Early Head Start (EHS)
Early Head Start (EHS) is a federally funded program for pregnant women and parents with low incomes and children from birth to age three. 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
Improved parenting
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
Reduced child maltreatment
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, 6, 7, 8 and improves parenting2, 3, 4, 5, 9, 10, 11. Small social emotional effects appear to continue through age ten12.
EHS modestly improves attention and focus5, language2, 4, 6, cognitive and social emotional skills such as social functioning and emotional regulation2, 3, 4, 5, 7, 8, and reduces aggressive behavior among participating children5. Children participating in EHS are more likely to engage in play with parents through age three2, 3. Enhanced language skills can help children better regulate emotions, reducing parental stress and improving parent-child interactions13.
EHS improves parenting2, 3, 4, 5, 10, 11, 14 by increasing parent supportiveness2, 3, 11, 15, emotional responsiveness3, 4, 11, 14, and developing parents’ ability to cognitively stimulate and positively interact with children2, 3, 4 and to create home environments that support learning2, 3, 4, 5, 7, 11. These positive effects can occur even in families experiencing high levels of stress and conflict10, 13. EHS also supports improved parenting by reducing the use of spanking2, 7 and increasing use of positive discipline6. EHS can improve family functioning and relationships, including improved coping skills and reduced stress with lasting effects3, especially for mothers who receive home-based infant mental health services through EHS16. EHS participation may reduce child maltreatment, especially physical and sexual abuse17, 18, through the combined effects of improved parenting, family well-being, and child development3.
EHS participation increases the likelihood of children having dental care visits for prevention and treatment19, 20 and may improve oral health knowledge among EHS staff and parents21. Available data shows EHS helps increase rates of immunization, breastfeeding, health insurance coverage, connection to medical and dental homes, and other health promoting practices22. EHS has been shown to increase developmental screening rates and support connecting children identified with developmental delays to appropriate intervention services22. 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 two23.
For parents, involvement in EHS programs is associated with increased school or job training participation6, especially for mothers2, which supports sustained improvements in income6. Income effects are often stronger in programs that offer more child and family services7. Parents participating in EHS are more likely to enroll their children in formal pre-kindergarten programs7. A New Jersey-based study suggests that school districts with EHS and Head Start programs are less likely to have a severe child care supply gap24.
Available data suggests program effects are strongest and EHS participation is longer when initial caregiver-parent relationships are positive, when families get involved in EHS25, and when teacher-child interactions are stable and high-quality26.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: supported by some evidence.
Early Head Start (EHS) has the potential to decrease disparities in education outcomes for children from families with low incomes29, 30 and for Black children8, 10, 31.
In general, there is strong evidence that preschool programs with family support services, such as EHS, reduce disparities in academic achievement and cognitive skills between students from low and high income backgrounds29, 30, 32, 33. Participation in preschool programs such as Head Start is associated with large long-term benefits for children from low income backgrounds, including increased high school completion, college enrollment and completion, economic self-sufficiency, labor force participation34, increased earnings, and improved health outcomes35.
High quality preschool programs, including EHS, that focus on reducing disparities in education access and quality in racial or ethnic minority communities can reduce racial achievement gaps36, 37. Black, Hispanic, Asian, and Native children as well as children from families with low incomes are less likely to be enrolled in preschool or have access to high quality preschool than white children and children from families with higher incomes38, 39, 40. EHS can be especially effective for Black participants8, 10, 31. Black families have higher likelihoods of experiencing stress, parenting challenges, and child developmental concerns because of structural racism; EHS appears effective at supporting Black families with low incomes in promoting positive parenting despite structural racism41. 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 needs42. Some outcomes may also last longer for Black participants than for white participants31. Additionally, the emphasis on parent involvement and intervention in early childhood is associated with a reduction in violent crime in adulthood, which is a public health issue that disproportionately impacts Black males in urban centers43.
Available data shows that Hispanic infants and toddlers make up 35 percent of those enrolled in EHS, despite lower preschool enrollment rates among Hispanic families due to language barriers, limited access to ECE programs, and economic inequities44. Programs like EHS have larger impacts on Hispanic children who are dual-language learners compared to other programs, likely because of its family-centered and culturally responsive approach, outreach, and retention strategies44. EHS can improve vocabulary for students learning English as a second language by the time they enter kindergarten5, 31. EHS programs can also increase engagement with Latino fathers, especially when programs hire bilingual staff and men, teach fatherhood skills, personally contact fathers, and increase service hours and home visits during evenings and weekends45.
People of color, people with lower socioeconomic status, and immigrants and refugees are more likely to experience trauma46, 47. Residents in communities that are racially and/or economically segregated may have higher risk of exposure to neighborhood violence and resulting traumatic loss48. Parental history of adverse childhood experiences (ACEs), a measure of trauma, have been shown to have intergenerational effects and have been associated with childhood problems, such as increased risk of developmental delays49. EHS may help mitigate the intergenerational effects of trauma as a culturally appropriate, positive caregiving intervention that is associated with improving parent-child relationships among racially and ethnically diverse EHS participants50.
Measures of neighborhood socioeconomic disadvantage, like the Area Deprivation Index, can help identify community specific adaptations, services, and family supports that EHS programs could implement to support improved health and well-being of EHS families51. Assessments and evaluations used to measure education outcomes are developed and validated with children from predominantly white, English-speaking, upper income households, which contributes to a deficit view of the skills, competencies, and behaviors of children from historically marginalized backgrounds served by programs like EHS52.
What is the relevant historical background?
In the U.S., there has never been an integrated national policy for early childhood education and care (ECEC) programs. Programs focused on child care and programs focused on early education developed separately. In the 1830s, nurseries provided children with basic care and supervision. Enrollment in such programs increased the most during times of war, and generally decreased after wars ended (from the Civil War through WWII). Early childhood programs became more available in the 1960s and 1970s, as maternal workforce participation increased and the number of households headed by single mothers grew53.
Disparities in educational opportunities in the United States are shaped by many factors, including a long history of racial segregation in schools and differences in family income levels. In 1954, the U.S. Supreme Court ruled in Brown v. Board of Education that racial segregation in public schools was unconstitutional54, but segregation remains a persistent problem55. Some legal battles over school segregation were not resolved until 201656 and structural barriers, such as continued residential segregation, play a significant role in maintaining school segregation and unequal access to resources, including high-quality early childhood education programs55. National interest in preschool as an intervention to address educational disparities was high in the 1960s when the Child-Parent Center (CPC) program began in Chicago and the HighScope Perry (HSP) preschool program began in Michigan57. Educational disparities across racial and economic groups were highlighted as a concern by teachers, administrators, and policymakers during this period with the Civil Rights movement and the “war on poverty”58.
In 1965, Head Start was established at the federal level as a community action program overseen by the Economic Opportunity Office to provide non-segregated preschool education programs to children from families with low incomes. Despite many obstacles and resistance from school boards and community organizations, many Civil Rights leaders and advocates persisted to establish and develop successful Head Start programs. Head Start programs also created employment opportunities and hired educators, administrators, and employees of color, even in the South59. When Head Start funding expanded in the 1980s and 1990s, preschool enrollment rates increased, though there still were not enough spaces to provide preschool for all eligible children53. Early Head Start was first funded in 1995 to serve expectant families with low incomes and their children from birth to age three59.
Equity Considerations
- What community partnerships could help your local Early Head Start programs offer better comprehensive family support services? In your community, what aspects of preschool programs are most important to families with low incomes? To students and families identifying as a racial or ethnic minority?
- Which populations in your community have lower rates of preschool attendance? What outreach activities might help reduce those disparities? How could your community increase access to and funding for high quality Early Head Start programs for children who aren’t participating?
- What disparities in educational opportunities and outcomes exist in your community? How do systemic factors such as residential segregation and disproportional school discipline rates contribute to these disparities?
- How can your local preschool program be structured to highlight and build on the knowledge, skills, abilities, and strengths of families in your community? What opportunities could this provide to develop caregiver-parent relationships and to support family involvement?
Implementation Examples
In the 2023 fiscal year, over 186,500 children were enrolled in Early Head Start (EHS) across all 50 states, Washington, D.C., and six U.S. territories and over 4,400 children were enrolled in American Indian and Alaska Native (AIAN) Early Head Start programs operated by tribal governments across 26 states27. 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 Start28.
Implementation Resources
‡ Resources with a focus on equity.
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.
Footnotes
* Journal subscription may be required for access.
1 ECLKC-EHS - Head Start Early Childhood Learning & Knowledge Center (ECLKC). Early Head Start (EHS) Programs.
2 Chazan-Cohen 2023 - Chazan-Cohen, R., Von Ende, A., & Lombardi, C. (2023). Parenting and family self-sufficiency services contribute to impacts of Early Head Start for children and families. Frontiers in Psychology, 14, 1302687.
3 Green 2020 - Green, B. L., Ayoub, C., Bartlett, J. D., Furrer, C., Chazan-Cohen, R., Buttitta, K., Von Ende, A., Koepp, A., & Regalbuto, E. (2020). Pathways to prevention: Early Head Start outcomes in the first three years lead to long-term reductions in child maltreatment. Children and Youth Services Review, 118, 105403.
4 Gedal Douglass 2021 - Gedal Douglass, A., Roche, K. M., Lavin, K., Ghazarian, S. R., & Perry, D. F. (2021). Longitudinal parenting pathways linking Early Head Start and kindergarten readiness. Early Child Development and Care, 191(16), 2570–2589.
5 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.
6 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.
7 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.
8 PPN - Promising Practices Network (PPN). On children, families and communities.
9 Berlin 2018a - Berlin, L. J., Martoccio, T. L., & Jones Harden, B. (2018). Improving early head start’s impacts on parenting through attachment-based intervention: A randomized controlled trial. Developmental Psychology, 54(12), 2316–2327.
10 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.
11 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.
12 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.
13 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.
14 Berlin 2018 - Berlin, L. J., Martoccio, T. L., & Jones Harden, B. (2018). Improving early head start’s impacts on parenting through attachment-based intervention: A randomized controlled trial. Developmental Psychology, 54(12), 2316–2327.
15 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.
16 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.
17 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.
18 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.
19 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.
20 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.
21 Joufi 2021 - Joufi, A. I., Claiborne, D. M., & Shuman, D. (2021). Oral health education and promotion activities by Early Head Start programs in the United States: A systematic review. American Dental Hygienists’ Association, 95(5), 14.
22 Horm 2024 - Horm, D. M., Brophy-Herb, H. E., & Peterson, C. A. (2024). Optimizing health services for young children in poverty: Enhanced collaboration between Early Head Start and pediatric health care. Frontiers in Public Health, 12, 1297889.
23 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.
24 Kim 2019 - Kim, J., & Wang, S. (2019). Head Start availability and supply gap of childcare slots: A New Jersey study. Children and Youth Services Review, 104, 104394.
25 Jeon 2018 - Jeon, S., Choi, J. Y., Horm, D. M., & Castle, S. (2018). Early Head Start dosage: The role of parent-caregiver relationships and family involvement. Children and Youth Services Review, 93, 291–300.
26 Choi 2019c - Choi, J. Y., Horm, D., Jeon, S., & Ryu, D. (2019). Do stability of care and teacher–child interaction quality predict child outcomes in Early Head Start? Early Education and Development, 30(3), 337–356.
27 US DHHS-ECLKC data - U.S. Department of Health and Human Services, Early Childhood Learning & Knowledge Center. (2024). Head Start Program Facts: Fiscal Year 2023. Retrieved October 22, 2024
28 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.
29 CG-TFR Education - The Guide to Community Preventive Services (The Community Guide). Task Force Recommends (TFR) center-based early childhood education programs (ECE) to improve educational outcomes that are associated with long-term health as well as social- and health-related outcomes.
30 Blueprints - Center for the Study and Prevention of Violence (CSPV). Blueprints for healthy youth development.
31 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.
32 Duncan 2013 - Duncan GJ, Sojourner AJ. Can intensive early childhood intervention programs eliminate income-based cognitive and achievement gaps? Journal of Human Resources. 2013;48(4):945-968.
33 RAND-Karoly 2016 - Karoly LA, Auger A. Informing investments in preschool quality and access in Cincinnati: Evidence of impacts and economic returns from national, state, and local preschool programs. Santa Monica: RAND Corporation; 2016.
34 Bailey 2021 - Bailey MJ, Sun S, Timpe B. Prep school for poor kids: The long-run impacts of Head Start on human capital and economic self-sufficiency. American Economic Review. 2021;111(12):3963-4001.
35 NBER-Garcia 2021a - Garcia JL, Heckman JJ, Ronda V. The lasting effects of early childhood education on promoting the skills and social mobility of disadvantaged African Americans. National Bureau of Economic Research (NBER). 2021: Working Paper 29057.
36 CG-Health Equity - The Guide to Community Preventive Services (The Community Guide). Health equity.
37 Burger 2010 - Burger K. How does early childhood care and education affect cognitive development? An international review of the effects of early interventions for children from different social backgrounds. Early Childhood Research Quarterly. 2010;25(2):140-165.
38 Colaner 2020 - Colaner AC. Availability of preschool in Chicago’s Hispanic-concentrated communities: A study of supply and directors’ support for universal programming. Early Childhood Research Quarterly. 2020;52:15-24.
39 Latham 2020 - Latham S, Corcoran SP, Sattin-Bajaj C, Jennings JL. Racial disparities in pre-k quality: Evidence from New York City’s universal pre-k program. Annenberg Institute for School Reform at Brown University. 2020: Working Paper 20-248.
40 US ED-Preschool 2015 - U.S. Department of Education (U.S. ED). A matter of equity: Preschool in America. 2015.
41 Heberle 2023 - Heberle, A. E., & Chazan-Cohen, R. (2023). Longitudinal and reciprocal relations among parent and child outcomes for Black Early Head Start families. Early Education and Development, 34(2), 387–407.
42 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.
43 Anders 2023 - Anders J, Barr AC, Smith AA. The effect of early childhood education on adult criminality: Evidence from the 1960s through 1990s. American Economic Journal: Economic Policy. 2023;15(1):37-69.
44 Mendez-Smith 2021 - Mendez-Smith J, Crosby D, Stephens C. Equitable access to high-quality early care and education: Opportunities to better serve young Hispanic children and their families. Annals of the American Academy of Political and Social Science. 2021;696(1):80-105.
45 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.
46 AAP-Duffee 2021 - Duffee, J., Szilagyi, M., Forkey, H., & Kelly, E. T. (2021). Trauma-informed care in child health systems. Pediatrics, 148(2), e2021052579.
47 Brown 2022 - Brown AGM, Shi S, Adas S, et al. A decade of nutrition and health disparities research at NIH, 2010–2019. American Journal of Preventive Medicine. 2022;63(2):e49-e57.
48 Stolbach 2017 - Stolbach, B. C., & Anam, S. (2017). Racial and ethnic health disparities and trauma-informed care for children exposed to community violence. Pediatric Annals, 46(10).
49 Miccoli 2022 - Miccoli, A., Song, J., Romanowicz, M., Howie, F., Simar, S., & Lynch, B. A. (2022). Impact of parental adverse childhood experiences on offspring development in Early Head Start: Parental adversity and offspring development. Journal of Primary Care & Community Health, 13, 21501319221084165.
50 Senehi 2021 - Senehi, N., Flykt, M., Biringen, Z., Laudenslager, M. L., Watamura, S. E., Garrett, B. A., Kominsky, T. K., Wurster, H. E., & Sarche, M. (2021). Emotional availability as a moderator of stress for young children and parents in two diverse Early Head Start samples. Prevention Science.
51 Hooper 2022 - Hooper, A., Hustedt, J. T., Slicker, G., Hallam, R. A., Gaviria-Loaiza, J., Vu, J. A., & Han, M. (2022). Area Deprivation Index as a predictor of economic risk and social and neighborhood perceptions among families enrolled in Early Head Start. Children and Youth Services Review, 137, 106468.
52 MDRC-Equity Pre-K - Portilla, X. A., & Iruka, I. U. (2024). Advancing equity in pre-K assessments elevating the strengths of children from racially and linguistically marginalized backgrounds. MDRC.
53 Kamerman 2007 - Kamerman SB, Gatenio-Gabel S. Early childhood education and care in the United States: An overview of the current policy picture. International Journal of Child Care and Education Policy. 2007;1(1):23-34.
54 US Courts-BvBE - United States Courts, Administrative Office of the U.S. Courts. Supreme Court landmarks in history: Brown v. Board of Education (BvBE) re-enactment.
55 EPI-Rothstein 2014 - Rothstein R. Brown v. Board at 60: Why have we been so disappointed? What have we learned? Washington, D.C.: Economic Policy Institute (EPI); 2014.
56 NPR-Domonoske 2016 - Domonoske C. After 50-year legal struggle, Mississippi school district ordered to desegregate. National Public Radio (NPR). 2016.
57 Temple 2022 - Temple JA, Ou SR, Reynolds AJ. Closing achievement gaps through preschool-to-third-grade programs. Frontiers in Education. 2022;7.
58 Economic Opportunities Act - Public Law 88-452. Senate (S) 2642: Economic Opportunities Act of 1964.
59 NHSA-Head Start history - National Head Start Association (NHSA). Black history month: A reflection on Head Start history.
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