Anisfeld, E., Sandy, J., & Guterman, N. B. (2004). Best Beginnings: A randomized controlled trial of a paraprofessional home visiting program: Technical report. Report to the Smith Richardson Foundation and New York State Office of Children and Family Services. New York: Columbia University School of Social Work.
Citation Year
Used in Implementation Reports
Study Participants

Women who were pregnant or had an infant under 2 months old and who lived in two eligible census tracts were screened using a checklist for risk factors for child abuse and neglect. Women who were deemed at risk were further screened using the Kempe Family Screening Inventory (FSI). Consenting women (n = 672) who received a score of 25 or higher on the FSI were assigned to the program group (n = 329) or the comparison group (n = 343). From November 1994 to November 1995, all women in one tract were assigned to the program group and participants from the other tract were enrolled in the comparison group. If Family Assessment Workers determined during the course of screening that a member of the family was affected by substance use, the family was provided additional Best Beginnings services (regardless of program or comparison group membership). Starting in November 1995, women were randomly assigned to the program group or comparison group within their census tract. Of the women who were randomly assigned, 535 were enrolled in Best Beginnings (273 in the program group, and 262 in the comparison group). Among participating women, 89.9% were born outside the United States and 88.3% were of Dominican ethnicity. On average at baseline, mothers were 26.3 years of age, 19.1% were employed, and 61.4% were receiving public assistance.


Eligible women were recruited from one of two contiguous census tracts in Washington Heights, New York. Most women were receiving health care from the New York Presbyterian Hospital (NYPH) Ambulatory Care Network Corporation (ACNC).

Home Visiting Services

Families in the program group received home visits modeled after Healthy Families New York, but modified to meet specific goals. Goals for the visits included (1) assessing family strengths and needs and connecting the families with needed services, (2) improving maternal psychosocial functioning and life course, (3) improving parent-child interactions, and (4) promoting child growth and development.

Comparison Conditions

Participants in the comparison group received 1-2 home visits every six months until the child was age 5, and were provided with educational materials and information about community services. Assessment, screening and referrals for needed services were provided.

Staff Characteristics and Training

Home visits were conducted by paraprofessionals who were fluent in Spanish. Staff were trained by HFA or the Healthy Families New York training team and protocols for service delivery were reinforced at staff meetings.

Author Affiliation

None of the study authors are developers of this model.

Funding Sources

New York State Office of Children and Family Services; the U.S. Department of Health and Human Services Children’s Bureau Abandoned Infants Assistance Program; and the Smith Richardson Foundation.

Best Beginnings Sample from New York
Yes for some outcomes
Confounding Factors
Baseline Equivalence
Established on race/ethnicity, SES, and feasible outcomes. Statistical controls for feasible baseline outcomes included.
Not applicable
Screening Decision
Passes screens
Design Detail
Randomized controlled trial