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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Breastfeeding.

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Strategy. Healthy Families America

Approach. Create a home visiting program for expecting and new parents

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Overview. Healthy Families America. (HFA) is a home visiting program model designed to work with overburdened families who are at risk for adverse childhood experiences. Developed in 1992 by Prevent Child Abuse America, the program is based on 12 Critical Elements operationalized through best practice standards that provide a quality structure while offering flexibility in implementation. HFA services begin prenatally for right after birth. Family support workers provide voluntary, intensive services for 3 to 5 years.[1]

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Community Organizing (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of families enrolled in the HFA home visiting program. (Measures the reach and scale of the program's recruitment efforts) Number of home visits completed by HFA family support workers. (Quantifies the volume and frequency of the core program service)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of HFA services delivered in adherence to the program's 12 Critical Elements. (Assesses fidelity to the evidence-based model) Percent of HFA family support workers who receive regular reflective supervision. (Measures a key quality assurance and staff support component)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of HFA sites achieving accreditation for certification in the HFA model. (Measures the number of sites meeting HFA rigorous quality standards) Number of community systems (e.g., health, child welfare) with formal linkages to HFA. (Assesses the program's level of cross-sector collaboration and integration) Number of HFA families who achieve their self-determined goals related to parenting for family functioning. (Measures family-centered outcomes and empowerment) Number of HFA children who reach key developmental milestones on schedule. (Assesses the program's impact on healthy child development)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of HFA families that reflect key characteristics of the community. (Assesses responsiveness and access to HFA) Percent of HFA family support workers who are hired from within the communities served. (Measures community-based workforce development and representation) Percent reduction in gaps in prenatal care access and birth outcomes among HFA participants. (Assesses the program's impact on perinatal health access) Percent of HFA graduates who show long-term positive outcomes in education, employment, and family stability. (Shows the sustained, multi-generational impact of HFA)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Healthy Families America (HFA). Great childhoods begin at home. https://www.healthyfamiliesamerica.org/

2 Harding K, Galano J, Martin J, Huntington L, Schellebach CJ. Healthy Families America effectiveness: A comprehensive review of outcomes. Journal of Prevention & Intervention in the Community. 2007;34(1-2):149-79.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.