Manuscript Details

Source

Love, J., Kisker, E., Ross, C., Schochet, P., Brooks-Gunn, J., Boller, K., et al. (2001). Building their futures: How Early Head Start programs are enhancing the lives of infants and toddlers in low-income families. Summary report. Report to Commissioner’s Office of Research and Evaluation, Head Start Bureau, Administration on Children, Youth and Families, and Department of Health and Human Services. Princeton, NJ: Mathematica Policy Research.
High rating
Author Affiliation
None of the study authors are developers of this model.
Funding Sources
Administration for Children and Families (ACF), the Child Outcomes Research and Evaluation team (CORE)within ACF’s Office of Planning, Research and Evaluation (OPRE), and the Head Start Bureau in the Administration on Children, Youth and Families (ACYF)

Study Design

Design Attrition Baseline equivalence Confounding factors Valid, reliable measures?
Randomized controlled trial Low Established on race/ethnicity and socioeconomic status; Established on many relevant outcomes None
Notes
The study expressed some effect sizes as a percentage of the standard deviation. To be consistent with other studies, HomVEE divided the study-reported effect size by 100 and rounded to two decimal places.

This study received a mixed rating. Outcomes from the 24-month parent interview have low attrition and receive a high rating, except parent’s overall health and maternal depression outcomes, which were assessable at baseline but did not demonstrate baseline equivalence and were not controlled, and therefore rate moderate. Outcomes from the Parent Services Interview had low attrition, but baseline equivalence for race/ethnicity and SES was not established on the analytic sample, so these outcomes rate moderate. Outcomes from the Child Assessment (Bayley) and Parent/Child Interactions have high attrition and were not assessable at baseline, so those outcomes receive a moderate rating.

Study Participants
This study relies on data from a randomized controlled trial of 17 Early Head Start (EHS) programs that began in 1995. Seven of the programs served clients through a home-based option (though other clients in other EHS options also received home visits) and are the focus of this report (EHS-HBO). The study randomly assigned 1,385 families, who applied to those 7 programs, either to receive home-based EHS or a comparison condition. This study included outcomes reported for the 2-year-old follow-up (other years of follow-up are reported in separate studies). For this follow-up, 966 parents (500 in EHS-HBO and 466 in the comparison group) provided data for parent interviews. Among parent interview participants, 45 percent were white, 25 percent were black, and 27 percent were Hispanic. One in four parents had more than a high school education, and one in 10 were in families living above the poverty line; one-third to one-half of families were receiving Aid to Families with Dependent Children (AFDC) or Food Stamps.
Setting
The study was conducted in 17 EHS programs throughout the United States, including 7 programs with home-based options, which are the focus of this report. Four programs were located in urban areas, and three programs were located in rural areas. The seven programs represented a mix of implementation timing; one early implementer had all EHS-HBO elements in place by 1997, and three later implementers had all elements in place by 1999; three programs did not have all elements in place by 1999. The early-implementing program had fully implemented both child and family development services early and continued to have those services in place in 1999.
Home Visiting Services
EHS-HBO services are intended to be delivered to study families via weekly home visits. Seventy percent of families in these programs received weekly visits during at least one of the first two follow-up periods, and 26 percent received such services throughout both periods. Over the first two years, families in the home-based option received an average of 71 visits. Typical home visits are at least one hour long. Topics for home visits included child growth and development, child play activities, housing issues, and parent-child communication.
Comparison Conditions
Control group families could not receive EHS-HBO services, but could receive other services available in their community.
Study Participants
This study relies on data from a randomized controlled trial of 17 Early Head Start (EHS) programs that began in 1995. Seven of the programs served clients through a home-based option (though other clients in other EHS options also received home visits) and are the focus of this report (EHS-HBO). The study randomly assigned 1,385 families, who applied to those 7 programs, either to receive home-based EHS or a comparison condition. This study included outcomes reported for the 2-year-old follow-up (other years of follow-up are reported in separate studies). For this follow-up, 966 parents (500 in EHS-HBO and 466 in the comparison group) provided data for parent interviews. Among parent interview participants, 45 percent were white, 25 percent were black, and 27 percent were Hispanic. One in four parents had more than a high school education, and one in 10 were in families living above the poverty line; one-third to one-half of families were receiving Aid to Families with Dependent Children (AFDC) or Food Stamps.
Setting
The study was conducted in 17 EHS programs throughout the United States, including 7 programs with home-based options, which are the focus of this report. Four programs were located in urban areas, and three programs were located in rural areas. The seven programs represented a mix of implementation timing; one early implementer had all EHS-HBO elements in place by 1997, and three later implementers had all elements in place by 1999; three programs did not have all elements in place by 1999. The early-implementing program had fully implemented both child and family development services early and continued to have those services in place in 1999.
Home Visiting Services
EHS-HBO services are intended to be delivered to study families via weekly home visits. Seventy percent of families in these programs received weekly visits during at least one of the first two follow-up periods, and 26 percent received such services throughout both periods. Over the first two years, families in the home-based option received an average of 71 visits. Typical home visits are at least one hour long. Topics for home visits included child growth and development, child play activities, housing issues, and parent-child communication.
Comparison Conditions
Control group families could not receive EHS-HBO services, but could receive other services available in their community.

Findings that rate moderate or high in this manuscript

Maternal health
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Parent’s health status 24 months postpartum Moderate
0.00 Not statistically significant, p ≥ 0.05 966 mothers EHS-HBO impact sample
PSI parental distress 24 months postpartum High
0.11 Not statistically significant, p ≥ 0.05 966 mothers EHS-HBO impact sample
PSI Parent-Child dysfunctional interaction 24 months postpartum High
0.07 Not statistically significant, p ≥ 0.05 966 mothers EHS-HBO impact sample
CIDI short screening scales: Major depression (probability) 24 months postpartum Moderate
0.09 Not statistically significant, p ≥ 0.05 966 mothers EHS-HBO impact sample
FES: Family conflict 24 months postpartum High
0.12 Not statistically significant, p ≥ 0.05 966 mothers EHS-HBO impact sample
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Child development and school readiness
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
BSID Mental Development Index (MDI)standard score Age 2 Moderate
0.08 Not statistically significant, p ≥ 0.05 814 children EHS-HBO impact study
Percentage with MDI < 85 Age 2 Moderate
0.02 Not statistically significant, p ≥ 0.05 814 children EHS-HBO impact study
Percentage with MDI < 100 Age 2 Moderate
0.03 Not statistically significant, p ≥ 0.05 814 children EHS-HBO impact study
MacArthur CDI – Vocabulary Production Age 2 High
0.13 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage with vocabulary production <25 Age 2 High
0.01 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage MacArthur CDI combining words Age 2 High
0.04 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Average MacArthur CDI – Sentence Complexity Age 2 High
0.08 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage with sentence complexity <2 Age 2 High
0.04 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Bayley BRS – Emotional Regulation Age 2 Moderate
0.07 Not statistically significant, p ≥ 0.05 814 children EHS-HBO impact study
Bayley BRS – Orientation/Engagement Age 2 Moderate
0.01 Not statistically significant, p ≥ 0.05 814 children EHS-HBO impact study
CBCL – Aggression Age 2 High
0.01 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Parent-Child Structured Play: Child Sustained Attention with Objects Age 2 Moderate
0.05 Not statistically significant, p ≥ 0.05 794 children EHS-HBO impact study
Parent-Child Structured Play: Child Negativity Toward Parent Age 2 Moderate
0.02 Not statistically significant, p ≥ 0.05 794 children EHS-HBO impact study
Parent-Child Structured Play: Child Engagement Age 2 Moderate
0.02 Not statistically significant, p ≥ 0.05 794 children EHS-HBO impact study
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Positive parenting practices
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
HOME emotional responsivity Age 2 High
0.10 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Parent-child structured play: Parent supportiveness Age 2 Moderate
0.14 Not statistically significant, p ≥ 0.05 794 children EHS-HBO impact study
HOME total score Age 2 High
0.13 Statistically significant,
p < 0.05
966 children EHS-HBO impact study
HOME support of cognitive, language, and literacy environment Age 2 High
0.10 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents that set a regular bedtime for child Age 2 High
0.09 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents and children that have regular bedtime routines Age 2 High
0.09 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents that read to child daily Age 2 High
0.02 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents that read to child as part of bedtime routine Age 2 High
0.16 Statistically significant,
p < 0.05
966 children EHS-HBO impact study
Reading frequency Age 2 High
0.01 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Parent-child activities to stimulate cognitive and language development Age 2 High
0.05 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
HOME maternal verbal/social skills Age 2 High
0.05 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Parent-child structured play: Parent detachment Age 2 Moderate
0.15 Not statistically significant, p ≥ 0.05 794 children EHS-HBO impact study
Parent-child structured play: Parent intrusiveness Age 2 Moderate
0.07 Not statistically significant, p ≥ 0.05 794 children EHS-HBO impact study
Parent-child structured play: Negative regard Age 2 Moderate
0.05 Not statistically significant, p ≥ 0.05 794 children EHS-HBO impact study
HOME absence of punitive interactions Age 2 High
0.01 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Spanked child in last week (percentage) Age 2 High
0.07 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
KIDI Age 2 High
0.17 Statistically significant,
p < 0.05
966 children EHS-HBO impact study
Percentage of parents that suggest responses to hypothetical conflict with child: Prevent or distract Age 2 High
0.07 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents that suggest responses to hypothetical conflict with child: Remove child or object Age 2 High
0.05 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents that suggest responses to hypothetical conflict with child: Talk and explain Age 2 High
0.13 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents that suggest responses to hypothetical conflict with child: Threaten or command Age 2 High
0.01 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents that suggest responses to hypothetical conflict with child: Shout Age 2 High
0.11 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents that suggest responses to hypothetical conflict with child: Physical punishment Age 2 High
0.07 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Percentage of parents suggesting only mild responses to the hypothetical conflicts Age 2 High
0.06 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Index of discipline severity Age 2 High
0.06 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Has syrup of Ipecac at home (percentage) Age 2 High
0.01 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Has poison control number (percentage) Age 2 High
0.00 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Has gates or doors in front of stairs (percentage) Age 2 High
0.07 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Uses guards or gates for windows (percentage) Age 2 High
0.06 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Covers electric outlets (percentage) Age 2 High
0.08 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Home has working smoke alarm (percentage) Age 2 High
0.00 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Uses a car seat (percentage) Age 2 High
0.01 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Observed child play area is safe (percentage) Age 2 High
0.01 Not statistically significant, p ≥ 0.05 966 children EHS-HBO impact study
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Family economic self-sufficiency
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Ever in education or training (percentage) 7 to 16 months after assignment Moderate
0.12 Statistically significant,
p < 0.05
1059 mothers EHS-HBO impact study
Ever in high school (percentage) 7 to 16 months after assignment Moderate
0.18 Statistically significant,
p < 0.01
1059 mothers EHS-HBO impact study
Ever in ESL class (percentage) 7 to 16 months after assignment Moderate
0.15 Statistically significant,
p < 0.05
1059 mothers EHS-HBO impact study
Ever in vocational program (percentage) 7 to 16 months after assignment Moderate
0.15 Statistically significant,
p < 0.05
1059 mothers EHS-HBO impact study
Average hours per week in education or training 7 to 16 months after assignment Moderate
0.16 Statistically significant,
p < 0.01
1059 mothers EHS-HBO impact study
In education or training: 1st quarter 7 to 16 months after assignment Moderate
0.03 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
In education or training: 2nd quarter 7 to 16 months after assignment Moderate
0.10 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
In education or training: 3rd quarter 7 to 16 months after assignment Moderate
0.06 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
In education or training: 4th quarter 7 to 16 months after assignment Moderate
0.13 Statistically significant,
p < 0.05
1059 mothers EHS-HBO impact study
In education or training: 5th quarter 7 to 16 months after assignment Moderate
0.16 Statistically significant,
p < 0.05
1059 mothers EHS-HBO impact study
Have high school diploma 7 to 16 months after assignment Moderate
0.01 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Have GED 7 to 16 months after assignment Moderate
0.03 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Ever employed 7 to 16 months after assignment Moderate
0.06 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Average hours per week employed 7 to 16 months after assignment Moderate
0.07 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Employed: 1st quarter 7 to 16 months after assignment Moderate
0.06 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Employed: 2nd quarter 7 to 16 months after assignment Moderate
0.13 Statistically significant,
p < 0.05
1059 mothers EHS-HBO impact study
Employed: 3rd quarter 7 to 16 months after assignment Moderate
0.08 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Employed: 4th quarter 7 to 16 months after assignment Moderate
0.02 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Employed: 5th quarter 7 to 16 months after assignment Moderate
0.08 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Ever employed or in education/training 7 to 16 months after assignment Moderate
0.03 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Average hours per week in any employment, education, or training activity 7 to 16 months after assignment Moderate
0.01 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Employment, education, or training: 1st quarter 7 to 16 months after assignment Moderate
0.00 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Employment, education, or training: 2nd quarter 7 to 16 months after assignment Moderate
0.04 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Employment, education, or training: 3rd quarter 7 to 16 months after assignment Moderate
0.03 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Employment, education, or training: 4th quarter 7 to 16 months after assignment Moderate
0.04 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Employment, education, or training: 5th quarter 7 to 16 months after assignment Moderate
0.03 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Ever received AFDC or TANF 7 to 16 months after assignment Moderate
0.03 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Received AFDC or TANF: 1st quarter 7 to 16 months after assignment Moderate
0.06 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Received AFDC or TANF: 2nd quarter 7 to 16 months after assignment Moderate
0.01 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Received AFDC or TANF: 3rd quarter 7 to 16 months after assignment Moderate
0.05 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Received AFDC or TANF: 4th quarter 7 to 16 months after assignment Moderate
0.01 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Received AFDC or TANF: 5th quarter 7 to 16 months after assignment Moderate
0.02 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Total AFDC or TANF benefits ($) 7 to 16 months after assignment Moderate
0.02 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Ever received welfare 7 to 16 months after assignment Moderate
0.06 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Total welfare benefits ($) 7 to 16 months after assignment Moderate
0.05 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Ever received food stamps 7 to 16 months after assignment Moderate
0.04 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Total food stamps benefits ($) 7 to 16 months after assignment Moderate
0.02 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Income above poverty line, (percentage) 7 to 16 months after assignment Moderate
0.02 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Child health
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Any child health services 7 to 16 months after assignment Moderate
0.05 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact sample
Any doctor visits 7 to 16 months after assignment Moderate
0.02 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact sample
Any emergency room visits 7 to 16 months after assignment Moderate
0.05 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact sample
Any dentist visits 7 to 16 months after assignment Moderate
0.01 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact sample
Any screening tests 7 to 16 months after assignment Moderate
0.07 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact sample
Any immunizations 7 to 16 months after assignment Moderate
0.35 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact sample
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Linkages and referrals
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Identification of child’s disability 7 to 16 months after assignment Moderate
0.45 Statistically significant, p < 0.05 1059 mothers EHS-HBO impact study
Services for child with disability 7 to 16 months after assignment Moderate
0.50 Statistically significant, p < 0.05 1059 mothers EHS-HBO impact study
Any education-related services 7 to 16 months after assignment Moderate
1.09 Statistically significant, p < 0.01 1059 mothers EHS-HBO impact study
Any employment-related services 7 to 16 months after assignment Moderate
1.00 Statistically significant, p < 0.01 1059 mothers EHS-HBO impact study
Any family health services 7 to 16 months after assignment Moderate
0.18 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Any family mental health services 7 to 16 months after assignment Moderate
0.05 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Transportation assistance 7 to 16 months after assignment Moderate
0.29 Statistically significant, p < 0.01 1059 mothers EHS-HBO impact study
Housing assistance 7 to 16 months after assignment Moderate
0.03 Not statistically significant, p ≥ 0.05 1059 mothers EHS-HBO impact study
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Black or African American
25%
Hispanic or Latino
27%
White
45%
Unknown
3%

Maternal Education

Less than a high school diploma
47%
High school diploma or GED
28%
Unknown
25%

Other Characteristics

Enrollment in means-tested programs
50%