Best Practices

Opportunities for Early Head Start to buffer infants and toddlers from toxic stress

Early Head Start may afford children the opportunity to experience the “buffering protection of a supportive adult relationship” in the face of toxic stress.

By Katherine W. Paschall, PhD, and Ann M. Mastergeorge, PhD

Infants and toddlers in low-income families face among the highest risks of experiencing maltreatment, and are at heightened risk for experiencing a wide array of risk factors that in combination represent toxic stress (U.S. Department of Health and Human Services [DHHS], 2013; Wilkins et al., 2014). Specifically, toxic stress “results from strong, frequent, or prolonged activation of the body's stress response systems in the absence of the buffering protection of a supportive adult relationship” (Shonkoff et al., 2012). Many low-income families interact with federal programs that aim to reduce the sources of toxic stress and maltreatment risk, including Early Head Start (EHS), which enrolled approximately 4.1 percent of low-income families with infants and toddlers in the U.S. in 2013. EHS is a two-generation early education program for families with children ages birth to 3 that aims to promote child development as well as parent and family well-being through home visitation, consultation and either direct or referred assistance for economic security and health needs. The EHS home visitation model is designated as an evidenced-based program under the federally funded Maternal Infant Early Childhood Home Visitation Program. Additionally, the federal government ecently expanded access to EHS through the new Early Head Start - Child Care Partnership grants in 2015 (Office of Early Childhood Development, Administration for Children and Families [ACF], 2016). EHS has demonstrated positive impacts on child development, parenting and family well-being (Love, Chazan-Cohen, Raikes, & Brooks-Gunn, 2013). However, most research has focused on broad dimensions of well-being and academic preparedness; only recently have researchers, program officers and policy makers turned their eyes toward EHS as a prevention and intervention strategy for maltreatment and toxic stress.

Recent evidence suggests that children enrolled in EHS in the mid-late 1990s had significantly fewer reports of child maltreatment or out-of-home placements due to maltreatment, were less likely to have multiple encounters with the child welfare system, and had a longer lag time between subsequent encounters (Green et al., 2014). Given that EHS did not set out to be a maltreatment prevention program, the findings were particularly surprising.

Why would EHS lead to fewer encounters with the child welfare system? Theoretical and empirical reviews suggest several reasons:

  • EHS participation is associated with reduced maternal harshness (U.S. DHHS, 2002).
  • Children enrolled in EHS display fewer aggressive behaviors during preschool, which leads to later reductions in maternal depressive symptoms (Chazan-Cohen et al., 2007).
  • Early childhood education programs provide additional “eye and ears” on children, increasing their safety (Dinehart, Katz, Manfra, & Ullery, 2013).
  • Child care and social support provided by EHS reduced parental stress and child-rearing related distress (Waldfogel, 2009; Zhai, Waldfogel, & Brooks-Gunn, 2013).

Taken together, these positive impacts indicate that in some ways, EHS may reduce the stressors, but it is more likely that EHS affords children the opportunity to experience the “buffering protection of a supportive adult relationship” in the face of toxic stress.

Recent research and programmatic efforts have focused on enhancing EHS programming to specifically target the sources and consequences of maltreatment and toxic stress. In 2011, the Administration for Children and Families funded six University-EHS partnership grantees to comprise the Buffering Toxic Stress Consortium. These partnerships have two purposes: 1) to identify common measures of risk and protective factors, and 2) test the impact of enhancing EHS services with evidenced-based programs specifically designed to target and treat sources of toxic stress and predictors of maltreatment. The evidenced-based enhancements include the Attachment and Biobehavioral Catch-up (ABC), the Playing and Learning Strategies (PALS) intervention, Parent-Child Interaction Therapy (PCIT), video coaching, and intensive group-based parent training. The consortium studies are still ongoing, but previous pilot research indicates that the ABC, PALS and PCIT effectively reduce children's physiological and behavioral stress responses, even among children who have been exposed to trauma and maltreatment (Harden, 2015).

Other steps are important for ensuring that EHS most appropriately addresses maltreatment and toxic stress. First, service coordination can be strengthened in order to fully realize the “it takes a village” approach to serving children who have experienced maltreatment. Currently, all EHS and Head Start programs prioritize enrollment for child welfare-involved children, although there is inconsistent use of memoranda of understanding and co-located staff (McCrae, Brown, Yang, & Groneman, 2015). Second, EHS teachers and home visitors need trauma-informed training, so they are better equipped to recognize traumatic stress in children and families. Infusing this knowledge into EHS services will ensure that all families have access to trauma-informed practices, and all staff feel competent in meeting the needs of the families they serve (Dinehart, Katz, Manfra & Ullery, 2013).

EHS research, programming, and policy are truly synergistic; each informs the other, driving innovation and refinement in order to provide the highest quality programming for a diverse population of low-income families in the United States. The Buffering Toxic Stress Consortium represents the fruits of these efforts, as their research outputs will not only inform EHS practice, but also policies related to programs for other high-risk families, as well as research relevant to implementation, prevention, developmental and psychological science. Refining and enhancing currently funded and implemented programs is advantageous, as the returns on this early investment will have far-reaching implications for positive developmental outcomes for young children.


Chazan-Cohen, R., Ayoub, C., Pan, B. A., Roggman, L., Raikes, H., McKelvey, L., Whiteside-Mansell, L., & Hart, A. (2007). It takes time: Impacts of Early Head Start that lead to reductions in maternal depression two years later. Infant Mental Health Journal, 28(2), 151-170.

Dinehart, L. H., Katz, L. F., Manfra, L., & Ullery, M. A. (2013). Providing quality early care and education to young children who experience maltreatment: A review of the literature. Early Childhood Education Journal, 41(4), 283-290.

Harden, B. J. (2015). Services for Families of Infants and Toddlers Experiencing Trauma: A Research-to-Practice Brief. Brief prepared for the Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Love, J. M., Chazan-Cohen, R., Raikes, H., & Brooks-Gunn, J. (2013). What makes a difference: Early Head Start evaluation findings in a developmental context. Monographs of the Society for Research in Child Development, 78(1), vii-viii.

McCrae, J. S., Brown, S. M., Yang, J., & Groneman, S. (2015). Enhancing early childhood outcomes: Connecting child welfare and Head Start. Early Child Development and Care, 1-16.

Office of Early Childhood Development [OECD], Administration for Children and Families [ACF]. (2016). Early Head Start-Child Care Partnerships: Growing the Supply of Early Learning Opportunities for More Infants and Toddlers. Year One Report. January 2015–January 2016. Washington, DC: OECD, ACF, U.S. DHHS.