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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.

Model(s) Reviewed: Healthy Families America (HFA)®
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
Moderate Randomized controlled trial High Established on race/ethnicity, SES, and feasible outcomes. Statistical controls for feasible baseline outcomes included. None None
Notes:

In 2020, HomVEE updated this review to move "Mother has health insurance" from the Maternal Health domain to the Family Economic Self-Sufficiency domain because ACF determined that health insurance coverage belongs in that domain. 

In 2020, HomVEE updated this review to move "Child has health insurance" from the Child Health domain to the Family Economic Self-Sufficiency domain because ACF determined that health insurance coverage belongs in that domain. 

footnote81

Submitted by user on Fri, 03/15/2019 - 14:29

Attrition rating is based on overall sample sizes because sample sizes for treatment and control groups were unavailable.

Study characteristics
Study participants Recruitment for the randomized controlled trial of Healthy Families New York (HFNY) occurred between March 2000 and August 2001. Pregnant women or parents with an infant 3 months of age or less who were found to be at risk for child abuse or neglect and lived in communities with high rates of teen pregnancy, infant mortality, and welfare receipt, and low rates of prenatal care were referred to HFNY. Consenting families were screened using the Kempe Family Stress Checklist (FSC); 1,297 eligible families who received scores of 25 or higher on the FSC were randomly assigned to the program group (n = 647) or the comparison group (n = 650). 1,157 mothers completed a baseline interview (589 in the program group and 568 in the comparison group). Of those who completed baseline interviews, 41.9% were African American, 17.0% were Latina, 33.7% were White, and the remaining 7.3% were of another race or ethnicity. On average, the mothers were 22.4 years of age, 52.3% had not completed high school or a GED , and 32.4% of the families were receiving welfare. This study reports on the first-year program impacts of HFNY, using a sample of 1,060 families who completed the first follow-up interview.
Setting Three Healthy Families New York sites were included in the study: Erie, Rensselaer, and Ulster counties. Erie serves primarily African American and Latino families in inner-city neighborhoods in Buffalo. Rensselaer and Ulster counties include urban, suburban, and rural locations; both serve largely White families, but with a substantial African American population in Rensselaer and Latino population in Ulster.
Intervention services Participants in the program group were assigned to an HFNY home visitor. Home visitors were scheduled to visit families biweekly during pregnancy (if they enrolled prior to the birth of the child) and at least weekly immediately following the birth of the child. The frequency of visits was gradually decreased based on family needs, and visits continued until the child turned 5 or began Head Start or kindergarten. Home visitors emphasized activities to improve the parent-child relationship, help parents understand child development and improve child growth, improve access to health care, and improve family functioning through the development and use of a Family Support Plan.
Comparison conditions Members of the control group received information about and referrals to other community services, though they were not referred to home visiting services that were similar to HFNY (DuMont et al., 2008).
Staff characteristics and training New HFNY staff members are required to attend an initial one-week training and to shadow and receive mentorship from experienced home visitors. “Intensive wraparound” training and ongoing training were provided to all staff.
Funding sources New York State Office of Children and Families Services, Bureau of Evaluation and Research
Author affiliation None of the study authors are developers of this model.

Findings details

Child health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Child ever without needed medical care
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 children % = 2.20 % = 1.40 Not Reported HomeVEE calculated = 0.28 Not statistically significant, p ≥ 0.05
Moderate Child has primary care provider
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 children % = 98.40 % = 98.60 = -0.20 HomeVEE calculated = -0.08 Not statistically significant, p ≥ 0.05
Moderate Mother breastfed baby
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,060 mothers % = 45.90 % = 44.70 = 1.20 Not available Not statistically significant, p ≥ 0.05
Moderate Number of months breastfed
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,060 mothers Adjusted mean = 1.01 Adjusted mean = 1.04 Mean difference = -0.03 Not available Not statistically significant, p ≥ 0.05
Moderate Number of well-baby visits
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 children Adjusted mean = 4.54 Adjusted mean = 4.61 Mean difference = -0.07 Not available Not statistically significant, p ≥ 0.05
Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Child has health insurance
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 children % = 93.90 % = 90.40 = 3.50 HomeVEE calculated = 0.30 Statistically significant,
p < 0.05
Moderate Education appropriate for age
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,061 families % = 57.50 % = 60.30 = -2.80 HomeVEE calculated = -0.07 Not statistically significant,
p > 0.05
Moderate Family received TANF
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,061 families % = 35.00 % = 30.40 = 4.60 HomeVEE calculated = 0.13 Not statistically significant, p ≥ 0.05
Moderate Family received WIC
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,061 families % = 74.80 % = 72.20 = 2.60 HomeVEE calculated = 0.08 Not statistically significant, p ≥ 0.05
Moderate Family received 50% income from work
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,061 families % = 51.20 % = 56.60 = -5.40 HomeVEE calculated = -0.13 Not statistically significant,
p > 0.05
Moderate Mother employed
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,061 families % = 40.80 % = 47.60 = 6.80 HomeVEE calculated = -0.17 Statistically significant,
p < 0.05
Moderate Mother has health insurance
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers % (adjusted) = 80.10 Adjusted mean % = 78.40 = 1.70 Not available Not statistically significant, p ≥ 0.05
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Above alcohol abuse cutoff (AUDIT)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers % (adjusted) = 2.00 Adjusted mean % = 3.80 = -1.80 Not available Not statistically significant, p ≥ 0.05
Moderate Above depression threshold (CES-D)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers % (adjusted) = 29.00 Adjusted mean % = 31.20 = -2.20 Not available Not statistically significant, p ≥ 0.05
Moderate Alcohol abuse (AUDIT)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers Adjusted mean = 1.14 Adjusted mean = 1.28 Mean difference = -0.14 Not available Not statistically significant, p ≥ 0.05
Moderate Depressive symptoms (CES-D)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers Adjusted mean = 11.45 Adjusted mean = 11.61 Mean difference = -0.16 Not available Not statistically significant, p ≥ 0.05
Moderate Drug use
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers % (adjusted) = 9.80 Adjusted mean % = 10.60 = -0.80 Not available Not statistically significant, p ≥ 0.05
Moderate Mother has primary care physician
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers % (adjusted) = 86.90 Adjusted mean % = 85.00 = 1.90 Not available Not statistically significant, p ≥ 0.05
Moderate Sense of personal mastery (PSM)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers Adjusted mean = 23.80 Adjusted mean = 23.55 Mean difference = 0.25 Not available Not statistically significant, p ≥ 0.05
Moderate Smoking
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers % (adjusted) = 41.30 Adjusted mean % = 43.80 = -2.50 Not available Not statistically significant, p ≥ 0.05
Moderate Smoking frequency
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 mothers Adjusted mean = 3.42 Adjusted mean = 3.93 Mean difference = -0.51 Not available Not statistically significant, p ≥ 0.05
Positive parenting practices
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Attitudes: Empathy (AAPI-2)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,060 mothers Adjusted mean = 37.12 Adjusted mean = 36.64 Mean difference = 0.48 Not available Not statistically significant, p ≥ 0.05
Moderate Attitudes: Inappropriate expectations (AAPI-2)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,060 mothers Adjusted mean = 19.11 Adjusted mean = 18.83 Mean difference = 0.28 Not available Not statistically significant, p ≥ 0.05
Moderate Attitudes: Physical punishment (AAPI-2)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,060 mothers Adjusted mean = 38.43 Adjusted mean = 38.01 Mean difference = 0.42 Not available Not statistically significant, p ≥ 0.05
Moderate Attitudes: Power/independence (AAPI-2)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,060 mothers Adjusted mean = 19.39 Adjusted mean = 19.40 Mean difference = -0.01 Not available Not statistically significant, p ≥ 0.05
Moderate Attitudes: Role reversal (AAPI-2)
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,060 mothers Adjusted mean = 23.59 Adjusted mean = 23.24 Mean difference = 0.35 Not available Not statistically significant, p ≥ 0.05
Moderate Child safety checklist
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY trial Year 1 1,060 mothers % = 86.10 % = 85.90 Not Reported Not available Not statistically significant, p ≥ 0.05
Reductions in child maltreatment
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate ER visits due to injury or ingestion
FavorableUnfavorable or ambiguousNo Effect
Full sample, NY Trial Year 1 1,061 children % = 3.80 % = 6.20 = -2.40 HomeVEE calculated = -0.31 Not statistically significant, p ≥ 0.05

Outcome measure summary

Child health
Outcome measure Description of measure Data collection method Properties of measure

Child ever without needed medical care

Percentage of children who had ever gone without needed medical care Parent/caregiver report

Not applicable

Child has PCP

Percentage of children who had a PCP Parent/caregiver report

Not applicable

Mother breastfed baby

Percentage of mothers who had breastfed their child Parent/caregiver report

Not applicable

Number of months breastfed

Number of months the mother had breastfed her child Parent/caregiver report

Not applicable

Number of well-baby visits

Number of well-child visits the child had received Review of medical records

Not applicable

Family economic self-sufficiency
Outcome measure Description of measure Data collection method Properties of measure

Child has health insurance

Percentage of children who had health insurance coverage

Parent/caregiver report

Not applicable

Family received WIC

Percentage of families who received WIC Parent/caregiver report

Not applicable

Family received TANF

Percentage of households that received TANF Parent/caregiver report

Not applicable

Family received 50% income from work

Percentage of households in which 50% of the household’s income came from work Parent/caregiver report

Not applicable

Mother employed

Percentage of mothers who were employed Parent/caregiver report

Not applicable

Mother has health insurance

Percentage of mothers who had health insurance coverage

Parent/caregiver report

Not applicable

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

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

Positive parenting practices
Outcome measure Description of measure Data collection method Properties of measure

AAPI-2: Physical punishment, Inappropriate expectations, Empathy, Role reversal, Power and independence

The AAPI-2 assesses parenting and childrearing attitudes. The researchers examined five subscales: inappropriate expectations, empathy, corporal punishment, role reversal, power, and independence Parent/caregiver report

Not reported by author

Child Safety Checklist (CSC)

The CSC assesses parental safety practices. Parents were asked how regularly they engaged in 23 child safety behaviors in the past year. Response choices included some of the time, none of the time, or all of the time. The authors analyzed the percentage of practices that parents reported doing all of the time. Parent/caregiver report

Not reported by author

Reductions in child maltreatment
Outcome measure Description of measure Data collection method Properties of measure

ER visits due to injury or ingestion

Percentage of children who, had at least one ER visit that involved injury or ingestion Parent/caregiver report

Not applicable