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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 Arizona Revised Statutes (A.R.S.) §41-1279.08
to evaluate the Healthy Families Program annually. This report contains
information related to program procedures and effectiveness.
Healthy Families—Arizona is a child abuse prevention
and child wellness and development program administered by the Department
of Economic Security (DES). 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.
The program coordinates with hospitals to identify
mothers giving birth in specific geographic areas whose family
characteristics may place them at risk for committing child abuse or
neglect, and/or whose babies may face increased health risk. Healthy
Families provides services through various contractors, which include
medical centers, local health departments, and social service agencies.
These contractors provide services at 23 sites in 10 counties.
The program is based on a home-visitation model. Home
visitors regularly visit families to offer support, educational materials,
and referrals to needed resources. Home visitors also help families
develop family support plans and encourage positive parent-child
interaction to strengthen bonds and promote development. Participation in
the program is voluntary and may continue for up to five years. In fiscal
year 2000, 1,254 families were enrolled in the program.
Healthy Families Participant Child
Abuse Rates Do Not Differ Significantly
from the Comparison Group
(See pages 13 through 19)
For the second year in a row, comparison of child abuse
rates for Healthy Families participants and a comparison group of families
who left the program shows that abuse rates were not significantly
different. Specifically, 1.7 percent of participant families received a
substantiated report of abuse and 1.8 percent of families who left the
program before receiving four home visits received a substantiated report.
These rates are comparable to the rates reported in the previous Office of
the Auditor General evaluation of the program (see Report No. 00-1), in
which 1.6 percent of participants and 1.4 percent of the comparison group
received substantiated reports of abuse.
While one possible explanation for these findings might
be that the program does not have a significant effect on child abuse, other
explanations may also account for the similarity in outcomes between the two
groups. First, it is possible that the effects of the program on preventing
child abuse cannot be adequately measured by the current evaluation design
because of changes in DES procedures for substantiating child abuse reports.
In particular, the occurrence of substantiated abuse reports has decreased
since the implementation of an appeals process. Second, preliminary analysis
of when abuse occurs for both program participants and the comparison group
suggests that abuse is likely to occur a year or more after enrollment, and
in most cases, after the family has left the program. Thus, participants may
not be enrolled in the program at the time when the risk of child abuse
increases.
Healthy Families Program Provides
Health Referrals, Encourages
On-Time Immunizations, and
Promotes Safety
(See pages 21 through 26)
The Healthy Families Program has been successful in
providing health referrals, encouraging parents to get their children
immunized, and in promoting home safety. On average, the majority of
children in the program are fully immunized and most children have a primary
health care provider. Additionally, Healthy Families staff regularly conduct
assessments of the physical and social development of children enrolled in
the program. Parents improved their compliance with home safety measures
such as covering electrical outlets and keeping poisons and choking hazards
out of reach.
Parenting Stress Measure
Shows Improved
Family Relations
(See pages 27 through 29)
Healthy Families parents showed significant decreases in
indicators of parental stress after one year in the program, suggesting that
program services may improve parent-child relations. In addition, parents
with higher stress levels related to areas such as social isolation and
depression also received referrals to mental health services at a higher
rate than parents with lower stress. To assist families in improving
parent-child interaction, home visitors regularly provide emotional support
and information to help parents understand their child’s behavior.
Other Pertinent Information
(See pages 31 through 34)
The previous report issued by the Office of the Auditor
General (see Report No. 00-1) offered several recommendations to improve the
measurement of the program’s effect on family functioning and reduction of
substance abuse. The previous evaluation also recommends tracking referrals
for children with developmental delays. To address these recommendations,
the program discontinued using the Home Observation for Measurement of the
Environment (HOME) questionnaire and will instead use the Parenting Stress
Index (PSI) to measure the program’s effect on family relations. The
program also replaced the CAGE substance abuse screen with a new
questionnaire that can measure the program’s effect on reducing
drug/alcohol dependency over time. Finally, the program added questions to
its family update form, which will enable staff to track whether children
with developmental delays are offered the appropriate referrals.
Statutory Annual Evaluation Components
(See pages 35 through 44)
This report also contains information that addresses
various components of the Healthy Families evaluation statute. These
components include information regarding participant demographics such as
mother’s age, marital status, income, ethnicity, and household size. Other
areas covered in the statutory components section contain information about
enrollment and disenrollment and employment.
Read full report in Acrobat PDF format
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