Head Start health managers play an important role in promoting safe, responsive, inclusive, and individualized services for children with known or suspected special health care needs, such as asthma, epilepsy, and diabetes. Health managers help staff gain the knowledge and skills to care for these children and support their families. Family support includes helping and educating families as they manage the care of their child, and it includes their child’s transitions to other education and health care systems.

Children with special health care needs (CSHCN) have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and need health and related services of a type or amount beyond what children generally need.

Recent data indicate that almost one in five children from birth to age 17 have a special health care need, and more than one in four families with children have at least one child with a special health care need.

Children with special health care needs may:

• Use prescription medication on a regular basis or for emergencies, such as when managing allergies, asthma, seizures, or diabetes
• Have regular appointments for medical or mental health care to manage a health condition
• Have health issues that affect participation in daily activities, such as eating, sleeping, and playing
• Require special therapies, such as physical, occupational, or speech therapy

Head Start Health Services Competencies

• O-4 K Understand the general principles of health and wellness, including promotion, prevention, early identification, and intervention.
• O-5 K Understand the risk factors that make some people healthy, and other people       
  unhealthy (e.g., determinants of health) that contribute to health disparities       
  among culturally and linguistically diverse populations.
• O-8 S Assist children and families to address challenges that affect their well-being,       
  promote resilience, and strengthen protective factors.
• CFH-10 K Be familiar with individual child and adult nutritional needs, preferences, and special dietary requirements including feeding recommendations for infants (e.g., breastfeeding, introduction of solids) and young children (e.g., food allergy/intolerance, portion size, body mass index).
• CFH-15 S Help families identify and overcome barriers to completing further diagnostic testing, follow up and treatment.
• CFH-16 S Develop and implement Individual Healthcare Plans (IHP) for children with special health care needs, in collaboration with families, the medical home, and other related service providers.
• CFH-21 S Demonstrate safe methods that meet state and tribal requirements of       
  administering medications, including consent, handling, labeling, storing,       
  disposing, and recognizing possible side effects.
• CFH-27 S Establish and maintain confidentiality policies and procedures.
• EF-1 A Believe that families are experts about, and the primary decision makers for, their children’s health.
• EF-5 S Identify and use family strengths when addressing health concerns.
• L-3 K Know how to access and use external health resources, including technical       
  assistance providers, health consultants, and state, tribal, and community agencies.

HSPPS Related to Children with Special Health Care Needs

• Purpose, 45 CFR §1302.40(a)
• Collaboration and communication with parents, 45 CFR §1302.41
• Child health status and care, 45 CFR §1302.42
• Child nutrition, 45 CFR §1302.44 
• Child mental health and social and emotional well-being, 45 CFR §1302.45
• Family support services for health, nutrition, and mental health, 45 CFR §1302.46
• Safety practices, 45 CFR §1302.47(b)(7)(vi)
• Additional Services for Children with Disabilities, 45 CFR §1302 Subpart F

State, Tribal, and Territorial Requirements      

Besides following the mandates in the HSPPS, Head Start programs must follow their own state, tribal, or territorial requirements for CSHCN in early childhood settings. Head Start programs must also follow rules about professional licenses for their staff and contractors who provide medical care or administer medication.

Rehabilitation Act of 1973, Section 504, and Americans with Disabilities Act of 1990, Title II       

The Americans with Disabilities Act of 1990 is a federal law requiring that children with special health care needs be provided with reasonable accommodations when attending a publicly funded program, such as a Head Start program, and that they benefit from the program and its services. The U.S. Department of Education has an overview of the laws on disability discrimination. Children are eligible for services under these laws based on certain health conditions that need special education and related services. Not every child with a special health care need is eligible for services under the federal laws. However, Head Start programs need to support all CSHCN or children who may be at risk for developmental delays or disabilities.

Caring for Our Children

• Chapter 8 Children with Special Health Care Needs and Disabilities
• Caring for Children with Special Health Care Needs Special Collections
  • Special Collections in Spanish
• Appendix O: Care Plan for Children with Special Needs
• 3.6.3.1 Medication Administration
• 3.6.3.2 Labeling, Storage, and Disposal of Medications
• 3.6.3.3 Training of Caregivers/Teachers to Administer Medication
• 9.2.3.9 Written Policy on Use of Medications

Social Determinants of Health and Equity Considerations

Special health care needs, such as asthma, obesity, mental health conditions, and poor oral health, are more common among children living in poverty. Children with several adverse childhood experiences are more likely to also have a special health care need. Racial disparities also affect rates of health conditions in certain children. For example, children who are Black, Latino, and American Indian and Alaska Native have higher rates of asthma and obesity compared with white children.

CSHCN also experience disparities in access to health care. Their needs are more likely to be unmet in every type of health care (e.g., medical, dental, vision, hearing, mental), with the widest gap in mental health care compared to children without special health care needs. Cost and availability of appointments are the most common reasons for unmet health care needs. Children in rural areas and children with families who don’t speak English face other barriers to getting care.

Many barriers that are out of a family’s control make it harder to manage special health care needs, including:

• Living in a community with few health care providers
• Lacking access to an ongoing source of continuous, accessible health care
• No health insurance or not enough coverage for medications and equipment
• Lacking transportation or time off work to attend medical appointments
• Experiencing homelessness, living in transitional housing, or having housing insecurities
• Living in a home with dust, poor ventilation, or pests
• Living in a neighborhood with poor air quality or limited access to fresh food
• Having limited access to health information that is culturally or linguistically appropriate so that the family can advocate for and manage their child’s health care needs

When Head Start staff are aware of these inequities and barriers to successful health care management, they can be better prepared to respond with individualized health care planning and family support. This includes advocating for and supporting any needed services. Programs that understand the challenges a family faces in managing their child’s health condition in the context of their home environment, community, and health care system can work with the family to mitigate these challenges.

Last Updated: May 6, 2024