Sunday, December 04, 2005
An Analysis of Head Start Policy and its Impact on Occupational Therapy
The Head Start and Early Head Start programs are comprehensive child development programs that serve children from birth to age 5, pregnant women, and their families. The program provides services to low-income preschool children including children with disabilities. The program is designed for children to achieve social, emotional, physical, and mental development. Head Start is a federal program within the Administration on Children, Youth and Families in the Department of Health and Human Services (DHHS). It was most recently reauthorized through fiscal year 2003 by PL 105-285. The program was scheduled for reauthorization in 2003 but no agreement could be reached on proposed changes to the programs. Head Start reauthorization is being currently debated in the House and Senate.
History of the Policy
The Head Start programs were originally a part of the ‘Great Society’ ideas that became the domestic policy initiatives of President Lyndon Johnson (1964). Johnson was committed to the legacy of Roosevelt’s New Deal. His policy initiatives included an expanded role of the federal government to raise the standard of living in urban areas, programs to maintain and improve environmental protections, and programs to improve the quality of national education.
The first ‘Great Society’ educational program, entitled Project Head Start, was funded through the Economic Opportunity Act of 1964. At that time, Head Start was an eight-week summer program. The project was designed to help end poverty by providing preschool children from low-income families with a program that would meet emotional, social, health, nutritional, and psychological needs.
President Nixon transferred Head Start programs to the Office of Child Development in the US Department of Health, Education, and Welfare which later became the DHHS. The Head Start programs are administered by local community organizations and schools. Head Start programs are funded by the DHHS Administration for Children and Families and the program are primarily for children whose family income is below the level set by the DHSS.
Goals of the Policy
The purpose of the Head Start programs are to promote school readiness by enhancing the social and cognitive development of low-income children through the provision of health, educational, nutritional, social, and other services. Services are delivered according to a needs assessment. Head Start uses a comprehensive service approach to early childhood education. These comprehensive services include Early Childhood Development and Health Services, Family and Community Partnerships, and Program Design and Management (NYSHSA, 2004). As part of this comprehensive service approach, Head Start programs have stringent program outcome requirements that must be met in order for them to continue to receive funding.
Head Start is designed to directly provide educational services to impoverished children, but in a broader sense the program provides social, health, and nutritional services to children and their low-income parents (Barnett & Hustedt, 2005). Head Start program outcomes are supposed to broadly include improvements in child health, parental involvement, nutrition, social activities, and school transition activities. There are also education performance standards to ensure the school readiness of children. Specifically, children enrolled in the program are supposed to develop phonemic, print, and numerical awareness. Standards are written for children to understand and use language to communicate for various purposes, to understand and use increasingly complex and varied vocabulary, and to develop and demonstrate an appreciation of books. Since Head Start programs also provide services to some non-English speaking children, these students must also demonstrate progress toward acquisition of the English language. Additional program outcomes for the program include administrative and financial management standards and standards relating to the condition and location of Head Start facilities.
Grants for the operation of Head Start and Early Head Start programs may be awarded to either public or private, for-profit or non-profit organizations, or public school systems. Actual program implementation can vary between localities, but an outline of one local Head Start program is provided for reference.
Holy Cross Head Start is a local Head Start program in Erie County of New York State. The program has five locations throughout the county. The program is administered by Project Head Start of Erie County, which in turn is funded by the Community Action Organization of Erie County. Community Action Organization of Erie County, Inc. provides a variety of services to low-income communities including Head Start, food programs, drug abuse programs, and other neighborhood services programs. They in turn receive their funding from the United States Health and Human Services Department, New York State Department of State, Community Services Block Grants, New York State Medicaid programs, Erie County, Catholic Charities, and a number of other funding sources.
The Holy Cross Head Start program is for children in Erie County who are three years of age and older and whose family income is below the level set by the Department of Health and Human Services. Head Start is a free program to all children who meet these eligibility requirements. The program is child-focused and has the overall goal of increasing the school readiness of young children in low-income families by helping them with achievement in social, emotional, physical, and mental development. There is no Early Head Start component to this local program. The example of the Holy Cross Head Start is a fairly typical example of how a community can choose to implement a Head Start program.
Changes over time
The Head Start program has steadily increased in scope and size since its inception. As previously identified, the program was initially an eight week educational summer program for three to five year olds and has since expanded to a year-round education, health, and nutrition program for children from birth to five.
There were several points of notable growth to the Head Start program over time. In 1972 the Economic Opportunity Act was amended, calling for expansion of Head Start program opportunities for children with disabilities. The legislation mandates that at least 10 percent of the national enrollment of Head Start consist of children with disabilities. In 1973 the home-based program option was initiated. This service provided visits in the family's home to help facilitate parental involvement with their child. In 1994 the Head Start Reauthorization Act added the Early Head Start program, whose mission is to promote healthy prenatal outcomes for pregnant women, enhance the development of very young children, and promote healthy family functioning. This program expanded Head Start services to children aged birth to three. In 1998 the Head Start Reauthorization Act included a mandate to expand Head Start to full-day and full-year services.
The Head Start program was scheduled for reauthorization in 2003 and has been the topic of heated Congressional debate. President George W. Bush proposed several significant changes to the Head Start program including giving states control over programs, increasing accountability standards, and refocusing the program on educational objectives. These proposed changes were not well received by the media or by Democratic members of Congress (Miller, 2003). Opponents to this plan are concerned that states would not appropriately fund Head Start and that the Head Start program is functioning well as it is currently designed.
Current reauthorization bills include The School Readiness Act of 2005 (H.R. 2123) and the Head Start Improvements for School Readiness Act (S. 1107). Both of these bills are awaiting floor action. Head Start programs are the subject of strong partisan politics with both Democrats and Republicans firmly entrenched in their respective positions regarding the program.
Research on Head Start outcomes has been mixed (Barnett & Hustedt, 2005). Critics state that that there is only tentative evidence to support the long-term effectiveness of Head Start programs. These critics believe that there is ‘fade-out’ of benefit by early primary grades on measures of IQ and academic achievement. Proponents of Head Start state that there is evidence suggesting decreased grade retention, decreased need for special education, higher rates of high school graduation, and decreased rate of incarceration among Head Start participants.
According to DHHS (2004) the fiscal year 2005 appropriation to Head Start programs is $6,609,290,000. An additional $233,824,000 is appropriated in 2005 for support programs including training and technical assistance, research, and program review. This totals a 2005 appropriation of $6,843,114,000 which is in stark contrast to the 1965 appropriation of $96,400,000. Head Start funding has increased every year since its inception. These high appropriation figures provide important context in understanding the passion associated with the Head Start debate.
There are some obvious problems in policy relating to early childhood health and education services that need to be addressed. The addition of the Early Head Start program has the potential to confuse community service delivery of Part C services that are already provided under IDEA as the early intervention program. DHHS identifies some areas of overlap between the two programs but states that Early Head Start can help to provide services to children who need help but are not receiving Part C assistance. According to their research, certain demographic groupings were less likely to receive Part C services and are particularly helped by Early Head Start programs. These groups include children in Hispanic families, children of teen and less-educated parents, and children of parents with moderate or high levels of cumulative demographic risks (DHHS, 2005). It will be helpful for future policy initiatives to more clearly delineate the roles of the respective Part C and Early Head Start programs.
Teacher qualifications are another significant problem with the Head Start programs. The Head Start Reauthorization Act of 1998 mandated that at least 50% of Head Start teachers have a minimum of an associate’s degree in early childhood education. Although it appears as though this standard has been met, there is still significant concern that this is an unacceptably low standard and that Head Start does not have the adequate funding to attract qualified teachers (GAO, 2003). Many care providers in Head Start programs lack appropriate credentials. It is a legitimate criticism to state that the Head Start program has confused policy between providing an early childhood education program and providing a job training and childcare program. Approximately 30% of Head Start staff has current or former children enrolled in the program (GAO, 1998).
Legislators need to carefully consider facts when debating policy associated with Head Start. Failure to reauthorize Head Start will contribute to ongoing policy confusion regarding the aims of the program. Other governmental programs such as NASA and Amtrak should serve as grim reminders of the policy morass that ensues when programs are left in the middle of bitter partisan political debates.
A bipartisan summit on the legitimate goals of the Head Start programs would provide an important first step toward cogent policy development. Concerned stakeholders including policymakers from DHHS and the Department of Education should be involved. There are many legitimate needs of the population served by the Head Start program. It is important to begin discerning between the programs that the involved agencies provide.
Impact on Occupational Therapy
Head Start programs do not provide direct funding for occupational therapy services; rather, they provide a context where these services may be delivered. Many of the children who are eligible for services under Parts B or C of IDEA may be seen in the context of Head Start programs. In these cases the Head Start program may represent their ‘natural environments.’ Any change in the Head Start program has a potential impact on the delivery of occupational therapy services to the children who participate in that program.
There are large numbers of Head Start-eligible families who are not currently enrolled in the program (ACF, 2001). Changes in program recruitment and enrollment have a potential to impact occupational therapy service delivery. It is likely that some of the children not enrolled in Head Start may be enrolled in other preschool programs where occupational therapy can be provided. However, it is more likely that many of these children who are not enrolled in Head Start will simply not be ‘identified’ as requiring related services until they reach school age.
Very little literature has been published by occupational therapists regarding children’s participation in Head Start programs. Marr, Cermak, Cohn, and Henderson (2003) documented the differences of time spent on fine motor activities between Head Start programs and kindergarten. However, there is no nationally standardized curriculum for Head Start and these observations were made in a two-county rural region, limiting the generalization of the results. This underscores the need for occupational therapists to be aware of the structure and curriculum of Head Start programs in their own geographic regions and to design interventions that meet the needs of children within their specific programs.
The needs of children who attend Head Start programs are significant but the delivery and reimbursement systems supporting related services are fragmented. Occupational therapists have an opportunity to advocate for improved coordination of health promoting and developmental services, to advocate for requirements that service providers have appropriate credentialing, and to propose innovative occupational therapy services that will address unmet needs. All of these actions will help to improve the quality of Head Start programs.
In the interim, occupational therapists should pursue grants and alternative funding mechanisms so that these important services can be provided directly in the context of Head Start. Small demonstration projects may be a potentially useful mechanism for occupational therapists to show the effectiveness of their programs. Therapists in preschools, outpatient programs, and private practice settings should also re-emphasize health and developmental needs in their programming so that these services can be extended to children in Head Start programs.
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Administration for Children and Families (ACF) (2001). Reaching out to families: Head Start recruitment and enrollment practices. Retrieved November 20, 2005 from http://www.acf.hhs.gov/programs/opre/hs/faces/reports/
Barnett, S.W. & Hustedt, J.T. (2005). Head Start's lasting benefits. Infants and Young Children, 18, 16-24.
DHHS (2004). Head Start program fact sheet. Retrieved November 20, 2005 from http://www.acf.hhs.gov/programs/hsb/research/2005.htm
DHHS (2005). Early Head Start Research and Evaluation Project (EHSRE), 1996–2005. Retrieved November 20, 2005 from http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/index.html
Economic Opportunity Act of 1964, Public Law 88-452.
Economic Opportunity Amendments of 1972, Public Law 92-424.
Head Start Act, Public Law 97-35, 42 USC § 9831 et seq.
Head Start Reauthorization Act of 1994, Public Law 103-252.
Head Start Reauthorization Act of 1998, Public Law 105-285.
Individuals with Disabilities Education Act (IDEA) Amendments of 1997, PL 105–17, 20 U.S.C.§§ 1400 et seq.
Johnson, Lyndon B. (Speaker). (May 22, 1964). The Great Society. Retrieved November 20, 2005 from http://www.americanrhetoric.com/speeches/lbjthegreatsociety.htm
Marr, D., Cermak, S., Cohn, E.S., & Henderson, A. (2003). Fine motor activities in head start and kindergarten classrooms. American Journal of Occupational Therapy, 57, 550 –557.
Miller, G.M. (2003, July 15). The Crush of Criticism on the RepublicanHead Start bill Continues. Retrieved November 20, 2005 from http://edworkforce.house.gov/democrats/headstartdc2.html
New York State Head Start Association (2005). About Head Start. Retrieved December 2, 2005 from http://www.nysheadstart.org/history.html
The School Readiness Act of 2005 (H.R. 2123). Retrieved November 20, 2005 from http://thomas.loc.gov/cgi-bin/query/z?c109:h.r.2123:
The Head Start Improvements for School Readiness Act (S. 1107). Retrieved November 20, 2005 from http://thomas.loc.gov/cgi-bin/bdquery/z?d109:S.1107:
United States General Accounting Office (GAO) (2003). Head Start: Increased percentage of teachers nationwide have required degrees, but better information on classroom teachers’ qualifications needed. Retrieved November 20, 2005 from http://www.gao.gov/new.items/d045.pdf
United States General Accounting Office (GAO) (1998). Head Start programs: Participant characteristics, services, and funding. Retrieved November 20, 2005 from http://www.gao.gov/archive/1998/he98065.pdf