Implementing Healthy Families America (HFA)® Meets HHS Criteria

Implementation last updated: 2020

The information in this profile reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the research reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Similarly, models described here may not all have impact studies, and those with impact studies may vary in their effectiveness. Please see the Effectiveness button on the left for more information about research on the effectiveness of the models discussed here.

Materials and forms to support implementation

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 program. The HFA Best Practice Standards (rev. 2018) offer specific guidelines on implementing the HFA model.

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Service delivery forms

The HFA National Office provides sample service delivery forms.

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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 adverse childhood experiences. 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.

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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 and 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; promoting healthy childhood growth and development; and enhancing family functioning by reducing risk and building protective factors.

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Available languages

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

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Fidelity measurement

To validate adherence to the HFA model, sites must comply with accreditation requirements, which involve conducting a site self-assessment; undergoing a peer-review site visit conducted by at least two external, nationally trained peer reviewers; and meeting a minimum 85 percent threshold of adherence to the HFA Best Practice Standards (rev. 2018).

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Fidelity standards

All HFA sites must adhere to 12 critical elements that serve as the framework for developing and implementing the program. The 12 critical elements are put into operation as best practice standards with specific criteria for rating site compliance. Sites must meet a minimum 85 percent threshold of adherence to the standards to maintain accreditation. The critical elements include the following:

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 adverse childhood experiences.
  3. Offer services voluntarily and use positive outreach efforts to build family trust.

Service Content

  1. Offer services intensively (at least once a week), with well-defined criteria and a process for increasing or decreasing frequency of service and service over the long term (three to five years).
  2. Take into account families’ cultural backgrounds such that the staff understand, acknowledge, and respect cultural differences among families. Staff and the materials used must reflect, to the greatest extent possible, the cultural, linguistic, geographic, racial, and ethnic diversity of the population served.
  3. Focus services on supporting the parent and the child by cultivating nurturing and responsive parent–child relationships and promoting healthy child growth and development.
  4. At a minimum, link all families to a medical provider to promote optimal health and development. Link families to additional services, as needed.
  5. Limit staff caseloads so that home visitors have adequate 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, home visiting, and supervision.
  3. Give service providers a framework, based on education or experience, for handling the variety of situations they might encounter when working with at-risk families. All service providers 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 can develop realistic and effective plans to empower families to meet their objectives; to understand why a family might 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.
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Implementation notes

The information contained on this page was last updated in April 2020. Recommended further reading lists the sources for this information. In addition, the HFA National Office reviewed the information contained in this profile for accuracy on February 13, 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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