Healthy Families America (HFA)

Evidence Rating  
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Date last updated

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 years1.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Improved parenting

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Reduced child maltreatment

  • Improved child well-being

  • Reduced low birthweight births

  • Increased breastfeeding rates

  • Reduced alcohol use

  • Improved cognitive skills

  • Increased academic achievement

What does the research say about effectiveness?

There is some evidence that Healthy Families America (HFA) improves parenting practices and attitudes2, 3. HFA may also reduce child abuse and neglect2, 3, 4, 5, 6, 7. Flexibility in implementation, inherent in the program’s design, is likely to contribute to variable effects. Additional evidence is needed to confirm effects and determine the characteristics of the most successful programs.

HFA parents appear to use positive parenting skills (e.g., stimulate, reassure, or praise a child) and engage in developmentally supportive activities more than non-participating parents8, 9. HFA has been shown to decrease self-reported cases of abuse and neglect in some circumstances3, 4, 5, 10 and increase use of non-violent discipline4, especially among first time mothers and families with substantiated instances of abuse or neglect4. However, HFA does not appear to affect substantiated official reports of child abuse and neglect, potentially due to surveillance bias3, 4, 6, 11.  

HFA has been shown to improve child well-being and safety7. HFA mothers are more likely to receive a developmental screening and practice safety behaviors (e.g., using car seats, keeping poison out of reach, etc.) than non-participants2, 8. Breastfeeding rates appear higher3 and alcohol use appears lower2, 3 for mothers who participate in HFA programs than for mothers who do not.

Mothers participating in Healthy Families New York (HFNY) are less likely to deliver low birthweight (LBW) babies than non-participants; positive effects are more likely for mothers who participate in the program earlier in their pregnancies. Decreases in LBW babies have also been shown in Virginia, Florida, and Washington, D.C. implementations of HFA3.

HFA may improve children’s cognitive development in some circumstances3. By age seven, children whose mothers participated in HFNY are more likely to be in gifted programs and less likely to be enrolled in special education classes than children whose mothers did not participate4. Participants’ children also demonstrate more learning-promoting behaviors and less grade retention than comparison children; effects on academic performance have been demonstrated for daughters of HFNY participants, but not for sons12

Implementation Examples

There are nearly 400 affiliated HFA program sites in 40 States, DC, and the U.S. territories1.

Implementation Resources

HFA - Healthy Families America (HFA). Great childhoods begin at home.


* Journal subscription may be required for access.

1 HFA - Healthy Families America (HFA). Great childhoods begin at home.

2 LeCroy 2011 - LeCroy CW, Krysik J. Randomized trial of the healthy families Arizona home visiting program. Children and Youth Services Review. 2011;33(10):1761-6.

3 Harding 2007 - 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.

4 DuMont 2010 - DuMont K, Kirkland K, Ehrhard-Dietzel S, et al. A randomized trial of Healthy Families New York (HFNY): Does home visiting prevent child maltreatment? Albany: University of Albany, State University of New York; 2010.

5 DuMont 2008 - DuMont K, Mitchell-Herzfeld S, Greene R, et al. Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect. Child Abuse & Neglect. 2008;32(3):295-315.

6 Duggan 2007 - Duggan A, Caldera D, Rodriguez K, et al. Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect. 2007;31(8):801-27.

7 CEBC - California Evidence-Based Clearinghouse for Child Welfare (CEBC). Information and resources for child welfare professionals: List of programs.

8 Green 2014 - Green BL, Tarte JM, Harrison PM, Nygren M, Sanders MB. Results from a randomized trial of the Healthy Families Oregon accredited statewide program: Early program impacts on parenting. Children and Youth Services Review. 2014;44:288-298.

9 Rodriguez 2010 - Rodriguez ML, Dumont K, Mitchell-Herzfeld SD, Walden NJ, Greene R. Effects of Healthy Families New York on the promotion of maternal parenting competencies and the prevention of harsh parenting. Child Abuse & Neglect. 2010;34(10):711-723.

10 Pew-Easterbrooks 2012 - Easterbrooks MA, Jacobs FH, Bartlett JD, et al. Initial findings from a randomized, controlled trial of Healthy Families Massachusetts: Early program impacts on young mothers' parenting. Washington, D.C.: Pew Charitable Trusts; 2012.

11 Bartlett 2014 - Bartlett JD, Raskin M, Kotake C, Nearing KD, Easterbrooks MA. An ecological analysis of infant neglect by adolescent mothers. Child Abuse & Neglect. 2014;38(4):723-734.

12 Kirkland 2012 - Kirkland K, Mitchell-Herzfeld S. Evaluating the effectiveness of home visiting services in promoting children's adjustment in school. Rensselaer: New York State Office of Children and Family Services, Healthy Families New York; 2012.