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SUMMARY
The Office of the Auditor General has completed an evaluation
of the Healthy Families Program. The Office of the Auditor General is required
pursuant to A.R.S. §41-1279.08 to evaluate the Healthy Families Program
annually. This report contains information related to the program’s
effectiveness.
The Healthy Families Program has five goals: (1) reduce child
abuse and neglect; (2) promote child wellness and proper development; (3)
strengthen family relations; (4) promote family unity; and (5) reduce dependency
on drugs and alcohol. Participation in the program is voluntary and may continue
for up to five years. Currently, about 1,200 families participate in the
program.
Two of the program’s intents are to stop child abuse and
neglect before it starts and to promote child development and wellness. This is
done by coordinating with hospitals to screen all mothers giving birth in target
geographic areas in an effort to identify families at risk for committing child
abuse or neglect and having poor health outcomes. Based on a home-visitation
model, family support specialists visit families regularly to provide support,
education, and referral to needed resources. By intervening early, within the
first three months of the child’s life, the program aims to help families
"get off to a good start" before bad patterns are established.
The Arizona Department of Economic Security (DES) administers
the Healthy Families Program. Appropriations for fiscal years 1997-99 totaled $3
million per year. With additional funding from DES’ Child Abuse Prevention
Fund and federal grants, program funding was just over $4.1 million in fiscal
year 1999.
To provide services, DES contracts with other organizations,
which include medical centers, local departments of public health, and local
social service agencies. DES currently has nine contracts with eight
organizations to provide services at
20 sites in 10 counties. An additional contract was awarded to a data management
firm for database management, evaluation, and quality assurance.
Program Effect on Child Abuse Rate
Difficult to Determine but Parenting
Stress is Reduced After Six
Months in Program
(See pages 11 through 17)
A critical measure of the program’s impact on preventing
child abuse is a comparison of the number of substantiated Child Protective
Services (CPS) reports received by Healthy Families participants and a similar
group of individuals who do not participate in the program. In the previous
evaluation, Healthy Families participants had a significantly lower rate (3.3
percent) of substantiated CPS reports than the rate (8.5 percent) found for a
comparison group. In contrast, this evaluation found that both groups had very
low, almost negligible, rates (less than 2 percent) of substantiated CPS
reports.
To rely on this measure as an indicator of effect on child
abuse may be problematic, however. The low rates of substantiated abuse may have
been influenced by several policy changes affecting Child Protective Services
and Healthy Families. First, CPS has instituted a new appeals process through
which individuals can challenge allegations of child abuse and neglect. Within
this process, a higher level of evidence is now required to substantiate a child
abuse case. The second policy change has been to institute the Family Builders
Pilot Program in Maricopa and Pima Counties to provide services to families who
received reports of low and potential risk of child abuse and neglect. Once a
case is referred to Family Builders, the CPS case is closed and cannot be
substantiated. The introduction of Family Builders reduces the pool of cases
eligible for investigation and substantiation. Finally, recent legislation
mandates that families who have had a substantiated CPS report not be offered
Healthy Families services. Thus, families with a demonstrated propensity for
abuse are no longer included among Healthy Families’ participants. Because of
these changes, in this year’s evaluation, no definitive conclusions can be
made about the program’s effect on preventing child abuse.
Other indicators show that the program may have some impact
on reducing child abuse risk. After six months in the program, Healthy Families
participants reported reduced parenting stress, potentially lowering their level
of child abuse risk. Alcohol and drug abuse, factors related to child abuse,
were measured, but due to the assessment tool’s limitations, evaluators were
unable to draw conclusions about the program’s impact on substance abuse.
Healthy Families Children Have
Positive Health Outcomes and
Improved Family Functioning
Within the Parent-Child Relationship
(See pages 19 through 26)
Healthy Families is successful in enhancing children’s
health and improving family functioning within the parent-child relationship.
Healthy Families participants showed positive outcomes in health-related
measures, including immunization rates and assessments of children’s physical
and social development. Immunization rates for Healthy Families participants
were substantially higher than the immunization rates for children from
community health centers. Almost all of the Healthy Families participants had a
primary health care provider for their children. Assessments of home environment
revealed improvements in parent-child relationships, including increases in
measures of parental responsivity, involvement, and provision of appropriate
play materials. Home safety assessments showed that parents also took measures
to ensure their children’s safety in the home. However, due to methodological
problems with the instrument used to assess home environment, it is recommended
that a new measure of family functioning be selected.
Statutory Evaluation Components
(See pages 27 through 36)
This report also includes information on a number of factors
that are required by the statute outlining the Healthy Families evaluation.
These factors include information about participant demographics, program
revenues and expenditures, enrollment figures, and participants’ self-reported
reasons for exiting the program. In addition, the report includes information
about program effects on employment and public assistance usage, including usage
of Temporary Assistance for Needy Families (TANF) and Food Stamps.
The statute also requires information on any long-term
savings associated with program services. Evaluators planned to include a
cost-benefit analysis detailing short- and long-term savings/costs of the
program. However, the analysis could not be completed because key measures,
including child abuse rates, needed to calculate potential benefits/costs, could
not be used.
Read full report in Acrobat PDF format
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