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Study Detail

Johns Hopkins University. (2005). Evaluation of the Healthy Families Alaska program. Report to Alaska State Department of Health and Social Services, Alaska Mental Health Trust Authority. Baltimore, MD: Author.

Program(s) Reviewed: Healthy Families America (HFA)®

Study Screening Details

Screening DecisionScreening Conclusion
Study Passes ScreensEligible for Review

Study Design Details

RatingDesignSampleAttritionBaseline EquivalenceReassignmentConfounding Factors
ModerateRandomized controlled trialAlaska SampleHighEstablished on race and SES. Baseline equivalence on outcomes not feasible.NoneNone
Notes:

Moderate rating applies to the following outcomes: rapid repeat birth, income above the poverty level, and employment. Community life skills and social support outcomes receive a low rating because establishing baseline equivalence on these outcomes is feasible but not demonstrated. Analyses of other outcomes are not rated for this report because they are represented in other studies.

Study Characteristics

Study Participants Between January 2000 and July 2001, 388 families who screened positive on a Healthy Families Alaska (HFAK) protocol for risk factors associated with poor health and social outcomes and received scores of 25 or higher on the Kempe Family Stress Checklist were recruited during pregnancy or at the time of birth (Duggan et al., 2007). Of these families, 364 consented to participate and were randomly assigned to the program group (n = 179) or the comparison group (n = 185). 325 families completed a baseline interview. The sample was 22% Alaska native, 55% Caucasian, 8% multiracial, and 15% were of other race. 58% of families were below poverty level, 58% of mothers had graduated from high school, and 73% had worked in the year prior to enrollment (Johns Hopkins University, 2005). The average age of mothers at baseline was 23.5 years. This study reports the second-year follow-up results of the HFA K evaluation, with a sample size of 138 program group primary caregivers and 140 comparison group primary caregivers. Most of the analyses of interview data reported by the authors are limited to biological mothers with custody of the index child at follow-up (249 families). Additional outcomes are reported from medical records (268 families), child protective services reports (309 families), and observational data (~237 families).

Note: Information on sample size was received through communication with the author.

Setting This study included six Healthy Families Alaska sites, two in Anchorage and one each in Wasilla, Fairbanks, Juneau, and Kenai.
Home Visiting Services Families in the program group were assigned to receive visits monthly until their child’s birth and weekly thereafter. By design, families receive gradually less frequent visits as they reach critical milestones, ranging to quarterly visits at the highest level of functioning. Families were enrolled in the program until they functioned sufficiently to “graduate” or until their child turned 2. In practice, home visits were less frequent than intended, with only 4% of families receiving 75% or more of their designated frequency of visits and completing the full two years. Home visits were intended to emphasize preparing for child growth, development, and critical milestones, screening and referral for developmental delays, promoting a safe environment, positive parent-child interactions, establishing a “medical home” for the child, and supporting the family during crises. The program also emphasized the development of an Individual Family Support Plan (IFSP) or setting and monitoring progress towards individual family goals.
Comparison Condition Families assigned to the comparison condition received referrals to other community services.
Staff Characteristics and Training Guidelines suggest paraprofessional staff have a high school diploma at a minimum and that program managers have a master’s degree in a relevant field. In five of the six sites included in the evaluation, home visits were conducted by paraprofessionals. The remaining site combined nurse-visiting and paraprofessional visiting models. Staff members were required to complete a one-week training geared directly to their role and a community-based training. Training for staff who conducted home visits or administered the Kempe Family Stress Checklist was conducted by certified instructors. All staff also had to complete 100 hours of training covering “child development, parent-child interaction, family dynamics, child safety, the dynamics of child abuse and neglect, crisis intervention and problem solving, communication skills, domestic violence, substance abuse, infant mental health and other related topics.” Continuous training varied by program. Training was initially administered by the Hawaii Family Stress Center and later by Great Kid’s Inc.
Funding Source Alaska Mental Health Trust Authority; Alaska State Department of Health and Social Services
Author Affiliation None of the study authors are developers of this program model.

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