The Hawaii Healthy Start program (HSP) is a home visitation program designed to improve family functioning, prevent child abuse and promote child health development. It has two parts:
The home visiting portion of the program is a multi-level system:
Families are monitored for achievement of milestones in healthy functioning and are promoted to service levels with lower expected visit frequency as family functioning improves.
The Hawaii Healthy Start program is delivered to mothers and fathers, where possible, who are at risk of child abuse and neglect. Families are deemed eligible for home visiting if they demonstrate certain risk factors (e.g. substance abuse, mental health) and are not already involved with child protection services for the target child.
The program has only been evaluated in the USA (Duggan et al. 2004).
A randomised control trial was conducted with 541 people (320 people were in the intervention group and 221 people were in the control group). The trial was evaluated once per year for three years. On average, parents were 23 years old. One third of parents were Native Hawaiian/Pacific Islander, and another 28% were Asian/Filipino. Two thirds of families were below the poverty level.
The program has not been tested in Australia or with Aboriginal Australians.
Overall, the Hawaii Healthy Start program has mixed effects on client outcomes.
Mixed research evidence (with no adverse effects):
The program is a home visitation program. The frequency of visits depends on the level a family is assessed as:
Assessment: Prenatal care providers refer some families to the program for assessment, but most families are screened and assessed at hospital when their children are born. When a mother’s medical record suggests risk or provides too little information to make a judgment, HSP early identification staff conduct a semi-structured assessment interview with the mother to determine risk more precisely using Kempe’s Family Stress Checklist. The Family Stress Checklist focuses on 10 risk factors for child abuse, such as:
The program considers a family to be at risk and, therefore, eligible for home visiting, if either parent scores 25 or higher on the Family Stress Checklist and if the family is not already involved with child protective services for the target child.
Home visitors assist families with:
Home visitors establish a trusting relationship with parents, in part by helping parents address existing crises.
Home visitors are trained paraprofessionals working under professional supervision. Training covers topics ranging from child development and parent-child interaction to the dynamics of child abuse, crisis intervention, problem solving, and domestic violence.
Not reported
The implementation system has many parts: staff recruitment and training, policies and protocols to facilitate service delivery, and mechanisms to integrate home visiting with community services. If a home visitor has great difficulty meeting with the family, the program has the option of placing the family on Level X, which focuses on creative outreach to establish contact with the family and does not have an expected number of visits.
One RCT conducted in the USA, with 541 final participants (Duggan et al. 2004).
16 Feb 2023
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