West Virginia WIC Policy & Procedure 10.04 Effective Date: 12/29/20 10.04

WIC/Head Start Program Referral______________________

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POLICY:

The West Virginia WIC Program will provide referrals to the West Virginia Head Start Association. The referral agreement will increase enrollment in Head Start and will prevent the duplication of hemoglobin testing for children participating in both programs.

PROCEDURE:

A. Referrals from the Head Start Program to WIC

1. The WIC Program will receive referrals from the local Head Start Program with the use of a referral form.

a. The WIC Local Agency will:

i. Include the local WIC clinic address and telephone number on the back of the referral form - “Local WIC Agency Stamp”;

ii. Distribute the referral forms to each Head Start Program in the Local Agency service area;

iii. Accept the completed referral from the WIC applicant/participant; and

iv. Enter the hemoglobin value, date performed and source of measurement into the Crossroads Anthro/Lab Screen if it was taken less than ninety (90) days prior to the WIC certification appointment (see Policy 2.13 Hematological Testing).

b. The West Virginia Head Start Association will:

i. Provide current lists of Head Start Programs and addresses to the WIC State Agency for distribution to the WIC Local Agencies.

c. The local Head Start Program will:

i. Complete the referral form, including the hemoglobin value and date performed, and give it to the applicant to take to the WIC clinic.

B. Referrals from WIC to the Head Start Program

1. The Head Start Program will receive referrals from the WIC Program using the Crossroads generated WIC Program Referral Form (WIC-35).

a. The WIC Local Agency will:

West Virginia WIC Policy & Procedure 10.04 Effective Date: 12/29/20 10.04

WIC/Head Start Program Referral______________________

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i. Refer each WIC applicant/participant age three (3) years or older to the Head Start Program on the Referral Program screen;

ii. If the child is not currently participating in the Head Start Program and the parent/guardian agrees to the referral, complete the Crossroads generated WIC Program Referral Form (WIC-35). Include the most recent hemoglobin on the referral;

iii. If the child is currently participating in the Head Start Program or the parent/guardian refuses the referral, the parent/guardian’s reason for refusal must be documented under Referral Refused Reason on the Referral Follow-Up screen;

iv. Send the completed referral form via mail, fax, or email to the local Head Start Program.

b. The local Head Start Program will:

i. Accept the completed referral from the WIC Program and use the WIC participant information included according to Head Start policy;

ii. Restrict the use or disclosure of the WIC participant information as stipulated in the Agreement between the West Virginia WIC Program and West Virginia Head Start Association (see Policy 10.02 Coordination of Program Services Attachment #4).

REFERENCES:

1. USDA Nutrition Services Standards, Standard 10, Program Coordination 2. USDA Nutrition Services Standards, Standard 11, Participant Referral 3. WIC Consolidate Regulations, Revised January 1, 2017, 7 CFR 246.7, Certification of Participants.