Early Start (New Zealand) Meets HHS Criteria

Model effectiveness research report last updated: 2023

Model overview

Theoretical approach

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 for at-risk families in the general population. However, the developers took steps to make the model 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 model that can be delivered to both Māori and non-Māori families in a culturally responsive way.

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Model services

Early Start provides services through home visitation and offers aspects of two established curricula that are incorporated into home visits and tailored to a family’s needs and situation. The two curricula the program uses are:

  1. Tākai Parenting Resource, which focuses on parenting, child and parent interactions, and the importance of relationships
  2. Level 4 Standard Triple P (Positive Parenting Program), which focuses on positive parenting practices and aims to address childhood behavior problems

Families are offered several additional services as needs are identified during the program:

  • 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

Early Start also offers the full Incredible Years Toddler Parenting Program, a group-based program that is run twice a year for referred Early Start families.

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Intended population

Early Start was designed to serve a general population of at-risk families with newborn children up to age 5. The developers took steps to make the model 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. During this time, families engage in an in-depth needs assessment based on a series of conversation topics. Third, families who consent to participate then are fully enrolled in the program for longer-term services based on their risk factors.

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Where to find out more

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

Child health

Findings rated moderate

Early Start (New Zealand)
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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

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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
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Child development and school readiness

Findings rated moderate

Early Start (New Zealand)
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Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Early childhood education, 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
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
Infant-Toddler Social and Emotional Assessment (ITSEA), 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

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High score equals unfavorable.

Infant-Toddler Social and Emotional Assessment (ITSEA), 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

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High score equals unfavorable.

Infant-Toddler Social and Emotional Assessment (ITSEA), 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

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High score equals unfavorable.

Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Performance IQ score
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
Wechsler Preschool and Primary Scale of Intelligence (WPPSI), 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
Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Verbal IQ score
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
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Reductions in child maltreatment

Findings rated moderate

Early Start (New Zealand)
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Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
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

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High score equals unfavorable.

Parent-Child Conflict Tactics Scale (CTSPC), Physical assault by any parent
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

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High score equals unfavorable.

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Positive parenting practices

Findings rated moderate

Early Start (New Zealand)
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Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance
Non-punitive attitudes (adapted from Child Rearing Practices Report and Adult-Adolescent Parenting Inventory)
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 (adapted from Child Rearing Practices Report and Adult-Adolescent Parenting Inventory)
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 (adapted from Child Rearing Practices Report and Adult-Adolescent Parenting Inventory)
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
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Maternal health

Findings rated moderate

Early Start (New Zealand)
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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

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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

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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

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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

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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

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High score equals unfavorable.

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Family economic self-sufficiency

Findings rated moderate

Early Start (New Zealand)
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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 = 3582.00 Unadjusted mean = 3380.00 Mean difference = 202.00 Study reported = -0.04 Not statistically significant, p ≥ 0.05

footnote150

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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

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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

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High score equals unfavorable.

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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
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

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High score equals unfavorable.

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In brief

Evidence of model effectiveness

Title General population Tribal population Domains with favorable effects
Early Start (New Zealand) Yes, Meets HHS Criteria Meets HHS criteria Does not meet HHS criteria for tribal population because the findings from high- or moderate-rated effectiveness studies of the model in tribal populations do not meet all required criteria.
  • Child development and school readiness,
  • Child health,
  • Positive parenting practices,
  • Reductions in child maltreatment,

Model description

Early Start is a 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 for at-risk families in the general population, and the developers took steps to make the model culturally responsive to the Māori, an indigenous population of New Zealand. Early Start serves families with newborns and children up to age 5.

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); families with lower needs receive up to one hour of home visiting monthly (level 3); and "graduate" families receive up to one hour of contact every three months (level 4). Home visitors in consultation with their supervisors determine when a family is ready to progress to the next level. 

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Extent of evidence

Results of search and review
Number of manuscripts
At least one finding was eligible for review…
5
  …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 or indeterminate2
2
  …but manuscript is additional source3
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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Summary of findings

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Criteria established by the U.S. Department of Health and Human Services

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
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