Healthy Families America (HFA)^®

Model effectiveness research report last updated: 2020

Effects shown in research

Child health

Findings rated high

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. doi:10.1016/j.chiabu.2007.02.008

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Adequate well-child visits	FavorableUnfavorable or ambiguousNo Effect	Year 2	Children in custody of biological mother at interview, Alaska trial	249 children	% (adjusted) = 4.00	Adjusted mean % = 8.00	OR = 0.96	HomVEE calculated = -0.45	Not statistically significant, p ≥ 0.05
Has primary care provider	FavorableUnfavorable or ambiguousNo Effect	Year 2	Children in custody of biological mother at interview, Alaska trial	249 children	% (adjusted) = 74.00	Adjusted mean % = 78.00	OR = 0.76	HomVEE calculated = -0.13	Not statistically significant, p ≥ 0.05
Immunizations up-to-date	FavorableUnfavorable or ambiguousNo Effect	Year 2	Children in custody of biological mother at interview, Alaska trial	249 children	% (adjusted) = 27.00	Adjusted mean % = 27.00	OR = 1.01	HomVEE calculated = 0.00	Not statistically significant, p ≥ 0.05

Duggan, A., McFarlane, E., Fuddy, L., Burrell, L., Higman, S. M., Windham, A., et al. (2004). Randomized trial of a statewide home visiting program: Impact in preventing child abuse and neglect. Child Abuse & Neglect, 28(6), 597–622.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Hospitalizations for ambulatory care	FavorableUnfavorable or ambiguousNo Effect	Years 1-3	Full sample, Hawaii trial	573 children	% = 12.00	% = 10.00	OR = 1.27	HomVEE calculated = 0.12	Not statistically significant, p ≥ 0.05

Landsverk, J., Carrilio, T., Connelly, C. D., Ganger, W., Slymen, D., Newton, R., et al. (2002). Healthy Families San Diego clinical trial: Technical report. San Diego, CA: The Stuart Foundation, California Wellness Foundation, State of California Department of Social Services: Office of Child Abuse Prevention.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Child has regular health care site	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, San Diego trial	435 children	% = 98.10	% = 97.70	= 0.40	HomVEE calculated = 0.12	Not statistically significant, p ≥ 0.05
Child has regular health care site	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	% = 98.00	% = 98.50	= -0.50	HomVEE calculated = -0.18	Not statistically significant, p ≥ 0.05
Child has specific health care provider	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, San Diego trial	435 children	% = 74.00	% = 81.60	= -7.60	HomVEE calculated = -0.27	Not statistically significant, p ≥ 0.05
Child has specific health care provider	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	% = 63.60	% = 72.20	= -8.60	HomVEE calculated = -0.24	Not statistically significant, p ≥ 0.05
Compliance with recommended number of well-child visits	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, San Diego trial	435 children	% = 58.60	% = 59.60	= -1.00	HomVEE calculated = -0.03	Not statistically significant, p ≥ 0.05
Compliance with recommended number of well-child visits	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	% = 85.80	% = 83.80	= 3.00	HomVEE calculated = 0.09	Not statistically significant, p ≥ 0.05
Immunizations up-to-date	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	% = 96.90	% = 95.90	= 1.00	HomVEE calculated = 0.18	Not statistically significant, p ≥ 0.05
Number of sick visits	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, San Diego trial	435 children	Median = 3.00	Median = 3.00	Not reported	Not available	Not statistically significant, p ≥ 0.05
Number of sick visits	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	Median = 1.00	Median = 1.00	Not reported	Not available	Not statistically significant, p ≥ 0.05
Number of well-child visits	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, San Diego trial	435 children	Mean = 7.00	Mean = 6.80	Mean difference = 0.20	HomVEE calculated = 0.05	Not statistically significant, p ≥ 0.05
Number of well-child visits	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	Mean = 2.40	Mean = 1.90	Mean difference = 0.50	HomVEE calculated = 0.22	Statistically significant, p < 0.05

LeCroy, C. W., & Lopez, D. (2018). A randomized controlled trial of Healthy Families: 6-month and 1-year follow-up. Prevention Science. Advance online publication. https://doi.org/10.1007/s11121-018-0931-4

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Immunizations	FavorableUnfavorable or ambiguousNo Effect	6 months	HFA vs. comparison group, Arizona, full sample	199 children	Unadjusted mean = 13.70	Unadjusted mean = 13.70	Mean difference = 0.00	Study reported = 0.04	Not statistically significant, p= 0.79
Well-baby checks	FavorableUnfavorable or ambiguousNo Effect	6 months	HFA vs. comparison group, Arizona, full sample	199 children	Unadjusted mean = 4.00	Unadjusted mean = 4.10	Mean difference = -0.10	Study reported = -0.06	Not statistically significant, p= 0.70

Lee, E., Mitchell-Herzfeld, S., 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.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Low birth weight	FavorableUnfavorable or ambiguousNo Effect	At birth	Full sample		Adjusted proportion = 0.05	Adjusted proportion = 0.10	OR = 0.43	HomVEE calculated = -0.51	Statistically significant, p = 0.02	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.
Preterm birth	FavorableUnfavorable or ambiguousNo Effect	At birth	Full sample		Not reported	Not reported	Not reported	Not available	Not statistically significant, p ≥ 0.05

Duggan, A. K., McFarlane, E. C., Windham, A. M., Rohde, C. A., Salkever, D. S., Fuddy, L., et al. (1999). Evaluation of Hawaii’s Healthy Start program. Future of Children, 9(1), 66–90; discussion 177–178.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Ever hospitalized for any reason	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 children	% = 17.00	% = 18.00	= -1.00	HomVEE calculated = -0.04	Not statistically significant, p ≥ 0.05
Ever hospitalized for any reason	FavorableUnfavorable or ambiguousNo Effect	Years 1 and 2	Full sample, Hawaii trial	534 children	% = 19.00	% = 22.00	= 3.00	HomVEE calculated = -0.11	Not statistically significant, p ≥ 0.05
Ever used emergency department	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 children	% = 40.00	% = 44.00	= -4.00	HomVEE calculated = -0.10	Not statistically significant, p ≥ 0.05
Ever used emergency department	FavorableUnfavorable or ambiguousNo Effect	Years 1 and 2	Full sample, Hawaii trial	534 children	% = 58.00	% = 60.00	= -2.00	HomVEE calculated = -0.05	Not statistically significant, p ≥ 0.05
Has a PCP who handles most health care needs	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 children	% = 93.00	% = 90.00	= 3.00	HomVEE calculated = 0.24	Not statistically significant, p ≥ 0.05
Has a PCP who handles most health care needs	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	567 children	% = 89.00	% = 84.00	= 5.00	HomVEE calculated = 0.26	Not statistically significant, p ≥ 0.05
Has a PCP who knows all aspects of child’s care	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 children	% = 84.00	% = 79.00	= 5.00	HomVEE calculated = 0.20	Not statistically significant, p ≥ 0.05
Has a PCP who knows all aspects of child’s care	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	567 children	% = 80.00	% = 75.00	= 5.00	HomVEE calculated = 0.17	Not statistically significant, p ≥ 0.05
Has a PCP who knows family’s concerns about child	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 children	% = 45.00	% = 48.00	= 3.00	HomVEE calculated = -0.07	Not statistically significant, p ≥ 0.05
Has a PCP who knows family’s concerns about child	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	567 children	% = 50.00	% = 39.00	= 11.00	HomVEE calculated = 0.27	Statistically significant, p < 0.05
Has a primary care provider (PCP)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 children	% = 94.00	% = 90.00	= 4.00	HomVEE calculated = 0.34	Not statistically significant, p ≥ 0.05
Has a primary care provider (PCP)	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	567 children	% = 91.00	% = 86.00	= 5.00	HomVEE calculated = 0.30	Not statistically significant, p ≥ 0.05
Immunizations up-to-date	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 children	% = 82.00	% = 82.00	= 0.00	HomVEE calculated = 0.00	Not statistically significant, p ≥ 0.05
Immunizations up-to-date	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	567 children	% = 87.00	% = 85.00	= 2.00	HomVEE calculated = 0.10	Not statistically significant, p ≥ 0.05

Duggan, A., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crowne, S. S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31(8), 801–827.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Child hospitalized for ambulatory care sensitive conditions (ACSC)	FavorableUnfavorable or ambiguousNo Effect	Years 1 and 2	Families with complete medical record data, Alaska trial	268 families	% (adjusted) = 9.00	Adjusted mean % = 9.00	OR = 1.09	HomVEE calculated = 0.00	Not statistically significant, p ≥ 0.05	footnote54 Submitted by user on Fri, 03/15/2019 - 14:29 Ambulatory care sensitive conditions include: asthma, pneumonia, other upper airway conditions, gastroenteritis, dehydration, cellulitis, and seizures.
Child seen in emergency department for ACSC	FavorableUnfavorable or ambiguousNo Effect	Years 1 and 2	Families with complete medical record data, Alaska trial	268 families	% (adjusted) = 81.00	Adjusted mean % = 78.00	OR = 1.23	HomVEE calculated = 0.11	Not statistically significant, p ≥ 0.05
Number of times hospitalized for ACSC	FavorableUnfavorable or ambiguousNo Effect	Years 1 and 2	Families with complete medical record data, Alaska trial	268 families	Adjusted mean = 0.11	Adjusted mean = 0.12	Mean difference = -0.01	Not available	Not statistically significant, p ≥ 0.05
Number of times seen in emergency department for ACSC	FavorableUnfavorable or ambiguousNo Effect	Years 1 and 2	Families with complete medical record data, Alaska trial	268 families	Adjusted mean = 3.13	Adjusted mean = 4.09	Mean difference = -0.96	Not available	Not statistically significant, p ≥ 0.05

Findings rated moderate

Anisfeld, E., Sandy, J., & Guterman, N. B. (2004). Best Beginnings: A randomized controlled trial of a paraprofessional home visiting program: Technical report. Report to the Smith Richardson Foundation and New York State Office of Children and Family Services. New York: Columbia University School of Social Work.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Number of pediatric emergency department visits	FavorableUnfavorable or ambiguousNo Effect	36 months	Program group children not affected by substance abuse, NY Best Beginnings trial	271 children	Not available	Not available	Beta = 0.12	Not available	Statistically significant, p < 0.05

Easterbrooks, M. A., Fauth, R. C., Menon, M., Stargel, L. E., & Kotake, C. (n.d.). The Massachusetts Healthy Families Evaluation Phase 2 (MHFE-2): Time 6 summary report. Tufts Interdisciplinary Evaluation Research, Tufts University.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Asthma (diagnosed past year)	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	384 children	Adjusted proportion = 0.07	Adjusted proportion = 0.14	Odds ratio = 0.46	HomVEE calculated = -0.47	Statistically significant, p <.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Effect size based on study OR Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
Child had dental visit (past year)	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	379 children	Unadjusted proportion = 0.95	Unadjusted proportion = 0.98	Mean difference = -0.03	HomVEE calculated = -0.60	Not statistically significant, p ≥ 0.05
Child had well visit (past year)	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	383 children	Unadjusted proportion = 0.99	Unadjusted proportion = 0.99	Mean difference = 0.00	HomVEE calculated = 0.00	Not statistically significant, p ≥ 0.05
Child visited emergency room (past year)	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	383 children	Unadjusted proportion = 0.27	Unadjusted proportion = 0.24	Mean difference = 0.03	HomVEE calculated = 0.11	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Obesity/overweight (past year)	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	384 children	Unadjusted proportion = 0.05	Unadjusted proportion = 0.05	Mean difference = 0.01	HomVEE calculated = 0.08	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Pediatric Quality of Life Inventory - physical functioning	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	381 children	Adjusted mean = 93.91	Adjusted mean = 91.91	Mean difference = 2.00	Study reported = 0.20	Statistically significant, p <.05	Effect size is the Cohen's d
Pediatric Quality of Life Inventory - school functioning	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	383 children	Unadjusted mean = 78.24	Unadjusted mean = 78.06	Mean difference = 0.18	HomVEE calculated = 0.01	Not statistically significant, p ≥ 0.05

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.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Baby received developmental screening in first year of life	FavorableUnfavorable or ambiguousNo Effect	Child's 1st birthday	HF Oregon 2010-2012	762 mothers	Adjusted proportion = 0.94	Adjusted proportion = 0.87	OR = 0.41	Not available	Statistically significant, p = 0.00
Child ever breastfed - full sample	FavorableUnfavorable or ambiguousNo Effect	Child's 1st birthday	HF Oregon 2010-2012	752 mothers	Adjusted proportion = 0.91	Adjusted proportion = 0.91	OR = 0.91	Not available	Not statistically significant, p ≥ 0.05
Parent ever told that child was not on track developmentally - full sample	FavorableUnfavorable or ambiguousNo Effect	Child's 1st birthday	HF Oregon 2010-2012	762 mothers	Adjusted proportion = 0.05	Adjusted proportion = 0.09	OR = 1.46	Not available	Not statistically significant, p = 0.08	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.

LeCroy, C. W., & Lopez, D. (2018). A randomized controlled trial of Healthy Families: 6-month and 1-year follow-up. Prevention Science. Advance online publication. https://doi.org/10.1007/s11121-018-0931-4

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Breastfeeding	FavorableUnfavorable or ambiguousNo Effect	6 months	HFA vs. comparison group, Arizona, full sample	199 mothers	Unadjusted proportion = 0.89	Unadjusted proportion = 0.79	Mean difference = 0.10	Study reported = 0.29	Statistically significant, p= 0.04
Immunizations	FavorableUnfavorable or ambiguousNo Effect	12 months	HFA vs. comparison group, Arizona, full sample	165 children	Unadjusted mean = 19.00	Unadjusted mean = 19.80	Mean difference = -0.80	Study reported = -0.02	Not statistically significant, p= 0.23
Well-baby checks	FavorableUnfavorable or ambiguousNo Effect	12 months	HFA vs. comparison group, Arizona, full sample	165 children	Unadjusted mean = 0.98	Unadjusted mean = 1.00	Mean difference = -0.02	Study reported = -0.15	Not statistically significant, p= 0.15

Mitchell-Herzfeld, S., Izzo, C., Greene, R., Lee, E., & Lowenfels, A. (2005). Evaluation of Healthy Families New York (HFNY): First year program impacts. Albany, NY: University at Albany, Center for Human Services Research.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Child ever without needed medical care	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 children	% = 2.20	% = 1.40	Not reported	HomVEE calculated = 0.28	Not statistically significant, p ≥ 0.05
Child has primary care provider	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 children	% = 98.40	% = 98.60	= -0.20	HomVEE calculated = -0.08	Not statistically significant, p ≥ 0.05
Mother breastfed baby	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1060 mothers	% = 45.90	% = 44.70	= 1.20	Not available	Not statistically significant, p ≥ 0.05
Number of months breastfed	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1060 mothers	Adjusted mean = 1.01	Adjusted mean = 1.04	Mean difference = -0.03	Not available	Not statistically significant, p ≥ 0.05
Number of well-baby visits	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 children	Adjusted mean = 4.54	Adjusted mean = 4.61	Mean difference = -0.07	Not available	Not statistically significant, p ≥ 0.05

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