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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 or 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. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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 directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

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

PROCESS MEASURES:

  • 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.)
  • Number of community referral sources actively sending families to the HFA program. (Tracks the extent of outreach and engagement of key partners.)

OUTCOME MEASURES:

  • Number of parents who receive prenatal support from the HFA program. (Assesses the program's success in early intervention and prevention.)
  • Number of families who complete the full 3 to 5-year HFA program. (Measures retention and dosage of services over time.)
  • Number of children in HFA who receive developmental screenings and follow-up services. (Links HFA to early identification and intervention for child development.)

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

PROCESS MEASURES:

  • 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.)
  • Percent of HFA families who receive their first home visit prenatally or within the first 3 months after birth. (Tracks adherence to the program's early engagement standards.)

OUTCOME MEASURES:

  • Percent of parents who report positive relationships with their HFA family support worker. (Assesses the quality of the therapeutic alliance, a key ingredient for success.)
  • Percent of HFA families connected to community resources that meet identified needs. (Measures the program's effectiveness in addressing social determinants of health.)
  • Percent of HFA children up-to-date on immunizations and well-child visits. (Tracks the program's influence on preventive health care utilization.)

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

PROCESS MEASURES:

  • Number of HFA sites achieving accreditation or certification in the HFA model. (Measures the number of sites meeting HFA's 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 sites offering enhanced services like father engagement or maternal depression screening. (Tracks the customization of HFA to meet local needs.)

OUTCOME MEASURES:

  • Number of HFA families who achieve their self-determined goals related to parenting or 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.)
  • Number of verified cases of child maltreatment prevented among HFA families, compared to baseline. (Captures the program's contribution to child abuse prevention.)

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

PROCESS MEASURES:

  • - Percent of HFA families that reflect the racial, ethnic, and language diversity of the community. (Assesses cultural responsiveness and equitable 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 of HFA advisory board members with lived experience relevant to the program's focus. (Tracks meaningful involvement of parents and residents in program governance.)

OUTCOME MEASURES:

  • - Percent reduction in disparities in prenatal care access and birth outcomes among HFA participants. (Assesses the program's impact on perinatal health equity.)
  • - Percent of HFA graduates who show long-term positive outcomes in education, employment, and family stability. (Captures the sustained, multi-generational impact of HFA.)
  • - Percent of cost savings in public services (e.g., child welfare, special education) attributable to HFA. (Measures the societal and economic return on investment of the program.)

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.