footnote80
High rating applies to outcomes in the study’s Tables 4 and 6. Outcomes in Tables 5 and 7 are excluded because they overlap with analyses reported in other reports.
Manuscript Detail
Model(s) Reviewed: Healthy Families America (HFA)®
| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Established on race and SES. Baseline equivalence on outcomes not feasible. | None | None |
Notes:
| Study participants | Families were recruited to the study between November 1994 and December 1995. 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 (Duggan, 2004a). 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, 270 families in the main comparison group, and 41 in the testing group comparison). On average, at baseline, mothers were 23.7 years of age (program group) and 23.3 years of age (comparison group). 63% (program group) and 67% (comparison group) of participating families lived below the poverty line. The racial composition of the program group was 34% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 10% Caucasian, and 27% of unknown primary ethnicity. The main comparison group consisted of 33% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 14% Caucasian, and 26% of unknown primary ethnicity. This study reports results from the first two follow-ups of the Hawaii Healthy Start randomized controlled trial. Follow-up interviews were completed for 88% of families in years 1 and 2, and 83% of participating families were included in both follow-ups. |
|---|---|
| Setting | Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii. |
| Intervention 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 families 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 old. Families still active at the end of year 1 received an average of 22 visits in the first year. |
| Comparison conditions | 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 sources | From 1991 to 1994, this evaluation received funding from: the Robert Wood Johnson Foundation; the Annie E . Casey Foundation; The David and Lucile Packard Foundation; the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services; the Hawaii Department of Health; and the Hawaii Medical Association committed office space and an administrative home for fieldwork staff. |
| Author affiliation | None of the study authors are developers of this model. |
Findings details
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Ever hospitalized for any reason | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1 and 2 | 534 children | % = 19.00 | % = 22.00 | = 3.00 | HomeVEE calculated = -0.11 | Not statistically significant, p ≥ 0.05 | |
| High | Ever hospitalized for any reason | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 children | % = 17.00 | % = 18.00 | = -1.00 | HomeVEE calculated = -0.04 | Not statistically significant, p ≥ 0.05 | |
| High | Ever used emergency department | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 children | % = 40.00 | % = 44.00 | = -4.00 | HomeVEE calculated = -0.10 | Not statistically significant, p ≥ 0.05 | |
| High | Ever used emergency department | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1 and 2 | 534 children | % = 58.00 | % = 60.00 | = -2.00 | HomeVEE calculated = -0.05 | Not statistically significant, p ≥ 0.05 | |
| High | Has a PCP who handles most health care needs | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 children | % = 89.00 | % = 84.00 | = 5.00 | HomeVEE calculated = 0.26 | Not statistically significant, p ≥ 0.05 | |
| High | Has a PCP who handles most health care needs | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 children | % = 93.00 | % = 90.00 | = 3.00 | HomeVEE calculated = 0.24 | Not statistically significant, p ≥ 0.05 | |
| High | Has a PCP who knows all aspects of child’s care | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 children | % = 80.00 | % = 75.00 | = 5.00 | HomeVEE calculated = 0.17 | Not statistically significant, p ≥ 0.05 | |
| High | Has a PCP who knows all aspects of child’s care | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 children | % = 84.00 | % = 79.00 | = 5.00 | HomeVEE calculated = 0.20 | Not statistically significant, p ≥ 0.05 | |
| High | Has a PCP who knows family’s concerns about child | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 children | % = 45.00 | % = 48.00 | = 3.00 | HomeVEE calculated = -0.07 | Not statistically significant, p ≥ 0.05 | |
| High | Has a PCP who knows family’s concerns about child | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 children | % = 50.00 | % = 39.00 | = 11.00 | HomeVEE calculated = 0.27 | Statistically significant, p < 0.05 |
|
| High | Has a primary care provider (PCP) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 children | % = 91.00 | % = 86.00 | = 5.00 | HomeVEE calculated = 0.30 | Not statistically significant, p ≥ 0.05 | |
| High | Has a primary care provider (PCP) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 children | % = 94.00 | % = 90.00 | = 4.00 | HomeVEE calculated = 0.34 | Not statistically significant, p ≥ 0.05 | |
| High | Immunizations up-to-date | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 children | % = 82.00 | % = 82.00 | = 0.00 | HomeVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | |
| High | Immunizations up-to-date | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 children | % = 87.00 | % = 85.00 | = 2.00 | HomeVEE calculated = 0.10 | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Mother earned HS degree or in school | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 81.00 | % = 80.00 | = 1.00 | HomeVEE calculated = 0.04 | Not statistically significant, p ≥ 0.05 | |
| High | Mother earned HS degree or in school | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 mothers | % = 82.00 | % = 81.00 | = 1.00 | HomeVEE calculated = 0.04 | Not statistically significant, p ≥ 0.05 | |
| High | Someone in household worked | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 68.00 | % = 70.00 | = -2.00 | HomeVEE calculated = -0.06 | Not statistically significant, p ≥ 0.05 | |
| High | Someone in household worked | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 mothers | % = 77.00 | % = 75.00 | = 2.00 | HomeVEE calculated = 0.07 | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Confidence in adult relations | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 mothers | Mean = 34.40 | Mean = 33.70 | Mean difference = 0.70 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Confidence in adult relations | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | Mean = 34.30 | Mean = 33.80 | Mean difference = 0.50 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Maternal life skills (CLSS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 mothers | Mean = 23.90 | Mean = 23.90 | Mean difference = 0.00 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Maternal life skills (CLSS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | Mean = 24.20 | Mean = 24.30 | Mean difference = -0.10 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Maternal social support (MSSI) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 mothers | Mean = 21.40 | Mean = 21.70 | Mean difference = -0.30 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Maternal social support (MSSI) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | Mean = 21.50 | Mean = 21.90 | Mean difference = -0.40 | Not available | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Learning environment (HOME) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | Mean = 35.20 | Mean = 35.20 | Mean difference = 0.00 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Learning environment (HOME) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 mothers | Mean = 34.60 | Mean = 34.10 | Mean difference = 0.50 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Mother-child interaction, Caregiver total score (NCAST) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | Mean = 12.80 | Mean = 12.70 | Mean difference = 0.10 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Mother-child interaction, Caregiver total score (NCAST) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 mothers | Mean = 15.00 | Mean = 14.60 | Mean difference = 0.40 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Mother-child interaction, Child total score (NCAST) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 mothers | Mean = 7.20 | Mean = 7.20 | Mean difference = 0.00 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Mother-child interaction, Child total score (NCAST) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | Mean = 6.80 | Mean = 6.50 | Mean difference = 0.30 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Parenting efficacy (PSOC) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | Mean = 75.20 | Mean = 74.40 | Mean difference = 0.80 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Parenting efficacy (PSOC) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 567 mothers | Mean = 76.10 | Mean = 74.10 | Not Reported | Not available | Statistically significant, p < 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Ever had injury needing medical care | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 children | % = 9.00 | % = 11.00 | = -2.00 | HomeVEE calculated = -0.14 | Not statistically significant, p ≥ 0.05 | |
| High | Ever had injury needing medical care | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1 and 2 | 534 children | % = 22.00 | % = 24.00 | = -2.00 | HomeVEE calculated = -0.07 | Not statistically significant, p ≥ 0.05 |
Outcome measure summary
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Ever hospitalized for any reason |
Percentage of children who had ever been hospitalized for any reason | Parent/caregiver report | Not applicable |
Ever used emergency department |
Percentage of children who had ever used the emergency department | Parent/caregiver report | Not applicable |
Has a PCP |
Percentage of children who had a PCP | Parent/caregiver report | Not applicable |
Has a PCP who handles most health care needs |
Percentage of children who had a PCP who handled most health care needs | Parent/caregiver report | Not applicable |
Has a PCP who knows all aspects of child’s care |
Percentage of children who had a PCP who knew about all aspects of the child’s care | Parent/caregiver report | Not applicable |
Has a PCP who knows family’s concerns about child |
Percentage of children who had a PCP who understood the family’s concerns about child | Parent/caregiver report | Not applicable |
Immunizations up-to-date |
Percentage of children who were up-to-date on the appropriate immunizations for the child’s age | Parent/caregiver report | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Mother earned high school degree or in school |
Percentage of mothers who had earned a high school degree or who were currently enrolled in school | Parent/caregiver report | Not applicable |
Someone in household worked |
Percentage of families in which a household member was employed | Parent/caregiver report | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
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 |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
NCAST: Caregiver total score NCAST: Child total score |
The NCAST assesses the quality of teaching interaction between caregivers and young children. The researchers examined separate composite scores for both children and parents. | Observation | Not reported by author |
PSOC |
The PSOC measures parent attitudes and self-efficacy. | Parent/caregiver report | Not reported by author |
HOME: Learning environment |
The HOME assesses parenting practices and aspects of the home environment. | Parent/caregiver interview and observational assessment | Not reported by author |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Ever had injury needing medical care |
Percentage of children who had ever had an injury that required medical care | Parent/caregiver report | Not applicable |