In 1999, Cuyahoga County Ohio launched the Early Childhood Initiative (ECI), a community-based multifaceted effort targeting key service needs for the population aged 0-5. ECI seeks to promote effective parenting, provide children access to health care services, and assure the availability of quality childcare. A central feature of this initiative has been the implementation of two home visitation programs - a one-time universal home visit (Welcome Home) at the time of birth for all first time and teen mothers and an extended home visitation (Early Start) program for those new parents in need of ongoing assistance due to a lack of parenting knowledge, self-management skills, or environmental challenges. The comprehensive evaluation of Welcome Home and Early Start documented the characteristics and experiences of new mothers who received only Welcome Home, new mothers who received Welcome Home and were referred on to Early Start by the Welcome Home nurse, and pregnant women or new mothers referred to Early Start by their Ohio Works First (OWF) caseworker. The report summarizes the changes observed in participants during the 11-month observation period and identifies potential impacts Early Start services might have had on these changes. The report also examines the extent to which the sample families were involved in a reportable act of child abuse during the initial six months following service referral.

The Early Start Program - An Assessment of Program Quality summarizes the findings of Chapin Hall's comprehensive evaluation of Early Start, one of Cuyahoga County Ohio's Early Childhood Initiative (ECI) programs. Early Start services are provided by 28 community-based agencies located throughout the county. Although all of the programs follow a common curriculum and have specific expectations regarding service duration and dosage, wide variation exists in agency focus (e.g., health care, child welfare, family support, mental health, etc.) and in the qualifications of the home visitors (e.g., nurses, social workers, child development specialists, paraprofessionals, etc.). The Early Start evaluation implemented a multi-method approach, including survey, administrative, and qualitative components, to document agency compliance with program standards and to explore additional quality considerations such as consistency in maintaining accurate and timely participant case records, staff retention and satisfaction with the work environment, knowledge of and coordination with other local service providers, development of an organizational culture that invites and rewards innovation and participatory decision-making, and sensitivity to cultural variations in parenting norms and attitudes toward formal support services.