New Zealand Early Start program

About the program

The New Zealand Early Start program is a home visitation program designed to assess family needs and risk of child maltreatment. It uses a social learning model approach to home visitation. The critical elements of this model include:

1. assessment of family needs, issues, challenges, strengths, and resources
2. development of a positive partnership between the family support worker and client
3. collaborative problem solving to devise solutions to family challenges
4. the provision of support, mentoring, and advice to assist client families to mobilize their strengths and resources
5. involvement with the family throughout the child’s preschool years.

The delivery of the program is based on a number of common principles:

• understanding of the client’s individual and cultural perspective
• active involvement of clients in the service by sharing ideas and experiences and involving clients in problem solving
• assisting clients to seek and generate their own solutions
• providing support and assistance for clients to implement their solutions
• teaching, mentoring, and providing the client with alternative strategies and solutions
• acting as an interpreter for the client in dealing with new material, ideas, or suggestions

Who does it work for?

The Early Start program is designed for parents with two or more risk factors for child maltreatment such as age, social support, planning of pregnancy, parental substance use, financial situation and family violence.

The program has only been evaluated in New Zealand (Fergusson et al. 2013).

A randomised control trial was conducted with 370 people (171 people were in the intervention group and 199 people were in the control group). On average, mothers were 24 years old. Twenty-five percent of mothers were Maori (Indigenous New Zealand), and most families were welfare dependent.

The New Zealand Early Start program has not been tested in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

• Child hospitalisation: families who participated in the Early Start program had children had fewer child hospitalisations for unintentional injuries, compared to families who did not participate in the program.
• Harsh parenting:
  • Mothers who participated in the Early Start program were less likely to use harsh punishment and physical or psychological disciplinary methods, compared to mothers who did not participate in the program.
• Parenting attitude: mothers who participated in the Early Start program reported higher levels of parenting confidence, compared to mothers who did not participate in the program.

No effects:

• Intimate partner violence:
  • The program has no effect on the rate of one partner receiving intimate partner violence.
  • The program has no effect on the rate of one partner committing intimate partner violence.
• Parent’s mental health: The program has no effect on maternal depression symptoms.
• Parent’s substance use: The program has no effect on the rate of smoking, alcohol use, or cannabis/other illicit drug use.

Negative outcomes:

No negative effects were found

How effective is it?

Overall, the New Zealand Early Start program has a mixed effect on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

• At least one high-quality randomised controlled trial (RCT) or quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT or QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT or QED studies show statistically significant adverse effects.

How is it implemented?

The support given to families in the New Zealand Early Start program is based on the needs of a family.

A four-level system is used where level 1 is for families with high need and level 4 is for families with low need.

The number of sessions held with a family depends on the level the family is assessed at.

Services are delivered by trained family support workers (FSWs) who visit families at home. All FSWs have nursing or social work qualifications and attend a 5-week training program. FSWs visit families to achieve a series of goals aimed at maximizing child and family health and well-being. These goals are:

• Improvements in child health: timely medical visits for common childhood morbidity, high levels of compliance to immunisation and well childcare checks, reductions in hospital visits for preventable childhood morbidity including childhood unintentional injuries and unintentional poisoning, and improvements in home safety and home environment.
• Reduction of child abuse: reduced agency contact for child abuse and neglect, reduced use of physical punishment, increased awareness of child abuse and neglect issues and effective use of child welfare services.
• Improvements in parenting skills: parental sensitivity, positive parenting and non-punitive parenting.
• Supporting parental physical and mental health: reductions in rates of unplanned pregnancy, early detection and treatment of depression, assistance with mental health and substance use disorders, and encouragement to use general practitioner services.
• Encouraging family economic and material well-being: reducing levels of welfare dependence, encouraging the use of budgeting services, encouraging workforce participation, and encouraging forward economic planning.
• Encouraging stable positive partnerships: Reduction of partner violence and partner conflict and improvements in partner relationships.

In the RCT, just under 60% of families received 3 or more years of the program (Fergusson et al. 2013).

How much does it cost?

Not reported

What else should I consider?

In New Zealand, the acquisition of Social Work or Nursing qualifications requires passing a bachelor level course at a relevant training institution. The decision to employ tertiary educated staff was based on the concerns of the Early Start Board to provide a professional level of service and also upon emerging evidence suggesting improved outcomes for tertiary trained workers (Fergusson et al. 2013).

Where does the evidence come from?

One RCT conducted in New Zealand, with 370 participants (Fergusson et al. 2013).

Further resources

The New Zealand Early Start website: https://www.earlystart.co.nz

Fergusson et al. (2013), Nine-year follow-up of a home-visitation program: A randomized trial. Pediatrics, Vol. 131, No. 2, pp. 297-303.