[Attachment:] Child Development Services During Home Visits and Socializations in the Early Head Start Home-Based Program Option

Selection of the Home-Based Program Option

The needs of the children and families enrolled in the Early Head Start program, as identified in the Community Assessment, drive the selection of the program option(s). Regulation 45 CFR Part 1305 requires that each Early Head Start and Head Start grantee and delegate agency conduct a Community Assessment within its service area once every three years and update it annually. Programs choosing to operate the home-based program option are bound by the regulations contained in 45 CFR 1306.33. The home-based program option is designed for families whose children and parents are primarily in their home environment. Early Head Start grantees should consider other program options for families with substantial child care needs.

Service Delivery Model of the Home-Based Program Option

The Head Start and Early Head Start home-based program option supports children and their families through home visits and group socialization experiences. Early Head Start home visits provide comprehensive services to support and strengthen the relationships between infants, toddlers and their parents. The strength and quality of these relationships are essential for optimal child development outcomes during this period of rapid social, emotional, physical, and cognitive development. Parents are encouraged and supported to later recreate and build on the activities that are introduced during the home visit.

Group socializations are another opportunity to strengthen and support relationships by providing parents with opportunities to: obtain feedback from EHS staff and other parents or community-based professionals about their child's interests, strengths, needs and resources; observe their children responding to other children and adults; and share and learn from others about the challenges and joys of parenting.

Home visits are planned collaboratively with the parents (or the child's legal guardian) to support the parents in their roles as primary caregivers of the child and to facilitate the child's optimal development. The Family Partnership Agreement must include the specific roles of parents during group socializations and home visits [ 45 CFR 1304.40(a)(2)]. Home visits are conducted with the child's parents or the child's legal guardians [ 45 CFR 1306.33(b)]. Furthermore, visits should be conducted in the child's home except in extraordinary circumstances when a short-term alternative arrangement may be necessary, for example, if the safety of the child or parent is in jeopardy or the family becomes homeless [ 45 CFR 1304.40(i)(4)]. Socializations are also conducted with parents or the child's legal guardian and may not be conducted with child care providers and other substitute caregivers [45 CFR 1306.33(c)].

Frequency and Duration of Home Visits and Socializations

The frequency and duration of home visits and group socializations specified in the Head Start Program Performance Standards are required to deliver the intensity of intervention that is necessary for positive child development outcomes. The regulations require home visits of 90 minutes duration to occur on a weekly basis year-round. It is recognized that programs may schedule fewer than 52 home visits per year, due to situations such as staff vacations and program training activities. Similarly, home visits with families with newborns may be initiated with a reduced frequency and duration to respect the family's need for rest and the adjustment to new routines. Following this transitional period, families should receive weekly home visits. Such flexible programming is necessary and appropriate to respond to the unique needs of families and in order to develop respectful relationships with them.

In addition, programs are required to offer families two socializations per month, or for Early Head Start programs operating year-round, 24 socializations per year. The socializations are to be conducted on a regular basis, approximately every other week. However, programs may elect to offer more frequent group socializations for a period of time, and then not offer them for a few weeks, such as during severe weather periods. In another example, very young infants and their parents should not be expected to attend socializations. The length of each socialization experience should be based on the developmental level of the child, the content of the socialization experience, and other child and family needs.

The federal regulations in 45 CFR 1306.33 specifying minimuns of 32 home visits and 16 socialization experiences per year are based on a part-year Head Start preschool program. Because Early Head Start is a 12 month program, the yearly number of home visits and socializations would increase accordingly.

Home Visitor Caseload

The Head Start Program Performance Standards specify an average caseload of 10 to 12 families per home visitor with a maximum of 12 families for any individual home visitor [ 45 CFR 1306.33(a)(5)]. Programs should determine caseload depending on the complexity and intensity of family needs, travel distances, and to ensure adequate planning time. The regulation requires the caseload to average at least 10 families. Within this average a program may wish to assign an individual home visitor a caseload of less than ten. This might occur when serving multiple children in one family, or when the quality of Early Head Start services could be compromised if the home visitor lacks sufficient time to adequately meet families' needs. For example, home visitors may need to provide additional support to families experiencing multiple or sustained stressors, such as maternal depression, violence in the home, health complications, or other family crises. Home visitors working in rural communities where families live great distances from each other, or in communities where medical, dental, and social services are difficult to access, might need additional time to fully meet each family's needs.

Child Development Services During Home Visits

The Content of the Home Visit: Curriculum Planning

The child development and education approach for infants and toddlers [ 45 CFR 1304.21(b)(1)(i-iii)] is based on the development of secure relationships; an understanding of the child's family and culture; the development of trust and security; and the opportunity to explore sensory and motor experiences with support from Early Head Start staff and family members. The Early Head Start curriculum is the vehicle through which child development and education is delivered. The curriculum, defined in 45 CFR 1304.3(a)(5), is a program's written plan that includes: 1) the goals for children's development and learning; 2) the experiences through which they will achieve these goals; 3) what staff and parents do to help children achieve these goals; and 4) the materials needed to support the implementation of the curriculum.

Parents play an integral role in the development of the program's curriculum [ 45 CFR 1304.40(e)(1)]. At the program level, parents are offered opportunities to participate in committees that develop or evaluate the program's curriculum. At the individual level, their active participation involves sharing knowledge about their particular child's interests, resources, and needs; choosing meaningful goals and experiences for their family; and determining if the curriculum is effectively meeting their child's needs. The Policy Council plays an equally important role by ensuring that the program's philosophy and long and short term goals and objectives are reflected in the curriculum [ 45 CFR 1304.50(d)(iii-iv)].

Curriculum Goals

Goals for children's development and learning are established in partnership with parents and based on the child's ongoing developmental assessment. The Head Start Program Performance Standards in 45 CFR1304.21 identify the developmental domains that curriculum goals should support, including social and emotional, language, cognitive, and motor skills. While these areas of development are often defined as distinct skills, it is important to understand that each area of development is connected to and affects every other. Thus, it is how these skills are integrated and work together that promotes important developmental outcomes for children, including the ability to form close, trusting relationships; curiosity and the motivation to learn; intentionality; problem solving; self-regulation; and the capacity to communicate.

Home visitors work closely with parents to ensure that goals and experiences are congruent with the family's culture; build on children's interests and abilities; promote curiosity and positive views about themselves and about learning; and use responsive interactions as the primary vehicle for learning.

Curriculum Experiences

The greatest opportunity for learning during the infant and toddler period is through daily experiences such as feeding, diapering or toileting, greetings or good-bye's, bathing, dressing, and play. All these experiences are new to infants and it is through their sensory systems - seeing, hearing, feeling, tasting, touching - that they experience the world. In addition, these routines occur many times throughout the day, therefore each home visit presents numerous opportunities to support the parent's ability to facilitate rich learning experiences in the home and enhance the pleasure that both the parent and child take in the relationship that they are building. For example, if the child is experimenting with making different sounds and the parents' goal is to encourage language skills, the home visitor can help identify ways to promote reciprocal communication between the parent and child during everyday routines such as meal times, when bathing, or by sharing books.

Each home visit should focus on the parent as the child's most important relationship and first teacher, and through the parent, focus on the needs of the child. Child development experiences, which focus on the relationship and interaction between the parent and child, should occur during each home visit. There are times when a parent is so distracted by personal needs that it is difficult to establish the focus on the child. It is important at these times to ensure that the parent gets the support he or she needs so that he or she can then be available to meet their child's needs. A home visitor in this circumstance might guide the focus back to the child by first listening to the parent's concerns, identifying resources, and then helping the parents understand how the family circumstances affect the child. The home visitor should ensure that the child development goals of the Early Head Start program are being addressed at the same time that the needs of the parents are supported.

Roles of Home Visitors and Parents: Ongoing Assessment and Individualized Services

Home visitors and parents work collaboratively to develop meaningful curriculum experiences. Parents and home visitors exchange information based on observations of the child and the ongoing infant-toddler assessments conducted by the home visitor and other Early Head Start staff with the parents. Home visitors follow the parents' lead in establishing goals for their infants or toddlers and support parents as they engage in sensitive and responsive interactions. Home visitors also provide education and guidance and empower parents to advocate on behalf of their young children.

Parents provide specific information on their child's routines, interests, skills, and the family's practices, and cultural traditions. Parents also provide information on the range of pleasurable experiences or challenging interactions with their infants and toddlers. For example, a parent can describe how her baby or toddler falls asleep, calms when upset, and reacts to sights, sounds, new situations or people.

Home visitors support parents' understanding that everyday routines provide the context for learning and development. They emphasize how these experiences provide rich opportunities for infants and toddlers to practice newly learned and emerging skills in naturally occurring events within the family. Home visitors also help parents understand how their support and enjoyment of their infants' and toddlers' exploration and learning promote curiosity, initiative, self-esteem and continued exploration.

Home visitors provide information on developmental stages and experiences that support the acquisition of skills such as self-regulation, problem solving and the capacity to use language for expression of feelings and ideas. Home visitors also provide information on how to observe and individualize experiences for infants based on temperament, learning style, and interests. At each new developmental stage, home visitors can support parents through the new routines, relationships and lifestyle changes that a baby brings into a home, as well as understand and manage the impact on siblings.

Based on assessment, and parents' questions, concerns or priorities, home visitors can provide information on the ways that parents can enhance their infants' ability to look, listen and self-soothe. For example, a home visitor might explain to a parent of an infant how self-soothing, an early self-regulatory skill, facilitates meaningful interaction with others and allows the infant to actively take in information about their world. Alternatively, for an older toddler, the home visitor might discuss the opportunity to build language skills during everyday routines and provide a variety of songs, rhymes and fingerplays for parents to use while dressing, bathing, or eating.

Home visitors consult with disability specialists and early intervention providers to identify how infants' and toddlers' Individual and Family Service Plan (IFSP) objectives can be implemented within daily routines. Home visitors also receive guidance on the use of assistive technology, augmentative communication, and adapted toys to promote infants' active participation in family routines and play with peers.

Materials

Home visitors should have a repertoire of parent education materials that are reflective of the range of adult learning styles of parents, and take into account language, education, and cultural differences. Parent education resources should be utilized in an individualized manner with parents and build on parents' competencies. Programs should possess a variety of different parenting education materials with different purposes: some provide parent-child activities to support developmental capacities while others are designed to enhance parent observations and interactions with their child. Home visitors should carefully select materials that best meet program goals and family priorities. Further, home visitors should be sensitive to cultural values and differences when choosing parenting education resources, play materials, and activities. It is critical to the development of the child that parents are supported as the child's primary and first teacher.

Child Development Services During Socializations

Purpose of Socializations

Early Head Start programs operating a Home Based Program Option provide two socializations per month (approximately 24 per year) for infants, toddlers and their parents. Socialization experiences for infant and toddlers are designed differently then socializations for preschoolers. The purpose of socialization experiences for infants and toddlers is to support child development by strengthening the parent-child relationship. The content of the group experience reflects this emphasis and incorporates the goals of the program and participating families such as: helping parents to better understand child development; encouraging parents to share their parenting challenges and joys with one another; providing activities for parents and children to enjoy together; offering structured and unstructured learning opportunities for both children and parents; and modeling successful strategies for engaging children and supporting their development.

Linking Socialization Experiences to the Home Visits

The socialization experiences support the goals established during the home visits. The Family Partnership Agreement must include the specific roles of parents in socializations and home visits [ 45 CFR 1304.40(a)(2)]. This provides a mechanism for connecting the home visits with the socialization experiences so that they build on family goals and are meaningful to the participants.

For example, if several families are working on creating a safe home environment for infants learning to walk, a socialization experience might be organized around a discussion of safety precautions and the challenges of baby-proofing their home. Such a discussion might include specific strategies for eliminating hazards as well as exploring ways to create safe environments that promote parent-infant relationships and the infant's physical, cognitive, social and emotional development. During the same socialization, the parents would learn how other parents are meeting the challenges of safely supporting infant exploration. The group might walk to a nearby playground to demonstrate and discuss outdoor safety as well. The home visitor would utilize group facilitation skills to create a trusting atmosphere; support successful strategies or model alternative strategies for redirecting children's behavior; build on each child's individual strengths; and emphasize ways to support the child's emerging developmental skills while creating a safe environment to explore.

Curriculum Planning for Socialization Experiences

The federal regulations in 45 CFR 1304. 21(b) which define the child development and education approach for infants and toddlers are applicable to Early Head Start services delivered through the socialization component of the Home-Based Program Option. Thus, these group experiences are designed to facilitate the development of emotional security through trusting relationships with a limited number of consistent and familiar people. Socialization experiences provide home-based Early Head Start staff the unique opportunity to focus on the parent-child relationship and interaction in the context of the group setting.

Socialization experiences for infants and toddlers support child development by focusing on relationships and are planned to support parents' interaction with their children. All activities should be appropriate for the ages and developmental level of the children present, and take into consideration adult needs and learning styles. Programs should consider the different developmental needs of young infants, mobile infants, and toddlers when planning socialization experiences. For example, young infants may tire easily and only tolerate group experiences of a short duration, while toddlers might enjoy a longer or more active group experience. For this reason, Early Head Start grantees may consider forming socialization groups based on the developmental level of the children: young infants, mobile infants, and toddlers. Mixed age groups can be appropriate for families with multiple children under three years of age or other family circumstances. Both models support the parent-child relationship when the experiences are planned to meet the developmental needs of the children in Early Head Start. Programs might consider separate accommodations for older siblings of the children enrolled in Early Head Start so that the parent is fully available to focus on the infant or toddler during the socialization experience.

Early Head Start staff should consider how the developmental functioning of infants affects their participation in the group experience. Socializations provide opportunities for infants to observe and interact with adults and with each other. From the beginning of life infants are aware of others and will participate in the give and take of socializations. The way infants interact with each other will evolve over time. Very young infants might indicate their joy at seeing a familiar face with a full body wriggle and a smile. A three-month-old infant might interact with other infants through eye contact, vocalization and observation. Six-month-olds can imitate the coos and squeals of their playmates. At nine months of age two infants might each press buttons on the same pop-up toy and laugh in delight over the other's accomplishment. At two years a toddler might vigorously affirm a toy is "mine" and learn better how to take turns through the guidance of parents and the home visitor.

To support the relationship-building focus of socializations, parents and infants are together during socialization experiences. If a socialization includes an activity that is parent-focused, such as a facilitated discussion, parents can participate with their infants nearby. As infants become more mobile and independent, there may be times when children and parents separate for short periods.

One of the benefits of the socialization experiences is the parenting education that occurs in many forms: through informal conversations between staff and parents as they interact with their children; during facilitated discussions on a particular topic related to the socialization experience; and by observing other parents and staff interact with children. Formal or more structured parenting education where the focus is exclusively on the adult should occur during times other than socialization experiences since the socialization experience is designed for parent-child interaction.

Similarly, socialization experiences may include outings or meals, but in the context of the socializations these should be small-group experiences and build on the goals of the socialization. Large-group family meals and activities should occur at times other then the socialization gathering. All socialization experiences are planned to address child development issues, parenting, and the parent-child relationship.

Grantees ensure that they are able to provide appropriate snacks and meals to each child during group socialization activities [ 45 CFR 1304.23(b)(2)]. The type and nature of the meal or snack is determined by the content and context of the particular socialization, as well as the developmental level of the child. Programs ensure that there is appropriate infant formula and baby foods available for infants. Socializations provide an excellent opportunity to address nutrition and healthful eating habits and promote child development through activities such as menu planning, discussion, and the preparing and sharing of snacks or meals.

Staffing for Socializations

The home visitor's relationship with the family is the primary avenue through which Early Head Start services are delivered in the Home Based Program Option. Thus, home visitors play a central role in the socialization experiences. Home visitor caseloads should be set at a level that allows them the time necessary to fully participate in the planning and implementation of socializations.

Early Head Start staff with the responsibility for planning and implementing socialization experiences should have expertise in infant and toddler development as well as facilitating groups of parents and children together. Early Head Start grantees might consider a designated staff position, working collaboratively with home visitors, for planning and implementing socialization experiences.

Group Size of Socializations

Early Head Start grantees determine the number of participants in group socialization experiences to support the goal of facilitating child development by strengthening the parent-child relationship. To meet this goal, group sizes should be limited. Large groups of infants and adults do not provide the intimacy or intensity of interaction that facilitates trust, predictability, and responsive caregiving. Smaller groups allow children, families, and staff greater opportunities for individual attention and meaningful interaction.

Environments for Socializations

Early Head Start grantees select the setting for socialization experiences with attention to the features that support a high quality environment for infant and toddler exploration and interaction with family members. Early Head Start grantees should identify a designated space for socialization experiences. This space need not be used solely for socializations. A designated space provides the participants with a stable and predictable setting and takes into consideration appropriate health and safety requirements such as facilities for toileting and hand washing, refrigeration, and heat. Programs must also ensure that children with disabilities can fully participate by making any necessary adaptations to the setting and materials to allow for active engagement with others and full participation in activities.

The environment should meet the needs of both children and adults. For example, adults should have comfortable places to sit that facilitate interaction with their children. Young infants need soft places to sit or lie down, and nursing mothers should have comfortable accommodations for breastfeeding. Mobile infants need safe places to crawl and surfaces to pull up on, while toddlers require adequate space to run and climb.

Transition Planning From Prenatal Services to the Home-Based Program Option

The regulations governing the home-based program option in 45 CFR 1306 refer to services for children and do not apply to services to pregnant women. Regulations governing services for pregnant women enrolled in the EHS program are found in 45 CFR 1304.40(c). However, EHS grantees may choose to provide services to pregnant women through home visits. In this case, the length and frequency of the home visits are based on the family's needs and goals. Similarly, programs may wish to, but are not required to provide socialization experiences for pregnant women.

Some Early Head Start grantees providing services to pregnant women will be transitioning the family into the Home-based Program Option following the birth of the baby. In this case, programs are urged to consider how the transition into the home-based program option can best meet family needs. For example, it may be preferable to have a gradual transition into the socialization experience, beginning before the birth of the baby. Pregnant women would have the opportunity to interact with other women at the same stage of pregnancy, learn from mothers who have recently delivered, and become familiar with the socialization environment and routines. Women with newborns may want to meet with smaller, less frequent groups, in a less structured environment, such as another woman's home.

Conclusion

The home-based program option is designed for families whose children and parents are primarily in the home environment and offers comprehensive Early Head Start services through regular home visits and group socializaton experiences. It is the relationship with the home visitor that forms the foundation for effective service delivery. Similarly, it is the relationship between the parent and infant or toddler that provides the foundation from which very young children develop the social competence necessary for success later in school and in life. Comprehensive, high-quality home visitation services strengthen and support families so that they, in turn, can provide the best possible support for their child.