232 THE JOURNAL OF SCHOOL HEALTH

HEALTH PROGRAM FOR IIlINNEAPOLIS PROJECT HEADSTART 1966

EVELYN E. HARTMAN, M.D., M.S. Director, Bureau of Maternal and Child Health

AL OLSON Health Educator, Minneapolis Health Department

General Information The Minneapolis Health Department has been requested to plan and

deveIop the health aspects of the Headstart program in the City since its inception in 1965. This was incorporated during the second year in the department’s Comprehensive Health Care Program for Children and Youth, funded through the Children’s Bureau of the U. S. Department of Health, Education, and Welfare. A program of medical, dental, labora- tory, vision and hearing screening activities as well as immunizations and tuberculin testing was developed and executed. Cooperation was received from the local medical and dental societies. Many volunteer groups assisted in carrying out the program. These included the Parent- Teacher Associations, the Preschool Vision and Hearing Survey of the State Medical Association, the local Hearing Society, the Auxiliaiy of the State Optometric Association and others.

The approximately 1,200 preschool children from the poverty areas in Minneapolis, who were to participate in the 1966 educational and cultural enrichment program sponsored by the Board of Education through O.E.O. funds had been identified by the schools. Home l‘isitors from the public schools visited the homes to determine eligibility and to receive a com- mitment, from the parent that the child would enroll in the program. The Home Visitors also described the health examinations that would be required for each child participating in Headstart. Children that were under the care of a private physician or dentist were requested to have a report from him on forms that were left with the family.

The children attended classes during an %week summer session in 25 schools in the “core city” having a concentration of poverty problems.

The health screening activities for four of the schools in 1966 were provided by the University of Minnesota which has a sub-project within the City Comprehensive Health Care Program. This report includes only the Minneapolis Health Departmenl portion of the program.

Supportive educational services to the Health Department’s medical and dental programs for children were provided by the Health Education Unit of the Department in cooperation with the local Dairy Council, t,he Program in Health Education of the University of Minnesota, School of Public Health and the Curriculum Consultant of the public schools.

Clinirs The children accompanied by a parent were requested to report to

health screening clinics scheduled during a one month period prior to the onset of the classroom program. The clinics were held in four settlement houses, one school, one community center and 14 chnrches. Make-up clinics were held Iater in the same locations in the afternoons wI1cn the classroom program had been completed for the day. The clinics w r e

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separate from the classroom program because of the experience of the previous year. When clinic sessions had been held in the schools a t the same time that the classroom program went on, there was much disruption of classroom activities. The third and final round of make-up clinics WUF held in the fall, 1966.

Children, whose immunizations were inconiplete after the final round of make-up clinics, were scheduled to attend Health Department neighbor- hood immunization and tuberculin testing clinics. Children whose parents failed to bring them to the Headstart clinics were referred to the Health Service of the schools to be included in their health screening programs.

Health Screeiiing The medical screening was done by pediatric residents from the County

Hospital assisted by registered nurses from the Health Department who prior to the examination had obtained a health history. The Health Department Laboratory was responsible for the hemoglobin deternina- tion and urinalysis.

The dental screening was done by dental residents from the University of Minnesota, School of Dentistry. Yision and hearing screening was done by trained volunteers.

Follo2e,-up Following each clinic session the records of the children were reviewed

for completeness and need to return to a make-up clinic. A pediatrician reviewed the records for need for medical follow-up. Dental referrals were likewise initiated. One or more health problems were found in 63.7 per cent of the children, with dental problems leading in frequency. Public health nurses visited each home where follow-up was needed, discussed the findings with the parent and assisted in making plans for follow-up care. Follow-up is being continued until each child receives the care he needs unless t)he family has moved out of the jurisdiction or refuses care. 111 the latter case, the pediatrician will make a judgment as to whether or not the health of the child will be jeopardized if the follow-up is riot done. If necessary, the family will be referred to the Child Protectioii Unit of the County Welfare Departnienl. Such R referral was made for one child with untreated congenital dislocation of the hips when the parents refused to take the child for medical diagnosis and treatment.

Szitrition Among health problems found in the children nutritional were third in

order of frequency. Families of children with borderline hemog1ol)ins who were not referred to the physician were counseled in one of three ways: in the Health Department’s maternity and child health clinics 1)y the nutritionist; by public health nurses; and by nutrition students from the University of Minnesota, School of Public Health, through home visith.

The following recommendations were made by the students from the School of Public Health regarding nutrition education for Headstart families: integrate nutrition education into the Headstart classroom and breakfast programs; present a single two hour program regarding basic family nutrition within an economy budget for members of mothers’ clubs; or conduct a series of six mothers’ club meetings on nutrition.

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Resources for Care Resources for medical and dental care included the family physician

and/or dentist (through the family’s own resources or through public assistance programs) ; the County Hospital; and by payment through Medical Assistance to Children (Title XIX).

The Comprehensive Health Care for Children and Youth Project paid for medical evaluation and diagnosis for children who were not eligible for Medical Assistance or where this eligibility determination was pend- ing. Patients with acute or emergency conditions were referred directly from screening clinics for medical and dental care and eligibility for pay- ment was determined later. The Comprehensive Health Care Project also paid for medical and dental treatment and after care for those children from low income families who were not eligible for Medical Assistance, provided they met the more liberal financial eligibility of the Project.

Records The original health records, as well as reports on diagnosis and treat-

ment, were sent to the school the child entered in September.

Health Education The goals of Health Education were to: (1) help Headstart children

develop new health habits; (2) strengthen those health habits already developed in the home; and (3) provide parents of Headstart youngsters with information on a wide variety of health subjects including information on direct service programs offered by the department.

In the classroom the Health Education effort focused on dental healt,h, personal hygiene, and because each Headstart school operated a breakfast program for the children, on nutrition. A Teacher’s Portfolio containing teaching guides, posters, and other instructional aides was developed. To make the dental education experience more meaningful, the department provided each child with toothbrush and toothpaste to be used for brush- ing the teeth after the school breakfast.

A separate pack of health materials including literature on child growth and development, nutrition, safety, communicable disease con- trol, and information on the department’s direct service programs was prepared for each Headstart social worker to be used in working with Headstart parents.

The final Health Education effort focused on the Mothers’ Clubs that had been organized by the social workers. The Health Educators were able to meet with the clubs, interpreting the total department effort in the Headstart Project and the direct services offered by the Health De- partment, and arranging for tours of the Public Health Center.

Findings 1. H e d t h Screening Activities

In the 21 Headstart schools served by the Health Department, the total enrollment was 997. Of these, 813 children received some type of health screening. One or more health problems were found in 63.7 per cent of the children, with dental problems leading in frequency, followetl by pro1 llems related to ears, nutrition, heart murmurs and eyes.

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a. Medical Screening Of the 804 children who had medical screening, 140 were examined

by the private physician, G8 in Health Department Well Child Clinics, 9 ill hospital clinics and 587 in Headstart clinics. Deviations were found in 202 children (24.8 per cent). b. Dental Screening

Dental screening was done for 782 children. Of these, 106 were exanuned by the private dentist, 673 in Headstart clinics. An addi- tional 3 examined by physicians in well child or hospital clinics had notations “dental caries.”

c . I’ision and Nearing Screening Of these,

705 had vision screening and 730 hearing screening in Headstart clinics. Private physicians gave visual tests to 58 children and hear- ing tests to 33 children; well child clinics screened 36 children for vision and 32 children for hearing; and hospital clinics tested 9 chil- dren for vision and 8 children for hearing.

Visual problems were found in 45 children (5.6 per cent); and hearing problems in 76 children (9.5 per cent). (1. Laboratory Tests

Of the 790 children who had hemoglobin determinations (13% in Headstart clinics, 95 by private physicians, 45 in well child clinics and 4 in hospital clinics), 76 or 9.6 per cent had low hemoglobins. Of the 737 children who had urinalyses, (59G in Headstart clinics, 95 by private physicians, and 46 in well child clinics), 14 or 1.9 per cent had abnormal findings.

2. Iminunizat ions and Tuberculin Tests Immunizations were up-to-date before Headstart clinics in 41 per cent

of the children for diphtheria-tetanus (-whooping cough) ; 15 per cent for polio; 69 per cent for smallpox; and 67 per cent for measles.

After Headstart, immunizations were up-to-date as follows: diphtheria- tetanus-whooping cough 86 per cent; polio 63 per cent; smallpox 76 per cent; and measles 79 per cent.

Mantoux tests were done for 7.58 children. There were no positive tuberculin tests. 3. Follow-up on Health Problems as of February 15, 1967

Of the 518 children with one or more health problems (with a total of 770 deviations) follow-up care is being given, or has been completed for 391 problems. No treatment was indicated for 148 deviations. F o ~ ~ o w - u ~ is still incomplete for 79 medical problems and 152 children with dental problems.

Mental and emotional cases identified through the classroom or by the school social workers are not included in this report. Only 12 such cases were identified through the Headstart health screening clinics.

Returns for the final remaining “hardest of hard core” cases are dis- couraging in relation to the amount of time and enerby spent for follow-up. In addition to the uncooperative families, however, the incomplete cases include many families who have moved out of the City or whose present address is unknown.

Dental problems were found in 28s children (3G.S per cent).

Vision and hearing screening was done for SO3 children.

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Summary A report has been prepared on the health program for the 1966 Project

Headstart in Minneapolis which included medical, dental, visual, hearing and laboratory screening, and immunizations and tuberculin testing for 813 children, as well as follow-up on health problems. The program in- volved working with and receiving cooperation from many public and voluntary agencies. The health program for Project Headstart was coordinated by the Minneapolis Health Department and incorporated into the department’s Comprehensive Health Care Program for Children and Youth funded through the Children’s Bureau of the U. S. Department of Health, Education, and Welfare. Supportive health education services to the medical and dental programs were provided.

* * * * *

EPIDEMIOLOGICAL APPROACH TO PREVENTING SCHOOL ACCIDENTS

HENRY M. PARRISH, M.D., Dr. P.H. GERALD H. WIECHMANN, Ph.D.

JANET W. WEIL, R.N., B.S. CAROLE A. CARR, R.N., M.S.P.H.*

Accidents are the leading cause of death among school children. Moreover, accidents are the leading cause of death in the United States for persons 1-34 years of age. The fact that slightly over 42 million children were enrolled in public elementary and secondary day schools in 1965, points out the necessity for an effective accident prevention pro- gram. (1) The Public Health Service has estimated that over 3 million injuries annually result from accidents at school. (2) Falls and bumping into an object or another person accounted for more than one-half of these injuries. Many people believe that public institutions, such as schools and hospitals, provide a safe environment. No one doubts for a minute that they should provide a safe environment. Parrish and Weil showed that hospitals aren’t necessarily safe. (3, 4) The same finding may be true for many schools. However, there is a shocking lack of careful, scientific studies of school accidents either to support or refute this hy- pothesis. Epidemiological studies should be able to provide these missing accident facts, since this method of study has been used successfully to prevent and control automobile accidents, home accidents, and industrial accidents. (5, G, 7) The purpose of this report is to define epidemiology and to suggest some ways that epidemiology can be used to study and prevent school accidents.

Epidemiology Epidemiology formerly was defined as the medical science dealing with

epidemics. At that time epidemiology was confined to the study of in- fectious diseases such as smallpox, cholera, and plague. Today the hori- zon of epidemiology has been extended to non-infectious diseases includ- ing accidents, heart disease, cancer, and mental diseases. Paul states that

*The authors are members of the Department of Community Health and Nedical Practice, University of Missouri School of Aledicine, Colmiibia, blissoiiri.