Children and Youth Services Review 93 (2018) 291–300

Contents lists available at ScienceDirect

Children and Youth Services Review

journal homepage: www.elsevier.com/locate/childyouth

Early Head Start dosage: The role of parent-caregiver relationships and T

family involvement
⁎
Shinyoung Jeona, , Ji Young Choib, Diane M. Horma, Sherri Castlea
a
Early Childhood Education Institute, University of Oklahoma-Tulsa, Tulsa, OK, United States
b
Human Development and Family Studies, Iowa State University, Ames, IA, United States

A R T I C LE I N FO A B S T R A C T

Keywords: The present study examined predictors and pathways relevant to children's dosage in Early Head Start (EHS)
Early Head Start dosage using the dataset from the Early Head Start Family and Child Experiences Study (Baby FACES; Vogel & Boller,
Parent-caregiver relationships 2009–2012). Dosage was defined in two ways: (a) leaving EHS early, before age eligibility ended, and (b) the
Family involvement total length of EHS enrollment. This study first examined factors predicting children's dosage of EHS with a
Baby FACES
particular focus on parent-caregiver relationships captured when children were age 1. Second, this study ex-
amined a potential mediational role of family involvement on the association between parent-caregiver re-
lationships and EHS dosage, controlling for child and family characteristics. Findings showed that children from
families with higher risks were more likely to leave EHS early and were enrolled in EHS for less time. Children
were less likely to leave EHS early when their caregivers reported positive relationships with parents when
children were age 1. However, the length of EHS enrollment was not predicted by parent-caregiver relationships
as reported either by parents or caregivers. Findings from mediation models showed that caregiver-reported
positive parent-caregiver relationships were associated with the higher level of family involvement during EHS
which, in turn, predicted both lower rates of early leaving and longer length of EHS enrollment. These results
indicate that promoting initial positive parent-caregiver relationships and encouraging family involvement in
EHS may be important for maximizing children's EHS dosage, which has been shown to be beneficial for the
development of children in EHS.

1. Introduction
It has been well documented that children growing up in poverty
are at greater risk for early developmental concerns than their peers
growing up in more affluent families (Duncan & Magnuson, 2013;
Nelson & Sheridan, 2011). As a way to reduce early developmental
gaps, early childhood educators, developmental psychologists, and
economists have emphasized the importance of quality experiences in
early care and education (ECE) for children from economically dis-
advantaged families (Duncan & Magnuson, 2013; Heckman, Pinto, &
Savelyev, 2013; Lee, Zhai, Brooks-Gunn, Han, & Waldfogel, 2014). This
body of research demonstrating the importance of quality ECE experi-
ences (Duncan & Magnuson, 2013; Duncan & Sojourner, 2013; Love
et al., 2005) serves as a justification for federally-funded early child-
hood intervention programs such as Early Head Start (EHS) and Head
Start (HS) that aim to reduce developmental gaps predicted by family
income.
EHS is a federally-funded child development and family support
program for low-income families serving pregnant women, infants, and
toddlers up to age 3. EHS aims to promote young children's develop-
ment and strengthen families through encouraging their engagement in
the program. Because the length of participation in ECE programs can
influence the potential benefits that families and children attain
(Berkel, Mauricio, Schoenfelder, & Sandler, 2011; Yazejian, Bryant,
Freel, Burchinal, & the Educare Learning Network Investigative Team,
2015), EHS has emphasized a longer duration of program participation
for children and families (Vogel et al., 2015). Despite the fact that fa-
milies are eligible for 3 years of EHS services once they are deemed
qualified, considerable numbers of EHS children and families leave EHS
early (i.e., children exit before turning age 3), which is a phenomenon
that is not yet fully understood. Although there are a limited number of
studies on why families choose to leave EHS early, a recent study
(Caronongan, Moiduddin, West, & Vogel, 2014) found that 35% of
children left EHS early (i.e., dropout) and that early EHS leavers had
more family risks than EHS graduates. Caronongan et al.’s study pro-
vided valuable information regarding differences in family and program

⁎
Corresponding author.
E-mail address: syjeon@ou.edu (S. Jeon).

https://doi.org/10.1016/j.childyouth.2018.07.032
Received 27 March 2018; Received in revised form 28 July 2018; Accepted 30 July 2018
Available online 01 August 2018
0190-7409/ © 2018 Elsevier Ltd. All rights reserved.
S. Jeon et al.
characteristics between early leavers and EHS graduates; however,
given the high rate of attrition in EHS, additional research is needed to
further identify risk and protective factors associated with and pre-
dicting the likelihood of early leaving in EHS (Xue et al., 2015). Ad-
ditionally, research on the total length of enrollment in EHS that con-
siders family risk and protective factors can provide information to help
programs maximize children's dosage in EHS.
1.1. Importance of dosage in early childhood programs
Considering that developmental gaps between children from dis-
advantaged and affluent families can emerge as early as 9 months of age
(Halle et al., 2009), entering early and staying longer in high-quality
ECE programs may be particularly important for children growing up in
low-income families. Empirical studies have demonstrated that the
length of enrollment in ECE programs is important for promoting early
development for children experiencing poverty (Campbell, Pungello,
Miller-Johnson, Burchinal, & Ramey, 2001; Hill, Brooks-Gunn, &
Waldfogel, 2003; Wen, Leow, Hahs-Vaughn, Korfmacher, & Marcus,
2012; Yazejian et al., 2015; Zaslow et al., 2010). For example, prior
research found that early entry into a high-quality ECE program and
longer lengths of enrollment led to better receptive language skills of
dual language learners from low-income families (Yazejian et al.,
2015). Similarly, Wen and colleagues found that children who attended
2 years of HS showed higher scores in academic and social outcomes
than children who attended 1 year. These studies suggest that the
maximum dosage of EHS including the full eligible period, birth to age
3, may be important for fully realizing the benefits of EHS on child
development (Caronongan et al., 2014; Zaslow et al., 2010). Although
the existing research documents the importance of entering programs
earlier and staying longer, we have limited understanding of the factors
associated with children's dosage in EHS.
In addition, few studies have investigated children's dosage con-
sidering both program graduation status and the total length of en-
rollment from program entry to exit. Program graduation status is cri-
tical for children from low income families because these children have
limited access to high quality ECE programs (Fuller, Holloway, & Liang,
1996; Loeb, Fuller, Kagan, & Carrol, 2004). Furthermore, EHS allows
eligible children and families to enroll at any point between birth to age
3, thus the length of enrollment could vary among children who
graduate from EHS. Due to differences in enrollment dates, it is possible
that children who graduate from EHS have shorter lengths of EHS ex-
perience than children who left EHS early. Because a minimum dosage
of exposure to high-quality ECE is needed to associate with child de-
velopmental outcomes (Zaslow et al., 2010), research on the length of
enrollment in EHS can enhance understanding about children's actual
dosage of EHS. Given that, the present study investigated both dosage
indicators, (a) early leaving status, addressing an attrition/ dropout
issue, and (b) the length of enrollment, capturing the actual length of
staying in the EHS programs.
1.2. Parent-caregiver relationships in early childhood programs
The ecological framework (Bronfenbrenner & Morris, 1998) posits
that features of the mesosystem—which consists of interactions among
proximal environments, such as parent-caregiver relationships—in-
fluence individuals' functioning and development. In line with the
ecological framework, studies have found that positive relationships
between parents and home visitors were associated with lower rates of
dropouts and longer duration of participation in ECE programs (Brand
& Jungmann, 2014; Girvin, Depanfilis, & Daining, 2007; Korfmacher,
Green, Spellmann, & Thornburg, 2007). Parent and caregiver relation-
ships can be important predictors of adjustment and participation in
ECE programs. For example, a report from the Harvard Family Research
Project emphasized the importance of family-school relationships in
ECE, because it affects children's adjustment and satisfaction in ECE
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Children and Youth Services Review 93 (2018) 291–300
programs (Weiss, Caspe, & Lopez, 2006).
Relationships between parents and caregivers in ECE include mul-
tiple dimensions such as establishing trust, frequent and open com-
munication, and collaboration (Elicker, Noppe, Noppe, & Fortner-
Wood, 1997; Elicker, Wen, Kwon, & Sprague, 2013; Shanti, 2017),
which reflect an overall collaborative partnership between parents and
a caregiver (Girvin et al., 2007; Korfmacher et al., 2007).
Lang and colleagues showed that parent-teacher relationships that
reflect collaboration between home and child care were associated with
higher levels of family involvement in center-based child care programs
for infants and toddlers (Lang, Schoppe-Sullivan, & Jeon, 2017). Shanti
(2017) also emphasized collaboration based on trust and communica-
tion as an important aspect of positive parent-caregiver relationships
that can lead to parents to engage in EHS programs. It is plausible that
well-established relationships between parents and caregivers can lead
to better adjustment of children and families in EHS, which may pre-
vent families and children from dropping out or leaving early and foster
longer participation in EHS.
1.3. Characteristics of children who leave early childhood programs early
Prior empirical research has found that certain characteristics of
children and families are associated with the likelihood of early leaving
in ECE (Brand & Jungmann, 2014; Caronongan et al., 2014; Roggman,
Cook, Peterson, & Raikes, 2008). For example, Caronongan and col-
leagues found that early EHS leavers, relative to EHS graduates, were
more likely to have family risk characteristics, such as living in a
household with lower income-to-need ratios, more housing instability
(moving at least once during their first year of EHS), and more maternal
demographic risk factors including being teen mothers. Roggman and
colleagues' study on families who drop out of home-based EHS services
also showed similar differences between early leavers and graduates.
They found that children with disabilities and children raised by single
mothers or by mothers who had poor English skills were more likely to
drop out of EHS home-based programs. Their study also found that the
families who left early received services that were less focused on child
development and that the parents were less engaged and more dis-
tracted during home visits.
In addition to child and family characteristics, the existing literature
highlights the potential role of program factors. For example, Brand and
Jungmann's (2014) study of a German home visiting program found
that while family characteristics, such as higher family social economic
status (SES), maternal age, grandmother's participation during home
visits, and lower numbers of maternal risk factors, predicted lower at-
trition rates, process quality features of the intervention, such as un-
successful visit attempts, level of maternal involvement in home visits,
and satisfaction with services, accounted for a larger amount of the
variance explaining dropout. Thus, in addition to child and family
characteristics, process quality features of the program including in-
dices of the level of family involvement are important predictors of
children's dosage in EHS.
1.4. Mediational role of family involvement
Family involvement in ECE programs refers to participation in a
variety of activities and family leadership opportunities (U.S.
Department of Health and Human Services [USDHHS], 2017). Family
involvement in ECE often includes parental volunteering and partici-
pation in school events and activities, as well as active parent-caregiver
communication about children's learning and development both at
home and in the ECE program (Fantuzzo, Tighe, & Childs, 2000). Fa-
mily involvement can be considered a type of partnership in ECE be-
cause parents and caregivers share responsibilities to support young
children's development (Westmoreland, Bouffard, O'Carroll, &
Rosenberg, 2009).
Although the focus of few studies, family involvement may explain
S. Jeon et al.
how parent-caregiver relationships predict children's dosage in ECE
settings. Two lines of research support the notion that family involve-
ment may act as a mechanism on the association between parent-
caregiver relationships and children's dosage. First, empirical research
has shown that secure and well-formed parent-teacher relationships
were associated with increased family involvement in multiple settings
including center-based infant and toddler care, HS, and kindergarten
(Lang et al., 2017; Nzinga-Johnson, Baker, & Aupperlee, 2009; Shanti,
2017; Waanders, Mendez, & Downer, 2007). Indeed, the USDHHS
(2018) has emphasized the need to strengthen parent and staff re-
lationships because they are associated with family involvement in HS
programs. Another line of research evidence has demonstrated that
more active family involvement is associated with lower rates of pro-
gram dropout and longer length of participation in home visiting pro-
grams (Brand & Jungmann, 2014; Damashek, Doughty, Ware, &
Silovsky, 2011; Roggman et al., 2008). For example, Brand and Jung-
mann's study found that families who were reported by home visitors to
be less involved in home visits were more likely to drop out of the
program than families who were reported to be highly involved.
These two lines of research showing links among family-caregiver
relationships, family involvement, and ECE participation provide the
statistical prerequisite (MacKinnon, Fairchild, & Fritz, 2007) for a po-
tential mediational role of family involvement between parent-care-
giver relationships and children's dosage in ECE programs. However,
given that a limited number of studies have simultaneously examined
the associations among parent-caregiver relationships, family involve-
ment, and children's ECE dosage, particularly for infants and toddlers,
we have a limited understanding of whether family involvement acts as
a mechanism explaining the association between parent-caregiver re-
lationships and dosage. Longitudinal investigations of parent-caregiver
relationships and family involvement in EHS with consideration of
various child and family characteristics would contribute to the un-
derstanding of predictors and mechanisms of early leaving and the
length of enrollment in EHS.
1.5. Current study
The present study strives to address this gap in the current litera-
ture. This study examined predictors and pathways relevant to chil-
dren's dosage of EHS by using the dataset of the Early Head Start Family
and Child Experiences Study (Baby FACES; Vogel & Boller, 2009–2012).
Dosage was defined in two ways: (a) leaving EHS early before age
eligibility ended and (b) the length of EHS enrollment. This study first
explored the parent-caregiver relationships established early in EHS
(i.e., when children were age 1) as a potential predictor of children's
EHS dosage. This focus is based on empirical research demonstrating
that positive parent-caregiver relationships predicted lower rates of
early leaving (Brand & Jungmann, 2014; Girvin et al., 2007) and longer
lengths of participation (Brand & Jungmann, 2014; Korfmacher et al.,
2007) in ECE programs. Second, this study examined whether parent
involvement in EHS acts as a mediator on the association between
parent-caregiver relationships and children's EHS dosage. This ex-
amination is based on studies showing that parent-teacher relationships
were associated with parent involvement in ECE programs (Korfmacher
et al., 2007; Lang et al., 2017; Shanti, 2017; Waanders et al., 2007),
which in turn associated with lower rates of attrition and longer length
of participation in ECE programs (Brand & Jungmann, 2014; Damashek
et al., 2011; Roggman et al., 2008). Specifically, the following research
questions were examined.
RQ1. Are parent-caregiver relationships and child and family
characteristics associated with children's EHS dosage?
RQ2: Does family involvement mediate the association between
parent-caregiver relationships and children's EHS dosage, controlling
for child and family characteristics?
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Children and Youth Services Review 93 (2018) 291–300
2. Methods
2.1. Data source
This study used the Early Head Start Family and Child Experiences
Study (Baby FACES; Vogel & Boller, 2009–2012) dataset, which is a
large longitudinal secondary dataset providing comprehensive in-
formation on EHS children and families as well as characteristics of the
EHS programs. In the Baby FACES study, a nationally representative
sample of 89 programs and 976 children was selected based on the
stratified clustered sampling approach. Given the use of this sampling
approach, the EHS programs (level 2) were recruited first and families
and children (level 1) were selected from these consented programs.
Approximately 94% of recruited programs consented, and approxi-
mately 88.5% parents of selected children consented to participate in
the Baby FACES study (Cannon, Murphy, Bloomenthal, & Vogel, 2014).
Baby FACES includes two cohorts of children based on their age at the
time of the spring site visit (i.e., data collection) in EHS: (a) a newborn
cohort, which includes pregnant women and children who were no
more than 8 weeks of age at the spring 2009 site visit, and (b) a 1-year-
old cohort, which includes children who were between the ages of 10
and 15 months at the spring 2009 site visit. Starting spring 2009, data
were collected each spring until the children turned age 3 (2011 for a 1-
year-old cohort [ages 1 to 3] and 2012 for a newborn cohort [age 0 to
3]).
The child-level data provides comprehensive information regarding
child and family characteristics obtained from interviews with parents
and caregiver (i.e., home visitors or teachers). In addition, information
about parent-caregiver relationships, from both parents and caregivers,
was gathered via interviews when EHS children were ages 1, 2, and 3.
Home visitors and teachers completed self-administrated ques-
tionnaires including questions about family involvement when children
were at ages 1, 2 and 3. Field staff, with at least 40 h of data collection
training, conducted interviews with parents, staff, and program direc-
tors. The Baby FACES technical report provides more detailed in-
formation on sampling, data collection procedures, and measures
(Vogel et al., 2011a).
2.2. Sample
For the purposes of this study, children were excluded if their par-
ents refused to answer whether their children exited the EHS programs
before the end of their age eligibility for the program (n = 2). We
further excluded children who left EHS between age 0 to 1 and thus,
had no opportunity to provide data on our key independent variables
(i.e., parent-caregiver relationships and family involvement in EHS;
n = 56) given the data collection design used in Baby FACES. We did
not impute the values due to the violation of basic assumption for im-
putation that is missing at random. In addition, we excluded children
who did not have a valid value for a sampling weight (W0910CSNT)
that represents a sample who were eligible at baseline and had parental
consent in 2009 and 2010 (n = 3). This sample selection criteria re-
sulted in the total sample size of 915 children in 88 programs.
The sample for the present study enrolled in EHS from July 2007 to
June 2009. For cohort 0 (n = 136) approximately 40% of children (or
pregnant mothers) enrolled in the EHS programs between November
2008 and January 2009. For cohort 1 (n = 779) approximately 40% of
children enrolled in the EHS programs between July and September in
2008. The rest of the study sample varied in the date of enrollment
because EHS allows families to enroll in the EHS programs at any point
up until the child turns age 3 (Cannon et al., 2014). Based on the
sampling strategy used in the Baby FACES, however, a possible max-
imum entry age for children should not exceed 15 months of age at the
first data collection point in spring 2009. Exit dates of early leavers in
this study varied as well. However, the majority of children graduated
EHS at the end of school year in spring 2011 or 2012. Among graduates
S. Jeon et al.
who were in a newborn cohort, approximately 80% graduated after
May in 2012. Among graduates who were in a 1-year-old cohort, ap-
proximately 70% graduated between June and August 2011.
2.3. Measures
2.3.1. EHS dosage
We used two indicators of dosage for the current study: (a) leaving
EHS early and (b) the length of enrollment in EHS. Leaving early, which is
a binary variable, indicates children left EHS before the end of their age
eligibility (i.e., prior to the child's third birthday; 1 = early leavers,
0 = EHS graduates). The length of enrollment in EHS, a continuous
variable, indicates the total months children stayed enrolled in EHS.
This variable was generated by Baby FACES based on children's entry
and exit dates. Such data was collected from multiple resources (e.g.,
weekly service reports from caregivers, annual roster checks in pre-
paration for Baby FACES site visits, and parent reports; Caronongan
et al., 2014).
2.3.2. Parent-caregiver relationships
The Parent-Caregiver Relationship Scale (PCRS; Elicker et al., 1997)
was independently completed by parents and caregivers when children
were age 1. The PCRS was used to measure the perceived quality of
relationships between parents and caregivers. The PCRS captures
multiple dimensions of parent-caregiver partnership and collaboration,
including trust and confidence, communication, respect/acceptance,
caring, competence/knowledge, and shared values (Cannon et al.,
2014). In Baby FACES, a shortened version that included 13 of the
original 35 items was used. The shorten version was generated by the
Baby FACES research team to appropriately measure the important
dimensions of parent-caregiver relationships with the least burden for
respondents. The shorten versions demonstrated acceptable internal
consistency and reliability (Cannon et al., 2014). Survey items for
parents include “If there is a problem, my child's teacher or home visitor
and I always talk about it soon”, “I like to work closely with child's
teacher or home visitor in order to gain a better understanding of
child”, and “I always trust child's teacher or home visitor to give him/
her good consistent care.” Teachers or home visitors responded to si-
milar questions including “If there is a problem, this child's parent and I
always talk about it soon”, “I like to work closely with this child's parent
in order to gain a better understanding of his/her child”, “I feel this
child's parent genuinely cares for him/her”, “This child's parent has the
knowledge and skills needed to be a good parent”, “This child's parent
gives me valuable suggestions about working with his/her child”, and “I
admire the way this parent works with his/her child”. All items were
rated from 1 = “strongly disagree” to 5 = “strongly agree”, and the
average score of 13 items was used in the current study. The internal
consistency of the PCRS rated by parents and caregivers when the EHS
children were age 1 were .93 and .94, respectively (Vogel et al., 2011b).
2.3.3. Family involvement
Home visitors or teachers reported the level of family involvement
during the past 6 months each spring when the child was age 1, 2, and
3. Baby FACES provides the average score of family involvement for
each child during their time in EHS; family involvement scores for each
year are not provided. Reponses include 1 = “Family was not involved
in the program at all”, 2 = “Family's involvement in the program was
consistently low throughout the past 6 months – the family keep some
appointments but missed or canceled frequently, family did not actively
engage in home visits and group activities, and child was often absent
from the center”, 3 = “Family's involvement in the program varied
during the past 6 months – the family was sometimes highly involved in
the program, and at other times the family's involvement was low”; and
4 = “Family was consistently highly involved in the program over the
past 6 months- the family kept most appointments and actively engaged
in home visits and group activities, and child attended center
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Children and Youth Services Review 93 (2018) 291–300
regularly”.
2.3.4. Baseline child and family characteristics
Parent-reported child characteristics used in this study include child
gender, race (European American, African American, Hispanic, or
mixed or other race/ethnicity), dual language learning (DLL) status (yes
vs. no), and disability status (yes vs. no). In addition, child age cohort
(newborn cohort vs. 1-year-old cohort) and service types that the child
received at age 1 (center-based, home-based, family child care, or
combination service) were used. Parent-reported family characteristics
used in this study include urbanity of location where family lives (urban
vs. rural), mother pregnant with focus child at enrollment (yes vs. no),
household income-to-needs ratio, mother's education (less than high
school vs. high school or higher); teen or single mother status (yes vs.
no); mother's employment status (yes vs. no); family welfare recipient
status (yes vs. no); the number of maternal demographic risks (e.g., teen
mother, single mother, maternal education level, maternal employment
status, and family welfare status), parental depression as measured by
Center for Epidemiologic Studies Depression Scale Short Form (Ross,
Mirowsky, & Huber, 1983); drug use (yes vs. no); parenting stress
measured by Parenting Stress Index-Short Form (Abidin, 1995); par-
ental immigrant status (both, either, or none of parents are im-
migrants); moving at least once during a given year (yes vs. no); in-
tergenerational family status (yes vs. no); parental physical health (fair
vs. poor health), and social support which was the average score of 13
items (e.g., someone to help with food shopping, meals, cleaning house,
bills, child care, and etc.). We used family characteristics data reported
at the first data collection for the present study. Most data were first
collected in spring 2009 except for maternal employment status and
parenting stress, which were collected when children were age 1 (i.e.,
spring 2009 for a 1-year-old cohort and spring 2010 for a newborn
cohort).
2.4. Data analyses
Preliminary analyses were conducted using Stata 14. First, mean
difference and chi-square tests were employed to check whether EHS
early leavers and graduates had differences in reported perceptions of
parent-caregiver relationships and family involvement, and in their
child and family characteristics (see Table 1). Second, distribution
graphs were generated to visualize the length of enrollment in EHS for
early leavers and EHS graduates (see Fig. 1). A sampling weight
(W0910CSNT) was applied to all preliminary analyses.
For the main analyses, 20 imputed datasets were generated using
multiple imputation (MI: Rubin, 1987) to handle item-level missing
data. All variables used in this study and additional auxiliary variables
were included in the MI model. To identify the proportion of variance
explained by EHS programs (level 2) in each of two outcome variables
(i.e., leaving EHS early and the length of enrollment in EHS), intra-class
correlation coefficients (ICCs) were calculated. Results showed that 3%
and 9% of the variances were explained by EHS programs for the status
of early leaving and the length of enrollment in EHS, respectively.
Given the ICCs, this study employed a multilevel modeling (MLM)
approach to the complex survey data using Mplus to investigate RQs 1
and 2. We used program IDs as a cluster to correct standard errors and a
chi-square test of model fit to account for issues regarding the non-
independence of observations (i.e., clustering) and the unequal selec-
tion probability of the sample (Muthén & Muthén, 2012; Muthén &
Satorra, 1995). For RQ1, we conducted direct models (model 1–1 and
1–2), and then for RQ2 we examined mediation models (model 2–1 and
2–2). Specifically, we employed a categorical complex analysis (i.e.,
multilevel logistic regression) for model 1–1 and 2–1 because the out-
come variable was a binary variable (i.e., early leavers vs. graduates).
Thus, results were presented in odd ratios for the two models (model
1–1 and 2–1). Fig. 2 depicts the mediation model that we examined for
RQ 2. Associations between parent-caregiver relationships at age 1 and
S. Jeon et al. Children and Youth Services Review 93 (2018) 291–300

Table 1
Parent-caregiver partnership and child and family characteristics between EHS early leavers and graduates.
EHS early leavers EHS graduates F Chi-Square

(n = 304, 31%) (n = 611, 69%) (df) (df)

Missing % M (SE) Missing % M (SE)

Partnership between parents-caregivers (PeC)

Caregiver-reported PeC relationships (age 1) 9.21 4.10 (.04) 5.73 4.24 (.02) 8.66⁎⁎ (1851)
Parent-reported PeC relationships (age 1) 22.04 4.48 (.03) 12.11 4.53 (.02) 1.12 (1773)
Family involvement 10.53 3.31 (.04) 0.33 3.47 (.02) 9.56⁎⁎ (1880)

Child characteristics in spring 2009

Cohort (1 = 1-year-old cohort) 0 81.87% 0 86.78% 3.77 (1)
Gender (1 = male) 0.33 53.91% 0 52.43% 0.17 (1)
Race 10.86 – 2.62 – 3.75 (3)
European American 37.78% 35.62% –
African-American 14.30% 19.77% –
Hispanic 36.27% 34.35% –
Mixed/other 11.65% 10.26% –
DLL status (1 = yes) 10.86 36.76% 2.13 41.41% 1.63 (1)
Disability (at age 1) 36.51 5.29% 24.88 8.41% 1.83 (1)
Service type 10.86 5.73 3.95 (3)
Center based 41.20% 43.94%
Home based 51.63% 52.02%
Family child care 0.76% 0.56%
Combination 6.41% 3.48%

Family characteristics in spring 2009

Urbanity (1 = urban) 0 64.16% 0 65.18% 0.08 (1)
Mother pregnant with focus child at enrollment (1 = yes) 0 27.89% 0 33.92% 3.30 (1)
Family income to needs ratio 25.66 2.12 (.08) 17.35 2.51 (.07) 11.99⁎⁎⁎(1730)
Mother education (1 = less than high school) 19.74 39.06% 11.13 36.77% . 0.36 (1)
Teen mother (1 = yes) 18.75 58.20% 5.24 50.14% 4.39 (1)
Single mother (1 = yes) 17.43 47.66% 10.15 44.79% 0.55 (1)
Maternal employment (1 = unemployed; at age 1) 22.70 51.81% 12.77 51.07% 0.03 (1)
Welfare recipient status (1 = yes) 21.05 71.23% 13.75 68.60% 0.52 (1)
Mom risk factors 21.38 2.61 (.09) 4.91 2.34 (.05) 6.30⁎ (1819)
Parental depression 21.05 5.55 (.41) 13.26 5.30 (.25) 0.25 (1769)
Parental drug use (1 = yes) 21.05 7.57% 13.26 7.17% 0.03 (1)
Parenting stress (at age 1) 24.67 11.06 (.39) 14.57 10.63 (.22) 0.92 (1750)
Parental psychological risk 22.37 1.55 (.04) 8.18 1.43 (.03) 3.72 (1796)
Parent immigrant status 21.38 13.75 1.31 (2)
Both of parents are immigrants 19.05% 19.08% –
Either of parents is an immigrant 11.90% 9.21% –
None of parents are immigrants 69.05% 71.71% –
Move at least once last year (1 = yes) 21.05 40.30% 13.09 27.58% 12.11⁎⁎ (1)
Intergenerational family (1 = yes) 17.43 12.77% 9.98 18.99% 4.57⁎ (1)
Parental physical health (1 = fair or poor health) 21.38 15.88% 13.75 9.49% 6.49⁎ (1)
Social support 21.05 30.79 (.57) 13.09 30.82 (.34) 0.01 (1770)

Notes. A sampling weight (W0910CSNT) was applied. ⁎p < .05, ⁎⁎

p < .01, ⁎⁎⁎
p < .001.

the average score of family involvement during their time in EHS were
defined as path A (i.e., from caregiver-perceived relationships to family
involvement) and B (i.e., from parent-perceived relationships to family
involvement). The association between family involvement and the
dosage of EHS (i.e., leaving early or the length of enrollment) was de-
fined as C in the model. Mediational effects (A*C or B*C) were calcu-
lated by multiplying A and C for model 2–1 and by multiplying B and C
for model 2–2. Same as with the preliminary analyses, the sampling
weight (W0910CSNT) was applied for all main analyses. Both indirect
and direct models were just-identified models (i.e., df = 0), thus al-
ternative fit indices were perfect (i.e., CFI = 1 and TLI = 1). To test fits
for the path models, we generated over-identified models by fixing non-
significant paths as 0 which allowed the degree of freedom in the
models. We found that over-identified models also showed the almost
perfect fit indices (e.g., CFI =0.99 and TLI =1) as the just-identified
models. Due to the fact that the over-identified models were not a
theory-based approach, we maintained the just-identified models.
3. Results
3.1. Preliminary findings
Our preliminary findings showed that 31% of the children in this
study left EHS before their age eligibility expired. Table 1 presents the
differences between EHS early leavers and graduates in parent-care-
giver relationships reported by caregivers and parents when children
were age 1, average family involvement during their time in EHS, and
child and family characteristics at the beginning of the first data col-
lection in spring 2009. Our findings showed that relative to EHS
graduates, early leavers were more likely to be from households with
lower income-to-need ratios, experience housing instability (indicated
by moving once or more in the first year of attending EHS) and have
mothers with more demographic risks. In addition, early EHS leavers
had less positive parent-caregiver relationships at age 1 reported by
caregivers and lower family involvement during their time in EHS than
EHS graduates. On the other hand, EHS graduates, relative to early EHS
leavers, were more likely from an intergenerational family and have
parents who had good physical health.
As shown in Fig. 1, there were variations in the length of EHS

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Fig. 1. The length of enrollment in EHS between early leavers and graduates.
Notes. A sampling weight (W0910CSNT) was applied.

enrollment by children's early leaving status. Early leavers were en-
rolled in EHS for an average of 17 months (SD = 7.81) with a range
between .50 months to 39.60 months. EHS graduates experienced EHS
for an average of 33 months (SD = 5.29) with a range between
19.50 months and 44 months. A few early leavers (3%) stayed in EHS
longer than 36 months and all of them entered EHS when their mothers
were pregnant. Some graduates (4%) were in EHS less than 24 months
because they entered the EHS programs at or after age 1. Regardless of
early leaving, the length of enrollment in EHS can vary for each child
due to different entry time points. However, the early leaving and the
length of enrollment in EHS were strongly correlated to each other in a
negative direction (r = −0.78, p < .001).
3.2. Predictors for child dosage of Early Head Start
To investigate RQ1, two direct models were separately examined for
each dosage outcome (see model 1–1 and 1–2 in Table 2). Model 1–1
showed that early leavers were 27% less likely to experience a positive
parent-caregiver relationship as perceived by the caregiver than EHS
graduates. In addition, early leavers were 18% and 64% more likely to
experience maternal demographic risks and moving experience in the
first year of EHS, respectively, compared to graduates. Early leavers
were 13% less likely to have higher income to need ratio than gradu-
ates. Early leavers were 48% less likely to be African-American than
graduates.
Findings from model 1–2 showed that parent-caregiver relation-
ships reported by parents and caregivers did not predict the length of
enrollment in EHS; however, a few family characteristics were found to
be significant. In addition to family income-to-needs ratio and moving
experiences, children who were from an intergenerational family,
whose mothers were pregnant with the study child when they enrolled,
and whose parents had good physical health tended to stay longer in
EHS.

Family involvement
(age 1 to 3)
A
C
Caregiver-reported B Leaving early (Model 1)
parent-caregiver
relationships at age 1
Length of enrollment
(Model 2)
Parent-reported
parent-caregiver
relationships at age 1

Child and Family

Characteristics
in spring 2009

Fig. 2. Mediation model.

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Table 2 in two ways–leaving EHS early and the length of enrollment in EHS.
Direct models. This study also adds to the sparse literature that has examined the
Model 1–1 Model 1–2 mediational role of family involvement on the association between
parent-caregiver relationships and EHS dosage, controlling for various
Direct model Direct model child and family characteristics.

Leaving early Length of

enrollment
4.1. Early leaving and length of enrollment in Early Head Start

b (SE) Odds ratio b (SE) Our study showed that 31% of the study sample left EHS early be-
fore they turned age 3 and were no longer eligible. This is a slightly
Partnership between parents-caregivers (PeC)
Caregiver-reported PeC −.32⁎ .73⁎ .90 (.48)
lower percentage than those found in other studies (e.g., 36% in
relationships (age 1) (.14) Roggman et al., 2008; 38.5% in Brand & Jungmann, 2014). The dif-
Parent-reported PeC −.07 (.18) .94 .05 (.69) ference may be because we excluded children who left EHS between
relationships (age 1) birth to age 1 (i.e., approximately 6%) in this sample. These children
Child Characteristics did not have data on our main study variables (i.e., parent-caregiver
Gender (1 = male) .00 (.17) 1.00 .15 (.59) relationships and family involvement) due to the data collection design
European American (ref) vs. −.65⁎⁎ .52⁎⁎ 1.81* (.84) used for Baby FACES. We did not impute the data as the missingness on
African-American (.24)
European American (ref) vs. −.27 (.21) .76 1.08 (.76)
these variables were not random.
Hispanic The length of children's enrollment in EHS varied based on dates of
European American (ref) vs. −.19 (21) .82 −.15 (.91) children's entry and exit (see Fig. 1). All children who stayed in EHS
Mixed/other more than 38 months were enrolled in EHS when their mothers were
Family Characteristics pregnant. Even among the EHS graduates, their length of EHS partici-
Urbanity (1 = urban) −.05 (.18) .95 −.19 (.63) pation varied widely (from 19.50 to 44 months) due to difference in the
Mother pregnant with focus child −.30 (.17) .74 10.43⁎⁎⁎ (.63)
timing of entry (i.e., enrollment date) to the EHS program. In addition,
at enrollment (1 = yes)
The number of maternal risk .17* (.08) 1.18⁎ −.39 (.28) even though most of the graduates completed the EHS program after
factors either spring 2011 (newborn cohort) or 2012 (1-year-old cohort), there
Parental psychological risks .23 (.14) 1.26 −.82 (.52) were a few variations in graduation dates. More variance in the length
Parental health (1 = fair or poor .46 (.25) 1.59 −2.13⁎ (.96) of enrollment in EHS was found among early leavers. Some children
health)
(3%) who left early stayed in EHS fewer than 6 months, while some
Family income to needs ratio −.14⁎ .87⁎ .48⁎ (.24)
(.07) early leavers (2%) stayed longer than 36 months. The results showed
Move at least once last year .48⁎⁎ (.18) 1.64⁎⁎ −1.47⁎ (.67) that early leaving does not necessarily reflect shorter length of enroll-
(1 = yes) ment in EHS. These findings indicate that it is not only important to
Intergenerational family −.44 (.25) .64 1.68⁎ (.78)
prevent early leaving but also to encourage early participation in EHS
(1 = yes)
in order to maximize the total length of children's enrollment in EHS.
Notes. P-C: Parent-Caregiver. A sampling weight (W0910CSNT) was applied. Nevertheless, it should be also noted that early leaving and length of
⁎
p < .05, ⁎⁎p < .01, ⁎⁎⁎p < .001. EHS experience were found to be strongly correlated (r = −0.78).
Although this study provides a descriptive picture of children's do-
3.3. Mediational role of family involvement sage in EHS, it is limited in providing in-depth information on what
types of experience early leavers had after exiting EHS, and late starters
To answer RQ 2, two mediation models were separately investigated experienced before joining EHS. Future studies examining family
for each dosage outcome (see model 2–1 and 2–2 in Table 3). Results choices for early care options outside of EHS and their association
from the both mediation models showed that parent-caregiver re- quality and other characteristics would enhance our understanding
lationships reported by caregivers when EHS children were age 1 were about whether EHS families could indeed experience better quality in
associated with family involvement in EHS controlling for child and EHS and thus reap enhanced benefit from longer participation in EHS.
family characteristics. Findings from model 2–1 showed that caregiver-
perceived parent-caregiver relationships were positively associated 4.2. Factors predicting children's dosage in Early Head Start
with family involvement, which, in turn, was associated with a lower
rate of EHS early leaving (i.e., mediational effect: b = −0.11, This study examined factors predicting the dosage of children's EHS
SE = 0.05, p < .05). Findings from model 2–2 showed that caregiver experiences including parent-caregiver relationships when children
reported parent-caregiver relationships were positively associated with were age 1. Our findings from the direct models (model 1–1 and 1–2)
family involvement, which, in turn, was positively associated with the showed that parent-caregiver relationships perceived by caregivers
length of enrollment in EHS (i.e., mediational effect: b = 0.40, when children were age 1 directly predicted low rates of early leaving,
SE = 0.20, p < .05). but not the length of enrollment in EHS (b = 0.90, SE = 48, p =. 051).
In line with findings from previous studies, these results imply that
better partnerships between parents and teachers could prevent chil-
4. Discussion dren and families from dropping out of EHS programs before the ser-
vices are scheduled to end (Brand & Jungmann, 2014; Girvin et al.,
EHS is a federally-funded child development and family support 2007; Korfmacher et al., 2007).
program for low-income children and their families offered at no cost to It should be noted that parent-caregiver relationships were found to
eligible families. Nonetheless, a considerable number of children and be a significant predictor for children's EHS dosage only when the re-
families leave the program before their eligibility ends (Caronongan lationship was reported by caregivers but not by parents. It is plausible
et al., 2014). Given the importance of children's dosage in ECE pro- that caregiver-reported relationships reflect their relative relationships
grams, especially for children living in poverty, there is a need to un- with parents in comparison to other parents of children in their room.
derstand this phenomenon. Using data from Baby FACES 2009, the In other words, caregivers may have rated their relationships with
present study examined whether parent-caregiver relationships and parents in comparison to their relationships with other parents while
child and family characteristics predict children's EHS dosage measured parents may not have reference point to rate their relationships with

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S. Jeon et al. Children and Youth Services Review 93 (2018) 291–300

Table 3
Mediation Models.
Model 2–1 Model 2–2

Mediation model Mediation model

Family involvement Leaving early Family involvement Length of enrollment

b (SE) b (SE) Odds ratio b (SE) b (SE)

Partnership between parents-caregivers (PeC)

Path A: Caregiver-reported PeC relationships (age 1) .31⁎⁎⁎ (.04) −.21 (.16) .81 .33⁎⁎⁎ (.04) .03 (.03)
Path B: Parent-reported PeC relationships (age 1) −.02 (.05) −.07 (.18) .93 −.02 (.04) .00 (.04)
Path C: Family involvement – −.35⁎ (.15) .70⁎ – .08⁎ (.04)

Child Characteristics
Gender (1 = male) .04 (.04) .01 (.17) 1.01 .04 (.03) .01 (.03)
European American (ref) vs. African-American .02 (.07) −.66⁎⁎ (.23) .52⁎⁎ .02 (.05) .07⁎ (.03)
European American (ref) vs. Hispanic .14⁎⁎ (.05) −.22 (.21) .80 .12⁎ (.04) .04 (.04)
European American (ref) vs. Mixed/other .07 (.08) −.17 (22) .84 .04 (.04) −.01 (.03)

Family Characteristics
Urbanity (1 = urban) −.06 (.06) −.08 (.18) .93 −.05 (.05) −.01(.03)
Mother pregnant with focus child at enrollment (1 = yes) .05 (.05) −.29 (.17) .75 .04 (.04) .51⁎⁎⁎ (.03)
The number of maternal risk factors −.02 (.02) .16 (.09) 1.17 −.05 (.05) −.04 (.04)
Parental psychological risks −.03 (.04) .23 (.14) 1.25 −.03 (.04) −.05 (.04)
Parental health (1 = fair or poor health) .03 (.06) .48 (.26) 1.61 .02 (.04) −.07⁎ (.03)
Family income to needs ratio .00 (.02) −.14⁎ (.07) .87⁎ .01 (.04) .07⁎ (.04)
Move at least once last year (1 = yes) −.04 (.05) .49⁎⁎ (.18) 1.63⁎⁎ −.03 (.04) −.07⁎ (.03)
Intergenerational family (1 = yes) −.05 (.06) −.46 (.25) .63 −.03 (.04) .07⁎ (.03)

Notes. P-C: Parent-Caregiver. A sampling weight (W0910CSNT) was applied. ⁎p < .05, ⁎⁎
p < .01, ⁎⁎⁎
p < .001.

caregivers. In addition, parent-reported parent-caregiver relationships
have been found to be biased toward positive ratings (Korfmacher et al.,
2007). Descriptive results also showed that caregiver-reported parent-
caregiver relationships (SD = .60) showed larger variation in the re-
sponses than parent-reported parent-caregiver relationships (SD = .51).
The correlation between parent-reported parent-caregiver relationship
and caregiver-reported parent-caregiver relationships was significant
but relatively low in its magnitude (r = .14 p < .01). It is important to
note that the items for measuring the relationship were slightly dif-
ferent for parents and caregivers. Specifically, in this study the parent-
caregiver relationships reported by caregivers captured caregivers'
evaluation of an initial collaboration with the parents as well as care-
givers' respect and acceptance of parental attitudes and knowledge of
child-rearing (e.g., “I feel this child's parent genuinely cares for him/
her”, “This child's parent has the knowledge and skills needed to be a
good parent”, “This child's parent gives me valuable suggestions about
working with his/her child”, and “I admire the way this parent works
with his/her child”). Our findings suggest that systematic supports may
be needed for caregivers to provide additional attention to families who
are less likely to have an initial collaborative relationship with them. In
line with these findings, EHS programs could ensure EHS caregivers
(i.e., home visitors and teachers) help parents know and understand the
value of building collaborative partnerships with caregivers. Specifi-
cally, for caregivers, EHS could reinforce knowledge of why and how to
build positive relationships with parents.
Our findings regarding associations between family characteristics
and early leaving are in line with the results of the profile study con-
ducted by Caronongan et al. (2014) using Baby FACES. Our findings
further showed that family characteristics including family income-to-
need ratios and moving were associated with both early leaving and the
length of enrollment in EHS. These findings are consistent with pre-
vious research showing associations of parental SES, including house-
hold income and residential instability, with the retention rate of ECE
programs (Brand & Jungmann, 2014; Roggman et al., 2008). Re-
sidential instability, identified by families' frequent moving, can jeo-
pardize children's length of enrollment in the same educational setting
(Astone & McLanahan, 1994; Roggman et al., 2008).
Compared to early leaving, the length of enrollment in EHS was
found to be associated with a greater number of family characteristics.
This study found that mothers who began the EHS programs when they
were pregnant with the focus child were more likely to show longer
enrollment in EHS than mothers who entered the program after their
children were born, implying that early entry can promote the total
length of enrollment in ECE programs. Findings also showed that
children who were from an intergenerational family and had physically
healthy parents were more likely to show longer enrollment in EHS. It is
plausible that children from intergenerational families may have ad-
ditional support to have a more stable care experience (Brand &
Jungmann, 2014). Conversely, poor parental physical health could
hamper parents' ability to keep a regular schedule and thus their chil-
dren's participation in EHS. In sum, understanding family character-
istics that are associated with early leaving or the length of enrollment
in EHS are important to provide tailored services to maximize EHS
participation for these at-risk groups. This findings highlight the im-
portance of EHS programs monitoring the family risk factors identified
in the present study and understanding that families at high risk likely
require tailored services to keep the child participating in the program.
4.3. Mediational role of family involvement
This study further examined the mediational role of family in-
volvement on the association between parent and caregiver relation-
ships and children's EHS dosage. The mediation model showed that
more positive parent-caregiver relationships as perceived by caregivers
when children were age 1were associated with increased family in-
volvement during their time in EHS, which in turn was associated with
lower rates of leaving EHS early and a longer length of enrollment in
EHS, controlling for varying child and family characteristics.
These findings are consistent with previous studies showing that
trust and collaborative relationships between parents and caregivers
can promote overall family involvement in ECE (Henrich & Blackman-
Jones, 2006; Nzinga-Johnson et al., 2009; Waanders et al., 2007).
Furthermore, this result is supported by a current research finding that
collaborative work between parent and teacher predicted higher levels
of family involvement in ECE programs for infants and toddlers (Lang
et al., 2017). In addition, our findings demonstrating that active family

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S. Jeon et al.
involvement in EHS was associated with the reduced likelihood of early
leaving and longer enrollment in EHS were in line with previous find-
ings (Brand & Jungmann, 2014; Roggman et al., 2008). These results
imply that parent-caregiver relationships, which reflect a good part-
nership between parents and caregivers and a higher level of family
involvement, are important factors to consider to maintain enrollment
of children until their EHS eligibility ends, thereby maximizing the
children's dosage. Specifically, the results suggest that parents who
collaborated well with caregivers and had positive parental attitudes
may be more likely to engage with EHS, which could help children and
families remain in the programs. If that is the case, EHS programs could
emphasize the importance of parent-caregiver relationships at the in-
itial stage of the program, because the strength of this relationship may
lead to active parental participation in the programs.
5. Limitations and future study
Several limitations are worth noting. First, the results of the present
study cannot assume causal effects on EHS dosages. In addition, even
though The Baby FACES included representative sample of EHS, pos-
sible unobserved selection bias, such as self-selection in attending the
EHS programs, could not be eliminated in this study. We attempted to
reduce this bias by including several control variables. Second, the
measurement of family involvement included 1 item which indicated
the level of family involvement at each time point (i.e., child age 1, 2
and 3). However, the average family involvement rating was reliable
with other indices of program engagement including items such as
participating as a member of parent council; volunteering in class-
rooms; doing maintenance, chores, or shopping for the program;
helping at special events and activities; attending special events; and
attending parent education/group activities. The internal consistency of
average family involvement ratings across 3 years with the other 6
items measuring program involvement at age 1, 2, and 3 were 0.75,
0.74, and 79, respectively. Third, while we included a comprehensive
list of child and family characteristics in the analytical models, there
could be other non-addressable or unexamined family circumstances for
leaving EHS early that are not available in Baby FACES, such as loss of
child or fetus, changes in child custody, moving out of service area, lack
of time due to employment, and enrolling in other services (Brand &
Jungmann, 2014). Last, this study was based on a secondary analysis of
the Baby FACES dataset and thus criticisms of the Baby FACES data
identified by the Baby FACES research team (Xue et al., 2015) are re-
levant to consider. However, the identified challenges including relia-
bility and validity issues of measures, few observation tools with es-
tablished psychometric properties, and lack of in-depth information on
program implementation and management, are somewhat tangential to
this study based on the number and type of variable extracted from the
dataset.
5.1. Implications of findings for practice and policy
Despite these limitations, findings from the present study provide em-
pirical evidence that caregiver-perceived parent-caregiver relationships and
other family characteristics (e.g., risk and protective factors) predict the
likelihood of early leaving and the length of enrollment in EHS. Moreover,
this study demonstrated that positive parent-caregiver relationships as per-
ceived by caregivers were associated with increased levels of family in-
volvement in EHS which, in turn, predicted lower rates of early leaving and
longer durations of EHS enrollment. The results of this study suggest that
positive parent-caregiver relationships and family involvement should be
emphasized as important processes to promote children's dosage in EHS.
EHS has been acknowledged as an important early intervention program
for low-income pregnant women and families with infants and toddlers.
Since EHS begun in 1995, it has shown positive influcences on both children
and their parents' outcomes(Beeber et al., 2010; Love et al., 2005). How-
ever, the effectiveness of EHS can be maximized when the programs are fully
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Children and Youth Services Review 93 (2018) 291–300
implemented for families and children they serve. This study suggests that
understanding the important roles of parent-caregiver initial relationships
and family involvement in EHS may be crucial for EHS programs to consider
and adequately address in their programming to prevent EHS families and
children from leaving early and to maximize the length of possible enrollment
in EHS. In addition, early enrollment in EHS and family risk factors, such as
residential instability and poor parental physical health, should receive fo-
cused attention to foster longer durations of EHS enrollment.
Future studies can further identify mechanisms underlying early
leaving and the length of enrollment in EHS. For example, future stu-
dies can examine when (i.e., exact time points) children are most likely
to leave early in EHS and what time-varying factors can predict the
timing of early leaving and the length of enrollment in EHS.
Acknowledgements
This research was supported by the Early Childhood Education
Institute (ECEI) at the University of Oklahoma (OU) at Tulsa with
funding from OU's University Strategic Organization initiative and the
George Kaiser Family Foundation. A portion of findings were presented
at the 2018 American Educational Research Association (AERA) con-
ference held in New York City in April 2018.
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