Home Visitor’s Handbook

For the Head Start Home-Based Program Option

Home Visitor’s Handbook

For the Head Start Home-Based Program Option
The Home Visitor’s Handbook for the Head Start Home-Based Program Option

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth, and Families

Head Start Bureau 

Prepared for the Head Start Bureau, under contract #105-98-2055,

by the Early Head Start National Resource Center @ ZERO TO THREE
Home Visitor’s Handbook

For the Head Start Home-Based Program Option

Table of Contents

Introduction 2

Part 1 | Essential Elements of the Home-Based Program Option 4

Part 2 | Frequently Asked Questions 7

Part 3 | Partnerships With Families 12

Part 4 | Home Visits 17

Part 5 | Socialization Experiences 23

Part 6 | Getting the Support You Need 28

Part 7 | Your Community 32

Part 8 | Additional Resources 35

Appendix A | Information Memorandum 39

Child Development Services During Home Visits and Socializations 

in the Early Head Start Home-Based Program Option

Appendix B | Information Memorandum 48

Services to Pregnant Women Participating in Early Head Start
The Home Visitor’s Handbook

Introduction

In your role as a home visitor, you provide comprehensive Head Start services to families. The

Head Start Program Performance Standards (45 CFR 1304, 1306, and 1308) identify the range of

services that you must arrange for or provide to the families you visit, including screening and

ongoing assessment of child development; medical, dental, and mental health services; child

development and education; and family partnerships that focus on setting goals and identifying

the responsibilities, timetables, and strategies for achieving those goals.

You have the opportunity that most professionals do not have to take a glimpse into the lives of

children and families. Your role is unique, and the relationships you build with families are the

most powerful tool you have to support young children and make a difference in their lives.

Your work is challenging. It is also enormously rewarding. You are not expected to do it all on

your own. We hope this Handbook will help you to discover how you can be your own best

resource and how your supervisor and colleagues, the families with whom you work, and your

community are all vitally important to the success of your program.

The Home Visitor’s Handbook for the Head Start Home-Based Program Option was created to help you

understand and do your job. This Handbook is part of a set of materials for the Head Start homebased program option: (1) The Program Administrator’s Checklist for the Head Start Home-Based

Program Option; (2) The Home-Based Supervisor’s Manual for the Head Start Home-Based Program

Option; (3) The Home Visitor’s Handbook for the Head Start Home-Based Program Option; (4) A Parent’s

Guide to the Head Start Home-Based Program Option; (5) The Beginning at Home video for the Head

Start Home-Based Program Option; and (6) The Beginning at Home Video Guide for the Head Start

Home-Based Program Option.

The Program Administrator’s Checklist for the Home-Based Program Option is a tool for program

administrators to consider how community needs and resources may make the home-based

program option the best choice for your community. The Checklist presents a number of questions that program leaders should address as they plan home-based services.

The Home-Based Supervisor’s Manual for the Home-Based Program Option provides your supervisor with information, materials, and strategies to support you in your work with families. The

Supervisor’s Manual contains background information on the history of home visiting; the

requirements outlined in the Head Start Program Performance Standards for home visits and socialization experiences; the process for effective supervision of home visitors; and materials to support supervisors in their own professional development. The Supervisor’s Manual will help you

know what to expect from your supervisor and how the two of you, together, support the families with whom you work.

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The Home Visitor’s Handbook for the HomeBased Program Option provides you with

tools to help you do your job. First, we provide the context for home visiting to help

you understand the big picture—why home

visiting is a successful strategy for delivering services and how to determine whether

home visiting is the right option for families. The next section of the Handbook

explores the “frequently asked questions”

of home visitors and provides you with

some answers to the questions that might

be on your mind. Next, we discuss the relationship-building process with families as

well as what you actually do on home visits

and during socialization experiences.

Finally, we address how you can get the

support you need to do your job well, how

to collaborate with community partners,

and where you can find resources for more

information.

A Parent’s Guide to the Head Start Home-Based Program Option is designed for you to use with

the families in your home-based program. It is written for parents to help them better understand how home visits work, what they can expect from you, the role parents play as the child’s

first teacher, and how the home is a learning environment. The Parent’s Guide is interactive. It

provides space for you to personalize the information for each family and for family members

to write their own thoughts about parenting and how they support their child’s development.

The Beginning at Home video offers 5 vignettes that demonstrate different aspects of a home visitor’s relationship with a family, and how those relationships are having an impact on the children and families with whom they work. The Beginning at Home Video Guide for the Home-Based

Program Option offers viewers an opportunity to deepen their understanding of the video content through discussion questions and training exercises.

Although each of these resources is designed with a particular audience in mind, they work best

when used collaboratively. Home-based supervisors, home visitors, and the families with whom

you work each play an equally important role in meeting the goals of home-based Head Start

services.

Introduction

3
Home Visitor’s Handbook

Head Start Home-Based Program Option

Part 1 | Essential Elements of the 

Home-Based Program Option

Home visiting is a method of service delivery. It is a way to offer support, guidance, information,

and child development services directly to families in their homes. The Head Start home-based

program is one of the options (45 CFR 1306) for delivering comprehensive Head Start services.

Home visiting is unique because it offers an opportunity for families to get the support they

want in their own homes. Home visiting allows you to do the following:

u Use the home environment to help parents create rich learning opportunities that build on

everyday routines and support their child’s development. The parent’s ability to recreate the

child development experiences after you leave is equally important to what you do during

the home visit.

u Provide support to families whose life circumstances might prevent them from participating

in more structured settings, families such as those who suffer severe stressors like maternal

depression or substance abuse. Working in the environment where families are most comfortable often lets you get to know families in a much more intimate way, which sets the

stage for close, trusting relationships—the critical element in any program designed to support children and their families.

u Be flexible and offer support and child development services during nontraditional hours to

families who work or go to school.

u Work with families who live in rural communities and who otherwise would not be able to

receive needed services.

Is the Home-Based Program Option the Right One for a Family?

The Community Assessment, conducted once every three years (45 CFR 1305), gives essential

information about the needs of families and resources available in your community. If any significant changes in the needs or resources available to families have occurred, the Community

Assessment should be updated and program administrators should reevaluate how your Head

Start program can best meet community needs, including whether the home-based program

option is appropriate for the current circumstances in your community.

Before a family is enrolled in the home-based program option, programs need to explore

whether the family’s needs and circumstances are appropriate for this program option. Family

needs and resources change, and thus, a child may move from one program option to another if

a more appropriate option is available. Many Head Start and Early Head Start programs offer a

variety of program options to meet changing family needs.

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In addition, a child enrolled in a center-based option, a combination-option, or a locally

designed program option may also receive home visits as an enhancement of those services.

Under these circumstances, the home visits are conducted according to the requirements of the

program option in which the child is enrolled and are based on family needs. The requirements

for the home-based program option as specified in 45 CFR 1306.33 are only for children who are

enrolled in that program option.

As you consider enrolling a family in your home-based program, consider the following questions:

u Are the children’s parents or other legal guardian (e.g., foster parent or custodial grandparent)

available to participate in the home visits and socialization experiences, as well as committed

and able to reinforce the child development goals during the time between home visits?

Child care providers and other temporary caregivers cannot substitute for the parent during

home visits [45 CFR 1306.33(b)]. Parents should know that, during the week when you are not

in their home, they are expected to recreate and build on the learning experiences that you

collaboratively plan and conduct on home visits. You should consider how you will involve

both of the parents, the extended family members, or other significant members of the

household in your home visits and in the program.

u Is this family available for the number of home visits and the duration of the home visits that

are required by the Head Start Program Performance Standards? 

You are responsible for conducting home visits on a weekly basis for 90 minutes duration (45

CFR 1306.33), which is the measure of the intensity of the services. Home visits must reach

this level of intensity to achieve the child development outcomes of the Head Start program.

Note that the federal regulations in 45 CFR 1306.33

that specify the yearly number of home visits and

socialization experiences are based on a 9-month

preschool Head Start program. Head Start and

Early Head Start programs that offer year-round

services are expected to adjust those numbers to

provide weekly home visits and two socialization

experiences per month for 12 months a year.

Although the goal of weekly home visits and

biweekly socializations is the ideal, it may not be a

goal you reach with every family each year. If you

notice that a particular family or a significant

number of families are not available for the intensity of home visits required by the Program

Performance Standards, you and your supervisor

should carefully reevaluate whether the homePart 1 | Essential Elements

5
based program is the appropriate program model for those families. In the case where significant numbers of families are not available for home visits in your community, your program

administrators should reevaluate community needs and resources as well as the program

options that might best meet family needs.

u Are there any barriers that might prevent this family from fully participating in the program?

Families are complex. A family’s needs, resources, and goals are fluid and can change unexpectedly. Accept that you cannot meet the needs of every family that calls on your program.

Sometimes you will not be able to help. No one program and no individual home visitor can

realistically help everyone. Know the limits of your program as well as your own professional

and personal boundaries.

For example, some family members may be hesitant or uncomfortable with the idea of a

stranger coming to their home. Be sensitive to how parents or other extended family members might feel about your presence in the home. Perhaps one parent wants you to be there,

but his or her spouse does not. Recognize how this tension will become part of the work you

do with the family and how the particular individuals with whom you work will shape your

role. (See Part 3 of this Handbook for more information on effective family partnerships.)

u Is this family available to participate in biweekly socialization experiences outside of the home?

Be aware of the obstacles families might face with this aspect of the home-based program

and brainstorm ahead of time how you might help families address any issues that could

prevent them from attending socialization experiences. For example, does the family need

transportation to get to the socializations? Explore whether your program will need to provide child care for siblings who are too old or too young for the socialization experience.

Home visiting may be ideal for some families. However, it will not be the right program option

for every family. The first step in building a quality home-based program is to ensure that you

are reaching the families that the home-based option is designed to engage. Learn to recognize

when the program model is not the right fit for a particular family, and help them to find the

resources that will better meet their needs.

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Head Start Home-Based Program Option

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Part 2 | Frequently Asked Questions

The following are examples of commonly asked questions about the home-based program

option. The answers are provided here as a guide; they are not intended to be an interpretation

of policy. Whenever you have a specific question about Head Start policy and your Head Start

program, your agency should seek the guidance of your Federal Program Specialist at the

Administration for Children and Families (ACF) Regional Office.

Questions About Home Visits

Q: The Head Start Program Performance Standards and program option regulations require home

visitors to provide comprehensive services. Am I expected to be an expert on everything—nutrition, health, family dynamics, child development, and all the other areas covered in the Program

Performance Standards? How do I do it all?

A: The Program Performance Standards do require that all the comprehensive Head Start services

are available to families in the home-based program option. You are responsible for introducing these services and for arranging or providing these services (45 CFR 1306.33). The Program

Performance Standards also specify the knowledge, experience, and skills that you need to do

your job well [45 CFR 1304.52(e)]. However, you are not expected to be an expert in all things.

You are expected to be familiar with and to help families access resources for all the elements of the Head Start program. This expectation is one reason why your community partnerships and the management systems for tracking services are vitally important in the

work that you do. Know your limits and know when you must refer families for help. Seek

professional development experiences in areas where you need further training or want to

improve your skills. Your supervisor and other colleagues are key resources to help you meet

this challenge. With your supervisor, discuss the expectations for your role, any concerns you

have, and ways he or she can help you provide comprehensive services to families.

Q: If a family needs child care, can that family also be enrolled in the home-based program option?

A: A family who needs child care is best served by a comprehensive system of coordinated services. Thus, a center-based option, combination option, or a child-care partnership would provide both the child care needs and the comprehensive Head Start services. A child participating in part- or full-time child care may also benefit from home visits because of particular

family circumstances, needs, or goals. In this case, the child might be enrolled in the centerbased option and receive home visits as an enhancement to those services. Alternatively, the

child might be enrolled in a combination program option and receive both center- and homebased services as specified in 45 CFR 1306.34.

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Home Visitor’s Handbook

Head Start Home-Based Program Option
Q: What do I do if a family has a 4-year-old in Head Start and an infant in Early Head Start. How

many home visits does this family get per week?

A: Each family receives one 90-minute home visit per week regardless of the number of children

enrolled in Head Start or Early Head Start. Home visits with multiple children require

thoughtful and creative planning as well as collaboration between the Head Start and Early

Head Start program to ensure that you address the child development goals of all the children. This coordination is particularly important when the Head Start and Early Head Start

programs are operated by different agencies.

Q: Sometimes parents have so much going on in their lives that I have a hard time getting them to

focus on the children during our home visits. How can I incorporate both the parent’s and the

child’s goals into the home visit?

A: Focusing on the children is enormously challenging when parents are dealing with difficult

or overwhelming life circumstances. Yet, you are in the home to deliver Head Start services

with the overall goal of promoting healthy child development. If you are working with parents who are dealing with challenging situations, it is important that you help the parents

get the support they need so they can meet their child’s needs. Listen attentively, and whenever possible, provide resources. Then, bring the focus back to the child by discussing how

the parent’s situation is having an effect on the child.

For example, if a parent is overwhelmed by financial problems, after you have spent some

time addressing those issues, you might inquire whether the baby has enough food and diapers. Ask the parents how they think the baby is reacting to the increased stress in the

household. Then link your child development experience to the current situation. In this

example, you might talk with the parent about how the baby needs consistent routines, especially during times of stress, and help the parents structure their day. You could come up

with activities that are soothing to both the parent and child, for example, more time cuddling in the rocking chair, reading favorite stories, or singing gentle lullabies. In this way, you

are supporting parents while simultaneously helping them to support their children.

Q: One of the families I work with keeps canceling our home visits, and I know that I am not going

to see them 52 times this year. I will be lucky to see them half that amount. Should they be terminated from the program?

A: The intensity (frequency and duration) of the services is a critical factor in your program’s

ability to achieve the anticipated outcomes for children. As described in Part 1 of this

Handbook, the Program Performance Standards require that you offer each family weekly home

visits and two group socializations per month (45 CFR 1306.33). The actual number of visits

you accomplish may vary because of illness, vacation, holidays, or other circumstances.

However, if a family demonstrates a consistent pattern of cancelled or missed appointments,

then you need to question whether the home-based model is the appropriate choice for that

particular family. In a case such as this one, work with your supervisor to (a) identify and

remove the barriers that are preventing the family from fully participating in the program or

(b) find another program option that better meets the family’s needs.

Home Visitor’s Handbook

Head Start Home-Based Program Option

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Q: What kind of flexibility is permitted with respect to how many families I work with at one time?

I am working with 10 families, and I seem never to have enough time to plan, attend socializations, and do my record-keeping tasks, much less anything extra like go to a training that I want

to attend.

A: The Program Performance Standards (45 CFR 1306.33) indicate an average of 10 to 12 families

per home visitor. The maximum number of families you can serve is 12. At any given time,

the number of families that you are working with can be lower than the average of 10 to 12

families, depending on the needs and circumstances of the particular families with whom

you are working. Families with more complex life circumstances and greater needs will naturally require more of your time. Logistical concerns such as the distance you must travel to

reach families should also be considered when deciding how many families you can serve.

Talk with your supervisor if you think the quality of the services you provide to families is

suffering because of time constraints.

Q: How often do I have to complete vision and hearing screenings?

A: You must obtain an initial screening for vision and hearing within 45 days of the child’s entry

into the program [45 CFR 1304.20(b)(1)]. Frequently, you can obtain preexisting information

such as a recent vision or hearing test that was performed at the child’s last well-child health

visit. If preexisting information is not available, then you will have to arrange for an ageappropriate screening, which can usually be accomplished during a well-child medical exam.

After this initial screening at the time of entry into the program, the frequency of vision and

hearing screenings are determined by your state Medicaid program. The schedule of ageappropriate preventive and primary health care must reflect the requirements for a schedule

of well-child care used by the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

program of your state Medicaid agency. This schedule must also incorporate the latest immunization recommendations issued by the Centers for Disease Control and Prevention and the

recommendations of your Health Services Advisory Committee that reflect the specific needs

of your community [45 CFR 1304.20(a)(1)(ii)]. Thus, vision and hearing screenings follow your

Part 2 | Frequently Asked Questions

9
state EPSDT schedule and are performed as a part of well-child care health exams. However,

as part of your ongoing assessment of children, any time that you or a parent has a concern

about a child’s health or development, you should refer that child for further evaluation to

ensure the early identification of health or developmental problems.

Questions About Stress and Safety

Q: How do I handle the challenges of being a home visitor? I feel like I am taking all the family’s

problems home with me. I am worried about getting burned out.

A: If you sense that you are becoming burned out, seek the support of your supervisor. The first

step is to recognize the signs of stress and burnout. Your frustrations, worry, or distress

should not get to a level that interferes with your job or your life outside of work. Try to identify the supports that would help you: informal peer support to talk openly about the challenges of your work; validation from your supervisor about the work you do; in-depth consultation on specific issues; access to mental health professionals; or time off to rest and recuperate from the demands of your job. The more proactive you are in meeting your own

needs, the better you will be able to meet the needs of children and families.

Q: Some of the homes I visit are in rough neighborhoods. I am afraid to go there. I have been wondering if I am just not cut out for this work.

A: Talk with your supervisor about your discomfort and try to determine what you find threatening. Carefully examine exactly what it is that is making you feel uncomfortable. In some

cases, your concern might be about things you witness—drug deals, fist fights, or vandalism.

Perhaps you sense a feeling of vulnerability when you drive long distances on a deserted

road after dark. In other cases, your discomfort might be less obvious and rooted in the unfamiliar. If you are working in diverse communities, it is not unusual to feel some discomfort

until you become familiar with the community and culture. Examine your own beliefs and

attitudes and educate yourself about cultural differences.

Ultimately, your safety is your first priority, and it is of equal concern to your program administrators. Identify the things you can do to protect yourself. If your agency does not have a

protocol for dealing with safety issues, your first step might be to approach your supervisor

to develop one. For example, perhaps you would feel comfortable if you had a cell phone

with you and a telephone number where your supervisor or other support person was readily

available should you need assistance. Or perhaps, in some neighborhoods, home visitors

should go on home visits in teams, never alone. Your local police department might be able

to provide crime-prevention training or self-defense classes. The police may also provide

additional police protection if they are aware that you are in the community. In addition, you

can enlist the families’ support in protecting your safety. They often can tell you what you

need to know to travel safely in the neighborhood, for example, what streets to avoid, locations of safer places to park, or the safest time of day to visit.

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Questions About Socialization Experiences

Q: Do we have to provide formula and diapers at socializations?

A: You must provide appropriate meals and snacks during socialization activities [45 CFR

1304.23(b)(2)]. Formula or baby food is an appropriate meal or snack for an infant. In fact,

socializations are an ideal time to address nutrition and healthful eating habits. Socialization

experiences also provide opportunities to model and teach proper health and hygiene practices. You should have appropriate toileting and diapering facilities available, including diapers, wipes, and other necessities, to ensure comfort and reduce the health risks for participating children and adults.

Q: Should siblings attend socializations?

A: Siblings may or may not attend socializations. Their attendance depends on the age and

developmental level of the children for whom the socialization is designed; the goals of the

socialization; logistics such as room capacity, licensing requirements, and staffing patterns;

family circumstances such as available child care; and your program’s design for socializations. In the case of a family with multiple children under the age of 5 years, it may be unrealistic to expect parents to attend a different socialization for each child. Thus, you might

design socializations for mixed age groups that allow parents to participate with all of their

children. In other cases, parents might welcome the opportunity to spend individual time

with their children and you might develop your socialization for a specific age or developmental level and provide on-site child care for older or younger siblings. Be flexible, be creative, and design your socialization experiences to meet the needs of the families with whom

you work.

Part 2 | Frequently Asked Questions

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Home Visitor’s Handbook

Head Start Home-Based Program Option

Part 3 | Partnerships with Families

One of the unique strengths of the Head Start program is the array of opportunities for parent

involvement and decision making. In fact, the partnerships you build with families are the foundation of Head Start success. Successful relationships

with families are characterized by mutual respect,

trust, acceptance, objectivity, flexibility, personalized attention, and cultural awareness.1

The process to collaboratively build a partnership

begins during your first contact with parents. It is

important to recognize that the relationship-building

process will vary for each family, depending on how

willing and ready parents are to participate in the

process. Family members bring to this relationship

their past experiences with other agencies or service

providers, their individual temperament and personality traits, as well as familial and cultural values—

all of which influence how they relate to you.

Relationships take time. You will build mutual trust and respect when you are sensitive to the

cues parents may give you about their comfort with the home visiting process.

uu of box>

The Family Partnership Agreement Process

The family partnership agreement is a process rather than a form. This process provides an

opportunity to identify family goals and how the family will achieve these goals. At the heart of

the family partnership agreement process is the individualization of Head Start services.

Individualized family partnership agreements describe family goals, responsibilities, timetables,

and strategies for achieving family goals. These agreements also describe a family’s progress in

achieving the goals they set. In the home-based program option, this agreement must include

the information just mentioned and the specific roles of parents in home visits and group

socialization experiences [45 CFR 1304.40(a)(2)].

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I became a single parent two years

ago and had to do all the caretaking for the kids all alone. The Early

Head Start program helped me be

hands-on with my kids. My son

has had a home visitor for two

years. He has really grown with

the help of the visitor. The visitor

also gives me ways to do more to

help my kids. I had no idea there

was so much the program could

help with. I have become an active

part in the lives of my kids.

—Father, Central Vermont

Community Action Council, Inc.,

Early Head Start, Barre, VT

1 U.S. Department of Health and Human Services. (1995). Family partnerships: A continuous process. Washington, DC: Head

Start Bureau.

Things You Can Do to Build a Partnership

u Always remember that you are an invited guest in the families’ homes. It is a great privilege that families open their homes and allow us into their lives in such personal ways.

u Think about the characteristics of trusting relationships in your own life and the qualities

that make them unique—the feeling of acceptance, being understood, or having your

needs met. These are the same qualities that you want to bring to your relationships with

families. What makes you feel accepted and understood? Perhaps it is how a person listens to you without judging, gives you another perspective from which to view things, or

provides concrete help when you need it. Maybe it is his or her tone of voice, an empathetic ear, or simply a hug when the person senses that you need it the most. Consider

how your interactions with families convey those messages.
The family partnership agreement does not have to be a written document. The focus is on relationship-building, not on record keeping. You can creatively document the family partnership

agreement process and keep track of how families are making progress toward their goals

through activities such as journals, video or audiotape recordings, or written plans. Each family

Part 3 | Partnerships with Families

13

u Give families the time they need to get comfortable with you, with the home visiting

process, and with the way that you will work together. Each family you work with will

move at a different pace. The first couple of home visits provide an opportunity to establish rapport—a way of being together that is comfortable, builds trust, and inspires honest

communication. It is often wise to let the relationship develop during the first few home

visits before you focus on specific issues such as the child’s developmental screening or

the completion of required forms or other paperwork. Once you have established your

relationship with the family, you are much more likely to have meaningful conversations

about child and family needs, resources, strengths, and goals.

u Familiarize yourself with principles of adult learning. Adults learn best when they are

actively involved in the learning process. Parents decide their own goals for learning,

share in the planning process, and are equal partners in decision making. By demonstrating respect and confidence in parents’ abilities, you help them discover their own solutions.

u Use A Parent’s Guide to the Head Start Home-Based Program as a tool to introduce families to

your program. The Parent’s Guide includes three parts: (1) Introducing Home-Based

Programs, which describes what a home-based program is and what parents can expect;

(2) You and Your Home Visitor, which explores how families work with you to best support their child’s development; and (3) Everyday Moments are Learning Moments, which

offers ideas for how parents can help their children learn by using objects and materials

in their home. You can use the Parent’s Guide to explain your home visiting program and

how you and the family will work together. Use the space provided in the Parent’s Guide to

personalize it with important information such as your name and contact number as well

as the day and time of your home visits and socialization experiences.

u Recognize that who you are as a person—your temperament, past experiences, family

and cultural values, and current life circumstances—shape how you respond to the families in your program. Some families will “click” with you right away, and others might not

feel like a good match. Talk openly with your supervisor about the reactions you have to

the families with whom you work. There is no “right” or “wrong” way to feel. It is normal

and expected that each family will elicit different kinds of feelings in you. Your supervisor

can help you to better understand your own reactions to the families and can help you

develop strategies that use this self-awareness to enrich your professional development.
partnership agreement will be different because it

is individualized to meet family needs and goals.

Your job is to document the process in a way that is

meaningful to you and the family and in a way that

(a) demonstrates to others how you have thoughtfully engaged the family in this process and (b)

allows you to effectively track change over time.

Some families may come to your program through a

referral from another agency that is also providing

services to the family. For example, many early

intervention programs for infants and toddlers with

disabilities work in collaboration with Early Head

Start. Families who have an infant or toddler with

an identified disability will already have a preexisting plan, or an Individualized Family Service Plan

(IFSP), with the early intervention program. In this

case, you would not duplicate their efforts but

would build on the preexisting plan to incorporate

the comprehensive Head Start services. Your family

partnership agreement process would document

how you are helping the family to reach the goals

articulated in the IFSP. In another example, you

might receive a referral from Child Protective

Services (CPS) for a preschooler in foster care. In

this case, the CPS worker may take the lead in

developing family goals, and you would work collaboratively with CPS and the foster parents to support the existing goals.

Ethical Considerations

You are often in situations where you need to

make a tough decision on the spot. How do you

respond when parents are so consumed by their

own problems that you cannot get them to focus

on their children? What do you do if you fear children are being neglected or abused? Should you

always be honest with families? Can you make

promises to families? What kind of information

can be kept confidential, and when should you

share sensitive information? Is it okay to go to family celebrations such as birthday parties?

Should you give out your personal phone number? Is it okay to lend money to a family who is

in a desperate situation?

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“There have been many rewarding experiences within this program for us.... The first experience that left a lifetime impression on me was with my Family

Support Worker* (FSW), who visited my home on a weekly basis.

We had become very close, I considered her a friend. She would

tell me about many resources

that were available to me in the

county. Many times I would act

as if I really did not need help,

because pride got in my way. I

was not accustomed to our family needing help from outside

resources, and I didn’t know

how to ask for help. But because

I had a trustworthy relationship

with my FSW she was able to

read into that. She began to tell

me that there is nothing wrong

with accepting help, because one

day you will be in a position to

help someone yourself. She even

went with me to a few places to

apply for different services.

Thanks to her, today I believe

strongly that pride will lead you

to an even bigger fall, but a

helping caring hand will lead

you to a successful outcome.”

—Mother, Family Services Agency

Early Head Start, Gaithersburg,

MD 

*Note that the Family Support

Worker job title refers to the

home visitor in this agency.
Part 3 | Partnerships with Families

15

Things You Can Do to Respond Ethically

u Know what your agency expects of you, and in advance, think through how you would

respond to specific situations. Your agency is required to have standards of conduct [45

CFR 1304.52 (h)(1)], and you can build on these for your particular needs. For example,

you and your supervisor should develop a crisis protocol for situations that you might

confront during a home visit, including situations such as child abuse or neglect [45 CFR

1304.22(a)(5)]. You are mandated by the Program Performance Standards to report suspected

child abuse. What specific signs would alert you to a potential problem? Would you confront the family? Call your supervisor? Report your suspicion to Child Protective Services?

Your crisis protocol should be as detailed as possible so you are familiar with all the steps

you must take to handle difficult situations with confidence and adequate support from

your agency.

u Have a cell phone and important contact numbers with you when you go on home visits.

Knowing that someone is available to help you at all times decreases the sense of isolation that you feel and allows you to share the responsibility of responding to a crisis with

others who can help.

u Do not remain in situations where you fear for your safety. If circumstances arise during

a home visit that make you feel unsafe, do what you need to do to protect yourself and

possibly others, including leaving the situation. Team up with your supervisor or another

home visitor to visit homes about which you are concerned. Having another person with

you can help you feel safer and can help you assess the situation as well as develop a

plan for addressing your concerns. Your personal safety is your highest priority.

u Be sensitive and respectful of cultural and familial differences. Explore your attitudes and

beliefs about working with people who are different from you. Seek professional development experiences to enhance your ability to work with culturally diverse families.

u Be honest with families about what they can expect from you. At the beginning of the

relationship, inform them about the confidentiality guidelines you will adhere to and the

circumstances in which you must break confidentiality.

u Discuss professional and personal boundaries with your supervisor. You have a professional relationship with the families with whom you work, but when you are in a helping

role, the lines between a professional relationship and a personal one can easily get

blurred. Think through how you can sensitively respond to family needs or requests that

are inappropriate in the context of a professional relationship. Also recognize when your

feelings for or involvement with a family become personal. This exploration provides

another opportunity for you to work with your supervisor on your professional development, to learn about what motivates you as a home visitor, and to discover how you can

best support families.
You probably encounter similar situations on a daily basis. In some cases, the answer will be

clear. In other cases, the situation may not have a “right” or “wrong” way to respond. You will

need to decide in the moment how to proceed. In the box on the previous page are some of the

steps you can take to guide you through these potentially difficult situations.

Your relationships with families will grow over time. You may encounter unexpected bumps along

the road. Often, the challenges you face in the relationship-building process provide the richest

opportunities to increase your self-awareness, both as a professional and as a human being. The

challenging moments are also powerful opportunities to provide families with experiences in

problem solving, patience, flexibility, and acceptance—some of the same qualities we hope parents

bring to their relationships with their children. In fact, your relationships with parents are models

for how to create a nurturing environment for children. Just as children need support to cope,

express emotions, communicate, persist in tasks, and negotiate conflict, so do adults. The experience of being accepted and cared for helps parents to best care for their children.

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Part 4 | Home Visits

Your Role as a Home Visitor

What do you actually do on a home visit? Are you

supposed to greet a family in a certain way? Do you

fill out particular forms? Are you expected to say or

do specific things? In reality, no two home visits

look exactly alike. You bring your own temperament, personality, beliefs, and values to any role

you have. Each family similarly comprises its own

personalities, history of relationships, and cultural

and familial values. Your relationship with each

family is influenced by this rich past and is further

colored by current circumstances—including variables such as how confident you feel in your job,

the amount of support you receive from your

agency, and your own personal life circumstances.

Families are also influenced by their current situations—job stability, financial concerns, housing, or

the quality of their relationships with others.

Given this complexity, we can offer no simple answer to the question What do you do on a home

visit? However, the following three principles provide a framework for how you can approach

each home visit, despite the great variability in the families with whom you work. Each of the

next three points will be discussed further in the following sections.

u You are in the home to support child development, the overall goal of the Head Start program. Thus, one of the first tasks you must accomplish with each family is to identify that

family’s child development goals. Your challenge is to ensure that each home visit maintains

a focus on those goals. Your program’s approach to curriculum helps you to meet goals for

children’s development and learning by providing experiences to meet those goals, by identifying the roles of staff members and parents, and by identifying the necessary materials and

equipment [45 CFR 1304.3(a)(5)].

u You recognize parents as their children’s first and most important teachers. You support parents so they can best support their children. You provide comprehensive Head Start services to

families because children do best when you attend to all areas of their development—physical,

social, cognitive, and emotional. Similarly, parents are best able to provide the support their

children need when their own needs for a healthy lifestyle are met—physical and emotional

health, social support, adult education or job skills, financial stability, and safe housing.

17

“When we first interviewed for

the program there was two

ladies that come out to the house

to meet me and D., and when

they asked me what my stress

level was I broke down crying

and we talked for a good hour

about what was stressing me

out. I just think that was so

wonderful that they took the

time because that’s what I needed at that time, feeling so isolated, alone, and exhausted.”

—Mother, Children’s Therapy

Center of Pettis County, Inc.,

Sedalia, MO

Home Visitor’s Handbook

Head Start Home-Based Program Option
u You capitalize on the learning opportunities in the home environment. The home-based

program is effective in fostering healthy development because you use the setting in which

children and families spend the majority of their time. You emphasize how everyday routines

provide meaningful opportunities for children to build on their developmental skills. You

help parents understand how simple household items and experiences captivate children’s

imagination and promote learning. For example, literacy experiences occur as parents talk

and sing with their children, as they follow a recipe during a cooking activity, or as they

name objects in the grocery store. You also support and empower parents to recreate and

build on these learning experiences for their children during the time between home visits.

These repeated experiences have a significant influence on learning and development, helping children to gain the motivation and curiosity to learn as well as the specific language, literacy, and numeric skills essential for success later in school.

Developmental Screening, Ongoing Assessment, and Curriculum Planning

One of your first tasks with a family is to conduct a developmental screening (within 45 days of

entry into the program) to identify any concerns about a child’s developmental functioning [45

CFR 1304.20 (b)(1)]. The screening process helps you decide whether developmental skills are

progressing as expected or whether certain concerns indicate the need for further evaluation.

An important point to remember is that the screening process does not lead to a decision about

whether or not a child has a developmental delay. Developmental screening is, by definition, a

process to determine whether further evaluation is necessary.

The screening process begins during the enrollment period as you build partnerships with families and initiate Head Start services. Screening requires more than filling out a formal tool such

as a checklist or form. Developmental screening involves observing the child as well as learning

from parents and other significant caregivers about the child’s development and behavior.

Parents take an active role in the developmental screening, ongoing assessment, and evaluation

of their children. Parents know their children best. They can tell you how their children typically

act, the skills their children have, and their children’s likes and dislikes. They are also the ones

with whom their children are most at ease and will therefore act more naturally, demonstrating

their true abilities.

The results of the screening and ongoing assessment are used to inform your goal setting with

families and to track progress over time. If you discover a concern about a child’s development,

the next step is to get a more in-depth evaluation from your local early intervention program.

For infants and toddlers under the age of 3 years, contact your Part C2 early intervention

provider. For preschoolers ages 3–5 years, contact the Preschool Grants program.3 Ideally, your

Head Start program has strong collaborative relationships with these community providers that

enable the referral and follow-up to occur in a timely and effective manner.

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2 “Part C” refers to Part C of the Individuals with Disabilities Education Act (Public Law 105-17), which outlines services

for infants and toddlers with disabilities.

3 The Preschool Grants program refers to Section 619 or Part B of the Individuals with Disabilities Education Act and

outlines the requirements for children with disabilities, ages 3 through 5 years.
The information you gather about the child’s development during the screening, ongoing assessment, and evaluation process is what you use to help parents identify the goals they have for

their child’s development and learning and to document progress and achievements. Your program’s approach to curriculum is the vehicle through which you identify goals, develop experiences to meet those goals, identify the roles of staff members and parents, and select the necessary materials. The approach to curriculum in the home-based program option ensures comprehensive learning experiences that are congruent with the curricular approach of other Head

Start program options.

Parents play an integral role in developing your program’s curriculum [45 CFR 1304.40(e)(1)].

Parents are able to participate in committees that develop and evaluate your program’s

approach to curriculum. Parent involvement on the Policy Council also gives them the opportunity to have an effect on your program’s curriculum. In addition, parents should be actively

involved in the curriculum planning for their children by sharing information about their child’s

interests, resources, and needs; choosing meaningful goals and experiences; and determining

whether the curriculum is meeting their child’s needs.

You are able to help parents identify their child’s emerging skills and learn how they can

strengthen these skills during their everyday routines. For example, the goals for a 6-month-old

infant might be to begin eating solid foods and learn how to sit unassisted. A toddler might be

working on increasing his or her vocabulary or identifying shapes and colors. A preschooler

might be learning letters of the alphabet or classification skills (e.g., sorting things into categories based on variables such as color, shape, or size). As you develop learning experiences to

foster these emerging skills, help parents understand why you chose certain experiences and

how those experiences promote development and learning.

During your home visit to the 6-month-old infant’s family, you might observe a feeding, and you

might provide some concrete guidance such as how thick the food should be, how often to

introduce a new food, and signs to look for to identify food allergies. You can also notice the

quality of the feeding activity, for

example, is the parent relaxed or

tense? Is the baby comfortably and

safely seated? What cues does the

baby give to indicate that he or she is

hungry or satisfied? How is the parent

making the feeding experience pleasurable for the baby? For the parent of

the toddler, you might demonstrate

how preliteracy experiences build

vocabulary. For example, you might

sing songs, say rhymes, or perform finger plays. You might make books for

the toddler with the parent and child.

Part 4 | Home Visits

19
You might make up games such as “I Spy ...” to identify shapes and colors around the house.

You could show the parent simple ways to stimulate thinking about these concepts, for example, by cutting the child’s sandwich into rectangles one day and triangles the next and talking

about the shapes as you eat lunch together. The parent of the preschooler learning classification

skills can have his or her child sort all the socks in the laundry basket by color or stack all the

Tupperware bowls and lids according to shape and size.

In each of these examples, what you do on the home visit is different, but your overarching goal

is the same: identifying child development goals and supporting parents to meet these goals

through their everyday interactions with their children at home.

Meeting Child Development Goals

Each home visit provides an opportunity for you, first, to focus on the parent as the child’s most

important relationship and as the child’s first teacher and, then, through the parent, to focus on

the needs of the child. Child development experiences occur during each home visit. In collaboration with parents, you develop experiences that focus on the relationship and interaction

between parent and child in addition to any specific skill you are working on with the child. You

may find that, sometimes, parents are so distracted or overwhelmed by their own needs that

maintaining a focus on the child is difficult. During these times, you give the parents the support they need so they can be available to meet the child’s needs. In your conversation with a

parent, it is important to listen to and acknowledge the parent’s concerns and to identify

resources that will help that parent reach his or her goals. Then you can bring the focus back to

the child by helping the parents understand how the family circumstances may be affecting the

child. This interaction is not an easy task. Yet, your ultimate purpose is to meet the child development goals of the Head Start program. This “balancing act” is a skill that you will develop

through experience, training, and self-awareness—and with much support from your supervisor.

Using Everyday Routines and the Home as a Learning Environment

One of the unique strengths of a home-based program is the opportunity it provides to seize on

the child’s natural environment to create learning opportunities. Parents and other caregivers

are already promoting their children’s learning, often without knowing it, as they interact sensitively and responsively during daily caretaking routines. For example, when a father gently tickles his baby’s feet and plays “This Little Piggy Went to Market” with her toes, she is learning that

“daddy takes care of me,” “I can trust him to keep me comfortable,” “we play funny games

together,” and “I recognize these words.” When a parent of a toddler lets the child struggle to put

on his or her own socks and shoes, that child has a chance to practice small motor skills by

using his or her hands and fingers to manipulate the socks and shoes and consequently learns

that “I am respected and trusted to do things myself” as well as “mommy or daddy is there to

help me if I need it.” Similarly, a preschooler who is allowed to help set the table is strengthening motor skills (how to walk and carry items), counting skills (four forks and four plates), color

identification (blue place mats and yellow napkins), and self-esteem (“I am a helper,” “I can do

things all by myself,” and “mommy trusts me with an important job”).

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One of your tasks is to help parents and caregivers realize the specific activities they do everyday that already contribute to their child’s learning and development. You can then build on

those interactions by offering additional activities or experiences that enhance the routines that

are already in place. For example, you might teach a parent simple songs or finger plays to use

with his or her baby during feeding or bathing routines to enhance language development. You

can show a parent of a toddler how the child practices important motor skills—balancing on

one foot, using his or her hands and fingers to button or zip—as the child actively participates

in getting him- or herself dressed each day. A preschool age child can learn discrimination and

Part 4 | Home Visits

21

Home Visits With Pregnant Women in Early Head Start

The federal regulations in 45 CFR 1306 refer to home-based services for children and do not

apply to pregnant women. The federal regulations for services to pregnant women enrolled in

Early Head Start programs are found in [45 CFR 1304.40(c)]. It is up to each service provider to

thoughtfully consider where the services to pregnant women should best take place. In some

cases, services will take place in the woman’s home. For other families, services may happen

at a clinic, a family support center, or a convenient combination of places that makes sense

given your particular Early Head Start program and the family’s needs and circumstances. If

you do decide to offer Early Head Start services to pregnant women in their homes, the length

and frequency of the home visits are based on the family’s needs and goals.

Similarly, pregnant women are not required to participate in socialization experiences.

However, some Early Head Start programs may choose to invite expectant parents who will

be transitioning into the home-based program option after the baby’s birth to socialization

experiences during the late stages of the pregnancy. For example, if you have a number of

expectant or new parents, you might design a group experience just for them. Pregnant

women and their families would be able to interact with other parents who are at the same

stage of pregnancy, learn from mothers and fathers who recently experienced the birth of

their babies, and become familiar with the socialization environment and routine. New parents would have the opportunity to talk about the changes they are going through, get support and advice from other parents or professionals, and reduce the social isolation that is

common among new parents.

In addition, note that, once the newborn has been enrolled in the home-based program

option, you have the flexibility to initiate home visits and socializations at a reduced frequency during the transition period into the home-based program (ACYF-IM-HS-00-22). You

should be sensitive to the family’s need for rest and to how they are recovering from childbirth. Some families may be eager for home visits to begin, but others might prefer to adjust

to new caregiving routines before they commit the energy to fully participate in the homebased program. You are expected to resume weekly home visits and biweekly socializations

after this transition period.
classification skills (e.g., how things are grouped together) as he or she helps clean up the toys,

putting all the blocks in one box and all the puzzle pieces in another box.

Part 3 of A Parent’s Guide to the Head Start Home-Based Program Option provides many examples of

the activities you can do with parents and children to enhance learning using household items

during everyday routines. In addition, a number of books and other resources are available (see

Part 8 of this Handbook) to help you develop learning opportunities with items usually found in

the home or through simple games and projects.

The ultimate power of the home visit lies in the parents’ ability to recreate the learning experiences after you leave. The more you do to help parents identify these learning opportunities and

foster their children’s development during the days you are not in the home, then the more successful you, the families, and your program will be.

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Part 5 | Socialization Experiences

What is the Purpose of Socialization Experiences

in a Home-Based Program?

Socialization experiences provide families and staff

members with special opportunities to support

child development and learning. Socializations

build on the experiences and goals that are

addressed during home visits as well as attend to

the needs of both children and parents.

The group experience is a valuable strategy for

delivering services because it provides parents with

the opportunity to obtain feedback from staff members and other parents about their children’s activities, strengths, and resources; to observe their children (when age appropriate) interacting with other

children and adults; and to share and learn with

others about the challenges and joys of parenting.

Socialization experiences incorporate all of the

services required by the Program Performance

Standards. For example, you can develop socialization experiences around topics related to medical,

dental, mental health, nutrition, or child development and education issues. Families are involved in all aspects of socialization experiences,

including planning, implementing, and evaluating. Community partners might be involved in

socialization experiences as guest speakers, or they might provide space or other resources for

socialization experiences. Finally, in keeping with the Performance Standards, socialization groups

require effective management systems such as planning, record keeping, and self-assessment.

Socializations are individualized to address the developmental level of each participating child

and the goals, needs, and resources of each family. The goals and outcomes for socialization experiences vary depending on the developmental level of the child and will change as a child’s development progresses. Socialization experiences and home visits are based on a curriculum that:

u articulates goals for children and parents;

u identifies the experiences through which they will achieve these goals;

u determines appropriate roles for staff members and parents;

u provides the necessary materials to carry out the plan;

u includes all areas of child development—cognitive, motor, language, social, emotional; and

u considers each child’s cultural, ethnic, and linguistic heritage and experience.

23

“At one of the EHS family time

socializations another mother

and I found ourselves conversing

and to both of our surprise we

had gone through very similar

situations. At one point, I felt like

backing out of the program and

crawling under a rock in hiding,

because of an unwanted experience in my life. After discussing

it with her, we both decided after

encouraging one another that we

were going to stay in the program, and not only that, we

would become more involved by

making a difference in the lives

of other families.”

—Mother, Family Services Agency

Early Head Start, Gaithersburg,

MD

Home Visitor’s Handbook

Head Start Home-Based Program Option
What Are the Major Differences Between Socializations for Preschoolers 

and Socializations for Infants and Toddlers?

Federal regulations (45 CFR 1306.33) define the purpose of socializations for preschoolers

(emphasis added):

The purpose of these socialization activities for the children is to emphasize peer group

interaction though age-appropriate activities in a Head Start classroom, community facility, home, or on a field trip. The children are to be supervised by the home visitor with

parents observing at times and actively participating at other times.

The Head Start Bureau Information Memorandum titled Child Development Services during Home

Visits and Socializations for the Early Head Start Home-Based Program Option (ACYF-IM-HS-00-22)

clarifies the purpose of socializations for infants and toddlers (emphasis added):

Socialization experiences for infants and toddlers are designed differently than 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.

Infants and toddlers are only beginning to build their first and most important relationships: the

relationships with their parents. Socialization experiences focus on the parent-child relationship

as the foundation from which children will then be able to develop close, trusting, and respectful relationships with peers and other adults as they grow.

In contrast, socialization experiences for preschoolers provide opportunities for peer group

interaction because 3-to-5-year-old children are at a developmental stage where they are beginning to form deeper relationships with their peers and where the peer group is beginning to

have a greater influence in their lives. The group setting provides opportunities for parents and

staff members to learn how children act in a group. The importance and influence of peer relationships grow as children enter preschool and, later, the elementary school environment. The

socialization experiences for preschoolers provide a supportive place in which they can practice

skills in taking on leadership, developing friendships, and negotiating conflict.

Integrating the Goals of Home Visits Into Socialization Experiences

Socialization experiences offer additional opportunities to work on the goals you have established with families during your home visits. Socializations should build on the activities and

topics you address in the home. For example, if you have a number of families working on early

literacy skills with their children, you might develop a number of experiences on this topic. Your

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socialization experience for infants or toddlers could include time for parents and children to

choose and read board books together; activities involving listening to audiotapes of children’s

songs and demonstrating finger plays for parents and children to do together (e.g., The Itsy Bitsy

Spider or The Wheels on the Bus); or a field trip to a local library to participate in a parent-infant

story time. You can develop a socialization on preliteracy skills for preschoolers that includes an

activity for parents and children to make a book together with pictures from magazines or the

child’s drawings; a dramatic play around a favorite story; or various activities built around the

theme “the letter of the day.” For example, if the letter of the day is B, then plan activities that

begin with B (balls, block building, or bubble blowing) and serve snacks that begin with B

(bananas, bean salad, broccoli, and blueberry yogurt). Be creative and have fun! Many of the

above examples are activities that the parents can recreate at home. You play an important role

in linking the socialization experiences and the home visits so parents understand how both

aspects of the home-based program work together to help them reach their goals.

Parents benefit from socialization experiences in a number of ways: by observing how other parents and staff members interact with their children; by participating in facilitated discussions

on a particular topic related to the socialization; or by conversing informally with other parents

or staff members as they interact with their children. However, socialization groups are not the

time to conduct formal parenting education classes. More structured parenting education that

focuses exclusively on the adult learner should have its own designated time. Reserve the

socialization time for experiences that include both the parents and their children as a special

time for them to be together, enjoy one another, and learn with others who share common

interests and goals.

Part 5 | Socialization Experiences

25
Staff Member and Parent Roles During Socializations

You play an active role in the socialization experience because your relationship is the most

powerful tool you have to provide families with the support they need to reach their goals. As

part of your ongoing family partnership agreement process, you must build in specific roles for

parents in home visits and socializations [45 CFR 1304.40(a)(2)]. These roles provide a way to

involve parents in all aspects of socializations, including planning them, carrying them out, and

evaluating them. Parent participation ensures that the goals and experiences of socializations

are culturally sensitive and relevant to participating families. Parents help you to individualize

the curriculum for their particular child.

Socialization experiences are an ideal time to use observation as a tool for parent education.

Child observation is a skill that parents and staff members can use to learn about child development, identify individual differences, and create meaningful learning experiences for children.

During socialization experiences, you can help parents hone their observation skills by together

watching their children at play and noticing aloud what their child’s interests, skills, habits, and

preferences are. For example, as you sit on the floor with a parent and his 8-month-old, you

might notice, “She sure lets you know she wants that ball. Look how she’s trying to crawl over

the pillow to get it.” Or you might ask, “Does she always turn her head away and fuss like that

when she’s had enough food?” With the parents of a preschooler, you might observe how imaginatively he or she uses the large cardboard boxes to create “houses” to hide in and “cars” to

drive. Or you might reflect on how a preschooler is trying to join in a group of peers: “It looks

like Brian really wants to play trains with those kids but he’s not quite sure how to get in on the

action.” As you observe and reflect on the child’s behavior, you are teaching parents about reading their child’s cues. You can then build on those insights to foster parent-child interactions

that best support the child’s development and learning.

Your agency may have a designated staff person to plan and carry out the socializations. This

staffing pattern enables the person in this role to devote focused time to coordinating, planning,

and carrying out the group experience. Ideally, this staff person would be an individual with

expertise in both child development and in leading activity groups for parents and children

together. However, even if a designated staff person manages the socializations, you still play an

active role to collaborate with that person because you are the one who has the strongest relationship with the families in your home-based program. You are the one who is consistently

available to the families, who is trusted, and with whom the families are most comfortable.

Group socializations provide you with new perspectives on your work with families as you interact with parents and children outside of the home environment. Group experiences, when conducted in collaboration with your colleagues, also provide you with the support of fellow staff

members as you share insights into family strengths and challenges. You should have enough

time in your work schedule to fully participate in socializations. If you find that your schedule

does not give you the time you need, talk with your supervisor to make the adjustments necessary for your full participation in this important aspect of the home-based program.

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Size, Composition, and Setting of Socializations

You determine the size and composition of your group socializations based on child and family

needs and goals. First, identify families who are working on similar goals and who could benefit

from a socialization experience on a common theme. The socialization experiences should be

meaningful for the families and relevant to the goals you are working on in the home.

Next, consider the individual needs of the children. Individual temperaments, learning styles, or

other special considerations may indicate a smaller and more intimate setting to optimize the

children’s comfort and ability to interact. Groups of infants and toddlers should be small to

enable the trust, predictability, and responsive caregiving that very young children need.

In some cases, you might group your socialization experiences according to developmental

level—young infants, mobile infants, toddlers, or preschoolers—and in other circumstances, you

might prefer a mixed age group. Each grouping has different advantages. Separate age groups

may be easier to plan for and facilitate, and they may allow parents to socialize with other parents who have the common bond of raising a child who is at a similar stage of development.

Mixed age groups allow parents with more than one child to participate in a single socialization

that involves all the siblings. They also provide older children an opportunity to be a leader,

teacher, or helper with younger peers. Younger children learn from their older peers as the older

children model self-help skills or new ways to play with objects.

The setting of your socialization experiences should be developmentally appropriate and should

support the goals of your socializations. You should have a designated space for your socializations so families have a predictable, stable, and safe environment. This space should have adequate facilities for diapering and toileting, hand-washing, food refrigeration, and temperature

control. You must make sure that the setting is accessible to children with disabilities so they

can actively engage with others and fully participate in the activities.

The setting you choose should be comfortable for both children and adults. For example, you

can provide comfortable seating for adults that also promotes parent-child interaction. You

might place portable stools around a child-size table for the adults to sit next to their children.

Offer adult-size chairs that can easily be moved around the room or places such as a hammock

or rocking chair where a parent and child could snuggle together. Young infants need safe places

to lie down; newly mobile infants need space to crawl and pull themselves up to stand; and toddlers and preschoolers need large spaces for climbing, running, and tumbling.

Socializations are a time for fun, learning, and support. In addition to the structured learning

that takes place, they provide informal “teachable moments” that offer rich, responsive, and relevant learning experiences in unplanned and often unexpected ways. These are the learning

experiences that usually have the greatest effect. Recognize how the unique qualities of the

socialization experience strengthen and enrich the work you do in the home.

Part 5 | Socialization Experiences

27
Part 6 | Getting the Support You Need

What Can I Expect From My Supervisor?

The Home-Based Supervisor’s Manual for the Head Start Home-Based Program Option includes detailed

descriptions of the role of the home-based supervisor and strategies that supervisors can use to

support the work you do with families. Familiarize yourself with the information in the

Supervisor’s Manual so you can talk with your supervisor about the kind of support that would be

most helpful to you.

The home-based supervisor has many roles and responsibilities in your program. As a mentor,

he or she supports you in your work by doing the following:

u Modeling—Your supervisor should be able to demonstrate the skills you are learning as a

home visitor. He or she shows you how to have respectful, trusting relationships with others

as you observe him or her interacting with families and staff members.

u Teaching—Your supervisor shares his or her expertise about the Head Start program, child

and family development, and home visiting as a strategy for delivering services. He or she

teaches you in many different ways: discussion, reading assignments, in-service training,

anecdotes, modeling, or formal instruction.

u Planning—Your supervisor contributes to the design and continuous improvement of the

home-based program. You share your experiences, successes, and challenges with your

supervisor so he or she can use those experiences to inform planning and improve the program.

u Leading—Your supervisor sets the tone for how you interact with families and with other

staff members. He or she is responsible for team-building efforts that help you feel supported

by a network of colleagues working together to realize the goals of the program. As a leader,

your supervisor provides an example for how to negotiate the challenges of your job.

u Advocating—Your supervisor advocates for you and for the needs of the families with whom

you work. He or she is your support person—the one you can turn to when you are struggling. He or she works with the program leadership to advocate for the resources you need to

work effectively with families.

u Assessing—Your supervisor shares in the responsibility for the quality of the home-based

services your agency provides. He or she assesses your job performance and supports you in

your professional growth. Your supervisor plays a role in program self-assessment and monitoring to ensure that your home-based program offers high quality services.

28

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One of the vehicles your supervisor uses to accomplish these goals is reflective, or supportive,

supervision. Reflective supervision refers to a collaborative relationship between you and your

supervisor that provides regular opportunities to reflect on your work. (See Part 8 of this

Handbook for additional resources on reflective supervision.) Ideally, you should have a regular,

scheduled opportunity to speak candidly with your supervisor about your work, to share your

accomplishments, and to brainstorm solutions to your struggles. Supervision is a time when you

develop self-awareness—why you bond with one family but just do not “click” with another,

what you can do to manage your stress, and what motivates you to do your job well.

Supervision is also a time to celebrate your strengths and achievements. It is a process through

which you are refueled, enabling you to go back out and knock on another door.

Training and Professional Development

To do your job well, you need skills in a variety of areas: child development and early childhood

education; principles of child health, safety, and nutrition; adult learning strategies; and family

dynamics. You must be skilled at communicating and at motivating people. In addition, you

must have knowledge of community resources and the skills to link families with appropriate

agencies and services [45 CFR 1304.52(e)]. Your Head Start program may have particular requirements such as the Child Development Associate (CDA) 4 credential for home visitors, specific college coursework, or a minimum level of experience.

Honestly assess where you need to develop your skills. Everyone has strengths and challenges.

Professional development is a lifelong, dynamic process. You will need an array of training experiences to refine your skills. The variety of opportunities resources that might be available to you

include:

u regional or national training conferences;

u local workshops;

u in-depth studies of particular families;

u opportunities to shadow experienced staff members;

u role playing;

u video observation of actual home visits or group socializations;

u team staffing meetings;

u written materials such as articles or books; and

u on-line resources such as coursework or relevant Web sites.

The goal of all your professional development and training activities is to provide more effective

services to children and their families. With the support of your supervisor, create a professional

development plan that will allow you to benefit over time from a number of varied learning

opportunities and resources.

Part 6 | Getting the Support You Need

29

4 The Child Development Associate (CDA) is a national credential for early care and education professionals. It is

administered by the Council for Early Childhood Professional Recognition.
A Word About Burnout

The intensity of the work you do can be tiring—physically, mentally, and emotionally. You have

to take good care of yourself so you can support families to take good care of their children.

Learn to recognize the signs of stress in your job, and develop strategies for coping before you

feel overwhelmed. Some common signs of burnout include the following:

u Feeling exhausted and overextended

u Feeling like you are incompetent or cannot make progress

u Becoming cynical, losing hope, or always feeling pessimistic

u Not enjoying your work anymore

At the first sign of trouble, talk with your supervisor about your feelings and brainstorm some

ways that you can take care of yourself. Perhaps you have not had a day off in a long time.

Perhaps the number of families you are working with has become unmanageable. Examine

whether any factors in your personal life are distracting you from your job and need attention.

We all need to live a balanced life to do our best work on the job. In your role as a home visitor,

it is especially important that you give to yourself, so you can give to the families and they, in

turn, can give to their children.

Management Systems That Support Your Work

Management systems help ensure that your program leaders will consistently and efficiently

provide what you need to do your job. Management systems are important because they are

tools that help you do your job more effectively. Given that these tools affect your job, you

should play an active role in developing or revising these systems. Indeed, you are the one who

is more familiar with your job than anyone else.

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The Head Start Program Performance Standards specify the following program management systems:

u program governance (45 CFR 1304.50);

u planning, communications, record keeping and reporting, program self-assessment and

ongoing monitoring (45 CFR 1304.51); and

u human resources and fiscal management (45 CFR 1304.52).

These same systems form the framework for the Program Review Instrument for Systems

Monitoring (PRISM) of Head Start and Early Head Start grantees.

Considering the Program Performance Standards systems more specifically, you should know about

program governance so you can support parent participation in Parent Committees and on the

Policy Council. Program planning ensures that the home-based program option is appropriate

for your community and identifies your program’s goals as well as how you will achieve those

goals. Systems for communicating, record keeping, and reporting have a direct effect on how

you do your job. What kind of records are you responsible for? How do you track the services

that you provide during home visits and socializations? How do you further the involvement of

the families with whom you work in the governance of your program? Human resource management also directly affects your job. Do you receive training and ongoing professional development opportunities? Is the staffing pattern of your agency adequate for you to do your job

well? Are you able to accomplish everything you need to do with the number of families on your

caseload, or do you feel like you do not have the time to meet the needs of those families who

have more complex life circumstances?

Talk with your supervisor if you have any questions or concerns about the way that the management systems are currently operating in your program. These systems exist only to help you

do your job in the most effective manner. If they are not working, take an active role to make

the changes that you need to do your job well. Partner with the other home visitors in your program and collectively brainstorm some solutions to the obstacles you face. Your input in developing or revising effective systems is invaluable.

Part 6 | Getting the Support You Need

31
Part 7 | Your Community

The comprehensive services you provide to families

in the Head Start program require strong collaboration with a variety of community agencies. You may

need to partner with the following types of organizations:

u Health clinics

u Dental providers

u Mental health consultants

u Nutrition and feeding services such as the

Women, Infants, and Children (WIC) program

u Social service providers to assist with housing,

education, or job training

u Early intervention programs for children with

disabilities

u Child care partners or school systems as

children transition into other settings

The particular community partnerships you develop depend on the needs of the families in

your program.

Developing a Partnership

Your agency may have formal, written partnership agreements with various agencies. These

written agreements strengthen the collaboration because they explicitly describe roles and

responsibilities, and they continue to exist after the individuals who established the partnership

leave their jobs. However, you may have the opportunity to establish partnerships through your

informal contacts with service providers. For example, you may become acquainted with the

children’s librarian at your local library as you regularly send families there to encourage early

literacy experiences. Through your relationship with the librarian, you might inspire him or her

to develop special parent-child “cuddle-up” story hours; create a toy-lending library; or lead a

group socialization experience for your program. Think about the individuals with whom you

regularly come into contact as you find resources for families. Often, these informal, familiar

relationships are the connections that can lead to strong collaborative partnerships. Being on

the “front line,” you have a tremendous influence on how visible your program is in the community, and you play an important role in the partnership process.

Using Management Systems for Effective Community Partnerships

Management systems and procedures exist to support the services you provide to families and

play an important role in community partnerships. You should be familiar with these systems

32

“When we first met Y., she was

13, and very much alone in this

world with a very challenging

life.... Watching Y. after she had

the children ... struggling with

where she’s going to live, how

she’s going to feed everyone ...

[we were] able to look at other

resources outside of Family Star

to support her on this very challenging journey.

—Executive Director, Family Star,

Denver, CO

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Head Start Home-Based Program Option
so you can use them as tools to achieve your goals with families. The following management

systems are identified in section 45 CFR 1304.51 of the Program Performance Standards. You will

notice that each of these systems is interrelated and influences the others as well as the services provided to children and families. In this section, we are focusing on how management systems support your community partnerships, but it is important to note that these same management systems play a role in all the program services that you provide to families.

Program planning: Your program’s Community Assessment can help determine the agencies that

are potential community partners depending on families’ needs. For example, if your

Community Assessment revealed a significant percentage of Head Start–eligible families with

low literacy skills, your program might target community agencies that provide adult education

and might approach community libraries for additional support and services.

Communications: You depend on your community partners to provide necessary services to families. Effective systems for communicating pertinent information to those involved determine

Part 7 | Your Community

33

Things You Can Do to Use Management Systems 

for Effective Community Partnerships

u Develop tracking forms to ensure that up-to-date records related to your work as a home

visitor are readily available.

u Create a personalized list of the agencies and individuals to whom you refer each family.

You might keep this list in a notebook or in a family file and use it to track when you

referred the family, the outcome of the referral, and any follow-up steps you need to take.

u Take the time to develop friendly, professional relationships with the community service

providers with whom you interact outside of your agency. Formal, collaborative partnerships are often built from the informal, respectful relationships you develop as you help

families find resources in the community. These informal relationships can have a powerful influence on how community agencies perceive your program.

u Make sure that families understand how much of the information they give you is communicated to other providers. All parties involved should be aware of your confidentiality

guidelines and adhere to them. Make sure that you are providing only relevant information to community providers.

u Keep in mind that the contacts you establish with community providers can become an

excellent source of volunteers for your program and of representatives for your policy

groups. Think about how you can make volunteer opportunities available to individuals and

organizations who are interested in supporting children and families in the community.
what kinds of information is provided, how information is shared in a timely manner, and the

confidentiality guidelines that protect family privacy.

Record keeping and reporting: You must be able to track the outcome of your referrals to community partners to ensure that services were rendered in a timely manner and are of sufficient

quality. Your records also help you track family progress and accomplishments over time. The

services rendered by community partners are included in reports of families’ and children’s

progress. This information helps your program administrators continually assess and improve

the quality of program services.

Self-assessment and monitoring: Your program should regularly review how effectively your

agency’s collaborations with community partners meet family needs. You can contribute to this

assessment by providing your supervisor and program administrators with feedback about how

services are having an effect on the families with whom you work. For example, are families

getting what they need from these agencies? Do they respond to referrals in a timely manner?

Do families feel comfortable with these services and have good experiences with these agencies? Because of your unique relationship with families, you are the one with whom families are

most likely to be candid about their experiences. Ongoing monitoring helps to ensure that your

program is successful in meeting the federal regulations.

In Closing

You do a tremendous job. But you do not do it alone. Your agency, your supervisor, your colleagues, your community, and the families with whom you work are your partners. We hope

that this Handbook not only has demonstrated how you are your own best resource but

also has provided some useful tools and

strategies for your work. The greater your

self-awareness, the more effectively you

will be able to get what you need to do your

job to the best of your ability. Ultimately, the

real power you have to effect change is

through the relationship you have with

families. Celebrate and honor yourself in

the same way that you then celebrate and

honor families, so they may always celebrate and honor their children.

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34
Part 8 | Additional Resources

Publications

Home Visiting

Fenichel, E. (Ed.). (1997). Home visiting. Zero To Three, 17(4).

Gomby, D., & Curess, P. (Eds.). (1999). Home visiting: Recent program evaluations. The Future of

Children, 9(1).

Harden, B. J. (1997). You cannot do it alone: Home visitation with psychologically vulnerable families and children. Zero to Three, 17(4), 10–16.

Klass, C. (1996). Home visiting: Promoting healthy parent and child development. Baltimore, MD:

Brookes.

Powers, S., & Fenichel, E. (1999). Home visiting: Reaching babies and families “where they live.”

Washington, DC: ZERO TO THREE.

Wasik, B. H., Bryant, D. M., & Lyons, C. M. (1990). Home visiting: Procedures for helping families.

Newbury Park, CA: Sage.

Learning Through Play and Everyday Activities

Bronson, M. B. (1995). The right stuff for children birth to 8: Selecting play materials to support development. Washington, DC: National Association for the Education of Young Children.

Dombro, A. L., & Wallach, L. (2001). The ordinary is extraordinary: How children under three learn.

Lincoln, NE: iUniverse.com.

Honig, A. S., & Brophy, H. E. (1996). Talking with your baby: Family as the first school. Syracuse, NY:

Syracuse University Press.

Karnes, M. B. (1982a). You and your small wonder: Activities for parents and babies, Book 1. Circle

Pines, MN: American Guidance Service.

Karnes, M. B. (1982b). You and your small wonder: Activities for parents and babies, Book 2. Circle

Pines, MN: American Guidance Service.

Miller, K. (1984). Things to do with toddlers and twos. Chelsea, MA: Teleshare.

Miller, K. (1989). The outside play and learning book: Activities for young children. Beltsville, MD:

Gryphon House.

Miller, K. (1990). More things to do with toddlers and twos. Chelsea, MA: Teleshare.

Segal, M. (1985). Your child at play. New York, NY: Newmarket Press.

U.S. Department of Health and Human Services. (1995). Fun and learning for parents and children:

An activities handbook. Washington, DC: Head Start Bureau.

Partnerships With Families

Lerner, C., & Dombro, A. (2000). Learning and growing together: Understanding and supporting your

child’s development. Washington, DC: ZERO TO THREE.

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Head Start Home-Based Program Option
Parlakian, R. (2001). The power of questions: Building quality relationships with families.

Washington, DC: ZERO TO THREE.

Powers, S., & Lerner, C. (2000). Learning and growing together tip sheets: Ideas for professionals in programs that serve young children and their families. Washington, DC: ZERO TO THREE.

ZERO TO THREE. (2001). Learning and growing together with families video package. Washington, DC:

Author.

Cultural Competency

Cortes, C. E. (2000). The children are watching: How the media teach about diversity. New York:

Teachers College Press.

Derman-Sparks, L., & A.B.C. Task Force. (1989). Anti-bias curriculum: Tools for empowering young children. Washington, DC: National Association for the Education of Young Children.

Flynn, N., Thorp, E., Evans, K., & Takemoto, C. (Eds.). (1998). Infusing cultural competence in early

childhood programs. Fairfax, VA: George Mason University.

Hopkins, S. (Ed.). (1999). Hearing everyone’s voice. Redmond, WA: Child Care Information Exchange.

Lynch, E. W., & Hanson, M. J. (1998). Developing cross-cultural competence: A guide for working with

children and their families (2nd ed.). Baltimore, MD: Brookes.

Mallory, B. L., & New, R. S. (Eds.). (1994). Diversity and developmentally appropriate practice. New York:

Teachers College Press.

Neugebauer, B. (Ed.). (1992). Alike and different: Exploring our humanity with young children.

Redmond, WA: Child Care Information Exchange.

Valdes, G. (1996). Bridging the distances between culturally diverse families and schools. New York:

Teachers College Press.

York, S. (1991). Roots and wings: Affirming culture in early childhood programs. Beltsville, MD:

Gryphon House.

Reflective Supervision and Relationship-Based Work

Almonte, B. E. (1994). Professionalism as culture change: Issues for infant/family community

workers and their supervisors. Zero to Three, 15(2), 18–23.

Eggbeer, L., & Fenichel, E.(Eds.). (1995). Educating and supporting the infant/family work force: Models,

methods, and materials. Washington, DC: ZERO TO THREE.

Fenichel, E. (1992). Learning through supervision and mentorship to support the development of infants,

toddlers, and their families: A sourcebook. Washington, DC: ZERO TO THREE.

Fenichel, E., and Eggbeer, L. (1990). Preparing practitioners to work with infants, toddlers, and their

families: Issues and recommendations for educators and trainers. Washington, DC: ZERO TO THREE.

Parlakian, R. (2001). Look, listen, and learn: Reflective supervision and relationship-based work.

Washington, DC: ZERO TO THREE.

Head Start Training Guides

The Training Guides for the Head Start Learning Community are a series of manuals that provide

information and resources for Head Start program staff members. The guides are organized into

the topic areas of Disabilities, Education, Health, Management, Parent Involvement, Social

Services, and Transition. Each topic area includes a Foundation Training Guide that focuses on the

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36
values and behaviors necessary to support the Head Start Program Performance Standards and

Technical Guides that address the specific knowledge and skills Head Start staff members need to

support their professional development and their work with children and families. An annotated list of the Training Guides is available on the Web site of the Head Start Information and

Publication Center (www.headstartinfo.org).

Web Sites

American Association for Home-Based Early Interventionists (www.aahbei.org)

The American Association for Home-Based Early Interventionists serves parents and those

working in the field of early home intervention with infants, toddlers, and preschoolers with

special needs. This organization places a special, though not exclusive, emphasis on the home

as a beneficial environment for early intervention.

The Fatherhood Project (www.fatherhoodproject.org)

The Fatherhood Project is a national research and education program that is examining the

future of fatherhood and is developing ways to support men’s involvement in childrearing. It

was founded in 1981 at the Bank Street College of Education in New York City by Dr. James A.

Levine and relocated in 1989 to the Families and Work Institute.

FatherNet (www.cyfc.umn.edu/Fathernet)

This Web site includes information on the importance of fathers and fathering and how fathers

can be good parents and parent educators. It includes research, policy, and opinion documents to

inform users about the factors that support and hinder men’s involvement in the lives of children.

The Home Visiting Center (www.unc.edu/~uncchv)

Established in 1996, the center builds on a century of home visiting efforts in this country. The

center’s mission is to promote interdisciplinary research and evaluation efforts, training efforts

at the college and university level, and ongoing professional development activities as well as to

advance the knowledge base concerning practice and training.

National Center for Education in Maternal and Child Health (http://www.ncemch.org)

This Web site offers selected publications, annotated bibliographies, numerous databases, related organizations, and a conference calendar. The center also provides access to a team of reference librarians to assist in your search for materials or information related to maternal and

child health.

The National Information Center for Children and Youth With Disabilities (www.nichcy.org)

NICHCY is a project of the Academy for Educational Development, operated through a cooperative agreement with the Office of Special Education Programs, U.S. Department of Education.

This Web site offers information on disabilities and disability-related services for individuals

from birth to 22 years. In addition to their publications, NICHCY offers information searches on

their database, referrals, and technical assistance.

Part 8 | Additional Resources

37
National Sudden Infant Death Syndrome (SIDS) Resource Center (www.circsol.com/sids)

The National SIDS Resource Center (NSRC) at the National Maternal and Child Health

Clearinghouse produces and provides professional and consumer education materials; makes

referrals to national, state, and community organizations; and maintains a database of technical

and public awareness documents.

National Home Visiting Programs

Healthy Families America

National Committee to Prevent Child Abuse

200 South Michigan Ave., 17th Floor

Chicago, IL 60604

312-663-3520

www.healthyfamiliesamerica.org

Healthy Steps for Young Children

Boston Medical Center

1 Boston Medical Center Place

Boston, MA 02118

617-414-4767

www.healthysteps.org

Home Instruction Program for Preschool Youngsters (HIPPY)

220 East 23rd St., Suite 300

New York, NY 10010

212-532-7730

www.hippyusa.org

Parents as Teachers National Center, Inc.

10176 Corporate Square Dr.

St. Louis, MO 63132

314-432-4330

patnc@patnc.org

www.patnc.org

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Appendix A | Attachment for Information Memorandum ACYF-IM-HS-00-22

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 shortterm 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 con39

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Head Start Home-Based Program Option
ducted 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 minimums 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.

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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)(iiii)] 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

Appendix A | Attachment for Information Memorandum ACYF-IM-HS-00-22

Child Development Services During Home Visits and Socializations 

41
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.

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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 selfsoothe. 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

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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

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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

Appendix A | Attachment for Information Memorandum ACYF-IM-HS-00-22

Child Development Services During Home Visits and Socializations 

45
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.

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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.

Source: U. S. Department of Health and Human Services. (2000). Child Development Services During Home Visits and

Socializations in the Early Head Start Home-Based Program Option. Washington, DC: Head Start Bureau.

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Home Visitor’s Handbook

Head Start Home-Based Program Option

Appendix B | Attachment for Information Memorandum ACYF-IM-HS-02-04

Services to Pregnant Women Participating in Early Head Start

A healthy pregnancy has a direct influence on the health and development of a newborn child.

Early Head Start (EHS) strives to have the greatest impact on participating children by offering

supportive services as early in life as possible. The prenatal period of growth and development

has a lasting impact on the child’s potential for healthy growth and development after birth.

Early Head Start programs provide services to pregnant women and their families and through

the child’s first three years of life. Early, continuous supports and services provide the best

opportunity for:

u healthy pregnancies and positive childbirth outcomes;

u supportive postpartum care for the parents and child; 

u fully involving fathers in the lives of their very young children; and

u nurturing and responsive care during infancy.

It is expected that pregnant women and their families who receive EHS services will enroll their

child in EHS following birth. The goal of serving pregnant women and their families in EHS is

ultimately to provide EHS services to their children in the appropriate child development program option (center-based, home-based, or combination option). It is not the intention of the

EHS program only to serve pregnant women without also providing services to the child upon

delivery. Planning for the transition to the appropriate child development program option

should begin at the time the pregnant woman is enrolled in the EHS program.

Management Systems

Effective management systems are necessary for quality services. EHS grantees are responsible

for developing effective systems for the delivery of services to pregnant women and their families in the following ways: 

u Planning comprehensive services and ongoing self-assessment. The Community Assessment

drives the planning process for services to pregnant women. The planning process ideally

includes input from community partners, program participants, and the Health Services

Advisory Committee. Planning is an ongoing activity and program services evolve as information is gathered about the effectiveness of those services.

u Communicating relevant information to all the parties involved. Communication systems are

developed to ensure that pregnant women receive comprehensive, individualized services,

and that community partners are well prepared to work in collaboration with EHS. The issue

of how much information should be shared and with whom is a sensitive matter that needs

48
to be addressed within formal confidentiality guidelines. These guidelines will consider both

the privacy of the family and what the professionals working with the family need to know

in order to provide the best possible care. These decisions are often made on a case-by-case

basis.

Another aspect of communication systems involves sharing information with governing bodies, such as the Head Start Policy Council. Effective communication systems with governing

bodies keeps the members informed about how the program is serving pregnant women and

their families, and gives them adequate time to review materials and participate in decisionmaking.

u Record keeping and reporting to ensure that services are rendered in a timely manner and to

monitor the outcome of the referrals to partnering agencies. Record keeping demonstrates how

the program is meeting the Performance Standards and other state or federal regulations in

regard to serving pregnant women. It also allows the program to monitor how the collaborative relationships with community agencies are working and make adjustments as necessary.

Records of work with individual pregnant women and their families allow staff and families

to follow their progress toward meeting their short and long term goals.

The Community Assessment and Program Planning Process

Program planning for services to expectant families begins with the Community Assessment.

Regulation 45 CFR Part 1305 requires that each EHS grantee and delegate agency conduct a

Community Assessment within its service area once every three years and update it annually.

This process identifies community needs and resources, which are used to develop both long

and short term objectives and goals for the program to meet the identified needs.

The Community Assessment drives the decision about how a program will provide services to

pregnant women in their community. This process identifies the needs of the pregnant women

in the community, the services they require, and the resources available to meet identified

needs. EHS grantees use this information to develop the specific services for the pregnant

women in their community. The Community Assessment paints a picture of a community at a

point in time. It identifies community resources as well as needs or gaps in services. For example, a Community Assessment in a rural area might reveal that there is a shortage of obstetricians, and that pregnant women are not receiving adequate prenatal care because they do not

have transportation to medical facilities in neighboring towns. The EHS program might address

this need by assisting the EHS pregnant women in accessing transportation, or by developing

partnerships with other agencies that could bring qualified health care providers into their community. Alternatively, a Community Assessment might reveal a high rate of teenage pregnancy.

In this case, the EHS program might collaborate with local schools to offer supportive services

that allow teens to remain in school while planning for the birth of their child and for the services they will need following delivery.

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A Community Assessment may also reveal that services to pregnant women are readily available in the community and women have access to them. Under such circumstances a best practice in EHS might be to complement the services that are already available by serving as a point

of referral to the existing services or by developing collaborative agreements with agencies serving pregnant women.

Eligibility and Enrollment (45 CFR 1305)

Eligibility

It is important to note that even when the Community Assessment reveals a need for services

to pregnant women, not all pregnant women in the community will be suitable candidates for

the EHS program. For example, a pregnant woman and her family should be informed prior to

enrollment that the EHS program is intended to serve the family pre-natally and through the

child’s first three years of life. Parents should be informed of the program service delivery

options, such as center- or home-based services, to determine the “match” between the family

needs and what the program can offer after the child is born. Pregnant women who do not

anticipate the need for EHS services for their children after birth are not appropriate candidates

for EHS.

For the purpose of determining eligibility based on family income, the pregnant woman is

counted as two members of the household. In the case of an unmarried teenage girl, her own

income determines her eligibility regardless of her parents’ income. The intent of the EHS program is to serve those with the greatest need, as indicated in selection criteria (45 CFR 1305.6). It

is therefore important for a program to consider factors in addition to income, such as social

supports or access to resources, when determining if a pregnant teen is an appropriate candidate for the EHS program.

Community Partnerships

Recruitment strategies play an important role in finding appropriate candidates for the EHS program. Community partners are some of the best resources for referrals. Formal agreements as

well as informal relationships with service agencies that come into contact with pregnant

women increase the exposure of EHS in the community. Formal agreements for collaboration

might include agreements with programs such as WIC, La Leche League, Healthy Start, or a local

mental health association. OB/GYN physicians, midwives, and clinics routinely come into contact with pregnant women and are excellent resources as well as providers of referrals.

A formal agreement for referrals between EHS and community agencies should include confidentiality guidelines about the kind of information to be shared, define who needs to receive

specific kinds of information, and outline procedures to ensure that communication occurs in a

timely manner. For example, an EHS program may receive a referral from WIC. The WIC representative would inform the EHS representative of the potential referral and have a protocol for

arranging a meeting between the family and the EHS representative. Part of the collaborative

agreement with WIC might include sharing information such as a nutritional assessment, and

EHS ensuring that a dietician reviews the assessment and provides follow-up.

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Enrollment

For the purpose of determining the number of individuals enrolled in an EHS program, the pregnant woman is counted as the one who is enrolled. Once the child is born, it is the child who is

enrolled in the EHS program. Furthermore, pregnant women and their families are not enrolled

in Head Start Program Options (45 CFR 1306). The Program Options are child development service delivery options. Thus, the regulations governing Program Options do not apply to pregnant

women. For example, while many services to expectant families may be delivered through home

visits, EHS staff are not required to follow the frequency and duration of home visits that are

required in the home-based program option for children. Program staff and families have the

flexibility to determine how services will be provided through the individualized Family

Partnership Agreement process.

The development of the Family Partnership Agreement [45 CFR 1304.40(a)(2)] is a process of collaborating with parents to develop a plan of program services that is driven by parents’ identification of family strengths, needs, resources, and goals. The Family Partnership Agreement determines how the services for pregnant women required in the Head Start Program Performance

Standards are individualized for each family. The development of the Family Partnership

Agreement is a process of building trust with families, helping them identify their goals, and

determining how the EHS program can support them in reaching those goals. It is important to

be prepared to adapt EHS services to the particular circumstances of each pregnant woman and

her family. Whenever possible, fathers are full participants in the EHS services to pregnant

women. The circumstances of the pregnancy, cultural differences, and the nature of the relationship between the mother and father will determine how EHS staff works with the entire family.

As Family Partnership Agreements are developed, EHS staff are encouraged to provide couples

who choose marriage for themselves with the skills necessary to form and sustain healthy marriages, and refer them to marital enrichment classes and premarital counseling groups.

EHS programs provide services to pregnant women and their families in their homes, in community-based settings, and through referrals to community partners, depending on individual

family need, resources, and goals. As described above, pregnant women may come to EHS

through many different routes and each one will have a slightly different enrollment process.

For example, if a pregnant woman is referred through a medical clinic, the program might begin

with an assessment of the woman’s current medical condition and ongoing needs. The EHS program representative might meet with the pregnant woman at the medical clinic and provide

information about the EHS services. The EHS representative could invite the pregnant woman to

visit the center, observe a socialization, or arrange to visit with the woman and her family in

their home to further discuss the opportunities available through the EHS program. In whatever

way the initial contact is made, the initial focus is on establishing a comfortable and trusting

relationship. This process takes some time and staff should be sensitive to how much information families are willing to share before that relationship has had the time to develop. The

Family Partnership Agreement process occurs as early as possible in the enrollment period so

that the specific needs of each pregnant woman and her family can be determined, the goals

set, and the services planned.

Appendix B | Attachment for Information Memorandum ACYF-IM-HS-02-04

Services to Pregnant Women Participating in Early Head Start

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Head Start Program Performance Standards Requirements 

for Services to Pregnant Women

The Head Start Program Performance Standards [45 CFR 1304.40 (c) (1) - (3)] describe the services

the EHS grantee must provide to pregnant women, and those services that they must assist

pregnant women to obtain. EHS programs must provide prenatal education on:

u fetal development, including the risks from smoking and alcohol;

u labor and delivery; 

u postpartum recovery, including information on maternal depression; and

u the benefits of breastfeeding.

EHS programs can, for example, provide this information through classes, support groups, or

home visits. Published resources can assist EHS staff to develop a comprehensive approach to

prenatal education that encompasses all of the required topics through resources such as

videos, books, prenatal journals, and prepared child birth courses. Local libraries, organized

groups such as La Leche League or Lamaze, health clinics, and county health departments may

offer additional resources.

The topic of maternal depression is addressed as part of prenatal education to alert pregnant

women and their families of the common signs and symptoms of the emotional changes during

pregnancy, labor, and the postpartum period. This preparation is extremely important so that

women are aware of both the common and milder form of “baby blues” as well as more serious

forms of depression that require professional intervention.

The information that is presented in prenatal education efforts should be highly individualized

to the particular family. Some of the variables that have an impact on the type of information

given to pregnant women and how it is presented include: stage of the pregnancy; age of the

pregnant woman; previous pregnancy or child birth experience; relationship with the child’s

father; mental health issues such as substance abuse or depression; and the pregnant woman’s

support systems and resources.

Services that the grantee must assist pregnant women to access include:

u comprehensive prenatal health care; and 

u postpartum health care.

One of the first steps upon enrolling a pregnant woman in EHS is to ensure that she has access

to prenatal health care, including dental care. EHS staff members serve as advocates and

liaisons between pregnant women and health care providers. The Health Services Advisory

Committee helps to develop linkages to service providers in the community. An important role

for EHS staff is to ensure that prenatal and postpartum health care is delivered in a timely manner, is responsive to the family’s needs, and that follow-up concerns are quickly attended to.

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EHS grantees will collaborate with various community partners to provide the prenatal education and comprehensive prenatal and postpartum care specified in the Head Start Program

Performance Standards. Developing a plan for services to pregnant women and their families is

unique because of the amount of flexibility it gives programs to determine the frequency, duration, and location where services are provided. For example, for one woman it may be desirable

to receive prenatal education in her home in a series of weekly visits. These visits could be of

any duration necessary to meet the family goal. In one instance a 45 minute visit for following

up on a prenatal appointment might be the goal; in another instance a 90 minute visit to discuss childbirth and delivery options could be the appropriate choice. In another example, a

woman might elect to participate in prenatal education classes held at a community center and

have EHS staff visit her home every other week for support and follow up. Alternatively, a pregnant woman may receive most of the EHS services in community settings. In this example, the

EHS program might have a staff person working in the same building where an OB/GYN clinic

operates. This EHS staff member could meet regularly with the pregnant women at the clinic

following prenatal health care appointments, as well as during weekly support groups for pregnant women that are facilitated by the EHS staff. In every case, EHS staff have the flexibility to

design a plan of services that fulfills the requirements of the Head Start Program Performance

Standards while meeting the particular needs of participating families.

The Head Start Bureau supports the promotion of safe and stable families as part of the delivery

of services to families, including Early Head Start pregnant couples. As such, services for pregnant couples may include activities and discussions that will seek to strengthen parental relationships and promote healthy marriages. Programs are encouraged to provide couples, who are

either currently married or who have voluntarily indicated a desire to get married, with help in

accessing the skills necessary to form and sustain healthy marriages, by guiding them to marriage education classes.

EHS Services to Pregnant Teens

EHS programs that provide services to pregnant teenagers will consider the particular needs of

this population. Teenage girls and their partners are in a unique developmental stage that has

implications for how EHS staff might design and deliver services. For example, recruitment

efforts might focus on the school setting or a community recreational center where teens are

likely to spend their time. In addition, teenagers tend to prefer to spend time with groups of

peers and might be better served by prenatal education efforts in a group setting rather than

one-on-one. When possible and appropriate, the father of the child will be involved in the program as well. Another consideration is the living arrangements of the teen mother. Many pregnant teens are living in the same household as their parents and perhaps other family members

who must all be considered when offering and planning EHS services for the pregnant girl. EHS

staff should be knowledgeable about the issues of working with multigenerational families. For

example, the mother or grandmother of the pregnant teen may play an important role in child

rearing values and expect to assume a certain amount of responsibility for the care of the new

baby. In this case it would be important for EHS staff to help all the members of the family to

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clarify roles and expectations for the child’s care prior to the birth of the child. EHS staff would

simultaneously work to support the relationship between the teen mother and her newborn

while validating the other important extended family relationships in the child’s life.

Health Services Advisory Committee 

The Health Services Advisory Committee (HSAC) is involved in all aspects of planning, delivering, and evaluating services for pregnant women in EHS. Members of the HSAC can assist with

developing health care guidelines, identifying community resources, and developing effective

collaborations for services to pregnant women. Ideally, health professionals from the field of

obstetrics and gynecology are active participants in the HSAC. Committee members offer their

professional expertise and experience in the community to address the issues affecting local

families. They can be instrumental, for example, in identifying dental providers who are knowledgeable about oral health during pregnancy, recognize the link between the mother’s oral

health and her child’s healthy development, and know how to provide safe dental care.

Transition Planning

The Family Partnership Agreement process also offers the opportunity to begin planning for EHS

services following the birth of the baby. This requires long term planning at two levels. First, EHS

programs should consider how they will simultaneously provide services to pregnant women

while ensuring that there will be space available for the infants in one of the child development

program options (center-based, home-based, or combination option), and that the available

option will meet the needs of the child and family. This type of planning begins when EHS programs are initially funded and are developing their program of services. The second level of long

term planning occurs with the expectant family at the time of enrollment to determine the

appropriate program option for the child after birth. EHS program staff work with the parents to

identify family needs and prepare for a smooth transition for the family when the baby is born.

Following delivery there is a period of time during which the mother is recovering from childbirth and the newborn is adjusting to the early weeks of life. Within two weeks of birth, EHS

programs are required to arrange for health staff to visit the newborn to ensure the well being

of the mother and child [45 CFR 1304.40 (i)(6)]. Ideally, the individual who conducts this visit will

have an existing relationship with the mother and family. If the EHS program does not have

health staff with the necessary training and experience, this visit can be conducted in collaboration with a community partner. This could be accomplished, for example, by contracting with

the clinic where the mother was receiving prenatal care, or in collaboration with a public health

program which offers postpartum home visits. This first postpartum visit offers the opportunity

to assess such things as success with nursing, sleeping and feeding issues, and the mother’s

emotional state, as well as the family’s resources and social support for coping with challenges.

The time frame for the child to begin EHS program services in the selected program option

depends on family needs. State child care regulations may determine the earliest age at which a

child can enter center-based care. Children transitioning into a home-based option have flexibility to begin program services when deemed appropriate by the EHS program and family.

Home Visitor’s Handbook

Head Start Home-Based Program Option

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Please see ACYF-IM-HS-00-22, Child Development Services During Home Visits and Socializations in the

EHS Home-Based Program Option, for additional information regarding transition planning from

prenatal services to the home-based program option.

Staff Development

Staff development and reflective or supportive supervision are essential elements of high quality services. Grantee and delegate agencies must provide a structured approach to staff training

and development [45 CFR 1304.52(k)(2)]. Working with expectant parents requires specialized

knowledge across a broad array of topics. Staff are trained in areas directly related to pregnancy

and child birth such as fetal health and development, child birth, lactation, and mother and

infant nutrition, as well as other areas that affect child health and development such as substance abuse, family functioning, and mental health. Local communities may have the opportunity to offer specific professional development opportunities such as certification as a lactation

consultant, child birth educator, or labor support person.

In Summary

Pregnancy and the newborn period are recognized as opportune times to have a positive and

lasting impact on the health and development of very young children. EHS programs are able to

provide supportive services to expectant parents that are flexible, responsive to family needs,

complement community resources and that build on family strengths and resources. This

unique opportunity to support children and their families from the earliest possible point and

through the first three years of life provides the greatest potential for healthy growth and development.

Source: U. S. Department of Health and Human Services. (2002). Services to Pregnant Women Participating in Early Head

Start. Washington, DC: Head Start Bureau.

Appendix B | Attachment for Information Memorandum ACYF-IM-HS-02-04

Services to Pregnant Women Participating in Early Head Start

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