Healthy Families America (http://www.healthyfamiliesamerica.org) is a network of programs that grew out of the Hawaii Healthy Start program. Healthy Families America programs aim to reduce child maltreatment and promote positive parent-child relationships. At-risk families are identified and enrolled either during pregnancy or shortly after the birth of a child. The intervention involves home visits by trained paraprofessionals who provide information on parenting and child development, parenting classes, and case management. Participants typically receive weekly home visits in the first six months after a child’s birth and may continue to receive periodic home visits until the child is three years old. Among programs included in the meta-analysis, participants typically received 29–43 home visits over a period of about 16 months.

 

^{^}WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change over time. For those effect sizes, we estimate outcome-based adjustments, which we apply between the first time ES is estimated and the second time ES is estimated. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured	Treatment age	Primary or secondary participant	No. of effect sizes	Treatment N	Effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis						Unadjusted effect size (random effects model)
					First time ES is estimated			Second time ES is estimated
					ES	SE	Age	ES	SE	Age	ES	p-value
Substance use^ Nonspecified substance use (i.e., alcohol, cannabis, or illicit drugs) that does not rise to the level of "disordered."	22	Primary	1	373	0.021	0.163	25	n/a	n/a	n/a	0.021	0.895
Major depressive disorder Clinical diagnosis of major depression or symptoms measured on a validated scale.	22	Primary	4	1080	-0.057	0.051	25	-0.029	0.063	27	-0.057	0.269
Employment Any employment, including part-time work.	22	Primary	2	462	0.077	0.091	25	0.000	0.000	26	0.077	0.397
Public assistance Any form of welfare assistance, such as Temporary Assistance for Needy Families (TANF) or Assistance for Families with Dependent Children (AFDC).	22	Primary	3	2226	0.006	0.031	25	0.006	0.031	25	0.006	0.838
Problem alcohol use Alcohol use reflecting problem behaviors (e.g., high frequency drinking, binge drinking, or drinking that has a high impact on daily life) for individuals who do not have an alcohol use disorder.	22	Primary	1	373	-0.166	0.172	25	-0.166	0.172	35	-0.166	0.335
Food assistance Receipt of food assistance, such as from the Supplemental Nutrition Assistance Program (SNAP).	22	Primary	3	2226	0.033	0.031	25	0.033	0.031	25	0.033	0.286
Repeat birth^ A birth that occurs within two years of a prior birth for the same mother.	22	Primary	1	263	0.041	0.187	21	n/a	n/a	n/a	0.041	0.827
Emergency department visits Whether someone visited the emergency department, or the number of times they visited the emergency department.	22	Primary	1	263	0.006	0.146	25	0.000	0.000	26	0.006	0.967
K-12 grade repetition Repeating a grade. This is sometimes called "grade retention."	1	Secondary	1	452	-0.012	0.122	8	-0.012	0.122	8	-0.012	0.920
K-12 special education Placement into special education services.	1	Secondary	1	452	-0.216	0.116	8	-0.216	0.116	8	-0.216	0.062
Preschool test scores^ Measures of cognition in young children on standardized scales.	1	Secondary	2	321	0.145	0.085	3	n/a	n/a	n/a	0.145	0.089
Externalizing behavior symptoms Symptoms of externalizing behavior (e.g., aggressive, hostile, or disruptive behavior) measured on a validated scale.	1	Secondary	2	578	-0.081	0.115	6	-0.044	0.072	9	-0.081	0.482
Internalizing symptoms Symptoms of internalizing behavior (e.g., sadness, anxiety, or withdrawal) measured on a validated scale.	1	Secondary	2	720	-0.151	0.161	6	-0.151	0.161	8	-0.151	0.348
Child abuse and neglect Substantiated or founded reports to child protective services.	1	Secondary	9	5003	-0.026	0.060	3	-0.026	0.060	17	-0.026	0.663
Out-of-home placement The removal of a child from parental care, most often to foster care.	1	Secondary	2	2006	0.180	0.164	6	0.180	0.164	6	0.180	0.274
Emergency department visits Whether someone visited the emergency department, or the number of times they visited the emergency department.	1	Secondary	1	263	0.190	0.099	7	0.000	0.000	8	0.190	0.055
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Caldera, D., Burrell, L., Rodriguez, K., Crowne, S. S., Rohde, C., & Duggan, A. (2007). Impact of a statewide home visiting program on parenting and on child health and development. Child Abuse & Neglect, 31(8), 829-852.

Center on Child Abuse Prevention Research. (1996). Intensive home visitation: A randomized trial, follow-up and risk assessment study of Hawaii's Healthy Start program (Final Report). Chicago: Prevent Child Abuse America.

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Duggan, A., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crowne, S. S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31(8), 801-827.

DuMont, K., Kirkland, K., Mitchell-Herzfeld, S., Ehrhard-Dietzel, S., Rodriguez, M. L., Lee, E., . . . Greene, R. (2010). Final report: A randomized trial of Healthy Families New York (HFNY): Does home visiting prevent child maltreatment? Renssalaer, NY: New York State Office of Children and Family Services.

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Easterbrooks, A., Chaudhuri, J., & Fauth, R. (2017). The Massachusetts Healthy Families Evaluation phase 2: Early childhood (MHFE-2EC): Final report to Massachusetts Department of Public Health, Children's Trust of Massachusetts. Medford, MA: Tufts Interdisciplinary Evaluation Research (TIER), Eliot-Pearson Department of Child Study and Human Development, Department of Urban and Environmental Planning, Tufts University.

Galano, J., & Huntington, L. (1999). Year VI evaluation of the Hampton, Virginia Healthy Families Partnership: 1992-1998. Hampton, VA: Virginia Healthy Families Partnership.

Green, B.L., Sanders, M.B., & Tarte, J. (2017). Using administrative data to evaluate the effectiveness of the Healthy Families Oregon home visiting program: 2-year impacts on child maltreatment & service utilization. Children and Youth Services Review, 75, 77-86.

Landsverk, J., Carrilio, T., Connelly, C.D., Ganger, W.C., Slymen, D.J., Newton, R.R., . . . Jones, C. (2002). Healthy Families San Diego clinical trial: Technical report. San Diego, CA: The Stuart Foundation.

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