Home Program

Healthy Families America (HFA)

Topic Areas
Scientific Rating
Child Welfare Relevance
Home Visiting Programs for Child Well-Being
1  — Well-Supported by Research Evidence
Medium

About This Program

Target Population: Parents/caregivers (adolescents or adults who are pregnant or parenting) and their children ages 0-5 years old (with no minimum or maximum age for parents enrolled).

For children/adolescents ages: 0 – 5, 12 – 17

For parents/caregivers of children ages: 0 – 5, 12 – 17

Program Overview

HFA is a home visiting model designed to work with families, beginning prenatally or subsequent to birth, who have histories of trauma, intimate partner violence, mental health issues, substance use disorder and/or other life stressors. HFA services are offered voluntarily, intensively, and over the long-term. Additionally, and with National Office approval, HFA sites may voluntarily enroll families referred from Child Welfare/Children’s Protective Services with a child up to 24 months of age, offering services for a minimum of three years after enrollment.

HFA is theoretically rooted in the belief that early; nurturing relationships are the foundation for a healthy and productive life. Building upon attachment and 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 secure attachment; services are strengths-based; family-centered; culturally responsive; and reflective.

As of August 2022, HFA is undergoing a rating review for the topic of Home Visiting Programs for the Prevention of Child Abuse and Neglect.

Program Goals

The goals of Healthy Families America (HFA) are:

For children:

  • Improve healthy childhood growth and development
  • Increase child health and safety
  • Improve child development and school readiness

For parents:

  • Cultivate and strengthen nurturing relationship with child
  • Increase positive parenting practices
  • Prevent and reduce child maltreatment
  • Enhance family well-being by reducing risk and building protective factors
  • Improve maternal health and well-being
  • Increase economic self-sufficiency
  • Prevent and reduce family violence

Logic Model

The program representative did not provide information about a Logic Model for Healthy Families America (HFA).

Essential Components

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

  • The 12 Critical Elements:
    • Initiate services early, ideally during pregnancy
    • Sites use a validated tool (Family Resilience and Opportunities for Growth (FROG) Scale) to identify family strengths and concerns at the start of services.
    • Offer services voluntarily and use personalized, family-centered outreach efforts to build trust with families
    • Offer services intensely and over the long-term, with well-defined progress criteria and a process for increasing or decreasing frequency of service
    • Staff (managers, supervisors, and direct service staff) celebrate diversity and honor the dignity of families and colleagues by educating and encouraging self and others, continuously striving to improve relationships. Sites work with others in their organization and community to identify and address existing barriers and increase access to services, especially for underrepresented groups in the community, confronting disparities caused by institutional racism and discrimination
    • Services focus on supporting the parent(s) as well as the child by cultivating the growth of nurturing, responsive parent-child relationships and promoting healthy childhood growth and development within a caring community
      • Children are present at in-home visits.
      • Children receive periodic developmental and social-emotional screenings and suspected developmental delays are tracked, including referrals made and follow-up on referrals.
      • Parent-child relationships are assessed by working with the parent and the child together.
      • Handouts and activities are in response to child needs as well as parent needs.
    • Link all families to a medical provider to ensure optimal health and development. Depending on the family’s needs they may also be linked to additional services related to:
        • Finances
        • Food
        • Housing assistance
        • School readiness
        • Childcare
        • Job training
        • Family support
        • Substance use treatment
        • Mental health treatment
        • Domestic violence resources
    • Services are provided by staff in accordance with principles of ethical practice and with limited caseloads to ensure Family Support Specialists have an adequate amount of time to spend with each family to meet their unique and varying needs and to plan for future activities
    • Service providers are selected because of their personal characteristics, their lived expertise and knowledge of the community they serve, their ability to work with culturally diverse individuals and their knowledge and skills to do the job
    • Service providers receive intensive training specific to their role to understand the key components of family assessment, home visiting, and supervision
    • All staff receive training on topics related to diversity and equity. All direct service staff and their supervisors receive basic training in areas such as:
        • Prenatal and infant care
        • Child safety and development
        • Family health
        • Parent-child relationships
        • Family goal setting
        • Reporting child abuse
        • Managing crisis situations
        • Responding to mental health, substance use, or intimate partner violence issues
    • Service providers receive ongoing, reflective supervision so they are able to develop realistic and effective plans to strengthen families

Program Delivery

Child/Adolescent Services

Healthy Families America (HFA) directly provides services to children/adolescents and addresses the following:

  • Children 0-5 of parents who may be teen parents, have parent-child attachment and bonding issues, family life stressors, social isolation, and/or inability to access health care, concrete supports, and community services

Parent/Caregiver Services

Healthy Families America (HFA) directly provides services to parents/caregivers and addresses the following:

  • Parent-child attachment and bonding issues, family life stressors, social isolation, or inability to access health care, concrete supports, and community services
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 focus child, HFA welcomes all interested family members in home visits, and works to engage fathers and co-parents in particular. In addition, parents are linked to other services in the community as needed, as detailed under the service content section.

Recommended Intensity:

Home visits are offered weekly and last 50-60 minutes. Visit frequency is reduced over time once standardized family progress criteria are met. Once meeting the defined progress criteria, visit frequency is reduced to biweekly visits, followed by monthly visits, and quarterly visits until successful completion of services and graduation from the program. During times of crisis families may be seen more frequently.

Recommended Duration:

Services are offered for a minimum of three years and can be offered up to five years.

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

This program does not include a homework component.

Languages

Healthy Families America (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 management or tracking system
  • Cell phones
  • Program Manager
  • 1 FTE Supervisor per 5-6 FTE direct services staff
  • Travel expense reimbursement (mileage)
  • A community advisory board
  • Diversified, and sustainable funding

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Staff members are selected because of a combination of personal characteristics, experiential, and educational qualifications.

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

  • Experience working with or providing services to children and families
  • An ability to establish trusting relationships
  • Acceptance of individual differences
  • Experience and humility to work with the culturally diverse populations that are present among the program's target population
  • Knowledge of infant and child development
  • Willing to engage in building reflective capacity (i.e., has capacity for introspection, communicating 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 or experience in supervising diverse staff with humility, 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 parent-infant health and dynamics of child abuse and neglect
  • Experience in supporting culturally diverse communities and families
  • Experience in home visiting with a strong background in early childhood prevention services
  • Willingness to engage in building reflective capacity (i.e. has capacity for introspection, communicating awareness of self in relation to others, recognizes value of supervision)
  • 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 diverse staff with humility
  • Administrative experience in human service or related program(s), including experience in quality assurance and continuous quality improvement
  • 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, or less than a Bachelor’s degree but with commensurate HFA experience
  • Willingness to engage in building reflective capacity (i.e., has capacity for introspection, communicating awareness of self in relation to others, recognizes value of supervision)
  • Infant mental health endorsement preferred

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

The manual is:

  • Healthy Families America. (2018). Foundations for family support – core training manual. Author.

The manual is made available to HFA affiliate sites when their staff attend HFA model specific training.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training is provided online in a blended format of self-paced and instructor-led content.

Number of days/hours:
  • 4 days (28 hours) of Foundations training for direct service staff; 3 additional days for supervisors
  • FROG Scale Training (21 hours) for users of the FROG assessment tool

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Healthy Families America (HFA) as listed below:

The HFA model is supported by 12 research-based critical elements and a comprehensive set of corresponding best practice standards. Community service providers seeking to affiliate with HFA are required to submit an implementation plan that explains how they intend to carry out model requirements. It is not unusual at this stage for sites to be uncertain of some areas. Prospective sites are provided with a series of consultation phone or video calls to help the organization determine its level of readiness to begin implementation.

Formal Support for Implementation

There is formal support available for implementation of Healthy Families America (HFA) as listed below:

The HFA National Office assigns a Training and Technical Assistance Specialist to each local affiliate to provide ongoing implementation support. Required periodic accreditation site visits measure each site’s ability to implement the model with fidelity and are a component 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 (HFA) as listed below:

HFA requires sites to utilize the HFA Best Practice Standards and to demonstrate fidelity to the standards through an initial fidelity assessment conducted by National Office staff and 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 154 standards and each standard 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 multiday site visit to determine the site’s rating (of exceeding, meeting or not yet meeting) for each standard. Site managers are required to attend an Implementation Training that focuses intensely on model expectations in accordance with the HFA Best Practice Standards..

Fidelity Measure Requirements:

Fidelity measures are required to be used as part of program implementation.

Implementation Guides or Manuals

There are implementation guides or manuals for Healthy Families America (HFA) as listed below:

The HFA Best Practice Standards is an extensive model-specific implementation document provided to all HFA affiliated sites. The HFA Central Administration Standards provide implementation guidance for systems, generally state-level, overseeing multiple HFA affiliates within their jurisdiction. HFA also offers a virtual “Advancing HFA for Key Stakeholders” training, providing local and state-level leadership with expert guidance and practical tips related to community planning, organizational infrastructure, budgeting, staffing, local advocacy, etc. 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 and includes expectations for site governance and administration.

Implementation Cost

There have been studies of the costs of implementing Healthy Families America (HFA) which are listed below:

Washington State Institute for Public Policy. (2019). Washington State Institute for Public Policy benefit cost results: Healthy Families America. https://www.wsipp.wa.gov/BenefitCost/ProgramPdf/119/Healthy-Families-America

Research on How to Implement the Program

Research has been conducted on how to implement Healthy Families America (HFA) as listed below:

Burrell, L., Crowne, S., Ojo, K., Snead, R., O’Neill, K., Cluxton-Keller, F., & Duggan, A. (2018). Mother and home visitor emotional well-being and alignment on goals for home visiting as factors for program engagement. Maternal and Child Health Journal, 22(Suppl 1), S43–S51. https://doi.org/10.1007/s10995-018-2535-9

Huntington, L., & Galano, J. (2013). Does home visiting benefit only first-time mothers: Evidence from Healthy Families Virginia. Zero to Three, 33(3), 24–30. https://eric.ed.gov/?id=EJ1003937

Latimore, A. D., Burrell, L., Crowne, S., Ojo, K., Cluxton-Keller, F., Gustin, S., Kruse, L., Hellman, D., Scott, L., Riordan, A., & Duggan, A. (2017). Exploring multilevel factors for family engagement in home visiting across two national models. Prevention Science, 18, 577–589. https://doi.org/10.1007/s11121-017-0767-3

McKelvey, L. M., Fitzgerald, S., Connors Edge, N. A., & Whiteside-Mansell, L. (2018). Keeping our eyes on the prize: Focusing on parenting supports depressed parents’ involvement in home visiting services. Maternal and Child Health Journal, 22(Suppl 1), 33–42. https://doi.org/10.1007/s10995-018-2533-y

Stargel, L. E., Fauth, R. C., Goldberg, J. L., & Easterbrooks, M. A. (2020). Maternal engagement in a home visiting program as a function of fathers’ formal and informal participation. Prevention Science, 21, 477–486. https://doi.org/10.1007/s11121-020-01090-x

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

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 most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for Healthy Families America (HFA) are summarized below:

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(6), 597–622. https://doi.org/10.1016/j.chiabu.2003.08.007

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

Population:

  • Age — Parents: Not specified, Children: Birth–3 years
  • Race/Ethnicity — Parents: 32% Native Hawaiian, 23% Asian, 20% Other Pacific Islander, 18% Other, and 7% Caucasian; Children: Not specified
  • Gender — Parents: 100% Female, Children: Not specified
  • Status — Participants were families at risk for child maltreatment.

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

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to describe the efficacy of the Hawaii Healthy Start Program (HSP) [now called Healthy Families America (HFA)]. Participants were randomly assigned to the HSP or to a control group. Measures utilized include the Parent-Child Conflict Tactics Scale (CTS-PC) and the Home Observation for Measurement of the Environment (HOME) Inventory. Results indicate 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 controlled 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 to prevent child abuse: Impact in reducing parental risk factors. Child Abuse & Neglect, 28(6), 623–643. https://doi.org/10.1016/j.chiabu.2003.08.008

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

Population:

  • Age — Not specified
  • Race/Ethnicity — 34% Native Hawaiian/Pacific Islander, 28% Asian/Filipino, 27% Other, and 12% Caucasian
  • Gender — Parents: 100% Female; Children: Not specified
  • Status — Participants were families at risk for child maltreatment.

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

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the sample from Duggan, McFarlane, et al. (2004). The purpose of the study was to assess the impact of the Healthy Start Program (HSP) [now called Healthy Families America (HFA)] in reducing malleable parental risk factors for child abuse in families of newborns identified, through population-based screening, as at-risk of child abuse. Participants were randomly assigned to HSP or control groups. Measures utilized include the Center for Epidemiological Studies Depression Scale (CES-D), Parenting Stress Index (PSI), Conflict Tactics Scale (CTS), and the CAGE Substance Abuse Screening Tool. Results indicate 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 more than75% of visits called for in the model. Limitations include 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 controlled 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. https://doi.org/10.1177/1077559503261336

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

Population:

  • Age — Parents: Mean=25.9–26.3 years; Children: Birth–3 years
  • Race/Ethnicity — Parents-Intervention/Parents-Control: 32%/34% Native Hawaiian, 24%/23% Other, 22%/22% Asian, 15%/14% Other Pacific Islander, and 6%/8% Caucasian; 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 basic study design, measures, results, and notable limitations)
This study uses the same sample as Duggan, McFarlane, et al. (2004). The purpose of the study was to describe the efficacy of the Hawaii Healthy Start Program (HSP) [now called Healthy Families America (HFA)]. Families were randomly assigned to either the Healthy Start Program or the control group. Measures utilized include the Parent-Child Conflict Tactics Scale (CTS-PC) and the Home Observation for Measurement of the Environment (HOME) Inventory. Results indicate no program effects on accessibility, engagement in parenting activities, or sharing responsibility for the child’s welfare. HSP fathers who were nonviolent and living with the child’s mothers showed increased parenting involvement, as did HSP fathers who were violent and had little contact at baseline. Limitations include overall, the program seemed to have no impact on fathers, HSP was associated with decreased maternal satisfaction with nonviolent fathers’ engagement, and program impact might also have been diminished by the control group’s use of alternative health and family-support services.

Length of controlled postintervention follow-up: 3 years.

Barlow, A., Varipatis-Baker, E., Speakman, K., Ginsburg, G., Friberg, I., Goklish, N., Cowboy, B.; Fields, P., Hastings, R., Pan, W., Reid, R., Santosham, M., & 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(11), 1101–1107. https://doi.org/10.1001/archpedi.160.11.1101

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 basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the short-term impact of a paraprofessional-delivered home-visiting intervention [now called Healthy Families America (HFA)] among rural Navajo and Apache pregnant teens. Participants were randomly assigned to HFA or a breastfeeding education program. Measures utilized include collected information about child care knowledge, skills, and involvement. Results indicate 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, lack of standardized measures, and the study lacked evaluators blind to the HFA group.

Length of controlled postintervention follow-up: None.

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(8), 801–827. https://doi.org/10.1016/j.chiabu.2006.06.011

Type of Study: Randomized controlled trial
Number of Participants: 325

Population:

  • Age — Parents: Not specified, Children: Prenatal or Birth–2 years
  • Race/Ethnicity — Parents: 55% Caucasian, 22% Alaska Native, 15% Other, and 8% Multiracial; Children: Not specified
  • Gender — Not specified
  • Status — Participants were families at risk for child maltreatment.

Location/Institution: Healthy Families Alaska (HFAK)

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine the efficacy of the Healthy Families Alaska (HFAK) program [an affiliate of Healthy Families America (HFA)]. Participants were randomly assigned to the HFAK program or to a control group who were referred to other services. Measures utilized include the Center for Epidemiological Studies Depression Scale (CES-D), the Mental Health Index (MHI-5), the CAGE Substance Abuse Screening Tool, the Revised Conflict Tactics Scale (CTS), the Home Observation of the Environment (HOME) Inventory, and the Adult-Adolescent Parenting Index. Results indicate 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 controlled postintervention follow-up: 2 years.

Caldera, D., Burrell, L., Rodriguez, K., Crowne, S. S., Rohde, C., & Duggan, A. (2007). Impact of a statewide home visiting program on parenting and on child health and development. Child Abuse & Neglect, 31(8), 829–852. https://doi.org/10.1016/j.chiabu.2007.02.008

Type of Study: Randomized controlled trial
Number of Participants: 325

Population:

  • Age — Parents: Mean=23.4–23.7 years, Children: Birth–2 years
  • Race/Ethnicity — Parents: 55% Caucasian, 22% Alaska Native, 15% Other, and 8% Multiracial; 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 basic study design, measures, results, and notable limitations)
This study used the sample from Duggan et al. (2007). The purpose of the study was to determine the efficacy of the Healthy Families Alaska (HFAK) [an affiliate of Healthy Families America (HFA)]. Families were randomly assigned to HFAK or a control group. Measures utilized include the Center for Epidemiological Studies Depression Scale (CES-D), Mental Health Index (MHI-5), the Revised Conflict Tactics Scale (CTS), the Bayley Scales of Infant Development (BSID), the Child Behavior Checklist (CBCL), the Nursing Child Assessment Satellite Teaching Scale (NCAST), the Knowledge of Infant Development Inventory, the Maternal Self-Efficacy Scale, Adult-Adolescent Parenting Index, the Infant Caregiving Inventory, and the Parent-Child Conflict Tactics Scale (CTS-PC). Results indicate no impact on child health, but home-visited children showed more favorable behavioral and developmental outcomes. Mothers in the HFAK group had higher self-efficacy and provided a better environment for learning and were also more likely to use parenting services. Limitations include few families met the definition of adequacy incorporating both duration of enrollment and visit frequency, reliance on self-reported measures, and cannot discern whether maternal self-efficacy is a factor or consequence of reduced problem behaviors in the child.

Length of controlled 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(3), 295–315. https://doi.org/10.1016/j.chiabu.2007.07.007

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

Population:

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

Location/Institution: Healthy Families New York (HFNY)

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effects of Healthy Families NY [an affiliate of Healthy Families America (HFA)] on parenting behaviors in the first 2 years of life. Families were randomly assigned to receive the Healthy Families NY program or standard services. Measures utilized include the Parent-Child Conflict Tactics Scale (CTS-PC) and official CPS report data. Results indicate that 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 controlled postintervention follow-up: None.

Lee, E., Mitchell-Herzfeld, S. D., Lowenfels, A. A., Greene, R., Dorabawila, V., & DuMont, K. A. (2009). Reducing low birth weight through home visitation: A randomized controlled trial. American Journal of Preventive Medicine, 36(2), 154–160. https://doi.org/10.1016/j.amepre.2008.09.029

Type of Study: Randomized controlled trial
Number of Participants: 501

Population:

  • Age — Parents: 21.8% under 18 years; Children: 0–3 months
  • Race/Ethnicity — Parents: 45% Black, 30% Caucasian, 22% Hispanic, and 3% Other; Children: Not specified
  • 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 basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effects of Healthy Families NY [an affiliate of Healthy Families America (HFA)] in reducing adverse birth outcomes among socially disadvantaged pregnant women and adolescents. Participants were randomly assigned to either Healthy Families NY or to a control group. Measure utilized include birth rates from birth certificates. Results indicate that after the intervention, mothers in the Healthy Families NY group were significantly less likely to have babies categorized as low birth weight than control group mothers. Limitations include lack of standardized measures and lack of follow-up.

Length of controlled 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. https://doi.org/10.1177/0890334409337308

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% Female
  • 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 basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate the effectiveness of a Healthy Families America (HFA) model for increasing breastfeeding rates among Latina immigrants. Participants were randomly assigned to either HFA or a control group. Results indicate that exposure to the HFA 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, lack of standardized measures, possible systematic experimenter bias, and minimal follow-up.

Length of controlled 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(10), 711–723. https://doi.org/10.1016/j.chiabu.2010.03.004

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

Population:

  • Age — Parents: Not specified; Children: 2.9–3.9 years
  • Race/Ethnicity — Parents: 42% Caucasian, 39% African American, 16% Hispanic, and 3% Other; Children: Not specified
  • Gender — Parents: 100% Female; Children: Not specified
  • Status — Participants were mothers at risk for child maltreatment.

Location/Institution: Healthy Families New York sites

Summary: (To include basic study design, measures, results, and notable limitations)
This study utilized the sample from DuMont et al. (2008). The purpose of the study was to evaluate the effectiveness of the Healthy Families New York [an affiliate of Healthy Families America (HFA)] in promoting parenting confidence and preventing maladaptive parenting behaviors in mothers at risk for child maltreatment. Measures utilized include the Puzzle Problem Solving Task, the Delay of Gratification Task, and the Cleanup Task. Participants were randomly assigned to Healthy Families NY or a control group. Results indicate 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 controlled 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. https://doi.org/10.1001/archpediatrics.2009.237

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

Population:

  • Age — Parents: Not specified, Children: Birth–9 years
  • Race/Ethnicity — Parents: 34% Native Hawaiian/Pacific Islander, 28% Filipino, 27% Other, and 12% Caucasian; Children: Not specified
  • Gender — Parents: 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 basic study design, measures, results, and notable limitations)
This study used the sample from Duggan, Fuddy, Burrell, et al. (2004). The purpose of the study was to evaluate the Hawaii Healthy Start Program [now called Healthy Families America (HFA)]. Participants were randomly assigned to the Hawaii Healthy Start Program or a control group. Measures utilized include the Conflict Tactics Scale and the Mental Health Index 5-item Short Form. Results indicate that intervention group women reported consistently lower unadjusted rates of maternal victimization and perpetration across all specific intimate partner violence (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 include 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 controlled 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(10), 1761–1766. https://doi.org/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% Female
  • Status — Participants were mothers with children at risk for child maltreatment at an Arizona program site.

Location/Institution: Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate the effectiveness of the Healthy Families Arizona (HFA) [an affiliate of Healthy Families America (HFA)] home visitation program for families at risk for child maltreatment. Participants were randomly assigned to a treatment or to Child Development control group. Measures utilized include the Kempe Family Checklist, Revised Parent-Child Conflict Tactics Scale, Adult-Adolescent Parenting Inventory-2 (AAPI), and the Emotional/Social Loneliness Inventory. Results indicate 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 controlled 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, Article 250276. https://doi.org/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 high-risk mothers and their children.

Location/Institution: Washington Heights, New York

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as Sandy et al. (2009). The purpose of the study was to examine 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, Healthy Families America (HFA), modified any of these factors. Families were randomized to the HFA home visiting program or a control group. Measures utilized include the Ages and Stages Questionnaire (ASQ), and the Kempe Family Stress Inventory (KFSI). Results indicate 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 controlled postintervention follow-up: None.

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. https://doi:10.1007/s11121-012-0297-y

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

Population:

  • Age — Parents: Mean=23 years, Children: 1–9 years
  • Race/Ethnicity — Parents: 33% Native Hawaiian or Pacific Islander, 28% Asian or Filipino, 28% Unknown, and 12% Caucasian; Children: Not specified
  • Gender — Adults: 100% Female, 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 basic study design, measures, results, and notable limitations)
This study uses the same sample as Duggan, Fuddy, Burrell, et al. (2004). The purpose of the study was to evaluate whether and how maternal attributes, including relationship security, moderate short- and long-term home visiting using the Healthy Families America (HFA) program impacts on maternal psychosocial functioning. Participants were randomly assigned to 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 short- and long-term outcomes for HFA and control mothers did not differ significantly. Demographic attributes, a general measure of overall maternal risk, and partner violence did not moderate program impact on psychosocial functioning outcomes. Maternal relationship security did moderate program impact. Mothers who scored high on relationship anxiety but not on relationship avoidance showed the greatest benefits, particularly at the long-term follow-up. Mothers scoring high for both relationship anxiety and avoidance experienced some adverse consequences of home visiting. Limitations include issues with the use and timing of measures and small sample size for subgroup analyses.

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

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. https://doi.org/10.1016/j.childyouth.2014.06.006

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

Population:

  • Age — Mean=22.5 years
  • Race/Ethnicity — 62% White, 24% Hispanic, and 14% Other Race/ethnicity
  • Gender — 100% Female
  • Status — Participants were first time mothers.

Location/Institution: Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of Healthy Families, Oregon (HFO), [an affiliate of Healthy Families America (HFA)] on service utilization and on early parenting and child risk and protective factors associated with abuse and neglect. Participants were randomly assigned to either HFO or a control group. 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 indicate 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 the findings may not be generalized to parents with more than one child, reliance on parent self-report data for all key outcomes, lack of follow-up, and generalizability due to gender.

Length of controlled postintervention follow-up: None.

Green, B. L., Sanders, M. B., & Tarte, J. M. (2017). Using administrative data to evaluate the effectiveness of the Healthy Families Oregon home visiting program: 2-year impacts on child maltreatment & service utilization. Children and Youth Services Review, 75, 77–86. https://doi.org/10.1016/j.childyouth.2017.02.019

Type of Study: Randomized controlled trial
Number of Participants: 2,727

Population:

  • Age — Parents: HFO: Mean=21.9 years, Control group: Mean=22.0 years; Children: HFO: Mean=0.48 weeks, Control group: 0.59 weeks
  • Race/Ethnicity — Parents: Not specified; Children: HFO: 57% White, 27% Hispanic/Latino/a, and 16% Other race/ethnicity, Control group: 60% White, 24% Hispanic/Latino/a, and 15% Other race/ethnicity
  • Gender — Not specified
  • Status — Participants were eligible HFO parents who were first-time parents with an infant under 90 days of age and identified as “at risk.”

Location/Institution: Seven of the 35 operational Health Families Oregon programs, Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the impact of the Healthy Families Oregon (HFO) [an affiliate of Healthy Families America (HFA)] home visiting program. Participants were randomly assigned to HFO or a community services-as-usual control group. Measures utilized include the New Baby Questionnaire (NBQ) and the Public Health Questionnaire-2 (PHQ-2). Results indicate families assigned to HFO program were no more or less likely to have a substantiated child abuse report than were controls (6.3% vs. 6.0%) but were significantly more likely to have an unsubstantiated report (9.7% vs. 7.9%). Among HFO families who were reported to the child welfare system, 86.2% (94 children) were reported after they had exited the program, while 13.8% (15 children) had a report while enrolled. However, 50.5% of children with unsubstantiated reports were reported while families were receiving HFO services, suggesting a surveillance effect for unsubstantiated reports. HFO families, compared to controls, were also significantly more likely to have been enrolled in Temporary Assistance for Needy Families (TANF) services for the first time, to have received more days of Supplemental Nutrition Assistance Program (SNAP), and to be enrolled in publicly funded substance abuse treatment services. Limitations include many HFO families did not receive the primary intended service of the program, home visiting; and reliance solely on administrative outcome data.

Length of controlled postintervention follow-up: Varied from none to 1 year 6 months.

Lee, E., Kirkland, K., Miranda-Julian, C., & Greene, R. (2018). Reducing maltreatment recurrence through home visitation: A promising intervention for child welfare involved families. Child Abuse & Neglect, 86, 55–66. https://doi.org/10.1016/j.chiabu.2018.09.004

Type of Study: Randomized controlled trial
Number of Participants: 104

Population:

  • Age — Control: Mean=22.53 years, HFNY: Mean=22.37 years
  • Race/Ethnicity — Control: 47% African American non-Latina, 34% White non-Latina, and 18% Latina; HFNY: 44% African American non-Latina, 34% White non-Latina, and 18% Latina
  • Gender — 100% Female
  • Status — Participants were mothers who had at least one substantiated child protective services (CPS) report.

Location/Institution: New York

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the sample from DuMont et al. (2008). The purpose of the study was to evaluate the effectiveness of Healthy Families New York (HFNY), [an affiliate of Healthy Families America (HFA)]. Participants were randomly assigned to either HFNY or a control group. Measures utilized include the Kempe Family Stress Inventory (KFSI), the Center for Epidemiologic Studies Depression Scale (CES-D), the Parent-Child Relationship Inventory (PCRI), the Adult Adolescent Parenting Inventory (AAPI), and administrative information from the New York Statewide Central Register of Child Abuse and Neglect. Results indicate by the child’s seventh birthday, mothers in the home-visited group were half as likely as mothers in the control group to be confirmed subjects for physical abuse or neglect. The number of substantiated reports for mothers in the control group was twice as high as for those in the home-visited group. Group differences were only observed after the child's third birthday. Results indicate that home-visited mothers had fewer subsequent births that may have contributed to less parenting stress and improved life course development for mothers. Limitations include small sample size, the study is limited to one region of the United States and one home visiting model, reliance on parent self-report data for all key outcomes, and generalizability due to gender.

Length of controlled postintervention follow-up: None.

Easterbrooks , M. A., Kotake, C., & Fauth, R. (2019). Recurrence of maltreatment after newborn home visiting: A randomized controlled trial. American Journal of Public Health, 109(5), 729–735. https://doi.org/10.2105/AJPH.2019.304957

Type of Study: Randomized controlled trial
Number of Participants: 688

Population:

  • Age — 16-20 years
  • Race/Ethnicity — 37% Non-white Hispanic, 36% Hispanic, 19% Non-white Black, and 8% Other non-Hispanic
  • Gender — 100% Female
  • Status — Participants were mothers who had at least one substantiated child protective services (CPS) report.

Location/Institution: Massachusetts

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate whether Healthy Families Massachusetts (HFM), [an affiliate of Healthy Families America (HFA)] reduced recurrence of child maltreatment in child protective (CPS) reports for primiparous (first-time) adolescent mothers. Participants were randomly assigned to either HFM or a control group. Measures utilized include administrative data from the Massachusetts CPS agency, the Department for Children and Families. Results indicate of the 52% of families who experienced initial CPS reports, 53% experienced additional CPS reports. Children of mothers in the home visiting group were less likely to receive a second report and had a longer period of time between initial and second reports. Limitations include proportion of mothers randomly assigned to the program group who failed to engage in the evaluation was greater than the proportion of mothers in the control group, reliance on parent self-report data for all key outcomes, and generalizability due to gender.

Length of controlled postintervention follow-up: None.

Green, B., Sanders, M. B., & Tarte, J. M. (2020). Effects of home visiting program implementation on preventive health care access and utilization: Results from a randomized trial of Healthy Families Oregon. Prevention Science, 21, 15–24. https://doi.org/10.1007/s11121-018-0964-8

Type of Study: Randomized controlled trial
Number of Participants: 2,727

Population:

  • Age — Not specified
  • Race/Ethnicity — 62% White, 27% Hispanic; 7% Multi-racial, 2% Asian/Pacific Islander, 1% Alaska Native/American Indian, and 1% African American
  • Gender — 100% Female
  • Status — Participants were first-time parents who were at high risk enrolled either prenatally or within 90 days of child’s birth.

Location/Institution: Seven of the 35 operational Health Families Oregon programs, Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the sample from Green et al. (2017). The purpose of the study was to examine program impacts on families’ use of preventive health care services. Participants were randomly assigned to Healthy Families Oregon (HFO) or a control group. Measures utilized include the New Baby Questionnaire (NBQ) and the Public Health Questionnaire-2 (PHQ-2). Results indicate that while there were no significant differences in health care access or utilization in the intent-to-treat models, positive outcomes were found when propensity score matching was used to limit the program sample to those who actually received services. Further, within the program group, children who were enrolled for longer had fewer gaps in health insurance coverage and received more well-baby visits and immunizations compared to those with less service. Limitations include the ability to detect program effects was compromised by the large proportion of families who were randomized into the HFO group but who never received a first home visit, the work of following-up with randomized families fell to programs, and families who moved out of state were lost to the sample.

Length of controlled postintervention follow-up: Varied.

Kirkland, K., Lee, E., Smith, C., & Greene, R. (2020). Sustained impact on parenting practices: year 7 findings from the Healthy Families New York randomized controlled trial. Prevention Science, 21, 498–507. https://doi.org/10.1007/s11121-020-01110-w

Type of Study: Randomized controlled trial
Number of Participants: 942 Mothers and 800 Children

Population:

  • Age — Parents: Control: Mean=22.63 years, HFNY: Mean=22.22 years; Children: Not specified
  • Race/Ethnicity — Mothers: Control/HFNY: 49%/47% African American non-Latina, 35%/35% White non-Latina, and 15%/16% Latina; Children: Control/HFNY: 50%/48% African American non-Latina, 34%/34% White non-Latina, and 14%/16% Latina
  • Gender — Parents: Control: 100% Female, HFNY: 100% Female; Children: Control: 50% Female, HFNY: 45% Female
  • Status — Participants were new or expectant mothers who met HFNY eligibility.

Location/Institution: Upstate New York

Summary: (To include basic study design, measures, results, and notable limitations)
This study used a subsample from DuMont et al. (2008). The purpose of the study was to examine whether Healthy Families New York (HFNY) [an affiliate of Healthy Families America (HFA)] participation predicts lower rates of harsh and abusive parenting 7 years after enrollment. Participants were randomly assigned to either HFNY or a control group. Measures utilized include the Center for Epidemiologic Studies Depression Scale (CES-D), the Kempe Family Stress Inventory (KFSI), the revised Conflict Tactics Scales: Parent-Child version (CTS-PC), the Conflict Tactics Scale-Picture Card Version (CTS-PCV), and state administrative child welfare databases. Results indicate at the 7-year follow-up, maternal-reported behaviors measured by CTS-PC showed a significantly increased use of positive parenting strategies and lower levels of serious physical abuse in the HFNY group compared with the control group. Significant group differences were observed for the frequency with which mothers engaged in severe or very severe physical assault. In addition, fewer children reported that their parents used minor physical assault. There was no intervention impact on indicated child protective service records. Limitations include reported measurement limitations for the CTS-PC, maternal report of CTS-PC was only collected from mothers who had custody of the target child at the time of year 7 interview, and study was not able to identify the specific program elements associated with HFNY’s sustained impact on maternal parenting behaviors.

Length of controlled postintervention follow-up: Approximately 6.5 years.

LeCroy, C. W., & Lopez, D. (2020). A randomized controlled trial of healthy families: 6-month and 1-year follow-up. Prevention Science, 21, 25–35. https://doi.org/10.1007/s11121-018-0931-4

Type of Study: Randomized controlled trial
Number of Participants: 245

Population:

  • Age — Mean=26 years
  • Race/Ethnicity — 66% Hispanic American; 15% Mixed Race, 11% White, 4% African American, and 4% Other
  • Gender — 100% Female
  • Status — Participants were recruited by research staff from local hospitals following the standard protocol for program engagement in Healthy Families.

Location/Institution: Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the Healthy Families Arizona (Healthy Families) [an affiliate of Healthy Families America (HFA)] home visitation program. Participants were randomly assigned to either a home visitation treatment group with regular home visits (Healthy Families) or a control group. Measures utilized include the Healthy Families Parenting Inventory (HFPI), the Rand Mental Health Inventory, the Adult Hope Scale, and the Social Loneliness subscale. Results indicate significant differences between the groups at both 6-month and 1-year follow-up assessments on use of resources, mobilizing resources, home environment, subsequent pregnancy, positive affect, and problem solving favoring the Healthy Families group. A significant difference was also found between the groups on total violence measured at the 1-year follow-up favoring the Healthy Families group. A qualitative linguistic inquiry and word count analysis was conducted of parent’s descriptions of their children and their parenting experiences. Results again revealed significant differences between the groups in narrative descriptions that favored the Healthy Families group. Limitations include small numbers of participants, considerable loss of participants at follow-up, and reliance primarily on parent self-reports.

Length of controlled postintervention follow-up: Varies up to 6 months.

Additional References

Daro, D., & Harding, K. A. (1999). Healthy Families America: Using research to enhance practice. The Future of Children, 9(1), 152–176. https://doi.org/10.2307/1602726

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. https://doi.org/10.1300/J005v34n01_08

Kirkland, K. (2013). Effectiveness of home visiting as a strategy for promoting children’s adjustment to school. Zero to Three, 33(3), 31–38. https://eric.ed.gov/?id=EJ1003938

Contact Information

Kathleen Strader, MSW, IMH-E® (IV)
Title: Chief Program Officer
Agency/Affiliation: Prevent Child Abuse America
Website: www.healthyfamiliesamerica.org
Email:
Phone: (248) 988-8990

Date Research Evidence Last Reviewed by CEBC: April 2021

Date Program Content Last Reviewed by Program Staff: October 2021

Date Program Originally Loaded onto CEBC: June 2015