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Healthy Families America (HFA)®

Meets DHHS criteria for an evidenced based model

Last Updated: April 2017

Effects Shown in Research & Outcome Measure Details for Child Development and School Readiness Outcomes

Impact Studies Rated High


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
Additional Source:

Cluxton-Keller, F., Burrell, L., Crowne, S., McFarlane, E., Tandon, S., Leaf, P., & Duggan, A. (2014). Maternal relationship insecurity and depressive symptoms as moderators of home visiting impacts on child outcomes. Journal of Child & Family Studies, 23(8), 1430-1443.

Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
BSID Cognitive score Favorable Children with complete medical record data, Alaska trial Age 2 249 children Adjusted mean = 88.0 Adjusted mean = 84.8 MD = 3.2 Statistically significant,
p < 0.05
Not available Primary
BSID percentage within normal limits on cognitive Favorable Children with complete medical record data, Alaska trial Age 2 249 children 58% (adjusted) 48% (adjusted) OR = 1.55 Statistically significant,
p < 0.05
HomVEE = 0.24 Primary
BSID percentage within normal limits on psychomotor No Effect Children with complete medical record data, Alaska trial Age 2 249 children 85% (adjusted) 80% (adjusted) OR = 1.36 Not statistically significant,
p > 0.05
HomVEE = 0.21 Primary
BSID Psychomotor score No Effect Children with complete medical record data, Alaska trial Age 2 249 children Adjusted mean = 98.1 Adjusted mean = 96.0 MD = 2.1 Not statistically significant,
p > 0.05
Not available Primary
CBCL percentage with externalizing scores in normal range Favorable Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children 82% (adjusted) 77% (adjusted) OR = 1.48 Statistically significant,
p < 0.05
HomVEE = 0.19 Primary
CBCL percentage with internalizing scores in normal range Favorable Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children 87% (adjusted) 79% (adjusted) OR = 2.06 Statistically significant,
p < 0.05
HomVEE = 0.35 Primary
CBCL total externalizing score No Effect Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children Adjusted mean = 50.8 Adjusted mean = 53.0 MD = -2.2 Not statistically significant,
p > 0.05
Not available Primary
CBCL total internalizing score Favorable Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children Adjusted mean = 48.2 Adjusted mean = 51.0 MD = -2.8 Statistically significant,
p < 0.05
Not available Primary
Child Response Score NCAST1 No Effect Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children Adjusted mean = 18.4 Adjusted mean = 18.5 MD = -0.9 Not statistically significant,
p > 0.05
Not available Primary

1 Child’s response to a caregiver who is teaching him/her a new skill.

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
BSID: MDI and PDI The BSID tests the mental, motor, and behavioral development and abilities of young children. The researchers examined the MDI and PDI as continuous and binary for scores <85 versus those greater than or equal to 85. Child assessment Not reported by author Primary
CBCL: Internalizing and Externalizing The CBCL is a questionnaire that assesses behavioral problems in young children. The internalizing and externalizing scales were measured as continuous and as a binary variable using recommended cut points for normal (<60) versus borderline (60–63) and clinical scores (>63). Parent/caregiver report Not reported by author Primary
NCAST: Child responsiveness The NCAST assesses the quality of caregiver-child teaching interaction. The researchers examined the composite child interaction score. Observation Not reported by author Primary

DuMont, K., Kirkland, K., Mitchell-Herzfeld, S., Ehrhard-Dietzel, S., Rodriguez, M. L., Lee, E., Layne, C., & Greene, R. (2010). “A randomized trial of Healthy Families New York (HFNY): Does home visiting prevent child maltreatment?” Rensselaer, NY: New York State Office of Children & Family Services and Albany, NY: The University of Albany, State University of New York, 2010.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Attention problems (CBCL) No Effect New York sample 7 year 897 mothers Adjusted mean = 4.77 Adjusted mean = 4.75 MD = 0.02 Not statistically significant, p > 0.05 Study-reported = 0.01 Primary
Percentage participating in a gifted program Favorable New York sample 7 year 897 mothers Adjusted mean = 5.38% Adjusted mean = 1.99% OR = 2.8 Statistically significant, p < 0.05 Not available Secondary
Percentage receiving remedial services No Effect New York sample 7 year 897 mothers Adjusted mean = 32.83% Adjusted mean = 33.31% OR = 0.98 Not statistically significant, p > 0.05 Not available Secondary
Percentage receiving special education Favorable New York sample 7 year 897 mothers Adjusted mean = 12.33% Adjusted mean = 16.74% OR = 0.7 Statistically significant, p < 0.05 Not available Secondary
Percentage repeating a grade No Effect New York sample 7 year 897 mothers Adjusted mean = 12.33% Adjusted mean = 16.74% OR = 0.98 Not statistically significant, p > 0.05 Not available Secondary
Percentage skipping school more than once No Effect New York sample 7 year 897 mothers Adjusted mean = 2.4% Adjusted mean = 2.2% OR = 1.08 Not statistically significant, p > 0.05 Not available Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Attention problems (CBCL) The Child BehaviorChecklist for Ages6ndash;8(CBCL/6-18) assesses children’s emotional and behavioral problems. Researchers selected five subscales that aligned with constructs of interest: attention problems, rule breaking and aggressive behaviors, social problems, and the anxious-depressed and withdrawn-depressed syndrome scales. Parent/caregiver report Not reported by author Primary
Percentage participating in a gifted program Percentage of children that were participating in a gifted or talented program at the time of the Year 7 interview Parent/caregiver report  Not applicable Secondary
Percentage receiving remedial services Percentage of children that were receiving remedial education services for math and writing at the time of the Year 7 interview Parent/caregiver report  Not applicable Secondary
Percentage receiving special education Percentage of children that were enrolled in special education services at the time of the Year 7 interview Parent/caregiver report  Not applicable Secondary
Percentage repeating a grade Percentage of children that had repeated a grade at the time of the Year 7 interview Parent/caregiver report  Not applicable Secondary
Percentage skipping school more than once Percentage of children that had skipped school more than once at the time of the Year 7 interview Parent/caregiver report  Not applicable Secondary

Landsverk, J., Carrilio, T., Connelly, C. D., Ganger, W., Slymen, D., Newton, R., et al. (2002). Healthy Families San Diego clinical trial: Technical report. San Diego, CA: The Stuart Foundation, California Wellness Foundation, State of California Department of Social Services: Office of Child Abuse Prevention.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
BSID, Mental Development Index (MDI) Favorable Full sample, San Diego trial Year 1 422 children Mean = 105.0
SD = 10.7
Mean = 102.5
SD = 11.3
MD = 2.5 Statistically significant,
p < 0.05
HomVEE = 0.23 Primary
BSID, Motor MDI No Effect Full sample, San Diego trial Year 1 422 children Mean = 113.5
SD = 13.6
Mean = 113.0
SD = 12
MD = 0.5 Not statistically significant,
p > 0.05
HomVEE = 0.04 Primary
CBCL Aggressive T score No Effect Full sample, San Diego trial Year 3 382 children Mean = 53.5
SD = 6.2
Mean = 53.6
SD = 5.3
MD = -0.1 Not statistically significant,
p > 0.05
HomVEE = -0.02 Primary
CBCL Anxious/Depressed T score No Effect Full sample, San Diego trial Year 3 382 children Mean = 53.5
SD = 5.5
Mean = 54.3
SD = 5.8
MD = -0.8 Not statistically significant,
p > 0.05
HomVEE = -0.14 Primary
CBCL Behavior Problems No Effect Full sample, San Diego trial Year 3 382 children Mean = 49.7
SD = 9.5
Mean = 51.1
SD = 9.3
MD = -1.4 Not statistically significant,
p > 0.05
HomVEE = -0.15 Primary
CBCL Destructive T score No Effect Full sample, San Diego trial Year 3 382 children Mean = 53.6
SD = 6.8
Mean = 53.3
SD = 5
MD = 0.3 Not statistically significant,
p > 0.05
HomVEE = 0.05 Primary
CBCL Externalizing problems T score No Effect Full sample, San Diego trial Year 3 382 children Mean = 49.4
SD = 9.3
Mean = 49.9
SD = 8.5
MD = -0.5 Not statistically significant,
p > 0.05
HomVEE = -0.06 Primary
CBCL Internalizing problems T score No Effect Full sample, San Diego trial Year 3 382 children Mean = 50.9
SD = 9.6
Mean = 52.6
SD = 9.9
MD = -1.7 Not statistically significant,
p > 0.05
HomVEE = -0.17 Primary
CBCL Sleep problems T score No Effect Full sample, San Diego trial Year 3 382 children Mean = 52.3
SD = 4.1
Mean = 52.7
SD = 4.4
MD = -0.4 Not statistically significant,
p > 0.05
HomVEE = -0.09 Primary
CBCL Somatic problems T score Favorable Full sample, San Diego trial Year 3 382 children Mean = 53.8
SD = 5.3
Mean = 55.2
SD = 6.5
MD = -1.4 Statistically significant,
p < 0.05
HomVEE = -0.24 Primary
CBCL Withdrawn T score No Effect Full sample, San Diego trial Year 3 382 children Mean = 55.1
SD = 7.2
Mean = 56.1
SD = 7.8
MD = -1.0 Not statistically significant,
p > 0.05
HomVEE = -0.13 Primary
Stanford Binet Abstract/Visual Reasoning SAS No Effect Full sample, San Diego trial Year 3 412 children Mean = 90.6
SD = 11.5
Mean = 90.5
SD = 10.4
MD = 0.1 Not statistically significant,
p > 0.05
HomVEE = 0.01 Primary
Stanford Binet Communication Survey No Effect Full sample, San Diego trial Year 3 412 children Mean = 101.8
SD = 16.4
Mean = 101.9
SD = 15.1
MD = -0.1 Not statistically significant,
p > 0.05
HomVEE = -0.01 Primary
Stanford Binet Partial Composite No Effect Full sample, San Diego trial Year 3 412 children Mean = 91.3
SD = 8.7
Mean = 91.3
SD = 8.7
MD = 0.0 Not statistically significant,
p > 0.05
HomVEE = 0.00 Primary
Stanford Binet Short Term Memory SAS No Effect Full sample, San Diego trial Year 3 412 children Mean = 98.6
SD = 10.8
Mean = 97.8
SD = 9.3
MD = 0.8 Not statistically significant,
p > 0.05
HomVEE = 0.08 Primary
Stanford Binet Sum of Area SAS No Effect Full sample, San Diego trial Year 3 412 children Mean = 326.9
SD = 78.8
Mean = 331.6
SD = 72
MD = -4.7 Not statistically significant,
p > 0.05
HomVEE = -0.06 Primary
Stanford Binet Verbal Reasoning Memory SAS No Effect Full sample, San Diego trial Year 3 412 children Mean = 86.5
SD = 12.2
Mean = 87.3
SD = 9.9
MD = -0.8 Not statistically significant,
p > 0.05
HomVEE = -0.07 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
BSID: MDI and PDI The BSID tests the mental, motor, and behavioral development and abilities of young children. The researchers examined both the mental development and psychomotor development scales. Child assessment Not reported by author Primary
CBCL:
  • Anxious/Depressed
  • Withdrawn
  • Sleep problems
  • Somatic problems
  • Aggressive
  • Destructive
  • Behavior problems
  • Internalizing problems
  • Externalizing problems
The CBCL is a questionnaire that assesses behavioral problems in young children. The researchers analyzed subscales related to withdrawal, sleep, somatic, aggressiveness, destructiveness, internalizing, and externalizing problems and behaviors. Parent/caregiver report Not reported by author Primary
Stanford Binet:
  • Short Term Memory SAS
  • Abstract/Visual Reasoning SAS
  • Verbal Reasoning Memory SAS
  • Sum of Area SAS
  • Partial Composite
  • Communication Survey
The Stanford-Binet assesses intelligence in young children. The researchers examined abstract/visual reasoning, verbal reasoning memory, communication, and summary and composite measures of intelligence. Child assessment Not reported by author Primary
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Impact Studies Rated Moderate


Anisfeld, E., Sandy, J., & Guterman, N. B. (2004). Best Beginnings: A randomized controlled trial of a paraprofessional home visiting program: Technical report. Report to the Smith Richardson Foundation and New York State Office of Children and Family Services. New York: Columbia University School of Social Work.
Additional Sources:

Anisfeld, E., Sandy, J., & Guterman, N. B. (2004). Best Beginnings: A randomized controlled trial of a paraprofessional home visiting program: Executive summary. Report to the Smith Richardson Foundation and New York State Office of Children and Family Services. New York: Columbia University School of Social Work.

Anisfeld, E., Sandy, J., & Guterman, N. B. (2004). Best Beginnings: A randomized controlled trial of a paraprofessional home visiting program: Narrative summary. Report to the Smith Richardson Foundation and New York State Office of Children and Family Services. New York: Columbia University School of Social Work

Rausch, J.C., M. McCord, M. Batista, and E. Anisfeld. (2012) “Latino Immigrant Children’s Health: Effects of Sociodemographic Variables and of a Preventative Intervention Program.” International Journal of Population Research, pp. 1-8, doi: 10.1155/2012/250276.

Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
ASQ Communication score No Effect Program group children not affected by substance abuse,
NY Best Beginnings trial
6 months 359 children, Mean = 55.7
SD = 5.9
Mean = 55.3
SD = 5.8
MD = 0.4 Statistical significance not reported HomVEE = 0.07 Primary
ASQ Composite score No Effect Program group children not affected by substance abuse,
NY Best Beginnings trial
6 months 359 children, Mean = 54.8
SD = 4.7
Mean = 54.0
SD = 5.8
MD = 0.8 Statistical significance not reported HomVEE = 0.15 Primary
ASQ Fine Motor score No Effect Program group children not affected by substance abuse,
NY Best Beginnings trial
6 months 359 children, Mean = 55.1
SD = 7.1
Mean = 54.2
SD = 7.5
MD = 0.9 Statistical significance not reported HomVEE = 0.12 Primary
ASQ Gross Motor score No Effect Program group children not affected by substance abuse,
NY Best Beginnings trial
6 months 359 children, Mean = 52.9
SD = 8.9
Mean = 51.8
SD = 10.1
MD = 1.1 Statistical significance not reported HomVEE = 0.12 Primary
ASQ Social score No Effect Program group children not affected by substance abuse,
NY Best Beginnings trial
6 months 359 children, Mean = 53.7
SD = 8.0
Mean = 54.2
SD = 7.8
MD = -0.5 Statistical significance not reported HomVEE = -0.06 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
ASQ:
  • Communication score
  • Gross Motor score
  • Fine Motor score
  • Social score
  • Composite score
The ASQ assesses the status of development in young children. The researchers examined subscales related to communication, motor development, and social practices. Parent/caregiver report Not reported by author Primary

King, T., Rosenberg, L., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. (2005). Prevalence and early identification of language delays among at-risk three year olds. Journal of Developmental & Behavioral Pediatrics, 26(4), 293–303.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
PLS-3 Score No Effect Children with developmental testing results, Hawaii trial Age 3 513 children Adjusted mean = 87.9 Adjusted mean = 87.1 MD = 0.8 Not statistically significant,
p > 0.05
Not available Primary
Prevalence of any delays (PLS-3 score ≤ 85) No Effect Children with developmental testing results, Hawaii trial Age 3 513 children 48% (adjusted) 49% (adjusted) OR = 0.97 Not statistically significant,
p > 0.05
Not available Primary
Prevalence of severe delays (PLS-3 score ≤ 70) No Effect Children with developmental testing results, Hawaii trial Age 3 513 children 9% (adjusted) 11% (adjusted) OR = 0.80 Not statistically significant,
p > 0.05
Not available Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
PLS-3 score The PLS assesses communication and language development in young children. The researchers examined the mean PLS score in addition to the prevalence of severe delays (PLS-3 score ≤ 70) and the prevalence of any language delays (PLS-3 score ≤ 85). Child assessment Not reported by author Primary

Kirkland, K., & Mitchell-Herzfeld, S. (2012). Evaluating the effectiveness of home visiting services in promoting children’s adjustment in school: Final report to the Pew Center on the States. Rensselaer, NY: New York State Office of Children and Family Services, Bureau of Evaluation and Research.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Days absent No Effect Healthy Families New York (HFNY) RCT, Year 7 1st grade 577 mother-child pairs 16.36 15.28 MD = 1.081 Not statistically significant, p > 0.05 HomVEE = 1.37 Primary
Doing poorly academically No Effect Healthy Families New York (HFNY) RCT, Year 7 1st grade 577 mother-child pairs 0.3031 0.3284 MD = -0.032 Not statistically significant, p > 0.05 HomVEE = -0.07 Primary
Doing poorly academically - Any of the 3 behaviors that promote learning No Effect Healthy Families New York (HFNY) RCT, Year 7 1st grade 577 mother-child pairs 0.1522 0.1598 MD = -0.012 Not statistically significant, p > 0.05 HomVEE = -0.03 Primary
Doing poorly academically - Reading or Math No Effect Healthy Families New York (HFNY) RCT, Year 7 1st grade 577 mother-child pairs 0.2085 0.2496 MD = -0.042 Not statistically significant, p > 0.05 HomVEE = -0.14 Primary
Excelling academically No Effect Healthy Families New York (HFNY) RCT, Year 7 1st grade 577 mother-child pairs 0.2601 0.2031 MD = 0.06 Not statistically significant, p > 0.05 HomVEE = 0.19 Primary
Excelling academically - All 3 behaviors that promote learning Favorable Healthy Families New York (HFNY) RCT, Year 7 1st grade 577 mother-child pairs 0.1315 0.0774 MD = 0.05 Statistically significant, p < 0.05 HomVEE = 0.36 Primary
Excelling academically - Reading and Math No Effect Healthy Families New York (HFNY) RCT, Year 7 1st grade 577 mother-child pairs 0.1599 0.1566 MD = 0.00 Not statistically significant, p > 0.05 HomVEE = 0.01 Primary
Retained in first grade Favorable Healthy Families New York (HFNY) RCT, Year 7 1st grade 577 mother-child pairs 0.0354 0.071 MD = -0.042 Statistically significant, p < 0.05 HomVEE = -0.44 Primary

1 Positive value is favorable to the comparison group.

2 Negative value is favorable to the intervention.

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Days absent Mean number of days absent in the first grade First grade school record Interrater agreement ranged from 89% to 99% Primary
Doing poorly academically Percentage of first-grade students whose best grade was below grade level in reading or math, or any of the behaviors that promote learning (working or playing cooperatively with others, following directions or classroom rules, or completing home or class work on time). First grade school record Interrater agreement ranged from 89% to 99% Primary
Doing poorly academically - Any of the 3 behaviors that promote learning Percentage of first-grade students whose best grade was below grade level in any of the behaviors that promote learning (working or playing cooperatively with others, following directions or classroom rules, or completing home or class work on time). First grade school record Interrater agreement ranged from 89% to 99% Primary
Doing poorly academically - Reading or Math Percentage of first-grade students whose best grade was below grade level in reading or math First grade school record Interrater agreement ranged from 89% to 99% Primary
Excelling academically Percentage of first-grade students whose best grade was above grade level in either reading and math, or in all three behaviors that promote learning (working or playing cooperatively with others, following directions or classroom rules and completing home or class work on time). First grade school record Interrater agreement ranged from 89% to 99% Primary
Excelling academically - All 3 behaviors that promote learning Percentage of first-grade students whose best grade was above grade level in all three behaviors that promote learning (working or playing cooperatively with others, following directions or classroom rules and completing home or class work on time). First grade school record Interrater agreement ranged from 89% to 99% Primary
Excelling academically - Reading and Math Percentage of first-grade students whose best grade was above grade level in reading and math First grade school record Interrater agreement ranged from 89% to 99% Primary
Retained in first grade Percentage of students who were retained in first grade First grade school record Interrater agreement ranged from 89% to 99% Primary
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