HeadStart

About the program

HeadStart is the largest publicly supported childcare program in the USA and is targeted at low-income children and children with disabilities, two groups at high risk for maltreatment. It is a primary prevention program offering services to an at-risk population of low-income families including pregnant women and families with children up to 3 years of age. It offers childcare, home visiting or a mix of the two.

The goals of the program are to improve parenting, reduce maltreatment (including the use of abusive discipline or neglectful behaviours), and promote parental involvement and parent education. The program seeks to promote healthy child development, and prevent negative child and family outcomes from the prenatal period, including: child health, social, emotional, cognitive and language development, parenting, and parent wellbeing. It also aims to reduce parental stress and opportunities for maltreatment by providing care for children outside the home. In addition, like other childcare programs, HeadStart can serve a monitoring function; parents might be deterred from abusing or neglecting their children because HeadStart staff observe that behaviour and report the family to child protective services.

Who does it work for?

HeadStart is targeted at low-income children and children with disabilities, two groups at high risk for maltreatment. Two studies were carried out in the USA (Green et al. 2020; Zhai et al. 2013). One study had a final sample of 2794 families, of which 35% were Black; 23% were Hispanic; 38% were White; 40% were adolescent mothers (Green et al. 2020).

The second study final sample was 2,807 families, comprised of 49% Black children, 20% Hispanic children and 17% White children, with 19% of households below the 50% poverty line, and 27% of mothers who had not completed high school (Zhai et al. 2013). Multiple comparison groups were used in the Zhai et al. (2013) study, including non-Head Start, parental, pre-kindergarten, other center-based, and other non-parental.

This review did not identify any evidence that the program has been evaluated in Australia or with First Nations communities.

What outcomes does it contribute to?

Positive outcomes:

Physical assault, Neglect, Child welfare involvement/contact with child protection services, Corporal/physical punishment/discipline: Zhai et al. (2013) report a statistically significant reduction in spanking, other physical assault, neglect and contact with child protection services. Zhai et al. (2013) also found that HeadStart participants were less likely to experience neglect when compared to other centre-based care and other non-parental care.

Parental stress, Dyadic reciprocity, Family conflict: Green et al. (2020) found improvements in dysfunctional parenting, including a reduction in spanking. Green et al. (2020) found that compared to control groups, families in HeadStart had less conflict, and parents reported lower levels of parenting distress. Zhai et al. (2013) observed a marginally significant improvement in parental warmth and a reduction in parental harshness for the intervention group.

No effect:

Child welfare involvement/contact with child protection services: Green and colleagues (2020) found no observed effect on substantiated maltreatment reports or out-of-home care placement.

Negative outcomes:

None.

Is the program effective?

Overall, the program has a positive effect on client outcomes.

How strong is the evidence?

Promising research evidence:

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects

How is it implemented?

The program is delivered by trained service providers in either Health Centres or family homes. The delivery and implementation of the program varies widely from site to site due to differences in implementation quality, curriculum choices, staffing structure, community characteristics and other factors. Services provided to individual families are tailored to their individual needs and circumstances. The intervention duration is up to two years.

How much does it cost?

Information not available

Where does the evidence come from?

One RCT with an initial sample size of 3,001 families across 17 HeadStart programs, which reduced to a final sample size of 2,794 (Green et al. 2020).

One QED study with an initial sample of 5,000 families across 20 large cities, which reduced to a final sample size of 2,807 (Zhai et al. 2013).

Both studies compared intervention groups with control groups.

Further resources

• https://www.acf.hhs.gov/ohs/about/head-start
• Green, B. L., et al. (2020). “Pathways to prevention: Early HeadStart outcomes in the first three years lead to long-term reductions in child maltreatment.” Children and Youth Services Review 118: N.PAG-N.PAG.
• Zhai, F., et al. (2013). “Estimating the effects of HeadStart on parenting and child maltreatment.” Children and Youth Services Review 35(7): 1119-1129.