Healthy Families America (HFA)

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 (HFA).

Expected Beneficial Outcomes (Rated)

  • Improved parenting

Other Potential Beneficial Outcomes

  • Reduced child maltreatment

  • Improved child well-being

  • Reduced low birthweight births

  • Increased breastfeeding rates

  • Reduced alcohol use

  • Improved cognitive skills

  • Increased academic achievement

Evidence of Effectiveness

There is some evidence that Healthy Families America (HFA) improves parenting practices and attitudes (LeCroy 2011*, Harding 2007*). HFA may also reduce child abuse and neglect (DuMont 2010, DuMont 2008*, Harding 2007*, Duggan 2007*, LeCroy 2011*, CEBC). 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 parents (Green 2014*, Rodriguez 2010*). HFA has been shown to decrease self-reported cases of abuse and neglect in some circumstances (DuMont 2010, DuMont 2008*, Harding 2007*, Pew-Easterbrooks 2012) and increase use of non-violent discipline (DuMont 2010), especially among first time mothers and families with substantiated instances of abuse or neglect (DuMont 2010). However, HFA does not appear to affect substantiated official reports of child abuse and neglect, potentially due to surveillance bias (Bartlett 2014*, DuMont 2010, Harding 2007*, Duggan 2007*).  

HFA has been shown to improve child well-being and safety (CEBC). 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-participants (Green 2014*, LeCroy 2011*). Breastfeeding rates appear higher (Harding 2007*) and alcohol use appears lower (LeCroy 2011*, Harding 2007*) 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 DC implementations of HFA (Harding 2007*).

HFA may improve children’s cognitive development in some circumstances (Harding 2007*). 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 participate (DuMont 2010). 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 sons (Kirkland 2012). 

Impact on Disparities

Likely to decrease disparities

Implementation Examples

There are nearly 400 affiliated HFA program sites in 40 States, DC, and the US territories (HFA).

Implementation Resources

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

Citations - Evidence

* Journal subscription may be required for access.

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.

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.

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.

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.

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.

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

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.

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.

Pew-Easterbrooks 2012 - Easterbrooks MA, Jacobs FH, Bartlett JD, Goldberg J, Contreras MM, Kotake C, & Chaudhuri JH. Initial findings from a randomized, controlled trial of Healthy Families Massachusetts: Early program impacts on young mothers' parenting. Washington, DC: Pew Charitable Trusts; 2012.

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.

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

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

Date Last Updated