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O. CONCLUSIONS AND IMPLICATIONS
In many respects, the health status and incidence of health problems among Early Head Start children are similar to the health status and problems of young children in low-income families nationally. These families and children are at greater risk for health problems and experience greater needs for health care than those in higher-income families.
More children were reported by their parents to be in fair or poor health at 14 months than at the two older ages. Even though Early Head Start parents reported improvements in their children’s overall health status as children grew, ongoing monitoring of health status is important. As children develop, different problems can emerge. For example, speech and language delays may not be observable until the second year of life; problems with walking may not be detected until the child is 18 months or older.
Disabilities are difficult to identify when children are very young. According to parents, small proportions of children in the Early Head Start research programs may have had sight, hearing, or mobility problems, and a few had diagnosed cognitive delays or behavior problems. More may have been experiencing developmental delays or behavior problems, however, as indicated by the assessments conducted for the research. The disparity between parent reports and the child assessment results may reflect parents’ lack of awareness or understanding of things they had been told by medical professionals or program staff, reluctance to report these kinds of problems because of the stigma associated with them, or research assessment results that did not adequately represent children’s ongoing abilities or functioning.
According to their parents, children in the Early Head Start research programs experienced high rates of asthma and respiratory problems. The data suggest that this may reflect, in part, the high levels of cigarette smoking in their homes. Early Head Start parents may need more education and support to help them stop smoking, for the benefit of their own health and that of their children. Other family members may also need help with smoking cessation, and parents may need help with minimizing their children’s exposure to household smoking when other family members smoke.
The research also suggests that Early Head Start parents need more education and support to improve some safety practices, including those related to poison control and car seat use as children get older. A significant proportion of Early Head Start families were not prepared for a poison emergency, and more than a quarter of all Early Head Start families did not report regular car seat use when their child was 3.
Like other low-income mothers of young children, the Early Head Start mothers in the research programs were at high risk for depression. As many as half the mothers may have been depressed when they enrolled in Early Head Start, and in subsequent interviews about one-third reported symptoms indicating it was likely they were clinically depressed. Because depression and mental health problems can interfere with healthy parent-child relationships, Early Head Start programs need to find ways to help parents gain access to mental health services and overcome these problems. This is no small challenge. Staff in many of the Early Head Start research programs reported that their communities did not have sufficient mental health services to which they could refer families, and efforts to obtain additional resources and work with community members to improve mental health services were required (ACF 2002b).
Because Early Head Start programs are charged with making sure that families have regular health care providers and access to the health care they need, but do not provide most health services directly, they must work with community health care providers to help families gain access to the care they need. In the Early Head Start research programs, most families and children reported being covered by health insurance, having a source of health care, and receiving health services during the 28 months after they enrolled. A small proportion of families, however, did not, and a small proportion of parents also reported that their family seldom or never received the health care it needed. Many of the research programs recruited families at health centers and WIC offices, where connections to health care services may already have been made. In Early Head Start programs implementing other recruitment strategies, the proportion of families lacking health insurance or access to health care that meets their needs may be higher. It is important for programs to identify families with unmet health care needs and work with them to address these needs. This may require working collaboratively with health care providers in their communities to address gaps in available health services or to find resources to pay for the needed services.
Consistent with trends among low-income families nationally, Hispanic families who enrolled in the Early Head Start research programs were less likely to report having health insurance or a regular health care provider for themselves or their children and more likely to report health problems. Some may have been non-citizens ineligible for public health insurance. Early Head Start programs that served them may have faced limited options in their communities for linking these families to needed health care services. Staff in programs serving these families need to work with health care providers in their communities to find ways of improving health care for Hispanic families who may otherwise fall through the cracks.
The youngest mothers may need special help from Early Head Start with protecting and promoting good health in their children. In the research programs, the mothers who were teenagers when their child was born were less likely to report implementing important safety practices and more likely to report using hospital emergency rooms for their children. This suggests that more education and support specifically designed for teenage mothers is needed to encourage them to adopt important safety practices, help them reduce the need for emergency medical services, and enable them to use preventive and primary health care services appropriately.
Early Head Start mothers who lacked a high school diploma or GED when they enrolled, many of whom were teenage mothers or Hispanic, were more likely to have children who received a low score on at least one of the developmental assessments conducted for the research. Despite this, their children were less likely to have received early intervention services. While this may simply reflect less awareness of early intervention services received among these mothers or differences in the types of delays their children experienced, it may also indicate that mothers with less education need more support from Early Head Start staff in accepting the need for and going through the process of arranging early intervention services. These parents may also need help in understanding normal development and observing children more closely.
The experiences of the research programs suggest that the health problems and health care needs of families who enroll in Early Head Start generally reflect those of low-income families across the nation. Several problems and needs appear to be more prevalent in these families, however, and indicate areas in which programs may be able to improve health-related services. These include promoting greater implementation of important safety practices, especially among younger mothers; reducing smoking by household members; offering asthma education; improving availability and access to mental health services; and promoting more developmental screening and referrals by primary care providers, especially for children in families with more demographic risks.
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