Workforce Quality and Early Childhood Development at Scale

Abstract

Early years programmes can improve child development, yet large-scale implementations often fail to replicate the impacts of small trials. This paper provides causal evidence on the role of workforce quality in driving effectiveness of England’s national home visiting programme for first time teenage mothers. Exploiting quasi-random assignment of families to nurses, we estimate individual impacts on programme retention and children’s outcomes and find considerable variable. A one standard deviation (SD) increase in visitor quality raises cognitive development by 0.20 SDs and socio-emotional development by 0.23 SDs at age two. Retention effects are uncorrelated with child outcomes, suggesting participation is not a reliable proxy for effectiveness. A rich set of worker characteristics and qualifications fail to predict effectiveness. Instead, process quality—the way services are delivered—emerges as central, operating partly through improvements in maternal mental health and reductions in prenatal risk behaviors. These findings highlight the importance of workforce quality and delivery processes for scaling early years interventions successfully.