A Healthy Start

Link to MinorityNurse.com

Minority nurses involved in Head Start programs are making a difference in the lives of at-risk children.

By Valerie Anderson

As a nurse, you help people achieve their best possible health every day; whether you are bringing a new baby into the world, assisting with a life-saving operation or researching new ways to treat diseases, your efforts have a profound impact on the health and well-being of your patients. Perhaps the most rewarding aspect of nursing, however, is the opportunity to improve the life of a child by providing him or her with a solid foundation of physical health. That foundation can provide a springboard from which the child will achieve success in school and in life. Nurses involved in the Head Start program have the opportunity to positively impact children's lives every day.

Since 1965, Head Start has been serving low-income children ages three to five and their families by providing a wide range of services in education and early childhood development; medical, dental and mental health; nutrition; and parent involvement. Head Start programs are operated at the community level by local public agencies, private organizations, Indian tribes and school systems.

Early Head Start, which began in 1994, offers services to low-income pregnant women and families with infants and toddlers younger than age three. Similar to Head Start, Early Head Start aims to enhance children's physical, social, emotional and intellectual development.

The Head Start program is administered by the national Head Start Bureau, the Administration on Children, Youth and Families (ACYF), the Administration for Children and Families (ACF) and the Department of Health and Human Services (DHHS). Head Start programs help thousands of children every year. In fiscal year (FY) 2000, the program served 857,664 children. That same year, local Head Start projects spent $5,102,907,000, which was received through grants awarded by the ACF Regional Offices and the Head Start Bureau's American Indian and Migrant Program branches.

“A Breath of Fresh Air”

While the majority of jobs available through Head Start go to teachers, the program also hires many nurses in order to provide adequate health care to children in Head Start programs, maintain the strict health standards of the program and provide health training for Head Start employees. To meet the needs of the diverse range of children enrolled in Head Start, minority nurses in particular are in high demand.

Minority nurses who are eager to get out of the hospital setting, looking to have their summers and weekends free and interested in making a profound impact on the lives of at-risk children and families need look no further than their local Head Start program for their dream job.

“For nurses who have been working in the acute care environment, Head Start is like a breath of fresh air,” says Anne Marie McCrary, CRNP, a health specialist at the Los Angeles County Office of Education (LACOE) Head Start State Preschool Division. “At Head Start we help people improve their lives by teaching them how to make positive changes for themselves.”

Nurses Who Speak Their Language

As the U.S. population continues to diversify, more and more minority nurses are needed to care for the increasingly multicultural population. Head Start programs, in particular, are serving increasingly diverse communities. In FY 2000, 34.5% of children enrolled in the program were black, 28.7% were Hispanic, 30.4% were white, 3.3% were American Indian, 2% were Asian and 1% were Hawaiian/Pacific Islander.

Head Start programs are tailored to fit each child's ethnic, cultural and linguistic heritage, creating a great need for minority nurses and volunteers who can provide culturally and linguistically competent care. “We have nurses on staff with a variety of backgrounds,” says McCrary, who is black. “Philippine, Hispanic, African American, Chinese, it's a wide variety.”

Rose M. Robins Troupe, RN, BSN, MPA, a nurse consultant, agrees that there are many opportunities for minority nurses in Head Start, and she believes being a minority is a benefit when working in the program. “As a minority nurse, I understand the needs of my community—I have an advantage over other nurses because these are my people. I am accustomed to living and working with at-risk populations,” Troupe asserts.

McCrary explains that having teachers and nurses with a similar racial and ethnic background as the children being served “helps them feel comfortable. Both the children and the parents [in Head Start] need someone [who understands their background]—someone who speaks their language,” she adds.

Marisol Willis, RN, assistant health coordinator of early childcare at a Head Start program in Evanston, Ill., works with many Spanish-speaking children.

“Being [Puerto Rican] is an advantage for me at Head Start; I am bilingual, and being able to speak the native language of the children and their parents is very helpful,” she says.

A large component of the Head Start program is preparing non-English-speaking children for kindergarten, where English may be the only language spoken. Willis, who began her Head Start career as a teacher's assistant, knows first-hand how important English language comprehension is for young children.

“I worked in a bilingual classroom of three- to four-year-olds, and most of the children spoke only Spanish. We set up activities for the children to help them with their English comprehension and usage; our goal was to make the transition a little easier for them when they left Head Start and went on to school,” she says.

Troupe, who is African American, agrees that being bilingual or even multilingual is an asset as a Head Start nurse. In fact, she advises all nurses interested in Head Start to learn at least Spanish.

“I took my first Spanish course this summer,” Troupe says. “The Hispanic population is growing and as Head Start nurses, we have to be prepared for that.”

Mending Cuts and Touching Lives

What exactly does being a Head Start nurse entail? Willis explains, “I deal with any health issue the children may have while at Head Start. The teachers bring children to [the Head Start nurses] for many different reasons: injuries, incidents where a child is having difficulty breathing or needs routine medication.”

While bandaging cuts and handing out medicine sounds a lot like the responsibilities of a school nurse, Head Start nurses do much more. “Any health-related incident requires a lot of paperwork,” Willis says. “If a teacher brings a child in with even a small scrape, we must inform the parents and send a copy of the information to the insurance company,” she says.

Keeping the children's medical and dental records up to date is also part of Willis's job. “I collect the paperwork regarding the children's medical history, including their past physical and dental records,” she says.

Head Start nurses also play an important role in the early diagnosis of possible health problems and encourage proper preventative care. “Without Head Start,” Troupe says, “a lot of children would go undiagnosed or poorly assessed in the areas of health and wellness. They would enter the school system with many strikes against them.”

A Helping Hand to Disabled Children

All children enrolled in Head Start need culturally competent health care provided by skilled nurses, but children with physical disabilities require even more specialized care. Every year at least 10% of the available enrollment slots must go to children with disabilities, and during the 1998-1999 operating period, Head Start programs exceeded that requirement by 3%.

Nurses develop individualized plans for Head Start students with disabilities, Troupe explains. “Nurses must take into consideration the child's deficiencies, strengths and needs and then make the necessary accommodations to integrate the child into the Head Start program,” she says. “Head Start nurses also create a multidisciplinary team for the child, which includes the child's family, therapist, physician, social worker, teacher and center directors, in order to ensure safety as well as proper care for the child.”

McCrary believes it is beneficial for both the disabled and the non-disabled children to be together in an integrated classroom. “It helps the [non-disabled] children develop an understanding of helping and accepting children with differences,” she says. “The children without disabilities take responsibility for assisting the disabled children in the classroom. I think it's important that they learn to be sensitive early on.”

A Different Kind of Nursing

Ideally all Head Start programs would employ at least one nurse to meet the health needs of the children enrolled in the program. However, because of a lack of funds, some programs must hire a nurse consultant instead.

Consulting is another way minority nurses can become involved in Head Start nursing as a career. Troupe owns her own health consulting business, Health Connections in Florissant, Mo., which provides nurse consultant services in the areas of health and nutrition for Head Start programs.

What do nurse consultants like Troupe do on a daily basis? It certainly means a deviation from the typical rotating shifts of most nurses. “I do a thousand and one things in my job,” Troupe says. “I provide technical assistance and training to Head Start programs by helping them develop protocols and procedures, adhere to performance standards, write operational plans and meet health regulations, such as assuring each child in the program has well-child visits and immunizations.”

As a nurse consultant, Troupe also works with Head Start employees to promote their understanding of personal health. “We have to set an example for our 'premature moms,'” she states.

However, to work in the area of health training or as a monitor of the health services at a Head Start program, you do not need to start your own company. Many Head Start grantee programs hire nurses for such positions on a full-time basis, such as Lula Munson-Smith, LPN, AA, a health coordinator at the Ounce of Prevention Fund in Chicago.

“On any given day I might be in the office or in the field,” Munson-Smith says. “If I am in the field I provide technical assistance or administer hearing and vision screening for Head Start children. I also monitor the health services and do health and safety training. When I am in the office I plan for workshops, do paperwork and attend lots of meetings.”

McCrary does similar work at LACOE, which is the largest Head Start/Early Head Start grantee in the nation. She is responsible for the health components of each of LACOE's delegate agencies; she plans, develops and conducts training and technical assistance for the agencies.

“I also orient new staff and work with the new Early Head Start programs,” McCrary says.

Both McCrary and Munson-Smith believe their jobs are making a profound impact on the lives of the families enrolled in Head Start.

“It's a great feeling to see Head Start staff members learning and growing from the classes we provide,” McCrary states. “Because of our training they are able to provide better care for the Head Start families.”

Influencing Positive Change

The national Head Start Bureau states that the goal of Head Start is to “enhance the social competence of children from low-income families.” The bureau defines social competence as “a child's everyday effectiveness in dealing with both the present environment and later responsibilities in school and in life.” Is Head Start reaching these goals? According to Willis, it is.

“I think it's an excellent program; it really does make a big difference in the children's academic readiness,” she says.

A recent study, “What Children Know and Can Do at the End of Head Start and What It Tells Us About The Program's Performance,” by Nicholas Zill, PhD, Gary Resnick, PhD and Ruth Hubbell McKey, PhD, examined how Head Start children rated in comparison to their peers in regards to school readiness. According to the study, “Head Start children possess academic knowledge and social skills that indicate a readiness to learn when the children reach kindergarten and first grade.” The study also found that by the end of kindergarten, the children had made substantial improvements in word knowledge, the ability to recognize letters, writing skills and phonemic awareness.

Studies aside, the minority nurses who work with Head Start children every day see first-hand the impact the program makes on children's lives.

“[As a Head Start nurse] I influence positive change mentally, physically and sometimes even spiritually,” Troupe explains. “It's rewarding because I'm helping people learn to help themselves. I'm teaching people how to be healthy and showing parents how to raise their children successfully. I'm in the position to influence change.”

McCrary agrees that Head Start is a positive experience for both the children and their parents.

“The families grow and benefit from the program,” she says. “Parents participate in the decision-making process at Head Start: They approve budgets, conduct their own meetings and take part in hiring and discharging staff. The parents play a valuable role, which teaches them how to get involved in other boards, like the PTA or the city council.”

The children and families at Head Start are not the only ones benefiting from the program-minority nurses, as well, are reaping the rewards. “It's a good feeling to know that you are returning something to the community,” McCrary says. “You have a sense of assisting people-not doing it for them, but assisting them and showing them how they can do it for themselves.”

Life Touchers for Hire

If you're interested in all the benefits Head Start nursing offers, McCrary advises you to contact the local Head Start programs in your community and offer to volunteer your services. “That will help you decide if it's somewhere you would like to work,” she says.

While there are not as many nursing positions available in Head Start as in typical clinical settings, having certain things on your resume will set you apart from the other applicants.

“It's important to have at least a bachelor's in nursing,” Troupe advises. “A background in public health nursing, women's and infant health and well-child/well-maternal-child is also helpful.”

Nurses interested in a career at Head Start must also have a desire to work with at-risk populations. Troupe finds this a demanding but rewarding part of her job.

“I enjoy working with at-risk families because at Head Start we are making a difference in their lives. We move the families from dependency to self sufficiency,” she says.

If you're satisfied in your current nursing position but are still interested in helping your local Head Start program, you could join the nearly 1,327,000 people annually who volunteer at Head Start centers across the country. Volunteer nurses are always needed to provide necessary health education, medical and dental examinations and other health services, or you can step outside your role as a health care provider and volunteer in the classroom, office or kitchen.

Whether you work full-time or volunteer at a Head Start program, you will receive personal fulfillment, Troupe believes.

“If you want to be a life toucher, than working at Head Start is a really great choice.”

Valerie Anderson is the associate editor of Minority Nurse.