Healthy Families America (HFA)^®

Healthy Families America (HFA) includes (1) screenings and assessments to determine whether families are at risk for child maltreatment or other adverse childhood experiences; (2) home visiting services; and (3) routine screening and assessment of parent–child interactions, child development, and maternal depression. In addition, many HFA sites offer parent support groups and services to promote fathers’ involvement. HFA is designed to cultivate and strengthen nurturing parent-child relationships, promote healthy childhood growth and development, and enhance family well-being by reducing risk and building protective factors. Local HFA sites select the focus population they plan to serve and offer weekly, hour-long home visits beginning prenatally or within the first three months after a child’s birth. Visit frequency decreases over time based on family progress, and services are offered until children are between the ages of 3 and 5.

For more information, see the research database. For more information on the criteria used to rate research, please see details of HomVEE’s methods and standards.

Healthy Families America (HFA) is rooted in the belief that early, nurturing relationships are the foundation of a healthy, productive life. Building on theories of attachment and bio-ecological systems and the tenets of trauma-informed care, the interactions between HFA’s direct service providers and families are relationship-based and designed to promote positive parent–child relationships and secure attachment. Services are strengths-based, family-centered, culturally sensitive, and reflective.

HFA is the signature program of Prevent Child Abuse America (PCA America). Programs interested in implementing the HFA model must apply for affiliation with the HFA National Office. 

The HFA National Office, headquartered in Chicago, provides support, technical assistance, training, state or multisite system development, and accreditation services to HFA affiliates.

In addition to individual local programs affiliating with HFA, several states and metropolitan areas have affiliated as HFA state or multisite systems. These systems have a central administration or other entity providing an infrastructure of support for HFA sites in a state or geographical region. The HFA National Office provides guidance to each state or multisite system on best practice standards for the central administrative entity.

HFA provides tailored support for families experiencing varying amounts of stress related to challenges such as single parenthood; low income; history of adverse childhood experiences; and current or previous issues related to substance use disorder, poor mental health, and/or intimate partner violence. Individual HFA sites select the specific characteristics of the focus population they plan to serve based on service gaps in the community.

HFA sites use the Family Resilience and Opportunities for Growth (FROG) Scale to begin building a relationship with each family while determining the presence of various risk and protective factors related to family health and well-being. The FROG Scale was developed specifically for HFA based on current research and feedback from its network.

Sites enroll families as early as possible, ideally before the child’s birth or within three months of the child’s birth.

HFA aims to reduce child maltreatment and intimate partner violence and promote:

• Parent–child interactions and positive parenting 
• Children’s development and school readiness 
• Children’s physical health
• Family self-sufficiency
• Access to primary care medical services and community services 
• Maternal health

HFA includes (1) screenings and assessments to determine whether families are at risk of child maltreatment or other adverse childhood experiences; (2) home visiting services; and (3) routine screening and assessment of parent–child interactions, child development, and maternal depression. In addition, many HFA sites offer services such as parent support groups and services promoting fathers’ involvement with their children. HFA encourages local sites to enhance their services with similar offerings that further address the specific needs of families in their communities. 

The HFA National Office does not require sites to use a specific curriculum; however, it does require that sites use evidence-informed parenting materials. The materials should address the following HFA goals: (1) cultivate and strengthen nurturing parent–child relationships, (2) promote healthy childhood growth and development, and (3) enhance family well-being by reducing risks and building protective factors.

HFA sites offer weekly home visits at the start of services. Home visits continue to be offered weekly until families meet HFA progress criteria for moving to less frequent services. When that happens, families move to visits every other week and then monthly. Typically, home visits last one hour. 

HFA sites begin to provide services prenatally or at birth and continue through the first three to five years of the child’s life. Each local site determines—usually based on available funding—whether to extend services beyond three years. 

Families referred by child welfare can enroll up to the time of the focus child’s second birthday, with services offered for a minimum of three years.

HFA sites may implement enhancements to the model as long as those enhancements do not compromise the site’s fidelity to the model as established in the HFA Best Practice Standards (rev. 2022). For example, some sites have included clinical staff to address substance use disorder and depression. Any adaptations (proposed changes that compromise the site’s fidelity to the HFA model) require a formal adaptation request, and approval of those adaptations is at the sole discretion of the HFA National Office and PCA America.

There are no requirements for the type of implementing agency; many different types of public and private agencies are implementing the HFA model, including public health, mental health, education, and child welfare agencies; federally qualified health centers; community-based nonprofit health and human service agencies; and stand-alone entities. 

All HFA sites must adhere to 12 critical elements that are the framework for developing and implementing the model. The 12 critical elements are put into operation as best practice standards with specific criteria for rating site compliance. Please contact the model developer for additional information about the critical elements.

HFA sites have three primary staff positions: (1) direct service staff; (2) supervisors who provide administrative, clinical, and reflective supervision to direct service staff; and (3) program managers who oversee program operations, funding, quality assurance, and evaluation. 

The HFA National Office allows sites flexibility in staffing and emphasizes hiring staff with lived expertise and knowledge of the community. The HFA National Office requires that direct service staff have, at a minimum, a high school diploma or equivalent. It also requires that sites select staff based on their personal characteristics, including: their experience working with or providing services to children and families; an ability to establish trusting relationships; acceptance of individual differences; their experience working with culturally diverse communities (that are present among the site’s intended population); their knowledge of infant and child development; their ability to maintain boundaries between personal and professional life; and their capacity for reflection. The HFA National Office requires that supervisors have either (1) a bachelor’s or master’s degree with relevant supervisory experience or (2) commensurate HFA experience if they do not have a bachelor’s degree. In addition, Infant Mental Health Endorsement is preferred, but not required, for all supervisors. 

The HFA National Office requires each direct service staff member to receive a minimum of one and a half to two hours of individualized reflective supervision per week to promote self-awareness, increase clarity in their work with families, build confidence, and increase service quality. Supervision sessions include administrative, clinical, and reflective supervision practices. In addition, supervisors shadow direct service staff at least twice a year to monitor and assess their performance and provide constructive feedback and professional development. Please contact the model developer for information on supervision or support offered to supervisors. 

Before providing services, the HFA National Office requires affiliated sites to provide orientation training to supervisors, program managers, and direct service staff. The training includes information about the challenges faced by the community’s families and the local resources available to support those families, along with information on staff safety, boundaries, and confidentiality. Nationally certified HFA trainers deliver the following HFA model-specific trainings to indicated staff in an online, blended learning format: 

• Foundations for Family Support Training (all staff) 
• FROG Scale Training (staff who administer the scale and their supervisors, before first administration) 
• Supervisor Training (supervisors and program managers) 
• Implementation Training (program managers) 

Please contact the model developer for additional information about training requirements. 

The HFA National Office requires staff to participate in ongoing professional development. Within 12 months of hire, supervisors and direct service staff must complete wraparound training on a variety of topics. The HFA National Office offers affiliated sites more than 38 hours of distance learning modules and/or recorded webinars that meet all the mandatory training requirements for three, six and 12 months post hire. Supervisors, program managers, and direct service staff must participate in annual ongoing training after the first year of employment based on staff need. Please contact the model developer for additional information about the ongoing professional development requirements.

Healthy Families America National Office
Prevent Child Abuse America
33 N Dearborn St., Suite 2300
Chicago, IL 60602

Phone: (312) 663-3520
Fax: (312) 939-8962
Email: hfamail@preventchildabuse.org
Website: http://www.healthyfamiliesamerica.org