Transition from Tele-Interventionto Face-to-Face Home Visits

Kansas tiny-k Programs

Guidance and Support Materials

(Following State and/or County Shelter-in-Place Orders)

June 1, 2020

KITS is a program of the University of Kansas Life Span Institute at Parsons and is supported through a grant from the Kansas Department of Health and Environment tiny-k Services to provide training and technical assistance to Kansas IDEA Part C Programs. (V- 5/27/2020)

Section A

Decision Tree

On the following page is a decision tree that was created to guide discussion and support decision making regarding transition from services delivered through tele-intervention, back to face-to-face home visits. The decision tree can support discussions between Kansas tiny-k program administrators, staff, and the families that they serve. Questions posed on the decision tree begin with potential "shelter in place" or other restrictive orders imposed by the state or local governments. Subsequent decisions must be consistent with state and local governmental orders and should be reviewed frequently due to the dynamic nature of the pandemic. This is only a guide and not intended to pose all questions that can or should be considered.

There have been numerous infographics, guidance documents, and videos developed to provide guidance for tele-intervention. The following list identifies a variety of sources and materials developed by leaders in the field of early intervention and early childhood special education.

KDHE – Toolkits: this page provides easy access to guidance materials for a wide array of social service providershttps://www.coronavirus.kdheks.gov/DocumentCenter/Index/27

Tele-Intervention Resources:

KITS – COCID 19 Tele-Intervention Resources – this is a compilation of resources addressing tele-intervention from a variety of sources and included documents, infographics and video resourceshttp://kskits.org/sites/kskits.drupal.ku.edu/files/docs/COVID_Tele_Intervention_Resources_5_19_20.pdf

Early Childhood Technical Assistance Center (ECTA) – ECTA is the OSEP identified early childhood center for COVID-19 resources including resources for tele-interventionhttps://ectacenter.org/topics/disaster/tele-intervention.asp

Early Childhood Personnel Center (ECPC) – this center provides resources for personnel development and includes sections for Part C and 619, college and university faculty, and familieshttps://ecpcta.org/covid-19-resources/

Section B

Kansas Department of Health and Environment

Interim Guidance for Home Visiting Services

This guidance (following pages) is based on what is currently known about the spread and severity of coronavirus disease 2019 (COVID-19). The purpose is to guide local maternal and child health programs and home visiting programs on 1) assessing the safety before starting a face to face home visit; and 2) preventing the spread of COVID-19 among individuals, families, and communities. KDHE will provide updated guidance as necessary based on the changing situation (KDHE - 5/7/2020).

KDHE – For Workers Who Visit Homes – one-page guidance on assessing risk for home visits and reassessing once in the homehttps://www.coronavirus.kdheks.gov/DocumentCenter/View/139/Guidance-for-Workers-Who-Go-Into-Homes-PDF---4-13-20?bidId=

Section C

COVID-19 tiny-k Emergency Preparedness Planning

Considerations for Lead Agency and Local tiny-k Programs

There are numerous considerations as tiny-k programs transition from tele-intervention back to face-to-face intervention in the homes of families. As this transition occurs tiny-k programs will want to reflect on the tenets of the Mission and Key Principles for early intervention and the basic requisites of Part C including timely and multidisciplinary evaluation, IFSP development based in functional outcomes for children and their families, services in natural environments, engaging families as decision makers, and using evidence-based practices.

Both tiny-k staff and families will have many questions about safety and the process/procedures that programs have in place. Often there are no clear easy answers only decisions based on known recommended practices for early intervention, recommendations from the health care community, and state and agency plans/strategies for reopening of services where physical interaction occurs.

It is imperative that program staff and families continue to engage in discussion that is reflective of recommendations from the health care community including social/physical distancing and use of masks and/or other personal protective equipment as deemed necessary by the tiny-k program.

The following table is designed to support the process of thinking through the procedures and activities tiny-k programs can identify for the development of strategies to return to face-to-face contact with young children and families.

COVID-19 Era tiny-k Preparedness Planning

Considerations for Lead Agency’s and Local tiny-k Programs

Health and Safety - Consider: Resources:

Including the local tiny-k leadership team, lead agency, and local tiny-k Coordinator in the development of the COVID-19 plan. Additional supports to consider could include KITS TA contact.

Work Place During the COVID-19 Pandemic: https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/workplace-decision-tree.pdf

DEC Resource to Support:https://www.dec-sped.org/covid-19

ECTA Resource to Support: https://ectacenter.org/topics/disaster/coronavirus.asp

Zero to Three COVID: https://www.zerotothree.org/resources/3291-coronavirus-resources-for-early-childhood-professionals

KITSkskits.org

Including the local county health department(s) in the development of the plan and seeking approval of components as needed within the plan.

State COVID FAQ:https://covid.ks.gov/wp-content/uploads/2020/05/Reopening-FAQ_5.19.2020_Final.pdf

Including a map and contact information of the county health department(s) located in your tiny-k service area. This information may be especially useful if staff/families live in different counties and may not all be under the same COVID-19 era related safety orders.

List of all local health departments and contact information as of 5/1/20: https://www.kdheks.gov/olrh/download/health_directory.pdf

Creating a plan and/or staff protocol for securing, cleaning, and correctly utilizing

CDC - Use of Cloth Face Coveringshttps://www.cdc.gov/coronavirus/2019-

personal protective equipment. ncov/prevent-getting-sick/diy-cloth-face-coverings.htmlCDC – Cloth Face Coverings: Questions and Answershttps://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-faq.html

CDC – Face Coverings Do’s and Don’ts: https://www.cdc.gov/coronavirus/2019-ncov/images/face-covering-checklist.jpg

KDHE – Maskshttps://www.coronavirus.kdheks.gov/246/Individual-Family-Care

KDHE – Toolkits: https://www.coronavirus.kdheks.gov/DocumentCenter/Index/27

CDC – When to Wear Gloveshttps://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/gloves.html

Developing a procedure that provides clear instructions to EI staff entering and leaving family homes, vehicles, buildings etc.

See Section B of this document for an example

Considerations for Schools (good for general environmental, groups, staff training, staff leave considerations)https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/index.html

Developing a screening process and/or protocol to track the health of EI staff and/or families before and after conducting a face-to-face home visit?

See Section D of this document for an example

Creating a plan outlining how staff can have year-round access to necessary paper files/documents, office supplies and/or other materials needed to fulfil their job duties.

KDHE tiny-k Interim Part C Guidance Document: http://kskits.org/sites/kskits.drupal.ku.edu/files/docs/KDHE_Guidance_for_tinyk_COVID1

9_1_3-24-2020.pdf

OSEP Fact Sheet: http://kskits.org/sites/kskits.drupal.ku.edu/files/docs/Supple_Fact_Sheet_3.21.20.pdf

Creating guidelines/procedures that outline expectations related to maintaining social distancing during home visits and methods for communicating this information to staff/families.

Social Distancing:https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html

Creating guidelines/procedures that outline expectations related to maintaining social distancing for staff while working in the office. Consider alternating work schedules locations, procedures for sanitizing shared office equipment and other surfaces.

Creating a formalized plan specifying the actions to be taken should a staff member and/or family member become exposed to COVID-19. Example activities include, but are not limited to:

Review state/local health department requirements for safe home entry.

Review state/local health department requirements for quarantine.

Develop a plan for contacting local health department.

Develop a plan for communicating with providers and families when necessary and as appropriate.

Guidelines for use of identifying possible length of quarantine and/or isolation periods: https://www.coronavirus.kdheks.gov/DocumentCenter/View/1086/Isolation-Quarantine-Release-Graphic-KS-PDF---5-5-20

Isolation and Quarantine | Frequently Asked Questions https://ks-kdhecovid19.civicplus.com/DocumentCenter/View/134/Isolation--Quarantine-Guidance-and-FAQs-PDF---5-14-20

Service Support - Consider: Resources:

Identifying a plan for documentation of services during COVID era and how that documentation is shared with families. (i.e., is this kept in service logs, home visit notes, kept in master file, working file). Directions on how to complete forms should be clearly delineated. Also consider:

Ensuring alignment to KDHE guidance and program-wide adherence to internal program plan.

tiny-k program KITS TA can assist as needed.

KDHE tiny-k Interim Part C Guidance Document:Permission for Verbal Consent

Documenting procedures/processes that have been identified for staff specifically during COVID era (i.e., what can be sent electronically, what needs to be mailed, how to document home visits).

Developing a plan for families who opt just for “check in’s” (i.e., how are IFSP reviews managed, how are IFSP meetings managed, and how transitions are to handled). How often is it expected that providers check in with these families? How are providers expected to document contacts? What is the plan when tele-intervention or face-to-face services are to be reimplemented for these families?

Community Support - Consider: Resources:

A formalized process for keeping connected with referral sources and community partners to ensure that timely referrals continue to be made to the tiny-k program during the pandemic. Example activities include, but are not limited to:

Updating program website. Ensuring responsive program

communication methods and processes (i.e. email, phone, letters).

Using community-based meetings such as LICC meetings to share pandemic related resources (ie. internet links to information related to virtual supports and services, KDHE COVID-19 posts, CDC information).

Updating partners on what services look like during this period as opposed to pre-pandemic (i.e., tele-intervention, assessments and evaluations processes, timeline expectations, etc.).

Child Find:https://ectacenter.org/topics/disaster/coronavirus-faq.asp#childfind

Collaborating with LICC members to identify methods for continuing LICC meetings while following social distance guidelines and/or conduct meetings virtually.

Staff Support - Consider: Resources:

Developing a plan to support the emotional safety of staff. Example activities include, but are not limited to:

Reflective supervision meetings for each provider on a regularly scheduled basis.

Supporting mindfulness activities. Supporting teaming activities within

teaming meetings. Developing training on self-care

strategies.

Employees: How to Cope with Job Stress and Build Resilience During the COVID-19- Pandemic https://www.cdc.gov/coronavirus/2019-ncov/community/mental-health-non-healthcare.html

Vanderbilt InfographicTaking Care of Yourself:

Creating a provider communication plan to ensure that providers have easy, quick access to important information that needs to be shared including the most current COVID information.

Developing personnel attendance policy that is responsive to current COVID era situations. Consider flexibility with work absences and plan for staff’s ability to work from home. Considerations could include:

Internet access. Access to colleagues. Access to supplies. Access to necessary electronics:

computer, ipad, phone.

Developing a plan and procedure to quickly change providers and adjust caseloads as needed. Example activities include, but are not limited to:

Including “Most Likely Provider Worksheet” in the process to ensure best fit for the family.

Including joint visits and the joint visit planning form in the process to ensure smooth transition from one primary provider to another.

Worksheet for Selecting The Most Likely Service Provider:

Joint Visit Planning Tool

FIPP Resources on Supporting Early Intervention during COVID

Other activities to support a smooth transition (i.e., transfer of contact information for family and provider, IFSP outcomes, current outcome rankings, current strategies and routines family has been working on, etc.).

Developing a plan and procedure for continued team meetings, joint visits, and any other identified supports for primary providers and the families they serve.

Identifying plans for continuation of IFSP reviews, provider observations, and other quality and recommended service practices.

IFSP Quality Indicator Rubric (QIR) v.1.21.2020

Developing responsive professional development plan throughout this time and reach out to KITS TA when needed for support.

Ensuring ways teams can continue to collaborate and develop bonding relationships, trust, and support. Such as identifying or creating opportunities for team members to connect outside teaming.

Developing a plan that outlines procedures to protect employees at a higher risk for severe illness.

Family Support - Consider: Resources:

Developing plans and procedures to ensure family choice is included when supporting service decisions.Example activities include, but are not limited to:

Supporting providers in understanding that services are a joint decision between the providers, team, and family guided based on family identified outcomes and based in the requirement of natural environments.

Developing scripts to support providers in their conversation with families about services.

Develop procedures for clear documentation of conversations with families (i.e., family service logs, home visit documentation, printed emails/texts, etc.).

ECTA Family Resources: https://ectacenter.org/topics/disaster/coronavirus-talking.asp

DEC Resources for Family:https://www.dec-sped.org/covid-19

KDHE Children and Mask Recommendations: Children and Masks:

AAP Masks and Children During COVID: Children and COVID AAP:

Developing a script explaining COVID related processes and procedures to families. This could include explaining masks, social distancing, etc. Develop support materials for families to increase their understanding of COVID era processes and procedures.

Ensure methods of communication between families and providers are individualized to each families access and preferences during COVID (i.e., cell phone, email, etc.).

Developing packets that reflect the COVID era processes and procedures as they relate to their child’s services and supporting their child at home through COVID.

Zero to Three: Trauma and Stresshttps://www.zerotothree.org/early-learning/trauma-and-stress

Zero to Three: Tips for Families: Coronavirus

Child Care Program Support - Consider: Resources:

Developing plans and procedures to ensure safety of supporting children in child care settings: Example activities include, but are not limited to:

Inform the child care program that tiny-k children are currently receiving services through tele-intervention. Develop a plan with child care providers to ensure safety for both tiny-k providers and child care program as a transition occurs returning to face-to-face intervention.

Develop a communication plan for quick and easy communication with child care provider(s), program, and tiny-k provider.

Develop plan if COVID exposure occurs at either the child care program or with provider.

Develop procedure or protocol for screening before each visit at child care for both tiny-k program staff, child care provider(s), and children.

Child Care Programs During the Pandemic: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/Childcare-Decision-Tree.pdf

Section D

Example Letter and Form for Face-to-Face Visit Screening

The following letter and screening form are only examples, that could be used, should a tiny-k program make the decision to institute some form of screening before returning to face-to-face home visits. The letter simply provides basic information and basis for use of the screening form. The screening form could be used each time a tiny-k staff member conducts a home visit. The form allows for both the family and the early intervention staff member to ask questions to briefly assess the advisability of engaging in an intervention session and the tiny-k staff entering the home.

The following are additional resource for potential screening activities that could be considered as decisions are made regarding returning to face-to-face interaction.

CDC – General Business FAQ: this page includes general questions about prevention of the spread of COVID-19https://www.cdc.gov/coronavirus/2019-ncov/community/general-business-faq.html

CDC – Workplace Decision Tools – these general considerations will need to be thought through and applied to early intervention https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/workplace-decision-tool.html

Apple – Apple in collaboration with the CDC, FEMA, and White House has developed a self-evaluation app to help in understanding COVID-19https://www.apple.com/covid19

US Steel – the is a simple 3 question screening tool to used to determine entry into US Steel facilitieshttps://www.ussteel.com/sites/default/files/DOCS-%23534542-v1-COVID-19_Visitor_Health_Screening_Questionnaire_3-13-20%20%28003%29.pdf

Tiny-k program logo/name

Date

Dear Parent,

In an effort to do our part in limiting the spread of COVID-19, we are introducing a new system to help you identify your risk and exposure. Prior to every home visit, your early intervention provider and an adult representative of the child’s household will answer several questions regarding any symptoms of and potential exposure to the Coronavirus, known as COVID-19, or other illnesses that they or those in their home may have. All questions must be answered and initialed. If answered ‘yes’, then the tiny-k staff member and family member must determine whether to proceed with the intervention session. In this way, both the provider and the child’s representative must say they are willing to assume risk from contact with the other party. If you are not comfortable with the risk, immediately inform (name -administrator of program) of your decision (telephone number). If you have a symptom you would like to explain, feel free to write on the back of the form (I.e. sneezing due to allergies, etc.). (name – administrator of program) should be notified of any concern, but the power for making decisions for your health and the health of your family rests in your hands.

Both parties need to initial and date the form for each home visit and then provide a full signature at the time it will be submitted to (name of program). The early intervention provider is responsible to send the form to (administrator of the program). This practice should start immediately and continue until you are instructed otherwise. Thank you.

Stay well,

NameAdministrator of Program XXX

Adapted with Permission: SEKRS, Life Span Institute at Parsons, University of Kansas, Parsons, KS.

Section E

Example Letter for Acceptance of Risk

The attached letter could be used when a tiny-k program makes the decision to return to face-to-face home visits. The letter simply provides basic information about where to access information on COVID-19 and alerts the family to the fact that some risk is incurred as tiny-k staff enter their home. The letter also affirms that the family is aware of the risk and accepts that risk.

Acknowledgment and Request for Face-to-Face Early Intervention Services

By my signature below, I acknowledge that I have been informed by (name of program) of the current outbreak of Coronavirus (COVID-19) throughout Kansas, the United States, and international communities. I further acknowledge that I have a shared responsibility to educate myself and any members of my home about COVID-19, and to follow all recommendations to help prevent or reduce the disease as made by the Kansas Department of Health and Environment (KDHE), the Centers for Disease Control and Prevention (CDC), or my local Health Department, including but not limited to:

The need to engage all individuals in my home to practice preventive hygiene and to report to (name of program) staff if anyone in my immediate family feels ill, has a fever or cough, or any other symptoms associated with COVID-19.

The need to report any travel outside of my immediate community to (name of program) staff.

The responsibility to report to (name of program) staff any conditions which require a mandatory home quarantine of any member of my immediate household under rules established by KDHE or any Health Department.

I further acknowledge that (name of program) has made information available to me from KDHE including:

Mandates for quarantine and isolation of travelers, close contacts and those being tested.

COVID-19 information sheet explaining symptoms, risk factors, tips to avoid getting COVID-19, and treatment information.

Steps to take if you are sick with COVID-19. How to reduce the spread of COVID –19. The ability to get more information from KDHE regarding COVID-19 by

calling 1-866-534-3463 or by visiting the KDHE website at https://govstatus.egov.com/coronavirus

In recognition of the above acknowledgments I hereby agree and authorize (name of program) to provide early intervention services in my home and recognize and assume the risk that entry into my home by employees of (name of program) during this time could provide further exposure to transmission of COVID-19.

___________________________ ________________ (Signature) Date

Adapted with Permission: SEKRS, Life Span Institute at Parsons, University of Kansas, Parsons, KS.

Section F

Mask/Gloves and Maintenance

Resources:

CDC - Use of Cloth Face Coverings: basic information on use, care and making of maskshttps://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

CDC – Cloth Face Coverings: Questions and Answers: Frequently asked questions about cloth face masks and safely wearing and removal of maskshttps://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-faq.html

CDC – Face Coverings Do’s and Don’ts: infographic on wearing cloth face maskshttps://www.cdc.gov/coronavirus/2019-ncov/images/face-covering-checklist.jpg

KDHE – Masks: includes information on children and masks and guidance for making of cloth maskshttps://www.coronavirus.kdheks.gov/246/Individual-Family-Care

Masks for Curbing the Spread of SARS-CoV 2 Coronavirus: A manual on masks: short manual on types (disposable/homemade), making, wearing, and cleaning of cloth maskshttp://164.100.117.97/WriteReadData/userfiles/FINAL%20MASK%20MANUAL.pdf

Use and Care of a Cloth Mask: quick one-page guide on use and care of maskshttps://www.nationaljewish.org/patients-visitors/patient-info/important-updates/coronavirus-information-and-resources/additional-resources/making-masks-for-health-care-workers/use-and-care-of-a-cloth-mask

Homemade Cloth Face Masks: FAQs, Assembly Guide, and Patterns: guide with patterns for homemade cloth maskshttps://healthcare.utah.edu/healthfeed/postings/2020/04/homemade-cloth-face-masks_web.pdf

CDC – When to Wear Gloves: quick guide for when gloves are needed and not recommended (not needed)https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/gloves.html