Implementing Early Start (New Zealand) Meets HHS Criteria

Model implementation profile 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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Implementation support availability

Early Start Project Ltd., a charitable non-governmental organization based in New Zealand, provides implementation support. The New Zealand Ministry of Development and Family and Community Service may provide technical assistance. The Early Start Project Ltd. also arranges with a private organization for technical assistance and support, especially for the development and maintenance of Early Start’s data systems.

Early Start Project Ltd. is available to consult with organizations interested in replicating the model outside of New Zealand.

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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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Targeted outcomes

Early Start is 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.

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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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Model intensity and length

Early Start includes four levels of service intensity:

  • Level 1 - High need: Up to three hours of client contact per week, which includes direct contact (via home visits) and indirect contact (such as reviewing client case notes and health recordings, planning, and discussing cases)
  • Level 2 - Moderate need: Up to three hours of home visiting per two-week period
  • Level 3 - Low need: Up to one hour of home visiting per month
  • Level 4 - Graduate: Up to one hour of contact (phone/home visitation) per three months

All families enter the program at Level 1 and move to higher levels over time based on their progress. Level changes are determined by home visitors in consultation with their supervisors.

Families can continue to receive services until the child reaches age 5.

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Adaptations and enhancements

The Early Start Project Ltd. reviews practices and adjusts the model to meet identified needs. Practices may be reviewed based on feedback from participants and home visitors, and the Early Start Project Ltd. also reviews practices periodically to adjust the model as needs arise in specific communities.

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Organizational requirements

The Early Start Project Ltd. recommends that organizations develop their Early Start program from the ground up by starting small and involving the community. The Early Start Project Ltd. does not have requirements or recommendations about the type or characteristics of organizations that can implement the model.

The model requires both programs and home visitors to meet a set of ongoing fidelity guidelines outlined in the Key Operating Policies and Procedures performance standards. Please contact the model developer for additional information about these guidelines.

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Staffing requirements

Early Start is staffed by home visitors (called Family Support Workers/Whanau Awhina), a general manager, a registered social worker, supervisors, and administrative support staff.

Programs employ home visitors with educational backgrounds in nursing, social work, early childhood education, teaching, or related fields. Home visitors must also have an awareness of relevant cultural issues, experience working with high-risk families, and evidence of good interpersonal skills and sound judgment. The Early Start Project Ltd. recommends, but does not require, that supervisors have an undergraduate degree in a social service or health area.

Home visitors receive, on average, two hours of supervision each week from trained supervisors. During these sessions, the pair reviews the home visitor’s caseload and case notes. They also discuss future plans for families. In addition, the supervisor provides time for the home visitor to discuss challenges or concerns.

Home visitors undergo four weeks of training that provides background on a wide range of issues relevant to family support work. Supervisors participate in a supervision training course. Please contact the model developer for additional information about the pre-service training requirement.

Each home visitor must receive a minimum of 20 hours of in-service training per year. Please contact the model developer for additional information about the ongoing professional development requirements for home visitors and supervisors.

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