Program

Healthy Families New York (HFNY)

OVERVIEW

Healthy Families New York (HFNY) is a home
visitation program for mothers who are at risk for developing abusive or
neglectful behaviors towards their children. The goals of HFNY are to promote
positive parenting, prevent child abuse and/or neglect, support prenatal care
and child health and development, and improve parental self-sufficiency. An
experimental evaluation of HFNY found that the program was effective in reducing
the amount of child abuse and neglect in the experimental group. Also, among
parents in “prevention” and “psychologically vulnerable” subgroups, those
parents in the experimental condition were less likely to report severe abuse
and/or neglect than mothers in the control group. A second evaluation found that
the program reduced the prevalence of low birth weight among participants’
children.

DESCRIPTION OF PROGRAM

Target population:
Pregnant women or mothers with newborns
younger than 3 months who are at risk for engaging in child abuse and neglect

Healthy Families
New York was developed as a prevention effort against child abuse and neglect.
The program is geared specifically towards young, first-time mothers who join
the program before the birth of their children. The program is centered on home
visitation services from trained paraprofessionals and home visitors from the
community who help promote positive parenting, prevent child abuse or neglect,
support prenatal care and child health and development, and improve parent
self-sufficiency. Parents who are evaluated as being potentially eligible for
the program are given a brief screening to determine final eligibility for the
program. Once eligibility is determined, the women in the program receive home
visits every other week during the mother’s pregnancy. Once the child is born,
visits are conducted weekly until the newborn is six months old. Then, the
visitation schedule is slowly decreased until the child enrolls in a school
program, Head Start, or reaches the age of 5 years. The home visits are
designed to improve the parent-child relationship, teach about child
development, encourage optimal growth, address family problems, and develop
individual family plans for self-sufficiency and functioning. Visits are
individually suited to the child and use varied curricula selected by staff
(example curricula used include “Partners for a Healthy Baby” and “Parents
as Teachers
“). Children are also screened using instruments that measure
developmental progress and referrals to other programs are available and
recommended to parents as needed. The cost per family of the HFNY program
ranged from $3000-3500 per year.

EVALUATION(S) OF PROGRAM

Study 1

Mitchell-Herzfeld, S. D., Izzo, C., Greene, R., Lee, E., & Lowenfels, A. A.
(2005). Evaluation of Healthy Families New York (HFNY): First year program
impacts
. Rensselaer, New York: New York State Office of Children & Family
Services.

Evaluated
Population: 
Women from three sites (N=1,173) who were determined eligible
for participation in the program based on scores from a screener, the Family
Stress Checklist, were evaluated.To be eligible, women had to score
above 25 points which defined those who were at risk of engaging in child abuse
and neglect. Women were interviewed and determined eligible (N=1,254) through
screener interviews, and 1,173 of those women completed a baseline interview.
This study adopted an intent-to-treat (ITT) analysis whereby these 1,173 women
were included in final analyses even if they dropped out of the program.
Thirty-four percent of mothers in the study were white, 45 percent were
African-American, and 18 percent were Latina. Thirty-one percent of mothers
were under 19, 54 percent were first time mothers, 53 percent had never
completed high school, and 82 percent had never been married.

Approach:
Mothers were identified using an initial screening as being potential study
participants. A Family Assessment Worker (FAW) then visited the home of
potential participants and described the program and evaluation. After agreeing
to take part in the program, the FAW administered the Family Stress Checklist
(FSC) to determine if the woman was eligible to participate in the study. Those
deemed eligible (greater than 25 points on the FSC) were randomly assigned to
either an experimental condition (N=579), which received all of the HFNY
services, or a control condition (N=594), which received referrals to other
programs based on a needs assessment given at the beginning of the interview.

The variables
measured at baseline and year 1 include: parents’ demographic characteristics
and background, marital status and living arrangements, housing and
neighborhood, parenting attitudes and practices, childhood history of abuse and
neglect, prenatal care and birth outcomes, child’s and parents’ health and
health care, child’s safety, employment, dependence on government assistance,
financial hardship, parents’ education and training, domestic violence, parents’
mental health and coping, social support, parental use of substances, and family
planning.

Parenting practices
included a previous abuse/neglect composite of behaviors, including: hit with
fist, hit with object, threw/knocked down, shook, grabbed neck, beat up, burned,
threatened with gun, left child home alone, not able to make sure child got
necessary medical attention, and so drunk/high had problem taking care of child.

Results:

Parenting
Attitudes and Practices

For the entire
sample, there were no significant impacts on parenting attitudes regarding
physical punishment, inappropriate expectations, empathy, role reversal, or
power/independence. However, certain subgroups did have impacts in one category.
For physical punishment, mothers in the treatment group who were under age 18
and mothers who scored in the lowest 25 percent on the depression scale were
significantly less likely to be in favor of physical punishment than control
mothers in the same sub-groups (38 versus 37, and 39 versus 37, respectively).

Parent-reported
neglect was the only parenting practice that was significantly different between
the treatment and control group (5 versus 9 percent, respectively). The Latina
subgroup also had a significantly smaller percentage of parents who had
neglected their children (2 percent versus 13 percent). For minor physical
aggression, mothers in a situation with no domestic violence showed a
significantly smaller percentage of any aggressive behaviors than the control
group (37 percent versus 51 percent). No significant differences were found for
the other prevalence outcomes, including the previous abuse/neglect composite,
severe/very severe physical abuse, minor physical aggression, and CPS reports.

The same variables
were examined, with one additional, psychological aggression, to assess how
often the parenting practices took place,. HFNY parents had significantly fewer
instances in the previous abuse/neglect composite (0.2 versus 0.5), of minor
physical aggression (2.3 versus 3.3), and of psychological aggression (3.2
versus 4.9). The subgroups with significant impacts were 18 or older (0.2 versus
0.7) and no domestic violence (0.1 versus 0.9) for serious abuse/neglect
composite, Latinas (0 versus 1.2) for the neglect variable, no domestic violence
(1.8 versus 3.3) for the minor physical aggression variable, and highest 25
percent on depression scale (4.0 versus 9.3) and no domestic violence (3.1
versus 5.1) for psychological aggression.

Prenatal Care
and Birth Outcomes

For prenatal care
and birth outcomes, the only significant impact was for low birth weight. A
smaller percentage of HFNY group mothers randomized at least two months before
their birth compared with control group mothers in the same situation (3 versus
8 percent) had low birth weight babies. No significant impacts were found for
number of prenatal care visits in the third trimester, premature birth, or
receipt of neonatal intensive care.

Child Health
and Safety

For child health
and safety, there was one significant impact for the entire sample. HFNY group
children were more likely to have health insurance (94 versus 90 percent). Among
parents who had already had another child at intake, the HFNY group mothers were
more likely to have breast-fed the child selected for this study than control
group mothers (50 versus 40 percent). No significant impacts were found for
whether the mother had health insurance, whether the mother had a primary care
provider, child having primary care provider, child ever went without needed
medical care, number of child emergency room visits, whether the family received
WIC, number of well baby visits, whether all immunizations were complete, number
of months breast-fed, child safety checklist, or any emergency room visits
involving injury or ingestion.

Mother’s Life
Course Development

There were two
significant impacts for mothers’ life course development variables, one for the
entire sample and one for mothers under age 18. HFNY group mothers were less
likely to be employed at year 1 compared with control mothers (41 versus 48
percent). Smoking frequency was significant for mothers under age 18; HFNY group
mothers smoked fewer cigarettes per day than control group mothers (an average
of 1.8 versus 3.3). There were no significant impacts for: TANF receipt, receipt
of less than 50 percent of income from work, having education appropriate for
age, achieving more education in the past year, depression score, being above
the depression cutoff, having a sense of personal mastery, smoking status,
alcohol abuse score, scoring above the alcohol abuse cutoff, amount of drinking,
average number of drinks when drinking, having any drug use, consistently using
birth control, and having a pregnancy or childbirth after the birth of the
target child or within a year prior to the year 1 interview.

Study 2

DuMont, K.,
Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., & Rodriguez, M.
(2006). Healthy Families New York (HFNY) randomized trial: Impacts on parenting
after the first two years. Working Paper Series: Evaluating Healthy
Families, OCFS Working Paper #1.

Evaluated
population:
The evaluated population is the same sample as in Study 1.

Approach:
For randomization procedures, see Study 1. Baseline measures were taken two
weeks after the intake interview. Then, women were assessed again when their
child was born and on the child’s first and second birthdays.

Mothers were given
a self-report measure of abusive and neglectful parenting and data was taken
from the Office of Children and Family Services (OCFS), which keeps records of
child abuse and neglect. Mothers were paid $40 for participation at each of the
three waves of data collection.

For analysis, two
subgroups were designed to measure the program’s impacts on different
populations. The first subgroup, the “prevention subgroup”, consisted of 170
first-time mothers under the age of 19 years who had been assigned to the
evaluation at a gestational age of 30 weeks or less. The second subgroup
consisted of 122 mothers determined to be “psychologically vulnerable” based on
the presence of depressive symptoms and mastery, measured respectively by the
Center for Epidemiologic Studies – Depression scale and the Mastery of
Psychological Coping Resources Scale. These variables were combined into an
index of psychological vulnerability and women scoring in the top 10 percent
were categorized as psychologically vulnerable.

To measure
parenting behaviors, parents were given the Conflict-Tactics Scale
(Parent-Child) to determine how often in the past year mothers engaged in
abusive or neglectful behaviors. The researchers also included substantiated
reports from Child Protective Services (CPS) as a measure of child abuse and
neglect.

Results: At
the first birthday follow-up, mothers in the HFNY program reported fewer acts of
very serious physical abuse compared with mothers in the control group. Mothers
in the HFNY program also reported fewer cases of minor physical aggression,
psychological aggression, and harsh parenting behaviors compared with mothers in
the control group. At year 2, mothers in the HFNY program reported fewer cases
of serious physical abuse compared with mothers in the control condition. There
were no differences found between groups at any of the follow-up assessments
with respect to substantiated reports from CPS.

Within the
“prevention subgroup,” mothers in the HFNY program were less likely to report
minor physical aggression compared to their counterparts in the control
condition (51 compared with 70 percent). Likewise, “prevention subgroup”
mothers in HFNY were less likely to report harsh parenting behaviors than
“prevention subgroup” mothers in the control condition (41 versus 62 percent).

Within the
“psychologically vulnerable subgroup”, mothers in the experimental program
reported fewer acts of serious abuse or neglect at year one compared with their
counterparts in the control group (two versus nine incidents of abuse or
neglect). At year one follow up, “psychologically vulnerable” mothers reported
less psychological aggression and, at year two, fewer instances of serious abuse
and neglect than mothers in the control condition (0.02 versus 0.6 incidents).

Study 3

DuMont, K. A., Mitchell-Herzfeld, S. D., Greene, R., Lee, E., Lowenfels, A.
A., Rodriguez, M., et al. (2008). Healthy Families New York (HFNY) randomized
trial: Effects on early child abuse and neglect. Child Abuse & Neglect, 32,
295-315.

Evaluated
Population: 
The evaluated population is the same as in Study 1.

Approach:
See Study 1 for randomization procedures. Mothers reported 27 of their own
parenting behaviors in the past year and five in the past week in an interview.
The questions covering the past year fell under six categories: neglect,
psychological aggression, nonviolent discipline, minor physical aggression,
severe abuse, and very severe abuse. The five questions for the past week
covered harsh parenting. In addition, official data on substantiated reports of
abuse and neglect (CPS reports) came from the Office of Children and Family
Services (OCFS) database, called CONNECTIONS. The variables taken into account
when examining the associations between program assignment and child abuse and
neglect are the following: race, random assignment at gestational age 30 weeks
versus earlier, site of participation, history of substantiated abuse or
neglect, first-time mother versus not, mother’s age, whether the mother was born
in the U.S., welfare receipt in the past year, psychological vulnerability, and
a single item capturing the mother’s history of being abused as a child.

Results: The
HFNY treatment group did not differ significantly in prevalence from the control
group on any of the six categories or number of substantiated reports of abuse
and neglect based on official records. Based on maternal report at year 1,
however, the HFNY group mothers reported fewer incidents of very serious
physical abuse (0.01 versus 0.08 times), minor physical aggression (2.4 versus
3.5), psychological aggression (3.3 versus 4.7), and harsh parenting in the past
week (1.2 versus 1.8) compared with control group mothers. At year 2, the
frequency of serious physical abuse was significantly lower in the HFNY group
mothers than the control group mothers (0.01 versus 0.04).

The prevention
subgroup, first-time mothers under age 19 who were randomly assigned at
gestational age 30 weeks or less, were less likely to report minor physical
aggression against their children in the past year (51 versus 70 percent) or
harsh parenting behaviors in the past week (41 versus 62 percent) at year 2. No
significant impacts were found for the prevalence of any other self-report
parenting behaviors or the frequency of self-report parenting behaviors.

A second subgroup
is called psychologically vulnerable; these are mothers with a low sense of
mastery and high levels of depressive symptoms. One significant impact was found
at year 1 for self-reported parenting behaviors in frequency, and none for
prevalence. HFNY mothers reported a significantly lower number of acts of
psychological aggression compared with the control mothers (2 versus 8.6). At
year 2 HFNY group mothers were less likely to report serious abuse or neglect (5
versus 19 percent). The frequency of serious abuse and neglect behaviors at year
2 was similar, 0.02 for HFNY mothers and 0.6 for control mothers. No impacts
were found based on substantiated CPS reports.

Study 4

DuMont, K. A., Mitchell-Herzfeld, S. D., Kirkland, K., Rodriguez, M., Walden,
N., Greene, R., et al. (2008). Effects of Healthy Families New York on
maternal behaviors: Observational assessments of positive and negative parenting
.
Rensselaer, New York: New York State Office of Children and Family Services.

Evaluated
Population: 
The base sample for this evaluation comes from the same sample
in Study 1. However, this study had special selection criteria for this
observational study embedded within its year 3 follow-up. Mothers who had
completed year 2 interviews and who lived in a certain range of the interviewers
were eligible. Of the 643 eligible women, 522 agreed to participate. The race
makeup of the sample was 42 percent white, 39 percent black, and 16 percent
Hispanic. Twenty-nine percent were under 19, and 12 percent were at least 30.
Fifty-five percent of participants were first-time mothers. Twenty-one percent
of mothers had been involved with CPS prior to baseline and 8 percent had at
least one substantiated report. The children involved in the year 3 observations
were an average of three years old, and 66 percent were at least three.

Approach:
The 522 mothers were in treatment (N=255) and control (N=267) groups, and had
not been randomized a second time. Three interaction tasks were video recorded:
a puzzle problem-solving task, a delay of gratification task, and a cleanup
task. In each task, the mother was observed for variables related to positive
parenting and negative parenting (harsh parenting and role-reversed parenting).
Positive parenting consisted of stimulating and engaging the child’s cognitive
skills, being sensitive to the child’s needs, and creating a structured
environment in which the child can explore.

Results: A
higher percentage of HFNY group mothers used positive parenting techniques in
all three tasks compared with mothers in the control group. Impact on the puzzle
task (97 versus 93 percent), delay task (17 versus 11 percent), and cleanup task
(85 versus 78 percent) differences were statistically significant.

Impacts for
subgroups were also examined for positive parenting and for negative parenting.
No significant impacts on positive parenting were found for mothers in the
prevention subgroup (first-time mothers under age 19 randomly assigned at
gestational age 30 weeks or less).

No significant
impacts were found for negative parenting overall, but there were when looking
at the prevention subgroup of young first-time mothers for the puzzle task (5
versus 22 percent) and the delay task (5 versus 24 percent), with the HFNY
mothers in the prevention subgroup being less likely to use negative parenting
behaviors. In contrast, no significant impacts were found for the non-prevention
subgroup on negative parenting.

Study 5

Lee, E., Mitchell-Herzfeld, S. D., Lowenfels, A. A., Greene, R., Dorabawila,
V., & DuMont, K. A. (2009). Reducing low birth weight through home visitation: A
randomized controlled trial. American Journal of Preventive Medicine, 36(2),
154-160.

Evaluated
Population: 
From the sample in Study 1, 501 mothers who had a single birth
and were randomized prior to 30 weeks gestational age were evaluated. Sixty-six
percent of participants were black or Hispanic and 90 percent were unmarried.

Approach:
Participants were randomly assigned to receive bi-weekly home-visitation
services (treatment group, N=236) or to a control group (N=265) at 30 weeks or
less of gestation. Low birth weight (less than 2,500 grams) was the only
outcome examined in this paper. Other variables taken into account were smoking
during pregnancy, TANF enrollment (Temporary Assistance for Needy Families),
race, Hispanic origin, program site, marital status, and number of previous
pregnancies.

Results:
Births to mothers in the treatment group compared with the control group were
statistically significantly less likely to be under 2,500 grams (five percent
versus ten percent, respectively). The difference in low birth weight births in
the treatment group did not vary by gestational age at randomization; rather,
within all subgroups (randomized at 30 weeks or fewer, 24 weeks or fewer, or 16
weeks or fewer) the treatment group mothers had significantly fewer low birth
weight babies than the control group mothers.

In racial
subgroups, the black mothers in the treatment group were the only ones to be
significantly different from the control group. The difference between HFNY
mothers and control mothers were non-significant for Hispanics and whites.

SOURCES FOR MORE
INFORMATION

References

DuMont, K.,
Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., & Rodriguez, M.
(2006). Healthy Families New York (HFNY) randomized trial: Impacts on parenting
after the first two years. Working Paper Series: Evaluating Healthy
Families, OCFS Working Paper #1.

DuMont, K. A., Mitchell-Herzfeld, S. D., Greene, R., Lee, E., Lowenfels, A. A.,
Rodriguez, M., et al. (2008). Healthy Families New York (HFNY) randomized trial:
Effects on early child abuse and neglect. Child Abuse & Neglect, 32,
295-315.

DuMont, K. A., Mitchell-Herzfeld, S. D., Kirkland, K., Rodriguez, M., Walden,
N., Greene, R., et al. (2008). Effects of Healthy Families New York on
maternal behaviors: Observational assessments of positive and negative parenting
.
Rensselaer, New York: New York State Office of Children and Family Services.

Lee, E., Mitchell-Herzfeld, S. D., Lowenfels, A. A., Greene, R., Dorabawila, V.,
& DuMont, K. A. (2009). Reducing low birth weight through home visitation: A
randomized controlled trial. American Journal of Preventive Medicine, 36(2),
154-160.

Mitchell-Herzfeld, S. D., Izzo, C., Greene, R., Lee, E., & Lowenfels, A. A.
(2005). Evaluation of Healthy Families New York (HFNY): First year program
impacts
. Rensselaer, New York: New York State Office of Children & Family
Services.

Link to program
curriculum: 
http://healthyfamiliesnewyork.org/

KEYWORDS:
Adolescents; Youth; Young Adults; Infants; Toddlers; Children; High-Risk;
Adolescent Mothers; Female Only; White/Caucasian; Black/African American;
Hispanic/Latino; Home-based; Home Visitation; Clinic-based; Child Care; Early
Childhood Education; Case Management; Public Assistance; Parent-Child
Relationship; Child Maltreatment; Depression/Mood Disorders; Other Physical
Health; Manual is Available; Parent or Family Component; Tobacco Use; Illicit
Drug Use; Alcohol Use; Contraception; Births.

Program
information last updated on 11/9/11.

 


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