title: Pediatricians' reported practices regarding early education and Head Start referral.
abstract: BACKGROUND
  Early learning programs have proven benefits for impoverished children; Head Start is the most widespread of such programs. The current involvement of pediatricians in the Head Start enrollment process is unknown.
  
  
  OBJECTIVE
  1) To assess the knowledge, attitudes, and reported practices of pediatricians on referring families to Head Start; 2) to assess pediatricians' receptivity to a potential practice-based intervention to enhance their ability to make Head Start referrals.
  
  
  METHODS
  Mail survey to stratified random sample of pediatricians practicing in poor and non-poor US zip codes. Prevalence estimates and logistic regression models were estimated using weighted data.
  
  
  RESULTS
  Of 1000 surveys distributed, 472 of 772 presumed-eligible subjects completed surveys for a response rate of 61%. Respondents and nonrespondents were similar with regard to age, gender, years in practice, and urban/rural practice setting. Eighty percent of pediatricians reported discussing child care arrangements with a majority of their preschool-aged patients' families, while only 14% reported actually assisting these families in applying to Head Start. Lack of time (77% of pediatricians) and nonphysician office staff (71%) were listed as the most significant barriers to helping families apply to Head Start. Unfamiliarity with early childhood education (10%) was generally not seen as a barrier to this practice. Head Start knowledge (adjusted odds ratio [aOR]: 1.43; 95% confidence interval [CI]: 1.01, 2.02), self-efficacy in advising families how to access local Head Start programs (aOR: 3.49; 95% CI: 1.46, 8.38), and the belief that it is the pediatrician's responsibility to do so (aOR: 9.98; 95% CI: 3.91, 25.48) were significantly associated with assisting families with Head Start enrollment. The majority of respondents (77%) reported a willingness to participate in a proposed computer-based intervention to aid eligible families in applying to Head Start. Having access to a social worker (aOR: 2.48; 95% CI: 1.17, 5.21) and respondent age (aOR: 0.96 for each year; 95% CI: 0.93, 0.99) were significantly associated with likely participation in the intervention.
  
  
  CONCLUSIONS
  Although pediatricians report commonly discussing child care issues, few actively assist patients in the application process for Head Start. An intervention to facilitate Head Start referral from the physician's office must address time and staff limitations; education of pediatricians is a secondary need.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle 98195, USA. msilve@u.washington.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
authors.forename: David C
authors.initials: DC
authors.lastname: Grossman
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D002675:Child, Preschool; D004493:Education / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D010819:Physician's Role; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends*; D020377:Self Efficacy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires