Program

Jan 16, 2013

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:
    • 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
  • Parenting attitudes and behaviors:
    • Positive parenting attitudes
    • Nonpunitive attitudes
    • Parenting score
    • Severe physical assault
  • Child behavior:
    • Internalizing score
    • 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.msd.govt.nz/documents/about-msd-and-our-work/publications-resources/evaluation/early-start-evaluation-report.pdf

KEYWORDS: Infants
(0-12 months), Toddlers (12-36 months), High-Risk, Home-based, Parent Training/Education,
Home Visitation, Skills Training, Family Conflict, Parent-Child Relationship, Males and Females
Co-ed, Child Maltreatment.

Program
information last updated on 9/16/09.