title: Hawaii's healthy start program of home visiting for at-risk families: evaluation of family identification, family engagement, and service delivery.
abstract: OBJECTIVE
  To describe family identification, family engagement, and service delivery in a statewide home visiting program for at-risk families of newborns.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  
  
  
  METHODS
  completeness and timeliness of early identification and home visiting activities; family characteristics: sociodemographics, child abuse risk factors, infant biologic risk.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  It is challenging to engage and retain at-risk families in home visiting. Service monitoring must be an integral part of operations.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. aduggan@jhu.edu
authors.forename: A
authors.initials: A
authors.lastname: Duggan
authors.forename: A
authors.initials: A
authors.lastname: Windham
authors.forename: E
authors.initials: E
authors.lastname: McFarlane
authors.forename: L
authors.initials: L
authors.lastname: Fuddy
authors.forename: C
authors.initials: C
authors.lastname: Rohde
authors.forename: S
authors.initials: S
authors.lastname: Buchbinder
authors.forename: C
authors.initials: C
authors.lastname: Sia
mesh_terms: D002648:Child; D002649:Child Abuse / Q000517:prevention & control; D002662:Child Health Services / Q000458:organization & administration; D003430:Cross-Sectional Studies; D006254:Hawaii; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D016730:Program Development; D015397:Program Evaluation; D012017:Referral and Consultation; D012959:Socioeconomic Factors