U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention 

June 2001 #23

Canada. Although Healthy Families America sites are administered through a variety of organizational structures, in many

States, local and statewide networks have emerged as the most

efficient infrastructure to support the growing number of sites.

Statewide systems facilitate communication among individual

Healthy Families America sites, provide training and supervision

for home visitors and other workers, establish quality assurance

mechanisms, and secure ongoing funding.

Critical Elements

All Healthy Families America sites must adhere to a set of critical

program elements based on current knowledge (suggested by

repeated evaluations of early intervention programs for new parents) about what constitutes a successful home visitation program.

These elements provide each site flexibility to adapt its program

design to local needs and conditions and innovate where possible.

Healthy Family America’s credentialing process uses the elements

to measure and improve the quality of services each site offers.

The critical elements include:

Initiating services prenatally or at birth

◆ The sites use a standardized assessment tool to systematically

identify families who most need services. The tool assesses

risk factors (such as social isolation, substance abuse, parental

history of abuse in childhood) associated with increased risk of

child maltreatment or other poor outcomes for children.

◆ Families voluntarily participate in the program. Caseworkers

use positive outreach efforts to build family trust in the caseworker and the program.

Providing services

◆ Home visitors offer participating families long-term services (usually 3 to 5 years), beginning intensively (at least one

visit per week), and use well-defined criteria for determining whether the intensity of service should be increased or

decreased.

Healthy Families America

by Nels Ericson

An estimated 3 million cases of suspected child abuse and neglect are reported to State and local Child Protective Service

(CPS) agencies every year, and more than 1 million of those

reports are confirmed. Recent data show that three or four children die every day from abuse and neglect in the United States,

but more than half of those fatalities do not show up on CPS

agency records.

Research has shown that child abuse victims are more likely to

underachieve in school and become involved in juvenile delinquency, substance abuse, and adult criminality. According to a

report released by the Carnegie Corporation of New York, “the

earliest years of a child’s life are society’s most neglected . . . yet

new evidence confirms that these years lay the foundation for all

that follows.”1

Meeting At-Risk Families’ Needs

In 1992, Prevent Child Abuse America, in partnership with

Ronald McDonald House Charities and with financial support

from the Freddie Mac Foundation, launched Healthy Families

America, a voluntary home visitation program designed to

improve the parenting skills of parents with newborns or small

children, encourage child health and development, and prevent

child abuse and neglect. Prevent Child Abuse America (formerly

the National Committee to Prevent Child Abuse) is the Nation’s

leading child abuse prevention organization. Healthy Families

America services include talking with parents to determine what

resources and services best meet their needs, providing information on how to care for a new baby, offering positive parenting

tips, and assisting new parents with stress management. More

than 90 percent of families offered Healthy Families America

services choose to participate in the program.

Today, Healthy Families America services are available in more

than 420 communities in 39 States, Washington, DC, and

June 2001 #23

1 Carnegie Corporation of New York. 1994. Starting Points: Meeting the Needs of

Our Youngest Children. New York, NY: Carnegie Corporation of New York.
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U.S. Department of Justice

Office of Justice Programs

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Washington, DC 20531

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Penalty for Private Use $300

◆ Services are culturally sensitive, and materials used reflect the

diversity of the population served.

◆ Comprehensive services support parents, parent-child interaction, and child development.

◆ Families are linked to a medical provider (for timely inoculations and well-child care) and, if needed, financial assistance,

food and housing assistance programs, school readiness programs, child care, job training programs, family support centers, substance abuse treatment programs, and domestic

violence shelters.

◆ Home visitors carry a light caseload so they have sufficient

time to spend with each family; the caseload varies from fewer

than 10 families to as many as 15 families.

Selecting and training home visitors

◆ Caseworkers are chosen based on their ability to establish

trusting relationships with participating families.

◆ All service providers receive basic training in cultural competency, substance abuse, child abuse reporting, domestic violence, drug-exposed infants, and available services in their

community.

◆ Service providers are trained so they understand the components of family assessment and home visitation.

Program Successes

Prevention programs such as Healthy Families America have been

shown to strengthen the parent-child relationship and improve

parents’ ability to meet the needs of their children. Healthy

Families America programs across the country have produced

the following results:

◆ Linking children to medical services. In Oregon, the 1997

statewide immunization rate for 2-year-olds was 73 percent,

while the immunization rate for children participating in the

Healthy Families America program was 97 percent. In Florida,

100 percent of 2-year-olds and 70 percent of 16- to 23-montholds in the Healthy Families America program were fully

immunized and current with well-baby checkups.

◆ Helping mothers seek prenatal care. In Oregon, 94 percent

of participating mothers sought early and comprehensive prenatal care for second pregnancies, compared with 61 percent

for their first pregnancies.

◆ Helping prevent child abuse. Some studies suggest that families enrolled in Healthy Families America are one-third to onehalf as likely to maltreat their children as comparable families

not enrolled in the program.

◆ Providing effective services to parents. In New Jersey, 98

percent of Healthy Families America participants were satisfied with the services they received, and 100 percent found

their home visitors to be supportive. In Virginia, 95 percent of

participants said the program improved their parenting.

Programs such as Healthy Families America that work with parents directly after their child’s birth stand the best chance of

reducing the risk of child abuse because most physical abuse and

neglect occur among children younger than 2, 44 percent of fatalities due to child maltreatment occur before the child’s first birthday, and the most critical brain development occurs during the

first few years of life. By focusing on a child’s early years, home

visitors help new parents provide children with experiences that

stimulate healthy brain development.

For Further Information

For more information on Healthy Families America and child

abuse prevention, contact Prevent Child Abuse America, 200

South Michigan Avenue, 17th Floor, Chicago, IL 60604–2404;

800–555–3748, 312–663–3520, 312–939–8962 (fax), www.

healthyfamiliesamerica.org, and www.preventchildabuse.org.

Nels Ericson is a Senior Writer/Editor with the Office of Juvenile Justice

and Delinquency Prevention.

The Office of Juvenile Justice and Delinquency Prevention is a component 

of the Office of Justice Programs, which also includes the Bureau of Justice

Assistance, the Bureau of Justice Statistics, the National Institute of Justice,

and the Office for Victims of Crime.

FS–200123