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INTRODUCTION
In 1995, a new federal initiative aimed at enhancing the development of infants and toddlers began with 68 grantees. This program, named Early Head Start by the Secretary’s Advisory Committee that created it, has grown into a national initiative with more than 700 grantees serving more than 55,000 families around the country. Seventeen of the initial program grantees participated in a national evaluation and local research studies that documented the implementation process and assessed program impacts and outcomes (Administration for Children and Families [ACF] 2002a and 2002b). These 17 research programs, which resemble all Early Head Start programs funded in 1995 and 1996, were the first to design and implement programs to meet the revised Head Start Program Performance Standards (U.S. Department of Health and Human Services [DHHS] 1996).
Early Head Start programs are comprehensive, two-generation programs that focus on enhancing children’s development while strengthening families. Designed for low-income pregnant women and families with infants and toddlers up to age 3, the programs provide a wide range of services through multiple service delivery strategies. All programs provide child development services delivered in home visits or child care, parenting education, health care and referrals, and family support services. Early Head Start programs try to meet families’ and communities’ needs through one or more official program options: (1) home-based (weekly home visits and at least two group socializations per month for each family), (2) center-based (center-based child care plus other activities), (3) combination (in which families receive both home visits and center experiences), and (4) locally designed. Because a program may offer multiple options, we grouped programs according to three approaches: (1) home-based, providing services to all families through the home-based option; (2) center-based, providing services to all families through the center-based option; and (3) mixed-approach, providing services to some families through the home-based option and to others through the center-based option, or providing services through the combination or locally designed option.
Because the health of infants and toddlers participating in Early Head Start can support or limit Early Head Start’s efforts to enhance their development in other domains, the Head Start Program Performance Standards require programs to provide or link families to preventive health care services and to ensure that children received needed treatment for health problems. In addition, Early Head Start programs, like Head Start programs, must make at least 10 percent of enrollment opportunities available to children with disabilities, and they must ensure that these children and their families receive the special early intervention services they need.
Knowledge of the health problems and disabilities experienced by children in the program and of the services they received can help staff identify and begin to address gaps in health-related services. Information about which families and children tend to experience health problems and disabilities or fail to get needed health and therapy services can help program staff anticipate which families are likely to have important health goals or needs that should be addressed in their service plan and which families may need special help obtaining health care.
This paper draws on the data collected for the national Early Head Start Research and Evaluation study to address this need for information. The following sections summarize the health services provided by Early Head Start programs; present the data and methods used in the paper; describe the health status and problems, including disabilities, experienced by children who were enrolled in Early Head Start; review their health insurance coverage and receipt of health services; examine differences in health and health care among key subgroups of children and families; and discuss the implications of these findings.
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