Lucia Sebastian is the Language Assistant at the Head Start in Noel, Missouri. She works with the numerous immigrant children who have limited English skills and need help to communicate.
She has a four-year old daughter enrolled at Head Start, but she recounted an incident where Head Start was instrumental in helping her older son, Victor.
When her son was eleven years old, he was playing baseball with a friend in the yard and got hit in the mouth with the bat. The blow knocked out several teeth, but Sebastian was unsure she could afford the costs of taking Victor to the hospital.
Neither she nor her husband work a full-time job with insurance benefits and since they're not citizens (though they are legal residents), they do not qualify for MO HealthNet, Missouri’s Medicaid program.
“I was so afraid,” Sebastian said. “I was so worried about taking him to the hospital because I was thinking 'How am I going to pay that money? How I will be paying another bill that I can't afford?”
Eventually, a family friend told her to take him to the hospital and figure out a way to pay the emergency room bills later. So Sebastian drove Victor to the hospital in Joplin, an hour away.
But three hours that elapsed between the accident and getting to the hospital, which meant it wasn't possible to save Victor's teeth. Sebastian said she then began to worry about more than just paying the emergency room bill. She said she didn’t know where she could go in McDonald County to get Victor follow-up care for the gaping holes in his mouth.
She ended up finding the answer at an unexpected place: the Head Start that her daughter attended. It was here that Sebastian got connected to a federally qualified health center in McDonald County, Access Family Care, where she could pay on a sliding scale for her son's treatments.
Head Start is a federally-funded program that is intended to educate children, feed them two meals a day and teach them about oral hygiene - it was not designed to work as a medical referral service. But in McDonald County, Head Start works to connect whole families to medical resources that they might not otherwise know about.
McDonald County is a rural county located in the far southwest corner of Missouri where several towns are closer to the Oklahoma-Arkansas border than other cities in Missouri. No town in the county has a population of more than 2,000. In the 2014 County Health rankings the county was ranked 115 out of 115 in clinical care compared to other Missouri counties , which includes factors like uninsured population, primary care doctors, dentists and preventable hospital stays.
These issues paired with barriers such as financial need, transportation and language for the county’s large immigrant population make it even more difficult to obtain care.
Few resources exist in the county for children who are younger than school age and, according to the US Census Bureau, make up 7.5% of the county’s total population. And many of them live below the federal poverty line.
But the Head Start program is trying to fill these gaps and connect families to the medical resources that are available.
There are three Head Start facilities in McDonald County – one in Anderson, one in Noel and one in Longview. They are currently serving 23 children under the age of three in Early Head Start and 107 children that range in age from three to five in Head Start.
The three programs are all at capacity and have long wait lists – 26 families in Noel alone.
Within the community, there are only three primary care physicians, no hospital and just a handful of clinics.
Tony Wright is the Resource Development Director for the Economic Security Corporation of Southwest Missouri, which runs the programs, and he said the Family Resource Specialists go above and beyond traditional expectations.
“It's not just a children's program," Wright said. "Whatever the need is that that family needs, they are the ones who are going to try to put them in contact with somebody to take care of - it may be a legal need, it may be medical, it may be who knows what they are going to come up against when they go in there, and they need some connection.”
Michelle Ocampo, whose daughter is enrolled in Head Start, said the program has been instrumental in ensuring that her child gets to her appointments. More than anything, she said, they remind her when check-ups are needed and when appointments are scheduled.
And this is part of Head Start’s mission. Ensuring that children enrolled in their program are getting the medical and dental care they need as they grow.
The programs help families with MO HealthNet applications, and connects both insured and uninsured parents to Access Family Care, which offers sliding scale payments. And when even these payments are too much, the Economic Security Corporation will pay appointment costs for Head Start families.
The programs also invite Access Family Care to their classrooms to apply fluoride varnish multiple times a year.
But Head Start’s assistance doesn’t end there.
Stephanie Massey, the Family Resource Specialist for the Head Start in Noel, said there is a major transportation issue in McDonald County and many families either have no car or no driver’s licenses.
“Transportation is a huge need down in this area - a lot of families rely on friends or family because we have no public transportation… and that is where Head Start steps in, where we can help provide that transportation to those appointments and routine care that they need.”
If a family cannot transport themselves, Head Start will make sure the children get to their appointments. Massey said she spends three to five days a month simply driving families in agency vehicles to their medical and dental appointments.
The Economic Security Corporation spends approximately $10,000 a year for transportation in their four-county region.
Massey said the increasing number of languages in Head Start has also made things even more difficult.
“And it's never easy,” Massey said. “You have a family who has a simple need of going to the doctor, and they may not take that type of insurance or they don't provide a language assistant at their facility, so then they come to you asking can you make this appointment for me… Just to get them to the doctor usually takes several days.”
Head Start provides translators, such as Lucia Sebastian, for families when they go to the doctor.
While Head Start does much for the families they serve, their resources are limited, and so is the number of children they can help.
The Head Starts are only able to help a fraction of the families in the area, and the wait lists for their programs tend to be long.
Wright says the programs potentially would expand to help more kids if more funding was available but that seems unlikely for now. “It isn't seen as [as] big a priority in Washington DC as it is out here in the trenches,” Wright said.