Descriptive Study of Head Start Health Services, 1993-1996

The program elements described included:

• Head Start staffing patterns, prior and ongoing staff training, and experience related to the Health Component;
• Utilization of community resources in the provision of health services;
• Barriers to the provision of health services for Head Start families and programs;
• Current preventive health efforts provided for children and parents; and
• Current screening, examination, referral, treatment, and follow- up procedures employed in each health domain.

Data Sources

The breakdown of data for this project were as follows:

• This study was conducted with a random sample of Head Start children and their families drawn from Head Start centers across 23 States and Puerto Rico.
• The sample started with 40 Head Start programs selected from the universe of 1,834 programs (grantee and delegate agencies) enrolling 4-year-old children. The second stage of sampling yielded 80 Head Start centers (2 centers for each of 40 programs), while the final stage was designed to select 15 children per center in order to meet the goal of 1,200 parent interviews, resulting in a nationally representative sample of Head Start families. The design resulted in a sample with a range of urban and rural sites, reflective of the overall Head Start program.
• At the end of the 1993-1994 Head Start program year, a total of 1,189 parent interviews and health file reviews were completed at 81 centers. Staff reports are based on 267 interviews with program coordinators and directors, while observational reports provided data on 177 meals provided at Head Start centers.

Study Findings

Highlights of the findings included:

• Staff reported working in Head Start for averages ranging from 9 years (Health and Nutrition Coordinators) to 15 years (Center Directors), and reported working in their current positions for between 5 and 6 years.
• About 95% of the interviewed staff reported that their highest level of education was a college degree or some college; approximately 40% of the Health Coordinators reported that they had nursing training, and approximately one third of the Mental Health Coordinators interviewed indicated that they had a master's degree. 64% of the Health Coordinators had either a nursing degree, a Bachelor's degree, or higher.
• The major types of organizations most commonly reported by Health Coordinators as being associated with their Head Start programs were public health agencies and private group providers. The most often reported services provided were medical services and screenings, eye care and vision screenings, immunizations, dental services, and nutrition services and meal planning.
• Nutrition, personal hygiene, first aid and safety, and dental health were the most frequently covered classroom health education topics, each being cited by over 85% of the Health Coordinators.
• Immunization rates based on the children's health record review showed that 87% of the 4-year-old children were fully immunized in accordance with the Program Information Report (PIR) reporting requirements (4 DPT, 3 OPV, 1 MMR, 1Hib).
• In serving Head Start families, programs engage in three areas of activities: assuring a) that children get screenings and needed health services, b) that children receive preventive care, and c) that both children and families learn to take responsibility for their own health care and health-related behaviors. The Health Component provides the opportunity for all families to benefit through prompt diagnosis and treatment, and by ensuring that the children are as healthy as possible before they enter kindergarten.

Frequently Asked Questions

Why was a descriptive study of the Head Start Health Services Undertaken?
A Descriptive Study of the Head Start Health Services was designed to provide a "national snapshot" of how local Head Start programs meet the medical, dental, nutrition, and mental health needs of the children and families they serve. The Head Start Bureau requires this information for the development of policies that will assist programs in responding to the populations of families served and the conditions faced by local programs. This descriptive study was undertaken because little current information was available regarding how program procedures address the health conditions that are common among Head Start children, the community health risks faced by families participating in Head Start, and the health resources available in the communities served by Head Start.

Why does Head Start have a Health Services Component?
From the very beginnings of Head Start thirty years ago, the program developers recognized the relationship of children's health and their ability to learn. Head Start is committed to a policy of ensuring that children who participate in the program enter school with no undetected health conditions that might impair their potential for success. The program's health services objectives are to arrange or facilitate health screenings, diagnoses, and treatments across the domains of medical, dental, mental health and nutrition conditions and to provide parents with the information they need to ensure that their children obtain appropriate health services.

What examples of effective practices were found in the study?
Effective practices were not determined by this study. A conscious effort was made throughout the study to avoid evaluation and to focus on pure description. One of the primary purposes of this study was to provide a descriptive base for a possible subsequent evaluation study of the Health Services, if deemed necessary. It is clear that measures of success or "high-results" will not be the same for each program. This may be due to variations in the community contexts impacting Head Start programs or even variations in the skill levels of parents of newly enrolled children.

What are the qualifications of the Head Start staff in the Health Services?
Head Start programs are supported by staff from a broad range of backgrounds, and include a number of individuals who worked many years within Head Start and moved up into various positions within the Health Services. Generally, about one third of the Health Coordinators held college degrees or higher, and nearly another third held nursing diplomas without a degree. The highest percentage of graduate degrees was found among the Mental Health Coordinators. Health Coordinators held the highest number of special certificates among the staff interviewed, with a high concentration of them being nursing-related certificates or licenses.

How are the costs of health services covered?
Approximately two-thirds of the children in Head Start have the costs of their health services covered by Medicaid. Other sources of payment were private insurance and direct payment. Free care was reported by only a small percentage of parents. Parents whose children were not covered by Medicaid indicated that they either had other insurance or that they were not eligible. Only a very small percentage of parents indicated that they had not heard of Medicaid or did not understand how to enroll. Head Start staff routinely query parents about Medicaid enrollment at the time of Head Start enrollment, and facilitate Medicaid enrollment as needed. Head Start programs only contribute to the cost of health services when all other options have been explored and funds are still necessary.

How successful is Head Start in encouraging parents to get their children fully immunized?
Over 80 percent of children in Head Start are immunized at the levels recommended by national advisors on immunization.

What are the primary health problems of Head Start children?
The most common health conditions are ear problems, speech and language problems, lower and upper respiratory problems, asthma, blood disorders, and gastrointestinal problems. These data are consistent with those reported in the Child Supplement of the National Health Interview Survey (1991). Several conditions (blood disorders, speech and language problems, and dental problems) were more likely to be picked up after enrollment in Head Start.

What are the primary community health risk factors faced by Head Start programs?
The primary risk factors included substance abuse, low parenting skills, lack of available support services for families, poor nutrition, and poverty. Child abuse and neglect and community violence were also mentioned, particularly by staff responsible for mental health services.

What are the community resources that are used most by Head Start programs?
Each Head Start program must link with the service providers in the community and be responsive to the needs of these communities. Head Start staff reported that many services are provided by organizations, rather than by individual providers. Examples of these organizations include public health agencies, private group providers, mental health organizations, and public interest/service organizations. The services most often provided include medical screenings and services, vision screenings and eye care, immunization services, dental services, and nutrition and meal planning services. Most of the parents reported receiving information to facilitate their linkage with community services from Head Start, either through parent education activities or through information provided at enrollment.

What are the barriers to obtaining health services for Head Start children?
Barriers to obtaining health services fall into three categories: community, personal, and internal. Community barriers include lack of childcare and transportation, distance between families and providers, costs of care, lack of needed providers, and inconvenient provider schedules. Personal barriers most often reported included parental lack of understanding, parental resistance, lack of time for parents to obtain services, and cultural barriers. Internal barriers include staff reports of a shortage of time and program resources necessary to assist families in overcoming problems.

How do Head Start programs support mental health services?
One of the main features of the Health Services requirement is for programs to foster the mental health status of children, parents, and staff. Head Start's approach to mental health is grounded in a perspective of promoting normal growth and development. However, it is also responsible for assuring that children receive screenings and treatment services as needed. These are provided either through the oversight of a Mental Health Coordinator or through a trained mental health consultant affiliated with the program.