“My preschooler has an IEP and health issues. He has a chronic heart condition, so he can’t run and jump like other kids because he gets tired easily. He has to take medicine at lunchtime. The special educators and teachers came up with great strategies so he can join in and also rest.” — Parent of a child with disabilities and special health needs

This chapter explains how health and mental health services work together to support children with disabilities and their families. First, we’ll talk about health regulations. Next, we’ll cover mental health.

As a disability services coordinator, you help make sure your program meets the health and mental health requirements for children with disabilities. You work closely with:

• Health managers
• Nutrition managers
• Mental health managers
• Mental health consultants
• Behavior specialists 

In some programs, the DSC may also serve as the health or mental health manager.

Your Role in a Team Approach

Children with disabilities, health needs, or both may need extra support to take part in daily activities. Some children may not be able to move around as much, need rest breaks, or take medicine during the day. Others may need help managing emotions or staying focused.

Working closely with the health and mental health services teams, you help create a plan that works for each child by:

• Talking with families about their child’s needs.
• Reviewing daily activities and schedules to identify needed accommodations.
• Working with teachers and specialists to find ways the child can join learning activities.
• Making sure the child has time to rest or take medicine if needed.
• Helping staff understand how to respectfully support the child in ways that promote health and safety.

Please note that while this chapter separates health services and mental health services into two separate sections, a team approach to supporting both body and mind health is best practice. As much as possible, teams of professionals should support positive outcomes by working together using a multidisciplinary approach.

A multidisciplinary approach ensures the child’s care is individualized to their needs. Each person on the team helps make this happen. Every role and relationship with the child and family offers different perspectives and strategies to ensure success.

Key Ideas

• Children with disabilities and their families should have access to all health and mental health services in your program.
• Working closely with the health manager and health team helps support children and families effectively.
• Health and mental health services should respect each family’s parenting style.
• Services must be tailored to meet each child’s individual needs.
• Mental health consultants play an important role in supporting children, staff, and families.
• In early childhood, mental health means helping children grow socially and emotionally.
• Some families may need help finding the right health or mental health services for their child.
• It’s important to address negative attitudes or misunderstandings about health and mental health when training staff and supporting families.
• Strong health and mental health services are a key part of a coordinated approach for children and their families.

What are the health services in Head Start programs?

Head Start programs must provide high-quality health, oral health, mental health, and nutrition services to all children. These services must match each child’s age, development, culture, and language to support their growth and school readiness.

Daily health routines must include:

• Nutritious meals and snacks
• Physical activity
• Rest or quiet time that fits the child’s age

Health and Mental Health Services Advisory Committee 

Every program must have an HMHSAC. This group may include:

• Head Start parents
• Health professionals
• Community partners
• Mental health providers and professionals

The committee helps:

• Identify health and mental health issues affecting families
• Find resources
• Advise on health and mental health policies and procedures

Health Requirements and Timelines

Within 30 calendar days of starting the program, staff must check if a child has:

• A source of ongoing care, like a regular health care provider or clinic
• Health insurance

If not, the program must help the family find both.

Within 90 calendar days (or 30 calendar days for short-term programs), staff must check if the child is up to date on:

• Preventative care (e.g., well-child and dental visits) based on state Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) periodicity schedules
• Immunizations based on CDC Immunization guidelines
• Any extra health needs identified by the HMHSAC

If a child is not up to date, the program must help the family schedule appointments or provide the services.

Oral Health and Nutrition

Programs must:

• Track and support oral health care, including:
  • Preventive care
  • Treatment and follow-up
• Identify and support each child’s nutrition needs, including
  • Special dietary requirements
  • Food allergies

Screenings and Referrals

Health services consist of screening and referral procedures. Per 45 CFR §1302.42(b)(2), within 45 calendar days of a child starting, the program must:

• Provide or get vision and hearing screenings
• Review health records or parent reports for concerns

If the program identifies concerns, it must take the following actions: 

• Support follow-up on screening, including further evaluation or diagnosis
• Help with treatment and follow-up
• Keep all records confidential

Working with Families

Head Start programs must work closely with families to support their child’s health and well-being. 

Programs must work with families to:

• Get parent consent before doing any health procedures or screenings
• Help parents:
  • Learn about well-child visits
  • Learn about healthy behaviors
  • Support their own well-being
  • Understand and use health and mental health systems
  • Get equipment or services their child needs
  • Connect with family support programs
  • Apply for extra help if needed

These efforts build trust and ensure that families feel supported and informed every step of the way. Check education and child development program services, 45 CFR Part §1302 Subpart C for more details. 

Staff Qualifications and Training

According to Human Resources, 45 CFR §1302 Subpart I, only qualified staff or consultants are allowed to:

• Perform health procedures
• Provide nutrition services 

To maintain high-quality care, programs must:

• Train staff on mental health and wellness topics that may affect their work with children and families
• Offer regular health-related training sessions to help staff stay informed about current practices and ways to better support the children in their care

This ongoing learning is essential for creating a safe, healthy, and supportive environment for all children.

Planning for Partnering

As the DSC, your main job is to make sure children with disabilities get all the health services they need. This includes:

• Keeping their immunizations up to date
• Meeting their oral health and nutrition needs
• Making sure their families can access health care

You ensure health care providers treat the health needs of the whole child, not just the disability. Ensuring children with disabilities can receive good oral health care, proper screenings, and other important services is critical for their growth and development.

Health care is a key part of the team approach to supporting children with disabilities and their families. When health, education, and family services work together, children are more likely to thrive.

HeadStart.gov provides tips about how to help children with disabilities brush their teeth and find comfortable positions. Share these resources with staff and families.

You don’t work alone. You team up with the health manager. They handle quality health services based on the Performance Standards. Your collaboration can differ by program. It depends on the program's size, structure, job qualifications, and more. The health manager usually flags medical records that show health issues. They also respond to parents' concerns about their child's health. The health manager checks vision and hearing screenings. They find children who need follow-up care. The health manager connects with children's medical and dental homes. They also link families to health resources in the community. 

Refer to the Health Manager Orientation Guide for a description of the roles and responsibilities. The Health Services Competencies describe the scope of work for health services staff.

Your partnership with the health manager helps you:

• Respond to the individual health needs of families of children with disabilities
• Seek local health professionals who work closely with children with disabilities or suspected delays
• Remove the barriers to health services for children with disabilities
• Promote a coordinated approach that ensures the full participation in program activities for children with disabilities and their families

You and the health team can encourage healthy eating, exercise, and rest. Look for ways to reduce staff stress at the program level. When caregivers take care of themselves, they are better able to care for young children. Plan health education opportunities with the health manager, other staff, and community resources. Offer learning opportunities to help reduce barriers and stigma around disabilities and health issues.

Children with Special Health Care Needs

Children with special health care needs are children who have, or are more likely to develop, long-term health conditions and who need more medical care, therapy, or other services than most children their age.

Children with special care needs may have Individual Health Care Plans (IHCPs). The health manager collaborates with the child’s family and health care provider to develop an IHCP. This plan outlines how to care for the child to promote their health and well-being while in the program. The IHCP includes information shared by families and health care providers and takes into consideration the activities in the program. 

The IHCP is used as a communication and training tool for staff. It may include:

• Medication protocols
• Medical procedures
• Adaptations during the daily routine
• Signs and symptoms of an emergency
• Actions to take in the case of an emergency
• Other health and safety practices
• Whether the child needs regular activity adaptations due to a medical condition

Some children with health concerns may be eligible for case management services under a Section 504 Plan, EPSDT, or other program. If children with health issues have delays that impact their learning, refer them to the local Part C or Part B agency for evaluation. If they qualify for IDEA services, an IFSP or IEP would be prepared.

You and the health staff have the same goal. You want to individualize services for children and their families. This ensures their full, safe, and effective participation in all program activities and services. You can help teachers and home visitors modify learning experiences for children with disabilities and health concerns. You and the health manager carry out policies and practices that support all children in the program.

Example: Coordinated Support for a Child with Feeding Challenges

If a child has feeding challenges and an IFSP or IEP, work with agency specialists and the health team to make sure those needs are clearly included in the child’s Individualized Health Plan. In this case, the child would fall within the shaded area of the diagram above. Support teachers and family child care providers in including the child during snack and mealtimes. This ensures everyone understands how to support the child during meals and snacks.

Some children with disabilities may also have health conditions that limit their physical activity. In these cases, it's important to work closely with early intervention staff, special education providers, Head Start education staff, and facilities staff to ensure the child can safely participate in playground and learning activities that match their abilities.

To support the child fully:

• Help teachers or family child care providers include the child during snack and mealtimes
• Support home visitors in doing the same during home-based visits
• If a child’s health condition limits physical activity, work with:
  • Early intervention staff
  • Special education providers
  • Head Start education staff
  • Facilities staff
• Make sure the child can still take part in playground and learning activities in a way that works for their abilities

What are mental health services in the Performance Standards?

The primary standards on mental health services appear in Health and Mental Health Program Services, 45 CFR §1302 Subpart D. They require programs to promote children’s mental health, social, and emotional well-being in the whole program. Programs must:

• Give teachers the tools to manage their classrooms well and to support children with challenging behaviors or other mental health concerns
• Pair staff and families with mental health consultants as needed
• Obtain parental consent for consultation services when their child enrolls
• Build community partnerships for mental health resources and services
• Invite parents and staff to discuss their children’s mental health, behavior, and development

The Performance Standards describe the roles and responsibilities of the mental health consultants. They must: 

• Help the program identify and support the social and emotional development of all children, including children with mental health concerns.
• Address the concerns of teachers, family child care providers, and home visitors about children’s social and emotional development and effective strategies.
• Teach parents and staff about how to promote mental health and where to get help when indicated.
• Help carry out practices, support, and policies to limit suspension and prohibit expulsion.

Staff Qualifications

Programs must hire licensed or certified mental health professionals. These professionals should have experience working with young children and their families. Only qualified staff, consultants, or contractors can perform health procedures or provide nutrition services.

Preventing Suspension and Expulsion

Programs must follow rules that limit suspension and prohibit expulsion. Mental health consultants can help staff:

• Understand children’s behavior
• Create strategies to support children
• Ensure every child can fully participate in the program

Community Mental Health Resources

Programs must:

• Find and connect families with mental health resources in the community
• Support both children and adults in accessing these services
• Build partnerships with local providers to meet family needs

Screening and Referrals

Within 45 days of enrollment, programs must:

• Use a developmental screening tool to assess each child’s social and emotional behavior
• Include family input and ongoing assessment data to understand the child’s needs
• Refer children for further evaluation if needed, including services under IDEA

Planning for Partnerships

You will likely work with the health manager, the mental health manager, and other staff. Together, you’ll build strong local partnerships. As you begin:

• Get to know the members of the HMHSAC and their areas of expertise
• Plan joint training to make consistent accommodations for children’s health and mental health needs
• Collaborate with a mental health consultant
• Be prepared to plan and communicate with children’s medical, dental, and mental health providers
• Communicate the key requirements of your programs’ suspension and expulsion policies
• Include feedback from families in efforts to improve health and mental health services

What is your role in mental health services?

As the DSC, you help make sure that children with disabilities and their families get the mental health services they need. These services are available to all Head Start children and families. They focus on building positive relationships — between children and their peers, between children and adults in the program, and between children and their families.

You may work with:

• The mental health consultant
• The health or mental health manager
• The education manager
• The child’s therapist, if they have one

In some programs, the DSC may also serve as the health or mental health manager, depending on qualifications and staffing.

Finding and Supporting Children Who Need Mental Health Services 

You help identify children who may need mental health support. You might lead this process or be part of a team. Just like with other referrals, you should track each child’s progress through the process. See Appendix C for a sample tracking sheet.

Work with your Part C early intervention or Part B special education partners to understand how they define emotional or behavioral delays. Each state sets its own eligibility criteria, so if you work with more than one school district, the rules may differ.

If a child shows signs of needing support, the team may:

• Collaborate with the program’s mental health consultant for support in the program
• Refer the child for a diagnostic evaluation
• Refer the child to a mental health clinic or provider

The referral team may include:

• Teachers
• Home visitors
• Mental health consultants
• Family service staff
• Other staff who know the child and family

If the child does not qualify for IDEA services, they may still qualify for a Section 504 Plan, or your program can create a Child Action Plan to provide support.

Working with a Mental Health Consultant

Some mental health consultants work directly for the Head Start program, and some are contracted (i.e., working for themselves or with a mental health agency). Often, managers prepare the contracts for the mental health consultant and supervise their work. They may ask you for input based on your knowledge of the children and their families in your program. In some programs, the DSC is also the mental health services manager. This is often a different role from the mental health consultant.

Make sure program staff know they have access to a mental health consultant. This consultant:

• Does not work directly with children
• Supports families, staff, caregivers, and program leaders
• Builds the capacity of caregivers to support young children’s social and emotional development collaborates with others to identify mental health concerns
• Supports staff and family well-being
• Helps connect programs and families to additional services

Early in the relationship, the consultant will likely meet with program leaders to understand your program’s needs. As you collaborate with staff and families, assess where the consultant’s support is most needed:

• All centers and family child care settings should receive regular consultation
• Consultation focuses on promoting social and emotional development for all children
• Some centers or staff may benefit from more frequent consultation
• Assessing the needs of staff can help prioritize where consultation should begin
• If one center reports frequent concerns about children’s behavior, ask the consultant to:
  • Meet with education staff
  • Explore what strategies have been working and not working
  • Explore next steps, including observing in the learning environment and talking with the family
• You and your management team may also request staff training from the consultant.

Stay informed about Performance Standards regarding the temporary suspension or expulsion of a child due to behavior. When a child’s participation is at risk, you must involve a mental health consultant.

The mental health team may need to explain to staff and families how the program does not expel or unenroll children due to behavior. Families and staff should all be oriented to the program’s policies and procedures for supporting children to be successful in the program. 

Creating Supportive Spaces for Social and Emotional Growth

The way educators set up and manage the learning environment often affects children’s social and emotional behavior. You can work with the education manager, coaches, and mental health consultant to help teachers and family child care providers create a safe, welcoming, and well-organized learning space. This kind of environment helps build strong, caring relationships between adults and children.

In home-based programs, staff can support families in creating a warm and responsive home. Let staff and families know that regular routines and predictable schedules help all children feel safe and grow emotionally. For children with disabilities, having a secure and calm environment is especially important for their mental health and development.

Early childhood mental health is the same as social and emotional development. 

Nurturing Social and Emotional Development

In some cases, a child has an identified social and emotional disability with an IFSP, IEP, Section 504 plan, or internal Child Action Plan in place. In other cases, a different type of disability affects social and emotional development. For example, the child with a physical disability might be unable to keep up with peers on the playground. The child with a speech disability might not be able to communicate well with others. As a result, they may feel rejected, frustrated, lonely, or anxious. Help staff and families learn the complex relationship between disabilities and social and emotional development.

Work with specialists, the mental health consultant, and other program staff to sort out these complexities. Remember that you are part of a coordinated effort. Together, you may identify effective strategies, such as:

• Making sure your program uses strategies to support positive interactions between children with and without disabilities
• Identifying strategies to help children with disabilities learn to regulate and express their feelings
• Using the ELOF as a guide to set social and emotional goals for children from birth to age 5
• Implementing a specific curriculum designed to promote social and emotional development
• Showing families and staff that some children with disabilities need more support to cope with their emotions. 

Individualizing services and learning opportunities for all children is key. View all children through a strength-based lens. This can lessen the stigma around mental health issues. 

Responding to Concerns About a Child’s Behavior

Educators, parents, or family members may come to you with serious concerns about a child’s behavior. They might be worried about a child who seems quiet, withdrawn, or disconnected. These behaviors can be challenging for adults — not because they are loud or disruptive, but because it’s hard to know how to help the child engage. Often, these children go unnoticed in the classroom and don’t fully participate.

In these cases, you and the education staff can work with the mental health consultant to create strategies that help the child feel more included. For example, you might pair the child with a peer during small-group activities to encourage connection and participation.

Other times, the concern is about children who act out. Teachers and parents may describe these children as “negative,” “defiant,” “aggressive,” or “destructive.” They may worry about the safety of the child, other children, and staff. These behaviors are often seen as disruptive, and teachers may respond by engaging in practices that could be harmful without realizing such as excluding the child from activities or separating them from their peers. Parents may try discipline strategies that don’t work — and sometimes make the child’s behavior worse.

It’s important to help staff and families understand that these adult responses can actually harm the goal of educating children with and without disabilities together. Instead, we must focus on building understanding, using positive behavior supports, and creating a safe, nurturing environment for every child.

A key feature of concerning behavior in children is that adults perceive it as challenging. Caregivers should remember that all behavior has meaning. Some behaviors may be typical for a child’s developmental stage. Adults can guide them through these behaviors. However, some children’s actions may signal deeper concerns that require further evaluation or support.

Working Together to Support Children’s Behavior

To help children with behavioral concerns, it’s important to work as a team. Your mental health consultant, special educators, and program staff can all offer helpful ideas. Together, you can create strategies that support the child in positive and respectful ways.

Personnel policies, 45 CFR §1302.90 explains how all staff and adults in the program must act. It says that staff must use positive behavior strategies and cannot use restraints or isolation to discipline a child. Following these rules helps keep your program safe for children and in line with federal law.

Sometimes, your team may need extra help. In those cases, you can reach out to community mental health resources. These experts can offer support when a child’s needs are more complex and require more specialized care.

Legal Protections and Best Practices for Supporting Children with Disabilities

The Performance Standards prohibits expulsions and limits suspensions for all children. Children who receive services under IDEA have special legal protections. 

If a child’s behavior is making it hard for them or others to learn, the IEP team should look at using positive behavior strategies. One helpful approach used in many Head Start programs is the Pyramid Model. This model uses different levels of support to help children grow socially, emotionally, and behaviorally.

When your team is thinking about alternatives to suspension or expulsion, ask:

• Is this option in the best interest of the child and their family?
• Does it allow the child to participate in the program fully and effectively?

If the answer to either question is “no,” then the option is not appropriate. For example, moving a child from a center-based program (where they interact with peers) to a home-based program is usually not okay — especially if the family needs full-day care. Any decision for a child with an IEP must support their plan and make sure they are learning in the least restrictive environment.

As the DSC, you are responsible for making sure children with mental health or behavior concerns are fully included. You also help your program follow important federal laws:

• Individuals with Disabilities Education Act
• Section 504 of the Rehabilitation Act
• Americans with Disabilities Act

These laws protect children from being treated unfairly or excluded because of a disability. They help create safe, supportive, and welcoming early learning environments 

Collaborative Steps to Support a Child with Behavior Concerns

When a child shows behaviors that make it hard for them or others to learn, it’s important to bring a team together to plan the right support. Talk with your program leaders, mental health consultant, and staff from health, education, and family services. Working as a team, you can create strategies that meet the needs of both the child and their family.

Steps to Support a Child with Challenging Behavior

Here are some helpful steps your team can take when a child is showing behaviors that make learning harder for them or others:

• Consult with the child’s health care provider to rule out any medical concerns that may contribute to the child’s behavior
• Do a functional behavior assessment. This helps you collect information to understand why the child is acting a certain way. It also helps you decide what support is needed.
• Check routines and activities. Make sure they are right for the child’s age and keep them interested and involved.
• Talk with the family. Ask how the child behaves at home and what works well for them. Families know their child best and can offer great ideas.
• Help staff build skills. Use coaching, mental health consultation, or training to help staff feel more confident in supporting the child.
• Think about a referral to the local IDEA agency. They can check if the child qualifies for services. A formal evaluation might lead to a diagnosis and support through an IFSP (Individualized Family Service Plan), IEP (Individualized Education Program), or a Section 504 plan.
• Create a Child Action Plan. While waiting for evaluation results, make a plan to support the child. If the child doesn’t qualify for services, keep using the plan to provide consistent help.
• Check for existing services. If the child already has an IFSP or IEP, contact the IDEA agency to make sure the child is getting all the support they need.

As a last resort, your program may consider moving the child to a different setting. However, this should only happen after trying all possible supports within the Head Start program and keeping good records of what was done. The decision must be made as a team — with agreement from the family, teachers, the IDEA agency, and the mental health consultant. If everyone agrees that a new placement is needed, your program must work closely with the family and other professionals to make sure the transition is smooth and supportive for the child.

Tips to Promote Quality Health and Mental Health Services for Children with Disabilities

Providing high-quality health and mental health services for children with disabilities requires collaboration across your program. Many of these responsibilities are shared with the health manager and health services staff, as well as the mental health manager or mental health consultant. Below are key strategies and questions to guide your efforts.

Health and Mental Health Practices

• Review screening results for health and mental health concerns. Discuss with managers whether a child needs a referral — for example, to the local IDEA agency or a medical/mental health provider.
• Monitor daily health and attendance records. Look for patterns, such as frequent absences among children with disabilities. Talk with families, education staff, and special education partners to make adjustments that support full participation.
• Promote oral health. Collaborate with the health manager to:
  • Train staff on how disabilities may affect oral health
  • Develop routines to help children brush their teeth
  • Ensure follow-up dental treatment is completed
• Support nutritional health. Review menus with the health manager and nutritionist to:
  • Identify accommodations during mealtimes
  • Help families access food that meets their child’s dietary needs
• Partner with the mental health consultant to assess program needs and determine how the consultant can support staff and families.
• Review Performance Standards on suspension and expulsion. Help staff understand your program’s policies. The policies need to support keeping children with disabilities enrolled.
• Ensure individualized teaching and learning. Help staff respond appropriately to challenging behaviors. Include all staff who interact with the child — transportation, nutrition, and health staff.
• Support medical procedures. Work with the health manager to:
  • Train staff on special equipment and routine modifications
  • Create a protocol for staff to contact you or the health manager when help is needed
• Monitor service delivery for children with IFSPs and IEPs to ensure they receive the health and mental health services outlined in their plans.
• Respect cultural beliefs and values. Ask families about their health practices and views on mental health. Help address any stigma or stereotypes they may face.
• Advocate for representation of medical and mental health services on the HMHSAC. Ensure the committee includes disability experts who can represent family perspectives. Transportation and access to specialists can be a challenge; include partners who can support access for families.
• Use community resources. Invite local providers to:
  • Share information with staff about early childhood health and mental health
  • Offer strategies for addressing common concerns

People Who Can Help

• Health manager and health staff
• Program leaders and managers
• Family services manager and family advocates
• Education managers, teachers, and home visitors
• Nutrition staff
• Mental health manager or mental health consultant
• HMHSAC members
• Training and technical assistance providers
• Community partners
• Families

Questions to Ask Your Team

• How do we include children with disabilities in our health and mental health services planning?
• How do we access relevant health and mental health information for children with disabilities?
• How do we work with medical, mental health, and dental providers of children with disabilities?
• How do we screen children with disabilities for health and mental health concerns?
• Are we satisfied with our screening procedures for social, emotional, and behavioral concerns?
• How do we use our ongoing assessment data to identify mental health concerns?
• What do our staff and families need to know about the relationship between disabilities and social and emotional development?
• What is our social and emotional curriculum?
• What are our behavior management policies?
• How do we prevent the suspension and expulsion of children with mental health concerns?

Scenario: Supporting Mealtime for Tony

Tony is 4 years old and uses a feeding tube. His Individualized Education Program (IEP) says he should get nutrition support and be included with his classmates during mealtimes. His parents share helpful tips they use at home, and the health manager creates an IHCP to support Tony in the program. This is all new for Tony’s teacher, Nury. She wants to make sure mealtime is a good learning experience for Tony and that the other children feel comfortable around him. Nury asks for help from the disability services coordinator, the health manager, and her education supervisor.

The team gives Nury several ideas.

Step 1: Observe and Reflect

• Nury watches lunchtime routines to see how learning happens naturally.
• She notices that the children are curious about Tony’s feeding tube.
• The team encourages her to use these moments to:
  • Help children build empathy and understanding
  • Practice communication skills
  • Support learning goals from the curriculum

Step 2: Add Learning to the Classroom

• The team helps Nury bring Tony’s experience into classroom activities:
  • A toy feeding tube is added to the dramatic play area so children can learn through pretend play.
  • Nury works with the librarian to find books about children with health needs and how they manage them.
• These tools help children understand Tony’s experience better and build empathy and connection.

Step 3: Build Peer Support and Belonging

• When Tony is in the hospital for a few days, the class makes a “Welcome Back” book with drawings and messages.
• When Tony returns, he is excited to get the book — and his classmates are proud to give it to him.