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 System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

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

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

For parents/caregivers of children ages: 0 – 5

Brief Description

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).

HFA is theoretically rooted in the belief that early, nurturing relationships are the foundation for life-long, healthy development. Building upon attachment, bio-ecological systems theories, and the tenets of trauma-informed care, interactions between direct service providers and families are relationship-based; designed to promote positive parent-child relationships and healthy attachment; strengths-based; family-centered; culturally sensitive; and reflective.

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.


Program Goals:

The goals of Healthy Families America (HFA) are:

  • 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

The essential components of Healthy Families America (HFA) include:

  • The 12 Critical Elements which can be broken into three broad areas: Service initiation, service content, and staff characteristics and supervision.
    • Service Initiation
      • Initiate services prenatally or at birth:
        • All families 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.).
        • 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 with past negative experiences 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.
        • Families are supported through the Family Goal Plan (FGP, formerly called the Individual Family Support Plan [IFSP]) process, including the activities and resources home visitors provide to help parents achieve their goals and build protective factors.
        • The program’s primary goal is the promotion of consistent, nurturing parent-child interactions and attachment which can lead to the reduction of adverse childhood experiences.
        • The program promotes positive child development skills, and health and safety practices with families through the use of curriculum or other educational materials. Additionally, it is very important that materials be presented in a lower grade level of reading, typically 5th grade or lower.
        • 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, mental health services, 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.
        • The program provides depression screening at various intervals and linkage to supports as needed.
        • 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 when served at varying levels of frequency (weekly, bi-weekly, monthly, etc.)
    • Staff Characteristics
      • Select service providers based on the following:
        • 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
        • Their skills to do the job
        • Based on education or experience, they have a framework, for handling the variety of situations they may encounter when working with at-risk families
      • 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 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 3 months, 6 months, and 12 months of hire (distance learning modules and/or in person).
      • 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.

Parent/Caregiver Services

Healthy Families America [Home Visiting for Child Well-Being] (HFA) directly provides services to parents/caregivers and addresses the following:

  • 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.)
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: This program involves the family or other support systems in the individual's treatment: While the focus is on the primary caregiver and index child, HFA welcomes all interested family members in home visits, and works to engage fathers in particular. In addition, parents are linked to other services in the community as needed, as detailed under the service content section.

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 a language other than English:

Spanish

For information on which materials are available in this language, 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 local implementing 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 direct services staff (home visitors and/or 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
  • Open to reflective practice (i.e. has capacity for introspection, communicates awareness of self in relation to others, recognizes value of supervision)
  • Minimum of a high school diploma or equivalent
  • Infant Mental Health endorsement preferred

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 visiting with a strong background in prevention services to the 0-3 age population
  • Master’s degree in human services or fields related to working with children and families, or Bachelor’s degree with 3 years of relevant experience)
  • Experience with reflective practice preferred
  • Infant Mental Health endorsement 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
  • Master’s degree in public health or human services administration or fields related to working with children and families, or a Bachelor’s degree with 3 years of relevant experience

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 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 Materials

There are pre-implementation materials to measure organizational or provider readiness for Healthy Families America [Home Visiting for Child Well-Being] (HFA) as listed below:

The HFA model is supported by 12 research-based critical elements and a series of corresponding best practice standards. At the time a provider seeks to affiliate with HFA, they are required to submit an implementation plan that discusses how they intend to carry out model requirements. It is not unusual at this stage for sites to be uncertain of some areas, and a structured consultation phone call occurs to help the organization determine its level of readiness to begin implementation. Prior to implementation, HFA sites are also provided a copy of the HFA Site Development Guide.

Formal Support for Implementation

There is formal support available for implementation of Healthy Families America [Home Visiting for Child Well-Being] (HFA) as listed below:

The HFA National Office provides ongoing implementation support, including a 3-day in-person Implementation Training that focuses intensely on what is expected to deliver HFA services in accordance with the HFA Best Practice Standards. Technical assistance (provided both in-person and remotely), staff training, and periodic accreditation site visits to measure each site’s ability to implement the model with fidelity are also components of the formal implementation support offered to sites. The National Office also provides CQI guidance as needed on how to address best practice standards not in adherence. Some materials are available at the HFA website: www.healthyfamiliesamerica.org

Fidelity Measures

There are fidelity measures for Healthy Families America [Home Visiting for Child Well-Being] (HFA) as listed below:

HFA requires implementing sites to utilize the HFA Best Practice Standards and to demonstrate fidelity to the standards through periodic accreditation site visits. The HFA Best Practice Standards serve as both the guide to model implementation, as described above, and as the tool used to measure adherence to model requirements. There are 152 standards and each is coupled with a set of rating indicators to assess the site’s current degree of fidelity to the model. All HFA affiliated sites are required to complete a self-study that illustrates current site policy and practice, and an outside, objective peer review team uses this in conjunction with a multi-day site visit to determine the site’s rating (of exceeding, meeting or not yet meeting) for each standard.

Implementation Guides or Manuals

There are implementation guides or manuals for Healthy Families America [Home Visiting for Child Well-Being] (HFA) as listed below:

HFA has a Site Development Guide and State Systems Development Guide that are accessible via the HFA website. The HFA Best Practice Standards is an extensive model-specific implementation document provided to all HFA affiliated sites. HFA Site Development Guide: Comprehensive planning guide to support prospective sites and new sites. Provides expert guidance and practical tips related to community planning, organizational infrastructure, budgeting, staffing, local advocacy, etc. The HFA State Systems Development Guide provides similar guidance as the site development guide but is geared toward state leaders who want to strengthen state-level infrastructure to support HFA home visiting in their state. The HFA Best Practice Standards is the go-to document for purposes of understanding the required elements of model implementation and expectations related to all aspects of policy and practice.

Research on How to Implement the Program

Research has not been conducted on how to implement Healthy Families America [Home Visiting for Child Well-Being] (HFA).

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 program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the 10 most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The 10 articles chosen for Healthy Families America (Home Visiting for Child Well-Being) (HFA) are summarized below:

*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 — Adults: Mean=23.3-23.7 years, Children: Birth-3 years
  • Race/Ethnicity — Adults: 34% Native Hawaiian/Pacific Islander, 28% Asian/Filipino, 12% Caucasian, and 27% Other; Children: Not specified
  • Gender — Adults: Females, Children: 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)
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 postintervention 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 — Adults: Mean = 25.9-26.3 years; Children: Birth-3 years
  • Race/Ethnicity — Adults: Intervention: 32% Native Hawaiian, 22% Asian, 15% Other Pacific Islander, 6% Caucasian, and 24% Other; Control: 34% Native Hawaiian, 22% Asian, 14% Other Pacific Islander, 8% Caucasian, and 23% Other. Children: Not specified
  • Gender — Adults: 100% Male, Children: 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)
Note: This study uses data from the same study as Duggan, Fuddy, Burrell et al. (2004). 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 postintervention 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 — 14-20 years
  • Race/Ethnicity — 100% American Indian
  • Gender — 100% Females
  • Status — Participants were pregnant adolescents recruited from American Indian health service catchment areas.

Location/Institution: One Apache and Three Navajo Communities

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the short-term impact of a paraprofessional-delivered home-visiting intervention (Healthy Families America [HFA]) 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 HFA group compared with the control group had significantly higher parent knowledge scores at 2 months and 6 months postpartum. HFA 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 HFA group, most measures were a type of self-report, and the study lacked evaluators blind to the HFA group.

Length of postintervention follow-up: None.

*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 — Adults: Mean=23.4-23.7 years, Children: Birth-2 years
  • Race/Ethnicity — Adults: 22% Alaska Native, 55% Caucasian, 8% Multiracial, and 15% other, Children: Not specified
  • Gender — Adults: 100% Female, Children: 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 postintervention 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 — 22% under 18 years
  • Race/Ethnicity — 45% Black, 22% Hispanic, 30% Caucasian, and 3% Other
  • Gender — 100% 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 postintervention 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 — 16-41 years
  • Race/Ethnicity — 87% Dominican, 5% Other Latin American, 4% Puerto Rican, 2% Mexican, 2% Salvadoran, and 1% African American
  • Gender — 100% 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 postintervention follow-up: None.

*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 — Adults: Not specified, Children: Birth-9 years
  • Race/Ethnicity — Adults: 34% Native Hawaiian/Pacific Islander, 28% Filipino, 12% Caucasian, and 27% Other; Children: Not specified
  • Gender — Adults: 100% Female, Children: Not specified
  • 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)
Note: This study uses data from the same study as Duggan, Fuddy, Burrell et al. (2004). 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 postintervention follow-up: 3 years.

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 — Adults: 29.1% less than 19 years, 40.9% 19-29 years, 12% 30 years or older, Children: 2.9-3.9 years
  • Race/Ethnicity — Adults: 42% Caucasian, 39% African American, 16% Hispanic, and 3% Other. Children: Not specified
  • Gender — Adults: 100% Females, Children: 52.7% Male
  • 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)
Note: This study used data from the same study as Lee, Mitchell-Herzfeld, Lowenfels et al. (2009). 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 postintervention follow-up: None.

Rausch, J. C., McCord, M., Batista, M., & Anisfeld, E. (2012). Latino immigrant children's health: Effects of sociodemographic variables and of a preventive intervention program. International Journal of Population Research, 2012, Article ID 250276, 8 pages. doi:10.1155/2012/250276

Type of Study: Randomized controlled trial
Number of Participants: 535

Population:

  • Age — Mean=26.3 years
  • Race/Ethnicity — 88% Dominican
  • Gender — 100% Female
  • Status — Participants were participating in the Best Beginnings home prevention home visitation program.

Location/Institution: Washington Heights, New York

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study used data from the same study as Sandy, Anisfeld, & Ramirez (2009). This study examined to what extent immigrant status and other factors play a role in determining measures of their children's health and well-being, and finally to investigate whether a home visiting intervention modified any of these factors. Families were randomized to the Healthy Families America (HFA) Home Visiting program or a control group. Measures utilized include the Ages and Stages Questionnaire (ASQ), the Kempe Family Stress Inventory (KFSI), pediatric intake forms, and other standardized questionnaire forms. Results showed that prenatal participation in HFA was significantly associated with more exclusive breastfeeding postdelivery. Participation in HFA was significantly positively associated with both overall and urgent pediatric visits. By 24 months, among prenatally enrolled mothers significantly more HFA than control group mothers had primary care providers. Participation in HFA did not have a significant impact on ASQ scores at 12 months but it did by 24 months. Male infants in the HFA group performed significantly better than male infants in the control group at 24 months. Limitations include generalizability due to the limited ethnicity and gender of the subjects and the small number of health indicators investigated for immigrant children.

Length of postintervention follow-up: None – program services were on-going.

McFarlane,E., Burrell, L., Crowne, S., Cluxton-Keller, F., Fuddy, L., Leaf, P., & Duggan, A. (2013). Maternal relationship security as a moderator of home visiting impacts on maternal psychosocial functioning. Prevention Science, 14(1), 25-39.

Type of Study: Randomized controlled trial
Number of Participants: 843

Population:

  • Age — Adults: Mean age =23 years, Children: 1-9 years
  • Race/Ethnicity — Adults: 32.5% Native Hawaiian or Pacific Islander, 28% Asian or Filipino, 12% Caucasian, 27.5% Unknown; Children: Not specified
  • Gender — Adults: 100% Females, Children: Not specified
  • Status — Participants were mothers with children at risk for child maltreatment at program sites in Hawaii.

Location/Institution: Six program sites on Oahu, Hawaii

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses data from the same study as Duggan, Fuddy, Burrell, et al. (2004). The study evaluated whether and how maternal attributes, including relationship security, moderate short- and long-term home visiting impacts on maternal psychosocial functioning. Families were randomly assigned to Healthy Families America (HFA) and control groups. Measures utilized include the Attachment Style Questionnaire (ASQ), The Center for Epidemiological Studies-Depression Scale (CES-D), the Mental Health Index 5-Item Short Form (MHI-5), The Revised Conflict Tactics Scale (CTS2), the CAGE, the Addiction Severity Index (ASI), and the Parenting Stress Index-Short Form (PSI-SF). Results indicate that there was little evidence of overall positive impacts on maternal psychosocial functioning. There was a significant program impact on only one outcome indicator when children were 1–3 years old, and no significant impacts when children were 7–9 years old. Results also found that maternal relationship security did moderate short- and long-term program impacts on maternal psychosocial functioning. Limitations include issues with the use and timing of measures and small sample size for subgroup analyses.

Length of postintervention follow-up: Varies – approximately 4-6 years.

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 Research Evidence Last Reviewed by CEBC: August 2016

Date Program Content Last Reviewed by Program Staff: October 2016

Date Program Originally Loaded onto CEBC: June 2009