DYSFUNCTIONAL FAMILIES IN THE HEAD START PROGRAM: 
MEETING THE CHALLENGE 
RICHA 
P. KUSSEROW 
INSPECTOR GENERA 
NOVEMBER 1989 
OAI-09-89-01000  EXECUTIVE SUMMARY 
PURPOSE 
Ths Head Star program inpection was conducted to (1) assess the needs of 
dysfuctonal fames, (2) estimate the number of enrolled children from 
dysfuctonal fames and (3) identif ways to overcome servce delivery barers 
faced by dysfuctonal famlies. 
BACKGROUND 
Head Star operates on the premise that chidren are best prepared for success 
grade school and beyond when they and their parents are involved in a
comprehensive program that addresses their educational, economic, social, physical 
and emotional needs. Head Star addresses the needs of the entie famiy by 
identifg the famy s social servce needs and promoting cooperative relationships 
among the famy, Head Star staff and servce providers. 
In recent years, Head Star sta have expressed concern about adequately servg 
dysfuctional, or multiproblem, famlies. Although most Head Star fames have 
some dicuty coping with certai aspects of daiy livig, the dfysufu nctonal famy 
problems are considered so severe that the famly is unable to  the necessary 
physical social and psychological needs of the chidren and other famy members. 
MAJOR FINDINGS 
The comprehensive needs of dysfunctional familes pose a special challenge for 
Head Start grantees. 
According to Head Star grantees, the problems most frequently faced by 
dysfunctional famlies involve substance abuse, lack of parenting skills, child abuse 
domestic violence and inadequate housing. As a result, dysfuctional famies need 
While al agreed that Head 
a wide range of servces.  Star should serve 
dysfuctional famlies, some grantees were concerned about the additional demands 
that these fames place on their program and staf. 
The number of dysfunctional familes in Head Start varies widely from grantee to 
grantee. 
The estimated percentage of chidren from dysfuctional fames curently enrolled 
in Head Star ranges from zero to 85 percent. No clear growth trend emerges, since 
almost hal of the grantees reported a decrease or no change in the number during a 
year period. Several grantees reported an increase in the severity of the problems 
faced by dysfunctional famlies.
 Although grantees have diffculty providing servces to dysfunctional familes, they 
have found some creative solutions. 
Servce referrals for dysfuctional famlies are frequently inadequate or unavailable. 
developing 
Grantees have aleviated some of the servce delivery barers by 
inovative approaches including the establishment of parenting program, support 
groups and special classes. 
Income guidelines, performance standards and lack of resources limit grantees 
some of the children from dysfunctional familes who are not 
abilty to serve 
eligible for federal "safety net" programs. 
Grantees agree that social needs should be considered as part of enrollment criteria. 
Neverteless, many children from dysfunctional fames are not enrolled because 
the famlies are the working poor and therefore exceed the income guidelines or 
incomes and are accorded higher priority for 
because other poor famlies have lower 
enrollment. These children may need Head Start even more than some children 
from currently eligible famiies who have the "safety net" of public assistance 
Medicaid, food stamps and subsidized housing. 
RECOMMENDATIONS 
1. Head Star should revise its enrollment criteria to provide grantees great 
flexibilty to enroll children from dysfunctional families. 
2. Head Star should use its discretionar grant authority to (a) develop ways of 
providing better access to community resources, (b) develop and test new and better 
approaches for Head Start grantees to assist dysfunctional families and (c) collect 
and disseminate successful strategies and best practices that grantees are using to 
(NOTE: This recommendation is 
meet the needs of dysfunctional famiies. 
consistent with the recommendations developed by the National Head Start Social 
Servces Task Force. 
COMMENTS 
We have modified our recommendations based on comments received from the 
Assistant Secretar for Human Development Servces (HDS). The complete HDS 
comments are included in the appendix to the report.  TABLE OF CONTENTS 
EXECUTI SUMMAY 
INTRODUCTION 
FINDINGS 
The comprehensive needs of dysfunctional familes pose a 
special challenge for Head Start grantees. 
fames 
Dysfuctional  face serious physical, mental and 
social problems. 
Alost 
all grantees believe that Head Star is the best 
program for chidren from dysfuctional fames despite 
the additional demands placed on staf. 
The number of dysfunctional familes in Head Start varies 
widely from grantee to grantee. 
Although grantees have diffculty providing servces to 
found some creative 
dysfunctional familes, they have 
solutions. 
Dysfuctional famlies have diculty obtainng needed 
servces. 
Grantees have creatively overcome some servce delivery 
barers. 
Income guidelines, performance standards and lack of 
resources limit grantees' abilty to serve some of the children 
from dysfunctional familes who are not eligible for federal 
safety net" programs. 
RECOMMENDATIONS AND COMMENTS 
APPENDIX: HDS Comments on the 
draf report  INTRODUCTION 
The Head Start Program 
Head Star is a comprehensive early childhood development program for preschool 
chidren from low-income famies. Established in 1964, Head Star anually serves 
00 
approxiately 450, children between the age of 3 and school entry age. A 
low-income famy, for Head Star enrollment puroses, is a family whose income is 
below the povert level (as defined by the Offce of Management and Budget) or a 
famy who is receiving public assistance, even if the famy s income exceeds the 
povert level. At least 90 percent of the children who are enrolled in each Head 
Star program must be from low-income fames. The Head Start regulations state: 
ll applications for admission. . . are received for more children from low-income 
famlies than the Head Star program can accommodate, the children from the 
lowest income famlies shall be given preference. 
Head Star consists of four major components (education, health, parent 
involvement and social servces) which are designed to serve children and their 
famlies. In Fiscal Year 1988, Head Star was administered th ough 1 29110 
public and private non-profit grantee agencies at a cost of approximately $1.2 bilion. 
The grantees are approved and funded by the Offce of Human Development 
he Deparent of Health and Human Servces (HHS).
Servces (HDS) of 

Although grantees are encouraged to tailor their programs to local community needs 
and resources, HHS has developed national program goals, objectives and 
performance standards. According to HHS reguations, the overall goal of Head 
Star is to increase social comp'etence for chidren of low-income families. To 
accomplish this goal, objectives and performance standards are concerned with such 
things as the chid' s health, self-confdence and mental skills, as well as the child' 
abilty to relate to his famly and the enhancement of the child and the family s sense 
of dignty and self-worth. Specific performance standards for each of the four major 
, among other things, that grantees: 
components of Head Start requie
involve parents in educational activities and provide parent training, 
provide a health education program for parents 
. identi the social servce needs of Head Star families and 
provide methods and opportunities for involving parents in the 
identification and use of family and community resources to meet the 
upport needs of the famy.
basic life 

Head Star emphasizes the role of parents in their children s education and 
development and promotes cooperative relationships among the family, Head Start
staf and servce providers.  . .
In order to assess the needs of the famy, Head Star has developed the Famly 
Needs Assessment (FNA). Head Star has issued a model FNA, but grantees can 
Al grantees are requied to admister an FNA for every . 
develop local varations. 
famy at the tie of enrollent or shortly t  ereafer. The FNA is intended to help 
Head Star staf and the famly identif famly needs and obtai appropriate servces. 
Cuently, Head Star has the capacity to enroll only about one in six preschool 
chidren eligible for the program. President Bush has requested an additional 
$e250l imgioni bin tlhee Fi scca Yheari 1d990r beudgnet to. e xpand Head Star to serve more
Dysfunctional Familes and Head Start 
In recent years, Head Star staf have expressed concern over the growig number of 
dysfuctional, or multiproblem, families enrollng in the program. This concern was 
reiterated by the National Head Star Social Servces Task Force which was created 
by the Commssioner of the HDS Administration for Chidren, Youth and Famies. 
The Task Force issued a report in November 1988 that stated: 
With the ever increasing number of multiproblem or 'dysfnctinal' 
countr, Head Star program have had 
families being seen in the 
careflly examine their cu"ent approaches to determine if they are 
suitable or efectie in successflly assisting many of these families to 
overcome those plaguing problems confronting them. 
Since Head Star enrolls the "neediest of the needy," most Head Star families have 
special needs and experience difficulty coping with aspects of daily living. A 
dysfuctional famy s problems are so severe, however, that the famy is unable to 
meet the physical, social and psychological needs of the chidren and other famy 
members. They are, therefore, unable to benefit fuly from the Head Start program. 
The term "dysfunctonal family" and "multiproblem family" are often used 
interchangeably. The following descrption of multiproblem famlies, taken from 
miors 
Working With Dvsfunctional Families. closely  the description
Lisa Kaplan 

of dysfuctional fames that we heard from Head Star grantees: 
The multiproblem family has a number of problems that cut across many 
dimensons of family life. Such a family can neither handle these 
problems itself nor find help in services available in the community. Its 
inability to cope with its problems ditinguishes this family from others. 
Repeated negate interactions destroy the possibility of positie 
communicaton and understqnding 'aong family members. 
. Multiproblem families are often isolated and alienated, possessing few, if 
any, positie support networks. Exernal problems may include the 
family s inability to get help from community agencies becaue it does not  Taow how to access services or becaue it has been thoroughly 
overwhelmed by the service system and/or angered by past encounters 
becaue of the failure of human service agencies to meet the family's 
needs. The relatonship between human service agencies and the 
dysfnctional family is characteried by mutual alienation. 
For this inpection, we told grantees that we were interested in discussing those 
famlies with serious problems that present barers to their ful participation in 
Head Star, paricularly in such areas as attendance, parent paricipation, referrals 
and home viits. 
METHODOLOGY 
We drew a random sample of 117 Head Star grantees from the universe of 
program 
approxiately 1 170 grantees. The sample consisted of Head Start 
throughout the country and included both urban and rural grantees with enrollments 
rangig from 20 children to over 3,500. We did not include Indian, migrant and 
terrtorial Head Star program for two reasons: (1) they are admistered 
separately from regular Head Star program and (2) these grantees are so different 
from reguar Head Star grantees that they should be studied separately. . Grantees 
were cont cted by telephone and requested to provide (1) estimates on the numbers 
and percent of dysfunctional families served, (2) the nature of the families' problems 
and (3) inormation about servces needed by dysfuctional famiies, barriers to 
getting servces, impact on staf and enrollment policies. We completed interviews 
with 116 of the 117 grantees.  . . 
FINDINGS 
THE COMPREHENSIVE NEEDS OF DYSFUNCTIONAL FAMILIES POSE A 
SPECIAL CHALLENGE FOR HEAD START GRANTEES. 
Dysfunctional familes face serious physical, mental and social problems. 
Although dysfuctional famies face many different  some are 
tyes of problems, 
clearly more pervasive than others. Grantees raned substance abuse, lack of 
parentig skills, child abuse, domestic violence and inadequate housing as the most 
common problems shared by dysfuctional famies. In discussing the most reported 
problem, substance abuse, grantees mentioned both alcohol and ilicit drugs 
includig cocae, crack cocaie and heroin Altogether, grantees identified about 
30 diferent problems that may characterie dysfunctional families. Included in the 
list were such things as mental iless, a jaied parent, severe health problems and 
ilteracy. 
Grantees cited substance abuse and child abuse and neglect most often as the 
problems that have worsened since 1986-87. Some grantees felt that increased drug 
use has led to increases in other problems, such as child abuse and domestic 
cries 
violence. Some stated that the increase in drug-related  resulted in declining 
their homes in the evening. 
parent paricipation because people are afaid to leave 
Many grantees mentioned an increase over the last 3 years in the third most 
reported problem, lack of parenting skills. These grantees described the tyical 
parent as a teen-age, single mother who lacks basic parenting skils, education and 
job traing. She  her mother for 
priar  is apathetic towards parental duties and defers to 
caretakng. These mothers require substantial Head Start staff 
commtment. 
The followig grantee comments ilustrate how difcult it is for Head Start to 
identi and treat the problems associated with dysfuctional families: 
Substance abuse is more a 'result ' than the problem; it stems from other 
mental ilness. 
issues like economics and 
Lak of education, job training program, incenties to work and low self 
esteem are the PROBLEMS; the reasons that families become 
problems like alcohol and substance abuse are
dysfnctional. 
syptoms of the dysfnction not the caues. 
The problems are so interrelated; for example, homelessness often results 
from substance abuse.  The combinaton of financial, social and emotional problems results in 
so much stress that the family cannot function. 
Grantees told us about several case studies that ilustrate the problems faced by 
dysfuctonal fames: 
This single mother is depressed and suicida. She had been told as a 
child by her mother that she was not wanted. She grew up in foster 
homes. Her husban was emotionally abusive and lef her, and her 
died. She is on welfare and lacks all educational, 
eldet son recently 
homemakng, parenting and job skills. Her twins are nonverbal becaue 
she never talked to them They alo do not walk well because they were 
kept in their cribs or play pen and seldom had freedom of movement. 
this family have three different fathers. Their 
The four children in 
mother was sent to  months last year and the family was 
prion for 
broken up and scatered among family members. The children 
behaior was so inappropriate that they were placed in foster care. While 
in counseling, the Head Star child disclosed information about abuse in 
the house. When the mother regained custody of the children, the Head 
ulcer. 
Star child became more violent, used profanity and displayed extreme 
mood changes. The child has alo deeloped an 
The parent of this Head Star child are illiterate and have no parenting 
skills. The Child Protectie Service had already taken away three of the 
mother s other children due to neglect and abuse. Afterwards, she gave 
birth to three more children. The Head Star child was still in diapers 
becaue the mother did not know how to toilet train. The children were 
locked in their bedroom because the mother could not stand their 
actiity. The children were abused, neglected and lacked basic medical 
care, inc;luding immunizations. The mother lacked transportation, and 
the father was not willing to tranport the children if it required him 
ditrted 
missing work. The mother greatly  social service agencies. 
The family lives in a rural area, with no running water or sewage system. 
Both parents are lacking parenting and job skills. The father has a drug 
abuse problem and abuses his spouse. He openly states that he expects 
his son to fail as he did. The child has a fear of socializing when at the 
center. 
This single mother is overwhelm d by responsibility. She often leaves her 
children alone and unsupervised while she sleeps. Substance abuse is 
suspected but not confirmed. Her lack of parenting skills and the other 
. family problems are reflected in the behavior of the Head Start child. 
The child has little self-confidence, is withdrawn in class and rebels 
- 5 , '
mad it 
against her mother. The family's lack of tranportation has 
virtly 
impossible for the child to atend the center. 
Almost all grantees believe that Head Start is the best program for children 
from dysfunctional familes despite the additional demands placed on staff. 
Despite the diculties they face in providing servces to dysfuctional famlies, 
90 percent of the grantees believe that Head Star is the program best able to serve 
these fames. Accordig to the grantees, Head  servg 
Star is successfu in 
dysfuctonal fames because: 
. Head Star treats famy problems holisticaly and comprehensively by 
providig support for physical, social and educational needs. Outside 
servce providers are unuccessful because they treat problems in 
isolation. 
. Head Star buids trust with fames when they do not trust other social 
servce providers. Famiies feel comfortable coming into the Head Start 
center and are more willng to accept treatment. 
. Knowledge about the famy helps Head Star staf get better results. " 
know every miute detai about the famy because.of the amount of 
contact we have " said one respondent. 
. Many grantees emphasized local flexibilty as a reason for Head Star' 
success in servg dysfuctional famies. As one grantee stated  The 
strcte; 
strong performance standards make possible a flexible 
in fact, 
the beauty of Head Start is that it can adapt to every communty and every 
famy. 
Grantees offered specic examples of their successes workig with dysfunctonal 
tw 
fames. The fist  mother of  who was mentioned in 
success story involves the 
the fist case study on page 5: 
This mother was involved in the Head Star program for a total of 4 
year-- year when the baby was Head Star 
2 year with the twins and 
age. The home visitor helped by first working on her self-esteem and then 
on life skills. A homemaker was secured by the Bead Start program to 
teach her homemaking and cooking skills. This mother was brought to 
parent workshops where, at first, she only looked at the floor. Gradally, 
she became involved in the policy council and eventually was elected 
president of the State parents' associaton. The home visitor assisted her 
in receiving vocational money which she used to atend a State college 
where she gradated magna cum laude in journalism. She now works 
for a local newspaper.  , "

Another case study also ilustrates the success of the Head Start home visit program: 
At the time she enrolled her daghter in Head Star, this mother was in 
the mide of a diffcult diorce. Her self-esteem was very low, and she 
was having behaior problems with her two children. Although she 
atended parent meetings, she was too shy to parcipate. Through the 
home visit program, Head Star was able to help her gain self-confidence. 
She was elected to the Head Star policy council, where she served as 
Secretar and was encouraged by the home visitor to tak the entrance 
exam for the job training parership program. She passed with flying 
colors and has since enrolled in a State university where- she is a straight 
student and wil be gradating with an associate degree in 
informaton processing and offce technology nex year. 
Several respondents felt that, while Head Start may be the best resource, it should 
not be viewed as the exclusive resource. As one grantee stated  I would not want to 
only with dysfunctional famlies or go out of its way to enroll
see Head Star work 

dysfuctional famlies. 
While dysfunctional famlies caused some diffculties in meeting performance 
standards and some problems for staf, most grantees reported that these were not 
overwhelming or crpplig. For example:

. About 62 percent said parent paricipation stayed th  same or increased 
durg 
the last 3 years. Some grantees reported that their parent 
parcipation rates could only be maintained through increased staff 
efforts. 
. Overall, attendance is down about 0.5 percent during the last 3 years, but 
most grantees attributed this to sickness and tranportation problems, not 
dysfunctional famlies. Only 9 out of the 51 who reported decreases in 
attendance mentioned causes that could be related to dysfunctional 
fames. 
. About 73 percent of the grantees indicated that they experience major 
classroom disruptions, but only 16 percent said the disruptions were very 
said that major disruptions 
frequent or severe. A majority of grantees 
were inrequent and limited to a smal number of children. While some 
attrbuted the disruptions to normal4-year-old behavior, many of the 
1986 associated the 
grantees that reported increased disruptions since 
disruptions with dysfunctional families. 
. Most  ntees (86 of 116), said there was no change in the difficulty in 
makg home visits, while 27 said it is getting more difficult and 3 said it is 
easier. Approximately one-fourth of the grantees did, however, express 
concern about potential violence or harm to staf during home visits.  Grantees report that working with dysfunctional famlies takes much more staff time 
and often leads to stress and burout. About 84 percent noted increased demands 
tie. 
One-to;.one counseling, assistance to parents and families, extra home 
on staf 
visits, referral for outside treatment and dealig with the children in the classrooms 
takes the most tie. About two-thrds said staf are adversely affected by stress, 
of the sample 
burnout and frstration. Despite these problems, only 22 percent 
reported increasing staf turnover. Moreover, while stress related to dysfunctional 
fames was mentioned as a cause of sta tuover, most grantees stated that low 
pay was a more important factor. 

Approxiately one-thid of the grantees said that some children should not be 
enrolled in Head Star. Violence and major handicapping conditions were most 
frequently mentioned as categories of families that Head Start might not be able to 
serve. "We wi not serve a famy if there is reason to believe it is unsafe to do so. 
Violence in the household, chairs thrown at our workers or threatening with guns 
are reasons why we would not serve a famly." Fames or  severe 
children with 
handicapping conditions such as the profoundly retarded were also mentioned
priary 
because some Head Start grantees feel they do not have the resources to 
serve such famies effectively. 
THE NUMBER OF DYSFUNCTIONAL FAMILIES IN HEA START VARES 
WIDELY FROM GRATEE TO GRATEE. 
Measurable, objective standards to identif dysfunctional families do not exist, and 
grantees do not usualy identify dysfunctional families during the Family Needs 
Assessment. Also, grantees are not required to maintain statistics or separate 
Most grantees said that they usually do not know 
records on dysfunctional famlies. 
the ful extent of a famly s problems at the time of enrollment, because people are 
reluctant to discuss their problems durng the FNA Grantees feel that there is no 
way to get information until trust is established. As one 
grantee said: 
After talking to them awhile, they open up. No real change has to take 
place. You just have to take the time to get to know the family, and that 
taks at least one home visit. 
The grantees arved at their estimates of the number of children from dysfunctional 
priary 
famlies  through discussions with staff and personal knowledge. Almost 
60 percent of the grantees also conducted a record 'review to identify those familes 
whom they consider dysfunctional. 
The estimated percentage of children from dysfunctional families currently enrolled 
in Head Star ranges from zero to 85 percent and has no relationship to the size or 
location of the program. Nine grantees with enrollments ranging in size from 34 to 
520t reported that none of their current chidren are from dysfunctional families. : 
Sixteen grantees with enrollments rangig in size from 30 to 2561 reported that 50  percent or more of their current chidren are from dysfunctional famlies. There was 
an equal distrbution of high and low percentages among rural and urban grantees. 
The 116 grantees estiated that 16 percent of the enrolled children came from 
dysfunctional fames in 1986 and 21 percent were from dysfunctional families in 
1988. No clear trend emerges, since alost hal of the grantees reported a decrease 
durg 
or no change in the number  the 3-year period. 
CHANGE IN PERCENTAGE OF DYSFUNCTIONAL FAMILIES 
COMPARED TO TOTAL ENROLLMENT 
(1986 TO 1988) 
Number of Grantees ReportinQ 
Decreases in percentage 
No change 
Increase of less than 5 percentage points 
Increase of 5-9 percentage points 
Increase of 10 percentage points or more 
TOTAL  116 
The highest increase over the period was 26 percentage points reported by only one 
grantee. Grantees that reported increases in the number of dysfunctional families 
also reported that parent parcipation has decreased, home visits and referrals are 
more difcult and classroom disruptions have increased. .

The data show that the problem of dysfuctional famies is an ongoing one that 
most grantees have been coping with over tie. Some grantees perceive the severity 
of the problem as correlated with local community phenomena such as factory 
closures or changes in the farm economy. Thus, they see changes as cyclical rather 
than representative of a trend. 
fames. 
Several grantees (even some that reported a decrease in the number of 
dysfunctional famies) reported an increase in the severity of the problems faced by 
dysfunctional 
ALTHOUGH GRATEES HAVE DIFFCULTY PROVIDING SERVICES TO 
DYSFUNCTIONAL FAMILIES, THEY HAVE FOUND SOME CREATIVE 
SOLUTIONS. 
Dysfunctional familes have difficulty obtaining needed services. 
Grantees encounter many servce delivery barers when they try to help 
dysfunctional famlies. Two-thirds of the grantees have diffculty makig referrals 
because servces are not readily avaiable in their communties. Grantees also have 
con ern about the quality and accessibilty of key servces for dysfunctional families.  They face the problem of providing servces when the family is unable or unwillng 
to accept referrals. 
According to the grantees, dysfunctional famies most frequently need: 
mental health servces, 
housing, 
substance abuse treatment,

education/job training, 
medicaldental servces, 
parenting skis traig and 
. chid abuse counseling. 
Grantees reported dissatisfaction with servces provided by community mental 
health centers because the centers are drasticaly understafed and may not be 
sensitive to the needs and problems of dysfuctional famlies. The grantees find that 
fames do not feel comfortable using the centers which do not generally address the 
mental health needs of young children. 

Grantees reported diffculty obtainig medical and dental servces for all their 
famlies. Dysfunctional famiies, because of their multiple needs, have an especially 
obtaing 
dicult time  these servces. For example, grantees said: 
Prenaal care has been cut drastically. The well-baby clinic is 
nonextent now. Immunizatons are no longer free. 
Doctors won t take Medicaid becaue the State is so late with the 
tried to pay the doctors ourselves and then take the 
payents. We have 
reimbursement, but we can only do this on a limited basis. 
Grantees expressed strong dissatisfaction with the decrease in resources for child 
protective servce agencies (CPS). They feel that CPS staffs are overburdened, 
inexperienced and can deal only with crsis situations. Several grantees said that a 
referral to CPS is "meangless." This problem is complicated by the fact that Head 
Star grantees are legally required to report child abuse. Grantees are concenied 
that if they report child abuse to an agency which will not follow up, they may only 
alenate the famiy and perhaps lose any help for the child and parents. 
About 72 percent of grantees indicated diffculties in making referrals because of 
the famlies' unwigness or inabilty to accept the referral. Many 
qualified their 
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- 10 . . 
denial  fear are major reasons famlies are unwillng to accept 
Grantees note that  and 
referrals. Denial is most common in fames with substance abuse problems. It is 
also a problem when referrals involve domestic violence, mental health or children 
with special needs. Fames are also unwiing to accept referrals due to fear of 
reprisal (e.g. removal of the children from the home), failure and stigmatization. 
Ths seems to be common in smal communities. Other explanations for a family 
being "unwilling" to accept a referral include pride, hopelessness and lack of interest. 
Grantees feel that Head Star should provide more tranportation. Transportation 
is the most common reason that famies are "unable" to complete a referral. 
Dysfunctonal famies, more than other families, lack transportation or the 
motivation to get tranportation. Grantees who cannot provide adequate 
tranportation rate this high on their ''wsh list. 
Grantees have creatively overcome some service delivery barriers. 
Grantees have implemented many good ideas for dealing with dysfunctional 
famlies. These ideas can be grouped under such topics as mental health training, 
parenting program and support groups, special classes or groups for severely 
disturbed and dysfunctional famiies, stress reduction and tracJdng famlies. after they 
leave Head Start. Specific projects include the following: 
. Some grantees have a mental health expert on staff or a mental health
consultant under contract. These professionals deliver mental health 
servces in the Head Star center. These grantees believe direct provision 
of mental health servces is the most effective way to meet the needs of 
dysfuctional famies. 
. Some grantees use Qther agencies to train Head Start staff; they 
intervewing techniques so they can 
concentrate on developing the stafs 
acquire better information from the famies. 
. Some  personal safety curriculum" for all kids and 
grantees have a "
parents. The program teaches the diference between "good touches" and 
bad touches" and has resulted in several children reporting child abus 
each year. 
. In some Head Start programs, when a problem is first identified in the 
classroom, the teacher meets with other Head Start staff and the mental 
health consultant to formulate a "team approach. 
. Some grantees have a key or lead contact within each referral agency
which makes the referral process easier. The contact in the agency trusts 
Head Star and knows that if Head Start calls there is a pressing problem 
that must be taken care of immediately. 
One grantee acquired an "innovation grant!' for children of alcoholic 
parents to form a suppo.r group which helps the child acquire better 
coping skills.  The following are a few examples of specific progran intiated by Head Start 
grantees to serve dysfunctional famlies better and help them overcome barriers to 
servce: 
TEEN PREGNANCY PROGRAM 
CENTER, COLORADO 
Ths Head Star grantee has become acutely aware of the increasing problem of teen 
pregnancy. In response to this concern the grantee formed a coalition which has 
met regularly over the past 2 years. The coalitiOIi has coordinated with the 
Governor s Intiative on Teen Pregnancy, supported legislation for Comprehensive 
Health Education in public schools, sponsored activities for youth and supported 
Moms-to-Moms efforts. The group is dynamc and positive and will continue to 
work to solve the problem of teen pregnancy. 
CHILD ABUSE TREATMENT PROGRAM 
SPOKANE, WASHINGTON 
Spokane Community Mental Health Center and Spokane County Head Start 
recognzed there are increasing numbers of dysfunctional families where children 
are at risk. The two agencies established a joint effort to change the lives of abusive 
parents and abused children. The partnership provides intensive servces for 
famies without mean to 
seek other resources. 
The tyical parent in the program is white, single and female. She is between 18 and 
24 years old and is a recipient of Aid to Famlies with Dependent Children. She 
most often comes from a childhood where she was a victim of sexual abuse, physical 
abuse or neglect or a combination of these. The average child in the program has 
experienced moderate to severe abuse and/or neglect. 
The parents meet three times weekly in a therapy group, which focuses on personal 
parnership and famy problems. This cooperative effort has enabled staff to 
integrate child and adult therapy program. The program allows for a 
comprehensive coordinated effort by community agencies to work more effectively 
with families and the issues surrounding child abuse and neglect in a mainstream 
setting. 
THE MENTAL HEALTH PLAYERS

ELMIRA, NEW YORK 
The Head Star prQgram has developed an agreement with the Elmira Mental 
Health Players to provide nontradi ional training for parents leading to increased 
awareness of mental health issues. The Elmira Players work at the Elmira 
Psychiatric Center and use role playing for community education. Where lectures 
d unresponsive, role-playing involved and moved them. The 
left audiences cool 
 ..-
Elmira Players have made hundreds of presentations before diverse audiences on 
scores of mental health themes. 
The Elma Players, workig Without scrpt, spontaneously role-playa scene or 
situation before an audience. The situation might be that of a parent grieving for a 
chid, an alcoholic mother in the famly, a hyperactive child in the classroom, a 
depressive patient in a mental hospital or a pregnant teenager confronting her 
parents. A moderator tells the audience about role-playing and about the problem 
to be portayed. The players come to the platfori already in character and act out 
the scene. Ths may take from 8-15 miutes. The audience participates by 
questionig the Players. The Players respond in character, sustaining the feeling of 
authenticity. The moderator closes 
with an interpretive synopsis. 
A real lie situation, acted out on a stage, involves the audience on an emotional 
level. Better understanding, acceptance and constructive attitude changes are more 
this process than would occur in reaction to a lecture or even a 
liely to occur in 
fi. The Players are helping Head Start establish its own players group to focus on 
mental health issues affecting Head Start families. 
INCOME GUIDELINES, PERFORMCE STANDARS AND LACK 
RESOURCES LIMIT GRATEES' ABILITY TO SERVE SOME OF THE 
CHILDREN FROM DYSFUNCTIONAL FAMILIES WHO AR NOT ELIGIBLE 
FOR FEDERA "SAFETY NET" PROGRAS. 
More than one-third of the grantees believe that cuent income guidelines do not
alow them to enroll the most needy famlies. In paricular
, grantees believe the 
gudelines exclude many of the workig poor. These are families who may have 
severe needs but with incomes above the guidelines and usualy with no health 
inurance or other benefits. These fames do not receive Aid to Families with 
Dependent Children, food stamps, subsidied housing or Medicaid because their 
incomes slightly exceed the poverty level. Some grantees stated they specifically 
excluded such enrollees because Head Start would have to pay medical bils: 
Ioften accept AFDC kids before others who may need help more so we 
won t be stuck with medical bills on that child--so our medical dollars 
will go farher. 
Almost al grantees believe enrollment should take into account the socially needy. 
Some programs already are doing this in determning the "neediest of the needy 
within the current income guidelines. Guidelines used by some grantees take into 
account such factors as income, age of the child (with 4-year olds having precedence 
over 3-year olds), isolation of the famly, a single parent family and referrals from 
other agencies. Some grantees say these criteria should be given as much weight as 
dicapping conditions when deciding to enroll a family. 
 Several grantees stated that the performance standards for attendance and parent 
paricipation sometimes actally worked agait servng dysfunctional families. 
Because these famlies have erratic attendance in the classroom and at Head Start 
fuctions, many are dropped from enrollment. 
Many grantees observed that dysfunctional famies frequently "fall through the 
The followig are examples of families who are hard to 
cracks" and are not enrolled. 
reach: 
far 
At the  and shanties on the outskirts of town, they are afraid 
social workers, they are hard to reach, they are transient people living in 
car and tent. 
We don t reach the mother lying drnk in the trailer park who is not able 
even to enroll a child--she will be caught later in public school, which is 
compulsory. .  RECOMMENDATIONS AND COMMENTS 
RECOMMENDATION #1-ENROLLMENT CRITERIA 
RECOMMENDATION: Head Star should revise its enrollment criteria to provide 
grantees greater flexibilty to enroll chidren from dysfunctional famlies. 
DISCUSSION: Cuent eligibilty crteria require that at least 90 percent of families 
have incomes below the income eligibilty  that famlies with the 
gudelies and 
lowest income be accorded the highest priority. Ths latter requirement prevents 
grantees from enrollg poor dysfunctional fames even if their needs are greater 
than other fames with lower incomes. 
RECOMMENDATION #2--DISCRETIONARY GRANTS 
RECOMMENDATION: Head Start should use its discretionar grant authority 
(a) develop ways of providing better access to community resources, (b) develop and 
test new and better approaches for Head Start grantees to assist dysfunctional 
famlies and ( c) collect and disseminate successful strategies and best practices that 
grantees are using to meet the needs of dysfunctional families. 
DISCUSSION: Although grantees generaly are coping with the special needs of 
dysfuctonal fames, they face servce delivery barers. These barriers include 
inaccessible servces and inadequate community resources. (NOTE: This 
recommendation is consistent with the recommendations developed by the National 
Head Star Social Servces Task Force. 
COMMENTS 
We received comments from the Assistant Secretar for HDS. Originally we 
recommended that Head Star set aside funds from the FY 1990 budget to serve 
dysfunctonal famies. The HDS disagreed with this recommendation, stating that a 
policy decision had been made to use additional Head Star funds to serve up to 
95,000 additional children. We recogne that nationally the need for Head Start 
servces is great and that the realities of making a choice between serving additional 
chidren and increasing servces to dysfunctional famlies is difficult. Therefore, we 
Weare 
defer to HDS on this matter and have dropped this recommendation. 
pleased to note that HDS wil give grantees as much flexibilty as possible to target 
and serve -dysfunctional famiies. 
We originaly recommended that HDS consider revising its eligibilty criteria to 
provide greater flexibilty to enroll dysfunctional famies \\th incomes above the 
income eligibilty guidelines. The HDS disagreed, stating that most of its grantees 
had not yet exhausted their current authority to enroll up to 10 percent of their 
- 15 clients from famlies with incomes above the povert income gudelines. The HDS 
further stated that it has prepared a Notice of Proposed Rulemakg (NPRM) which 
would provide greater flexibilty to grantees to enroll dysfuctional famies. 
Although we continue to believe that grantees should have greater flexibilty to 
serve over-income dysfunctional famlies, we agree that the NPRM is a step in the 
right direction, and we have changed our recommendation accordingly. 
appendix. 

The HDS fuly concurred with our recommendation to use its 
discretionar grant 
authority to help dysfunctional famies. Complete HDS comments are in the " '
::j 
,...  ..  ~~.;~ .~
 : . ;j 
Office df 
DEPARTMENT OF HEALTH  ERVICES  . Human Development SerVIces
&. HUMAN 
(F - C' 
, 'i.(. 

IS39 SEP IS  1':  Assistant Secretary 
Washington DC 20201 
PN 
2: 
SE I 
5 1989 
IG  L- 
AIGA 
TO:  Richard P. usserow
Inspect 
General 
ADM ' 
FROM:  Assis ant secretary 
for Human Development Services
 ..v 
I)A
SUBJECT:  Draft Report on -Dysfunctional Families in the He1!ra- d
Start Program: 
Meeting the Challenge,  OAI-09-89-0l000 
Attached are comments on the draft report by the Office of

Inspector General (OIG) on . Dysfunctional 
Families in the Heaa
Start Program: 
Meeting the Challenge, . OAI-09-89-0l000. 
This report is valuable as it captures current impressions on the

nature and prevalence of dysfunctional
 families in Head Start. 

also describes how Head Start programs 
are responding to the

special needs of these families.

I woald like to thank your oftice for the timely completion of

this report. It 
was especially useful that Paul 
Gottlober, Region
IX, Office of Analysis and Inspections, could share the findings

at the recent First National Insti 
tute for Head Start Social 
Services Coordinators. The report' s content 
was most relevant to
the Institute' s attendees. 
Mr. Gottlober will be working with the
Head Start Bureau on further analysis of the OIG report data using

demographic data that the Bead Start Bureau 
 in the

1987- program year. The demographic data ocollnecte d each Head Start
88 
grantee include, for example, the distribution of income among

families served by the program as well as the parents' educational

attainment and employment status. 
These data bases are being

shared to explore relationships between program demographic

information and reported incidence of dysfunctional families. 
nt on this draft report.
We apprectiate the opportunity to comme
am pleaseG with the amount of communication between the Office of

Human Development Services and OIG. 
This communication can assist 
iinn efffecotivrelmy cooarditnaitoing neff.o rtIs  whfic h 
 will  result in useful

you have any questions on the comments on t 
245-3176.
draft report, 
please call Deborah Bass at 

Attachment  COMMENTS OF THE OFFICE OF HUMAN DEVELOPMENT SERVICES 
ON TH 
OFFICE OF INSPECTOR GENERAL' S REPORT, -DYSFUNCTIONAL  FAMILI ES 
IN THE HEAD START PROGRAM: MEETING THE CHALLENGE,

OAI-09-89-0l000 
General Comments

I would like to commend the staff of the Office of Inspector

General (OIG) for the timeliness and quali  report. 
ty of this  The 
report captures current impressions on the nature and prevalence

of dysfunctional families in Head Start. It also describes how

Hfeaamd iSltiaerst.  programs are responding to the special needs of those

Most of the respondents to the OIG felt that Head 
Start was an appropr iate vehicle to serve dysfunctional

families. 
It is noted that the report excluded any information on the

Indian or Migrant Head Start programs. There was no explanation
luded. 
of why these groups were not in  Alcoholism is a major, if
not the leading, problem among the Indian population, yet this

included. In 
group was not  addition, the Indian community has 
had years of experience in dealing with the kinds of problems

that are now characterized as -
any migrant

dysfunctional. -
families are dysfunctional primarily because of the instability

of their lifestyles. It would have been Useful to see how

migrant programs cope with the severe needs of families who face

some of the same problems as families in traditional programs. 
Many of the issues raised in the OIG report will be addressed in

proposed Head Start evaluation projects for fiscal year 1990. 
The Off ice of Human Development Services (OHDS) will be gathering

more specific information on the characteristics of families

served by Head Start and the responses of grantees to those

needs. Particular 
attention will be given to those problems 
rated in your study as most prevalent in dysfunctional families,
i. e., 
substance abuse, child abuse and neglect, domestic
vioience, and inadequate housing.  Page 2

OIG Recommendation 

If additional funds are available for the Head Start program, as

t' s 
proposed in the presiden  1990 budget, a portion of the funds 
should be set aside to address the needs of dysfunctional

families. . 
OHDS Comment

We do not concur with the recommendation. 
In distributing new funds for expansion, our primary objective

will be to ensure that all communities in the country have an

opportuni ty to receive a fair share of Head Start funds that is

proportionate to their population of eligible children. 
However,
although we do not intend to reserve 
funds specifically for

serving dysfunctional families, we will continue to actively

encourage grantees to serve families 
wi th special needs.

Within the framework of the national goal of serving up to 95, 
000
additional children, grantees will be given as  flexibility
much-
as possible to target expansion resources on dysfunctional

families and to design special services to meet their needs. 
In addition, the Head Start Bureau, Administration for Children,

You th and Families (ACYF), has received the report of the Head

Force. 
Start Social Services Task 
That report includes specific
recommendations for allocating social service resources to

address the needs of dysfunctional families. We will incorporate

these recommendations in a plan for better serving the social

service needs of all families, including those described as being

dysfunctional. 
OIG Recommendation #2

Head Start should consider revising its enrollment criteria to

assure that grantees have the flexibility to enroll children of

dysfunctional families even if 
their income is above the poverty

level. . 
OHDS Comment

We do not concur wi 
th the recommendation. 
The Head Start Bureau, ACYF, encourages grantees to consider
multipl 
criteria in filling the ten percent over-
income slots
available in current law and 
regulation.. H9wever, analyses of
 Page 3

1987- program Information Report 
the  88  (PIR) indicate that 54
percent of the programs report that less than fi 
ve percent of the
families served are 
report that more thaonver -nincoimne; eonl y percent of t19h  epire r-cent of the grantees
families are
over-
income guidelines. For most grantees, there is room for
lexibili ty, wi thin existing guidelines, to increase the number

of over-income families served. 
The Administration for Children, Youth and Families 
1305.  is drafting a

revision of 45 CFR Part 
The revision will specify the
recrui tment, selection, 
and enrollment procedures which will
require that each grantee has a formal process for selecting

children from among applicants that considers specific family

needs in addition to income. 
The comment and review process for
this Notice of Proposed Rulemaking will provide us with an

opportuni ty to further consider the question of whether changes

in Head start enrollment pOlicy should be made.

Addi tionally, ACYF will promote grantee responsiveness to
opportunities at the State and local .
levels to extend the Head 
Start model of services to a wider range of 
families. For

example, in Rhode Island, programs are now able to use State

funds to extend services to more of the .working poor. 
The  Head
Start Bureau recognizes 
must increasingly become involved

technical assistance to support the coordination of services 
funding to meet the needs of families.  and
OIG Recommendation #3

Head Start should use its discretionary grant authority to (a)
develop ways of providing better access to community resources,
(b) develop and test new and better approaches for Head Start
grantees to assist dysfunctional 
families, and (c) collect and

disseminate successful strategies and best practices that
grantees are using to meet the needs of dysfunctional families.

OHDS Comment

We concur with the recommendation. 
Head Start' s coordinated discretionary grants authori 
ty has been,
and will increasingly be, directed to enhancing the 
capaci ty of

grantees to effectively serve dysfunctional families and to

promote family self-sufficiency. The 
OIG' s report, feedback from

OHDS Regional Offices, and the Head Start Social Services Task

Force report have all underscored the need for high-quality
resources and technical assistanc

to enable grantees to address 
the needs of dysfunctional families.