Journal Issue: Home Visiting: Recent Program Evaluations Volume 9 Number 1 Spring/Summer 1999
Child abuse is not a new phenomenon. Since the first parent-child dyad, adult caregivers have struggled with the demands presented by their children.1,2 In response, parents have drawn on their experiences with their own parents and extended family members, the support and advice of friends, and assistance from local services and related resources. During the past 30 years, prevention advocates from the family support, early childhood, and child abuse prevention movements have designed and implemented hundreds of interventions to resolve parents' lack of knowledge and skills, to create extended networks of formal support, and to alter normative and societal standards for child rearing and education. Together, they have created a plethora of programs that many believe have significantly improved conditions for children.3,4,5
Not all families, however, have access to these programs, and so not all children are being helped.6,7 Indeed, Healthy Families America (HFA), an initiative developed by the National Committee to Prevent Child Abuse (since renamed Prevent Child Abuse America) in 1992, grew out of the recognition that not enough services were available to all in need, that many of these efforts unfortunately changed their focus and intent in response to shifts in funding sources and staff interests, and that few communities had the full breadth and depth of services needed to achieve notable change in those families at highest risk.
In response, HFA planners designed an intensive home visitation program in partnership with colleagues at the Hawaii Family Stress Center8 and others engaged in designing comparable family support and early childhood interventions. From the outset, HFA's home visitation program was viewed as one component in a three-part strategy to achieve significant and lasting change in the rates of child maltreatment and other negative outcomes for children. Equally important were efforts to create (1) a program context in which all families would be better able to access the assistance they needed, and (2) a research context in which services would be refined on the basis of empirical evidence.
This article begins by briefly reviewing HFA's theory of change, its overall goals and objectives, and the structure of its intensive home visitation component. The article then reviews the design and status of the 35 evaluations currently under way or being planned at HFA programs across the country, highlighting the specific role the HFA Research Network has played in facilitating the development and cross-referencing of these efforts. This summary is followed by a more in-depth presentation of specific outcome findings emerging from 17 of these evaluations. The article concludes by discussing the findings' program and policy implications.