Early Start

About the program

The critical elements of the Early Start  model include:

• Assessment of family needs, issues, challenges, strengths, and resources
• Development of a positive partnership between the family support worker and client
• Collaborative problem solving to devise solutions to family challenges
• The provision of support, mentoring, and advice to assist client families to mobilise their strengths and resources
• Involvement with the family throughout the child’s preschool years.

The program goals are: improvements in child health; reduction in child abuse; improvements in parenting skills; improvements in parental physical and mental health; family economic and material wellbeing; and stable and positive intimate partnerships. 

The delivery of services is based on several common principles:

• Understanding of the client’s individual and cultural perspective
• ·Active involvement of clients in the service by sharing ideas and experiences, and engaging 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 program is designed for families of children who have been identified as at risk, for example because of the age of parents, parental social support, unplanned pregnancy, parental substance use, the family financial situation, family violence, or where there were serious concerns about the ability of the family to care for the child.

In an RCT in New Zealand with 443 families, 27% of parents in the intervention group were Maori, and 24.8% of mothers and 30.7% of fathers in the control group were Maori (Fergusson et al. 2005). In the intervention group, 90.1% of families were welfare dependent; in the control group, 88.4% of families were welfare dependent.

The program has not been evaluated in Australia.

What outcomes does it contribute to?

Positive outcomes:

Child visits to hospital ER, Positive parenting, Physical assault: Fergusson et al. (2005) provided evidence that the program has a positive effect on child safety through a reduction in child visits to hospital Emergency Rooms. They also demonstrated a positive effect on parenting that was not reliant on punishment.

No effect:

Child abuse and neglect: The same study failed to demonstrate an effect on the reduction of harm as measured by rates of contact with child welfare agencies.

Negative outcomes:

None

Is the program effective?

Overall, the program had a mixed effect on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects

How is it implemented?

The program is delivered to families of preschool aged children and has a duration of 36 months. The program involves home visits by family support workers with nursing or social work qualifications who have also attended a five-week training program specific to Early Start. Each family support worker supports 10 to 20 families.

The program of home visitation is tailored to meet individual family needs. An initial needs assessment is conducted through four weekly visits, to determine the subsequent level of intervention. The study did not provide information on the contents of each level of intervention

How much does it cost?

Information not available

Where does the evidence come from?

The study was an RCT with original sample size of 443 families, final sample size of 391 families, of whom 220 received the intervention (Fergusson et al., 2005).

Further resources

• https://www.earlystart.co.nz/what-we-do/
• Fergusson, D. M., et al. (2005). “Randomized trial of the Early Start program of home visitation.” Pediatrics 116(6): e803-809.