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Early Head Start-Home Visiting (EHS-HV)§

Meets DHHS criteria for an evidenced based model

Last Updated: July 2016

In Brief for Child Development and School Readiness Outcomes

Impact Studies Rated High


Chazan-Cohen, R., Raikes, H. H., & Vogel, C. (2013). V. Program subgroups: Patterns of impacts for home-based, center-based, and mixed-approach programs. Monographs of the Society for Research in Child Development, 78(1), 93-109.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
CBCL Aggressive behavior No Effect Home-based program approach Age 5 927 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = -0.091 Primary
Child has an individualized education plan No Effect Home-based program approach Age 5 802 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = -0.021 Secondary
Engagement during play No Effect Home-based program approach Age 5 829 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = 0.04 Primary
English receptive vocabulary (PPVT) No Effect Home-based program approach Age 5 802 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = 0.05 Primary
FACES positive approaches to learning Favorable Home-based program approach Age 5 927 Not reported Not reported Not reported Statistically significant, p < 0.01 Study reported = 0.18 Secondary
FACES Social Behavior Problems Favorable Home-based program approach Age 5 927 Not reported Not reported Not reported Statistically significant, p < 0.05 Study reported = -0.131 Secondary
Leiter attention sustained No Effect Home-based program approach Age 5 802 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = 0.09 Primary
Negativity toward parent during play No Effect Home-based program approach Age 5 829 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = -0.011 Primary
Observed attention No Effect Home-based program approach Age 5 802 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = 0.07 Primary
Observed Leiter emotion regulation No Effect Home-based program approach Age 5 802 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = 0.02 Primary
Speech problems No Effect Home-based program approach Age 5 802 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = -0.101 Secondary
Woodcock Johnson Applied Problems No Effect Home-based program approach Age 5 802 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = 0.08 Primary
Woodcock Johnson Letter-Word identification (English) No Effect Home-based program approach Age 5 802 Not reported Not reported Not reported Not statistically significant, p > 0.05 Study reported = 0.03 Primary

1 Negative value favors the intervention.

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
CBCL Aggressive behavior The Child Behavior Checklist is a questionnaire that assesses behavioral problems in young children. Parent survey Internal consistency= 0.89 Primary
Child has an individualized education plan Percent of parents who report that their child has an individualized education plan. Parent survey Not reported by author Secondary
Engagement during play Assessment of parent-child semistructured play evaluated children’s engagement with parent and negativity toward parents. The free play tasks and coding scheme used were adapted from the National Institute of Child Health and Development (NICHD) Study of Early Child Care. Videotape observation Intercoder reliability= 96% Primary
English receptive vocabulary (PPVT) The Peabody Picture Vocabulary Test (PPVT)-III assesses receptive vocabulary for Standard American English in young children. Child assessment Internal consistency= 0.96 Primary
FACES positive approaches to learning Subscales from Family and Child Experiences Survey (FACES) assessed child social-emotional functioning, social skills, and positive approaches to learning. Parent survey Internal consistency= 0.64 Secondary
FACES Social Behavior Problems Subscales from Family and Child Experiences Survey (FACES) assessed child social-emotional functioning, social skills, and positive approaches to learning. Parent survey Internal consistency= 0.76 Secondary
Leiter attention sustained The Leiter-R Sustained Attention test assesses skills in memory or attention in children. Child assessment Internal consistency= 0.75 Primary
Negativity toward parent during play The child’s behavior during a play task was coded. Child engagement with parent was measured as the extent to which the child interacted with the parent and communicated positive feelings. Child negativity toward parent measured displays of anger, rejection, or a negative reaction to parent’s behavior. Child sustained attention with objects was measured as the duration of the child’s focus on an object or set of objects. Videotape observation Intercoder reliability= 99% Primary
Observed attention The Leiter-R Sustained Attention test assesses skills in memory or attention in children. Child assessment Internal consistency= 0.93 Primary
Observed Leiter emotion regulation The Leiter-R Sustained Attention test assesses skills in memory or attention in children. Child assessment Internal consistency= 0.93 Primary
Speech problems Parent survey response. Parent survey Not reported by author Secondary
Woodcock Johnson Applied Problems The Woodcock-Johnson-Revised Test (WJ-R) assesses scholastic ability and intelligence in children. The Applied Problems subscale measures symbolic representation, counting, and simple addition and subtraction. Child assessment Internal consistency= 0.91 Primary
Woodcock Johnson Letter-Word identification (English) The Woodcock-Johnson-Revised Test (WJ-R) assesses scholastic ability and intelligence in children. The Letter-Word Identification subscale measures recognition of letters and words. Child assessment Internal consistency= 0.84 Primary

Jones Harden, B., Chazan-Cohen, R., Raikes, H., & Vogel, C. (2012). Early head start home visitation: The role of implementation in bolstering program benefits. Journal of Community Psychology, 40(4), 438-455.
Additional Source:

Jones Harden, B., Chazan-Cohen, R., Raikes, H., & Vogel, C. (2010). Early Head Start home visitation: The role of implementation in bolstering program benefits. Unpublished manuscript.

Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
FACES aggression No Effect EHS-HV impact study Kindergarten entry 928 children Adjusted mean = 2.6 Adjusted mean = 2.7 MD = -0.1 Not statistically significant,
p > 0.05
Study-reported = -0.07 Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
FACES: Aggression Subscales from FACES assessed child social-emotional functioning, social skills, and positive approaches to learning. Child assessment Cronbach’s α = 0.64 Secondary

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.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Average MacArthur CDI – Sentence Complexity No Effect EHS-HV impact study Age 2 966 children Adjusted mean = 8.5 Adjusted mean = 7.8 MD = 0.7 Not statistically significant,
p > 0.05
Study-reported =0.08 Primary
CBCL – Aggression No Effect EHS-HV impact study Age 2 966 children Adjusted mean = 10.4 Adjusted mean = 10.5 MD = -0.1 Not statistically significant,
p > 0.05
Study-reported = -0.01 Primary
MacArthur CDI – Vocabulary Production No Effect EHS-HV impact study Age 2 966 children Adjusted mean = 56.4 Adjusted mean = 53.5 MD = 2.9 Not statistically significant,
p > 0.05
Study-reported = 0.13 Primary
Percentage MacArthur CDI combining words No Effect EHS-HV impact study Age 2 966 children Adjusted mean = 77.3 Adjusted mean = 75.6 MD = 1.7 Not statistically significant,
p > 0.05
Study-reported = 0.04 Primary
Percentage with sentence complexity <2 No Effect EHS-HV impact study Age 2 966 children Adjusted mean = 28.3 Adjusted mean = 30.2 MD = -1.9 Not statistically significant,
p > 0.05
Study-reported = -0.04 Primary
Percentage with vocabulary production <25 No Effect EHS-HV impact study Age 2 966 children Adjusted mean = 11.3 Adjusted mean = 11.2 MD = 0.1 Not statistically significant,
p > 0.05
Study-reported = 0.01 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
CBCL: Aggression The CBCL is a questionnaire that assesses behavioral problems in young children. Parent/caregiver report Not reported by author Primary

MacArthur CDI – Vocabulary Production

Percentage with vocabulary production < 25

Percent MacArthur CDI combining words

Average MacArthur CDI – Sentence Complexity

Percentage with sentence complexity < 2

The CDI assesses language development in young children. Vocabulary production measured the number of words out of 100 the parent had heard the child say. Sentence production measured the extent to which the child used more grammatically complex sentences. Percentage combining words measured the Percentage of children who are using at least two-word phrases. The researchers also examined the percentage with vocabulary production < 85 and sentence complexity <2. Parent/caregiver report Not reported by author Primary

Roggman, L. A., & Cook, G. A. (2010). Attachment, aggression, and family risk in a low-income sample. Family Science, 1(3), 191-204. doi:10.1080/19424620.2010.567829
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Child aggression (24 months) No Effect one site from larger EHS evaluation 24 months 167 not reported not reported Coeff=0.061 Not statistically significant, p > 0.05 Not available Primary
child aggression (36 months) No Effect one site from larger EHS evaluation 36 months 143 not reported not reported Coeff=0.072 Not statistically significant, p > 0.05 Not available Primary

1 Higher score equals unfavorable; Note that this outcome controls for physical punishment at 24 months

2 Higher score equals unfavorable; Note that this outcome measures the incremental impact between 24 months and 36 months and also controls for aggression at 24 months)

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Child aggression For a 19-item subscale on aggression from the Child Behavior Checklist, the number of times a behavior was never true, true, or often true of the child Parent/caregiver report Cronbach's α = 0.85 Primary
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Impact Studies Rated Moderate


Love, J., Kisker, E., Ross, C. M., Schochet, P. Z., Brooks-Gunn, J., Paulsell, D., et al. (2002). Making a difference in the lives of infants and toddlers and their families: The impacts of Early Head Start. Volumes I-III: Final technical report [and] appendixes [and] local contributions to understanding the programs and their impacts. Washington, DC: U.S. Department of Health and Human Services, Head Start Bureau.
Additional Sources:

Love, J. M., Kisker, E. E., Ross, C., Raikes, H., Constantine, J., Boller, K., et al. (2005). The effectiveness of Early Head Start for 3-year-old children and their parents: Lessons for policy and programs. Developmental Psychology, 41(6), 885–901. doi:10.1037/0012-1649.41.6.885

Roggman, L. A., Boyce, L. K., Cook, G. A., & Hart, A. D. (2002). Making a difference in the lives of infants and toddlers and their families: The impacts of Early Head Start. Vol. 3, Local contributions to understanding the programs and their impacts. Washington, DC: Administration for Children and Families, Office of Planning, Research, and Evaluation, Child Outcomes Research and Evaluation.

Raikes, H. H., Chazan-Cohen, R., Love, J. M., & Brooks-Gunn, J. (2010). Early Head Start impacts at age 3 and a description of the age 5 follow-up study. In Childhood Programs and Practices in the First Decade of Life: A Human Capital Integration. Reynolds, A.A., Rolnick, A.J., Englund, M.M, and Temple, J.A., eds. New York: Cambridge University Press, 99-118.

Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Bayley Behavioral Rating Scale(BRS): Emotional regulation No Effect EHS-HV impact study Age 3 744 children Adjusted Mean = 4 Adjusted Mean = 4 MD = 0 Not statistically significant,
p > 0.05
Study-reported = 2.1 Primary
Bayley BRS: Orientation/Engagement No Effect EHS-HV impact study Age 3 744 children Adjusted Mean = 3.9 Adjusted Mean = 3.8 MD = 0 Not statistically significant,
p > 0.05
Study-reported = 3.4 Primary
Bayley Mental DevelopmentIndex(MDI)Standard Score No Effect EHS-HV impact study Age 3 746 children Adjusted Mean = 94.1 Adjusted Mean = 92.8 MD = 1.2 Not statistically significant,
p > 0.05
Study-reported = 9.5 Primary
Child behavior checklist - aggressive behavior No Effect EHS-HV impact study Age 3 746 children Adjusted Mean = 11.2 Adjusted Mean = 11.7 MD = -0.5 Not statistically significant,
p > 0.05
Study-reported = -7.8 Secondary
Engagement of parent during parent-child puzzle challenge task No Effect EHS-HV impact study Age 3 744 children Adjusted Mean = 5.1 Adjusted Mean = 5 MD = 0.1 Not statistically significant,
p > 0.05
Study-reported = 5.6 Primary
Engagement of parent during parent-child semistructured play Favorable EHS-HV impact study Age 3 744 children Adjusted Mean = 4.8 Adjusted Mean = 4.6 MD = 0.2 Statistically significant,
p < 0.05
Study-reported = 19.2 Primary
Frustration during parent-child puzzle challenge task No Effect EHS-HV impact study Age 3 744 children Adjusted Mean = 2.7 Adjusted Mean = 2.6 MD = 0.1 Not statistically significant,
p > 0.05
Study-reported = 5.9 Primary
Negativity toward parent during parent-child semistructured play No Effect EHS-HV impact study Age 3 744 children Adjusted Mean = 1.3 Adjusted Mean = 1.3 MD = -0.0 Not statistically significant,
p > 0.05
Study-reported = -6.6 Primary
Peabody Picture Vocabulary Test (PPVT)-III Standard Score No Effect EHS-HV impact study Age 3 746 children Adjusted Mean = 84.6 Adjusted Mean = 83.1 MD = 1.5 Not statistically significant,
p > 0.05
Study-reported = 9.1 Primary
Percentage with PPVT-III<85 No Effect EHS-HV impact study Age 3 746 children 45.6% 48.6% -3 Not statistically significant,
p > 0.05
Study-reported = -6.1 Primary
Percentage with MDI <85 No Effect EHS-HV impact study Age 3 746 children 20.5% 22% -1.4 Not statistically significant,
p > 0.05
Study-reported = -3.1 Primary
Persistence during parent-child puzzle challenge task No Effect EHS-HV impact study Age 3 744 children Adjusted Mean = 4.7 Adjusted Mean = 4.6 MD = 0.1 Not statistically significant,
p > 0.05
Study-reported = 12.0 Primary
Sustained attention with objects during parent-child semistructured play No Effect EHS-HV impact study Age 3 744 children Adjusted Mean = 5 Adjusted Mean = 4.9 MD = 0.1 Not statistically significant,
p > 0.05
Study-reported = 10.6 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Bayley Behavioral Rating Scale(BRS): Emotional regulation The Bayley BRS assesses child behavior, with each item scored on a 5-point scale. Emotional regulation was an average score on items including negative affect and attention adaptation to change in test materials. Trained assessor ratings Not reported by author Secondary
Bayley BRS : Orientation/Engagement The Bayley BRS assesses child behavior, with each item scored on a 5-point scale. Orientation and engagement was an average score on items including positive affect, interest in materials, and exploration of objects and surroundings. Child assessment Not reported by author Secondary
Bayley Mental DevelopmentIndex(MDI)Standard Score The MDI of the BSI D assesses the cognitive functioning of young children. Child assessment Not reported by author Primary
Child behavior checklist - aggressive behavior The CBCL is a questionnaire that assesses behavioral problems in young children. Parent/caregiver report Not reported by author Secondary
Engagement of parent during parent-child puzzle challenge task Children were given puzzles at increasing levels of challenge to work on with their parent. The task was videotaped, and child and parent behaviors were coded on a 7-point scale by child development researchers according to strict protocols. The scales are based on a puzzle task used by Brooks-Gunn et al. (1992) in the Newark Observational Study of the Teenage Parent Demonstration. Engagement measures the extent to which the child shows, initiates, or maintains interaction with the parent. Very high engagement receives a 7. Videotape observation Not reported by author Secondary
Engagement of parent during parent-child semistructured play The child’s behavior during a play task was coded. Child engagement with parent was measured as the extent to which the child interacted with the parent and communicated positive feelings. Videotape observation Not reported by author Secondary
Frustration during parent-child puzzle challenge task Children were given puzzles at increasing levels of challenge to work on with their parent. The task was videotaped, and child and parent behaviors were coded on a 7-point scale by child development researchers according to strict protocols. The scales are based on a puzzle task used by Brooks-Gunn et al. (1992) in the Newark Observational Study of the Teenage Parent Demonstration. Frustration measures the degree to which the child expresses frustration or anger toward the puzzle task. Very high frustration receives a 7. Videotape observation Not reported by author Secondary
Negativity toward parent during parent-child semistructured play The child’s behavior during a play task was coded. Child negativity toward parent measured displays of anger, rejection, or a negative reaction to parent’s behavior. Videotape observation Not reported by author Secondary
Peabody Picture Vocabulary Test (PPVT)-III Standard Score The PPVT -III is a test of children’s receptive vocabulary. Child assessment Not reported by author Primary
Percentage with MDI <85 The MDI of the BSI D assesses the cognitive functioning of young children. Child assessment Not reported by author Primary
Percentage with PPVT -III<85 The PPVT -III is a test of children’s receptive vocabulary. Child assessment Not reported by author Primary
Persistence during parent-child puzzle challenge task Children were given puzzles at increasing levels of challenge to work on with their parent. The task was videotaped, and child and parent behaviors were coded on a 7-point scale by child development researchers according to strict protocols. The scales are based on a puzzle task used by Brooks-Gunn et al. (1992) in the Newark Observational Study of the Teenage Parent Demonstration. Persistence measures how goal-oriented, focused, and motivated the child remains toward the puzzle throughout the task. Very high persistence receives a 7. Videotape observation Not reported by author Secondary
Sustained attention with objects during parent-child semistructured play The child’s behavior during a play task was coded. Child sustained attention with objects was measured as the duration of the child’s focus on an object or set of objects. Videotape observation Not reported by author Secondary

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.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Bayley BRS – Emotional Regulation No Effect EHS-HV impact study Age 2 814 children Adjusted mean = 3.6 Adjusted mean = 3.6 MD = 0.0 Not statistically significant,
p > 0.05
Study-reported = 0.07 Primary
Bayley BRS – Orientation/Engagement No Effect EHS-HV impact study Age 2 814 children Adjusted mean = 3.6 Adjusted mean = 3.6 MD = 0.0 Not statistically significant,
p > 0.05
Study-reported = 0.01 Primary
BSID Mental Development Index (MDI)standard score No Effect EHS-HV impact study Age 2 814 children Adjusted mean = 91.6 Adjusted mean = 90.5 MD = 1.1 Not statistically significant,
p > 0.05
Study-reported = 0.08 Primary
Parent-Child Structured Play: Child Engagement No Effect EHS-HV impact study Age 2 794 children Adjusted mean = 4.3 Adjusted mean = 4.3 MD = 0.0 Not statistically significant,
p > 0.05
Study-reported = 0.02 Primary
Parent-Child Structured Play: Child Negativity Toward Parent No Effect EHS-HV impact study Age 2 794 children Adjusted mean = 1.7 Adjusted mean = 1.7 MD = 0.0 Not statistically significant,
p > 0.05
Study-reported = -0.02 Primary
Parent-Child Structured Play: Child Sustained Attention with Objects No Effect EHS-HV impact study Age 2 794 children Adjusted mean = 5.1 Adjusted mean = 5.0 MD = 0.1 Not statistically significant,
p > 0.05
Study-reported = 0.05 Primary
Percentage with MDI < 100 No Effect EHS-HV impact study Age 2 814 children Adjusted mean = 73.0 Adjusted mean = 71.9 MD = 1.1 Not statistically significant,
p > 0.05
Study-reported = 0.03 Primary
Percentage with MDI < 85 No Effect EHS-HV impact study Age 2 814 children Adjusted mean = 31.5 Adjusted mean = 32.5 MD = -1.0 Not statistically significant,
p > 0.05
Study-reported = -0.02 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type

Bayley BRS: Emotional Regulation

Bayley BRS: Orientation/Engagement

The Bayley BRS assesses child behavior, with each item scored on a 5-point scale. Emotional regulation was an average score on items including negative affect and attention adaptation to change in test materials. Orientation and engagement was an average score on items including positive affect, interest in materials, and exploration of objects and surroundings. Trained assessor ratings Not reported by author Primary

BSID, MDI

Percentage with MDI <85

Percentage with MDI <100

The MDI of the BSID assesses the cognitive functioning of young children. In addition to the mean MDI score, the researchers examined the percentage with MDI <85 and MDI <100. Child assessment Not reported by author Primary
Parent-child Structured Play:
  • Child Sustained Attention with Objects
  • Child Negativity Toward Parent
  • Child Engagement
The child’s behavior during a play task was coded. Child engagement with parent was measured as the extent to which the child interacted with the parent and communicated positive feelings. Child negativity toward parent measured displays of anger, rejection, or a negative reaction to parent’s behavior. Child sustained attention with objects was measured as the duration of the child’s focus on an object or set of objects. Videotape observation Not reported by author Primary

Roggman, L., Boyce, L. K., & Cook, G. (2009). Keeping kids on track: Impacts of a parenting-focused Early Head Start program on attachment security and cognitive development. Early Education & Development, 20(6) 920-941
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Attachment security Favorable EHS-HV impact study (Utah) 18 months 161 children Not reported Not reported β = 0.17 Statistically significant,
p < 0.05
Not available Secondary
BSID MDI No Effect EHS-HV impact study (Utah) 24 months 161 children Not reported Not reported Not reported Not statistically significant,
p > 0.05
Not available Primary
BSID MDI Favorable EHS-HV impact study (Utah) 36 months 161 children Not reported Not reported β = 0.19 Statistically significant,
p < 0.05
Not available Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Attachment Q-Sort scale The Attachment Q-Sort assesses security of attachment and dependency in young children. Each of the 90 items is a description of a specific behavior. Items are sorted by the mother/caregiver into nine piles of 10 cards each based on how likely or unlikely the item matches the behavior of her child. Parent/caregiver report with the assistance of a trained interviewer r = 0.64 Secondary
BSID, MDI The MDI of the BSID assesses the cognitive functioning of young children. Child assessment Cronbach’s α = 0.79 at age 14 months, Cronbach’s α = 0.85 at age 24 months, Cronbach’s α = 0.99 at age 36 months Primary
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