Duggan, A., Fuddy, L., McFarlane, E., Burrell, L., Windham, A., Higman, S., & Sia, C. (2004). Evaluating a statewide home visiting program to prevent child abuse in at-risk families of newborns: Fathers’ participation and outcomes. Child Maltreatment, 9(1), 3–17.

Citation Year
Used in Implementation Reports
Study Participants

Hawaii Healthy Start Program (HSP) staff screened the medical records of mothers from Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Families were eligible for HSP if one or both parents scored at least 25 on the Family Stress Checklist, mothers could be interviewed in English, and families were not already enrolled in HSP. If HSP home visiting intake was open on the day a family was deemed eligible, the family was invited to participate. A total of 897 families were eligible to be enrolled, and 730 of them agreed to participate. Using a table of random numbers, families were randomly assigned to one of three groups: a study treatment group or a study control group (both evaluated at one, two, and three years), or a testing control group (evaluated only at three years). The analytic sample for this study does not include families evaluated only at three years. The final analytic sample includes 600 families, 354 in the HSP group and 246 in the control group. Of these, at baseline, approximately 67 percent of mothers were high school graduates, and 49 percent were currently working. Mothers were 44 percent Native Hawaiian, 11 percent Other Pacific Islander, 25 percent Asian, 6 percent white, and 15 percent some other race.


Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.

Home Visiting Services

Home visiting services are provided to the mother and, when possible, also to the father. Home visits are weekly in the beginning, then gradually decrease to quarterly meetings, lasting from three to five years. The goal of home visits is to prevent child abuse and promote child health and development by focusing on improved family functioning. After addressing immediate crises, home visitors work on family functioning through role modeling, problem solving, and accessing social services. Home visitors also identify needs for professional support, such as domestic violence, substance abuse, mental health, and community resources.

Comparison Conditions

The comparison group was referred to community resources.

Staff Characteristics and Training

Home visitors were trained paraprofessionals with professional supervision. Home visitors attended a five-week training that included such topics as working with men, domestic violence, and community resources.

Author Affiliation

None of the study authors are developers of this program model.

Funding Sources

Maternal and Child Health Bureau (R40 MC 00029, formerly MCJ 240637; R40 MC 00123, formerly MCJ 240838); the Robert Wood Johnson Foundation 18303); the Annie E. Casey Foundation (94-4041); the David and Lucile Packard Foundation (93-6051, 94-7957, 97 8058, and 98-3448); and the Hawaii State Department of Health (99-29-J).

Study Reg

Clinicaltrials.gov Identifier: NCT00218751. Study registration was assessed by HomVEE beginning with the 2014 review.

Citation short
Duggan, A., Fuddy, L., McFarlane, E., Burrell, L., Windham, A., Higman, S., & Sia, C. (2004)
Confounding Factors
Baseline Equivalence
Established on race and ethnicity; not established on SES; outcomes not feasible to assess at baseline
Screening Decision
Passes screens
Design Detail
Randomized controlled trial