ECEAP Child/Family Files and Staff Conversations

Date of Site Visit Click here to enter a date. Contractor Subcontractor Name: If applicable: Site Information: Site Name: Site Current Early Achievers Rating Focus Classroom:

Names of classroom Lead teacher Enrollment and Family support Health Staff staff: Eligibility staff staff ECEAP Staff Note taker: Conversation Lead: Choose an item. Choose an item. Class start date: Other information:

Pre-K Specialist will prepare information for five files and review a minimum of three on site. If in any section you find missing or inaccurate information review 1-2 more files for that section. For Visits in Oct., Nov, and Dec. You will choose 5 files from the 2016-17 year to review for sections D, E, and F. You will choose an additional 5 files from the 2017-18 year to review for Eligibility and Enrollment Pre-K Specialist will attach a copy of the ELMS Child Record Summary for each child.

Files for Monitoring Sections D, E, F Files for Monitoring Eligibility Child Initials/ELMS ID number Child Initials/ELMS ID number 1 1 2 2 3 3 4 4 5 5

ECEAP Child/Family Files and Staff Conversations

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Contents Section B: Eligibility, Recruitment, Prioritization, Enrollment& Attendance...... 2 Section D: Health, Safety and Nutrition ...... 5 Section E: Early Childhood Education ...... 8 Section F: Family Partnerships ...... 12

Section B: Eligibility, Recruitment, Prioritization, Enrollment& Attendance Section B: Child/Family File Monitoring

Note: Use the Child Record Summary Report to compare information entered in ELMS to the contractor’s documentation. Verify Child Age, Household members, Eligibility & Priority Points, Eligibility Tracked by Viewing… and Enrollment History. If no documentation of income was available, or if the family has no income ask to see the signed statement of income provided by the employer or parent. The form or child record summary does not cover: • The reason monthly income was used to determine eligibility. Staff will have to go into each individual child's online ELMS application to view the reason. • For visits done after April 1 2017: last year, the child record summary showed the child with 100 points for a returning student on April 1 when the new school year was available in ELMS. Most of those children had only been enrolled the current school year, and that category of eligibility was not the reason they were eligible in the fall. Specialists need to be on the look for this after April 1. If a child was eligible due to CPS/FAR/ICW involvement and is over income, it will show in the list of priority points

ECEAP Child/Family Files and Staff Conversations

Child/In/ELMS ID 1. 2. 3. 4. 5. Staff signed a ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No statement (or CEF), identifying Describe: Describe: Describe: Describe: Describe: documents reviewed to determine eligibility?

Parent signed ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No statement (or CEF) that information is accurate? Describe: Describe: Describe: Describe: Describe:

Child date of birth ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No Describe: Describe: Describe: Describe: Describe:

Household member ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No

Describe: Describe: Describe: Describe: Describe:

Legal authority to ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No enroll

Describe: Describe: Describe: Describe: Describe:

ECEAP Child/Family Files and Staff Conversations

Family Size ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No

Describe: Describe: Describe: Describe: Describe:

Annual income ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No source

Describe: Describe: Describe: Describe: Describe:

Annual Income ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No

Describe: Describe: Describe: Describe: Describe:

Monthly Income ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No Source

Describe: Describe: Describe: Describe: Describe:

Monthly income ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No

Describe: Describe: Describe: Describe: Describe:

Additional Notes:

ECEAP Child/Family Files and Staff Conversations

Section D: Health, Safety and Nutrition

Section D: Child/Family File Monitoring D-4 Parent Consent Forms

1. 2. 3. 4. 5. Participation in EA ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No

Describe: Describe: Describe: Describe: Describe:

Medication ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No Administration ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A Describe: Describe: Describe: Describe: Describe:

Emergency medical ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No treatment

Describe: Describe: Describe: Describe: Describe:

Health screenings ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No and assessments

Describe: Describe: Describe: Describe: Describe:

Transportation ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A Describe: Describe: Describe: Describe: Describe: Additional Notes:

ECEAP Child/Family Files and Staff Conversations

1. 2. 3. 4. 5.

Documents contained in child/family file D-2 Individual health ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No plan in file ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A Describe: Describe: Describe: Describe: Describe: D-5 Allergy ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No information in file ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A

Describe: Describe: Describe: Describe: Describe:

D-5 Accident reports ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No in file ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A

Describe: Describe: Describe: Describe: Describe:

D-5 Food preferences ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No and restrictions documented in file

Describe: Describe: Describe: Describe: Describe:

D-5 Medical and ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No dental history in file Describe: Describe: Describe: Describe: Describe:

ECEAP Child/Family Files and Staff Conversations

1. 2. 3. 4. 5. D-7 Staff informed ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No parents when they suspected or identified health Describe: Describe: Describe: Describe: Describe: issues or developmental concerns for the child

D-8 Dental ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No screening results in file

Describe: Describe: Describe: Describe: Describe:

D-9 Well Child ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No examination records in file Describe: Describe: Describe: Describe: Describe:

D-10 Immunization ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No records in file

Describe: Describe: Describe: Describe: Describe:

ECEAP Child/Family Files and Staff Conversations

1. 2. 3. 4. 5. D-11 Record of ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No medication (maybe in files or in other ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A documentation) Describe: Describe: Describe: Describe: Describe:

Additional Notes:

Section E: Early Childhood Education Section E: Child/Family File Monitoring Child/In/ELMS ID 1. 2. 3. 4. 5. E-10 Developmental ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No screening tool administered with parent consent Describe: Describe: Describe: Describe: Describe:

Record evidence of: ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No (If notes entered in ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A ELMS you may be able to answer prior Evidence: Evidence: Evidence: Evidence: Evidence: to visit) Documenting referrals for further assessment if needed:

ECEAP Child/Family Files and Staff Conversations

Record evidence of: ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No Follow-up with ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A parents to ensure needed services Evidence: Evidence: Evidence: Evidence: Evidence: were received.

Record evidence of: ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No Working with the ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A local LEA to develop an IEP Evidence: Evidence: Evidence: Evidence: Evidence:

Copy of IEP in ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No child/family file. ☐ N/A ☐ N/A ☐ N/A ☐ N/A ☐ N/A

Notes and addition follow-up: E-12 Parent Teacher Conferences Teachers and Parents ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No met in person. Describe: Describe: Describe: Describe: Describe:

ECEAP Child/Family Files and Staff Conversations

During conferences ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No teachers: record examples (If notes entered in ELMS Examples: Examples: Examples: Examples: Examples: you may be able to answer prior to visit) Learned about the family’s culture and language.

During conferences ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No teachers: record examples Examples: Examples: Examples: Examples: Examples: Discussed their observations of child’s development and progress During conferences ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No teachers: record examples Discussed parent’s Examples: Examples: Examples: Examples: Examples: observations of child’s development and progress

During conferences ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No

ECEAP Child/Family Files and Staff Conversations teachers: record Examples: Examples: Examples: Examples: Examples: examples Shared screening and assessment results During conferences ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No teachers: Obtained parent input for program Examples: Examples: Examples: Examples: Examples: planning

During conferences ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No teachers: Parents jointly planning goals for Examples: Examples: Examples: Examples: Examples: the child

During conferences ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No teachers: record examples Maintained written Examples: Examples: Examples: Examples: Examples: documentation of these discussions

ECEAP Child/Family Files and Staff Conversations

Additional notes and Follow-ups:

Section F: Family Partnerships Section F: Child/Family File Monitoring Child/In/ELMS ID 1. 2. 3. 4. 5. F-1 Required visits ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No were with the Describe: Describe: Describe: Describe: Describe: individual family Record evidence of ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No working in partnership with Examples: Examples: Examples: Examples: Examples: family to:

Assess family strengths and needs: Record evidence of ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No working in partnership with family to: Examples: Examples: Examples: Examples: Examples:

Set goals:

Record evidence of ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No working in partnership with family to: Examples: Examples: Examples: Examples: Examples:

Coordinate transitions:

ECEAP Child/Family Files and Staff Conversations

F-4 Resources and Referrals Record evidence of ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No Referrals documented in the Examples: Examples: Examples: Examples: Examples: file or in ELMS

Record evidence of ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No ☐Yes ☐ No Documentation of follow-up on Examples: Examples: Examples: Examples: Examples: referral.

Additional notes or follow up