Implementing Healthy Families America (HFA)® Meets HHS Criteria

Model implementation summary last updated: 2020

The information in this implementation report 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 manuscripts 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. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

Model overview

Theoretical approach

Healthy Families America (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.

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Implementation support

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 or multisite system development, and accreditation services to HFA sites.

Ten states and one large metropolitan area have affiliated as an HFA state or multisite system. These include Arizona, Florida, Indiana, Kansas, Massachusetts, Michigan, New York, Ohio, Oregon, San Diego, and Virginia. State or 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 implementing 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 or multisite system through guidance on best standards for the central administrative entity. In addition, the HFA National Office offers a comprehensive accreditation process that includes the central administrative entity and the sites it supports.

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Intended population

HFA seeks to engage 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 psychosocial assessment used 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 sites enroll families before the child’s birth or within three months of the child’s birth. After families are enrolled, HFA sites offer them services until the child’s third birthday, and preferably until the child’s fifth birthday.

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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 children’s 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 children’s injuries and emergency department use.

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Model services

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 and assessment of parent–child interactions, 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 additional services such as these that further address the specific needs of their communities and target populations.

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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 depends 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 the child’s life. Each local site determines—usually based on available funding—whether to extend services beyond three years.

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HFA has 590 affiliated sites across 38 states, the District of Columbia, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, the U.S. Virgin Islands, and Israel.

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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 (rev. 2018). 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.

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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 in February 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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