Healthy Families America (HFA)^®

Model effectiveness research report last updated: 2020

Effects shown in research

Child development and school readiness

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
BSID Cognitive score	FavorableUnfavorable or ambiguousNo Effect	Age 2	Children with complete medical record data, Alaska trial	249 children	Adjusted mean = 88.00	Adjusted mean = 84.80	Mean difference = 3.20	Not available	Statistically significant, p < 0.05
BSID percentage within normal limits on cognitive	FavorableUnfavorable or ambiguousNo Effect	Age 2	Children with complete medical record data, Alaska trial	249 children	% (adjusted) = 58.00	Adjusted mean % = 48.00	OR = 1.55	HomVEE calculated = 0.24	Statistically significant, p < 0.05
BSID percentage within normal limits on psychomotor	FavorableUnfavorable or ambiguousNo Effect	Age 2	Children with complete medical record data, Alaska trial	249 children	% (adjusted) = 85.00	Adjusted mean % = 80.00	OR = 1.36	HomVEE calculated = 0.21	Not statistically significant, p ≥ 0.05
BSID Psychomotor score	FavorableUnfavorable or ambiguousNo Effect	Age 2	Children with complete medical record data, Alaska trial	249 children	Adjusted mean = 98.10	Adjusted mean = 96.00	Mean difference = 2.10	Not available	Not statistically significant, p ≥ 0.05
CBCL percentage with externalizing scores in normal range	FavorableUnfavorable or ambiguousNo Effect	Age 2	Children in custody of biological mother at year 2 follow-up interview, Alaska trial	249 children	% (adjusted) = 82.00	Adjusted mean % = 77.00	OR = 1.48	HomVEE calculated = 0.19	Statistically significant, p < 0.05
CBCL percentage with internalizing scores in normal range	FavorableUnfavorable or ambiguousNo Effect	Age 2	Children in custody of biological mother at year 2 follow-up interview, Alaska trial	249 children	% (adjusted) = 87.00	Adjusted mean % = 79.00	OR = 2.06	HomVEE calculated = 0.35	Statistically significant, p < 0.05
CBCL total externalizing score	FavorableUnfavorable or ambiguousNo Effect	Age 2	Children in custody of biological mother at year 2 follow-up interview, Alaska trial	249 children	Adjusted mean = 50.80	Adjusted mean = 53.00	Mean difference = -2.20	Not available	Not statistically significant, p ≥ 0.05
CBCL total internalizing score	FavorableUnfavorable or ambiguousNo Effect	Age 2	Children in custody of biological mother at year 2 follow-up interview, Alaska trial	249 children	Adjusted mean = 48.20	Adjusted mean = 51.00	Mean difference = -2.80	Not available	Statistically significant, p < 0.05

DuMont, K., Kirkland, K., Mitchell-Herzfeld, S., Ehrhard-Dietzel, S., Rodriguez, M. L., Lee, E., ... & Greene, R. (2010). A randomized trial of Healthy Families New York (HFNY): Does home visiting prevent child maltreatment? Rensselaer, NY: New York State Office of Children & Family Services and Albany, NY: University of Albany, State University of New York.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Aggressive behaviors (CBCL)	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean = 6.99	Adjusted mean = 6.72	Mean difference = 0.27	Study reported = 0.04	Not statistically significant, p ≥ 0.05
Anxious, depressed (CBCL)	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean = 2.89	Adjusted mean = 2.97	Mean difference = -0.08	Study reported = -0.03	Not statistically significant, p ≥ 0.05
Attention problems (CBCL)	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean = 4.77	Adjusted mean = 4.75	Mean difference = 0.02	Study reported = 0.01	Not statistically significant, p ≥ 0.05
Percentage participating in a gifted program	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean % = 5.38	Adjusted mean % = 1.99	OR = 2.80	Not available	Statistically significant, p < 0.05
Percentage receiving remedial services	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean % = 32.83	Adjusted mean % = 33.31	OR = 0.98	Not available	Not statistically significant, p ≥ 0.05
Percentage receiving special education	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean % = 12.33	Adjusted mean % = 16.74	OR = 0.70	Not available	Statistically significant, p < 0.05
Percentage repeating a grade	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean % = 12.33	Adjusted mean % = 16.74	OR = 0.98	Not available	Not statistically significant, p ≥ 0.05
Percentage skipping school more than once	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean % = 2.40	Adjusted mean % = 2.20	OR = 1.08	Not available	Not statistically significant, p ≥ 0.05
Rule-breaking behavior (CBCL)	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean = 2.74	Adjusted mean = 2.66	Mean difference = 0.08	Study reported = 0.03	Not statistically significant, p ≥ 0.05
Social problems (CBCL)	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean = 1.31	Adjusted mean = 1.15	Mean difference = 0.16	Study reported = -0.04	Not statistically significant, p ≥ 0.05
Withdrawn, depressed (CBCL)	FavorableUnfavorable or ambiguousNo Effect	7 year	New York sample	897 mothers	Adjusted mean = 1.47	Adjusted mean = 1.54	Mean difference = -0.07	Study reported = -0.04	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
BSID, Mental Development Index (MDI)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, San Diego trial	422 children	Mean = 105.00	Mean = 102.50	Mean difference = 2.50	HomVEE calculated = 0.23	Statistically significant, p < 0.05
BSID, Motor MDI	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, San Diego trial	422 children	Mean = 113.50	Mean = 113.00	Mean difference = 0.50	HomVEE calculated = 0.04	Not statistically significant, p ≥ 0.05
CBCL Aggressive T score	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	382 children	Mean = 53.50	Mean = 53.60	Mean difference = -0.10	HomVEE calculated = -0.02	Not statistically significant, p ≥ 0.05
CBCL Anxious/Depressed T score	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	382 children	Mean = 53.50	Mean = 54.30	Mean difference = -0.80	HomVEE calculated = -0.14	Not statistically significant, p ≥ 0.05
CBCL Behavior Problems	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	382 children	Mean = 49.70	Mean = 51.10	Mean difference = -1.40	HomVEE calculated = -0.15	Not statistically significant, p ≥ 0.05
CBCL Destructive T score	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	382 children	Mean = 53.60	Mean = 53.35	Mean difference = 0.30	HomVEE calculated = 0.05	Not statistically significant, p ≥ 0.05
CBCL Externalizing problems T score	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	382 children	Mean = 49.40	Mean = 49.90	Mean difference = -0.50	HomVEE calculated = -0.06	Not statistically significant, p ≥ 0.05
CBCL Internalizing problems T score	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	382 children	Mean = 50.90	Mean = 52.60	Mean difference = -1.70	HomVEE calculated = -0.17	Not statistically significant, p ≥ 0.05
CBCL Sleep problems T score	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	382 children	Mean = 52.30	Mean = 52.70	Mean difference = -0.40	HomVEE calculated = -0.09	Not statistically significant, p ≥ 0.05
CBCL Somatic problems T score	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	382 children	Mean = 53.80	Mean = 55.20	Mean difference = -1.40	HomVEE calculated = -0.24	Statistically significant, p < 0.05
CBCL Withdrawn T score	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	382 children	Mean = 55.10	Mean = 56.10	Mean difference = -1.00	HomVEE calculated = -0.13	Not statistically significant, p ≥ 0.05
Stanford Binet Abstract/Visual Reasoning SAS	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	Mean = 90.60	Mean = 90.50	Mean difference = 0.10	HomVEE calculated = 0.01	Not statistically significant, p ≥ 0.05
Stanford Binet Communication Survey	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	Mean = 101.80	Mean = 101.90	Mean difference = -0.10	HomVEE calculated = -0.01	Not statistically significant, p ≥ 0.05
Stanford Binet Partial Composite	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	Mean = 91.30	Mean = 91.30	Mean difference = 0.00	HomVEE calculated = 0.00	Not statistically significant, p ≥ 0.05
Stanford Binet Short Term Memory SAS	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	Mean = 98.60	Mean = 97.80	Mean difference = 0.80	HomVEE calculated = 0.08	Not statistically significant, p ≥ 0.05
Stanford Binet Sum of Area SAS	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	Mean = 326.90	Mean = 331.60	Mean difference = -4.70	HomVEE calculated = -0.06	Not statistically significant, p ≥ 0.05
Stanford Binet Verbal Reasoning Memory SAS	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 children	Mean = 86.50	Mean = 87.30	Mean difference = -0.80	HomVEE calculated = -0.07	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
ASQ Communication score	FavorableUnfavorable or ambiguousNo Effect	6 months	Program group children not affected by substance abuse, NY Best Beginnings trial	359 children	Mean = 55.70	Mean = 55.30	Mean difference = 0.40	HomVEE calculated = 0.07	Statistical significance not reported
ASQ Composite score	FavorableUnfavorable or ambiguousNo Effect	6 months	Program group children not affected by substance abuse, NY Best Beginnings trial	359 children	Mean = 54.80	Mean = 54.00	Mean difference = 0.80	HomVEE calculated = 0.15	Statistical significance not reported
ASQ Fine Motor score	FavorableUnfavorable or ambiguousNo Effect	6 months	Program group children not affected by substance abuse, NY Best Beginnings trial	359 children	Mean = 55.10	Mean = 54.20	Mean difference = 0.90	HomVEE calculated = 0.12	Statistical significance not reported
ASQ Gross Motor score	FavorableUnfavorable or ambiguousNo Effect	6 months	Program group children not affected by substance abuse, NY Best Beginnings trial	359 children	Mean = 52.90	Mean = 51.80	Mean difference = 1.10	HomVEE calculated = 0.12	Statistical significance not reported
ASQ Social score	FavorableUnfavorable or ambiguousNo Effect	6 months	Program group children not affected by substance abuse, NY Best Beginnings trial	359 children	Mean = 53.70	Mean = 54.20	Mean difference = -0.50	HomVEE calculated = -0.06	Statistical significance not reported

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
Child has IEP or 504 plan	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	370 children	Unadjusted proportion = 0.27	Unadjusted proportion = 0.30	Mean difference = -0.02	HomVEE calculated = -0.07	Not statistically significant, p ≥ 0.05
Child in afterschool program	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	368 children	Adjusted proportion = 0.55	Adjusted proportion = 0.42	Odds ratio = 1.71	HomVEE calculated = 0.32	Statistically significant, p <.05	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.
Strengths and Difficulties Questionnaire - externalizing	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	366 children	Unadjusted mean = 5.58	Unadjusted mean = 5.60	Mean difference = -0.02	HomVEE calculated = -0.01	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.
Strengths and Difficulties Questionnaire - internalizing	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	360 children	Unadjusted mean = 3.48	Unadjusted mean = 3.51	Mean difference = -0.03	HomVEE calculated = -0.01	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.

King, T., Rosenberg, L., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. (2005). Prevalence and early identification of language delays among at-risk three year olds. Journal of Developmental & Behavioral Pediatrics, 26(4), 293–303.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
PLS-3 Score	FavorableUnfavorable or ambiguousNo Effect	Age 3	Children with developmental testing results, Hawaii trial	513 children	Adjusted mean = 87.90	Adjusted mean = 87.10	Mean difference = 0.80	Not available	Not statistically significant, p ≥ 0.05
Prevalence of any delays (PLS-3 score ≤ 85)	FavorableUnfavorable or ambiguousNo Effect	Age 3	Children with developmental testing results, Hawaii trial	513 children	% (adjusted) = 48.00	Adjusted mean % = 49.00	OR = 0.97	Not available	Not statistically significant, p ≥ 0.05
Prevalence of severe delays (PLS-3 score ≤ 70)	FavorableUnfavorable or ambiguousNo Effect	Age 3	Children with developmental testing results, Hawaii trial	513 children	% (adjusted) = 9.00	Adjusted mean % = 11.00	OR = 0.80	Not available	Not statistically significant, p ≥ 0.05

Kirkland, K., & Mitchell-Herzfeld, S. (2012). Evaluating the effectiveness of home visiting services in promoting children’s adjustment in school: Final report to the Pew Center on the States. Rensselaer, NY: New York State Office of Children and Family Services, Bureau of Evaluation and Research.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Days absent	FavorableUnfavorable or ambiguousNo Effect	1st grade	Healthy Families New York (HFNY) RCT, Year 7	577 mother/child dyads	= 16.36	= 15.28	Mean difference = 1.08	HomVEE calculated = 1.37	Not statistically significant, p ≥ 0.05	footnote163 Submitted by user on Fri, 03/15/2019 - 14:29 Positive value is favorable to the comparison group.
Doing poorly academically	FavorableUnfavorable or ambiguousNo Effect	1st grade	Healthy Families New York (HFNY) RCT, Year 7	577 mother/child dyads	= 0.30	= 0.33	Mean difference = -0.03	HomVEE calculated = -0.07	Not statistically significant, p ≥ 0.05	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.
Doing poorly academically - Any of the 3 behaviors that promote learning	FavorableUnfavorable or ambiguousNo Effect	1st grade	Healthy Families New York (HFNY) RCT, Year 7	577 mother/child dyads	= 0.15	= 0.16	Mean difference = -0.01	HomVEE calculated = -0.03	Not statistically significant, p ≥ 0.05	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.
Doing poorly academically - Reading or Math	FavorableUnfavorable or ambiguousNo Effect	1st grade	Healthy Families New York (HFNY) RCT, Year 7	577 mother/child dyads	= 0.21	= 0.25	Mean difference = -0.04	HomVEE calculated = -0.14	Not statistically significant, p ≥ 0.05	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.
Excelling academically	FavorableUnfavorable or ambiguousNo Effect	1st grade	Healthy Families New York (HFNY) RCT, Year 7	577 mother/child dyads	= 0.26	= 0.20	Mean difference = 0.06	HomVEE calculated = 0.19	Not statistically significant, p ≥ 0.05
Excelling academically - All 3 behaviors that promote learning	FavorableUnfavorable or ambiguousNo Effect	1st grade	Healthy Families New York (HFNY) RCT, Year 7	577 mother/child dyads	= 0.13	= 0.08	Mean difference = 0.05	HomVEE calculated = 0.36	Statistically significant, p < 0.05
Excelling academically - Reading and Math	FavorableUnfavorable or ambiguousNo Effect	1st grade	Healthy Families New York (HFNY) RCT, Year 7	577 mother/child dyads	= 0.16	= 0.16	Mean difference = 0.00	HomVEE calculated = 0.01	Not statistically significant, p ≥ 0.05
Retained in first grade	FavorableUnfavorable or ambiguousNo Effect	1st grade	Healthy Families New York (HFNY) RCT, Year 7	577 mother/child dyads	= 0.04	= 0.07	Mean difference = -0.04	HomVEE calculated = -0.44	Statistically significant, p < 0.05	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.

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