U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES

Administration for Children and Families

Administration on Children, Youth and Families

Head Start Bureau

Physically Healthy 

and Ready to Learn

®

National Head Start Training and Technical 

Assistance Resource Center

Technical Assistance Paper No. 1
Physically Healthy and Ready to Learn

Technical Assistance Paper No.1

This document was developed by the National Head Start Training and Technical Assistance Resource

Center (HSNRC) at Pal-Tech, Inc. in collaboration with the Head Start Bureau. The contents of this paper

are not intended to be an interpretation of policy. 

Developed for the Head Start Bureau by the National Head Start Training and Technical Assistance

Resource Center at Pal-Tech, Inc., under contract No. 233-02-0002.

Cover photos: (top) Photo by T. Summers. Mooresville Family Resource Center and (bottom) photo by J. Brough Schamp. SECO HS.
Physically Healthy and

Ready to Learn

Technical Assistance Paper No. 1

TABLE OF CONTENTS

Introduction ......................................................................................................................................3

An Ounce of Prevention: Building a Healthy Foundation for Learning............................5

Making a Determination About Current Health Status ......................................................................5

Let’s Take a Peek: Screening for Developmental, Sensory, and Behavioral Concerns ..........................6

Keeping Kids Healthy: Ongoing Care ........................................................................................8

Establishing Staff and Parent Communication ........................................................................8

Promoting Child Health and Safety ............................................................................................9

Emergencies ......................................................................................................................................10

Injury Prevention ..............................................................................................................................10

Child Abuse and Neglect ..................................................................................................................11

First Aid Kits ....................................................................................................................................13

Short-Term Exclusion and Admittance: Communicable Diseases ......................................................14

Wash Your Hands: Hygiene Procedures ............................................................................................15

Administration, Handling, and Storage of Medication ......................................................................16

Providing Nutrition Services ........................................................................................................17

Family Meal Service ........................................................................................................................17

Child and Adult Care Food Program................................................................................................18

Food Safety and Sanitation ..............................................................................................................18

Nutrition Assessment........................................................................................................................18

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Technical Assistance Paper No. 1 Photo by J. Brough Schamp. SECO Head Start.
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National Head Start Training and Technical Assistance Resource Center

Photo by J. Brough Schamp. SECO Head Start.

Individualizing Health and Education Services........................................................................19

Involving Parents: It’s a Process!..................................................................................................19

Family Partnership Agreement............................................................................................................19

Building Community Partnerships ..............................................................................................20

The Health Services Advisory Committee ..........................................................................................20

Establishing Health Systems..........................................................................................................21

Planning..............................................................................................................................................21

Community Assessment......................................................................................................................21

Record Keeping ..................................................................................................................................23

Reporting Systems ..............................................................................................................................24

Special Issues ....................................................................................................................................24

Establishing a Medical Home and Dental Home ................................................................................24

Oral Health ........................................................................................................................................25

Obesity and Physical Activity ............................................................................................................26

Let’s Celebrate Diversity! Cultural Competence in Health..................................................................28

Conclusion ........................................................................................................................................30

References ..........................................................................................................................................31

Head Start Resources......................................................................................................................33
Physically Healthy and

Ready to Learn

Technical Assistance Paper No. 1

INTRODUCTION

Alejandro Gutierrez and his family recently immigrated to the United States from a small village 

in Mexico to a densely populated urban community. The family does not speak English, nor do 

they have access to close friends or family who can serve as translators. Alejandro and his family 

share an apartment with another immigrant family. One of the adults in the home is a smoker, 

which is a new experience for Alejandro and his family. Prior to moving, Alejandro seemed 

healthy, but his mother has begun noticing that his breathing is accompanied by a stuffy and 

runny nose, coughing, sneezing, and restless sleep. Alejandro’s mother is hesitant to visit a doctor 

because of the language barrier. She tries a few traditional home remedies to make her son 

comfortable, but his difficulty breathing is persistent.

When Alejandro’s mother finds out about the local Head Start program, she enrolls him. The 

health staff immediately suspect his breathing troubles as possible early signs of asthma. They 

refer Alejandro’s parents to a local community clinic that provides services to Spanish-speaking 

immigrants. The doctor at the clinic diagnoses Alejandro with asthma and prescribes the medicine 

he needs for his breathing problem. After Alejandro’s visit to the clinic, his mother notices

immediate improvement in his breathing and sleeping. He seems his usual self again.

Left untreated, Alejandro’s condition would have worsened, possibly leading to costly emergency services.

And saddled with his condition, his overall development might have been impaired. But now that he is

healthy again, Alejandro can get back to learning and growing. Children must be physically healthy to

learn and Head Start helps make that happen. The comprehensive health services provided by Head Start

identify urgent health needs, as in the case of Alejandro Gutierrez, and ensure follow-up treatment as well

as ongoing well-child care. 

Head Start’s overall mission is to help children from low-income families start school ready to learn. To

be ready to learn, young children need to be healthy. But, what is meant by health? The World Health

Organization defines health as “a state of complete physical, mental and social well-being and not merely

the absence of disease or infirmity” (Preamble to the Constitution of the World Health Organization as

adopted by the International Health Conference, 1946). The Head Start Program Performance Standards,

which all programs are required to implement, support and promote this holistic view of health. Head

Start’s commitment to wellness embraces a comprehensive vision of health as the foundation for cognitive,

social, and emotional development for each child. 

Head Start has a long history of providing comprehensive health services to young children and their 

families. Project Head Start began in 1965 as a summer program designed to break the cycle of poverty

for pre-kindergarteners by providing school readiness support. Dr. Robert Cooke, Professor and Chairman

of Pediatrics at Johns Hopkins University, was appointed by the Office of Economic Opportunity to chair

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an advisory committee to establish the framework for Project Head Start. The committee’s final report,

known as the Cooke Report (1965), recommended that a comprehensive early care and education 

program promote optimal physical health, emotional and social development, cognitive development, and

a sense of responsibility, dignity, and self-worth for each child and family. These recommendations have

provided the foundation for Head Start’s comprehensive health care approach with its focus on preventive

health care and parental involvement.

This Technical Assistance Paper offers guidance to programs regarding the implementation of the Head

Start Program Performance Standards on child health and developmental services, child health and safety,

and child nutrition. The paper examines how physical health influences children’s development and how

child health and development are integrated with parent engagement, community support, and systems

planning. The paper also discusses how Head Start programs can promote a culture of healthy lifestyles in

every classroom and home so that young children will embrace lifelong healthy practices. Finally, the

paper explores specific health-related concerns of many Head Start programs, including establishing a

medical and dental home, promoting oral health, addressing obesity and physical activity, and embracing

cultural considerations in health. The paper is divided into these major sections:

z An Ounce of Prevention: Building a Healthy Foundation for Learning

z Keeping Kids Healthy: Ongoing Health Monitoring

z Establishing Staff and Parent Communication

z Promoting Child Health and Safety

z Providing Nutrition Services

z Individualizing Health and Education Services

z Building Community Partnerships

z Establishing Health Systems

z Special Issues

Photo by T. Dickson
AN OUNCE OF PREVENTION:

Building a Healthy Foundation for

Learning

Young children grow, change, and develop quickly.

Therefore, Head Start has only a brief opportunity

to address threats to their health and development

and promote wellness and healthy practices. The

Head Start Program Performance Standards

require that programs provide comprehensive

health services that include a medical evaluation,

dental examination, and a screening for 

developmental, sensory and behavioral concerns.

The Head Start Program Performance Standards

also require that the comprehensive health services 

program be individualized to address the unique

needs of each child and family. 

Results from screenings, information from parents,

and ongoing observations are used to assess the specific health needs of children and families. These

results might also indicate the need to individualize

health services for children with disabilities. In providing comprehensive health services, Head Start

connects children with a medical and dental home

to provide ongoing well-child care including immunizations and appropriate well-child check-ups that

include treatment for medical, behavioral, and oral

health concerns.

The Head Start Program Performance Standards

mandate that Head Start staff collaborate with

families on early identification of health and 

developmental concerns [45 CFR 1304.20]. Head

Start health staff is required to put into action the

critical concepts of prevention and early intervention by connecting families to a medical/dental

home and ongoing care; supporting parent involvement in health care; developing an individualized

health plan; and ensuring tracking and follow-up

health care. Also, Head Start staff implement

other preventive measures such as proper nutrition

and a safe environment. 

The Head Start Program Performance Standards

require a comprehensive health program that

includes these components: 

z a determination of current health status

z screening for developmental, sensory, and 

behavioral concerns

z ongoing health care

z communication between staff and parents

z consideration of health and safety issues

z provision of nutrition services

z provision of individualized health services

MAKING A DETERMINATION ABOUT CURRENT

HEALTH STATUS

The Head Start Program Performance Standards

require that all programs collaborate with parents

to determine if each child in Head Start has an

ongoing, continuous, accessible source of health

care, also known as a medical home or dental

home [45 CFR 1304.20(a)(1)(i-iii & iv)]. To promote healthy development and to ensure optimal

learning, every child needs a medical and dental

home that is available after the child leaves 

Head Start. (Refer to Special Issues section for

more information on a medical home and 

dental home). 

The first step to ensuring comprehensive health

services is to collaborate with families within 90

days from the child’s date of entry into the program to determine if the child has access to ongoing health care. Review local program policy to

determine the timing of entry into a Head Start

Program. If the family does not have an established medical home for both health and dental

services, then the grantee must assist families in

accessing a source of health care [45 CFR

1304.20(a)(1)(i)]. To ensure that children receive

prompt medical and dental evaluation and/or

treatment, Head Start staff assist families to

obtain a source of funding for health services,

such as Medicaid’s Early Periodic Screening,

Diagnostic, and Treatment program (EPSDT). If

funds are not available to families, then Head

Start funds may be used [45 CFR 1304.20(c)(5)]. 

EPSDT service is Medicaid’s comprehensive and

preventive child health program for individuals

under the age of 21. EPSDT includes periodic

health, vision, dental, and hearing screening and

treatment services. Once a medical or dental

home is established, each child visits the health

care provider on a schedule of preventive and primary health care as required in the EPSDT periodicity schedules developed by each state [45 CFR

1304.20(a)(1)(ii)].

Under EPSDT periodicity schedules, health and

dental services must be provided at intervals determined to meet reasonable standards of medical and

dental practice. If children are up-to-date on a

schedule of well-child care, Head Start programs

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ensure that they continue to follow the recommended schedule for well-child care [45 CFR

1304.20(1)(ii)(B)]. If a child is not up-to-date on

well-child care, then Head Start programs assist

the family in accessing health services to bring the

child up-to-date [45 CFR 1304.20(a)(1)(ii)(A)]. It

is possible that children are up-to-date on wellchild care but do not have a continuous source of

available health care. In this case, staff and parents

work together to plan strategies to ensure that the

family acquires a continuous source of care or a

medical home. (Refer to the Special Issues section

for more information on a medical home.)

For children with observable, known, or suspected

health or developmental problems, Head Start programs obtain or arrange for further diagnostic testing, examination, and treatment, which may be

accessed through EPSDT programs [45 CFR

1304.20(a)(1)(iii) & (iv)]. Programs also develop

and implement a follow-up plan for any condition

identified to ensure that any needed treatment has

begun [45 CFR 1304.20(a)(1)(iii) & (iv)]. If a

medical home is in place, then follow-up care can

be initiated without significant delay. 

LET’S TAKE A PEEK: SCREENING FOR

DEVELOPMENTAL, SENSORY, AND BEHAVIORAL

CONCERNS

The screening process allows for early detection of

health and developmental concerns. The Head

Start Program Performance Standards mandate

that within 45 days of a child entering Head Start,

appropriate screening procedures must be conducted to determine if developmental skills (e.g., walking and talking), sensory abilities (hearing and

vision), and behavioral skills (social and 

emotional), are progressing as expected [45 CFR

1304.20(a)(b)(1)]. This screening process must be

carried out in coordination with parents, staff, and

community partners. 

Head Start does not require the use of specific

screening instruments [45 CFR 1304.20(b)

Guidance]. However, the Head Start Program

Performance Standards Guidance specifies that

screenings must be reliable, valid, and comprehensive [45 CFR 1308.6(b)(3)]. Appropriate standardized measures must be used whenever available.

Screenings should be conducted using multiple

sources of information including information from

family and staff observations, child and family medical history, and other information such as EPSDT

reports. Furthermore, screenings must be culturally

sensitive to language and cultural values and must

be age-appropriate. (Refer to the Head Start Bulletin

on Screening and Assessment Issue 2001 No. 70 for

detailed information on screening). 

The three kinds of screenings required are:

Developmental screenings. Developmental screenings provide a composite picture of a child’s developmental status including physical, social, emotional, and intellectual functioning. Acquisition of ageappropriate developmental skills depends, in part,

on a child’s health status. All children grow sequentially through patterned and predictable milestones,

and each child develops at his or her own rate,

which contributes to individuality. If the initial

screening in Head Start uses a standardized measure, a child’s developmental status can be compared

to norms for his/her age. This information can be

used effectively by Head Start parents and staff to

determine how programs can best respond to each

child’s individual characteristics and needs.

EPSDT

Early: Assessing a child's health early in life so

that potential diseases and disabilities can be

prevented or detected in the early stages, when

they can be treated most effectively;

Periodic: Assessing children's health at key

points to assure continued healthy development;

Screening: Using tests and procedures to

determine if children screened have conditions

requiring closer medical or dental attention,

including attention to mental health problems;

Diagnostic: Determining the nature and cause

of conditions identified by screenings and those

requiring further attention; and

Treatment: Providing services needed to control, correct, or reduce physical and mental

health problems.

Head Start, Medicaid, & CHIP: Partners for Healthy

Children. A Guide for Head Start Programs. Administration

for Children and Families and Health Care Finance

Administration, September 1999.
Sensory screenings. Sensory screenings involve

vision and hearing. These screenings can often be

conducted during well-child visits as specified in a

state’s EPSDT program or by licensed professionals

such as an audiologist or ophthalmologist. A

state’s EPSDT periodicity schedule determines

when vision and hearing screenings are appropriate. The American Academy of Ophthalmology

recommends that preschoolers be screened for

common eye problems during their regular pediatric appointments and vision testing should be

conducted for all children starting at around 3

years of age. 

Parents and staff work together to watch for signs

of potential vision problems. Young children with

vision problems usually do not squint, but they

may cover one eye when looking at things close up

or complain about headaches. Often, children who

have difficulty learning may actually have 

undetected vision problems. Preschoolers typically

develop visually guided eye-hand-body coordination, fine motor skills, and the visual motor skills

necessary to learn to read. 

The goal of screening for hearing loss in

preschoolers is to identify children whose hearing

loss may interfere with speech and language

development, overall health and well-being, or

future school performance. In addition, because

hearing loss of preschoolers is so often associated

with middle ear disease or ear infections, it is also

recommended that preschoolers be screened for

middle ear disorders. Frequent or untreated ear

infections also can lead to speech and language

delays. Parents and staff work in partnership to

monitor for symptoms of an ear infection such as

pulling on the ears, drainage, fever, and/or irritability. Some children may pass an initial hearing screening, but still be at risk for hearing loss

that is inherited, fluctuates or is progressive (gets

worse over time), or is manifested later in development. Therefore, it is important to obtain a

family history and to monitor children’s hearing

status on a regular basis.

Behavioral screenings. Behavioral screenings

focus on social-emotional development. Head

Start staff and families look for signs of increasing

self-regulation, self-help, and self-control in young

children as well as positive interactions with family

and peers. This information on social-emotional

functioning can be incorporated into the behavioral screening. When concerns are raised as a

result of the behavioral screening, programs

should consult with a mental health provider to

address a child’s identified mental health needs [45

CRF 1304.20(b)(2)]. Most importantly, Head Start

staff, families and mental health providers work

together to identify early signs of emotional and

behavioral concerns. If necessary, a mental health

provider will develop an appropriate treatment

plan for children and families. 

Head Start programs assess the availability of mental health resources for families in need and promote successful partnerships with families/caregivers, community support systems and local

resources. Head Start programs also support 

family/caregiver strengths and cultural values and

beliefs about mental health. 

Screenings do not determine a diagnosis or need

for early intervention services. However, the

results may suggest the need for an in-depth formal evaluation by a professional [45 CFR

1304.20(b) Guidance]. The formal evaluation

more fully assesses the child’s status and determines what intervention may be needed (e.g., special education or related services). (Refer to the

Head Start Bulletin on Screening and Assessment

Issue 2001 No. 70).

It is important to note that programs may find it

challenging to complete all screenings within the

required 45 days. Some strategies to help facilitate

the screening process include:

z conducting pre-enrollment meetings for parents

to inform them about necessary screenings and 

to help them identify providers to conduct the 

screening; 

z communicating with parents about the 

importance of maintaining an individual child

health record to reduce duplication of services;

z establishing relationships with local health care

providers who understand and support Head 

Start’s requirements for timely screening and 

assessment;

z developing collaborations with colleges and 

universities with professional schools so that 

students in nutrition, nursing, speech pathology, 

audiology, and other allied health fields can help

with screenings; and

z empowering parents to be peer advocates for

health care services.

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In completing a daily health check, observe

or learn through discussion with home

caregivers whether any signs of illness 

are present such as:

z elevated temperature, pale or flushed coloring

z repeated severe coughing

z stomach ache, vomiting and/or diarrhea

z red and/or draining eyes or ears

z undiagnosed skin rashes, sores, bruises, 

and/or swellings

z unusual activity levels such as irritability or 

fussy listless behavior

In addition, staff can be alert to signs of:

z tooth discoloration or bleeding gums during tooth 

brushing activities

z signs of injury such as bruising or 

abnormal swelling

z abnormal emotional or behavioral patterns 

different from the previous day's attendance 

(i.e., timid, fearful, or aggressive behavior)

z unusual changes in eating, sleeping, and 

toileting patterns

z unusual changes in physical activity 

such as frequent falling

z lack of response to verbal commands

z decreased talking

(American Academy of Pediatrics 2002)

Screenings are not one-time events. To ensure 

positive outcomes for preschoolers served in Head

Start, it is essential to identify concerns early, keeping in mind that problems may be identified anytime during the program year. If a child is suspected of having a health concern after the initial

screening period has passed, a referral must be

made for a formal evaluation.

KEEPING KIDS HEALTHY: 

Ongoing Health Monitoring

In a quality early care and education program,

ongoing assessment is the basis for individualizing

all services. That is why it is important for staff to

periodically observe, document, and record children’s progress and to discuss with parents what

they notice about their child’s development. Head

Start Program Performance Standard [45 CFR

1304.20(d)] mandates that programs implement

procedures by which Head Start children are

observed throughout the day as they participate in

indoor and outdoor experiences, routines, transitions, arrivals, and departures. These observations

help staff to identify any new or recurring medical,

dental, or developmental concerns so that appropriate referrals can be made as soon as possible. 

As part of ongoing health monitoring, daily health

checks of each child can be conducted at the beginning of each day. If a parent or guardian accompanies the child to Head Start, then they can

exchange information with staff and specific signs

or symptoms of illness can be identified in time to

prevent the spread of infection. Staff are not

expected to be able to diagnose illness, but be sensitive to a child’s condition. On occasion, this

health check may lead to a decision that the child is

not well enough to attend Head Start. In those

instances, appropriate action is taken (e.g., isolate

the child from other children) until a parent can

come to take the child home or to the primary

medical provider. (Refer to page 14 for more information on Short-Term Exclusion and Admittance.) 

It is important that parents and staff form strong

partnerships in order to promote the child’s health

and to address health concerns. Strong partnerships enable staff and parents to maintain an open

line of communication regarding the ongoing

health status of children in order to protect all 

children and staff from illness and to respond to

children’s health needs.

ESTABLISHING STAFF AND PARENT

COMMUNICATION 

The Head Start Program Performance Standards

mandate that programs establish and implement

communication systems to ensure that timely and

accurate information is provided to parents, policy

groups, staff, and the general community [45 CFR

1304.20(e)(1-5)]. A key responsibility of health
staff is the exchange of health information. Health

staff may be talking with parents about their

child’s health needs, working with family service

staff about how to collect sensitive health 

information from families, or negotiating with a

community resource to provide health services to

Head Start children and families. 

A communication system may seem easy to 

implement because we are often in touch with people—either on the phone, catching up with a coworker in the hall, sending an e-mail, or writing

notes. A good tip is to consider whether 

communication is clear and whether the 

information supports efficient management of

health services and addresses family needs.

In order to develop or improve a communication

system, it is important to consider the audience; tailor each message accordingly; use various communication styles (i.e., formal or informal); and consider

the language and culture of the listener. 

A system for effective communication may include:

z communication that is culturally sensitive and

considers literacy levels;

z oral and written communication in the native

language of the child and family using an 

interpreter whenever necessary;

z ongoing communication with parents regarding

follow-up that addresses identified health needs;

z home visits when sensitive information needs to

be discussed;

z sharing the health services plan with policy 

groups and parent committees as part of an 

open exchange of ideas;

z daily or weekly notes sent home to families in 

their native languages as well as a general 

newsletter; and

z orientation activities held at the beginning of

the year for families, staff, and community 

partners.

Head Start respects families in their role as primary

caregiver. One way to demonstrate respect is to

provide information—written and/or oral—in the

families’ primary preferred language and in a way

that is culturally sensitive. A culturally sensitive

communication system ensures the exchange of

information that allows families and professionals

to become fully involved in program services; for

example, translating health-related terminology in

a way that is understandable is a critical task,

because families have the responsibility for their

children’s health and well-being (Refer to Special

Issues section on Cultural Considerations.) 

Consider the following ideas and sources for 

assistance in providing communication in the 

parents’ language:

z train staff and/or parents who can serve as 

interpreters on health issues;

z contact local community organizations, such as 

refugee or immigrant agencies or ethnic 

associations for assistance and possible 

interpretation services; and

z partner with community colleges or universities 

for ideas about communicating with multicultural populations and to obtain 

interpretation services.

Establishing a communication system that supports

the unique needs of families and respects their 

cultural diversity will ensure that Head Start 

programs provide the best possible health care for

all children. 

PROMOTING CHILD HEALTH 

AND SAFETY

A primary right of every child in Head Start is to

learn in a healthy and safe environment. Head

Start Program Performance Standard [45 CFR

1304.22 (a-f)] mandates that programs establish

health and safety policies and procedures for:

z preventing injuries on-site

z notifying parents in case of an emergency

z handling suspected cases of child abuse 

and neglect

z dealing with communicable diseases

z promoting hygiene

z administering medication

Creating and maintaining a safe environment for

children is a task that requires thoughtful planning

and careful implementation. The Head Start 

management team, the Policy Council, and the

Parent Committee, as well as the agency’s Board,

have important roles in assuring that sound policies are in place. The Health Services Advisory

Committee (HSAC) supports the development of

policies and procedures that ensure children’s

health and safety. Finally, community partnerships

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National Head Start Training and Technical Assistance Resource Center

can provide valuable guidance on effective policies

to prevent and manage emergencies. 

It is essential that every Head Start staff member

and volunteer receive ongoing training on safety

policies and procedures to effectively implement

day-to-day health and safety practices. 

EMERGENCIES

The medical aspect of caring for children is likely

to be the area of care for which classroom staff are

least prepared, as their training is usually in early

childhood education. However, all Head Start 

programs establish written procedures to respond

to routine, urgent, or emergency medical needs [45

CFR 1304.22(a)]. Procedures include rapid

response emergencies, telephone numbers of 

emergency response teams, evacuation routes, and

contact information to notify parents. Head Start

programs institute clear, easy-to-follow procedures

and ensure that everyone is up-to-date and trained

on effective health and safety practices. 

Head Start staff understands what emergencies

young children may have, but it is useful to

involve other professionals, such as police and

firemen, when developing emergency procedures.

They can be a strong network of support. It is

likely that there are emergency policies in place in

Head Start agencies, but agencies routinely review

and update them and ensure that staff are trained

and prepared.

INJURY PREVENTION

Preventing childhood injuries is a common concern

for Head Start staff, parents, and the community.

Injuries are not always emergencies, but staff and

volunteers can ensure that safety practices are

maintained [45 CFR 1304.22(d)(1)(2)]. Children

learn by exploring the environment, which can

expose them to situations where injuries may

occur. The playground is one environment where

children may hurt themselves. Playground equipment and activities should be developmentally

appropriate and offer interactive experiences. 

Head Start staff ensure that drinking water is nearby to prevent dehydration, and that first aid kits

are near the play area or close at hand to make it

easier for staff to access them quickly when 

needed. Impact-absorbing materials on playgrounds reduce the chance of serious injury. 

General health and safety practices may include,

but are not limited to:

z Medication administration and storage

z Admission and readmission after illness, including 

inclusion/exclusion criteria

z Health evaluation procedures on intake, including 

physical assessment of the child and other criteria used 

to determine the appropriateness of a child's attendance

z Managing children with communicable diseases

z Injury prevention and managing children with injuries

z Tracking communicable illnesses and problems that 

arise in the care of children with communicable illnesses;

z Head Start staff, parent, and volunteer training on 

illness and injury prevention

z Communication with parents and health care providers 

in the event of illness or injury

z Practices for emergencies that require medical care 

within an hour

(American Academy of Pediatrics 2002)

Health and safety policies and procedures should 

include information on:

z Medical and dental emergencies

z Rapid response emergencies (e.g., a child choking)

z Conditions of short-term exclusion and admittance

z Medication administration and storage procedures

z Contacting parents in the event of an emergency

z Record-keeping and reporting

z Staff training on health practices

z Hygiene practices

z First aid kits

z Contacting the Poison Control Center at 800-222-1222

(American Academy of Pediatrics 2002)
Any exposed dirt is be free of toxins, including

lead. Head Start staff visually observe playing children at all times. 

Childhood injuries can be prevented in Head Start,

in the home, and in the community when programs

maintain safe environments and promote safe

behaviors for children and adults. Children safely

explore their environment if programs maintain:

z a safe learning environment by closely 

supervising young children (teaching, 

monitoring, and enforcing safe behaviors for

children and providing developmentally 

appropriate experiences and materials);

z a safe indoor environment created by 

maintaining a physical space that is not 

cluttered where children and adults can 

move about the room freely (toys that are 

developmentally appropriate and non-toxic 

enhance safety);

z an appropriate outdoor space in accordance 

with the Head Start Program Performance 

Standards [45 CFR 1304.53(a)(9)] designed to

support the developmental progress of all 

children and to prevent injuries; and

z an emotionally safe environment by 

communicating in a respectful manner 

and using appropriate body 

language [45 CFR 1304.53].

CHILD ABUSE AND NEGLECT

All Head Start programs have procedures in place

to support staff when dealing with suspected or

known cases of child abuse and neglect. (Refer to

Head Start Program Performance Standard

1304.22(a)(5) and Appendix A to 1301.31,

Identification and Reporting of Child Abuse and

Neglect, for detailed definitions and procedures.)

Child abuse is considered an emergency, so it is

essential to intervene in any suspected case of

abuse and neglect, both for the safety of the child

and for the wellness of the family. Federal, state,

and tribal laws also require educators and caretakers to report all suspected cases of abuse and neglect. Laws about when and to whom to report

vary by state, but failure to report abuse is a crime

in all states and may lead to legal penalties. 

As Head Start agencies formulate and implement

their policies for dealing with child abuse and neglect, they can consider the guidelines in the box on

the following page.

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Photo by J. Brough Schamp. SECO Head Start.
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National Head Start Training and Technical Assistance Resource Center

Steps to consider as you develop and implement policies for 

child abuse and neglect:

INVOLVE THE HSAC, GOVERNING BOARD, AND POLICY COUNCIL when developing policies and procedures for reporting suspected cases of child abuse and/or neglect.

ESTABLISH PARTNERSHIPS with physicians, child psychiatrists, nurses, nurse practitioners, and child

protective services who are knowledgeable about child abuse and neglect. Many mistakes in reporting can be avoided by working with an experienced consultant before deciding what to do.

However, when the level of suspicion is high, consultation with an outside expert may be unnecessary.

UNDERSTAND FEDERAL, STATE, LOCAL, AND TRIBAL REGULATIONS for reporting 

suspected child abuse and/or neglect.

z The facility shall report to the Department of Social Services, child protective services, or

police (as required by state and local laws) in any instance where there is reasonable cause 

to believe that child abuse, neglect, or exploitation may have occurred.

PROVIDE STAFF AND VOLUNTEER ORIENTATION AND TRAINING on identififying and 

reporting child abuse and neglect. Staff training may include:

z Information about child abuse reporting procedures that contains a summary of the state 

and/or tribal child abuse reporting regulations;

z Information on state, local, and/or tribal laws governing immunity from legal penalties and 

how reporting suspected child abuse can affect employment status;

z Proper protocol for reporting suspected abuse and/or neglect in the case of suspected 

caregiver abuse or abuse from a Head Start staff member or volunteer;

z Increased awareness of common signs and symptoms of child abuse (i.e., physical abuse,

emotional abuse, and sexual abuse) and/or neglect (i.e., failure to provide basic life 

necessities such as food, clothing, a safe environment, or shelter).

z What procedures staff and volunteers must follow to request time off if they feel too 

stressed to work with children; and

z Educating staff and volunteers to be helpful rather than punitive towards abusing or 

neglecting parents and other caregivers.

REGULARLY ORIENT AND TRAIN PARENTS on child abuse and/or neglect policies 

and procedures. 

z Training for parents should be conducted in a sensitive manner by helping parents to 

understand that child abuse laws are designed to protect children and families;

z Define the terms of child abuse and neglect for parents and what standards Head Start 

uses in determining suspected child abuse and/or neglect

z Offer orientations for parents on the need to prevent abuse and neglect;

z Explain what parents can do to alleviate stress at home when they need a break from the 

children;

z Offer information on state, local, and/or tribal laws that mandate facilities to report 

suspected child abuse and/or neglect.

(Adapted from the Head Start Performance Standard 1304.22(a)(5) and related Guidance) 

(Also refer to Appendix A to 1301.31, Identification and Reporting of Child Abuse and Neglect)
FIRST AID KITS

In order to respond to the minor injuries children

incur while at Head Start, staff have access to a

first aid kit that can be used when children are on

the playground or in the center, going on a field

trip, or being transported to and from their home.

Head Start Program Performance Standards

require that inventories must be taken regularly

and kits should be replenished frequently [45 CFR

1304.22(f)(1)(2)].

Consider the following suggestions as you prepare

first aid kits:

z Be sure that the supplies in the first aid kit are

age appropriate.

z Be sure that there are enough supplies. 

z Assign a staff person to check the supplies and 

re-stock as necessary.

z Develop a checklist of inventory.

z Monitor expiration dates.

z Train staff to use the first aid kits.

The American Red Cross has compiled an

approved list of supplies to include in a first aid

kit. The HSAC also can recommend materials for

the kit. For example, the American Academy of

Pediactrics no longer recommends syrup of Ipecac

for home use, but the HSAC may have specific

program recommendations. Review local program

policies and state laws to determine any other specific requirements for a first aid kit. 

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Technical Assistance Paper No. 1

INVENTORY OF EACH FIRST AID KIT 

First aid kits should contain at least 

the following:

 Vinyl disposable gloves (remember, some 

children can be allergic to latex)

 Sealed packages of antiseptics for cleaning

 Scissors and tweezers

 Digital thermometer (be sure to check 

batteries often)

 Packaged swabs or cotton

 Bandage tape, various types of gauze and 

bandages

 Universal phone number for 

Poison Control Center: 

800-222-1222

The American National 

Red Cross

Photo by D. Drake. North Wyoming Community Action Program MSHS.
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National Head Start Training and Technical Assistance Resource Center

Illnesses that may require temporary

exclusion may include:

z Persistent fever

z Persistent or increased lethargy

z Persistent fever accompanied by a stiff neck, 

lethargy, irritability, crying

z Diarrhea

z Signs of dehydration

z Blood or mucus in the stool

z Persistent vomiting

z Contagious stages of communicable diseases

such as measles, mumps, chickenpox, rubella

z Untreated infestation of scabies, head lice, or

ring worm

z Untreated tuberculosis

z Undiagnosed rash

z Difficulty in breathing

z Undiagnosed jaundice

z Other conditions as determined by the 

director or health manager

(American Academy of Pediatrics 2002)

TECHNIQUES TO STOP THE SPREAD OF DISEASE

z Staff, families, and children must wash hands.Hand washing and cleanliness are critical to stop

the spread of infectious respiratory, intestinal tract, and skin diseases. 

z Ensure that all children receive age appropriate immunizations.

z Wear latex or vinyl gloves whenever contact with bodily fluids (e.g., blood, mucous, or

saliva) occurs. Be sure that the child does not have an allergy to latex.

z Do not allow food to be shared.

z Clean and disinfect toys and used surfaces with a bleach solution.

z Use disposable eating utensils and cups whenever possible. Wash eating utensils in a 

dishwasher or with hot soapy water when necessary.

z Use disposable towels and tissues and dispose in a step can with a trash can liner.

z Clean and cover broken skin promptly.

z Open windows and air out classrooms often.

z Each child must have a personal mat or crib and other personal items such as combs 

and blankets. Do not allow sharing.

z Notify parents when children have been exposed to communicable diseases.

(American Academy of Pediatrics 2002)

SHORT-TERM EXCLUSION AND ADMITTANCE:

COMMUNICABLE DISEASES

As an inclusive program, Head Start works diligently to accommodate the needs of children who

will benefit from participating in the program.

Other preschool programs may exclude children

who are not potty-trained or who need special

attention because of a chronic condition, but Head

Start does not. Children can not be excluded from

Head Start programs for chronic long-term illnesses, such as HIV or asthma [45 CFR

1304.22(b)(2)]. Every effort should be made to

accommodate children unless their attendance

poses a significant and serious threat to children

and staff.

However, at times children must be excluded for

health reasons such as a short-term contagious illness [45 CFR 1304.22 (b)(1)]. A significant problem for parents may result when there is an unexpected day that their child cannot attend Head

Start. Therefore, exclusion due to illness can be a

difficult policy to implement, but there are times

when a child needs to be cared for at home. 

The challenge in this inclusive environment is

two-fold:

z Are exclusion policies maximally inclusive?

z Do staff and parents support necessary 

exclusion policies?

With guidance from the HSAC, agencies are

assured that any exclusion policy is well-thought

out and decisions to exclude children are reasonable. Children can be readmitted when appropriate criteria are met.
WASH YOUR HANDS: HYGIENE PROCEDURES

Communicable illnesses are the bane of early childhood programs because young children often pass

illnesses to others. Handwashing is the most effective way to reduce the spread of infectious disease;

Head Start programs are required to maintain

effective handwashing practices for adults and children [45 CFR 1304.22 (e)(1)(2)]. 

Hygiene procedures should include developing

handwashing policies, posting handwashing

instructions in appropriate locations, and training

staff to stop the spread of disease. 

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Technical Assistance Paper No. 1

Photo by J. Brough Schamp. SECO Head Start.

When to wash your hands

z Handwashing must occur upon arrival for the

day or when moving from one child care

group to another;

z Handwashing must occur before and after

 eating, handling food, or feeding a 

child

 giving medication

 playing in water that is used by more

than one person

z Handwashing must occur after

 diapering

 using the toilet or helping a child use

a toilet

 handling bodily fluids (e.g., mucus, 

blood, vomit) from sneezing, wiping 

and blowing noses, from mouths, or 

from sores

 handling uncooked food, especially

raw meat and poultry

 handling pets and other animals

 playing in sandboxes

 playing on the playground

 cleaning or handling the garbage

(American Academy of Pediatrics 2002) 

HANDWASHING INSTRUCTIONS

 Use water no less than 60 degrees F and no

more than120 degrees F, finding a comfortable temperature.

 Moisten hands and apply liquid soap (antibacterial soap is not required).

 Rub hands together vigorously until a 

soapy lather appears and continue for at 

least 10 seconds. 

 Rub areas between fingers and around 

fingernails, jewelry, and back of hands.

 Rinse hands under running water until 

they are free of soap and dirt. Leave 

the water running while drying hands.

 Dry hands with a clean, disposable paper 

or single use towel.

 Turn faucets off with a disposable paper 

or single-use cloth towel if faucets do not 

shut off automatically.

 Dispose of paper towel in a lined trash can.

 Lotion may be used to prevent drying

and chapping.

Adapted from USDA-FDA Foodborne Illness

Education Information Center,

http://www.nal.usda.gov/foodborne/
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National Head Start Training and Technical Assistance Resource Center

There are FIVE RIGHTS that must be respected when giving medications to a child:

1. THE RIGHT CHILD: Double check that you have the right child when administering 

the medication.

2. THE RIGHT MEDICINE: Check that the medicine’s name on the label/prescription matches the child 

actually receiving the medication.

3. THE RIGHT DOSE: Read and understand the prescription directions for dosage. Also, 

understand other circumstances relative to administration (such as with or without meals).

4. THE RIGHT ROUTE: Read and understand the prescribed method to administer the medication.

5. THE RIGHT TIME: Read and understand the prescription directions for frequency.

National Resource Center for Health and Safety in Child Care: http://nrc.uchsc.edu/

Additional safety steps to consider:

z Have the written health care provider's order, the 

pharmacy-labeled bottle, and the parent's written

request BEFORE giving the first dose. Make sure 

all three documents are consistent.

z Keep the medicine at the facility under lock and key 

and refrigerate when necessary. When medication 

is sent back and forth from home to the center, there 

is an increased risk of missed doses, lost medicine, 

unsafe storage, and other children accidentally 

taking the drug. Most pharmacies will "split" the 

prescription at no extra charge if parents ask.

z Each child reacts uniquely to each medication. In 

addition to prescriptions from their health care 

provider, families may independently purchase 

many medicines, herbs, vitamins, and home

remedies. Since these all affect the body and may 

interact with each other, they must ALL be considered

medications in Head Start.

z Head Start staff document all medications 

administered.

CFR 45 1304.22(C)(1-6)

ADMINISTRATION, HANDLING, AND STORAGE OF

MEDICATION

The proper use of medication can make an 

enormous difference in a child’s overall health and 

participation in Head Start. Head Start staff are

aware of what medication a child is receiving at

home, who prescribed the medicine and when, and

the known reactions or side effects [45 CFR

1304.22(c)(5)]. All Head Start programs have

policies and procedures in place to ensure the safe

storage, handling, and administration of 

medication [45 CFR 1304.22(c)(1-6)]. 

Managing medication can be complicated because

proper dosage, timing, and careful observation of

any effects of the medication are important. There

are state regulations and guidelines for child care 

settings that address safe administration of 

medications including prescription medicines, as

well as medications purchased over-the-counter.

The HSAC establishes policies and procedures for

administering over-the-counter drugs.

The first step in managing medication is to 

determine who may administer it [45 CFR

1304.22(c)(2). The nurse practice acts in each state

define who is qualified to administer medications in

child care settings and programs must be aware of

and adhere to these regulations. Any Head Start

staff member who administers medication receives

appropriate training to promote safety. The training

is usually provided by a nurse. Head Start staff are

familiar with the actions of medications, administration, dosages, measurement, documentation, and

the specific policies of the Head Start program.

Assigning specific staff to medication administration increases accuracy and safety. 

The challenges of medication administration highlight the urgent need to connect families with medical homes. A medical home will include a practitioner who can work with parents and staff to

ensure that medication is administered, labeled,

and properly stored. 
PROVIDING NUTRITION SERVICES

Healthy nutrition is fundamental to a child’s healthy

development and positive outcomes even before the

child is born. Head Start promotes wellness, growth,

and development by encouraging and supporting

healthy eating habits through comprehensive nutrition services. These services include family style

meal service, safe food preparation practices, assessing nutritional needs of children, and ensuring balanced diets [45 CFR 1304.23(b)(1)]. Many of the

children in Head Start programs face challenges getting enough food or getting healthy food to eat.

When a family’s meal patterns are erratic, or the

food is not health-promoting, or there is insecurity

about the availability of food, many aspects of a

child’s life are affected negatively. 

It is important for staff to have a clear understanding of the role good nutrition plays in growth and

learning and how healthy and positive eating experiences contribute to social, emotional, and cognitive development. Head Start is also committed to

helping parents promote their children’s health.

This will involve teaching their children lifelong

healthy eating habits [45 CFR 1304.23(b)(3)], providing healthy food on a limited budget, and

encouraging learning about new foods while

respecting cultural, familial, or personal food preferences. Head Start families come from many different cultures and each Head Start program builds

its food services with attention to this diversity. 

FAMILY MEAL SERVICE

The Head Start requirement for family-style meal

service is very important. When children eat

healthy foods in a nurturing and

relaxed environment, such as a

Head Start classroom, there

are many benefits. Their sense

of security, their social skills,

and their language are developing. Children also have the

opportunity to try new foods

and to learn how to be

involved in food preparation

and clean-up [45 CFR

1304.23(c)]. It is important to

work with teaching staff to

assure that good nutrition is

taught as well as provided and

that meal and snack times are

enjoyable and positive.

The adults in the program can learn a great deal

about children by eating with them. Mealtime is

an opportunity for sharing stories of the day in a

pleasant atmosphere. Food is not used as reward

or punishment, and experimentation with new

foods is encouraged, but not forced [45 CFR

1304.23(c)(2) and Guidance].

Staff collaborate to plan program meal services,

making sure the physical layout of the classroom is

conducive to pleasant meal times. Head Start programs allow teachers to inquire about any concerns or questions they may have. Some programs

have struggled with embracing the family-style

meal philosophy, particularly those agencies that

contract with an outside vendor or are located

within a school system. 

The reality is that some children being served in

Head Start have very few opportunities to talk

with adults at meal time. Many parents are working or going to school, and meals are often on the

run. Yet, whenever possible, it is beneficial to sit

down together and share a meal as a family. Head

Start staff encourage families to be creative. Head

Start staff also brainstorm ways to facilitate conversations between adults and children. 

Encouraging adults to talk with children about the

kinds of food on the table or to try a new food

together will promote social relationships as well

as teach healthy nutrition. Parents may be surprised about how many “teachable moments”

occur at mealtimes. For example, the shapes and

sizes of food or steps in food preparation are interesting topics for preschoolers and parents to discuss together. 

To ensure successful nutritional

services, Head Start programs

are aware of any behavior or

comments among staff and parent volunteers, such as discussions about weight, which could

send negative messages to children. It is useful to educate staff

and families about food variety,

especially fruits and vegetables,

and about the healthy food

choices made by different cultural groups. 

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Technical Assistance Paper No. 1

Eating family-style is not about

having child-sized 

utensils! It is a concept that

every agency can embrace. 

It is about providing opportunities for children to have meaningful conversations with

adults at meal times 

and to develop social 

relationships. Family-style

means that adults sit with the

children and eat with them.
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National Head Start Training and Technical Assistance Resource Center

CHILD AND ADULT CARE FOOD PROGRAM (CACFP)

In accordance with the USDA and the CACFP, the

Head Start Program Performance Standards are

specific in requiring Head Start programs to provide a nutrition program that meets the nutritional

needs and feeding requirements of each child,

including those with special dietary needs and

children with disabilities [45 CFR 1304.23(b)(1)].

Children who are enrolled in part-day Head Start

are provided with at least a third of their daily

nutritional needs, and children in full-day programs receive one-half to two-thirds of their daily

nutritional needs, depending upon the length of

the program day [45 CFR 1304.23(b)(1)(ii)].

Home-based programs work with families to

assure adequate nutrition for their children and

encourage socialization around mealtimes,

whether these times occur in the home or in group

Head Start activities. 

The Child and Adult Care Food Program (CACFP)

from the United States Department of Agriculture

(USDA) recommends appropriate serving sizes for

all ages. Food served in Head Start programs

adheres to accepted dietary guidelines from the 

USDA. Yet there is a great deal of flexibility in the

choice of foods within these guidelines [45 CFR

1304.23(b)(1)(i)].

FOOD SAFETY AND SANITATION

Safe food preparation, handling, and storage are

critical in preventing illness. The Head Start

Program Performance Standards offer clear guidelines for food safety, in conjunction with food safety rules and regulations of local areas, states and

tribal organizations [45 CFR 1304.23 (e)(1)]. It is

important that agencies are familiar with the laws

in their communities and ensure that their facilities

are in compliance with all applicable food safety

laws, including those related to the storage, preparation, and health of food handlers. 

Agencies that contract with outside food vendors

also receive regular reports on safety and sanitation related to food handling to ensure that food

service contractors have met all required regulations. Staff and volunteers, including the teaching

teams who eat family-style with the children, are

trained about food safety and sanitation. In

order to maintain standards of food safety, agencies conduct self-inspections on a quarterly basis

and ensure that any necessary corrections are

made accordingly. 

NUTRITION ASSESSMENT

The first step in planning a nutrition program is to

understand the needs of the families and children

being served. In identifying their nutritional

needs, staff consider all available information

from the review of health records, family interviews, and health screenings [45 CFR

1304.23(a)(1)(2)(3)]. Many Head Start families

may be current or former participants in the

Women, Infants, and Children (WIC) program

whose services include follow-up on weight gain

and eating patterns. This information also will be

useful in making nutrition plans.

Food Safety Tips

z Wash hands before and after

handling food.

z Keep all food preparation 

surfaces clean.

z Keep raw meat separate from other foods at 

all times.

z Refrigerate food promptly.

z Cook all food thoroughly.

Photo by J. Brough Schamp. SECO Head Start.
In conversations with the parents, staff will be able

to learn a great deal about each child’s health and

food preferences, as well as cultural considerations.

Often it is the health aides or family service workers who have these conversations with parents. It

is vital that they share this information with other

staff such as the teaching team. However, it is

important to consider the information received

from parents about individual children in light of

the overall picture of nutrition (and health) of the

community. Head Start staff analyze all nutritionrelated data from all sources to ensure nutritional

needs are identified comprehensively. For example:

Is lead paint an issue in the homes? What are the

lifestyles of the families in the community – do

they prepare meals at home or rely on fast foods?

Are there safe playgrounds or parks in the neighborhood where families can be active? How does

culture influence food choices? Answering these

and related questions offers insight into the nutritional needs of the children. 

Written records about health matters are useful,

but some nutritional challenges (such as obesity)

are very complex. Written records may not convey

family, cultural, or community issues that contribute to a challenging situation. Therefore, other

kinds of information may prove useful. For example, Head Start health staff can plan to be present

in the center during socialization time or in the

family child care home during meal time when the

children can be observed. Head Start staff observe

carefully to notice positive eating behaviors, preferences and potential problems. Head Start staff talk

with the team who work with the children and discuss any problems of overeating, poor appetite,

food with poor nutritional value, or stress around

mealtime. Even if one can not have direct contact

with Head Start families and children, it is important to obtain information from other sources in

order to plan the nutritional services. Head Start

staff also respect cultural backgrounds that influence food preferences.

INDIVIDUALIZING HEALTH AND

EDUCATION SERVICES

One of Head Start’s core principles is to individualize health and education services for all children

[45 CFR 1304.20(f)(1)(2)(i-iv)] because each child

has an individual pattern of growth, development,

and unique health needs. Head Start programs use

the results of screenings, observations (e.g., daily

health checks), evaluations, information from

health care providers and parent interviews to individualize health services for children and families.

Specifically, the status of each child’s individual

health, nutrition, oral health, safety and mental

health can be improved significantly when services

are tailored to meet their unique needs. For example, program experiences can be tailored, the curriculum adapted, and the physical environment

modified to support each unique health and educational need. Individualizing can make a dramatic

difference in learning and in outcomes across all

developmental domains.

All Head Start programs collect health information when a child enrolls. When reviewing this

information, program staff may notice that there

is a prevalent health problem in the community.

This may require some changes in program policies and procedures, and it may require specific

staff and parent education efforts. For example,

there may be concerns in the community about

the prevalence of asthma coupled with awareness

of high levels of family smoking. Staff can

address these topics in an educational session

with parents and other community members.

INVOLVING PARENTS: It’s a Process!

Strong and effective partnerships with parents are

the key to fully implementing the Head Start

Program Performance Standards related to health

[45 CFR 1304.40(f-h)(1-4)(i)]. It is Head Start’s

role to promote healthy development by supporting parents to become educated health care consumers as well as their child’s advocate with

schools and in the community.

FAMILY PARTNERSHIP AGREEMENT (FPA)

All families in Head Start go through a process of

identifying family strengths and needs and deciding

what support they need in pursuing their goals.

The Family Partnership Agreement (FPA) process is

individualized, strengths-based, family-driven, and

staff supported. Each family in the program determines the strategies, responsibilities, and timetables

included in their FPA. As a part of the family partnership process, the health staff work with parents

to identify their health needs and help them access

health-related services and resources in the community [45 CFR 1304.40(a)(2)(3)].

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National Head Start Training and Technical Assistance Resource Center

The FPA process also may entail building upon

pre-existing family plans from other community

agencies. A new plan is not necessary. Make sure

that additional responsibilities are not placed on

the family. Rather, strategies are to be developed

with the other agencies to ensure that services are

received, that information is shared appropriately

with confidentiality maintained, and that the roles

of each agency are clearly defined. 

Head Start programs enable parents to access

services that meet their specific needs and interests by developing a system of referrals and community connections, including access to emergency or crisis resources, educational or counseling programs that address mental health needs

and issues such as substance abuse, child abuse

and neglect, and domestic violence. This referral

system becomes part of a larger effort among program staff and parents to provide user-friendly

community resource information. 

It is essential to have a feedback loop in this system.

Parents who access services are asked if those services meet the needs of their family and are quality

services. Parents report on language and cultural

sensitivity and on the overall timeliness of the provided services. This information from parents is used

to update the list of local service providers. If gaps

or inadequacies in service are identified by parents,

Head Start staff work to improve the service delivery of these providers and, if necessary, cultivate

relationships with other providers.

BUILDING COMMUNITY 

PARTNERSHIPS

THE HEALTH SERVICES ADVISORY COMMITTEE

The Head Start Program Performance Standards

require that every Head Start program form and

maintain a Health Services Advisory Committee

(HSAC) to advise in the planning, operation, and

evaluation of health services in Head Start and

Early Head Start programs [45 CFR 1304.41(B)].

The HSAC links Head Start programs to essential

persons, organizations, and resources within the

community. The HSAC plays an important role in

ensuring that Head Start children have medical and

dental homes that will remain in place after they

leave the program. The HSAC also plays an integral part in the development of health policies and

procedures for Head Start programs. This committee is unique in Head Start programs because it is

an internal resource: It helps programs look carefully at how high quality health services can be

provided for families. It also is an external

resource: It allows programs to draw on resources

in the greater community to meet the needs of

Head Start families.

The committee is formed on a voluntary basis and

composed of Head Start parents and staff, health

and human services professionals, and other community volunteers who are representative of the

cultural and linguistic groups served by the local

Head Start program. The Head Start Program

Performance Standards do not specify who or how

many should serve on the committee. Rather, each

Head Start program determines committee membership based on program needs that are specified

by the program’s most recent community assessment. Head Start programs are creative in determining how to use the HSAC, how often it meets,

and when to access members’ expertise outside of

the regularly scheduled meetings.

The HSAC is a valuable resource in the community

assessment process because its members are knowledgeable about available community resources.

The HSAC also can assist in forming partnerships

between the Head Start program and local healthcare providers and building relationships between

the Head Start program and the local community. 

Participants on the HSAC may include,

but are not limited to:

z Pediatricians 

z Nurses 

z Nurse practitioners

z Dentists

z Nutritionists

z Mental health providers

z Women, Infants, and Children 

(WIC) program staff

z Medicaid and SCHIP staff

z Head Start parents

z Head Start staff
ESTABLISHING HEALTH SYSTEMS

In Head Start agencies, a systems approach is critical to quality service delivery and overall accountability in all areas of program functioning.

Implementing a systems approach requires cooperation, communication, and coordination among all

members of the Head Start management team.

Each manager is an important part of the bridge

between a program’s management system and its

service delivery system. 

PLANNING

Planning is one of the most important aspects of

the systems approach. A plan provides the

groundwork to anticipate and prepare to meet the

needs and objectives of the Head Start program,

children, and families. Program planning occurs in

a continuous cycle and involves key members of

the Head Start community (e.g., the HSAC, parent

groups and policy groups). Although every agency

has its own method or style of planning, there are

some required elements that all agencies incorporate into planning [45 CFR 1304.51(a)(1)(i)-(iii)]:

z community assessment to evaluate 

community and family strengths, needs, 

and resources;

z involvement of policy and parent groups 

(such as the HSAC) in the formulation of 

multi-year program goals along with shortterm program objectives that specifically 

address Health Services;

z a written Health Services plan for 

implementing established goals and targeting 

health service delivery for Head Start children 

and families;

z a yearly self-assessment process to formulate 

new short- and long-range program goals, 

revise existing goals, and set financial 

objectives; and

z ongoing monitoring activities.

COMMUNITY ASSESSMENT

Planning for health services begins with the community assessment as mandated by Head Start [45

CFR 1304.51(a)(1)(i)]. The community assessment

is a dynamic process by which programs collect

data that identify community health, education,

nutrition, and social services needs, strengths, and

resources. Though the community assessment is

conducted every three years, it is updated annually.

Programs use data collected during the community

assessment to make decisions about the types of

services to provide for children and families and to

assist in establishing health priorities. 

The identified health needs will provide the 

basis for:

z development of annual objectives for the 

Health Services Program;

z identification of health education priorities 

for parents, staff, and children;

z identification of common problems and 

health risks facing the community which can 

be addressed by the health services team and

coordinators of other Head Start components

and which parents can be made aware of 

(e.g., the presence of lead-based paint in 

communities); and

z assessment of community cultural 

demographics.

Health needs are defined by families of Head Start

eligible children and by institutions in the community that serve young children [45 CFR 1305.3].

Head Start programs collaborate with other local

service providers in order to conduct more comprehensive community assessments and to assist in

interpreting results. Collaborating partners could

be other child care agencies and organizations that

serve young children and their families. Every

Head Start program is responsible for ensuring

that community data on health needs, strengths,

and resources are collected and analyzed on a regular basis. Members of the HSAC have access to

sources of health data and are involved in the community assessment. Remember to utilize internal

and external sources of information such as:

z local or state health departments

z program health records from the previous year

z community libraries

z local universities or colleges

z census data

z professional organizations such as the 

American Dental Association or the American 

Academy of Pediactrics

z other social service and health agencies such 

as WIC or Medicaid

z parents

Although the Head Start Program Performance

Standards give programs the flexibility to “tailor”

plans to meet their specific needs, there are key

health-related elements that should be included in

the community assessment. Refer to the chart on

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Technical Assistance Paper No. 1
22

KEY ELEMENTS IN COMMUNITY ASSESSMENT

KEY ELEMENTS COMPONENTS AND CONSIDERATIONS

Culture/Race/Religion

Local cultural issues/considerations

z Language/ethnicity

z Healing beliefs/attitudes

Spiritual/social diversity

Census/Demographics

Age Distributions

z Percent of population under 5 years old

Average family size for population

Education level

z Percent of non-high school graduates

z Percent of high school graduates

Percent of population under 200 percent of poverty level

Prevalent industries

Funding/Policies/Laws

Medicaid benefits

SCHIP availability

Private insurance availability and cost

Grant opportunities

Employment/human resources

Educational Institutions

Adult education

High school equivalency

ESL classes

Nursing/dental hygiene/audiology/PA schools

Preschool/daycare centers

Disability services

School district LEA's

Health Resources

Hospitals

Clinics

z Free or low-cost clinics

Medical specialties

z Pediatric dentists

State and local health departments

z Immunizations

z WIC

z Communicable disease control

z Community/patient health education

z Information on services for children 

with disabilities

Prenatal services/education availability

Allied Health Services/NGOs

American Red Cross chapters

American Heart Association

March of Dimes

Food banks

Other service agencies

Focus Group Interviews

Review perceived community's strengths and needs from all

groups

z Head Start eligible parents

z Community leaders, professionals, 

and community partners

z Health Services Advisory Committee

(Italiano-Thomas. 2003. National Head Start Health Services Institute)

National Head Start Training and Technical Assistance Resource Center
the previous page for the key health-related elements of a community assessment.

RECORD KEEPING

A well-maintained confidential record-keeping system is essential to the accomplishment of Health

Services goals [45 CFR 1304.51(g)]. The Head

Start Program Performance Standards require that

Head Start programs establish and maintain efficient and effective record-keeping systems to provide accurate and timely information regarding

children, families, and staff. Efficient health record

keeping serves multiple purposes: 

z evaluating services provided or “quality 

assurance” 

z monitoring progress towards meeting positive

outcomes for children and families

z ensuring children receive needed services

z accountability with regard to parents, 

professionals, and providers

z individualized health services for children 

and families

z developing training approaches for staff 

and families

z research and program planning

z enhancing staff’s understanding of each 

child and communication among staff 

about children and their families 

z documenting health services activities in 

case of legal action

z furnishing health information for the PIR, 

PRISM, and other official reports

z documenting compliance with Federal, tribal, 

state, and local regulations as well as 

program policies

The four components of a well-maintained recordkeeping system are:

1. Individual Child Health Record

2. Tracking Systems

3. Staff and Volunteer Health Records

4. Confidentiality and Access Policies and Procedures

Head Start programs ensure that children are upto-date on a schedule of well child care in accordance with State EPSDT schedules and the Centers

for Disease Control recommended immunizations

schedule. This information appears in the

Individual Child Health Record of each child. 

Information contained in these records is factual

and stated in a non-judgmental and unbiased manner that demonstrates respect for the child and

family. All Head Start staff members are familiar

with the mandated components of the health

record [ 45 CFR 1304.20(a)(1)(i-iv) and

1304.51(g)]. Health records are periodically

reviewed and updated by a designated health services staff member in order to identify the strengths

and weaknesses of the current system.

A tracking system is a management tool designed

to assist health staff in keeping track of all the

various items found in the Child Health Records

of the children enrolled in the program. 

Establishing a tracking system helps to ensure that

children remain up-to-date on a schedule of wellchild care. The tracking system assists with scheduling appointments, providing follow-up services,

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Technical Assistance Paper No. 1

An Individual Child Health Record must

contain: 

z Parent contact information

z Emergency contact information

z Health care provider contact information

z Payment information, including Medicaid 

eligibility and status

z Individual and family medical history

z Immunization history

z Screening results

z Physical examination results and evaluation

z Family informed consent forms for: release 

of records, medical emergencies, transportation,

diagnostic evaluation, consultations

z Dental history, examination results and

treatment information

z Dietary assessment nutrition history

z Family and developmental history

z Cultural beliefs that may affect the health care 

of the family

z Progress notes

z Daily medications

z Record of accidental injuries occurring 

during program activities

z Recommendations to the child's home and to 

the Head Start program

z Diagnosis and treatment plans, completed 

treatment, follow-up

Adapted from Healthy Young Children, p.99 (2002)
24

National Head Start Training and Technical Assistance Resource Center

and compiling program status information for

ACYF. Each program develops their own tracking

system. Tracking can be done by paper and pencil

or on a computer.

To ensure a safe and healthy environment for children and staff, all staff and regular volunteers

demonstrate that they are in good health. Agencies

develop a policy in consultation with the HSAC to

address the establishment and maintenance of staff

and volunteer health records.

Programs also ensure appropriate confidentiality of

the information found in the Child Health Record

[45 CFR 1304.51(g)]. Programs are required to

develop confidentiality policies and procedures to

ensure that all staff members are aware of and

implement those policies correctly [45 CFR

1304.52(h)(1)(ii)]. The written policy includes procedures for internal storage, use, and handling of

identifiable health information, as well as procedures for safeguarding confidentiality when electronically transmitting records to other providers

and programs.

REPORTING SYSTEMS

The Head Start Program Performance Standards

require programs to establish and maintain efficient and effective reporting systems that generate

periodic reports of financial status and program

operations [45 CFR 1304.51(h)(1)]. Programs also

generate official reports for Federal, state, and

local authorities, as required by applicable law [45

CFR 1304.52(h)(2)]. There are two types of

reports agencies compile on a regular basis – fiscal

reports (the status of monies/funds) and program

reports (what agencies have accomplished in a particular area such as health). Maintaining an efficient reporting system is important because it

allows programs to control program quality, maintain program accountability, and advise governing

bodies, policy groups, and staff of program

progress. Reporting systems allow staff to centralize information, coordinate services, and provide

program oversight. Health information is collected

and reported in a user-friendly fashion. 

The following funding sources/agencies may have

reporting requirements to consider when designing

reporting systems. 

z Administration for Children and 

Families/Head Start Regional Office Program 

Information Report (PIR). The PIR is a yearly 

request for specific information on a range of 

Head Start activities. Health questions 

inquire about immunizations, dental treatments, and treatment of a range of medical 

conditions. It is wise to examine a copy of 

what was requested the previous year.

z Medicaid: Early and Periodic Screening, 

Diagnosis and Treatment program (EPSDT) 

and State Children’s Health Insurance 

Program (SCHIP)

z Child Care Food Program/School 

Lunch Program

z State Child Care Licensing

z The Special Supplemental Nutrition Program

for Women, Infants and Children (WIC)

z Occupational Safety and Health 

Administration (OSHA)

Oversight councils, committees, and/or boards

require reports to fulfill their responsibilities and

seek information to determine whether health

services are being delivered appropriately. It is

important to consider what programs need in

order to provide proper oversight of responsibilities and what information would help managers

coordinate and integrate services. 

Comprehensive and regular data-gathering over a

period of time enables programs to look at health

trends, to keep track of all activities undertaken

and their results, and to analyze the time and

resources requested to perform specific tasks. 

SPECIAL ISSUES

This section addresses topics that deserve special

attention in order for Head Start programs to 

provide ongoing, comprehensive health services to

children and families.

ESTABLISHING A MEDICAL HOME AND DENTAL HOME

The Head Start Program Performance Standards

require all Head Start programs to ensure that each

child in Head Start has an ongoing, continuous,

accessible source of health care, which is also

known as a medical home. Head Start’s definition

of a medical home is consistent with that of the

American Academy of Pediatrics (AAP), though the

AAP’s is more specific.

Depending on community resources, a Head Start

family may have a variety of options for health

care. The health care provider might be a physician, nurse practitioner, or traditional healer. The
medical home might be located in a physician’s

office, hospital outpatient clinic, school-based and

school-linked clinic, community health center,

health department clinic, or even a communitybased mobile van. Some families may have special

considerations. For example, farmworkers’ families

who have a permanent “home-base” often have a

medical home established in the permanent community in addition to a “mobile” medical home in the

temporary/seasonal community. As long as the

medical home meets the AAP’s definition, medical

care may be provided in various locations.

The concept of a dental home is derived from the

AAP’s concept of a medical home. Pediatric primary dental care includes the same characteristics

set forth in the AAP’s definition of a medical home,

i.e., accessible, continuous, family-centered, comprehensive, coordinated, compassionate, and culturally and linguistically sensitive. The dental home

is a specialized primary dental care provider who

exists within the broader concept of the medical

home, and is a necessary part of complete wellchild care.

With support from Head Start as needed, the 

family has responsibility for identifying a medical

and a dental home in the community. In order to

help families make sound decisions and access the

services they need, the Head Start program 

educates families about:

z the importance of having a medical home and 

a dental home and well-child care;

z how to apply for and keep up with medical 

insurance and dental insurance;

z how to choose a health care provider; 

z how to appropriately and effectively use a 

medical home and a dental home (learning 

when to seek the doctor’s or recognized medical 

authority’s help);

z why taking the child periodically for the 

recommended well-child visits/preventive 

check-ups is important; 

z what health care providers should be 

providing during well-child visits;

z following up on EPSDT screenings and 

recommended treatment; 

z how to prepare for and deal with health 

emergencies and treatment; and

z practicing and modeling preventive 

care practices.

It is essential to address barriers to treatment in

order to ensure that whenever possible, families

secure recommended medical/dental procedures.

Barriers may include:

z lack of information 

z transportation difficulties 

z the need for translators 

z cultural values and mores

z inflexible work hours 

z lack of funds 

z fear of “officials” due to immigrant legal 

status and often marginalized status imposed 

by society

z the unwillingness of providers to serve Head 

Start children

z scarce medical/dental resources in the 

community (Developing partnerships with local

providers to provide these services may take 

time and perseverance.) 

When access to care is a problem for Head Start

families, programs explore and exhaust ways to

facilitate the provision of needed services and document all efforts to access providers and funding

sources. These efforts may include:

z providing after-hours care

z obtaining medical advice by telephone 

z providing on-site services (as long as this is 

being done within the parameters of the Head 

Start Program Performance Standards, the AAP

definition of a medical home, and state and local 

child care licensing requirements) while helping 

families stay connected to a medical home

ORAL HEALTH

Oral health is an essential component of a child’s

overall health and wellness. The impact of dental

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Technical Assistance Paper No. 1

Definition of a Medical Home

Head Start

A child’s medical home is a source of 

continuous, accessible, coordinated care that 

can continue beyond the time of Head Start 

enrollment. 

[45 CFR 1304.20(a)(1)(i) Guidance]

American Academy of Pediatrics

A child’s medical home will include these 

characteristics: accessible, continuous, familycentered, comprehensive, coordinated, 

compassionate, and culturally and linguistically

sensitive.

[American Academy of Pediatrics 1999]
26

National Head Start Training and Technical Assistance Resource Center

diseases on a child can be devastating to a child’s

general health. Children with poor oral health

often experience chronic pain and as a result, they

may lack energy, concentration, and a positive attitude toward learning. They may have difficulty

eating or speaking. In fact, children at and below

the poverty level have much higher rates of tooth

decay than the rest of the population. 

The most important consideration in addressing

oral health within the Head Start community is

establishing a dental home. The high occurrence

of dental disease among Head Start children also

can be alleviated by educating Head Start parents

and staff about good dental care and nutrition and

by helping families overcome access barriers.

However, low-income families often face many

challenges when trying to access oral health care.

One barrier is access to insurance coverage. Data

from a 1996 Department of Health and Human

Services report show that in 1993 only 1 in 5 children covered by Medicaid actually received preventive services, and no states provided preventive

services to more than 50 percent of eligible children (Office of Inspector General Report 1996).

Now, only about 1 in 4 eligible Medicaid children

receive preventive services (Crall 2004).

The decreasing number of dentists, both regular

and pediatric, also is a barrier to care access. While

the dental workforce is diminishing, the U.S. population is growing, and the number of children at

higher risk for dental disease is increasing. 

Furthermore, many dentists do not have experience

with preschoolers or are hesitant to accept patients

covered by Medicaid.

How can Head Start staff help children and families overcome these barriers?

z Educate Head Start staff, parents, and 

children about good oral health

z Educate and outreach to the dental 

community

z Work with local Technical Assistance 

specialists

z Form community-based partnerships and 

establish systems to provide dental homes and 

comprehensive care including:

z on-site assessment and individualized

prevention and disease management

z in-office/clinic diagnosis, prevention 

and treatment services, as needed

z local dental groups linked to Head 

Start programs

OBESITY AND PHYSICAL ACTIVITY

The main causes of obesity in children are poor

nutrition and inadequate physical activity.

Obesity can pose health risks, such as diabetes

and heart disease, that may carry into adulthood.

For poor children, obesity can be an even greater

risk factor because the most inexpensive foods are

also the least nutritious, containing high levels of

calories and fat.

Head Start programs address nutrition and physical activities in their daily curriculum as mandated

by the Head Start Program Performance Standards

and in order to promote positive child outcomes

[45 CFR 1304.23]. 

Strategies to address issues related to obesity and

physical activity include:

z making nutrition and structured physical activity 

an integral part of daily classroom curriculum

z limiting the amount of foods that are high in 

sugar, fat, salt, or refined grains

z modeling good eating habits

Photo by J. Barrett. Head Start of Washington Co., Inc.
z educating families about healthy alternatives 

for meals and snacks through parent training

z interacting with a nutrition coordinator to 

create a nutrition policy

z avoiding celebrations that encourage poor 

or excessive eating habits by offering sweets, 

potato chips, or soda

z reinforcing family-style meals

z educating children about healthy foods and 

making children aware of a variety of new 

foods such as whole grains, vegetables, 

and fruits

z introducing healthy culture-specific foods

Head Start programs work with families to promote good nutrition at home, teach parents about

nutrition, and encourage them to: 

z always have healthy snacks available.

z avoid using food as a reward or punishment.

z limit sweetened beverages (juice, soda, 

sweet tea).

z eat more colorful foods, especially green 

vegetables and fruit.

z use recipes that are lower in fat.

z sit down for family meals.

z reduce sendentary time.

The 2004 National Healthcare Disparities Report

(U.S. Department of Health and Human Services,

Agency for Healthcare Research and Quality 2004)

identifies African-Americans, Hispanics or Latinos,

Native Hawaiians and Other Pacific Islanders, and

American Indians and Alaska Natives as priority

populations with unique health care needs or issues

that require special attention. This collective of

priority populations also includes immigrants and

refugees. Individuals in these priority populations

are less likely to receive preventive care, screening

services, or access to quality health care, and are

more likely to have poorer overall health.

Furthermore, minority women, children, and people who are poor within these priority groups are

at even greater health risk. Furthermore, members

of these priority populations are more likely to be

uninsured, thereby further compounding their ability to stay healthy and receive needed services. 

Residents of rural communities also have special

health care needs (rural is defined by the Bureau of

Census as “any geographic location that is not

urban”). There is considerable ethnic and racial

diversity in many rural areas throughout the U.S.,

and rural communities are often populated by

immigrants and other priority groups. For example, the largest growth of the Hispanic population

is in the Southwest region of the country and the

rural South is largely populated by AfricanAmericans (U.S. Census Bureau 2000).

Furthermore, larger populations of young children

and the elderly reside in rural areas. 

Similar to other priority populations, rural communities have an increased incidence of chronic

disease, are in poorer health, experience more

injuries and perceive themselves to be less healthy

than their urban counterparts. Like the priority

populations identified by DHHS, their access to

health care resources is limited (The National

Advisory Committee on Rural Health and Human

Services 2004).

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Technical Assistance Paper No. 1

Photo by J. Brough Schamp. Higher Horizons Head Start.
28

National Head Start Training and Technical Assistance Resource Center

It is important that Head Start staff build their

own cultural competence to work effectively with

families and communities of priority populations

identified as health risks. The Commonwealth

Fund (Betancourt, Green, & Carrillo 2002) defines

cultural competence as “the ability of systems to

provide care to patients with diverse values, beliefs,

and behaviors, including tailoring delivery to meet

the social, cultural, and linguistic needs of everyone seeking healthcare. Cultural competence also

can be described as a vehicle to increase access to

quality care for all patient populations.”

Lack of knowledge about the health practices of

different cultural and priority groups contributes to

disparities in health care leading to poorer health

status. Improvement can be achieved through the

development and implementation of cultural health

awareness programs that focus on special populations. Despite what we know about the importance of cultural competence, major gaps in knowledge continue to exist. Head Start is placing

greater emphasis on cultural sensitivity and education to improve health promotion and disease prevention in Head Start families and children. The

next section provides strategies that Head Start

programs can consider as they build culturally

competent health programs. 

LET’S CELEBRATE DIVERSITY: CULTURALLY

COMPETENT STRATEGIES FOR HEALTH CARE

Focus on Priority Populations

Head Start health services support health activities

that target priority populations suffering from

health disparities based on factors such as,

race/ethnicity, gender, age, income, insurance status, and/or rural or urban geographical location.

A good place for programs to start is to understand how each of these factors contributes to poor

or restricted health care services and access for culturally diverse populations.

Educate Priority Populations about Health Services 

Priority populations often underutilize health services for many reasons and are not able to reap the

benefits of services that do exist. For example,

immigrants and refugees may not know where to

go for medical attention. Illegal immigrants fear

that they will be caught and deported if they access

health services. Head Start programs start by educating families on available health care services in

the community that support cultural practices of

priority populations. Further, programs identify

community-based health care agencies that specialize in providing services to illegal immigrants or

other priority groups. Finally, linking families to

medical homes that are representative of their culture is paramount. The HSAC is an effective asset

to educate families about accessible and culturally

relevant health services.

Enhance Community-Based Partnerships

Head Start programs serving a culturally diverse

population establish linkages with communitybased programs that will enhance the coordination

of health services. It is wise to encourage community partnerships by educating local doctors on the

challenges faced by Head Start children in priority

populations. Head Start programs may think

about connecting with University-based allied

health programs and other professional schools,

such as medical, dental, and law, that have experience in serving multicultural populations. Finally,

Head Start programs seek out community

providers that represent the population served in

their program and include representatives from

immigrant or refugee groups on the HSAC or other

important governing bodies. 

Educate Parents

Parents in the priority populations may not be fully

informed about the necessity of preventive health

care visits. Their communities may not have partnership systems in place, and a child may not see a

doctor until an already serious health problem has

occurred. It is important to respect traditional

medical practices of families while teaching parents

basic health and safety techniques and the warning

signs of potential health problems. The messages

can be presented in workshops, conferences, parent

groups and in culturally relevant materials. 

Informing parents about resources is an important

way to ensure that children get the health care they

need. Many Head Start families may not know

how to find Medicaid and SCHIP health-related

resources; Head Start staff help them learn about

and gain access to these valuable and free programs. Head Start staff also provide support to

parents in gathering information and filling out

application forms and providing language interpretation services when needed. 

Expand the Community Assessment

A Community Assessment is mandated by the

Head Start Program Performance Standards [45

CFR 1305.3]. Accurate data collection and analy-
ses are critical components in addressing health

disparities and lead to improving cultural competence in health delivery. Head Start health programs include an assessment of cultural demographics reflecting race/ethnicity, language, healing beliefs, and common religious practices. Head

Start programs also collect data on the community-based health care providers who represent cultures served by Head Start. The data can be used

to connect families to culturally appropriate

health care services.

Link Families with Medical and Dental Homes

Data from the Community Assessment is used to

link families with medical and dental homes

where the health care providers are sensitive to

their cultural values and beliefs. Illegal immigrants are connected with health care providers

who will provide services when needed.

Programs consult with the HSAC when there are

no health care providers in the community who

accommodate cultural differences. 

Assure Quality Health Care

Head Start programs ensure quality health care

by implementing comprehensive and accurate

record-keeping and reporting systems, health care

tracking systems, and sound procedures for monitoring follow-up of health care services received

by Head Start families. 

Include Cultural Competence in Staff

Development 

To ensure a clear understanding of the diverse

populations they serve, Head Start programs

adopt culturally competent values and practices in

all areas—health services as well as education,

family services, and others. One place to start is

to educate staff about cultural values such as

child rearing practices, traditional medical beliefs,

the impact of spirituality on health practices, cultural definitions of health and illness, and perceptions about social service institutions.

Additionally, Head Start programs establish multicultural committees to support outreach, training, and hiring practices. Finally, Head Start programs consider building cultural competence into

staff performance evaluations.

Ensure Linguistic Access in Health Care

Hundreds of languages are spoken in both urban

and rural communities, and there are large populations of Limited English Proficient (LEP) families in all regions of the United States. Head Start

supports efforts to address language differences

that may impact comprehensive health and education services for children, families, and staff

(Head Start Bulletin on English Language

Learners 2005 Issue No. 78).

Language barriers directly impact the accessibility

of health care and can affect the quality of health

care that is received. It is critical that clients are

able to communicate with their health care

providers. Communicating in the client’s preferred language ensures the correct exchange of

information, allows families to provide informed

consent for treatment, reduces confidentiality

issues, and increases families’ knowledge about

their own health status. Federally funded programs have a responsibility to accommodate language differences (Perkins, 2003). 

There are multiple steps for Head Start programs

to take: 

z assess which predominate languages are 

spoken in local neighborhoods when 

conducting a community assessment;

z include a detailed plan for addressing 

language barriers in the health services plan;

z translate vital documents (e.g., health intake 

forms), providing translators when 

necessary, and notifying families that these 

services are available; 

z periodically review the quality of language 

services and translated documents in 

the Head Start program; and

z recruit and train health services staff that 

reflects community culture and language.

It is imperative that the health status of members

of these priority populations improves. Head

Start programs can help by understanding the

cultural differences that influence the health

practices of families, being leaders in advancing

systemic change such as improving accessibility

to health care, accommodating cultural differences in daily health practices, and adopting cultural competence principles in all Head Start

services. Building cultural competence among all

staff will empower families of priority populations to achieve their goal—a better quality of

life for their children.

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Technical Assistance Paper No. 1
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National Head Start Training and Technical Assistance Resource Center

CONCLUSION

Children learn best when they are healthy and

safe and when their parents are fully engaged in

helping the family achieve optimal health. To fulfill Head Start’s mission to help children from

low-income families start school ready to learn,

Head Start programs promote and teach healthy

practices to children, parents, and communities.

The Head Start Program Performance Standards

provide a solid foundation to help Head Start

programs establish family partnerships and support a culture of healthy lifestyles in classrooms

and homes. Young children will have a good start

in life when they receive comprehensive health

services within a prevention framework. Head

Start is definitely the foundation that prepares

children to be healthy and ready to learn well

beyond the preschool years.

Photo courtesy of Education Services, Inc.
REFERENCES

American Academy of Ophthalmology: http://www.aao.org/ 

American Academy of Pediatrics. 2002. Caring for Our Children: National Health and Safety Performance

Standards: Guidelines for Out-of-Home Child Care Programs. Elk Grove Village, IL

American Academy of Pediatrics, Committee on Children with Disabilities. 1999. Care Coordination:

Integrating Health and Related Systems of Care with Special Health Care Needs. Pediatrics; 104; 978-981.

American National Red Cross: http://www.redcross.org/ 

Aronson, Susan S., ed., compiled with Patricia M. Spahr. 2002. Healthy Young Children: A Manual for

Programs. National Association for the Education of Young Children. Washington, D.C.

Betancourt, Joseph R., Alexander R. Green, and J. Emilio Carrillo. 2002. Cultural Competence in Health

Care: Emerging Frameworks and Practical Approaches. New York: The Commonwealth Fund. 

Child and Adult Care Food Program: http://www.fns.usda.gov/cnd/care/cacfp/aboutcacfp.htm 

Crall, James. 2004. Policy and Program Considerations for Improving Oral Health in EHS/Head Start.

Washington, D.C.: Head Start - Maternal and Child Health Bureau Intra-Agency-Agreement Meeting.

Italiano-Thomas, Graciela. 2003. First Things First: Planning and Community Assessment. Washington,

D.C.: National Head Start Health Services Institute.

Kaiser Commission on Medicaid and the Uninsured. 2000. Health Insurance Coverage and Access To Care

Among Asian Americans and Pacific Islanders. Washington, D.C.: The Henry J. Kaiser Family Foundation.

Kaiser Commission on Medicaid and the Uninsured. Prepared by Jane Perkins, drawn from a paper from

the Commission. 2003. Ensuring Linguistic Access in Health Care Settings: An Overview of Current Legal

Rights and Responsibilities. Washington, D.C.: The Henry J. Kaiser Family Foundation. 

The National Advisory Committee on Rural Health and Human Services. 2004. The 2004 Report to the

Secretary: Rural Health and Human Services Issues. Washington, D.C.

National Resource Center for Health and Safety in Child Care: http://nrc.uchsc.edu/ 

Preamble to the Constitution of the World Health Organization as adopted by the International Health

Conference, New York, June 19-22, 1946; signed July 22, 1946 by the representatives of 61 States (WHO,

Official Records of the World Health Organization, Vol. 2, p. 100), Washington, D.C.: entered into force

on April 7, 1948.

U. S. Department of Agriculture - Food & Drug Administration (USDA-FDA) Foodborne Illness Education

Information Center: http://www.nal.usda.gov/foodborne/ 

U.S. Department of Commerce: Economics and Statistics Administration, U.S. Census Bureau. Prepared by

Betsy Guzman. 2001. The Hispanic Population: Census 2000 Brief. Washington, D.C.

U.S. Department of Health, Education, and Welfare: Office of Child Development. Prepared by Robert

Cooke. 1965. Recommendations for a Head Start Program (also known as The Cooke Report).

Washington, D.C.

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National Head Start Training and Technical Assistance Resource Center

U.S. Department of Health and Human Services: Administration for Children and Families,

Administration on Children, Youth and Families, Head Start Bureau. Prepared by the National Head Start

Training and Technical Assistance Resource Center. 2001. Head Start Bulletin on Screening and

Assessment. Issue No. 70. Washington, D.C.

U.S. Department of Health and Human Services: Administration for Children and Families,

Administration on Children, Youth and Families, Head Start Bureau. Prepared by the National Head Start

Training and Technical Assistance Resource Center. 2005. Head Start Bulletin on English Language

Learners. Issue No. 78. Washington, D.C.

U.S. Department of Health and Human Services: Administration for Children and Families,

Administration on Children, Youth and Families, Head Start Bureau. Head Start Program Performance

Standards and Other Regulations. 2005.Washington, D.C.

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Financing Administration. Prepared under Contract No. 105-96-2010. 1999. Head Start, Medicaid, &

CHIP: Partners for Healthy Children. A Guide for Head Start Programs. Washington, D.C.

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Utilization. Washington, D.C.
HEAD START RESOURCES

Selected Training Guides

Disabilities

Including Children with Significant Disabilities in Head Start. 1998.

http://www.headstartinfo.org/publications/children_significant/index.htm

Leading the Way: Disabilities Services and the Management Team. 1997.

http://www.headstartinfo.org/publications/leading_way/

Setting the Stage: Including Children with Disabilities in Head Start. 1995.

http://www.headstartinfo.org/publications/including_children/index.htm 

Supporting Children with Challenging Behaviors: Relationships Are Key. 1990.

http://www.headstartinfo.org/publications/challenging_behavior/contents.htm 

Translating the IEP into Everyday Practice. 1998.

http://www.headstartinfo.org/publications/iep/index.htm 

Education

Individualizing: A Plan for Success. 1998.

http://www.headstartinfo.org/publications/individualizing/contents.htm

Family and Community Partnerships

Building Supportive Communities. 1995.

http://www.headstartinfo.org/publications/building_sup_com/index.htm

Community Partnerships: Working Together. 2000.

http://www.headstartinfo.org/publications/community_partnerships/index.htm

Family Partnerships: A Continuous Process. 1999.

http://www.headstartinfo.org/publications/family_partnerships/index.htm 

Health

Caring for Children with Chronic Conditions. 1998.

http://www.headstartinfo.org/publications/children_cc/ccccont.htm 

Enhancing Health in the Head Start Workplace. 1996.

http://www.headstartinfo.org/publications/enhancing_health/contents.htm 

Preventing and Managing Communicable Diseases. 1996.

http://www.headstartinfo.org/publications/preventing_managing_communicable/index.htm

Safety First: Preventing and Managing Childhood Injuries. 2000.

http://www.headstartinfo.org/publications/safety_first/index.htm

Sustaining a Healthy Environment. 1997.

http://www.headstartinfo.org/publications/sustaining_healthy/index.htm

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Well Child Health Care. 1998.

http://www.headstartinfo.org/publications/wchc/index.htm

Management Systems and Procedures

Planning and Reviewing for Success. 1999.

http://www.headstartinfo.org/publications/planning_reviewing/index.htm 

Mental Health

Promoting Mental Health. 1998. 

http://www.headstartinfo.org/publications/mental_health/contents.htm 

Parent Involvement

Communicating with Parents. 2000.

http://www.headstartinfo.org/publications/communicating_with_parents/index.htm

Engaging Parents. 1995. 

http://www.headstartinfo.org/publications/engaging_parents/index.htm

Partners in Decision Making. 2000. 

http://www.headstartinfo.org/publications/partners/index.htm

Transition

Planning for Transitions. 1997. 

http://www.headstartinfo.org/publications/Planning_Transitions/index.htm

Head Start AudioVisual Materials

Building Blocks for Father Involvement (Including 5 Booklets). 2004.

http://www.headstartinfo.org/publications/building_blocks1.htm

http://www.headstartinfo.org/publications/building_blocks2.htm

Curriculum in Head Start/Individualizing in Head Start (including Users’ Guide). 1987. (print)

Early Head Start Information Kit: Research to Practice Addendum – Multimedia Kit. 2003.

http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/index.html

Embracing Our Future. 2004. 

http://www.headstartinfo.org/pdf/EmbracingFuture_Guide1.pdf 

Mental Health in Head Start: A Partner for Families (Including Discussion Guide). 2000.

http://www.bmcc.edu/Headstart/VideoGuides/MentalHealth/ 

Mental Health in Head Start: It’s Everybody’s Business (Including Discussion Guide). 2000.

National Head Start Child Development Institute Tape 6: Social and Emotional Development. 2000.

http://www.hsnrc.org/hsnrc/cdi/content.cfm

Partnership with Parents (Including User’s Guide). 2000. 

http://www.bmcc.edu/Headstart/Partner_Parents/ 

Risk and Reality: Teaching Preschool Children Affected by Substance Abuse (Including Discussion 

Guide). 2000. 

http://www.bmcc.org/Headstart/VideoGuides/TeachingSA/index.html
Weaving Connections. 2002.

http://www.acf.hhs.gov/programs/hsb/connections/

Other Head Start Publications

A Holistic Approach to Health and Safety. 2004. 

http://www.headstartinfo.org/pdf/holistic_health_safe_TA7.pdf

Child Development Services During Home Visits and Socializations in the EHS Home-Based Programs

Options. 2002. 

http://www.headstartinfo.org/pdf/Child_Development.pdf

Child Health Record. (English). 1990. http://www.headstartinfo.org/pdf/ChildHealthRecord.pdf 

Child Health Record. (Spanish). 1990. (print) 

Child Health Record Instructions.

Developmental Screening, Assessment, and Evaluation: Key Elements for Individualizing Curricula in

Early Head Start Programs. 2002.

http://www.headstartinfo.org/publications/hsbulletin72/hsb72_09.htm 

Facilities Management Toolkit. n.d.

http://www.headstartinfo.org/infocenter/fac_manag_tkit.htm

The Family Partnership Agreement Process (Early Head Start Program Strategies). 2003.

http://www.headstartinfo.org/pdf/EHS/mpsfamily.pdf

Fatherhood Initiative Resource Guide. 2001. 

http://www.headstartinfo.org/infocenter/guides/father_intro.htm

Giving Children the Earliest Head Start: Developing an Individualized Approach to High-Quality

Services for Pregnant Women (Technical Assistance Paper No. 3). 2000.

http://www.ehsnrc.org/pdffiles/TANo3.pdf

Handbook for Volunteer Coordinators in Head Start. 1990.

http://www.bmcc.edu/Headstart/Vol_Coordinators/

Head Start Bulletin #69: Early Head Start. 2000.

http://www.headstartinfo.org/publications/hsbulletin69/cont_69.htm

Head Start Bulletin #71: Head Start and Partners Forum on Oral Health. 2002.

http://www.headstartinfo.org/publications/hsbulletin71/cont_71.htm

Head Start Bulletin #73: Mental Health. 2002. 

http://www.headstartinfo.org/publications/hsbulletin73/cont_73.htm

Head Start Bulletin #75: Adult Health. 2003.

http://www.headstartinfo.org/publications/hsbulletin75/cont_75.htm

Head Start Bulletin #76: Child Outcomes. 2003.

http://www.headstartinfo.org/publications/hsbulletin76/cont_76.htm

Head Start Bulletin #77: Father Involvement. 2004.

http://www.headstartinfo.org/publications/hsbulletin77/cont_77.htm

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Head Start Handbook of the Parent Involvement Vision and Strategies. 1996. (print)

Head Start, Medicaid, and CHIP: A Guide for Head Start Programs. 1999.

http://www.headstartinfo.org/pdf/chip.pdf

Head Start Leaders Guide to Positive Child Outcomes: Strategies to Support Positive Child Outcomes.

2003.

http://www.headstartinfo.org/pdf/HSOutcomesguideFINAL4c.pdf

Head Start Path to Positive Child Outcomes. 2003.

http://www.headstartinfo.org/pdf/hsoutcomespath28ppREV.pdf

Head Start Self-Assessment Guide. 2005. 

http://www.headstartinfo.org/self_assessment/table_of_contents.htm

Health Data Tracking Instrument. 1990. 

http://www.headstartinfo.org/pdf/HealthDataTrackingInstrument.pdf

Helping Children Affected by Substance Abuse: A Manual for the Head Start Management Team. 1984.

http://www.bmcc.edu/Headstart/Manuals/Kidsaffected

Infant and Toddler Transitions. 1999.

http://www.headstartinfo.org/publications/infant-toddler_transitions/index.htm

Meeting Techniques Resource Guide. 2002. 

http://www.headstartinfo.org/infocenter/guides/mt_intro.htm

Monitoring Toolkit. n.d. 

http://www.headstartinfo.org/infocenter/monitoring_tkit.htm

Multicultural Principles for Head Start Programs. 1996. 

http://www.bmcc.org/Headstart/Cultural/index.html

National Head Start Child Development Institute User’s Guide. 2000. 

http://www.hsnrc.org/CDI/UGintro.cfm

National Head Start Child Development Implementation Planner. 2000.

http://www.hsnrc.org/CDI/pdfs/WholeIP-Eng2001.pdf

Parent-Held Child Health Record. 1992.

http://www.headstartinfo.org/pdf/HeadStartParentHeldChildHealthRecord.pdf

Pathways to Prevention: A Comprehensive Guide for Supporting Infant and Toddler Mental Health.

2004. 

http://www.headstartinfo.org/pdf/Pathwaysto.pdf

Personal Safety for Children: A Guide for Parents. 2003. 

http://www.ncjrs.org/pdffiles1/ojjdp/psfceng.pdf 

National Head Start Health Services Institute Notebook: Philosophy, Performance, Promise. 2003.

http://www.hsnrc.org/HealthInst/0304_HIWkbk.pdf

PRISM All Instruments FY 2005. 2004. 

http://www.headstartinfo.org/pdf/2005PRISMInstrument.pdf
PRISM Guide for FY 2005. 2004. 

http://www.headstartinfo.org/pdf/2005PRISMGuide.pdf

Promoting Social and Emotional Confidence (Training Modules). Center on the Social and Emotional

Foundations for Early Learning. 2003. 

http://csefel.uiuc.edu/modules.html 

Resource Guide on Head Start Employee Assistance Programs. 2001.

http://www.bmcc.org/Headstart/Trngds/Resource_EAP/index.html

Resources for Professionals: A Community of Support for Infant/Toddler Mental Health. n.d.

http://www.headstartinfo.org/pdf/ResourcesforPro.pdf

Responding to Children Under Stress: A Skill-based Training Guide for Classroom Teams. 1980.

http://www.bmcc.edu/Headstart/Stress/

Responding to the Mental Health Needs of Infants, Toddlers and Families (Early Head Start Program 

Strategies). 2003. 

http://www.headstartinfo.org/pdf/EHS/mpsmentalhealth.pdf

Supporting Substance-Abusing Families: A Technical Assistance Manual for the Head Start

Management Team. 1985.

http://www.bmcc.edu/Headstart/Manuals/SAFamilies/

Training Guide for Food Service Personnel in Programs for Young Children. 1998.

http://www.headstartinfo.org/pdf/TrainingGuideforFoodservicePersonnelinProgramsforYoung

Children.pdf 

What Works Briefs. Center on the Social and Emotional Foundations for Early Learning. 2003.

http://csefel.uiuc.edu/whatworks.html

WIC and Head Start: Partners in Promoting Health and Nutrition for Young Children and Families.

(WIC Nutrition Series). 1996. 

http://www.fns.usda.gov/oane/MENU/Published/WIC/FILES/wichdst.pdf 

To order print and audio-visual resources:

Write: Head Start Information and Publication Center (HSIPC)

P.O. Box 26417

Alexandria, VA 22313-0417

Call: 1-866-763-6481

Fax: 703-683-5769

E-mail: puborder@headstartinfo.org

Web: www.headstartinfo.org

Costs vary with the resource. Consult http://www.headstartinfo.org 

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