Tackling Toxic Stress

Innovating in Early Head Start: Can Reducing Toxic Stress Improve Outcomes for Young Children?

How can families in the most difficult circumstances be supported to give children the best chance to succeed? Federal administrators of the Early Head Start program for young children and families think addressing the sources of toxic stress may be the answer. Recognizing the potential benefits to society—and potential improvements in outcomes for the families they serve—the U.S. Administration for Children and Families (ACF) has launched a trailblazing research effort to find more effective ways to enhance child development in the nation’s poorest families.

early-head-startResearch has demonstrated that consistent, supportive caregiving has the potential to prevent or mitigate the harmful effects of adverse experiences—such as the disorder and deprivation associated with poverty—and the excessive levels of stress they may cause in children. Toxic stress can cause disruptions in the developing brain and body that affect both physical and mental health for a lifetime.

Designed to support healthy child development in families below the poverty line, Early Head Start was selected as a promising pathway to catalyze new ideas for improving the relationships that can protect children from toxic stress. (See sidebar.) In 2011, ACF announced a grant program seeking researchers to test promising parenting interventions, such as enhanced weekly home-based coaching, for Early Head Start’s highest-risk families. In prior research, this group failed to show the same social and behavioral gains, such as more positive interactions with their parents and less aggression, that lower-risk children had made by participating in Early Head Start.

“This is a huge breakthrough that the federal government—and particularly an agency that funds early childhood services—is funding this kind of research.”

Philip A. Fisher

Finding ways to minimize toxic stress on children “is an active topic of conversation” at his agency, says Mark H. Greenberg, Deputy Assistant Secretary for Policy at ACF, which is part of the U.S. Department of Health and Human Services. “We want to support efforts to help families achieve the best outcomes” for children, he says.  “The research evidence about the effects of toxic stress in early childhood and its potential lifelong consequences is striking, and we want to identify potential implications for policy and programs.”

The significance of the new federal interest in using the science of early childhood development to advance policy and practice cannot be underestimated, says Philip A. Fisher, a professor of psychology at the University of Oregon and a senior scientist at the Oregon Social Learning Center. Fisher is a co-investigator on one of the funded projects at the University of Denver that uses a video coaching intervention with Early Head Start families.

“This is a huge breakthrough that the federal government—and particularly an agency that funds early childhood services—is funding this kind of research,” says Fisher, who is also a senior fellow at the Center on the Developing Child. “Ten years ago, nobody would have thought an agency like that would have any interest in anything related to the brain. It’s a game changer.”

Building Responsive Caregiving

For the past decade, ACF has been tracking the growing body of scientific evidence about the power of severe or prolonged adverse childhood experiences to become toxic to developing brains and other organ systems and weaken brain architecture, thereby limiting school readiness and potentially harming lifelong health, learning, and behavior. Among the most relevant findings: The development of healthy brain architecture relies on responsive relationships with adult caregivers, and such relationships help children to learn how to handle stressful experiences. In the absence of these supportive relationships, as the severity or number of adverse experiences mounts, the likelihood of a child’s poor outcomes also increases, including developmental delays, learning disabilities, and childhood behavior problems, as well as diabetes, heart disease, depression, drug abuse, alcoholism, and other major health problems over a lifetime.

Given what is now known, identifying how Early Head Start can use its longstanding home-visiting program to build responsive caregiving and help alleviate the effects of toxic stress is a timely goal with lasting impact, says Mary Bruce Webb, the director of the Division of Child and Family Development in ACF’s Office of Planning, Research and Evaluation, who oversees ACF’s child and family development research. “These early experiences cascade into the future in some very dramatic ways.”

The five-year research grants, which were awarded in 2011 to researchers at six universities and total $12 million, target an acute need: improving basic parent-child interactions in the highest-risk families receiving weekly home visits. In addition to the risk posed by poverty, many families participating in the current research studies have, as ACF defined it, “four or five of the following risks: teen mother, single mother, mother not having GED or high school diploma, not being employed or in school, and receiving welfare/TANF.”

Clancy Blair, the principal investigator of an intervention for mothers in New York City that received an ACF grant, says parents in poverty can be physically and emotionally drained from the demands of caring for a young child, juggling two or three low-wage jobs, and still being unable to pay the bills. Finding the energy and patience to play with their child—especially in front of a stranger dispensing advice—may be the last thing they want to do, but that is part of why effective home visits are crucial, explains Blair, a professor of applied psychology at New York University. “Inherently, children’s development is driven through relationships,” he says. “It’s the way that children learn about the world.”

By contrast, many Early Head Start home visitors, Blair says, work directly with the children, such as doing art projects to build fine motor skills. Instead, he says, “as much as possible, Early Head Start should be focusing on parent-child interaction, because that’s where the rubber hits the road; that’s where things are going to change for kids, and for caregivers as well.”

Strengthening Behavior of Parents—and Staff

Fisher’s project in Colorado, meanwhile, implements a “microsocial” video coaching intervention, which starts with videotaping parents interacting with their children, then edits the videos into clips of just a few seconds to help parents understand the positive things they already do. From there, the program coach can help them build on strengths.The six research projects funded by ACF are testing different interventions, each 10 to 15 sessions long. (See sidebar.) Blair’s uses a curriculum called Play and Learning Strategies (PALS) developed by Susan Landry, director of the Children’s Learning Institute at the University of Texas Health Science Center at Houston. In the intervention, home visitors show parents video clips of positive caregiving techniques, then videotape the parents enacting the same situations and analyze their behavior in the clips together.

A key to the Early Head Start research is learning not only which interventions work, but also which can be implemented with the resources, including staff and money, that are currently available in most Early Head Start programs.

The intense focus on implementation is vital to learning how to scale up high-quality programs, says Aleta Meyer, a senior social science research analyst with the Division of Family Strengthening in ACF’s Office of Planning, Research and Evaluation. From effective training to ongoing supervision, Early Head Start programs must focus not just on changing the behavior of parents, but on changing the behavior of intervention staff to implement programs with fidelity over time. “You don’t just hand people a manual and expect to get the same kind of outcomes” seen in controlled research studies where extensive resources were put into staff selection, training, and support, Meyer says.

Many early childhood services for babies and toddlers “haven’t been informed by developmental science,” notes Webb of ACF. “People are trying to do their best, but they just have a different frame of reference than people who do research. To the extent that we do these kinds of [research] projects, it will bring things into sharper focus and help people to be a little more intentional in how we address this population.”


Early Head Start: The Charge and the Challenge

Early Head Start evolved out of the federally funded Head Start program in 1994 as a way to formalize its work with pregnant women, infants, and toddlers. The aim is to support the physical, social, emotional, cognitive, and language development of each child as early in life as possible. Eligibility is based primarily on having income lower than the federal poverty line, which was $19,090 for a family of three in 2012. Approximately 3 million children under the age of 3 live in U.S. families meeting this requirement.

Each state’s spending on Early Head Start is capped at 55 percent of its Head Start funding allocation. In fiscal year 2012, Early Head Start served 113,566 children in about 1,000 programs across the country. Services begin as early as pregnancy and end when a child turns 3 and is eligible for Head Start preschool. Almost half of Early Head Start families receive weekly home visits designed to help parents support a child’s development. The other participants attend Early Head Start child care centers and receive home visits twice a year.

The federal agency that oversees Early Head Start, the Administration for Children and Families (ACF), has conducted Head Start and Early Head Start research for 20 years, focusing on social and emotional health and parent-child attachment. In a 2002 research and evaluation project, ACF found that the programs improved parent-child interactions and reduced aggression in 3-year-olds. According to the study, likely reasons included the positive effect on parents’ warm sensitivity toward the child during play and on reducing the incidence of physical punishment in the previous year. Despite success serving families suffering from depression—a major risk factor among Early Head Start parents—it did not have an effect on parenting or child outcomes for the highest-risk families. That finding has prompted the current research effort.


Early Head Start University Partnership Grants: Buffering Children from Toxic Stress

Grantees, 2011-2016

View more articles from the Tackling Toxic Stress series

Article written by Carol Gerwin, a freelance writer and editor specializing in education and child development, who is based in Newton, Mass.

Published: August 14, 2013 

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