This document was printed from the website of the California Evidence-Based Clearinghouse for Child Welfare (CEBC), which you can access at http://www.cebc4cw.org/
This document was printed from the website of the California Evidence-Based Clearinghouse for Child Welfare (CEBC), which you can access at http://www.cebc4cw.org/
Note: Healthy Families America program declined to participate in the CEBC review process. The following information was obtained from publicly available sources.
Scientific Rating:
4
Evidence Fails to Demonstrate Effect
See scale of 1-5
Relevance to Child Welfare Rating:
2
Medium
See scale of 1-3
Child Welfare Outcomes: Permanency
Brief Description:
Healthy Families America has been rated by the CEBC in the area of Home Visiting. Healthy Families America is program initiative developed by Prevent Child Abuse America in 1992. Its target population is all newborns and their parents and targeted outcomes include reduction in child abuse and neglect, better mother and child health outcomes, support for cognitive and emotional development among children, and better life course outcomes for mothers.
Programs may differ by site, but typically include an initial assessment of all new parents, with encouragement for families with risk factors to participate in weekly home visits at first. Intensity is reduced as the families meet specific goals. Sites may vary in curriculum chosen for home visits, most appropriate target population, and level of risk. Critical elements of the program are based on theory, research, and practice in family support, attachment, and ecological models of child development.
Manual and Training section:
There is a manual and training available. Please contact Helen Reif, Director of Training at hreif@preventchildabuse.org for more information.
Relevant Published, Peer-Reviewed Research:
Healthy Families America is rated a "4 - Evidence Fails to Demonstrate Effect " on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least two or more randomized controlled trials (RCTs) that have found the practice has not resulted in improved outcomes, when compared to usual care. If multiple outcome studies have been conducted, the overall weight of evidence does not support the benefit of the practice. The overall weight of evidence is based on the preponderance of published, peer-reviewed studies, and not a systematic review or meta-analysis. For more information on the rating of a "4 - Evidence Fails to Demonstrate Effect," please see the Scientific Rating Scale.
Duggan, A., McFarlane, E., Fuddy, L., Burrell, L., Higman, S. M., Windham, A., et al. (2004). Randomized trial of a statewide home visiting program: impact in preventing child abuse and neglect. Child Abuse and Neglect, 28, 597-622.
Type of Study: Randomized controlled trial
Number of participants: 643 families
Population:
Location/Institution: Hawaii
Summary: (To include comparison groups, outcomes, measures, notable limitations) Families were randomly assigned to the Healthy Start Program (HSP) or to a control group. Mothers were evaluated using the parent-child Conflict Tactics Scale, and on observed parenting behaviors using the Home Observation for Measurement of the Environment (HOME) Inventory. Hospitalizations, substantiated child protective services reports, and mother's relinquishment of care were also tracked. Results show that the treatment and control groups did not differ on most measures of maltreatment. HSP mothers were less likely to use common methods of corporal/verbal punishment, but this effect was traced to only one agency. HSP mothers reported less neglectful behavior, related to decreased preoccupation with problems and improved access to medical care at one agency studied.
Length of post-intervention follow-up: 3 years.
Duggan, A., Fuddy, L., McFarlane, E., Burrell, L, Windham, A., Higman, S., & Sia, C. (2004). Evaluating a statewide home visiting program to prevent child abuse in at risk families of newborns: Fathers' participation and outcomes. Child Maltreatment, 9(1), 3-17.
Type of Study: Randomized controlled trial
Number of participants: 643 families
Population:
Location/Institution: Hawaii
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: This study used the same sample as Duggan, McFarlane et al (2004). above. Families were randomly assigned to either the Healthy Start Program (HSP) or the control group. Data were collected through interviews with mothers, HSP record reviews, and surveys of home visitors. Data concerning fathers included the father's participation in home visits and factors influencing the following: their participation, their role in parenting as identified by maternal reports, their accessibility, their responsibility, and their engagement. Analysis showed no program effects on accessibility, engagement in parenting activities, or sharing responsibility for the child's welfare. HSP fathers who were non-violent and living with the child's mother showed increased parenting involvement, as did HSP fathers who were violent and had little contact at baseline.
Length of post-intervention follow-up: 3 years.
Whipple, E. E., & Nathans, L. L. (2005). Evaluation of a rural Healthy Families America (HFA) program: The importance of context. Families in Society, 86(1), 71-82.
Type of Study: Pretest/Posttest
Number of participants: 115 families
Population:
Location/Institution: Not given
Summary: (To include comparison groups, outcomes, measures, notable limitations) Measures were completed every 3 months for each family. The Services Update Questionnaire measured program involvement and child health and development outcomes. The Infant/Toddler HOME Inventory observational measure assessed parent-child interactions and learning environment. The Parenting Stress Index (Short Form) measured normative stresses experienced by parents of young children, including depression, restriction of role, social isolation, and relationship with spouse. Finally, the Ages and Stages Questionnaire identified infants and children who showed potential developmental problems. Overall, few significant effects were seen on the measures over the course of program involvement. However, family characteristics, including maternal age, education, number of children, and marital status were correlated with better outcomes on measures. Level of program involvement also predicted lower parental stress levels and higher level of program completion. The authors note that there was a high drop-out rate, with few families reaching the 30-month follow-up.
Length of post-intervention follow-up: 6 to 30 months.
Duggan, A., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crown, S. S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31, 801-827.
Type of Study: Randomized controlled trial
Number of participants: 325 families
Population:
Location/Institution: Alaska
Summary: (To include comparison groups, outcomes, measures, notable limitations) Families were randomly assigned to the Healthy Families program or to a control group who were referred to other services. Families were measured at baseline on maternal mental health, substance abuse, and partner violence by interview. Depression was assessed by the Center for Epidemiological Studies Depression Scale (CES-D). General mental health was assessed by the Mental Health Index (MHI-5), substance abuse was defined as a CAGE score greater than or equal to 2, combined with alcohol use in the year prior to pregnancy. Partner violence was measured using the Revised Conflict Tactics Scale (CTS). Maternal psychological resources were gauged with a method combining measures of intelligence, mental health, and sense of mastery. The outcomes for this study consisted of CPS reports, maternal relinquishment of caregiving, hospitalizations or emergency room visits, and maternal reports of disciplinary and neglectful parenting behaviors measured by the parent-child CTS. The home environment was observed and quality was measured with the Home Observation of the Environment (HOME) Inventory. Mother-child interactions were also observed. At follow-up, maternal depression and partner violence were reassessed and parenting attitudes were measured with the Adult-Adolescent Parenting Index. Results indicated no program effects on maltreatment reports and most measures of potential maltreatment. Mothers who received home visits reported using mild forms of discipline less often. There was no program impact on parental risks. Home visitors were shown to often fail in addressing risks and linking families with community resources.
Length of post-intervention follow-up: 2 years.
Caldera, D., Burrell, L., Rodriguez, K., Crowne, S. S., Rohde, C., & Duggan, A. (2007). Impact of a statewide home visiting program on parenting and on child health and development. Child Abuse & Neglect, 31, 829-852.
Type of Study: Randomized controlled trial
Number of participants: 325 families.
Population:
Location/Institution: Alaska
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: This study used the same sample as Duggan, et al. (2007). Families were randomly assigned to Healthy Families or to a control group. Mothers completed interviews to determine baseline demographic and risk variables. See Duggan et al. (2007) for a list of maternal baseline measures. Child outcomes were measured using incidences of injuries requiring medical care. Child development was assessed with the Bayley Scales of Infant Development (BSID) and problem behavior was measured with the Child Behavior Checklist (CBCL) and the Nursing Child Assessment Satellite Teaching Scale. Parent outcomes at follow-up were assessed using the Knowledge of Infant Development Inventory, the Maternal Self-Efficacy Scale, the Adult-Adolescent Parenting Index, and the Infant Caregiving Inventory. In addition, disciplinary strategies were evaluated using the parent-child Conflict Tactics Scale and maternal recognition of developmental issues and linkage to medical care and other community services was evaluated. The study found no impact on child health, but home-visited children showed more favorable behavioral and developmental outcomes. Mothers in the intervention group had higher self-efficacy and provided a better environment for learning. They were also more likely to use parenting services.
Length of post-intervention follow-up: 2 years.
DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., Rodreguez, M., & Dorabawila, V. (2008). Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect. Child Abuse, 32, 295-315.
Type of Study: Randomized controlled trial
Number of participants: 1173
Population:
Location/Institution: New York State
Summary: (To include comparison groups, outcomes, measures, notable limitations) Families at risk for child abuse who were expecting their first child or with a child under three months of age were screened for inclusion using the Kempe Family Stress Checklist. Families were randomly assigned to receive the Healthy Families New York program or standard services. Participants were interviewed at baseline, 1, and 2 years. Mothers reported on parenting behaviors using the parent-child Conflict Tactics Scale (CTS-PC). Official CPS report data was also examined for the intervention period. At one year, mothers in the HFNY program reported fewer acts of very serious abuse, minor physical aggression, and psychological aggression, in the past year, as well as fewer acts of harsh parenting in the last week. At year 2, HFNY mothers reported significantly fewer acts of serious physical abuse. There was a trend toward lower levels of neglect at both times for HFNY mothers, as well, although it did not reach significance. No group differences were found for substantiated CPS reports. Further analyses showed that the results for minor physical aggression in the past year and harsh parenting in the past week were concentrated in a group of younger, first-time mothers who were assigned to the intervention at 30 weeks of pregnancy or less. The more diverse group of HFNY families did not differ from controls on these variables at two years. A subgroup HFNY women classified as "psychologically vulnerable" was also compared to the more diverse HFNY group. These women were significantly less likely to report incidents of serious abuse or neglect than controls, while there was not significant difference for other HFNY women. The authors suggest that program resources may best be allocated by concentrating them on younger and more psychologically vulnerable women and by beginning the intervention prior to the birth of the first child.
Length of post-intervention follow-up: None.
Lee, E., Mitchell-Herzfeld, S.D., Lowenfels, A. A., Greene, R., Dorabawila, V., & DuMont, K. A. (2009). Reducing low birth weight through home visitation: A randomized controlled trial. American Journal of Preventive Medicine, 36(2), 154-160.
Type of Study: Randomized controlled trial
Number of participants: 236 Program, 265 control
Location/Institution: New York.
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: This study uses the same sample as Dumont et al. (2008). Mothers in the HFNY program received home visits focused on social support, prenatal education, and links to community services. Analysis showed that mothers in the HFNY group were significantly less likely to have babies categorized as low birth weight.
Length of post-intervention follow-up: None.
References:
Daro, D., & Harding, K. A. (1999). Healthy Families America: Using research to enhance practice. The Future of Children, 9(1), 152-176.
Harding, K., Galano, J., Martin, J, Huntington, L., & Schellenbach, C. J. (2007). Healthy Families America effectiveness: A comprehensive review of outcomes. Journal of Prevention and Intervention in the Community, 34(1/2), 149-179
Contact Information
Name: Helen Reif, Director of Training
Affiliation/Agency: Healthy Families America
E-mail: hreif@preventchildabuse.org
Phone: 312-663-3520, x830
Fax Number: 312-939-8962
Website: www.healthyfamiliesamerica.org/home/index.shtml
Date review compiled: June 2009 (Originally reviewed in 2009)