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A. INTEGRATION OF HEALTH SERVICES INTO EARLY HEAD START
Good health is the foundation for child cognitive, language, and social-emotional development, and health services are a central focus of Early Head Start. The Head Start Program Performance Standards charge programs with ensuring that all children have a regular source of health care and access to the health, dental, and mental health services they need. Programs must also track health services to ensure that children receive all recommended well-child examinations, immunizations, and needed treatments. Within 90 days of enrollment, programs must assess whether each child has an ongoing source of health care, obtain a professional determination as to whether each child is up-to-date on preventive and primary health care, and develop and implement a follow-up plan for any health conditions identified.
Maternal health and prenatal care are essential for ensuring normal development of very young children. Late or inadequate prenatal care, malnutrition, and exposure to harmful substances are associated with poorer birth outcomes and later developmental disorders (Child Trends 2002). Thus, Early Head Start programs also emphasize prenatal care and education (by providing prenatal information, developing prenatal care and education plans, implementing prenatal education curricula, making referrals to prenatal care and childbirth preparation classes in the community, and encouraging breastfeeding).
Early Head Start programs facilitate access to health care, and in some instances, they arrange to provide health-related services directly. All 17 programs that participated in the national evaluation helped families find regular sources of medical care for their children, and some helped families navigate their state’s Medicaid managed care system. Several programs had nurses on staff who provided some health services (especially well-child examinations), tracked receipt of health services, and helped families arrange services. Some programs provided mental health services through agency staff and community partners to families who needed them. Some programs provided child mental health services on site at their centers. Several programs provided transportation to medical appointments when families needed it. The differences in health care services provided by the research programs reflected variations in families’ health care needs as well as differences in the availability of health care in the communities they served. Ratings of implementation of health services for children showed that in many programs, it took time to fully implement key performance standards related to child health services, but three-quarters of the research programs did so within three years of beginning services to families (ACF 2002b).1
Like Head Start, Early Head Start programs also emphasize services to meet the needs of children with disabilities. The Head Start Program Performance Standards require programs to refer families to Part C when they suspect a child has a disability.2 Staff must also work closely with Part C staff to coordinate services, and the performance standards encourage them to develop joint service plans whenever appropriate. Programs must make at least 10 percent of enrollment opportunities available to children with disabilities and make intensive efforts to recruit them.
The Early Head Start programs participating in the national evaluation adopted a range of strategies for coordinating services for children with disabilities with Part C, including developing joint service plans, arranging therapy services to be provided in Early Head Start classrooms, arranging for Early Head Start staff to serve as the service coordinators for Individual Family Service Plans (IFSPs), participating with parents and Part C providers in service coordination meetings, and forming SpecialQuest teams with local Part C providers to work on enhancing coordination between the two programs (ACF 2002b).3 As was the case for health services, ratings of implementation of services for children with disabilities showed that in many programs, it took time to fully implement key performance standards, but two-thirds of the research programs did so within three years of beginning services to families.
1 In-depth site visits provided information for rating levels of implementation along key program elements (24 elements in 1997 and 25 in 1999) contained in the Early Head Start program grant announcement and the Head Start Program Performance Standards. Although the implementation ratings were designed for research purposes and were not used to monitor compliance, they included criteria on most of the dimensions that the Head Start Bureau uses in program monitoring, including child development and health, family development, community building, staff development, and management systems. Ratings were developed systematically through a consensus-based process involving site visitors, project staff, and outside experts. Details of the implementation study design and findings can be found in ACF (1999, 2000, and 2002b). (back)
2 Early intervention services are provided by agencies designated under Part C of the Individuals with Disabilities Education Act (IDEA) Amendments of 1997 (PL105-17) to be responsible for ensuring that services are provided to all children between birth and age 3 who have disabilities. (back)
3 SpecialQuest is part of the Head Start training and technical assistance system. It is a public-private partnership between the Conrad N. Hilton Foundation and the Head Start Bureau and is administered by the California Institute on Human Services at Sonoma State University. Its mission is to help professionals and family members involved in Early Head Start and Migrant Head Start programs develop skills and strategies for working with infants and toddlers who have significant disabilities. (back)
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