Handout F-1: Why is Everyone Sick?

Lead Teacher's Report

When the children arrive in the morning, many have dirty diapers, so we change them all first. We lay them all down on the carpet and then put on our gloves. We change all of the babies' diapers and then take off the gloves and throw the diapers and gloves in the trash. When the children have diarrhea, we seal the diaper in a plastic bag. The bathroom sink is way down the hall, but luckily we don't need to wash our hands, since we wear gloves.

Then we give the children their bottles and snacks. The teachers and parents prepare the food in our kitchen area in the room.

After snack, we bring out the toys and let the children play on the carpet area or at play tables for most of the morning. Then we put the toys back into their cabinets.

Before lunch, we change diapers again. The toddlers also use the potty. The children wash their hands in a bowl of soapy water that we pass around. We also dip a washcloth in the soapy water to wash off their faces. Staff and parents wash their hands with the children. We pass around a towel to dry our hands.

The children eat seated in the adults' laps on the carpet or in chairs at the play tables. We save the left over food for the afternoon snack.

After lunch, we all brush our teeth at the sink. The children take naps on mats on the carpet. The after noon is similar to the morning: free play and then snack time. We keep the children indoors most days, because we don't want the babies to catch colds outdoors.

Handout F-2: Why is Everyone Sick?

 

Handout G: Air Quality

Fresh air disperses germs and reduces the spread of illness.

Maintain good ventilation of indoor space

• Keep air temperature between 65 and 72 degrees F.
• Open windows to circulate fresh air.
• Clean air conditioners and humidifiers regularly.
• Spread out toys and equipment.
• Alternate cribs/cots head-to-toe, three feet apart.
• Do not allow smoking.

Maximize outdoor play

In hot and sunny weather:

• Play in the shade.
• Wear hats, visors, sunglasses, and sunblock cream.
• Drink liquids frequently.
• Use sprinklers and hoses for water play.

In cold and wet weather:

• Dress in warm, waterproof clothes.
• Play in areas shielded from wind and rain.
• Play outdoors for briefer periods.
• Have an extra supply of dry clothes.

Module 3 

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Recognizing & Managing Communicable Diseases

Outcomes

After completing this module, participants will be able to:

• Recognize the signs and symptoms of illness in young children,
• Respond appropriately to ill children,
• Communicate effectively with parents and health care providers about illness.

Key Concepts

Recognizing and managing communicable diseases involves a partnership among staff, families, and health professionals.

Head Start staff's role is to:

• Work with health professionals to develop health policies, staff training, and information for parents.
• Observe children for signs of illness.
• Care for ill children until they can be sent home.
• Document signs and symptoms, as well as actions taken.
• Minimize the spread of illness to other children and staff.
• Discuss with parents their ill child's condition, whether he is too sick to attend, the need for medical evaluation and treatment, and when to return.

Head Start staff's role is not to diagnose or prescribe treatment for illness-that's the health care provider's role; and not to provide total care for sick children-that's the parents' role.

Background Information

Head Start staff members are on the "front line" caring for children. You may recognize and respond to the first signs of illness in children. Dealing effectively with illness in children requires a partnership among staff, parents, children, and health care providers.

A. The Daily Health Check

The daily health check is a quick assessment of each child's health. It takes less than a minute. You gather information from what the parent and child tell you, and what you observe. You use all of your senses-listen, look, feel, and smell.

Do the health check each day:

• When the child arrives at the program
• Throughout the day

(See Handout H: Daily Health Check)

When you do the health check every day, you learn what is normal for each child, and you recognize unusual signs or symptoms indicating that the child might be ill.

When you recognize the early signs of illness, you can make the child more comfortable and alert the parents that the child might need medical evaluation and treatment. For example, you might observe that a child complains of sore throat and has a red body rash and fever. Documenting your observations, calling the parents to take the child home, and advising them to take the child to the doctor can lead to prompt diagnosis of strep throat and treatment for the child. This can prevent more severe illness for the child and the spread of the illness to others.

B. Assessing the Ill Child

1. Interpreting the Health Check

The health check tells you when a child might not be feeling "his normal self." These signs might indicate illness, fatigue, hunger, injury, or stress. Your assessment of the ill child involves careful observation, understanding of childhood illness, and familiarity with the child.

Different children have different ways of showing you that they might be sick. For example, one child's "stomachache" might mean that she needs to have a bowel movement, but for another child that she's anxious or upset, and for another child that he's sick with the "stomach flu" and ready to vomit.

Children can also show different signs at different ages:

• It can be difficult to tell when infants are sick. You need to be alert to small signs such as fussiness, poor appetite, listlessness, or feeling warm.
• When toddlers and young preschoolers are sick, they often have a general complaint, "I don't feel good." You need to ask them to tell you or show you where it hurts.

2. Checking for Fever

When a child complains of not feeling well and looks and acts sick, you may take the child's temperature to tell whether he has a fever. Fever is when the body's temperature rises higher than normal. Body temperature can rise in response to an illness, immunization, exercise, overdressing, or hot weather.

Fever is not an illness in itself-it is a possible sign of illness. Consider fever along with all of the other signs and symptoms (i.e., how sick the child looks and acts) to determine how sick the child is.

C. Caring for the Ill Child

When a child is sick, staff must decide whether the child is too sick to stay m the program. Although it is not the role of the program to care for ill children, staff need to provide care until the parents arrive. You need to rely on clear health policies and your own judgment and experience.

1. When a Child Is Too Sick to Attend

A child is too sick to attend the program if (any of the following):

• The child is too sick to participate comfortably in the program's activities.
• The staff cannot adequately care for the needs of the sick child without compromising the care of other children.
• The child might have a specified communicable disease that could spread to other children and staff.

(See Handout K: When a Child Is Too Sick to Attend)

2. Developing a Care Plan

When children are sick, they have greater emotional and physical needs.
The basic care plan should follow the "4 C's":

• Comfort the child
• Care for the child's symptoms
• Complete the Symptom Record
• Call the parents

Comfort

Ill children may feel irritable, sad, lonely, frightened, angry, and bored. They often regress to a less mature level of behavior. Nurturing by a trusted caregiver in a familiar setting can reduce the stress of an illness:

• Touch and sing to the child.
• Frequently ask how she is feeling and acknowledge her feelings with understanding and concern.
• Let her know who will pick her up and when.
• Encourage the other children to draw a get-well picture, make her a snack, or choose a toy for her to play with.

Care

Isolation or "Get-Well" Area: The isolation or get-well area is a place to care for the sick child, slightly away from the main area of activity. The purpose is to isolate the germs so they don't spread to other children. Do not isolate the child Maintain constant supervision of the sick child to observe her symptoms, care for her needs, and make her feel included.

Rest and Activities: When a child is sick, especially with a fever, he has a greater need for rest because his body is working to fight off the illness. Provide opportunity for quiet play, rest, and sleep.

Nutrition and Fluids: When a child has a fever, vomiting, or diarrhea, he has a greater need for nutrition and fluids to replace what is being lost. However, many children lose their appetite when they are sick. Frequently offer small amounts of liquids (e.g., water, juice, broth, gelatin) and light snacks (e.g., crackers, toast, noodles, tortillas, rice, bananas, applesauce).
Care for Fevers: When fever accompanies an illness, it actually helps the body fight off the disease. A fever is usually not harmful and does not need to be treated. To make the child feel more comfortable you may:

• Undress the child to the point of comfort (i.e., light clothes and a sheet or blanket). Do not bundle the child to "sweat out" the fever.
• Frequently offer clear liquids to drink.
• Place a cool compress on the child's forehead.

Medications: Medications may be prescribed to treat an illness or relieve symptoms. But medications can also be dangerous if they are given when not needed, or if they are given in the wrong way, wrong amount, or at the wrong time. They can be dangerous even when given properly, for example, if the child has an allergic reaction.

Give medicines only in accordance with state licensing regulations and when prescribed by the child's health provider. Staff members should be trained in procedures to administer medications and document each time they give medicine to a child.

Emergency Care: Although severe illness is rare among children, staff must recognize and get immediate medical care (emergency medical system, 911) for the following:

• Signs that the brain may not be functioning well-such as, listlessness, confusion, seizures, severe irritability, severe headache, uncon sciousness.
• Breathing problems-such as, rapid breathing, persistent coughing, wheezing, sucking-in around the ribs, choking, bluish/grayish lips or nails.
• Severe loss of body fluids and circulation problems due to large blood loss, persistent vomiting or diarrhea, or dehydration-signaled by pale/ashen color, cold hands and feet.
• Severe pain-such as, headache, abdominal pain, chest pain.

NOTE: Have emergency contact information and consent for emergency treatment signed by the parents on file for each child. Make sure the in formation is current.

Completing the Symptom Record

It is important to document the child's illness in order to share information with the parents. This helps parents know how their child is feeling and how they should care for him. If they take the child to the doctor, it will aid in the diagnosis and treatment.

Documentation is also important for the program's records. The records can be reviewed by a health consultant for improving the prevention and management of illnesses in the program. The records will also be available to the licensing agency, public health authority, or insurer in case of severe illnesses or complications.

Carefully document:

• The signs and symptoms of illness that you observe.
• How you responded to the symptoms. (See Handout I: Symptom Record)

Calling Parents

Staff and parents depend on each other for sharing concern and responsibility for the child and respecting each other's feelings and beliefs. Since a child's illness can add stress to the relationship between caregivers and parents, sensitive communication around illness is crucial.

Prepare in advance by developing clear, up-to-date health policies. Give parents a copy of the policies and discuss them during enrollment/orientation and parent-teacher meetings. Explain that, although the program takes many measures to reduce the spread of disease, it is inevitable that children get sick. Clarify the policy on when a child is too sick to attend and help parents plan who will care for the child when she is sick.

When a child is sick, always report the symptoms to the parents, either immediately or at the end of the day, depending upon the severity of the symptoms.

• Express your concern about the child's health and comfort. For example, "I'm concerned that Emma hasn't wanted to eat or play and just doesn't seem herself."
• Describe the child's symptoms and what you did. For example, "Joey vomited up his formula twice. He's been pulling at his left ear and has a fever of 101 under the arm. I cleaned him up, and he's asleep now." Do not be vague, for example, "Joey feels hot." Do not diagnose the illness, for example, "Joey has an ear infection so you need to pick him up and get him antibiotics."
• Try to be sensitive to the parents' situation. If the child needs to be sent home, tell the parents that you understand it might be difficult for them to make last-minute arrangements. Ask who will be able to pick up the child and when they will come. Try to be flexible-unless it is a medical emergency, immediate pick-up is not usually necessary. Reassure them that you will keep the child comfortable until they arrive.
• Discuss the possible need for medical evaluation and treatment. When in doubt, suggest that the health provider check it out. Depending upon how sick the child looks and acts, you might state, "It's probably nothing serious, but if she's not getting better you might want to have her checked by her health provider," or "She looks pretty sick, and I really think that you should take her to the doctor right away."
• Ask the parents to give you the health care provider's diagnosis and treatment recommendations. Emphasize that you are concerned about the child. Also, you may need to notify other parents and the health department of exposure to a communicable disease. Tell the parents when the child can return (e.g., when the symptoms resolve or 24 hours after starting antibiotics).

NOTE: When giving information to other parents or posting exposure notices, maintain confidentiality-do not report the name of the child
 

D. Communicating with Health Providers

Periodically, health concerns arise that are beyond the knowledge of Head Start teachers, directors and health coordinators. Programs need to develop relationships with health professionals who can provide assistance. Keys to effective communication include:

• Address questions to the appropriate health provider. For ex ample, when your concerns address the health of a specific child, consult the child's health care provider (with the parents' permis sion). When the concerns are group health issues (e.g., health policies or infection control practices), contact your programs s health consult ant or the public health department.
• State your concern briefly and clearly. Have all of the necessary facts (e.g., the Symptom Record) on hand.
• Listen carefully and document the advice. If you don't understand something, clarify it immediately. If the advice is complicated, re quest written information. Summarize to confirm your understanding.

Questions for Discussion/
Reflection:

When a child becomes ill, it can be very stressful for the child, parent, and Head Start staff. Dealing effectively with illness requires cooperation among staff, families, and health professionals.

• What is the greatest challenge for you in dealing with communicable diseases in the program?
• What has your program done to encourage cooperation among staff, parents, and health professionals regarding communicable diseases?
• What could your program do to manage illnesses more effectively?

 Activity 1: The
Daily
Health Check

Purpose: This activity helps participants develop their skill observing children for signs of health and illness.

This activity is particularly helpful for teachers and aides. You will need:

• A copy of Handout H: Daily Health Check, for each participant
• Handout I: Symptom Record
• Handout J: Does the Child Look Sick?-blank chart
• Key to Activity 1: Does the Child Look Sick? (for trainer only)

Step 1: Review the importance of the Daily Health Check (see Back ground Information) and how to do it-Handout H: Daily Health Check.

Step 2: Schedule 30 minutes for the coaching group to greet children and parents as they enter a classroom in the morning. Do the Daily Health Check with each family-talking with the child and parent and observing the child.

Step 3: Identify one child with the most signs of being sick. Using Handout I: Symptom Record, fill in the child's symptoms that you observe. Make a list of the additional information you would like to have. Make a list of additional information you would like to have. Whom do you need to get that information from? The child? Parent? Teacher?

Step 4: Have the group members sit down together and discuss the Daily Health Check. Ask:

Approximately how long did it take to do the Daily Health Check for each child?

What felt most comfortable for you?

What was most difficult for you?

Step 5: Using Handout J: Does the Child Look Sick?, fill in all the signs they observed of children "Looking Healthy" and the signs of possibly "Looking Sick." Try to note signs from every category (See Key to Activity 1).

Step 6: Ask: What signs and symptoms do you think are most helpful in determining how sick a child is?

Step 7: When the Symptom Record is complete, use it to help answer the following questions about the child you are observing. Ask:

• Do you think that this child is too sick to stay in the program for the rest of the day?
• If yes, why do you think that?
• If no, what additional signs or symptoms would you watch for to indicate that the child is too sick to stay in the program?
• What would you say to the parents?
• Under what circumstances might you want to call a health professional? What would you say?
• How would you care for the child until she is picked up?
• Why is it helpful to document the child's symptoms and your actions in a Symptom Record?

Points to Consider:

• The daily health check involves observing and talking with the parent and child. It should be done every day as children enter the program, and throughout the day.
• One of the best signs of whether a child is ill is how she looks and acts, especially comfort, activity level, and appetite.
• A child is too sick to attend the program if he is too sick to participate in activities, staff cannot care for his needs, or he might have a speci fied communicable disease.
• When a child is ill, communication with parents must be clear, informative, and sensitive to the parents' concerns (see Background Information).
• Consult a health professional about signs of severe illness, questions about diagnoses and treatment, and to report communicable diseases.
• A Symptom Record documents observations and actions to inform parents and health care providers. It may also be reviewed by management, consultants, licensing, courts, or insurers.

Does the Child Look Sick?

One of the best signs of whether a child is seriously ill is how she looks and acts. Check the child for signs of health and illness.
  

Looking Healthy

Looking Sick

  

General Appearance	Comfortable Cheerful, responsive Active, playing Behavior appropriate for child and time of day Good appetite	Excessive crying, clinginess, fusiness Doubled over in pain, unalbe to move Listless, lethargic, unresponsive Noappetite Vomiting, diarrhea
Breathing	Breathing slowly Relaxed Quiet	Breathing fast Difficulty breathing Sucking in around ribs Flaring nostrils Persistent cough Wheezing
Skin	Normal skin color and texture for child Normal skin temperature No rashes, sores, swelling, or bruising No scratching ar skin or scalp	Pale, grayish, flushed, yellowish Hot or cold and clammy skin Skin rashes, sores, swelling, or bruising Scratching at skin or scalp Skin doesn't spring back when pinched
Eyes, Nose, Ears, and Mouth	Eyes bright and clear Nose clear Eyeas clear Mouth without sores, swallowing comfortable	Eyes swollen, red, crusty, goopy, watery, yellowish, or sunken Nose congested or runny Ears draining pus or blood Pulling at ears Mouth or lips with sores, excessive drooling, difficulty swallowing
Odors	No odor or normal odor of child	Breath smells foul or fruity Stool smells foul

Activity 2: Assessing
the Child Who
Is Ill: Twenty
Questions

Purpose: This activity helps participants develop skill in assessing an ill child and communicating with parents about the child's illness. For this activity, you will need:

• Key to Activity 2: Crystal's Story (for trainer only)
• A copy of Handout I: Symptom Record, for each participant
• A copy of Handout K: When a Child Is Too Sick to Attend, for each participant
• Flip chart paper and markers

Step 1: Explain that this exercise helps assess how sick a child is.

Step 2: Instruct participants to imagine they are a classroom teacher. Read aloud Crystal's Story-Part 1.

Step 3: Tell participants that they need to determine how sick Crystal is and how to care for her. They will play a game of Twenty Questions to find out the information. Their questions should search for:

• Information about the child's symptoms and behavior. You must specify who would you ask and what you would ask them, for example, "I want to ask Crystal, 'What's bothering you-your stomach, your head, your throat...?"'
• Observations of the child, for example, "I want to observe Crystal's skin."

Step 4: Distribute Handout I: Symptom Record. Instruct participants to fill in the information and observations they make.

Step 5: As the participants ask for information and observations, the trainer will reveal pieces of information based on Crystal's Story-Part 2. Participants should fill in Crystal's Symptom Record.

Step 6: After participants have asked 20 questions, explain that this is all the information that they could obtain in the midst of their busy day caring for Crystal and all of her classmates.

Step 7: Distribute Handout K: When a Child Is Too Sick to Attend. Explain that this is the current health policy that your program has adopted to determine when a child is too sick to attend.

Step 8: Ask participants:

• Do you think Crystal is too sick to stay in the program for the rest of the day? What questions were most helpful in determining that?
• When do you want to call her parents? What would you say?
• Under what circumstances might you want to call a health professional? What would you say?
• How would you care for Crystal until she is picked up?
• What would you do to minimize the spread of Crystal's illness to other children and staff?
• Why is it helpful to document the child's symptoms and your actions in a Symptom Record?

Points to Consider:

• When a child complains, "I feel sick," you need to ask questions and observe the child (e.g., degree of comfort, activity level, appetite, breathing, skin) to determine how sick she is.
• A child is too sick to attend the program if he is too sick to participate in activities, staff cannot care for his needs, or he might have a speci fied communicable disease.
• Call Crystal's parents and discuss:
• Your concern about Crystal.
• The signs and symptoms you observed and what you did.
• That she needs to be picked up; who will come and when? Be understanding of the parents' situation.
• How you'll take care of her until they arrive.
• Your suggestion that she see the doctor and your request that they tell you the diagnosis and recommended treatment.
• When Crystal can return to school.
• Consult a health professional about signs of severe illness, questions about diagnoses and treatment, and to report communicable diseases.
• As you care for Crystal until she's picked up: comfort her, make a place for her to rest, and offer her small amounts of clear liquids to drink.
• To minimize the spread of Crystal's illness:
• Make sure that Crystal washes her hands well, especially after using the toilet.
• Make sure that staff members wash their hands well after caring for Crystal and before preparing and serving food.
• Don't share food or drinks.
• A Symptom Record documents observations and actions to inform parents and health care providers and may be reviewed by manage ment, consultants, licensing, courts, or insurers.

Crystal's Story

Key to Activity 2

· PART 1
 
Crystal is a three-and-a-half year old who is usually very active and cheerful. She is quieter than usual when she arrives at school. When it's time for snack, she complains, "I don't feel good."

· PART 2
 
A. Information from:
 
Parents:

• Crystal complained of a stomach ache last night.
• Crystal didn't eat much breakfast this morning.
• Crystal's brother is home sick with fever, vomiting, and diarrhea.

 Teachers:

• Crystal was clingy and whiny this morning.
• Crystal just wanted to play quietly this morning.

 Crystal:

• My tummy hurts.
• My head hurts.
• I have diarrhea.
• I feel like I'm going to throw up.

 B. Observations of Crystal:

•  General appearance-sad, uncomfortable, no appetite, low activity level
• Breathing-normal
• Skin-pale, cold, and clammy
• Eyes/nose/ears/mouth-eyes glassy
• Odors-breath smells fruity, stool smells foul
• Temperature-l 01 degrees F. axilliary

 Activity 3: What Would You Do?

Purpose: This activity helps staff members develop their skills in re sponding to communicable diseases in their program.

For this activity, you will need:

• Flip chart paper and markers (at least five)
• Five copies of Handout K: When a Child Is Too Sick to Attend
• Handout L: What Would You Do?
• Appendix: Communicable Disease Fact Sheets: Infectious Diarrhea, Chicken Pox, Head Lice, Impetigo

Step 1: Explain that this activity allows participants to plan how to manage communicable diseases in the classroom.

Step 2: Divide participants into five groups. Distribute to each group one story from Handout L: What Would You Do? and flip chart paper and a marker.

Step 3: Instruct each group to read its story of a child with a communicable disease in Head Start.

Step 4: Ask each group:

• Do you need any more information about a specific disease?
• What do you need?
• What resources would you use?

 

Step 5: Tell participants that they went to their health resource library or spoke with their health consultant or local health department and got written material on communicable diseases. Distribute Handout K: When a Child Is Too Sick to Attend, to every group, and the Fact Sheets to the groups as follows:

•  Story #1: Infectious Diarrhea
• Story #2: Chicken Pox
• Story #3: (No diagnosis yet)
• Story #4: Head Lice
• Story #5: Impetigo

Step 6: Ask: What are the strengths and weaknesses of using fact sheets for managing communicable diseases in Head Start?

Step 7: Instruct each group to take approximately 15 minutes to review the story and the fact sheet and list on the flip chart paper what the program should do to manage the communicable disease.

Step 8: Bring the groups back together. Ask each small group to report back to the large group. Read the story aloud, post the plan, and explain how you assessed and managed the situation.

Step 9: Explain that, although each story is different, there are some common steps to consider in managing a communicable disease. Ask participants to scan the plans for all of the stories and look for the common themes
 
On flip chart paper, wnte the title "Managing Communicable Diseases: Ten Steps to Consider." Underneath it, list four cat egories: "The Ill Child," "Parent," "Health Professionals," and "The Program" (staff and other children and families).
 
Have participants list the ten general steps to managing diseases (see Key to Activity 3: Managing Communicable Diseases).

Step 10: Ask participants:

• Why is a partnership among staff, families, and health professionals needed to manage communicable diseases effectively in Head Start?
• What are some of the challenges in working with families and health professionals, in dealing with communicable diseases?
• What strategies have been helpful in working with families and health professionals around illness?
• How could your program respond more effectively to diseases?

 Points to Consider:

• Head Start programs need to use reliable health resources-current written materials and health professionals-to develop health policies on preventing, recognizing, and managing communicable diseases.
• When children are ill, staff should be careful not to diagnose or prescribe the treatment for an illness-that is the role of the health care provider. When a health professional has made the diagnosis, fact sheets can help inform staff and parents about what the disease is and how to manage it.
• Often, when children are ill, staff do not know the diagnosis (e.g., Story #3), or they may make an incorrect diagnosis (e.g., Story #5). Pending further information from the health care provider, management decisions should be based on the child's symptoms.
• For every illness, programs should consider each step in Managing Communicable Diseases (Key to Activity 3). For each step, ask: "Is this necessary?" "What should I do?"
• When responding to communicable diseases, communication between staff and parents must be clear, informative, and sensitive to each others' concerns (see Background Information).

Managing Communicable Diseases:
Ten Steps to Consider

Key to Activity 3

In Relation to...
 
The Ill Child:

•  Observe the child
• Assess the child: Is she too sick to attend? What care does she need?
• Care for the child.
• Document the symptoms and actions taken.

The Parent:

• Call the parent: Explain your observations and actions, assessment of how sick the child is, the need for her to go home, the need for medical evaluation and treatment, and when to return to the program.

Health Professionals:

• Call the program's health consultant or the child's health care provider (with parents' permission) with questions.
• Call emergency medical services for severe illness.
• Call the health department for reportable diseases.

The Program-Staff and Other Children and Families:

• Follow infection control measures to prevent the spread of disease.
• Notify parents and staff about exposure to certain communicable diseases. Monitor other children and staff for illness.

Activity 4:
Handling an Outbreak

Purpose: This activity helps participants respond effectively to outbreaks. of communicable diseases.

This activity is particularly helpful for directors, health coordinators, and head teachers. You will need:

• A copy of Handout Ml-2: Handling an Outbreak, for each participant
• A copy of the Appendix: Communicable Disease Fact Sheets- Chicken Pox and Hepatitis A, for each participant

---

Trainer's note: If another communicable disease (e.g., ringworm or measles) has been an issue for the program, you may rewrite Han4out M and substitute the corresponding Appendix fact sheets for those above. 

---

 
Step 1: Have participants imagine they are program directors or health coordinators. They are notified of an outbreak of a communicable disease in their program and will coordinate the response to the outbreak.

Step 2: Distribute Handout M1-2: Handling an Outbreak, and the Appendix: Communicable Disease Fact Sheets for chicken pox and hepatitis A. Allow participants a few minutes to review Out break #1 and the chicken pox fact sheet.

Step 3: Using the fact sheet as a guide, work through the responses to the questions on handling the outbreak.

Step 4: Repeat Steps 2 and 3 for Outbreak #2: Hepatitis A.

Step 5: Discuss:

• Why is a partnership among staff, families, and health professionals needed to manage communicable diseases effectively in Head Start?
• What are some of the challenges in working with families and health professionals in dealing with communicable diseases?
• What strategies have been helpful in working with families and health professionals regarding illness?
• How could your program respond more effectively to diseases?

Points to Consider:

• Head Start programs need to use reliable health resources-current written materials and health professionals-to develop health policies on preventing, recognizing, and managing communicable diseases.
• Both parents and staff need to be informed about the program's health policies.
• When children are ill and a health care provider has made the diagnosis, fact sheets can help inform staff and parents about what the dis ease is and how to manage it.
• During outbreaks of communicable diseases, communication between staff and parents must be clear, informative, and sensitive to each others' concerns.
• Every program should have an ongoing relationship with the local health department and/or a health consultant (e.g., Health Services Advisory Committee member) to call in case of questions about com municable diseases.

 Next Steps:
Ideas to Extend
Practice

Establishing a Relationship with a Health Consultant

Every program should develop a relationship with a Health Service Advisory Committee member or a health consultant, such as a physician or nurse. Your health consultant can help you develop the health policies and update them annually, since health recommendations may change. The health consultant can also help with training for staff and workshops for parents. Your consultant might visit your program periodically to observe infection control practices, review your illness records, and identify health practices that need improvement. Your health consultant can also assist in accessing local resources and address any health questions that might arise.

Reviewing and Revising Your Health Policy

Review your program's health policy to determine whether it covers all aspects of preventing, recognizing, and managing communicable diseases. For example: Do the infection control policies address band washing, gloves, diapering/toileting, cleaning and disinfecting, disposal of wastes, and food handling? Do staff conduct daily health checks and complete symptom records for ill children? Do you have a policy on when a child is too sick to attend? Do you have exposure notices on communicable diseases? Do you have a Blood-Borne Pathogens Exposure Plan?

Work with a health consultant and your Health Services Advisory Committee to make sure your health policy is complete and up-to-date. Review the health policy annually.

Training Staff on the Health Policy

Make sure that all staff receive a written copy of and training on the health policy. Staff need to be informed about what the policy is and why it is important. Invite your health consultant and Health Services Advi sory Committee members to address any questions about the policy. Update the training annually.

Informing Parents about the Health Policy At orientation, give parents a brief summary of the program's health policy. Review the key points, such as when they should keep their child home for illness. When illnesses arise, use the fact sheets as exposure notices. Make sure that written material is translated into the families' languages. Offer a parent-staff workshop during the year to address any concerns about the health policy and the management of illness in the program. Invite your health consultant and Health Services Advisory Committee members to address any questions.

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