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Implementing Healthy Families America (HFA)®

Meets DHHS criteria for an evidenced based model

Materials and Forms to Support Implementation

Last Updated

May 2015


Operations Manuals

The Healthy Families America Site Development Guide (rev. 2014) is a guidebook that provides information for sites on planning, developing, and implementing an HFA site. The HFA Best Practice Standards offer specific guidelines on HFA model implementation.


Service Delivery Forms

The HFA National Office provides sample service delivery forms.


Assessment Tools

The HFA National Office requires use of a standardized assessment instrument that measures key risk factors for child abuse and neglect, and other poor childhood outcomes. Most HFA sites use the parent survey (formerly the Kempe Family Stress Checklist) as their assessment tool. Sites may submit a formal request to use an alternate assessment tool; approval is at the discretion of the HFA National Office.



The HFA National Office does not require sites to use a specific curriculum; however, it does require that sites use an evidence-informed curriculum with (1) participant/family materials and (2) a facilitator’s manual with specific guidelines for delivering the curriculum and a focus on anticipatory guidance. The curriculum should address the HFA goals related to cultivating, strengthening, and nurturing parent-child relationships; promote healthy childhood growth and development; and enhance family functioning by reducing risk and building protective factors.


Available Languages

HFA sites can select a curriculum that is available in the languages spoken by its target population. Many sites implement curricula that are available in English and Spanish.


Fidelity Measurement

To validate adherence to the HFA model, sites must comply with accreditation requirements, which involves conducting a program self-assessment; undergoing a peer-review site visit that is conducted by at least two external, nationally trained peer reviewers; and meeting a minimum 85% threshold of adherence to the HFA Best Practice Standards.


Fidelity Standards

All HFA sites are required to adhere to 12 critical elements that serve as the framework for program development and implementation. The 12 critical elements are operationalized as best practice standards with specific criteria for rating site compliance. The critical elements include:

Service Initiation

  1. Initiate services prenatally or at birth.
  2. Use a standardized assessment tool to systematically identify families who are most in need of services. This tool should assess the presence of various factors associated with increased risk for child maltreatment or other poor childhood outcomes.
  3. Offer services voluntarily and use positive outreach efforts to build family trust.

Service Content

  1. Offer services intensively (for example, at least once a week) with well-defined criteria for increasing or decreasing frequency of service and service over the long term (for example, three to five years).
  2. Make services culturally competent such that the staff understands, acknowledges, and respects cultural differences among participants; staff and materials used should reflect the cultural, linguistic, geographic, racial, and ethnic diversity of the populations served.
  3. Focus services on supporting the parent as well as supporting parent-child interaction and child development.
  4. At a minimum, link all families to a medical provider to ensure optimal health and development. Link families to additional services, as needed.
  5. Limit staff caseloads to ensure that home visitors have an adequate amount of time to spend with each family to meet their unique and varying needs and to plan for future activities.

Administration (Personnel, Staffing, Training, Supervision, Governance and Administration)

  1. Select service providers because of their personal characteristics, their willingness to work in or their experience working with culturally diverse communities, and their skills to do the job.
  2. Train service providers about their role so they understand the essential components of family assessment and home visitation.
  3. Give service providers a framework, based on education or experience, for handling the variety of situations they may encounter when working with at-risk families. All service providers should receive basic training in areas such as cultural competency, substance abuse, reporting child abuse, domestic violence, drug-exposed infants, and services in their community.
  4. Give service providers ongoing, effective supervision so that they are able to develop realistic and effective plans to empower families to meet their objectives; to understand why a family may not be making progress and how to work with the family more effectively; and to express their concerns and frustrations so that they can see that they are making a difference and avoid stress-related burnout.



The information contained on this page was last updated in May 2015. HFA/8/7#devreferences"> Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the HFA National Office in April 2015. HomVEE reserves the right to edit the profile for clarity and consistency.