Programs that Work

Early Head Start

Program Info

Outcome Areas

Children Ready for School

Indicators

Children ages 0 to 5 exhibiting age-appropriate mental and physical development

Topic Areas

     Age of Child
       Early Childhood
     Type of Setting
       Home Visiting
       Child Care / Preschool
     Type of Service
       Family Support
       Parent Education
     Type of Outcome Improved
       Behavior Problems
       Physical Health
       Substance Abuse

Evidence Level (What does this mean?)

Proven

Program Overview

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 708 community-based programs serving 61,500 children in 2003.

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 a 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.

Program Participants

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.

Evaluation Methods

National Evaluation (Love et al., 2002)

The EHS national evaluation project was a 26-month study carried out in 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 to 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.

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.

Utah Study

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. 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 Pre-K 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 childre's cognitive and language development at age 3. Specifically:

EHS children earned significantly higher standard scores on the Bayley Mental Development Index (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 (at a probability of error level of 0.05) for the percentage of children scoring below 85 on the MDI (also 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.

Utah Study

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.

Probable Implementers

Early childhood programs

Funding

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 2002, the total EHS budget was $654 million, and the average cost per child was $10,544.

Implementation Detail

Program Design

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 themselves 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 Web site, 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 twice annual 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, and
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 sizeable gains across most of the cognitive and social-emotional outcomes.

Across all three of the program approaches, EHS had a favorable impact on children’s cognitive and language development, on controlling 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. Compared with the other two approaches, center-based programs appear to have had greater favorable impacts on improving children’s social-emotional development, and on improving the cognitive development of children with mild delays.

These variations could be attributable in part to varying durations of families’ program participation. Families continued to participate in mixed-approach programs for a longer period, on average, than did families in center-based or home-based programs. These differences in length of program participation, which may be partly attributable to the mixed-approach program’s greater flexibility in providing services as family needs change, could have enabled children to make stronger and more sustained progress (Love et al., 2002).

The authors also examined some other program- and site-level subgroups to explore whether the impact of EHS varied as a function of either urban or rural program location or whether state welfare regulations require parents to engage in work activities while their youngest child is less than one year old. Neither of these other analyses suggested that they were important ways of classifying programs to examine differences in impacts on services or on children and families.

A number of additional evaluations have been conducted for this program, but we included only those studies with methodologies meeting the Promising Practices Network criteria.

Example Sites

The EHS program has been implemented in 708 sites nationwide.

Contact Information

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

Available Resources

The Early Head Start National Resource Center (http://www.ehsnrc.org/), maintained by the Administration for Children & Families, U.S. Department of Health & Human Services, contains many references and resources for learning more about EHS standards, services, and program implementation.

Bibliography

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," 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, 2002, Mathematica Policy Research, Inc.: Princeton, NJ.

Last Reviewed

March 2010

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