Manuscript Details

Source

Johns Hopkins University. (2005). Evaluation of the Healthy Families Alaska program. Report to Alaska State Department of Health and Social Services, Alaska Mental Health Trust Authority. Baltimore, MD: Author.

Moderate rating
Author Affiliation

None of the study authors are developers of this model.

Funding Sources

Alaska Mental Health Trust Authority; Alaska State Department of Health and Social Services

Study Design

Design Attrition Baseline equivalence Confounding factors Valid, reliable measures?
Randomized controlled trial High Established on race and SES. Baseline equivalence on outcomes not feasible. None
Notes
Moderate rating applies to the following outcomes: rapid repeat birth, income above the poverty level, and employment. Community life skills and social support outcomes receive a low rating because establishing baseline equivalence on these outcomes is feasible but not demonstrated. Analyses of other outcomes are not rated for this report because they are represented in other studies.
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% were of 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 of interview data reported by the authors are limited to biological mothers with custody of the index child at follow-up (249 families). Additional outcomes are reported from medical records (268 families), child protective services reports (309 families), and observational data (~237 families).

 

Note: Information on sample size was received through communication with the author.

Setting

This study included six Healthy Families Alaska sites, two in Anchorage and one each in Wasilla, Fairbanks, Juneau, and Kenai.

Home Visiting 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 towards individual family goals.

Comparison Conditions

Families assigned to the comparison condition received referrals to other community services.

Were any subgroups examined?
No
Subgroups examined

• Parity (multiparous) • Intimate partner violence (any incident of physical assault in past year) • Risk of child maltreatment (mother screens positive for high risk of child abuse)

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% were of 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 of interview data reported by the authors are limited to biological mothers with custody of the index child at follow-up (249 families). Additional outcomes are reported from medical records (268 families), child protective services reports (309 families), and observational data (~237 families).

 

Note: Information on sample size was received through communication with the author.

Setting

This study included six Healthy Families Alaska sites, two in Anchorage and one each in Wasilla, Fairbanks, Juneau, and Kenai.

Home Visiting 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 towards individual family goals.

Comparison Conditions

Families assigned to the comparison condition received referrals to other community services.

Were any subgroups examined?
No
Subgroups examined

• Parity (multiparous) • Intimate partner violence (any incident of physical assault in past year) • Risk of child maltreatment (mother screens positive for high risk of child abuse)

Findings that rate moderate or high in this manuscript

Family economic self-sufficiency
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Household income above poverty level Year 2 Moderate
0.02 Not statistically significant, p ≥ 0.05 249 mothers Biological mothers with custody of index child at interview, Alaska trial
Household member employed Year 2 Moderate
0.05 Not statistically significant, p ≥ 0.05 249 mothers Biological mothers with custody of index child at interview, Alaska trial
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Maternal health
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Rapid repeat birth Child age 2 Moderate
0.04 Not statistically significant, p ≥ 0.05 325 mothers Full sample, Alaska trial
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

American Indian or Alaska Native
22%
White
55%
Two or more races
8%
Unknown
15%

Maternal Education

Less than a high school diploma
42%
High school diploma or GED
58%

Other Characteristics

Indigenous population
22%
Enrollment in means-tested programs
76%