HEAD START®

Laying a Foundation in Health & Wellness

Training Guides for the Head Start Learning Community

Table of Contents | Preface | Introduction | Module 1 | Module 2 | Module 3
| Continuing Professional Development | Resources

Linking Health and Social Competence

Module 2 | Activity 1 | Activity 2 | Activity 3 | Next Steps

Outcomes

After completing this module, participants will be able to identify health issues in children that limit their everyday effectiveness and devise an action plan to improve effectiveness.

Key Concepts

Social competence, as defined by Head Start, emphasizes skills and behaviors that improve “everyday effectiveness.” Basic health needs must be met to achieve social competence.

To support health, we must know the health status of Head Start families.

Each person finds her or his own level of wellness and everyday effectiveness—everyone is different and everyone changes throughout life.

Joining families as partners in their health supports Head Start’s central mission to develop social competence.

Background Information

A. Health Status
Many things contribute to health, including family background, personal behaviors, environment, and access to services. Some things that influence health are in our control, others are not. One thing we know: In general, some groups experience more health problems than others. Communities of color (regardless of income level) and low-income families (regardless of race) carry a disproportionate share of preventable disease and injury.

Relative Frequency of Health Problems in Children in Low-Income
Families Compared with Other Children

Health Problem: Delayed immunization
Relative Frequency: Triple

Health Problem: Asthma
Relative Frequency: Higher

Health Problem: Lead poisoning
Relative Frequency: Triple

Health Problem: Death in the first month of life
Relative Frequency: Triple

Health Problem: Child death due to injuries
Relative Frequency: double-Triple

Health Problem: Child death due to disease
Relative Frequency: Triple-quadruple

Health Problem: Percent with conditions limiting school activity
Relative Frequency: Double-triple

Health Problem: Lost school days
Relative Frequency: 40% more

Health Problem: Severe iron-deficiency anemia
Relative Frequency: Double

Health Problem: Delays in growth and development
Relative Frequency: Double

B. Health Status Questions & Answers

• Why is it important to know about all of these health problems
  
  Pinpointing the problems lets us know where to take action. Knowing the threats to health that low-income families face, we can offer our respect and affirmation to families who are working hard to achieve and maintain wellness. It is easy to become frustrated with families who may not be taking care of health concerns the way we want them to. Understanding that their health problems are shared by other low-income families is a sign that some of the health risks they live with are not within their control, rather they are built into the system. Unless we can identify the barriers we cannot help families to overcome them through individual behavior change or organized action for change in the community that will improve health (housing, transportation, discrimination, health insurance, other factors).
  
  *Barbara Starfield, "Child and Adolescent Health Status Measures" (1992), article from The Future of Children (volume 2, number 2), the annual report of The David and Lucile Packard Foundation.
  Children's Defense Fund, The State of America's Children, 1991 (Washington, D.C.: The CDM Group, Inc.), as cited in A Descriptive Study of the Head Start Health Component: Literature Review (1994).
  Adams and Hardy, Current Estimates from the National Health Survey, United States, 1988, as cited in A Descriptive Study of the Head Start Health Component: Literature Review (The CDM Group, 1994).
  
  
• Why do children in low-income families experience more health problems?
  
  We know that social, emotional, spiritual, and environmental factors affect physical health. Low-income families may be stressed in all of those dimensions; consequently, physical health is affected. Lack of income limits access to health care services. Some factors that influence low-income families’ health are in their control (behaviors such as smoking, food choices), and others are not (systemic class- and race-based discrimination). High risks for low-income families include exposure to environmental hazards resulting from unsafe and unhealthy neighborhoods, poor housing, poor nutrition, inadequate preventive care, and barriers to care.
  
  
• What is Head Start’s role?
  
  Most children in Head Start are from families with incomes of less than $12,000 a year. Even so, children in Head Start are healthier than children from low-income families who do not receive Head Start services. Head Start children are more likely to get preventive care such as immunizations, have better nutrition, fewer cavities, and practice better dental hygiene. Head Start makes a difference! You make a difference!!
  
  

C. Social Competence and Health

Building “social competence” has been the central goal of Head Start since it began in the 1960s. Social competence means everyday effectiveness for now and in the future. Everyday effectiveness means different things for different people, but it can include:

For Children:

• ability to play with friends cooperatively
  
  
• ability to perform basic developmental self-care skills such as dressing, eating, communicating needs
  
  
• ability to cope with everyday stress such as waiting for their turn, resolving conflict over sharing
  
  
• ability to learn
  
  
• etc. . . .
  
  

• ability to relate to others: family, friends, coworkers
  
  
• ability to handle most day-to-day activities: budget, buy groceries, keep appointments, get car repaired
  
  
• ability to meet responsibilities
  
  
• ability to know when to seek help
  
  
• etc. . . .
  
  

Many things we do every day in Head Start help children to be effective in their world. We also know that learning to be effective in the preschool years helps to build a foundation for effectiveness in school and as an adult. Experiences that make learning fun and teach children they are worthy of love and respect build their self-confidence.
Persons with disabilities and/or chronic illnesses achieve social competence and everyday effectiveness. Each person can be supported to achieve his own level of everyday effectiveness and wellness.

Head Start has always understood that all the dimensions of health are related and each dimension needs to be supported to achieve lifelong social competence. The legislation that authorized Head Start reads, in part:

“The overall goal of the Head Start Program is to bring about a greater degree of social competence in children of low-income families. By social competence is meant the child’s everyday effectiveness in dealing with both present environment and later responsibilities in school and life. Social competence takes into account the interrelatedness of cognitive and intellectual development, physical and mental health, nutritional needs, and other factors that enable a developmental approach to helping children achieve social competence.”

Questions for Discussion/Reflection

• What barriers to health are common among the families you work with?
  
  
• Can you identify characteristics that are shared by low-income families who do not experience many health problems—characteristics that seem to improve resiliency and contribute to wellness?
  
  
• Consider that the goal of Head Start was written in the early 1960s. What do you think about it today? Is it out of date, or was it ahead of its time? How does the work you do with children and families each day correspond to the Head Start mission?
  
  

Activity 1: Take a Program Health Snapshot

Purpose: This activity will help participants build a health status profile of families in their program. Systematically collecting this information can reveal patterns of illness that could suggest corrective actions. For example, if many children in the program have asthma, it might help to encourage the adults in the children’s lives (staff and parents) to stop smoking. If many children have high blood lead levels, it suggests an effort is needed to get paint, soil, and water tested in their neighborhoods. If many children regularly miss school with colds or diarrhea, maybe it is time to do a refresher on handwashing and infection control. Doing a health status profile from time to time can show changes (improvements and new or more severe problems) over time.

This activity will be most useful for staff other than the health coordinator. Participants can make it as simple or as elaborate as they like. You will need:

• Handout C: Health Snapshot Worksheet
  
  
• Writing materials

Step 1: Fill out Handout C: Health Snapshot Worksheet. This will be the basis of the work plan for your research project (see sample of Handout C at the end of this activity for question ideas, but feel free to list any others you are curious about). If you don’t know what sources of information are available to you, check with your center director for ideas for program information sources and your local public health department for community information sources.

Step 2: Looking at your questions and your possible sources of information, pick three questions that you can find the answers to given the amount of time and energy you want to devote to this.

Step 3: Set a timeline to gather the information you are looking for. You might make phone calls, review records (with appropriate confidentiality safeguards), or conduct in-person interviews.

Step 4: Share the information you have learned. You might put together a brief presentation for a staff meeting, a parent group, or for the Health Services Advisory Committee.

Step 5: Spend some time with your health coordinator discussing what you have learned and brainstorming what actions to take.

Points to Consider:

• Health information is personal and records should always be kept confidential. Health information should be shared only with the individual’s (or parents’) permission, and only when necessary for the individual’s care.
  
  
• Patterns of health needs emerge when we take a close look at information about groups of children and families.
  We need to examine the facts before we jump to conclusions.
  
  
• Every community has many sources of information to explore. A health snapshot could be a part of planning for expansion.
  
  

Activity 2: Social Competence and Health

Purpose: This activity links social competence with the five dimensions of health by asking participants to analyze stories. It is intended to reinforce the point that basic health needs—including food, shelter, freedom from pain and illness, safety—must be taken care of before we can fully engage in our developmental “work.” In each of the situations, health concerns are having an impact on everyday effectiveness.

For this activity you will need:

• A copy of one story for each pair—Handouts D , E, F, G, H
  
  
• Writing materials

Step 1: Find a partner to work with. Together read the story at the top of your handout.

Step 2: Discuss the story and, drawing on your experiences as Head Start staff, fill in the lines at the bottom of the page with ideas about health problems or positive health behaviors and conditions that might be affecting the situation described. These stories are scenarios in which social competence (defined as everyday effectiveness) is impacted, at least in part, by basic health concerns.

The five dimensions of health offer a framework for analysis. Consider them; however, all of the situations might not have contributing factors in each dimension. That is okay. If time allows, discuss more than one story.

Step 3: After discussing the story, discuss the following questions with your partner:

If you want to, share your examples and think of actions that occurred or could have occurred that would have supported your everyday effectiveness.

Points to Consider:

• Like wellness, everyday effectiveness is made up of a balance of skills and capabilities in many dimensions. We strive to attain well-rounded development and competence.
  
  
• Basic health needs, if not attended to, can interfere with everyday effectiveness. On the other hand, high-level wellness (health over and above freedom from pain and illness) can raise the level of effectiveness.
  

Activity 3: Consulting Circles

Purpose: This activity offers a framework for a team of Head Start staff people to look at everyday effectiveness from a wholistic perspective:

• wholistic in terms of areas of health considered; and
  
  
• wholistic in terms of team communication practices.

For this activity you will need:

• One copy of Handout I: Consulting Circles Framework for each participant
  
  
• Writing materials for participants

Notes to Trainer: Although this is a staff training activity, it can be enhanced by the participation of a parent in the group discussion. If there is an interested parent who feels comfortable being involved in this exercise, please include her. If a parent is not available, a staff person should take the role of a parent in the discussion. Throughout these instructions, “parent” can be taken to mean either an actual parent or a staff person playing that role.

Step 1: Discuss with the participants the information outlined in the background information related to everyday effectiveness, social competence, health and health status. Explain that generally, when everyday effectiveness is affected by a health concern, it is not a simple issue. Parents often use Head Start staff as resources when they have concerns about their children. A parent is likely to raise a concern about a child’s everyday effectiveness with the staff person with whom she is most comfortable. However, the staff person can best support the parent in her concern if the staff person calls on the expertise of the entire Head Start team.

A ground rule of confidentiality needs to be set up in any group discussing families, and parents need to be informed and consent to the fact that information about their child’s experience at Head Start will be shared with the team.

Step 2: Head Start staff people are regularly faced with challenges in everyday effectiveness. Ask your participants to take a few moments and think about a time when a parent approached them with a concern; a problem with everyday effectiveness where information from several team members could have been helpful.

Step 3:Ask the participants to break into groups of five or six, with the groups including staff people with different roles in the program. Ask them to share the concerns that parents have brought to them. Ask them to choose one story where many team members could contribute to the family support action plan and use that story to practice using the framework. Some examples:

• “Jamal is always very tired when I pick him up and sleeps for three hours where he never used to nap before...”
  
  
• “Monika won’t run around with her brothers anymore and seems to be having difficulty with her breathing since we moved into our new apartment building near the interstate freeway...”
  
  
• “I’ve noticed that Sally has started hitting her friends again, and I don’t have the patience to deal with her since my husband moved out...”

Step 4: The parent begins by explaining her concern about her child. Staff members should discuss the situation from the perspective of their own roles as consultants to the family. Emphasize that staff members probably already have lots of knowledge and information about this child and lots of understanding about this situation—they should draw on that and share it with the rest of the team.

Step 5: Distribute Handout I—Consulting Circle Framework. The parent can begin by posing any questions she has for the team and sharing her viewpoint and special understanding about the child. Other members share their special viewpoint and understanding that they have based on their roles in the child and family’s life (i.e., nutritionist, teacher, family service worker). In discussion with the group, fill out the first table on Handout I—Consulting Circle Framework, describing factors which impact everyday effectiveness. Remember to note strengths and supports to everyday effectiveness as well as things that get in the way.

Step 6: Once the team has considered the possible factors affecting everyday effectiveness, have them look at the lower half of the handout.

Step 7: As a team, consider how each team member can contribute to supporting the family. It may not make sense for every team member to work directly with the family and child, but they all may have a role in supporting and providing information to the team member with whom the family feels most comfortable. For example, the nutritionist who did an assessment of Jamal’s diet may not need to work directly with his mom—this might feel chaotic or overwhelming to Mom. The nutritionist might, instead, help the family service worker to understand the nutrition assessment so that the FSW can use that information in helping Mom figure out why Jamal is so tired. The parent should note exactly how she would like to be involved with each staff person.

Step 8: Bring the participants back to the larger group. Ask them to share the work of their team in planning their efforts. Consider which parts of the exercise were easy to do and where there were difficulties.

Points to Consider:

• Coordination and teamwork take time and resources. How can we encourage communication among team members and with parents as a regular practice in our program?
  
  
• Are there barriers to team communication—climate, policies, time constraints—which need to be addressed?
  
  
• Were all five areas of wellness—physical, emotional, spiritual, socio-cultural and environmental—represented in the background for this particular problem with everyday effectiveness? Only a few? Was an area present but not obvious?
  
  
• How did overall community factors affect this situation?
  
  
• Caring for young children is hard work, especially when those children and their families are experiencing many kinds of stress. Meeting together in a Consulting Circle can make parents and staff feel less alone and overwhelmed and provide an opportunity to learn from other disciplines.
  
  
• Pay attention to the process of the group so that it feels and acts like a team of equals. Check in to see how the group is handling differences in level of education, training, etc. Each person has a unique perspective to contribute.

Next Steps: Ideas to Extend Practice

Work for Environmental Health in Your Community

• polluting industries and freeways are often located in low-income communities
  
  
• the families may have poorer health to begin with and therefore are more likely to become ill from poor air quality, substandard housing, polluted water, unwholesome food, and other environmental problems
  Low-income communities suffer disproportionately from environmental threats to wellness because:

People in many communities have organized successfully to clean up their environment, or to prevent polluters from coming in. What can you do?

If there is vacant land in your community, try to put it to good use for all. See if there is a gardening organization that can help you set up a community garden. Helpers can be the Mayor’s Office in some cities, or such groups as the San Francisco League of Urban Gardeners (SLUG), Boston Urban Gardeners (BUG), New York’s Green Guerrillas, or Tree People in Los Angeles.

What is the major type of employment in your area? If it is agriculture, look into the kind of chemicals to which workers may be exposed. If it is a type of manufacturing, investigate whether workers might be exposed to unsafe conditions or substances. If you are concerned, contact the health department or the local office of the US or state Occupational Safety and Health Administration (OSHA).

A neighborhood cleanup can be a great way to build a community spirit and to empower neighbors to become more active in environmental issues. It is something that everyone can support, and it can show results very quickly. If graffiti is a problem, help to organize a day where neighbors of all ages can gather to paint it out. See if your local planning department or garbage company will help you sponsor a “neighborhood pick-up day” during which people can put out old furniture, appliances and other large items which are unsightly if left on the sidewalk. Helpers in these causes can be the mayor’s office, local foundations and businesses and corporations.

Invite a Local Health Expert to Be a Guest Speaker
If learning about the health status of children in the program generates interest and curiosity, capitalize on it! Invite a local public health official or a health/environmental community activist to speak at a staff/parent gathering about health conditions for children.

Make Wellness and Everyday Effectiveness Part of Routine Assessment
Review your family needs assessment format. Ask yourself: Does this assessment capture information about all the dimensions of health? Does it look for strengths as well as problems? Does it help us to know about the child’s everyday effectiveness? If the answer to any of these questions is no, consider how the assessment might be changed to become more comprehensive.