Implementing Early Start (New Zealand)

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, and 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.

Early Start was designed to be a mainstream program. However, the developers took steps to ensure that the model would be relevant to the Māori, an indigenous population of New Zealand. During the development phase, the Early Start team consulted with Māori representatives on the design of the program. The developers established an Early Start board, half of whose members were Māori, to oversee implementation of the program and to foster an organizational culture that was respectful and sensitive to the needs and perspectives of Māori families. The Māori board members provided a Māori cultural training to all Early Start staff and Māori home visitors were hired to work with Māori families. These efforts aimed to create a universal model that can be delivered to both Māori and non-Māori families in a culturally responsive way.

Early Start Project Ltd., a charitable non-governmental organization based in New Zealand, provides implementation support.

In New Zealand, technical assistance may be provided by the Ministry of Development and Family and Community Services. Early Start Project Ltd. also arranges with a private organization for technical assistance and support, especially for the development and maintenance of Early Start’s data systems.

Early Start targets at-risk families with newborn children up to age 5. Although it was designed as a mainstream program, the developers took steps to ensure that the model would be culturally responsive to the Māori, an indigenous population of New Zealand.

Early Start uses a three-stage eligibility determination process. First, Early Start administers a short risk assessment containing items on maternal age, extent of family support, whether the pregnancy was planned or unplanned, substance abuse, family violence, and child abuse and neglect. Any family with two or more risk factors continues to the next stage of the process. Second, families enroll in Early Start for a one-month assessment period to become acquainted with the program and so Early Start can learn about the family. Third, families complete an in-depth needs assessment based on a modified version of the Kempe Family Stress Checklist and are fully enrolled in the program for longer-term services.

Early Start is designed to improve child health; reduce child abuse; improve parenting skills; support parental physical and mental health; encourage family economic well-being; and encourage stable, positive partner relationships.

Early Start provides services through home visitation. All Early Start families receive services based on four established curricula:

1. Partnership in Parenting Education (PIPE) “Listen, Love, Play,” which focuses on listening, trust, language, problem solving, feelings, and how babies learn
2. Triple P (Positive Parenting Program), which focuses on positive parenting practices and means to address childhood behavior problems
3. Getting Ready for School focused on 4 year olds
4. Incredible Years

Families are offered several additional services based on need:

• Infant and child safety awareness
• Linkages to supportive services in the community, including budget, health, and relationship services
• Advice and support concerning healthy lifestyle choices, including family and child nutrition
• Household and time management

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.

Both a breastfeeding support group for young parents and services focused on the early years are available through Early Start Project Ltd.

Early Start is implemented by the Early Start Project Ltd., a charitable non-governmental organization based in New Zealand.

The model requires both programs and home visitors to meet a set of ongoing fidelity guidelines outlined in the Key Operating Policies and Procedures performance standards. Please contact the model developer for additional information about these guidelines.

Early Start is staffed by 17 to 20 full-time home visitors (called Family Support Workers/Whanau Awhina). Other staff include a general manager, clinical manager, three clinical supervisors, and administrative support staff.

Early Start employs home visitors with educational backgrounds in nursing, social work, early childhood education, teaching, or related fields. Home visitors must also have an awareness of cultural issues, experience with high-risk families, and evidence of good interpersonal skills and sound judgment.

Home visitors receive, on average, two hours of clinical supervision each week from trained supervisors. During these sessions, the pair reviews the home visitor’s caseload and case notes. They also discuss future plans for families. In addition, the supervisor provides time for the home visitor to discuss challenges or concerns.

Home visitors undergo four weeks of training that provides background on a wide range of issues relevant to family support work. Please contact the model developer for additional information about the pre-service training requirement.

Each home visitor must receive a minimum of 20 hours of in-service training per year. Please contact the model developer for additional information about the ongoing professional development requirement.