Mental Health: A Report by the Surgeon General

Project Head Start, though generally conceived of as an early childhood intervention program, is probably this country’s best known prevention program. In 1965, when it was designed and first implemented in 2,500 communities, Head Start’s target population was economically disadvantaged preschool children. Its goal was to improve the social competence of these children through an 8-week comprehensive intervention that included a center-based component and a home visit by community aides, focusing on social, health, and education services (Karoly et al., 1998). A number of psychologists, most notably Jerome Bruner (1971), argued that children can be trained to think in a more logical way and that the development of logic is not entirely predetermined. Bruner’s views were very influential in launching early intervention programs such as Head Start. There is now ample evidence that, by providing an appropriately stimulating environment, significant advances in knowledge and reasoning ability can be achieved.

The program has served over 15 million children and has cost $31 billion since its inception (General Accounting Office, 1997). It has changed in many ways in the intervening years, and there now is considerable program variation across localities (Zigler & Styfco, 1993). Early evaluations of Head Start showed promising results in terms of higher IQ scores, but over the years many of the findings have met with criticism and skepticism. The reason is that there has been no national randomized controlled trial to evaluate the program as originally designed (Karoly et al., 1998).

Repeated evaluations of Head Start programs that did not employ such a rigorous design (Berrento-Clement et al., 1984; Seitz et al., 1985; Lee et al., 1990; Yoshikawa, 1995) have shown that, although focused early education can improve test scores, the advantage is short-lived. The test scores of children of comparable ability who do not receive early childhood education quickly catch up with those who have been in Head Start programs (Lee et al., 1990). Yet there appear to be more enduring academic outcomes. A review of 36 studies of Head Start and other early childhood programs found them to lower enrollment in special education and to enhance rates of high school graduation and promotion to the next grade level (Barnett, 1995). Head Start and other forms of early education offer arguably even more important benefits, which do not become apparent until children are older. The advantages are mainly social, rather than cognitive, and include better peer relations, less truancy, and less antisocial behavior (Berrento-Clement et al., 1984; Provence, 1985; Seitz et al., 1985; Webster-Stratton, 1998; Weikart, 1998). Although important from a societal perspective, it is not known whether these very significant benefits are due to direct effects on the child or to the parent education programs that often accompany Head Start programs (Zigler & Styfco, 1993).

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