Asian
28%
Source
Duggan, A. K., McFarlane, E. C., Windham, A. M., Rohde, C. A., Salkever, D. S., Fuddy, L., et al. (1999). Evaluation of Hawaii’s Healthy Start program. Future of Children, 9(1), 66–90; discussion 177–178.
Model(s) Reviewed
Funding Sources
From 1991 to 1994, this evaluation received funding from: the Robert Wood Johnson Foundation; the Annie E . Casey Foundation; The David and Lucile Packard Foundation; the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services; the Hawaii Department of Health; and the Hawaii Medical Association committed office space and an administrative home for fieldwork staff.
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 |
Notes
High rating applies to outcomes in the study’s Tables 4 and 6. Outcomes in Tables 5 and 7 are excluded because they overlap with analyses reported in other reports.
Study Participants
Families were recruited to the study between November 1994 and December 1995. Hawaii Healthy Start Program staff screened the medical records of mothers from one of four Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Mothers found to be at risk, or those whose records did not contain sufficient information to screen out, were screened further using the Kempe Family Stress Checklist; eligible families were those in which either parent scored 25 or greater (Duggan, 2004a). Of the 897 families who were eligible to participate in the study, 730 (81%) agreed to participate and were randomly assigned to the program group (n = 395), the main comparison group (n = 290), or a testing comparison group (n = 45). 684 families completed a baseline interview (373 families in the program group, 270 families in the main comparison group, and 41 in the testing group comparison). On average, at baseline, mothers were 23.7 years of age (program group) and 23.3 years of age (comparison group). 63% (program group) and 67% (comparison group) of participating families lived below the poverty line. The racial composition of the program group was 34% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 10% Caucasian, and 27% of unknown primary ethnicity. The main comparison group consisted of 33% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 14% Caucasian, and 26% of unknown primary ethnicity. This study reports results from the first two follow-ups of the Hawaii Healthy Start randomized controlled trial. Follow-up interviews were completed for 88% of families in years 1 and 2, and 83% of participating families were included in both follow-ups.
Setting
Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.
Home Visiting Services
Home visiting services were designed to provide three to five years of home visiting, with weekly visits for most or all of the child’s first year of life, and visits of gradually decreasing frequency thereafter depending on family need. Home visitors endeavored to establish trusting relationships with families, help them resolve immediate crises, and help them build on existing strengths to improve their ability to function independently. Visitors helped families develop problem-solving skills, connected families to needed services, and aimed to develop an individual service plan with each family every six months and help the family reach six-month goals. The actual frequency of visits, however, was lower than that specified by the model, with families receiving an average of 13 visits in the child’s first year of life, and 51% of families not actively participating in the program by the time the child was 12 months old. Families still active at the end of year 1 received an average of 22 visits in the first year.
Comparison Conditions
The main comparison group was tested annually to measure outcomes. A second “testing” comparison group was evaluated only at year 3 to ascertain the effect of repeated testing on observed outcomes (Duggan, McFarlane, Fuddy, Burrell, Higman, Windham, et al., 2004).
Were any subgroups examined?
No
Study Participants
Families were recruited to the study between November 1994 and December 1995. Hawaii Healthy Start Program staff screened the medical records of mothers from one of four Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Mothers found to be at risk, or those whose records did not contain sufficient information to screen out, were screened further using the Kempe Family Stress Checklist; eligible families were those in which either parent scored 25 or greater (Duggan, 2004a). Of the 897 families who were eligible to participate in the study, 730 (81%) agreed to participate and were randomly assigned to the program group (n = 395), the main comparison group (n = 290), or a testing comparison group (n = 45). 684 families completed a baseline interview (373 families in the program group, 270 families in the main comparison group, and 41 in the testing group comparison). On average, at baseline, mothers were 23.7 years of age (program group) and 23.3 years of age (comparison group). 63% (program group) and 67% (comparison group) of participating families lived below the poverty line. The racial composition of the program group was 34% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 10% Caucasian, and 27% of unknown primary ethnicity. The main comparison group consisted of 33% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 14% Caucasian, and 26% of unknown primary ethnicity. This study reports results from the first two follow-ups of the Hawaii Healthy Start randomized controlled trial. Follow-up interviews were completed for 88% of families in years 1 and 2, and 83% of participating families were included in both follow-ups.
Setting
Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.
Home Visiting Services
Home visiting services were designed to provide three to five years of home visiting, with weekly visits for most or all of the child’s first year of life, and visits of gradually decreasing frequency thereafter depending on family need. Home visitors endeavored to establish trusting relationships with families, help them resolve immediate crises, and help them build on existing strengths to improve their ability to function independently. Visitors helped families develop problem-solving skills, connected families to needed services, and aimed to develop an individual service plan with each family every six months and help the family reach six-month goals. The actual frequency of visits, however, was lower than that specified by the model, with families receiving an average of 13 visits in the child’s first year of life, and 51% of families not actively participating in the program by the time the child was 12 months old. Families still active at the end of year 1 received an average of 22 visits in the first year.
Comparison Conditions
The main comparison group was tested annually to measure outcomes. A second “testing” comparison group was evaluated only at year 3 to ascertain the effect of repeated testing on observed outcomes (Duggan, McFarlane, Fuddy, Burrell, Higman, Windham, et al., 2004).
Were any subgroups examined?
No
Findings that rate moderate or high in this manuscript
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Ever had injury needing medical care | Year 1 | High | 0.14 | Not statistically significant, p ≥ 0.05 | 564 children | Full sample, Hawaii trial | ||
| Ever had injury needing medical care | Years 1 and 2 | High | 0.07 | Not statistically significant, p ≥ 0.05 | 534 children | Full sample, Hawaii trial |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Learning environment (HOME) | Year 1 | High | Not statistically significant, p ≥ 0.05 | 564 mothers | Full sample, Hawaii trial | |||
| Mother-child interaction, Caregiver total score (NCAST) | Year 1 | High | Not statistically significant, p ≥ 0.05 | 564 mothers | Full sample, Hawaii trial | |||
| Mother-child interaction, Child total score (NCAST) | Year 1 | High | Not statistically significant, p ≥ 0.05 | 564 mothers | Full sample, Hawaii trial | |||
| Learning environment (HOME) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 567 mothers | Full sample, Hawaii trial | |||
| Mother-child interaction, Caregiver total score (NCAST) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 567 mothers | Full sample, Hawaii trial | |||
| Mother-child interaction, Child total score (NCAST) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 567 mothers | Full sample, Hawaii trial | |||
| Parenting efficacy (PSOC) | Year 1 | High | Not statistically significant, p ≥ 0.05 | 564 mothers | Full sample, Hawaii trial | |||
| Parenting efficacy (PSOC) | Year 2 | High | Statistically significant, p < 0.05 |
567 mothers | Full sample, Hawaii trial |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Mother earned HS degree or in school | Year 1 | High | 0.04 | Not statistically significant, p ≥ 0.05 | 564 mothers | Full sample, Hawaii trial | ||
| Someone in household worked | Year 1 | High | 0.06 | Not statistically significant, p ≥ 0.05 | 564 mothers | Full sample, Hawaii trial | ||
| Mother earned HS degree or in school | Year 2 | High | 0.04 | Not statistically significant, p ≥ 0.05 | 567 mothers | Full sample, Hawaii trial | ||
| Someone in household worked | Year 2 | High | 0.07 | Not statistically significant, p ≥ 0.05 | 567 mothers | Full sample, Hawaii trial |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Maternal life skills (CLSS) | Year 1 | High | Not statistically significant, p ≥ 0.05 | 564 mothers | Full sample, Hawaii trial | |||
| Maternal social support (MSSI) | Year 1 | High | Not statistically significant, p ≥ 0.05 | 564 mothers | Full sample, Hawaii trial | |||
| Confidence in adult relations | Year 1 | High | Not statistically significant, p ≥ 0.05 | 564 mothers | Full sample, Hawaii trial | |||
| Maternal life skills (CLSS) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 567 mothers | Full sample, Hawaii trial | |||
| Maternal social support (MSSI) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 567 mothers | Full sample, Hawaii trial | |||
| Confidence in adult relations | Year 2 | High | Not statistically significant, p ≥ 0.05 | 567 mothers | Full sample, Hawaii trial |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Ever used emergency department | Year 1 | High | 0.10 | Not statistically significant, p ≥ 0.05 | 564 children | Full sample, Hawaii trial | ||
| Ever hospitalized for any reason | Year 1 | High | 0.04 | Not statistically significant, p ≥ 0.05 | 564 children | Full sample, Hawaii trial | ||
| Has a primary care provider (PCP) | Year 1 | High | 0.34 | Not statistically significant, p ≥ 0.05 | 564 children | Full sample, Hawaii trial | ||
| Has a PCP who handles most health care needs | Year 1 | High | 0.24 | Not statistically significant, p ≥ 0.05 | 564 children | Full sample, Hawaii trial | ||
| Has a PCP who knows all aspects of child’s care | Year 1 | High | 0.20 | Not statistically significant, p ≥ 0.05 | 564 children | Full sample, Hawaii trial | ||
| Has a PCP who knows family’s concerns about child | Year 1 | High | 0.07 | Not statistically significant, p ≥ 0.05 | 564 children | Full sample, Hawaii trial | ||
| Immunizations up-to-date | Year 1 | High | 0.00 | Not statistically significant, p ≥ 0.05 | 564 children | Full sample, Hawaii trial | ||
| Has a primary care provider (PCP) | Year 2 | High | 0.30 | Not statistically significant, p ≥ 0.05 | 567 children | Full sample, Hawaii trial | ||
| Has a PCP who handles most health care needs | Year 2 | High | 0.26 | Not statistically significant, p ≥ 0.05 | 567 children | Full sample, Hawaii trial | ||
| Has a PCP who knows all aspects of child’s care | Year 2 | High | 0.17 | Not statistically significant, p ≥ 0.05 | 567 children | Full sample, Hawaii trial | ||
| Has a PCP who knows family’s concerns about child | Year 2 | High | 0.27 | Statistically significant, p < 0.05 |
567 children | Full sample, Hawaii trial | ||
| Immunizations up-to-date | Year 2 | High | 0.10 | Not statistically significant, p ≥ 0.05 | 567 children | Full sample, Hawaii trial | ||
| Ever used emergency department | Years 1 and 2 | High | 0.05 | Not statistically significant, p ≥ 0.05 | 534 children | Full sample, Hawaii trial | ||
| Ever hospitalized for any reason | Years 1 and 2 | High | 0.11 | Not statistically significant, p ≥ 0.05 | 534 children | Full sample, Hawaii trial |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- Hawaii