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Dental Dayz – Classroom Outreach


NOCAC Teaching Staff Responsibilities:

  1. During the first home visit, the NOCAC Teacher will encourage parent/guardian to sign the BCHC Dental Consent for Exam. (form N11 – Dental Consent To Exam) (Only children with a signed authorization form will receive Dental Prevention services in the Head Start classroom)
  2. The signed original form will be forwarded to the Family Advocate (FA). It is recommended that a copy be kept in the site file.


Family Service Specialist Responsibilities:

  1. The Teachers will work in partnership with Health and Safety Assistant on days that dental services are scheduled in a classroom to assure that children are escorted to and from the dental services as efficiently as possible. If the FA is unable to be at the site on the scheduled day, he/she should inform their supervisor to arrange alternative support. (This is most critical on days when more than 10 children are scheduled for services.)
  2. The Teacher/FA will determine the family’s capacity to follow-through with the referral recommendations and proceed accordingly.
  • Level 1 and 2 referrals: families will be expected to follow through on their own unless there are unusual barriers in place. If NOCAC Staff determine the family cannot follow through appropriately on level 1 & 2 referrals, they will contact the Health and Safety Manager for assistance.
  • Level 3 and Level 4 referrals: the FA will work from the follow-up plan developed by the Health and Safety Manager and document progress in ChildPlus.

 Health and Safety Manager Responsibilities:

  1. Health and Safety Manager will work with a dental provider to develop a schedule at the beginning of each program year that indicates when the Dental Dayz will be at a particular center. The schedule will be adapted as needed throughout the school year dependent on results and planned prevention interventions.
  2. Head Start Support Staff will/may accompany the Dental provider to classrooms to provide administrative support if more than 5 children are scheduled for services.
  3. The Health and Safety Manager will serve as a backup as needed.
  4. The Data Systems Specialist will enter all results into ChildPlus in accordance with ChildPlus protocol for health events.
  5. A copy of the Dental Health Exam (form N9 – Dental Health Exam form) form will then be forwarded to Health and Safety Manager so that she can develop a follow-up plan in ChildPlus.
  6. The Health and Safety Manager will manage any associated contracts or billing as it relates to Dental Providers.


Forms and Additional Guidance:  (Draft as of 8/11/22)

  • BCHC Dental Consent for Exam (form N11)
  • Dental Health Exam
  • Dental Dayz Summary Form (form N10)
  • BCHC Nitrous Oxide Permission (English) (form N12)
  • BCHC Nitrous Oxide Permission (Spanish)
  • BCHC Oral Surgery Consent (English) (form N13)
  • BCHC Oral Surgery Consent (Spanish)
  • BCHC HIPPA Privacy (form N14)











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