the Performance Standards. 2. Parent Committee meetings will be held at a time when it is most convenient for the majority of the parents to attend. If participation declines, the meeting time may be changed to accommodate the current needs of the parent population. 3. All parents are members of the Parent Committee and will receive notification of the time, date, and location of the monthly meetings. 4. Staff will work with parents and community agencies to assist in planning and implementing activities and programs that meet parents needs and interests and reflect the culture and linguistic diversity of the family. 5. At the first or second parent meeting, Parent Committee officers will be elected. These officers will include: Chairperson, Vice Chairperson, Secretary, Classroom Representative and an Alternate. (See Job Description for each Parent Committee Officer.) Topics/ideas for future meetings will be solicited. 6. Staff will offer training to the Parent Committee officers in October. 7. Prior to the monthly Parent Committee meeting, the officers and Classroom Representatives will meet with staff to develop an agenda with input from staff and other interested parents. The agenda form will be handed out at the Parent Committee meeting. Items can be added if time and interest allows. 8. Topics for future meetings will be solicited. September Orientation October Elections November December January February March April May June Picnic, Celebration Topics along with Parent Education Plan Form (FS/PI 14e) will be due to the EHS Supervisor/Area Manager at least two weeks prior to the start of a new planning period. 9. Agendas will include the following (Parent Committee Agenda FS/PI 14j): Call to Order/Welcome/Introductions Review Agenda/Additions; Read minutes of previous meeting; Policy Council report by Policy Council member; 1 (C: 09/01; R: 08/15)

111 FS/PI 14a Committee reports by Chairperson, if any; Old Business: any business not covered in reports, questions; New Business: any information to take to Policy Council, items that need to have parent committee votes; Developmentally Appropriate Practice Information/Activity for parents by staff; Parent education topic from parent input and/or topics mandated by Federal Performance Standards presented by staff, Area Manager/EHS Supervisor, Program Specialist/Consultant or guest speakers; Parent Curriculum Input Announcements regarding Head Start/EHS/ECEAP and community resources and events, opportunities to sign up for volunteer time or projects, next Parent Committee Meeting. 10. Parent Committee officers, with staff guidance and support, are to facilitate the Parent Committee meetings and follow the agenda developed. 11. Agenda, attendance sheet, minutes, and a summary of the topics discussed will be placed in the Center Notebook. 12. Childcare will be provided for Head Start/EHS/ECEAP children and their siblings when parents/guardians are attending parent meetings per available funds (See Childcare Policy and Procedure.) 13. The Food Service Supervisor submits a menu proposal to each Family Advocate/EHS Staff for input and revisions (which may include input from program parents). Revisions are made and copies of the program Parent Meeting Schedule/Menu are distributed to the appropriate staff members and a copy to be placed in Center Notebooks. 14. Staff will flex their work schedules to attend parent committee meetings. Per Area Manager/EHS Supervisor approval, staff will flex their work schedules to interact with families during weekend events (e.g., picnics, religious and Tribal ceremonies, or other cultural events), if necessary. Policy complies with the Head Start Performance Standards: (d) (1 )-3, (f) (3) (i) &(ii), (f) (l), (f) (4) (i) & (ii), (f) (2) (i), (ii) & (iii) 2 (C: 09/01; R: 08/15)

112 FS/PI 14b Lower Columbia College Head Start / EHS / ECEAP Family Nights Policy To provide evening opportunities for parents to interact with their children by participating in developmentally appropriate activities in a warm and welcoming environment. Approved by Policy Council September 28, 2001 Procedure 1. Parents may vote in Parent Committee meeting if they wish to hold a Family Night in addition to the Parent Committee Meetings and Family and Family Nights already held by the program. 2. Activities will be planned and facilitated by Head Start/EHS/ECEAP staff. These activities must be developmentally appropriate for Head Start/EHS/ECEAP children and the family must accompany and participate with the children. 3. Staff will select a dinner meal from the established cost effective menu provided by the EHS Manager/Health Specialist and noted on the back of the Parent Meeting Schedule/Menu. Staff in conjunction with their program parents, can choose to provide a simple snack instead of a dinner meal. 4. A program Food Service Form must be completed by a Teacher/Family Advocate/EHS Staff and approved by their Area Manager/EHS Supervisor. The EHS Manager/Health Specialist must receive the completed form at least three (3) weeks prior to the scheduled meeting date. 5. If staff are collecting a count of the number of parents and children to be in attendance, a current count is to be submitted to the EHS Manager/Health Specialist and Lead Cook at least ten (10) days prior to the scheduled meeting date. (This count is to be a total count, of children and adults, for the Family Night. One staff member will be designated to contact the EHS Manager/Health Specialist and Lead Cook with this determined number. Policy complies with the Head Start Performance Standards: (d) (1 )-3, (f) (3) (i) &(ii), (f) (l), (f) (4) (i) & (ii), (f) (2) (i), (ii) & (iii) (C: 08/02; R: 08/14)

113 FS/PI 14c Lower Columbia College Head Start / EHS / ECEAP Support Group Proposal Your Name: Date: TOPIC: OBJECTIVES: PROJECTED START AND END DATE, TIME AND LOCATION: FACILITATORS: (If other than a staff member, please list qualifications) MATERIALS NEEDED: Return form to your Area Manager/EHS Supervisor at least three (3) weeks in advance of projected start date so that it may be present to the Assistant Director for approval. Approval Date: (R: 09/10; C: 07/98)

114 Time In: Time Out: Date / Fecha: Lower Columbia College Head Start/EHS/ECEAP Parent Sign-In / Lista de Registro para los Padres del Programa Event / Evento: FS/PI 14d LOC ID Print Name Nombre Thank you for coming. Please sign in for our records. Gracias por asistir. Por favor firme el registro para nuestros reportes. Signature Firma Name of Enrolled Child Nombre de niño inscrito Center/Teacher Centro/Maestra 30 minutes of the meeting time will be counted as In-kind for the business agenda unless otherwise noted by facilitator. A menos que el facilitador indique lo contrario, se considerará que 30 minutos de la reunión fueron usados para la agenda de gobierno y éstos serán incluidos en las horas de trabajo voluntario. Staff Signature Date Please forward completed form to Gwyn Wilson. (C: 10/93; R: 08/15)

115 LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Parent Education Plan FS/PI 14e Year Site Submitted by SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY DATE DATE DATE DATE DATE TOPIC TOPIC TOPIC TOPIC TOPIC SPEAKER SPEAKER SPEAKER SPEAKER SPEAKER VIDEO/MATERIALS VIDEO/MATERIALS VIDEO/MATERIALS VIDEO/MATERIALS VIDEO/MATERIALS DESCRIPTION DESCRIPTION DESCRIPTION DESCRIPTION DESCRIPTION White: Family Advocate/EHS Staff File Yellow: Area Manager/EHS Supervisor Pink: EHS Manager/Health Specialist (R: 09/10; C:07/01)

116 LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Parent Education Plan FS/PI 14e Year Site Submitted by FEBRUARY MARCH APRIL MAY JUNE DATE DATE DATE DATE DATE TOPIC TOPIC TOPIC TOPIC TOPIC SPEAKER SPEAKER SPEAKER SPEAKER SPEAKER VIDEO/MATERIALS VIDEO/MATERIALS VIDEO/MATERIALS VIDEO/MATERIALS VIDEO/MATERIALS DESCRIPTION DESCRIPTION DESCRIPTION DESCRIPTION DESCRIPTION White: Family Advocate/EHS Staff File Yellow: Area Manager/EHS Supervisor Pink: EHS Manager/Health Specialist (R: 09/10; C:07/01)

117 FS/PI 14f Lower Columbia College Head Start/EHS/ECEAP Parent Center Committee Responsibilities Assists staff with program development in all component areas by relating parents concerns about their children and explaining particular community needs, customs, values and expectations. Works closely with classroom teachers/ehs staff to carry out the daily activities program. Assists in recruiting and scheduling volunteers for center activities. Plans, conducts, and participates in informal and formal activities for all parents using needs assessment. Assists in staff recruitment and screening. Elects representatives to the Policy Council group; sends directions, questions, requests for activity funds to the Policy Council group via representatives. Lower Columbia College Head Start/EHS/ECEAP Responsabilidades para el Comité de Padres del Centro Asistir al personal con el programa de desarrollo en todos los componente del área a través de relacionar las preocupaciones de los padres acerca de sus niños y explicar las necesidades de la comunidad, costumbres, valores y expectaciones. Trabaja cercanamente con los maestros(as) del salón de clase para llevar a cabo el programa de actividades de todo los días. Asiste en recluir y citar los voluntarios(as) para las actividades del centro. Planea, conduce, y participa en las actividades informales y formales para todos los padres usando valoración de las necesidades. Asiste en el reclutamiento del personal. Elige los representantes para el grupo de la Mesa Directiva; manda direcciones, preguntas, solicita fondos para actividades al grupo de la Mesa Directiva por medio de los presentantes; también evalúa el paquete de donación de Head Start/ECEAP. (C: 08/02; R: 09/10)

118 FS/PI 14g Lower Columbia College Head Start / EHS / ECEAP Parent Center Committee Guidelines The Chairperson, Vice-Chairperson and Secretary/Historian should be elected by the entire parent group at the First Parent Center Committee Meeting of the year. Chairperson is responsible for the following: Leads the meeting Appoints a timekeeper to help keep the meeting on time Makes sure everyone gets a chance to speak Calls the meeting to order and formally closes the meeting when the time is up Reviews any item that is going to need a vote prior to calling for a vote Meets with other Officers, Class Representative(s), and Family Advocate prior to the Parent Center Committee meeting to set up the agenda Does not vote unless there is a tie. Only then may he/she vote to break a tie Gets in touch with all Committee Chairs (if there are any) to get the Agenda organized, as each Committee Chair will make a brief report each month. Facilitation involves: Preparing the Agenda Starting the meeting on time Keeping the group on topic and on time Being aware of the group dynamic/mood/needs Helping everyone participate democratically o Making sure there is agreement about the decision-making method o Calling on people Encouraging quiet people to talk Discouraging domination by a few people Checking for clarity of communication - "I think I hear you saying..." Summarizing progress of the meeting from time to time Moving the group to the point of decision Getting clarity about responsibilities: Task check Note: The whole group should learn to accept responsibility for the conduct of the meeting and for helping the facilitator. This means individual self-discipline. It also means people should be willing to point out when the group is digressing or to make process suggestions. In addition, be aware that deep involvement in the issue at hand, especially if it is controversial, is incompatible with good, fair facilitation. The facilitator can ask someone else to facilitate temporarily when too personally involved in the issue being discussed. Vice-Chairperson is responsible for the following: Should understand the job of the Chairperson If Chairperson is ill and/or cannot attend a meeting, then the Vice-Chairperson leads the meeting (C: 09/05; R: 09/10)

119 FS/PI 14g If Chairperson resigns, Vice-Chairperson takes over as Chairperson, and a new Vice- Chairperson is elected Assists with the development of the agenda Assists Chairperson as needed Attends monthly Parent Center Committee meeting Note: The Vice-Chairperson position is a good starting place for someone new at it; helps prepare Agenda. Can be timekeeper, can be observer (watching how people are responding/participating, pointing out need to hear from some who haven't spoken), and may become facilitator for next meeting. Secretary is responsible for the following: Notes who attends the meetings and gives the Family Advocate a list of all attendees Writes down what happens at each meeting (in brief) and keeps a copy of these minutes in the Center Notebook so that any parent can take a look at the Minutes Book Shall write up the minutes or type them within 5 days of the monthly meeting and post them on the Classroom Parent Board Shall have copies of any documents or forms used for Head Start / EHS / ECEAP parent activities Timekeeper is responsible for the following: Makes sure the Chairperson is running the meeting in a timely fashion and ends on time There can be a different person being the timekeeper at each meeting. Committees Sub-Committees may be developed as needed. A Chairperson of each sub-committee should make a report at the Parent Center Committee meeting. Key Ingredients for a Good Meeting Advance preparation is very helpful Important to have a blackboard or flip chart where all can see Key questions agenda planners face: o What are the goals of the particular meeting? o Where do we need to be at its conclusion - what decisions must be made at this meeting? (C: 09/05; R: 09/10)

120 Parent Center Committee Guidelines FS/PI 14g Lower Columbia College Head Start / EHS / ECEAP Guías para los Comités de Padres de Familia El Presidente, Vicepresidente y Secretaria/Historiador deberán ser elegidos por el grupo entero de padres de familia en la Primera Reunión del Centro del Comité de Padres de Familia del año. El Presidente es responsable de lo siguiente: Dirigir la reunión Asignar a alguien que ayude a tomar el tiempo para mantener la reunión a su hora Asegurarse que todos tengan la oportunidad de hablar Iniciación de la reunión y formalmente terminar la reunión cuando se termine el tiempo Repasar cada asunto del que se valla a votar antes de pedir los votos Reunirse con otros Funcionarios, Representantes de los Salón de Clases, y Trabajadoras Sociales una semana antes de la Reunión del Comité de Padres de Familia de cada mes y organizar la agenda No da su voto a menos de que haya un empate. Solamente es cuando el/ella puede dar su voto para romper el empate Mantenerse en comunicación con todos los Presidentes de los Comités (si es que hay algunos) para organizar la Agenda, ya que cada Presidente del Comité deberá dar un reporte breve cada mes. El conducir la reunión implica: Preparar la Agenda Iniciar la reunión a tiempo Mantener a el grupo en el tema y a tiempo Estar conciente de las dinámicas/actitud/necesidades del grupo Ayudar a todos a participar democráticamente o Asegurarse que haya un acuerdo acerca del método de tomar-decisiones o Llamar a las personas Animar a las personas calladas a hablar Desalentar la dominación de algunas personas Revisar que la comunicación sea clara - "Creo que te escucho decir..." Resumir el progreso de la reunión de vez en cuando Dirigir al grupo al punto de decisión Obtener aclaración acerca de las responsabilidades: Revisar el trabajo Nota: El grupo completo deberá aprender aceptar responsabilidades para la conducta y para ayudar a la persona que este dirigiendo la reunión. Esto quiere decir disciplina- de uno mismo. Esto también quiere decir que las personas deberán estar dispuestas a indicar cuando el grupo se este desviando del tema o dar sugerencias. En adición, estar conciente que involucrarse muy afondo en el asunto, especialmente si es controversial, es incompatible en dirigir la reunión bien y justa. Quien este dirigiendo la reunión le puede pedir a alguien mas que la dirija temporalmente si es que se involucra demasiado en el asunto del que se esta discutiendo. (C: 09/05; R: 09/10)

121 Parent Center Committee Guidelines FS/PI 14g El Vicepresidente es responsable de lo siguiente: Debe de entender las responsabilidades del Presidente Si el Presidente esta enfermo y/o no puede asistir a la reunión, entonces el Vicepresidente conducirá la reunión. Si el Presidente renuncia, el Vicepresidente tomara el cargo de la Presidencia, y se elegirá a un nuevo Vicepresidente. Ayudar con el desarrollo de la agenda Apoyar al Presidente cuando sea necesario Asistir a las reuniones de los Comités de Padres de Familia. Nota: La posición de Vicepresidente es un buen comienzo para alguien nuevo en este lugar. Esta posición ayuda con la preparación de agendas, puede tomar el tiempo, puede ser quien hace las observaciones (ver como las personas están respondiendo/participando, hacer preguntas a alguien que no haya tenido la oportunidad de hablar), y a lo mejor ser quien conduzca la próxima reunión. La Secretaria es responsable de lo siguiente: Tomar notas de quien asistió a las reuniones y darle copias a las Trabajadoras Sociales Tomar notas de todo lo que ocurre en cada reunión (breve) y colocar copias de las minutas en el Cuaderno del Centro para que los padres de familia las puedan ver. Tendrá 5 días después de la reunión para tener las minutas escritas y deberá colocarlas en el Pizarrón de Padres de Familia en el Salón de Clases. Deberá tener copias de todos los documentos necesarios que se utilizan para las actividades de padres de familia de Head Start / EHS / ECEAP. Quien Toma el Tiempo es responsable de lo siguiente: Asegurarse que el Presidente de inicio a la reunión a su hora y que termine a tiempo Puede ser alguien diferente en cada reunión que tome el tiempo Comités Pueden desarrollarse subcomités conforme sea necesario. Cada Presidente de los subcomités deberá dar un reporte en las Reuniones de los Comités de Padres de Familia. Ingredientes Claves para una Buena Reunión Prepararse con anticipación es de mucha ayuda Es importante tener un pizarrón en donde todos puedan ver Preguntas claves durante la elaboración de la agenda: o Cuales son las metas de esta reunión en particular? o Que se debe realizar al terminar la reunión que decisiones se deberán tomar en esta reunión? (C: 09/05; R: 09/10)

122 FS/PI 14h Lower Columbia College Head Start / EHS / ECEAP Center Officers and Their Duties Chairperson Open meetings Call for minutes Preside over meetings in accordance with Robert s Rules of Order Attend all committee meetings, Head Start functions and activities and/or delegate the responsibility to the co-chairperson Establish meeting date and time for Center Meeting and attend monthly meeting Serve as a moderator and only vote in case of a tie Allow full discussion so that people are clear about the issues Vice-Chairperson Assume all Chairperson s responsibilities during his/her absence Works with Chairperson and Secretary on agenda Attend monthly Center Meetings Assist the Chairperson as needed Secretary / Historian Take minutes at all meetings and prepare for next meeting Read and answer correspondence as directed by the group Keep a set of minutes as a permanent record to be filed in the Head Start files and available to Head Start parents upon request Work with Chairperson and Vice-Chairperson on agenda for regular business meeting Attend monthly Center Meetings Help the Chairperson follow agenda and write down and read motions when needed Make three (3) copies of minutes: One each to Teacher, Advocate, and Chairperson Clip and save newspaper articles and pictures (R: 09/10; C: 09/01)

123 Center Officer Duties FS/PI 14h Lower Columbia College Head Start / EHS / ECEAP Funcionarios del Centro y sus Responsabilidades Presidente Inicia las reuniones. Solicita las minutas. Preside las reuniones de acuerdo con Las Reglas de Orden de Robert". Asiste a todas las reuniones del comité, funciones y actividades del Head Start y/o delega la responsabilidad al vicepresidente. Establece las fechas y el horario para las reuniones del Centro y asiste mensualmente a las reuniones. Sirve como moderador y solamente vota en caso de un empate. Permite la discusión total discusión para que la gente este segura de los asuntos. Vice-Presidente Asume todas las responsabilidades del Presidente durante su ausencia. Trabaja con el Presidente y Secretario en la agenda. Asiste a las reuniones mensuales del Centro. Apoya al Presidente cuando es necesario. Secretario/ Redactor Toma nota para las minutas y las prepara la próxima reunión. Lee y contesta la correspondencia dirigida a grupo. Conserva las copias de las minutas como un expediente permanente para ser guardado en el archivo del Head Start y a disposición de los padres de familia que los soliciten. Trabaja con el Presidente y Vice-Presidente en la agenda para regular los asuntos de las reuniones. Asiste a las reuniones mensuales. Ayuda al Presidente a seguir la agenda y cuando es necesario escribe y lee las mociones. Hace tres (3) copias de las minutas: una para la Maestra, otra para la Trabajadora Social y otra para el Presidente. Archiva y guarda artículos y fotos de los periódicos. (C: 04/03; R: 10/10)

124 FS/PI 14i Lower Columbia College Head Start/EHS/ECEAP Job Description for Classroom Representatives 1. Accept other parents for whatever they can do. 2. Represent all parents in his/her classroom. 3. Ask parents to help in classroom. 4. Ask parents to come to Parent Meetings. 5. Gather ideas and concerns from parents by phone or classroom contact and take written ideas from classroom to Parent Center Committee. 6. Invite parents to activities. 7. Help arrange field trips, ask parents to participate on field trips. 8. Maintain complete confidentiality. 9. Represent classroom at Policy Council by attending and participating in discussions. 10. Act as liaison between Policy Council and the Parent Center Committee. 11. Talk with teacher/ehs staff to find out what help from parents is needed. 12. Send THANK YOU to parents!!! (C: 09/01; R: 06/12)

125 Classroom Representative Job Description FS/PI 14i Lower Columbia College Head Start/EHS/ECEAP La descripción del trabajo para los Representantes del Salón de Clases 1. Acepta a otros padres para cualquier cosa que se pueda hacer. 2. Representa a todos los padres en su Salón de Clases. 3. Pide a los padres que ayuden en el salón de clases. 4. Pide a los padres que vengan a las Juntas de los Padres. 5. Junta ideas y preocupaciones de los padres a través del teléfono, contacto en el salón de clase, y toma ideas escritas del salón de clases para el Centro del Comité de los Padres. 6. Invita a los padres a las actividades. 7. Ayuda a arreglar las excursiones, pide a los padres que participen el las excursiones. 8. Mantiene completa confidencialidad. 9. Representa al salón de clases en la junta directiva a través de asistir y participación en la discusión. 10. Se fija que los datos de la Junta Directiva sean puestos en el salón de clases. 11. Platica con los maestros para darse cuenta cual es la ayuda necesitada de los padres. 12. Manda las GRACIAS a los padres! (C: 11/02; R: 06/12)

126 LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Parent Committee Meeting / Reunion Del Comite De Padres De Familia FS/PI 14j Center / Centro: Date / Fecha: AGENDA Call to Order/Welcome/Introductions / Orden del día/bienvenidos/introducciones Review Agenda/Additions / Revisión de la Agenda/Adiciones Read Minutes of Previous Meeting / Lectura de las Minutas de la Reunión Anterior Policy Council Report - Class Representatives Reportes de la Mesa Directiva y de los Representantes de Clase Committee Reports / Reportes del Comité Old Business / Asuntos Anteriores New Business / Asuntos Nuevos DAP Topic/Presenter / Prácticas Apropiadas para el Desarrollo/Presentador Parent Education Topic/Parent Curriculum Input/Presenter / Tema de Educación para Padres/Curriculum Padres de entrada/presentador Family/Teacher Advocate Report/Announcements / Reporte de la Maestra/Trabajadora Social/Anuncios (C: 08/01; R: 08/15)

127 FS/PI 14k1 Lower Columbia College Head Start / EHS / ECEAP Parent / Community Written Concern / Feedback Policy Policy It is the desire of the Head Start / Early Head Start / ECEA Program to encourage communication among parents, community members, and Head Start / EHS / ECEAP staff. Procedure It is important that questions, concerns, ideas and problems be dealt with in a positive manner. Parents and community members should feel comfortable expressing their concerns directly to the individual staff member involved. Every attempt should be made to handle the situation directly. After communications have been attempted, and the situation is still unresolved, the concern should be put in writing. Written concerns should include the name of the person and/or site, date of occurrence, names of people involved, and possible solutions. The Policy Council Representative is the parent s link to overall program operation. Parents could consult their Policy Council Representative for advice and assistance. The written concern will be given to the Area Manager and/or EHS Supervisor within ten (10) working days, and a meeting will be scheduled to discuss the situation. The Area Manager and/or EHS Supervisor may invite all or part of the following to review the situation: Parent Center Committee Officers, Community Member, Policy Council Representative, Family Advocate, individual staff person addressed in the concern and Assistant Director or Director. A written response will be prepared by the Area Manager and/or EHS Supervisor outlining action taken and given to Parent and/or Parent Committee Chairperson within ten (10) working days of the meeting. If the Parent / Community member(s) and/or Parent Center Committee is not satisfied with the written response from the Area Manager and/or EHS Supervisor, the Parent/Community member(s) may request a joint meeting of the Policy Council for final resolution of the concern/problem through a written request to the Policy Council Chairperson. Policy complies with Head Start Performance Standard(s) (R: 08/10; C: 09/01)

128 Parent Community Written Concern Feedback Policy & Procedure FS/PI 14k1 Lower Columbia College Head Start / ECEAP Políticas para Presentar Por Escrito las Inquietudes de los Padres/Comunidad Política Es el deseo del Programa de Head Start / Early Head Start / ECEAP propiciar la comunicación entre los padres, miembros de la comunidad y el personal del Head Start / EHS /ECEAP. Procedimiento Es importante que las preguntas, inquietudes, ideas y problemas sean manejados de una manera positiva. Los padres y los miembros de la comunidad deben sentirse cómodos al expresar sus inquietudes directamente al miembro del personal involucrado. Cada intento deber ser hecho para manejar la situación directamente. Después que la comunicación ha sido intentada y la situación no es resuelta, la inquietud deberá ser puesta por escrito. Los reportes escritos deben incluir el nombre de la persona y/o del centro, fecha en que ocurrió, nombres de las personas involucradas y posibles soluciones. El representante de la Mesa Directiva es el conducto del padre de familia con toda la operación del Programa. Los padres podrían consultar con sus Representantes del Consejo Directivo para pedir consejo y apoyo. Los reportes escritos deberán ser entregados al Supervisor del Área y/o Supervisor de EHS dentro de los siguientes diez (10) días laborales y se programará una reunión para discutir la situación. El Supervisor del Área y/o Supervisor de EHS podría invitar a todas o parte de las siguientes personas para revisar la situación: Funcionarios del Comité de Padres de Familia del Centro, Miembros de la Comunidad, Representantes de la Mesa Directiva, Trabajadora Social, miembro del personal señalado en la queja y al Asistente del Director o al Director. Una respuesta por escrito será preparada por el Supervisor del Área y/o Supervisor de EHS señalando las acciones tomadas y se le dará al padre de familia y/o Presidente del Comité de Padres de Familia dentro de los siguientes diez (10) días laborales de la reunión. Si el padre de familia/miembro de la Comunidad y/o Comité de Padres de Familia del Centro no están satisfechos con la respuesta del Supervisor del Área y/o Supervisor de EHS, el padre de familia/miembro de la comunidad podría requerir una reunión con la Mesa Directiva para una resolución final de la inquietud/problema a través de un requerimiento escrito al Presidente de la Mesa Directiva. Policy complies with Head Start Performance Standard(s) (C: 09/01; R: 10/10)

129 FS/PI 14k Lower Columbia College Head Start / EHS / ECEAP Parent / Community Written Concern / Feedback Form Name: Phone #: Site: Date: Description of Concern / Feedback: (Please include date of incident, people involved and/or site concern). Possible Solutions to the Problem: Signature: Area Manager / EHS Supervisor Director / Asst. Director / EHS Mgr./Health Specialist Meeting Date: Response Mailed: (Attached) Date Received Signature (C: 09/01; R: 09/10)

130 Parent Community Concern Form FS/PI 14k Lower Columbia College Head Start / EHS / ECEAP Reporte Escrito de Padres o Miembros de la Comunidad Formato para Exponer o Recibir Soluciones acerca de un Problema o Inquietud Nombre: Lugar: Teléfono #: Fecha: Descripción del problema o inquietud: (Por favor incluya la fecha del incidente, las personas involucradas y el lugar donde ocurrió el hecho). Soluciones posibles para el problema: Firma: Directora del Área / Supervisor de EHS Director / Asist. Director / Dir. de EHS/Esp. de Salud Fecha de la Reunión: Respuesta Recibida: (Adjunta) Fecha recibida Firma (C: 11/02; R: 09/10)

131 FS/PI 14l Lower Columbia College Head Start / EHS / ECEAP Parent Committee Minutes Form Call to order _. Date. Attendance / Introductions (see attached sign-in). Minutes / Review Motion. Passed Tabled Failed By Second. Agenda Review / Additions Additions Deletions ACTION Items Item Motion _ Discussion Passed Tabled Failed By Second. Item Motion Discussion Passed Tabled Failed By Second. Item Motion Discussion Passed Tabled Failed By Second. continues on back 1 (C: 10/11)

132 FS/PI 14l Informational Items Item Discussion Item Discussion Item Discussion Item Discussion Announcements: Date of next meeting: Other announcements: Motion to Adjourn By Second. Adjourned at p.m. Minutes submitted by 2 (C: 10/11)

133 FS/PI 14l Lower Columbia College Head Start / EHS / ECEAP Forma para las Minutas del Comité de Padres Inicio de la reunión _ Fecha. Asistencia / Presentaciones (ver la forma de firmas anexa). Revisión / Minutas Moción _. Aprobada Pospuesta Rechazada Por Secundada. Revisión de la Agenda / Adiciones Adiciones Eliminaciones Asuntos de ACCIÓN Asunto Moción _ Discusión Aprobada Pospuesta Rechazada Por Secundada Asunto Moción _ Discusión Aprobada Pospuesta Rechazada Por Secundada Asunto Moción _ Discusión Aprobada Pospuesta Rechazada Por Secundada Continúa en la parte de atrás 1 (C: 10/11)

134 FS/PI 14l Asuntos de INFORMACION Asunto Discusión Asunto Discusión Asunto Discusión Asunto Discusión Anuncios: Fecha de la próxima reunión: Otros anuncios: Moción para clausurar Hecha por Secundada. Clausura de la Reunión a las p.m. Las minutas fueron entregadas por 2 (C: 10/11)

135 Lower Columbia Head Start/EHS/ECEAP Parent Committee Meeting Evaluation FS/PI 14m Parent Committee Meeting Date and Topic: Presenter(s): Tell us your thoughts! This meeting was helpful and I learned something new Disagree Agree I would like to learn more about this topic. YES NO What would you change? Ideas for next gathering: (C: 05/05; 05/14)