Hawaii's Healthy Start Program of Home Visiting for At-Risk Families: Evaluation of Family Identification, Family Engagement, and Service Delivery

TLDR

Performance varied by program site, and engaging and retaining at‑risk families in home visiting remains challenging, underscoring the need for integrated service monitoring. The study aims to describe family identification, engagement, and service delivery in Hawaii’s Healthy Start Program for at‑risk newborn families. The statewide program combines population‑based screening and assessment to identify at‑risk families, followed by paraprofessional home visits, with cross‑sectional and longitudinal studies evaluating early identification processes and participation characteristics, and early identification staff determined risk status for 84 % of target families. Enrollment was higher among families with higher risk scores, young mothers with limited schooling, and infants at biologic risk; half of enrolled families remained active at one year with an average of 22 visits, and over 80 % of those active received core services, though engagement varied by site and was influenced by parental risk factors.

Abstract

To describe family identification, family engagement, and service delivery in a statewide home visiting program for at-risk families of newborns.Six target communities of Hawaii's Healthy Start Program (HSP), which incorporates 1) early identification of at-risk families of newborns via population-based screening and assessment, and 2) paraprofessional home visiting to improve family functioning, promote child health and development, and prevent child maltreatment.Cross-sectional study: describes early identification process and family characteristics associated with initial enrollment. Longitudinal study: describes home visiting process and characteristics associated with continued participation.Cross-sectional study: civilian births in 6 communities (n = 6553). Longitudinal study: at-risk families in the intervention group of a randomized trial of the HSP (n = 373).completeness and timeliness of early identification and home visiting activities; family characteristics: sociodemographics, child abuse risk factors, infant biologic risk.Early identification staff determined risk status for 84% of target families. Families with higher risk scores, young mothers with limited schooling, and families with infants at biologic risk were more likely to enroll in home visiting. Half of those who enrolled were active at 1 year with an average of 22 visits. Families where the father had multiple risk factors and where the mother was substance abusing were more likely to have >/=12 visits; mothers who were unilaterally violent toward the father were less likely. Most families were linked with a medical home; linkage rates for other community resources varied widely by type of service. Half of families overall, but >/=80% of those active at 1 year, received core home visiting services. Performance varied by program site.It is challenging to engage and retain at-risk families in home visiting. Service monitoring must be an integral part of operations.