Less than half of low-income children have access to high-quality early childhood programs that could dramatically improve their opportunities for a better future. This statistic is tragic when one considers that skills developed in the first five years of life greatly influence success later in life. Expanding access and options for parents to access quality early childhood programs have proven benefits for individuals and society in reduced healthcare costs, increased school achievement and a more educated workforce.
This research details the evidence showing how high-quality programs prepare children with the skills needed for academic success.
Parents as Teachers
Albritton, S.; Klotz, J.; Roberson, T.
Parents as Teachers parents read more to their children, used more techniques to support book/print concepts, and had more children’s books in the home.
Source: Research and Training Associates, Inc. (2006). Albritton, Sl., Klotz, J., & Roberson, T. (2004). “The effects of participating in a Parents as Teachers program on parental involvement in the learning process at school and home.” E-Journal of Teaching and Learning in Diverse Settings, 1, 188-208.
Pfannenstiel, J.; Lambson, T.; Yarnell, V.
More than one-half of the Parents as Teachers children observed with developmental delays overcame those delays by age 3.
Source: Pfannenstiel, J., Lambson, T., & Yarnell, V. (1991). “Second wave study of the Parents as Teachers program.” Overland Park, KS: Research & Training Associates.
Wagner, M.; Iida, E.; Spiker, D.
Adolescent mothers in an urban community who participated in Parents as Teachers scored lower on a child maltreatment precursor scale than mothers in the control group. These teen mothers showed greater improvement in knowledge of discipline, showed more positive involvement with children and organized their home environment in a way that was more conducive to child development. Children participating in Parents as Teachers were much more likely to be fully immunized for their given age, and less likely to have been treated for an injury in the previous year.
Source: Wagner, M., Iida, E., and Spiker, D. (2001). “The multisite evaluation of the Parents as Teachers home visiting program: Three-year findings from one community.” Menlo Park, CA: SRI International.
Healthy Families America
DuMont, K.; Mitchell-Herzfeld, S.; Greene, R.; Lee, E.; Lowenfels, A.; Rodriguez, M.
Women enrolled prenatally in Health Families America (HFA) had fewer low-birth weight babies. Low birth weight is associated with higher infant mortality as well as substantial short- and long-term challenges to child health and development.
Source: DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., Rodriguez, M., et al. (2008). Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect. Child Abuse & Neglect, 32(3), 295–315.
Kirkland, K.; Mitchell-Herzfeld, S.
Research shows that HFA reduces the number of Adverse Childhood Experiences (ACEs), which research definitively shows is essential for life-long health and productivity. For example, HFA reduces child maltreatment, harsh punishment, and improved the use of non-violent discipline.
Source: Kirkland, K., & Mitchell-Herzfeld, S. (2012). “Evaluating the effectiveness of home visiting services in promoting children’s adjustment in school: Final report to the Pew Center on the States.” Rensselaer, NY: New York State Office of Children and Family Services, Bureau of Evaluation and Research.
Home Instruction for Parents of Preschool Youngsters (HIPPY)
Jacobson, A.L.; Ramisetty-Mikler, S.
Black, M.M.; Powell, D.
Parents participating in the HIPPY program report spending more time reading to their children; teaching them letters, words and numbers; visiting the library and monitoring their child’s TV use.
Source: Jacobson, A.L. & Ramisetty-Mikler, S. (2000). “The HIPPYCORPS initiative: Getting things done.” 1999-2000 Annual Program Evaluation Report. Prepared for The Texas HIPPY Center. Center for Parent Education, University of North Texas.
Source: Black, M.M. (2010). “HIPPY Americorps Evaluation: Parental involvement in literacy activities and volunteer activities in the community in California, Florida and Hawaii.” University of South Florida, Department of Child and Family Studies.
Source: Black, M.M. and Powell, D. (2005). “HIPPY AmeriCorps Evaluation: Parent Involvement in Literacy Activities and Children’s Receptive Vocabulary Development.” University of South Florida. Department of Child and Family Studies.
Nievar, A. M.; Jacobson, A.; Dier, S.
Bradley, R.H.; Gilkey, B.
Center for Human Investment Policy
Children participating in Home Instruction for Parents of Preschool Youngsters have demonstrated statistically significant higher achievement scores in reading, math and social studies in third, fifth and sixth grades based on multiple measures used in Arkansas, Texas, Florida and Colorado.
Source: Nievar, A. M., Jacobson, A., & Dier, S. (2011). “Home visiting for at-risk preschoolers: A successful model for Latino families.” Early Childhood Research Quarterly, 26, 268-277.
Source: Bradley, R.H., & Gilkey, B. (2002). “The impact of the Home Instructional Program for Preschool Youngsters (HIPPY) on school performance in 3rd and 6th grades.” Early Education and Development, 13(3), 301-311.
Source: Center for Human Investment Policy (2003). “Five Year Study of the Impact of HIPPY School Years 1997- 1998 Through 2001-2002.” University of Colorado at Denver. Graduate School of Public Affairs. Denver, CO.
Crusto, C.A.; Lowell, D.; Paulicin, B.; Reynolds, J.; Feinn, R.; Friedman, S.R.; Kaufman, J.S.
Source: Crusto, CA, Lowell, D, Paulicin, B, Reynolds, J, Feinn, R, Friedman, SR, Kaufman, JS. (2008). “Evaluation of a Wraparound Process for Children Exposed to Family Violence.” Best Practices in Mental Health: An International Journal, Volume 4, Number 1, Pages 1-18.
Crusto, C.A.; Whitson, M.L.; Feinn, R; Gargiulo, J; Hold, C; Paulicin, B.; Simmons, W.; Lowell, D.
Source: Crusto, CA, Whitson, ML, Feinn, R, Gargiulo, J, Hold, C, Paulicin, B, Simmons, W, Lowell, D. (2013). “Evaluation of a Mental Health Consultation Intervention in Preschool Settings.” Best Practices in Mental Health: An International Journal, Volume 9, Number 1, Pages 1-21
Lowell, D.I.; Carter, A.S.; Godoy, L.; Paulicin, B.; Briggs-Gowan, M.J.
Source: Lowell, DI, Carter, AS, Godoy, L, Paulicin, B, Briggs-Gowan, MJ. (2011). “A Randomized Controlled Trial of Child FIRST: A Comprehensive, Home-Based Intervention Translating Research into Early Childhood Practice.” Child Development, Volume 82, Number 1, Pages 211–226.
Nurse Family Partnership
Nurse-Family Partnership has consistent evidence, based upon replicated randomized controlled trials with different populations living in different contexts, that it:
• improves prenatal health 7-9
• reduces childhood injuries 7, 10, 11
• reduces the rates of subsequent pregnancies and births 7, 9, 12-14
• increases the intervals between first and second pregnancies and births 7, 9, 12-14
• increases maternal employment 7, 9, 14
• reduces women’s use of welfare 12-14, 25
• reduces children’s mental health problems 15, 16, 24
• increases children’s school readiness and academic achievement 9, 16, 17
• reduces costs to government and society 18, 19, 25
• is most effective for those most susceptible to the problems examined 1
The following outcomes have been observed among program participants compared to their counterparts assigned to the control group in at least one randomized trial:
Improved pregnancy outcomes:
• 35 percent fewer cases of pregnancy-induced hypertension 7
• 79 percent reduction in preterm delivery among women who smoke cigarettes 8
• 31 percent reduction in very closely spaced (<6 months) subsequent pregnancies 12
Improved child health and development:
• 39 percent fewer healthcare encounters for injuries or ingestions in the first two years of life among children born to mothers with low psychological resources 22
• 56 percent reduction in emergency room visits for accidents and poisonings in the second year of the child’s life 11
• 8 percent reduction in state-verified reports of child abuse and neglect by child age 15 20
• 50 percent reduction in language delays by child age 21 months 9
• 5 point increase in language scores on a test with a mean of 100 and standard deviation of 15 among 4-year-old children born to mothers with low psychological resources 17
• 3.95 point increase in receptive language (when averaged across age 2, 4, and 6) among children born to mothers with low psychological resources 27
• 1.03 point increase in sustained attention when averaged across age 4, 6, and 9 among children born to mothers with low psychological resources 27
• 67 percent reduction in behavioral and emotional problems at child age 6 16
• 9 percentile increase in math and reading achievement test scores in grades 1-3 among children born to mothers with low psychological resources 23
• 67 percent reduction in 12-year-old children’s use of cigarettes, alcohol, or marijuana 24
• 28 percent reduction in 12-year olds’ mental health problems (depression and anxiety) 24
• 3 point increase in 12-year-old children’s reading and math achievement test scores on a test with a mean of 100 and standard deviation of 15 among those born to mothers with low psychological resources 24
• 6 percentile increase in group-based reading and math achievement test scores in grades 1-6 among children born to mothers with low psychological resources 249
• 59 percent reduction in arrests by child age 15 21
• 90 percent reduction in adjudication as PINS (person in need of supervision) for incorrigible behavior 21
• 33 percent fewer arrests among female children at age 19 26
• 80 percent fewer convictions among female children at age 19 26
• 73 percent increase in age at 1st arrest among female children at age 19 26
• 82 percent fewer current arrests among female children at age 19 26
• 89 percent fewer current convictions among female children at age 19 26
• Reduced childhood mortality from preventable causes at age 20 27
Increased self-sufficiency of the family:
• 1-month increase in labor force participation during second year of child’s life 9
• 46 percent increase in father presence in household by child age 4 12
• 30-month reduction in use of AFDC-TANF among mothers who were poor and unmarried at registration 13
• 7-month (or 82 percent) increase in labor force participation 4 years after delivery of first child among low-income unmarried mothers 14
• 1.75 month reduction in use of AFDC-TANF between child age 5 and age 6 16
• 1.83 month reduction in use of Food Stamps between child age 5 and 6 16
• 61 percent fewer arrests of mothers by child age 15 20
• 72 percent fewer convictions of mothers by child age 15 20
• $12,300 discounted savings (2006 dollars) in Food Stamps, Medicaid, and AFDC-TANF from child age 0-12 compared to program cost of $11,511 (2006 dollars) 25
• 13 percent increase in duration of mothers’ relationships with current partners by child age 12 25
• Reduced all-cause maternal mortality rate when comparing control group participants with combined treatment groups of participants receiving pre-natal and 2 post-partum home visits and participants who received pre-natal, post-partum, and infancy/toddler home visitation 27. Note: • • This finding is not significant when comparing the control group with participants who received the NFP intervention (i.e., prenatal, infancy, and toddler home visits), but it is observed in the expected direction (P = .19) 27
1. Olds DL. Prenatal and infancy home visiting by nurses: from randomized trials to community replication. Prevention Science 2002 Sep; 3(3):153-72.
2. Olds DL, Hill PL, O’Brien R, Racine D, Moritz P. Taking preventive intervention to scale: the Nurse-Family Partnership. Cognitive and Behavioral Practice 2003; 10(4):278-90.
3. Coalition for Evidence-Based Policy [homepage on the Internet]. Council for Excellence in Government; [cited 2007 Feb 1]. Available from: http://coexgov.securesites.net/index.php?keyword=a432fbc34d71c7.
4. Blueprints for Violence Prevention model program selection criteria [homepage on the Internet]. Center for the Study and Prevention of Violence; c2004 [cited 2007 Feb 1]. Available from: http://www.colorado.edu/ cspv/blueprints/model/criteria.html.
5. Flay BR, Biglan A, Boruch RF, Castro FG, Gottfredson D, Kellam S, Moscicki EK, Schinke S, Valentine JC, Ji P. Standards of evidence: criteria for efficacy, effectiveness and dissemination. Prevention Science 2005 Sep; 6(3):151-75.
6. Katz R. FDA: evidentiary standards for drug development and approval. NeuroRx: The Journal of the American Society for Experimental NeuroTherapeutics 2004 Jul; 1(3):307-16.
7. Kitzman H, Olds DL, Henderson CR Jr, Hanks C, Cole R, Tatelbaum R, McConnochie KM, Sidora K, Luckey DW, Shaver D, et al. Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. Journal of the American Medical Association 1997 Aug 27; 278(8):644-52.
8. Olds DL, Henderson CRJ, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics 1986 Jan; 77(1):16-28.
9. Olds DL, Robinson J, O’Brien R, Luckey DW, Pettitt LM, Henderson CR Jr, Ng RK, Sheff KL, Korfmacher J, Hiatt S, et al. Home visiting by paraprofessionals and by nurses: a randomized, controlled trial. Pediatrics 2002 Sep; 110(3):486-96.
10. Olds DL, Henderson CR Jr, Kitzman H. Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? Pediatrics 1994 Jan; 93(1):89-98. © Copyright 2014 Nurse-Family Partnership. All rights reserved. 4
11. Olds DL, Henderson CR Jr, Chamberlin R, Tatelbaum R. Preventing child abuse and neglect: a randomized trial of nurse home visitation. Pediatrics 1986 Jul; 78(1):65-78.
12. Kitzman H, Olds DL, Sidora K, Henderson CR Jr, Hanks C, Cole R, Luckey DW, Bondy J, Cole K, Glazner J. Enduring effects of nurse home visitation on maternal life course: a 3-year follow-up of a randomized trial. Journal of the American Medical Association 2000 Apr 19; 283(15):1983-9.
13. Olds DL, Eckenrode J, Henderson CR Jr, Kitzman H, Powers J, Cole R, Sidora K, Morris P, Pettitt LM, Luckey D. Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. Journal of the American Medical Association 1997 Aug 27; 278(8):637-43.
14. Olds DL, Henderson CRJ, Tatelbaum R, Chamberlin R. Improving the life-course development of socially disadvantaged mothers: a randomized trial of nurse home visitation. American Journal of Public Health 1988 Nov; 78(11):1436-45.
15. Olds D, Henderson CR Jr, Cole R, Eckenrode J, Kitzman H, Luckey D, Pettitt L, Sidora K, Morris P, Powers J. Long-term effects of nurse home visitation on children’s criminal and antisocial behavior: 15- year follow-up of a randomized controlled trial. Journal of the American Medical Association 1998 Oct 14; 280(14):1238-44.
16. Olds DL, Kitzman H, Cole R, Robinson J, Sidora K, Luckey D, Henderson C, Hanks C, Bondy J, Holmberg J. Effects of nurse home visiting on maternal life-course and child development: age-six follow-up of a randomized trial. Pediatrics 2004; 114:1550-9.
17. Olds DL, Robinson J, Pettitt L, Luckey DW, Holmberg J, Ng RK, Isacks K, Sheff K. Effects of home visits by paraprofessionals and by nurses: age-four follow-up of a randomized trial. Pediatrics 2004; 114:1560-1568.
18. Aos, S.; Lieb, R.; Mayfield, J.; Miller, M.; Pennucci, A. Benefits and costs of prevention and early intervention programs for youth. Olympia, WA: Washington State Institute for Public Policy; 2004.
19. Karoly, L. A.; Kilburn, M. R.; Cannon, J. S. Early childhood interventions: proven results, future promise. Santa Monica, CA: RAND; 2005.
20. Reanalysis Olds et al. Journal of the American Medical Association 1997 Aug 27; 278(8):637-43.
21. Reanalysis of Olds et al. Journal of the American Medical Association 1998 Oct 14; 280(14):1238-44.
22. Reanalysis of Kitzman et al. Journal of the American Medical Association 1997 Aug 27; 278(8):644-52; See also Memphis Year 9 results, citation #23, finding that nurse-visited children as a trend were less likely to die from birth through age 9, an effect accounted for by deaths due to potentially preventable causes, such as preterm delivery, Sudden Infant Death Syndrome, and injuries.
23. Olds DL, Kitzman H, Hanks C, Cole RE, Anson EA, Sidora-Arcoleo KJ, Luckey DW, Henderson CRJ, Holmberg J, Tutt RA, et al. Effects of nurse home visiting on maternal and child functioning: age-nine follow-up of a randomized trial. Pediatrics 2007; 120(4).
24. Kitzman HJ, Olds DL, Cole RE, Hanks CA, Anson EA, Arcoleo-Sidora KJ, Luckey DW, Knudtson MD, Henderson CR Jr., Holmberg JR. Enduring effects of prenatal and infancy home visiting by nurses on children: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics and Adolescent Medicine May 2010, 164(5):412-418.
25. Olds DL, Kitzman HJ, Cole RE, Hanks CA, Arcoleo-Sidora KJ, Anson EA, Luckey DW, Knudtson MD, Henderson CR Jr., Bondy J, Stevenson AJ. Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics and Adolescent Medicine May 2010, 164(5):419-424.
26. Eckenrode J, Campa M, Luckey DW, Henderson CR Jr., Cole RE, Kitzman HJ, Anson EA, Arcoleo-Sidora KJ, Powers J, Olds DL. Long-term effects of prenatal and infancy nurse home visitation on the life course of youths 19-Year follow-up of a randomized trial. Archives of Pediatrics and Adolescent Medicine January 2010; 164(1):9-15.
27. Olds DL, Holmberg JR, Donelan-McCall N, Luckey DW, Knudtson MD, Robinson J. Effects of home visits by paraprofessionals and nurses on children: Follow-up of a randomized trial at ages 6 and 9 years. JAMA Pediatrics February 2014; 168(2):114-121.
28. Olds DL, Kitzman H, Knutdson M, Anson E, Smith JA, Cole R. Effect of home visiting by nurses on maternal and child mortality. JAMA Pediatrics; July 2014; doi:10.1001/jamapediatrics.2014.472.