Estimated Costs of Implementation

Average Cost per Family

According to the Office of Head Start, the average cost per child ranges from $9,000 to $12,000 [2012 dollars]. Estimates are based on costs associated with delivering comprehensive services on a year-round basis. Estimates include costs related to assessments of children and families, case management, and facilitation and tracking of referrals. In addition, cost estimates include the program structure, governance, management, and supervisory supports.

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Labor Costs

No information is available.

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Purchase of Model or Operating License

There are no costs associated with operating licenses. Rather, program sites receive funding to operate Early Head Start through a federal competitive application process.

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Materials and Forms

No information is available about the costs of materials and forms.

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Training and Technical Assistance

No information is available about the costs of training and technical assistance.

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Infrastructure

No information is available about the costs of data systems used to support implementation.

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Recruitment and Retention

No information is available about the costs of recruiting and retaining families.

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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the Office of Head Start on January 16, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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Training to Support Implementation

Requirements for Program Certification

To receive funding, Early Head Start-Home-Based Option programs apply to ACF and provide a detailed plan for model implementation and adherence to the applicable performance standards. The criteria for selection of applicants includes:

  • The cost-effectiveness of the proposed program;
  • The qualifications and experience of the applicant and the applicant’s staff in planning, organizing, and providing comprehensive child development services at the community level;
  • The quality of the proposed program as indicated by adherence to, or evidence of, the intent and capability to adhere to the Head Start Program Performance Standards;
  • The proposed program design and options, including the suitability of facilities and equipment proposed to be used in carrying out the program; and
  • The need for Head Start services in the community served by the applicant.
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Pre-Service Staff Training

At a minimum, the Head Start Program Performance Standards require that Early Head Start-Home-Based Option programs provide an orientation to all new staff that includes the goals and philosophy of the Early Head Start-Home-Based Option and how they are implemented in the individual program. Early Head Start-Home-Based Option programs must implement a systematic approach to staff training to assist staff and volunteers in acquiring the knowledge and skills needed to provide high quality, comprehensive services within the scope of their job responsibilities. This training must be directed toward improving the ability of staff and volunteers to deliver services required by Early Head Start-Home-Based Option regulations and policies. In addition, all staff must be trained in how to implement the curriculum.

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In-Service Staff Training

Early Head Start-Home-Based Option programs are required to provide ongoing opportunities for training and professional development. Programs must implement a structured professional development system, with the potential for academic credit where possible. Home visitors are required to participate in a minimum of 15 hours of professional development per year.

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Training Materials

Training materials are available on the Early Childhood Learning and Knowledge Center (ECLKC) website.

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Qualified Trainers

No information is available.

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Technical Assistance

The Office of Head Start provides training/technical assistance (T/TA) to program staff to support their service delivery. T/TA consists of (1) direct funding to grantees; (2) regional T/TA networks, including Migrant and Seasonal Head Start and American Indian and Alaska Native Head Start; and (3) six National Centers. The six National Centers collectively act as comprehensive providers of infant-toddler and Early Head Start expertise, resources, information, and training. The National Centers are the result of collaboration between ACF’s Office of Head Start and Office of Child Care to provide joint T/TA across early care and education programs. They aim to promote consistent practices across communities, states, tribes, and territories.

ACF regional staff also provide technical assistance.

Technical assistance materials are available on the ECLKC website.

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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the Office of Head Start on January 16, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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More Information about the Model

Where to Find Out More

Administration for Children and Families
Office of Head Start (OHS)
Mary E. Switzer Building
330 C Street, SW, 4th Floor
Washington, DC 20201
Website: http://www.acf.hhs.gov/programs/ohs/ , http://eclkc.ohs.acf.hhs.gov/hslc

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Recommended Further Reading

The following references were sources for the implementation profile or were recommended by the developer for further reading.

Center for Law and Social Policy. (February 2016). Early Head Start participants, programs, families, and staff in 2014. Retrieved June 21, 2018, from https://www.clasp.org/sites/default/files/publications/2017/04/EHS-2014-Fact-Sheet-.pdf.

U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start. (September 2016). Head Start program performance standards. Retrieved June 21, 2018, from http://eclkc.ohs.acf.hhs.gov/sites/default/files/pdf/hspps-appendix.pdf.

U.S. Department of Health and Human Services, Administration for Children and Families, Early Childhood Learning and Knowledge Center. (May 2018). Training and technical assistance centers. Retrieved June 21, 2018, from https://eclkc.ohs.acf.hhs.gov/about-us/article/training-technical-assistance-centers.

U.S. Department of Health and Human Services, Administration for Children and Families, Early Childhood Learning and Knowledge Center. (June 2018). Home-Based Option. Retrieved June 21, 2018, from https://eclkc.ohs.acf.hhs.gov/programs/article/home-based-option.

U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start. (November 2016). Technical assistance. Retrieved June 21, 2018, from https://www.acf.hhs.gov/ohs/assistance.

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Implementation Experiences

Summary of Sources

Information in this section is based on studies included in the HomVEE review. For EHS-HBO, we reviewed 28 studies, including 7 randomized controlled trials or quasi-experimental designs and 21 standalone implementation studies. (Please see Studies for Implementation Experiences for a list of the studies and to link to the characteristics of the samples examined in the effectiveness studies.)

In the sections below, we consider all pieces of research about a particular sample to be a single study. For example, six studies described the characteristics of the same group of participants at the time they enrolled into a national cross-site evaluation. These six publications are cited as one study. There are 17 distinct samples across the 28 publications.

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Characteristics of Model Participants

Caregivers in EHS-HBO studies were primarily mothers (87 to 100 percent) (11 studies). In studies of populations that involved fathers, 1 to 13 percent of caregivers were fathers (six studies).

The average caregiver age ranged from 17 to 27 (six studies), and approximately 22 to 39 percent of parents were younger than 20 (three studies). Twelve to 39 percent of mothers were pregnant at the time of enrollment (five studies). The average age of children involved varied. In two studies, about 40 percent of children were four months old or younger. In one additional study, the average child’s age at enrollment was 14 months.

Programs served racially and ethnically diverse families (14 studies). Nine to 100 percent of program participants were white (seven studies); the percentage who were African American ranged from 3 to 100 percent (13 studies); and the percentage of participants who were Hispanic ranged from 7 to 62 percent (12 studies). Two to 11 percent of program participants identified as another race or multiple races (eight studies).

Twenty-one to 43 percent of caregivers were unemployed (four studies); families had low incomes (five studies); and 21 to 77 percent of caregivers received public assistance (six studies). About one-third to three-quarters of caregivers did not have their high school diploma or a high school equivalency degree (eight studies).

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Location and Setting

Programs were located in 18 states (10 studies). Studies occurred in all but one Census region of the United States, including:

  • Midwest (six studies)
  • Northeast (five studies)
  • South (one study)
  • West (five studies)

Programs sites included urban (eight studies), rural (six studies), and suburban (two studies) settings.

A variety of agencies implemented EHS-HBO, including:

  • Head Start or EHS agencies (five studies)
  • Community-based/nonprofit organizations (five studies)
  • Health clinics (three studies)
  • Government human service departments (three studies)
  • Universities (two studies)
  • School districts (two studies)
  • Foundations (one study)
  • Child care agencies (one study)
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Staffing and Supervision

EHS-HBO staff included home visitors who worked with families in their homes (17 studies), supervisors (nine studies), and program managers or directors (three studies).

Additional staff supported  EHS-HBO programs, including nurses or health care specialists (four studies); family support specialists or advocates (four studies); psychologists or other mental health professionals (three studies); male involvement specialists (three studies); child development specialists (two studies); and speech and language specialists (two studies). A national survey of  EHS-HBO reported that some programs also included disability, literacy, and nutrition specialists (one study).

Most programs required that staff had at least an associate’s degree, and some programs preferred a bachelor’s degree or higher (nine studies). Other programs only required a high school diploma (two studies). Home visitors had educational backgrounds in human services fields including child development, nursing, counseling, and other disciplines (seven studies). Some programs required that home visitors had experience conducting home visits with infants and toddlers or with low-income populations (five studies); others required a child development associate credential (two studies).

Four studies described pre-service training that included (1) general pre-service orientation (two studies), (2) a one-week training for key program staff, and/or (3) a two-week intensive training for staff (three studies). Pre-service training often consisted of two or more of these training types for any given program.

Seven studies described in-service training, which consisted of (1) ongoing trainings on  EHS-relevant topics such as child development and nutrition (five studies), (2) individual observation and feedback (two studies), and/or (3) annual trainings at training institutes (two studies). In-service training often consisted of two or more of these training types for any given program.

Supervision activities included (1) individual meetings with supervisors (two studies), (2) staff meetings or group sessions (two studies), (3) in-field observations of home visits (one study), (4) case reviews (two studies), (5) reflective supervision sessions (four studies), and/or (6) performance reviews (two studies). The ratio of home visitors to supervisors ranged from four to seven home visitors for every supervisor (three studies).

Home visiting staff’s caseloads ranged from 6 to 24 families (six studies).

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Model Components

Participants received home visiting plus center-based group socializations (15 studies). The home visits covered:

  • Child development (10 studies)
  • Health services, including medical, dental, mental health, or vision screenings and referrals (nine studies)
  • Community resources (five studies)
  • Parent-child interactions (five studies)
  • Family goals around employment, adult education, housing, and family relationships (three studies)
  • Nutrition (two studies)
  • Family well-being (one study)

Most programs followed federal EHS guidelines, which recommend weekly visits (14 studies) for 90 minutes (nine studies). EHS guidelines also recommended families participate from the birth of the child to age 3 (11 studies).

Programs used the following assessments (seven studies):

  • Denver Developmental Screening Test II (two studies)
  • Hawaii Early Learning Profile® (one study)
  • Ages and Stages Questionnaires® (one study)
  • Early Learning Accomplishment Profile (one study)
  • The Infant Toddler Development Assessment (one study)
  • Behavioral, Emotional, Social Screening Checklist (one study)
  • Infant/Toddler Home Inventory (one study)
  • Family Assessment Tool (one study)

Programs used the following curricula (five studies):

  • Parents as Teachers® (two studies)
  • Hawaii Early Learning Profile® curriculum materials (two studies)
  • WestEd’s Program for Infant/Toddler Caregivers (one study)
  • Partners in Parenting® (one study)
  • Teaching Strategies GOLD® (one study)
  • Partners for a Healthy Baby® (one study)
  • Games to Play with Babies (one study)
  • Games to Play with Toddlers (one study)
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Model Adaptations or Enhancements

Five studies described adaptations or enhancements to the core EHS-HBO model.

Infant mental health consultation. An infant mental health consultant provided intensive training for home visitors on infant mental health (two studies). In one study, the program managers and direct-service staff participated in a 12-week seminar; the other study included 36 hours of training over six weeks focused on home visiting, early relationships, and development. Home visitors participated in infant mental health case conferences and received reflective supervision (both studies). Home visitors had master’s degrees (one study).

Professional home visitors. Both professionals and paraprofessionals served as home visitors (one study).

Parental employment training. Parents were offered training to become child care providers (one study).

Parent-child communication protocols. Parent-child communication protocols were used to enhance the development of secure attachment between the child and parent (one study).

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Dosage

Families received an average of three to four visits per month (five studies). Visits were shorter than the recommended 90 minutes, lasting 60 to 70 minutes (two studies).

Half to two-thirds of families participated for about two years of the three-year intervention (two studies). Families participated an average of 21 to 22 months (two studies).

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Lessons Learned

Studies discussed lessons learned about implementation, including lessons about staffing, intensity and content of services, and engagement with families:

Staffing. Several lessons related to staffing considerations.

  • Finding a diverse, yet qualified staff was difficult (four studies).
  • Turnover among home visitors and supervisors led to low staff morale and disruption of services for families (four studies). In one study, staff reported dissatisfaction with low wages, which contributed to turnover.
  • Studies noted the importance of reflective supervision and monitoring home visitor caseload (five studies).
  • Studies noted the importance of initial training, ongoing training to respond to children’s cognitive and developmental needs, on-the-job training, and frequent one-on-one supervision (seven studies).

Intensity and content of services. Lessons related to the services families received included:

  • Studies noted the need for greater intensity of services, including increasing the frequency of home visits and group socializations, and better addressing the child’s cognitive and developmental needs (two studies).
  • Community partnerships and access to community resources are important to address health issues, identify disabilities, and connect families with needed services (two studies).
  • Programs may need to focus more on adult mental health issues for families to participate and engage in activities (six studies).
  • Although studies indicated that many of the programs met EHS performance standards, there was considerable variation in how the model was implemented (one study).
  • Programs should offer services to involve fathers (three studies).
  • The prevalence of disabilities among young children in poverty suggests that programs would benefit from additional help in connecting children with disability support (two studies).

Engagement with families. Lessons related to participant retention included:

  • One study noted the difficulty in reaching full enrollment due to families’ lack of understanding of the required commitment, moving out of the area, and other obligations that interfered with families’ ability to participate fully.
  • Programs should engage families in an ongoing manner to prevent attrition (three studies).
  • Barriers to engagement included staff turnover, difficulties in scheduling visits, and families’ personal challenges (four studies).
  • To achieve family goals, home visitors need to build strong working relationships with families that are trusting, sensitive, and secure (four studies).
  • Programs need to develop new strategies to prevent families with many demographic risk factors from dropping out (two studies).

 

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Prerequisites for Implementation

Type of Implementing Agency

According to the Head Start Program Performance Standards, Early Head Start-Home-Based Option agencies can include (1) entities operating Head Start programs; (2) entities operating American Indian, Alaska Native, or Migrant or Seasonal Head Start programs; and (3) other public entities, and nonprofit or for-profit private entities, including community-based and faith-based organizations.

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Staffing Requirements

Early Head Start-Home-Based Option programs have several primary staff positions:

  • Home visitors who conduct home visits with families and run group socialization meetings,
  • Home visitor supervisors,
  • Comprehensive services staff (such as disabilities and curriculum specialists), and
  • A director who oversees the program.

In addition, Early Head Start-Home-Based Option programs must have management staff with content expertise in the following areas:

  • Early childhood development and health services, including child development and education;
  • Child medical, dental, and mental health;
  • Child nutrition;
  • Services for children with disabilities; and
  • Family and community partnerships, including family support and family engagement.
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Staff Education and Experience

Home visitors providing home-based services must have a minimum of a Home Visitor Child Development Associate (CDA) or comparable credential, or equivalent coursework as part of an associate’s or bachelor’s degree.

Home visitors are also required to demonstrate competency in planning and delivering home-based services that (1) effectively implement the home visiting curriculum; (2) promote children’s progress across the standards described in the Head Start Early Learning Outcomes Framework: Ages Birth to Five, including children with disabilities and dual language learners, as appropriate; and (3) build respectful, culturally responsive, and trusting relationships with families.

The Early Head Start-Home-Based Option director must have demonstrated skills and abilities in a management capacity relevant to human services program management.

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Supervision Requirements

Head Start Program Performance Standards require an organizational structure and staffing patterns to support full implementation of all requirements for the Early Head Start-Home-Based Option.

At a minimum, the Head Start Program Performance Standards require that Early Head Start-Home-Based Option programs conduct performance reviews and use the results to identify training and professional development needs, and assist in improving staff skills and professional competencies.

Programs must monitor curriculum implementation and fidelity, and provide support, feedback, and supervision for continuous improvement of implementation through the system of training and professional development.

Early Head Start recommends several supervision strategies to retain, develop, and support staff. These include consistent, formal, reflective supervision, and opportunities for home visitors to meet together.

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Staff Ratio Requirements

The Head Start Program Performance Standards require that home visitors maintain an average caseload of 10 to 12 families, with a maximum of 12 families for any individual home visitor.

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Data Systems/Technology Requirements

While there are no specific infrastructure or data system requirements, the Office of Head Start recommends that programs establish and maintain record-keeping systems that allow them to provide accurate, up-to-date information and generate timely financial and programmatic reports.

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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the Office of Head Start on January 16, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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Materials and Forms to Support Implementation

Operations Manuals

Information about implementing the Early Head Start-Home-Based Option is included in the Head Start Program Performance Standards and in resources included on the Early Childhood Learning and Knowledge Center (ECLKC) website.

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Service Delivery Forms

Local programs select their own service delivery forms.

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Assessment Tools

Although Early Head Start does not require the use of a specific assessment tool, each Early Head Start program must implement a process for ongoing assessment. The Head Start Program Performance Standards require that programs perform or obtain screenings to identify concerns regarding a child’s developmental, sensory, behavioral, motor, language, social, cognitive, perceptual, and emotional skills. Early Head Start recommends that programs implement screening procedures that are sensitive to the child’s cultural and linguistic background and that the screening be done in conjunction with the child’s parent.

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Curriculum

Early Head Start-Home-Based Option programs must implement a developmentally appropriate, research-based early childhood home visiting curriculum that:

  • Promotes the parent’s role as the child’s teacher through experiences focused on the parent-child relationship and, as appropriate, the family’s traditions, culture, values, and beliefs;
  • Aligns with the Head Start Early Learning Outcomes Framework: Ages Birth to Five and, as appropriate, state early learning standards;
  • Supports measurable progress toward goals outlined in the framework; and,
  • Includes plans and materials for learning experiences based on developmental progressions and how children learn.

Programs must provide parents with an opportunity to review the selected curricula and instructional materials used in the program.

If a program chooses to substantially modify a curriculum to better meet the needs of one or more specific populations, the program must (1) partner with early childhood education curriculum or content experts, and (2) assess if the adaptation adequately facilitates progress toward school readiness goals.

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Available Languages

Because programs select their own research-based early childhood home visiting curriculum, they can select materials in the languages appropriate for the families they serve. All Early Head Start-Home-Based Option programs are required, through the Head Start Program Performance Standards, to work with families in their primary, or preferred language.

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Fidelity Measurement

According to the Head Start Program Performance Standards, Early Head Start-Home-Based Option programs must establish and implement procedures for the ongoing monitoring of their own operations, as well as those of each of their delegate agencies. At least once every program year, Early Head Start-Home-Based Option programs must conduct a self-assessment of their effectiveness and progress in meeting program goals and objectives and in implementing federal regulations. Early Head Start-Home-Based Option programs are monitored for compliance with the performance standards by a team of external consultants according to a schedule based on the program’s five-year funding cycle. The review teams use a monitoring protocol developed by the Office of Head Start to review programs.

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Fidelity Standards

All Early Head Start-Home-Based Option programs must follow relevant Head Start Program Performance Standards.

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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the Office of Head Start on January 16, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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Model Overview

Implementation Support

The Early Head Start-Home-Based Option is administered by the Office of Head Start in the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services (HHS).

ACF regional offices oversee the administration of ACF programs, including the Early Head Start-Home-Based Option. The regional offices guide the programmatic and financial management of the Early Head Start-Home-Based Option in their jurisdictions and provide assistance, resources, and information to the various entities responsible for administering these programs.

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Theoretical Model

The Early Head Start-Home-Based Option is a comprehensive, two-generation federal initiative aimed at enhancing the development of infants and toddlers while strengthening families. The model is founded on nine principles:

  1. High-quality services;
  2. Activities that promote healthy development and identify atypical development at the earliest stage possible;
  3. Positive relationships and continuity, with an emphasis on the role of the parent as the child’s first, and most important, relationship;
  4. Activities that offer parents a meaningful and strategic role in the program’s vision, services, and governance;
  5. Inclusion strategies that respect the unique developmental trajectories of young children in the context of a typical setting, including children with disabilities;
  6. Cultural competence that acknowledges the profound role that culture plays in early development;
  7. Comprehensiveness, flexibility, and responsiveness of services that allow children and families to move across various program options over time as their life situation demands;
  8. Transition planning; and
  9. Collaboration with community partnerships that allow programs to expand their services.
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Target Population

The Early Head Start-Home-Based Option targets low-income pregnant women and families with children from birth to age 3 years. To be eligible for the Early Head Start-Home-Based Option, most families must be at or below the federal poverty level. Early Head Start-Home-Based Option programs must make at least 10 percent of their enrollment opportunities available to children with disabilities who are eligible for Part C services under the Individuals with Disabilities Education Act in their state. Each individual Early Head Start-Home-Based Option program is allowed to develop specific program eligibility criteria, aligned with the model’s performance standards.

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Targeted Outcomes

The Early Head Start-Home-Based Option aims to (1) promote healthy prenatal outcomes for pregnant women, (2) enhance the development of very young children, and (3) promote healthy family functioning.

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Model Components

The Early Head Start model includes home- or center-based services, a combination of home- and center-based programs, and family child care services (services provided in family child care homes). The focus of this report is on the home-based service option. Early Head Start-Home-Based Option services include (1) weekly 90-minute home visits, and (2) two group socialization activities per month for parents and their children.

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Model Intensity and Length

Early Head Start-Home-Based Option programs provide one home visit per week per family (with a minimum of 46 home visits per year) lasting for a minimum of 90 minutes each. They also provide a minimum of 2 group socialization activities per month for each family (with a minimum of 22 group socialization activities each year).

Early Head Start-Home-Based Option services are provided to eligible pregnant women and families with children from birth to 3 years of age.

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Location

Early Head Start-Home-Based Option programs operate in all 50 states, the District of Columbia, and the U.S. territories of American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.

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Adaptations and Enhancements

No information is available.

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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the Office of Head Start on January 16, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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