American Indian or Alaska Native
22%
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
Model Reviewed: Healthy Families America (HFA)®
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Established on race and SES. Baseline equivalence on outcomes not feasible. |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
Notes
In 2020, HomVEE updated this review in three ways. First, HomVEE moved two findings on CTS-PC discipline from the Positive Parenting Practices to the Reductions in Child Maltreatment because ACF determined that nonviolent discipline and corporal punishment outcomes belong in the Positive Parenting Practices domain, unless those outcome are assessed using the Conflict Tactics Scale-Parent/Child. Second, HomVEE moved "Child has health care coverage" from the Child Health domain to the Family Economic Self-Sufficiency domain because ACF determined that health insurance coverage belongs in that domain. Finally, HomVEE moved the NCAST Child Response Score from the Child Development and School Readiness to the Positive Parenting Practices domain because ACF determined that outcomes assessed with the NCAST, including the NCAST total score, most appropriately belong in the Positive Parenting Practices domain.
Johns Hopkins University (2005) reports on the same outcomes based on maternal report and finds no statistically significant outcomes. These results are based on medical records.
High rating applies to hospitalization and emergency room visit outcomes. Analyses of other outcomes receive a moderate rating because of high attrition.
Findings that rate moderate or high in this manuscript
Child Development and School Readiness
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description | |
|---|---|---|---|---|---|---|---|---|
| BSID Cognitive score | Age 2 | High | Statistically significant,p < 0.05 | 249 children | Children with complete medical record data, Alaska trial | |||
| BSID percentage within normal limits on cognitive | Age 2 | High | 0.24 | Statistically significant,p < 0.05 | 249 children | Children with complete medical record data, Alaska trial | ||
| BSID percentage within normal limits on psychomotor | Age 2 | High | 0.21 | Not statistically significant, p ≥ 0.05 | 249 children | Children with complete medical record data, Alaska trial | ||
| BSID Psychomotor score | Age 2 | High | Not statistically significant, p ≥ 0.05 | 249 children | Children with complete medical record data, Alaska trial | |||
| CBCL percentage with externalizing scores in normal range | Age 2 | High | 0.19 | Statistically significant,p < 0.05 | 249 children | Children in custody of biological mother at year 2 follow-up interview, Alaska trial | ||
| CBCL percentage with internalizing scores in normal range | Age 2 | High | 0.35 | Statistically significant,p < 0.05 | 249 children | Children in custody of biological mother at year 2 follow-up interview, Alaska trial | ||
| CBCL total externalizing score | Age 2 | High | Not statistically significant, p ≥ 0.05 | 249 children | Children in custody of biological mother at year 2 follow-up interview, Alaska trial | |||
| CBCL total internalizing score | Age 2 | High | Statistically significant,p < 0.05 | 249 children | Children in custody of biological mother at year 2 follow-up interview, Alaska trial |
Child Health
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description | |
|---|---|---|---|---|---|---|---|---|
| Adequate well-child visits | Year 2 | High | 0.45 | Not statistically significant, p ≥ 0.05 | 249 children | Children in custody of biological mother at interview, Alaska trial | ||
| Has primary care provider | Year 2 | High | 0.13 | Not statistically significant, p ≥ 0.05 | 249 children | Children in custody of biological mother at interview, Alaska trial | ||
| Immunizations up-to-date | Year 2 | High | 0.00 | Not statistically significant, p ≥ 0.05 | 249 children | Children in custody of biological mother at interview, Alaska trial |
Family Economic Self-Sufficiency
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description | |
|---|---|---|---|---|---|---|---|---|
| Has health care coverage | Year 2 | High | 0.45 | Statistically significant,p < 0.05 | 249 children | Children in custody of biological mother at interview, Alaska trial |
Positive Parenting Practices
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description | |
|---|---|---|---|---|---|---|---|---|
| Caregiver contingency score (NCAST) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Child Response Score NCAST | Age 2 | High | Not statistically significant, p ≥ 0.05 | 249 children | Children in custody of biological mother at year 2 follow-up interview, Alaska trial | |||
| Cognitive growth fostering (NCAST) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Infant caregiving (AAPI) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Maternal self-efficacy (Teti scale) | Year 2 | Moderate | Statistically significant,p < 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Parenting attitudes (AAPI) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Parenting knowledge (KIDI) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Quality of home environment (HOME) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Recognition of child developmental delay | Year 2 | Moderate | 0.14 | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | ||
| Response to distress (NCAST) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Sensitivity to cues (NCAST) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Social-emotional growth fostering (NCAST) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial |
Reductions In Child Maltreatment
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description | |
|---|---|---|---|---|---|---|---|---|
| No ER visits due to injuries | Child age 2 | High | 0.11 | Not statistically significant, p ≥ 0.05 | 268 children | Families with complete medical record data, Alaska trial | ||
| No hospitalizations due to injuries | Child age 2 | High | 0.13 | Not statistically significant, p ≥ 0.05 | 268 children | Families with complete medical record data, Alaska trial | ||
| No injuries requiring medical care | Child age 2 | High | 0.09 | Not statistically significant, p ≥ 0.05 | 268 children | Families with complete medical record data, Alaska trial | ||
| Use of mild physical strategies, frequency (CTS-PC) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | |||
| Use of nonviolent disciplinary strategies, frequency (CTS-PC) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial |
This study included participants from the following locations:
- Alaska
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 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 condition
Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.
Comparison Conditions
Families assigned to the comparison condition received referrals to other community services.
Subgroups examined
• Risk of child maltreatment (mother screens positive for risk of child abuse) • Intimate partner violence (reported history of IPV or no history of IPV)
Funding Sources
Alaska Mental Health Trust Authority and the Alaska State Department of Health and Social Services.