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Healthy Families America (Home Visiting for Child Well-Being) (HFA)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
Medium

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The Healthy Families America (Home Visiting for Child Well-Being) (HFA) program has been rated by the CEBC in the area of: Home Visiting for Child Well-Being.

  • Types of Maltreatment: Does not target any specific kind of maltreatment
  • Target Population: Overburdened families who are at-risk for child abuse and neglect and other adverse childhood experiences. Families are determined eligible for services once they are screened and/or assessed for the presence of factors that could contribute to increased risk for child maltreatment or other poor childhood outcomes, (e.g., social isolation, substance abuse, mental illness, parental history of abuse in childhood, etc.). Home visiting services must be initiated either prenatally or within three months after the birth of the baby.

Healthy Families America (HFA) has been rated by the CEBC in both Home Visiting topic areas. Please click here to see the HFA entry and rating in the Home Visiting for Prevention of Child Abuse and Neglect topic area.

HFA is a home visiting program model designed to work with overburdened families who are at-risk for child abuse and neglect and other adverse childhood experiences. It is designed to work with families who may have histories of trauma, intimate partner violence, mental health issues, and/or substance abuse issues. HFA services are offered voluntarily, intensively, and over the long-term (3 to 5 years after the birth of the baby).

The HFA model is based upon 12 Critical Elements. These Critical Elements are operationalized through a series of standards that provide a solid structure for quality, yet offer programs the flexibility to design services specifically to meet the unique needs of families and communities.

HFA’s Vision: All children receive nurturing care from their family essential to leading a healthy and productive life.

HFA’s Mission: To promote child well-being and prevent the abuse and neglect of our nation’s children through home visiting services.

HFA Program Goals:

  • Build and sustain community partnerships to systematically engage overburdened families in home visiting services prenatally or at birth.
  • Cultivate and strengthen nurturing parent-child relationships.
  • Promote healthy childhood growth and development.
  • Enhance family functioning by reducing risk and building protective factors.

Essential Components

HFA’s 12 Critical Elements make up the essential components of the HFA Model. They can be broken into three broad areas: Service initiation, service content, and staff characteristics and supervision.

Service Initiation

  • Initiate services prenatally or at birth.
    • The screening and assessment should occur within two weeks after the birth of the baby.
    • The first home visit should occur within three months after the birth of the baby – preferably prenatally.
  • Administer a standardized (i.e., in a consistent way for all families) assessment
    • The Parent Survey (formerly the Kempe Family Stress Checklist) is conducted to identify the family strengths as well as family history and/or issues related to higher risk of child maltreatment and/or poor childhood outcomes.
    • HFA staff must be well-trained in how to administer and score the assessment.
  • Offer services voluntarily and use positive outreach efforts to build family trust.
    • Services must be voluntary.
    • Program staff must identify positive ways to establish a relationship with a family and keep families interested and connected over time because many participants are often reluctant to engage in services and may have difficulty building trusting relationships.

Service Content

  • Offer services intensively with well-defined criteria for increasing or decreasing frequency of service and over the long-term.
    • Services should be offered AT LEAST WEEKLY during the 1st six months after the birth of the baby.
    • The family’s progress is used for determining service intensity – as the family’s confidence and self-sufficiency increases, the frequency of visits decrease.
    • HFA offers services for a minimum of three years and up to five years after the birth of the baby.
  • Provide services that are culturally sensitive.
    • Ethnic, racial, language, demographic, and other cultural characteristics identified by the program must be taken into account in overseeing staff-family interactions.
    • Staff receives training designed to increase understanding and sensitivity of the unique characteristics of the service population.
    • The program analyzes the extent to which all aspects of its service delivery system (assessment, home visitation, and supervision) are culturally sensitive.
  • Provide services that focus on supporting the parent as well as supporting parent-child interaction and child development.
    • Home visiting staff discuss and review, in supervision and with families, issues identified in the initial assessment during the course of home visiting services.
    • Program services to families are guided by the Individual Family Support Plan (IFSP).
    • The program promotes positive parent-child interaction, child development skills, and health and safety practices with families through the use of curriculum or other educational materials.
    • The program monitors the development of participating infants and children with a standardized developmental screening, tracks children who are suspected of having a developmental delay, and follows through with appropriate referrals and follow-up.
  • Link all families to a medical provider to assure optimal health and development (e.g., timely immunizations, well-child care, etc.) Depending on the family's needs, they may also be linked to additional services such as financial, food, and housing assistance programs, school readiness programs, child care, job training programs, family support centers, substance abuse treatment programs, and domestic violence shelters.
    • Participating Target Children are linked to a medical/health care provider
    • The program ensures immunizations are up-to-date for target children and provides information, referrals, and linkages to available health care resources for all participating family members.
    • Families are connected to additional services in the community.
  • Limit staff caseloads
    • No more than 15 families who are currently being seen weekly
    • No more than 25 families per caseload

Staff Characteristics

  • Select service providers based on their personal characteristics (i.e., non-judgmental, compassionate, ability to establish a trusting relationship, etc.), their willingness to work in or their experience working with culturally diverse communities, and their skills to do the job. Service providers have a framework, based on education or experience, for handling the variety of situations they may encounter when working with at-risk families.
  • Provide basic training for service providers in areas such as cultural competency, substance abuse, reporting child abuse, domestic violence, drug-exposed infants, and services in their community.
    • All staff must receive Orientation training prior to working with families.
    • All staff must receive training in Wraparound topics within 6 months and 12 months of hire (distance learning modules and/or in person).
  • Provide intensive training to Service providers specific to their role.
    • All staff must receive in-person Core Training in either Parent Survey (Assessment) or Integrated Strategies (Home Visitors) within six months of hire.
    • Supervisors also receive in-person training based on the track (assessment or home visiting) they supervise and administrative, clinical, and reflective practice training within six months of hire.
  • Provide ongoing, effective, accountable, clinical, and reflective supervision to all service providers.
    • Direct service providers must receive weekly, individualized supervision.
    • Full-time supervisors are to have 6 or fewer direct services staff.
    • Direct service staff must receive skill development and professional support and be held accountable for the quality of their work.
    • Supervisors and Program Managers are also held accountable for the quality of their work and provided with skill development and professional support.

Additionally, it is very important that materials be presented in a lower grade level of reading, typically 5th grade or lower.

Child Component

Healthy Families America (Home Visiting for Child Well-Being) (HFA) was not designed with a child component.

Parent / Caregiver Component

Healthy Families America (Home Visiting for Child Well-Being) (HFA) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

  • Expectant or new parents screened and/or assessed as moderate to high risk for child maltreatment and/or poor early childhood outcomes (e.g., mental health issues, domestic violence, substance abuse, poverty, housing, lack of education, lack of social support, etc.).
Treatment Involves Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Children develop within the context of a relationship.  Relationship-based early intervention focuses on strengthening the parent (or caregiver)-child relationship. HFA takes advantage of teachable moments in order to encourage the healthy parent-child relationship.  There are three key aspects in building a relationship that must be present to grow a mentally and emotionally healthy child.  Parents or caregivers must touch the child, have eye contact, and give quality time to the child. Children must experience, regulate and express emotions, to form close and secure interpersonal relationships, and to explore his or her environment and learn. The end result is forms a strong attachment to the parent or caregiver. It is critical that early caregivers know how to promote healthy social and emotional well-being through nurturing and consistent relationships.

Group Format

Healthy Families America (Home Visiting for Child Well-Being) (HFA) was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Delivery Setting

This program is typically conducted in a(n):

  • Birth Family Home

Homework

This program does not include a homework component.

Languages

Healthy Families America (Home Visiting for Child Well-Being) (HFA) has materials available in languages other than English:

Chinese, Japanese, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • A host agency or a collaboration of host agencies that provide office space with confidentiality related to participant files/records
  • Computer and email
  • Data or tracking system
  • Cell phones
  • Program Manager
  • 1 FTE Supervisor per 5-6 FTE home visitors
  • 1 FTE Supervisor per 5-6 FTE assessment staff
  • Travel expense reimbursement (mileage) for home visitors
  • A community advisory board
  • Diversified, and sustainable funding.

Minimum Provider Qualifications

Program staff is selected because of a combination of personal characteristics, experiential, and educational qualifications.

Direct Service Staff should have qualifications including, but not limited to:

  • Experience in working with or providing services to children and families.
  • An ability to establish trusting relationships.
  • Acceptance of individual differences.
  • Experience and willingness to work with the culturally diverse populations that are present among the program’s target population.
  • Knowledge of infant and child development.

Supervisors should have qualifications including, but not limited to:

  • A solid understanding of and experience in supervising and motivating staff, as well as providing support to staff in stressful work environments.
  • Knowledge of infant and child development and parent-child attachment.
  • Experience with family services that embrace the concepts of family-centered and strength-based service provision.
  • Knowledge of maternal-infant health and dynamics of child abuse and neglect.
  • Experience in providing services to culturally diverse communities/families.
  • Experience in home visitation with a strong background in prevention services to the 0-3 age population.
  • Bachelor’s degree in human services or related field required (Master’s degree preferred).

Program managers should have qualifications including, but not limited to:

  • A solid understanding of and experience in managing staff.
  • Administrative experience in human service or related program(s), including experience in quality assurance/improvement and program development.
  • A bachelor’s degree in human services administration or related field required (Master’s degree preferred).

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training is provided in person either in state or regionally

Number of days/hours:

4 full days for direct service staff, 5 days for supervisors. Two tracks: Parent Survey (assessment) and Integrated Strategies (home visiting). Three day advanced clinical and reflective practice training for Supervisors.

Implementation Information

Since Healthy Families America (Home Visiting for Child Well-Being) (HFA) is highly rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Assessments

To be given to organizations or providers in order to measure organizational or individual readiness:

There are currently no pre-implementation assessments.

Implementation Tools — for the program (e.g., implementation guides or manuals)

The implementation tools that are available are the HFA Site Development Guide and HFA Self-Assessment Tool – Best Practice Standards for Accreditation. 

Fidelity Measures

The HFA Self-Assessment Tool – Best Practice Standards for Accreditation is available.

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Duggan, A., Fuddy, L., Burrell, L., Higman, S., McFarlane, E., Windham, A., & Sia, C. (2004). Randomized trial of a statewide home visiting program: Impact in reducing parental risk factors. Child Abuse & Neglect, 28, 623-643.

Type of Study: Randomized controlled trial
Number of Participants: 643

Population:

  • Age range — Families with children aged birth to 9 years
  • Race/Ethnicity — 34% Native Hawaiian/Pacific Islander, 28% Asian/Filipino, 12% Caucasian, and 27% Other
  • Gender — Females
  • Status — Participants were families at risk for child maltreatment.

Location / Institution: Three regional community agencies on Oahu, Hawaii

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study assessed the impact of the Healthy Start Program (HSP) (a former version of Healthy Families America) in reducing malleable parental risk factors for child abuse in families of newborns identified, through population-based screening, as at-risk of child abuse. Measures used included the Center for Epidemiological Studies Depression Scale (CES-D), Parenting Stress Index (PSI), Conflict Tactics Scale (CTS), and CAGE questions (which ask about alcohol use). Results indicated that malleable parental risks for child abuse were common at baseline. There was no significant overall program effect on any risk or on at-risk mothers’ desire for and use of community services to address risks. There was a significant reduction in one measure of poor mental health at one agency and a significant reduction in maternal problem alcohol use and repeated incidents of physical partner violence for families receiving ≥75% of visits called for in the model. Limitations included home visitors often failed to recognize parental risks and seldom linked families with community resources, and HSP training programs were under-developed in preparing staff to address risks and to link families with community resources. Overall, the home visiting program did not reduce major risk factors for child abuse that made families eligible for service.

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

Population:

  • Age range — Families with children aged birth to 3 years
  • Race/Ethnicity — 32% Native Hawaiian, 23% Asian, 20% Other Pacific Islander, 7% Caucasian, and 18% Other
  • Gender — Not Specified
  • Status — Participants were families at risk for child maltreatment.

Location / Institution: Three regional community agencies on Oahu, Hawaii

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Families were randomly assigned to either the Healthy Start Program (HSP) (same as Healthy Families America) or the control group. Data were collected through interviews with mothers, HSP record reviews, and surveys of home visitors. Data concerning fathers included fathers’ participation in home visits and factors influencing their participation, role in parenting as identified by maternal reports, accessibility, responsibility, and 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 mothers 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.

Barlow, A., Varipatis-Baker, E., Speakman, K., Ginsburg, G., Friberg, I., Goklish, N., … & Walkup, J. (2006). Home-Visiting Intervention to Improve Child Care Among American Indian Adolescent Mothers: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 160, 1101-1107.

Type of Study: Randomized controlled trial
Number of Participants: 53

Population:

  • Age range — 14 to 20 years
  • Race/Ethnicity — American Indian
  • Gender — Females
  • Status — Participants were pregnant adolescents recruited from American Indian health service catchment areas.

Location / Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the short-term impact of a paraprofessional-delivered home-visiting intervention among rural Navajo and Apache pregnant teens. Main outcome measures included child care knowledge, skills, and involvement. Participants assigned to the control arm were scheduled to receive home visits covering breastfeeding lessons. Data collected included child care knowledge and skills test scores and maternal self-reports at baseline, 2 months, and 6 months postpartum. Results indicated that mothers in the intervention compared with the control group had significantly higher parent knowledge scores at 2 months and 6 months postpartum. Intervention group mothers scored significantly higher on maternal involvement scales at 2 months postpartum and scores approached significance at 6 months postpartum. No between-group differences were found for child care skills. Limitations included the inability to study teen mothers’ child care capacity, a notable number of dropouts particularly in the intervention arm, most measures were a type of self-report, and the study lacked evaluators blind to the intervention group.

Length of post-intervention follow-up: 6 months postpartum.

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

Population:

  • Age range — Families with children aged birth to 2 years
  • Race/Ethnicity — 22% Alaska Native, 55% Caucasian, 8% Multiracial, and 15% Other
  • Gender — Not Specified
  • Status — Participants were families at risk for child maltreatment.

Location / Institution: Healthy Families Alaska (HFAK)

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Families were randomly assigned to Healthy Families or to a control group. Mothers completed interviews to determine baseline demographic and risk variables; measures used included the Center for Epidemiological Studies Depression Scale (CES-D), Mental Health Index (MHI-5), CAGE scores (which ask about alcohol use), and the Revised Conflict Tactics Scale (CTS). Child outcomes were measured using incidences of injuries requiring medical care. Children were assessed using the Bayley Scales of Infant Development (BSID), Child Behavior Checklist (CBCL), and the Nursing Child Assessment Satellite Teaching Scale (NCAST). Parent outcomes at follow-up were assessed using the Knowledge of Infant Development Inventory, the Maternal Self-Efficacy Scale, Adult-Adolescent Parenting Index, Infant Caregiving Inventory, Parent-Child Conflict Tactics Scale (CTS-PC), 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 and were also more likely to use parenting services.

Length of post-intervention follow-up: 2 years.

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: 501

Population:

  • Age range — 22% of mothers under 18 years
  • Race/Ethnicity — 45% Black, 22% Hispanic, 30% Caucasian, and 3% Other
  • Gender — Females
  • Status — Participants were pregnant women and adolescents and their infants 3 months of age or younger at high risk for low birth weight and infant mortality.

Location / Institution: Healthy Families New York (HFNY)

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Mothers in the Healthy Families NY program received home visits focused on social support, prenatal education, and links to community services. Analysis showed that after the intervention, mothers in the Healthy Families group were significantly less likely to have babies categorized as low birth weight than control group mothers.

Length of post-intervention follow-up: None.

Sandy, J. M., Anisfeld, E., & Ramirez, E. (2009). Effects of a prenatal intervention on breastfeeding initiation rates in a Latina immigrant sample.  Journal of Human Lactation, 25(4), 404-411.

Type of Study: Randomized controlled trial
Number of Participants: 238

Population:

  • Age range — 16 to 41 years
  • Race/Ethnicity — 87% Dominican, 5% Other Latin American, 4% Puerto Rican, 2% Mexican, 2% Salvadoran, and 1% African American
  • Gender — Females
  • Status — Participants were mothers who participated in the Best Beginnings program for breastfeeding support.

Location / Institution: Washington Heights, New York City, NY

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of the present study was to evaluate the effectiveness of a prenatal health education intervention aimed at increasing breastfeeding rates in an urban, low-income, predominantly Dominican immigrant sample. Program group families received services based on the Healthy Families America model along with certain enhancements to promote breastfeeding. Family support workers visited program group families on a weekly basis while mothers were pregnant. Results indicated that exposure to the intervention did not affect mother report of any breastfeeding (ABF) during the first week postpartum, but it did affect mother report of exclusive breastfeeding (EBF). Consistent with findings from numerous prior studies, breastfeeding outcomes in the present study were significantly positively associated with a measure of household income (ABF and EBF) and significantly negatively associated with maternal acculturation level (ABF). Limitations included the lack of double blinding and possible systematic experimenter bias, and minimal follow-up.

Length of post-intervention follow-up: Up to 1 week postpartum.

Bair-Merritt, M. H., Jennings, J. M., Chen, R., Burrell, L., McFarlane, E., Fuddy, F., & Duggan, A. K. (2010). Reducing maternal intimate partner violence after the birth of a child: A randomized controlled trial of the Hawaii Healthy Start home visitation program. Archives of Pediatrics & Adolescent Medicine, 164(1), 16-23.

Type of Study: Randomized controlled trial
Number of Participants: 643

Population:

  • Age range — Families with children aged birth to 9 years
  • Race/Ethnicity — 34% Native Hawaiian/Pacific Islander, 28% Filipino, 12% Caucasian, and 27% Other
  • Gender — Females
  • Status — Participants were families with an infant at high risk for maltreatment.

Location / Institution: Three regional community agencies on Oahu, Hawaii

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Using data collected to evaluate the Hawaii Healthy Start Program (same as Healthy Families America), the study estimated over two 3-year intervals (during program implementation and over long-term follow-up) whether home visitation beginning after the birth of a child was associated with changes in (1) average rates of mothers’ IPV victimization and perpetration and (2) rates of specific IPV types (physical assault, verbal abuse, sexual assault, and injury). Caregivers in the intervention and control groups participated in interviews at baseline following the child’s birth and at follow-up when the child was 1 to 3 years of age and then annually when the child was 7 to 9 years of age. Measures used included the Conflict Tactics Scale and the Mental Health Index 5-item short form. Results indicated that intervention group women reported consistently lower unadjusted rates of maternal victimization and perpetration across all specific IPV types compared with control women. There was a general decline in overall rates of IPV over time for both groups. However, when the children were 7 to 9 years of age, the intervention group did not report significantly lower rates of IPV victimization or perpetration than the control group. Verbal abuse may have increased for the intervention group. Limitations included minimal actual IPV program content, Healthy Start Program home visitors struggled to maintain visit frequency and retain families, and women self-reported their own and their partner’s IPV.

Length of post-intervention follow-up: 3 years.

Cullen, J. P., Ownbey, J. B., & Ownbey, M. A. (2010). The effects of the Healthy Families America Home Visitation Program on parenting attitudes and practices and child social and emotional competence. Child & Adolescent Social Work Journal, 27, 335-354.

Type of Study: One group pretest-posttest design
Number of Participants: 64

Population:

  • Age range — Families with children aged birth to 5 years
  • Race/Ethnicity — 78% Caucasian, 17% African American, 2% Hispanic, and 3% Other
  • Gender — 14% Male, 86% Female
  • Status — Participants were under-resourced families at risk for child maltreatment who were referred from human service organizations.

Location / Institution: Healthy Families in rural Western North Carolina

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of the Healthy Families America program in a rural setting for families at risk for maltreatment. Intervention length ranged from 2.5 to 5 years for families. Measures used included the Kempe Family Stress Inventory (KFSI), Adult-Adolescent Parenting Inventory-Revised (AAPI-R, AAPI-2), and the Ages and Stages Questionnaire Social-Emotional (ASQ-SE) completed by the parent every 1 to 3 weeks. Results indicated that highly significant positive changes were noted between pre and post-intervention assessments on all attitudinal and behavioral factors, parental attitudes, and children’s social and emotional competence. Limitations included lack of a control group or random assignment. While the intervention length was extensive, the study did not provide an actual follow up.

Length of post-intervention follow-up: None.

Rodriguez, M. L., Dumont, K., Mitchell-Herzfeld, S. D., Walden, N. J., & Greene, R. (2010). Effects of Healthy Families New York on the promotion of maternal parenting competencies and the prevention of harsh parenting. Child Abuse & Neglect, 34, 711-723.

Type of Study: Randomized controlled trial
Number of Participants: 522

Population:

  • Age range — Families with children aged 2.9 to 3.9 years
  • Race/Ethnicity — 42% Caucasian, 39% African American, 16% Hispanic, and 3% Other
  • Gender — Females
  • Status — Participants were mothers at risk for child maltreatment.

Location / Institution: Healthy Families New York sites

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of the Healthy Families New York home visiting program in promoting parenting confidence and preventing maladaptive parenting behaviors in mothers at risk for child maltreatment. The study used microlevel observational assessments of mother-child interactions in the third wave of a randomized controlled trial (DuMont et al. 2008). Participants were randomly assigned during pregnancy or shortly after the birth of the target child to an intervention group that was offered home visiting services or a control group that was given referrals to other services. Results indicated that Healthy Families was effective in fostering positive parenting, such as maternal responsivity and cognitive engagement. With respect to negative parenting, Healthy Families mothers in the High Prevention Opportunity subgroup were less likely than their counterparts in the control group to use harsh parenting, while no differences were detected for the Limited Prevention Opportunity subgroup. The major study limitation was lack of follow-up.

Length of post-intervention follow-up: None.

Whipple, E. E. & Whyte, J. D. (2010). Evaluation of a Healthy Families America (HFA) programme: A deeper understanding. British Journal of Social Work, 40, 407-425.

Type of Study: One group pretest-posttest design
Number of Participants: 163

Population:

  • Age range — 15 to 50 years
  • Race/Ethnicity — 48% Caucasian, 27% African American, 7% Hispanic, 10% Multiracial, and 8% Other
  • Gender — Not Specified
  • Status — Participants were families at risk for child maltreatment and their Family Support Workers (FSWs) employed by the local government health department.

Location / Institution: Mid-western U.S. county

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of HFA in meeting its goals and to better understand the role of therapeutic alliance. Measures included the Infant/Toddler and Early Childhood (HOME) Inventory, Working Alliance Inventory (WAI), and Ages and Stages Questionnaire (ASQ). Results indicated that families demonstrated positive health and child development-related outcomes and improved in their ability to provide a positive home environment; children successfully met developmental milestones; and home visitors were highly effective in engaging families and creating a working alliance. Limitations include the lack of a control group and that data is only reported on outcome measures for the first year of program involvement due to compromised sample size in later time frames.

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.

Galano, J., Credle, W., & Perry, D. (2001). Developing and sustaining a successful community prevention initiative: The Hampton Healthy Families Partnership. Journal of Primary Prevention, 21(4), 495-509.

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: Cydney M. Wessel, MSW
Agency/Affiliation: Healthy Families America at Prevent Child Abuse America
Website: www.healthyfamiliesamerica.org
Email:
Phone: (312) 218-7414

Date Reviewed: April 2011 (originally reviewed in June 2009)