Awarded Cooperative Agreement to Prevent Violence and Violence-Related Injury


This project is evaluating the effectiveness of an improved method of implementing Hawaii’s original Healthy Start Program (HSP)—a popular and prevailing paraprofessional model of home visitation to prevent child abuse and neglect in at-risk families of newborns.

20%–30% of children are born into families at risk for child neglect or abuse. If risk factors are not addressed, parenting and child outcomes will be adversely influenced. Parenting outcomes are defined as family functioning and parenting (e.g., risks for maltreatment, observational, or self-reported measures of maltreatment); child outcomes are defined as social development and behavior.

The HSP model, disseminated in 39 states, comprises population-based screening for at-risk families of newborns and assessment of home visits by trained paraprofessionals. The program links at-risk families to primary care and other services to reduce the risk of child maltreatment. Results from the first RCT motivated Hawaii to refine its HSP and implementation system to better integrate HSP services with pediatric primary care.

The project aims to:

  1. Develop and pilot test two modifications to the implementation system: performance criteria and fidelity measures. Building on activities now underway, this work will include a national survey of existing approaches, qualitative and quantitative studies of HSP knowledge and attitudes, HSP record review to measure current service quality, and consultation with experts to develop core competencies. Investigators will develop and pilot test methods to assess home visitor skills. They also will generate timely staff-member performance profiles for comparison with standards and norms.

  2. Conduct a quasi-experimental study to assess the impact of these modifications on the (a) delivery of home-visiting services, and on (b) family functioning, parenting, and child outcomes. This will involve random assignment of HSP sites to intervention and control groups; enrollment of a representative, population-based sample of 240 at-risk families of newborns; baseline measurement of risk and protective factors; and follow-up at 1 and 2 years to measure parenting and child outcomes.

The investigators hypothesize that (a) the enhanced implementation system improves actual delivery of home visiting services; (b) the enhanced implementation system improves HSP impact on family functioning and on parenting and child outcomes; and (c) HSP impact on family functioning and parenting mediate its impact on child outcomes.