Family Start workers make regular home visits and, using a structured program, seek to improve parenting capability and practice. Workers also actively work to promote breastfeeding, reduce home hazards, connect infants to immunisation and primary health services, promote children’s participation in early childhood education, and connect families to services that could help address family violence, substance abuse, mental health and other challenges they face.
The programme is delivered by contracted providers with the aim of ensuring services are provided in a manner that is responsive to each community. Providers include iwi, Pacific, faith-based and other Non-Government Organisations.
Families are referred to Family Start by a range of individuals and agencies including midwives, Well Child/Tamariki Ora nurses, Child Youth and Family (CYF) and Police. Families can also self-refer. Children are generally enrolled either before birth or in their first year, and can remain in the programme until the family “graduates” or the child reaches school age.
Family Start workers deliver services at varying levels of intensity depending on the family’s needs, and visits are weekly or fortnightly. A central programme component is delivery of a child development and parent education curriculum.
A number of studies and reviews of Family Start have been conducted over the years. These have tended to find that families selected to be interviewed value the programme. But they have also highlighted variation in practice and performance across providers. None of these previous studies has been able to establish the effectiveness of Family Start in improving outcomes. This new study was commissioned to fill that gap.
The results indicate that the enhanced Family Start programme that was phased in to new areas between 2005 and 2007 was associated with statistically significant positive impacts in a number of domains.
Positive impacts are found for Family Start children overall, and for Māori and Pacific children who participated in the programme.
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Date of last publication
What this study tells us:
- the enhanced Family Start programme phased in to new areas between 2005 and 2007 had positive impacts on use of some health services and children’s participation in Early Childhood Education
- mortality rates in the first 2 years of life were significantly reduced for children who participated in Family Start, with reductions in injury death and SUDI
- Family Start children were more likely to come to the early attention of CYF and more likely to have substantiated findings of maltreatment, but no more likely to be hospitalised for injuries coded as maltreatment related or considered markers for maltreatment.
- whether all providers generated positive impacts
- the mechanisms by which positive impacts were achieved
- whether Family Start children were more likely to have contact with CYF in the longer term (or whether the programme simply brought forward contact that would have occurred in any case), and whether increased early contact was preventive in that concerning behaviours and circumstances were identified and addressed early
- whether impacts estimated, which relate to the programme as it was for children born prior to 2012, would be similar to those delivered by the programme in its current form – changes intended to make Family Start more effective and to more tightly target the programme to families facing the greatest number of challenges introduced in 2011-12 may mean that Family Start is now more effective, but this study can’t say
- whether outcomes less readily measured using administrative data were impacted (eg. inter partner conflict and violence, parents’ discipline practices, and child cognition)
- what parents and caregivers thought of the effectiveness of Family Start
- whether the programme benefits outweighed the costs – whether Family Start was “cost effective” for the cohort studied.
- the study will help inform the on-going development of intensive home visiting services in New Zealand.
The enhanced Family Start programme that was phased in to new areas between 2005 and 2007 was associated with some small but statistically significant positive impacts for Family Start children overall, and for Māori and Pacific children who participated in the programme.
Reduced Child Mortality
The most striking finding from the study is evidence that Family Start reduced post-neonatal mortality. The evidence of a programme impact was strongest and most persuasive in the case of Sudden Unexplained Deaths in Infancy (SUDI) and injury deaths.
Mortality results are very promising and consistent with emerging evidence from studies of home visiting programmes in the United States. They are of particular interest in the New Zealand context because infant mortality rates are high in this country compared with other OECD countries, with particularly high rates for Māori infants.
Positive Impacts on Use of some Health Services and Early Childhood Education
Like the Early Start randomised controlled trial, findings indicate positive impacts on connection to some health services and to early childhood education. Compared to a matched control group who had similar characteristics but lived in areas where Family Start was not available, children who received Family Start:
had a higher likelihood of being fully immunised at one or more milestone in their first 2 years
had a higher rate of participation in early childhood education at age 4..
In addition, there was some indication that mothers had a higher rate of use of community-based mental health services in the first year post-birth as a result of Family Start. Mothers of Māori children appeared more likely to use community-based addiction services as a result of Family Start.
The study found no significant impact on participation in the B4School Check, the last of the Well Child/Tamariki Ora health checks. By the time the B4School Check was due, most children would no longer be participating in Family Start. Data on participation in earlier Well Child/Tamariki Ora checks were not available for study.
A concerning finding was that Family Start children were less likely to be enrolled with a primary health organisation (PHO) at age 1 than the matched control group. This was seen in overall results and for Māori children, and may reflect an unintended programme effect. By age 2 there was no evidence of a negative impact on PHO enrolment in overall results, and Māori children who received Family Start were in fact more likely to be enrolled with a PHO than children in the matched control group.
The study looked at whether Family Start had an impact on hospital admissions that were coded as being for a maltreatment-related injury, or were for injuries in infancy that are considered “markers” for maltreatment.
There was no evidence of an impact, positive or negative, on such admissions. There is some ambiguity in interpretation of an absence of a reduction in these measures. Underlying injury rates may have been reduced, but rates of hospitalisation might have appeared unchanged as a result of more families seeking treatment for children’s injuries as a result of Family Start.
Finally, the study found children who received Family Start were more likely to come to the early attention of Child Youth and Family (CYF) compared to the matched control group. Results suggested that an increased rate of notification to CYF was likely to have also led to increases in the proportion of children with substantiated findings of maltreatment.
The magnitude of this effect was difficult to establish: while the matched control group was similar to the children who received Family Start on most characteristics, they were more likely to be in a family where older children had previously come to the attention of CYF and this, rather than participation in Family Start, might explain some of the estimated difference in early contact with CYF; in addition, some children entered Family Start as a result of earlier CYF involvement resulting in “reverse causality” inflating some of the estimated effects.
These results suggest that the presence of the Family Start worker in the home, and increased contact with other services as a result of Family Start, made it more likely that concerning behaviours and circumstances were identified and brought to the early attention of CYF.
Studies of other home visiting programmes have also suggested these sorts of effects. The study highlights the difficulty in using administratively sourced measures to capture whether maltreatment is reduced as a result of home visiting programmes.