Chlamydia Trachomatis and Gonorrhea Case Investigation
All reported cases will be interviewed in order to provide appropriate health counseling, assure compliance with treatment, and obtain information regarding sexual partners.
The interview period is 60 days from onset of symptoms, or for asymptomatic cases, 60 days from date of treatment. The case will be advised that the information is confidential and contacts will not be told who provided the nurse with their names.
It is the health department’s responsibility to assure that all sex partners within the 60-day window are tested and treated. The public health nurse will use professional judgment as to the most appropriate approach to use in contacting clients. As a general guideline, clients will be contacted either by telephone or with a nondescript letter as soon as possible after the report is received. When contact is made by phone, the interviewer will request the client to provide identifying information (i.e. birth date) in order to assure the correct person is being spoken with.
If the nurse is not successful in making phone contact with the case after several attempts at different times of the day, a letter will be mailed to the case.
If there is no response after one week, a second letter will be mailed.
If there is no response to Letter #2, a certified letter will then be mailed.
A field visit may be done if the public health nurse believes this may be a successful contact strategy.
Once the case is interviewed and sex partners are established, those contacts listed by the case will be notified and referred for testing and treatment. Education will be provided as to the nature of the infection, transmission, risk factors, etc.
Clients unable to be contacted via telephone, letter, or field visit may be closed out as “unable to locate.”
As directed in DHS 145.14 Administrative Code, the Health Officer will be notified of delinquent cases by health care providers whenever their patients do not comply with the treatment plan for sexually transmitted infections.
If unable to submit information via WEDSS, complete paper documentation.
Reported cases of Syphilis will be phoned to the Division of Public Health for follow up as soon as possible. The Division of Public Health will do a complete investigation of the case. Health department staff may assist with information regarding locating factors and treatment as requested by Division of Public Health staff.
Refer to the Epinet and Control of Communicable Diseases Manual for procedures on less commonly reported sexually transmitted infections.
EVALUATION: Quarterly and annual statistics of reported diseases will be reviewed, analyzed, and provided to the Health and Human Services Committee. Program will be assessed annually for necessary procedural changes.
Control of Communicable Diseases Manual (current edition)
Red Book (current edition)
EpiNet Manual, State of Wisconsin, Department of Health Services, Communicable Disease Section: http://hanplus.wisc.edu/epinet/
DHS 145 Wisconsin Administrative Code
Wisconsin Statutes Chapter 252
Patient Health Care Records / Wisconsin Statute 146.82
Wisconsin Statute 146.83(1)
Suspected Child Abuse and Neglect / Wisconsin Statute 48.981
Wisconsin Statute 948.025
Wisconsin Statute 940.225
Wisconsin Statute 948.02
Wisconsin Statute 253.07(1)(b)]
POLICY TITLE: Blood Lead Screening for Children
EFFECTIVE DATE: 07/05/2006
DATE REVIEWED/REVISED: 01/17/2007, 07/23/2012
AUTHORIZED BY: Jen Rombalski, Health Officer PURPOSE STATEMENT: To assure availability and accessibility of blood lead screening for children ages 1-6 years at risk for lead poisoning according to the Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).
RESPONSIBLE STAFF: Public Health Nurse
The analyzer will be calibrated per the manufacturer’s directions prior to being used. See the User’s Guide for calibration instructions. Record the results on the Lead Care II Data Sheet. The analyzer must be calibrated in the following circumstances:
The first time it’s used
Each time screeners start a new lot of test kits
Any time the analyzer displays a recalibration message
Each time a new shipment is received.
Blood lead proficiency testing will be conducted bimonthly in the odd months following the procedures outlined by the Wisconsin State Laboratory of Hygiene.
Lead screening will be offered free of charge to all families with 1 and 2 year old children and those that are less than 5 years old and have never been tested. BadgerCare will be billed for those that are eligible. Those clients that are not on BadgerCare will be tested under the Childhood Lead Prevention grant.
Upon the request of a parent or guardian for lead screening have the accompanying adult complete the consent form.
Collecting the blood:
Place all collection materials on top of a disposable pad. Open the retractable lancet, alcohol pad, gauze, Band-Aid, etc and have all needed supplies ready to perform the test.
Wash child’s hand with soap.
Put on powder free gloves.
Massage the child’s hand & the lower part of the finger you’ll use for sampling. Turn the hand palm down. Clean the child’s finger with an alcohol pad.
Hold the child’s finger in a downward position and using a retractable lancet, poke the palm side surface of the finger.
Apply slight pressure to the finger to start the blood flow. Blot away the first drop of blood with a gauze pad.
To collect the child’s blood sample, hold the heparinized capillary tube almost horizontal with the green band on top, filling to the black line. Avoid over filling
Using a downward motion remove excess blood from the outside of the tube with a clean gauze pad. Be careful to not drain blood from the end of the capillary tube.
Inspect the tube for proper filling. Make sure there are no gaps or bubbles or excess blood on the outside of the tube.
Preparing the sample for analysis:
Remove the cap from the treatment reagent tube & place it face side up on a clean gauze pad. Do not allow the inside of the cap to touch anything as this can contaminate the sample.
Place the full capillary tube in the reagent tube. Insert the plunger into the top of the capillary tube and dispense the blood sample completely into the treatment reagent.
Replace the cap on the reagent tube. Invert it 8-10 times to mix the sample completely.
The test sample is ready to analyze when the mixture turns brown.
Storage: Once the sample has been prepared it can be stored for 48 hours at room temperature or up to 7 days refrigerated. If refrigerated, bring to room temperature before analyzing. If the sample is not tested immediately or more than one sample is collected before analyzing, label the tube with the client’s name.
Analyzing the Sample:
Remove a sensor from the sensor container, closing the container immediately. Grasp the sensor at the end without the black bars.
Insert the sensor with the black bars facing up completely into the analyzer. When the sensor is correctly inserted the analyzer beeps & the following message is displayed, “Add 1 Drop of Sample to X on Sensor, Sensor Lot XXXX”
Make sure the sensor lot number matches the lot number on the display. If the number doesn’t match, recalibrate the analyzer & test controls that are in the new test kit.
Make sure the sample is at room temperature and uniformly mixed before testing.
Remove the cap from the tube. Remove a transfer dropper from its container. Squeeze the walls of the dropper and insert the tip into the sample. Release the pressure to draw the sample into the dropper.
BEFORE ADDING THE SAMPLE, MAKE SURE THE FOLLOWING MESSAGE IS DISPLAYED: “Add 1 Drop of Sample to X on Sensor, Sensor Lot #xxxxx”
Touch the dropper tip to the X on the sensor and squeeze the walls to release the sample.
The analyzer will beep & display the following message, “Testing, XXX Seconds to Go, Sensor Lot #XXXX”
After 3 minutes, the analyzer will beep again to indicate the test is done.
Record the test results on the lead lab log.
Remove the used sensor and discard in a biohazard container.
The analyzer is ready for the next sample when the following message appears: “Last Test Result, x.x mg/dl Pb, Insert sensor, Sensor lot #xxxx”
Display reads, “Low” if it detects blood lead levels below 3.3 mg/dl. Record this result as <3.3 mg/dl
Display reads, “High” if the test result is greater than 65 mg/dl. Record this result as >65 mg/dl
Enter the results in ROSIE.
Record the result on the lead reporting form and give to parents along with the “Look out for Lead” pamphlet.
Consult with Environmental Health Specialist regarding levels of concern.
Perform quality control measures to assure accurate results
Run Lead Care II quality controls per manufacturer’s directions
Run blood lead proficiency samples from the State Lab of Hygiene.
REFERENCES/LEGAL AUTHORITY: Wisconsin State Lab of Hygiene at http://www.slh.wisc.edu/ehd/toxicology/reports/longstick.pdf
Wisconsin Statutes Ch. 254
Center of Disease Control and Prevention
Wisconsin Childhood Lead Poisoning Prevention Program
EFFECTIVE DATE: 07/23/2012 DATE REVIEWED/REVISED: 07/23/2012
AUTHORIZED BY: Jen Rombalski, Health Officer PURPOSE STATEMENT: To promote and maintain the health and well-being of nutritionally at-risk pregnant, breastfeeding and postpartum women, infants and children residing in Buffalo County. RESPONSIBLE STAFF:
Reference Wisconsin WIC Operations Manual.
REFERENCES/LEGAL AUTHORITY: Wisconsin WIC Operations Manual located at Wisconsin Department of Health Services website
POLICY TITLE: Child Abuse or Neglect Reporting
EFFECTIVE DATE: 7/16/12
DATE REVIEWED/REVISED: 7/16/12
AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director PURPOSE STATEMENT: 1. To assure Health Department staff designated as mandatory reporters of child abuse or neglect comply with appropriate regulations.
2. To guide staff in making a referral for child abuse or neglect.
3. To assist staff in serving as advocates for vulnerable children.
4. To prevent unnecessary injury and death associated with child abuse or neglect.
POLICY: It is the legal responsibility of the Pepin County Health Department to report suspected cases of child abuse or neglect. These mandates are derived from Wisconsin Statute 48.981(2), which stipulates the following:
Any of the following persons who has reasonable cause to suspect that a child seen by the person in the course of professional duties has been abused or neglected or who has reason to believe that a child seen by the person in the course of professional duties has been threatened with abuse or neglect and that abuse or neglect of the child will occur shall report the suspected abuse or neglect and/or threatened abuse or neglect.
Anyone intentionally violating this statute by failing to file a report as required may be fined or imprisoned or both. Any person participating in good faith in the making of a report shall have immunity from any liability, civil or criminal, that results by reason of the action. No person making a report may be discharged from employment for doing so. Employees of the Pepin County Health Department covered by this statute include:
Environmental Health Inspectors
Public Health Aides
WIC Ancillary Staff
Any medical or mental health professional not otherwise specified
Health Department personnel who are mandatory reporters will be available to work actively with the Human Services Department following child abuse or neglect referrals. While the laws of confidentiality apply in all child abuse or neglect cases, they shall not be allowed to interfere with the legal obligation to refer such cases to Pepin County Human Services.
PROCEDURE: Any Health Department staff member who either suspects a child has been abused or neglected, or has received a report of suspected abuse or neglect, shall proceed as follows:
The employee has the responsibility to report a suspected case of child abuse or neglect to Social Services as soon as possible on the same day the information becomes available.
The employee shall inform the Director either before the report is made or as soon as possible after making the report with Human Services.
If any doubt exists as to whether or not to report, such doubt should be resolved in favor of reporting.
If the child is in imminent danger, call law enforcement or 911.
If the child is not in imminent danger, contact Pepin County Human Services and ask for Access.
Provide the specific referral information to the Access Social Worker.
Work collaboratively with Human Services on any follow up reports, documentation, or other information requested. Anything that the employee feels is relevant to the abuse or neglect report is releasable to Human Services. HIPAA rules do not apply in child abuse/neglect investigations.
If the Health Department employee feels it would benefit the child to discuss the abuse or neglect issue with school personnel, it is allowable to discuss the issue with a school nurse or counselor (as long as the counselor is a certified counselor under chapter 457 Wisconsin Statutes).
Per Section 146.82 of Wisconsin Statutes:
(2) Access without informed consent. (a) Notwithstanding sub. (1), patient health care records shall be released upon request without informed consent in the following circumstances….:
2. To the extent that performance of their duties requires access to the records, to a health care provider or any person acting under the supervision of a health care provider or to a person licensed under s. 146.50, including medical staff members, employees or persons serving in training programs or participating in volunteer programs and affiliated with the health care provider, if any of the following is applicable:
a. The person is rendering assistance to the patient.
b. The person is being consulted regarding the health of the patient.
c. The life or health of the patient appears to be in danger and the information contained in the patient health care records may aid the person in rendering assistance.
d. The person prepares or stores the records, for purposes of the preparation or storage of those records. EVALUATION: All cases of suspected child abuse and neglect will be appropriately reported and documented. Methods of evaluation include chart review and review of reports filed with Pepin County Human Services.
HIPAA privacy practices
Wisconsin State Statute 48.981
Wisconsin State Statute 48.981
POLICY TITLE: Childhood Lead Poisoning Prevention
EFFECTIVE DATE: 11/12/03
DATE REVIEWED/REVISED: 7/19/12
AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director PURPOSE STATEMENT: To assure access to blood lead screening for all children under the age of six who are at risk for lead poisoning. Childhood lead poisoning interferes with the normal development of a child’s brain and can result in lower IQ, learning disabilities, behavior problems like aggression and hyperactivity.
In Pepin County, blood lead screening is performed by WIC, private providers and Health Department staff.
POLICY: To prevent and control lead poisoning in children by following the guidance and information from the Wisconsin Childhood Lead Poisoning Prevention Program. The health department will assure blood lead screening, and case management services as appropriate, for all children under the age of six.
All children under the age of six shall have a verbal screening for blood lead risk (WCLPP Handbook, Chapter 7, Wisconsin Blood Lead Screening Recommendations, “4 Easy Questions”).
Enrolled in Medicaid or WIC?
Live in a building built before 1950?
Live in a building with remodeling built before 1978?
Have a sibling with lead poisoning?
a. If answers to the questions indicate the child is not at high risk for lead poisoning, blood screening shall be done at 12 and 24 months.
b. If answers indicate the child is at high risk, blood screening shall be done, beginning at 6 months or at the age risk is identified.
c. Children shall be reassess at least annually for risk of exposure.
Trained staff will provide the blood lead testing according to Wisconsin State Laboratory of Hygiene: Recommended Procedure for the Collection of Blood Lead Specimens by Fingerstick (attached).
The Health Department will maintain a registry of all blood lead results.
Follow Up Date
Private providers are required to report all blood lead screening of children under the age of six. Lab reporting is done directly to the State of Wisconsin Childhood Lead Program.
CASE MANAGEMENT SERVICES
All children screened with blood lead levels (BLLs) >10 mcg shall receive case management services according to standards described in the Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP) Handbook for Local Health Departments. Activities shall be documented on the “Nursing Case Management Report: Children with Elevated Blood Lead Levels” (DPH 4771A). The services shall include, but not be limited to, the following:
Educational interventions for the parent/caregiver to include:
Potential sources of lead exposure
Review schedule and plan for follow-up testing
Monitoring of timeliness and levels of follow-up testing
Identify and refer for needed services
Advocate for the child in settings where necessary
Communicate assessments and interventions to the health care provider
For lead results 10-19 mcg/dL:
A public health nurse will advise the parent and health care provider that a follow-up confirmatory venous blood lead test shall be done within 3 months.
If the child has two results of 15-19 mcg/dL three months apart, an environmental investigation shall be completed.
For lead results 20-44 mcg/dL:
A PHN will advise the parent and health care provider that a follow-up confirmatory venous lead test shall be done within 1-4 weeks.
An environmental investigation shall be completed.
For lead results 45-69 mcg/dL:
A PHN will advise the parent and health care provider that a follow-up confirmatory venous lead test shall be done within 24-48 hours.
An environmental investigation shall be completed.
For lead levels >70 mcg/dL:
A PHN will advise the parent and health care provider that a case management confirmatory venous lead test shall be done immediately as an emergency lab test.
An environmental investigation shall be completed.
Close the case with the BLL has remained <15ug/dl for six months AND lead hazards have been controlled or eliminated AND there are no new exposure. A copy of the “Nursing Case Closure Report:Children with Elevated Blood Lead Levels” (DPH4771B) shall be submitted to WCLPPP.
Agency may complete “Medicaid Targeted Case Management” for reimbursement.(DPH 4771AB)
Pepin County Health Department will contract with a certified lead inspector/risk assessor to provide environmental investigations in homes where lead-poisoned children reside. These investigations may also include locations where a child visits, such as relatives’ homes, daycares, etc. Environmental investigations will be conducted in accordance with the Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP) quality criteria, using guidelines indicated in the WCLPPP Handbook, 2002.
BLOOD LEAD RESCREENING TIMELINES
General blood lead screening is recommended at ages 1 and 2 years. If those results are under 10 mcg/dL, no further screening is needed unless risk factors change.
Recommended Schedule for Obtaining a Confirmatory Venous Sample
Recommended Frequency for Case management Blood Lead Testing
Venous Blood Lead Level (mcg/dL)
Early Case management
(First 2-4 tests after identification)
Late Case management
(After level begins to decline)
Every 3 months
Every 6-9 months
Every 1-3 months
Every 3-6 months
Every 1-3 months
Every 1-3 months
Every 2-4 weeks
Chelation with F/U
Timeframes for Environmental Investigation and Other Case Management Activities
Venous Blood Level
Provide caregiver lead education.
Assure case management testing.
Refer to other services as needed.
Within 30 days
Above actions, plus:
If BLLs persist (2 venous in this range at least 3 months apart) or increase, proceed according to actions for BLLs 20-44.
Within 2 weeks
Above actions, plus:
Provide coordination of care.
Assure medical care is provided.
Provide an environmental investigation and control current lead hazards.
Within 1 week
Within 48 hours
Above actions, plus:
Hospitalize child for chelation therapy immediately.
Within 24 hours
EVALUATION: Statistics as to the number of one and two-year-olds on WIC screened and tested, and the number of one and two-year-olds not tested is tabulated quarterly and Health and Human Services Committee annually and are included in the agency annual report.
Wisconsin State Statute, Chapter 254 and related Administrative Rules
HUD Guidelines - Chapter 7
HFS 163 - Certification Requirements
Centers for Disease Control (CDC). Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control.
Wisconsin Division of Health (2002). Wisconsin Childhood Lead Poisoning Prevention and Control Handbook for Local Health Departments
Lead Paint Safety Field Guide-PPH45035 www.dhs.wisconsin.gov/lead
POLICY TITLE: Children and Youth with Special Health Care Needs (SCYHCN)
EFFECTIVE DATE: 2/8/05
DATE REVIEWED/REVISED: 6/20/12
AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director PURPOSE STATEMENT: To assure adequate services and support are available to families of children and youth with special health care needs. POLICY: Pepin County Health Department will provide referral and follow-up services to families with children and youth with special health care needs, as well as case management services when needed. PROCEDURE:
Referrals to this program are obtained from WIC, the local school districts, Birth-3 Program, the Regional CSHCN Office, and other health care providers.
Staff will contact CSHCN families in order to assess current level of services, need for additional services and provide confidential emotional support.
Information will be provided and appropriate referrals will be made as needed to the following services:
Primary providers and specialists, health benefits counselors, Birth –Three, Headstart, Child care/respite services, Mental Health Services, Dental Care , Nutrition Services, Transportation, Recreational Opportunities, Vocation/Transition counseling, Legal Services, Housing assistance, Support Groups, School special education programs, Healthy Start, SSI, Katie Beckett, WIC
A database of current resources will be maintained and made available
through the Pepin County Health Department.
After referral, families will be contacted to assess level of satisfaction with referral and need for further services.
When appropriate, families will be offered Case Management: more personalized assistance in obtaining the needed health care services.
Data concerning the CSHCN clients, and the CSHCN Objectives will be entered in SPHERE. An annual report summarizing objectives and deliverables will be submitted to the Regional CSHCN Office.
Pepin County Health Department will maintain a County Parent Liaison to provide parent referrals and support.
PCHD staff will attend trainings and updates provided by the CSHCN regional office.
Children and Youth with Special Healthcare Needs enrollment form:
S:\PUBLIC HEALTH\CSHCN\9-01-11CYSHCN form..doc
S:\PUBLIC HEALTH\CSHCN\9-1-11 CYSHCN form back.doc
Children’s Miracle Network Grant Application for Individual Support: S:\PUBLIC HEALTH\Updated Policies and Procedures 2012\Parent and Child Health\CYSHCN Forms\CYSHCN Children's Grant Application.doc EVALUATION:
POLICY TITLE: Child Passenger Safety
EFFECTIVE DATE: 1/15/10
DATE REVIEWED/REVISED: 6/15/12
AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director PURPOSE STATEMENT:
To ensure that correct child passenger safety seats (hereafter referred to safety seats) are properly installed in vehicles and that correct CPS educational information is disseminated.
POLICY: A certified CPS Technician shall perform CPS safety seat inspections for any individual that
provides written consent. CPS Techs shall follow the National Highway Traffic Safety Administration’s (NHTSA) Standardized Child Passenger Safety Technician Training Guidelines for evaluating safety seats for proper use and installation.
Client shall complete Pepin County Public Health’s Child Passenger Safety Seat checklist form, and sign the consent for inspection
The CPS Tech shall weigh and measure the child, if present
The CPS Tech shall review all features of the safety seat, and make any necessary adjustments prior to proceeding to the client’s vehicle, if utilizing a new safety seat.
The CPS Tech shall accompany the client to the client’s vehicle, observe current installation (if appropriate), and document findings on the checklist form.
The CPS Tech shall remove the safety seat, if installed, from the vehicle.
The CPS Tech shall read the labels on the safety seat, and record the brand, date of manufacture, and model number. If the safety seat is older than six years, a new safety seat shall be provided.
The CPS Tech shall compare the brand and model number against the most current recall list. If the safety seat is found to be recalled, the CPS Tech shall either complete a recall form and give the client recall details and company contact information and instruct client to call manufacturer and resolve the recall situation, OR provide a new safety seat.
The CPS Tech shall ask the client if they are the original owners of the safety seat, and ask about the crash history of the seat. The answers shall be documented on the checklist. NHTSA guidelines for reuse of a safety seat involved in a crash shall be explained. If the crash history is unknown, a new safety seat shall be provided.
The CPS Tech shall read the labels on the safety seat that provide information on the height and weight parameters appropriate for using the seat. The CPS Tech shall compare these parameters to the height and weight of the child using the seat. Wisconsin State Statues shall be referenced and enforced.
The CPS Tech shall inspect the harness system on the safety seat, and instruct the client in the correct use of the harness for the child.
The CPS Tech shall review the seat belt or LATCH system in the vehicle, and discuss the placement of the safety seat with the client. The CPS Tech shall advocate for placing the safety seat in the middle of the back seat of the vehicle, whenever possible. The client shall, after receiving education regarding the placement, make the final decision regarding the seating position used.
The CPS Tech shall review the evidence regarding rear-vs. forward-facing with the client, compare the child’s weight parameters listed on the seat for the rear-vs. forward-facing, and make a recommendation regarding rear-vs. forward-facing based on the available information. The client shall, after receiving education regarding rear-vs. forward-facing, make the final decision regarding the position used.
The CPS Tech shall provide information to the client on the proper installation technique, including the type of locking device within the seat belt system, tightness of the seat belt or LATCH, use of tether, and appropriate recline angle for the safety seat.
The CPS Tech shall discuss the dangers of unused seat belts, and projectiles
The CPS Tech shall request that the client demonstrate their understanding of the installation by properly installing the safety seat in the vehicle.
The CPS Tech shall request that the client sign the inspection form acknowledging the understanding of the recommendations made by the CPS Tech, and validating that the client was the last person to install the safety seat and secure the child in the seat.
The CPS Tech shall request that the client surrender any safety seat that has expired, has any major safety recalls, or for which the crash history is unknown. The CPS Tech shall cut the straps on the surrendered seat prior to disposal.
The CPS Tech shall review the checklist form for completeness, record any adjustments or items used for the safety seat installation, and sign and date the checklist form.
If it is determined that a new safety seat is needed, the CPS tech shall provide the owner with an appropriate seat for the child. Safety seats shall be provided based on eligibility and availability. Children must be present at the time of inspection for a new CPS to be distributed.
(CPS Techs must follow specific CPS grant guidelines when distributing free seats.)
Equipment needed: Pepin County Public Health Child Passenger Safety Checklist, clipboard, pen, locking clip, roll of shelf liner, pool noodle, scissors, duct tape, current recall list (www.hsrc.unc.edu/safety_info/child_passenger_safety/child_restraint_recalls_pdf.cfm), educational materials, car seat, as appropriate, vehicle manual, if available
National Highway Traffic Safety Administration’s (NHTSA) Standardized Child Passenger Safety Technician Training Guidelines
POLICY TITLE: Head Lice Prevention and Control
EFFECTIVE DATE: 1/27/11
DATE REVIEWED/REVISED: 7/16/12
AUTHORIZED BY: Heidi Stewart, BSN, Health Officer /Director PURPOSE STATEMENT:
To assure identified individuals are properly treating head lice using current recommended public health methods to control further spread within their households and other settings such as childcare and school.
To serve as a consultant to schools, child care centers or other institutions for head lice control.
To make accessible free head lice shampoo if available to the department in order to lessen the burden of cost associated with the treatment of head lice.
To increase the public’s knowledge on the control and prevention of head lice.
POLICY: The Head Lice Prevention and Control Policy is implemented by Pepin County Health Department personnel to prevent and control the spread of head lice.
Public Health Nurses may be contacted by families or other health professionals in consultation for head lice control.
Families may come to the office for assessment and education. The professional may do home or school visits when barriers exist that prevent the family from coming into the office. Consultation and education may also occur in group settings such as child care centers or schools.
Assessment will be completed for the presence of an active head lice infestation. The assessment tool can be found here: S:\PUBLIC HEALTH\Updated Policies and Procedures 2012\Parent and Child Health\Head Lice Forms\head lice assessment tool.doc
Hygienic practices will be used when nursing staff are conducting head lice checks. Adults will be instructed on how to conduct a head lice check.
Health education will be done with the family on lice identification, incubation period, method of spread, nit removal, treatment, environmental steps to control further spread and prevention.
Control recommendations will be offered following the current test practice.
The family may be assisted in contacting their primary physician for prescription strength shampoos/treatments.
Parents will be encouraged to report infestation to the child care center, school and close relatives/friends to assist in eliminating possible re-exposure after treatment.
EVALUATION: REFERENCES/LEGAL AUTHORITY:
Wisconsin Department of Health and Family Services Pediculosis Fact Sheet
American Academy of Pediatrics 2003 Red Book
Report of the Committee on Infectious Diseases 26th Edition
POLICY TITLE: Health Check Screenings and Referrals
EFFECTIVE DATE: 1/2/04
DATE REVIEWED/REVISED: 6/26/12
AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director PURPOSE STATEMENT: To encourage preventive care and assure access to HealthCheck screenings and referrals to children with Medical Assistance.
POLICY: Pepin County Health Department will offer HealthCheck screenings and referrals to children who have Medical Assistance (MA) and are not enrolled in a Health Maintenance Organization (HMO).
A public health nurse will provide a comprehensive physical exam to non-HMO Medical Assistance eligible children through the HealthCheck Program. This will be done by appointment, or in conjunction with WIC, immunizations or PNCC visits.
The HealthCheck screening will include a comprehensive history, physical examination, developmental assessment, physical measurements, dental screening, hearing screening, vision screening, selected laboratory tests and age-appropriate immunizations.
If the HealthCheck screening reveals the need for any follow up examination by a physician, dentist, vision specialist, or other services, the public health nurse will make the appropriate referral(s).
HealthCheck screenings and referrals are covered through the Medical Assistance program, therefore Medical Assistance will be billed for the service(s).
The public health nurse will follow up on all referrals made to assure appropriate services were received.
Documentation will be completed by the public health nurse on the HealthCheck Services form (attached) and other age-appropriate HealthCheck forms.
Referral Guidelines for HealthCheck Screenings
Schedule referral appointments within 60 days. Services must be provided within 6 months for HealthCheck referrals.
Age 3-5 years: 20/50 or less or a one line difference between eyes.
Age 6+ years: 20/40 or less or a two line difference between eyes.
MD Referral: > 95% systolic or diastolic
PHN Follow Up: Between 90-95% (with weight control information if needed).
Puretone: Failure to hear one or more frequencies at 20 decibels (at 1000 and 2000), 25 decibels (at 4000), one or both ears.
Tympanogram: Flat, rounded, humped or obscured peak; peak more negative than –250mmH20. Refer to PHN for recheck in 4-6 weeks. If fails puretone and clinical symptoms, refer to MD.
Recheck Failure: Medical referral.
6 months to 10 years of age: > 12.0 – provide positive reinforcement.
11.0-12.0 – provide nutrition counseling.
< 11.0 – provide nutrition counseling and referral.
10-14 years of age: > 12.5 – provide positive reinforcement.
11.5-12.5 – provide nutrition counseling.
< 11.5 – provide nutrition counseling and referral.
Males14 years of age and up: 12.0-13.0 – provide nutrition counseling.
< 12.0 – provide nutrition counseling and referral.
Females 14 years of age and up: 11.5-12.5 – provide nutrition counseling.
< 11.5 – provide nutrition counseling and referral.
Test children at ages 1 and 2 years, or test one time if between ages 2 and 6 years and the child has never been tested. Follow up is provided if the test is greater than or equal to 10mcg/dL. See the lead follow up policies and procedures for details.
Protein: Trace to negative = normal.
1+ = recheck by public health nurse
2+ or more = referral to MD
Glucose: Refer any positive findings to MD
Follow guidelines for referral on page 3 of Health History form.
Dietary practices are abnormal (baby bottle tooth decay);
Eruption of teeth is abnormal (delayed or crowned);
Dental disease is present.
Age 3 years and up – Refer ALL children if due for exam.
The following methods will be used to outreach to families for HealthCheck:
Provide information about HealthCheck in newborn packets.
Ask about MA at immunization clinics. If a child needs a HealthCheck and has MA the screening may be scheduled or done immediately (see exclusions below). Follow up HealthCheck appointments will be scheduled after the exam is completed.
HealthChecks will be coordinated with WIC, PNCC or other agency appointments to allow increased convenience to families.
HealthCheck information brochures will be provided to Human Services and they will be distributed by Human Services at Income Maintenance appointments and in other instances when appropriate.
Children who are on MA and are enrolled in HMOs will receive HealthChecks through the HMOs. Mayo, Marshfield, Wabasha, and Interstate clinics all do their own HealthChecks as well. This office will not conduct outreach for this population.
POLICY TITLE: Home Births – Third Party Corroboration of Birth Facts
EFFECTIVE DATE: 12/27/07
DATE REVIEWED/REVISED: 7/16/12
AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director PURPOSE STATEMENT:
To provide guidance to Pepin County Health Department public health nurses who are responsible for completing the third-party corroboration of non-hospital births.
To ensure completion of correct paperwork with families in need and SVRO.
To teach parents having unattended home births how to obtain birth certificate paperwork through the SVRO.
POLICY: Pepin County Health Department will assure Public Health Nurses (PHNs) have the necessary nursing skills and equipment to interview the parent, as well as examine the infant to complete the mandatory activities as outlined in this procedure. The mandatory activities include:
Verify the identification of the mother.
Interview the mother in person concerning various aspects of her pregnancy to identify possibly suspicious or inconsistent information.
Examine the child to verify sex and approximate age.
Assess mother’s healing and possible postpartum needs.
Complete and compare the Non-Hospital Delivery Birth Certificate Worksheet (DPH F-05108) for consistency with agency findings and/or records.
Complete and compare the information on the Third-Party Corroboration of Birth Facts Form (DPH F-05112) with the child’s Non-Hospital Delivery Birth Certificate Worksheet.
Ensure completion of the Attendant’s Birth Certificate Worksheet –Non-Hospital (DPH F-05109NH).
Assure that the Third-Party Corroboration of Birth Facts Form, Non-Hospital Delivery Birth Certificate Worksheet, and Attendant’s Birth Certificate Worksheet-Non-Hospital are filed together with the State Vital Records Office (SVRO) within 10 days of the family’s receipt of the Home Delivery Birth Certificate Worksheet (DPH 5103AH) from the SVRO.
Wisconsin births can only be registered by hospital designees, a Home Delivery Birth Certificate Designee (HDBCD) who is registered with the SVRO, legal husbands/fathers, and mothers. Mothers who deliver at home, without the presence of a HDBCD must file their children’s worksheet with third-party corroboration. Corroboration can only be given by healthcare providers with experience caring for children, or pregnant or postpartum women. These healthcare providers include: physicians, hospital staff, clinic staff, HDBCDs, and public health nurses.
This procedure is to be carried out by Public Health Nurses for mothers with infants who appear to be under one year of age and who are born at home or elsewhere without being attended by a registered Birth Certificate Designee who is registered with the State Vital Records Office (SVRO) to file births.
The parents call the WI Vital Records Department, (608) 266-1373, and request the third-Party Corroboration of Birth Part I of the Third-Party Corroboration of Birth Facts. (Attachment 3 – DHFS Letter: Information re: fees, birth certificate, etc.).
PHN to assure the (DPH 5112) form is complete.
View and/or copy mother’s identification:
One photo ID (Wisconsin Driver’s License or Wisconsin picture ID)
Two non-photo documents (property tax bill, Social Security card, check or bank book, recent lease, or bills with current address).
4. Ask the mother where and when the baby was born.
The birth must have occurred in Wisconsin.
The birth must have occurred in the past 12 months. Infants/toddlers presenting after 12 months of stated birth should be referred to Vital Records at 608-267-0914 for information regarding how to proceed with delayed registration of birth.
5. Ask the mother about specific aspects of her pregnancy to identify possibly suspicious or inconsistent information. Document her responses. The questions might include:
How is your baby doing? How are you doing?
Did you obtain prenatal care? If so, where?
Did you have any physical or emotional difficulties during your pregnancy?
Was this a good time for you to be pregnant?
How did the delivery go? Did you have any difficulties?
Was the baby born on time? Early? Late?
What do family members think about the new baby? Father? Siblings?
Are you concerned that your baby might inherit any diseases or other characteristics that run in the family?
Do you have any questions about the care of your baby?
6. Observe the mother’s behavior and the interaction between the infant and mother and document (e.g., soothing behaviors, responds to infant cues, smiles and vocalizes with infant, infant smiles and vocalizes with mother).
7. Examine the infant to verify sex and approximate age. Assessment should include:
Head to toe undressed visual inspection to verify sex.
Assess gestational or approximate age based on physical and neurological findings and/or developmental milestones.
For all infants, measure length, weight, and head circumference and plot on a CDC growth chart or on an intrauterine growth chart for infants who are premature. The chart will give an approximate age based on the measurements. The CDD charts are located at http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/charts.htm#Set%201.
For infants who are one month of age or younger (factor in prematurity if known), estimate gestational age utilizing The New Ballard Score (Ballard, J.L., et al, New Ballard score. The Journal of Pediatrics 1991;119:417-422, (Attachment 4), a maturity rating tool.
For infants who are older than one month (factor in prematurity if known), assess neurologic reflexes along with developmental milestones to compare stated age. The neurological reflexes and
developmental milestones are found in Whaley and Wong, (1991),Nursing Care of Infants and Children (4th edition). In addition, the milestones are found in Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents (2nd edition, 2002).
8. Complete Part II of the Third-Party Corroboration of Birth Facts. Compare the information with the Home Delivery Birth Certificate Worksheet (DPH 5103 AH). Compare the Home Delivery Birth Certificate Worksheet (DPH 5103AH) Attachment 2) for consistency with agency findings and/or records.
If the information is compatible, sign the Third-Party Corroboration of Birth Facts Form, make a copy of the form for the agency, and return the original completed form to the mother.
If the information is questionable or not compatible, do not complete the form and contact the SVRO for further direction. Inform immediate supervisor and determine if a referral should be made to the county’s social services department.
Information for only one infant per form.
The corroborator must be the person who performs the interview and the exam.
9. Discuss with the mother the importance of well child exams, immunizations, public health services, and other community resources as appropriate.
10. Instruct the mother to mail both forms, Third-Party Corroboration of Birth Facts Form (DPH 5112) and the Home Delivery Birth Certificate Worksheet (DPH 5103AH) to the WI Vital Records Office within five days.
11. Document the exam per agency protocol for documentation.
Ballard, J.L., et al, New Ballard score. The Journal of Pediatrics 1991;119:417-422.
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Second Edition Revised. HRSA. 2002.
Information About and Instructions for Third-Party Corroboration of Birth Facts(DPH 5112).
Wisconsin Vital Records Numbered Memo, Corroboration of Birth Facts: General Information, revisions to Form (DPH
5112) dated 02/04/05.
Whaley, Lucille, F., and Wong, Donna L. (1991). Nursing Care of Infants and Children (4th Edition). Mosby Year Book: St. Louis.
s.69.14(2)(a), Wis. Stats.
POLICY TITLE: Lazy Eye Screening
EFFECTIVE DATE: 5/26/06
DATE REVIEWED/REVISED: 6/20/12
AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director PURPOSE STATEMENT: To facilitate early diagnosis of lazy eye and early intervention to prevent vision loss.
POLICY: Pepin County Health Department will facilitate lazy eye screening by providing home screening kits and instructions to parents of three or four year old children.
PROCEDURE: Pepin County Health Department will send lazy eye screening kits to parents of preschool-age children. This kit will include an introductory letter, the Precision Vision chart, and the following instructions for parents: