A Systems Approach to Serving Pregnant Women
in Early Head Start

By Mireille Kanda, M.D.

"It is particularly important that parental health is linked to children's health and development."

–Statement of the Advisory Committee on Services for Families with Infants and Toddlers, Department of Health and Human Services, September 1994

The link between a pregnant woman's health and the health of her child is a well-established fact. Early and regular prenatal care, a healthy diet, exercise, and avoidance of stress, alcohol, and other harmful substances are a few things all mothers can do to ensure that their child will be born healthy.

Early Head Start programs are in a unique position to support pregnant women and can offer this support through a combination of systems and services (as required by the Head Start Program Performance Standards).

Services to pregnant women begin with planning. Early Head Start programs use their community assessment tools to gain an understanding of the needs of the population they are serving, as well as to identify available community resources.

Factors to consider include:

• What existing community services serve pregnant women, and what types of services do they provide (health, social services, employment and/or training, education, substance abuse treatment, and nutrition)?
  
• Are these services readily accessible in terms of public transportation, hours of service, and geographic distance from families being served by the Early Head Start program?
  
• Are there particular populations that are not being served, such as pregnant teens or young pregnant teens?

Community Partnerships
Community partnerships play a key role in serving pregnant women. Strong partnerships that begin with a shared vision and clearly defined roles and responsibilities of each partner support the efforts of Early Head Start programs by maximizing program resources, reducing the likelihood of duplicating services, and making community services more family friendly.

Communication
To support these and other partnerships, there is a need for communication systems. Formal and informal systems of communication with community partners, staff, and parents are essential. When planning a program's approach to services to pregnant women, the issue of confidentiality needs to be addressed early on. Most community partners, with a family's consent, will be able to share information. Making this happen smoothly requires hard work and assurances that the Early Head Start program has systems and procedures in place that protect the privacy of the families they serve.

Communication with families is another factor to consider. After enrollment, what systems of communication are in place to ensure that the needs of pregnant women are being met? Is this communication formal (regular meeting time or telephone contact) or informal (unannounced home visits or notes in the mail.)? Does the pregnant woman feel comfortable talking with the Early Head Start staff person with whom she has a primary relationship? If not, are there other staff members with whom she can talk informally?

Informal and formal systems of communication between staff are often the link between systems and services in an Early Head Start program. Regular staff meetings provide opportunities to discuss family needs, gaps in service, community resources, and whether additional supplies and staff could better support programs. Data about family needs, self-assessments, and ongoing monitoring can also be shared during staff meetings. Integrated service delivery, a key feature of services to pregnant women, faces many challenges and requires good communication to remain effective.

Family Partnership Agreements
The Family Partnership Agreement Process is where the Early Head Start program and pregnant woman work together to identify goals, strengths, and needed services. It is also where feelings of trust between the program and the family begin. During this process, the type and frequency of support needed is established. For example, some pregnant women may need home visits on a regular basis, some may not need them at all, and some may need them intermittently. During this process, it may be decided that the pregnant woman wants to participate in Early Head Start center-based or socialization events to learn more about parenting and child development. There may also be discussion on what information the woman may need about labor and delivery, breast feeding, smoking cessation, and substance abuse services. It is also the place where discussions may begin about what types of services the child may receive (home- or center-based) after birth. It is important to take the necessary steps to transition newborns into the program. Whatever the need, the family partnership agreement process is the vehicle by which many services in Early Head Start take place.

Ongoing monitoring and self-assessment
Ongoing monitoring and self-assessment are two separate systems that support services to pregnant women in Early Head Start. They provide valuable information about how the program is operating as well as what, if any, changes are needed to ensure the delivery of high-quality services. Since the Head Start Program Performance Standards require Early Head Start programs to assist pregnant women in accessing comprehensive prenatal and postpartum services, the ongoing monitoring system is one way to make sure that pregnant women receive quality, comprehensive, and timely prenatal and postpartum services.

Another way to do this is through tracking. The Head Start Program Performance Standards require programs to follow up with each family to determine whether the kind, quality, and timeliness of services received through referrals meet family expectations and circumstances 1304.20 (b)(2). This follow-up is critical for pregnant women. Tracking services to make sure appointments are kept, needed services are provided, and that problems (with either the family or a community service provider) are identified and addressed early on are yet another way to ensure high-quality services.

As you can see, services to pregnant women are comprehensive, complicated, and challenging. But what better time to work with women to ensure they and their child-to-be are healthy, happy, and have the support they need?

Mireille (Mimi) Kanda is the Chief of the Head Start Bureau's Health and Disabilities Branch, T: 301-594-4001.