Context Early childhood development programs such as Head Start have proven
benefits for impoverished children. However, few physicians assist families
Objective To test if a primary care–based intervention is efficacious in
increasing Head Start attendance.
Design, Setting, and Participants Randomized controlled trial of 246 Head Start–eligible children
aged 0 through 4 years recruited in spring 2003 from 4 health clinics in Seattle,
Interventions List of Head Start telephone contacts provided to families of all children
and, for those in the intervention group, a computer-generated packet containing
a physician referral letter (and a physical examination form and immunization
record, if available) mailed directly to Head Start by study personnel.
Main Outcome Measure Head Start attendance by January 2004.
Results The 123 children analyzed in each study group were similar at baseline.
Overall, 72 children (29%) were successfully connected with Head Start (ie,
actively attending or on a waiting list) by January 2004. Among the intervention
group, 50 children (41%) were successfully connected with Head Start, contrasted
with 22 (18%) in the control group (adjusted difference, 17%; 95% confidence
interval [CI], 8%-27%). Among the intervention group, 31 children (25%) were
actively attending Head Start, contrasted with 14 (11%) in the control group
(adjusted difference, 12%; 95% CI, 3%-21%). Only 2 clinics contributed children
to Head Start waiting lists. Among children from these clinics, 19 of 87 (22%)
in the intervention group got onto a Head Start waiting list, vs 8 of 94 (9%)
in the control group (adjusted difference, 13%; 95% CI, 5%-21%). To get 1
child either into Head Start or onto a waiting list, we needed to refer 4
Conclusion Facilitating an initial connection to Head Start on families' behalf
substantially increased Head Start attendance.