Healthy Families America effectiveness: a comprehensive review of outcomes

This paper reviews 33 evaluations of Healthy Families America sites, with emphasis on 15 studies that include a control or comparison group. Outcome domains include child health and development, maternal life course, parenting, and child maltreatment. Parenting outcomes (e.g., parenting attitudes) show the most consistent positive impacts. Mixed results in other domains indicate the need for in-depth research to identify factors associated with better outcomes. Several factors that may contribute to differences in outcomes are discussed, including site implementation and quality, differences in family risk levels, and recent augmentations to program design. The paper also highlights two large-scale evaluations, one community-wide (Hampton, Virginia) and one statewide (Indiana), to illustrate exemplary evaluation approaches found in HFA research. Overall, HFA's continuing evolution has been positively impacted by researcher-practitioner partnerships.     

Introduction: the challenge of integrating research into practice

The Introduction to this volume on the ways Healthy Families America (HFA) integrates research, theory, and practice describes nine articles that offer a contemporary snapshot of HFA research and practice, including four empirical articles presenting research and practice at the state, multi-state, or national level and the most comprehensive summary of HFA outcomes. It contrasts the history of child abuse prevention with progress in the fields of substance abuse and violence prevention. It presents arguments underscoring the critical importance of the researcher-practitioner relationship and the need for an iterative model of action research. It examines implementation and action research challenges, illustrates lessons learned, and recommends ways to strengthen HFA and guide the next phase of child abuse prevention.     

Development and implementation of a quality assurance infrastructure in a multisite home visitation program in Ohio and Kentucky

As home visitation programs go to scale, numerous challenges are faced in implementation and quality assurance. This article describes the origins and implementation of Every Child Succeeds, a multisite home visitation program in southwestern Ohio and Northern Kentucky. In order to optimize quality assurance and generate new learning for the field, a Web-based system (eECS) was designed to systematically collect and use data. Continuous quality assurance procedures derived from business and industry have been established. Findings from data collection have documented outcomes, and have identified clinical needs that potentially undermine the impact of home visitation. An augmented module approach has been used to address these needs, and a program to treat maternal depression is described as an example of this approach. Challenges encountered are also discussed.     

The evaluation of Healthy Families Arizona: a multisite home visitation program

Healthy Families Arizona is a broadly implemented home visitation program aimed at preventing child abuse and neglect, improving child health and development, and promoting positive parent/child interaction. The program began as a pilot in two sites in 1991 and by 2004 had grown to 48 sites located in urban, rural, and tribal regions of the state. The unique administrative structure of the program and collaboration between evaluation and quality assurance have helped overcome many of the problems familiar to home visitation programs. This paper describes how a systematic focus to improve processes and outcomes has positioned the program for a randomized longitudinal study. Key components of the program are described and evaluation results are presented.     

The promise of primary prevention home visiting programs: a review of potential outcomes

Home visitation (HV) is a promising service delivery model, despite a history of mixed documented results. Compiling results on the promising family and child development outcomes in the HV literature has utility for current programs and those under development. We review traditional outcomes (e.g., child maltreatment prevention) from the literature on HV, but we also present nontraditional outcomes (e.g., community connection) that may be relevant for future evaluations. Programs that document their implementation and study their outcomes through a thoughtful, planned process may capture important and much needed information on strengthening families through HV.     

I’m From the Government and I’m Here to Help: How Can Public Health Perspectives Improve Outreach in Child Maltreatment Prevention Programs?

State and local governments are designing programs to prevent child maltreatment at an increasing rate. A relatively small portion of families offered these programs go on to engage in and complete services. Workers in a child maltreatment prevention program implemented across 21 sites in 1 state documented outreach efforts in logs maintained by program evaluators. Additionally, evaluators interviewed 23 outreach workers and supervisors who were developing and refining outreach strategies in this prevention program. Data from logs and responses to interviews speak to challenges in navigating prevention outreach with families to achieve engagement and buy-in, particularly when “cold-calling” about screened-out reports of child maltreatment. This paper presents a summary of barriers and facilitators of family engagement in outreach for prevention services, guidance from the public health literature on improving outreach strategies for at-risk populations, and suggested practice, policy, and research implications.     

Healthy Families America state systems development: an emerging practice to ensure program growth and sustainability

In an era of fiscal constraints and increased accountability for social service programs, having a centralized and efficient infrastructure is critical. A well-functioning infrastructure helps a state reduce duplication of services, creates economies of scale, coordinates resources, supports high-quality site development and promotes the self-sufficiency and growth of community-based programs. Throughout the Healthy Families America home visitation network, both program growth and contraction have been managed by in-state collaborations, referred to as "state systems." This article explores the research base that supports the rationale for implementing state systems, describes the evolution of state systems for Healthy Families America, and discusses the benefits, challenges and lessons learned of utilizing a systems approach.     

The Prenatal/Early Infancy Project

Summary

We describe a program of pregnancy and infancy nurse home visitation for families at social risk because of the mother's young age, single-parent status, or poverty. The program sought to prevent a number of maternal and child health problems that emerge early in the life cycle and that might be prevented with improvements in prenatal health habits, care of the child, and the psychosocial context of the family. The nurses carried out three major activities: (1) parent education regarding influences on fetal and infant development and regarding the mother's own education, employment, and family planning; (2) the involvement of family members and friends in the pregnancy, birth, and early care of the child; and (3) the linkage of family members with other health and human services. The nurses emphasized the importance of establishing a caring and supportive relationship with the mother and her family, building upon parents' strengths, promoting parental control over their life circumstances, and adapting the educational content of the program to the individual needs of the family.     

美国人力资源战略的实施策略及对我国的启示

美国人力资源战略的成功实施使其在世界人才竞争中一直保持竞争优势,这与其选择合理的实施策略是分不开的。本文通过梳理美国国家层面人力资源战略的相关政策和措施,归纳了美国实施人力资源战略的主要策略选择,提出对我国实施人力资源战略实施的一些启示。     

Parental attitudes following exposure to child abuse prevention campaign materials: a randomized trial

The purpose of this study was to evaluate child abuse prevention campaign materials. Using a randomized posttest design, 600 parents from an online research panel were recruited and surveyed. Multiple regression results indicate that exposure to the campaign materials had a significant relationship with four of the five domains (effects of child maltreatment, the appropriateness of harsh parenting, the physical dangers and needs unique to childhood, and the power to prevent child maltreatment). These results have implications for the child abuse prevention practitioners who seek to design and distribute effective campaign materials.     

Police Charging Decisions in Child Maltreatment Investigations: Findings from the 2008 Ontario Incidence Study of Reported Child Abuse and Neglect

The objective of this study was to use logistic regression and examine factors that influence charging decisions by the police during child maltreatment investigations. An estimated 4,808 substantiated child maltreatment investigations that involved police were obtained from the 2008 Ontario Incidence Study of Reported Child Abuse and Neglect. Of the 4,808 cases examined, police laid charges in about one-third of the cases. Controlling for all other factors, police were 1.6 times more likely to lay charges in physical abuse cases and 2.5 times more likely to lay charges in sexual abuse cases. Other factors associated with police charging decisions include: older victim, cases with multiple types of maltreatment, cases opened for ongoing services, and cases of the child living in a house known to have drugs or household hazards. The article discusses the results and their implications for child welfare policy and practice.     

Predictive Risk Modelling to Prevent Child Maltreatment: Insights and Implications from Aotearoa/New Zealand

Predictive risk modeling to identify children at risk of maltreatment has attracted considerable interest internationally. Using the example of the development of the predictive risk model in Aotearoa/New Zealand, the potential of such approaches to provide new insights into the causes of child maltreatment is explored with reference to what were identified as the main predictors of child maltreatment. The implications of these main predictors are considered both for the reform of child protection services and the future use and development of predictive risk modeling.     

A Statewide Study of the Public's Knowledge of Child Abuse Reporting Laws

This study conducted telephone interviews with a random sample of adults (N = 509) in a state with a universal child abuse reporting law. A substantial proportion of the interviewees (39%) were not aware of this law. Findings indicated that the public's understanding was mixed. Most respondents knew that reports could be made anonymously and that their identity could be kept private. However, most believed that children are automatically removed from the home if there is maltreatment and more than 50% were not aware they could be charged with a misdemeanor for failing to report a suspicion of child abuse. The respondents who had ever made a report (19%), had a greater knowledge of the laws than those who had not made a report. Older adults and those with less education had the least accurate perception of child abuse reporting policies. When asked about barriers to reporting, respondents cited worries that reporting would not help the child. Findings suggest that efforts to increase the public's comfort with reporting may require strategies to increase their confidence that the benefits will outweigh the risks for the child.     

Assessing the Relationship Between a Peer-Mentoring Program and Case Outcomes in Dependency Court

Building successful family-centered programs to support families whose children have been removed can be especially challenging to child welfare agencies. Peer-mentoring programs match families new to the dependency system with a mentor who has successfully reunified with their children. The current study examines the relationship between a peer-mentoring program, Parent for Parent (P4P), engagement levels of parents, and case outcomes for these families. Findings revealed that participants in the peer-mentoring program experienced increased engagement levels and improved outcomes for their cases. Specifically, mothers and fathers who participated in P4P increased their compliance with case plans and visitation, as well as increased presence at court hearings. Reunification rates increased for all families who participated in the peer-mentoring program, compared to those who did not. Few associations were found between racial and ethnic groups and program participation. The implications of these findings and suggestions for future research are discussed.     

Building the Evidence Base for Intensive Family Preservation Services

This article examines the state of intensive family preservation services (IFPS) research. Using studies of IFPS in five states, this article seeks to establish whether IFPS can be regarded as an evidence-based practice, an increasingly important standard for publicly funded services. While reporting rates of repeat child maltreatment, the analysis uses placement rates as the main outcome measure and compares effect sizes using Cohen's arcsine transformation for data reported as proportions. Significant differences in rates of child out-of-home placement and repeat maltreatment were found in some studies, particularly for higher risk families. The findings also underscore the difficulty of identifying which families to serve (targeting), ensuring treatment fidelity, and employing rigorous and appropriate evaluation methods. Overall, additional research is needed to move IFPS from a promising practice to an evidence-based practice.     

在经济复苏中推进循环经济发展——基于实施家电以旧换新政策的分析

家电以旧换新政策具有经济与环保的双重效应,其政策实施方案是促进经济复苏举措中有利于中国循环经济发展的典型代表,应从推进家电产业发展循环经济的高度,在生产者环保责任、行业规划与支持政策、信息管理、环保法规宣传与执行等方面做出进一步努力。     

“I could not have made it without them”: Examining Trainee Cohort Perspectives on MSW Education for Public Child Welfare

This article reports findings from an evaluation of an MSW child welfare training program focused on increasing retention of knowledgeable, competent and experienced child protective service workers. From qualitative data gathered as part of the process evaluation, we found the cohort effect to be the most salient factor participants experienced as contributing to their successful program completion and their 100% retention rate. Analysis of the cohort effect yielded five themes instrumental in participants' individual and collective success: mutual support, empowerment, belief in self and their finding of a home base which ultimately helped them to launch their professional selves.     

Stopping the Cycle of Child Abuse and Neglect: A Call to Action to Focus on Pregnant and Parenting Youth in and Aging Out of the Foster Care System

Each year, a significant number of adolescents become pregnant in the United States, with more than half of these pregnancies resulting in live births. Adolescent parenting is associated with poor outcomes, including increased risk of child maltreatment. Youth “aging out” of the foster care system may be at greater risk of maltreating their children due to their experiences of child maltreatment, a lack of social support, and little preparation for parenthood. This article examines current programs and policies targeting pregnant and parenting youth aging out and presents a research agenda that focuses on pregnancy prevention and positive parenting.     

Healthy Families America Research Practice Network: a unique partnership to integrate prevention science and practice

The goal of the Healthy Families America Research to Practice Network (RPN) was to foster communication among academic researchers, community-based evaluators, and practitioners to integrate science-based prevention practices into practice settings. The RPN goals were guided by and are a response to the limitations of past and current research paradigms in the social sciences. Accomplishments included creation of a 40-member researcher-practitioner council, development of a national Program Information Management System, and completion of a 4-year national Implementation Study, employing data from over 100 sites in nine states. The discussion examines what was learned about this rare experiment in creating practitioner-scientist partnerships and the impact of the RPN on child abuse and neglect prevention. A five-year plan to sustain and strengthen a practice-research collaborative is recommended.