The research team at Georgia Health Policy Center (GHPC) will conduct secondary data analysis of the Baby FACES 2018 data set in order to support ACF in furthering its research and programmatic goals and inform the broader field of early care and education (ECE). The study focuses on referral-making processes and referral connections among children and families who are at-risk within EHS programs. This study seeks to understand which EHS families are being referred to services based on level and type of risk, including demographic and other risk-related indicators (e.g., absent parent, parent with substance use issue). This study will examine the level of need and how it aligns with the rates of referral and referral connection. Additionally, GHPC will conduct novel research on the following variables that may moderate referral-making and referral uptake: urbanicity of the EHS program, quality of staff relationships with families, and the types of training staff have received. GHPC will employ a range of data methods to develop a family level risk index, analyze descriptive statistics, explore variables through regression models, and test moderating factors.