Early Head Start andDevelopmental Disabilities

Craig T. Ramey, Ph.D.Craig T. Ramey, Ph.D.

Georgetown Distinguished Professor of Health StudiesGeorgetown Distinguished Professor of Health StudiesDirector, Georgetown Center on Health and EducationDirector, Georgetown Center on Health and Education

EHS Disabilities SummitEHS Disabilities SummitWashington, D.C.Washington, D.C.February 5, 2004February 5, 2004

10 Hallmarks of Children Who10 Hallmarks of Children WhoSucceed in SchoolSucceed in School

Eager to learnEager to learn Ask lots of questionsAsk lots of questions Work hard and know Work hard and know

effort matterseffort matters Have good social-Have good social-

emotional skillsemotional skills Can assess their own Can assess their own

skills wellskills well Parents are role Parents are role

models for learningmodels for learning

Parents promote Parents promote learning at homelearning at home

Family routines support Family routines support doing well in schooldoing well in school

Parents set and Parents set and maintain limitsmaintain limits

Schools have high Schools have high student expectations, student expectations, support teacher support teacher development, and development, and communicate communicate frequently with parentsfrequently with parents

Ramey & Ramey, Going to School, 1999

Good health is the Good health is the foundation for learning, foundation for learning, development and school development and school

success.success.

The developmental The developmental domains of health, domains of health,

cognition, social and cognition, social and emotional development emotional development

are closely linked by are closely linked by neurobiological neurobiological

connections and personal connections and personal experiences.experiences.

WHO Definition of HealthWHO Definition of Health

A state of complete physical, mentalA state of complete physical, mental

and social well-being and not merely theand social well-being and not merely the

absence of disease or infirmity.absence of disease or infirmity.

Health Promotion and Disease Health Promotion and Disease PreventionPrevention

Promotion of mental healthPromotion of mental health mentoring in cognitive, socialmentoring in cognitive, social

and emotional basicsand emotional basics responsive language experiencesresponsive language experiences stable and caring adultsstable and caring adults good role modelsgood role models

Health Promotion and Disease Health Promotion and Disease PreventionPrevention

Promotion of social well-beingPromotion of social well-being Safe environmentsSafe environments Enjoyable play and learning activitiesEnjoyable play and learning activities Supportive, informative and frequentSupportive, informative and frequent

interactions with parents andinteractions with parents and

other adultsother adults

Some Facts about Developmental Some Facts about Developmental DisabilitiesDisabilities

Majority of children with intellectual, socialMajority of children with intellectual, social

and emotional disabilities are born healthyand emotional disabilities are born healthyBiological risk conditions(e.g., LBW, Biological risk conditions(e.g., LBW, prematurity) prematurity)

result in different outcomes, result in different outcomes, depending on depending on cognitive,cognitive,

social and emotional supportsocial and emotional supportAbout 11% of children are in special educationAbout 11% of children are in special educationEthnic and regional differences in Ethnic and regional differences in developmentaldevelopmental

disabilities are poorly understooddisabilities are poorly understood

Seven Essential Transactions ForSeven Essential Transactions ForCaregivers with Young ChildrenCaregivers with Young Children

1.1. Encourage explorationEncourage exploration

2.2. Mentor in basic skillsMentor in basic skills

3.3. Celebrate developmental advancesCelebrate developmental advances

4.4. Rehearse and extend new skillsRehearse and extend new skills

5.5. Protect from inappropriate Protect from inappropriate disapproval,disapproval,

teasing, and punishmentteasing, and punishment

6.6. Communicate richly and Communicate richly and responsivelyresponsively

7.7. Guide and limit behaviorGuide and limit behavior

Ramey & Ramey, 1999Right from Birth

Sources of Available Support for Sources of Available Support for Early Intervention FundingEarly Intervention Funding

Elementary and Secondary Education Act:Elementary and Secondary Education Act:Title I: Disadvantaged ChildrenTitle I: Disadvantaged ChildrenTitle V: Innovative Block GrantTitle V: Innovative Block Grant

Early Head StartEarly Head Start Head StartHead Start Child Care Development Fund (CCDF)Child Care Development Fund (CCDF) Temporary Assistance for Needy Families Temporary Assistance for Needy Families

(TANF)(TANF) Early Reading FirstEarly Reading First Social Services Block GrantSocial Services Block Grant Even StartEven Start Early Intervention (0-2 yrs; 3-5 yrs)Early Intervention (0-2 yrs; 3-5 yrs)

Psychosocial Developmental Psychosocial Developmental Priming MechanismsPriming Mechanisms

Encouragement to explore the Encouragement to explore the environmentenvironment

Mentoring in basic cognitive and social Mentoring in basic cognitive and social skillsskills

Celebrating new skillsCelebrating new skills Rehearsing and expanding new skillsRehearsing and expanding new skills Protection from inappropriate punishment Protection from inappropriate punishment

or ridicule for developmental advancesor ridicule for developmental advances Stimulation in language and symbolic Stimulation in language and symbolic

communicationcommunication

Potential Levels of Early Potential Levels of Early InterventionIntervention

Developmental of Biomedical Developmental of Biomedical affordancesaffordances

Prenatal and perinatal services Prenatal and perinatal services Children’s direct learning opportunities Children’s direct learning opportunities Development of family skillsDevelopment of family skillsDevelopment of professionals’ Development of professionals’

knowledge and skillsknowledge and skillsDevelopment of community and cultural Development of community and cultural

norms concerning inclusionnorms concerning inclusion

Statement of the problemStatement of the problem

For a variety of reasons, the early years are For a variety of reasons, the early years are believed to be the most efficacious period believed to be the most efficacious period to intervene in the lives of poor children.to intervene in the lives of poor children. Development appears to be more malleable in Development appears to be more malleable in

the early years.the early years. Children who arrive at kindergarten lacking Children who arrive at kindergarten lacking

basic readiness skills tend to fall further behind basic readiness skills tend to fall further behind in later years.in later years.

Massive attempts to prepare poor children for Massive attempts to prepare poor children for school success, such as Head Start, were school success, such as Head Start, were initially disappointing.initially disappointing.

Research was needed to learn whether intensive Research was needed to learn whether intensive early intervention that began in the infancy early intervention that began in the infancy period could make more lasting difference for period could make more lasting difference for poor children.poor children.

Stages for the Development of a Stages for the Development of a Scientific Knowledge-BaseScientific Knowledge-Base

1.1. Proof of concept studiesProof of concept studies

2.2. Efficacy studiesEfficacy studies

3.3. Effectiveness studiesEffectiveness studies

4.4. Efficiency studiesEfficiency studies

Hierarchy of Criteria for Hierarchy of Criteria for Evidence-based PracticesEvidence-based Practices

Multi-site randomized controlled Multi-site randomized controlled trialtrial Single site randomized controlled Single site randomized controlled trialtrial Single site randomized trial (not Single site randomized trial (not controlled)controlled) Case/control studyCase/control study Observational studyObservational study Opinions of best practicesOpinions of best practices

Key Research Question for Key Research Question for Abecedarian (ABC) ProjectAbecedarian (ABC) Project

Can the cumulative developmental Can the cumulative developmental toll experienced by high-risk toll experienced by high-risk childrenchildrenbe prevented or reduced be prevented or reduced significantlysignificantlyby providing systematic, high-by providing systematic, high-quality, early childhood education quality, early childhood education fromfrombirth through kindergarten entry?birth through kindergarten entry?

The Abecedarian (ABC) Project The Abecedarian (ABC) Project is a randomized controlled is a randomized controlled trial (RCT) that tests the trial (RCT) that tests the

efficacy of early childhood efficacy of early childhood education for high-risk education for high-risk

children and their families.children and their families.

ABC EligibilityABC Eligibility Recruitment in community agencies Recruitment in community agencies

serving poor womenserving poor women

High Risk IndexHigh Risk Index

Other criteriaOther criteria Healthy newborn childHealthy newborn child Living within commuting distance of FPGLiving within commuting distance of FPG Likely to remain in areaLikely to remain in area

Who was invited to take Who was invited to take part?part?

120 families invited to enroll120 families invited to enroll 8 refused random assignment8 refused random assignment

2 infants reassigned at insistence of authorities2 infants reassigned at insistence of authorities

1 ineligible due to biological condition 1 ineligible due to biological condition (seizure disorder with moderate MR)(seizure disorder with moderate MR)

ParticipantsParticipants 4 cohorts of children born between 1972 4 cohorts of children born between 1972

and 1977and 1977

Half randomly assigned to preschool Half randomly assigned to preschool education program, half were controlseducation program, half were controls

Original SampleOriginal Sample NN MalesMales FemalesFemales Treated Treated 57 57 2929 2828 ControlControl 54 54 2323 3131 TotalTotal 111111 5252 5959

EC

EE

CC

CE

29 Males28 Females

23 Males31 Females

Study DesignStudy Design

R

E

C

Age 12 Age 15 Age 21

Preschool Treatment Ages 0-5

Preschool Treatment Ages 0-5

Follow-up AssessmentsSchool-age Treatment Ages 5-8

N=111

Educational InterventionEducational Intervention

Very intenseVery intense Full day childcare programFull day childcare program 5 days/week5 days/week Year roundYear round Began in infancy (mean entry age: 4.4 months, range: 6 weeks to 6 Began in infancy (mean entry age: 4.4 months, range: 6 weeks to 6

months)months) 5 years, until kindergarten entry5 years, until kindergarten entry

University-based settingUniversity-based setting Medical care on siteMedical care on site Stable staffStable staff Low adult : child ratiosLow adult : child ratios

1 : 3 infants1 : 3 infants 1 : 4–5 toddlers1 : 4–5 toddlers 1 : 7 preschoolers1 : 7 preschoolers

PreschoolPreschool CurriculumCurriculum

Eclectic in natureEclectic in nature

Stressed Stressed contingently contingently responsive early responsive early environment environment for infantsfor infants

Learningames for Learningames for the First Three the First Three YearsYears (Sparling & Lewis, 1979, recently reissued)(Sparling & Lewis, 1979, recently reissued)

Natural part of infant’s or toddler’s dayNatural part of infant’s or toddler’s day

Learningames for Threes and Fours: A Guide to Adult and Learningames for Threes and Fours: A Guide to Adult and Child PlayChild Play (Sparling & Lewis, 1984)(Sparling & Lewis, 1984)

Key Abecedarian (ABC) Program Key Abecedarian (ABC) Program ComponentsComponents

Health and Mental HealthHealth and Mental Health NutritionNutrition Family SupportFamily Support Parent InvolvementParent Involvement Early Childhood Early Childhood EducationEducation

Preschool ResultsPreschool Results Tests of cognitive development constituted major outcome Tests of cognitive development constituted major outcome

during early yearsduring early years

Infants equivalent at outset (3 month Bayley MDI scores)Infants equivalent at outset (3 month Bayley MDI scores)

Cognitive measuresCognitive measures Bayley Scales of Infant DevelopmentBayley Scales of Infant Development

3–18 months3–18 months Stanford-Binet Intelligence ScaleStanford-Binet Intelligence Scale (Form LM, 1972 norms) (Form LM, 1972 norms)

2–4 years2–4 years Wechsler Preschool & Primary Scale of IntelligenceWechsler Preschool & Primary Scale of Intelligence

5 years5 years

Preschool Test ScoresPreschool Test Scores

60

70

80

90

100

110

120

0.25 0.5 1.5 2 3 4 5

Age at Testing (years)

Mea

n S

tand

ardi

zed

Sco

re

Treated

Control

Percent of Abecedarian Sample in Normal IQRange (>84) by Age (longitudinal analysis)

Martin, Ramey, & Ramey, 1990American Journal of Public Health

Positive Effects on:Positive Effects on: IQ PerformanceIQ Performance Learning & cognitive Learning & cognitive

performanceperformance Social responsivenessSocial responsiveness Language developmentLanguage development

Decreased Effects:Decreased Effects: Incidence of intellectual Incidence of intellectual

disabilitydisability

Brief Summary of Abecedarian Brief Summary of Abecedarian ResultsResults

During Preschool PeriodDuring Preschool Period

Resilience to biological Resilience to biological risk conditionsrisk conditions

Maternal educationMaternal education Maternal employmentMaternal employment

Ramey & Ramey, 1999Ramey & Ramey, 1999

School-Age ProgramSchool-Age Program

R

E

C

EC

EE

CC

CE

Age 12 Age 15 Age 21

Preschool Treatment Ages 0-5

Preschool Treatment Ages 0-5

Follow-up AssessmentsSchool-age Treatment Ages 5-8

School-Age ProgramSchool-Age Program Home-School Resource teacher Home-School Resource teacher

(first three years of school)(first three years of school) Consultation with classroom teacherConsultation with classroom teacher Individualized curriculum items based on needsIndividualized curriculum items based on needs Encouragement of parental involvement with home Encouragement of parental involvement with home

activitiesactivities Liaison between home & schoolLiaison between home & school Family support as neededFamily support as needed

School-Age ResultsSchool-Age Results

Reading Scores: Reading Scores: Strong preschool effect on reading scores at Strong preschool effect on reading scores at

age 8 (p<.01)age 8 (p<.01) Significant trend for EE>EC>CE>CC (p<.05)Significant trend for EE>EC>CE>CC (p<.05) No effect for school-aged treatment aloneNo effect for school-aged treatment alone

Four-Group Reading Scores at Age 8

82

84

86

88

90

92

94

96

EE EC CE CC

Treatment Group

Sta

nd

ard

Sco

re

Trend for preschool effect on Trend for preschool effect on mathematics scores (p<.10)mathematics scores (p<.10) Linear trend in mathematics scores not Linear trend in mathematics scores not

significantsignificant No effect for school-age treatment alone No effect for school-age treatment alone

School-Age ResultsSchool-Age Results

Four-Group Math Scores at Age 8

86

88

90

92

94

96

98

EE EC CE CC

Treatment Group

Stan

dard

Sco

re

Long-Term EffectsLong-Term Effects

R

E

C

EC

EE

CC

CE

Age 12 Age 15 Age 21

Preschool Treatment Ages 0-5

Preschool Treatment Ages 0-5

Follow-up AssessmentsSchool-age Treatment Ages 5-8

Long-Term EffectsLong-Term Effects

Intellectual measures in the follow-Intellectual measures in the follow-upup Age-appropriate Wechsler scales Age-appropriate Wechsler scales

administeredadministered Full Scale IQ used in plotsFull Scale IQ used in plots Examiners unaware of earlier Examiners unaware of earlier

treatment/control statustreatment/control status Because school-age treatment had Because school-age treatment had

no effect, reverted to two-group no effect, reverted to two-group modelmodel

Long-Term Effects on Long-Term Effects on intellectual developmentintellectual development

Adjusted IQ Trajectory, Ages 2 to 21 Years

75

85

95

105

2 3 4 5 6.5 8 12 15 21

Age (Years)

IQ S

core

s

Treated

Control

Long-Term Effects,Long-Term Effects, continuedcontinued Treated children earned higher scores across timeTreated children earned higher scores across time Treatment/control group difference was greater Treatment/control group difference was greater

during the early, treatment yearsduring the early, treatment years Slopes differ in treatment/post-treatment phasesSlopes differ in treatment/post-treatment phases Treated children differed from control children in Treated children differed from control children in

rates of change during treatment years but rates of change during treatment years but notnot during post-treatment yearsduring post-treatment years

Both groups showed upward trends during the Both groups showed upward trends during the early years and declines in post-treatment yearsearly years and declines in post-treatment years

Up to young adulthood, the group with early Up to young adulthood, the group with early treatment maintained an advantage over controls.treatment maintained an advantage over controls.

Can we identify mediators of Can we identify mediators of long-term treatment effects on long-term treatment effects on

cognitive development?cognitive development?

Early task orientation mediated effects of Early task orientation mediated effects of early treatment on test scores but effect early treatment on test scores but effect size did not show much change when this size did not show much change when this factor was entered into the model.factor was entered into the model.

Early verbal development accounted for Early verbal development accounted for much of the treatment effect on test much of the treatment effect on test performance, and in later years, wholly performance, and in later years, wholly accounts for it.accounts for it.

Long-Term Effects,Long-Term Effects, continuedcontinued

Adding child and family Adding child and family characteristics to the prediction characteristics to the prediction modelmodel No significant effect for child genderNo significant effect for child gender No significant treatment x gender interactionNo significant treatment x gender interaction Gender x timeGender x time22 interaction reflects complex interaction reflects complex

pattern of change in intellectual test pattern of change in intellectual test performance of males and females over timeperformance of males and females over time

Long-Term Effects,Long-Term Effects, continuedcontinued Females change more rapidly in early childhoodFemales change more rapidly in early childhood Females decline more sharply than males in early Females decline more sharply than males in early

adolescenceadolescence Males decline more sharply than females in later Males decline more sharply than females in later

adolescenceadolescenceAge x Gender Interaction in Control Group

75

85

95

105

0 5 10 15 20 25

Age (years)

IQ S

core

Female

Male

Long-Term Effects,Long-Term Effects, continuedcontinued There is also a main effect for the HOME There is also a main effect for the HOME

scorescore Main effect is moderated by a HOME x age interactionMain effect is moderated by a HOME x age interaction Effect of HOME is stronger in the early yearsEffect of HOME is stronger in the early years

Parental attitudes in early life did not Parental attitudes in early life did not have a significant effect on intellectual have a significant effect on intellectual test performance.test performance.

No significant effects of mother’s marital No significant effects of mother’s marital status.status.

Long-Term Effects,Long-Term Effects, continuedcontinued

Does a modest effect on IQ test Does a modest effect on IQ test performance matter? performance matter?

The evidence indicates that the significant The evidence indicates that the significant long-term effect of treatment on academic long-term effect of treatment on academic performance was mediated by its effect on performance was mediated by its effect on early cognitive performance. early cognitive performance.

Long-Term Effects,Long-Term Effects, continuedcontinued

Does a modest effect on IQ performance Does a modest effect on IQ performance really matter?really matter?

Early treatment was associated with Early treatment was associated with significantly higher scores on reading from age significantly higher scores on reading from age 8 to age 218 to age 21Predicted Reading Scores, Ages 8 to 21, by Treatment

Group

80

85

90

95

100

8 12 15 21

Age (Years)

IQ S

core

Control

Treatment

Long-Term Effects,Long-Term Effects, continuedcontinued

Does a modest effect on IQ matter? Does a modest effect on IQ matter? Early treatment was associated with Early treatment was associated with

significantly higher scores on math from age 8 significantly higher scores on math from age 8 to age 21to age 21

Predicted Math Scores, Ages 8 to 21, by Treatment Group

80

85

90

95

100

8 12 15 21

Age (Years)

IQ S

core

Control

Treatment

Long-Term Effects,Long-Term Effects, continuedcontinued

Real-life benefits in young adulthoodReal-life benefits in young adulthood Treated group attained more years of Treated group attained more years of

educationeducation Treatment associated with increased likelihood Treatment associated with increased likelihood

of attending a 4-year college or universityof attending a 4-year college or universityStudents Ever Attending a Four-Year College or University,

in percentage, by treatment group

0

5

10

15

20

25

30

35

40

Group

Pe

rce

nta

ge

of

Gro

up

Control Treated

Long-Term Effects,Long-Term Effects, continuedcontinued

Teenaged parenthood was less likely for those Teenaged parenthood was less likely for those having preschool treatment.having preschool treatment.

Age at Birth of First Child

16.5

17

17.5

18

18.5

19

19.5

20

Group

Ag

e in

Ye

ars

Control Treated

WhatWhat was the early intervention was the early intervention worth?worth?

Cost-benefit study was carried out at Cost-benefit study was carried out at the National Institute of Early the National Institute of Early Education Research (NIEER) at Education Research (NIEER) at Rutgers UniversityRutgers University

Leonard Masse and Steven BarnettLeonard Masse and Steven Barnett

Cost of Abecedarian Program Compared with Cost of Abecedarian Program Compared with Others (1999 Dollars)Others (1999 Dollars)

ABCABC CH CH SchoolsSchools

Child Child CareCare

Head Head StartStart

Annual Cost Annual Cost per Childper Child

$11,152$11,152 $13,401$13,401 $7,070$7,070 $5,616$5,616

Annual Annual Teacher Teacher SalarySalary

$31,460$31,460 $24,050-$24,050-$31,350 $31,350 (+)(+)

$15,30$15,3088

- -

Ratio of Costs to BenefitsRatio of Costs to Benefits

NIEER researchers estimated that the NIEER researchers estimated that the Abecedarian program will save Abecedarian program will save society, on average, $4 for every society, on average, $4 for every dollar spent. dollar spent.

Why would it save money?Why would it save money?

Individuals who had early childhood Individuals who had early childhood education are projected to earn, on education are projected to earn, on average, roughly $143,000 more over average, roughly $143,000 more over their lifetimes than preschool controls.their lifetimes than preschool controls.

Mothers of children who had the free Mothers of children who had the free preschool program are expected to preschool program are expected to earn about $133,000 more over their earn about $133,000 more over their lifetimes (preliminary figures).lifetimes (preliminary figures).

Why would it save money? (continued)Why would it save money? (continued)

School districts can expect to save about School districts can expect to save about $11,000 per child because of reductions in $11,000 per child because of reductions in the need for special or remedial education the need for special or remedial education services.services.

There appeared to be a reduction in There appeared to be a reduction in smoking among those with early childhood smoking among those with early childhood education, leading to better health and education, leading to better health and longer lives (saving approximately longer lives (saving approximately $164,000 per person).$164,000 per person).

NIEER ConclusionsNIEER Conclusions

The Abecedarian program effected The Abecedarian program effected significant savings to society.significant savings to society.

The estimate may be conservative because The estimate may be conservative because of the community where the children grew of the community where the children grew up – relatively affluent and low crime.up – relatively affluent and low crime.

Benefits of a similar analysis for the Perry Benefits of a similar analysis for the Perry Preschool study estimate $7 saved for Preschool study estimate $7 saved for each dollar spent. This was due largely to each dollar spent. This was due largely to a significant reduction in criminal a significant reduction in criminal involvement among treated individuals. involvement among treated individuals.

Abecedarian Project

Ramey & Ramey, 1999 MR/DD Research Review

Key Findings from Abecedarian Key Findings from Abecedarian ProjectProject

(“Abecedarian” …one who learns(“Abecedarian” …one who learnsthe basics such as the alphabet)the basics such as the alphabet)

5 to 21 Years Old5 to 21 Years Old• Intelligence (IQ)• Reading and math skills• Academic locus-of-control• Social Competence• Years in school, including college• Full-time employment• Maternal education• Maternal employment

• Grade Repetition• Special Education

placement• Teen Pregnancies• Smoking and drug

use

Ramey et al, 2000

Project CAREProject CARE

A RCT designed to be a replication ofA RCT designed to be a replication ofAbecedarian Project (ABC)Abecedarian Project (ABC)with a 2with a 2ndnd treatment group treatment group

to test the potential efficacy of an to test the potential efficacy of an intensiveintensive

home visiting program with the samehome visiting program with the sameABC educational curriculum for 5 yearsABC educational curriculum for 5 years

Adapted from Wasik, Ramey, Bryant, & Sparling. Child Development, 1990

Abecedarian (ABC) Preschool Findings Replicated Abecedarian (ABC) Preschool Findings Replicated in thein the

First 3 Years of Life in Randomized Controlled First 3 Years of Life in Randomized Controlled Trials (RCT’s)Trials (RCT’s)

ArkansasArkansas

ConnecticutConnecticut

FloridaFlorida

MassachusettsMassachusetts

New YorkNew York

Ramey & Ramey, 2000in Securing the Future

North CarolinaPennsylvaniaTexasWashington

Infant Health and Development Infant Health and Development ProgramProgram

Designed to test the efficacy of ABC Designed to test the efficacy of ABC interventionintervention

for children who were < 37 weeksfor children who were < 37 weeks

gestation and < 2500 gm at birthgestation and < 2500 gm at birthConducted at 8 sitesConducted at 8 sitesIntervention modified for biological risk Intervention modified for biological risk factorsfactorsIntervention lasted only until 36 mos. CA Intervention lasted only until 36 mos. CA

Infant Health and Development Program (2001-2500 grams)

Children’s IQ at 36 months: Children’s IQ at 36 months: Maternal Education X Treatment Maternal Education X Treatment

GroupGroup

70

75

80

85

90

95

100

105

110

Some HighSchool

High SchoolGraduate

Some College CollegeGraduate

Control

Intervention

(n=232)(n=162) (n=166)(n=104) (n=134)(n=63) (n=76)(n=48)

Infant Health and Development Program

Ramey & Ramey (1998), Preventive Medicine

Outcomes Affected Positively (*p<.01) Outcomes Affected Positively (*p<.01) by the Infant Health & Development by the Infant Health & Development

ProgramProgram12 12 MonthsMonths

24 24 MonthsMonths

36 36 MonthsMonths

Cognitive DevelopmentCognitive Development NSNS ++ ++Adaptive and Prosocial Adaptive and Prosocial BehaviorBehavior

-- -- ++Behavior ProblemsBehavior Problems -- ++ ++VocabularyVocabulary -- ++ ++Receptive LanguageReceptive Language -- ++ ++ReasoningReasoning -- -- ++Home EnvironmentHome Environment NSNS -- ++Maternal Interactive BehaviorMaternal Interactive Behavior -- -- ++Maternal Problem SolvingMaternal Problem Solving -- -- ++Ramey 1999, adapted from Gross, Spiker, & Haynes, 1997, Helping Low Birth Weight, Premature Babies

RecommendationsRecommendations

Recognize the WHO concept of Recognize the WHO concept of health andhealth and its implications for Head Start its implications for Head Start programsprograms Promote the WHO concept of health Promote the WHO concept of health toto communities, programs, families andcommunities, programs, families and childrenchildren Emphasize health promotion and Emphasize health promotion and disabilitydisability preventionprevention

RecommendationsRecommendations

Design and implement a strong Design and implement a strong accountabilityaccountabilitysystem that continuously monitors system that continuously monitors programprogramquality and documents child and quality and documents child and programprogramprogress and outcomesprogress and outcomes

To inform quality improvements To inform quality improvements To strengthen training and technical To strengthen training and technical assistanceassistance

Health and human

development are mutually enhancing. Head Start can

and is promoting both.