Medical Home-Head Start Partnership to Promote Early Learning for Low-Income Children

Abigail Grant, MD, FAAP
Medical Director | Harborview Pediatric Clinic
Clinical Assistant Professor | Department of Pediatrics, University of Washington

Fostering early childhood development is critical for promoting lifelong educational success as well as physical and mental wellbeing. The High/Scope Perry Preschool Program and Abecedarian Project provided evidence that high quality early education positively nurtured childhood development and improved long-term outcomes such as high school graduation rates, lower teen pregnancy rates, higher adult earning potential, and decreased criminal activity.  Early learning programs provide particular benefits to low-income children including improvements in cognitive development, social emotional skills, family engagement, and health-related outcomes such as up-to-date immunization status, access to wellness care, and healthier body mass index. Despite the strong evidence in support of early learning, 6 out of 10 US children are not enrolled in publicly funded preschools.  Families face significant barriers to enrollment including the limited availability of programs, difficulty completing the necessary paperwork, and cultural preferences for home-based care .

The American Academy of Pediatrics (AAP) policy statement on early education supports the role of pediatricians in ensuring quality early child care and early learning opportunities. Within the medical home, pediatricians can help families overcome barriers to enrollment by facilitating connections to early learning programs. However, pediatricians also face barriers related to screening and referring to community resources including lack of time, limited knowledge of available resources, and limited staff support.

To overcome these barriers, the Harborview Pediatric Clinic, which serves a diverse, low-income patient population in Seattle, partnered with the Denise Louie Education Center (DLEC) to build a medical home-Head Start partnership and referral system.  Key steps included: 1) a referral process and tracking system integrated within the electronic medical record; 2) an early learning community partner as a single point of referral contact; and 3) staff and provider education about early learning programs.

The 5-step referral process (see Figure) was developed to overcome barriers faced by both providers and families in connecting with local early learning programs. To standardize the process, a one-page instruction protocol was sent via email and also laminated and kept next to provider workstations for easy reference. Medical providers were instructed to screen families for interest in enrolling their child in Early Head Start or Head Start based on age and refer during all wellness visits for children ages 0 to 4 years. With parental consent, the medical provider created a templated letter in the EMR auto-populated with patient demographic and contact information that was directly routed to the clinic social worker.  The problem list in the EMR was used to track screening and referral status using an “educational circumstance” ICD-10 code which was updated to Head Start referral status (e.g., “Head Start referred”). The clinic social worker entered each referral into a tracking registry to monitor referral status and sent the referral letters by facsimile to the DLEC. Denise Louie Education Center staff used the demographic information provided to determine the appropriate Early Head Start or Head Start agency for each child. Denise Louie Education Center staff then sent each referral to the appropriate agency, a critical step given the large geographic region served by the clinic. Ongoing meetings ensured continual improvement of the partnership and referral process.






With this partnership, screening rates significantly increased from 8 percent at baseline to 46 percent following implementation. Early education referral rates increased from 1 to 20 percent among a high-risk pediatric clinic population. The ongoing benefits of the referral system over time were highlighted by the finding that after one year of full implementation, more than fifty percent of children in the intervention group had been referred to early learning programs.

The American Academy of Pediatrics Head Start–Medical Home Learning Collaborative provided a small grant to fund program educational materials and evaluation.


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