Head Start Research Articles

Engagement with reservation-based Head Start teachers to explore their stress and coping: A qualitative study

BackgroundNative Americans residing in remote reservation communities find strength in connection to place, culture, language, and sovereignty; they also face challenges as their communities struggle with historical and contemporary traumas that have resulted in poverty, high crime and suicide rates and drug misuse. The psychological well-being of Head Start teachers who teach and support the needs of Native American children, is overlooked. MethodsQualitative interviews (n = 18) and focus groups (n = 9) were conducted with Head Start teachers, supervisors, parents, and ancillary staff to identify risk and protective factors at each level of the socioecological model (individual, relationships, community, society). Using content analysis and F4 analyse software two coders identified recurring themes. ResultsIndividually teachers are resilient, focused more on the children's well-being than their own. Family was both significant support and stressor. Community struggles with drug and alcohol misuse and homelessness were the most frequent stressors. Workplace support included their supervisors and the mentorship they provided each other. Spirituality in the form traditional cultural practices, prayer and Christen faith were important sources of support and well-being. ConclusionsThis paper provides insight into the stress and coping mechanisms of reservation-based Head Start teachers, identifying ways to protect and promote their health and well-being. It is important to provide support at all levels of the socioecological model to enable these teachers to strengthen their physical and psychological health and wellbeing so that they may support the children and families of Head Start to help strengthen Native American health overall.

A Comparative Feasibility Study To Evaluate Fruit and Vegetable Delivery Methods in a Produce Prescription Program for Head Start Parent-Child Dyads

A Comparative Feasibility Study To Evaluate Fruit and Vegetable Delivery Methods in a Produce Prescription Program for Head Start Parent-Child Dyads

Obesity Indices Positively Correlate With Age in 2 to 5-Year-Old Children in a Head Start Program and Was Exacerbated by the Coronavirus Disease 2019 Pandemic

Obesity Indices Positively Correlate With Age in 2 to 5-Year-Old Children in a Head Start Program and Was Exacerbated by the Coronavirus Disease 2019 Pandemic

Emotion Knowledge Relates to Cortisol for Children Attending Head Start Preschool

ABSTRACT Research Findings: The ability to manage emotions is thought to be important for regulating stress at a physiological level, yet no prior published studies have examined young children’s emotion understanding or knowledge in relation to the stress hormone cortisol. The present study investigated the statistical relation between emotion knowledge (EK) and cortisol levels for 307 young children ages 3–5 years who attended Head Start preschool, and their primary caregivers. All of the child participants faced economic hardship and 80% were Black, Indigenous, and People of Color (BIPOC) and thereby positioned to experience systemic racism. At the start of the preschool year, EK, or understanding of emotions, was assessed using a well-validated emotion matching task and basal cortisol levels were measured via salivary assay. Results of a multiple linear regression analysis revealed that, after accounting for demographic covariates, greater EK was associated with lower cortisol. Practice or Policy: The finding that EK relates to cortisol levels in early childhood highlights the importance of addressing emotional competence in early intervention programs. Notably, the relationship may be bidirectional and reducing stress levels also may facilitate advancing young children’s emotion understanding. Interventions that promote EK and reduce stress levels may advance overall school readiness.

Under what conditions does missing school matter most? Examining associations between absenteeism and child outcomes in Head Start

Although prior research has shown that preschoolers’ absenteeism is negatively associated with their learning and developmental outcomes, few studies have examined the conditions under which absenteeism matters more versus less. This study reproduces research exploring differences in these associations across different levels of preschool classroom quality and extends this literature by considering the role of children’s home learning environments. Using data from the Head Start Family and Child Experiences Survey, 2009 Cohort, results showed that associations between children’s absenteeism rates and children’s language, literacy, and approaches to learning skills varied by levels of classroom quality experienced. These joint associations differed by development outcome. Moreover, high levels of household stimulation were found to buffer the negative associations between absenteeism and children’s literacy skills. Finally, results showed little evidence for meaningful differences in the associations between children’s absenteeism, classroom quality, and developmental outcomes based on levels of household stimulation. Findings highlight the importance of considering how the classroom environments they are missing and the home environments they may be experiencing when absent from school matter for young children’s development.

Valuations of target items are drawn towards unavailable decoy items due to prior expectations.

When people make choices, the items they consider are often embedded in a context (of other items). How this context affects the valuation of the specific item is an important question. High-value context might make items appear less attractive because of contrast-the tendency to normalize perception of an object relative to its background-or more attractive because of assimilation-the tendency to group objects together. Alternatively, a high-value context might increase prior expectations about the item's value. Here, we investigated these possibilities. We examined how unavailable context items affect choices between two target items, as well as the willingness-to-pay for single targets. Participants viewed sets of three items for several seconds before the target(s) were highlighted. In both tasks, we found a significant assimilation-like effect where participants were more likely to choose or place a higher value on a target when it was surrounded by higher-value context. However, these context effects were only significant for participants' fastest choices. Using variants of a drift-diffusion model, we established that the unavailable context shifted participants' prior expectations towards the average values of the sets but had an inconclusive effect on their evaluations of the targets during the decision (i.e. drift rates). In summary, we find that people use context to inform their initial valuations. This can improve efficiency by allowing people to get a head start on their decision. However, it also means that the valuation of an item can change depending on the context.

Pathways between parental depressed mood and child cognition in economically marginalized populations

Research supports parental depressed mood, negative parenting, and family conflict as risk factors for poorer cognition in early childhood. The current study is the first to examine bidirectional associations between maternal and paternal depressed mood, negative maternal and paternal parenting, family conflict, and child cognition. Data was drawn from the Early Head Start Research and Evaluation study using interviews, self-report, and performance-based measures completed by parents when children were age 14 months, age 2 years, and age 3 years. Results showed bidirectional pathways between maternal depressed mood and child cognition, but a unidirectional pathway from child cognition to paternal depressed mood. Family conflict mediated links between greater maternal depressed mood and poorer child cognition, but negative maternal parenting mediated links between poorer child cognition and negative maternal depressed mood. Results highlight transactional relations among parents and children as well as the salience of family conflict and negative parenting in exacerbating this transaction.

Impact of refresher training on the outcomes of trachomatous trichiasis surgery

Background/aimsTrachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher...

MDB-83. OUTCOMES OF INFANTS AND YOUNG CHILDREN WITH NEWLY DIAGNOSED SHH MEDULLOBLASTOMA TREATED ON THE NEXT CONSORTIUM “HEAD START” 4 PROTOCOL

Abstract BACKGROUND Infants and young children with SHH medulloblastoma were demonstrated to have a favorable outcome on “Head Start (HS)” III clinical trial utilizing five cycles of induction followed by one myeloablative high-dose chemotherapy (HDCT) cycle. We present the results of “Head Start” 4 (HS-4) trial where SHH subgroup patients received either three or five cycles of induction based on response followed by one HDCT cycle (similar to HS III). METHODS Eligibility included children <6 years of age at diagnosis of localized medulloblastoma and <10 years for patients with disseminated disease. Eligible patients with SHH medulloblastoma were considered “low-risk” and non-randomly assigned to receive three cycles (five cycles if <complete response) of induction chemotherapy (vincristine, cisplatin, cyclophosphamide, etoposide, and high-dose methotrexate) followed by consolidation with single HDCT cycle (thiotepa, carboplatin, etoposide) and autologous hematopoietic stem-cell rescue. RESULTS Thirty-nine children with SHH medulloblastoma were enrolled on HS-4 with median age of 2.18 years (range: 0.28-6.88 years). Median follow-up for this cohort is 41 months (range: 18-67 months). Patients with localized SHH medulloblastoma (n=28) had significantly better 3-year event-free (EFS) compared to disseminated patients (n=11): 96.4% (95% CI: 90-100%) and 36.4% (95% CI: 16.6-79.5%), respectively (p<0.0001); however, there was no significant difference in 3-year overall survival (OS) between the two groups: 100% and 90.0% (95% CI: 73.2-100%), respectively (p=0.10). The estimated 3-year EFS for localized SHH subtype 1 and 2 patients was 100% and 95%, respectively (p=0.63). None of trial patients received irradiation prior to progression. All patients, except for four, underwent three cycles of induction. Germline variants were detected in 27% of patients tested (8/30). CONCLUSION We report excellent results for young children with localized SHH medulloblastoma when treated with only three cycles (reduced) of induction and single HDCT cycle on HS-4 trial without irradiation. Molecular data will be presented.

ETMR-13. MARROW-ABLATIVE CONSOLIDATION CHEMOTHERAPY WITH AUTOLOGOUS HEMATOPOIETIC PROGENITOR CELL RESCUE (HDCT) DECREASES THE DEVELOPMENT OF CHOROID PLEXUS CARCINOMA (CPC)-SPECIFIC RELAPSE IN HIGH-RISK TP53-MUTATED (GERMLINE OR SOMATIC) YOUNG CHILDREN WITH NEWLY DIAGNOSED CPC

Abstract BACKGROUND CPC are childhood cancers in which the loss of TP53 function defines unfavorable disease. CPC-free survival rates have remained poor in patients with TP53 mutations and recent data revealed CPC-free survival of 29% with a non-marrow-ablative chemotherapy strategy. Previously reported results of the “Head Start” (HS) HDCT approach were limited by small patient numbers and incomplete TP53 mutation data. Consequently, the role of HDCT in TP53-mutated CPC remains unclear. METHODS We have analyzed data on TP53 status, CPC-free survival and second cancers from the largest cohort of patients who received initial therapy with the intent of undergoing HDCT. RESULTS Twenty-seven children with CPC received HS-like induction chemotherapy and 23 completed HDCT consolidation. Somatic or germline TP53 mutations were identified in 17 patients, 4 exhibited TP53 wild type (TP53wt); TP53 status remained untested in 6. Five-year CPC-free survival was 66% for patients with TP53 germline mutations (n=12), 40% for those with somatic tumor TP53 mutations (n=5) and 50% with confirmed TP53wt (n=4). Among patients with germline TP53 mutations, only 4/12 experienced CPC recurrences, 4 died from secondary cancers and 4 are currently alive. The 5-year CPC-free survival for 23 patients who underwent HDCT was 52%. All six survivors with TP53 mutations had undergone HDCT, and 5/6 avoided irradiation. Eight/12 patients with TP53 germline mutations and Li-Fraumeni Syndrome (LFS) developed second malignancies, including 6 patients in HDCT group and the remaining 2 patients who did not undergo consolidative HDCT. CONCLUSIONS Our data indicate that HDCT consolidation is associated with improved CPC-free survival compared with historical reports in children with TP53 mutated CPC. The ultimate development of second cancers affects outcomes for those with LFS, irrespective of HDCT treatment. These data justify the inclusion of HDCT in the prospective international trial under development for young children with newly diagnosed TP53 mutated CPC.

ETMR-29. PRIMARY CNS SARCOMAS IN CHILDREN AND ADOLESCENTS: EXPERIENCE OF AN INSTITUTION

Abstract BACKGROUND Soft tissue sarcomas represent 6% of childhood cancers, less than 0.2% of CNS tumors are primary intracranial sarcomas. Their origin is pluripotential primitive mesenchymal cells. OBJECTIVE to evaluate clinical and genetic characteristics and report the experience of a rare CNS tumor. METHODS review of CNS tumors database at IOP/GRAACC/UNIFESP for the period 2008-2024, searching for all types of sarcomas that involved the CNS. RESULTS case series included 7 male, 2 female patients; average age at diagnosis 11.3 years. Supratentorial was the most common site of occurrence (66.6%), posterior fossa and intramedulary (2 and 1 cases, respectively) were found. One PF sarcoma presented as a second neoplasm after 2 years finished treatment for medulloblastoma, the other was diagnosed just after metilation. The presenting symptoms varied with tumor location, specially hemiparesis, seizure and headache. Gross total resection was achieved in 7 cases (77.7%), 1 after second look surgery. Histology and immunohistochemistry studies revealed: spinocellular sarcoma, fusocellular and myxoid sarcoma, gliosarcoma, meningeal sarcoma, Ewing sarcoma, condrosarcoma and synovial sarcoma. Work-up excluded other primary tumor origin outside CNS. Analyses for genetic characteristics were performed by Next Generation Sequencing in 6 patients (66.6%) and the following alterations were found: NRAS, TP53, JAK3, NF2, C11orf95-RELA fusion, PDGFRA. Some of these, by now, with no significant meaning for the disease. All patients underwent multimodal treatment. Chemotherapy involved mainly ICE Protocol (55.5%), but also Head Start Protocol and Ewing Sarcoma Protocol. Follow-up ranged from 13 months to 12 years, 90% of patients are alive, 2 (28.5%) dealing with endocrinal issues after focal radiotherapy. The mean overall survival was 61.4 months. CONCLUSION CNS primary sarcomas were mostly observed in the supratentorial region and in older children, with male predilection. Multimodal treatment seems to benefit patients’ outcomes. More patients and longer follow-up periods are needed to further elucidate the biological features of these tumors.

LMIC-03. BRAINSTEM RADIATION NECROSIS IN A PATIENT WITH RECURRENT MEDULLOBLASTOMA. SUCCESFULL TREATMENT OF A HIGHLY FEARED COMPLICATION

Abstract BACKGROUND Medulloblastoma is the most common malignant brain tumor in pediatric population. Standard treatment combines surgery, risk-adapted craniospinal irradiation and chemotherapy. Given the well-known cognitive sequelae in young children associated to radiation, strategies in infants try to avoid upfront radiation. A significant number of patients treated during infancy will ultimately relapse. Re-irradition in relapse setting has proven to be effective in disease control (survival depending on several factors) although there is a concern in exceeding radiation tolerance and risk of toxicity. METHODS Herein, we describe the case of male patient that presented at 1 year of age with a non-metastatic anaplastic medulloblastoma that was completely resected. He received 3 cycles of adjuvant chemotherapy (as per Head Start II), local relapse was detected in tumor bed during evaluation and was completely resected, afterwards he received myeloablative chemotherapy with stem cell rescue and posterior fossa radiation therapy (54 Gy). At 8 months off therapy patient developed spinal relapse in imaging with negative cytology, then treated with spinal irradiation 36Gy without adjuvant chemotherapy. He remained disease free during 12 months, then tumor recur at the right cerebellopontine angle, surgery was complete and there was no evidence of distant disease. Patient received adjuvant local radiation with 30.6Gy followed by chemotherapy (bi weekly bevacizumab + irinotecan). Cumulative maximal dose to brainstem was 84Gy. 2 months after radiation patient presented with extreme sleepiness and imaging findings compatible with brainstem radiation necrosis, symptoms resolved promptly after scheduled bevacizumab. Patient is currently 6-year-old and remains free of disease after 3 years off therapy. CONCLUSION Medulloblastoma treatment in infants is challenging because survival is not the only goal. Future clinical trials will help to better tailored treatment based on molecular biology. Re-irradiation in medulloblastoma has been described as well tolerated but clinician should be aware of its complications and management.

“Hey, What do you Need?”: How Head Start Directors Responded to COVID-19 Challenges

“Hey, What do you Need?”: How Head Start Directors Responded to COVID-19 Challenges

Pop-Up Safety Town: Leveling the Playing Field for Children in Underserved Communities Through Injury Prevention Education.

Unintentional injuries are the leading cause of morbidity and mortality among children and adolescents in the United States. Traditional injury education interventions for children often are inaccessible due to cost and logistics in underserved communities, exacerbating injury disparities. A new approach is needed to close this gap for families with preschool children. Collaborating with Head Start preschools optimizes engagement and accessibility to families in underserved communities. Involving caregivers and community organizations addresses the limitations of conventional interventions and community-specific injury prevention concerns. Pop-up Safety Town offers a more affordable model for injury prevention education, particularly in underserved regions. The model's approach, using adaptable education, mobile and reusable materials, and volunteer staffing, offers greater potential for achieving sustainable impact in these underserved communities. Pop-up Safety Town presents a novel upstream solution to address disparities in injury prevention education in underserved communities.

Cognitive Distancing Language in Parent-Child Book Sharing Among Low-Income Mexican American and Chinese American Families: Cultural Group Comparisons and Links to Children’s Executive Functions

ABSTRACT Research Findings: In the context of parent-child book sharing, cultural influences on cognitive distancing language and associations with child executive function (EF) have been understudied. This study examined cultural group similarities/differences in parent and child book-sharing distancing language among preschool-aged dual language learners from low-income Mexican American (MA) and Chinese American (CA) families. We further tested concurrent relations between parent/child distancing language and children’s EF. The sample consisted of 88 children (45 MAs, 43 CAs, age = 38–68 months) enrolled in Head Start preschools and their parents. To assess distancing language, utterances were coded for cognitive demand and classified as referential (low demand), behavioral (moderate demand), or inferential (high demand). Cognitive tasks tapping inhibitory control and cognitive flexibility were used to assess child EF. Results showed parents and children from both cultural groups produced comparable numbers of story-related utterances. MA dyads used higher proportions of parent/child inferential statements and a lower proportion of parent referential questions. The proportions of parent behavioral questions and child behavioral statements were positively related to child cognitive flexibility. Practice or Policy: Findings highlight heterogeneity in parent-child verbal interactions among low-income multilingual families and have implications for promoting preschoolers’ cognitive/language development in diverse populations.

Change in Nutrition and Physical Activity Practices in Early Childcare and Education Settings in Illinois During the COVID-19 Pandemic.

For many young children, early childcare and education (ECE) programs are the only source of nutritious meals and physical activity (PA); however, the COVID-19 pandemic led to program closures, restrictions, and changed practices. To examine changes in nutrition and PA-related best practices in ECE settings in Illinois from 2019, just prior to the pandemic, as compared to 2022. We also examined how changes over time varied by program type (ie, centers vs homes), Child and Adult Care Food Program (CACFP) status, and/or Head Start/Early Head Start status. The study design is a repeated cross-sectional survey administered in December 2019 and October 2022. State of Illinois. A total of 888 and 1162 ECE providers completed initial and follow-up surveys, respectively. NA. Provider report of meeting 14 nutrition and 9 PA-related best practices. Overall, 9 nutrition-related best practices were maintained and 5 declined over time. Centers, CACFP, and Head Start providers reported significant declines in meeting nutrition-related practices over time. A total of 8 PA-related best practices were maintained and 1 declined over time. Centers reported a significant decline in 5 of the PA-related best practices over time, and these declines were significantly different than in homes over time. Similarly, Head Start programs reported a decline in 4 PA-related best practices over time, and the change was significantly different from non-Head Start programs in 3 of the 4 practices. The findings of this study should be considered a new baseline for ECE nutrition and PA-related best practices in Illinois and should serve as a wake-up call for advocates nationwide with regard to the provision of nutrition and PA-related best practices in centers and by CACFP and Head Start providers postpandemic.

Guided Drawing with Preschool Dual Language Learners in Head Start: Building Science Vocabulary and Content Knowledge

Drawing offers a way for young children to demonstrate what they understand about the world. This study reports on the findings from an eight-week intervention program called guided drawing designed to build vocabulary and content knowledge for dual language learners in Head Start settings. Four researcher-designed assessment measures were used to assess thirteen preschoolers’ vocabulary and concept knowledge at the receptive, expressive, and definitional levels in a pre/post-intervention design. Analysis of researcher-designed measures reveals positive changes in all vocabulary and concept knowledge areas targeted by the intervention. Thematic analysis of researcher–child interactions and drawing products indicates the guided drawing intervention provided opportunities and context for every participating child to explore new content and concepts related to science learning; reveal what they know; grow knowledge and vocabulary; reveal misunderstandings; and overhear and adopt new language.

Lessons from the field: Jail experiences of pregnant incarcerated women in a home visiting program

AbstractObjectiveIn this report, we share results of a qualitative study of the experiences of pregnant incarcerated women (PIW), released women (RW), and home visitors who participated in an Early Head Start Home‐Based Option (EHS‐HBO) program that was delivered in a jail. We discuss the challenges of researching and supporting PIW's experiences and offer lessons learned.BackgroundCarceral environments such as jails present challenges for PIW that can compromise pregnancy outcomes. Research supports the efficacy of targeted interventions, such as EHS‐HBO, for other populations (e.g., people who use substances); however, these interventions have not yet reached incarcerated populations.MethodThrough separate focus groups for PIW (n = 6) and home visitors (n = 5), and semistructured interviews with RW (n = 3), study participants shared their experiences as PIW and the carceral context.ResultsThemes, determined inductively through thematic analysis, included (a) emotional pain from postdelivery separation, (b) struggles accessing help, (c) lack of faith in medical care, and (d) social support in and out of jail.ConclusionResults from this study elucidate recommendations for home visitors visiting PIW in jail and training jail personnel about maternal health.ImplicationsOur study highlights the need to further develop home visiting programs and support for PIW and RW. Opportunities for training of jail and home visiting personnel were identified through the focus groups and interviews conducted. The information shared will help professionals working with PIW learn about remarks, attitudes, challenges, and standards of care impacting PIW and maternal mental health.

Marrow-ablative consolidation chemotherapy (HDCT) to decrease the development of choroid plexus carcinoma (CPC) specific relapse in high-risk TP53-mutated (germline or somatic) young children with newly diagnosed CPC.

2088 Background: Choroid plexus carcinomas (CPC) are highly malignant, early childhood cancers in which the loss of TP53 function is a central element of their development and defines unfavorable disease. To date, CPC-free survival rates have remained poor; recent data from St. Jude including complete TP53 mutation status, yielded CPC-free survival of only 29% with a non-marrow-ablative chemotherapy strategy. The rarity of CPC has constrained the ability to explore the role of HDCT with autologous hematopoietic progenitor cell rescue (AuHPCR). Previously reported results of the "Head Start" (HS) HDCT approach showed some promise of cure, but were limited by small patient numbers, short follow-up and incomplete TP53 mutation data. Consequently, the role of HDCT and AuHPCR in TP53-mutated CPC remains unclear. Methods: We have analyzed data on TP53 status, therapy, treatment responses, CPC-free and overall survivals (OS) and second cancers from the largest cohort of such patients, all who received initial therapy with the intent/consideration of undergoing consolidative HDCT. Results: Twenty-seven children with CPC (median age, 16 months) received HS-like induction chemotherapy regimens or ICE with the intent of utilizing consolidative HDCT. Twenty-three of 27 completed HDCT consolidation; the remaining 4 patients did not proceed with HDCT due to parental choice. Somatic or germline TP53 mutations were identified in 17 patients, while 4 patients exhibited TP53 wild type (TP53wt); TP53 status remains untested or unavailable in 6 patients. Five-year CPC-free survival and OS for the entire cohort were 47.8% and 44.4%. CPC-free survival for those with TP53 germline mutations (n=12) was 66%, for those with somatic tumor TP53 mutations (n=5) was 40% and for those with confirmed TP53wt (n=4) was 50%. The 5-year CPC-free survival for all 23 patients who underwent HDCT and AuHPCR was 52%, comprising 3/4 TP53wt patients, 10/12 TP53 germline mutated patients and all 5 TP53 somatic tumor mutated patients. Notably, all six survivors with TP53 mutations had undergone HDCT with AuHPCR, and all but one avoided irradiation. Eight out of 12 patients with documented genotypic (TP53 germline mutated) Li-Fraumeni Cancer Predisposition Syndrome (LFS) developed second malignancies. Conclusions: Our data indicate that HDCT with AuHPCR consolidation is associated with improved CPC-free survival compared with historical reports in young children with high-risk TP53 mutated CPC. However, the ultimate development of second cancers substantially affects outcomes for those with LFS, irrespective of HDCT treatment. These data justify the inclusion of HDCT and AuHPCR in the prospective international trial under development for young children with newly diagnosed TP53 mutated CPC.

CSP2023: 270 - The Smart Head Start Project: Encouraging Family Caregiver Involvement in Fundamental Activities following General Surgery using an Education Leaflet

CSP2023: 270 - The Smart Head Start Project: Encouraging Family Caregiver Involvement in Fundamental Activities following General Surgery using an Education Leaflet