Healthy Families America (HFA)^®

Model effectiveness research report last updated: 2020

Effects shown in research & outcome measure details

Maternal health

Findings rated high

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.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Above threshold for depression (CES-D = 16)	FavorableUnfavorable or ambiguousNo Effect	Year 1 follow-up	Full sample, San Diego trial	435 mothers	% = 39.00	% = 42.00	= -3.00	HomeVEE calculated = -0.08	Not statistically significant, p ≥ 0.05
Above threshold for depression (CES-D = 16)	FavorableUnfavorable or ambiguousNo Effect	Year 3 follow-up	Full sample, San Diego trial	412 mothers	% = 33.00	% = 29.00	= 4.00	HomeVEE calculated = 0.11	Not statistically significant, p ≥ 0.05
Confidence in adult relationships	FavorableUnfavorable or ambiguousNo Effect	Year 1 follow-up	Full sample, San Diego trial	435 mothers	Mean = 33.40	Mean = 33.80	Mean difference = -0.40	HomeVEE calculated = -0.08	Not statistically significant, p ≥ 0.05
Confidence in adult relationships	FavorableUnfavorable or ambiguousNo Effect	Year 3 follow-up	Full sample, San Diego trial	412 mothers	Mean = 33.70	Mean = 33.80	Mean difference = -0.10	HomeVEE calculated = -0.02	Not statistically significant, p ≥ 0.05
Depressive symptoms (CES-D)	FavorableUnfavorable or ambiguousNo Effect	Year 1 follow-up	Full sample, San Diego trial	435 mothers	Mean = 14.50	Mean = 15.50	Mean difference = -1.00	HomeVEE calculated = -0.10	Not statistically significant, p ≥ 0.05
Depressive symptoms (CES-D)	FavorableUnfavorable or ambiguousNo Effect	Year 3 follow-up	Full sample, San Diego trial	412 mothers	Mean = 12.50	Mean = 12.90	Mean difference = -0.40	HomeVEE calculated = -0.04	Not statistically significant, p ≥ 0.05
Drinks per day	FavorableUnfavorable or ambiguousNo Effect	Year 1 follow-up	Full sample, San Diego trial	435 mothers	Mean = 2.50	Mean = 2.30	Mean difference = 0.20	HomeVEE calculated = 0.08	Not statistically significant, p ≥ 0.05
Drinks per day	FavorableUnfavorable or ambiguousNo Effect	Year 3 follow-up	Full sample, San Diego trial	412 mothers	Mean = 2.10	Mean = 2.40	Mean difference = -0.30	HomeVEE calculated = -0.15	Not statistically significant, p ≥ 0.05
Maternal social support (MHI)	FavorableUnfavorable or ambiguousNo Effect	Year 1 follow-up	Full sample, San Diego trial	435 mothers	Mean = 18.60	Mean = 19.10	Mean difference = -0.50	HomeVEE calculated = 0.00	Not statistically significant, p ≥ 0.05
Mental Health (MHI)	FavorableUnfavorable or ambiguousNo Effect	Year 1 follow-up	Full sample, San Diego trial	435 mothers	Mean = 22.90	Mean = 22.20	Mean difference = 0.70	HomeVEE calculated = 0.15	Not statistically significant, p ≥ 0.05
Mental Health (MHI)	FavorableUnfavorable or ambiguousNo Effect	Year 3 follow-up	Full sample, San Diego trial	412 mothers	Mean = 24.00	Mean = 24.10	Mean difference = -0.10	HomeVEE calculated = -0.02	Not statistically significant, p ≥ 0.05
Parenting Stress (PSI)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, San Diego trial	435 mothers	Mean = 72.40	Mean = 71.22	Mean difference = 1.20	HomeVEE calculated = 0.06	Not statistically significant, p ≥ 0.05
Parenting Stress (PSI)	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, San Diego trial	412 mothers	Mean = 71.20	Mean = 72.82	Mean difference = -1.60	HomeVEE calculated = -0.08	Not statistically significant, p ≥ 0.05
Problem substance use (CAGE Alcohol Screening">CAGE Alcohol Screening">CAGE Alcohol Screening">CAGE Alcohol Screening">CAGE Alcohol Screening">CAGE)	FavorableUnfavorable or ambiguousNo Effect	Year 1 follow-up	Full sample, San Diego trial	435 mothers	% = 21.00	% = 18.00	= 3.00	HomeVEE calculated = 0.54	Not statistically significant, p ≥ 0.05
Problem substance use (CAGE Alcohol Screening">CAGE Alcohol Screening">CAGE Alcohol Screening">CAGE Alcohol Screening">CAGE Alcohol Screening">CAGE)	FavorableUnfavorable or ambiguousNo Effect	Year 3 follow-up	Full sample, San Diego trial	412 mothers	% = 9.00	% = 10.00	= -1.00	HomeVEE calculated = -0.07	Not statistically significant, p ≥ 0.05
Repeat birth within 36 months of index birth	FavorableUnfavorable or ambiguousNo Effect	Year 3 follow-up	Full sample, San Diego trial	412 mothers	% = 27.00	% = 22.00	= 5.00	HomeVEE calculated = 0.16	Not statistically significant, p ≥ 0.05
Repeat pregnancy within 36 months of index birth	FavorableUnfavorable or ambiguousNo Effect	Year 3 follow-up	Full sample, San Diego trial	412 mothers	% = 43.00	% = 50.00	= -7.00	HomeVEE calculated = 0.15	Not statistically significant, p ≥ 0.05

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Outcome measure	Outcome measure description	Collection method	Properties
CES-D: Above threshold for depression	The CES-D is a 20-item assessment of depressive symptoms. The researchers examined the total score and a binary measure indicating whether the total depression score was at or above a cutoff of 16.	Parent/caregiver report	Not reported by author
CES-D: Depressive symptoms	The CES-D is a 20-item assessment of depressive symptoms. The researchers examined the total score and a binary measure indicating whether the total depression score was at or above a cutoff of 16.	Parent/caregiver report	Not reported by author
MHI	The MHI assesses levels of anxiety and depressive symptoms.	Parent/caregiver report	Not applicable
Confidence in adult relationships	No description provided by author	Parent/caregiver report	Not reported by author
Drinks per day	Number of drinks the parent consumed per day on average	Parent/caregiver report	Not applicable
Parenting Stress (PSI)	The PSI assesses stress in the parent-child relationship arising from child temperament, parental depression, and negatively reinforcing parent-child interactions.	Parent/caregiver report	Not reported by author
Problem substance use (CAGE)	Percentage of parents with problem alcohol use, defined as a report of alcohol use in the year prior to pregnancy and a CAGE score greater than or equal to 2	Parent/caregiver report	Not reported by author
Repeat pregnancy within 36 months of index birth	Percentage of mothers who had a repeat birth within 36 months after the index birth	Parent/caregiver report	Not applicable

LeCroy, C. W., & Lopez, D. (2018). A randomized controlled trial of Healthy Families: 6-month and 1-year follow-up. Prevention Science. Advance online publication. https://doi.org/10.1007/s11121-018-0931-4

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Emotional loneliness	FavorableUnfavorable or ambiguousNo Effect	6 months	HFA vs. comparison group, Arizona, full sample	199 mothers	Unadjusted mean = 9.80	Unadjusted mean = 10.00	Mean difference = -0.20	Study reported = -0.03	Not statistically significant, p= 0.94
Hope	FavorableUnfavorable or ambiguousNo Effect	6 months	HFA vs. comparison group, Arizona, full sample	199 mothers	Unadjusted mean = 26.90	Unadjusted mean = 26.60	Mean difference = 0.30	Study reported = 0.15	Not statistically significant, p= 0.31
Subsequent pregnancy	FavorableUnfavorable or ambiguousNo Effect	6 months	HFA vs. comparison group, Arizona, full sample	199 mothers	Cases = 1.00	Cases = 3.00	Not reported	Not available	Not statistically significant, p ≥ 0.05	Authors describe reduced subsequent pregnancies as favorable to the intervention.
Substance abuse treatment	FavorableUnfavorable or ambiguousNo Effect	6 months	HFA vs. comparison group, Arizona, full sample	199 mothers	Unadjusted proportion = 0.01	Unadjusted proportion = 0.01	Mean difference = 0.00	HomeVEE calculated = 0.26	Not statistically significant, p = 0.07	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. , HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.

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Outcome measure	Outcome measure description	Collection method	Properties
Emotional loneliness	Social Loneliness subscale (DiTommaso and Spinner, 1993)	Parent/caregiver report	alpha=.86
Hope	Adult Hope Scale (Snyder et al., 1991)	Parent/caregiver report	alpha=.67
Subsequent pregnancy	Whether became pregnant by follow-up	Parent/caregiver report	Not reported by author
Substance abuse treatment	Whether treated for substance abuse by follow-up	Parent/caregiver report	Not reported by author

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.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Confidence in adult relations	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 mothers	Mean = 34.30	Mean = 33.80	Mean difference = 0.50	Not available	Not statistically significant, p ≥ 0.05
Confidence in adult relations	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	567 mothers	Mean = 34.40	Mean = 33.70	Mean difference = 0.70	Not available	Not statistically significant, p ≥ 0.05
Maternal life skills (CLSS)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 mothers	Mean = 24.20	Mean = 24.30	Mean difference = -0.10	Not available	Not statistically significant, p ≥ 0.05
Maternal life skills (CLSS)	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	567 mothers	Mean = 23.90	Mean = 23.90	Mean difference = 0.00	Not available	Not statistically significant, p ≥ 0.05
Maternal social support (MSSI)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 mothers	Mean = 21.50	Mean = 21.90	Mean difference = -0.40	Not available	Not statistically significant, p ≥ 0.05
Maternal social support (MSSI)	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	567 mothers	Mean = 21.40	Mean = 21.70	Mean difference = -0.30	Not available	Not statistically significant, p ≥ 0.05

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Outcome measure	Outcome measure description	Collection method	Properties
CLSS: Maternal life skills	The CLSS assesses a person’s transportation, budgeting, support service, support-involvement, interests-hobbies, regularity/organization routines, practices, and resources.	Parent/caregiver report	Not reported by author
MSSI: Maternal social support	The MSSI assesses caregiver social support with regard to the division of household tasks and responsibilities for child rearing, access to transportation, interaction with other adults, and community involvement.	Parent/caregiver report	Not reported by author
Confidence in adult relations	No description provided by author	Parent/caregiver report	Not reported by author

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.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Alcohol or drug use	FavorableUnfavorable or ambiguousNo Effect	Year 2	Biological mothers with custody of index child at interview, Alaska trial	249 mothers	% = 28.00	% = 33.00	OR = 0.80	HomeVEE calculated = -0.14	Not statistically significant, p ≥ 0.05
Any illicit drug use	FavorableUnfavorable or ambiguousNo Effect	Year 2	Biological mothers with custody of index child at interview, Alaska trial	249 mothers	% = 21.00	% = 18.00	OR = 1.23	HomeVEE calculated = 0.12	Not statistically significant, p ≥ 0.05
Problem alcohol use	FavorableUnfavorable or ambiguousNo Effect	Year 2	Biological mothers with custody of index child at interview, Alaska trial	249 mothers	% = 13.00	% = 22.00	OR = 0.52	HomeVEE calculated = -0.39	Not statistically significant, p ≥ 0.05

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Outcome measure	Outcome measure description	Collection method	Properties
Alcohol or drug use	Percentage of parents with a positive CAGE score and who drank in the past year or who had any illicit drug use in 2 years prior to baseline interview	Parent/caregiver report	Not applicable
Any illicit drug use	Percentage of parents who engaged in illicit drug use, defined as a report of any illegal drug use in the past 2 years	Parent/caregiver report	Not applicable
Problem alcohol use	Percentage of parents with problem alcohol use, defined as a report of alcohol use in the year prior to pregnancy and a CAGE score greater than or equal to 2	Parent/caregiver report	Not reported by author

Duggan, A., Fuddy, L., Burrell, L., Higman, S. M., McFarlane, E., Windham, A., et al. (2004). Randomized trial of a statewide home visiting program to prevent child abuse: Impact in reducing parental risk factors. Child Abuse & Neglect, 28(6), 623–643.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Illicit drug use	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 mothers	% = 9.00	% = 9.00	= 0.00	HomeVEE calculated = 0.00	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Illicit drug use	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	556 mothers	% = 10.00	% = 11.00	= -1.00	HomeVEE calculated = -0.06	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Illicit drug use	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, Hawaii trial	548 mothers	% = 11.00	% = 9.00	= 2.00	HomeVEE calculated = 0.14	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Illicit drug use	FavorableUnfavorable or ambiguousNo Effect	Years 1-3	Full sample, Hawaii trial	564 mothers	Not available	Not available	OR = 1.06	Not available	Not statistically significant, p ≥ 0.05
Mothers with depressive symptoms (CES-D)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 mothers	% = 23.00	% = 23.00	= 0.00	HomeVEE calculated = 0.00	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Mothers with depressive symptoms (CES-D)	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	556 mothers	% = 16.00	% = 18.00	= -2.00	HomeVEE calculated = -0.09	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Mothers with depressive symptoms (CES-D)	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, Hawaii trial	548 mothers	% = 16.00	% = 16.00	= 0.00	HomeVEE calculated = 0.00	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Mothers with depressive symptoms (CES-D)	FavorableUnfavorable or ambiguousNo Effect	Years 1-3	Full sample, Hawaii trial	564 mothers	Not available	Not available	OR = 0.97	Not available	Not statistically significant, p ≥ 0.05	footnote51 Submitted by user on Fri, 03/15/2019 - 14:29 Adjusted odds ratios are based on the average effect across all follow-up years.
Poor general mental health (MHI < 67)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 mothers	% = 36.00	% = 46.00	= -10.00	HomeVEE calculated = -0.25	Statistically significant, p < 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Poor general mental health (MHI < 67)	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	556 mothers	% = 35.00	% = 38.00	= -3.00	HomeVEE calculated = -0.20	Statistically significant, p < 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Poor general mental health (MHI < 67)	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, Hawaii trial	548 mothers	% = 29.00	% = 32.00	= -3.00	HomeVEE calculated = -0.09	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Problem alcohol use (CAGE)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 mothers	% = 8.00	% = 10.00	= -2.00	HomeVEE calculated = -0.15	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Problem alcohol use (CAGE)	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	556 mothers	% = 8.00	% = 9.00	= -1.00	HomeVEE calculated = -0.08	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Problem alcohol use (CAGE)	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, Hawaii trial	548 mothers	% = 7.00	% = 10.00	= -3.00	HomeVEE calculated = -0.24	Statistically significant, p < 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Problem alcohol use (CAGE)	FavorableUnfavorable or ambiguousNo Effect	Years 1-3	Full sample, Hawaii trial	564 mothers	Not available	Not available	OR = 0.76	Not available	Not statistically significant, p ≥ 0.05
Severe parenting stress (PSI)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, Hawaii trial	564 mothers	% = 11.00	% = 10.00	= 1.00	HomeVEE calculated = 0.06	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Severe parenting stress (PSI)	FavorableUnfavorable or ambiguousNo Effect	Year 2	Full sample, Hawaii trial	556 mothers	% = 8.00	% = 9.00	= -1.00	HomeVEE calculated = -0.08	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Severe parenting stress (PSI)	FavorableUnfavorable or ambiguousNo Effect	Year 3	Full sample, Hawaii trial	548 mothers	% = 8.00	% = 8.00	= 0.00	HomeVEE calculated = 0.00	Not statistically significant, p ≥ 0.05	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
Severe parenting stress (PSI)	FavorableUnfavorable or ambiguousNo Effect	Years 1-3	Full sample, Hawaii trial	564 mothers	Not available	Not available	OR = 1.04	Not available	Not statistically significant, p ≥ 0.05

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Outcome measure	Outcome measure description	Collection method	Properties
CES-D: Depressive symptoms	The CES-D is a 20-item assessment of depressive symptoms. A binary variable was formed from the total score where parents with scores greater than or equal to 24 were said to have probable cases of depression.	Parent/caregiver report	Not reported by author
MHI: Poor general mental health	The MHI assesses levels of anxiety and depressive symptoms. The researchers created a binary variable where those with MHI scores less than 67 were considered to have poor mental health.	Parent/caregiver report	Not reported by author
PSI: Severe parenting stress	The PSI assesses stress in the parent-child relationship arising from child temperament, parental depression, and negatively reinforcing parent-child interactions. A mother was considered positive for severe parenting stress if she scored positive for personal adjustment problems, child abuse potential, or high child abuse potential as defined by Abidin.	Parent/caregiver report	Not reported by author
Illicit drug use	Percentage of parents who engaged in illicit drug use, defined as a report of any illegal drug use in the past year	Parent/caregiver report	Not reported by author
Problem alcohol use (CAGE)	Percentage of parents with problem alcohol use, defined as a report of alcohol use in the year prior to pregnancy and a CAGE score greater than or equal to 2	Parent/caregiver report	Not reported by author

El-Kamary, S. S., Higman, S. M., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. K. (2004). Hawaii’s Healthy Start home visiting program: Determinants and impact of rapid repeat birth. Pediatrics, 114(3), e317–e326.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Did not use birth control after index child’s birth	FavorableUnfavorable or ambiguousNo Effect	One year postpartum	Full sample, Hawaii trial	564 mothers	% (adjusted) = 18.00	Adjusted mean % = 20.00	OR = 0.85	HomeVEE calculated = -0.08	Not statistically significant, p ≥ 0.05
Maternal desire for RRB	FavorableUnfavorable or ambiguousNo Effect	One year postpartum	Full sample, Hawaii trial	564 mothers	% (adjusted) = 9.00	Adjusted mean % = 11.00	OR = 0.80	HomeVEE calculated = -0.14	Not statistically significant, p ≥ 0.05
No family planning site	FavorableUnfavorable or ambiguousNo Effect	One year postpartum	Full sample, Hawaii trial	564 mothers	% (adjusted) = 15.00	Adjusted mean % = 14.00	OR = 1.06	HomeVEE calculated = 0.05	Not statistically significant, p ≥ 0.05
Rapidrepeat birth (RRB)	FavorableUnfavorable or ambiguousNo Effect	One year postpartum	Full sample, Hawaii trial	564 mothers	% (adjusted) = 21.00	Adjusted mean % = 20.00	OR = 1.05	HomeVEE calculated = 0.04	Not statistically significant, p ≥ 0.05	footnote52 Submitted by user on Fri, 03/15/2019 - 14:29 Rapid repeat birth is defined as a birth occurring within 24 months after a previous birth or a repeat birth while still a teen for adolescent mothers (El-Kamary et al., 2004).

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Outcome measure	Outcome measure description	Collection method	Properties
Did not use birth control after index child’s birth	Percentage of mothers who were not using birth control at the time of the interview and who did not use any birth control since the index birth	Parent/caregiver report	Not applicable
Maternal desire for RRB	Percentage of mothers who desired to have another child within 2 years after the index birth	Parent/caregiver report	Not applicable
No family-planning site	Percentage of mothers who lacked access to a family-planning site	Parent/caregiver report	Not applicable
Rapidrepeat birth (RRB)	Percentage of mothers who had a repeat birth within 24 months after the index birth or, for teenagers, had a repeat birth at any time through the age of 19 years	Parent/caregiver report	Not applicable

LeCroy, C. W., & Krysik, J. (2011). Randomized trial of the Healthy Families Arizona home visiting program. Children and Youth Services Review, 33(10), 1761–1766.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Alcohol use	FavorableUnfavorable or ambiguousNo Effect	12 months	Arizona sample	171 mothers	Mean % = 12.00	Mean % = 20.50	Mean difference = -8.50	HomeVEE calculated = -0.40	Statistically significant, p = 0.04
Alcohol use	FavorableUnfavorable or ambiguousNo Effect	6 months	Arizona sample	180 mothers	Mean % = 16.50	Mean % = 35.20	Mean difference = -18.70	HomeVEE calculated = -0.59	Not available
Using birth control	FavorableUnfavorable or ambiguousNo Effect	12 months	Arizona sample	171 mothers	Mean % =	Mean % = 72.20	Not reported	Not available	Not statistically significant, p = 0.54
Using birth control	FavorableUnfavorable or ambiguousNo Effect	6 months	Arizona sample	180 mothers	Mean % = 65.80	Mean % = 65.10	Mean difference = 0.70	HomeVEE calculated = 0.03	Not statistically significant, p = 0.061

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Outcome measure	Outcome measure description	Collection method	Properties
Alcohol use	Alcohol use was measured by a series of questions that included: Do you drink beer or alcohol? To which the mother could answer yes or no. If the mother answered yes, then another question was asked: In the past two weeks how many times did you drink beer or alcohol?	Parent/caregiver report	Not applicable
Using birth control	A measure of consistent use of birth control since last birth	Parent/caregiver report	Not applicable

Findings rated moderate

Healthy Families America (HFA)^®

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Easterbrooks, M. A., Fauth, R. C., Menon, M., Stargel, L. E., & Kotake, C. (n.d.). The Massachusetts Healthy Families Evaluation Phase 2 (MHFE-2): Time 6 summary report. Tufts Interdisciplinary Evaluation Research, Tufts University.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Parenting Stress Index - difficult child	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	380 mothers	Unadjusted mean = 24.14	Unadjusted mean = 25.97	Mean difference = -1.83	HomeVEE calculated = -0.24	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Parenting Stress Index - parental child-dysfunctional interaction	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	380 mothers	Unadjusted mean = 18.38	Unadjusted mean = 19.71	Mean difference = -1.33	HomeVEE calculated = -0.22	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Parenting Stress Index - parental distress	FavorableUnfavorable or ambiguousNo Effect	8 years	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	379 mothers	Unadjusted mean = 24.41	Unadjusted mean = 26.32	Mean difference = -1.91	HomeVEE calculated = -0.22	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.

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Outcome measure	Outcome measure description	Collection method	Properties
Parenting Stress Index - difficult child	Parenting Stress Index - Difficult Child subscale	Self-report questionnaire	Not reported
Parenting Stress Index - parental child-dysfunctional interaction	Parenting Stress Index - Parental-Child Dysfunctional Interaction subscale	Self-report questionnaire	Not reported
Parenting Stress Index - parental distress	Parenting Stress Index - Parental Distress subscale	Self-report questionnaire	Not reported

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.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
CDC Pregnancy Risk Assessment Monitoring System (PRAMS) measure of maternal depression- full sample	FavorableUnfavorable or ambiguousNo Effect	Child's 1st birthday	HF Oregon 2010-2012	764 mothers	Adjusted mean = 2.17	Adjusted mean = 2.22	Mean difference = -0.05	HomeVEE calculated = -0.06	Not statistically significant, p ≥ 0.05	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.
Parenting Stress Index - Short Form (PSI) - General Distress subscale score - full sample	FavorableUnfavorable or ambiguousNo Effect	Child's 1st birthday	HF Oregon 2010-2012	764 mothers	Adjusted mean = 1.78	Adjusted mean = 1.86	Mean difference = -0.08	HomeVEE calculated = -0.11	Not statistically significant, p ≥ 0.05	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.
Parenting Stress Index - Short Form (PSI) - Parenting Stress subscale score - full sample	FavorableUnfavorable or ambiguousNo Effect	Child's 1st birthday	HF Oregon 2010-2012	764 mothers	Adjusted mean = 2.02	Adjusted mean = 2.14	Mean difference = -0.12	HomeVEE calculated = -0.14	Not statistically significant, p = 0.07	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.
Parenting Stress Index - Short Form (PSI) Total Score	FavorableUnfavorable or ambiguousNo Effect	Child's 1st birthday	HF Oregon 2010-2012	764 mothers	Adjusted mean = 1.90	Adjusted mean = 2.00	Mean difference = -0.10	HomeVEE calculated = -0.14	Not statistically significant, p = 0.06	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.

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Outcome measure	Outcome measure description	Collection method	Properties
CDC Pregnancy Risk Assessment Monitoring System (PRAMS) measure of maternal depression- full sample	CDC Pregnancy Risk Assessment Monitoring System (PRAMS) is a 3-item measure of maternal depression.	Parent/caregiver report	Not reported by author
Parenting Stress Index - Short Form (PSI) - General Distress subscale score - full sample	The Parenting Stress Index-Short Form General Distress subscale.	Parent/caregiver report	Crohnbach's alpha = .715
Parenting Stress Index - Short Form (PSI) - Parenting Stress subscale score - full sample	The Parenting Stress Index-Short Form Parental Distress subscale measures the level of distress parents feel in their role because of personal factors.	Parent/caregiver report	Crohnbach's alpha = .638
Parenting Stress Index - Short Form (PSI) Total Score	The Parenting Stress Index-Short Form assesses stress in the parent-child relationship arising from child temperament, parental depression, and negatively reinforcing parent-child interactions.	Parent/caregiver report	Crohnbach's alpha = .794

LeCroy, C. W., & Lopez, D. (2018). A randomized controlled trial of Healthy Families: 6-month and 1-year follow-up. Prevention Science. Advance online publication. https://doi.org/10.1007/s11121-018-0931-4

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Contraception use	FavorableUnfavorable or ambiguousNo Effect	6 months	HFA vs. comparison group, Arizona, full sample	199 mothers	Unadjusted proportion = 0.76	Unadjusted proportion = 0.66	Mean difference = 0.10	Study reported = 0.21	Not statistically significant, p= 0.14
Mental health index	FavorableUnfavorable or ambiguousNo Effect	6 months	HFA vs. comparison group, Arizona, full sample	199 mothers	Unadjusted mean = 19.00	Unadjusted mean = 24.70	Mean difference = -5.70	Study reported = 0.35	Statistically significant, p= 0.02	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Subsequent pregnancy	FavorableUnfavorable or ambiguousNo Effect	12 months	HFA vs. comparison group, Arizona, full sample	165 mothers	Unadjusted mean = 0.05	Unadjusted mean = 0.12	Mean difference = -0.07	Study reported = 0.25	Not statistically significant, p=0.10	Authors describe reduced subsequent pregnancies as favorable to the intervention.

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Outcome measure	Outcome measure description	Collection method	Properties
Contraception use	Whether or not used contraceptives	Parent/caregiver report	Not reported by author
Mental health index	Rand Mental Health Inventory Mental Health Index (negative effect is favorable)	Parent/caregiver report	alpha=.91

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.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Above alcohol abuse cutoff (AUDIT)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 mothers	% (adjusted) = 2.00	Adjusted mean % = 3.80	= -1.80	Not available	Not statistically significant, p ≥ 0.05
Above depression threshold (CES-D)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 mothers	% (adjusted) = 29.00	Adjusted mean % = 31.20	= -2.20	Not available	Not statistically significant, p ≥ 0.05
Alcohol abuse (AUDIT)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 mothers	Adjusted mean = 1.14	Adjusted mean = 1.28	Mean difference = -0.14	Not available	Not statistically significant, p ≥ 0.05
Depressive symptoms (CES-D)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 mothers	Adjusted mean = 11.45	Adjusted mean = 11.61	Mean difference = -0.16	Not available	Not statistically significant, p ≥ 0.05
Drug use	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 mothers	% (adjusted) = 9.80	Adjusted mean % = 10.60	= -0.80	Not available	Not statistically significant, p ≥ 0.05
Mother has primary care physician	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 mothers	% (adjusted) = 86.90	Adjusted mean % = 85.00	= 1.90	Not available	Not statistically significant, p ≥ 0.05
Sense of personal mastery (PSM)	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 mothers	Adjusted mean = 23.80	Adjusted mean = 23.55	Mean difference = 0.25	Not available	Not statistically significant, p ≥ 0.05
Smoking	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 mothers	% (adjusted) = 41.30	Adjusted mean % = 43.80	= -2.50	Not available	Not statistically significant, p ≥ 0.05
Smoking frequency	FavorableUnfavorable or ambiguousNo Effect	Year 1	Full sample, NY Trial	1061 mothers	Adjusted mean = 3.42	Adjusted mean = 3.93	Mean difference = -0.51	Not available	Not statistically significant, p ≥ 0.05

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Outcome measure	Outcome measure description	Collection method	Properties
AUDIT: Alcohol abuse	The AUDIT assesses the degree to which a person’s alcohol use is harmful. Respondents reported the frequency with which they experienced eight, different symptoms of alcohol abuse, with possible scores ranging from 0 to 32. A score of 8 or more indicated a strong likelihood of alcohol abuse. The researchers examined the total score and a binary variable representing whether a respondent was above or below the cutoff of 8.	Parent/caregiver report	Not reported by author
DAST: Drug use	The DAST assesses the degree to which a person’s use of illegal or legal drugs is harmful. The researchers used the instrument to examine the percentage of parents who reported using illegal drugs.	Parent/caregiver report	Not reported by author
CES-D: Depressive symptoms CES-D: Above depression threshold	The CES-D is a 20-item assessment of depressive symptoms. The researchers examined the total score (range 0–60) and a binary measure indicating whether the total depression score was at or above a cutoff of 16, which defined cases of probable depression.	Parent/caregiver report	Not reported by author
Mastery ofPsychological CopingResources Scale(PSM): Sense of personal mastery	The PSM assesses the extent to which respondents believe that their life chances are under their own control. The assessment measures the degree of agreement with eight statements related to the respondents’ capacity to affect events and circumstances in their lives.	Parent/caregiver report	Not reported by author
Mother has primary care physician	Percentage of mothers who had a primary care physician	Parent/caregiver report	Not applicable
Smoking	Percentage of parents who reported smoking cigarettes	Parent/caregiver report	Not applicable
Smoking frequency	Average number of cigarettes smoked per day	Parent/caregiver report	Not applicable

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.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Perceived social support (MSSI)	FavorableUnfavorable or ambiguousNo Effect	12 months	Program group members not affected by substance abuse, NY Best Beginnings trial	325 mothers	Mean = 6.50	Mean = 6.60	Mean difference = -0.10	HomeVEE calculated = -0.03	Statistical significance not reported
Perceived social support (MSSI)	FavorableUnfavorable or ambiguousNo Effect	24 months	Program group members not affected by substance abuse, NY Best Beginnings trial	274 mothers	Mean = 6.20	Mean = 6.60	Mean difference = -0.40	HomeVEE calculated = -0.12	Statistical significance not reported
Perceived social support (MSSI)	FavorableUnfavorable or ambiguousNo Effect	6 months	Program group members not affected by substance abuse, NY Best Beginnings trial	354 mothers	Mean = 6.20	Mean = 7.20	Mean difference = -1.00	HomeVEE calculated = -0.31	Statistical significance not reported

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Outcome measure	Outcome measure description	Collection method	Properties
MSSI: Perceived Social Support	The MSSI assesses caregiver social support with regard to the division of household tasks and responsibilities for child rearing, access to transportation, interaction with other adults, and community involvement. The researchers analyzed the 3-item Perceived Social Support subscale, with possible scores ranging from 0 to 13.	Parent/caregiver report	Not reported by author

Jacobs, F., Easterbrooks, A., & Mistry, J. (2015). The Massachusetts Healthy Families evaluation-2 (MHFE-2): A randomized, controlled trial of a statewide home visiting program for young parents: Final report to the Children's Trust of Massachusetts. Medford, MA: Tufts Interdisciplinary Evaluation Research.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Repeat pregnancy (self report), time 3	FavorableUnfavorable or ambiguousNo Effect	2 years post enrollment	MA sample	612 mothers	Not reported	Not reported	OR = 0.94	HomeVEE calculated = -0.04	Not statistically significant, p = 0.72	footnote162 Submitted by user on Fri, 03/15/2019 - 14:29 Negative value is favorable to the intervention.

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Outcome measure	Outcome measure description	Collection method	Properties
Repeat pregnancy (self report), time 3	Interview question on whether the mother had become pregnant again since the birth of the target child	Mother self-report	Not reported

Jacobs, F., Easterbrooks, M. A., Goldberg, J., Mistry, J., Bumgarner, E., Raskin, M., Fosse, N., & Fauth, R. (2015). Improving adolescent parenting: Results from a randomized controlled trial of a home visiting program for young families. American Journal of Public Health, published online ahead of print, e1-e7.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Repeated birth	FavorableUnfavorable or ambiguousNo Effect	2 years post enrollment	MA sample	612 mothers	Not reported	Not reported	OR = 0.73	HomeVEE calculated = -0.19	Not statistically significant, p = 0.16¹	footnote244 Submitted by user on Fri, 03/15/2019 - 14:29 The <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated p-value of the effect size is statistically significant (p=0.02)

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Outcome measure	Outcome measure description	Collection method	Properties
Repeated birth	Percentage of mothers who gave birth subsequent to the target child	Mother self-report	Not reported

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.

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Rapid repeat birth	FavorableUnfavorable or ambiguousNo Effect	Child age 2	Full sample, Alaska trial	325 mothers	% = 16.00	% = 17.00	OR = 0.96	HomeVEE calculated = -0.04	Not statistically significant, p ≥ 0.05	footnote52 Submitted by user on Fri, 03/15/2019 - 14:29 Rapid repeat birth is defined as a birth occurring within 24 months after a previous birth or a repeat birth while still a teen for adolescent mothers (El-Kamary et al., 2004).

Show outcome measure summary

Outcome measure	Outcome measure description	Collection method	Properties
Rapid repeat birth	Percentage of mothers who had a repeat birth within 24 months after the index birth	Parent/caregiver report	Not reported by author

LeCroy, C. W., & Krysik, J. (2011). Randomized trial of the Healthy Families Arizona home visiting program. Children and Youth Services Review, 33(10), 1761–1766.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Emotional loneliness	FavorableUnfavorable or ambiguousNo Effect	6 months	Arizona sample	180 mothers	Mean = 1.75	Mean = 1.74	Mean difference = 0.01	HomeVEE calculated = 0.01	Not statistically significant, p = 0.34
Pathways to goal	FavorableUnfavorable or ambiguousNo Effect	12 months	Arizona sample	171 mothers	Mean = 12.96	Mean = 12.69	Mean difference = 0.27	HomeVEE calculated = 1.69	Not statistically significant, p =0.87
Pathways to goal	FavorableUnfavorable or ambiguousNo Effect	6 months	Arizona sample	180 mothers	Mean = 13.00	Mean = 13.17	Mean difference = -0.17	HomeVEE calculated = -0.89	Not statistically significant, p =0.12
Use of resources	FavorableUnfavorable or ambiguousNo Effect	12 months	Arizona sample	171 mothers	Mean = 2.53	Mean = 1.95	Mean difference = 0.58	HomeVEE calculated = 1.58	Statistically significant, p =0.001

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Outcome measure	Outcome measure description	Collection method	Properties
Emotional loneliness	The Emotional/Social Loneliness Inventory was used to examine coping and the sense of isolation.	Parent/caregiver report	Not reported by author
Pathways to goal	The authors used the Adult Hope Scale subscale that measures the ability to plan for personal goal achievement and referred to it as pathway to goals.	Parent/caregiver report	Not reported by author
Use of resources	A scale representing the number of resources the family reported using such as mental health counseling, financial counseling, center-based family assistance, and so forth	Parent/caregiver report	Not applicable

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.

Healthy Families America (HFA)^®

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Frequency of prenatal care visits during third trimester	FavorableUnfavorable or ambiguousNo Effect	At birth	Full sample		Not reported	Not reported	Not reported	Not available	Statistically significant, p<0.05¹
Mother has primary care provider	FavorableUnfavorable or ambiguousNo Effect	At birth	Full sample		Unadjusted proportion = 0.94	Unadjusted proportion = 0.88	Not reported	Not available	Statistically significant, p<0.05	footnote250 Submitted by user on Fri, 03/15/2019 - 14:29 <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr> reported p value.

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Outcome measure	Outcome measure description	Collection method	Properties
Frequency of prenatal care visits during third trimester	Mother was asked about the frequency of prenatal care visits during third trimester.	Maternal interview	Not reported
Mother has primary care provider	Mother was asked if had primary care provider.	Maternal interview	Not reported

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