Head Start and Early Head Start
     Head Start
     Migrant and Seasonal Programs Branch
     American Indian/Alaska Native Programs Branch
     Early Head Start
Head Start Health Services
     The Philosophy
Performance Standards
     Medical Home
     Well-Child Care Visits
     Tracking Health Progress
     Screening
     Parent Involvement in Health
     Child Health and Safety
     Child Nutrition
     Child Mental Health
     Ongoing Collaborative Relationships
     Health Services Advisory Committee

Head Start and Early Head Start

Head Start

Head Start is a national program that provides comprehensive developmental services for low-income, preschool children ages three to five and social services for their families. Approximately 1,600 community-based nonprofit organizations and school systems have developed unique and innovative programs to meet specific needs. Head Start began in 1965 in the Office of Economic Opportunity.

The Department of Health and Human Services, Administration for Children and Families (ACF) oversees Head Start. Grants to conduct Head Start programs are awarded to local public or private, nonprofit or for profit agencies by the ten ACF Regional Offices and the Head Start Bureau's American Indian/Alaska Native and Migrant and Seasonal Programs Branches. At least 10 percent of the enrollment opportunities in each program must be made available to children with disabilities.

Migrant and Seasonal Programs Branch

Migrant and Seasonal Head Start is administered from the national level through local and regional grantees. It is designed to provide comprehensive services to children from birth to compulsory school age in eligible mobile and seasonal farm worker families. Migrant families typically:

• Meet the annual Head Start poverty income guidelines
• Earn at least 51 percent of their annual income from agricultural work
• Change their place of residence at least once within each 24 consecutive months

Head Start staff tailor health services to the needs of these families. Head Start may schedule health appointments before the migrant families arrive at sites and make night and weekend appointments to accommodate the family work schedules. They also assist families in arranging follow-up care at their new location.

The Migrant Health Program works with Head Start staff and other public health service programs to meet the needs of migrant families. Most children in migrant families are eligible for Medicaid and State Children's Health Insurance Program (SCHIP).

American Indian/Alaska Native Programs Branch

American Indian and Alaska Native programs are administered centrally from Washington, D.C. Federally recognized tribes, consortia, and Alaska Native corporations are the grantees that operate the Head Start/Early Head Start programs. They vary in size, geography, and population and operate in 26 states.

Head Start has a long-standing collaborative partnership with the Indian Health Service. Tribal health departments provide treatment, referrals, or payments for medical and dental health care, or for related services. In some cases, managed care organizations are responsible for Indian health care.

Early Head Start

In 1994, the Head Start Reauthorization Act established Early Head Start to assist low-income families with infants and toddlers, including children with disabilities, and pregnant women. Participants receive the same comprehensive child development education, health, nutrition, and mental health services as Head Start families. The Early Head Start staff serve as advocates and liaisons to service providers for the pregnant women they serve.

Program sponsors include Head Start grantees, school systems, universities, colleges, community mental health centers, city and county governments, Indian tribes, community action agencies, child care programs, and other nonprofit agencies. Early Head Start projects must coordinate with local Head Start programs to ensure continuity of services for children and families.

Head Start Health Services

The Philosophy of Head Start Health Services

When Head Start first began, voluntary community health providers offered many health services on-site in Head Start programs, such as immunizations and medical and dental treatment. Since then, however, Head Start programs have changed service delivery by placing an emphasis on partnerships with providers. These partnerships enable Head Start to respond to modifications in the health care delivery system and the needs of Head Start families.

Currently, to comply with the Head Start Program Performance Standards and to best meet the needs of families, programs design their services to take into account a variety of factors, including the results of the community assessment. Programs then determine whether to be a provider of direct health services, a broker of health services, or some combination of the two.

The focus of Head Start health services is to prevent health problems whenever possible by carefully addressing the needs of enrolled children. Successful partnerships are the key to the success of this approach. When conditions or illnesses are found, they are addressed quickly with the help of competent health care partners in an effort to improve the health of the child and to prevent future problems.

Some services Head Start programs provide include:

• Assisting families in finding a medical home
• Locating sources of funding for health services
• Working with local Medicaid and SCHIP agencies to determine a child's eligibility for medical assistance
• Tracking health services
• Offering health promotion activities, including information about well-child care and training and information on child health and development

Performance Standards Requirements for Health Services

Medical Home

Head Start staff members make an effort to coordinate health services with families. They strive to ensure that each child has a source of continuous, accessible, coordinated care that serves as a "medical home."

The Head Start Performance Standards requirement for a community assessment offers an opportunity for staff to identify and evaluate what health services are available locally.

This activity:

• Supports efforts to find each child a medical home
• Enables families to carry out future efforts to ensure health care
• Assists the staff to meet the goal of offering broad preventive health care

In cases in which there is not a continuous source of health care, staff plan to help a family acquire a medical home. These include:

• Determining the values and beliefs of families regarding preventive health maintenance for family members
• Assisting families in applying for Medicaid or SCHIP services
• Working with local Medicaid and SCHIP agencies to determine a child's eligibility for medical assistance and to identify Medicaid and SCHIP providers
• Seeking help from the Health Services Advisory Committee (HSAC) to identify potential providers, sources of funding for health services, and ways to inform community health providers about the health needs of Head Start children and families
• Helping families get appointments with medical providers
• Once a medical home is located, staff periodically review health records to ensure that recommended treatment and preventive services are being provided, and that providers make plans for both treatment and follow-up.

Well-Child Care Visits

In addition to ensuring that Head Start families find a medical home for their children's care, the Head Start Program Performance Standards require a determination by a health care professional that a child is up-to-date on a schedule of well-child care. Since health care in Head Start requires family involvement, Head Start staff members are expected to emphasize to parents the importance not only of finding a health care provider, but also of scheduling future preventive and primary health care. Only continuous care will identify and address problems quickly.

Well-child care includes scheduled age appropriate preventive and primary health care including medical, dental, and mental health care. Staff obtain a useful schedule for this care from the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program of the Medicaid agency of each state through the Health Department. The Centers for Disease Control and Prevention issues immunization recommendations. The Indian Health Service also provides guidelines for well-child care.

Tracking Health Progress

One aspect of health service management is taking steps to assist families with children needing further examination and treatment. The goal is to complete health services treatment and follow-up by the end of the program year. To accomplish this, the responsible staff member checks regularly with parents and staff to determine the status of examinations and treatments and the status of immunizations and diagnostic testing.

The Head Start staff member responsible for tracking a child's health care works with all of the staff in contact with the family to ensure that health records are carefully reviewed. The staff may be at the center, in a family child care setting, or may be home visitors.

Head Start staff members also tell parents how to use the referral procedures necessary to obtain health care services. For example, a child with a heart condition will require the services of a specialist, and a referral to that doctor from the primary care provider may be required before the visit can be arranged.

To track health care services, staff must maintain child health records. The records include the results of any examination and treatment plan and indicate progress in completing treatment for all conditions requiring follow-up. Records are reviewed with parents and are confidential. Head Start also facilitates transitions for families and transfers a child's health records to the next location if families move or when the child is no longer enrolled in Head Start.

Screening

When a child enrolls in Head Start, steps are taken to assess the child's health quickly to identify any health concerns. The emphasis is on scheduling preventive and primary health care. The screening also enables staff and partners to ensure prompt intervention to address problems. For example, it can identify children who need further assessment to determine if they need vision services or hearing aids, mental health services, special education, or other related services.

The screening procedures must be sensitive to the child's cultural, linguistic, and developmental background. Head Start also expects parents to be involved in the health care process, since they have the primary, long-term responsibility for their children's health.

The screening process is particularly important for children with disabilities. Some children who enroll in Head Start have previously identified disabilities and must be scheduled for immediate services. Other children with disabilities are identified during the screening process and need urgent intervention or care. Head Start works with community partners to locate services available for children who need care for disabling conditions.

The Department of Health and Human Services and the Department of Education, through the Federal Interagency Coordinating Council, have developed a cooperative agreement for coordinated screening. These efforts make timely screening feasible and also make it possible to expedite immunizations by making them available during the screening process. Coordinated screening also provides an excellent parent education opportunity, since information about child development, preschooler behavior, and services such as WIC, Medicaid, and SCHIP can be made available to families while their children are screened.

The Program Performance Standards require that children be screened for developmental, sensory, behavioral, hearing, and vision problems within 45 days after entry into the program. The child's health status must be determined by a health care professional within 90 days of entry. Head Start's health partners in community agencies may offer some direct services, such as providing screenings on-site. In many cases, additional community interventions are appropriate to ensure that the child's progress is adequately supported.

There are special provisions about screening and assessment for programs that do not operate for 90 days, such as those serving migrant farm workers and their families. In those locations, the screening and assessment of children must take place within 30 days from the child's entry into the program. This necessitates:

• Scheduling health services before or during the first weeks of the program
• Obtaining records from other states and programs
• Arranging night and weekend appointments to accommodate migrant work schedules

Parent Involvement in Health

Parents are principally responsible for maintaining the health and nutrition of their children. They can establish healthy habits in the home and find health, nutrition, and mental health services if they are educated about and involved in these matters. Grantee and delegate agencies provide education programs for parents and families on medical, dental, nutritional, and mental health issues. The staff convey information using expert guest speakers, hands-on experiences, and newsletters. The programs are designed with parent attitudes, cultures, languages, beliefs, fears, and educational levels in mind. The staff also use community resources and consult with the HSAC (see below ) when developing programs.

The medical and dental health education program assists parents in understanding how to enroll and participate in a system of ongoing family health care, rather than relying on emergency rooms. Agencies provide names and addresses of providers and information about after-hours care and how to obtain medical advice by telephone. The staff encourage parents to apply for Medicaid or SCHIP health benefits and to keep the child connected with a medical home after the child leaves Head Start.

The staff encourage parents to become active partners in their children's medical and dental health care and to accompany their children to appointments, provide emotional support, and request explanations of medical conditions and procedures. If the schedule of working parents limits their availability for appointments, staff seek night clinics or services at nontraditional times. Parents are encouraged to model healthy behaviors by going to doctors and dentists themselves.

Parents are offered the opportunity to learn about preventive care, emergency first aid, hazards, safety practices, and general health information, and are taught to detect signs of health problems. The staff offer nutrition education, and parents discuss the nutritional status of their child with the staff. Mental health professionals assist parents in promoting a positive mental health environment for children and train them to recognize stress and other risk factors, and how and when to ask for help. The staff offer group opportunities for parents to share experiences and develop solutions to problems with their children, and also provide individual opportunities for confidential discussions about mental health. Efforts are made to acquaint mental health professionals with family concerns and cultural issues.

Child Health and Safety

Head Start aims to support healthy physical development by encouraging practices that prevent illness or injury, and by promoting positive, culturally relevant health behaviors that enhance lifelong well-being. This means that all programs must develop policies and procedures concerning health emergency procedures, conditions of short-term exclusion, medication administration, injury prevention, hygiene, and first-aid kits.

Child Nutrition

Head Start promotes child wellness by providing nutrition services that supplement and complement those of the home and community. Each program's child nutrition services help families meet each child's nutrition needs and establish good eating habits that nurture healthy development.

To do this, programs must provide the following nutritional services:

• identification of each child's nutritional needs;
• meal service in center-based programs;
• help with nutrition for families; and
• food safety and sanitation protocols.

Child Mental Health

The Head Start regulations around mental health focus on enhancing awareness and understanding of mental wellness and the contribution that mental health information and services can make to the wellness of all children and families. They encourage building collaborative relationships among children, families, staff, mental professionals, and the larger community to design program practices that respond to a child's mental health needs. Programs must also work to educate staff and parents on issues related to mental health.

Ongoing Collaborative Relationships

Agencies are encouraged to form partnerships with health care, mental health, and nutritional services organizations, including local health departments, community health centers, managed care organizations, medical or dental schools, and professional associations. The HSAC can offer information about providers and resources in the community.

Grantee and delegate agencies' discussions with state, tribal, and local officials can lead to local collaborations. Other resources for families include local elementary schools, libraries and museums, providers of child care services, and any other organization or business that provides support and resources to families. Collaborations with local elementary schools and child care providers can support successful transitions between Head Start and other child care settings and Head Start and elementary schools. In addition, child care collaborations can involve joint training; multiple funding sources for full-day services; shared facilities, resources, and equipment; and coordinated use of transportation.

Services obtained through the local educational agency or another agency for education services to children with disabilities are arranged through a written agreement.

Finally, agencies contribute to community efforts to prevent and treat child abuse and neglect by collaborating with local child abuse prevention programs and with agencies serving children and families affected by physical, emotional, or sexual abuse and neglect, and seek service providers familiar with the culture and language of the families concerned.

Health Services Advisory Committee

A critical component to Head Start's preventive health care system is the local HSAC. This committee includes Head Start parents and staff, health and human services professionals, and other community volunteers who are representative of the racial and ethnic groups served by the local Head Start program. Head Start programs may invite representatives from Medicaid, SCHIP, and managed care organizations in the community to participate in the HSAC. The committee members meet to discuss program issues in the medical, dental, mental health, nutrition, and human services fields.

This advisory committee assists in the development of health policies and procedures and supports Head Start's objective to provide continuous and accessible health care for children and families. Its members are knowledgeable about prevalent community health problems and can respond to questions from Head Start staff about strategies to address these problems. The HSAC can provide guidelines regarding:

• Accessing health, dental, and mental health services
• Serving Head Start children with asthma
• Setting standards for prenatal care
• Scheduling tuberculin and lead tests
• Scheduling dental visits and services
• Using topical fluoride, water fluoridation, and other dental services
• Testing and preventive measures for community health problems, including sickle cell anemia, intestinal parasites, fetal alcohol syndrome/effect, baby bottle tooth decay, overweight and obesity, head lice, and hepatitis A
• Scheduling immunizations in addition to those already planned
• Discussing the adequacy of local EPSDT services
• Administering medication and staff physicals

In addition, the HSAC can contribute to the community assessment by responding to questions about the availability of local providers, including managed care providers, changes in Medicaid, the implementation of SCHIP, sources of funding for local health services, and ways to inform community health providers about the health needs of Head Start children and families.

See also:
     Weaving Connections [PDF, 1.54MB]