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Implementing Healthy Families America (HFA)®

Meets DHHS criteria for an evidenced based model

Model Overview

Last Updated

May 2015


The information in this profile reflects feedback from this model’s developer as of the above date. The description of the implementation of the model here, including any adaptations, may differ from how it was implemented in the studies reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the DHHS criteria for evidence of effectiveness.


Implementation Support

Healthy Families America (HFA) is the signature program of Prevent Child Abuse America (PCA America). The HFA National Office, located in Chicago, Illinois, provides support, technical assistance, training, affiliation, state/multisite system development, and accreditation services to HFA sites.

Ten states and one large metropolitan area have affiliated as an HFA state/multisite system. These include Arizona, Florida, Indiana, Kentucky, Massachusetts, New York, Ohio, Oklahoma, Oregon, San Diego, and Virginia. State/multisite systems have a central administration or other entity providing an infrastructure of support for HFA sites in a state or geographical region. The designated central administrative entity provides HFA training for staff at all sites, facilitates implementation of the model, assists established sites in preparing for HFA accreditation, increases public awareness and advocacy, identifies potential funding streams, and evaluates services and outcomes. The HFA National Office provides support to each state/multisite system through guidance on best standards for the central administration entity. In addition, the HFA National Office offers a comprehensive accreditation process that includes the central administration and the sites it supports.


Theoretical Model

HFA is theoretically rooted in the belief that early, nurturing relationships are the foundation for life-long, healthy development. Building upon attachment and bio-ecological systems theories and the tenets of trauma-informed care, interactions between direct service providers and families are relationship-based; designed to promote positive parent-child relationships and healthy attachment; strengths-based; family-centered; culturally sensitive; and reflective. 


Target Population

HFA is designed for parents facing challenges such as single parenthood; low income; childhood history of abuse and other adverse child experiences; and current or previous issues related to substance abuse, mental health issues, and/or domestic violence.

Individual HFA sites select the specific characteristics of the target population they plan to serve (such as first-time parents, parents on Medicaid, or parents within a specific geographic region); however, the HFA National Office requires that all families complete the parent survey (formerly the Kempe Family Stress Checklist), a comprehensive assessment to determine the presence of various factors associated with increased risk for child maltreatment or other adverse childhood experiences.

The HFA National Office requires that families be enrolled prenatally or within three months of birth. Once enrolled, HFA sites offer services to families until the child’s third birthday, and preferably until the child’s fifth birthday.


Targeted Outcomes

HFA aims to (1) reduce child maltreatment; (2) improve parent-child interactions and children’s social-emotional well-being; (3) increase school readiness; (4) promote child physical health and development; (5) promote positive parenting; (6) promote family self-sufficiency; (7) increase access to primary care medical services and community services; and (8) decrease child injuries and emergency department use.


Model Components

HFA includes (1) screenings and assessments to determine families at risk for child maltreatment or other adverse childhood experiences; (2) home visiting services; and (3) routine screening for child development and maternal depression. In addition, many HFA sites offer services such as parent support groups and father involvement programs. HFA encourages local sites to implement enhancement services such as these that further address the specific needs of their communities and target populations.


Model Intensity and Length

HFA sites offer at least one home visit per week for the first six months after the child’s birth. After the first six months, visits might be less frequent. Visit frequency is based on families’ needs and progress over time. Typically, home visits last one hour.

HFA sites begin to provide services prenatally or at birth and continue through the first three to five years of life. Each local site determines—usually on the basis of available funding—if services will be extended beyond three years.



HFA has more than 600 affiliated sites across 39 states, the District of Columbia, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, the U.S. Virgin Islands, and in Canada.


Adaptations and Enhancements

HFA sites may implement enhancements to the model, as long as those enhancements do not compromise the site’s fidelity to the model as established in the HFA Best Practice Standards. For example, some sites have included clinical staff to address substance abuse and depression. Any adaptations or proposed changes that compromise the site’s fidelity to the HFA model require a formal adaptation request, and any approval of such are the sole discretion of the HFA National Office and PCA America.



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.