Public Health Department Policy & Procedure Manual Example

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Step I

Have your child identify the pictures close up: apple, house, square (box), ball (circle). The link to the screening chart is found here: S:\PUBLIC HEALTH\Updated Policies and Procedures 2012\Parent and Child Health\Lazy Eye Forms\lazy eye screening chart.pdf

Step II

Check your child’s eyes. You will need: the prescription vision chart, adhesive tape, a paper cup, a ruler or tape measure

  1. Hang the Precision Vision chart at your child’s eye level on a bare wall with no windows in a well-lighted room.

  2. Measure 10 feet from the chart and put a piece of tape down. Your child’s heels should be on the line of tape.

  3. Show your child how to hold the cup over his or her LEFT eye, keeping both eyes open. Your child should not peek. Sometimes it helps to have someone else cover the child’s eye with the cup.

  4. Sit next to the Precision Vision chart and point to each of the pictures. Start at the top. Ask your child to identify the picture. Praise your child each time he/she responds.

  5. If your child can identify the picture, move down to the smaller picture.

  6. Now have your child hold the cup over his or her RIGHT eye and follow the same steps.

*If your child is tired or bored, try another day.

Step III – Screening Results

Children ages 3-5 years should see the 40-foot E line easily with each eye.

Children ages 6 and older should see the 30-foot E line easily with each eye.

When screening is completed, parents call or email Pepin County Health Department with the results. Follow-up will be done for all children who are unable to see the middle line, or the 20/40 line.


POLICY TITLE: Maternal and Child Health Services (MCH)



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director

  1. To promote the health of families in Pepin County.

  2. To educate staff and community on the Life Course Model and Early Childhood Theory

The Pepin County Health Department will provide resource and referral information and limited direct services to parents. Visits include but are not limited to:

  • Pregnant women in need of information or referral to community support programs

  • Families following the birth of a child

  • Families with children and youth with special health needs

  • Families and older children in need of community resources

  • Families and children under their legal guardianship such as foster care or grandparents raising grandchildren

Procedure for Parent/Child Visits:

  1. Provide a basic level of services to families identified by the hospital or other community professionals as being in need of follow-up. The intensity and length of service is based on need. A PHN will:

  • Assess the family’s strengths and resources needed to meet parent/child needs.

  • Assist with appropriate resources and referrals.
  • Provide nursing care and case management until immediate needs are met.

  • Provide health teaching, anticipatory guidance as needed.

    1. Home visits are not required. All families have the right to refuse a home visit or any other public health service. Some families may prefer asking questions and getting information over the telephone. This is up to the client and assistance can be provided in person at the home, in the office, in a neutral community site or over the phone. Printed material may be sent in the mail.

    1. The PHN will provide follow up services and referrals as indicated. Ongoing services are based on the needs of the family and plan for medical follow up.

    1. PHN will attempt to contact the family within 10 working days of receipt of the referral. The purpose of the contact is to offer public health services.

    1. The PHN will document the visit on departmental flow sheets, written narrative notes or printed, signed and dated Word Document, SPHERE charting or Nightengale Notes.

    1. If a home visit appears threatening on the referral or through prior nursing experience with the client, staff should seek assistance from a second member of the parent child team and conduct the visit jointly, or the visit should not be conducted. The Home and Worksite Visitation Safety Policy will be followed for threatening situations.

    1. Family needs that are identified and indicate a gap in services that are unavailable in the county will be discussed with the supervisor. The parent/child team may discuss apparent gaps in services to investigate ways to bring community partners together for resolution.

Procedure Specific to Pregnant Women:

The PHN may offer pregnancy health promotion/disease prevention and do limited physical health assessments to women requesting assistance during pregnancy. Assistance to locate and apply for community resources will be offered per client need.

  • This service will be billed to PNCC for eligible women when the client’s needs require monthly visitation. See separate PNCC policy and procedure.

  • Intermittent pregnancy assistance will be offered to meet the client’s resource needs and provide timely health education through each trimester of pregnancy.

  • Care will assure access to and not replace regular medical care.

Procedure Specific to Newborn Follow-up:

  1. Pepin County Health Department will engage in the following functions related to postpartum/newborn follow-up:

  • Review all birth records for high-risk newborns or for potential postpartum needs. This includes reviewing birth weight, medical conditions, and psychosocial factors that would suggest the family would benefit from services.

  • Using the birth records, the families of all newborns will be placed on a mailing list to receive information on services available to Pepin County families

  • Accept written/verbal referrals from hospitals, clinics, community agencies and family.

  • Work collaboratively with the Women, Infants, and Children (WIC) program.

  1. Some clients may not be directly referred by a health care provider, but may appear high-risk when reviewing the birth records. These families will also be contacted to offer a PHN home visit.

3. Home visit components may include but are not limited to:

  • Well Child Exam/Health Check information, need for primary medical home and payer source for follow up care.

  • Health and developmental history.

  • Environmental assessment and teaching. This includes but is not limited to well water testing, human health hazards, indoor air quality, lead poisoning, pets and housing, and performing a home safety assessment (see home safety assessment policy).

  • Psychosocial assessment including: sources of social support, adjustment to newborn or child’s changing needs, ability to communicate, ability to arrange for community resources, coping and/or grief response to child’s medical condition/diagnosis, family relationships, and caretaking/parenting skills.

  • Health teaching and guidance. This includes but is not limited to: nutrition and elimination, growth and development, sleep and awake states, child/infant stimulation and social needs, parenting skills, child care, medications and other treatment procedures, safety, primary care follow up appointments, immunizations, and parent’s understanding and comfort with monitoring equipment.

  • Assessment of resources needed and assure service needs are met.

  • Postpartum assessment includes but is not limited to: psychosocial factors (feelings about delivery, adjustment to baby, support systems, postpartum depression, stress, and interaction with the infant), physiological factors (integument, pain, circulation, bowel and genitor-urinary function), and health related behaviors (nutrition, sleep and rest patterns, activity, family planning, substance use, and postpartum check-up)



  • Essentials of Maternal and Neonatal Nursing. Carole Ann Kenner RN, C, DNS and Aileen MacLaren RN, MSN, CNM. Springhouse Corporation, 1993.

  • Child Health Nursing: Partnering with Children and Families. Jane W. Ball RN, CPNP,

  • DrPH and Ruth Bindler RNC, PhD, Pearson/Prentice Hall 2006.

  • Caring For Your Baby and Young Child. Steven Shelov MD, FAAP, American Academy of Pediatrics. Bantam Books, 1998.

  • Caring for Your School-Age Child. Edwards Scholr MD, FAAP, American Academy of Pediatrics. Bantam Books, 1999.

  • Caring for Your Adolescent. Donald Greydanus MD, FAAP, and American Academy of Pediatrics. Bantam Books, 1991.

  • Maternal and Child Health Nursing. Adele Pillitteri RN, PNP, PhD. Lippincott Williams and Wilkins, 2003.

  • Patient Teaching Guides. Jane W. Ball RN, CPNP, DrPH. Mosby-Year Book, Inc 1998.

  • MCH/CSHCH Update, Wisconsin Department of Health and Human Services. Printed quarterly, and located on the HAN @

  • WI State Statue, Board of Nursing, Nurse Practice Act Chapter 441-441.01 (4) (a).

  • Board of Nursing, Rules of Conduct Chapter N7-N7.04 (60).

POLICY TITLE: Prenatal Care Coordination (PNCC)



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director

To assure women enrolled in the PNCC program receive adequate and appropriate services to improve the birth outcomes.

PNCC will help a recipient and, when appropriate, the recipient’s family gain access to medical, social, educational, and other services related to the recipient’s pregnancy. Wisconsin Medical Assistance (MA) PNCC services are available to MA eligible pregnant women with a high risk for adverse pregnancy outcomes during pregnancy through the first 60 days following delivery of the infant. PNCC services may be available through the Maternal and Child Health grant to women who are not eligible to receive the services under MA. PNCC services include all of the following:

  • Outreach

  • Initial assessment

  • Care plan development

  • Ongoing care coordination and monitoring

  • Health education and nutrition counseling


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