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

Planning for a Healthier Tommorrow

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

Outcomes

Upon completing this module, participants—as individuals and in teams—will develop strategies that incorporate health promotion into a variety of interactions with Head Start staff, children, and families.

Key Concepts

Habits and behaviors have powerful effects on long-term health. Behaviors learned in childhood, those that support health and those that harm health, have lifelong effects.

Role modeling is a powerful way to teach children.

Parents are the primary health role models for their children. In addition, all staff, regardless of job title, have opportunities to promote wellness.

Efforts that support health can be organized into three levels, which address:

Basic Health Needs

Disease Prevention and Protection from Injuries

Health Promotion

Background Information

A. How Does Health Build Over Time?

Over the past forty years, researchers have studied how our personal actions and habits present risks to our health. Some behaviors such as cigarette smoking and seat belt usage are certainly linked to long-term health. If you smoke cigarettes you are much more likely to suffer from lung cancer, heart disease or emphysema (among other sicknesses) and you are much more likely to have a shorter life than someone who does not smoke. If you wear seat belts when you drive, you are much more likely to survive a car crash than someone who is in a crash without seat belts.

Our role in health promotion in Head Start is very important because the best time to start healthy habits is early in the life of child and a good time to teach health habits to a family is when they are learning to care for young children at home. Children are learning attitudes and habits that are more likely to become part of their lives if they begin early and are carried out consistently.

For example, the child who learns to be active and enjoy sports is more likely to exercise throughout her life. The child who eats lots of fruits, vegetables and whole grains is more likely to enjoy those foods throughout his life. We can think about each of the healthy or unhealthy habits in this way. The earlier they are started, the more likely it is that they will be continued. When something negative cannot be changed—say a family history of heart disease—healthy habits can reduce risk.

Many studies of people’s behavior and their long-term health have been carried out. Two of the most famous studies are those carried out on the whole population of the town of Framingham, Massachusetts and the one which looked at 7,000 people who lived in Alameda County, California. Both studies followed the people for over twenty years. These two studies are considered “classics.”

The Framingham and Alameda County studies have been very important to the fields of health education and medicine because they looked at many people over long periods of time. The problems which lead to heart failure, cancer, early death, etc., are problems which build for a long time. These studies showed us that people’s behaviors early in life definitely had an effect on their longevity. Perhaps more importantly for many people, the studies have shown that people’s quality of life is affected. People who practice positive health behaviors feel better regardless of the length of their lives. The researchers of the Framingham study have challenged medical professionals to look at heart disease (and other health problems) very differently from how they have looked at them in the past. The researchers believe that heart failure should not be considered an “accident” or “tragic act of God,” but a failure of the medical care system to teach people to practice preventive, health promoting behaviors.

The two studies found certain specific behaviors with varying impacts, which affected the length of peoples’ lives:

*Eight Unhealthy Habits or Circumstances (Framingham Heart Study2)

1) high blood pressure
2) diabetes
3) obesity
4) lack of exercise
5) high cholesterol levels
6) cigarette smoking
7) family history of heart disease
8) “Type A” (hostile, aggressive) behavior

The Seven Healthy Habits (Alameda County Study1)

1) never smoke cigarettes
2) get regular physical activity
3) use no alcohol or use alcohol moderately*
4) sleep 7-8 hours each day regularly*
5) maintain proper weight
6) eat breakfast daily
7) do not eat between meals

* Note: Some of these behaviors, e.g., moderate alcohol use, sleep ing only 7-8 hours daily, and not snacking are not appropriate for young children.

B. How Important is Role Modeling to Health?

• Children learn by imitating. From a baby’s first babbling to preschoolers playing house, to teenagers exploring gender roles, children are hard at work imitating what they see around them. The video we show the children about choosing unprocessed foods will have far less of an impact if we are sipping a diet soda as we watch. Sometimes, children are too busy watching what we do to hear what we say.
  
  
• Children observe, imitate and learn from many adults, including adults that are neither teachers nor caregivers. Adults are all-powerful role models and we can use that power for health regardless of our formal job within Head Start.

1 Rosenbaum and Luxembourg. “You Can’t Live Forever,” Better Health Foundation, University of California, San Francisco/Mount Zion Hospital (1993).

2 Kannel, W.B. and Larson, M. “Long-term Epidemiologic Prediction of Coronary Disease: The
Framingham Experience,” Cardiology (1993):82(2-3):137-52.

C. Where Can Head Start Work to Improve Health?

Head Start can intervene in health by providing services to families regarding:

Basic Health Needs:

food, clothing, shelter, nurturance, treatment of acute illness/injury conditions, safety

Disease Prevention and Protection from Injuries:

Health Promotion:

Questions for Discussion/Reflection

• How does thinking in terms of the three levels of health—as described above—“stretch” your vision of health services in Head Start?
  
  
• Since parents are primary role models, how can we support health teaching in the home?
  
  
• What messages did your family give you about health habits related to eating, sleeping, or exercise? Do you still have habits that you developed in childhood?
  
  
• Have you known anyone who made a major change in lifestyle: quit smoking, started a walking program, took up meditation…Has that person found himself to be happier?
  

Activity 1: Connections

Purpose: This activity is to raise participants’ awareness of how behavior contributes to long-term health or to disease and about the overlapping benefits of positive health behaviors.

Preliminary Preparation: This activity works best with 12 to 20 participants. Divide them into four teams: A, B, C, D. There are two handouts for each team; one handout of large cards and one of small cards. Copy Handouts J–M onto card stock (red, green and yellow) and cut out the cards. Each team should have 5 large cards and 20 small cards. Place the cards in envelopes for each team.

For this group activity you will need:

Handouts J, K, L, M copied onto red, green and yellow card stock

4 envelopes

Flip chart and markers

Writing materials for participants

Step 1: Define the following:

a. Outcome = something that happens to a person after time, possibly many years

b. Behavior = a person’s actions or habits

c. Condition = the situation someone is in, can be unchangeable such as ethnicity, family history

Step 2: Brainstorm with the group about outcomes and behaviors. Ask them to suggest one or two health outcomes such as obesity, a healthy heart, osteoporosis. Write each outcome at the top of a sheet of flip chart paper. Then ask them which behaviors contribute to each outcome and list the behaviors underneath.

Step 3: Tell participants they will be working in small groups to match long-term health outcomes with the behaviors that cause or contribute to them.

This is a friendly, competitive game to show participants the great variety of health-promoting and health-damaging behaviors in which we all engage. Then we link those behaviors to long-term health outcomes.

Divide your group into four teams, 3 to 5 people per team. Give each team the packet or envelope of cards you prepared beforehand (see Preliminary Preparations). Tell participants to keep their cards in their packet or envelope until you tell them to start.

Step 4: When you say “go,” each team should begin to organize their cards. They will need to sort, then fill in the blank cards; each team has five outcome (large) cards and they need to organize the behavior (small) cards underneath.

It is a puzzle, because some of their cards are blank. They should fill in the appropriate blank cards with either behaviors or outcomes. Their final product will be five outcome (large) cards with at least four contributing behavior or condition (small) cards under each one (see graphic below).

Step 5: First team done should call out. These team members get a small prize (an apple, a bookmark, a coupon for a healthy treat . . .)

Step 6: Tell the teams with the red outcome cards (filled in and blank) to get together. Tell the teams with the green outcome cards (filled in and blank) to get together. Have them compare their results. Where were there similarities? Where were there differences?

Step 7: Now go around the room and ask each group to read an outcome card and list the behaviors that lead to that outcome.

Step 8: Ask each group to choose one outcome in their set that they think can be most strongly affected by a Head Start program through role modeling, not program activities. Ask them to describe exactly what they do in this area to encourage healthy behaviors and discourage unhealthy ones.

Points to Consider:

• One behavior may have many effects, good and bad.
  
  
• Many outcomes are very long-term, and won’t be seen for many years.
  
  
• Some behaviors and situations are in our power to change, some are not. However, we can usually affect the overall outcome. If a person’s family has an unfortunate tendency toward heart disease, he can still minimize his own risk by not smoking, eating low-fat foods, managing his stress, and enjoying aerobic exercise several times a week. If another person’s family of origin was abusive and overused alcohol, she can still decide to avoid alcohol herself, and look to church, friends and coworkers for emotional support.
  
  
• Are there behavior connections that you don’t agree with? Are not sure of? Was there teamwork in making these connections?
  
  
• The connections with some behaviors and situations have been well studied. We can be sure of these; other connections are not so certain. Where connections are uncertain—does meditation really reduce my risk of heart disease? —the best approach is to try the behavior if it has a likelihood of helping and there are no indications of harm.
  

Key to Handouts J - M

OUTCOME Card - Emphysema/Lung Cancer
BEHAVIOR (or CONDITION) Cards

OUTCOME Card - Depression
BEHAVIOR (or CONDITION) Cards

OUTCOME Cards - A Bad Back
BEHAVIOR (or CONDITION) Cards

OUTCOME Card - Strong Heart/Aerobic Fitness
BEHAVIOR (or CONDITION) Cards

OUTCOME Card - Healthy Skin
(fewer wrinkles and less skin cancer)
BEHAVIOR (or CONDITION) Cards

OUTCOME Card - Strong Bones and Teeth
BEHAVIOR (or CONDITION) Cards

OUTCOME Card - A Healthy Planet
BEHAVIOR (or CONDITION) Cards

OUTCOME Card - Happy, Alert Old Age
BEHAVIOR (or CONDITION) Cards

Activity 2: Role Modeling

Purpose: This activity is to help staff reflect on the way children learn and the power staff hold as role models of health behavior.

For this activity you will need:

• An opportunity for participants to observe children at play
  
  
• Writing materials including note pad for each participant

Step 1: Review the background information for Module 3. Arrange for a time to watch a group of children in your program during free play. If you are not regularly in the classroom, you will have to arrange to do this with the classroom staff at a time that they feel it would not be intrusive.

Step 2: Observe a group of children at free play for at least 20 minutes. Bring paper and pencil and jot down your observations. What language or behavior are they copying from the adults around them? Make notes of the play the children are engaged in, the language they use.

Step 3: Immediately after the observation period, or at another time, review your notes and consider the following questions:

Step 4: Observing the children and considering the above questions, it’s clear that children learn by watching adults, even when that is not what we intend! Keeping that in mind, review the list of behaviors we encourage in children. Do you ever have occasion to model these behaviors? If there are other positive health behaviors you model, add them to the list. “Teachable moments” happen all the time, in and out of the classroom.

I can model…

Using words to resolve conflict

Sharing

Wearing seat belts

Reading

Washing hands

Cleaning up after myself

Eating wholesome foods

Expressing feelings

Exercising regularly

Not smoking cigarettes

Using a tissue to wipe nose

Car-pooling or using public transportation

Step 5: With a partner, consider how your staff models health practices—during the course of their day with Head Start children and families—that lead to better health at all three levels:

• basic health needs
  
  
• disease prevention and protection from injuries
  
  
• health promotion

What more can be done? For example, using the above list:

• Wearing seat belts protects from injury—What could staff in each component area do to encourage safe travel?
  
  
• Expressing feelings is a basic human need, along with the need for someone to hear about those feelings—What more could staff in each component area do to encourage appropriate expressions of feelings?

Points to Consider:

• People learn very well through modeling because they can actually see a behavior.
  
  
• We model behaviors as groups and as individuals. People, especially children, will avoid a behavior if the peer group disapproves, and will try new things if others in the group are doing them.

Activity 3: Head Start Center Action Plan

Purpose: This activity gives participants the opportunity to consider how the three levels of services are provided in each component area of their Head Start Centers.

This exercise is a group activity. You will need:

One copy of the following handouts for each participant:

• Handout N: Basic Health Needs
  
  
• Handout O: Disease Prevention/Injury Protection
  
  
• Handout P: Health Promotion
  
  
• Handout Q: Head Start Center Action Plan
  
  
• Flip chart and markers
  
  
• Writing materials for participants
  

Step 1: Review background information in Module 3 on the three levels of health services (see p. 47):

• Basic Health Needs
  
  
• Disease Prevention and Protection from Injuries
  
  
• Health Promotion

On a sheet of flip chart paper, list the three levels of health and ask the participants to give examples of services and activities for each level. Be sure to have examples from the physical, mental/emotional, social, environmental, and spiritual dimensions of health. Some examples:

• Basic Health Needs: some food to eat, someone to look out for me, non-hazardous air, the ability to move about (physical capabilities), removal of barriers
  
  
• Disease Prevention/Protection from Injuries: nutritious food, someone to love me, clean and fresh air, good shoes, and a safe climbing structure

• Health Promotion: tasty and diverse food, loving support for my adventures and growth, a chance to visit mountains or beaches, special training for my favorite sport or activity

Step 2: Divide your participants into groups by component or functional area. Give each person in the group the following handouts:

• N: Basic Health Needs;
  
  
• O: Disease Prevention/Injury Protection; and
  
  
• P: Health Promotion.

Ask them to fill these out as they consider ways in which they—as a component team—support the health of children on the different levels. What activities or services are being provided? Where are the gaps? Where are improvements needed?

Step 3: After approximately 10 minutes, ask the group members to consider their lists. Ask them to think of the one area where they believe they can make a change, an improvement, during the next few months. This could be a change in meeting basic needs, disease prevention/injury protection, or health promotion. Ask them to star that item, and to think about what resources are necessary for them to make that change.

Step 4: On flip chart paper, draw a large grid to look like the Head Start Center Action Plan provided. Distribute Handout Q: Head Start Center Action Plan.

Bring the group back together and, on the grid, build a plan for the program, listing the most important areas for action. Ask each component team to indicate which level of service or activity they plan to address. Check off that one and write in their plan. Be sure to indicate, as you write what must be done, the resources necessary to achieve this goal.

Step 5: Discuss any barriers that may be in the way of achieving the goals they set for their program(s). How can the barriers be addressed? How can the team in one component area support the efforts of another? See Next Steps: Ideas to Extend Practice (p. 62) for ways to continue and expand this activity.

Points to Consider:

• Most programs offer services in the middle level: disease prevention and protection from injury. Examples of such services are lessons in using a toothbrush, washing hands, providing food that is nutritious and adequate. Sometimes it is a challenge to think of what we can do in the other two areas. Sometimes what is done in basic health needs is “invisible.”
  
  
• Each component area can address health services. Those that are not traditionally thought of as health areas, such as management or social services, may have a hard time imagining how they help or how they can help. But, without each component team committing effort in its own way, the entire effort will be limited.
  
  

Next Steps: Ideas to Extend Practice

Take a Field Trip

Is there another Head Start program you know of that has had success promoting wellness in an innovative way? If so, organize a site visit with interested staff to observe, ask questions, and get inspired. Contact your Regional Office for nearby sites with excellent and innovative health programs.

Schedule a Program Planning Day

Take the program plan from Activity 3 and use it as a blueprint for a planning day to be held in conjunction with a Health Services Advisory Committee meeting. Use the experts on the HSAC and parents as strategic planning consultants to help you achieve your goals.

Expand the Program Plan to Staff and Families

Redo Activity #3, the Head Start Center Action Plan. Instead of having each group consider what they do for the health of children, ask them to consider what they offer or what they could offer to families in their programs.

Another time, redo the activity considering the health needs of staff.