Head Start Agencies Research Articles

Investigation of key domains associated with worker well-being and burnout and turnover in the early care and education workforce.

The early care and education (ECE) workforce provides care for children aged zero to five. This critical segment of the workforce experiences significant burnout and turnover rates resulting from extensive demands, including job stress and poor overall well-being. Factors associated with well-being in these settings and the resulting impacts on burnout and turnover are understudied. The purpose of this study was to investigate associations between five well-being domains and burnout and turnover outcomes among a large sample of Head Start ECE staff in the United States. An 89-item survey based off the National Institutes of Occupational Safety and Health Worker Wellbeing Questionnaire (NIOSH WellBQ) was administered to ECE staff employed in five large urban and rural Head Start agencies. The WellBQ is made up of five domains intended to measure worker well-being as a holistic construct. We utilized linear mixed-effect modeling with random intercepts to investigate associations between sociodemographic characteristics, well-being domain sum scores and burnout and turnover. After controlling for sociodemographic variables, the well-being Domain 1 (Work Evaluation and Experience) (β = -.73, p < .05) and Domain 4 (Health Status) (β = -.30, p < .05) were significantly and negatively associated with burnout; the well-being Domain 1 (Work Evaluation and Experience) (β = -.21, p < .01) was significantly and negatively associated with turnover intent. These findings suggest that multi-level well-being promotion programs could be critical to mitigate ECE teacher stress and address individual-, interpersonal-, and organizational-level predictors of overall ECE workforce well-being.

Effects of a Sleep Health Education Program for Children and Parents on Child Sleep Duration and Difficulties

Preschool-aged children often lack sufficient sleep and experience sleep difficulties. A consistent bedtime routine, falling asleep alone, and other sleep practices reduce difficulties and increase sleep duration. To evaluate the effects of a preschool-based sleep health literacy program on children's sleep duration and difficulties and on parent sleep knowledge, attitudes, self-efficacy, and beliefs 9 and 12 months after the program. This stepped-wedge cluster randomized clinical trial was implemented across the 2018-2019 school year. Head Start preschool personnel delivered interventions and collected outcomes data at baseline and 4 follow-ups. Seven Head Start agencies across New York State were randomized to implement interventions in either fall 2018 or winter and spring 2019. Outcomes were ascertained at 9- and 12-month follow-up. From March 19 through September 28, 2018, Head Start staff recruited (a) English- or Spanish-speaking parents (b) of children 3 years of age on or about September 2018 (c) who planned to remain at the site through the school year. Altogether, 519 parent-child (aged 3 years) dyads completed baseline and (any) follow-up data. A 2-week classroom curriculum for children, a 1-hour parent workshop, and 1-on-1 parent discussions at home or school. Outcomes were the pre- vs postintervention differences measured at baseline and 9-month follow-up for parent-reported child school-night sleep duration per sleep logs, mild or moderate sleep difficulties per a validated questionnaire, and the total and domain scores for parent sleep knowledge, attitudes, self-efficacy, and beliefs. A modified intention-to-treat analysis excluding participants with only baseline data was used. The mean (SD) age at enrollment of 519 children was 2.7 (0.1) years, 264 (50.9%) were girls, 196 (37.8%) lived in Spanish-speaking households, and 5 (0.9%) identified as Alaskan Native or American Indian, 17 (3.2%) as Asian American or Pacific Islander, 57 (10.8%) as Black, 199 (37.8%) as White, and 63 (12.0%) as other. Mean sleep durations increased nonsignificantly from baseline by 5.6 minutes (95% CI, -2.3 to 13.6 minutes; P = .17) at 9-month follow-up and by 6.8 minutes (95% CI, 0.2-13.7 minutes; P = .06) at 12-month follow-up. There was a slight improvement in parental knowledge (1.13 unit increase from baseline; 95% CI, 0.13-2.12 units), but no significant outcomes for parent sleep attitudes (0.16 unit increase from baseline; 95% CI, -0.46 to 0.77 units), self-efficacy (-0.13 unit decrease from baseline; 95% CI, -1.02 to 0.76 units) and beliefs (-0.20 unit decrease from baseline; 95% CI, -0.56 to 0.16 units). Intervention effects for child sleep difficulties were not significant (odds ratio, 1.13; 95% CI, 0.62-2.09). Fewer than 1 in 4 parents accurately perceived their child's sleep difficulty at 12 months. The findings of this large pragmatic, stepped-wedge cluster randomized clinical trial, albeit largely negative, may have implications for the sustained impact, focus, and potential population-level effects of sleep education programs. Future research should evaluate the effects of more recurrent programming that emphasizes recognition of sleep problems and whether small increments of sleep across months and years in early childhood have meaningful effects. ClinicalTrials.gov Identifier: NCT03556462.

Supporting family meal frequency: Screening Phase results from the Simply Dinner Study

We aimed to test main, additive, interactive effects, and feasibility of all possible combinations of six intervention components implemented for 8 weeks (Cooking/Serving Resources; Meal Delivery; Ingredient Delivery; Community Kitchen; Nutrition Education; Cooking Demonstrations). Primary outcomes were family meal frequency and preschoolers' dietary quality; secondary outcomes included family meal preparation type, meal preparation barriers, family functioning, and kitchen inventory adequacy. All possible intervention combinations were tested using a randomized factorial trial design in the first phase of a Multiphase Optimization Strategy (MOST). Feasibility was assessed via attendance, delivery logs, and satisfaction. Parent-reported data collection included: socio-demographics, frequency and type of family meals; preschooler dietary intake; perceived barriers to meal planning and preparation; assessment of family functioning; and a kitchen inventory of materials generally needed for meal preparation. Participants (n = 499) were recruited at two Head Start agencies in mid-Michigan with data collection and delivery of some intervention components in participants' homes. Promising intervention bundles were identified by evaluating pre-to post-intervention effect sizes. The combination of Cooking/Serving Resources and Meal Delivery increased family meal frequency (Cohen's d = 0.17), cooking dinner from scratch (d = 0.21), prioritization of family meals (d = 0.23), and kitchen inventory (d = 0.46) and decreased use/consumption of ready-made (d = −0.18) and fast foods (d = −0.23). Effects on diet quality were in the expected direction but effect sizes were negligible. Community Kitchen, Nutrition Education, and Cooking Demonstration showed poor feasibility due to low attendance while Ingredient Delivery was infeasible due to staffing challenges related to its labor intensity. Additionally, although not one of our pre-specified outcomes, Cooking/Serving Resources (RR = 0.74) and Meal Delivery (RR = 0.73) each decreased food insecurity. Cooking/Serving Resources combined with Meal Delivery showed promise as a strategy for increasing family meal frequency.

Assistant Teachers, Workplace Satisfaction, and the Creation of a Culturally Competent Workforce Pipeline in Head Start

Early care and education programs like Head Start provide a critical foundation for later achievement for children from vulnerable communities. Notably, recruiting and retaining bilingual teachers is an ongoing struggle for many Head Start agencies. Assistant teachers are more likely to be bilingual than their lead teacher counterparts ( Jacoby, in press ) and are important contributors to a workforce pipeline that diversifies staff. We conducted this qualitative study with 35 assistant teachers to understand how workplace attributes influence satisfaction and job retention in Head Start. Workplace attributes such as wages and support for professional education and those with symbolic value, such as the robustness of the program, both played an important role. We also found that the instrumental-symbolic framework demonstrated utility for understanding how workplace attributes might be leveraged to recruit and retain linguistically and culturally competent teaching staff.

Improving parent oral health literacy in Head Start programs.

Parental low oral health literacy is thought to contribute to child oral health disparities. Few large-scale interventions can improve oral health literacy for diverse, high-risk populations. We sought to determine whether an oral health literacy intervention aimed at parents of children attending Head Start programs improved oral health literacy and behaviors. Staff from 29 Head Start agencies across the country were trained to deliver a parent oral health literacy intervention. Parent surveys were conducted at baseline and approximately 6 months later, following intervention completion. Surveys measured parent and child demographics, oral health knowledge, behaviors, information sources, and health care utilization. Paired t tests and mixed-effects regression models controlling for agency, child age, and race/ethnicity evaluated whether measures improved after the intervention. In addition, at follow-up, agency staff were asked to complete an open-ended survey reporting how the intervention impacted their site. Responses were coded using a grounded theory approach. A total of 2,011 (87%) parents completed both the baseline and follow-up surveys. All oral health knowledge and behaviors improved significantly from baseline to follow-up. In addition, parents reported using more oral health information sources, using more preventative oral health care, and less emergency room (ER) use for child dental problems. Head Start staff perceived that the intervention increased parental oral health literacy, enhanced parental oral health engagement, improved child oral health behaviors, and facilitated health communication with parents. Findings suggest that this intervention successfully improved oral health literacy for diverse parents of children at high risk for dental caries.

Problem-Solving Education to Prevent Depression Among Low-Income Mothers

Although problem solving has been an important component of successful depression prevention and treatment interventions, evidence to support problem solving's mechanism of action is sparse. To understand the mechanism of an efficacious depression prevention intervention, problem-solving education (PSE). A multivariate path analysis was embedded within a randomized efficacy trial (February 15, 2011, to May 9, 2016). Participants were mothers with depressed mood, anhedonia, or depression history (but not in current major depressive episode) at 1 of 6 Head Start agencies. Participants were followed up for 12 months with serial assessments of potential intervention mediators and depressive symptoms. Problem-solving education (n = 111) and usual Head Start services (n = 119). Primary outcomes were depressive symptom elevations, which were measured bimonthly. Eight plausible intervention mediators were assessed: problem-solving ability; mastery; self-esteem; perceived stress; behavioral activation; and avoidant, problem-focused, and social coping. Among 230 participants, 152 (66.1%) were Hispanic; mean (SD) age was 31.4 (7.3) years. Based on associations with either PSE participation or depressive symptom outcomes, problem-solving ability, perceived stress, behavioral activation, and problem-focused coping were included in a parsimonious, multivariate path model. In this model, only perceived stress was associated with both PSE participation and depressive symptoms. Participants in the PSE group had adjusted standardized perceived stress change scores that were 11% lower than controls (95% CI, -0.19 to -0.03), and improvement in perceived stress generated an adjusted rate ratio (aRR) of 0.42 (95% CI, 0.33-0.53) for depressive symptom elevations. Participants in the intervention group also had standardized behavioral activation change scores 15% greater than controls (95% CI, 0.01-0.30) and problem-focused coping change scores 17% greater than controls (95% CI, 0.03-0.31); however, changes in these constructs were not associated with a differential rate of depressive symptom elevations. The direct effect of PSE on depressive symptom elevations (aRR, 0.72; 95% CI, 0.52-0.97) was greater than the mediated effect explained by improvement in perceived stress (aRR, 0.91; 95% CI, 0.85-0.98). Problem-solving education is efficacious in preventing depressive symptoms and appears to work by decreasing perceived stress; however, the mechanism for much of PSE's impact on depression remains unexplained. These results can be used to simplify the intervention model in preparation for effectiveness testing. ClinicalTrials.gov Identifier: NCT01298804.

Efficacy of a Maternal Depression Prevention Strategy in Head Start

Low-income and minority mothers experience a disproportionate incidence of depression and lack access to treatment services. Development of prevention strategies in accessible community-based venues is a potentially important public health strategy. To determine the efficacy of a depression prevention strategy embedded in Head Start. This randomized clinical trial was performed from February 15, 2011, through May 9, 2016, at 6 Head Start agencies serving families at or below the federal poverty level. Participants included mothers with depressed mood, anhedonia, or depression history but who were not in a current major depressive episode. Participants were followed up for 12 months with masked outcome assessments. Final follow-up was completed on May 9, 2016. Participants were randomized to a problem-solving education (PSE) intervention (n = 111) or usual Head Start services (n = 119). Primary outcomes were problem-solving skills and depressive symptoms. To capture the chronicity and intensity of symptoms, the Quick Inventory of Depressive Symptoms was administered bimonthly, and rates of clinically significant symptom elevations were compared across groups. Secondarily, the presence of a major depressive episode was assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Among the 230 participants, 152 (66.1%) were Hispanic, with a mean (SD) age of 31.4 (7.3) years. An intention-to-treat analysis among 223 participants contributing follow-up data found no differences in problem-solving skills across groups. The mean (SD) number of depressive symptom elevations among the PSE participants was 0.84 (1.39) compared with 1.12 (1.47) among the usual service participants (adjusted incident rate ratio [aIRR], 0.60; 95% CI, 0.41-0.90). In analyses stratified according to baseline depressive symptoms, PSE exerted a preventive effect among those with lower-level baseline symptoms, with a mean (SD) of 0.39 (0.84) elevations among PSE participants compared with 0.88 (1.37) among usual service participants (aIRR, 0.39; 95% CI, 0.21-0.75). However, no difference was observed among those with higher-level baseline symptoms (mean [SD] elevations, 2.06 [1.92] for PSE and 2.00 [1.91] for usual service; aIRR, 1.10; 95% CI, 0.67-1.80). Analysis of symptom scores followed the same pattern, with an adjusted mean reduction of 1.33 (95% CI, 0.36-2.29) among participants with lower-level baseline symptoms. The PSE intervention is efficacious in preventing depressive symptom episodes and performs optimally among those with initial low-level symptoms. Additional effectiveness studies in Head Start are necessary to develop meaningful public health programs. clinicaltrials.gov Identifier: NCT01298804.

Promoting Sleep Health Among Families of Young Children in Head Start: Protocol for a Social-Ecological Approach.

Inadequate or poor quality sleep in early childhood impairs social–emotional and cognitive function via effects on the developing brain and increases obesity risk via hormonal and endocrine effects. The prevalence of short sleep duration, behavioral sleep problems, and sleep-disordered breathing among children aged 3 to 5 years is 20% to 50%. Healthy sleep habits increase sleep duration and prevent behavioral sleep problems. Awareness of sleep-disordered breathing symptoms leads to its timely treatment. We designed a study that aims to empower families whose children are in early childhood programs with the knowledge and skills needed to obtain healthy sleep and to recognize a sleep problem. We used the social–ecological framework to guide individual, interpersonal, organizational, community, and policy interventions. This study builds on the Sweet Dreamzzz, Inc, Early Childhood Sleep Education Program (ECSEP) in Head Start. A stepped-wedge–cluster randomized trial will test effects on child, parent, and classroom outcomes; a policy evaluation will assess the impact of knowledge-translation strategies. The study has 3 aims. The first is to adapt educational materials into multimedia formats and build the capacity of Head Start agencies to implement the study. The second aim is to enroll 540 parent–child dyads in a primary prevention trial of sleep health promotion in Head Start and to analyze effects on children’s sleep duration (primary outcome); parents’ knowledge, attitudes, self-efficacy, and behavior; and children’s sleep difficulties. The third aim is to conduct a secondary prevention feasibility study of screening and guidance for sleep problems. Secondary outcomes are changes in classroom behaviors and policies. Integrating sleep health literacy into early childhood programs could affect the life-course development of millions of children.

Developmental and Health Services in Head Start Preschools: A Tiered Approach to Early Intervention

ObjectiveTo describe a tiered approach to identifying and addressing developmental and health concerns among low-income preschool children in Head Start. MethodsAnalytic sample consisted of 3- to 5-year-old Head Start students (n = 1171) from 14 centers in Los Angeles County serving predominantly Latino families during 2008−2009. All Head Start students were screened for developmental and health concerns and assigned to 1 of 3 tiers of intervention need: Tier 1 children needed only the usual Head Start curriculum, Tier 2 children needed targeted interventions (excluding special education), and Tier 3 students received special education services. Logistic regressions were used to analyze predictors of each tier, with screening results and sociodemographic variables as covariates. ResultsSixty-nine percent of children were in Tier 1, 25% in Tier 2, and 6% in Tier 3. Tier 2 children most commonly needed mental health services and were less likely than those in Tier 1 to be from primarily English-speaking homes (odds ratio = 0.6, P < .01). Tier 3 children were significantly less likely to be female than Tier 2 children (odds ratio = 0.4, P < .05). ConclusionsMore than one-quarter of low-income children not in special education may need targeted interventions, particularly mental health services. Although Head Start agencies are required to identify and address these needs, many other early education and clinical settings do not. Establishing screening and intervention guidelines for this intermediate-risk group represents a key policy gap for the child health and education systems.

“Eat Healthy, Stay Active!”: A Coordinated Intervention to Improve Nutrition and Physical Activity among Head Start Parents, Staff, and Children

Examine the effectiveness of the "Eat Healthy, Stay Active!" pilot program, a multisite, 6-month educational intervention to promote healthy nutrition and physical activity among Head Start staff, parents, and children. Comparison of within-group preintervention and postintervention knowledge and behavior, along with anthropomorphic measurements. The study was conducted in a convenience sample of six large Head Start agencies in five states. Participants included 496 staff, 438 parents, and 112 preschool children. The 6-month intervention consisted of core trainings and reinforcing activities for staff and parents that aligned with children's curricula. Pre-post questionnaires and anthropometric measurements examined changes in body mass index (BMI), knowledge, and behaviors related to nutrition and physical activity. Paired t-tests to compare preintervention and postintervention weights and BMI; multiple regression analyses to examine associations between weight changes and other covariates, including knowledge and behavior changes, controlling for sociodemographic variables. Each group of participants demonstrated significant reductions in BMI (mean = 30.1 to 29.2; p < .001 in adults and 17.0 to 16.6; p < 0.001 in children) and in the proportion of obese children (30% to 21%; p < .001) and adults (45% to 40%; p < .001). Child weight changes correlated with parent weight changes. This intervention showed promising initial results, with potential effectiveness as an intervention to promote healthier behaviors among adults and children in Head Start settings.

Closer Than “Arms Length”

This article focuses on collaborative relationships between contractors and government agencies and explores which contract characteristics, contractor traits, and environmental factors are associated with the development of such relationships. The study uses data from the Partnership Impact Research Project, a three-round longitudinal survey of over one hundred child care centers and Head Start agencies in Ohio. Our findings suggest that stronger collaborative contracting relationships are associated with greater contract specificity, better contractor service quality, and contractor affiliation with a larger organization. On the other hand, a contractor’s financial autonomy and nonprofit status are negatively related to collaborative relationship strength. We also find that a contractor’s internal management capacity is positively associated with the development of shared procedures governing contractual relationships.

The Continuing Problem of Asthma in Very Young Children: A Community‐Based Participatory Research Project

Asthma is a chronic health condition that has a disproportionate effect on low-income minority children who reside in large urban areas. African-American children report significantly higher rates than the general population of children and have more-severe asthma and poorer outcomes. This article describes the prevalence of asthma in a particularly vulnerable group: children aged 2-5 participating in Detroit Head Start programs. Health screens were distributed to caretakers of all children attending 6 Head Start agencies. Caretakers of children identified with active asthma symptoms were asked to complete an in-depth phone interview regarding their child's asthma. Data collected from 3,254 children (78% African American) revealed that 27% met criteria for probable asthma. Of those with persistent symptoms, 26% were undiagnosed, and 21% were untreated. Baseline data (n = 675) showed that 95% had a regular doctor, but 36% had had no health care visit for asthma in the previous year. Of children with a history of asthma episodes, more than half reported 3 or more episodes in the preceding year. Forty-three percent of caretakers had discussed their child's asthma with Head Start, and 31% had an asthma action plan on file with Head Start. Asthma remains a significant problem in this population, especially for African Americans, as evidenced by high levels of undiagnosed children with persistent symptoms and questions regarding the care they receive. Head Start is a way to reach young children with asthma, but may need help to develop the capacity to assist families.

Head Start-Operated Full-Day Services: Successes, Challenges, and Issues

Researchers conducted focus groups in three Minnesota Head Start programs that provide full-day services. The purpose of this descriptive study was to understand how these programs operated, the strengths and challenges of full-day Head Start programs, and how working parents and those on public assistance described these services. Findings include parents' satisfaction with various models of full-day services and parents' needs for extended hour care, transportation, information about full-day options, and child care assistance. Attributes of successful models include guaranteed fiscal support to programs, long-term partnerships with community programs, equipment, supplies, and renovation funds for child care programs, and Head Start mentoring and support personnel to work with family and center providers. Full-day models coupled with postsecondary training opportunities provide a viable means to help families obtain family self-sufficiency. Challenges and issues include concerns about the quality of some child care programs, inadequate fiscal and Head Start staff support for child care partners, and lack of understanding of the differences between Head Start and child care. These findings are important because Head Start agencies, recognizing the need for full-day services, are now developing and implementing these services, and the three programs provide several models, each with strengths, weaknesses, and issues.

Understanding barriers to parent involvement in Head Start: a research-community partnership

The present study was conducted by a research institute, The NCJW Center for the Child, in partnership with two Head Start agencies in New York City. The research grew out of practitioners’ concerns about parent involvement in their programs and what barriers may be inhibiting participation. Sixty-eight mothers whose children had completed one year of Head Start were interviewed using the Barriers to Parent Involvement Survey. Results revealed that mothers reported the presence of many difficult life experiences, but few were reported as actual barriers by many mothers. Five out of 20 of these experiences were associated with staff ratings of mothers’ level of participation. Developing ways to address barriers to participation at the Head Start agencies is discussed in light of the research findings. Information about wider application of the survey as well as research and programmatic implications of the results are included.