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L. HEALTH CARE SERVICES
All children received some health services (visited a health professional or dentist or emergency room or received immunizations or screening tests) by the time of the 28-month follow-up interview (Table 10). During each follow-up period, however, the parents of a small proportion of children reported that their child received no health services (3.2 to 6 percent). We found no large or consistent difference in overall levels of health care receipt among key subgroups of Early Head Start children. As described below, however, patterns of health care use varied among key subgroups.
| By 7 Months After Enrollment |
7-16 Months After Enrollment |
16-28 Months After Enrollment |
By 28 Months After Enrollment |
|
|---|---|---|---|---|
| Percentage of Children with: | ||||
|
70.7 | 88.6 | 89.8 | 99.0 |
|
66.6 | 79.1 | 76.6 | 95.2 |
|
47.4 | 61.5 | 61.1 | 82.4 |
|
3.8 | 12.3 | 24.5 | 28.3 |
|
23.2 | 31.8 | 30.2 | 54.6 |
|
NA | 8.1 | 10.6 | NA |
| Average Number of : | ||||
|
2.2 | 2.5 | 2.0 | 6.7 |
|
1.7 | 2.5 | 2.3 | 6.3 |
|
0.4 | 0.7 | 0.6 | 1.6 |
|
NA | 0.1 | 0.1 | NA |
| Percentage of Children Who Received: | ||||
|
92.3 | 86.6 | 65.5 | 98.8 |
|
26.9 | 44.4 | 42.1 | 66.7 |
|
14.3 | 22.2 | 26.5 | 40.6 |
|
9.4 | 14.6 | 15.5 | 27.7 |
| Percentage
of Children Who Received Any Health Services |
96.3 | 96.8 | 99.7 | 100.0 |
| Sample Sizea | 979-1,063 | 1,030-1,073 | 1,040-1,075 | 966-1,075 |
| Source: Parent services follow-up interviews completed an average of 7, 16, and 28 months after enrollment for families who completed the 28-month interview. | ||||
| NA = not available. | ||||
| aRange reflects minimum and maximum sample sizes for items in table. | ||||
In nearly all families (98 percent), other family members also received some health services (visited a health professional or dentist or emergency room or received immunizations or screening tests) at some time during the combined follow-up period. During each 6- to 11-month follow-up period, however, other members in 12 to 18 percent of families received no health services.
1. Visits to a Health Professional
Most parents reported that their child visited a doctor or other health professional at least once in each follow-up period (Table 10). Virtually all reported that their child had visited a health professional at least once by the time of the 28-month follow-up interview (99 percent).
Nearly all Early Head Start children had been taken to a health professional for a well-child examination (check-up) at least once by 28 months after enrollment (95 percent of parents reported at least one check-up). In each 6- to 11-month follow-up period, two-thirds to three-fourths of children were reported to have had a check-up.11
Most children also had been taken to a health professional for treatment of a health problem at least once by 28 months after enrollment (82 percent). In each follow-up period, between half and two-thirds of children visited a health professional for treatment of an illness.
Children in home-based programs were less likely than children in other types of programs to have been taken to a health professional for treatment of an illness by the time of the 28-month follow-up interview (76 percent), while children in mixed-approach programs were more likely to have visited a health professional for treatment of an illness (90 percent). The lower rates of health care visits for illness among children in home-based programs may reflect, in part, the fact that these children probably spent less time in group settings with other children where they might have been exposed to illnesses (Johansen, Liebowitz, and Waite 1988; Hardy and Fowler 1993; and NICHD 2001).
2. Emergency Room Use
About half of Early Head Start children had been taken to an emergency room for health care by 28 months after enrollment (55 percent). During each 6- to 11-month follow-up period, between one-fourth and one-third of children visited an emergency room (Table 10). This rate of emergency room use is comparable to annual rates of emergency room use among poor and near-poor U.S. children under age 6 in 1999–2000 (29 to 32 percent; DHHS 2002).
By the time of the 28-month follow-up interview, Early Head Start children were reported to have visited an emergency room an average of 1.6 times. About 9 percent of children were reported to have been taken to an emergency room for health care five or more times. In each follow-up period, children reported to be in fair or poor health were much more likely than children reported to be in better health to have visited an emergency room (53 compared with 28 percent during the third follow-up period, for example).
During the second and third follow-up periods, 8 to 10 percent of children were reported to have visited an emergency room for an accident or injury. In those two periods, 18 to 22 percent of all emergency room visits were for accidents and injuries.
Emergency room use was similar among other family members. Emergency room use by at least one other family member increased from 29 percent in the first follow-up period to 34 percent in the third follow-up period, and by the 28-month follow-up interview, at least one other family member in 56 percent of families had ever visited an emergency room.
3. Receipt of Mental Health Care
At least one family member in 21 percent of program families received treatment for an emotional, personal, or mental problem (not including drug or alcohol treatment) during the follow-up period. In the great majority of these families, it was the child’s primary caregiver who received treatment. A small proportion of families reported that a family member received drug or alcohol treatment during the follow-up period (5 percent).
Considering both treatment for mental health problems and drug and alcohol problems, nearly one-fourth of program families received mental health services at some time during the follow-up period. The proportion reported to be receiving these services in any given follow-up period ranged from 11 to 12 percent. In sites where depressive symptoms were measured at enrollment, families in which the primary caregiver was at risk for depression at enrollment were more likely than other families to use mental health services (32 versus 22 percent).
4. Visits to a Dentist
Children’s dental visits increased substantially over the combined follow-up period, from 4 percent about 7 months after enrollment (when children were, on average, 10 months old) to 25 percent about 28 months after enrollment (when children were 32 months old, on average).12 Children in center-based programs and children enrolled in programs outside of urban areas were more likely than children in other types of programs to have visited a dentist.
In about half of families, at least one other member of the family visited a dentist during each follow-up period, and by 28 months after enrollment, other members in at least three-fourths of families had visited a dentist.
5. Preventive Health Care and Safety Practices
Nearly all children had received some immunizations by 28 months after enrollment (99 percent). Children in urban programs were more likely to have received immunizations in the later follow-up periods.
Two-thirds of Early Head Start children were reported to have received some screening tests by 28 months after enrollment. Forty-one percent were reported to have had a hearing screening, and 28 percent had had a lead screening.13 Children in center-based and mixed-approach programs were more likely to have had screening tests, while children in home-based programs were less likely to have had screening tests, including hearing and lead screenings. Children enrolled in urban programs were more likely to have had screening tests, including hearing and lead screenings.
Of the seven safety practices asked about in the parent interviews conducted when children were 14 and 24 months old, parents reported practicing five, on average (see Table 11). Almost all parents reported using guards for stairways (94 percent), and maintaining a working smoke detector (94 percent) at either the 14-month or 24-month interview. Many parents also reported using window guards (81 percent), covering electrical outlets (84 percent), and maintaining a safe play environment (86 percent).
Early Head Start parents are most in need of information on safety practices related to poison control. Nearly two-thirds of parents (62 percent) did not keep ipecac in the home, and nearly half (48 percent) did not know how to find the number to call for poison control information.14
Car seat use declined as children grew older.15 Almost all parents (96 percent) used car seats when children were 14 months of age. By the time they reached 24 months, 81 percent reported using car seats, and the proportion declined to 71 percent at 36 months. The decline in car seat use may reflect the fact that as children age, they don’t like being restrained in a car seat and are more able to unbuckle themselves. It is also possible that as children grow, parents may not have resources to replace an infant car seat with a toddler seat.
| Child's Age | ||||
|---|---|---|---|---|
| 14 Months | 24 Months | 36 Months | Ever by 24 Months |
|
| Percentage of Families Who: | ||||
|
26.2 | 30.1.2 | NA | 37.7 |
|
30.2 | 38.2 | NA | 52.3 |
|
84.7 | 79.3 | NA | 93.9 |
|
63.8 | 64.5 | NA | 81.3 |
|
69.4 | 60.2 | NA | 83.8 |
|
82.6 | 86.3 | NA | 93.7 |
|
64.5 | 67.8 | NA | 86.1 |
|
95.7 | 81.3 | 70.6 | 98.5a |
Average Number of Safety |
5.1 | 5.1 | NA | 5.1 |
| Sample Sizeb | 696-950 | 829-942 | 1,036 | 868-1,036 |
| Source: Parent Services Follow-Up Interviews (PSIs) completed an average of 16 and 28 months after enrollment for families who completed the 28-month follow-up interview. | ||||
| NA = not available. | ||||
| aPercent reporting that they ever used a car seat for their child by age 3. | ||||
| bRange reflects minimum and maximum sample sizes for items in table. | ||||
11 The American Academy of Pediatrics recommends seven preventive visits before age 1, three preventive visits between ages 1 and 2, and annual visits starting at age 2 (American Academy of Pediatrics 2000). (back)
12 The American Academy of Pediatric Dentistry recommends that children receive their first preventive dental visit by age 1 and that they visit the dentist for preventive care every 6 months after that (American Academy of Pediatric Dentistry 2000). (back)
13 These screenings probably led to the discovery of health problems in some children. As reported earlier, parents reported that 3 percent of children had a diagnosed hearing problem and 6 percent had a high blood lead level. (back)
14 In a new policy statement, the American Academy of Pediatrics (AAP) recommends that "syrup of ipecac no longer be used routinely as a home treatment strategy. Until November 2003, the AAP advised that parents keep a 1-ounce bottle of syrup of ipecac in the home to induce vomiting if it was feared a child had swallowed a poisonous substance. Ipecac was recommended for use only on the advice of a doctor or poison control center. Although it seems to make sense to induce vomiting after the ingestion of a potentially poisonous substance, it was never proven to be effective in preventing poisoning. Recent research has failed to show benefit for children who were treated with ipecac. This is the key reason for this policy change" (http://www.aap.org/advocacy/releases/novpoison.htm). (back)
15 Car seat use was the only safety practice asked about in the parent interview conducted when children were 36 months old. (back)
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