EARLY START

OVERVIEW

Early Start is a home visitation program, which uses a social learning model approach to focus on family needs, strengths, challenges, and resources. An evaluation of outcomes at the 36-month follow-up found impacts on mean number of healthcare visits, up-to-date well-child check-ups, hospital visits for injury/poisoning, dental care initiation, duration of early childhood education, community service contacts, positive parenting attitudes, nonpunitive attitudes, parenting score, severe physical assault, child internalizing scores, and total behavior score. There was a marginal impact on child externalizing scores, and there were no impacts child immunizations and contact with agencies for child abuse or neglect.

DESCRIPTION OF PROGRAM

Target population: At-risk families

Early Start is a home visitation program. Using a social learning model approach, the program includes:

· Assessing family needs, strengths, challenges, and resources;

· Developing a partnership between the family and family support worker;

· Developing a collaborative problem-solving approach to address family challenges;

· Providing support, mentoring, and advice to assist families in using their strengths and resources; and

· Remaining involved with the family throughout the child's preschool years

Program delivery is based on the level of family need, as determined by the family support worker. Level 1 (high need) involves one to two hours of weekly home visits; Level 2 (moderate need) includes up to one hour of home visits per two weeks; Level 3 (low need) includes up to one hour of contact, either through phone or a home visit, per month; and Level 4 (graduate) involves up to one hour of contact, by phone or home visit, per three months.

Family support workers, with nursing or social work degrees, receive a five-hour training session. They visit families to achieve the following goals, varying by each family's needs: improve child health, reduce child abuse, improve parenting skills, support parental physical and mental health, encourage family economic well-being, and encourage positive partnerships such as reduce partner violence.

Family support workers help develop a Family Support Plan and an Individual Family Plan for each family. The Family Support Plan is developed by the family support worker along with other Early Start staff to address general issues, such as child health, along with family-specific issues, such as child neglect. The Individual Family Plan is developed by both the family and family support worker and centers on family goals for the next three months. Family support workers carry a caseload of 10 to 20 families.

EVALUATION(S) OF PROGRAM

Fergusson DM, Grant H, Horwood J, Ridder EM. (2005). Randomized Trial of the Early Start Program of Home Visitation. Pediatrics, 116(6):e803-e809.

Evaluated population: A total of 443 families were enrolled in the Early Start program. Among the families enrolled in the Early Start program, the mean age of the mother was 25 years, while the mean age of the father was 27 years; the majority of families were lower income, as 88% were receiving welfare. This program and study took place in New Zealand, and while the majority of families enrolled in the program were white, 27% were Maori, the indigenous people of New Zealand.

Approach: Families were recruited by New Zealand's Plunket community nurses, and referred to the program if they had at least two risk factors such as family violence, lack of social support, and limited finances. Families were then randomly assigned to either the Early Start intervention (n=220) or control group (n=223). Assessments were made at baseline as well as at the 6-, 12-, 24-, and 36-month follow-up periods. Families were assessed using two sources-in-home interviews and medical record reviews. Families were assessed on a variety of areas, including: number of visits to the family doctor; up-to-date child immunizations; hospital visits for injuries and poisoning; dental visit initiation; child attendance at preschool; contacts with community service agencies; positive parenting; nonpunitive parenting; child abuse and neglect; child externalizing behaviors; and child internalizing behaviors.

Families were also assessed on family function, and those who exceeded a certain assessment threshold were provided with full services, while those families falling below the assessment threshold received four home visitations of up to 2.5 hours for three months; however, only 3% of families were offered four home visits. Families enrolled in the control group were paid $50 per assessment interview.

Results: At the 36-month follow-up, there were significant impacts and, generally, small effect sizes (.21-.31) on the following outcomes:

· Healthcare:

o Mean number of healthcare visits

o Up-to-date well-child check-ups

o Hospital visits for injury/poisoning

o Dental care initiation

· Duration of early childhood education

· Community service contacts

· Parenting attitudes and behaviors:

o Positive parenting attitudes

o Nonpunitive attitudes

o Parenting score

o Severe physical assault

· Child behavior:

o Internalizing score

o Total behavior score

There was a marginal impact on child externalizing score, and there were no impacts child immunizations and contact with agencies for child abuse or neglect.

SOURCES FOR MORE INFORMATION

For more information, please visit: http://www.earlystart.co.nz/

References

Fergusson DM, Grant H, Horwood J, Ridder EM. (2005). Randomized Trial of the Early Start Program of Home Visitation. Pediatrics, 116(6):e803-e809.

Fergusson D, Grant H, Horwood J, Ridder E. (2005). Early Start Evaluation Report. Available at: http://www.earlystart.co.nz/pdf/evalreport.pdf

Program categorized in this guide according to the following:

Evaluated participant ages: Infants (0-12 months), Toddlers (12-36 months)

Program age ranges in the guide: 0-36 months

Program components: Home visitation

Measured outcomes: Family Conflict, Child Maltreatment, Parent-child relationship

KEYWORDS: Infants (0-12 months), Toddlers (12-36 months), High-Risk, Home-based, Parent Training, Home Visitation, Skills Training, Family Conflict, Parent-Child Relationship, Co-ed, family conflict, child abuse, parent-child relationship.

Program information last updated on 9/16/09.

		© Child Trends 2003