Hawaii Healthy Start (Paraprofessional home visitation program for new mothers with children at-risk of abuse/neglect)
Randomized controlled trial indicates that the program has no significant impact on the level of child abuse or neglect in the families it serves.
Description of the Intervention: Hawaii Healthy Start Program is a large, statewide program that provides home visits by trained paraprofessionals to mothers who 1) have just given birth and 2) whose families' were identified as at-risk of child abuse and neglect based on risk factors like parental substance abuse, poor mental health, or history of domestic abuse. Paraprofessionals visit these women for the first three to five years of their child's life and 1) help parents with crises; 2) model problem-solving skills, 3) help parents access needed social services, and 4) provide parenting education.
The program serves as a model for approximately 420 similar paraprofessional visitation programs in 39 states, coordinated by the Healthy Families America organization. These programs received a total of $185 million in public and private funding in 2001.
EVIDENCE ON THE PROGRAM'S EFFECT
Study
Randomized controlled trial of 685 families at multiple program sites. Families were randomly assigned to an intervention group, which participated in the Hawaii Healthy Start program, or a control group, which did not.
Findings at the three-year follow-up:
The study found no significant differences between the intervention and control groups in the study's main outcome measures, including:
- Mothers' self-reports of psychological or physical abuse/neglect of children.
- Number of hospitalizations of children for trauma or ambulatory care sensitive conditions.
- Percent of mothers relinquishing primary caregiver role.
- Percent of families on whom Child Protective Service reports of neglect or abuse were filed.
Discussion of study quality: (click here for glossary of terms)
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This was a relatively large study with low attrition and a long-term follow-up: At the three-year follow-up, 81% of the original sample had completed all three annual interviews.
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The study reported outcomes using an intention-to-treat analysis.
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In measuring outcomes, the study used children's official medical records and Child Protective Services reports on child abuse/neglect to supplement data from maternal interviews and staff observations of parenting behavior.
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Staff gathering outcome data were blind as to treatment condition.
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The intervention and control groups were virtually identical prior to the intervention.
Source (click on linked authors' names to get their contact information)
Duggan, Anne, Loretta Fuddy, Lori Burrell, Susan M. Higman, Elizabeth McFarlane, Amy Windham, and Calvin Sia . Randomized trial of a statewide home visiting program: impact in preventing child abuse and neglect. Child Abuse & Neglect 28 (2004) 597-622.
Duggan, Anne, Elizabeth C. McFarlane, Amy M. Windham, Charles A. Rohde, David S. Salkever, Loretta Fuddy, Leon A. Rosenberg, Sharon B. Buchbinder, Calvin C.J. Sia. “Evaluation of Hawaii's Health Start Program.“ The Future of Children-- Home Visiting Programs: Recent Program Evaluations, Vol. 9, No. 1, Spring-Summer 1999.
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