Mary Guertin, Thames Valley Council for Community Action, Inc.
Larissa Zoot, MPH, Administration for Children and Families, Region 1 J. Zoë Beckerman, Esq., Feldesman Tucker Leifer Fidell LLP
Partners in Success: Perspectives on Achieving and Demonstrating
Compliance in Early Head Start
15th Annual Birth To Three Institute
CONTENTS:
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FELDESMANTUCKERLEIFER
FIDELL LLP
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MEMORANDUM TO: Zero to Three FROM: J. Zoë Beckerman, Esq. Partner SUBJECT: Copyright Holder’s Permission DATE: May 9, 2011 In accordance with Zero to Three’s (“ZTT’s”) policy of requiring a copyright holder’s permission to reprint previously published information, on behalf of my firm, Feldesman Tucker Leifer Fidell LLP, I hereby provide ZTT permission to use and distribute to its Birth to Three Institute’s participants the copyrighted information contained in slides 6-14 of the slide set for “Partners in Success: Perspectives on Achieving and Demonstrating Compliance in Early Head Start.” The other slides in our slide set are not copyrighted. With this permission, ZTT may provide these slides to the participants of its upcoming Birth to Three Institute on June 20-23, 2011, for them to download or print for their personal use only. Any other use or disclosure by ZTT or its Birth to Three Institute’s participants is a violation of federal copyright law. Should you require any additional information from me regarding this copyright, please do not hesitate to be in touch. My email is [email protected] and my additional contact information is below.
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June 22, 2011 1
Partners in Success: Perspectives on Achieving and Demonstrating
Compliance in Early Head Start
Birth to Three Institute
Presenters:Mary Guertin
Larissa Zoot, M.P.H.J. Zoë
Beckerman, Esq.
2
Presenter: Mary Guertin
• Head Start Director at the Thames Valley Council for Community Action, Inc.
– Program: HS/EHS program serving 539 children in New London County, CT. Uses EHS HB option, Preschool HB option, single session centerbase and extended day
options– Role: oversee a management team of 12 and a staff of 90– Held position for 23 years with a background in public
and private preschool education • [email protected], phone: 860‐425‐6516
3
Presenter: Larissa Zoot, M.P.H.
• Head Start Program Specialist/Federal Review Team Leader at the Administration for Children and
Families – Region 1, New England– Role: funding, monitoring and leadership for Head Start
and Early Head Start programs
• [email protected]– Note: grantees are encouraged to contact their own
Program Specialist
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Presenter: J. Zoë
Beckerman, Esq.
• Partner at Feldesman Tucker Leifer Fidell LLP– Focusing on Head Start and Federal Grants Law
• Managing Principal of FT Solutions LLC
• Has counseled associations and many HS/EHS programs across the country on legal, regulatory
compliance and government affairs matters– Assists programs in a variety of matters including
clearing monitoring findings
• [email protected]; telephone: 202‐466‐8960FELDESMANTUCKERLEIFERFIDELL LLP
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Perspective from a Lawyer
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My Role in Compliance
• Advice and Counsel• Helping to “keep programs’
noses clean”
– As a federal grants attorney, I work with Head Start/Early Head start programs to understand the laws
and regulations and advise whether they are in compliance and if not…
– I help to investigate and analyze risk areas and/or problems;
– I also help to develop compliance programs, corrective action plans/steps, edit and review policies and
procedures, etc.– Also teach about hotspot areas and compliance
programs
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Why Focus on Compliance?
• Preventing, deterring and fixing problems is a part of striving for excellence
• Draft OIG Compliance Program Guidance for Recipients of PHS Research Awards includes elements to a good compliance program (70 Fed
Reg. 71312) http://oig.hhs.gov/fraud/complianceguidance.asp
• OIG Recommends a Seven Step Program for Compliance
© Feldesman Tucker Leifer Fidell LLP. All rights reserved. 8
1. Assigning Oversight to a Compliance
Officer/Contacts
• Compliance Officer manages compliance program on a day‐to‐day basis
– Implementing and operationalizing Board‐established polices
– Establishing compliance program procedures– Hiring compliance staff– Allocating and operating within available resources– Overseeing/monitoring effectiveness of compliance
program– Coordinating resolution of compliance issues– Visible to employees, contractors and board members– Periodic reporting to board of directors and PC on
compliance program activities
© Feldesman Tucker Leifer Fidell LLP. All rights reserved. 9
2. Developing/Implementing Written
Policies and Procedures
• Purpose: to promote quality and to provide a structured approach for reducing errors, fraudulent activity and other
non‐compliant behavior within the organization• Have written policies and procedures that:
– Describe compliance expectations• e.g., Standards of Conduct or Code of Ethics
– Implement the operation of the compliance program– Provide guidance to employees and others on dealing with
potential compliance issues
– Identify how to communicate compliance issues to appropriate
compliance personnel and
– Describe how potential compliance problems are investigated and
resolved
• Required: HS Regulations; See, e.g.
45 CFR§1301.31
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3. Conducting Appropriate Training and
Education
• Train and educate all affected employees and persons associated with the agency including executives and
governing body members– Encompass compliance issues, expectations and the compliance
program operation
– Should occur periodically and be made a part of the orientation for
a new employee, appointee or associate, executive and governing
body member
– Need not be formal, classroom‐style training– Standard: effective communication
• Required: HS Regulations; 45 CFR§1304.52(l)(1)‐(3)
© Feldesman Tucker Leifer Fidell LLP. All rights reserved. 11
4. Developing Open Lines of
Communication
• Develop procedure for employees to seek clarification from compliance officer if question arises
• Require employees to report conduct that a reasonable person would, in good faith, believe to be
erroneous/fraudulent• Include provisions in written standards of conduct stating
that failure to report erroneous/fraudulent conduct is a violation of Compliance Program
• In policies and procedures, also include: assurance of non‐ retaliation for individuals who report in good faith; process
for responding; tracking/routing for investigation/oversight; documentation of resolution
• Partially Required: HS Regulations; 45 CFR§1304.51(b) et seq.
© Feldesman Tucker Leifer Fidell LLP. All rights reserved. 12
5. Conducting Internal Monitoring and
Auditing
• Conduct comprehensive baseline self‐audit (assessment) of risk area practices
• Audit other functions as appropriate, considering historic high‐risk areas for your program
• Implement follow‐up audits and monitoring• Promptly communicate results to compliance
officer, contacts or committee, as applicable• Required: HS Self‐Assessment; 45 CFR§1304.51(i)(1)
© Feldesman Tucker Leifer Fidell LLP. All rights reserved. 13
6.
Enforcing Disciplinary Standards through Well Publicized Guidelines
• Establish procedures for disciplining individuals who violate law/applicable standards
• Necessary to add credibility and integrity to your Compliance Program
• Set forth Standards of Conduct in Board and PC policies, personnel policies and contracts including disciplinary
actions that maybe imposed as a result of illegal/unethical conduct
• Disciplinary guidelines must be well publicized in personnel manuals and contracting procedures
• Address guidelines in in‐house training• Required: HS Act and Regulations for Violations of
Standards of Conduct; §642(c)(1)(X) of the Head Start Act
© Feldesman Tucker Leifer Fidell LLP. All rights reserved. 14
7. Responding Appropriately to
Detected Offenses
• Have systems for responding to compliance issues as they are raised, including:
– Investigating potential compliance problems– Responding to compliance problems as identified in the
course of self‐evaluations and audits– Taking prompt, thorough corrective action on problems
promptly and implementing procedures, policies and systems as necessary to reduce the potential for
recurrence– Reporting if necessary– Required: under HS Act Governance Provisions;
§642(c)(1)(X)(bb) of the Head Start Act
15
Perspective from a Federal Program Specialist
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My Role(s) in Compliance
• Program Specialist:– Review and negotiate funding applications– Provide ongoing support, troubleshooting and policy
clarification for grantees– Monitor programs via review reports, EOM, Risk
Management, PIR and other data sources– Support State HS Association– Support/Engage State Collaboration Director– Partner with Technical Assistance providers– Offer guidance to program in preparing for review
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My Role(s) in Compliance, Con’t.
• Federal Review Team Leader:– Evaluate program compliance via management of
review team and review implementation– Ensure accuracy and quality of draft report– Build effective communication/partnership with grantee
being reviewed– Share information with grantee’s home Regional
Office/Program Specialist
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Resources to Support Programs in Building Compliance
• Office of Head Start• Regional Office program and fiscal staff• State TA offices and Grantee Specialists• National Centers for Technical Assistance• Early Childhood Learning and Knowledge Center,
Head Start Enterprise System, and other web and data resources
• State Head Start Associations, NHSA
or other national associations
• Other grantees/peers!• Consultants
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Tips for Demonstrating Compliance
• 3 Most Important Items in Preparation for Review:– Attitude– Self Assessment and Ongoing Monitoring– Articulating effective systems– Plan
• then breathe
(Anyone good at counting here?...)
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Articulating Effective Systems
To articulate effective systems, you need to consider:
• Mechanisms• Responsibilities• Analysis• Action
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Other Key Points
• My perspective is influenced somewhat by my personal approach, by the characteristics of my Region, and also by
the leadership in my Region• The role of a Program Specialist has changed substantially
over the last ten years• Every grantee/RO relationship is different, despite common
elements• Program Specialist’s role also includes acknowledging
grantees’
success and sharing opportunities• Compliance is not about passing a review; compliance is
about program stability and, ultimately, about children and families
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Perspective from a Head Start Director
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What Is Compliance?
• Adherence to all laws, rules and policies• Not a one‐day‐a‐week event
– What is the connection between performance standards and compliance?
• Clear working policies and procedures– Note: Make sure they work for your type of
program, evaluation will focus on their contents
24
Important Questions Regarding Compliance
• Training:– How do we train on policies and procedures?– Who is trained?– How can you involve everyone in the agency?
• Support Systems:– What systems are developed to support
compliance?– How is the Regional Office part of the system?
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Important Questions Regarding Compliance, Con’t.
• Types– What types of compliance should you focus on?
• Fiscal• Programmatic
• Self Assessment– How important is self assessment and what is its
relationship to compliance?
• Monitoring Findings– Action plans, corrective action, risk management
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Tips and Items to Keep in Mind
• Know all rules and how they relate to each other in terms of compliance:
– Federal– State– Local
• Consider where your support comes from– Relationship with Regional Office and Program Specialist
• When and how do you communicate with them?
• Know monitoring protocol and be prepared…
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Questions and Answers