title: Developmental and health services in head start preschools: a tiered approach to early intervention.
abstract: OBJECTIVE
  To describe a tiered approach to identifying and addressing developmental and health concerns among low-income preschool children in Head Start.
  
  
  METHODS
  Analytic sample consisted of 3- to 5-year-old Head Start students (n = 1171) from 14 centers in Los Angeles County serving predominantly Latino families during 2008-2009. All Head Start students were screened for developmental and health concerns and assigned to 1 of 3 tiers of intervention need: Tier 1 children needed only the usual Head Start curriculum, Tier 2 children needed targeted interventions (excluding special education), and Tier 3 students received special education services. Logistic regressions were used to analyze predictors of each tier, with screening results and sociodemographic variables as covariates.
  
  
  RESULTS
  Sixty-nine percent of children were in Tier 1, 25% in Tier 2, and 6% in Tier 3. Tier 2 children most commonly needed mental health services and were less likely than those in Tier 1 to be from primarily English-speaking homes (odds ratio = 0.6, P < .01). Tier 3 children were significantly less likely to be female than Tier 2 children (odds ratio = 0.4, P < .05).
  
  
  CONCLUSIONS
  More than one-quarter of low-income children not in special education may need targeted interventions, particularly mental health services. Although Head Start agencies are required to identify and address these needs, many other early education and clinical settings do not. Establishing screening and intervention guidelines for this intermediate-risk group represents a key policy gap for the child health and education systems.
authors.affiliation: Department of Pediatrics, Mattel Children's Hospital and David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. bnelson@mednet.ucla.edu
authors.forename: Bergen B
authors.initials: BB
authors.lastname: Nelson
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
authors.forename: Steven R
authors.initials: SR
authors.lastname: Forness
authors.forename: Olivia
authors.initials: O
authors.lastname: Pillado
authors.forename: Susan
authors.initials: S
authors.lastname: Savage
authors.forename: Helen M
authors.initials: HM
authors.lastname: DuPlessis
authors.forename: Whitcomb
authors.initials: W
authors.lastname: Hayslip
authors.forename: Sheryl H
authors.initials: SH
authors.lastname: Kataoka
mesh_terms: D002662:Child Health Services; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis*; D018479:Early Intervention, Educational; D004519:Education, Special; D005260:Female; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D008403:Mass Screening; D008605:Mental Health Services; D020380:Needs Assessment; D016017:Odds Ratio; D012017:Referral and Consultation; D018570:Risk Assessment; D012947:Social Work; D012959:Socioeconomic Factors