Randomized trial of the Early Start program of home visitation.

OBJECTIVE To evaluate the extent to which a program of home visitation (Early Start), targeted at families who are facing stress and difficulty, had beneficial consequences for child health, preschool education, service utilization, parenting, child abuse and neglect, and behavioral adjustment. METHODS The study used a randomized, controlled trial design in which 220 families who were participating in the Early Start program were contrasted with a control series of 223 families who were not participating in the program. Families were enrolled in the program after population screening that was conducted by community health nurses. Families were enrolled in the program for up to 36 months. Outcomes were assessed at 6, 12, 24, and 36 months after trial entry. RESULTS Families in the Early Start series received a mean of 24 months of service. Comparisons between the Early Start and control series over the 36-month follow-up period revealed that families in the Early Start program showed significant benefits in the areas of improved utilization of child health services, reduced rates of hospital attendance for injury/poisoning, increased preschool education, increased positive and nonpunitive parenting, reduced rates of severe parent/child assaults, and reduced rates of early problem behaviors. Effect sizes (Cohen's "d") were found to be in the small to moderate range, with d ranging from .03 to .31 (median: .22). CONCLUSIONS The Early Start program was associated with small to moderate benefits in a wide range of areas relating to child health, preschool education, parenting, child abuse, and early behavioral adjustment. Comparisons with other studies are made, and threats to validity are considered.