King, T., Rosenberg, L., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. (2005). Prevalence and early identification of language delays among at-risk three year olds. Journal of Developmental & Behavioral Pediatrics, 26(4), 293–303.
Citation Year
Used in Implementation Reports
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 Kempe’s Family Stress Checklist; eligible families were those in which either parent scored 25 or greater.  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).

This study focuses on 304 program group children and 209 comparison group children who had available medical records and developmental testing results at age 3 and whose mothers completed at least one interview. On average, at baseline, mothers were 23.7 years of age (program group) and 22.9 years of age (comparison group). 62% (program group) and 64% (comparison group) of participating families lived below the poverty line. The racial composition of the program sample was 34% native Hawaiian or Pacific Islander, 27% Asian or Filipino, 11% Caucasian, and 29% of unknown primary ethnicity. The comparison group consisted of 33% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 12% Caucasian, and 28% of unknown primary ethnicity.

Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.
Home Visiting 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 them 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. Families still active at the end of year 1 received an average of 22 visits in the first year (Duggan et al., 1999).
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.
Author Affiliation
None of the study authors are developers of this model.
Funding Sources
Maternal and Child Health Bureau (R40 MC 00029, formerly MCJ 240637, and 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). Dr. King’s effort was also supported by a National Research Service Award from the Health Resources and Services Administration, Bureau of Health Professions (5 T32 HP 10004).
Hawaii Sample
Citation short
King, T., Rosenberg, L., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. (2005)
Confounding Factors
Baseline Equivalence
Established on race and SES. Baseline equivalence on outcomes not feasible.
Not applicable
Screening Decision
Passes screens
Design Detail
Randomized controlled trial