Early Head Start (EHS)

Evidence Rating  
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Date last updated

Early Head Start (EHS) is a federally funded program for pregnant women and parents with low incomes and children aged 0 to 3. The program’s comprehensive approach includes child care, parent education, health and mental health services, and family support. EHS programs can be home-based, center-based, or offer a mix of home and center services1.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Improved cognitive skills

  • Improved social emotional skills

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Improved family functioning

  • Reduced aggression

  • Reduced stress

  • Improved parenting

  • Increased school readiness

  • Increased family income

  • Reduced hospital utilization

  • Increased access to oral health care

What does the research say about effectiveness?

There is strong evidence that Early Head Start (EHS) increases participating children’s cognitive and social emotional skills2, 3, 4, 5. Small social emotional effects appear to continue through age 106.

EHS modestly improves attention and focus2, language3, cognitive and social emotional skills such as social functioning and emotional regulation2, 4, 5, and reduces aggressive behavior among participating children2. Enhanced language skills can help children better control themselves and regulate emotions, reducing parental stress and improving parent-child interactions7.

EHS can improve parenting2, 8, 9, parent supportiveness9, 10, engagement4, and emotional responsiveness9, and increase use of positive discipline3 while reducing spanking4. EHS can also bolster parents’ ability to cognitively stimulate and positively interact with children despite high stress7. EHS can lead parents to create home environments that support learning2, 4, 9 and enroll their children in formal pre-kindergarten programs4. Mothers who receive home-based infant mental health services through EHS report improved family functioning and relationships, especially improved coping skills and reduced stress; these effects last after program completion, in some cases for several years11. Early program evaluations suggest that EHS participation may reduce child maltreatment, especially physical and sexual abuse12, 13. In some circumstances, EHS can help children develop vocabulary despite family stress8.

EHS participation increases the likelihood of children having dental care visits for prevention and treatment14, 15. Among Latino families, EHS programs that include health education decrease pediatric emergency room visits and inappropriate use of over-the-counter medications for children under age 216.

Parent participants in home-based EHS have demonstrated increases in school or job training participation and sustained improvements in income3. Income effects can be stronger in programs that offer more child and family services4.

EHS can be especially effective for black participants5, 8, 17. Black parent participants are more likely to be employed or in school than their peers, and report a small reduction in their children’s hospitalization needs18. Some outcomes may also last longer for black participants than for white participants17. EHS can improve vocabulary for English as a Second Language (ESL) speakers by the time they enter kindergarten2, 17.

Research identifies 23 EHS program practices that can increase engagement with Latino fathers. Practices include hiring bilingual staff and men, teaching fatherhood skills, personally contacting fathers to convey that the program is for fathers as well as mothers, and increasing service hours and home visits during times when fathers are available such as evenings and weekends19.  

How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples

In the 2020-2021 school year, over 187,700 children were enrolled in Early Head Start (EHS) across all 50 states, although only 10% of children eligible for EHS had access to the program. The National Head Start Association has started a campaign to increase the number of EHS spots so that it will be equal to the number available through Head Start20.

Implementation Resources

EHS NRC - Early Head Start National Resource Center (EHS NRC).

NHSA-EHS Resources - National Head Start Association (NHSA). Resource library topic: Early Head Start.

NHSA-States - National Head Start Association (NHSA). 2022 state fact sheets: Click on your state to download your state's Head Start fact sheet or explore Head Start locations in detail.

CCEE Research Connections-EHS 2015 - Child Care & Early Education (CCEE) Research Connections. Basic information for Early Head Start (EHS)-Childcare Partnerships: Fact sheets and briefs. 2015.

OPRE-Baby FACES - Office of Planning, Research and Evaluation (OPRE), Administration for Children and Families, U.S. Department of Health and Human Services. Early Head Start family and child experiences study (Baby FACES), 2007-2020.


* Journal subscription may be required for access.

1 ECLKC-EHS - Head Start Early Childhood Learning & Knowledge Center (ECLKC). Early Head Start (EHS) Programs.

2 Vogel 2013 - Vogel C, Brooks-Gunn J, Martin A, Klute MM. Impacts of Early Head Start participation on child and parent outcomes at ages 2, 3, and 5. Monographs of the Society for Research in Child Development. 2013;78(1):36-63.

3 Chazan-Cohen 2013 - Chazan-Cohen R, Raikes HH, Vogel C. Program subgroups: Patterns of impacts for home-based, center-based, and mixed-approach programs. Monograph of the Society for Research in Child Development. 2013;78(1):93-109.

4 Harden 2012 - Harden BJ, Chazan-Cohen R, Raikes H, Vogel C. Early Head Start home visitation: The role of implementation in bolstering program benefits. Journal of Community Psychology. 2012;40(4):438-455.

5 PPN - Promising Practices Network (PPN). On children, families and communities.

6 Mathematica-Vogel 2010 - Vogel CA, Xue Y, Moiduddin EM, Carlson B. Early head start children in grade 5: Long-term follow-up of the early head start research and evaluation project study sample. Princeton: Mathematica Policy Research for the Office of Planning, Research and Evaluation (OPRE), Administration for Children and Families (ACF), U.S. Department of Health and Human Services (U.S. DHHS); 2010: OPRE 2011-8.

7 Ayoub 2011 - Ayoub C, Mastergeorge AM, Vallotton CD. Developmental pathways to integrated social skills: The roles of parenting and early intervention. Child Development. 2011;82(2):583-600.

8 Vallotton 2012 - Vallotton CD, Harewood T, Ayoub CA, et al. Buffering boys and boosting girls. The protective and promotive effects of Early Head Start for children's expressive language in the context of parenting stress. Early Childhood Research Quarterly. 2012;27(4):695-707.

9 Raikes 2014 - Raikes HH, Roggman LA, Peterson CA, et al. Theories of change and outcomes in home-based early head start programs. Early Childhood Research Quarterly. 2014;29(4):574-585.

10 Mortensen 2014 - Mortensen JA, Mastergeorge AM. A meta-analytic review of relationship-based interventions for low-income families with infants and toddlers: Facilitating supportive parent–child interactions. Infant Mental Health Journal. 2014;35(4):336-353.

11 Mckelvey 2015 - Mckelvey L, Schiffman RF, Brophy-Herb HE, et al. Examining long-term effects of an infant mental health home-based early head start program on family strengths and resilience. Infant Mental Health Journal. 2015;36(4):353-365.

12 Chazen-Cohen 2015 - Chazan-Cohen R, Green BL, Ayoub C, et al. Research-to-practice brief: Promising evidence that early head start can prevent child maltreatment. Child Abuse & Neglect Prevention. 2015;1.

13 Green 2014a - Green BL, Ayoub C, Bartlett JD, et al. The effect of early head start on child welfare system involvement: A first look at longitudinal child maltreatment outcomes. Children and Youth Services Review. 2014;42:127-135.

14 Burgette 2017 - Burgette JM, Preisser JS, Weinberger M, et al. Impact of early head start in North Carolina on dental care use among children younger than 3 years. American Journal of Public Health. 2017;107(4):614-620.

15 Burgette 2017a - Burgette JM, Preisser JS, Weinberger M, et al. Enrollment in early head start and oral health-related quality of life. Quality of Life Research. 2017;26(10):2607-2618.

16 Stockwell 2014 - Stockwell MS, Catallozzi M, Larson E, et al. Effect of a URI-related educational intervention in early head start on ED visits. Pediatrics. 2014;133(5):e1233-e1240.

17 Raikes 2013 - Raikes HH, Vogel C, Love JM. IV. Family subgroups and impacts at age 2, 3, and 5: Variability by race/ethnicity and demographic risk. Monographs of the Society for Research in Child Development. 2013;78(1):64-92.

18 Harden 2012a - Harden BJ, Sandstrom H, Chazen-Cohen R. Early Head Start and African American families: Impacts and mechanisms of child outcomes. Early Childhood Research Quarterly. 2012;27(4):572-81.

19 Acevedo-Polakovich 2017 - Acevedo-Polakovich ID, Spring HE, Stacy ST, Nordquist EA, Normand MM. Engaging Latino fathers into early head start: A review of the literature. Children and Youth Services Review. 2017;82:347-353.

20 NHSA-Early Head Start 2022 - National Head Start Association (NHSA). Early Head Start facts and figures: A proven support for children, pregnant women, and families. 2022.