Protecting the Health & Well-Being of Our Nation's Children: An Eval of Healthy Families America

By: Mitchell A. Kaplan, Ph.D., CPSP, & Marian M. Inguanzo, MSW, ACSW

 There is a silent epidemic that is devastating and destroying the lives of our country’s most vulnerable citizens. The epidemic is known as child abuse and neglect, and it is having some catastrophic effects on the health and well-being of our nation’s children. Child abuse currently represents one of our nation’s fastest growing public health crises.

    Experts who have examined the many individual and social causes of this problem have described it as a multifaceted phenomenon that embodies physical, psychological, and sexual factors associated with the maltreatment and neglect of children. Epidemiological data collected from collaborative national surveys conducted by the U.S. Centers for Disease Control and Prevention and the Federal Administration for Children and Families indicate that there are an estimated three million cases of abuse and neglect of children reported in the United States each year. Social scientists who have studied the problems associated with this important public health issue conjecture that the actual number of incidents of child abuse and neglect in our nation reaches far beyond the boundaries of what is currently reported to federal and state child welfare agencies. National mortality statistics reveal that 1,500 children die each year in the United States as a result of child abuse and neglect, and 79% of these fatalities occur among children under the age of four.

    Findings from a number of federally-funded studies reveal that the abuse and neglect of children occurs among individuals of every socioeconomic status, ethnic and cultural background, religious affiliation, and educational level. National crime statistics indicate that 90% of sexual assaults on children under the age of 12 are perpetrated by someone the child knows and trusts, like a family member or close friend.

    Clinicians in the fields of psychology, social work, and public health who have worked with abused children and their families argue that this type of physical and emotional trauma in one’s early life has serious long-term psychosocial consequences for the individual, the family, and society as a whole. Data from a number of clinical studies strongly suggest that early child abuse and neglect often leads to severe forms of antisocial self-destructive behaviors in later adult life. Data from national and state funded surveys conducted by child welfare agencies across the country over the last two decades found that:

• 80% of young adults with a history of child abuse entering mental health treatment facilities were diagnosed as suffering from one or more psychiatric disorders such as depression, anxiety, eating disorders, and post traumatic stress disorders;
• children who were victims of child abuse and neglect were 25% more likely to experience teen pregnancy compared to their peers who did not suffer such trauma in their early lives;
• children who experience early child abuse and neglect were 59% more likely to be arrested as juveniles, 28% more likely to be arrested as adults, and 30% more likely to commit violent crimes compared to their peers who were not abused;
• 37% of the women and 14% of the men currently incarcerated in U.S. prisons have a history of child abuse and neglect at some time during their early childhood; and
• there is a strong connection between child abuse and neglect and the abuse of illicit drugs and alcohol in adult life.

    Studies show that adults who experience abuse and neglect during their early childhood are two and half times more likely to engage in the abuse of alcohol and four times more likely to engage in the abuse of illicit drugs compared to their peers in the general U.S. population. The data further suggest that two thirds of the adults who are currently being treated for drug or alcohol addiction in recovery programs in the U.S. have a previous history of abuse and neglect as children (United States Centers for Disease Control and Prevention and the Federal Administration for Children and Families CDC publication onliine).

    Analysis of the data discussed above has led many policy makers to argue that the key to the development and implementation of effective child abuse prevention programs lies in the establishment of a comprehensive multifaceted three-pronged strategic approach that emphasizes:

• the creation of targeted public awareness campaigns that educate communities at risk about the extent of the problem,
• fosters the development of positive parenting behaviors and attitudes, and
• provides instructional guidance so that new parents can learn the skills they will need to develop positive parenting methods that lead to the establishment of a safe nurturing home environment where every child has the opportunity to get a healthy start in life.

Overview of Healthy Families America

    Public concern about the abuse and neglect of children in our nation has been at the forefront of the political agenda of legislators at the federal and state levels for many years. Whereas several key national and local initiatives have been proposed by lawmakers over the past two decades to remedy the problems associated with this growing national issue, no single approach or program has been shown to be sufficiently effective at preventing the behaviors that are a major cause of child abuse.

    Lawmakers fervently acknowledged that a comprehensive program needed to be developed that could adequately address the key issues associated with this evolving national concern. In 1991, the United States Advisory Board on Child Abuse and Neglect proposed the implementation of a new national child abuse prevention initiative, which soon became known as Healthy Families America. The program was launched in 1992 under the auspices of the National Committee to Prevent Child Abuse, in partnership with Ronald McDonald House Charities and the Freddie Mac Foundation.

    The initial concept for the Healthy Families America strategic intervention program was based on the outcome results of several large scale evaluation studies of federally funded child abuse preventive service programs conducted by Daro and Cohn in the 1970s and 1980s. The studies compared the efficacy and cost effectiveness of a number of different types of service interventions designed to prevent child abuse and neglect among high risk client populations. One study compared clients receiving basic child abuse prevention services with those receiving enhanced home visitation and other supportive services. Outcome results indicated that the behaviors that lead to child abuse and neglect showed a significant statistical reduction among those clients receiving enhanced preventive and supportive services, such as home visits and group therapy, compared to those who received basic services alone (Cohn & Daro, 1988). Similar results were obtained from controlled studies conducted by Lutzker and Rice (1984, 1987), Olds, Chamberlin, and Tadebaum (1986), and Seitz, Rosenbaum, and Apfel (1985). Data from follow-up studies documented substantial improvements in parenting behaviors and family life among clients who received enhanced child abuse prevention services compared to those clients who did not receive such intensive intervention.

    Healthy Families America was modeled after a pilot program that was originally started in Hawaii in the mid 1980s called Hawaii Healthy Start, a voluntary initiative that offered home visits by paraprofessionals to new parents identified as being at high risk for child abuse. The program has grown steadily across the nation since its inception in 1992. Healthy Families America home visitor programs currently exist in 440 communities across 36 states in the United States and in several of the Canadian provinces.

    The primary goal of the national program is to assist expectant and new mothers to give their children a healthy start in life through the promotion of positive parenting skills that will enhance a child’s development and sense of well being and prevent behaviors that contribute to child abuse and neglect. Healthy Families America strongly believes that, for the program to be effective in preventing behaviors that lead to child abuse, services need to be implemented on a case-by-case basis in accordance with the specific needs of individual families. The program encourages service professionals to assist families at risk to develop and maintain strong supportive ties with the health care system. Preventive services are provided in an atmosphere that fosters bonds of friendship, trust, and social support among program participants, service professionals, and community health care and child welfare agencies.

    One of the key components that make the Healthy Families America program so successful is early intervention. Supportive services begin at the time of the child’s birth and continue for a specified time period lasting between three and five years. Every new parent that becomes a participant in a Healthy Families America program has access to some intervention services based on his or her level of need. Level of need for service intervention is determined by caseworkers who utilize a standardized assessment tool to systematically identify families at risk for behaviors that can lead to the onset of child abuse.

    Healthy Families America provides overburdened parents with supportive services that can assist them in coping with everyday stressful situations that often accompany the process of becoming a parent for the first time. Professional family support caseworkers utilize positive community outreach strategies to build the trust of participating families in both the caseworker and the program. Family participation in the program is on a strictly voluntary basis.

    All comprehensive preventive services provided to families at risk participating in Healthy Families America programs across the nation are culturally sensitive and support the establishment of healthy parent-child interactions that lead to positive physical and emotional growth and development among children. In addition to providing direct supportive services to high risk families, Healthy Families America  family support caseworkers also provide their clients with referral links to other community based organizations and service professionals who can offer them additional healthcare and social services that can help these clients to give their child a healthy start in life. These services include financial assistance, food and housing assistance, child care and school readiness programs, job training programs, substance abuse treatment programs, domestic violence shelters, and medical care services from community physicians.

    Research has shown that in the communities where Healthy Families America programs have been implemented, 90% of families that were invited to participate accepted the supportive services that were offered to them.

Healthy Families America—What do the results of evaluations tell us about the success of the program?

    Since their inception in the early 1990s, Healthy Families America programs have been the subject of 30 nationwide evaluations designed to determine the efficacy of the supportive services offered in preventing child abuse. Evaluators have utilized a number of different applied research methodologies to conduct these evaluations. These methodologies have included randomized experiments, quasi experimental designs with comparison groups, and single group pre-test and post-test designs. Two of the most comprehensive national evaluations were conducted on the Hawaii Healthy Start and Healthy Families New York programs, which used randomized designs to study program effectiveness. In both the Hawaii Healthy Start and the Healthy Families New York studies, participating clients and their families were randomly assigned to either a treatment group or a control group and were evaluated for behavioral changes at specific time periods over the course of the service implementation process.

    Results indicated that Healthy Families America produces significant measurable benefits for participants in the areas of parent child interaction and parental capacity. The data revealed that clients who utilized the services of Healthy Families America programs (a) were better able to care for their children in positive ways, (b) had greater access to and were more able to use healthcare services effectively, (c) were able to significantly reduce behaviors that contribute to child abuse and neglect, and (d) were better equipped to resolve personal and family problems in constructive ways without resorting to behaviors that foster the abuse and neglect of children that is so often seen in low income single parent households. Overall summaries of the data from evaluations of the HHSP and HFNY, as well as other similar programs, clearly indicate that a well implemented Healthy Families America program of supportive services can achieve significant positive outcomes in terms of the reduction and prevention of child abuse and neglect for those high risk families who choose to take advantage of these kinds of protective services.

References

Cohn, A., & Daro, D. (1988). Is treatment too late: what ten years of evaluative research tell us. Child Abuse and Neglect. 11 (3), 433-442.

Lutzker, J., & Rice, J. (1984). Project 12-Ways: Measuring outcome of a large in-home service for treatment and prevention of child abuse and neglect. Child Abuse and Neglect. 8, 519-524.

Lutzker, J., & Rice, J. (1987). Using recidivism data to evaluate Project 12-Ways: An ecobehavioral approach to the treatment and prevention of child abuse and neglect. Journal of Family Violence, 2 (4), 283-290.

Olds, D., Chamberlin, R., & Tadebaum, R. (1986). Preventing child abuse and neglect: a randomized trial of nurse home visitation. Pediatrics, 78, 65-78.

Seitz, V., Rosenbaum, L., & Apfel, N. (1985). Effects of family support intervention: A ten-year follow-up. Child Development, 56, 376-391.

Additional Resources

Becker-Weidman, A. (2000). National Institute on Drug Abuse Study on Child Abuse and Neglect.

Centers for Disease Control and Prevention and the Federal Administration for Children and Families. CDC publication. Retrieved online at http://www.cdc.gov/mmwr.

Daro, D., & Harding, K. (1999). Healthy Families America: Using research to enhance practice. The Future of Children Home Visiting: Recent Program Evaluations 9 (1):152–176.

Donnelly, A. C. (1992, March/April), Healthy Families America: Child abuse must be prevented. Children Today, 21 (2).

Duggan, A. K., McFarlane, E. C., Windham, A. M., Rohde, C. A., Salkever, D. S., Fuddy, L., Rosenberg, L. A., Buchbinder, S. B., & Sia, C. J. (1999). Evaluation of Hawaii’s Healthy Start Program. The Future of Children Home Visiting: Recent Program Evaluations 9 (1), 66–90.

Mitchell–Herzfeld, S., Izzo, C., Greene, R., Lee, E., & Lowenfels, A. (2005). Evaluation of Healthy Families New York (HFNY): 1st year program impacts. Rensselaer, N.Y.: New York State Office of Children and Family Services, Bureau of Evaluation and Research. Albany, N.Y.: Center for Human Services Research, University at Albany. Retrieved online at http://www.ocfs.state.ny.us/main/prevention/assets/HFNY_FirstYearProgramImpacts.pdf/

Prevent Child Abuse in America: Current Trends in Child Abuse Reporting and Fatalities—The results of the 2000 Fifty State Survey.

National Clearinghouse on Child Abuse and Neglect. (2005). Long term consequences of child abuse and neglect.

Mitchell A Kaplan, Ph.D., is a program evaluation and grant writing consultant in private practice. He received his Ph.D. in sociology from the City University of New York Graduate School and University Center in 1987 and was the recipient of a three-year Postdoctoral Research Training Fellowship from the National Institute on Drug Abuse. For the past 22 years, he has directed federally funded research projects for nonprofit social service and healthcare agencies in New York City. He can be contacted at DrMKaplan@aol.com. Marian Inguanzo, MSW, is an international consultant specializing in program development, community organization, and social advocacy. She has worked in professional social work for more than 15 years, providing mental health, case management, and program development services to nonprofit social service agencies in the New York City area serving special needs populations with chemical dependence, domestic violence, criminal justice, HIV/AIDS, and aging issues. She can be reached at Marianinguanzo8@aol.com