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.
Model(s) Reviewed:
Healthy Families America (HFA)®
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Established on race and SES. Baseline equivalence on outcomes not feasible. | None | None | Not assessed in manuscripts reviewed before 2021 |
Notes:
High rating applies to the following outcomes: child maltreatment, mother relinquished role, child hospitalized for ACSC, and child seen in the emergency room. A moderate rating applies to all other outcomes in the study’s Table 3, as well as the partner violence and substance use outcomes in the study’s Table 4, because of high attrition and equivalence on race and SES. Mental health outcomes in Table 4 receive a low rating because of high attrition and statistically significant baseline differences by race or SES.
| Study participants | Between January 2000 and July 2001, 388 families who screened positive on a Healthy Families Alaska (HFAK) protocol for risk factors associated with poor health and social outcomes and received scores of 25 or higher on the Kempe’s Family Stress Checklist were recruited during pregnancy or at the time of birth (Duggan et al., 2007). Of these families, 364 consented to participate and were randomly assigned to the program group (n = 179) or the comparison group (n = 185). 325 families completed a baseline interview. The sample was 22% Alaska native, 55% Caucasian, 8% multiracial, and 15% other race. 58% of families were below poverty level, 58% of mothers had graduated from high school, and 73% had worked in the year prior to enrollment (Johns Hopkins University, 2005). The average age of mothers at baseline was 23.5 years. This study reports the second-year follow-up results of the HFA K evaluation, with a sample size of 138 program group primary caregivers and 140 comparison group primary caregivers. Most of the analyses are limited to families in which the biological mothers had custody of the index child at follow-up (249 families), with additional outcomes obtained from medical records (268 families). The outcomes included in this study were also described in an earlier report (Johns Hopkins University, 2005). |
|---|---|
| Setting | This study included six Healthy Families Alaska sites, two in Anchorage and one each in Wasilla, Fairbanks, Juneau, and Kenai. |
| Intervention services | Families in the program group were assigned to receive visits monthly until their child’s birth and weekly thereafter. By design, families receive gradually less frequent visits as they reach critical milestones, ranging to quarterly visits at the highest level of functioning. Families were enrolled in the program until they functioned sufficiently to “graduate” or until their child turned 2. In practice, home visits were less frequent than intended, with only 4% of families receiving 75% or more of their designated frequency of visits and completing the full two years. Home visits were intended to emphasize preparing for child growth, development, and critical milestones; screening and referral for developmental delays; promoting a safe environment; positive parent-child interactions; establishing a “medical home” for the child; and supporting the family during crises. The program also emphasized the development of an Individual Family Support Plan (IFSP) or setting and monitoring progress toward individual family goals. |
| Comparison conditions | Families assigned to the comparison condition received referrals to other community services. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). Subgroups are not listed for manuscripts reviewed before 2021. |
| Funding sources | Alaska Mental Health Trust Authority and Alaska State Department of Health and Social Services. |
| Author affiliation | None of the study authors are developers of this model. |
| Peer reviewed | Peer reviewed status is not listed for manuscripts reviewed before 2021. |
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Child hospitalized for ambulatory care sensitive conditions ( |
FavorableUnfavorable or ambiguousNo Effect |
Families with complete medical record data, Alaska trial | Years 1 and 2 | 268 families | % (adjusted) = 9.00 | Adjusted mean % = 9.00 | OR = 1.09 | HomVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | Ambulatory care sensitive conditions include: asthma, pneumonia, other upper airway conditions, gastroenteritis, dehydration, cellulitis, and seizures.
|
| High | Child seen in emergency department for ACSC | FavorableUnfavorable or ambiguousNo Effect |
Families with complete medical record data, Alaska trial | Years 1 and 2 | 268 families | % (adjusted) = 81.00 | Adjusted mean % = 78.00 | OR = 1.23 | HomVEE calculated = 0.11 | Not statistically significant, p ≥ 0.05 | |
| High | Number of times hospitalized for ACSC | FavorableUnfavorable or ambiguousNo Effect |
Families with complete medical record data, Alaska trial | Years 1 and 2 | 268 families | Adjusted mean = 0.11 | Adjusted mean = 0.12 | Mean difference = -0.01 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Number of times seen in emergency department for ACSC | FavorableUnfavorable or ambiguousNo Effect |
Families with complete medical record data, Alaska trial | Years 1 and 2 | 268 families | Adjusted mean = 3.13 | Adjusted mean = 4.09 | Mean difference = -0.96 | Not available | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Alcohol or drug use | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at interview, Alaska trial | Year 2 | 249 mothers | % = 28.00 | % = 33.00 | OR = 0.80 | HomVEE calculated = -0.14 | Not statistically significant, p ≥ 0.05 | |
| High | Any illicit drug use | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at interview, Alaska trial | Year 2 | 249 mothers | % = 21.00 | % = 18.00 | OR = 1.23 | HomVEE calculated = 0.12 | Not statistically significant, p ≥ 0.05 | |
| High | Problem alcohol use | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at interview, Alaska trial | Year 2 | 249 mothers | % = 13.00 | % = 22.00 | OR = 0.52 | HomVEE calculated = -0.39 | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Mother relinquished role (child lived separately from mother for one month or more) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Alaska trial | Years 1 and 2 | 322 families | % = 18.00 | % = 16.00 | OR = 1.19 | HomVEE calculated = 0.09 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Attitudes toward corporal punishment (AAPI) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 20.50 | Adjusted mean = 10.10 | Mean difference = 0.38 | Not available | Not statistically significant, p ≥ 0.05 | |
| Moderate | Poor caregiver interaction, (NCAST score = 35) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 17.00 | % = 21.00 | OR = 0.79 | HomVEE calculated = -0.16 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Poor quality home environment (HOME score = 33) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 20.00 | % = 31.00 | OR = 0.51 | HomVEE calculated = -0.36 | Statistically significant, p < 0.05 |
|
| Moderate | Total AAPI score | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 130.00 | Adjusted mean = 125.60 | Mean difference = 4.47 | Not available | Not Statistically significant, p >: 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Common corporal punishment (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 19.48 | Adjusted mean = 24.17 | Mean difference = -4.69 | Not available | Statistically significant, p < 0.05 |
|
| High | Common corporal punishment (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 91.00 | % = 92.00 | OR = 0.80 | HomVEE calculated = -0.08 | Not statistically significant, p ≥ 0.05 | |
| High | Corporal/verbal punishment (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 66.00 | % = 68.00 | OR = 0.92 | HomVEE calculated = -0.05 | Not statistically significant, p ≥ 0.05 | |
| High | Corporal/verbal punishment Frequency (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 4.02 | Adjusted mean = 4.57 | Mean difference = -0.55 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Extreme physical punishment (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 2.00 | % = 3.00 | OR = 0.75 | HomVEE calculated = -0.25 | Not statistically significant, p ≥ 0.05 | |
| High | Extreme physical punishment Frequency (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 0.19 | Adjusted mean = 0.04 | Mean difference = 0.15 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Hit with object (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 10.00 | % = 5.00 | OR = 2.40 | HomVEE calculated = 0.45 | Not statistically significant, p ≥ 0.05 | |
| High | Hit with object Frequency (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 0.33 | Adjusted mean = 0.46 | Mean difference = -0.13 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Mild physical assault (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 80.00 | % = 85.00 | OR = 0.70 | HomVEE calculated = -0.21 | Not statistically significant, p ≥ 0.05 | |
| High | Mild physical assault Frequency (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 9.56 | Adjusted mean = 11.93 | Mean difference = -2.38 | Not available | Statistically significant, p < 0.05 |
|
| High | Neglectful behavior (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 19.00 | % = 22.00 | OR = 0.81 | HomVEE calculated = -0.11 | Not statistically significant, p ≥ 0.05 | |
| High | Neglectful behavior Frequency (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 0.92 | Adjusted mean = 0.75 | Mean difference = 0.16 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Neglectful behavior revised (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 18.00 | % = 18.00 | OR = 0.97 | HomVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | |
| High | Neglectful behavior revised Frequency (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 0.65 | Adjusted mean = 0.66 | Mean difference = -0.01 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Psychological aggression (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 84.00 | % = 83.00 | OR = 1.10 | HomVEE calculated = 0.04 | Not statistically significant, p ≥ 0.05 | |
| High | Psychological aggression Frequency (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 11.17 | Adjusted mean = 13.09 | Mean difference = -1.92 | Not available | Statistically significant, p < 0.05 |
|
| High | Severe assault Frequency (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 0.41 | Adjusted mean = 0.30 | Mean difference = 0.10 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Severe assault (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 9.00 | % = 7.00 | OR = 1.28 | HomVEE calculated = 0.17 | Not statistically significant, p ≥ 0.05 | |
| High | Threat to esteem (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | % = 24.00 | % = 22.00 | OR = 1.17 | HomVEE calculated = 0.07 | Not statistically significant, p ≥ 0.05 | |
| High | Threat to esteem Frequency (CTS-PC) | FavorableUnfavorable or ambiguousNo Effect |
Biological mothers with custody of index child at follow-up, Alaska trial | Year 2 | 246 mothers | Adjusted mean = 0.95 | Adjusted mean = 0.64 | Mean difference = 0.31 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Substantiated CPS reports, all types | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Alaska trial | Child age 2 | 297 families | % = 9.00 | % = 9.00 | = 0.00 | HomVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | |
| High | Substantiated CPS reports, all types | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Alaska trial | Child age 1 | 309 families | % = 12.00 | % = 10.00 | = 2.00 | HomVEE calculated = 0.12 | Not statistically significant, p ≥ 0.05 | |
| High | Substantiated CPS reports, neglect | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Alaska trial | Child age 2 | 297 families | % = 6.00 | % = 7.00 | = -1.00 | HomVEE calculated = -0.10 | Not statistically significant, p ≥ 0.05 | |
| High | Substantiated CPS reports, neglect | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Alaska trial | Child age 1 | 309 families | % = 10.00 | % = 6.00 | = 4.00 | HomVEE calculated = 0.34 | Not statistically significant, p ≥ 0.05 |