Early Ed Watch - logo

The Case for 'Comprehensive Services'

This is the fifth post in a seven-part series on the future of Head Start. Please join us for a web chat on this topic on Tuesday, Sept. 22 at 12:30 p.m. EDT here at EarlyEdWatch.org. We invite you to email us questions to get the chat rolling. 

Last year Rhode Island Governor Donald Carcieri stirred up a storm of criticism when he said that Head Start "has been the biggest waste of money" and needs to "get into the early education business" instead.

His comment said a lot -- not only about his own misunderstandings of the program, but about how Head Start is perceived in the outside world. Many mistakenly believe that Head Start isn't doing a good enough job of preparing children to succeed in school because it has devoted too much energy to providing health, nutrition and parent-involvement services. 

Among Head Start's advocates, these "comprehensive services"- medical screenings, parenting classes, tooth brushing after every meal -- have become almost sacrosanct. But, as discussed in yesterday's post, Head Start also provides instruction in literacy and other school-readiness skills. In fact,  just 9.3 percent of Head Start's total $6.8 billion annual budget in 2006 was for health and nutritional services, with a comparable amount going to family support services, according to data provided by the Administration for Children and Families to Early Ed Watch.  By contrast, 43 percent went to education. This is not a case of Head Start offering comprehensive services to the exclusion of preschool instruction.

The more relevant questions today are:  How exactly should Head Start balance these two responsibilities? Should state-funded pre-K programs be performing the same balancing act? And how should the services offered by states, localities and Head Start interoperate? 

First, let's consider how well Head Start's comprehensive services have been working.

Head Start providers are required by law to evaluate the medical history and needs of every enrolled child and to arrange for a dental exam within 90 calendar days of the child's entry into the program. Decades of research show that these screenings have a positive impact.  A 2007 study in The Quarterly Journal of Economics on mortality rates showed that, compared to Head Start attendees, elementary school children without Head Start are more likely to die of causes addressed by Head Start's services. In addition, Head Start children at ages 3 and 4 have much greater access to dental care than those who didn't attend, according to the 2005 Impact Study.  The study also showed that 3-year-olds enrolled in Head Start were healthier in general than their peers, but no effect showed up for 4-year-olds. And a 1995 study in The American Economic Review showed that immunization rates go up when children attend Head Start.  No study exists, as far as we know, showing Head Start having a negative impact on children's health.

Sept. 8: Competing, Collaborating and Evolving
Sept. 9: Seeking Signs of Change Since 2007
Sept. 11: Checking Assumptions on School Readiness
Sept. 15: A Tilt Toward Literacy
Today: The Case for 'Comprehensive Services'
Friday: The Benjamin Buttonization of Head Start
Sept. 21: Future Tracks
Sept. 22: Web chat (email us your questions)


Early Head Start comes with good news, too. More than 90 percent of babies in Early Head Start received complete medical screenings in 2007 - exceeding HHS's target, according to data in the budget submission for 2009 from the Administration for Children and Families.

"One of things that has disappointed me is that Head Start never gets the credit it deserves for what it has done with kids' health," says Edward Zigler, one of the early directors of Head Start and a professor emeritus in child psychology at Yale University."

Do these health findings play a role in the cognitive and social growth of children in Head Start? Academic researchers haven't arrived at an answer to this question yet. But experts in child development have long theorized that children's health and mental well-being are inextricably linked to later academic success, not to mention the general ability to become active citizens who can cope with life's challenges. This idea has anchored Head Start's identity as a child development program since the appointment of Urie Bronfenbrenner, a Cornell psychologist famous for his ecological approach, to the planning committee for Head Start more than 44 years ago.

Given the solid data that we have on health outcomes alone, it's clearly worthwhile to continue Head Start's work in ensuring, at the very least, that children receive proper medical attention.

Another aspect of Head Start that comes under the "comprehensive services" umbrella is parent involvement, an approach that grew out of the 1960s Great Society agenda and War on Poverty.  Since the beginning, Head Start parents have been volunteering in classrooms, taking parenting classes, and participating on the Parent Policy Councils that are unique to the Head Start model.  These councils have decision-making authority over curriculum and staff, and in many cases, they allow parents to take leadership roles in their community for the first time. Many other parents use volunteering as a first step towards getting a higher degree, becoming a teacher, or perhaps a program director.

In 2008, more than 890,000 Head Start parents -- roughly one per child - volunteered with the program, according to the Head Start Program Information Report.  But beyond that, there is little data to examine on how, if and in what ways parental involvement makes a difference to Head Start children in particular. It's an area ripe for more research.

Head Start also delivers nutrition services, provides healthy meals to children each day, and offers lessons for parents on how to limit high-fat, high-sugar foods. But, again, little is understood about the impact of these services.  Few if any peer-reviewed articles appear in keyword searches of nutrition and Head Start.

Still, most early childhood advocates consider comprehensive services well worth protecting -- and they have worried that changes to Head Start might lead to weak funding for such programs. In 2001, for example, the Bush administration proposed turning Head Start into a block grant to states, rather than making grants directly to local school districts and non-profits. At the time, many advocates for the program worried that giving states more control would lead to a diminished emphasis on children's health and social well-being, turning Head Start programs into little more than literacy-based preschools instead.

But that shift in funding didn't happen and worries have subsided since.  Today, policymakers at the federal level and in many states are focused on building bridges between Head Start and other organizations that provide health and well-being services for young children. States are facing the happy prospect of new money from the Early Learning Challenge Fund -- a federal grant system that is written into legislation now being debated in Congress.  But whether states can win these new grants will depend in part on well their early childhood programs work together.  As Head Start evolves to find its place in this new paradigm, we need to examine what states are doing to build a family-friendly system of early childhood services to connect all children to local resources that already exist if and when they need them.

One model -- exemplified, in fact, by Head Start -- is to think of early learning centers of all kinds as the starting point, not the end point, for health and other social services.  Teachers and program directors in Head Start don't don a white coat and do the health check-ups themselves. Instead, they serve as brokers, connecting children and their families to existing Medicaid-eligible services as well as those offered by community organizations. (Given how difficult it can be in some communities to find a doctor that accepts Medicaid, this assistance is invaluable for many families.)

The North Carolina Smart Start program, for example, has adopted a similar strategy that involves its state pre-K program. Smart Start funds county-level partnerships that work to connect families, regardless of income, to local health services. Those funds are combined with money for More at Four, the state pre-kindergarten program, to allow children who qualify to receive the highest level of services offered by both state pre-k and Head Start.

Arizona is another interesting case. It is one of many states where the state pre-K program originally focused primarily on education and has not required providers to give medical referrals. But things are changing with First Things First, a three-year-old initiative, funded by a tobacco tax, that works to build community connections for families in the state. The program will serve middle-income children as well as the low-income children served by Head Start. "Our focus is to create a support bubble around children and their families," said Karen Woodhouse, First Things First's deputy director.

Could it be that state pre-k programs are actually starting to look a little more like Head Start when it comes to offering comprehensive services? And in doing so, could they also pave the way for further expansion of comprehensive services into the early elementary grades -- as the "community schools" movement advocates? If so, it becomes even more critical to find the most effective ways for Head Start and state systems to collaborate or divvy up the job.  For some insights on that front, stay tuned for our next post.