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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.

Model(s) Reviewed: Early Head Start Home-Based Option
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
High Randomized controlled trial Low Established on race/ethnicity and socioeconomic status; Established on many relevant outcomes None None
Notes:

footnote38

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

The study expressed some effect sizes as a percentage of the standard deviation. To be consistent with other studies, HomVEE divided the study-reported effect size by 100 and rounded to two decimal places.

footnote175

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

This study received a mixed rating. Outcomes from the 24-month parent interview have low attrition and receive a high rating, except parent&rsquo;s overall health and maternal depression outcomes, which were assessable at baseline but did not demonstrate baseline equivalence and were not controlled, and therefore rate moderate. Outcomes from the Parent Services Interview had low attrition, but baseline equivalence for race/ethnicity and <abbr title="socioeconomic status">SES</abbr> was not established on the analytic sample, so these outcomes rate moderate. Outcomes from the Child Assessment (Bayley) and Parent/Child Interactions have high attrition and were not assessable at baseline, so those outcomes receive a moderate rating.

Study characteristics
Study participants This study relies on data from a randomized controlled trial of 17 Early Head Start (EHS) programs that began in 1995. Seven of the programs served clients through a home-based option (though other clients in other EHS options also received home visits) and are the focus of this report (EHS-HBO). The study randomly assigned 1,385 families, who applied to those 7 programs, either to receive home-based EHS or a comparison condition. This study included outcomes reported for the 2-year-old follow-up (other years of follow-up are reported in separate studies). For this follow-up, 966 parents (500 in EHS-HBO and 466 in the comparison group) provided data for parent interviews. Among parent interview participants, 45 percent were white, 25 percent were black, and 27 percent were Hispanic. One in four parents had more than a high school education, and one in 10 were in families living above the poverty line; one-third to one-half of families were receiving Aid to Families with Dependent Children (AFDC) or Food Stamps.
Setting The study was conducted in 17 EHS programs throughout the United States, including 7 programs with home-based options, which are the focus of this report. Four programs were located in urban areas, and three programs were located in rural areas. The seven programs represented a mix of implementation timing; one early implementer had all EHS-HBO elements in place by 1997, and three later implementers had all elements in place by 1999; three programs did not have all elements in place by 1999. The early-implementing program had fully implemented both child and family development services early and continued to have those services in place in 1999.
Intervention services EHS-HBO services are intended to be delivered to study families via weekly home visits. Seventy percent of families in these programs received weekly visits during at least one of the first two follow-up periods, and 26 percent received such services throughout both periods. Over the first two years, families in the home-based option received an average of 71 visits. Typical home visits are at least one hour long. Topics for home visits included child growth and development, child play activities, housing issues, and parent-child communication.
Comparison conditions Control group families could not receive EHS-HBO services, but could receive other services available in their community.
Staff characteristics and training Not specified
Funding sources Administration for Children and Families (ACF), the Child Outcomes Research and Evaluation team (CORE)within ACF’s Office of Planning, Research and Evaluation (OPRE), and the Head Start Bureau in the Administration on Children, Youth and Families (ACYF)
Author affiliation None of the study authors are developers of this model.

Findings details

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High CBCL – Aggression
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 10.40 Adjusted mean = 10.50 Mean difference = -0.10 Study reported = -0.01 Not statistically significant, p ≥ 0.05
High Average MacArthur CDI – Sentence Complexity
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 8.50 Adjusted mean = 7.80 Mean difference = 0.70 Study reported = 0.08 Not statistically significant, p ≥ 0.05
High MacArthur CDI – Vocabulary Production
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 56.40 Adjusted mean = 53.50 Mean difference = 2.90 Study reported = 0.13 Not statistically significant, p ≥ 0.05
High Percentage MacArthur CDI combining words
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 77.30 Adjusted mean = 75.60 Mean difference = 1.70 Study reported = 0.04 Not statistically significant, p ≥ 0.05
High Percentage with sentence complexity <2
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 28.30 Adjusted mean = 30.20 Mean difference = -1.90 Study reported = -0.04 Not statistically significant, p ≥ 0.05
High Percentage with vocabulary production <25
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 11.30 Adjusted mean = 11.20 Mean difference = 0.10 Study reported = 0.01 Not statistically significant, p ≥ 0.05
Moderate BSID Mental Development Index (MDI)standard score
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 814 children Adjusted mean = 91.60 Adjusted mean = 90.50 Mean difference = 1.10 Study reported = 0.08 Not statistically significant, p ≥ 0.05
Moderate Bayley BRS – Emotional Regulation
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 814 children Adjusted mean = 3.60 Adjusted mean = 3.60 Mean difference = 0.00 Study reported = 0.07 Not statistically significant, p ≥ 0.05
Moderate Bayley BRS – Orientation/Engagement
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 814 children Adjusted mean = 3.60 Adjusted mean = 3.60 Mean difference = 0.00 Study reported = 0.01 Not statistically significant, p ≥ 0.05
Moderate Parent-Child Structured Play: Child Engagement
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 794 children Adjusted mean = 4.30 Adjusted mean = 4.30 Mean difference = 0.00 Study reported = 0.02 Not statistically significant, p ≥ 0.05
Moderate Parent-Child Structured Play: Child Negativity Toward Parent
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 794 children Adjusted mean = 1.70 Adjusted mean = 1.70 Mean difference = 0.00 Study reported = -0.02 Not statistically significant, p ≥ 0.05
Moderate Parent-Child Structured Play: Child Sustained Attention with Objects
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 794 children Adjusted mean = 5.10 Adjusted mean = 5.00 Mean difference = 0.10 Study reported = 0.05 Not statistically significant, p ≥ 0.05
Moderate Percentage with MDI < 100
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 814 children Adjusted mean = 73.00 Adjusted mean = 71.90 Mean difference = 1.10 Study reported = 0.03 Not statistically significant, p ≥ 0.05
Moderate Percentage with MDI < 85
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 814 children Adjusted mean = 31.50 Adjusted mean = 32.50 Mean difference = -1.00 Study reported = -0.02 Not statistically significant, p ≥ 0.05
Child health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Any child health services
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 7 to 16 months after assignment 1,059 mothers % = 99.10 % = 99.60 = -0.50 HomeVEE calculated = -0.05 Not statistically significant, p ≥ 0.05
Moderate Any dentist visits
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 7 to 16 months after assignment 1,059 mothers % = 10.70 % = 10.80 = -0.10 HomeVEE calculated = -0.01 Not statistically significant, p ≥ 0.05
Moderate Any doctor visits
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 7 to 16 months after assignment 1,059 mothers % = 93.60 % = 93.40 = 0.20 HomeVEE calculated = 0.02 Not statistically significant, p ≥ 0.05
Moderate Any emergency room visits
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 7 to 16 months after assignment 1,059 mothers % = 41.30 % = 43.20 = -1.90 HomeVEE calculated = -0.05 Not statistically significant, p ≥ 0.05
Moderate Any immunizations
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 7 to 16 months after assignment 1,059 mothers % = 96.30 % = 97.90 = -1.60 HomeVEE calculated = -0.35 Not statistically significant, p ≥ 0.05
Moderate Any screening tests
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 7 to 16 months after assignment 1,059 mothers % = 52.40 % = 49.40 = 3.00 HomeVEE calculated = 0.07 Not statistically significant, p ≥ 0.05
Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Average hours per week employed
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers Adjusted mean = 12.70 Adjusted mean = 13.80 Mean difference = -1.10 Study reported = 0.07 Not statistically significant, p ≥ 0.05
Moderate Average hours per week in any employment, education, or training activity
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers Adjusted mean = 17.80 Adjusted mean = 17.70 Mean difference = 0.10 Study reported = -0.01 Not statistically significant, p ≥ 0.05
Moderate Average hours per week in education or training
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers Adjusted mean = 4.90 Adjusted mean = 3.70 Mean difference = 1.20 Study reported = -0.16 Statistically significant,
p < 0.01
Moderate Employed: 1st quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 36.00 % = 39.20 = -3.20 Study reported = 0.06 Not statistically significant, p ≥ 0.05
Moderate Employed: 2nd quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 39.80 % = 46.40 = -6.60 Study reported = 0.13 Statistically significant,
p < 0.05
Moderate Employed: 3rd quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 46.80 % = 51.00 = -4.20 Study reported = 0.08 Not statistically significant, p ≥ 0.05
Moderate Employed: 4th quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 52.20 % = 53.00 = -0.80 Study reported = 0.02 Not statistically significant, p ≥ 0.05
Moderate Employed: 5th quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 57.10 % = 60.80 = -3.70 Study reported = 0.08 Not statistically significant, p ≥ 0.05
Moderate Employment, education, or training: 1st quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 53.00 % = 52.90 = 0.10 Study reported = 0.00 Not statistically significant, p ≥ 0.05
Moderate Employment, education, or training: 2nd quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 57.90 % = 59.90 = -2.00 Study reported = 0.04 Not statistically significant, p ≥ 0.05
Moderate Employment, education, or training: 3rd quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 62.50 % = 59.90 = -1.50 Study reported = 0.03 Not statistically significant, p ≥ 0.05
Moderate Employment, education, or training: 4th quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 65.30 % = 64.00 = 1.90 Study reported = -0.04 Not statistically significant, p ≥ 0.05
Moderate Employment, education, or training: 5th quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 69.30 % = 63.40 = -1.20 Study reported = 0.03 Not statistically significant, p ≥ 0.05
Moderate Ever employed
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 66.90 % = 69.60 = -2.70 Study reported = 0.06 Not statistically significant, p ≥ 0.05
Moderate Ever employed or in education/training
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 79.20 % = 80.20 = -1.00 Study reported = 0.03 Not statistically significant, p ≥ 0.05
Moderate Ever in ESL class (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 2.30 % = 0.70 = 1.60 Study reported = -0.15 Statistically significant,
p < 0.05
Moderate Ever in education or training (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 45.50 % = 39.60 = 6.30 Study reported = -0.12 Statistically significant,
p < 0.05
Moderate Ever in high school (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 11.50 % = 6.20 = 5.30 Study reported = -0.18 Statistically significant,
p < 0.01
Moderate Ever in vocational program (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 12.70 % = 8.50 = -6.80 Study reported = -0.15 Statistically significant,
p < 0.05
Moderate Ever received AFDC or TANF
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 54.10 % = 52.60 Not reported = -1.50 Study reported = -0.03 Not statistically significant, p ≥ 0.05
Moderate Ever received food stamps
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 66.00 % = 64.20 = 1.80 Study reported = -0.04 Not statistically significant, p ≥ 0.05
Moderate Ever received welfare
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 75.30 % = 69.60 = 2.70 Study reported = -0.06 Not statistically significant, p ≥ 0.05
Moderate Have GED
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 8.20 % = 9.00 = -0.80 Study reported = 0.03 Not statistically significant, p ≥ 0.05
Moderate Have high school diploma
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 46.50 % = 45.90 = 0.60 Study reported = -0.01 Not statistically significant, p ≥ 0.05
Moderate In education or training: 1st quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 24.50 % = 23.30 = 1.20 Study reported = -0.03 Not statistically significant, p ≥ 0.05
Moderate In education or training: 2nd quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 28.90 % = 24.60 = 4.30 Study reported = -0.10 Not statistically significant, p ≥ 0.05
Moderate In education or training: 3rd quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 29.50 % = 26.70 = 2.80 Study reported = -0.06 Not statistically significant, p ≥ 0.05
Moderate In education or training: 4th quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 28.20 % = 22.60 = 5.60 Study reported = -0.13 Statistically significant,
p < 0.05
Moderate In education or training: 5th quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 30.50 % = 23.60 = 6.90 Study reported = -0.16 Statistically significant,
p < 0.05
Moderate Income above poverty line, (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers Adjusted mean % = 30.50 Adjusted mean % = 29.70 Mean difference = 30.80 Study reported = -0.02 Not statistically significant, p ≥ 0.05
Moderate Received AFDC or TANF: 1st quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 43.20 % = 40.40 = 2.80 Study reported = -0.06 Not statistically significant, p ≥ 0.05
Moderate Received AFDC or TANF: 2nd quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 42.60 % = 43.00 = -0.40 Study reported = 0.01 Not statistically significant, p ≥ 0.05
Moderate Received AFDC or TANF: 3rd quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 47.00 % = 44.50 = 2.50 Study reported = -0.05 Not statistically significant, p ≥ 0.05
Moderate Received AFDC or TANF: 4th quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 39.20 % = 39.50 = -0.30 Study reported = -0.01 Not statistically significant, p ≥ 0.05
Moderate Received AFDC or TANF: 5th quarter
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 37.80 % = 38.80 = -1.00 Study reported = 0.02 Not statistically significant, p ≥ 0.05
Moderate Total AFDC or TANF benefits ($)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers Adjusted mean = 1967.80 Adjusted mean = 1927.50 Mean difference = 49.30 Study reported = -0.02 Not statistically significant, p ≥ 0.05
Moderate Total food stamps benefits ($)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers Adjusted mean = 1435.80 Adjusted mean = 1400.90 Mean difference = 34.90 Study reported = -0.02 Not statistically significant, p ≥ 0.05
Moderate Total welfare benefits ($)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers Adjusted mean = 4141.40 Adjusted mean = 3911.70 Mean difference = 229.70 Study reported = -0.05 Not statistically significant, p ≥ 0.05
Linkages and referrals
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Any education-related services
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 83.40 % = 45.20 = 38.20 Study reported = 1.09 Statistically significant, p < 0.01
Moderate Any employment-related services
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 71.60 % = 32.60 = 39.00 Study reported = 1.00 Statistically significant, p < 0.01
Moderate Any family health services
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 97.60 % = 98.20 = -0.60 Study reported = -0.18 Not statistically significant, p ≥ 0.05
Moderate Any family mental health services
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 19.70 % = 18.40 = 1.30 Study reported = 0.05 Not statistically significant, p ≥ 0.05
Moderate Housing assistance
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 55.60 % = 54.20 = 1.40 Study reported = 0.03 Not statistically significant, p ≥ 0.05
Moderate Identification of child’s disability
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 5.10 % = 2.50 = 2.60 Study reported = 0.45 Statistically significant, p < 0.05
Moderate Services for child with disability
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 3.80 % = 1.70 = 2.10 Study reported = 0.50 Statistically significant, p < 0.05
Moderate Transportation assistance
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study 7 to 16 months after assignment 1,059 mothers % = 29.80 % = 20.70 = 9.10 Study reported = 0.29 Statistically significant, p < 0.01
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High FES: Family conflict
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 24 months postpartum 966 mothers Adjusted mean = 1.70 Adjusted mean = 1.70 Mean difference = 0.00 Study reported = -0.12 Not statistically significant, p ≥ 0.05
High PSI Parent-Child dysfunctional interaction
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 24 months postpartum 966 mothers Adjusted mean = 17.10 Adjusted mean = 17.50 Mean difference = -0.40 Study reported = -0.07 Not statistically significant, p ≥ 0.05
High PSI parental distress
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 24 months postpartum 966 mothers Adjusted mean = 25.10 Adjusted mean = 26.20 Mean difference = -1.10 Study reported = -0.11 Not statistically significant, p ≥ 0.05
Moderate CIDI short screening scales: Major depression (probability)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 24 months postpartum 966 mothers Adjusted mean = 14.70 Adjusted mean = 12.00 Mean difference = 2.80 Study reported = 0.09 Not statistically significant, p ≥ 0.05
Moderate Parent’s health status
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact sample 24 months postpartum 966 mothers Adjusted mean = 3.40 Adjusted mean = 3.40 Mean difference = 0.00 Study reported = 0.00 Not statistically significant, p ≥ 0.05
Positive parenting practices
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High HOME absence of punitive interactions
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 4.30 Adjusted mean = 4.30 Mean difference = 0.00 Study reported = -0.01 Not statistically significant, p ≥ 0.05
High HOME emotional responsivity
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 6.50 Adjusted mean = 6.40 Mean difference = 0.10 Study reported = 0.10 Not statistically significant, p ≥ 0.05
High HOME maternal verbal/social skills
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 2.90 Adjusted mean = 2.90 Mean difference = 0.00 Study reported = 0.05 Not statistically significant, p ≥ 0.05
High HOME support of cognitive, language, and literacy environment
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 10.30 Adjusted mean = 10.10 Mean difference = 0.20 Study reported = 0.10 Not statistically significant, p ≥ 0.05
High HOME total score
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 26.90 Adjusted mean = 26.40 Mean difference = 0.50 Study reported = 0.13 Statistically significant,
p < 0.05
High KIDI
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 3.40 Adjusted mean = 3.30 Mean difference = 0.10 Study reported = 0.17 Statistically significant,
p < 0.05
High Covers electric outlets (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 61.00 % = 57.20 = -3.80 Study reported = 0.08 Not statistically significant, p ≥ 0.05
High Has gates or doors in front of stairs (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 72.70 % = 75.50 = -2.80 Study reported = -0.07 Not statistically significant, p ≥ 0.05
High Has poison control number (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 36.50 % = 36.40 = 0.10 Study reported = 0.00 Not statistically significant, p ≥ 0.05
High Has syrup of Ipecac at home (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 30.20 % = 30.60 = -0.40 Study reported = -0.01 Not statistically significant, p ≥ 0.05
High Home has working smoke alarm (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 83.20 % = 83.30 = -0.01 Study reported = 0.00 Not statistically significant, p ≥ 0.05
High Index of discipline severity
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 2.50 Adjusted mean = 2.60 Mean difference = -0.10 Study reported = -0.06 Not statistically significant, p ≥ 0.05
High Observed child play area is safe (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 74.60 % = 74.20 = 0.04 Study reported = 0.01 Not statistically significant, p ≥ 0.05
High Parent-child activities to stimulate cognitive and language development
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 4.50 Adjusted mean = 4.50 Mean difference = 0.00 Study reported = 0.05 Not statistically significant, p ≥ 0.05
High Percentage of parents and children that have regular bedtime routines
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 69.20 % = 65.10 = 4.10 Study reported = 0.09 Not statistically significant, p ≥ 0.05
High Percentage of parents suggesting only mild responses to the hypothetical conflicts
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 48.00 % = 45.10 = 2.90 Study reported = 0.06 Not statistically significant, p ≥ 0.05
High Percentage of parents that read to child as part of bedtime routine
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 26.00 % = 19.50 = 6.50 Study reported = 0.16 Statistically significant,
p < 0.05
High Percentage of parents that read to child daily
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 55.50 % = 54.40 = 1.10 Study reported = 0.02 Not statistically significant, p ≥ 0.05
High Percentage of parents that set a regular bedtime for child
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 58.70 % = 54.00 = 4.70 Study reported = 0.09 Not statistically significant, p ≥ 0.05
High Percentage of parents that suggest responses to hypothetical conflict with child: Physical punishment
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 23.00 % = 26.10 = -3.10 Study reported = -0.07 Not statistically significant, p ≥ 0.05
High Percentage of parents that suggest responses to hypothetical conflict with child: Prevent or distract
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 69.60 % = 66.60 = 3.00 Study reported = 0.07 Not statistically significant, p ≥ 0.05
High Percentage of parents that suggest responses to hypothetical conflict with child: Remove child or object
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 78.60 % = 80.40 = -1.80 Study reported = -0.05 Not statistically significant, p ≥ 0.05
High Percentage of parents that suggest responses to hypothetical conflict with child: Shout
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 6.00 % = 3.60 = 2.40 Study reported = 0.11 Not statistically significant, p ≥ 0.05
High Percentage of parents that suggest responses to hypothetical conflict with child: Talk and explain
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 34.10 % = 28.10 = 6.00 Study reported = 0.13 Not statistically significant, p ≥ 0.05
High Percentage of parents that suggest responses to hypothetical conflict with child: Threaten or command
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 28.80 % = 28.20 = 0.50 Study reported = 0.01 Not statistically significant, p ≥ 0.05
High Reading frequency
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children Adjusted mean = 4.60 Adjusted mean = 4.60 Mean difference = 0.00 Study reported = -0.01 Not statistically significant, p ≥ 0.05
High Spanked child in last week (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 49.00 % = 52.40 = -3.40 Study reported = -0.07 Not statistically significant, p ≥ 0.05
High Uses a car seat (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 81.10 % = 80.70 = 0.04 Study reported = 0.01 Not statistically significant, p ≥ 0.05
High Uses guards or gates for windows (percentage)
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 966 children % = 52.60 % = 55.40 = -2.80 Study reported = -0.06 Not statistically significant, p ≥ 0.05
Moderate Parent-child structured play: Negative regard
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 794 children Adjusted mean = 1.40 Adjusted mean = 1.50 Mean difference = -0.10 Study reported = -0.05 Not statistically significant, p ≥ 0.05
Moderate Parent-child structured play: Parent detachment
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 794 children Adjusted mean = 1.40 Adjusted mean = 1.50 Mean difference = -0.10 Study reported = -0.15 Not statistically significant, p ≥ 0.05
Moderate Parent-child structured play: Parent intrusiveness
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 794 children Adjusted mean = 1.80 Adjusted mean = 1.90 Mean difference = -0.10 Study reported = -0.07 Not statistically significant, p ≥ 0.05
Moderate Parent-child structured play: Parent supportiveness
FavorableUnfavorable or ambiguousNo Effect
EHS-HBO impact study Age 2 794 children Adjusted mean = 4.00 Adjusted mean = 3.90 Mean difference = 0.10 Study reported = 0.14 Not statistically significant, p ≥ 0.05

Outcome measure summary

Child development and school readiness
Outcome measure Description of measure Data collection method Properties of measure

CBCL: Aggression

The CBCL is a questionnaire that assesses behavioral problems in young children. Parent/caregiver report

Not reported by author

MacArthur CDI – Vocabulary ProductionPercentage with vocabulary production < 25Percent MacArthur CDI combining wordsAverage MacArthur CDI – Sentence ComplexityPercentage 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

BSID, MDIPercentage with MDI <85Percentage 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

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

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

Child health
Outcome measure Description of measure Data collection method Properties of measure

Any child health services

No description provided Parent report

Not applicable

Any dentist visits

No description provided Parent report

Not applicable

Any doctor visits

No description provided Parent report

Not applicable

Any emergency room visits

No description provided Parent report

Not applicable

Any immunizations

No description provided Parent report

Not applicable

Any screening tests

No description provided Parent report

Not applicable

Family economic self-sufficiency
Outcome measure Description of measure Data collection method Properties of measure

Average hours per week employed

Parents were asked about jobs that they had held during the follow-up period, including the start and end dates for those jobs and the typical hours per week they worked in those jobs. From that information, the authors constructed a weekly timeline of employment activities and indicators of whether parents were employed during the first five quarters following random assignment. They also calculated the average hours per week parents spent in employment during the 15-month follow-up period. Averages include zero hours. Parent report

Not applicable

Average hours per week in any employment, education, or training activity

The weekly histories of education/training activities and jobs were combined to create a timeline of participation in any of these self-sufficiency activities and indicators of whether parents participated in any self-sufficiency activities during each of the first five quarters following random assignment. The authors also added the average number of hours spent in education/training and jobs to get the average number of hours parents spent in any self-sufficiency activities during the first 15 months after random assignment. Averages include zero hours. Parent report

Not applicable

Average hours per week in education or training

The average hours per week that program participants spent in school or job/vocational training Parent/caregiver report

Not applicable

Employed

Percentage of parents who were employed at the 1st, 2nd, 3rd, 4th, and 5th quarters after enrolling in EHS Parent/caregiver report

Not applicable

Employment, education, or training

Percentage of parents who participated in school, job/vocational training, or employment activities at the 1st, 2nd, 3rd, 4th, and 5th quarters after enrolling in EHS Parent/caregiver report

Not applicable

Ever employed

Percentage of parents who had ever been employed during their time in the program Parent/caregiver report

Not applicable

Ever employed or in education/training

Percentage of parents who had ever participated in an education or job training program or been employed during their time in the program Parent/caregiver report

Not applicable

Ever in ESL class

Percentage of parents who had ever enrolled in ESL classes during their time in EHS Parent/caregiver report

Not applicable

Ever in education or training

Percentage of parents who had ever participated in an education or job training program during their time in EHS Parent/caregiver report

Not applicable

Ever in high school

Percentage of parents who had ever enrolled in high school during their time in EHS Parent/caregiver report

Not applicable

Ever in vocational program

Percentage of parents who had ever enrolled in a vocational training program during their time in EHS Parent/caregiver report

Not applicable

Ever received AFDC or TANF

Parents were asked about their receipt of benefits, including the amount they received and the months during which they received it. From this information the authors created a monthly timeline of benefit receipt, as well as indicators of benefit receipt during each of the first five quarters after random assignment. They also added the benefit amounts to obtain the total amount received during the 15-month follow-up period. Parent report

Not applicable

Ever received food stamps

Parents were asked about their receipt of benefits, including the amount they received and the months during which they received it. From this information the authors created a monthly timeline of benefit receipt, as well as indicators of benefit receipt during each of the first five quarters after random assignment. They also added the benefit amounts to obtain the total amount received during the 15-month follow-up period. Parent report

Not applicable

Ever received other welfare

Percentage of households that had ever received welfare benefits during their time in the program, including (1) AFDC or TANF, (2) SSI, (3) food stamps, and (4) GA Parent/caregiver report

Not applicable

Ever received welfare

Parents were asked about their receipt of benefits, including the amount they received and the months during which they received it. From this information the authors created a monthly timeline of benefit receipt, as well as indicators of benefit receipt during each of the first five quarters after random assignment. They also added the benefit amounts to obtain the total amount received during the 15-month follow-up period. Parent report

Not applicable

Has GED

Percentage of parents who had earned a GED Parent/caregiver report

Not applicable

Has high school diploma

Percentage of parents who had earned a high school diploma Parent/caregiver report

Not applicable

In education or training

Percentage of parents who were participating in an education or job training program at the 1st, 2nd, 3rd, 4th, and 5th quarters after enrolling in EHS Parent/caregiver report

Not applicable

Income above poverty line, (percentage)

Parents were asked about their family income during the last year. The authors compared information on their annual income and the number of children in their family with federal poverty levels to create an indicator of whether or not the family’s income during the year prior to the second follow-up was above the poverty level. Parent report

Not applicable

Received AFDC or TANF

Percentage of households that had ever received AFDC or TANF at the 1st, 2nd, 3rd, 4th, and 5th quarters after enrolling in EHS Parent/caregiver report

Not applicable

Total AFDC or TANF benefits

A sum of reported household AFDC or TANF benefits Parent/caregiver report

Not applicable

Total food stamp benefits

A sum of reported household food stamp benefits Parent/caregiver report

Not applicable

Total welfare benefits ($)

A sum of all reported household welfare benefits, including (1) AFDC or TANF, (2) SSI, (3) food stamps, and (4) GA Parent/caregiver report

Not applicable

Linkages and referrals
Outcome measure Description of measure Data collection method Properties of measure

Any education-related services

Indicates whether the family reported receiving any education-related services from the EHS program Parent interview

Not applicable

Any employment-related services

Indicates whether the family reported receiving help finding a job from the EHS program Parent interview

Not applicable

Any family health services

No description provided Parent report

Not applicable

Any family mental health services

No description provided Parent report

Not applicable

Housing assistance

Indicates whether the family reported receiving housing assistance from the EHS program Parent interview

Not applicable

Identification of child’s disability

Indicates whether the family reported that a child’s disability was identified Parent interview

Not applicable

Services for child with disability

Indicates whether the family reported receiving services for a child with a disability Parent interview

Not applicable

Transportation assistance

Indicates whether the family reported receiving trasnporation assistance from the EHS program Parent interview

Not applicable

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

FES: Family conflict

The FES assesses the social-environmental characteristics of families. The researchers used the Family Conflict dimension, which measures the extent to which anger, aggression, frustration, and contentious interactions are common in the family. Parent/caregiver report

Cronbach’s α = 0.67

PSI–SF: Parental DistressPSI: Parent-Child Dysfunctional Interaction

The PSI–SF assesses stress in the parent-child relationship arising from child temperament, parental depression, and negatively reinforcing parent-child interactions. The researchers used two subscales: (1) Parental Distress, which measures the level of distress parents feel in their role because of personal factors; and (2) Parent-Child Dysfunctional Interaction, which measures parents’ perception of parent-child interaction not meeting expectations and feelings of child rejection and abuse. Parent/caregiver report

Cronbach’s α = 0.82 (Parental Distress)Cronbach’s a = 0.78 (Parent Child Dysfunctional Interaction)

CIDI-SF: Major depression

The CIDI-SF assesses the presence of six Diagnostic and Statistical Manual of Mental Disorders and two DSM-IIIR substance disorders. The researchers used one section of the CIDI-SF, Major Depression, which provided the probability of a depressive episode having been experienced during the previous 12 months. Parent/caregiver report

Not reported by author

CIDI short screening scales: Major depression (probability)

Provides a probability for a DSM-IV major depressive episode in the past 12 months Parent assessment

Not reported by author

Parent’s health status

A measure of perceived health status on a scale of 1 (poor) to 5 (excellent) Parent/caregiver report

Not reported by author

Positive parenting practices
Outcome measure Description of measure Data collection method Properties of measure

KIDI

The KIDI measures the parent’s knowledge of childrearing practices and developmental processes. The researchers selected a subset of 8 items from the 17 items used in the Infant Health and Development Program evaluation. Items were coded on a 4-point scale indicating the average level of accuracy of responses to each statement. Parent/caregiver report

Cronbach’s α = .56

HOME:

  • Emotional responsivity
  • Total score
  • Support of cognitive, language, and literacy environment
  • Maternal verbal/social skills
  • Absence of punitive interactions
The HOME assesses parenting practices and aspects of the home environment. Emotional responsivity measures the parent’s verbal responsivity to child, praise of child, and expressions of warmth and affection to child (sum of 7 observation items). Support of cognitive, language, and literacy environment measures the presence of toys, books, and developmentally appropriate furnishings and equipment. It also includes parental cognitive stimulation such as reading and talking to the child (sum of 12 items). Maternal verbal-social skills measures the parent’s ability to speak freely and clearly to the interviewer, with a maximum potential score of 3. Absence of punitive interactions measured harsh or punitive parenting behavior observed during the HOME interview. Items were scored 1 if the parent did not engage in the particular harsh or punitive behavior. Parent/caregiver interview and observational assessment

Cronbach’s α = 0.74 (Emotional responsivity) Cronbach’s α = 0.76 (Total score)  Cronbach’s α = 0.68 (Support of cognitive, language, and literacy environment) Cronbach’s α = 0.71 (Maternal verbal/social skills) Cronbach’s α = 0.78 (absence of punitive interactions)

Covers electric outlets

Percentage of families who used covers for the electrical outlets that the child could reach in the home Parent/caregiver report

Not applicable

Has gates or doors in front of stairs

Percentage of families who used guards or gates in front of their staircases Parent/caregiver report

Not applicable

Has poison control number

Percentage of parents who had access to the poison control number in case of poison emergencies Parent/caregiver report

Not applicable

Has syrup of Ipecac at home

Percentage of parents who kept syrup of Ipecac in the home in case of poison emergencies Parent/caregiver report

Not applicable

Home has working smoke alarm

Percentage of families who had working smoke alarms in the home Parent/caregiver report

Not applicable

Observed child play area is safe

Percentage of families who had a safe child play area Interviewer observation

Not applicable

Parent-child activities to stimulate cognitive and language development

The frequency with which the parent engaged in several activities with the child that can stimulate cognitive and language development, including reading or telling stories, dancing, singing, and playing outside together Parent/caregiver report

Not reported by author

Percentage of parents and children who have regular bedtime routines

Percentage of parents who had regular routines with the child around bedtime, such as singing lullabies, putting toys away, or telling stories Parent/caregiver report

Not applicable

Percentage of parents who read to child as part of bedtime routine

Percentage of parents who read to child as part of the regular bedtime routine and followed this routine four out of five weekdays in previous week Parent/caregiver report

Not applicable

Percentage of parents who read to child daily

Percentage of parents who read to the child every day or more than once per day Parent/caregiver report

Not applicable

Percentage of parents who set a regular bedtime for child

Percentage of parents who set a regular bedtime for the child, and the child was put to bed at that time four out of five weekdays in previous week Parent/caregiver report

Not applicable

Percentage of parents who suggest responses to hypothetical conflict with child:

  • Prevent or distract
  • Remove child or object
  • Talk and explain
  • Threaten or command
  • Shout
  • Physical punishment

Percentage of parents suggesting only mild responses to the hypothetical conflicts Index of discipline severity

Parents were asked how they would respond to three situations: (1) child keeps playing with breakables; (2) child refuses to eat; and (3) child has a temper tantrum in a store. Responses were coded dichotomously with 1 if the reference technique is ever mentioned and 0 if not. The percentage of mild responses was a binary variable indicating parents who mentioned only the following types of responses for each situation: prevent the situation; distract the child; talk to the child or explain the issue; ignore the behavior; or remove the child or object. The index of severity measured the degree of harshness of discipline strategies suggested. An individual’s score on this index ranged from 1 to 5, and was determined by the harshest strategy that was suggested in response to any of the three conflict situations. Parent/caregiver report

Not applicable Not reported by author (for Index of discipline severity)

Reading frequency

A measure of the frequency with which parents read to their child Parent/caregiver report

Not applicable

Spanked child in last week

Percentage of parents who had spanked the child in the previous week Parent/caregiver report

Not applicable

Uses a car seat

Percentage of families who used a car seat for the child, and it was in the back seat of the car. Parent/caregiver report

Not applicable

Uses guards or gates for windows

Percentage of families who used guards or gates for their windows Parent/caregiver report

Not applicable

Parent-child structured play:

  • Parent supportiveness
  • Parent detachment
  • Parent intrusiveness
  • Negative regard
Parent behavior during a structured play task was coded. Parent supportiveness was measured as contingent responsivity, positive regard, and cognitive stimulation. Parent detachment was measured as under-involvement, lack of awareness, attention, or engagement. Parent intrusiveness was measured as over-involvement or over-control. Parent negative regard was measured as discontent, anger, or rejection. Videotaped observation

Not reported by author