Pathways to Care
Accessing the health care delivery system in a community can be challenging. This learning activity can help Head Start parents and health staff share their knowledge and experience in doing this with others. Requiring approximately 45 to 60 minutes to complete, the activity utilizes a handout that is included here.
The following is an excerpt from Well-Child Care: Making It Happen.
Services for Children
- Handout: Children in Need
Step 1: Ask the participant to imagine that she is going to write an example for a new staff person in Head Start, in order to help the new person understand the health care system in this community.
Ask the participant to think about a child that has recently been enrolled in Head Start and had a need for specialized health services. (If a situation does not come easily to mind, use a sample story from Handout: Children in Need.)
Step 2: Ask the participant to think about the steps that she went through in order to help the family access care.
- Who was the first person she talked with?
- Where did they go from there?
Think about the path that was taken to get the care needed.
Step 3: Ask the participant to write or draw an illustration of the care pathway. Label each step on the way, and indicate which people had to be involved.
Also make note of barriers or pitfalls that were encountered, and how you handled them.
Step 4: Ask the participant to share the story with you and/or present the scenario at a staff meeting for feedback and additional ideas.
- Barriers occur at expected and unexpected points and require detours or alternative routes. However, there are usually logical ways to proceed in order to access care.
- Head Start staff members can help families in a number of ways, but cannot lead the families all the way. We can only guide them to the pathways to health care. The goal is to empower them to be able to stay on path or to create pathways for themselves.
- Advocacy is necessary to make needed services available when an assessment of the community indicates that these services are missing.
- Collaboration and communication between existing service agencies will greatly improve the delivery of services to children.
Well-Child Health Care: Making It Happen...
The Health Coordinator from Olympia, Washington sums it up this way: "If the work I do can affect a change in the bigger system, then health services are improved for all children in the community, not just the percentage that comes to Head Start."
Mrs. Johnson has been courageously living with AIDS for the past two years. When her daughter Tameka (2½ years old) was first enrolled in Early Head Start last fall, she would attend school daily in crisply pressed cotton dresses, her hair a beautiful rainbow of colored barrettes. The teacher’s aide has noticed lately that she attends school in the same clothes for days on end—sometimes smelling of urine. Her ankles are covered with infected fleabites and she has begun hoarding food in her cubby. Mrs. Johnson had always kept her properly nourished, even though the AIDS food delivery program misses their neighborhood. The Home Visitor and social worker stop by Tameka’s home on Friday night. They find the house in disarray, overrun by cats. Mrs. Johnson, unable to lift herself off the couch, has slipped into the early stages of AIDS dementia.
Christina has been totally insulin dependent since her pancreas was removed in infancy. Now, at the age of four, she has moved from her grandparents’ home in another city. Her mother will be caring for her and is unfamiliar with the needs of a diabetic child. There is no diabetic education program at the local county hospital. The staff is aware that she is totally dependent on the injected insulin and proper glucose monitoring for her health. It has been usual for the Emergency Medical Technician (EMT) unit to be called to her home on a monthly basis due to dangerously low or high glucose levels. Her grandmother wants to know where the nearest EMT unit is stationed relative to the school. She will be arriving for school in two weeks and it is your job to set up the staffing to meet her needs.
Jessie spent the second year of his life living in a car in Kentucky with his parents. Medical care during those years consisted of desperate trips to the emergency room in the middle of the night for antibiotics—that were stopped as soon as he looked better. He now lives with his aunt and five cousins and attends Head Start with her children. He has not seen his parents for one year. He has failed his hearing test twice and his speech is difficult to understand. Previous inquiries have shown that the nearest speech therapist willing to accept Medicaid children is 1½ hours away. He seems shy and withdrawn, and would sit and play for hours by twirling a rubber band if you did not redirect him to the boisterous play of those around him. His aunt says, “Oh that boy is no problem, it’s like he’s not even here!”
The Health Coordinator at Tall Pines Indian Reservation has always been relieved to see low lead levels in her Head Start children. This fall however she notices an increase in the number of children with borderline high levels and even has three children with high levels. Because there is no communication between services on the reservation, she cannot check with the other early childhood program to see if they also have increased levels. There are no lead testing clinics available to test the siblings of her Head Start students. A community member does remember a lot of scraping and painting going on last summer at the recreation center.
Marcus’ epilepsy had been kept under control since his diagnosis last summer. Now you notice him staring off into space at very frequent intervals during activities that used to engage him. His father, a hard-working brick layer, has had custody of the children since Christmas. You remember that Marcus missed a week of school at that time due to a medication overdose. When you gave the father literature on epilepsy after that incident, he thanked you kindly but said he would have to have his older daughter read it to him. With no other relatives in town for support, he often seems overwhelmed and stressed at drop off in the morning. Marcus seems to devour his food on Monday mornings and he has started trying to eat clay during art class.
Pierre is a bubbly, impish boy with boundless energy. He lost a good deal of his hearing due to a severe illness while living in Haiti and his speech is hard to understand. The doctor says he should have tubes put into his ears. He also has amblyopia or “lazy eye”. He has been fitted for glasses with a patch over the good eye, but there is no one in the town who will make the hearing aid for those on public assistance. Upon arrival at school, if he is wearing his glasses he whips them off and hides them in his cubby. His mother explains that “He’s embarrassed to look different from the other kids. Why not wait until he’s older and he can read. And there’s nothing wrong with the way he talks. I can understand what he’s saying. Can’t you? He’s still young, he’ll catch up.”
This winter has been one of the coldest in Wisconsin history. When Mr. Jackson lost his job at the machine shop he also lost his health insurance. Although probably eligible for funds, he left the welfare office in embarrassment when given a stack of papers he could not read. Lack of money led to the shut- off of his gas and electric at the house and Janetta (14-months-old) lost three weeks of school with pneumonia. Since the pneumonia, it seems like one illness after another takes Janetta from school. The home visitor that comes to check on the family notices Janetta coughing hard. The Jacksons are giving her half doses of antibiotics from her last illness; hoping she will get better before needing another run
to the emergency room. Her father tells you the ER doctor mentioned something about putting tubes into her ears at her last visit. Mr. Jackson sighs in desperation, “I’ve brought home a paycheck to my family every Friday since I was 17. I got no other job skills. Now I’ve let everybody down—especially Janetta.”
When Tabitha’s great-grandmother died last Spring, she and her 18-year-old mother lost their small farmhouse in West Virginia. An uncle in Chicago reluctantly offered to take them in for “one month and not a minute more.” Now seven people reside in a one bedroom flat in the city. Although her medical exam results indicate no problems, you notice Tabitha wheezing during strenuous play. Her mother is five months pregnant and looks pale and exhausted during conferences. She says she knows all the smoking in the house isn’t good, “but they won’t listen to me.” Used to growing her own food, she is unaware that WIC exists and she and Tabitha live on a lot of snack foods from the corner store. She has no prenatal care, fearing she could never afford a city doctor. Her dream is to become a teacher while in Chicago and return to the clean, open spaces of West Virginia.
The Faith Bible Church sponsored the emigration of the Song family from Cambodia last summer. Upon request from the pastor, the Home Visitor comes to the apartment to enroll the twin boys Ritha and Sok. Although four years old, they are the size of most two-year-olds due to severe malnutrition while in Cambodia. They do not speak yet. Their two-year-old brother still cannot walk and the five- month-old is the size of most newborns. There are four older siblings in the home, including the 20- year-old who lost one leg in a landmine injury. He has never had physical therapy. Mr. Song was a farmer in Cambodia, but is eager to learn English and then a new trade as soon as possible. Like the Songs, the 10 other Cambodian families at the Head Start center have survived a war and witnessed many atrocities, but there is not one mental health counselor who speaks Cambodian taking public assistance cases in the entire county.
"Pathways to Care." 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: September 24, 2014