Healthy Families America [Home Visiting for Prevention of Child Abuse and Neglect] (HFA)

Scientific Rating:
4
Evidence Fails to Demonstrate Effect
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 Prevention of Child Abuse and Neglect] (HFA) has been rated by the CEBC in the area of: Home Visiting Programs for Prevention of Child Abuse and Neglect.

Target Population: Overburdened families who are expecting a child or have a baby younger than 3 months old and are at risk for child abuse and neglect and other adverse childhood experiences

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 Child Well-Being 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 in 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 and Program Managers 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 Prevention of Child Abuse and Neglect] (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: 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 Prevention of Child Abuse and Neglect] (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 service 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

Relevant Published, Peer-Reviewed Research

This program 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. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Note regarding Child Welfare Outcomes: Healthy Families America is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale in the Home Visiting for Child Well-Being topic area, based on the published, peer-reviewed research available for child well-being outcomes.

All of the research below has outcomes related to the Home Visiting for Prevention of Child Abuse and Neglect topic area, not the Home Visiting for Child Well-Being topic area.

Duggan, A., McFarlane, E., Fuddy, L., Burrell, L., Higman, S. M., Windham, A., & Sia, C. (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

Population:

  • Age — Children: Birth-3 years, Adults: Not specified
  • Race/Ethnicity — Children: Not specified; Adults: 32% Native Hawaiian, 23% Asian, 20% Other Pacific Islander, 7% Caucasian, and 18% other
  • Gender — Children: Not specified; Adults: 100% 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)
Families were randomly assigned to the Healthy Start Program (HSP) [now called Healthy Families America] or to a control group. Measures used included the Parent-Child Conflict Tactics Scale (CTS-PC) and 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 indicated 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. It should be noted that the study was conducted prior to implementation of HFA’s national accreditation system. Limitations include high dropout rate of initial sample and study did not show impact on child abuse and neglect.

Length of postintervention follow-up: 3 years.

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 — Children: Not specified, Adults: Not specified
  • Race/Ethnicity — Children: Not specified; Adults: 34% Native Hawaiian/Pacific Islander, 28% Asian/Filipino, 12% Caucasian, and 27% Other
  • Gender — Children: Not specified, Adults: 100% 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)
Note: This study utilizes information from Duggan, McFarlane, et al. (2004). The study assessed the impact of the Healthy Start Program (HSP) [now called 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., 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

Population:

  • Age — Children: Prenatal or Birth-2 years, Adults: Not specified
  • Race/Ethnicity — Children: Not specified, Adults: 55% Caucasian, 22% Alaska Native, 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 the Healthy Families [now called Healthy Families America] 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. Measures used included the Center for Epidemiological Studies Depression Scale (CES-D), Mental Health Index (MHI-5), CAGE scores (which ask about alcohol use), Revised Conflict Tactics Scale (CTS), and 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 and home visitors often failed to address caregiver risks and link to community resources. Limitations include biased self-reported outcome measures, too few families had services that met some of more stringent definitions, and measures that incorporated discussion of risks for abuse did not reflect the quality of discussion.

Length of postintervention follow-up: 2 years.

DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., Rodriguez, M., & Dorabawila, V. (2008). Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect. Child Abuse & Neglect, 32, 295-315.

Type of Study: Randomized controlled trial
Number of Participants: 1173

Population:

  • Age — Children: Birth to 2 years, Adults: Not specified
  • Race/Ethnicity — Children: Not specified; Adults: 35% Caucasian, 46% African American, and 19% Hispanic
  • Gender — Children: Not specified, Adults: 100% Female
  • Status — Participants were families at risk for child maltreatment.

Location/Institution: Healthy Families New York (HFNY)

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effects of Healthy Families NY, a home visiting program modeled after Healthy Families America on parenting behaviors in the first 2 years of life. Families were randomly assigned to receive the Healthy Families NY program or standard services. Participants were interviewed at baseline, 1 and 2 years follow-up. Mothers reported on parenting behaviors using the Parent-Child Conflict Tactics Scale (CTS-PC) and official CPS report data was also examined for the intervention period. At one-year follow-up, mothers in the Healthy Families NY 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, Healthy Families NY mothers reported significantly fewer acts of serious physical abuse. There was trend toward lower levels of neglect at both times for Healthy Families NY program mothers, as well, although it did not reach significance. No group differences were found for substantiated CPS reports. Limitations include generalizability due to gender, high attrition rate, and lack of follow-up.

Length of postintervention follow-up: None.

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 — Children: Prenatal or Birth-5 years, Adults: Not specified
  • Race/Ethnicity — Children: Not specified; Adults: 78% Caucasian, 17% African American, 2% Hispanic, and 3% Other
  • Gender — Children: Not specified; Adults: 86% Female and 14% Male
  • 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 postintervention assessments on all attitudinal and behavioral factors, parental attitudes, and children’s social and emotional competence. Limitations include lack of randomization, lack of control group, and lack of follow-up.

Length of postintervention 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 — Children: 2.9-3.9 years, Adults: Not specified
  • Race/Ethnicity — Children: Not specified; Adults: 42% Caucasian, 39% African American, 16% Hispanic, and 3% Other
  • Gender — Children: Not specified; Adults: 100% 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)
Note: The study used microlevel observational assessments of mother-child interactions in a three-year follow-up of the DuMont et al. (2008) study. The study evaluated the effectiveness of the Healthy Families New York [now called Healthy Families America] home visiting program in promoting parenting confidence and preventing maladaptive parenting behaviors in mothers at risk for child maltreatment. 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 NY was effective in fostering positive parenting, such as maternal responsivity and cognitive engagement. With respect to negative parenting, Healthy Families NY 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. Limitations include generalizability due to gender and high attrition rates.

Length of postintervention follow-up: 3 years.

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 — Children: Birth-9 years, Adults: Not specified
  • Race/Ethnicity — Children: Not specified; Adults: 34% Native Hawaiian/Pacific Islander, 28% Filipino, 12% Caucasian, and 27% Other
  • Gender — Children: Not specified, Adults: 100% Female
  • 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.

LeCroy, C. W., & Krysik, J. (2011). Randomized trial of the Healthy Families Arizona home visiting program. Children and Youth Services Review, 33, 1761-1766. doi:10.1016/j.childyouth.2011.04.036

Type of Study: Randomized controlled trial
Number of Participants: 195

Population:

  • Age — Mean=24 years
  • Race/Ethnicity — 60% Hispanic, 21% Caucasian, and 19% not specified
  • Gender — 100% Females
  • Status — Participants were mothers with children at risk for child maltreatment at an Arizona program site.

Location/Institution: Arizona

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of the Healthy Families Arizona [now called Healthy Families America] home visitation program for families at risk for child maltreatment. Participants were randomly assigned to a treatment or to Child Development control group. Mothers were assessed at intake, 6- and 12-month follow-ups using the Kempe Family Checklist, Revised Parent-Child Conflict Tactics Scale, Adult-Adolescent Parenting Inventory-2 (AAPI), and the Emotional/Social Loneliness Inventory. Results indicated that significant results favoring the experimental group in contrast to the control group were found on some measures in each of five domains including violent parenting behavior; parenting attitudes and practices; parenting support; mental health and coping; and maternal outcomes. Looking specifically at abusive parenting behaviors, the program found results on two of nine behaviors: shouted, yelled, or screamed at child; and slapped child's hand. Limitations include significant differences between the HFA and control groups at baseline (generally indicating the HV group was at higher risk, and addressed through statistical control), small sample size, and lack of information on service that may have been received by the control group families.

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

Green, B. L., Tarte, J. M., Harrison, P. M., Nygren, M., & Sanders, M. B. (2014). Results from a randomized trial of the Healthy Families Oregon accredited statewide program: Early program impacts on parenting. Children and Youth Services Review, 44, 288-298.

Type of Study: Randomized controlled trial
Number of Participants: 803

Population:

  • Age — Mean=24 years
  • Race/Ethnicity — 60% Hispanic, 21% Caucasian, and 19% Not Specified
  • Gender — 100% Females
  • Status — Participants were mothers with children at risk for child maltreatment at an Arizona program site.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of Healthy Families, Oregon (HFO), [now called Healthy Families America] through a telephone survey. Participants were randomly selected group of mothers to assess early outcomes at their child's 1-year birthday. Participants were randomly assigned (402 HFO and 401 control) to assess the effects of the program on service utilization and on early parenting and child risk and protective factors associated with abuse and neglect. Measures utilized include the Adult Adolescent Parenting Inventory, Corporal Punishment Subscale (AAPI-CP), the Parent–Child Activities Scale (PCAS), the Protective Factors Survey (PFS), the Parenting Stress Index — Short Form (PSI-SF), and the Pregnancy Risk Assessment Monitoring System. Results found that mothers assigned to the Healthy Families program group read more frequently to their young children, provided more developmentally supportive activities, and had less parenting stress. Children of these mothers were more likely to have received developmental screenings, and were somewhat less likely to have been identified as having a developmental challenge. Families with more baseline risk had better outcomes in some areas; however, generally there were not large differences in outcomes across a variety of subgroups of families. Limitations include that the findings may not be generalized to parents with more than one child, reliance on parent self-report data for all key outcomes, and generalizability due to gender.

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

Dew, B., & Breakey, G. F. (2014). An evaluation of Hawaii’s Healthy Start Program using child abuse hospitalization data. Journal of Family Violence, 29(8), 893-900.

Type of Study: Quasi-experimental
Number of Participants: 4,774 familes

Population:

  • Age — Children: Mean=10.6 months, Adults: Not specified
  • Race/Ethnicity — Not Specified
  • Gender — Children: Not specified, Adults: 100% Females
  • Status — Participants were mothers with children at risk for child maltreatment at an Oahu program site.

Location/Institution: Oahu, Hawaii

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The goals of this study were to (1) assess efficacy of Hawaii’s Healthy Start Program [now called Healthy Families America] program in implementation of the screening and assessment process, and (2) assess the effectiveness of the home visiting services in preventing serious abuse and neglect. Data were drawn from the Healthy Start statewide data system and from the records of Kapiolani Medical Center for Women and Children. Participants were assigned to either a high-risk group or a low-risk category. The measure utilized was the Family Stress Checklist (FSC). Results revealed hospitalization was nonrandomly distributed across service categories. Results suggest the screening and assessment procedure differentiated between parents with greater and lesser degrees of risk for being abusive or neglectful. In addition, the results support the idea that an intervention as modest in scope as Healthy Start can prevent child abuse or neglect. Limitations include looking retrospectively and only at families with a serious form of abuse or neglect and non-randomization of participants.

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

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: April 2016

Date Program Originally Loaded onto CEBC: June 2015