Improving Early Intervention for Head Start Preschoolers
Research By: Karen Burkett, PhD, APRN, PPCNP
Post Date: April 18, 2025 | Publish Date: January 2025
Early childhood is a critical time for learning and development, shaping a child’s future health, behavior and success in school. Yet, for children in Head Start programs—federally funded preschool programs designed to support children in families with low-income—developmental delays are sometimes missed or not addressed as early as they could be.
One in six children younger than 5 years of age has a developmental delay (DD), which, as the child grows, will shift diagnostically to one or more developmental disabilities, including autism spectrum disorder, intellectual disability, language disorder or attention-deficit/hyperactivity disorder. Without early support, these children are often left with worsened outcomes.
A recent study published in the Journal of Developmental and Behavioral Pediatrics, led by Karen Burkett, PhD, APRN, a pediatric nurse practitioner in Cincinnati Children’s Division of Developmental and Behavioral Pediatrics and nurse researcher in Patient Services, identified key barriers that impede early identification and support for these children, and possible solutions that can help lessen these gaps in care.
Identifying the Gaps
The study brought together voices from Head Start parents, teachers and healthcare providers—with diverse representation across racial and ethnic groups—to better understand the challenges in detecting and addressing developmental delays.
Findings revealed three major barriers:
- Breakdowns in communication between teachers and primary care providers often left families without clear guidance on next steps. Developmental assessments often happen in both educational and healthcare settings, but the families can be left out of the loop as to what the professionals in these sectors are planning to do for their child. Without communication between the two sectors, families often find themselves stuck in the middle, but without clear direction on where to go.
- Parental perception of socioeconomic bias and stigma left families hesitant to seek or follow through with professional recommendations. Parents in the study expressed the feeling of being stereotyped as poor across educational and healthcare settings and feeling judged, which led to more hesitancy to take action or disclose concerns about their child that could be perceived negatively by clinicians and teachers. Families also expressed that even if they were transparent about their child’s challenges, it was hard to build trust if they had a different provider at each visit.
- The daily challenges of poverty meant that families had to prioritize immediate needs over long-term developmental concerns. Parents already struggle with daily life, dealing with rigid work schedules and limited transportation. On top of that, the large amount of paperwork needed for their child’s evaluations and support systems can feel overwhelming, adding to their exhaustion.
These barriers can lead to delays in intervention, which are particularly pronounced for Black and Latino families who, on average, receive a developmental disability diagnosis 18 to 24 months later than White families.
Implementing Solutions Together
As seen above, when parents didn’t follow through with recommendations for their child’s development, it usually wasn’t because they didn’t care. Instead, the systems around them often made it harder—not easier—for them to get help.
Here’s what family, clinician and teacher participants said could make a difference:
- Cultural understanding and training: Teachers and doctors knew that families from different racial and economic backgrounds might need different kinds of support—but many weren’t sure how to talk about it in the right way. Increased training for providers in tailoring communication to different groups could help build trust and make sure everyone feels heard.
- More consistent health care support: Clinicians don’t always check for developmental delays after 30 months of age. Even when they do, not all children—especially those from lower-income or racially diverse families—get referred for help. To help mend this problem, stronger professional alliances between health and social sectors could help shepherd families through the process of evaluation and treatment at all stages of a child’s life. This could look like the creation of a family navigation program.
- Family navigation programs: Parents said they would benefit from someone who could guide them—especially someone who understands their background and can offer emotional support. A parent navigator could:
- Explain what the teacher or doctor is recommending
- Help schedule evaluations
- Encourage follow-through on appointments and plans
- Explain any complex language or processes they might run into along the way
- More training for teachers and doctors: By law, public schools have 45 days from the day of the request to complete an evaluation process and determine eligibility . Many teachers thought this burden fell largely on the parent and many clinicians thought that school support was based only on medical diagnoses, not educational performance. Training for both groups on national and local processes could help them give better guidance to families.
- Sharing information across systems: With permission from parents, doctors and teachers could share screening results and updates. This way, they can give the same message and show parents they’re working as a team. New resources, such as the “Act Early” tools developed by the Center for Disease Control (CDC) can help make this easier by allowing real-time sharing of results and plans.
What’s Next
Burkett’s recent research efforts and her ongoing collaborations with Nancy Roberto, MSN, APRN, senior director of the Advanced Practice Providers division, and Tanya Froehlich, MD, MS, division director of Developmental and Behavioral Pediatrics, have the potential to lead to even more progress in the area of accessing mental health services for young children using a family navigation program.
In early 2024, with their support, she and co-principal investigator Kelly Kamimura-Nishimura, MD, MS, submitted an R34 grant proposal to the National Institute of Mental Health to engage mental and behavioral health services for preschoolers at risk. The team received the award in August 2024, launching a study that will assess the impact of a family navigation program on young children in Head Start with mental health concerns.
In the meantime, Burkett’s team has not only shared the results of their studies globally in peer-reviewed publications but also locally with select primary cares, Head Start directors, disability coordinators and parent advisory councils to start improving the outcome for Head Start children.
| Original title: | Missed Opportunities for Intervening Early in Preschoolers with Developmental Concern: Perspectives From Head Start Parents, Teachers, and Healthcare Providers |
| Published in: | Journal of Developmental and Behavioral Pediatrics |
| Publish date: | January 2025 |
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The Research Horizons blog features news and insights about the latest discoveries and innovations developed by the scientists of Cincinnati Children's. This blog does not provide medical advice, diagnosis, or treatment.
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