V. Areas of Assessment

    Appropriate planning, referral, and advocacy with substance-abusing families begins with a careful assessment of a number of infant/child, parental, environmental, and other caregiver factors. By inquiring about each of these areas, Head Start staff can better determine the priority, level, and types of services needed by the family as a whole. The following section is intended to provide guidelines regarding factors that should be ex plored as part of a comprehensive family assessment.

Determining One's Own Attitudes and Feelings

    Just as do other service providers who work with families, Head Start staff need to become acquainted with methods for assessing potential substance abuse within a family home. A first, healthy step in this direction is to evaluate one's own personal attitudes toward alcohol and other drug abuse. In recognition of the strong feelings that many people have about this subject, it is widely acknowledged that agencies need to provide staff with opportunities to explore and/or share with each other their thoughts and concerns regarding substance abuse within the family setting.

    Many factors may influence a staff member's ability to assess the needs of a substance- abusing family:

    In order to learn to recognize and identify the abuse of alcohol and/or other drugs within a family, it is strongly recommended that all staff who work with substance-abusing families participate in in-service substance abuse training, and that they receive ongoing consultation to assist them in their work with these complex families. Readily available supportive services can help staff develop sensitivity to the problems of substance-abusing families, an awareness of family needs, and skill in assessing children and parents.

    Head Start programs with significant needs in this area should identify and develop an ongoing relationship with a consultant or hire a staff member who is a certified alcohol and drug counselor. This professional could assist in developing strategies for working with families. He or she could also provide clinical guidance to staff regarding specific approaches with individual families.

Assessment of the Infant and Child

    It is important to remember that substance abuse within a family can affect all children living in the home. Thus, in order to complete a family assessment, Head Start staff need to gather information not only about the preschool-aged child who is enrolled in the center-based program, but also about other siblings, including young infants, who may be residing within the family home. Further, staff should keep in mind the fact that children may appear to be physically healthy but nonetheless may have developmental and educational deficits. Careful observation of all children in a substance-abusing family is essential in planning for the family as a whole and for making appropriate educational and health care referrals.

Infant Assessment

    Drug- and alcohol-affected infants are a vulnerable population of children who frequently have health problems and/or special care requirements. Information about such an infant generally is gathered through observations of the baby, as well as through interviews with the primary caregiver(s) and discussions with involved health care personnel. To understand the infant's needs, staff should seek answers to the following questions:

    In rare cases, the baby may have more serious problems with which the parents are struggling. The following observations are needed for medically fragile infants: Child Assessment

    Children can have special needs not only because of prenatal alcohol or other drug exposure, but because they have been raised in environments where these substances are abused. Since the basic care of children in households where caregivers abuse alcohol and/ or other drugs often is inadequate, these youngsters frequently have special nutritional, health care, emotional, and educational needs. Furthermore, in comparison with the general population, child maltreatment occurs with greater frequency in substance-abusing families. Fumes from drugs that are smoked may be inhaled by children within the home, children may ingest substances accidentally, and youngsters can be deliberately given drugs or alcohol by substance-abusing adults. In order to ensure that the needs of such children are adequately addressed, Head Start staff should explore a variety of issues, examining both the strengths of the child as well as his or her needs. These issues include:

    Health. Is the child receiving ongoing health care? Does the child have a chronic illness? Are immunizations current? Are there any untreated medical conditions? Is the child's growth patterns within expected ranges, or is there evidence of failure to thrive? If untreated medical problems are present, staff may need to assist with referrals for pediatric care, dental, and/or nutritional services.

    Physical care and supervision. When not in school, how and with whom does the child spend most of his or her time? Does the child generally appear clean and appropriately dressed at school? Does the child have a history of abuse, neglect, or repeated injuries? Substance-abusing caregivers may provide inadequate physical care and supervision. When there are concerns in these areas, it may be helpful for staff to assist the caregiver with locating an after-school placement for the child or explore with the caregiver possible alternate arrangements for child care with other reliable family members or friends.

    Development. What skills and abilities does the child display within the classroom? How does he or she relate to peers at school and to Head Start staff? When behavioral problems, learning deficits, or short attention spans are noted, it is important to remember that such problems are exacerbated by environmental instability. Offering families referrals for substance abuse treatment and programs that assist with financial, housing, legal, and other social stresses can often help to stabilize a chaotic home environment.

    Family relationships. Since role-reversal is common in substance-abusing families, has the young child assumed the role of a parent by performing adult caregiver tasks? If so, what resources are needed to support the family so that the child can be freed from inappro priate and dangerous responsibilities?

Assessment of Parents

    Head Start staff need to understand the assessment process which must take place in order to nurture and support a parent into seeking needed treatment. In most cases, Head Start staff probably will only participate in a portion of this assessment before they are able to move a family to more professionally trained substance abuse counselors or into treatment. However, it is important for staff to understand the complete picture of needed information and the reasons it is needed.

In gathering information about parents, Head Start staff need to be aware of varying patterns of alcohol and/or other drug abuse within a family setting, the pressures that often are exerted by substance-abusing individuals on partners and other family members who do not use, the roles of extended family members and friends, and the financial ramifications of substance abuse in terms of how family income is both obtained and expended. A comprehensive assessment of parents (and, when indicated, other significant adults living within the family home) should address the following areas:

Substance Abuse History

    Exploring a parent's history of alcohol or other drug use is important in understanding the chronicity of the problem, as well as for determining which treatment resources are most appropriate for individual parents. While the information obtained during an initial discussion with a parent often is not complete, talking with parents over time frequently provides additional insight into their substance abuse problem. When parental consent has been obtained in a manner consistent with Federal regulations concerning disclosure of such information, communicating with members of the extended family, significant others, and professionals from other agencies also can be helpful for understanding the impact of the parents' substance abuse on the entire family.

    To better assist a substance-abusing parent, Head Start staff may find it helpful to explore the following:

Drug and Alcohol Treatment History

    Once Head Start staff have gathered information regarding substance abuse by a parent (or other significant family member), the next step is to inquire about prior attempts at treatment. The following areas should be explored:

    Familiarity with treatment approaches. Even if the parent has never been in treatment, what does he or she know about recovery programs (including 12-step support groups, methadone maintenance, residential treatment, and outpatient clinics)? Staff can encourage parents to consider treatment by informing them about available types of treatment and resources, and by offering assistance in contacting treatment programs.

    Past treatment experiences. Has the parent ever been in a drug or alcohol treatment program? If so, where and for how long? What was the motivation for seeking treatment, and what were the circumstances under which the parent left treatment? Any indication of motivation should be pursued as a possible strength.

    Current participation in treatment. For parents currently participating in a treatment program, how long have they been enrolled and how often do they attend? What are the hours of the sessions? What child care arrangements have been made? Do other family members support their efforts? What are their feelings about their progress? If a parent does not seem to be making progress, staff may consider asking him or her for permission to consult with the substance abuse counselor.

Health and Health Care

    Substance-abusing parents often have health problems related to their abuse of alcohol and/or other drugs. Such problems frequently can adversely affect the parents' ability to care for both themselves and their children. Thus, staff should assess the following:

    What is the parent's general state of health? Are there any untreated medical problems or chronic illnesses? Substance-abusing parents are at high risk for communicable diseases (such as tuberculosis) and sexually transmitted diseases, including HIV/AIDS. Such parents may need to be referred for medical evaluations. Also, because these diseases are increasing in prevalence, Head Start program staff may want to include information about these common communicable diseases in the educational programs routinely offered to parents.

     If medical care is needed, does the parent have financial and logistical access to services? If not, staff can offer assistance with applications for Medicaid and help the parent to locate appropriate local clinics and physicians.

Mental Health

    The parent's need for mental health services also should be explored. While this may be difficult to evaluate, due to current intoxication or chronic substance abuse, identification of co existing mental health problems is essential for connecting families with counseling and psychosocial services. In talking with the parent, it is important for staff to determine the following:

    Has the parent ever obtained assistance from a mental health counselor? Has he or she ever been hospitalized for psychiatric reasons? If so, the history of hospitalization, length of stay, and reasons for admission should be explored.

    Have medications for a psychiatric illness been prescribed for the parent?  If so, why were they prescribed, and is the parent currently taking the medications? This information is particularly relevant to making an appropriate substance abuse treatment referral, since some substance abuse treatment programs may be reluctant to accept clients who are currently taking medications for treatment of a psychiatric disorder. In addition, a lapse in taking necessary medications or the mixing of prescribed medications with other substances may exacerbate psychiatric symptoms and place both the parent and child at risk.

    Does the parent have a history of violence toward others? Is there a history of domestic violence? Substance abuse, psychiatric problems, and problems with impulse control can be closely intertwined.

Awareness of the Impact of Drug Use on the Child

    Another significant area to assess is parents' understanding of the relationship between their substance abuse and their children's care. The willingness of the parent to acknowledge the impact of their substance abuse may indicate their receptivity to services for them selves as well as for their children. Staff should explore the following with caregivers:

    Daily caregiving. How do the parents provide for their children's needs during periods of alcohol or other drug abuse and/or in situations of relapse? Do the parents exercise judgement in leaving their children in the care of responsible relatives or friends, or are the children left with strangers or brought along with the parents into dangerous situations?

    Child abuse and neglect. Do the parents acknowledge that their behaviors while under the influence of alcohol or other drugs can place their children at risk? Are they willing to seek treatment and other needed services for themselves and their children? In situations where a child is at risk for abuse or neglect, staff will need to report their concerns to the local child protective services agency.

    Understanding of infant behaviors. In cases of prenatal substance abuse, how do the parents view the infant's symptoms? Initially, parents may deny that symptoms or other problems exist. Although this initial denial can serve as a protective coping mechanism for parents, continued denial may interfere with the parents' obtaining needed services for the child.

Parenting Skills and Responsiveness to Child

    An awareness of a parent's caregiving skills and responsiveness to his or her child is a particularly critical aspect of the assessment process. Because many substance-abusing caregivers themselves were poorly parented as children, they may lack healthy role models for parenting their own children. Staff can obtain much information by listening sensitively to parental comments and by observing parent-child interactions. Such information can help staff ascertain how best to involve parents in Head Start activities as well as determine the need for referrals to parenting education programs or individualized counseling. It can also identify some parenting strengths on which to build an improved parent-child relationship.

    Staff observations should encompass the following:

    Understanding of child development. How do parents react to their children's behavior? How do they provide praise and discipline?. Are the parents' expectations age- appropriate? Parental participation in parent discussion groups may be very helpful when the parents' expectations are incongruent with the children's capacities, or when parents are prone to extremes in physical discipline.

    Provision of emotional support. How do the parents respond to their children's emotional needs? For example, how do the parents respond to the children's crying? Is there evidence of affection between the parent and child? Such information may be helpful in identifying the need for therapeutic counseling to strengthen parent-child attachment.

    Prior history of child abuse or neglect. Have there been previous child abuse or neglect investigations, or is the family currently involved with a child welfare agency? If a parent has other children in out-of-home placement, what were the reasons for placement and what is the parent's level of interaction with these children? When the family is receiving services from a child welfare agency, it often is helpful for staff to obtain parental consent to talk with agency personnel. By sharing information and working collaboratively, staff may be more effective in their work with the entire family.

Work History and Education

    Information regarding parents' work histories and educational backgrounds can help staff better understand the parents' level of literacy and survival skills, as well as the extent to which their substance abuse has had an impact on their day-to-day responsibilities.

    What are the parents' occupations? Are the parents employed? If not, when were they last employed? What is the reason for their current unemployment? Such information will help staff provide appropriate referrals for employment and job training.

    What are the parents' education levels? Do they have difficulty with reading, writing, and/or comprehension? This information is critical to understanding parents' ability to function within community programs and will help staff minimize barriers to appropriate treatment and services. It also may highlight the need for referrals to literacy, ESL (English as a Second Language), or GED (General Equivalency Diploma) programs.

Assessment of the Home Environment

    Much of the information described above may be obtained during discussions with parents outside the family home, but some information can only be obtained through a home visit. While a family's situation may appear to be stable on the basis of interviews within the Head Start setting, a home visit may reveal a somewhat different picture.

Environmental Conditions of the Home

    It is important to observe the conditions of the child's home environment. Secure and nurturing living conditions provide a foundation for the child's optimal development, while inadequate conditions can pose risks for illness or accidents. However, here, as in the other assessment areas, sound clinical judgement is of the essence. A family may live in poor circumstances, on the street, or in a shelter due to poverty, bad fortune, or hardship. In other cases, a family's lack of residence or impoverishment also may be due to parental substance abuse. In evaluating the home environment, staff should make note of the following:

    Stability. How long has the family resided at the current address? Is there a pending eviction? Is this a stable residence? Planning for services, especially in-home services, often is dependent upon a family's remaining at a particular address or within a specific geographic area.

    Safety. Are there safety or health hazards? Are there rodents or other infestations? It is important to determine how the family has attempted to remedy these situations, as well as whether the family's housekeeping habits have contributed to these problems. Depending upon the situation, advocacy, homemaking services, or parental education may be needed.

    Food. Is there sufficient food in the home? If not, the family may be assisted by referrals to the food stamp program and for WIG services.

    Utilities. What is the condition of the electrical system, gas lines, water supply, and sanitary facilities? Does the family have a telephone? If not, is there a nearby phone where messages can be left? These factors are particularly critical when a child in the family is medically fragile. Many communities have special programs that provide low-income families with partial payment of utility bills and/or low rates for emergency telephone service. Where these programs are available, staff may be able to help families gain access to them.

    Sleeping space. Has sleeping space been provided for family members?

    Clothing. Is basic clothing provided? For example, do children have clothes that are appropriate for the climate?

    Age-appropriate toys, books, and play area. What toys and books are available for the children? Do they have a safe play space? This information can help staff gain a better picture of the children's daily experiences within the home.

Partners or Parent Substitutes within the Home

    Partners or other parent substitutes living in the home may be supportive, stabilizing individuals who can help with caregiving or, at the other end of the spectrum, these persons also may be substance abusers or may be involved in illegal or violent activities. Because substance abuse can lead to a lessening of inhibitions and controls, and because family stresses can increase in connection with the quest to maintain an addiction, abuse of alcohol and/or other drugs by persons living within the home can lead to domestic violence. The family's ability to protect a child and provide for his or her basic needs becomes seriously impaired under such circumstances. In observing the home environment, staff should note the following:

    In situations of domestic violence, staff may be able to provide life-saving help for families by connecting parents with battered women's shelters and counseling programs for abused individuals and individuals who batter.

Family Support Systems within the Community

    Another important part of the assessment process includes learning about the family's support system. In many instances, staff may be able to work with individual relatives and friends to ensure that the child is receiving appropriate care when a parent is unwilling or unable to provide it. Further, helping a parent identify resources to rely upon during difficult times may provide an important "safety net" for the child. In talking with parents, staff should explore the following:

    What are the parent's relationships with extended family, friends, and neighbors? Do family members live in the area? Have family members and significant others been encouraging of parental attempts to make lifestyle changes? In assessing the family support system, staff may find it helpful to obtain appropriate consents to talk with relatives and friends in order to determine their level of commitment and the circumstances under which they will be available to help the family.

    Is the parent involved with a church, temple, or community group? Is there a member of the clergy who can become involved in strengthening and counseling family members?

Relative Caregivers

    Relatives are the primary caregivers for some children who are enrolled in Head Start programs. In many cases, such young children have been formally placed with relatives by the legal system. In other instances, children reside with relatives based upon informal arrangements between parents and other family members. In either case, the substance-abusing parent frequently lives in the household, either on a permanent or an intermittent basis. To support such "kinship caregivers" in the care of young relatives, staff need to gather information in the areas discussed below.

Parenting Skills

    A careful evaluation of the relatives' ability to meet the children's basic needs is just as important as the parental assessment described earlier. If Head Start has an enrolled child living with a relative of a substance-abusing parent, it is very important for staff to know how to support the relative and the child in this situation. While many relative caregivers are able to provide excellent care, others may not have the energy, resources or commitment to doing so, leaving a child vulnerable to further stress. The following questions should be addressed to determine what are the strengths and needs of relative caregivers:

    Ability to provide care. Does the relative have emotional, physical, or intellectual limitations that would impair his or her ability to provide adequate care and supervision for the child? With increasing frequency, grandparents are caring for very young grandchildren, and some of these caregivers are elderly or have health problems. In such situations, it is important for staff to help caregivers locate respite, day care, and other services to assist with day-to-day caregiving responsibilities.

    Knowledge of child development. How does the relative respond to the child's behaviors? How does he or she provide praise and discipline? Are expectations age-appropriate? If it has been many years since a relative has cared for a young child, he or she may benefit from participation in a parent discussion group, as well as from enrollment in a parent education class.

    Relationship with other family members. How do the relative and the child relate to each other? What has been their prior pattern of interaction? What is the status of the relative's relationship with the child's parent(s) and other significant family members?

Alcohol andlor Other Drug Use

    Because intergenerational abuse of alcohol and/or other drugs characterizes so many substance-abusing families, it is important to explore this issue with relative caregivers. By being aware of potential problems, Head Start staff can help prevent a child from residing in yet another environment affected by substance abuse. In exploring a relative's use of alcohol or other drugs, it is helpful to gather the following information:

    Does the relative have a history of substance abuse? If so, what was the extent of the addiction? How long has the relative been in recovery? What impact has substance abuse had upon this individual's life and functioning?

    When a relative caregiver is currently abusing alcohol or other drugs, staff will need to assess many of the same factors described previously in the section on parental assessment.

Quality of the Relative's Relationship with the Parent

    The dynamics of the relationship between parents and relative caregivers is frequently complex and difficult to assess. Often, this relationship has implications for the child's physical safety and emotional well-being, especially in situations where there is ongoing conflict between parents and extended family members. In kinship situations, staff should explore the following:

Access to Services

    A relative caregiver's use of community services should also be examined. Some relatives may be reluctant to access resources because they wish to keep family problems private and may see parental substance abuse as stigmatizing. They may perceive substance abuse as a "moral failure." Other relatives may be unaware of services, unfamiliar with how to use them, and/or unaccustomed to asking for assistance. In order to be certain that relatives are familiar with the resources available to them and that they are able to use these services, it is important for staff to assess the following:
 

Foster Parents

    Some children who are served by Head Start programs reside in foster care. For many of these children, foster parents are the lifeline to consistent and stable nurturing. In order to identify services that may be required to support the foster parent who is caring for a child from a substance-abusing family, attitudes towards birth parents and caregiving and family supports should be carefully explored.

Attitudes Towards Birth Parents

    A foster parent's feelings and attitudes towards birth parents will greatly influence the child's feelings about his or her parents, as well as the child's own self-esteem. Staff should assess the following:

Caregiving and Family Supports

    Because many children from substance-abusing families have special medical or educational needs, it is critical to assess the foster parent's experience in caring for special-needs children, as well as the supports available for the foster family.

VI. Working with Children in a Preschool Setting

    By the time they enter a preschool setting such as Head Start, children usually are developmentally ready for a center-based program where they will meet new friends, develop relationships with adults other than their parents, and learn about sharing, communicating, and meeting the expectations of others. These preschool experiences will help to foster success as the children prepare to enter kindergarten. They also form the foundation of the children's approach to the world outside their home.

    Over the years, the Head Start Bureau has consistently taken a creative approach in meeting its mission of promoting comprehensive child development and family support services for young children and their families. This chapter focuses on the ways in which Head Start staff can help meet the special needs of children who live with substance-abusing families or who may have been exposed prenatally to alcohol and/or other drugs. In particular, the Head Start mental health curricula for staff and families are important to note: Mental Health in Head Start: A Weliness Approach for staff, and As I Am for children.

    There is strong evidence that in some cases prenatal substance abuse can produce complications that range from spontaneous abortion and stillbirth to prematurity, impaired fetal growth, mental retardation, and learning problems. However, it is important to re member that not all children who were prenatally exposed to alcohol or other drugs have problems with long-term development. We do not yet have the expertise to determine why some children experience problems related to prenatal substance exposure, while others seem to remain unaffected by their mothers' abuse of alcohol or other drugs during pregnancy.

    In considering the long-term development of children whose parents use alcohol and/or other drugs, we must take into account the interplay between biological and environmental factors that influence behaviors, just as we do with all children who are at high risk for developmental problems. Within the average Head Start population, it is difficult to differentiate between those specific behaviors that may be attributed to environmental influences and those that stem from biological causes. It is clear that long-term behavioral patterns are influenced by environmental conditions, and experience has shown that instability, disorga nization, and emotional upheaval within the family environment can place a child at risk for developmental difficulties. We also know that children who are reared in organized, supportive, and nurturing environments tend to perform better at school and develop healthier relationships with other persons later in life. This is where Head Start staff can make a positive difference in the lives of substance-affected children and their families.

    There is no specific constellation of behaviors that can be used to diagnose the effects of living in a substance-abusing environment. Thus, each individual child must be assessed with respect to his or her own unique set of abilities and needs. However, many children from substance-abusing families demonstrate some of the following problem behaviors:

    A number of strategies have been shown to be effective in addressing these difficult behaviors, some of which are addressed below.

CLASSROOM ORGANIZATION

    The atmosphere, physical setting, and daily routine are important in promoting a positive learning experience for any child. The As I Am curriculum lists a number of suggestions for effective classroom organization. For a child who resides with a substance-abusing family, it is especially important to build in opportunities to foster self-esteem, learn about self control, and experience success in program activities. Further, when a child demon strates any of the behaviors listed above, a well-thought-out classroom environment can promote ongoing positive experiences that can alleviate some of the problems. Features that Head Start staff can build into the classroom include:

    It is very important for staff to establish a routine within the program setting. Children depend upon an overall structure to help them organize themselves and their interactions with the environment. Within the constraints of this routine, staff need to allow time for children to be creative and to explore their surroundings, as well as make choices for them selves. As they make decisions and take responsibility for their choices, children can develop problem-solving skills as well as feelings of control within their environment. This, in turn, enhances self-esteem.

THE ROLE OF HEAD START STAFF

    Head Start staff should be guided in their approach to promoting comprehensive child development and family support services by the As I Am curriculum, which focuses on the total child and provides a context for fostering self-confidence and skills for healthy living. The curriculum provides a framework for using the classroom experience to foster positive learning activities, increase autonomy and independence, and promote social skills. As they plan program activities, Head Start teaching teams and other related staff need to be aware that:

    In light of these basic tenets, Head Start staff can support every child's individual development through careful observation, effective communication, and strategies for enhancing learning experiences.

Careful Observation

    Ongoing observations of children's behavior, including how children learn, express feelings, and deal with difficult situations, are critical if staff members are to plan appropriately for children and their families. For instance, if a child frequently appears agitated or emotionally upset on Monday mornings, staff need to explore the potential causes of this behavior. They might begin by supporting the child in a quiet area and using discussion or puppet play to find out why the child is upset. If the child comes from a substance-abusing family, it may be the case that alcohol or other drug use is heightened over the weekend, resulting in increased family turmoil or dysfunction. In such a case, staff can then attempt to begin a dialogue with the parent about the child's behavior and its relationship to the family environment, bring up the issue of substance abuse treatment, and explore the possibility of having the child stay with a reliable non-substance-abusing family member during periods of parental substance abuse.

    Further, careful observation can help staff learn about each child's individual temperament. To effectively plan activities that promote a child's overall development, staff need to become knowledgeable about each child's:

    Communication among staff members regarding their observations of children in the program is essential. Staff conferences are important for examining individual children's progress and program activities on an ongoing basis. By sharing information about a child's behaviors and activities, staff can develop a more complete picture of the child's overall skills, abilities, and development.

Effective Communication

    All children have both positive and negative feelings. Thus, it is important for staff to encourage children to identify and talk about their feelings, and to help them learn to express different feelings in appropriate ways, both verbally and non-verbally. When children have delayed language development, props (e.g., pictures, toys, felt boards) may provide a vehicle through which they can communicate how they feel at a given time. For example, a child who has been left unattended while his or her parent is engaged in binge use of alcohol or other drugs may communicate in some way that he or she is afraid of being left alone. In such a case, staff in turn need to validate the child's communicated feelings and also pursue with family members ways of alleviating the situation.

    Communication, whether verbal or non-verbal, also helps to build trust, and trusting relationships are known to positively influence future development. By listening carefully to children, acknowledging and discussing their behavior, feelings, and experiences in a non-judgmental way, staff can help make children feel worthwhile. This validation promotes the healthy self-esteem that is so critical for optimal development.

Enhancing Learning Experiences for All Children

    Respect for children's cultural and family backgrounds is a cornerstone of the Head Start philosophy. Thus, whenever possible, staff need to incorporate culturally appropriate activities to enhance the learning experiences for children. Further, preschoolers often come into the Head Start program from a world that previously has been largely restricted to their immediate family environment and neighborhood. To facilitate a child's transition into a Head Start program, it is helpful for staff to determine the following:

    When they know this information, staff also may begin to see ways in which they can assist caregivers in providing more enriched home environments for their children.

Strategies for Children with Special Needs

    The following approaches can help to enhance learning experiences for all children enrolled in Head Start:

    In addition, there are several other strategies that have proven useful for enhancing learning among children who may have special needs. Some of the more common behaviors that have been observed in children who live in substance-abusing households are listed below, with accompanying ideas about how to get beyond these behaviors and foster developmental growth.

Distractibility

    A child who has heightened responses to internal and external stimuli may experience problems with concentration. He or she may be easily distracted by sounds, people, and movement within the environment. To assist a child who has such difficulties, staff can do the following:

Impulsivity or Hyperactivity

    Impulsive and hyperactive behaviors are demonstrated by some children who come from substance-abusing families. Such youngsters may act out their impulses or find it difficult to remain seated in a circle or at a table with other children. The following strategies may prove helpful:

Speech and Language Delays

    Children whose lives are affected by abuse of alcohol and/or other drugs may experience delays in expressive and/or receptive speech and language. When there are problems with expressive communication, children may have difficulty signaling their feelings through eye contact, gestures, or vocalization. Other children may continue to articulate in an infantile manner at the preschool level. Others, unable to verbalize their needs, may express themselves through behavior such as shouting, banging, or stomping. Even children who have attained some language skills may be unable to use these skills to communicate their feelings and needs.

    Children who have problems understanding language may be unable to decipher staff's cues. They may not be able to follow directions, even when these instructions are appropriate for their current developmental level. Such children also may not respond to verbal praise. In group situations, youngsters who have language and speech delays may tend to observe rather than verbally engage with their peers, or they may inappropriately initiate interaction by hitting, pushing, biting, or making negative remarks.

    In order to foster the development of effective communication skills, staff can consider the following strategies:

Difficulty with Task Organization and Sporadic Mastery of Tasks

    Some young children who are affected by abuse of alcohol and/or other drugs have difficulty organizing and sequencing purposeful activities. Such youngsters may appear confused during play time, engaging instead in aimless wandering, or mouthing or throwing toys in a random fashion. Further, a child who has problems with task organization and processing may at any given time be unable to perform a task that he or she had previously mastered. When a child has problems in this area, staff can implement the following strategies:

Problems with Attachment and Separation

    Problems with attachment and separation, especially during times of transition, some times occur among children from substance-abusing families. Such children may find it difficult to end a preferred activity, let go of a favorite object, or transition out of Head Start. When a child is experiencing difficulty with attachment and separation, there are a number of things that staff can do:

Difficulty with Developing Appropriate Social Skills

    In some cases, children from substance-abusing households may have difficulty developing appropriate social skills. Within the Head Start setting, such children may not look to adults for comfort, approval, or assistance. They may go from one adult to another without indicating any preference, or they may show indiscriminate attachment and "clingy" behavior with all adults. When there is a lack of social and environmental nurturing at home, children may learn to become non-responsive in general. Such youngsters may seem listless, passive, and withdrawn. They may have difficulty joining other children in play or other wise behave inappropriately with peers.

    To help a child develop healthy social skills, at least one staff member needs to establish a relationship with him or her. The following strategies may prove useful in developing such a relationship:

Delays in Motor Development

    Some children whose lives are affected by abuse of alcohol or other drugs may have delays in motor development. They may have difficulty with gross motor skills, in which case they may walk into objects, trip or stumble without apparent cause, or have difficulty with such activities as swinging, climbing, throwing, catching, jumping, running, and balancing. When there are delays in fine motor development, children may have immature grasping skills. Such children may have difficulty manipulating objects (e.g., stacking blocks, stringing beads, cuffing paper, drawing with a pencil or crayon) and may exhibit unsteady movements while engaged in these activities.

    For a child who has problems with motor skills, staff can do the following:

CONCLUSION

    With respect to specific interventions with children, much of the material included in this chapter is not new to Head Start staff. The Head Start philosophy and the As I Am mental health curriculum materials can be applied effectively with substance-abusing families as well as with non-substance-abusing families. However, children from substance- abusing families may exhibit behaviors that sometimes are difficult to understand and redirect. Staff need to be aware that a well-organized, consistent, nurturing, and individualized approach can help these children to make gains in their social, emotional, intellectual, and motor development. Even though these gains may be difficult to measure in some children, experience has shown that positive environmental factors, even over a limited period of time, can provide such youngsters with a developmental head start in preparation for future developmental stages.

CONFIDENTIALITY

    Head Start's guidelines for confidentiality normally prevent staff from disclosing information to other agencies without parental consent. However, there are two situations where Federal or State laws may override the Head Start grantee's guidelines.

    When families are involved with health care, mental health, social welfare, substance abuse treatment, and other community agencies, staff members must obtain appropriate, legally framed consents from parents to enable both communication among Head Start staff and interagency collaboration on the family's behalf.



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