Head Start and Mental Health
Jim O'Brien, Program Specialist, Health and Disabilities Services Branch, Head Start Bureau
Head Start has always recognized that promoting the healthy development of children includes attention to mental health. As with physical health, Head Start's primary strategy is to prevent problems by reducing risks and nourishing healthy habits. And when mental health services are needed, Head Start helps children and their families receive them.
The Performance Standards set out the following mental health objectives for Head Start:
Head Start programs, with assistance from mental health professionals, must design and implement a mental health effort with three levels of intervention:
- Assist all children in their emotional, cognitive, and social development toward the goal of social competence;
- Provide necessary mental health services to children with special needs;
- Inform staff and parents of the need for an environment which is supportive and responsive to the developmental needs of the child; and
- Mobilize community services to serve the mental health needs of children and their families.
Prevention:
- Prevention
- Identification/Referral
- Treatment/Support
Prevention is the central mental health activity of Head Start and is represented throughout activities of the entire program - family support, parent involvement, parent and staff education, developmentally appropriate activities for children, and responsive health and nutrition.
Prevention is a major part of the responsive, nurturing, and stimulating Head Start environment for promoting mental health development.
Head Start gives parents an opportunity to share concerns, learn about their child's emotional development, and receive practical advice on how to address these concerns. This information and support can play an important role in building and reinforcing strong parent- child relationships and preventing or disrupting potentially harmful patterns. Prevention must also include information and support for the Head Start staff trying to meet the needs of the children and families they serve.
Mental health professionals have increasingly recognized that a child's family is an essential component in prevention efforts. Parents' interactions with their children contain powerful messages, some helpful and some hurtful, about ways of dealing with such basic emotions as fear, affection, and anger. With information and support, parents and staff can learn and practice ways to help young children develop "mentally healthy" habits which are critical to achieving social competence.
Dealing with a child's emotions can be an "emotional" experience, particularly for a parent who is isolated from support systems. Many low-income parents face the significant mental health risks of isolation from social supports, and lack a sense of effectiveness. In Head Start, parents can participate in a program which respects their individual strengths and needs, and helps them to access personal and community resources to meet these needs. Promoting each parent's sense of effectiveness is a form of preventive mental health which can accrue benefits for their entire family.
Identification:
The health and developmental screening and assessment provided for each Head Start child includes efforts to identify possible mental health problems. The purpose of mental health screening is early identification of problems which, without appropriate intervention, may interfere with the child's development. A mental health professional must be available, at least on a consultation basis, to the Head Start program to provide advice and assistance in screening and assessment. The screening process is only one means of identifying mental health problems facing Head Start children; problems are also identified through parent reports, teacher observations, and referrals from outside agencies (e.g., Child Protective Services.)
To identify the mental health needs of children, the Head Start program must create an atmosphere in which a parent or teacher feels comfortable asking for help with a child who is experiencing emotional or behavioral problems. Too often parents, and even teachers, can be reluctant to admit that they do not know how to deal with challenging behaviors. The Head Start program should, with the assistance of its mental health professional, conduct training for parents and Head Start staff about addressing mental health problems, including specific guidance on how to seek additional help.
Identifying the mental health needs of parents, and of staff, are also important activities for the Head Start program. Head Start staff can be expected to need assistance from mental health professionals to design and deliver effective services for children and families experiencing mental health problems. Many Head Start families face chronic stresses associated with poverty, including community violence, social isolation, and the difficulties in meeting the primary needs of shelter, food, and safety. Many families deal with additional issues of substance abuse, teen parenting, and family violence which can influence family functioning and child development
Treatment/Support:
Few Head Start programs have staff on hand to provide mental health treatment to children and families. Head Start's role usually involves helping families with identified needs to receive mental health services. Often, the Head Start program can serve as an environment in which mental health objectives - ranging from a child's development of social interaction skills to a parent's participation in a support network - may be addressed with support and consultation from a mental health professional. Head Start programs must develop and maintain relationships with community mental health and family support agencies for the purpose of designing interventions for the child and family in the regular Head Start program. Yet, the Head Start program must be responsive to specific mental health needs which it cannot address by itself.
When children and families with significant mental health needs are identified, the next step is to involve a qualified professional. Head Start must play a supportive role to see that this referral is acted upon by the family, and that the services offered are responsive to the family's needs. Often, the Head Start program's contribution is helping families find the strength to seek help and to persevere in addressing problems. Peer support groups at the Head Start program, comprised of other Head Start parents, can play an important role in securing meaningful and sustained participation in a treatment program.
Additionally, the social service staff and mental health consultant must work together to access services for parents. Many Head Start programs have become increasingly active in establishing partnerships with community mental health and family support programs so that their mutual services are more accessible to low- income families with young children. Head Start can help by addressing barriers to service, such as lack of child care and transportation, and fear or negative attitudes about mental health services. Identifying resources, including EPSDT/Medicaid, for mental health services is an important role that Head Start programs play.
As Head Start centers continue to improve program quality and serve more children and families, careful attention to the design and implementation of their mental health component will be critical. The Advisory Committee on Head Start Quality and Expansion has recommended in its report, Creating a 21st Century Head Start, that special attention be paid to family support efforts. Strengthening the program's capacity to meet mental health needs of children and families will be critical to Head Start's efforts to improve program quality.