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Effect of a Clinic-Based Referral System to Head Start
A Randomized Controlled Trial
Michael Silverstein, MD, MPH;
Christopher Mack, MS;
Nicole Reavis, MEd;
Thomas D. Koepsell, MD, MPH;
Gregory S. Gross, EdD;
David C. Grossman, MD, MPH
JAMA. 2004;292:968-971.
Context Early childhood development programs such as Head Start have proven benefits for impoverished children. However, few physicians assist families with enrollment.
Objective To test if a primary care–based intervention is efficacious in increasing Head Start attendance.
Design, Setting, and Participants Randomized controlled trial of 246 Head Start–eligible children aged 0 through 4 years recruited in spring 2003 from 4 health clinics in Seattle, Wash.
Interventions List of Head Start telephone contacts provided to families of all children and, for those in the intervention group, a computer-generated packet containing a physician referral letter (and a physical examination form and immunization record, if available) mailed directly to Head Start by study personnel.
Main Outcome Measure Head Start attendance by January 2004.
Results The 123 children analyzed in each study group were similar at baseline. Overall, 72 children (29%) were successfully connected with Head Start (ie, actively attending or on a waiting list) by January 2004. Among the intervention group, 50 children (41%) were successfully connected with Head Start, contrasted with 22 (18%) in the control group (adjusted difference, 17%; 95% confidence interval [CI], 8%-27%). Among the intervention group, 31 children (25%) were actively attending Head Start, contrasted with 14 (11%) in the control group (adjusted difference, 12%; 95% CI, 3%-21%). Only 2 clinics contributed children to Head Start waiting lists. Among children from these clinics, 19 of 87 (22%) in the intervention group got onto a Head Start waiting list, vs 8 of 94 (9%) in the control group (adjusted difference, 13%; 95% CI, 5%-21%). To get 1 child either into Head Start or onto a waiting list, we needed to refer 4 children.
Conclusion Facilitating an initial connection to Head Start on families' behalf substantially increased Head Start attendance.
Author Affiliations: Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Mass (Dr Silverstein); Robert Wood Johnson Clinical Scholars Program (Drs Silverstein, Koepsell, and Grossman), Harborview Medical Center (Mr Mack and Dr Grossman), and Departments of Pediatrics (Ms Reavis and Dr Grossman) and Epidemiology (Dr Koepsell), University of Washington, Seattle; Dr Gross is an independent consultant in Jacksonville, Fla.
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