Early Start
About This Program
Target Population: Parents of a newborn (usually up to 12 months of age) and/or parents in the antenatal period facing multiple disadvantages
For parents/caregivers of children ages: 0 – 1
Program Overview
Early Start is a home visitation program that originated in New Zealand. It focuses on providing tamariki (children) in whānau (families) facing multiple disadvantages with supports and practical assistance.
The key features of the program are:
- Families are enrolled when their child is under one year, and ideally during the antenatal period. The primary focus is the child, providing family support and education to ‘nurture the baby early’ and encourage improvements in lifelong experiences.
- Families receive a comprehensive program which is provided by trained Family Support Workers with qualifications in Nursing, Social Work, Education, Early Childhood Education, or an allied profession.
- The service consists of a modular program of home visiting which may last up to five years.
- The frequency of home visiting varies according to family need and ranges from Level 1 home visiting (weekly) to Level 4 home visiting (one visit every four months).
- The aims of the program are to address a range of issues relating to the well-being of the enrolled child and their family.
Program Goals
The goals of Early Start are:
- Greater contact with family doctors
- Higher usage of well-child services
- Fewer hospital attendances by their child for childhood accidents
- Higher attendance of their child at preschool dental services
- Greater participation of their child in preschool education
- More positive and less punitive parenting
- Lower rates of severe physical assault of their child
- Lower rates of childhood behavioral problems in their child
- Lower rates of hospital attendance by their child for injury over the period from birth to nine years
Logic Model
The program representative did not provide information about a Logic Model for Early Start.
Essential Components
The essential components of Early Start include:
- Target Population:
- Early Start targets at-risk families with newborn children up to age 5 years old.
- The Early Start participants are generally families subject to disadvantages in a number of areas including:
- Socioeconomic deprivation
- Adverse maternal childhood experiences
- Maternal and partner adjustment problems
- Averse pregnancy history including:
- Youth at first pregnancy
- High rates of unplanned pregnancy
- High rates of smoking in pregnancy
- High complexities in their day-to-day lives
- Low overall capability of many of these families
- Theoretical Model:
- Early Start aims to create a collaborative, problem-solving partnership between the home visitor and family to:
- Maximize child health
- Increase child and family well-being
- Build strengths
- Eliminate deficiencies
- Early Start recognizes that child well-being can occur only through the more general health and well-being of the family, although the target child is treated as the primary focus of services.
- Targeted Outcomes
- Improve child health
- Reduce child abuse
- Improve parenting skills
- Support parental physical and mental health
- Encourage family economic well-being
- Encourage stable, positive partner relationships
- Increase parental capacity and capability of raising happy, healthy and thriving children
- Model Intensity and Length
- Early Start includes four levels of service intensity:
- Level 1 - High need: Up to three hours of client contact per week, which includes direct contact (via home visits) and indirect contact (such as reviewing client case notes and health recordings, planning, and discussing cases)
- Level 2 - Moderate need: Up to three hours of home visiting per two-week period
- Level 3 - Low need: Up to one hour of home visiting per month
- Level 4 - Graduate: Up to one hour of contact (phone/home visitation) per three months
- All families enter the program at Level 1 and move to higher levels over time based on their progress. Level changes are determined by home visitors in consultation with their supervisors.
- Families can continue to receive services until the child reaches age 5.
- Early Start provides services through home visitation. All Early Start families receive services based on four established curricula:
- Tākai open-source NZ parenting resource which focuses on listening, trust, language, problem solving, feelings, and how babies learn
- Triple P (Positive Parenting Program), which focuses on positive parenting practices and means to address childhood behavior problems
- Incredible Years Toddler
- Families are offered several additional services based on need:
- Infant and child safety awareness
- Parent child interactions
- Linkages to supportive services in the community, including budget, health, mental health and relationship services
- Advice and support concerning healthy lifestyle choices, including family and child nutrition
- Household and time management
Program Delivery
Parent/Caregiver Services
Early Start directly provides services to parents/caregivers and addresses the following:
- Depression
- Substance abuse
- Poverty
- History of Family Violence
- History of any form of neglect of children
- Coping skills
- Increasing parental capacity and capability
- Poor family health
- Housing
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: The extended family and or any close supports may also be involved. At times, child welfare agency personnel may be involved.
Recommended Intensity:
The number of home visits per week/month varies based on the level of needs of the family. See the levels described in the above Essential Components section.
Recommended Duration:
Long-term Home Visiting. Usually about 3 years involvement and up to 5 years.
Delivery Settings
This program is typically conducted in a(n):
- Adoptive Home
- Birth Family Home
Homework
Early Start includes a homework component:
Occasional homework is given such as completing a family tree, a profile book, and a family plan.
Resources Needed to Run Program
The typical resources for implementing the program are:
Computers; personnel; workspaces; admin support, supervision support, and leadership
Manuals and Training
Prerequisite/Minimum Provider Qualifications
An undergraduate degree in Social Work, Nursing, Early Childhood and other relevant qualifications. Supervisors will have completed a professional Supervision course (or equivalent outside of New Zealand).
Manual Information
There is a manual that describes how to deliver this program.
Program Manual(s)
Manual Details:
- Early Start. (2022). Early Start practice manual (3rd ed.). Author.
Access to the manual can be requested through the contact located at the bottom of the page.
Training Information
There is training available for this program.
Training Contact:
- Early Start Project
www.earlystart.co.nz/contact-us
Training Type/Location:
Inquiries sent via the Contact Us page above will be forwarded to a person who would be available for informal consultation.
Number of days/hours:
Informal consultation is available.
Implementation Information
Pre-Implementation Materials
There are no pre-implementation materials to measure organizational or provider readiness for Early Start.
Formal Support for Implementation
There is no formal support available for implementation of Early Start.
Fidelity Measures
There are fidelity measures for Early Start as listed below:
Internal fidelity measures in the form of Benchmarks are used. Performance appraisal includes client feedback and observations of a home visitor.
Implementation Guides or Manuals
There are implementation guides or manuals for Early Start as listed below:
Early Start has two key manuals. The ES Operations manual and the Practice Manual alongside the Orientation Manual and Supervisors Manual
Implementation Cost
There are no studies of the costs of Early Start.
Research on How to Implement the Program
Research has not been conducted on how to implement Early Start.
Relevant Published, Peer-Reviewed Research
Child Welfare Outcomes: Safety and Child/Family Well-Being
Fergusson, D. M., Grant, H., Horwood, L. J., & Ridder, E. M. (2005). Randomized trial of the Early Start program of home visitation. Pediatrics, 116(6), e803–e809. https://doi.org/10.1542/peds.2005-0948
Type of Study:
Randomized controlled trial
Number of Participants:
443 families
Population:
- Age — Mean age at enrollment: Control=24.4 years; Intervention=24.6 years
- Race/Ethnicity — Control=27% Māori; Intervention=25% Māori
- Gender — Not specified
- Status — Participants were families with an infant who were identified by community nurses as being at risk or meeting the screening cut point on the Hawaii Healthy Start Program measure.
Location/Institution: Christchurch, New Zealand
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the extent to which the Early Start home visitation program, targeted at families who are facing stress and difficulty, had beneficial consequences for child health, preschool education, service utilization, parenting, child abuse and neglect, and behavioral adjustment. Participants were randomly assigned to the Early Start program or a control group. Measures utilized include a parenting questionnaire that contained items derived from the Child Rearing Practices Report and the Adult-Adolescent Parenting Inventory, the severe/very severe assault subscales of the Parent-Child Conflict Tactics Scale, parental report of contact with Child Welfare for issues relating to child abuse and neglect, and the Infant Toddler Social and Emotional Assessment Scale. Results indicate that families in the Early Start program showed significant benefits in the areas of improved utilization of child health services, reduced rates of hospital attendance for injury/poisoning, increased preschool education, increased positive and nonpunitive parenting, reduced rates of severe parent/child assaults, and reduced rates of early problem behaviors. Parents in the Early Start series reported a substantially lower rate of severe child assaults than did the control series (4% vs 11%), suggesting that the program was effective in reducing rates of physical child abuse. Limitations include the open trial design in which both clients and research interviewers were aware of the treatment group to which the family was assigned, the higher dropout rate for the Early Start group, and that only 75% of families who were screened as positive agreed to enter the trial.
Length of controlled postintervention follow-up: None.
Fergusson, D. M., Grant, H., Horwood, L. J., & Ridder, E. M. (2006). Randomized trial of the Early Start program of home visitation: parent and family outcomes. Pediatrics, 117(3), 781–786. https://doi.org/10.1542/peds.2005-1517
Type of Study:
Randomized controlled trial
Number of Participants:
443 families
Population:
- Age — Mean at enrollment: Control=24.4 years; Intervention=24.6 years
- Race/Ethnicity — Control=27% Māori; Intervention=25% Māori
- Gender — Not specified
- Status — Participants were families with an infant who were identified by community nurses as being at risk or meeting the screening cut point on the Hawaii Healthy Start Program measure.
Location/Institution: Christchurch, New Zealand
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fergusson et al. (2005). The purpose of the study was to examine the extent to which the Early Start program of home visitation, had beneficial consequences in the areas of maternal health, family functioning, family economic circumstances, and exposure to stress and adversity. Participants were randomized to the Early Start program or a control group. Measures utilized include items from the Composite International Diagnostic Interview related to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the Revised Conflict Tactics Scale, a study developed measure of Family Exposure to Stress and Adversity, and self-report by the parents on maternal health and well-being, family stability, and family economic and material well-being. Results indicate that there were no significant differences between the Early Start and control group in any comparisons and that there was a consistent lack of association between maternal and family outcomes and group membership. Limitations include lack of blinding to study group assignment, different response rates between the two groups, and the use of self-report measures.
Length of controlled postintervention follow-up: None.
Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2013). Nine-year follow-up of a home-visitation program: A randomized trial. Pediatrics, 131(2), 297–303. https://doi.org/10.1542/peds.2012-1612
Type of Study:
Randomized controlled trial
Number of Participants:
443 families
Population:
- Age — Mean at enrollment: Control=24.4 years; Intervention=24.6 years
- Race/Ethnicity — Control=27% Māori; Intervention=25% Māori
- Gender — Not specified
- Status — Participants were families with an infant who were identified by community nurses as being at risk or meeting the screening cut point on the Hawaii Healthy Start Program measure.
Location/Institution: Christchurch, New Zealand
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fergusson et al. (2005). The purpose of the study was to evaluate the extent to which the Early Start home-visitation program, had benefits for child abuse, child behavior, and parental- and family-level benefits to the 9-year follow-up to study entry. Participants were randomized to Early Start or a control group. Families were enrolled in the Early Start program for up to 5 years. Outcomes were assessed at 6 months, annually from 1-year to 6 years, and at 9 years after study entry. Measures utilized include administrative hospital records; the Parent–Child Conflict Tactics Scale; the Parenting Scale; the Strengths and Difficulties Questionnaire; questions from the Composite International Diagnostic Inventory measuring Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; the Revised Conflict Tactics Scale; and several self-report measures. Results indicate that families in the Early Start program showed significant benefits in reduced risk of hospital attendance for unintentional injury, lower risk of parent-reported harsh punishment, lower levels of physical punishment, higher parenting competence scores, and more positive child behavioral adjustment scores. There were no significant differences between the Early Start and control series on a range of measures of parental behavior and family outcomes, including maternal depression, parental substance use, intimate partner violence, adverse economic outcomes, and life stress. Limitations include that the rate of attrition in the Early Start group was significantly higher than that of the control group at the 9-year follow-up.
Length of controlled postintervention follow-up: None.
Additional References
No reference materials are currently available for Early Start.
Contact Information
- Jan Egan
- Agency/Affiliation: Early Start Project Ltd
- Website: www.earlystart.co.nz
- Email: jan.egan@earlystart.co.nz
- Phone: (643) 365-9087
Date Research Evidence Last Reviewed by CEBC: August 2023
Date Program Content Last Reviewed by Program Staff: October 2023
Date Program Originally Loaded onto CEBC: October 2023
