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Is the Whole Greater than the Sum of Its Parts? Impacts on Child Outcomes from a Home-Visiting Parenting Program and Its Interaction with Preschool

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Title: Is the Whole Greater than the Sum of Its Parts? Impacts on Child Outcomes from a Home-Visiting Parenting Program and Its Interaction with Preschool
Language: English
Authors: Remy Pages (ORCID 0000-0002-0396-6498), Tracy Payne, Herman T. Knopf
Source: Early Childhood Education Journal. 2025 53(4):1313-1324.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 12
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Early Childhood Education
Preschool Education
Adult Education
Descriptors: Preschool Children, Preschool Education, Parent Child Relationship, Parent Education, Parent Participation, Parent School Relationship, Parents, Home Visits, Parent Teacher Cooperation, School Readiness, Thinking Skills, Program Effectiveness, Family Environment, Family Problems
DOI: 10.1007/s10643-024-01720-x
ISSN: 1082-3301
1573-1707
Abstract: This study evaluates the effects of a weekly home-visiting parenting program designed to enhance parent-child engagement with educationally-enriching activities and its potential interaction with children's participation in state-funded preschool. Utilizing a comprehensive dataset linked across various administrative sources, we employed a quasi-experimental approach featuring inverse probability weighting regression adjustment and nearest neighbor matching to assess outcomes as measured at or leading up to kindergarten entry. We focused on a cohort of 2,000 diverse children born between 2012 and 2016, aged three and four at the intervention's onset. Participation in the home-visiting program was associated with significant positive effects on children's cognitive skills, IDEA Part B service uptake, and the likelihood of reported child maltreatment, which persisted after adjusting for state-funded preschool participation. We found no statistical evidence of interactions between the program and preschool, underscoring the program's additive contributions to early childhood development and family well-being.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1462385
Database: ERIC
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  Value: <anid>AN0183749986;5mx01apr.25;2025Mar19.03:39;v2.2.500</anid> <title id="AN0183749986-1">Is the Whole Greater than the Sum of Its Parts? Impacts on Child Outcomes from a Home-Visiting Parenting Program and its Interaction with Preschool </title> <p>This study evaluates the effects of a weekly home-visiting parenting program designed to enhance parent-child engagement with educationally-enriching activities and its potential interaction with children's participation in state-funded preschool. Utilizing a comprehensive dataset linked across various administrative sources, we employed a quasi-experimental approach featuring inverse probability weighting regression adjustment and nearest neighbor matching to assess outcomes as measured at or leading up to kindergarten entry. We focused on a cohort of 2,000 diverse children born between 2012 and 2016, aged three and four at the intervention's onset. Participation in the home-visiting program was associated with significant positive effects on children's cognitive skills, IDEA Part B service uptake, and the likelihood of reported child maltreatment, which persisted after adjusting for state-funded preschool participation. We found no statistical evidence of interactions between the program and preschool, underscoring the program's additive contributions to early childhood development and family well-being.</p> <p>Keywords: Home-visiting; Parenting; Early childhood development; Child maltreatment; Cognitive skills; Special education; Psychology and Cognitive Sciences Psychology Medical and Health Sciences Public Health and Health Services</p> <p>Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10643-024-01720-x.</p> <hd id="AN0183749986-2">Introduction</hd> <p>Evidence highlighting the crucial link between early investments in children and subsequent outcomes (e.g., Almond et al., [<reflink idref="bib4" id="ref1">4</reflink>]; Duncan et al., [<reflink idref="bib28" id="ref2">28</reflink>]; Yoshikawa et al., [<reflink idref="bib89" id="ref3">89</reflink>]) has spurred attention to the nature and delivery systems of those investments (e.g., Britto et al., [<reflink idref="bib15" id="ref4">15</reflink>]; Duncan et al., [<reflink idref="bib29" id="ref5">29</reflink>]; Francesconi & Heckman, [<reflink idref="bib42" id="ref6">42</reflink>]; Kalil, [<reflink idref="bib54" id="ref7">54</reflink>]). Recent research underscores the effectiveness of home-visiting programs focusing on parenting and early childhood development in low-income settings globally (e.g., Araujo et al., [<reflink idref="bib6" id="ref8">6</reflink>]; Attanasio et al., [<reflink idref="bib7" id="ref9">7</reflink>]; Doyle, [<reflink idref="bib27" id="ref10">27</reflink>]; Dupas et al., [<reflink idref="bib32" id="ref11">32</reflink>]; Emmers et al., [<reflink idref="bib33" id="ref12">33</reflink>]; McCormick et al., [<reflink idref="bib62" id="ref13">62</reflink>]; Morris et al., [<reflink idref="bib66" id="ref14">66</reflink>]). To illustrate, a recent meta-analysis (Jeong et al., [<reflink idref="bib51" id="ref15">51</reflink>]) encompassing 102 randomized controlled trials of parenting interventions across 33 countries, serving families with children aged 3 or under, estimated positive impacts (lower bounds of pooled effect sizes ranging from 0.1 to 0.3) on various measures. These measures included parenting knowledge and practices, parent–child interactions, as well as the child's early cognitive, language, and motor skills, socioemotional development, and attachment.</p> <p>By contrast, a meta-analysis by Grindal and colleagues ([<reflink idref="bib46" id="ref16">46</reflink>]), focusing on parenting education services in the U.S., found little overall value-added from such initiatives on children's cognitive skills, beyond the effects generated by preschool programs. Nevertheless, positive and larger effects were observed when programs included frequent home visits (e.g., one or more home visits per month) and specifically targeted the practice of parenting skills. Additionally, re-analyzing the randomized evaluation Head Start Impact Study, Gelber and Isen showed that Head Start's impact on parental involvement was meaningful, persisting, and positively associated with impacts on children's cognitive skills (Gelber & Isen, [<reflink idref="bib44" id="ref17">44</reflink>]).</p> <p>In high-income country settings, families with young children typically are exposed to various options for early care and education arrangements, and analyses of the impact of home-visiting parenting interventions would need to consider other type of early investments (Feller et al., [<reflink idref="bib34" id="ref18">34</reflink>]; Kline & Walters, [<reflink idref="bib55" id="ref19">55</reflink>]). Combinations of services, such as home-visits coupled with preschool participation, and exploration of counterfactual scenarios (e.g., informal care versus parental care versus preschool) could introduce variations in program impacts and contribute to explaining some of the documented mixed results (e.g., as recently reported in Michalopoulos et al., [<reflink idref="bib64" id="ref20">64</reflink>]; for an instance of a health intervention acting as a substitute of preschool, see Rossin-Slater & Wüst, [<reflink idref="bib75" id="ref21">75</reflink>]).</p> <p>In general, this literature suggests two main themes. Firstly, more nuanced interpretations of the results are needed due to the heterogeneity of impacts; results that are likely related to program characteristics and contexts (Duncan et al., [<reflink idref="bib29" id="ref22">29</reflink>]; Howard & Brooks-Gunn, [<reflink idref="bib50" id="ref23">50</reflink>]; Jervis et al., [<reflink idref="bib52" id="ref24">52</reflink>]; Sweet & Appelbaum, [<reflink idref="bib81" id="ref25">81</reflink>]). Secondly, it highlights that home-visiting programs, incorporating a responsive-caregiving component, exhibit more meaningful effects on child outcomes compared to programs lacking this element (Jeong et al., [<reflink idref="bib51" id="ref26">51</reflink>]; for a comprehensive review, see Britto et al., [<reflink idref="bib15" id="ref27">15</reflink>]). The recognition of responsive caregiving as a pivotal mechanism in the success of home-visiting programs holds policy significance. Indeed, with relevant consideration of local contexts (Grantham-McGregor & Walker, [<reflink idref="bib45" id="ref28">45</reflink>]), implementing scaled interventions that target nurturing parent-child interactions could prove to have impressive benefit-to-cost ratios that offer long-term returns akin to iconic early childhood interventions like the Perry Preschool Program or the Abecedarian Project (García & Heckman, [<reflink idref="bib43" id="ref29">43</reflink>]).</p> <p>Three hypotheses can be proposed to explain the heterogenous findings described above. The first hypothesis suggests that early inputs act as substitutes. For instance, gains generated by an intervention on early literacy might be fully compensated by kindergarten attendance for children in the control group (e.g., Dearing et al., [<reflink idref="bib25" id="ref30">25</reflink>]; Vernon-Feagans & Bratsch-Hines, [<reflink idref="bib84" id="ref31">84</reflink>]), with evidence of compensation manifesting as a negative interaction between the two investments (e.g., Bailey et al., [<reflink idref="bib8" id="ref32">8</reflink>]). By contrast, a second hypothesis posits that early inputs act independently, such that their impacts are additive, and interaction estimates are not meaningful (e.g., Carr et al., [<reflink idref="bib17" id="ref33">17</reflink>]; Currie & Almond, [<reflink idref="bib23" id="ref34">23</reflink>]; Simonsmeier et al., [<reflink idref="bib79" id="ref35">79</reflink>]). Finally, a third hypothesis posits that early inputs lead to multiplier effects, where one investment provides a greater yield when gains are also observed from another investment (Johnson & Jackson, [<reflink idref="bib53" id="ref36">53</reflink>]). This synergistic effect is identified by a positive interaction between investments such that their combined impact exceeds the sum of each impact considered separately. The present study aimed to test these hypotheses in the context of a weekly home-visiting program targeting the responsive and instructional skills of parents with preschool-aged children. The study estimated the impacts of the home-visiting parenting program on various child outcomes and examined interactions between the effects of the home-visiting program and the effects of the state-funded preschool program.</p> <hd id="AN0183749986-3">Parenting and Early Skill Development</hd> <p>Variations in social, cultural, and economic conditions can potentially lead to variations in parent-child interactions and children's early skill formation. For instance, parents and caregivers who are unemployed, underemployed, or without family supports like paid leave and healthcare are likely to experience stressors that can interfere with parenting. And children who are provided opportunities to engage in hands-on learning, shared book reading, or enriching educational interactions (with parents and other caregivers) are more likely to develop a set of skills that prepare them better for formal schooling than children who have not had those regular experiences (e.g., Merz et al., [<reflink idref="bib63" id="ref37">63</reflink>]; Mistry et al., [<reflink idref="bib65" id="ref38">65</reflink>]; Wade et al., [<reflink idref="bib86" id="ref39">86</reflink>]).</p> <p>Home-visiting parenting programs typically provide parents with education about child development and guidance on beneficial parenting practices (Duncan et al., [<reflink idref="bib29" id="ref40">29</reflink>]; Michalopoulos et al., [<reflink idref="bib64" id="ref41">64</reflink>]). They aim to support responsive caregiving, developmentally appropriate expectations, and environment-person transactions that induce favorable timely effects on child's development (e.g., Bornstein et al., [<reflink idref="bib13" id="ref42">13</reflink>]; Briley et al., [<reflink idref="bib14" id="ref43">14</reflink>]; Cunha et al., [<reflink idref="bib22" id="ref44">22</reflink>]; Masek et al., [<reflink idref="bib58" id="ref45">58</reflink>]). While any given transactions is context- and domain-specific, as when, for example, parenting's influences on a child's math skill originates from math-related parent-child interactions (Daucourt et al., [<reflink idref="bib24" id="ref46">24</reflink>]), successful parenting programs tend to shift "business-as-usual" parental preferences and investments as a whole (e.g., parent-child time allocation, parental beliefs, and caregiving practice; see Bono et al., [<reflink idref="bib11" id="ref47">11</reflink>]; Carneiro et al., [<reflink idref="bib16" id="ref48">16</reflink>]; Cunha et al., [<reflink idref="bib21" id="ref49">21</reflink>]; Fiorini & Keane, [<reflink idref="bib37" id="ref50">37</reflink>]). One could then expect early home-visiting parenting programs to generate family-level changes that are durable and general (Fraley et al., [<reflink idref="bib41" id="ref51">41</reflink>]), as evidenced by the breadth and persistence of effects stemming from variations in early parental sensitivity or home environments (e.g., Cooke et al., [<reflink idref="bib20" id="ref52">20</reflink>]; Duncan et al., [<reflink idref="bib30" id="ref53">30</reflink>]; García & Heckman, [<reflink idref="bib43" id="ref54">43</reflink>]; Madigan et al., [<reflink idref="bib57" id="ref55">57</reflink>]; Tamis-LeMonda et al., [<reflink idref="bib82" id="ref56">82</reflink>]).</p> <p>Impacts of early responsive caregiving on child affective and cognitive development have a longstanding research record. Theory posits that learning might be optimal when a sensitive caregiver gauges a child's interests and cognitive level, offering inputs within the bounds of Vygotsky's zone of proximal development, which marks the distance between a child's actual and next developmental level (Vygotsky, [<reflink idref="bib85" id="ref57">85</reflink>]). Responsive caregiving thus establishes a norm of contingent reciprocity, i.e., "serve-and-return" interactions (see, Shonkoff & Bales, [<reflink idref="bib78" id="ref58">78</reflink>]), where inputs are initiated or responded to by both child and caregiver. Environments that are rich of early sensitive serve-and-return experiences are deemed crucial for a child's developing affective and cognitive capacity, language development, and learning (e.g., Bernard et al., [<reflink idref="bib10" id="ref59">10</reflink>]; Ferjan Ramírez et al., [<reflink idref="bib35" id="ref60">35</reflink>]; Tomasello et al., [<reflink idref="bib83" id="ref61">83</reflink>]).</p> <hd id="AN0183749986-4">Home Instruction for Parents of Preschool Youngsters (HIPPY)</hd> <p>The Home Instruction for Parents of Preschool Youngsters (HIPPY) program offered an ideal environment for assessing the effects of a "serve-and-return" parenting intervention.</p> <p>HIPPY's mission is partnering with parents to prepare their preschool-aged children for success in school (HIPPY United States, [<reflink idref="bib49" id="ref62">49</reflink>]). The program supports parents as their children's first teachers by providing them the tools, skills, and confidence to share academic-related activities with their young children in the home. HIPPY currently operates in 15 countries and is delivered in seven languages. In the United States, the program is delivered by almost 130 sites in 20 states. HIPPY is an approved home visiting model of the Federal Department of Health and Human Services' Home Visiting Evidence of Effectiveness (Department of Health and Human Services, [<reflink idref="bib26" id="ref63">26</reflink>]).</p> <p>The HIPPY curriculum consists of an evidence-based and developmentally appropriate sequence of educationally enriching activities, scripted for parents with children ages two to five within a "serve and return" framework. During each weekly visit, parents are trained on delivering a packet of five activities addressing different learning domains, along with related books and raw materials needed to engage their children between 15 and 30 min each day. Parents or legal guardians will have enacted up to 150 playful learning activities and read hundreds of books together with their child, each year they participate in the program (HIPPY United States, [<reflink idref="bib49" id="ref64">49</reflink>]).</p> <p>HIPPY home visitors are typically recruited among current or former participating parents who are members of the communities they aim to serve. A HIPPY home-visit consists of a home visitor and a parent or caregiver spending at least 45 min together, reviewing the previous week's activity packet, and role-playing the five activities for the upcoming week. Additionally, parents will have developed a social network of support during group meetings, received information on positive child development features (e.g., on establishing a space and time for shared academic-oriented activities), and tips on how to communicate with teachers and navigate school institutions (HIPPY United States, [<reflink idref="bib49" id="ref65">49</reflink>]).</p> <p>There is some evidence that the HIPPY model helps parents build self-efficacy as their children's teachers (Nathans et al., [<reflink idref="bib67" id="ref66">67</reflink>]; Nievar et al., [<reflink idref="bib68" id="ref67">68</reflink>]). Earlier evaluations of the program reported mixed results regarding child outcomes (Baker et al., [<reflink idref="bib9" id="ref68">9</reflink>]). However, a recent larger-sample study found that the odds of passing a state kindergarten-readiness screener were 1.6 times greater and the odds of being promoted to first grade were five times greater for children who participated in the program compared to those who did not (Payne et al., [<reflink idref="bib71" id="ref69">71</reflink>]). Correlational studies also found associations between HIPPY participation and academic achievement in the early grades (Abdulaziz, [<reflink idref="bib2" id="ref70">2</reflink>]; Nievar et al., [<reflink idref="bib69" id="ref71">69</reflink>]).</p> <hd id="AN0183749986-5">The Present Study</hd> <p>The current investigation assesses the impact of HIPPY on the early developmental outcomes of children from predominately low-income families in Florida. By leveraging diverse administrative data sources, a quasi-experimental methodology was adopted, integrating both weighting and matching strategies to mitigate the influence of unobservable selection biases. The study concentrated on three key outcomes: performance on the Kindergarten Readiness Screener; the propensity to engage with services provided under the Individuals with Disabilities Education Act (IDEA) Part B plan; and the likelihood of documented instances of child maltreatment. For each outcome, we determined the average effects of HIPPY on the participating families (treatment effects on the treated) and then analyzed these effects in conjunction with those associated with preschool attendance. Our analysis not only delineated the principal effects of HIPPY on child development but also explored the interactive effects, assessing whether simultaneous participation in both HIPPY and preschool programs produced a synergistic impact greater than the aggregate effect of each program individually.</p> <hd id="AN0183749986-6">Preschool Environment</hd> <p>Launched in 2005, the Voluntary Prekindergarten (VPK) program in Florida is a statewide initiative that guarantees every child aged four access to at least 540 h of free-of-charge, structured education per academic year, equating to three hours per school day. This program is designed around a curriculum that emphasizes early literacy and math skills, aiming to adequately prepare children for kindergarten. Managed by the Division of Early Learning, part of the Florida Department of Education, the Voluntary Prekindergarten (VPK) program is offered in both public and private settings. This initiative aims for the enhancement of early childhood education and the promotion of equitable access to essential foundational learning experiences for all children across the state (Florida Department of Education, Division of Early Learning, [<reflink idref="bib39" id="ref72">39</reflink>]).</p> <hd id="AN0183749986-7">Method</hd> <p></p> <hd id="AN0183749986-8">Data and Sample</hd> <p>Our dataset integrates information from several Florida state agencies and departments by utilizing children's Social Security Numbers (SSN) for initial data linkage. When exact SSN matches were not possible or SSNs were unavailable, we employed alternative record linkage techniques based on a combination of children's first and last names, birth month, gender, and either seven or eight digits of their SSN or at least two of the following identifiers: birth day, birth year, and middle initial. This comprehensive dataset includes vital statistics from birth certificates, Medicaid eligibility records from both the Department of Health and the Agency for Health Care Administration (DOH/AHCA), and information on kindergarten test scores, participation in the Individuals with Disabilities Education Act (IDEA) Part B plan, and the Voluntary Prekindergarten (VPK) program from the Department of Education and the Division of Early Learning (DOE/DEL). Additionally, it encompasses records of child maltreatment, participation in the Supplementary Nutrition Assistance Program (SNAP), and Temporary Cash Assistance (TCA) from the Department of Children and Families (DCF), along with data on participation in the Home Instruction for Parents of Preschool Youngsters (HIPPY) program, provided by the University of South Florida.</p> <p>Our total sample size (<emph>N</emph> = 574,763) includes families participating in HIPPY and other families for whom data was linked. The birth cohorts of children in our sample range from 2011 to 2016. On average, children participating in HIPPY were about 4 years old and were typically enrolled in the program for at least one year. While we had complete data across all measured outcomes and covariates for HIPPY participants (<emph>n</emph> = 2,000), we derived a comparison group from the broader sample by focusing on those with complete data sets (<emph>n</emph> = 526,145).</p> <p>Table 1 Descriptive statistics for the overall sample, HIPPY and comparison groups</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>Overall</p><p>sample</p></th><th align="left"><p>HIPPY</p><p>group</p></th><th align="left"><p>Comparison</p><p>group</p></th><th align="left"><p>Wald test</p><p><italic>p</italic>-values</p></th></tr></thead><tbody><tr><td align="left"><p>Cognitive skills</p><p>(Kindergarten readiness screener scores)</p></td><td align="left"><p>520</p><p>[108]</p></td><td align="left"><p>513</p><p>[107]</p></td><td align="left"><p>520</p><p>[109]</p></td><td align="left"><p>0.0044</p></td></tr><tr><td align="left"><p>IDEA plan (part B) in Kindergarten</p></td><td align="left"><p>8.98</p></td><td align="left"><p>17.70</p></td><td align="left"><p>8.89</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p>Child maltreatment by Kindergarten</p></td><td align="left"><p>14.71</p></td><td align="left"><p>17.30</p></td><td align="left"><p>14.51</p></td><td align="left"><p>0.0004</p></td></tr><tr><td align="left"><p>Preschool participation (VPK)</p></td><td align="left"><p>57.18</p></td><td align="left"><p>57.90</p></td><td align="left"><p>57.01</p></td><td align="left"><p>0.4214</p></td></tr><tr><td align="left"><p><italic>Mother characteristics</italic></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>College graduate</p></td><td align="left"><p>22.99</p></td><td align="left"><p>17.25</p></td><td align="left"><p>22.97</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p>Did not graduate from high school</p></td><td align="left"><p>14.39</p></td><td align="left"><p>15.70</p></td><td align="left"><p>14.53</p></td><td align="left"><p>0.1399</p></td></tr><tr><td align="left"><p>Age at child's birth (in <italic>yrs.)</italic></p></td><td align="left"><p>28.06</p><p>[5.89]</p></td><td align="left"><p>27.40</p><p>[5.98]</p></td><td align="left"><p>28.10</p><p>[5.90]</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p>Race/ethnicity:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Black</p></td><td align="left"><p>21.70</p></td><td align="left"><p>35.31</p></td><td align="left"><p>22.71</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p>White</p></td><td align="left"><p>47.81</p></td><td align="left"><p>29.77</p></td><td align="left"><p>45.50</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p>Hispanic</p></td><td align="left"><p>25.67</p></td><td align="left"><p>31.71</p></td><td align="left"><p>26.94</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p>Other</p></td><td align="left"><p>4.83</p></td><td align="left"><p>3.25</p></td><td align="left"><p>4.88</p></td><td align="left"><p>0.0007</p></td></tr><tr><td align="left"><p>Born outside of U.S.</p></td><td align="left"><p>26.38</p></td><td align="left"><p>31.10</p></td><td align="left"><p>27.54</p></td><td align="left"><p>0.0004</p></td></tr><tr><td align="left"><p>Married</p></td><td align="left"><p>50.37</p></td><td align="left"><p>34.97</p></td><td align="left"><p>49.89</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p>Prenatal WIC</p></td><td align="left"><p>53.18</p></td><td align="left"><p>72.50</p></td><td align="left"><p>53.55</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p><italic>Child characteristics</italic></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Low birth weight (< 2,500 gr)</p></td><td align="left"><p>7.98</p></td><td align="left"><p>9.51</p></td><td align="left"><p>8.01</p></td><td align="left"><p>0.0182</p></td></tr><tr><td align="left"><p>Gender (female)</p></td><td align="left"><p>48.50</p></td><td align="left"><p>48.49</p></td><td align="left"><p>48.25</p></td><td align="left"><p>0.8285</p></td></tr><tr><td align="left"><p>First born</p></td><td align="left"><p>39.37</p></td><td align="left"><p>37.35</p></td><td align="left"><p>39.47</p></td><td align="left"><p>0.0531</p></td></tr><tr><td align="left"><p>IDEA plan (part B) in preschool</p></td><td align="left"><p>6.88</p></td><td align="left"><p>14.81</p></td><td align="left"><p>6.85</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p><italic>Family characteristics</italic></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Medicaid</p></td><td align="left"><p>64.88</p></td><td align="left"><p>83.81</p></td><td align="left"><p>65.08</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p>SNAP</p></td><td align="left"><p>58.86</p></td><td align="left"><p>79.60</p></td><td align="left"><p>59.20</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p>TCA</p></td><td align="left"><p>11.14</p></td><td align="left"><p>18.69</p></td><td align="left"><p>11.19</p></td><td align="left"><p>< 0.0001</p></td></tr><tr><td align="left"><p><italic>N</italic> children</p></td><td align="left"><p>574,763</p></td><td align="left"><p>2,000</p></td><td align="left"><p>526,145</p></td><td align="left" /></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph> HIPPY: Home Instruction for Parents of Preschool Youngsters. Wald test <emph>p</emph>-values refer to test of mean or proportion differences between the HIPPY group and the comparison group. Standard deviation for continuous variables are in brackets. IDEA: Individuals with Disabilities Education Act; WIC: Women, Infant, and Children program; SNAP: Supplemental Nutrition Assistance Program; TCA: Temporary Cash Assistance. All sampled children were born in the state of Florida</p> <p>Table 1 outlines the descriptive statistics regarding outcomes and background characteristics for the full sample, HIPPY participants, and the comparison group. Although the overall sample and comparison group showed nearly identical statistics, marked distinctions were evident between HIPPY participants and the comparison group. HIPPY mothers were more likely to not have a college degree or be unmarried at the time of their child's birth and were more often beneficiaries of means-tested programs such as Women, Infant, and Children (WIC), Medicaid, Supplemental Nutrition Assistance Program (SNAP), and Temporary Cash Assistance (TCA). A higher proportion of HIPPY families identified with historically marginalized minority groups (35% and 32% identified as Black or Hispanic, respectively, compared to 23% and 27% in the comparison group). About 15% of children in the HIPPY program utilized special education services in preschool (IDEA), as opposed to around 7% in the comparison group. We also noted that the rate of preschool participation (VPK) was virtually the same between the HIPPY group and the comparison group, at about 57–58%.</p> <hd id="AN0183749986-9">Outcomes Considered</hd> <p>As previously indicated, our investigation centered on three primary outcomes, detailed in the initial rows of Table 1.</p> <hd id="AN0183749986-10">Cognitive Skills</hd> <p>This outcome is based on Florida's kindergarten readiness screener, the Renaissance STAR early literacy and numeracy assessment, administered within the first 30 days of kindergarten entry. Ranging from 300 to 900, scores of 500 or above are indicative of "kindergarten ready" (Florida Department of Education, [<reflink idref="bib40" id="ref73">40</reflink>]). This computer-adaptive assessment evaluates a variety of skills and knowledge across domains including the alphabetic principle, concept of word, visual discrimination, phonemic awareness, phonics, vocabulary, and early numeracy. There is evidence that kindergarten STAR assessment scores are associated with early developmental and behavioral screenings (Schlichting et al., [<reflink idref="bib76" id="ref74">76</reflink>]). The assessment demonstrates adequate reliability, strong internal consistency, along with moderate concurrent and predictive validity (Clemens et al., [<reflink idref="bib19" id="ref75">19</reflink>]; Hadley et al., [<reflink idref="bib47" id="ref76">47</reflink>]; McBride et al., [<reflink idref="bib61" id="ref77">61</reflink>]). In our sample, descriptive analysis revealed a statistically significant but relatively small mean difference between the groups, with the HIPPY group scoring an average of 7 raw points lower than the comparison group (Cohen's <emph>d</emph> = 0.07; <emph>p</emph> =.004).</p> <hd id="AN0183749986-11">IDEA Services</hd> <p>Defined as a binary indicator for participation in kindergarten services such as special education, physical, occupational, and speech therapy, as well as supplementary aids or services, under the Individuals with Disabilities Education Act (IDEA) Part B (Centers for Disease Control & Prevention, 2018). Approximately 18% of children in the HIPPY group utilized IDEA services, compared to about 9% in the comparison group (mean group difference: 9%; <emph>p</emph> <.0001).</p> <hd id="AN0183749986-12">Child Maltreatment</hd> <p>Defined as a binary indicator for the occurrence of one or more reported instances of child maltreatment during the HIPPY participation period, substantiated by credible evidence upon investigation (Florida Department of Children & Families, [<reflink idref="bib38" id="ref78">38</reflink>]). Reports of child maltreatment were observed in approximately 17% of HIPPY families compared to about 15% in the comparison group (mean group difference: 2%; <emph>p</emph> =.0004).</p> <p>In summary, families participating in the HIPPY program were observed to be more disadvantaged across both covariates and the outcomes considered. Given these findings, it is crucial to employ a quasi-experimental design, which will be detailed in the following section, aiming to achieve balance between the participants in the HIPPY program (the treatment group) and the pool of individuals in the comparison group. This approach is necessary to account for key baseline characteristics that may influence selection into the program or affect outcomes.</p> <hd id="AN0183749986-13">Empirical Strategy</hd> <p>In evaluating the impact of HIPPY, the potential outcomes framework, also known as the Rubin causal model, anchors our empirical strategy (Angrist & Pischke, [<reflink idref="bib5" id="ref79">5</reflink>]). This approach posits two potential states for each individual: one if the individual participates in HIPPY, and one if they do not. Yet, only one of these outcomes is observable for any individual, leaving the counterfactual outcome hypothetical. Central to our analysis is the Average Treatment Effect on the Treated (ATET), which provides an estimation of the program's impact specifically on its recipients. It is formally represented as</p> <p>Graph</p> <p>where is the outcome if the individual participates in HIPPY, is the outcome if they do not participate, and identifies individuals who participate in the program.</p> <p>To compute ATET, we utilized both an Inverse Probability Weighting Regression Adjustment (IPWRA) and a nearest-neighbor matching technique. IPWRA mitigates potential selection biases by applying weights inversely proportional to the likelihood of receiving the treatment. The estimator is "doubly robust" as it remains consistent if either the model for the treatment assignment (propensity score model) or the model for the outcome (regression model) is correctly specified, but not necessarily both, making it a reliable tool for our analysis (Wooldridge, [<reflink idref="bib88" id="ref80">88</reflink>]). Nearest-neighbor matching complements the previous technique by pairing each treated individual with one or more untreated individuals who are similar in observed characteristics (Abadie et al., [<reflink idref="bib1" id="ref81">1</reflink>]), effectively reducing the analytic subsample size but enhancing the comparability between treated and untreated groups, making it a valuable part of our empirical strategy. By integrating IPWRA and nearest-neighbor matching, we leverage both a model-based and a direct comparison methodology.</p> <p>We employed the <emph>teffects</emph> routines in Stata 17 to conduct the Inverse Probability Weighting Regression Adjustment (IPWRA) and nearest-neighbor matching analyses. To explore the interactions between HIPPY and preschool attendance, we applied regression models utilizing the inverse probability weights derived from the IPWRA for further regression adjustments. In addition to balancing our models on covariates, we included fixed-effects for birth cohort, school district, and year of kindergarten-readiness assessment specifically for the cognitive skills outcome model.</p> <p>We investigated the following research questions:</p> <p></p> <ulist> <item> What is the impact of HIPPY on kindergarten readiness, IDEA service uptake, and incidence of child maltreatment?</item> <p></p> <item> How does preschool attendance affect the impact of HIPPY on kindergarten readiness, IDEA service uptake, and incidence of child maltreatment?</item> <p></p> <item> What are the direction, magnitude, and significance of the interactions between HIPPY and preschool attendance?</item> </ulist> <hd id="AN0183749986-14">Results</hd> <p>Table 2 Covariate balance summary between the HIPPY group and the comparison group (<emph>N</emph> = 510,670)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>Standardized differences</p></th><th align="left" colspan="2"><p>Variance ratio</p></th></tr></thead><tbody><tr><td align="left" /><td align="left"><p>Raw</p></td><td align="left"><p>Weighted</p></td><td align="left"><p>Raw</p></td><td align="left"><p>Weighted</p></td></tr><tr><td align="left"><p>SNAP</p></td><td align="left"><p>0.44</p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.67</p></td><td align="left"><p>0.97</p></td></tr><tr><td align="left"><p>Medicaid</p></td><td align="left"><p>0.43</p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.59</p></td><td align="left"><p>0.97</p></td></tr><tr><td align="left"><p>TCA</p></td><td align="left"><p>0.20</p></td><td align="left"><p>0.00</p></td><td align="left"><p>1.49</p></td><td align="left"><p>1.02</p></td></tr><tr><td align="left"><p><italic>Mother characteristics</italic>:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Age</p></td><td align="left"><p>-0.11</p></td><td align="left"><p>-0.01</p></td><td align="left"><p>1.92</p></td><td align="left"><p>1.01</p></td></tr><tr><td align="left"><p>Prenatal WIC</p></td><td align="left"><p>0.38</p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.80</p></td><td align="left"><p>0.99</p></td></tr><tr><td align="left"><p>College graduate</p></td><td align="left"><p>-0.15</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.80</p></td><td align="left"><p>1.00</p></td></tr><tr><td align="left"><p>Not high school graduate</p></td><td align="left"><p>0.02</p></td><td align="left"><p>-0.01</p></td><td align="left"><p>1.05</p></td><td align="left"><p>0.97</p></td></tr><tr><td align="left"><p>Married</p></td><td align="left"><p>-0.30</p></td><td align="left"><p>-0.02</p></td><td align="left"><p>0.90</p></td><td align="left"><p>0.99</p></td></tr><tr><td align="left"><p>Born outside of U.S.</p></td><td align="left"><p>0.07</p></td><td align="left"><p>-0.01</p></td><td align="left"><p>1.06</p></td><td align="left"><p>0.99</p></td></tr><tr><td align="left"><p>Black</p></td><td align="left"><p>0.27</p></td><td align="left"><p>0.01</p></td><td align="left"><p>1.28</p></td><td align="left"><p>1.01</p></td></tr><tr><td align="left"><p>Hispanic</p></td><td align="left"><p>0.08</p></td><td align="left"><p>-0.01</p></td><td align="left"><p>1.08</p></td><td align="left"><p>0.99</p></td></tr><tr><td align="left"><p><italic>Child characteristics</italic>:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Low birth weight</p></td><td align="left"><p>0.05</p></td><td align="left"><p>0.00</p></td><td align="left"><p>1.15</p></td><td align="left"><p>1.01</p></td></tr><tr><td align="left"><p>Gender (female)</p></td><td align="left"><p>-0.01</p></td><td align="left"><p>0.00</p></td><td align="left"><p>1.00</p></td><td align="left"><p>1.00</p></td></tr><tr><td align="left"><p>First born</p></td><td align="left"><p>-0.04</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.98</p></td><td align="left"><p>1.00</p></td></tr><tr><td align="left"><p>IDEA in preschool</p></td><td align="left"><p>0.25</p></td><td align="left"><p>0.00</p></td><td align="left"><p>1.94</p></td><td align="left"><p>1.01</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph> HIPPY: Home Instruction for Parents of Preschool Youngsters. SNAP: Supplemental Nutrition Assistance Program; TCA: Temporary Cash Assistance; WIC: Women, Infant, and Children program; IDEA: Individuals with Disabilities Education Act</p> <p>Table 2 presents the covariate balance estimates from the IPWRA model analysis, involving a sample of 510,670 children. The weighted standardized mean differences between the HIPPY participants and the comparison group approached zero, and the variance ratios were close to 1, indicating excellent balance on key characteristics between groups. Nearest-neighbor matching models, utilizing either 1 or 4 matched neighbors (as recommended in Abadie et al., [<reflink idref="bib1" id="ref82">1</reflink>]), yielded sample sizes of <emph>n</emph> = 4,000 (<reflink idref="bib2" id="ref83">2</reflink>,000 in the treatment group and 2,000 in the control group) and <emph>n</emph> = 10,000 (<reflink idref="bib2" id="ref84">2</reflink>,000 treated and 8,000 control), respectively. Balance estimates for these models were nearly identical to those from the IPWRA model, underscoring the robustness of our covariate balancing approach across different methodologies (see the Online Appendix, Table A.1 & A.2).</p> <p>Table 3 HIPPY average treatment effect on the treated (ATET) and HIPPY x Preschool Interaction on cognitive skills</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>(1)</p></th><th align="left"><p>(2)</p></th><th align="left"><p>(3)</p></th><th align="left"><p>(4)</p></th><th align="left"><p>(5)</p></th></tr></thead><tbody><tr><td align="left"><p>HIPPY</p></td><td align="left"><p>0.07<bold>***</bold></p><p>[0.03; 0.11]</p></td><td align="left"><p>0.09<bold>***</bold></p><p>[0.04; 0.14]</p></td><td align="left"><p>0.09<bold>***</bold></p><p>[0.05; 0.14]</p></td><td align="left"><p>0.06<bold>***</bold></p><p>[0.02; 0.10]</p></td><td align="left"><p>0.08<bold>***</bold></p><p>[0.02; 0.14]</p></td></tr><tr><td align="left"><p>Preschool</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.22<bold>***</bold></p><p>[0.12; 0.32]</p></td><td align="left"><p>0.27<bold>***</bold></p><p>[0.24; 0.31]</p></td></tr><tr><td align="left"><p>HIPPY x Preschool</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>− 0.04 (<italic>p</italic> =.39)</p></td></tr><tr><td align="left"><p><italic>N</italic> children</p></td><td align="left"><p>510,670</p></td><td align="left"><p>4,000</p></td><td align="left"><p>10,000</p></td><td align="left"><p>510,670</p></td><td align="left"><p>510,670</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph> HIPPY: Home Instruction for Parents of Preschool Youngsters. Measures for cognitive skills were obtained from the kindergarten readiness screener scores, normalized to have a mean of zero and standard deviation of one. Models (<reflink idref="bib1" id="ref85">1</reflink>) and (<reflink idref="bib2" id="ref86">2</reflink>) implement an inverse probability weighting regression-adjustment (IPWRA). Models (<reflink idref="bib2" id="ref87">2</reflink>) and (<reflink idref="bib3" id="ref88">3</reflink>) implements the Nearest Neighbor matching, with 1 and 4 neighbor(s), respectively. In the IPWRA model (<reflink idref="bib4" id="ref89">4</reflink>), the Preschool estimate refers to preschool effect for the HIPPY group. Model (<reflink idref="bib5" id="ref90">5</reflink>) implements an inverse probability weighted OLS regression with HIPPY x Preschool interaction. Covariates and fixed effects for school district, birth cohort, and kindergarten readiness screener year of administration were implemented throughout. 95% confidence intervals are in brackets. <bold>***</bold>significant at the 1% level</p> <p>The first four columns of Table 3 outline the average treatment effect on the treated (ATET) of the HIPPY program on cognitive skills at the entry to kindergarten. Column (<reflink idref="bib1" id="ref91">1</reflink>) presents the IPWRA model's findings, indicating a statistically significant boost of approximately 7% of a standard deviation in cognitive skills due to program participation (95% CI = [0.03; 0.11]). The Nearest Neighbor Matching models, depicted in columns (<reflink idref="bib2" id="ref92">2</reflink>) and (<reflink idref="bib3" id="ref93">3</reflink>), show a somewhat higher effect size, at 9% of a standard deviation, albeit with slightly broader confidence intervals. These estimates suggest that HIPPY's impact on cognitive skills is robust across different methodological approaches. Column (<reflink idref="bib4" id="ref94">4</reflink>) reveals that including preschool participation marginally adjusts the estimate from model (<reflink idref="bib1" id="ref95">1</reflink>) downward, implying that HIPPY's influence operates independently of preschool effects, which themselves contributed a significant increase of about 22% of a standard deviation in cognitive skills among HIPPY participants. The interaction between HIPPY and preschool, presented in column (<reflink idref="bib5" id="ref96">5</reflink>), was minor and negative, suggesting a potential compensatory effect, but it was not statistically significant. Consequently, the notion that preschool could serve as a substitute for HIPPY's influence is not strongly supported. Instead, the data favor an additive effect model.</p> <p>Table 4 HIPPY average treatment effect on the treated (ATET) and HIPPY x Preschool Interaction on IDEA Uptake</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>(1)</p></th><th align="left"><p>(2)</p></th><th align="left"><p>(3)</p></th><th align="left"><p>(4)</p></th><th align="left"><p>(5)</p></th></tr></thead><tbody><tr><td align="left"><p>HIPPY</p></td><td align="left"><p>0.02<bold>***</bold></p><p>[0.01; 0.03]</p></td><td align="left"><p>0.02<bold>**</bold></p><p>[0.004; 0.03]</p></td><td align="left"><p>0.02<bold>***</bold></p><p>[0.01; 0.03]</p></td><td align="left"><p>0.02<bold>***</bold></p><p>[0.01; 0.03]</p></td><td align="left"><p>0.01 (<italic>p</italic> =.28)</p></td></tr><tr><td align="left"><p>Preschool</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.01 (<italic>p</italic> =.61)</p></td><td align="left"><p>− 0.004 (<italic>p</italic> =.28)</p></td></tr><tr><td align="left"><p>HIPPY x Preschool</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.01 (<italic>p</italic> =.33)</p></td></tr><tr><td align="left"><p><italic>N</italic> children</p></td><td align="left"><p>510,670</p></td><td align="left"><p>4,000</p></td><td align="left"><p>10,000</p></td><td align="left"><p>510,670</p></td><td align="left"><p>510,670</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph> HIPPY: Home Instruction for Parents of Preschool Youngsters. IDEA: Individuals with Disabilities Education Act. Models (<reflink idref="bib1" id="ref97">1</reflink>) and (<reflink idref="bib2" id="ref98">2</reflink>) implement an inverse probability weighting regression-adjustment (IPWRA). Models (<reflink idref="bib2" id="ref99">2</reflink>) and (<reflink idref="bib3" id="ref100">3</reflink>) implements the Nearest Neighbor matching, with 1 and 4 neighbor(s), respectively. In the IPWRA model (<reflink idref="bib4" id="ref101">4</reflink>), the Preschool estimate refers to preschool effect for the HIPPY group. Model (<reflink idref="bib5" id="ref102">5</reflink>) implements an inverse probability weighted OLS regression with HIPPY x Preschool interaction. Covariates and fixed effects for school district and birth cohort were implemented throughout. 95% confidence intervals are in brackets. <bold>***</bold>significant at the 1% level</p> <p>In Table 4, both types of estimators—Inverse Probability Weighting Regression Adjustment and Nearest Neighbor Matching—demonstrated in columns (<reflink idref="bib1" id="ref103">1</reflink>) through (<reflink idref="bib3" id="ref104">3</reflink>), consistently reveal a significant 2% point increase in IDEA service uptake at kindergarten among HIPPY participants. This increase translates to an effect size of 6% of a standard deviation. The OLS weighted regression model, presented in column (<reflink idref="bib4" id="ref105">4</reflink>), confirms HIPPY's sustained impact, with maintained effect size and significance. Preschool attendance appeared not to influence this outcome, showing a negligible change (0.006% points; <emph>p</emph> =.61) and thus, making the interaction estimates in model (<reflink idref="bib5" id="ref106">5</reflink>) appear noisy and less informative. The core finding is that participation in the HIPPY program appears to significantly boost the likelihood of IDEA service enrollment for children who had not received such services before kindergarten entry.</p> <p>Table 5 HIPPY average treatment effect on the treated (ATET) and HIPPY x Preschool Interaction on Maltreatment</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>(1)</p></th><th align="left"><p>(2)</p></th><th align="left"><p>(3)</p></th><th align="left"><p>(4)</p></th><th align="left"><p>(5)</p></th></tr></thead><tbody><tr><td align="left"><p>HIPPY</p></td><td align="left"><p>− 0.02<bold>**</bold></p><p>[-0.03; − 0.001]</p></td><td align="left"><p>− 0.03<bold>***</bold></p><p>[-0.04; − 0.01]</p></td><td align="left"><p>− 0.02<bold>**</bold></p><p>[-0.04; − 0.004]</p></td><td align="left"><p>− 0.02<bold>**</bold></p><p>[-0.03; − 0.001]</p></td><td align="left"><p>− 0.02<bold>*</bold></p><p>[-0.05; 0.001]</p></td></tr><tr><td align="left"><p>Preschool</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>− 0.01 (<italic>p</italic> =.56)</p></td><td align="left"><p>− 0.03<bold>***</bold></p><p>[-0.04; − 0.01]</p></td></tr><tr><td align="left"><p>HIPPY x Preschool</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.02 (<italic>p</italic> =.33)</p></td></tr><tr><td align="left"><p><italic>N</italic> children</p></td><td align="left"><p>510,670</p></td><td align="left"><p>4,000</p></td><td align="left"><p>10,000</p></td><td align="left"><p>510,670</p></td><td align="left"><p>510,670</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph> HIPPY: Home Instruction for Parents of Preschool Youngsters. Models (<reflink idref="bib1" id="ref107">1</reflink>) and (<reflink idref="bib2" id="ref108">2</reflink>) implement an inverse probability weighting regression-adjustment (IPWRA). Models (<reflink idref="bib2" id="ref109">2</reflink>) and (<reflink idref="bib3" id="ref110">3</reflink>) implements the Nearest Neighbor matching, with 1 and 4 neighbor(s), respectively. In the IPWRA model (<reflink idref="bib4" id="ref111">4</reflink>), the Preschool estimate refers to preschool effect for the HIPPY group. Model (<reflink idref="bib5" id="ref112">5</reflink>) implements an inverse probability weighted OLS regression with HIPPY x Preschool interaction. Covariates and fixed effects for school district and birth cohort were implemented throughout. 95% confidence intervals are in brackets. <bold>***</bold>significant at the 1% level; <bold>**</bold> significant at the 5% level; <bold>*</bold> at the 10% level</p> <p>Table 5 offers consistent evidence of HIPPY's beneficial impact, as shown across all models (columns 1 to 4). It reveals that, by kindergarten entry, families and children participating in the HIPPY program were about 2% points less likely to be reported for child maltreatment compared to their counterparts in the comparison group. This statistically significant reduction translates into an effect size of approximately 5% of a standard deviation, underscoring HIPPY's role in mitigating risk factors linked to maltreatment or neglect. Model (<reflink idref="bib4" id="ref113">4</reflink>)'s analysis on the effect of preschool attendance within HIPPY families indicates a 1% point reduction in maltreatment reports, which, however, did not achieve statistical significance (<emph>p</emph> =.50). This outcome suggests that preschool attendance, in isolation, does not markedly alter the likelihood of maltreatment reports among HIPPY participants. Moreover, the small and positive but non-significant (<emph>p</emph> =.39) interaction effect estimated in model (<reflink idref="bib5" id="ref114">5</reflink>) suggests that preschool attendance does not robustly substitute or enhance HIPPY's protective impact against maltreatment.</p> <hd id="AN0183749986-15">Discussion</hd> <p>In this study, we explored the impacts of the Home Instruction for Parents of Preschool Youngsters (HIPPY) program on cognitive skills, disability-related service uptake, and the occurrence of child maltreatment among families with preschoolers, particularly those of color and those facing resource challenges. We further examined the synergy between HIPPY and preschool attendance by testing three hypotheses: preschool serves as a substitute for HIPPY's impacts; HIPPY's impacts are amplified by preschool participation; and HIPPY's impacts are additive.</p> <p>Our findings indicate modest yet significant benefits of HIPPY across all examined outcomes. Specifically, HIPPY participation led to a 7% of a standard deviation gain in literacy and numeracy skills at kindergarten entry, corresponding to a 3%-point increase in meeting Florida's kindergarten readiness threshold. Additionally, children in the HIPPY program were more likely to engage in special education services (+ 2% points) and less likely to be reported for child maltreatment (-2% points) by kindergarten.</p> <p>The lack of meaningful interaction effects suggests that the impacts of HIPPY and preschool attendance are additive, aligning with existing literature on the benefits derived from state-wide preschool, parenting programs, and subsequent investments (e.g., Carr et al., [<reflink idref="bib17" id="ref115">17</reflink>]; Duncan et al., [<reflink idref="bib31" id="ref116">31</reflink>]; Watts et al., [<reflink idref="bib87" id="ref117">87</reflink>]). There are a few reasons why the impacts of these two types of early interventions may follow different mechanisms. Firstly, HIPPY operates as a home-visiting program that primarily targets parents, thereby indirectly benefiting children. In contrast, Florida's Voluntary Prekindergarten Program directly engages children within child-care centers or elementary schools. Secondly, while HIPPY includes academic-related activities that may mirror preschool curricula, home visitors place a strong emphasis on fostering parent-child relations, such as contingent reciprocity, the establishment of routines, and cultivating habits of mind. Consequently, although preschool environments provide foundational academic and social skills, HIPPY supplement these effects by enhancing nurturing care practices within the home, which in turn contributes to kindergarten readiness.</p> <p>HIPPY's positive impact on cognitive skills aligns with findings from other home-visiting parenting programs (e.g., Doyle, [<reflink idref="bib27" id="ref118">27</reflink>]; Filene et al., [<reflink idref="bib36" id="ref119">36</reflink>]; McCormick et al., [<reflink idref="bib62" id="ref120">62</reflink>]; Nix et al., [<reflink idref="bib70" id="ref121">70</reflink>]). Its relatively modest effect size, when compared to other parenting interventions, could be attributed to the large size of our sample and the program's broad geographical reach. These smaller estimates likely represent a scaling effect, providing a realistic expectation of the effects HIPPY might achieve at an even larger scale.</p> <p>The observed increase in special education services uptake during kindergarten following HIPPY participation may be interpreted through two lenses. Firstly, a key component of HIPPY focuses on educating parents about child development milestones and available institutional resources for children with specific needs. This could lead to parents being more aware of their child's developmental path and more effective in navigating administrative and institutional processes. Indeed, a significant portion of children in the HIPPY program who were enrolled in an IDEA plan during kindergarten required speech or language services, needs that were previously unidentified. Although we controlled for preschool-years IDEA uptake, the increased special education uptake in kindergarten could indicate a selection bias for which our analysis did not account (Steiner et al., [<reflink idref="bib80" id="ref122">80</reflink>]). In such scenario, HIPPY's impact on cognitive skills might have potentially been underestimated, as children requiring special education often have lower scores on school readiness tests.</p> <p>The observed decrease in the likelihood of child maltreatment associated with HIPPY participation underscores the program's potential to strengthen affective and emotional bonds, both between parents and their children and between parents and providers. The former observation is supported by a meta-analysis on the effectiveness of home-visiting programs (Filene et al., [<reflink idref="bib36" id="ref123">36</reflink>]; see also, Koop et al., [<reflink idref="bib56" id="ref124">56</reflink>]), which identified sensitive and responsive parenting as crucial for positive outcomes across various domains, particularly in maltreatment prevention and cognitive development. This effect is likely more pronounced in contexts of lower socioeconomic status or poverty, where families may encounter a higher frequency of chaotic life events and have limited access to beneficial social capital and support networks (Morris et al., [<reflink idref="bib66" id="ref125">66</reflink>]). Additionally, the bonding between parents and providers, is recognized as a critical factor for the successful implementation of any home visiting model (e.g., Riley et al., [<reflink idref="bib73" id="ref126">73</reflink>]). Thus, theoretically, HIPPY's intensive visiting schedule and the practice of recruiting former parent participants as home visitors to serve within their communities facilitate the development of an effective working alliance.</p> <hd id="AN0183749986-16">Limitations and Future Directions</hd> <p>Two important caveats warrant consideration: firstly, the statistical significance of HIPPY's impact on maltreatment contrasts with its relatively imprecise estimation (confidence interval upper-bound close to zero), necessitating cautious interpretation of this result. Secondly, HIPPY's influence on maltreatment presents a divergence from other studies investigating home-visiting effects on maltreatment, early injuries, and neglect (Matone et al., [<reflink idref="bib59" id="ref127">59</reflink>], [<reflink idref="bib60" id="ref128">60</reflink>]), suggesting HIPPY's unique approach may lead to different outcomes compared to other programs. This distinction reinforces the importance of context and program specifics in assessing the effectiveness of home-visiting interventions on child welfare. Additionally, while Florida HIPPY shows promise in enhancing parental self-efficacy and improving child learning outcomes, caution must be exercised in generalizing these finding without careful examination of the specific contexts and populations involved.</p> <p>In our study, we applied a quasi-experimental methodology to investigate HIPPY, enhancing our confidence that the observed impacts were unbiased. Nevertheless, a second (quasi-)experimental design would have been ideal to more accurately estimate preschool attendance's causal effects and further minimize confounding variables affecting our interaction effects. Additionally, our analysis lacked information on alternative preschool arrangements for families not participating in Florida's Voluntary Prekindergarten Program. It's also conceivable that the true estimates for the interaction terms might have been too minimal to identify due to insufficient statistical power. Nonetheless, interactions of such slight magnitudes are likely to have minimal practical significance (Sherman & Pashler, [<reflink idref="bib77" id="ref129">77</reflink>]).</p> <p>Given the potential of HIPPY to significantly improve early caregiving and parent-child relationships, its impacts for the participating children are anticipated to have enduring effects (Roisman & Fraley, [<reflink idref="bib74" id="ref130">74</reflink>]). A sustained enhancement of the home environment may trigger a developmental cascade, offering protection against risks (e.g., Hentges et al., [<reflink idref="bib48" id="ref131">48</reflink>]) and promoting intellectual growth (e.g., Ahmed et al., [<reflink idref="bib3" id="ref132">3</reflink>]; Borairi et al., [<reflink idref="bib12" id="ref133">12</reflink>]). Unfortunately, our data limitations precluded exploring these compelling hypotheses, underscoring the need for comprehensive longitudinal studies, especially in the realm of early childhood policy, cost considerations, and scalability.</p> <p>While an economic analysis of HIPPY falls outside this study's scope, we propose that targeted parenting programs like HIPPY are promising avenues for social investment. If HIPPY effectively bolsters parent-child interactions, it may also mitigate future educational challenges, such as chronic absenteeism or grade retention. Further investigation into long-term school outcomes is recommended. Considering the study's findings on maltreatment prevention and the substantial lifetime costs associated with non-fatal child maltreatment (Peterson et al., [<reflink idref="bib72" id="ref134">72</reflink>]), HIPPY could be cost-effective for the families under consideration, based solely on its maltreatment impact.</p> <hd id="AN0183749986-17">Conclusion</hd> <p>The impact of HIPPY on cognitive skills was substantial and remained significant beyond effects from preschool attendance. Additionally, the program's modest effect in reducing the likelihood of child maltreatment suggests enhanced family dynamics. Furthermore, the increased engagement of HIPPY families with special education and related services in kindergarten indicates that the program empowers parents to navigate and advocate within educational settings for their children. These findings collectively affirm the pivotal role of HIPPY in supplementing traditional educational pathways and fostering foundational elements of early childhood development.</p> <hd id="AN0183749986-18">Electronic Supplementary Material</hd> <p>Below is the link to the electronic supplementary material.</p> <p>Graph: Supplementary Material 1</p> <hd id="AN0183749986-19">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0183749986-20"> <title> References </title> <blist> <bibl id="bib1" idref="ref81" type="bt">1</bibl> <bibtext> Abadie A, Drukker D, Herr JL, Imbens GW. Implementing matching estimators for average treatment effects in Stata. The Stata Journal. 2004; 4; 3: 290-311. 10.1177/1536867X0400400307</bibtext> </blist> <blist> <bibl id="bib2" idref="ref70" type="bt">2</bibl> <bibtext> Abdulaziz NA. 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  Label: Title
  Group: Ti
  Data: Is the Whole Greater than the Sum of Its Parts? Impacts on Child Outcomes from a Home-Visiting Parenting Program and Its Interaction with Preschool
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Remy+Pages%22">Remy Pages</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-0396-6498">0000-0002-0396-6498</externalLink>)<br /><searchLink fieldCode="AR" term="%22Tracy+Payne%22">Tracy Payne</searchLink><br /><searchLink fieldCode="AR" term="%22Herman+T%2E+Knopf%22">Herman T. Knopf</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Early+Childhood+Education+Journal%22"><i>Early Childhood Education Journal</i></searchLink>. 2025 53(4):1313-1324.
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Preschool+Education%22">Preschool Education</searchLink><br /><searchLink fieldCode="EL" term="%22Adult+Education%22">Adult Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Education%22">Preschool Education</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Education%22">Parent Education</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Participation%22">Parent Participation</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+School+Relationship%22">Parent School Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Home+Visits%22">Home Visits</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Teacher+Cooperation%22">Parent Teacher Cooperation</searchLink><br /><searchLink fieldCode="DE" term="%22School+Readiness%22">School Readiness</searchLink><br /><searchLink fieldCode="DE" term="%22Thinking+Skills%22">Thinking Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Environment%22">Family Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Problems%22">Family Problems</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10643-024-01720-x
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1082-3301<br />1573-1707
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study evaluates the effects of a weekly home-visiting parenting program designed to enhance parent-child engagement with educationally-enriching activities and its potential interaction with children's participation in state-funded preschool. Utilizing a comprehensive dataset linked across various administrative sources, we employed a quasi-experimental approach featuring inverse probability weighting regression adjustment and nearest neighbor matching to assess outcomes as measured at or leading up to kindergarten entry. We focused on a cohort of 2,000 diverse children born between 2012 and 2016, aged three and four at the intervention's onset. Participation in the home-visiting program was associated with significant positive effects on children's cognitive skills, IDEA Part B service uptake, and the likelihood of reported child maltreatment, which persisted after adjusting for state-funded preschool participation. We found no statistical evidence of interactions between the program and preschool, underscoring the program's additive contributions to early childhood development and family well-being.
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  Data: 2025
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  Label: Accession Number
  Group: ID
  Data: EJ1462385
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1462385
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  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1007/s10643-024-01720-x
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 1313
    Subjects:
      – SubjectFull: Preschool Children
        Type: general
      – SubjectFull: Preschool Education
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Parent Education
        Type: general
      – SubjectFull: Parent Participation
        Type: general
      – SubjectFull: Parent School Relationship
        Type: general
      – SubjectFull: Parents
        Type: general
      – SubjectFull: Home Visits
        Type: general
      – SubjectFull: Parent Teacher Cooperation
        Type: general
      – SubjectFull: School Readiness
        Type: general
      – SubjectFull: Thinking Skills
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Family Environment
        Type: general
      – SubjectFull: Family Problems
        Type: general
    Titles:
      – TitleFull: Is the Whole Greater than the Sum of Its Parts? Impacts on Child Outcomes from a Home-Visiting Parenting Program and Its Interaction with Preschool
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            NameFull: Tracy Payne
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              Type: published
              Y: 2025
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