A program that included advanced practice nursing (APRN) students increased well-child examinations among children enrolled in Early Head Start (EHS) and Head Start (HS) programs in Baltimore. The training program successfully aided in the delivery of required health exams, screenings, and immunizations for children while giving NP students hands-on training, according to a poster presented at the National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care held March 15 to 18, 2023, in Tampa, Florida.

“This program has expanded from primarily Baltimore City where it started and now encompasses EHS/HS in Montgomery County, Prince Georges County, and Baltimore County,” explained study author Ann Marie Felauer, DNP, CPNP-AC/PC.

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Baltimore has 47 EHS and HS sites that enroll 3200 children. A 2018 chart review of data from 263 children enrolled in EHS sites in Baltimore identified the following gaps in care:  

  • 58% were missing their well-child examination
  • 36% to 45% were missing components of blood screening
  • 38% had not been fully immunized
  • 35% had not seen a dentist or did not have a dental provider

To help close these gaps, Dr Felauer and colleagues from the University of Maryland School of Nursing developed a program to allow APRN students to provide on-site supplemental well-child examinations, assist with health screening, and offer caregiver and EHS/HS staff access to health education and support. The program was initiated in the fall of 2018.

Well-Child Examinations Increased With Program

Between 2018 and 2019, 303 well-child examinations were performed through this program. After a decrease in program numbers during the initial year of the COVID-19 pandemic, the program has been growing every year:

  • In 2021 to 2022, APRN students spent 63 days at EHS/HS sites and provided care to 313 children  
  • In 2022 to 2023, APRN students spent 97 days at EHS/HS sites and provided care to 472 children

In visits conducted in 2021 and later, dramatic increases in the number of children who were behind on immunizations or mandated screenings stemming from the COVID-19 pandemic were seen (Table).

Table. Identified Health Care Needs in 2022-2023

Health Care Need% Missing
Vision or hearing screening31%
Lead screening29%
Overweight/obesity screening27%
Developmental abnormality screening24%
Anemia screening24%
Speech assessment18%

“Currently, about 62% of children seen during well-visits require follow-up and referrals,” Dr Felauer said. Recognition of these unmet health care needs through the program “has created a safety network to identify necessary services as well as promoted a system to ensure healthier children in Maryland.”

Program Provides APRN Learning Opportunities

Access to pediatric primary care sites for APRN student training is challenging. The access provided by this program is “pivotal to UMSON maintaining its ability to adequately prepare nurses and required an innovative model to address this critical need and expand the number of entry-level and APRN nurses in primary care,” the study authors explained. The program currently has 14 APRN students scheduled to receive over 250 clinical hours this spring semester at EHS/HS sites.

This project is funded through 2024 by a Nurse Support Program II grant from the Health Services Cost Review Commission administered by the Maryland Higher Education Commission.

The authors believe that this program could be replicated in each state to “provide much-needed access to health care and clinical sites for APRN nursing students,” Dr Felauer and colleagues concluded.

“The sites are excited to have us, and the families are happy to see us,” Dr Felauer said. Her advice to other institutions looking to start a similar program: “Reach out to the sponsoring agencies for EHS/HS to see what they need and want.”

Visit Clinical Advisor’s meetings section for more coverage of NAPNAP 2023.


Felauer AM, Gourley B, Roesch A. A child’s footsteps towards health equity: academic and community partnerships to achieve better health outcomes. Presented at: NAPNAP National Conference; March 15-18, 2023; Tampa, FL.