The mission of Healthy Families America (HFA) is to promote child well-being and prevent the abuse and neglect of our nation’s children through home visiting services. The goals of the program are to:
- 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
The program targets expecting and new parents whose infants are less than 3 months old and who are identified as at risk of abusing or neglecting their children. Assessments are conducted prenatally or at the time of birth. Enrollment begins prenatally and continues to up to 3 months after birth.
The HFA model uses a strengths-based approach, which promotes parent–child bonding and positive interactions, educates parents about child health and development, helps parents access community resources, and uses family and community supports to assist parents in addressing problems such as substance abuse or mental health issues.
All HFA sites must adhere to a set of critical program elements based on current knowledge about what constitutes a successful home visitation program. These elements provide each site the flexibility to adapt its program design to local needs and conditions and to innovate where possible. Moreover, HFA’s credentialing process uses the elements to measure and improve the quality of services that each site offers. The critical elements are as follows:
Initiating services prenatally or at birth
- The sites use a standardized assessment tool to systematically identify families who most need services.
- Families voluntarily participate in the program. Caseworkers use positive outreach efforts to build family trust in the caseworker and the program.
- Home visitors offer participating families long-term services (usually 3 to 5 years), beginning intensively (at least one visit per week), and use well-defined criteria for determining whether the intensity of service should be increased or decreased.
- Services are culturally sensitive.
- Comprehensive services support parents, parent–child interaction, and child development.
- Families are linked to a medical provider (for timely inoculations and well-child care) and, if needed, financial assistance, food and housing assistance programs, school readiness programs, child care, job training programs, family support centers, substance abuse treatment programs, and domestic violence shelters.
- Home visitors carry a light caseload; the caseload varies from 15 families who are currently being seen weekly to no more than 25.
Selecting and training home visitors
- Caseworkers are chosen on the basis of their ability to establish trusting relationships with participating families.
- All service providers receive basic training in cultural competency, substance abuse, child abuse reporting, domestic violence, drug-exposed infants, and available services in their community.
- Service providers are trained to understand the components of family assessment and home visitation.
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DuMont and colleagues (2010) reported no program effects on the prevalence or number of confirmed child Protective Services (CPS) reports of child maltreatment for the sample as a whole. The authors noted that the absence of a program impact on confirmed CPS reports may be attributable to greater surveillance of mothers assigned to the Healthy Families New York (HFNY) intervention. They found that HFNY mothers who self-reported committing acts of serious abuse or neglect were significantly more likely to have a CPS report than control mothers who self-reported serious abuse or neglect (42.9 percent versus 22.2 percent), suggesting that incidents of child maltreatment committed by HFNY parents were more likely to be detected and reported to CPS.
Women in the Recurrence Reduction Opportunity (RRO) subgroup who received the HFNY intervention had significantly lower rates of initiation of preventative, protective, or placement services, compared with RRO mothers in the control group (38 percent versus 60 percent). HFNY mothers had fewer confirmed CPS reports for any abuse or neglect as well as physical abuse (although this was not statistically significant). There were no significant differences found with women in the High Prevention Opportunity (HPO) subgroup.
Mothers in the HFNY group self-reported engaging in serious physical abuse significantly less frequently and using nonviolent discipline strategies significantly more frequently than mothers in the control group. Children in the HFNY group were significantly less likely to report that their mothers used minor physical aggression than children in the control group (70.8 percent versus 77.2 percent). The authors found no differences in children’s reports of their mothers’ nonviolent discipline practices. No program effects were found for the prevalence of neglect.
Women in the HPO subgroup who received HFNY were less likely to self-report engaging in psychological aggression (79.7 percent versus 91.2 percent) and using minor physical aggression tactics less frequently, but these were not statistically significant. No differences were found for maternal reports of neglect. Findings were not reported for women in the RRO group because of insufficient sample size.
Precursors to Delinquency
HFNY mothers were significantly more likely to report that their children participated in gifted programs than control group mothers. Children in the HFNY intervention received special education services less often than those in the control group, but these results were not statistically significant. No significant differences were found regarding problem behaviors, socioemotional difficulties, and self-regulation.
Owing to size and group representativeness, data analysis was only appropriate for the HPO group in this area. HFNY children in the HPO group were significantly less likely to score below average on the Peabody Picture Vocabulary Test Fourth Edition than the HPO children in the control group. No differences were found regarding child functioning domains.
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