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Study Detail

Duggan, A., Fuddy, L., McFarlane, E., Burrell, L., Windham, A., Higman, S., et al. (2004). Evaluating a statewide home visiting program to prevent child abuse in at-risk families of newborns: Fathers’ participation and outcomes. Child Maltreatment, 9(1), 3–17. doi:10.1177/1077559503261336

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 trialHawaii SampleHighEstablished on race and SES. Baseline equivalence on outcomes not feasible.NoneNone

Study Characteristics

Study Participants Hawaii Healthy Start Program staff screened the medical records of mothers from one of four Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Mothers found to be at risk, or those whose records did not contain sufficient information to screen out, were screened further using the Kempe Family Stress Checklist; eligible families were those in which either parent scored 25 or greater. Of the 897 families who were eligible to participate in the study, 730 (81%) agreed to participate and were randomly assigned to the program group (n = 395), the main comparison group (n = 290), or a testing comparison group (n = 45). 684 families completed a baseline interview (373 families in the program group and 270 families in the main comparison group) and were included in the study . On average, at baseline, mothers were 23.7 years of age (program group) and 23.3 years of age (comparison group) and fathers were 26.3 years of age (program group) and 25.9 years of age (comparison group). In each follow-up year, interviews were completed for 88% of families. 81% of participating families completed all three follow-up interviews. The main analytic sample for this study consisted of 600 families from all three follow-up years – 354 in the program group and 246 in the comparison group. The racial composition of the program group of mothers was: 45% native Hawaiian, 11% other Pacific Islander, 23% Asian, 6% Caucasian, and 16% of unknown race/ethnicity. The comparison group consisted of: 42% native Hawaiian, 12% other Pacific Islander, 28% Asian, 6% Caucasian, and 13% of unknown race/ethnicity.
Setting Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.
Home Visiting Services Home visiting services were designed to provide three to five years of home visiting, with weekly visits for most or all of the child’s first year of life, and visits of gradually decreasing frequency thereafter depending on family need. Home visitors endeavored to establish trusting relationships with families, help them resolve immediate crises, and help them build on existing strengths to improve their ability to function independently. Visitors helped families develop problem-solving skills, connected them to needed services, and aimed to develop an individual service plan with each family every six months and help the family reach six-month goals. The actual frequency of visits, however, was lower than that specified by the model, with families receiving an average of 13 visits in the child’s first year of life, and 51% of families not actively participating in the program by the time the child was 12 months. Families still active at the end of year 1 received an average of 22 visits in the first year (Duggan et al., 1999).
Comparison Condition The main comparison group was tested annually to measure outcomes. A second “testing” comparison group was evaluated only at year 3 to ascertain the effect of repeated testing on observed outcomes (Duggan, McFarlane, Fuddy, Burrell, Higman, Windham et al., 2004).
Staff Characteristics and Training Trained paraprofessionals were recruited from the community to conduct the home visits (Duggan et al., 1999).
Funding Source Maternal and Child Health Bureau (R40 MC 00029, formerly MCJ 240637; R40 MC 00123, formerly MCJ 240838), the Robert Wood Johnson Foundation 18303), the Annie E. Casey Foundation (94-4041), the David and Lucile Packard Foundation (93-6051, 94-7957, 97 8058, and 98-3448), and the Hawaii State epartment of Health (99-29-J).
Author Affiliation None of the study authors are developers of this program model.

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