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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 Health 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
Adequate well-child visits No Effect Children in custody of biological mother at interview, Alaska trial Year 2 249 children 4% (adjusted) 8% (adjusted) OR = 0.96 Not statistically significant,
p > 0.05 		HomVEE = -0.45 Primary
Has health care coverage Favorable Children in custody of biological mother at interview, Alaska trial Year 2 249 children 95% (adjusted) 90% (adjusted) OR = 2.05 Statistically significant,
p < 0.05 		HomVEE = 0.45 Secondary
Has primary care provider No Effect Children in custody of biological mother at interview, Alaska trial Year 2 249 children 74% (adjusted) 78% (adjusted) OR = 0.76 Not statistically significant,
p > 0.05 		HomVEE = -0.13 Secondary
Immunizations up-to-date No Effect Children in custody of biological mother at interview, Alaska trial Year 2 249 children 27% (adjusted) 27% (adjusted) OR = 1.01 Not statistically significant,
p > 0.05 		HomVEE = 0.00 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Adequate well-child visits Percentage of children who had adequate well-child visits according to the American Academy of Pediatrics guidelines Review of medical records Not applicable Primary
Has health care coverage Percentage of children who had health care coverage Parent/caregiver report Not applicable Secondary
Has PCP Percentage of children who had a PCP Parent/caregiver report Not applicable Secondary
Immunizations up-to-date Percentage of children who had up-to-date immunizations according to the American Academy of Pediatrics guidelines Review of medical records Not applicable Primary
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.
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
Ever hospitalized for any reason No Effect Full sample, Hawaii trial Year 1 564 children 17% 18% -1 Not statistically significant,
p > 0.05 		HomVEE = -0.04 Secondary
Ever hospitalized for any reason No Effect Full sample, Hawaii trial Years 1 and 2 534 children 19% 22% 3 Not statistically significant,
p > 0.05 		HomVEE = -0.11 Secondary
Ever used emergency department No Effect Full sample, Hawaii trial Year 1 564 children 40% 44% -4 Not statistically significant,
p > 0.05 		HomVEE = -0.10 Secondary
Ever used emergency department No Effect Full sample, Hawaii trial Years 1 and 2 534 children 58% 60% -2 Not statistically significant,
p > 0.05 		HomVEE = -0.05 Secondary
Has a PCP who handles most health care needs No Effect Full sample, Hawaii trial Year 1 564 children 93% 90% 3 Not statistically significant,
p > 0.05 		HomVEE = 0.24 Secondary
Has a PCP who handles most health care needs No Effect Full sample, Hawaii trial Year 2 567 children 89% 84% 5 Not statistically significant,
p > 0.05 		HomVEE = 0.26 Secondary
Has a PCP who knows all aspects of child’s care No Effect Full sample, Hawaii trial Year 2 567 children 80% 75% 5 Not statistically significant,
p > 0.05 		HomVEE = 0.17 Secondary
Has a PCP who knows all aspects of child’s care No Effect Full sample, Hawaii trial Year 1 564 children 84% 79% 5 Not statistically significant,
p > 0.05 		HomVEE = 0.20 Secondary
Has a PCP who knows family’s concerns about child No Effect Full sample, Hawaii trial Year 1 564 children 45% 48% 3 Not statistically significant,
p > 0.05 		HomVEE = -0.07 Secondary
Has a PCP who knows family’s concerns about child Favorable Full sample, Hawaii trial Year 2 567 children 50% 39% 11 Statistically significant,
p < 0.05 		HomVEE = 0.27 Secondary
Has a primary care provider (PCP) No Effect Full sample, Hawaii trial Year 1 564 children 94% 90% 4 Not statistically significant,
p > 0.05 		HomVEE = 0.34 Secondary
Has a primary care provider (PCP) No Effect Full sample, Hawaii trial Year 2 567 children 91% 86% 5 Not statistically significant,
p > 0.05 		HomVEE = 0.30 Secondary
Immunizations up-to-date No Effect Full sample, Hawaii trial Year 1 564 children 82% 82% 0 Not statistically significant,
p > 0.05 		HomVEE = 0.00 Secondary
Immunizations up-to-date No Effect Full sample, Hawaii trial Year 2 567 children 87% 85% 2 Not statistically significant,
p > 0.05 		HomVEE = 0.10 Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Ever hospitalized for any reason Percentage of children who had ever been hospitalized for any reason Parent/caregiver report Not applicable Secondary
Ever used emergency department Percentage of children who had ever used the emergency department Parent/caregiver report Not applicable Secondary
Has a PCP Percentage of children who had a PCP Parent/caregiver report Not applicable Secondary
Has a PCP who handles most health care needs Percentage of children who had a PCP who handled most health care needs Parent/caregiver report Not applicable Secondary
Has a PCP who knows all aspects of child’s care Percentage of children who had a PCP who knew about all aspects of the child’s care Parent/caregiver report Not applicable Secondary
Has a PCP who knows family’s concerns about child Percentage of children who had a PCP who understood the family’s concerns about child Parent/caregiver report Not applicable Secondary
Immunizations up-to-date Percentage of children who were up-to-date on the appropriate immunizations for the child’s age Parent/caregiver report Not applicable Secondary
Duggan, A., McFarlane, E., Fuddy, L., Burrell, L., Higman, S. M., Windham, A., et al. (2004). Randomized trial of a statewide home visiting program: Impact in preventing child abuse and neglect. Child Abuse & Neglect, 28(6), 597–622.
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
Hospitalizations for ambulatory care No Effect Full sample, Hawaii trial Years 1-3 573 children 12% 10% OR = 1.27 Not statistically significant,
p > 0.05 		HomVEE = 0.12 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Hospitalizations for ambulatory care Percentage of children who were hospitalized for ambulatory care Review of medical records Not applicable Primary
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.
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
Childhospitalized for ambulatory care sensitive conditions (ACSC)1 No Effect Families with complete medical record data, Alaska trial Years 1 and 2 268 families 9% (adjusted) 9% (adjusted) OR = 1.09 Not statistically significant,
p > 0.05 		HomVEE = 0.00 Primary
Childseen in emergency department for ACSC No Effect Families with complete medical record data, Alaska trial Years 1 and 2 268 families 81% (adjusted) 78% (adjusted) OR = 1.23 Not statistically significant,
p > 0.05 		HomVEE = 0.11 Primary
Number of timeshospitalized for ACSC No Effect Families with complete medical record data, Alaska trial Years 1 and 2 268 families Adjusted mean = 0.11 Adjusted mean = 0.12 MD = -0.01 Not statistically significant,
p > 0.05 		Not available Primary
Number of timesseen in emergency department for ACSC No Effect Families with complete medical record data, Alaska trial Years 1 and 2 268 families Adjusted mean = 3.13 Adjusted mean = 4.09 MD = -0.96 Not statistically significant,
p > 0.05 		Not available Primary

1 Ambulatory care sensitive conditions include: asthma, pneumonia, other upper airway conditions, gastroenteritis, dehydration, cellulitis, and seizures.

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type

Child hospitalized forACSC

Child seen in emergency department for ACSC

Number of timeshospitalized for ACSC

Number of timesseen in emergency department for ACSC

 		The researchersused the Parker& Schoendorf (2000) definitionof ACSC to examine hospitalizations that might have been avoided with adequate primary care. The list of conditions includes asthma, pneumonia, other upper airway conditions, gastroenteritis, dehydration, cellulitis, and seizures. The percentage of children hospitalized for ACSC, the percentage of children that were seen in the emergency department for ACSC, the number of times the child was seen in the emergency department for ACSC, and the number of times the child was hospitalized for ACSC were analyzed. Parent/caregiver report and review of medical records Not applicable 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
Anxious, depressed (CBCL) No Effect New York sample 7 year 897 mothers Adjusted mean = 2.89 Adjusted mean = 2.97 MD = -0.08 Not statistically significant, p > 0.05 Study-reported = -0.03 Primary
Social problems (CBCL) No Effect New York sample 7 year 897 mothers Adjusted mean = 1.31 Adjusted mean = 1.15 MD = 0.16 Not statistically significant, p > 0.05 Study-reported = -0.04 Primary
Withdrawn, depressed (CBCL) No Effect New York sample 7 year 897 mothers Adjusted mean = 1.47 Adjusted mean = 1.54 MD = -0.07 Not statistically significant, p > 0.05 Study-reported = -0.04 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Anxious, depressed (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
Social 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
Withdrawn, depressed (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
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
Child has insurance coverage1 No Effect Full sample, San Diego trial Year 1 435 children 84.2% 87.2% -3 Not statistically significantNot statistically significant,
p > 0.05 		HomVEE = -0.15 Secondary
Child has insurance coverage No Effect Full sample, San Diego trial Year 3 412 children 82.4% 84% -1.6 Not statistically significant,
p > 0.05 		HomVEE = -0.07 Secondary
Child has regular health care site No Effect Full sample, San Diego trial Year 3 412 children 98% 98.5% -0.5 Not statistically significant,
p > 0.05 		HomVEE = -0.18 Secondary
Child has regular health care site No Effect Full sample, San Diego trial Year 1 435 children 98.1% 97.7% 0.4 Not statistically significant,
p > 0.05 		HomVEE = 0.12 Secondary
Child has specific health care provider No Effect Full sample, San Diego trial Year 1 435 children 74% 81.6% -7.6 Not statistically significant,
p > 0.05 		HomVEE = -0.27 Secondary
Child has specific health care provider No Effect Full sample, San Diego trial Year 3 412 children 63.6% 72.2% -8.6 Not statistically significant,
p > 0.05 		HomVEE = -0.24 Secondary
Compliance with recommended number of well-child visits No Effect Full sample, San Diego trial Year 1 435 children 58.6% 59.6% -1 Not statistically significant,
p > 0.05 		HomVEE = -0.03 Secondary
Compliance with recommended number of well-child visits No Effect Full sample, San Diego trial Year 3 412 children 85.8% 83.8% 3 Not statistically significant,
p > 0.05 		HomVEE = 0.09 Secondary
Immunizations up-to-date No Effect Full sample, San Diego trial Year 3 412 children 96.9% 95.9% 1 Not statistically significant,
p > 0.05 		HomVEE = 0.18 Secondary
Number of sick visits No Effect Full sample, San Diego trial Year 3 412 children Median = 1 Median = 1 Not available Not statistically significant,
p > 0.05 		Not available Secondary
Number of sick visits No Effect Full sample, San Diego trial Year 1 435 children Median = 3 Median = 3 Not available Not statistically significant,
p > 0.05 		Not available Secondary
Number of well-child visits Favorable Full sample, San Diego trial Year 3 412 children Mean = 2.4
SD = 2.8 		Mean = 1.9
SD = 1.7 		MD = 0.5 Statistically significant,
p < 0.05 		HomVEE = 0.22 Secondary
Number of well-child visits No Effect Full sample, San Diego trial Year 1 435 children Mean = 7.0
SD = 3.8 		Mean = 6.8
SD = 3.7 		MD = 0.2 Not statistically significant,
p > 0.05 		HomVEE = 0.05 Secondary

1 This study was assigned a moderate rating for this outcome due to statistically significant differences between the program and comparison groups at baseline.

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Child has insurance coverage Percentage of children who had health insurance coverage Parent/caregiver report Not applicable Secondary
Child has regular health care site Percentage of children who had a location they typically went to for health care Parent/caregiver report Not applicable Secondary
Child has specific health care provider Percentage of children who had a specific health care provider Parent/caregiver report Not applicable Secondary
Compliance with recommended number of well-child visits Percentage of children who had received the recommended number of well-child visits for their age, defined as six or more visits in the first year of life, three or more visits in the second year of life, and one or more visits in third year of life Parent/caregiver report Not applicable Secondary
Immunizations up-to-date Percentage of children who were up-to-date on the appropriate immunizations for the child’s age Parent/caregiver report Not applicable Secondary
Number of sick visits Number of sick visits the child had received Parent/caregiver report Not applicable Secondary
Number of well-child visits Number of well-child visits the child had received Parent/caregiver report Not applicable Secondary
Lee, E., Mitchell-Herzfeld, S., Lowenfels, A. A., Greene, R., Dorabawila, V., & DuMont, K. A. (2009). Reducing low birth weight through home visitation: A randomized controlled trial. American Journal of Preventive Medicine, 36(2), 154–160.
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
Low birth weight Favorable Full sample At birth 501 Adjusted proportion= 0.05 Adjusted proportion = 0.10 OR = 0.43 Statistically significant, p = 0.02 HomVEE = -0.511 Primary
Preterm birth No Effect Full sample At birth 501 Not reported Not reported Not reported Not statistically significant, p > 0.05 Not reported Primary

1 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
Low birth weight The study considered a baby born weighing less than 2,500 grams as low birth weight. The study determined birth weight using birth certificates. Birth certificate Not applicable Primary
Preterm birth The study considered a baby born after 37 or fewer weeks of gestation as a preterm birth. New York State Department of Health birth records Not applicable 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
Number of pediatric emergency department visits Unfavorable Program group children not affected by substance abuse,
NY Best Beginnings trial 		36 months 271 children Not available Not available Beta = 0.12 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
Number of pediatric emergency department visits Number of pediatric emergency department visits between birth and age 36 months Parent/caregiver report Not applicable Secondary
Green, B. L., Tarte, J. M., Harrison, P. M., Nygren, M., & Sanders, M. B. (2014). Results from a randomized trial of the Healthy Families Oregon accredited statewide program: Early program impacts on parenting. Children and Youth Services Review, 44, 288-298.
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
Baby received developmental screening in first year of life Favorable HF Oregon 2010-2012 Child's 1st birthday 762 mothers Adjusted proportion = 0.94 Adjusted proportion = 0.87 OR = 0.41 Statistically significant, p = 0.00 Not available Secondary
Child ever breastfed - full sample No Effect HF Oregon 2010-2012 Child's 1st birthday 752 mothers Adjusted proportion = 0.91 Adjusted proportion = 0.91 OR = 0.91 Not statistically significant, p>0.05 Not available Secondary
Parent ever told that child was not on track developmentally - full sample No Effect HF Oregon 2010-2012 Child's 1st birthday 762 mothers Adjusted proportion = 0.05 Adjusted proportion = 0.09 OR = 1.461 Not statistically significant, p = 0.08 Not available Secondary

1 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
Baby received developmental screening in first year of life This survey item asks whether the baby received a developmental screening in first year of life. Parent/caregiver report Not reported by author Secondary
Child ever breastfed - full sample This survey item asks whether the child was ever breastfed. Parent/caregiver report Not reported by author Secondary
Parent ever told that child was not on track developmentally - full sample This survey item asks whether the parent was ever told that the child was not on track developmentally. Parent/caregiver report Not reported by author Secondary
Mitchell-Herzfeld, S., Izzo, C., Greene, R., Lee, E., & Lowenfels, A. (2005). Evaluation of Healthy Families New York (HFNY): First year program impacts. Albany, NY: University at Albany, Center for Human Services 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
Child ever without needed medical care No Effect Full sample, NY Trial Year 1 1,061 children 2.2% 1.4% Not available Not statistically significant,
p > 0.05 		HomVEE = 0.28 Secondary
Child has health insurance Favorable Full sample, NY Trial Year 1 1,061 children 93.9% 90.4% 3.5 Statistically significant,
p < 0.05 		HomVEE = 0.30 Secondary
Child has primary care provider No Effect Full sample, NY Trial Year 1 1,061 children 98.4% 98.6% -0.2 Not statistically significant,
p > 0.05 		HomVEE = -0.08 Secondary
Mother breastfed baby No Effect Full sample, NY Trial Year 1 1,060 mothers 45.9% 44.7% 1.2 Not statistically significant,
p > 0.05 		Not available Secondary
Number of months breastfed No Effect Full sample, NY Trial Year 1 1,060 mothers Adjusted mean = 1.01 Adjusted mean = 1.04 MD = -0.03 Not statistically significant,
p > 0.05 		Not available Secondary
Number of well-baby visits No Effect Full sample, NY Trial Year 1 1,061 children Adjusted mean = 4.54 Adjusted mean = 4.61 MD = -0.07 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
Child ever without needed medical care Percentage of children who had ever gone without needed medical care Parent/caregiver report Not applicable Secondary
Child has health insurance Percentage of children who had health insurance coverage Parent/caregiver report Not applicable Secondary
Child has PCP Percentage of children who had a PCP Parent/caregiver report Not applicable Secondary
Mother breastfed baby Percentage of mothers who had breastfed their child Parent/caregiver report Not applicable Secondary
Number of months breastfed Number of months the mother had breastfed her child Parent/caregiver report Not applicable Secondary
Number of well-baby visits Number of well-child visits the child had received Review of medical records Not applicable Primary
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