A home visiting program designed to work with families who may have histories of trauma, intimate partner violence, mental health issues and/or substance abuse issues.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
Healthy Families America (HFA) is a program designed to promote child wellbeing and prevent the abuse and neglect of children through home visiting services. HFA works with families with histories of trauma, intimate partner violence, mental health issues and/or substance abuse issues. Services are offered voluntarily and intensively over 3 to 5 years after the birth of the baby's birth. HFA sites may voluntarily enrol families with a child up to age 2 referred from Child Welfare or Children’s Protective Services, offering services for a minimum of 3 years subsequent to enrolment.
Aims
- Build early, nurturing relationships for lifelong, healthy development
- Promote positive parent-child relationships
- Promote healthy child development and lifelong wellbeing
- Promote child social-emotional development
- Promote parenting skills
- Connect families to community resources.
Impact
The evidence for HFA is mixed for system, child and family outcomes. These outcomes were investigated across a broad evidence base from 11 included randomised controlled trials and 2 quasi-experiments.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Yes | Yes | Not found |
| System | Health service use | Yes | Yes | Yes |
| Child | Mental health/behaviour | Yes | Yes | Not found |
| Child | Wellbeing | Yes | Yes | Not found |
| Family | Employment | Not found | Yes | Not found |
| Family | Functioning | Yes | Yes | Yes |
| Family | Welfare/poverty | Yes | Yes | Not found |
| Parent/caregiver | Mental health/functioning | Yes | Yes | Yes |
| Parent/caregiver | Parenting skills | Yes | Yes | Not found |
| Parent/caregiver | Reproductive outcomes | Yes | Yes | Not found |
| Parent/caregiver | Social support | Yes | Yes | Not found |
| Parent/caregiver | Substance abuse | Yes | Yes | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
HFA has an evidence rating of Well-supported+.
This means that HFA has evidence from at least 2 randomised controlled trials (RCT) and/or quasi-experiments (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on 13 research outputs from 8 primary studies - 6 RCTs and 2 QEs. Another 5 RCTs and 2 QEs were identified but did not count towards the evidence due to concerns with study quality. HFA has not received a Very well-supported rating as a rigorous systematic review with meta-analysis has not been conducted.
| Study design | Number of research outputs included (Note: Can include research outputs from the same study) |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 11 |
| Quasi-experiment | 2 |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of the evidence from the included studies. The 2 included QEs were identified with low quality of evidence and results from the QEs should be interpreted with caution.
The studies were conducted in the United States and do not include Aboriginal children and families.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The studies were conducted across multiple states in the United States, including Georgia, New York, New Mexico, North Carolina, Alaska, Arizona, Massachusetts, Indiana, Florida, and Oregon.
Sample characteristics
- The studies’ sample sizes ranged from 227 (161 intervention, 66 control) to 2,727 mothers.
- The studies included participants identifying as African Americans, Hispanic, White, Asian and Apache or native Americans or tribal affiliated backgrounds.
Implementation
Delivery model, mode and setting
- HFA is delivered in-person, to the parent only, in their home.
Target cohort
- Expectant or new parents who are at-risk of child abuse and neglect outcomes, including first-time young mothers seeking assistance with parenting
- Infants and toddlers under 3 months of age.
Program delivery
- The 12 critical elements of HFA for effective home visitor services include:
- Initiating services prenatally or at birth
- Using standardised screening and assessment tools to systematically identify and assess families most in need
- Assessing the presence of various factors associated with increased risk for child maltreatment or other adverse childhood experiences
- Offering services voluntarily and using positive, persistent outreach efforts to build family trust
- Offering services intensely and over the long-term, with well-defined criteria and a process for increasing or decreasing frequency of service
- Taking into account the culture of families in the services offered
- Focusing on supporting the parents as well as the child through services
- Linking all families to a medical provider to ensure optimal health and development
- Providing additional services depending on the family’s needs
- Ensuring 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
- Selecting appropriate service providers
- Providing intensive training to service providers specific to their role to understand the essential components of family assessment, home visiting and supervision.
Duration and intensity
- Services are offered prenatally or at birth until the child is at least 3 years of age and can be offered until the child reaches 5 years of age.
- HFA offers weekly home visits for a minimum of 6 months after the birth of the baby. Upon meeting the defined criteria for family functioning, visits and services are tapered off over time; the frequency of home visits reduce to bi-weekly, monthly then quarterly.
- During pregnancy, families typically receive 2 to 4 visits per month.
- During times of crisis, families may be seen 2 or more times per week.
- Home visits typically run for 50 to 60 minutes.
Manuals and guides
- There is an implementation guide to support the delivery of HFA.
- HFA requires implementing sites to utilise the HFA Best Practice Standards and to demonstrate fidelity to the standards through periodic accreditation site visits.
- The HFA Best Practice Standards serves as both the guide to model implementation and to measure adherence to model requirements.
Additional information
- The Healthy Families America website has more information about HFA.
Staffing
- Staffing requirements include a local implementing agency or a collaboration of host agencies, a program manager, one full-time supervisor per 5 to 6 full-time direct services staff (such as home visitors and/or assessment staff) and a community advisory board.
- Program staff selection should consider a combination of personal characteristics, experience and educational qualifications. At a minimum, staff should have a high school diploma or equivalent.
- At a minimum, supervisors and program managers should have a master’s degree in human services, services administration or in fields related to working with children and families, or a bachelor’s degree with 3 years of relevant experience.
Training
- Training is provided in in-person across 4 full days for direct service staff and 5 days for supervisors. The training for supervisors includes a 3-day advanced clinical and reflective practice training.
To our knowledge, HFA is not available and has not been implemented in Australia.
Cost
In the United States, HFA is supported and funded by the United States federal and state funding streams.
References
Studies identified and included in the review
- Caldera D, Burrell L, Rodriguez K, Crowne SS, 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.
- Duggan A, Caldera D, Rodriguez K, Burrell L, Rohde C & Crowne SS (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31(8):801-827.
- Duggan AK, Berlin LJ, Cassidy J, Burrell L & Tandon SD (2009). Examining maternal depression and attachment insecurity as moderators of the impacts of home visiting for at-risk mothers and infants. Journal of Consulting & Clinical Psychology, 77(4):788-799.
- 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.
- Easterbrooks MA, Bartlett JD, Raskin M, Goldberg J, Contreras MM, Kotake C, Chaudhuri JH & Jacobs FH (2013). Limiting home visiting effects: Maternal depression as a moderator of child maltreatment. Pediatrics, 132:S126-133.
- Easterbrooks MA, 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.
- Green BL, Sanders MB & Tarte J (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.
- Jacobs F, Easterbrooks M, Goldberg J, Mistry J, Bumgarner E, Raskin M, Fosse N & Fauth R (2016). Improving adolescent parenting: Results from a randomized controlled trial of a home visiting program for young families. American Journal of Public Health, 106(2):342-349.
- LeCroy CW & Davis MF (2017). Randomized trial of Healthy Families Arizona: Quantitative and qualitative outcomes. Research on Social Work Practice, 27(7):747-757.
- LeCroy CW & Lopez D (2020). A randomized controlled trial of Healthy Families: 6-month and 1-year follow up. Prevention Science, 21(1):25-35.
- 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.
- McKelvey L, Burrow N, Balamurugan A, Whiteside-Mansell L & Plummer P (2012). Effects of home visiting on adolescent mothers' parenting attitudes. American Journal of Public Health, 102(10):1860-1862.
- Ondersma SJ, Martin J, Fortson B, Whitaker DJ, Self-Brown S, Beatty J, Loree A, Bard D & Chaffin M (2017). Technology to augment early home visitation for child maltreatment prevention: A pragmatic randomized trial. Child Maltreatment, 22(4):334-343.
Studies identified but not counted towards the evidence rating due to study quality
- 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, 160:1101-1107.
- Berlin LJ, Martoccio TL, Appleyard Carmody K, Goodman WB, O'Donnell K, Williams J, Murphy RA & Dodge KA (2017). Can typical US home visits affect infant attachment? Preliminary findings from a randomized trial of Healthy Families Durham. Attachment & Human Development, 19(6):559-579.
- Chambliss JW (2000). An experimental trial of a home visiting program to prevent child maltreatment. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61(3-B):1628.
- Euser S, Alink LR, Stoltenborgh M, Bakermans-Kranenburg MJ and van IJzendoorn MH (2015). A gloomy picture: A meta-analysis of randomized controlled trials reveals disappointing effectiveness of programs aiming at preventing child maltreatment. BMC Public Health, 15:1068.
- Falconer MK, Clark M & Parris D (2011). Validity in an evaluation of healthy families Florida-A program to prevent child abuse and neglect. Children and Youth Services Review, 33(1):66-77.
- Geeraert L, Van den Noortgate W, Grietens H & Onghena P (2004). The effects of early prevention programs for families with young children at risk for physical child abuse and neglect: a meta-analysis. Child Maltreatment, 9(3):277-291.
- Gessner BD (2008). The effect of Alaska's home visitation program for high-risk families on trends in abuse and neglect. Child Abuse & Neglect, 32(3):317-33.
- LeCroy CW & Krysik J (2011). Randomized trial of the Healthy Families Arizona home visiting program. Children and Youth Services Review, 33(10):1761-1766.
- Rodriguez M, Dumont K, Mitchell-Herzfeld S, Walden N & 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.
- van der Put CE, Assink M, Gubbels J & Boekhout van Solinge NF (2018). Identifying effective components of child maltreatment interventions: A meta-analysis. Clinical Child and Family Psychology Review, 21(2):171-202.