A child abuse prevention model developed to support at-risk families with newborns through home visits.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. 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
Hawaii’s Healthy Start Program (HSP) is a paraprofessional home visiting model for at-risk families. The goal of HSP is to identify vulnerable families before abusive and neglectful parenting behaviours arise. Families receive early childhood home visits aimed at promoting child health, decreasing child maltreatment and positive parenting skills through linkages with community resources. These resources include health and mental health services, early childhood education, childcare, family literacy, employment, social services, developmental screening and appropriate child development, child health, and positive parenting skills and problem-solving techniques. HSP is delivered in the United States, Canada and the Philippines.
Aims
- Prevent child abuse and neglect
- Promote child health and development in newborns
- Improve maternal life and parenting skills
- Improve maternal mental health
- Promote family social support
- Reduce family violence and addictions
- Increase parenting education
- Connect families to community resources.
Impact
The evidence is mixed and inconclusive across most child, family and parent outcomes. There was no effect or difference found for reducing child protection system contact between families in the intervention group compared to the those in the comparison group. The studies examined the effectiveness of HSP up until 3 years and 7 to 9 years of age.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Not found | Yes | Not found |
| System | Health service use | Yes | Yes | Not found |
| Child | Wellbeing | Not found | Yes | Yes |
| Family | Employment | Yes | Yes | Yes |
| Family | Functioning | Yes | Yes | Yes |
| Parent/caregiver | Education | Yes | Yes | Not found |
| Parent/caregiver | Mental health/functioning | Yes | Yes | Not found |
| Parent/caregiver | Parenting skills | Yes | Yes | Yes |
| Parent/caregiver | Reproductive outcomes | Not found | Yes | Not found |
| Parent/caregiver | Social support | Yes | Yes | Yes |
| 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.
HSP has an evidence rating of Well-supported+.
This means that HSP 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 9 research outputs from 2 RCTs. All except one study (Bugental et al., 2002) used a national dataset. HSP 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 |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 8 |
| Quasi-experiment | 1 |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of evidence from the included studies. The included QE was identified with low quality of evidence and results from the QE should be interpreted with caution.
The studies were conducted in Hawaii 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
- All studies were conducted in Oahu, Hawaii.
Sample characteristics
- The studies’ sample sizes ranged from 96 to 685 families.
- All eligible families had a child born between November 1994 and December 1995, had an English-speaking mother, were not involved with Child Protective Services and had an infant who was at high risk of maltreatment. The majority of families participated in the home visits when the child was 3 to 36 months of age.
- There was diverse ethnic representation across the studies, including native Hawaiians, Pacific Islanders, Asians and other multicultural populations.
Implementation
Delivery model, mode and setting
- HSP is delivered in-person, to the parent only, in their home by paraprofessional home visitors.
Target cohorts
- Mothers and families at risk of poor child outcomes
- Newborns and infants, within their first week after birth.
Program delivery
- Intervention families receive early home visitation, with the initial home visit occurring within one week of the child’s birth.
- Community agencies administer the delivery of home visit services. Paraprofessional home visitors provide direct services such as teaching about child development, role-modeling positive parenting and problem-solving strategies and offering emotional support.
Duration and intensity
- All HSP families are expected to initially participate in weekly visits. Visits are tapered as families achieve greater competency.
- Home visits are designed to be carried out for at least 3 years, but it is challenging to retain families. On average, families participate in 13.6 visits during the first year.
Manuals and guides
- We were unable to locate any manuals or guides to implement HSP.
Additional information
- The State of Hawaii, Department of Health website has more information about HSP.
We were unable to locate any information on staff and training requirements.
To our knowledge, HSP is not available and has not been implemented in Australia.
Cost
We were unable to locate any information on the cost of HSP.
References
Studies identified and included in the review
- Bair-Merritt MH, Jennings JM, Chen R, Burrell L, McFarlane E, Fuddy F & Duggan AK (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.
- Bugental DB, Ellerson PC, Lin EK, Rainey B, Kokotovic A & O'Hara N (2002). A cognitive approach to child abuse prevention. Journal of Family Psychology, 16(3):243-258.
- Duggan AK, McFarlane EC, Windham A, Rohde C, Salkever DS, Fuddy L, Rosenberg LA, Buchbinder SB & Sia C (1999). Evaluation of Hawaii's Healthy Start Program. The Future of Children, 3:66-90.
- Duggan A, McFarlane E, Fuddy L, Burrell L, Higman SM, Windham A & Sia C (2004a). Randomized trial of a statewide home visiting program: Impact in preventing child abuse and neglect. Child Abuse and Neglect, 28:597-622.
- Duggan A, Fuddy L, Burrell L, Higman S, McFarlane E, Windham A & Sia C (2004b). Randomized trial of a statewide home visiting program to prevent child abuse: Impact in reducing parental risk factors. Child Abuse & Neglect, 28:623-643.
- Duggan A, Fuddy L, McFarlane E, Burrell L, Windham A, Higman S & Sia C (2004c). 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.
- El-Kamary SS, Higman SM, Fuddy L, McFarlane E, Sia C & Duggan AK (2004). Hawaii's Healthy Start home visiting program: Determinants and impact of rapid repeat birth. Pediatrics 114(3):e317-326.
- McCurdy K (2001). Can home visitation enhance maternal social support? American Journal of Community Psychology, 29(1):97-112
- 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.
Studies identified but not counted towards the evidence rating due to study quality
- Dew B & Breakey GF (2014). An evaluation of Hawaii’s Healthy Start program using child abuse hospitalization data. Journal of Family Violence, 29:893-900.
- 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.
- 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.
- 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