Head Start
Does the much-touted preschool program really deliver?
By Sarah Glazer

When President Lyndon B. Johnson and War on Poverty chief R. Sargent Shriver launched Head Start with great fanfare in 1965, there was confidence the preschool program would start impoverished children on the road to success. Now, with President Clinton poised to expand the program to serve every poor child in the nation, experts question whether Head Start children actually experience lasting benefits.. . . .

Read the Full Report (Subscription Required)

Should the Head Start program be expanded?

Marian Wright Edelman President, Children's Defense Fund,. From National Forum, March 1993.	John Hood Research Director, John Locke Foundation,. From Policy Analysis, CATO Institute, Dec. 18, 1992.

Head Start's Health Benefits: Fact or Fancy?

Even if Head Start does not guarantee school success, some supporters argue, it performs a valuable service by making sure that poor children get their shots on time. In fact, Head Start officials say 88 percent of children in the program have been fully immunized and that another 8 percent are up to date on their immunizations, although not yet fully immunized.

Those impressive figures have lent new support to Head Start at a time when approximately half of the 2-year-olds in inner-city neighborhoods lack their necessary immunizations. Supporters also point to other aspects of Head Start's health package, including checkups and follow-up care. “That's reason to fund Head Start in itself,” the Children's Defense Fund's Helen Blank, one of the program's most vocal champions, said recently.#

But an unpublished draft report by the inspector general of the Department of Health and Human Services (HHS) throws cold water on the immunization claim. Investigators examined medical files from a national sample of 3,100 Head Start children in 80 different programs. They said the records showed complete immunizations for only 43 percent of the children.##

“It raises serious questions about one of the major claims to fame of Head Start,” said one Republican Hill staffer who has seen the report.

It was not clear whether the remaining children were actually missing their immunizations or whether their shots had simply not been recorded.

“It may very well be there were programs that were fudging the data,” says Wade F. Horn, who headed the HHS' Administration on Children, Youth and Families in the Bush administration. Centers receiving federal Head Start funds are not required to submit children's individual health records to HHS. Instead, they just report how many children they have immunized. The problem with that system, Horn says, is that “People can lie.”

Other factors contributing to the low immunization rate, according to the draft report, were parents not scheduling or keeping immunization appointments and difficulties in finding doctors willing to provide immunizations throughout the school year.

Another highly touted aspect of Head Start, the level of medical screenings and follow-up care, also falls short of the 97 percent coverage claimed by the program, according to the inspector general's investigators. They found that only 53 percent of the children received all required health screenings, and that about 18 percent of the children identified as needing medical treatment received no follow-up care.

Helping families is another area where Head Start is making disappointing headway, the investigation suggests. According to federal guidelines, Head Start workers are supposed to take an in- depth history of each family's health, employment and income needs and then help them either directly or through referral to social service agencies. Only 28 percent of all families who participated in Head Start had most or all of their identified needs met, according to the report.

Largely to blame, the report suggested, are difficulties Head Start programs faced in hiring enough qualified staff to keep up with an expanded and increasingly troubled enrollment. For example the average caseload climbed to 95 children per social service worker in 1991-2, the report noted. In 1990, the Human Services Reauthorization Act authorized Head Start to continue through fiscal 1994 with the goal of serving all eligible children.

Since Head Start began expanding in 1990, the number of families with drug, alcohol abuse and other serious problems also has grown, according to an earlier inspector general's report. Growing numbers of children with behavioral problems are showing up at Head Start centers, as well. Almost 40 percent of the Head Start programs report that newly enrolled children come from families economically worse off than the families they served before the expansion.* # Transcript of the “MacNeil/Lehrer NewsHour,” Feb. 16, 1993. ## Office of Inspector General, Department of Health and Human Services, Evaluating Head Start Expansion Through Performance Indicators (Draft Report), February 1993, p. 9. * Office of the Inspector General, Department of Health and Human Services, Head Start Expansion: Grantee Experiences (Draft Report), December 1992.