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4.0 Program Staffing and Staff Qualifications
"It takes an incredible amount of
coordination and commitment
by everybody and it's worth it.
We do it because it makes a difference."
—Head Start Staff
4.1 Overview
A review of the literature over the past two decades uncovers few studies that focus on Head Start program staffing and the qualifications of the Health Component staff who assist families in gaining access to health services. In one, an examination of indices of Head Start program quality (Brush, 1993), researchers noted that programs employing staff with higher levels of education had fewer health items out of compliance with Federal regulations, as measured by data collected on the On-Site Program Review Instrument (OSPRI). In the same vein, a Task Force charged to study and make recommendations to strengthen Head Start's Health Component urged in its report that Head Start set minimum education and experience requirements for Health Component Staff, and develop career paths and staffing patterns that will promote program quality (Head Start Health Coordinator's Task Force Report, 1990). Related to this, many Head Start Program Directors, in responding to a General Accounting Office (GAO) survey, reported that they had insufficient qualified staff to meet the complex needs of the children and families that they serve, and that low salaries hampered their ability to hire qualified staff (GAO, 1994).
4.2 Findings
The data presented in this section were obtained primarily from interviews with Head Start program staff. These staff members included: Health Coordinators, Mental Health Coordinators, Nutrition Coordinators, Parent Involvement Coordinators, and Center Directors. It should be noted that, at some Head Start programs, more than one individual was interviewed for a given staff position (i.e., Health Coordinator and Parent Involvement Coordinators) because more than one person was functioning in that role. For other staff positions (i.e., Mental Health Coordinators and Nutrition Coordinators), fewer than 40 interviews are reported upon because not every program had a person filling the role or the staff members was not available. In the case of Center Directors, for some of the programs included in the study, one individual was responsible for both centers visited.
4.2.1 Program Staffing
This section presents data collected on: program staffing, staff roles, and the issue of staff performing multiple roles.
Program Staffing. Exhibit 4-1 presents staff responses regarding their work experience in Head Start. While most staff reported that they had worked for Head Start for approximately 9 or 10 years, Center Directors reported average job tenures of almost 15 years. All staff reported working in their current position for approximately 5 or 6 years on average.
Health Coordinators, Parent Involvement Coordinators, and Center Directors reported being paid to work approximately 39 hours per week, while Mental Health and Nutrition Coordinators reported being paid to work approximately 36 hours per week. All staff, however, reported actually working an average of 5 to 7 hours more than the number of hours a week for which they were paid. Those staff reporting multiple roles were asked how many hours per week they spent working in their primary role. Responses varied from approximately 25 hours for Health Coordinators to approximately 10 hours for Mental Health Coordinators.
|
Respondents |
|||||
|---|---|---|---|---|---|
|
Health |
Mental |
Nutrition |
Parent |
Center |
|
|
Mean Number of Years with Head Start |
9.0 |
10.5 |
8.7 |
10.7 |
14.5 |
|
Mean Number of Years in Current Position |
5.5 |
5.9 |
5.0 |
5.8 |
6.6 |
|
Mean Number of Hours per Week Paid |
38.8 |
36.4 |
36.2 |
39.0 |
38.8 |
|
Mean Number of Hours per Week Worked |
43.8 |
42.5 |
41.2 |
45.2 |
45.8 |
|
Mean Number of Hours per Week Spent in Capacity of Current Position |
24.8 |
10.1 |
16.9 |
23.2 |
21.6 |
|
Average Number of Years Performing Multiple Roles* |
4.6 |
5.3 |
7.3 |
5.1 |
6.4 |
|
N |
42 |
37 |
39 |
42 |
59 |
| NOTE: Questions were open-ended. *Averages are calculated only for those performing multiple roles. |
|||||
Staff Roles. The Head Start program staff interviewed were presented with a list of tasks that Health Component staff might perform, and were asked to indicate the tasks that they, themselves, performed, and those performed by others. Then, from the list of tasks that they did themselves, staff were asked to identify the three tasks that they performed most frequently. What emerges from their responses is that most Health Component staff are involved in both the role of "broker" of health services and in the direct provision of services.
Health and Mental Health Coordinators tend to typify the dual role of health service provider/broker. Both staff positions were involved in conducting screenings and examinations, reviewing the results of these tests and consulting with other Health Component staff in assessing their implications for the health needs of the children in their charge. When a health need was identified, both Health and Mental Health Coordinators devoted a great deal of time coordinating the actual delivery of services with other Head Start staff, as appropriate, and working with health care providers both in arranging for treatment and in following up on the treatment provided and its ramifications for further service requirements. Health and Mental Health Coordinators also reported that they spend a significant amount of their time conducting health/mental health education classes for parents and teachers and engaging in interagency collaborations.
Nutrition Coordinators were primarily involved in the planning, purchase, and delivery of food to the children enrolled in the program. They also conduct growth screenings and assist with the identification of child, family and community nutrition problems by conducting nutrition assessments, providing nutritional counseling, and conducting nutrition education classes for teachers and parents.
Parent Involvement Coordinators provide a major link between the parents of enrolled children and Head Start program staff. Parent education appears to be the primary mechanism through which this is accomplished.
Center Directors reported that they had direct involvement in health-related activities, such as providing health education to children in the classroom, as well as conducting parent education and teacher training on health-related topics. Center Directors also reported that they worked with local community health providers both in making arrangements for services to be delivered to children in need, and also in following up on referrals made by other Health Component staff.
Multiple Staff Roles. Many staff reported that they performed roles in multiple staff positions. While approximately one third of the Center Directors (32.2%) interviewed reported that they had responsibilities in addition to their Center Director responsibilities, half or more of the respondents in each of the other staff positions associated with the Health Component reported performing multiple roles: 50.0% of the Health Coordinators, 56.4% of the Nutrition Coordinators, 66.7% of the Parent Involvement Coordinators, and 78.4% of the Mental Health Coordinators. Health Component staff in programs with enrollments of fewer children were more likely to perform multiple functions.
There is an inverse relationship between the number of Head Start Centers a Health Coordinator is responsible for and the likelihood of that coordinator working in multiple roles, with the proportion of Health Coordinators reporting multiple roles decreasing as the number of centers increases. Thus, it appears that while staff in smaller programs are more likely to wear "multiple hats," the staff roles and functions in larger programs seem to be more cleanly delineated. It should be pointed out that this issue may be related to the locus of activity (e.g., Program level versus Center level), and the fact that many large programs may have extra staff working under the direction of the Health Coordinator.
In general, multiple role respondents reported that they had been hired to perform more than one role. Between one half and two thirds of the respondents in each staff position indicated that this was the primary reason for performing multiple roles. Other reasons, also cited by substantial proportions of Center Directors and Mental Health Coordinators, were program evolution and staff changes.
When asked what, if any, problems accompanied performing more than one role, large proportions (between 66% and 86%) of the respondents in each staff category cited time constraints as a problem. Insufficient salary for the job demands was also indicated as a problem by many respondents in all staff positions.
Staff responses regarding multiple staff roles appear to be linked to concerns expressed by staff about program-related barriers to care facing Head Start families (see Chapter 5: Program Procedures and Linkages with the Community). When discussing program-internal barriers to care, respondents indicated that limited Head Start and Health Component budgets and staff shortages were common barriers. The fact that substantial proportions of staff perform multiple roles (for which they were hired), and that this situation poses significant time constraints, may be the underlying basis for these staff perceptions. These conditions also may be related to the reports of Head Start Program Directors (GAO, 1994) that they have insufficient qualified staff to meet the needs of the children and families they serve.
4.2.2 Staff Qualifications
Staff Education. Previous research has suggested that programs that employ staff that are more highly educated score better on indices of Head Start program quality (Brush, 1993), and that Program Directors perceive that low Head Start salaries hamper their ability to hire qualified staff (GAO, 1994). Thus, against this backdrop, staff education was a major focus of this investigation. When asked about the highest level of education they had achieved, (see Exhibit 4-2), the proportion of respondents reporting Bachelor Degrees (or higher) varied among the staff positions, from a high of 67.7% among Mental Health Coordinators (66.7% of Nutrition Coordinators also reported a Bachelor degree or higher) to a low of 33.3% among Health Coordinators. Larger proportions of respondents in programs with enrollments of 1,000 or more reported a Bachelor or Nursing Degree (or higher) than did their counterparts in programs with enrollments under 500. Results for the mid-size programs (enrollments of 500-999) were varied. This suggests that larger programs are more successful in attracting more highly educated staff, perhaps because their funding levels allow them to pay the salaries that the higher education credentials claim. Larger programs may also have Program Coordinators with Bachelor or Nursing Degrees who supervise staff who have not attained these qualifications.
|
Respondents |
|||||
|---|---|---|---|---|---|
|
Health |
Mental |
Nutrition |
Parent |
Center |
|
|
Some High School |
2.4 |
- |
- |
- |
- |
|
High School/ |
4.8 |
2.7 |
7.7 |
4.8 |
3.4 |
|
Some College |
23.8 |
16.2 |
17.9 |
33.3 |
25.4 |
|
Associate's Degree |
4.8 |
8.1 |
- |
7.1 |
33.9 |
|
Nursing Diploma |
30.9 |
5.4 |
7.7 |
- |
- |
|
Bachelor's Degree |
19.0 |
27.0 |
38.5 |
35.8 |
22.0 |
|
Graduate School |
- |
2.7 |
10.3 |
7.1 |
5.1 |
|
Master's Degree |
11.9 |
32.5 |
17.9 |
9.5 |
8.5 |
|
Doctorate/MD |
2.4 |
5.4 |
- |
2.4 |
1.7 |
|
N |
42 |
37 |
39 |
42 |
59 |
Much higher and consistent proportions of staff from Head Start programs sponsored by School Systems reported Bachelor Degrees than did staff from programs sponsored by other types of organizations (see Exhibit 4-3). This may reflect a value placed on academic credentialing in school systems. It should also be noted that none of the respondents from an Indian Tribe reported a Bachelor or Nursing Degree.
|
Respondents |
|||||
|---|---|---|---|---|---|
|
Program Sponsor |
Health |
Mental |
Nutrition |
Parent |
Center |
|
CAA* |
58.8 |
56.3 |
64.7 |
42.1 |
20.8 |
|
School System |
100.0 |
100.0 |
100.0 |
83.3 |
66.7 |
|
Private/ |
60.0 |
53.8 |
83.3 |
58.3 |
35.0 |
|
Government Agency** |
100.0 |
100.0 |
100.0 |
66.7 |
100.0 |
|
Indian Tribe |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
| *Community Action Agency **Any government agency other than a public school system or a Community Action Agency (CAA). |
|||||
When staff respondents were asked to volunteer (open-ended question) the fields in which they held degrees, Center Directors, Mental Health Coordinators, and Parent Involvement Coordinators most often reported Education and/or Early Childhood Development. Nutrition Coordinators generally indicated academic training in the areas of Food and Nutrition/Dietetics and Home Economics.
Of the one third of the Health Coordinators who had completed college and/or at least some graduate school, over half had specialized in the field of nursing. Approximately another third (30.9%) of the Health Coordinators reported that they had a Nursing Diploma, and these respondents were fairly evenly divided between Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). Overall, approximately two out of five of the Health Coordinators interviewed reported having received training in nursing. However, the fact that more Health Coordinators tended to have nursing diplomas than baccalaureate degrees may be an indication of when the individuals received their training. Three quarters of the respondents reporting a nursing diploma received their credential in the 1950s, '60s and '70s, when these types of programs were more prevalent. Currently, only a small number of nursing graduates come from these programs (Bureau of Labor Statistics, 1996).
4.2.3 Staff Certification and Training
Staff Certification. Program staff were asked whether they held any current job-related certificates or licenses. Their responses to this (open-ended) question are presented in Exhibit 4-4 (the reader should note that, since respondents could report holding multiple certificates/licenses, column percents in this exhibit may not add up to 100%). The open-ended nature of this question may account for the generally low response rates observed in this table. The certificate/license most often mentioned was First Aid, which was cited by 41.3% of the Health Coordinators. This was followed by Cardiopulmonary Resuscitation (CPR) (14.3%).
Among the other staff interviewed (Mental Health, Nutrition, and Parent Involvement Coordinators), there was little consensus in terms of specific certificates/licenses. There were also several "Other" certificates/licenses reported, each cited by one or two individuals. These account for the substantial proportions appearing in the "Other" category in Exhibit 4-4. The areas in which these "Other" certificates/licenses were held included: Audio Screening, EKG Technician, Emergency Medical Technician, Psychiatric Nursing, Pharmacology, and Family Development.
|
Respondents |
|||||
|---|---|---|---|---|---|
|
Certificate/ License |
Health |
Mental |
Nutrition |
Parent |
Center |
|
CPR |
14.3 |
8.1 |
2.6 |
2.4 |
8.5 |
|
First Aid |
41.3 |
5.4 |
5.1 |
2.4 |
6.8 |
|
State Nursing License |
9.5 |
- |
2.6 |
- |
- |
|
Licensed Practical Nurse (LPN) |
9.5 |
2.7 |
2.6 |
- |
- |
|
Registered Nurse |
11.9 |
2.7 |
- |
- |
- |
|
Certified Nurse's Aid |
2.4 |
- |
- |
2.4 |
- |
|
Licensed Social Worker |
4.8 |
2.7 |
- |
14.3 |
1.7 |
|
Unspecified Teaching Certificate |
9.5 |
13.5 |
5.1 |
7.1 |
10.2 |
|
Child Development License |
9.5 |
10.8 |
2.6 |
11.9 |
35.6 |
|
Registered Dietician |
- |
- |
15.4 |
- |
- |
|
Child Center Permit |
- |
- |
- |
- |
11.9 |
|
Other* |
11.9 |
32.4 |
23.1 |
11.9 |
20.3 |
|
N |
42 |
37 |
39 |
42 |
59 |
| Note: Question was open-ended. Staff could report multiple certificates/licenses. *The "Other" category includes areas in which only one or two individuals reported holding specific certificates/licenses. |
|||||
Staff Training. Staff interviewers also inquired about the training provided to Head Start staff. Center Directors and Health Coordinators were asked about the training provided at their centers during the 1993-94 program year. Three quarters or more of the respondents interviewed reported that they provided training on the following health topics: nutrition, neglect/abuse, children with special needs, growth/development, CPR, and First Aid/safety.
Since the training of Health Coordinators was deemed to be of critical importance to the functioning of the Health Component, these individuals were asked what training on health issues for young children and their families they, personally, had received since September, 1993. When presented with a list of training topics, a majority of the Health Coordinators reported that they had received training in 15 of the 20 topic areas cited. This training was generally provided by other program staff or by local consultants or community providers.
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