An intensive home-visiting service for families with newborn babies where difficult situations may negatively impact on the life chances of children in their care.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
Australian Study
Risk of Bias
Cost
Target Age Group
About
Early Start is a long-term (up to 5 years) home-based service offered to families in Christchurch, New Zealand with social and family circumstances that may put the health and wellbeing of their newborn babies at risk. Family Support Workers seek to form a collaborative partnership with their client families to maximise positive outcomes for the child, parents and extended family in a culturally sensitive and safe manner.
Aims
- Support family wellbeing
- Promote physical, social and emotional wellbeing of infants and children
- Promote healthy child development
- Promote child safety and wellbeing
- Increase parenting education
- Improve parenting knowledge for new mothers
- Provide support through crisis
- Reduce family violence and addictions.
Impact
Early Start improved child's attendance in early childhood education and parenting skills. Parents' attitudes at 9-years post trial entry towards harsh/physical punishment improved. There was no effect found for improving child protection system contact, parent mental health and parent substance abuse. Evidence was mixed and inconclusive for family functioning, welfare and employment.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Not found | Yes | Not found |
| System | Health service use | Yes | Yes | Not found |
| Child | Education | Yes | Not found | Not found |
| Child | Mental health/behaviour | Yes | Yes | Not found |
| Family | Employment | Yes | Not found | Yes |
| Family | Functioning | Yes | Yes | Yes |
| Family | Welfare/poverty | Yes | Yes | Yes |
| Parent/caregiver | Mental health/functioning | Not found | Yes | Not found |
| Parent/caregiver | Parenting skills | Yes | Not found | Not found |
| Parent/caregiver | Reproductive outcomes | Yes | Not found | Yes |
| Parent/caregiver | Substance abuse | Not found | Yes | Yes |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
This means that
This assessment is based on 3 research outputs from one primary study.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 3 |
| Quasi-experiment | Not identified or included |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of evidence from the included studies.
The study was conducted in New Zealand and does not include Aboriginal children and families.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The RCT was conducted in Christchurch, New Zealand.
Sample characteristics
- Of those eligible for the trial, 443 (75%) agreed to participate in the study. 220 enrolled in the Early Start series and 223 enrolled in the control series.
- Almost one third of the sample identified as Māori.
Implementation
Delivery model, mode and setting
- Early start is delivered in-person, to families in their home, by trained Family Support Workers.
Target cohort
- Families with children up to age 5 experiencing social and family circumstances that may put the health and wellbeing of their children at risk.
- Referrals are accepted for young mothers up to age 24 and their families/whanau from 12 weeks prenatal to 9 months postnatal.
Program delivery
- Early Start Family Support Workers work with client families and their extended families using a collaborative, problem- solving and solution focussed approach to maximise positive outcomes for the client child, parents and extended family, finding a balance between:
- Family strengths and challenges
- Family generated goals and agency generated goals.
- Early Start uses a social learning model approach to home visitation. The elements of this 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.
Manuals and guides
- We were unable to locate any manuals or guides to implement Early Start.
Additional information
- The Early Start website has more information about the program.
Staffing
- Early Start employs a team of full time Family Support Workers who visit families at home. All clinical staff at Early Start have professional qualifications with backgrounds in either nursing, social work, early childhood education, teaching or other related fields.
Training
- All Family Support Workers are required to attend a 5-week training program to familiarise themselves with the program principles and their role.
To our knowledge, Early Start is not available and has not been implemented in Australia.
Cost
We were unable to locate any information on the cost of Early Start.
References
Studies identified and included in the review
- Fergusson DM, Grant H, Horwood LJ, Ridder EM (2005). Randomized Trial of the Early Start program of home visitation. Pediatrics, 2005;116:e803–e809.
- Fergusson DM, Grant H, Horwood LJ, Ridder EM (2006). Randomized trial of the Early Start program of home visitation: Parent and family outcomes. Pediatrics, 117(3):781-786.
- Fergusson DM, Boden JM, Horwood LJ (2013). Nine-year follow-up of a home-visitation program: A randomized trial. Pediatrics, 131(2):297-303.
Studies identified but not counted towards the evidence rating due to study quality
- Euser S, Alink LR, Stoltenborgh M, Bakermans-Kranenburg MJ and van IJzendoorn M (2015). A gloomy picture: a meta-analysis of randomized controlled trials reveals disappointing effectiveness of programs aiming at preventing child maltreatment. BMC Public Health, 15:1068.
- van der Put CE, Assink M, Gubbels J & Boekhout van Solinge NF (2018). Identifying effective components of child maltreatment interventions:
- A meta-analysis. Clinical Child and Family Psychology Review, 21(2): 171-202