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    1. #1
      IfasehunReincarnated's Avatar
      IfasehunReincarnated is offline Never Let Them Disrespect the Ancestors

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      Head Start Day in the Park


      0 Not allowed! Not allowed!
      "Head Start Day in the Park" this Saturday

      Wednesday, July 27, 2005 6:47 PM CDT

      Recruitment and Enrollment Fair for early-childhood program

      A Head Start success story: Jane describes her high school years as turbulent and destructive. She fought often with her mother and experienced moments of deep despair. When she discovered she was pregnant at the age of 16, she dropped out of high school. After a fight with her mother, she left home to live with her boyfriend.

      Within a few months she made the positive decision to return home and re-enter school, where she met a Head Start prenatal services worker. She enrolled in Head Start's prenatal program, where she learned about pregnancy and childbirth in weekly 90-minute sessions with her home visitor.

      After her baby's birth, she transitioned to Early Head Start, and her home visitor began to work with her on establishing and working toward goals for herself and her child. Jane's daughter recently graduated from Head Start and attends kindergarten, for which she was well-prepared. Jane finished high school, enrolled in college, and is now working for Head Start full-time and about to finish her bachelor's of arts in education.

      Jane is a St. Louis Head Start success story, but hers is just one of thousands such stories being told this year around the country as Head Start celebrates 40 years of early childhood success. The St. Louis City Head Start Alliance celebrates this milestone with a "Head Start Day in the Park" Recruitment and Enrollment Fair. Families with age-eligible children (birth to five years) and expectant parents who live in the City of St. Louis are encouraged to attend the Fair in Forest Park on Saturday, July 30, from 10 a.m. to 2 p.m.

      Where: World's Fair Pavilion, Forest Park, across from the Saint Louis Zoo

      When: Saturday, July 30, 10 a.m.- 2 p.m.

      Who: Families with age-eligible children (birth to five years) and expectant parents who reside in the City of St. Louis

      Why: Parents want the best educational opportunities for their children. Studies show that children who complete the Head Start program are better prepared for Kindergarten, more likely to stay in school, have higher test scores and better grades, and are more likely to go on to college.

      Who benefits: Parents whose children enroll in Head Start receive health and nutritional information, access to educational and employment resources, and advice on age-appropriate activities for their child's continued development. The Head Start program provides a safe, fun, culturally diverse learning environment. In several City Head Start programs, multiple languages are spoken. Both classroom and home-based options are available.


      At the Head Start Day in the Park, families can:

      * Learn more about Head Start and how to enroll their age-eligible children

      * Enjoy free food and entertainment

      * Meet local celebrities, such as DJ Dwight Stone of 100.3 the Beat.

      * Receive free health screenings, including cholesterol and blood pressure checks for adults and blood pressure, lead tests, and height/weight screenings for children

      * Apply for birth certificates and social security cards (required for Head Start enrollment) and Medicaid

      For more information, contact Beth von Behren, at (636) 946-0101.
      All is Well. Workin' Hard - Tryin' to Save Time for Fam. Check in Periodically.

    2. #2
      RecoveringAA's Avatar
      RecoveringAA is offline Warrior

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      Ethical Implications/another view


      0 Not allowed! Not allowed!
      Greetings of Afrikan Love Family,

      I am Joanie, a RE~covering Afrikan amerikkkan and RE~presentative from the Voices in the Margins.

      I have such mixed feelings about Head Start and Early Head Start.

      Nina Simone asked the question: "What will happen now that the King of Love is Dead" (The Very Best of Nina Simone 1967-1972, Sugar in my Bowl, Martin Luther King Suite, track #'s 21&22).
      I assert one thing that happened is that they gave US "Head Start".

      Here are some of my findings while working and developing a Early Head Start program here in philly:
      Running head: EXPLORING USE OF PARA-PROFESSIONALS







      Exploring the Ethical Implications of using Para-Professionals as home visitors with High-risk families
      Joanie McCollum
      MCP/Hahnemann University

      Abstract
      This article will address the ethical implications of using paraprofessionals in the provision of services to families surviving in poverty1. The basis for this discussion will be supported by the professional experiences of the author in a Philadelphia based Early Head Start program. The philosophy and approach of Head Start, Early Head Start and Home Visiting were reviewed. The author contends that the most unethical of practices were taking place in the longest running government funded program for young children and their families. Those practices included responsibility overload, underpayment and inappropriate use of para-professionals as home visitors. The end result in the Early Head Start program, Keeping Families connected, was that the para-professionals were treated unethically.

      Exploring the Ethical Implications of using Para-Professionals in home visiting with High-risk families

      Our government continues to fund programs that employ paraprofessional staff as home visitors, one example being Head Start. Head Start is the longest running nationally funded program and provides a model of service provision for young children and their families. Early Head Start, an outgrowth of Head Start, enrolls children aged 0-3 while Head Start enrollees are aged 3-5. While working in an Early Head Start program in Philadelphia, I was challenged by what appeared to be a highly unethical practice. Changes in the use of para-professional home visitors in the Keeping Families Connected Early Head Start program resulted in ethical implications that stem from compensation disparity and responsibility overload. Problems with the implementation arose based on misguided efforts to empower para-professional home visitors by convincing them that their perceived shared values, connection to the community and similarities with the client population enabled them to meet all the needs of child and family.
      This paper will review the original design of “Keeping Families Connected”2, a Philadelphia based Early Head Start program. Part one will focus on the historical development of Head Start programs, use of the home as a learning environment and paraprofessional home visitor as primary service provider. In part two, I will explore the intended role of the paraprofessional home visitor in this program, change in role functioning and the ethical implications of that role change.
      Background Research
      Head Start has traditionally led the way in providing services to children surviving in poverty1 with a primary aim towards providing pre-school children from economically and socially disadvantaged families with a “head start” on formal education (U.S. Head Start Bureau, 1983). Program guidelines were based on the premise that “children living in, poverty is subject to risks to and unintentional neglect of their health, education and welfare”. (U.S. Head Start Bureau, 1983, Pg. 1) Therefore, a diverse community of service providers including early childhood and nursery school educators established programs in a variety of venues including schools, churches and recreational centers. Head Start operated as a center-based pre-school program for children aged 3-5 years surviving in poverty.
      Head Start recommends comprehensive program’s designed “to foster the healthy development of young children from low-income families” (Head Start web site). Head Start hoped to achieve its goal through the comprehensive nature of including a focus on the child, parent, staff and community development to meet the needs of enrolled children and their families. Parent’s involvement in planning, administration and daily activities of the Head Start program was also a key component. It provided parents the opportunity to develop work skills for employment.
      In 1964, the War on Poverty ensued following recognition that parents with a grade school education headed large portions of families surviving in poverty. The Economic Opportunity Act of 1964 initiated this war with three primary weapons, Job Corps, the Community Action Programs (CAP), and VISTA (a domestic peace corp.). Some local governments however, refused to apply for CAP grants because the proposal of their usage placed administrative control and resources in the hands of its intended beneficiaries, poor people (Zigler & Styfco, 1993). “In an effort to make the CAP more palatable to local officials…the Head Start project was born” (Zigler & Styfco, pg. 3).
      Since its inception in 1965, Head Start’s accomplishments include more then the documented success for children, families and the community (See Zigler and Valentine, 1979 pgs. 22-23 and Devaney, Ellwood & Love, 1997 for full review). Head Start was also successful in promoting educational and employment opportunities for parents (Zigler & Styfco 1993 pgs. 10-12). However, the success gained was not without numerous challenges.
      The first challenge arose in 1967 when philosophical differences between early childhood educators and the nursery school movement, coupled with the additional opportunities for education and employment for parents led to the use of paraprofessional staff (Parents of Head Start children) in the Head Start program (Zigler & Valentine, 1979). The result was the replacing of trained teachers with neighborhood residents. That practice was supported by two assumptions. First, in order to aid children, strengthening their home and environmental forces was necessary. Secondly, since early childhood educators could not define or defend a consistent educational approach, a professional educator’s approach was not a “must” (Zigler and Valentine, 1979). Finally, the consensus was that neighborhood residents knew better than the professionals what were the needs and nature of the children and parents.
      To improve the quality of the child’s education while helping parents improve child-rearing skills and secure employment, Head Start launched the National Credentialing Development Associate (CDA) program. This body was charged with assuring that staff in early childhood programs maintained a level of competency necessary to work with young children. It was reported that, “many CDA trainees have been parents of current or former Head Start children” (Zigler & Styfco, 1993, pg. 7). The CDA reports that “over the past 15 years, child development programs based on home visits to families have been established to support parents in their parenting role, involve them in the full development and education of their children, and help them reach their goals for themselves and their children” (CDA 1992 pg. v.). Home visitors were women residing in the communities where services were provided.
      Another challenge Head Start faced was that “while center-based Head Start programs are suffering from uneven program quality, the home-based model…is expanding and becoming increasingly popular. In a home-based program the range of services corresponds to that in a center-based program and the goals are the same. The emphasis in a home-based model is that the focus is on improving parent functioning through individualized teaching, demonstration, and guidance by staff” (Zigler & Valentine, 1979 pg. 228).
      Early Head Start was “created by Congress in the reauthorization of the Head Start Act in 1994” (Early Head Start Information Website) and implemented its first wave of programs in 1995. This author conducted a recent Internet poll of Early Head Start programs and found an increase in programs exercising the home-based option. Of the 28 programs searched, 54% exercised both home and center based services, 45% provided home-based services only and only 1% exercised the center-based option with this population. Early Head Start is currently in its 7th wave of program funding and boast’s of having served 45,000 children since its inception (Jerald, 2000).
      In 1993, Olds and Kitzman reviewed the results of early intervention programs, which had experimental research components. (Pgs. 53-92) The primary purpose of this review was to gain further clarity regarding program components that were most effective in home visiting serving low-income pregnant women and parents of young children. The results of those experiments were compiled and analyzed and the authors recommended a practice approach that focused on comprehensive services to families with greatest need provided by “well trained professionals” and allowed for frequent contact with families in the home. Based on their findings, the authors pronounced, “Carefully designed home visiting programs should continue to receive support”. (Pg. 53, italics added)


      Staffing and Program Design of Keeping Families Connected, Early Head Start
      The Early Head Start program with which I was employed served pregnant and parenting teens and their young children ages zero to three. The client population was predominantly families of African descent3, 97%, and Latino, 3%. Services were provided in the home utilizing a multi-disciplinary, family-centered care approach. This approach is best suited to the population of teen parents and their families of African descent residing in impoverished communities (Boyd-Franklin 1989). It focuses on the strengths and needs of all family members, recognizing and respecting the inter-relatedness of the family system.
      The program goal simply stated is to “support parents in their individual growth and development while they meet and support the developmental needs of their child (ren) in reaching their full potential” (KFC EHS grant proposal). The staffing pattern and structure present in this program were intentionally designed to take into account the multiple challenges low-income families experience. The design was implemented to support the roles of multidisciplinary team members, while also setting it as a standard for our Early Head Start program. Family systems practitioners and some early childhood educators have advocated this family-focused multi-systemic approach (Harden, 1997, Roberts, Wasik, Casto& Ramey 1991, Aponte 1994, Sims 1999, Boyd-Franklin & Bry, 2000 and Madsen, 1999, Yoshikawa & Knitzer 1997).
      The staff included five para-professional home visitors and two professional home visitors (licensed social workers). Home visitors were assigned as teams for the family with one professional home visitor working with 2 ½ of the paraprofessionals caseload. Therefore, professional home visitors managed a caseload size of approximately 36 families with a focus on psychosocial needs of parents and other caregivers while paraprofessionals provided home based Head Start services for 12 children. This caseload size was in keeping with Head Start Standards for child development focused home visitors (Performance Standard 1306.33). The role of the professional home visitors (licensed social workers) was to provide in home therapeutic services. These responsibilities included clinical assessments of emotional health needs, individual and family counseling, and linkage to the program’s case manager. This structure was intended to free the paraprofessional home visitors to work with parents around the child- focused issues for which they were trained.
      Home Visitor Role in KFC-EHS
      Literature Supporting Paraprofessionals as Home Visitors
      Home visiting has been hailed by C. Klass (1996) as “the new profession”; however, home visiting has been used to provide services in the homes of the poor since 1877. (Kendra, 2001 pg.128) Home- based services were provided to “paupers” during the Elizabethan Era in England. Florence Nightingale in the late 19th century had a “strong influence” on the inception of home visiting. The “most comprehensive home visiting programs” were instituted in Denmark during the 1930’s. Home visiting in the United States can be traced to settlement house employees who influenced home visiting services during the late 19th and early 20th centuries. “Home visiting is a term that has been widely used to describe services provided in the home either for an individual or for the entire family. Such help typically has focused on social, psychological, educational, or health needs and has been provided by a wide range of professionals and paraprofessionals” (Robert’s, Wasik, Castro, & Ramey 1991 pg. 131).
      Programs supporting healthy growth and development of young children by way of home visiting and paraprofessionals as home visitors have been instrumental in Head Start programs since the late 60’s. One such program is the Parent Child Centers (PCC), which began in 1968. PCC’s were developed based on the recommendation of the Department of Health, Education and Welfare Task Force on Early Childhood Development and a special White House Task Force on Early Childhood. They differentiated themselves from center based Head Start as PCC’s were to be “preventive” versus “remedial”. The goal was to support children from birth to three years and thereby “head off” the progressive damages of living in poverty. The essential elements of PCC programs are consistent with goals and standards of care in Early Head Start programs (Zigler & Valentine 1979).
      Home Start was another key program informing Early Head Start programs. For three years in the early seventies, Home Start “provided the same child-development services that are available through Head Start centers, but the learning took place in the home” (Zigler & Valentine, pg 352). The “home visitor” was identified as key in operating Home Start programs and was typically a “community resident who had undergone some training in the principles of child development and the goals of Home Start” (pg. 352). Rationales for home visiting were that (1) center based services could not ensure learning continuity in the home environment, (2) center based programs were not feasible in many communities and (3) learning takes place in the home and could be diffused to siblings. This approach also offered the opportunity to compare merits of both center based and home based options. Head Start did adopt Home Start’s model by introducing the Home-based option in Head Start (Zigler & Valentine, 1979).
      In 1991, The U.S. Advisory Board on Child Abuse and Neglect recommended implementation of “a new federal initiative aimed at preventing child maltreatment: to begin immediately to phase in a universal voluntary neonatal home visiting system” (Krugman, 1993, pg. 185). This recommendation was triggered by reports of an infant who sustained extensive medical injuries due to parental neglect and abuse. It was believed that a visit to the home prior to the child’s hospitalization for sustained injuries could have facilitated recognition and prevention of the problem. At that time, the efforts of professional nurse home visitors demonstrated positive outcomes on maternal and child health and well being (Haitt, Sampson, and Baird 1997, Kearny, 2000). Since the Advisory Board’s recommendation of a universal home visiting program initiative, there has been a ground swell of home visiting programs addressing child, family and mental health outcomes. As in all programs that employ para-professional home visitors, the similarities of the client population in terms of race, gender, and social experiences are of primary benefit. (Korfmacher, 1998 &1999, Klass, 1996, Hiatt, Sampson and Baird, 1997, Devaney, Ellwood, and Love. 1997, Duggan, 2000) A high school diploma or equivalent, successful completion of home visiting training program and the above-mentioned characteristics were the base line requirements for consideration as a para-professional home visitor in the Keeping Families Connected Early Head Start program. They must also have parented children themselves. They were classified as “successful” in their endeavors to overcome challenges such as, single parenting, surviving abusive family and partner relationships and substance abuse and would be in a better position to support the clients they served.
      The role of the paraprofessional home visitor in the KFC EHS program was consistent with the CDA’s recommendation for home visitors and was to be focused on parent/child interaction in the provision of the child development component of the program. The paraprofessional home visitor was to work as part of a team with the professional home visitor. As a team member, the paraprofessional home visitor’s role is to educate young mothers about how their young children grow and to develop and provide hands on parenting skill/support to aid in the child’s development. As previously stated, social workers worked with the parents around addressing their personal issues and supporting them in resolving relationship challenges as well as supporting the attainment of personal goals.
      In the area of child development, the paraprofessional home visitor’s primary responsibilities include involving family members in on-going developmental screenings using the Ages and Stages Questionnaire and utilizing the results of this assessment. The home visitor, with support of the Child Development Specialist, is to individualize the information, materials and activities and implement the Family Curriculum Guide. Paraprofessional home visitors also completed vision and hearing screenings, nutrition assessments and provided activity-based interventions like selecting and preparing food during home visits.
      The CDA recommends home visitors have an attitude of viewing parents as partners as this is intrinsic in a parent-focused home based program. The three basic elements in a home visit included commitment to 1) the philosophy that parents are partners, 2) provide effective information exchange and 3) develop a good interpersonal relationship. The role of the home visitor is meant to be secondary to that of the parent in a home-based program. The home visitor’s role is to “facilitate learning vs. transmitting knowledge”. Communication with parents should be multidirectional and the home visitor should encourage parent/child interaction in a positive way. Home visitors should enhance development of parents’ teaching, interaction and problem solving skills, which would lead to increased self-confidence, and self-esteem. The home visitor's primary function is seen as guiding parents towards answers for their questions utilizing their own knowledge skill and experience base. As a member from the community, the home visitor is seen as having “much to share” with Head Start parents (pg. 10). The staffing pattern in KFC EHS was designed to promote that sharing.
      During the initial phase of program implementation, ten staff members made up our Early Head Start team. It was comprised of the five paraprofessional home visitors of African decent, one Caucasian professional home visitor, a part-time Caucasian nutritionist, one Home-based supervisor of African decent (experienced paraprofessional home visitor), one Social Service Coordinator of African decent and the Director, a Social Worker of Hispanic decent. The home-based supervisor provided weekly supervision for paraprofessional staff while the social service coordinator supervised professional staff and the home based supervisor. A nurse practitioner and child development specialist and an additional social worker were yet to be hired. With the introduction of a Caucasian Child Development Specialist (experienced in the traditional Head Start approach) and one Caucasian Nurse practitioner came the first series of structural changes in the role of the paraprofessional home visitor. The Child Development Specialist was to spend 30% of her full time position with the Early Head Start program assuring the appropriateness of curriculum activities and to provide on-going training for all staff in the area of child development. Staffing patterns were uniquely diverse in the areas of class, race, religious preference, cultural experiences and finally, educational backgrounds. Zigler (1994) advocated support for socioeconomic integration in Head Start programs. While Head Start has not yet been able to expand and include children from various SES, our program was able to provide this diversity on the staff level.
      Change in Home Visitor Role
      With the full multidisciplinary team in place, structural changes and the concept of “home visitor” changed. The professional home visitor functions were shifted to the para-professional home visitors. In the end, the paraprofessional staff became the gate- keepers to the family providing child development education in the home during weekly ninety minute visits, assessing and referring parents for emotional health services to meet their needs, facilitating bi-monthly socialization groups for children and parents and assessing, with parents, the child’s growth and development utilizing the Ages and Stages Questionnaire at age appropriate intervals. Para-professional home visiting staff managed a maximum caseload of twelve high-risk families. Professional home visitors were relegated to enrollment and case management functions and utilized on an as needed basis. The paraprofessional staff determined this need. The requirements for home visitors included in the CDA Credentialing Board’s statement are: 1) Knowledgeable and experienced in all areas of child development, 2) help parents appreciate the rapid growth and development of their children and meet changing needs, 3) be familiar with and sensitive to the community where the families live, 4) be skilled adult educators who are able to establish a trusting working relationship with clients and 5) be able to work cooperatively with other program staff and establish links with community agencies providing family services. (Pg v. National Credentialing Program 1992). At first glance this does not appear to be an unreasonable expectation, however when the salary and limited knowledge base in adult mental health of paraprofessional staff is taken into account, this situation may become unethical.
      Robert Halpern (1993) suggests “services for poor families have been shaped by a tendency to ask more from these families that they can reasonably deliver-a tendency to use services as a substitute for adequate income, housing, and economic opportunity. Together these factors have led to chronic dilemmas of shared values, stance, and boundaries for service providers working with young families living in poverty” (Pg. 159). Broadening this view could lead one to question if Head Start is asking from their para-professional home visitors, more than they can reasonably deliver in the face of such a challenging population. Additionally, Harden, (1997), supported these challenges and suggested that “generic home visiting will not meet the needs of psychologically vulnerable families… intensive, specialized, and coordinated services are required” (Pg. 10).
      Use of professional or para-professional staff depend on the program’s primary mission, goals, recipients and economic resources. Within the discipline of Education, there seems to be a tendency toward use of para-professional staff possibly due to the constraints on spending for families surviving in poverty (President’s Commission, 1983). A recent survey of home visiting programs in the U. S., found that 60% of programs serving low-income families did not require a bachelor’s degree for their home visitors. This suggested a different staffing pattern might be in existence for programs serving low-income families (Powell, 1993). Similarly, in Early Head Start, “there is no degree or training requirement for home visitors of family support workers” (Jerald, 2000, pg. 34). It has also been reported that, “home visitors are the primary staff who carry out a home-based child development program” (pg. v., 1992 National Credentialing program CDA.) Finally, there is a plethora of literature concerned with the use and effectiveness of home visiting in service provision for young children classified as “high risk”, “at risk”, and/or low-income (Hiatt, Sampson, Baird, 1997, Roberts, et al., 1991, Kearney, 2000, Olds and Kitzman, 1993, Ramey and Ramey, 1993, Halpern, 1993, Krugman, 1993, Olds, et al. 1997). These concerns spring from the nature and impact of poverty in the lives of children and families health. As reported by Hiatt, Sampson and Baird (1997), “minimal understanding of the para-professional’s efficacy exists in the literature…and that…valid evidence of paraprofessional efficacy will be essential before the Advisory Boards proposal can be fully justified” (Pg. 78). Also noted in the literature is that “Head Start’s difficulties have to do with implementation, not design” (Zigler, 1994, pg. 39). This was certainly the case in our Head Start Program.
      While full day trainings were held on understanding and appreciating family values, cultural competence and working with teen parents, there was a noted absence in training courses for para-professional home visitors on the social/emotional impact of poverty on children and families, family systems theories and effective use of self. Glink, Stott, and Eggbeer (2000) contend, “In work with infants, toddlers, and families, services are delivered through the vehicle of relationships. Regardless of the expertise a candidate brings to a position, her effectiveness will depend in large measure on her ability to establish and maintain supportive relationships with children, families, and colleagues” (Pg.45). Keim, (2000) report “evaluations of intervention programs that use home visiting have shown that improved child and family outcomes are more likely in families that participate more intensely and voluntarily, over an extended period of time, than in families with limited participation. In other words, home visitors must engage and retain families with limited participation long enough to see results” (Pg.38). While it is recognized that home visitors must be able to develop therapeutic alliance with families (Keim, 2000, Harden, 1997), the question arises as to what are the guiding theories for practice and components of the therapeutic relationship.
      Ethical Implications of Role Change
      As a licensed social worker and budding family therapist, I believe effective use of self is the key factor in the development of a therapeutic relationship. Client-Centered, psychoanalytic oriented and systems theorist’s all consider a relationship based on unconditional positive regard, genuineness and accurate empathy as requisite components of the therapeutic relationship (Prochaska, 19884). Techniques for facilitating change in these disciplines include listening, directing or being directed by client and/or encouraging self- expression of feelings, thoughts and behaviors and are predominantly mental health oriented. Head Start’s foundations are grounded in educational and medical disciplines whose primary techniques for facilitating change is modeling, highlighting social or physical reinforcements and teaching. These techniques are consistent with a behavioral approach and outcomes to treatment. Actually, “modeling theory” of the therapeutic relationship, suggests that:
      “The therapist would do clients an injustice to pretend to be unconditional in positive regard since social reinforcements, including positive regard, are in reality contingent. The therapist is not concerned with accurate empathy, since accurate observation is most critical in determining both the rate of responding and whether therapy is in fact being effective. Nor is the therapist particularly concerned with being genuine, since what clients need is a competent therapist, not one who is preoccupied with being authentic. If there is any general value to a therapeutic relationship, it is most likely to be the result of the modeling that the therapist does for clients”. (Prochaska, 1984 pg. 301)

      In fact, educators and physicians as well as those in the mental health disciplines are bound by certain standards of care guiding individual behavioral choices. Mental health and the medical professions are also bound by codes of ethics, which are inherently tied with legal implications for their interactions with individuals they seek to “help” in that violations of said codes could lead to law suits or expulsion from the profession. Therefore, inappropriate use of self with clients or patients carries swift and punitive penalties. Educators view “parents as partners” vs. “clients” or “patients”. The relationship is more peer, non-hierarchal oriented. It appears the provider in this role is not held accountable, as they are to function as equals, sharing knowledge. In an unstructured environment such as the homes of families surviving in poverty, structure is needed. The families, their structures and home environment are labeled as: “Under-organized” (Aponte 1996), “families in extreme distress” (Shalom & Shamai 2000), “psychologically vulnerable” (Harden1999), “at risk” (Duggan, 2000). These are the primary family characteristics for eligibility to the Head Start programs. The peer/partner model home visitors are encouraged to utilize is inconsistent with theories based in mental health disciplines.
      The development of the relationship is the key intervention in which mental health professionals (who may be a home visitor) are trained and held legally accountable. Theories and practice, which are consistent with working with adults and families who are struggling with competing and conflicting urgent needs are based primarily in psychology, family therapy and social work training programs. Those needs include, “educational, advice, emotional and social support, concrete help (transport to child health clinics… help finding housing…), increasing formal and informal support,” (Kendrick et al. 2000). Therefore, education is only one component in the needs of families surviving in poverty.
      I believe this change in role for our paraprofessional home visitors, that of taking on the responsibilities for all disciplines, without appropriate training and skill development in all disciplines is unethical. Also, having home visitors function as teachers in the areas of health, nutrition, dental care, and child -development while also functioning as peer, therapist and case manager yet receive the lowest financial compensation seems downright abusive.
      Salary for paraprofessional home visitors is typically three times less than professional staff who remain in the office and “teach” or “train” the home visitors. The home visitor is the one whose very safety, (emotional and physical) are jeopardized on a daily basis. They are the ones on the front lines, in the drug infested, high crime and violent communities. The compassionate home visitors, who on a daily basis, listen to and witness first hand, the pain and suffering experienced by families surviving in poverty become co-suffers. “Excessive co-suffering also impedes and may even paralyze the [physician] in a state of inaction”. (Pellegrino & Thomasma 1997, Pg. 81) The home visitors are confronted, along with the family, with the limited amount of quality resources, cultural insensitivity to their needs or unavailability of both their communities. The home visitors are responsible for providing direct interventions to assure our most precious societal commodity, our children are protected, provided for and nurtured towards success, yet they are compensated the least. I strongly believe this is a crime and the most unethical of practices.
      Furthermore, Hiatt, Sampson and Baird (1997) believe that paraprofessionals themselves, based on similarity to the client populations, were in need of strengthening their own socioemotional and external resources if they were to be effective in accomplishing the same for their client families. Two of the five paraprofessional home visitors in Keeping Families Connected Early Head Start had consistent problems with childcare and would bring the child to work with them or needed to take frequent time off.
      The Question arises of how Head Start and similar programs which place paraprofessionals in the home as primary care provider can justify fighting the “war on poverty” by employing individuals who have suffered and continued to suffer the impact poverty has had in their lives. They may or may not have had the “benefit” of a Head Start program and without the job as a home-based para-professional; they (para-professional home visitors) would be in the same spot as the clients they serve.
      Trust in human relationships is impossible to separate. “Without it we could not live in society or attain even the rudiments of a fulfilling life. Without trust we could not anticipate the future and we would therefore be paralyzed into inaction” (Pellegrino and Thomasma pg. 65). For families surviving in poverty, including para-professional home visitors, this is a key barrier to utilizing services offered. As Pellegrino and Thomasma point out, to trust and entrust places families in a position of vulnerability, depending on the good will and motivations of those they are expected to trust. In accepting the services offered by Head Start, our families are entrusting their very lives by relying on the good will of the agency, defenders of the law, policy makers and funders of service. Because of the unique characteristics of families surviving in poverty, paraprofessionals experienced a limited amount of trust in the professional staff that was there to support them. I believe a significant amount of this tension was grounded in issues of racism, discrimination and the practice of imposing dominant cultural views in the lives of “minorities” (Boyd-Franklin 1989). Pellegrino and Thomasma acknowledge the potential of providers to show a “disrespect, lack of concern, indifference, or disengagement from this person’s way of seeing her predicament” (Pg. 80). There was no training or supervision component built into Keeping Families Connected Early Head Start to help the para-professional home visitors to address this quandary.
      In our Early Head Start program, I noted a tendency of the home visitors to focus on their own good rather than the good of the client. Due to the similarities in the emotional state of home visitors and their clients, home visitors worried about their own competency and perceived clients’ non-participation in service as a reflection on them as people and helpers indicating a lack of emotional and professional boundaries. In our Early Head Start program, staff that was qualified to address the emotional health needs of parents of Head Start children were challenged with performance standards that appeared to limit their ability to provide such service. Education staff (home visitors and Child Development Coordinator) argued, “the need for limited staff involvement in the home, the need to support and encourage use of other community resources, and ultimately, that Head Start’s focus was on the child and that Head Start could not meet all the needs of Head Start families.” (Education staff, personal communications, 1998). This approach did not seem to support recommendations in previously cited studies advocating the need for a multi-disciplinary/multi-dimensional approach to children and families surviving in poverty nor the recommendations of the American Hospital Association’s report entitled Values in Conflict: Resolving Ethical Issues in Health Care. Their report suggest that “in the best scenario’s, these networks would be clinically and fiscally accountable for delivering high quality care to their enrollees along a seamless continuum and also would be focused on improving the health statistics of its broader community” (1994 Pg. 45).
      I believe that Head Start could benefit tremendously by the recommendation laid out in the winter 1993 issue of “The Future of Children”. In that issue, Ramsey, Olds and Kitzman, Halpern advocate the utilization of a multi-systems approach with home visiting programs.

      Conclusion
      Several authors, in their discourses about home visiting as an approach to improving the lives of children and families, pontificate about “high quality services”, “well-trained staff” (Olds & Kitzman, 1993), comprehensive (Halpern, 1993), and multi-systemic (Yoshikawa, 1997) approaches. They support the notion of the continued utilization of “home visitors” as direct care service providers. They also advocate increased funding, program expansions and further “research”. They also happily acknowledge that further research is needed to trust the efficacy of home visiting as a valid intervention to address the needs of families surviving in poverty. This article was written to begin the discussion regarding ethical implications of home visiting by paraprofessional staff. Further investigation and research is warranted to assess para-professional staff perceptions and experiences. Measurements assessing perceived racist, oppressive, marginalizing of staff is indicated. Studies should also focus on level of burnout, trauma reactions (identification with the aggressor), and potential depressive symptomatology for para-professional staff.
      Head Start was initiated as a “war on poverty” over thirty years ago. Since that time, the face of poverty has grown obnoxious and insurmountable. The President’s Commission and the American Hospital Association have spelled out factors affecting the insurmountable task of achieving self-sufficiency in the literature addressing ethical implications in accessing health care. I believe paraprofessionals can play a vital role in Head Start programs. Their training in child development and connection to the community could enable them to provide invaluable information to parents. Problems are sure to surface however, when there is an expectation or belief that they can also address the mental health needs of families or are led to believe that the education they provide to parents is sufficient to facilitate growth and change in the monstrous face of poverty.



      References
      American Hospital Association. (1994). Values in Conflict: Resolving Ethical Issues in Health
      Care. (2nd ed.). Washington, DC. Author.
      Aponte, H. J. (1994). Bread & Spirit: Therapy with the New Poor Diversity of Race, Culture, and Values. New York: W. W. Norton & Co.
      Boyd-Franklin, N., & Bry, B. H. (2000). Reaching Out in Family Therapy: Home-Based, School, and Community Interventions. New York: The Guilford Press.
      Boyd-Franklin, N., Ph.D. (1989). Black Families in Therapy: A Multisystems Approach. New York: The Guilford Press.
      Devaney, B. L., PhD., Ellwood, M. R., M.S.W., & Love, J. M., PhD. (1997). Programs That Mitigate the Effects of Poverty on Children. The Future of Children. 7(2). 88-112.
      Duncan, G. J., Brooks-Gunn, J., & Klevanov, P. K. (1994). Economic Deprivation and Early Childhood Development. Child Development, 65, 296-318.
      Duggan, A., ScD., Windham, A., MPH., McFarlane, E., MPH., Fuddy, L., LCSW, MPH., Rhode, C., PhD., Buchbinder, S., PhD., Sia, C., MD. (2000). Hawaii’s, Healthy Start Program of Home Visiting for at-risk families: Evaluation of Family Identification, Family Engagement and Service Delivery. American Academy of Pediatrics. 105(1). 250-259.
      Glink, P., Stott, F., Eggbeer, L. (2000). Selecting Staff for Infant/Family Programs: Issues and Strategies. Zero to Three. 21, 44-50.
      Halpern, R., Ph.D. (1993). The Societal Context of Home Visiting and Related Services for Families in Poverty. The Future of Children, 3(3), 158-171.
      Harden, B. J. (1997). You Cannot Do It Alone: Home Visitation with Psychologically Vulnerable Families and Children. Zero to Three, 17(4), 10-16.
      Hiatt, S. W., Sampson, D., & Baird, D. (1997). Paraprofessional Home Visitation: Conceptual and Pragmatic Considerations. Journal of Community Psychology, 25(1), 77-93.
      Jerald, J. (2000). The Early Head Start Work Force. Zero to Three. 21, (32-36).
      Kearney, M. H., RNC, PhD, York, R., RN, PhD, & Deatrick, J. A., RN, PhD. (2000). Effects of Home Visits to Vulnerable Young Families. Journal of Nursing Scholarship, 32(4), 369-376.
      Kendrick, D., Elkan, R., Henith, M., Dewey, M., Blair, M., Robinson, J., Williams, D., Brummell, K. (2000). Does Home Visiting improve parenting and the quality of the home environment?: A Systematic review and meta analysis. Archives of Disease in Childhood. 82, 443-451.
      Keim, A. L. (2000). Finding and Supporting the Best: Using the insights of Home Visitors and Consumers in Hiring, Training, and Supervision. Zero to Three. 21, 37-43.
      Klass, C. S., Ph.D. (1996). Home Visiting: Promoting Healthy Parent and Child Development. New York: Paul H. Brookes Publishing Co.
      Korfmacher, J., Ph.D. (1998). Examining the Service Provider in Early Intervention. Zero to Three, 17-22.
      Krugman, R. D., M.D. (1993). Universal Home Visiting: A Recommendation from the U.S. Advisory Board on Child Abuse and Neglect. The Future of Children, 3(3), 184-191.
      National Credentialing Program. (1992). Home Visitor: Child Development Associate Assessment System and Competency Standards. Council for Early Childhood Professional Recognition: Washington DC.
      Olds, D. L., Ph.D., & Kitzman, H., Ph.D. (1993). Review of Research on Home Visiting for Pregnant Women and Parents of Young Children. The Future of Children, 3(3), 53-92.
      Pellegrino, E. D., & Thomasma, D. C. (1993). The Virtues in Medical Practice. New York: Oxford University Press.
      Powell, D. R., Ph.D. (1993). Inside Home Visiting Programs. The Future of Children, 3(3), 23-38.
      Prochaska, J.O. (1984). Systems of Psychotherapy. Chicago: The Dorsey Press.
      Ramey, C. T., Ph.D., & Ramey, S. L., Ph.D. (1993). Home Visiting Programs and the Health and Development of Young Children. The Future of Children, 3(3), 129-139.
      Roberts, R. N., Wasik, B. H., Casto, G., & Ramey, C. T. (1991). Family Support in the Home: Programs, Policy, and Social Change. American Psychologist, 131-137.
      Shalom, A.S., Shamai, M. (2000). Therapeutic Intervention with Poor, Unorganized Families. New York: The Haworth Press Inc.
      Sims, B. E. (1999-2000). Fostering Parent –Child Interactions through Family Support. Zero to Three. 37-40.
      Sokoly, M. M., MS, & Dokecki, P. R., Ph.D. (1992). Ethical perspectives on family-centered early intervention. Infants and Young Children, 4(4), 23-32.
      U.S. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. (1983). A Report on the Ethical Implications of Differences in the Availability of Health services: Vol. 1. Securing Access to Health Care. Washington, DC: Government Printing Office.
      U.S. Head Start Bureau. (1986). The Head Start Home Visitor Handbook: building a home-based program. Washington DC: Government Printing Office.
      U.S. Department of Health and Human Services. Head Start Program Performance Standards and Other Regulations. (1996). Washington, DC: Government Printing Office.
      Yoshikawa, H., Knitzer, J. (1997). Lessons from the Field: Head Start Mental Health Strategies to Meet Changing Needs (Executive Summary). [on-line], cpmcnet.columbia.edu/dept/nccp/lessons.html
      Zigler, E. (1994). Reshaping Early Childhood Intervention to Be a More Effective Weapon Against Poverty. American Journal of Community Psychology, 22(1), 37-47.
      Zigler, E., Valentine, J. (1979). Eds. Project Head Start: A Legacy of the War on Poverty. New York: The Free Press.
      Zigler, E., Styfco, J.S. (1993). Eds. Head Start and Beyond: A National Plan for Extended Childhood Intervention. New Haven: The University Press.


      Author Note
      1. The author addresses the context of economic and spiritual deprivation in which the families reside as opposed to describing family as “poor”, low-income”, “high risk”. This terminology recognizes poverty as a condition or state of being versus characteristic of the family.
      2. Program name adopted by staff in 1999 prior to this staff member’s departure. Name represented mission of staff and this author. Child Development, Nurse Practitioner and Nutritionist had left program prior to name development.
      3. Term preferred by author who is a woman of African descent. Term used to describe individuals whose historical and cultural origins are in Africa.


      Assante sana for allowing me to share

      In Love of AFrikans home and abroad
      Last edited by RecoveringAA; 07-28-2005 at 12:24 PM. Reason: highlights

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      IfasehunReincarnated is offline Never Let Them Disrespect the Ancestors

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      You posted a full research paper. lol I understand and believe me, I know the system is flawed. Unfortunately in some places its all they got. I see families where I wouldnt trust their own kinfolk to help them rear and support their children. Where you got one adult (and it may not be the parent) that is the only ray of hope in a family for some kids.

      We got headstart programs here where the teachers can barely read themselves. But the flipside is that we got parents that keep that same child home to watch them bag up weed or watch rikki lake all day. And by the time school starts they still dont know ABCs but they can fight like Tyson.

      What to do? I wish to God we finally start developing and endorsing our own programs and curriculum. In the meantime our children got few choices.
      All is Well. Workin' Hard - Tryin' to Save Time for Fam. Check in Periodically.

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      Hey, you and I need to dialogue more on social and human services. I dont think a lot of people have that background 'round here.
      All is Well. Workin' Hard - Tryin' to Save Time for Fam. Check in Periodically.

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      Quote Originally Posted by IfasehunReincarnated
      Hey, you and I need to dialogue more on social and human services. I dont think a lot of people have that background 'round here.

      Works for me

      Asante sana

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      Quote Originally Posted by IfasehunReincarnated
      What to do? I wish to God we finally start developing and endorsing our own programs and curriculum. In the meantime our children got few choices.
      This is my ultimate goal/aim/passion/desire....

      BE~cause OUR children have few choices other than going about BE~ing "reared" (as in back..wards) in amerikkkan ideological thoughts and BE~haviors.

      Akpe for shaing and allowing me to share

      p.s. why you lol cause i posted my re~search paper? :cheers:

      Just wanted to give a full account of where I was coming from and trust that some student could benefit from the work.

      Re~member folks....no plagarism..give credit where due.

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