Advocacy, Action, and Access

Key Concepts, Background Information

Partnerships between parents, programs, and community organizations affect the level of health care Head Start families receive. This learning tool offers Head Start health staff, managers, and other program staff a summary of the key concepts and background information related to advocacy and partnerships with community organizations. Questions for group discussion and individual reflection are included.

The following is an excerpt from Well-Child Health Care: Making It Happen.

Key Concepts
Parents As Community Advocates
Community Partnership
Children's Health Insurance Program (SCHIP)
The Links for Families Program
     Strategic Planning
     Information Dissemination
Questions for Discussion/Reflection


Key Concepts

Head Start offers a key link to introducing young children and their parents into a broader network of community support. As a central community institution, Head Start can notice gaps in service and advocate for change.

Staff members fully understand the ins and outs of the health care system in their community can facilitate the efforts of parents to receive the best care for their families.

Receiving the best care requires three levels of advocacy:

  • Advocacy on a personal level with an individual health care provider to assure the delivery of needed services (for oneself or for a child)
  • Advocacy with a health care system to assure that the benefits promised are delivered as described in contracts
  • Advocacy to make changes in the system if offered services do not meet the needs of families

As Head Start assists parents in understanding and receiving services, it can also help community providers to understand and effectively serve Head Start families.

Background Information

A. Parents as Community Advocates

Parents play a vital role in the community as advocates for the health of their children. The Head Start staff can support and encourage parents as they influence the goals and character of community services and make them more responsive to the needs of their particular community. Consider Mrs. Huey's story...

Mrs. Huey, her husband and three daughters recently emigrated from Hong Kong. They live in the top floor of a 90-year-old Victorian house. The two older girls participate in Head Start and the family includes a six month old baby. Upon enrollment in Head Start, the girls were linked to a medical home for routine examinations and blood work. It was discovered that they both had borderline "high" lead levels in their blood. The Head Start health coordinator explained the meaning of the test results to Mrs. Huey and strongly recommended the baby be tested. The baby had even higher lead levels than her sisters.

Mrs. Huey and the Head Start Family Service Worker found many health violations in the tiny apartment-most notably chipping paint and crumbling asbestos covered duct work. With this knowledge and the support of a Head Start advocate for translation, Mrs. Huey notified the landlord of the problem. He ignored her completely. Mrs. Huey then approached the Health Department with letters of support from her medical doctor and the Lead Poisoning Prevention Program.The Health Department visited her home and made the landlord clean up the lead problem and asbestos in all five of his units.

Knowing her neighbors must be in similar danger of lead poisoning, Mrs. Huey and her neighbors convinced the community health center to hold a free clinic for lead testing of children. Of the 45 children tested, five children had elevated levels. A health educator from Head Start held a workshop in the evening for the community to attend and learn how to safely deal with lead paint. Mrs. Huey pointed out to the Lead Poisoning Prevention Program that most people on her street could not read the English-only lead prevention pamphlets. Literature in English, Spanish, and Chinese is now distributed throughout the community.

Mrs. Huey's story shows the power that one advocate can have in a community. Head Start staff members can help empower parents by supporting their efforts with education, logistical support (translation, transportation), and information regarding existing community resources.

Mrs. Huey's neighborhood has a special need for lead poisoning awareness. By building partnerships between existing community services, she was able to improve the delivery of community services in her neighborhood. When agencies share information and collaborate, the delivery of services to children and families is improved. Through Head Start's educational workshops and the Lead Prevention Organization's literature in three languages, the public is now becoming informed. When the health center expanded its services to provide a special screening clinic for lead, those already poisoned could be identified and treated. The Lead Poisoning Prevention Organization and the doctor at Mrs. Huey's clinic communicated with the Health Department to ensure a swift response.

B. Community Partnership

Head Start is a central community institution for low-income families and children. The Advisory Committee on Head Start Quality and Expansion (1993) asked how this institution should function in the 21st Century. Head Start staff members play pivotal roles in reaching out to the greater community and forming alliances between community services and linking children into this network of resources. For families to be stable and thriving they need services from a broader community and they also need to be involved in that community.

An important link to the broader community lies in the Health Services Advisory Committee (HSAC). This body within Head Start is made up of local health care providers, experts in relevant fields, and parents. It may include an official from the Public Health Department, physician, school administrator, dentist and experts in mental health and disabilities, and Head Start staff members. Medical professionals on the committee often agree to treat Head Start students in their offices. The Health Services Advisory Committee looks at available community health services and advises on how to handle health issues. Head Start staff members are advised of important health issues in the community (e.g., increases in tuberculosis or environmental pollutants) and advised how to best protect the health of their children with this knowledge (e.g., yearly tuberculosis testing). The HSAC devises a working health plan that responds to current information regarding the community. With guidance from the HSAC, the Head Start health plan will not be static and outdated, but change with current needs. Through contact with the members of the community on the HSAC, Head Start staff can acquaint the community at large with their vision that "parents are the primary educators, nurturers and advocates for their children", and must be respected in that role.

For parents, entering the broad network of services can be quite daunting. Staff members can first assist parents in applying for Medicaid if eligible. If parents are informed that a needed service is "uncovered", the staff can assist them in confirming this. Parents and staff members can then advocate for a change in policy that would provide coverage in the future. In most cases funds for uncovered services will be provided by Head Start. By working in partnership with Medicaid providers, Head Start can open the door to a wealth of services to meet well-child health care needs and special needs. These special services include occupational therapy, physical therapy, speech therapy, and mental health counseling.

When staff member keep abreast of health care information in the community, they are most effective in assisting parents. Funding cuts, state immunization requirements, new funding sources and eligibility requirements are all changing elements in the dynamic field of health care. An active Health Services Advisory Committee can be very helpful by providing current information.

When parents and Head Start staff members take an active role in community planning, they provide a powerful force in the development of broader community resources that reflects the needs of parents and families. Proactive steps need to be taken to establish ongoing relationships with community organizations. After identifying recurring concerns of Head Start families, alliances can be formed between families, the staff, and services to meet those needs. Examples of collaborations could be a large medical center, Head Start and the local clinic.

Through this partnership, seminars and workshops dealing with relevant topics can be held for parents and the staff. A wealth of health care knowledge can come to the Head Start center. Other community partners could include local Park and Recreation departments, the health clinic serving local children, and a representative of the police station to help ensure safe recreation for the children when they leave Head Start. Strong communication, cooperation and sharing of information among agencies and community partners will build collaborations that can truly meet the needs of the Head Start community into the 21st century.

Note to Trainer/Coach:
For more information on forming a supportive community, see the guides A Design for Family Support and Building Supportive Communities in the Social Services series of Training Guides for the Head Start Learning Community.

C. Children's Health Insurance Program (CHIP)

The Balanced Budget Act of 1997 included a comprehensive children's health initiative under Title XXI of the Social Security Act, the State Children's Health Insurance Program (CHIP). This new program enables states to initiate and expand health insurance coverage for uninsured children. The law allows states the option to expand coverage for children through a separate child health insurance program, through expanding Medicaid coverage, or developing a program that combines features of both Medicaid and CHIP. CHIP is a valuable resource for those Head Start families who make too much money to qualify for Medicaid, yet cannot afford to purchase private health insurance.

Head Start State Collaboration Offices should be working with State CHIP planning committees about developing outreach strategies and enrollment plans for children and families to ensure Head Start is included in a states Child Health Plan. Specific strategies for outreach that can be conducted by Head Start programs include:

  • informing families about Medicaid and CHIP as part of their enrollment process;

  • contacting their State Medicaid office to see if presumptive eligibility is being offered to children enrolled in Head Start;

  • assisting families with completing the application for Medicaid and CHIP—some states may have developed a joint application;

  • inviting a representative from Medicaid or CHIP to become members of the HSAC; and

  • linking with community partners who are also involved in Medicaid and CHIP to share ideas about how to coordinate education and outreach activities.

Note to Trainer/Coach:
Other sources of information about Medicaid and CHIP is either the ACF Home Page or Web Site...or the Health Financing Administration Home Page...The Head Start State Collaboration Offices and the Head Start Quality Improvement Centers (HSQICs) are also resources for programs wanting state specific information.

D. The Links for Families Program

An example of a working collaboration is the Links for Families program operating in Boston, Massachusetts. This program combines the ABCD Head Start program, Boston Medical Center, and the network of community health centers in Boston. This program was initiated in 1996 because the same population of children used, or were eligible for, both services and there was no formal mode of communication between the two services. The collaboration allows Head Start and the medical providers to work most efficiently together. The collaboration works on three levels. These are as follows:

  • Strategic Planning: Solutions to challenges to communication and service delivery are explored. One example is the development of a consent form to enable teachers and physicians to communicate directly about the children while respecting confidentiality and parental consent. Another example is the development of a referral system where physicians can directly link eligible children to their local Head Start center through a central office.

  • Cross-training: This area permits the Head Start program and the medical providers to share knowledge. A Health Manager from Head Start now visits the clinics personally to inform the medical staff which examinations and forms Head Start needs to be sure that children are up-to-date with their care. This decreases misinformation and unnecessary services. Phone calls between the two agencies decreased, and when there are questions, the medical staff now have a personal contact to call for answers. Physicians or early childhood specialists go out to the Head Start sites to teach the staff about relevant topics. These include substance abuse, reading behavioral cues, handling aggressive behavior or lead poisoning. Valuable knowledge is shared by all members of the collaboration to the benefit of the children.

  • Information Dissemination: This area allows the staff from both institutions to understand the other's organizational structure. With this knowledge, the proper person or department is easily accessed when an answer to a specific question is needed.

Note to Trainer/Coach:
For more information on collaboration building, see the guides Community Partnerships: Working Together in the Social Services series, and Sustaining a Healthy Environment in the Health series of Training Guides for the Head Start Learning Community.

Questions for Discussion/Reflection

Think about your own personal experiences in advocating for change. It can range from being as simple as changing the lunch times at school so your kindergartner does not collide with 5th graders, to creating a public campaign to clean-up the toxic landfill in your community.

  • What obstacles did you have to overcome? (Fear of public speaking? Persons in authority ignoring you?)

  • Did you learn any skills that can apply to advocating for change to benefit your Head Start community?

  • Did you work alone or organize a group of people to work toward the same goal? What is most effective?

"Advocacy, Action, and Access. Key Concepts, Background Information." Well-Child Health Care: Making It Happen. Training Guides for the Head Start Learning Community. HHS/ACF/ACYF/HSB. 1998. English.

Last Reviewed: May 2009

Last Updated: February 19, 2015