Giambruno C, Cowell C, Barber-Madden R, Mauro-Bracken L
Maternal and Child Health Program, Columbia University School of Public Health, New York, NY 10032, USA.
J Community Health. 1997 Apr;22(2):101-14. doi: 10.1023/a:1025160705362.
Data were gathered as part of a larger survey of 218 Head Start Programs in Region II (New York City, New York State (excluding New York City), New Jersey, Puerto Rico and U.S. Virgin Islands) in 1993-94. The general purpose of the survey was to obtain information on child health, screening practices, training needs, family health and community problems, barriers to diagnosis and treatment and the extent of linkages between Head Start programs and health and nutrition providers at the local level. In this study barriers to the care of Head Start children and their families were examined as perceived by the Health Coordinators or other health related staff of the Health Services Component of these programs. The extent of linkages with health and nutrition service providers were also examined. The most frequently reported barriers were lack of parent participation (72%), private transportation not available (67%), parents' perception of quality of care (64%), distance to provider (63%), cost of transportation (63%), lack of funding (56%), limited/inconvenient hours (56%), and health services not available in the community (55%). On average, programs reported linkages to 14.5 providers (including an average of 4 nutrition programs). More than 90% of them reported linkages with public health services, child protective services, WIC and private physicians/dentists. Finally, the extent of barriers and linkages were compared across different geographic areas. Significant barriers were identified in this study, yet the survey confirmed and validated the extensive nature of formal linkages with health and nutrition service providers at the local levels. These findings may indicate that the current levels of service availability may not be sufficient to meet the severity and diversity of health needs of this population.
这些数据是1993 - 1994年对第二地区（纽约市、纽约州（不包括纽约市）、新泽西州、波多黎各和美属维尔京群岛）的218个启蒙计划项目进行的一项更大规模调查的一部分。该调查的总体目的是获取有关儿童健康、筛查做法、培训需求、家庭健康和社区问题、诊断和治疗障碍以及启蒙计划项目与地方层面的健康和营养服务提供者之间的联系程度等方面的信息。在本研究中，这些项目的健康服务部门的健康协调员或其他与健康相关的工作人员所感知到的启蒙计划儿童及其家庭的护理障碍得到了调查。与健康和营养服务提供者的联系程度也进行了调查。最常报告的障碍包括家长参与度不足（72%）、没有私人交通工具（67%）、家长对护理质量的看法（64%）、到服务提供者的距离（63%）、交通费用（63%）、资金不足（56%）、营业时间有限/不方便（56%）以及社区没有健康服务（55%）。平均而言，各项目报告与14.5个服务提供者有联系（包括平均4个营养项目）。其中超过90%的项目报告与公共卫生服务、儿童保护服务、妇女、婴儿和儿童营养补充计划（WIC）以及私人医生/牙医有联系。最后，对不同地理区域的障碍程度和联系程度进行了比较。本研究确定了重大障碍，但该调查证实并验证了与地方层面的健康和营养服务提供者正式联系的广泛性质。这些发现可能表明，目前的服务可及水平可能不足以满足该人群健康需求的严重性和多样性。
