Program Profile:
Sound to Harbor Head Start/ECEAP in Tumwater, WA

Staying Healthy &


Nearly all children in Head Start are also enrolled in Medicaid. The standards and guidelines of both programs reinforce the connections between physical health and cognitive development—and by extension, school readiness. When it all works as intended, young children stay healthy and focused, their families make use of the myriad health services that are supposed to be available to them, and children achieve their school readiness goals.

Among these Medicaid-covered services are oral health services, which are critical to children’s overall health and well-being. According to the American Academy of Pediatrics, tooth decay is the most common pediatric disease among young children and can lead to physical and psychological disabilities. It is also a barrier to school readiness, because dental pain can keep children home from school or distracted from learning.

At Sound to Harbor Head Start/ECEAP in Western Washington State, Director of Program Operations Debi Beagle and Health Services Coordinator Jennifer Helseth have used creative approaches to connect children and families with oral health services across a physical area of great geographic and demographic diversity. Its 22 sites cover three counties and more than 4,000 square miles, including the urban state capital in Olympia on Puget Sound as well as sparsely populated areas on the rugged Washington Coast. About 750 mostly 4 year-olds attend two programs: Head Start and its Washington State equivalent, the Early Childhood Education and Assistance Program.

“We are a bit more rural than urban, with everything in between,” Beagle explains. “Our communities are so different. Geographical concerns are huge, and transportation is a big issue.” The program provides transportation for the children to most program sites. The staff also strives to connect families with providers of medical and dental care. Access to care is as serious a challenge for Sound to Harbor’s rural sites as it is in most rural parts of the country, and Helseth’s staff of seven health care advocates spend much of their time chasing it down.

In common with all Head Start programs, Sound to Harbor collects data on children’s Medicaid-mandated health and dental screenings as well as referrals for treatment. The addition or loss of even one Medicaid provider can change the data picture for some communities. Helseth recalls the emergency that ensued when a dentist who treated children in the coastal town of Aberdeen suddenly retired. “We had only two dentists in Aberdeen who were accepting children on Medicaid,” Helseth explains. The children who had been seeing him were referred to a provider in a larger community more than 80 miles and two hours away. But parents found the distance and the cost of the commute prohibitive. “We had 15 kids referred to treatment who weren’t getting it because of high gas prices,” Helseth says. It took her team several days “to put all the pieces together,” and when it did, the children were referred to another dentist with a practice only an hour away.

In addition to the quantitative health data that Head Start programs are expected to collect, Beagle has come to depend on what she calls “the perceptual data—the human stories from our children and families.” Often, the stories serve as catalysts for new program policies. This is how Sound to Harbor came to invite the Tooth Fairy into its classrooms.

Beagle was concerned that many families in her program didn’t understand why they should take their children to dental appointments. “I’d hear, ‘It’s just baby teeth,’ or ‘I never went to the dentist when I was a kid.’ This told me we needed to increase dental education.” Beagle turned for help to Tammy Questi, a registered dental hygienist who served on the program’s Health Services Advisory Committee and worked with program staff to implement Cavity Free Kids, an oral health project designed by the Washington Dental Service Foundation specifically for Head Start and ECEAP.

Questi visits classrooms throughout most of the school year in a pink fairy costume with wings, a toothbrush headband, and earrings made of toothpaste tubes. She presents dental education in the preschool classrooms and at parent meetings. She provides dental screenings with parental permission on children enrolled in the state-financed ECEAP classrooms. This is aligned with the State Medicaid Agency responsibilities that require a dentist to perform screenings. When Questi detects dental problems—cavities, missing teeth, swollen gums, abscesses, etc.—she reports them to a health advocate for follow-up with the family and its dental provider. If she suspects that children have advanced conditions that aren’t being treated, she probes gently with such questions as, “Does it hurt to eat an apple?”

But the most important part of Questi’s job is raising awareness of the importance of oral health. Children learn about sugar bugs (plaque), healthy eating, and proper dental hygiene. “I explain to parents that once tooth decay starts, it’s an infection. And if you had an infection on your arm, you’d go to the doctor,” Questi says. She emphasizes that dental caries “is the only disease that’s 100% preventable.”

Helseth knows the message is getting through. “Parents call asking why we’re telling our kids about ‘sugar bugs in the mouth,’” Helseth reports. “And I’m glad, too, because that means they’re bringing it home.” She believes that the Tooth Fairy and the program’s overall emphasis on preventive dental care has helped increase the number of children who have recently seen a dentist and reduce the number of children with problems requiring dental treatment.

Still, Helseth believes that Sound to Harbor children are losing ground in accessing dental treatment, in part because some providers are retiring, and their successors are less likely to work with Medicaid. Also, Washington State has been cutting back on Medicaid eligibility for some client groups, and as Helseth explains, “We’ve learned that when the family loses dental care, the child loses care, too.”

Beagle says Sound to Harbor tries to work within such external pressures by “really looking at the needs of the whole child and how health is involved. We’re trying to develop a strong foundation, without health issues getting in the way—without any barriers to learning.”

(This profile is based on interviews conducted in January 2012.)

Last Reviewed: June 2014

Last Updated: August 28, 2014