The 2012-2013 Head Start Health Manager Descriptive Study (HSHMDS) provides a unique opportunity to examine issues of family engagement in the context of health-related services in HS/EHS programs (see the text box). In this brief, we use data from the study to address the following questions: 1. In what ways do EHS and HS programs support family engagement in health-related aspects of program services? 2. What are the barriers to family engagement from the health manager perspective? 3. To what extent do the barriers to family engagement differ by program or health manager characteristics and the populations served? 4. What are the implications of the HSHMDS findings and the current knowledge base regarding family engagement for the HS/EHS health services area? To address the first two questions, we review descriptive findings from the Health Manager Survey component of the HSHMDS regarding the strategies HS/EHS programs use to engage parents or guardians in health-related services and programming and the reported barriers that health managers encounter. Where possible, we integrate more qualitative information gleaned from the interviews that followed the structured survey. To address the third question, we extend those findings to examine the factors associated with family engagement as one of the key barriers cited by HS/EHS health managers. In answering the final question, we conclude the brief with insights from the broader family engagement literature and how research can inform approaches to family engagement in the context of health-related services in Head Start. (author abstract)