Programs that Work
Early Head Start
Children Ready for School
Children ages 0 to 5 exhibiting age-appropriate mental and physical development
Age of Child
Early Childhood (0-8)
Type of Setting
Child Care / Preschool
Type of Service
Health Care Services
Type of Outcome Addressed
Cognitive Development / School Performance
Evidence Level (What does this mean?)
Early Head Start (EHS) is a federally funded community-based program for low-income pregnant women and families with infants and toddlers up to age 3. Its mission is to promote healthy prenatal outcomes for pregnant women, enhance the development of children age 0-3, and support healthy family functioning. Since its inception in 1994, EHS has become a nationwide effort of 650 community-based programs serving 66,000 children in 2009.
EHS programs utilize multiple strategies to provide a wide range of services to participants. Services include child development services delivered in home visits, child care, comprehensive health and mental health services, parenting education, nutrition education, health care and referrals, and family support.
EHS offers children and families comprehensive child development services through one or more official program options: (1) center-based, (2) home-based, and (3) combination programs (in which families receive both home visits and center experiences). Children and families enrolled in center-based programs receive comprehensive child development services in a center-based setting, supplemented with home visits by the child's teacher and other EHS staff (a minimum of two home visits per year to each family). In home-based programs, children and their families are supported through weekly home visits and bimonthly group socialization experiences.
EHS does not feature a single program model, but asks each grantee to select service delivery options that will best meet the needs of the families and communities it serves. The changing needs and circumstances of families often mean that one program option does not meet the developmental needs of a child over a three-year period. Accordingly, EHS programs often offer multiple program options so that children and families can receive different services as their circumstances change.
The EHS program targets primarily low-income pregnant women and families with children up to 3 years of age.
To be eligible for the national research study, the primary family caregiver had to be pregnant or have a child younger than 12 months of age. About 25 percent of the families enrolled while the mother was pregnant. Family caregivers enrolled in EHS in the 17 sites from the national study were on average 23 years old, and 62 percent were first-time parents. The sample was diverse: One-third of families were African-American, one-fourth were Hispanic, and slightly more than one-third were white. Nearly half of the EHS primary caregivers did not have their high school diploma at the time of enrollment, and 45 percent were employed or in some type of school or training. Most families were receiving public assistance of some kind, with 77 percent covered by Medicaid, 88 percent receiving Women, Infants, and Children (WIC) benefits, almost half receiving food stamps, one-third receiving Aid to Families with Dependent Children (AFDC) or Temporary Assistance for Needy Families (TANF), and 7 percent receiving Supplementary Security Income (SSI) benefits.
National Evaluation (Love et al., 2002; Vogel et al., 2011)
The EHS national evaluation project was carried out at 17 sites that were purposively selected as being generally representative of all EHS programs. The 17 sites were distributed across the major regions of the country—six in the West, four in the Midwest, four in the Northeast or Mid-Atlantic, and three in the South. About half were in urban areas and half in rural areas, with home-based, center-based, and mixed-approach programs in each.
The 17 research programs were not randomly selected. However, the research sites included a wide range of locations and program approaches, the families served by the research programs resembled the families served by other EHS programs, and the research sites differed with respect to their experience serving infants and their years in operation. Thus, the results from the evaluation of these programs are likely to be applicable to other EHS programs.
As soon as program officials from each site determined that applicant families met the EHS eligibility guidelines, families were randomly assigned to either the treatment or the control group. Control group families were able to receive other services in the community, as long as those services were not provided by EHS. Therefore, the comparisons of treatment and control group outcomes represent the effects of EHS services relative to the receipt of all other community services available to families in the absence of EHS. During the sample intake period (between July 1996 and September 1998), 3,001 families were randomly assigned to the treatment groups (1,513 families) and control groups (1,488 families). Most sites included samples of between 150 and 200 families, divided evenly between the two research groups.
Researchers examined outcomes for the Early Head Start participants and their families at age 3, age 5, and age 8 (fifth grade).
Key outcomes at age 3 included measures of both cognitive skills and social-emotional development. Cognitive measures included the Bayley Mental Development Index (MDI) standard score and the Peabody Picture Vocabulary Test (PPVT). Children who spoke Spanish in the home were assessed using a Spanish version of the PPVT. Social-emotional development was assessed by observations of children's behavior during semi-structured play, as assessed by trained observers of videotaped parent-child interactions. Key measures included engagement of parent (maintained interaction), negativity toward parent, and sustained attention to objects during parent-child play; engagement of parent, persistence, and frustration during a parent-child puzzle challenge task; emotional regulation as measured by the Bayley Behavior Rating Scale (BRS); orientation/engagement on the BRS (a measure of cooperation and positive affect); and aggressive behavior as measured by the Achenbach Child Behavior Checklist.
Forty-nine outcomes were assessed at age 8, including social-emotional outcomes, child academic outcomes, parenting and the home environment, family well-being and mental health, and parent self-sufficiency. Additionally, multi-domain indices were constructed from the outcomes to measure cumulative risk and cumulative success. The age-8 follow-up included 1,632 respondents, or 54.4 percent of the baseline sample. Attrition was particularly high among the highest-risk respondents. However, study authors conducted sensitivity testing to determine the effect of attrition on impact estimates and found that findings were similar across different models.
Roggman et al. (2002) conducted a site-specific study in the Bear River, Utah, EHS site. Bear River EHS was a member of the national study, and families who applied for and who qualified for the Bear River EHS were randomly assigned to either EHS or a control group. The authors assessed whether the developmental path (change over time) for cognitive skills was different for children in EHS versus the control group. The sample included 201 mothers (103 in the EHS group and 98 in the comparison group) who were either pregnant at the time of application or had infants under ten months old. To meet program requirements, more than 90 percent of families were low-income, as defined by federal poverty guidelines, and most families (97 percent) received some sort of public assistance, such as Medicaid, food stamps, or WIC benefits. Most children in the sample were Caucasian (82 percent). Cognitive skills were assessed using the Bayley Scales of Infant Development at 14, 24, and 36 months, and data were collected as part of the national study.
Results from a prekindergarten follow-up study are expected to be published shortly. PPN will update this EHS program summary when the new results are available.
Key Evaluation Findings
National Study (Love et al., 2002)
Results indicated that EHS enhanced children's cognitive and language development at age 3. Specifically,
- EHS children earned significantly higher standard scores on the MDI than did control children (a mean score of 91.4 compared with a mean score of 89.9).
- EHS children scored significantly higher on the PPVT than did control children (a mean score of 83.3 versus a mean score of 81.1).
- Significantly fewer EHS children than control children scored below 85 on the PPVT (27.3 percent versus 32.0 percent), a score representing substantially lower language ability than the national average.
- No statistically significant differences were found between the treatment and control groups for the percentage of children scoring below 85 on the MDI (a score lower than the national average).
- No significant impacts were found for the Spanish version of the PPVT.
Results also indicated significant effects from EHS on children's social-emotional behavior. Compared with control group children, EHS children were significantly
- more engaging of their parents during semi-structured play
- more attentive to objects during semi-structured play
- less negative toward their parents during parent-child semi-structured play
- less aggressive toward their parents, as measured by the Child Behavior Checklist.
EHS programs did not have a significant impact on a child's engagement of his or her parent (i.e., maintaining interaction with the parent), persistence, or engagement during a parent-child puzzle-challenge task. In addition, no significant effects were found for a child's emotional regulation or orientation/engagement, as indicated by ratings by trained observers on the Bayley Behavior Rating Scale.
Across the 49 individual outcomes measured for the full sample, only two were found to show improvement for EHS participants, compared with controls. EHS children had significant improvement relative to the control group on
- social-emotional success, as measured by an index that includes the absence of the following risk factors (none of which reached individual significance):
- externalizing behaviors
- internalizing behaviors
- attention problems
- peer bullying
- parent reports of children being anxious or depressed.
Results of subgroup analyses are reported in the Issues to Consider section of this summary.
Roggman et al. (2002) assessed whether cognitive skills differed among EHS and comparison group children. Results showed that changes in cognitive skills over time were different for those in EHS than for those in the comparison group. Across measurements at 14, 24, and 36 months, EHS participants maintained stable test scores that did not change significantly with age. Conversely, the comparison group children exhibited statistically significant decreases in their standardized cognitive skill scores between the initial and final measurement points.
Early childhood programs
EHS is a federal initiative funded by the Head Start Bureau, the Administration on Children, Youth and Families, and the American Indian Programs Branch. In fiscal year 2009, the total federal EHS budget was $709 million. Note that EHS sites must also provide another source of funding to cover additional indirect costs.
The framework of EHS includes four required program components:
- Child Development: EHS programs must support the physical, social, emotional, cognitive, and language development of each child. The services that programs must provide directly or through a referral include early-education services in a range of developmentally appropriate settings, home visits, parent education and parent-child activities, comprehensive health and mental health services, and high-quality child care services.
- Family Development: Programs must attempt to empower families by developing goals for parents and their children. Staff and parents must develop individualized family development plans that focus on the child's developmental needs and the family's social and economic needs. The services that programs must provide directly or through a referral include child development information; comprehensive health and mental health services (including smoking cessation and substance abuse treatment); adult education, literacy, and job skills training; assistance in obtaining income support, safe housing, or emergency cash; and transportation to program services.
- Community Building: Programs are required to conduct an assessment of community resources so as to enable them to build a comprehensive network of services and supports for pregnant women and families with young children. The goal of this network is to increase family access to community support, make the most efficient use of limited resources, and improve the service delivery system for all families in the community.
- Staff Development: EHS staff members must have the capacity to develop caring, supportive relationships with both children and families. Ongoing training, supervision, and mentoring encompass an interdisciplinary approach and emphasize relationship building. Staff development is grounded in established best practices in the areas of child development, family development, and community building. EHS programs must be committed to continuous improvement, through ongoing training and technical assistance provided by the EHS National Resource Center (EHS NRC).
Training and Technical Assistance
The EHS NRC provides training and technical assistance to EHS staff and teachers through leadership meetings, a comprehensive website, and national training events. In partnership with the infant/toddler specialists at the 15 Head Start quality improvement centers across the country, the EHS NRC works to ensure that EHS programs have information and training on best practices in all areas of program services and management.
The EHS NRC provides training and technical assistance to EHS staff and teachers in a variety of ways. Specific activities include:
- convening biannual meetings of an expert technical work group
- developing a compendium of quality training resources for consumers
- conducting presentations on best practices at national and regional conferences
- creating technical assistance papers on select topics
- providing orientation training for newly funded EHS programs
- planning Annual Institutes for Head Start birth-to-three programs
- providing Program for Infant Toddler Caregivers (PITC) intensive training
- conducting three national audio-conferences per year featuring expert faculty and EHS program representatives
- developing satellite television training events that are broadcast on the satellite network of the National Head Start Association
- creating partnership and links among EHS programs through the hosting of list serves (web-based discussion groups) for the EHS community.
Issues to Consider
This program received a "proven" rating. The national evaluation of EHS used rigorous standards, including a randomized experimental design with a two-year follow-up. Participants experienced significant and sizable gains across most of the cognitive and social-emotional outcomes. A number of additional evaluations have been conducted for this program, but we included only those studies with methodologies meeting the Promising Practices Network evidence criteria.
The significant impacts found for Early Head Start at age 3, however, did not persist into fifth grade, save for a composite measure of social-emotional success, which showed favorable impacts at both age 3 and in fifth grade.
Racial/ethnic subgroup analyses were conducted, and authors found that, at both age 3 and in fifth grade, a greater impact was realized among the African-American participants, relative to controls, than children from other racial/ethnic groups in the study. Hispanic children also fared moderately better; among white children, very few of the outcomes were significant at age 3 and none were significant at age 8.
Subgroup analyses were also conducted to examine program approaches (center-based, home-based, or mixed-approach). In the age-3 analyses, across all three of the program approaches, EHS had a favorable impact on children's cognitive and language development, on children's levels of aggression, and on children's behavior in relation to their parents during semi-structured play. Nevertheless, the pattern of impacts on children and parents varied somewhat across program approaches. For most child development outcomes, the impact of the program did not differ significantly by program approach. Mixed-approach programs had a somewhat stronger pattern of favorable impacts on children; they demonstrated greater positive impact on children's language development and various aspects of social-emotional development than did the center-based or home-based approach programs. Mixed-approach programs also reduced the proportion of children with receptive vocabulary scores (a measure of listening comprehension of spoken words) below 85 to a substantially greater extent than did other programs. In the fifth-grade follow-up, home-based programs had generally more favorable impacts than center-based or mixed-approach programs, which showed weak and inconsistent impacts relative to controls.
Finally, authors analyzed outcomes for children based on risk profiles. In both the age-3 and fifth-grade studies, the highest-risk group suffered unfavorable outcomes, compared with controls. Authors suggest that this might be due to the fact that high-risk children were more concentrated in programs that were not fully implemented.
The EHS program has been implemented in 650 sites nationwide (as of fiscal year 2009).
Early Head Start National Resource Center @ ZERO TO THREE
2000 M. Street, NW, Suite 200
Washington, DC 20036
Tel (202) 638-1144
Fax (202) 638-0851
The Early Head Start National Resource Center (http://www.ehsnrc.org/), maintained by the Administration for Children and Families, U.S. Department of Health and Human Services, contains many references and resources for learning more about EHS standards, services, and program implementation.
Love, John M., Ellen E. Kisker, Christine M. Ross, Peter Z. Schochet, Jeanne Brooks-Gunn, Diane Paulsell, Kimberly Boller, Jill Constantine, Cheri Vogel, Allison Sidle Fuligni, and Christy Brady-Smith,
Making a Difference in the Lives of Infants and Toddlers and Their Families: The Impacts of Early Head Start, Vol. I, Final Technical Report,
Princeton, N.J.: Mathematica Policy Research, Inc., and New York, N.Y.: Columbia University's Center for Children and Families at Teachers College, 2002.
Roggman, Lori A., Lisa K. Boyce, Gina A. Cook, and Andrea D. Hart, "How Much Better Than Expected? Improving Cognitive Outcomes in Utah's Bear River Early Head Start," in Making A Difference in the Lives of Infants and Toddlers and Their Families: The Impacts of Early Head Start, Volume III: Local Contributions to Understanding the Programs and Their Impacts,
Vogel, Cheri A., Yange Xue, Emily M. Moiduddin, Ellen Eliason Kisker, and Barbara Lepidus Carlson, Early Head Start Children in Grade 5: Long-Term Follow-Up of the Early Head Start Research and Evaluation Study Sample, Washington, D.C.: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, OPRE Report #2011-8, 2010.