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Healthy Families America

Category

Family Support

Child's Age

0-1 years, 1-2 years, 2-3 years, 3-4 years, 4-5 years

Participant

Children, Parents/Guardian

Languages

English, Spanish

Brief Description

A home visiting program developed to work with families who may have histories of trauma, intimate partner violence, mental health issues and/or substance abuse issues. Focus on prenatal support, family goal planning, family service planning, strengthening parent-child interaction, parent support and education, child development information, and health and safety information. Program activities identify existing service gaps and supports families through relationship-building strategies that are strengths-based, family-centered, culturally responsive, and reflective.

Expected Impact

  • Increase in positive parenting outcomes (such as reading to children, participating in developmentally appropriate and supportive activities, healthy home environments, and breastfeeding) 
  • Increase in early identification and treatment of developmental delays 
  • Increase in use of community resources 
  • Increase in positive parental mental health and coping strategies 
  • Decrease in abuse, neglect, and harsh parenting 

Core Components for Model Fidelity

  • Home Visits:  Home visiting curriculum must meet the standards of Healthy Families America. For Smart Start funding, Parents as Teachers, Growing Great Kids, and Partners for a Healthy Baby are the allowable curricula.  
  • Screenings: All families receive screenings for child development and depression. For Smart Start funding, participants must also complete the Healthy Families Parenting Inventory (HFPI) as a pretest and posttest.  
  • Referrals: Families are linked to medical providers and any other additional services needed. 
  • Community Advisory Board: Focus on HFA planning, implementation, and continuous quality improvement of site services. Comprised of members representing diverse lived experiences.

Languages Materials are Available in

English, Spanish

Delivery Mode

In-person or telehealth home visits.

Dosage

Home Visits  

  • Typically, home visits occur weekly in the home, last a minimum of one hour, and the child is present. Home visitors offer voluntary services that use positive outreach efforts to build family trust. 
  • Ongoing frequency is determined by family need using HFA’s leveling system. Services may be gradually reduced to biweekly, monthly, or quarterly for up to 3-5 years. 

Community Advisory Board  

  • Convenes at least quarterly. 

Infrastructure for Implementation

Materials: Implementing necessities also include a data management or tracking system and the ability to provide travel expense reimbursement (mileage) for home visitors.  
 
Space: Office space with confidentiality related to participant files/records. 

Staffing Requirements

Home Visitors: Minimum high-school diploma or equivalent and knowledgeable about the community, culturally responsive, and receive on-going supervision and training. In year one staff are working with 10-12 families, 16 families in year two, and up to 20 families in year three. At any given time, individual home visitors should not exceed 30 families.

Supervisors: Master’s degree, OR bachelor’s degree with 3 years of relevant experience, OR less than a bachelor’s degree with commensurate HFA experience. 1 FTE supervisor per 5-6 FTE home visitors & for larger sites, a staff person to assist with initial intake, assessment & enrollment of new families. HFA staffing recommends a 5:1 Home Visitors (direct service staff) to Supervisor ratio. Some roles and FTEs may be combined. 

Program Managers: Master’s degree in public health, human services administration, or child and family related fields OR bachelor's degree with 3 years of relevant experience, OR high school degree with experience implementing with Healthy Families America.  

NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Positive Childhood Alliance North Carolina (PCANC) or National Family Support Network (NFSN) for more information, training, and certification. 

Training for Model Fidelity

Training is provided online in a blended format of self-paced and instructor-led content. 

  • Foundations training: 4 days (28 hours) for direct service staff, supervisors, and program managers. 
  • Family Resource and Opportunities for Growth (FROG) Scale Training (21 hours) for users of the FROG assessment tool. 
  • Advancing HFA Home Visiting: optional comprehensive 3–4-hour training for funders, policymakers, administrators, and community leaders will learn about their role in supporting high-quality home visiting and explore how they can best support local programs in implementing the HFA model to fidelity. 
  • Additional training is required for Supervisors and Program Managers.  

For more information, contact Kit Patterson, Senior Director of Training & TA, kpatterson@preventchildabuse.org.  
 
If using Smart Start-approved alternative curriculum, home visitors must be officially trained by that curriculum provider. 

Contact Information

https://www.healthyfamiliesamerica.org/
 
Diana Sanchez: Site Development Specialist; dsanchez@preventchildabuse.org 

Cost Estimates

  • Personnel Costs: ~$103,300, including a Program Manager (0.2 FTE), Supervisor (0.2 FTE), Data Entry/Support Person (0.25 FTE), and Family Support Specialist 1 (1.0 FTE). 
  • To ensure model fidelity, staff must complete training, pay the HFA annual fee, and other associated costs totaling ~$11,060 in year one. 
    • Application fee: $500, payable to Prevent Child Abuse America  
    • Training cost based on role 
      • Family Support Specialist: $1,250 each 
      • Supervisor: $1,680  
      • Program Manager: $2,380 
      • Advancing HFA Home Visiting (optional training for organization leaders, not HFA program staff): $450 per trainee 
    • Annual Fee: Determined by site size
  • Non-personnel Costs: Year one, ~$15,177 for materials/curriculum, professional development, technology/equipment.
  • Evaluation Costs: Year one ~$5,500 for Ages and Stages Questionnaire materials, other measurement tools, and access to the HFA data system.

Estimates are based on HFA curriculum and not the other approved curriculum options. 

Purpose Service Code (PSC)

5525 – Home Visiting 

Program Identifier (PID)

Healthy Families America (HFA)

Minimal Outputs for NCPC Reporting

FY 24-25:

  • Number of parents/guardians partcipating†

†Select Family Support Programs data collection will include basic demographic data for parent/guardian participants including Race, Ethnicity. Data on interpretation and transportation will be collected when appropriate.  

Minimal Outcomes for NCPC Reporting

FY 24-25:

  • Increase in positive parenting practices 

Minimal Measures for NCPC Reporting

FY 24-25:

Please select one of the following:

  • Keys to Interactive Parenting Scale (KIPS)
  • Parenting Interaction with Children: Checklist of Observations Linked to Outcomes (PICCOLO)
  • Parents’ Assessment of Protective Factors (PAPF)
  • Protective Factors Survey
  • Healthy Families Parenting Inventory (HFPI) *Preferred Measure*

NCPC Evidence Categorization

Evidence Based- 2 randomized control trials and a 7-year follow-up study of a randomized controlled trial.  
 
To access additional resources, visit HFA’s Evidence of Effectiveness. 

Research Summary

The studies are included based on strength of study and relevance. LeCroy and Lopez (2020)1 found that HFA families used more safety practices at 6 months, but not at 1 year. HFA families had positive differences regarding their use of resources. They scored higher on multiple positive parenting outcomes, including positive parent/child behavior. Home environment scores were higher and had large effect sizes at 6 months and 1 year. HFA families breastfed more at 6 months with no difference for immunizations or well-baby checks. Positive outcomes related to mental health and coping for HFA families were found and outcomes also showed less violence in the families. Kirkland et al. (2020)2 completed a follow up of HFNY 7 years after initial enrollment. They found that HFNY mothers used nonviolent discipline strategies more frequently and were more likely to engage in them. HFNY mothers were also less likely to commit serious physical abuse and engaged in these behaviors less frequently. Children reported significantly lower rates of minor physical assault by mothers, but there was no significant difference in children's reports of non-violent discipline. There were no differences in the number of CPS reports. Jacobs et al. (2015)3 did not find differences in likelihood of CPS- reported child maltreatment, however HFM mothers experienced less difficulty with their children and less parenting distress. No differences were detected for child health and development. HFM mothers were more likely to finish 1 year of college; no differences were found for high school completion or employment status. HFM mothers were more likely to use condoms, but no differences for other birth control methods or for the likelihood of having a second child were found. Lastly, HFM mothers were less likely to participate in risky behaviors and less likely to report partner violence (specifically at the 12-month interview). 

  1. ^ See LeCroy & Lopez (2020). A RCT conducted on 245 families that were eligible for HFA (defined as having a moderate risk of abuse). A majority were Hispanic with an average age of 26 and a low-income, low-education background. Measures included the Subscale for Mobilizing Resources and interview questions about resources accessed, the HFPI (home environment, role satisfaction, parent/child behavior, parenting efficacy, depression, social support, and problem solving subscales),  the Parenting Sense of Competence Scale, the Rand Mental Health Inventory, the Pathway of Goals subscale of the Adult Hope subscale, the Social Loneliness subscale, frequency of violent acts (7-items, author created), and self-report descriptions of children for linguistic analysis, as well as self-report interview responses on personal care, breast feeding, immunizations, and well-baby visits. 
  2. ^ See Kirkland et al. (2020). This randomized control trial is a 7-year follow up to a study sampling families at risk for child abuse with diverse racial and ethnic backgrounds. Data was collected at baseline, at the child’s second birthday, and 7 years after baseline. For the year 7 follow-up, participants included 942 eligible mothers and 800 children targeted by the intervention. Data was collected through the mother’s self-reports and the child’s self-reports on harsh parenting tactics (severe physical assault was not measured in the child interview). Measures included the Center for Epidemiologic Studies Depression Scale, child protective services reports, the revised Conflict Tactics Scales: Parent-Child version, the Conflict Tactics Scale-Picture Card Version, and the Kempe Family Stress Inventory. 
  3. ^ See Jacobs et al. (2015). The study was completed using a randomized controlled trial design. 704 participants were randomly assigned to receive home visiting services through Healthy Families Massachusetts (HFM) or to the control group. In order to participate mothers had to be at least 16, speak either English or Spanish, and be new to the program. The study used a nested design such that the analytic sample was somewhat different for various outcome indicators. The outcomes analyzed included parenting, child development, education, family planning, and maternal health/well-being. Data was collected through telephone and in-person interviews at 12- and 24-months post-enrollment and public agency records. Measures used included self-report demographics, administrative data, public health agency data, the Center for Epidemiological Studies Depression Scale, CPS records, the Parenting Stress Index Short Form, the corporal punishment subscale of the Conflict Tactics Scale – Parent-Child, the Brief Infant-Toddler Social and Emotional Assessment, the Youth Risk Behavior Surveillance System, and the Conflict Tactics Scale-Partner.   

Researched Population

  • Parents with children ages birth through 5 
  • Children at risk for abuse or neglect 
  • Teen parents 
  • People who speak English as a second language or are English Language Learners    
  • People with low-income  
  • Families from diverse racial/ethnic backgrounds 

Clearinghouse and Compendium References

Promising Practices Network rated Healthy Families New York as Proven

Home Visiting Evidence of Effectiveness rated Meets DHHS Criteria

Title IV-E Prevention Services Clearinghouse rated as Well Supported

California Evidence-Based Clearinghouse rated as Well Supported by Research Evidence for child well-being

National Home Visiting Resource Center Rated Evidence-Based 

Jacobs, F., Easterbrooks, M. A., Goldberg, J., Mistry, J., Bumgarner, E., Raskin, M., Fosse, F., & Fauth, R. (2015). Improving adolescent parenting: Results from a randomized controlled trail of a home visiting program for young families. American Journal of Public Health, e1-e8. https://doi.org/10.2105/AJPH.2015.302919

Kirkland, K., Lee, E., Smith, C., & Greene, R. (2020). Sustained impact on parenting practices: Year 7 findings from the Healthy Families New York randomized controlled trial. Prevention Science, 21, 498-507. https://doi.org/10.1007/s11121-020-01110-w 

LeCroy, C. W., & Lopez, D. (2020). A randomized controlled trial of Healthy Families: 6-month and 1-year follow-up. Prevention Science, 21, 25-35. https://doi.org/10.1007/s11121-018-0931-4

  • Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant and Early Childhood Mental Health® (Endorsement or IECMH-E®)
    • Highly recommended by NCPC
    • NCIMHA Endorsement Overview
    • Two Endorsement categories depending on scope of practice
      • Infant Mental Health Endorsement®: For professionals working with or on behalf of children birth to 3.
      • Early Childhood Mental Health Endorsement®: For professionals working with or on behalf of children 3 to 6.
    • Supports professionals in identifying and developing the knowledge and skills necessary to provide services that are high quality, culturally informed, reflective, and relationship based.
    • Endorsement offers career paths that focus on principles, best practice skills, and reflective work experiences that lead to increased confidence and credibility.
    • No additional training is required for Endorsement.
    • Many applicants may find that many of their onboarding, in service, conference, discipline specific certification, and NCIMHA sponsored trainings can be utilized to complete an Endorsement application.
    • NCIMHA Competency Guidelines® & Crosswalks: NCIMHA provides multiple crosswalks connecting the Competency Guidelines to well-recognized training curricula for professionals seeking Endorsement. Below are a few of these crosswalks that are particularly salient to the Smart Start Network as the curricula are included in Smart Solutions. Please view the associated Smart Solutions entries as well as NCIMHA's website for additional information about these curricula and other opportunities.


Local Partnerships Currently Implementing

Local Partnerships in purple have adopted Healthy Families America. Local Partnership contact information can be found here.