EARLY 

HEAD 

START 

NATIONAL 

RESOURCE 

CENTER


Family, Friend 

and Neighbor Care in 

Early Head Start: 

Strengthening

Relationships

and Enhancing

Quality 

Technical Assistance Paper No. 

11

U.S. Department of Health and Human Services
 

Administration for Children and Families 


Administration on Children, Youth and Families 


Head Start Bureau 

4 

EARLY 

HEAD 

START 

NATIONAL 

RESOURCE 

CENTER
 

Family, Friend and Neighbor Care in 

Early Head Start: 

Strengthening Relationships 

and Enhancing Quality 

Technical Assistance Paper No. 11 

First Printing: 2006 

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 # HHSP23320042900YC, by the 

Early Head Start National Resource Center @ ZERO TO THREE. 
Technical Assistance Paper No.
 

11
 

Family, Friend and Neighbor Care in 

Early Head Start: 

Strengthening

Relationships and

Enhancing Quality 

Grandmas have probably always cared for their grandbabies –– a few hours while the parents are out, 

days or nights while the parents are working, or even longer, more permanent periods of time. Other 

family members and friends also care for each other's children, through play dates, helping out, or in 

arrangements where small fees are paid for the hours of care. These types of child care arrangements 

are known as “kith and kin” care and contrast with more formal child care settings, such as centerbased child care, in a number of important ways. Parents rely on family, friends, or neighbors for 

child care because of their deep trust in these relationships, for their convenience, flexibility, and low 

to no cost. 

1 

The quality of care 

that children receive 

in all child care 

arrangements has 

come under increased 

scrutiny as scientists and educators 

are gaining a better understanding of 

the impact of all early experiences 

on the developing brain. Early Head 

Start programs always work with 

families and child care partners to 

assure that infants and toddlers have 

the learning experiences, emotional 

grounding, and safe and healthy 

environments that promote optimal 

development throughout their days. 

However, program staff members 

have not traditionally worked with 

the extended family or friends who 

are providing child care for the 

children of families enrolled in EHS. 

Thus, in 2003, the Head Start 

Bureau launched the Enhanced 

Home Visiting Pilot Project 

(EHVPP) to offer opportunities for 

EHS programs to work with family, 

friend, and neighbor care. 

Participants in the EHVPP have 

discovered ways to broaden their 

contributions to families by working 

across generations and they have 

boosted the self-esteem of these 

caregivers by acknowledging the 

important role they play in 

supporting the children's healthy 

development. 
E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

2 

Why We Care 

About Family, 

Friend, and 

Neighbor 

Caregiving 

I

nfants are more likely to be cared 

for by other family members, 

friends, and neighbors (FFN) than 

in more formal settings, when they 

are not with their parents. Family, 

friends, and neighbors may or may 

not be licensed or registered and the 

childcare may be in the form of 

formal or casual arrangements. 

Formal arrangements may be 

scheduled, regular child care on a 

consistent schedule. More casual 

arrangements might include, for 

example, a last minute call to a 

neighbor to provide child care when 

an unexpected need arises. Parents 

have many reasons for using this 

type of care: 

their own feelings of trust in 

family members, 

the caregiver has a natural, 

familial investment in the child, 

the caregivers are flexible about 

hours and rarely charge fees, 

there are low ratios, and 

cultural messages are consistent 

with those of the parents. 
TECHNICAL ASSISTANCE PAPER NO .11 

However, many of the aspects of 

quality care associated with good 

outcomes in children are often 

missing in these informal care 

arrangements: specially trained 

caregivers, safe and healthy 

environments for young children, 

and developmentally appropriate 

learning activities. There are both 

strengths and drawbacks to family, 

friend, and neighbor care. Early 

Head Start is developing strategies 

designed to build on the strengths of 

FFN care, while providing support to 

increase quality. 

DEMOGRAPHICS 

In America, about 45% of infants in 

care are with relatives other then 

their parents; another 10% are with 

friends or neighbors (R. N. Brandon 

et al., 2002; Smith, 2002). The 

national evaluation of EHS found 

that 42% of families enrolled in the 

home-based option used this form of 

care (Love, 2003). The caregiver is 

most often a grandmother or an aunt 

of the child (R. N. Brandon et al., 

2002; Ramsburg, 2005). As family 

members, they reflect the culture 

and ethnicity of the child and 

family. Most are Latino, African 

American, or Asian with about 35% 

being European Americans. 

Immigrant women often provide 

informal child care for family or 

friends and most often rely on FFN 

care for their own children. The age 

range of the FFN caregivers is from 

the teens to the 70’s or 80’s with 

relatives tending to be older 

caregivers, in their forties or early 

fifties. Many have other employment 

(Porter & Kearns, 2005). Caregivers 

tend to have little formal education 

and have incomes under the poverty 

level, similar to the families they 

serve (Ramsburg, 2005). 

The Caregivers in the Enhanced Home 

Visiting Pilot Project 

54% of the caregivers are grandparents, 21 % are other relatives, 

and 25 % are not related to the child. 

12 % are licensed or registered family child care providers. 

29% of caregivers had not graduated from high school; 39 % had a 

high school diploma or GED. and 18% had some college, with 5% 

earning a 4 year college degree. 

75% of the caregivers are White, 13% Latino, 7 % AfricanAmerican, and 4% Native American. 

12 % speak a primary language other than English. 

(Mathematica Policy Research, 2005) 

3 
E ARLY HEAD START NATIONAL RESOURCE CENTER 

4 

The Unique 

Issues of Family, 

Friend, and 

Neighbor Care 

for Early Head 

Start Children 

I

nformal child care arrangements 

are a complex issue for Early Head 

Start for several reasons. For 

example, alhough there are likely 

benefits to any child in spending 

time with a loving grandmother, the 

same risks that pose challenges to 

EHS families are likely to be present 

in the FFN caregiver’s life as well— 

poverty, low education level, poor 

health care, poor nutrition, low 

literacy skills, and little specific 

knowledge of child development. 

These risks in the child’s life 

circumstances may have a negative 

impact on optimal development. 

Early Head Start is a comprehensive 

child development program designed 

to address all of these elements and 

provide the foundation needed for 

healthy development. The challenge 

to the EHS programs participating in 

the EHVP pilot project is to use the 

inherent benefits of FFN care while 

addressing the areas of concern. 

The Enhanced Home Visiting Child 

Care Arrangements 

79% of the family, friend, and neighbor arrangements are provided 

during the day on weekdays; 16% are in the evenings. 

64 % of the care arrangements are provided only in the caregivers’ 

home, and16 % in the child’s home. 15% of the child care was provided 

in households where the caregiver and child lived together. 

46% of the children are in FFN care at least 20 hours a week; 30% 

are in FFN care for over 40 hours a week. 

(Mathematica Research Institute, 2005) 

UNAPPRECIATED BENEFITS 

Early studies of FFN care relied on 

measures of quality traditionally used 

in more formal center and homebased care, such as environmental 

rating scales and the level of the 

teacher’s education, and by 

comparison it appeared that the 

quality of FFN care was sub-par. 

Nonetheless, FFN care is frequently 

used by many parents. A study in 

Illinois reported 70% of the mothers 

as saying they did not consider using 

any other type of care (Ramsburg, 

2005). Both Early Head Start 

parents and those in the general 

population say they use FFN care 

because they know and trust the 

caregiver, the situation is stable and 

flexible, and there is comfort in the 

cultural continuity. Some of the 

benefits are described below: 

Knowing and Trusting the Caregiver 

Most babies in relative care are 

being cared for by their 

grandmother. Oftentimes, the three 

generations live in the same 

household and the childcare 

arrangement derives from a mutual 

sense of responsibility among the 

family members in the home. One 
TECHNICAL ASSISTANCE PAPER NO .11 

EHS mother, living in a fourgenerational home, described her 

daughter’s caregiving arrangement 

with her own grandmother this way: 

My grandma has always taken care 

of kids. She’s had my baby since birth. 

They have their little jokes between the 

two of them, their own language. They 

have their routines; she naps in 

grandma’s bed. I’ve read about the 

importance of relationships, well, she 

doesn’t lack for relationships. Gramma 

is one of the better people to keep an 

eye on her. 

Most relatives who provide care 

for babies and toddlers do it out of a 

personal commitment to the child’s 

well-being. The Early Head Start 

programs describe the relatives 

providing care as being happy to 

participate in the EHVP project 

because they already value the EHS 

experience and want to participate 

more directly. They feel they could 

learn how to provide additional 

enrichment and contribute to the 

child’s future success by using the 

ideas and activities they learn from 

the home visitors. One grandmother 

said, “I’ll do anything for my 

grandchild ... if it benefits Head 

Start, I’ll do anything!” 

Many Early Head Start mothers 

are young and still relatively 

dependent on the advice and support 

of their own mothers. A study of 

relative caregivers in Chicago 

reported that they considered caring 

for a grandchild or other relative as a 

natural role within the family. One 

woman said, “Quite naturally, I 

would be the one to watch them” 

(Bromer, 2005). Bromer described 

the grandmothers as providing much 

more than caregiving: They gave 

childrearing advice to parents, 

encouraged them to spend time with 

their children, urged them to take 

the child’s perspective (explaining 

what you want rather than using 

physical punishment), and helped 

the mother understand the child’s 

developmental stage. 

Relative caregivers also have the 

advantage of caring for very few 

children at one time—oftentimes 

only one child—and being able to 

provide move focused attention to 

that child. They don’t consider 

caregiving a job; indeed, they rarely 

get paid for the service. They are 

doing it because they want to help 

the young family become established 

and because they enjoy time with 

the child. 

Stability and Flexibility 

EHS programs report that the 

relative caregiver lives in the same 

home as the parent and child in 15% 

of the families. For many parents and 

caregivers, this means that the 

grandparents can care for the child 

during non-traditional work hours 

without real disruptions in their own 

routines. The ongoing familial 

relationship provides an inherent 

stability. Issues of staff turnover or a 

home family provider moving or 

closing her business do not exist. 

5 
E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

6 

Cultural continuity 

The desire for cultural continuity 

may be explicit or implicit in FFN 

care. Women who are recent 

immigrants often choose and/or 

provide FFN care specifically because 

of the comfort of the familiar 

language and customs 

Supporting Literacy Skills 

One EHS enhanced home visitor described a grandmother who had no books in her home and who would not use the ones 

brought by the home visitor. As time passed, the visitor came to 

understand that the grandmother had German measles as a child and 

had word recall problems and very low literacy skills. All of her 

experiences with reading had been filled with shame and 

embarrassment. Because the two women had established a warm 

relationship, the visitor was able to support the grandmother in simply 

trying to look at the pictures in a book with her grandchild. After 

several visits of modeling “reading” the pictures, the grandmother tried 

it, reading the words she knew and talking about the pictures. For the 

grandmother, the child, and the visitor, this was an enormous success. 

RECOGNIZED CONCERNS 

The areas of concern related to FFN 

care for EHS children generally 

cluster in two categories: socioeconomic risk factors and the 

absence of specialized activities and 

environments that promote early 

learning. These concerns have been 

evident in the EHVP pilots and 

numerous studies of FFN care. 

Socioeconomic Issues 

Despite the best of intentions, there 

are a variety of challenges to FFN 

care in providing quality learning 

experiences for infants and toddlers. 

The caregiver’s own poverty and low 

educational skills may equate to 

having few resources to share with 

the child. These factors then tend to 

be associated with less enriched 

language and literacy experiences for 

the child, extensive use of television, 

and sometimes, limited parenting 

skills. In fact, many of the older FFN 

caregivers described the information 

provided by EHS as “new ways of 

doing things now.” 

Very few of the FFN homes were 

“baby-proofed.” Perhaps given the 

informal nature of the caregiving 

relationships, simple tasks such as 
covering outlets, removing dangerous 

materials from reach, or keeping a 

first aid kit on hand either hadn’t 

occurred to FFN caregivers or they 

did not have the money to purchase 

the necessary items. Many EHVP 

programs have provided the 

materials, information, and assistance 

needed to make the homes safer for 

the babies and toddlers. Some aspects 

of safety that are commonly regulated 

in center or home-family care were 

not recognized as dangerous within 

FFN homes. One recurring issue that 

EHVP staff has had to address is the 

issue of caregivers or other adults 

smoking cigarettes in the presence of 

the babies. 

A widespread concern related to 

socioeconomic issues in FFN care is 

the extent of health related problems 

experienced by the caregivers 

(Guzman, 2004). Some 

grandmothers are unable to attend 

group meetings because of their poor 

health. Some research reports that 

grandmothers in poorer health are 

more likely to provide care—possibly 

because they are unable to work. 

However, other reports describe 

employed grandmothers as providing 

care more often—possibly because of 

their more robust health (Guzman, 

2004). Because of related issues of 

poverty, even younger grandmothers 

are more likely to be coping with 

significant health issues. 

Quality Issues 

Some of the benefits accrued by 

infants and toddlers through 

participation in Early Head Start 

include better performance in 

cognitive and language 

development, higher emotional 

engagement of the parent, more 

sustained attention with play 

objects, and less aggressive behavior. 

The Early Head Start research 

indicates EHS parents are more 

emotionally supportive, provide 

more language and learning 

stimulation, read to their children 

more, and spank them less than the 

control group. The strongest and 

most numerous impacts were for 

programs that offered a mix of 

home-visiting and center-based 

services and that fully implemented 

the performance standards early 

(John M. Love et al., 2005). 

The Early Head Start research 

draws a direct connection between 

the quality of services offered and 

the outcomes for the children. The 

National Institute of Child Health 

and Human Development (NICHD) 

longitudinal study of child care 

echoes the findings that quality 

matters. NICHD found that relative 

care was neither helpful nor 

detrimental to children’s 

development, possibly because the 

TECHNICAL ASSISTANCE PAPER NO .11 

experiences with close relatives are 

very similar to those with parents. 

However, in non-relative care, 

caregivers with higher educations 

and fewer children per adult had 

more stimulating and well organized 

environments, which resulted in 

children with better vocabularies, 

more advanced attention and 

memory skills, and better peer 

relationships. On the other hand, 

children who watched more TV had 

more behavior problems, smaller 

vocabularies, and poorer math skills 

(Todd, 2001). 
8 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

The lack of the FFN caregiver’s 

specialized education in child 

development may be most important 

in serving those infants and toddlers 

with special needs. In the EHVP 

sample, 16% of children have an 

identified or suspected disability or 

delay, placing even greater demands 

on the caregivers to provide 

specialized care. 

Enhanced Home 

Visiting as an 

EHS Response 

Although FFN care has been an area of increasing attention for 

the entire early childhood field in 

recent years, the Head Start Bureau 

took particular interest in its 

potential impacts on infants and 

toddlers being served by Early Head 

Start. If quality is of concern, as 

suggested by early studies, the high 

percentage of EHS children being 

served in FFN care could be 

spending significant hours of their 

days and weeks in situations that are 

not promoting optimal development. 

On the other hand, even if 

traditional measures of quality were 

not describing the strengths of FFN 

care adequately, it was still likely 

that EHS was not fully utilizing the 

potential of the close relationships 

inherent in FFN care to promote early 

learning and support families. So, in 

2003 the Head Start Bureau 

introduced the Enhanced Home 

Visiting Pilot Project. 

Expected Outcomes of the Enhanced 

Home Visiting Pilot Project 

Infants and toddlers will receive enhanced quality care as a result of 

the support, training, resources, and home visiting activities that their 

caregivers receive. 

Positive experiences during the early years in enhanced caregiving 

settings will lay a strong foundation for early learning, improve child 

outcomes, and ensure that infants and toddlers will be better prepared 

for school. 

The Head Start Bureau will learn about the needs of non-parental 

kith and kin providers, and what support systems are needed to help 

them provide quality care. 

Relationships, communication, and understanding between parents 

and caregivers will be enhanced, to the benefit of children. 

Head Start community collaborations with local home visiting agencies will be developed, thereby integrating and coordinating local community resources. 

Caregivers will be trained and qualified in infant/toddler caregiving, 

increasing the number of quality caregivers in the field. 

(Hill, 2003) 

Early Head Start programs were 

invited to develop models for 

providing services that would offer 

FFN caregivers “support and training 

to promote the early language, 

literacy, and learning of children in 

their care” (Hill, 2003). Early Head 

Start programs serving children in a 

home-based option where the child’s 

parents are working and the child is 

in the keeping of another caregiver 

were invited to apply for funding to 

develop a model that would provide 

training, resources, and services to 

these caregivers. The participating 

EHS programs were instructed that 

the models they designed were to 

offer home visits to FFN caregivers in 

addition to, not in lieu of, the regular 

home visits with the EHS child and 

family. 

The outcomes of the proposed 

pilots are described in the box on 

the side. The approach to the 

project was designed by each 

program and each had unique 

experiences. 
ENHANCED HOME VISITING 

PROGRAM MODELS 

Each participating Early Head Start 

programs created its own design for 

finding, recruiting, and serving family, 

friend, and neighbor caregivers. 

Generally, the parents introduced the 

program to the caregivers and 

requested their participation. Most 

programs used some combination of 

home visits and socializations, similar 

to regular home-based services, 

although the frequency of visits — 

once or twice a month — was much 

lower. Some provided visits by the 

same staff member to the parents and 

the caregiver; some used two different 

visitors. 

True to the spirit of EHS, the 

visitors to the caregivers’ homes spent 

the first months of the project 

developing relationships with the 

caregivers. Programs often utilized 

more experienced home visitors for 

this work and they were able to 

communicate their respect for the 

importance of the consistent, loving 

role of the caregiver in the child’s life. 

Home visitors kept the focus of the 

visits on the child’s development, 

using the child’s learning goals as a 

source of consistency between the 

parents and caregivers. Although 

there were many aspects of the 

caregiving they wished to see 

changed, home visitors concentrated 

on the child’s developmental goals 

and suggested activities for supporting 

development. Some specific health 

and safety concerns were addressed, 

including hand washing and 

diapering procedures. Changes in 

caregiving occurred over time. Home 

visitors supported caregivers by 

bringing into the home books and 

literacy materials, toys, art materials, 

and safety equipment such as first aid 

kits, outlet covers, cabinet locks, door 

handle covers, and curtain cord 

winders. 

According to interviews with 

some program sites, although only a 

small percentage of caregivers 

attended the group socializations, 

those caregivers attended very 

regularly and expressed their 

enjoyment of the opportunity to get 

together with other caregivers, most 

TECHNICAL ASSISTANCE PAPER NO .11 

of whom were women. Group 

activities included discussion groups, 

and sharing information on topics 

such as language development, 

literacy, and nutrition. One site 

provided sewing and cooking 

activities. A couple of programs 

offered activities either individually 

or as a group involving visits to parks, 

libraries, and museums, opportunities 

that were unknown to many of the 

relatively isolated caregivers. 

One caregiver, who is monolingual 

Spanish-speaking, had lived in the 

community for 4 years without ever 

visiting any of these interesting 

places. The home visitor took her to 

the art center, a nature center and 

several parks, and now the woman 

takes her grandchildren to these 

places. One program encouraged the 

caregivers to attend a class designed 

for infant/toddler caregivers adapted 

to their own small group. The 

caregivers, many of them 

grandmothers, were amazed to 

discover so much new information 

9 
10 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

on development — and at their ability 

to master the material. By providing 

incentives for caregivers, EHVP 

programs were able to increase 

participation at first, but after a 

while the groups themselves had an 

inherent value for the participants. 

In focus groups conducted for 

the pilot evaluation, caregivers 

expressed their appreciation for the 

individualized approach and regular 

adult company, and reported that 

their particular needs and interests 

were being met (Paulsell et al. 2006). 

Opportune Moments 

Enhanced Home visitors described some dramatic encounters in which their access to the extended family had very beneficial effects. 

For example, a home visitor invited an uncle who provided care to a 

child in EHS to participate in a “Father Involvement Conference.” 

Sitting next to him at the conference, she noted his anguished 

emotional state and asked if he was alright. He explained that he had 

shaken his own child and his wife took the children and went to a 

women’s refuge. He was distraught but wanted to continue his 

participation at the conference. During an activity in which the men 

drew pictures of their own fathers, he broke down in tears, telling the 

home visitor that he realized he was being just like his own father — and 

he desperately wanted to change. With the help of the home visitor he 

pursued therapy and anger management and the family was gratefully 

re-united. The home visitor’s ability to be present and trusted created 

vital turning points for families that were experiencing hidden crises. 

UNEXPECTED ISSUES 

The EHVP programs based their new 

venture on the tried and true models 

of their home-based programs, drew 

on their deep knowledge of child 

development, and utilized their wellpracticed relationship building skills. 

Still, despite all their experience 

working with children and families, 

enhanced home visiting held 

numerous surprises for programs. 

Some FFN caregivers were similar to 

the families with whom they work in 

EHS. These caregivers had 

considerable social service needs, 

their recruitment and retention were 

challenging, and the age differences 

between caregivers and home visitors 

were problematic. Each service 

model carried its own complications. Social Service Needs 

Early Head Start is a comprehensive 

child development program and 

provides numerous services to EHS 

families. As a rule, the EHS program 

would not provide comprehensive 

services to child care providers in 

center-based or home-family care, 

but FFN care presented a gray area 

for how the program could work 

with the caregiver or use program 

resources. When FFN caregivers 

were members of the extended 

family, these individuals sometimes 
lived in the same household as the 

EHS child. Home visitors were 

directed to support improvements in 

the learning environment, but it was 

not unusual for other problems to 

intrude. Some models held firmly to 

providing only child development 

services. Others provided 

information and referrals for FFN 

caregivers but were very concerned 

about being overwhelmed by the 

caregiver’s needs. Still other 

programs recognized relative 

caregivers as family members and 

responded to this opportunity to 

provide inter-generational services to 

families that maintained close intergenerational relationships. 

Recruitment and Retention 

While the majority of the 

participants were accepting of the 

EHS program’s services, some of the 

grantees had difficulty recruiting and 

maintaining the number of FFN 

caregivers for which they had been 

funded. The biggest challenge was 

the limited pool of 

families/caregivers from which 

programs could recruit. Some 

caregivers were reluctant to enroll 

and may have been uncomfortable 

with the idea of having unfamiliar 

visitors in their homes. 

It also turns out that FFN 

caregiving can be quite fluid. As the 

parents’ work situation changes, if 

disagreements flare up, or if other, 

more traditional options for care 

become available, the caregiving 

arrangement can change. However, 

TECHNICAL ASSISTANCE PAPER NO .11 

several FFN caregivers participating 

in the program wanted to recruit 

new EHS children to care for so that 

they could continue with the 

training and the visits. 

Age Differences and Similarities 

Some of the EHVP program home 

visitors were older women, often 

grandmothers themselves. Some of 

these home visitors also had adult 

children and grandchildren living 

with them. Though there were often 

large differences in educational and 

economic status between these home 

visitors and the FFN caregivers, the 

similarity of the life experience 

created a bond between them. The 

programs report that it was easier for 

the older caregivers to accept older 

home visitors. Initially, there was 

some distrust of young, college 

educated home visitors. Some FFN 

caregivers spoke with scorn of how 

“things keep changing in how you 

raise kids. The experts can’t make up 

their minds.” However, patient, 

respectful relationship-building on 

the part of the home visitor 

generally paid off. Caregivers became 

more accepting of new information, 

saying things like, “They know so 

much more about babies and 

learning today than when I raised 

my kids.” 

11 
12 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

1 or 2 Home Visitors? 

Some of the EHS programs used the 

same home visitor to work with the 

parents and the caregiver, and some 

chose to hire a separate visitor just 

for the caregivers. Each model had 

its strengths and its drawbacks. 

Programs found they were better 

able to ensure consistency of 

messages when one home visitor was 

assigned to both the family and the 

FFN caregiver.. The visitor could 

direct everyone’s focus to the same 

developmental goals and provide 

materials and activities that created 

a series of coherent learning 

experiences and expectations. 

Parents and caregivers would receive 

the same developmental information 

and advice. The drawbacks to 

having one home visitor included 

the large amount of record-keeping 

and paperwork for one child and the 

difficulty in resolving conflicts 

between caregivers and parents when 

each expected the home visitor’s 

allegiance in the matter. 

When programs used different 

home visitors, communication 

between them was sometimes 

problematic. In order to minimize 

the possibility of parents and 

caregivers hearing conflicting 

messages, it was important that the 

information and advice given by the 

two visitors were consistent. Programs 

that had regularly scheduled meetings 

and other systems for continuously 

sharing information were able to 

improve the communication 

between caregivers and parents. One 

of the greatest benefits of having two 

visitors, however, was their ability to 

model and sustain conflict resolution, 

enabling the parent and caregiver to 

each feel supported by an ally. 
TECHNICAL ASSISTANCE PAPER NO .11 

ACROSS THE GENERATIONS 

Perhaps the most startling realization 

for many programs was how closely 

involved many Early Head Start 

children and parents are with their 

extended families. Some programs 

describe doing home visits in the 

past and having the grandmother, 

who lives in the same home, 

leave the room because of a 

misunderstanding that the home 

visit was only for the benefit of the 

parents. While the Head Start 

Program Performance Standards 

specify that the home visit must be 

with the parent and not an 

alternative caregiver, they do not 

exclude additional caregivers. Even 

pilot models using two visitors 

sometimes held joint visits with the 

parents and caregiver because they 

found them so beneficial. 

Many of the caregivers reported 

increased self-esteem as they came to 

appreciate their ability to contribute 

to a child’s development and wellbeing. The parents developed higher 

regard for the caregiver’s 

contribution, as well, leading to a 

greater sense of cooperation among 

them. 

Whether it is an issue of 

generational differences or other 

long-lived conflicts, parents and 

grandparents sharing the care of a 

young child can have numerous 

disagreements. Home visitors who 

establish caring relationships with 

both the parents and grandparents 

are able to help negotiate these 

issues. Sometimes it is a matter of 

providing accurate developmental 

information. One program provided 

an in-home, mini-training on 

temperament and challenging 

behavior that brought the mother 

and grandmother together in a new, 

mutual understanding of the child. 

Another program offered some 

formal communication training and 

helped the extended family establish 

family meetings as a way of 

maintaining on-going communication 

and solving problems as they arise. 

Many programs identified additional 

training needs for the home visitors 

who work with multiple generations 

in a family. 

13 
14 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

The children in Early Head Start 

often have deep and meaningful 

relationships with grandparents, 

aunts, and uncles. The participating 

EHVP programs discovered that 

working within the larger family 

group added a new level of depth 

and effectiveness to their work. Most 

programs have indicated a desire to 

continue this level of involvement 

with families. Programs hope to 

continue to include caregivers in 

some of the regularly scheduled 

home visits, socializations, and 

family events, and to encourage EHS 

parents to share the child 

development information they 

receive with extended family 

members, friends, and neighbors who 

are deeply involved in their lives. 

IMPROVING QUALITY 

One of the most unique aspects of 

FFN care is that the caregiver so 

often has a genuine, personal 

investment in the child’s well-being. 

Staff from a few of the enhanced 

home visiting programs reported 

some success with encouraging 

caregivers to reduce detrimental 

behaviors, such as their use of the 

television and cigarette smoking in 

the presence of the children, when 

caregivers understood the potential 

harm that each might cause this 

child. Over time, the caregivers also 

embraced the health and safety, 

literacy, language, and learning 

activities introduced by the home 

visitors and the group experiences. 

They became more thoughtful and 

intentional in their activities with 

the children and often greeted the 

home visitor at the door with reports 

of recent activities or the child’s 

newest accomplishments. When the 

caregiver had additional children in 

her charge, they all benefited from 

her new skills and knowledge. 

Another benefit impacting 

improved quality was the reduction 

in social isolation for caregivers. 

Through participation in group 

socializations, family events, or 

classes, they developed new 

friendships with caregivers in similar 

situations. These positive outcomes 

could be incorporated in traditional 

home-visiting programs by being 

more inclusive of FFN caregivers. By 

inviting the caregivers to attend 
TECHNICAL ASSISTANCE PAPER NO .11 

socializations with the families (or 

additional socializations), 

distributing information to 

caregivers, opening lending libraries 

to their participation, and inviting 

them to parent education events, a 

home-based program could greatly 

increase its effectiveness without any 

major increase in costs. 

Community Connections 

A third area of impact for the EHVP 

programs is the development of new 

community partnerships. New 

partnerships were established 

between Early Head Start programs 

and other home visiting programs 

such as Parents as Teachers. In one 

pilot, the two programs co-existed 

within the same agency for years 

without really developing a 

partnership. Now, they recognize 

their similarities and a potential for 

ongoing, mutual contribution. 

An increase in referrals to early 

intervention and children’s 

protective services resulted from the 

additional relationship developed 

with the FFN caregiver. Sometimes, 

having an additional home visitor 

getting to know the child alerted the 

program to more subtle issues. 

In some cases, the EHS program 

became aware of additional services 

in their own community. Resource 

and Referral agencies had programs 

and services for family, friend, and 

neighbor caregivers that had been 

unknown to EHS programs. Various 

social service agencies serving the 

elderly became resources for EHS 

programs that had not previously 

had reasons to access them. Such 

new partnerships will continue to 

enrich the EHS programs, well 

beyond the funding of the EHVP 

initiative. 

Conclusion 

Family, friend and neighbor care is an important sector of child care 

for infants and toddlers, especially 

for Early Head Start families. The 

impact of early experiences on brain 

development, the hours spent in 

FFN care, and the concerns about 

the quality of caregiving motivated 

the Head Start Bureau to engage 

Early Head Start home-based 

programs in an initiative to find and 

support their children’s FFN 

caregivers. EHS staff discovered 

unique strengths in these caregivers 

including their commitment to the 

children, their trusting relationship 

within the family, and their 

flexibility. Perhaps the most 

significant result was the EHS 

program staff’s own deeper 

understanding of the importance of 

extended family relationships for 

Early Head Start families. 

15 
16 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

References
 

Brandon, R. (2005). 

Enhancing family friend and neighbor caregiving quality: The research case for public 

engagement. Washington, DC: American 

Public Human Services Association. 

Brandon, R. N., Maher, E. J., Battelle, 

J. M. J., & Doyle, S. (2002). 

Understanding family, friend, and neighbor 

care in Washington State: Developing 

appropriate training and support. Seattle: 

Human Services Policy Center, Evans 

School of Public Affairs, University 

of Washington. 

Bromer, J. (2005). 

Ways of caring: How relative caregivers 

support children and parents. Perspectives 

on family, friend and neighbor child care: 

Research, programs and policy Occasional 

Paper Series, 15, 14 - 25. 

Flanagan, K., & West, J. (2004). 

Children born in 2001: First results from 

the base year of the early childhood 

longitudinal study, birth cohort. 

Washington, DC: National Center 

for Education Statistics. 

Guzman, L. (2004). 

Grandma and grandpa taking care of 

the kids: Patterns of involvement. Child 

Trends Research Brief, Publication 

# 2004-17, 1-7. 

Hill, W. (2003). 

Enhanced home visiting pilotproject 

funding opportunity notice: Head Start 

Bureau. 

Love, J. M., Kisker, E. E., Ross, C., 

Raikes, H., Constantine, J., Boller, K., 

et al. (2005). 

The effectiveness of early Head Start for 

3-year-old children and their parents: 

Lessons for policy and programs. 

Developmental Psychology, 41(6), 885-901. 

Love, J. M., Kisker, E. E., Ross, C. M., 

Schochet, P. Z., Brooks-Gunn, J., 

Paulsell, D., et al. (2003). 

Making a difference in the lives of infants 

and toddlers and their families: The impacts 

of early head start. Washington, DC: 

Child Outcomes Research and 

Evaluation, U.S. Department of Health 

and Human Services. 

Porter, T., & Kearns, S. (2005). 

Family, friend, and neighbor care: Crib 

notes on a complex issue. Perspectives on 

family, friend and neighbor child care: 

Research, programs and policy, 5-14. 

Ramsburg, D. (2005). 

Illinois study of license-exempt care from 

a parent-provider perspective. Paper 

presented at the Society for Research in 

Child Development, Atlanta, GA. 

Shonkoff, J. P., & Phillips, D. A. (2000). 

From neurons to neighborhoods: 

The science of early development. 

Washington, D.C.: National 

Academy Press. 

Siegel, D. J. (1999). 

The developing mind: How relationships 

and the brain interact to shape who we are. 

New York: Guilford Press. 

Smith, K. (2002). 

Who’s minding the kids? Washington, 

D.C.: U.S. Department of Commerce. 

Todd, C. M. (2001). 

The NICHD child care study results: 

What do they mean for parents, child-care 

professionals, employers and decision 

makers? 
EARLY HEAD START NATIONAL RESOURCE CENTER