IMPROVING ACCESS TO HEALTH CARE:

1
IMPROVING ACCESS TO HEALTH CARE THE HEAD START
EXPERIENCE
Nan Gaylord, PhD, RN, CPNP and Margaret Pierce,
MSN, MPH, RN, BC The University of Tennessee
College of Nursing, Knoxville
PROBLEM STATEMENT Head Start is a federally
funded child development program that
concentrates on preparing children of low income
families for school. A pre-enrollment and an
annual physical exam are required for all
children but a significant number of children in
Knox County have been unable to comply with this
requirement. Head Start staff asked the
University of Tennessee College of Nursing
faculty to provide physical exams for the
children and at the same time offering pediatric
and family nurse practitioner students
opportunity for clinical practice.
RESEARCH QUESTIONS ? What are the common health
problems in this high risk preschool
population? ? What are the barriers to health
care access identified by parents of these
children? ? What health problems can be managed
by Head Start and/or Pediatric Nurse
Practitioner/Family Nurse Practitioner
faculty/students?
METHOD Parents who accepted the offer for the
health evaluation of their child were invited to
participate in a study designed to identify
common health problems of this population of
preschoolers and perceived barriers to the
acquisition of health care. Parents were asked to
complete a questionnaire identifying reasons they
decided to utilize the health evaluations
provided by the College of Nursing students and
faculty. Their childrens records were analyzed
along with the history and physical exam data to
determine health and developmental concerns.

• RESULTS
• Three hundred twenty (320) children were assessed
  by the College of Nursing students and faculty.
• Two hundred ninety-five (295) of the 326 problems
  identified were able to be managed by the
  resources available in the Head Start Program, by
  the College of Nursing nurse practitioner
  faculty/students or by a collaboration of both
  programs.
• Thirty-one (31) of the 326 problems identified
  required referral for management to outside
  providers (9.5).
• All parents agreed to participate in the study
  and completed a questionnaire concerning health
  care access issues. More parents agreed to
  participate in the study than were able to be
  accommodated with a physical exam for their child.

Parents Identified the Following Barriers in
Accessing Health Care for their Child No
Insurance (82) 26 Conflicts with Work Schedule
(43) 13 No Transportation (30) 9 Appointment
given after exam due, physical exams not done in
winter months, difficult to schedule, no
appointment available (100) 31 No Primary Care
Provider/No provider accepting insurance (18) 6
Other (13) 4 Language Barrier (6) 2 No
answer (19) 6
Review of Student Records Revealed the Following
Health and Developmental Concerns Managed by
Faculty and Students with Follow-up at Head Start
(101) URI/Viral Syndromes (27) AOM/SOM (19)
Cerumen Impaction (13) Infestation (6) Other
(36) includes 12 blood lead levels Referred
for Management by Head Start Professionals
(145) Abnormal health screens (51)
Developmental Delays (23) Lead risk assessments
(19) Nutritional Concerns (13) Mental
Health/Behavior Problems (3) Other
(36) Referred to Outside Health Professionals
(90) Dental (59) Dental Services available
through Head Start Program Vision (15) Other
(16)

• RELEVANCE TO PRACTICE
• Pre-enrollment and annual physical exams
  facilitate early recognition of health and/or
  developmental concerns in this pre-school
  population.
• Lack of access to care Is multi-factorial.
• Services provided and coordinated by the Head
  Start program along with the intervention and
  follow-up of identified concerns impacts the
  present health and future potential of this
  high-risk preschool population.
• Advance practice nurses in the Head Start setting
  can manage many common health problems reducing
  the need for parents to access primary care
  providers in the community.