Evaluation of Hawaii’s Healthy Start Program Anne K. Duggan, Elizabeth C. McFarlane, Amy M. Windham, Charles A. Rohde, David S. Salkever, Loretta Fuddy, Leon A. Rosenberg, Sharon B. Buchbinder, Calvin C.J. Sia Abstract Hawaii’s Healthy Start Program (HSP) is designed to prevent child abuse and neglect and to promote child health and development in newborns of families at risk for poor child outcomes. The program operates statewide in Hawaii and has inspired national and international adaptations, including Healthy Families America. This article describes HSP, its ongoing evaluation study, and evaluation findings at the end of two of a planned three years of family program participation and follow-up. After two years of service provision to families, HSP was successful in linking families with pediatric medical care, improving maternal parenting efficacy, decreasing mater- nal parenting stress, promoting the use of nonviolent discipline, and decreasing injuries resulting from partner violence in the home. No overall positive program impact emerged after two years of service in terms of the adequacy of well-child health care; maternal life skills, mental health, social support, or substance use; child devel- opment; the child’s home learning environment or parent-child interaction; pediatric health care use for illness or injury; or child maltreatment (according to maternal reports and child protective services reports). However, there were agency-specific pos- itive program effects on several outcomes, including parent-child interaction, child development, maternal confidence in adult relationships, and partner violence. Significant differences were found in program implementation between the three administering agencies included in the evaluation. These differences had implications for family participation and involvement levels and, possibly, for outcomes achieved. The authors conclude that home visiting programs and evaluations should monitor program implementation for faithfulness to the program model, and should employ comparison groups to determine program impact. H awaii’s Healthy Start Program (HSP), a child abuse prevention pro- gram, uses home visitors to help families turn away from abusive and neglectful parenting behaviors and toward parenting that pro- motes healthy child development. Based on Henry Kempe’s lay therapy program 1 and the work of Selma Fraiberg, 2 the goal of HSP is to identify vulnerable families before their day-to-day stresses, isolation, and lack of parenting knowledge and good role models give rise to abusive and neglect- 66 66 The Future of Children HOME VISITING: RECENT PROGRAM EVALUATIONS Vol. 9 • No. 1 – Spring/Summer 1999 Anne K. Duggan, Sc.D., is associate professor of pediatrics at Johns Hopkins University School of Medicine, with joint appointment in the School of Hygiene and Public Health, Depart- ment of Health Policy and Management, in Baltimore, MD. Coauthors and their project titles are as fol- lows. From The Johns Hopkins University: Amy M. Windham, M.P.H., project director, 1996–present; Charles A. Rohde, Ph.D., statisti- cian; David S. Salkever, Ph.D., health economist; Leon A. Rosenberg, Ph.D., developmental psycholo- gist; and Sharon B. Buchbinder,R.N.,Ph.D., project director, 1994–96. From the Hawaii Depart- ment of Health: Loretta Fuddy, A.C.S.W., M.P.H., co-investigator. From the Hawaii Medical Asso- ciation: Elizabeth C. McFarlane, M.P.H., field- work director, and Calvin C.J. Sia, M.D., co-investigator.