Early Start (New Zealand) Meets HHS Criteria

Last updated: 2011

Effects shown in research & outcome measure details

To see details on each finding HomVEE reviewed in well-designed research, click on the name of an outcome domain.

Model overview

109

Early Start aims to create a collaborative, problem-solving partnership between the home visitor and family to maximize child health, increase child and family well-being, build strengths, and eliminate deficiencies. Early Start recognizes that child well-being can occur only through the more general health and well-being of the family, although the target child is treated as the primary focus of services.

Early Start was designed to be a mainstream program. However, the developers took steps to ensure that the model would be relevant to the Māori, an indigenous population of New Zealand. During the development phase, the Early Start team consulted with Māori representatives on the design of the program. The developers established an Early Start board, half of whose members were Māori, to oversee implementation of the program and to foster an organizational culture that was respectful and sensitive to the needs and perspectives of Māori families. The Māori board members provided a Māori cultural training to all Early Start staff and Māori home visitors were hired to work with Māori families. These efforts aimed to create a universal model that can be delivered to both Māori and non-Māori families in a culturally responsive way.

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68

Early Start provides services through home visitation. All Early Start families receive services based on four established curricula:

  1. Partnership in Parenting Education (PIPE) “Listen, Love, Play,” which focuses on listening, trust, language, problem solving, feelings, and how babies learn
  2. Triple P (Positive Parenting Program), which focuses on positive parenting practices and means to address childhood behavior problems
  3. Getting Ready for School focused on 4 year olds
  4. Incredible Years

 

Families are offered several additional services based on need:

  • Infant and child safety awareness
  • Linkages to supportive services in the community, including budget, health, and relationship services
  • Advice and support concerning healthy lifestyle choices, including family and child nutrition
  • Household and time management
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106

Early Start targets at-risk families with newborn children up to age 5. Although it was designed as a mainstream program, the developers took steps to ensure that the model would be culturally responsive to the Māori, an indigenous population of New Zealand.

Early Start uses a three-stage eligibility determination process. First, Early Start administers a short risk assessment containing items on maternal age, extent of family support, whether the pregnancy was planned or unplanned, substance abuse, family violence, and child abuse and neglect. Any family with two or more risk factors continues to the next stage of the process. Second, families enroll in Early Start for a one-month assessment period to become acquainted with the program and so Early Start can learn about the family. Third, families complete an in-depth needs assessment based on a modified version of the Kempe Family Stress Checklist and are fully enrolled in the program for longer-term services.

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113

Early Start Project Ltd.

Postal Address:
P.O. Box 21013
Edgeware,
Christchurch 8143
New Zealand

Street Address:
354 Armagh St
Linwood,
Christchurch 8011
New Zealand

Phone: +64 3365 9087
Fax: +64 3365 9237
Email: reception@earlystart.co.nz
Web: www.earlystart.co.nz 

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Effects shown in research & outcome measure details

Reductions in child maltreatment

Findings rated moderate

Early Start (New Zealand)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Percent attended hospital for accident/injury or accidental poisoning
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 382 children % = 17.50 % = 26.30 = -8.80 Study reported = 0.22 Statistically significant, p < 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Percent severe/very severe physical assault by any parent (Conflict Tactics Scale)
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 families % = 4.40 % = 11.70 = -7.30 Study reported = 0.26 Statistically significant, p < 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Show outcome measure summary
Outcome measure Outcome measure description Collection method Properties Operations links

Percent attended hospital for accident/injury or accidental poisoning

The percentage of children who attended the hospital for accidents/injuries or accidental poisonings within the past 36 months

Review of medical records

Not applicable

Percent attended hospital for accident/injury or accidental poisoning

The percentage of children who attended the hospital for accident/injury or accidental poisoning Parent/caregiver report

Not applicable

Percent severe/very severe physical assault by any parent (Conflict Tactics Scale)

The Severe/Very Severe assault subscales of the Parent-Child Conflict Tactics Scale was used to assess child abuse/neglect.

Parent/caregiver report

Not reported by author.

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Positive parenting practices

Findings rated moderate

Early Start (New Zealand)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance
Non-punitive attitudes (CRPR)
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 391 children Unadjusted mean = 10.12 Unadjusted mean = 9.90 Mean difference = 0.22 Study reported = 0.22 Statistically significant, p < 0.05
Percent smoke-free home/smoke-free area
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 children % = 80.80 % = 81.60 = -0.80 Study reported = -0.02 Not statistically significant, p ≥ 0.05
Positive parenting attitude (Child Rearing Practices Report [ CRPR])
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 391 children Unadjusted mean = 10.14 Unadjusted mean = 9.88 Mean difference = 0.26 Study reported = 0.26 Statistically significant, p < 0.05
Total parenting score (CRPR)
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 391 children Unadjusted mean = 10.14 Unadjusted mean = 9.87 Mean difference = 0.27 Study reported = 0.27 Statistically significant, p < 0.05
Show outcome measure summary
Outcome measure Outcome measure description Collection method Properties Operations links

Non-punitive attitudes (CRPR)

Positive and punitive parenting practices were assessed using a 49-item measure that combined items from the Child Rearing Practices Report (CRPR), the Adult-Adolescent Parenting Inventory (AAPI) and study developed items.

Parent/caregiver report

Cronbach's α ranged from 0.73 to 0.89.

Positive parenting attitude (Child Rearing Practices Report [ CRPR])

Positive and punitive parenting practices were assessed using a 49-item measure that combined items from the Child Rearing Practices Report (CRPR), the Adult-Adolescent Parenting Inventory (AAPI) and study developed items.

Parent/caregiver report

Cronbach’s α ranged from 0.73 to 0.89.

Total parenting score (CRPR)

Positive and punitive parenting practices were assessed using a 49-item measure that combined items from the Child Rearing Practices Report (CRPR), the Adult-Adolescent Parenting Inventory (AAPI) and study developed items.

Parent/caregiver report

Cronbach's α ranged from 0.73 to 0.89.

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Maternal health

Findings rated moderate

Early Start (New Zealand)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Percent any family/social relationship problem
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 families % = 81.30 % = 82.90 = -1.60 Study reported = 0.04 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Percent ever pregnant to 36 months
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 mothers % = 42.90 % = 47.60 = -4.70 Study reported = 0.09 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Percent major depression
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 mothers % = 36.00 % = 37.10 = -1.10 Study reported = 0.02 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Percent mother smoked cigarettes
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 mothers % = 73.10 % = 68.90 = 4.20 Study reported = -0.09 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Percent substance use problems
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 mothers % = 38.50 % = 33.00 = 5.50 Study reported = -0.11 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Show outcome measure summary
Outcome measure Outcome measure description Collection method Properties Operations links

Percent any family/social relationship problem

The percentage of families who experienced any family or social relationship problems within the past 36 months Parent/caregiver report

Not applicable

Percent ever pregnant to 36 months

The percentage of mothers who had become pregnant within the past 36 months Parent/caregiver report

Not applicable

Percent major depression

The authors used items from the Composite International DiagnosticInterview (CIDI) to assess whether parents ever met the DSM-IV diagnostic criteria for major depression within the past 36 months. Parent/caregiver report

Not reported by author.

Percent mother assaulted by any partner

The ConflictTactics Scale (CTS2) was used to assess partner violence. The percentage of parents who reported any incident of psychological or physical assault by any partner within the past 36 months. Parent/caregiver report

Not reported by author.

Percent mother smoked cigarettes

Percentage of mothers who smoked cigarettes within the past 36 months Parent/caregiver report

Not applicable

Percent substance use problems

Items from the CompositeInternational DiagnosticInterview (CIDI) was used to assess alcohol and drug abuse and dependence. The percentage of parents with substance use problems within the past 36 months. Parent/caregiver report

Not reported by author.

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Family economic self-sufficiency

Findings rated moderate

Early Start (New Zealand)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Mean amount of debt
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 families Unadjusted mean $3,582 = 3582.00 Unadjusted mean = 3380.00 Mean difference = 202.00 Study reported = -0.04 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Mean family income per week
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 families Unadjusted mean = 454.00 Unadjusted mean = 443.00 Mean difference = 11.00 Study reported = 0.08 Not statistically significant, p ≥ 0.05
Percent income inadequate/very inadequate
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 families % = 41.80 % = 37.40 = 4.40 Study reported = -0.09 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Percent welfare dependent
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 families % = 89.60 % = 86.40 = 3.20 Study reported = -0.10 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Show outcome measure summary
Outcome measure Outcome measure description Collection method Properties Operations links

Mean amount of debt

The average amount of debt families owed over the past 36 months Parent/caregiver report

Not applicable

Mean family income per week

The average of families' income per week over the past 36 months Parent/caregiver report

Not applicable

Percent income inadequate/very inadequate

The percentage of families who reported that the adequacy of their income to meet their basic family needs was inadequate/very inadequate within the past 36 months. Parent/caregiver report

Not applicable

Percent welfare dependent

The percentage of families that were ever dependent on welfare within the past six months Parent/caregiver report

Not applicable

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Child health

Findings rated moderate

Early Start (New Zealand)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Number of home safety features
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 children Unadjusted mean = 5.20 Unadjusted mean = 4.90 Mean difference = 0.30 Study reported = 0.17 Not statistically significant, p ≥ 0.05
Number of visits made to family doctor in past 36 months
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 children Unadjusted mean = 23.50 Unadjusted mean = 20.70 = 2.80 Study reported = 0.24 Statistically significant, p < 0.05
Percent attended hospital for any other reason
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 382 children % = 68.40 % = 74.20 = -9.80 Study reported = 0.13 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Percent breastfed for six months or more
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 children % = 31.30 % = 34.10 = -2.80 Study reported = -0.05 Not statistically significant, p ≥ 0.05
Percent of children up to date with immunizations
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 children % = 92.50 % = 91.90 = 0.60 Study reported = 0.24 Not statistically significant, p ≥ 0.05
Percent of children up to date with well-child checks
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 children % = 41.90 % = 30.10 = 11.80 Study reported = 0.24 Statistically significant, p < 0.05
Percent with dental service
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 391 children % = 72.30 % = 62.80 = 9.50 Study reported = 0.20 Statistically significant, p < 0.05
Show outcome measure summary
Outcome measure Outcome measure description Collection method Properties Operations links

Number of home safety features

The number of safety features present in the home including working smoke alarms; plug protectors on electric sockets; childproof latches on cupboards; locked medicine cabinet/safe storage of medicines; safe storage for poisons; hot water temperature set at 60°C or lower; fireguards for open fires, log burners, or heaters; and an escape route planned in case of fire. Parent/caregiver report

Not applicable

Percent attended hospital for any other reason

The percentage of children who attended the hospital for reasons other than accident/injury in the past 36 months Review of medical records

Not applicable

Percent breastfed for six months or more

The percentage of children who were breastfed for six months or more. Parent/caregiver report

Not applicable

Percent of children up to date with immunizations

The percentage of children who were up to date with immunizations. Review of medical records

Not applicable

Percent of children up to date with well-child checks

The percentage of children who were up to date with well-child checks

Parent/caregiver report

Not applicable

Percent smoke-free home/smoke-free area

The percentage of homes that were always smoke-free within the past 36 months Parent/caregiver report

Not applicable

Percent with dental service

The percentage of children enrolled to receive free dental service

Parent/caregiver report

Not applicable

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Reductions in juvenile delinquency, family violence, and crime

Findings rated moderate

Early Start (New Zealand)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Percent mother assaulted by any partner
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 families % = 26.40 % = 22.30 = -4.10 Study reported = -0.10 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Show outcome measure summary
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Child development and school readiness

Findings rated moderate

Early Start (New Zealand)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Duration of attendance (months)
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 children Unadjusted mean = 16.40 Unadjusted mean = 13.60 Mean difference = 2.80 Study reported = 0.22 Statistically significant, p < 0.05
Percent ever attended early childhood education
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 388 children % = 90.80 % = 84.50 = 6.30 Study reported = 0.19 Not statistically significant, p ≥ 0.05
Performance IQ
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 367 children Unadjusted mean = 98.10 Unadjusted mean = 96.80 Mean difference = 1.30 Study reported = 0.08 Not statistically significant, p ≥ 0.05
Total IQ
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 367 children Unadjusted mean = 97.70 Unadjusted mean = 96.50 Mean difference = 1.20 Study reported = 0.07 Not statistically significant, p ≥ 0.05
Total behavior score
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 391 children Unadjusted mean = 9.87 Unadjusted mean = 10.11 Mean difference = -0.24 Study reported = 0.24 Statistically significant, p < 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Total externalizing score
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 391 children Unadjusted mean = 9.90 Unadjusted mean = 10.09 Mean difference = -0.19 Study reported = 0.19 Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Total internalizing score
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 391 children Unadjusted mean = 9.86 Unadjusted mean = 10.12 Mean difference = -0.26 Study reported = 0.26 Statistically significant, p < 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

Verbal IQ
FavorableUnfavorable or ambiguousNo Effect
36 months Christchurch sample 367 children Unadjusted mean = 97.70 Unadjusted mean = 97.00 Mean difference = 0.70 Study reported = 0.04 Not statistically significant, p ≥ 0.05
Show outcome measure summary
Outcome measure Outcome measure description Collection method Properties Operations links

Duration of attendance (months)

Duration of attendance in early childhood education (in months)

Parent/caregiver report

Not applicable

Percent ever attended early childhood education

Percentage of children who ever attended early childhood education Parent/caregiver report

Not applicable

Performance IQ

The Wechsler Preschool and Primary Scale of Intelligence (WPPSI) was used to assess intelligence at age three. The authors obtained a verbal IQ score, a performance IQ score , and full score IQ Child assessment

Cronbach's α = 0.86 for the performance subscale, 0.93 for the verbal subscale, and .0.94 for the total scale.

Total IQ

The Wechsler Preschool and Primary Scale of Intelligence (WPPSI) was used to assess intelligence at age three. The authors obtained a verbal IQ score, a performance IQ score , and full score IQ . Child assessment

Cronbach's α = 0.86 for the performance subscale, 0.93 for the verbal subscale, and .0.94 for the total scale.

Total internalizing/Total externalizing score

Child social-emotional /behavioral problems were assessed using 50 items from the Infant-Toddler Social and Emotional Assessment (ITSEA). The following dimensions of behavior combine to form the Externalizing score: activity, aggression/defiance, peer aggression, and emotional negativity. The dimensions of inhibition/separation problems and depression/withdrawal comprise the Internalizing score. Items are rated on a 3-point scale from not true (1), rarely to very true (2), and often (3).

Parent/caregiver report

Cronbach’s α ranged from 0.47 to 0.85, with a median of 0.75.

Verbal IQ

The Wechsler Preschool and Primary Scale of Intelligence (WPPSI) was used to assess intelligence at age three. The authors obtained a verbal IQ score, a performance IQ score , and full score IQ. Child assessment

Cronbach's α = 0.86 for the performance subscale, 0.93 for the verbal subscale, and .0.94 for the total scale.

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In brief

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This model meets the criteria established by the Department of Health and Human Services (HHS) for an “evidence-based early childhood home visiting service delivery model” for the general population, but does not meet the criteria for tribal populations.

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16

Early Start is a voluntary home visiting program designed to improve child health, reduce child abuse, improve parenting skills, support parental physical and mental health, encourage family economic well-being, and encourage stable, positive partner relationships. Early Start was designed to be a mainstream program, targeting at-risk families with newborns and children up to age 5. However, the developers took steps to ensure that the model would also be culturally responsive to the Māori, an indigenous population of New Zealand. Home visitors deliver services at varying levels of intensity depending on the family’s needs. Families with the highest needs receive up to three hours of home visits and indirect contact per week (level 1), families with moderate needs receive up to three hours of home visiting every two weeks (level 2), and families with lower needs receive up to one hour of home visiting monthly (level 3). The fourth and final level of services includes up to one hour of contact every three months. Home visitors in consultation with their supervisors determine when a family is ready to progress to the next level. For more information, please read the Model Overview.

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39

Results of search and review
Number of manuscripts
At least one finding was eligible for review…
3
  …and at least one finding rated high
0
  …and at least one finding rated moderate (but none rated high)
1
  …and all findings that were eligible for review rated low
0
  …but manuscript is additional source1
2

For more information, see the research database. For more information on the criteria used to rate research, please see details of HomVEE’s methods and standards.

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103

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29

Information based on comprehensive review of all high- and moderate-rated manuscripts
CriterionCriterion descriptionCriterion met?
1High- or moderate-quality impact study?Yes
2Across high- or moderate-quality studies, favorable impacts in at least two outcome domains within one sample OR the same domain for at least two non-overlapping samples?Yes
3Favorable impacts on full sample?Yes
4Any favorable impacts on outcome measures sustained at least 12 months after model enrollment?
Reported for all research but only required for RCTs.
Yes
5One or more favorable, statistically significant impact reported in a peer-reviewed journal?
Reported for all research but only required for RCTs.
Yes

Notes: If the model does not meet criterion 3 but meets criteria 1 and 2 based on findings from subgroups, the impacts must be replicated in the same domain in two or more studies using non-overlapping analytic study samples. HomVEE assesses and reports criteria 4 and 5 for all models that have well-designed research, but meeting those two criteria is only required of models for which all findings are from randomized controlled trials. Please read the HHS criteria for evidence-based models for more information.

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