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SUMMARY
The Office of the Auditor General has completed the final in a series
of three annual evaluations of the Healthy Families Pilot Program. This evaluation was
conducted pursuant to the provisions of Laws 1994, Ninth S.S., Ch. 1, §9. This final
evaluation provides information regarding the Program’s effectiveness.
The Healthy Families Pilot Program is based on the premise that child
abuse can be prevented by improving parent-child bonding, developing parents’ coping
skills, providing emotional support and assistance during family crises, and helping
parents develop appropriate behaviors. Participation is voluntary and uses the home visit
model based on Hawaii’s nationally recognized Healthy Start Program. The Program is
community based, enrolling the families of newborns and potentially serving them through
the child’s fifth birthday.
The Arizona Department of Economic Security is responsible for
administering the Healthy Families Pilot Program. A total of 1,952 families was enrolled
in the Program from January 1995 through June 1997. Due to attrition, 897 families were
receiving some level of service on June 30, 1997.
Healthy Families Appears
to Reduce Child Abuse.
However, Results Vary by
Type of Participant and
Length of Enrollment
(See pages 9 through 14)
Overall, the Healthy Families Program appears to reduce the likelihood
of substantiated reports of abuse or neglect, but the impact varies by participant type
and by the length of time participants are enrolled.
Almost 95 percent of the Healthy Families participants are free of
substantiated Child Protective Services (CPS) reports of abuse or neglect. Almost 97
percent of families who received at least six months of services had no substantiated CPS
reports. The 97 percent contrasts to 92 percent for comparison group families for a
similar time period. Families with no prior CPS reports and more than one child had rates
of abuse or neglect of 3.3 percent, in contrast to 8.5 percent for comparison group
families. However, the results are inconclusive for first-time parents, who represent
approximately 50 percent of the participants, and for the very small number of families
with prior history of abuse or neglect. Even after receiving six months of service from
Healthy Families, 26.9 percent of the families with prior history of abuse or neglect had
at least one additional substantiated CPS report. However, there is no comparable data
that would allow for a conclusion as to whether the Program is effective or ineffective in
reducing abuse among these families.
The Program’s benefits for high-risk families and families with a
history of substantiated incidents of abuse and neglect are not clear. However, until it
is determined if families with a history of abuse benefit from Healthy Families, the
Program should increase the intensity of services for these participants in an effort to
reduce their rates of abuse and neglect.
Finally, Program staff should more clearly focus on abuse and neglect
prevention as the goal of the Program and receive additional ongoing training on
techniques to identify abuse and neglect and effectively address such problems when they
occur. Finally, since the Program is most effective for families who receive at least six
months of service, the Program should focus on engaging and retaining families.
Healthy Families Shows Some
Success at Improving
Home Environment
(See pages 15 through 19)
Most Healthy Families participants are providing their children with
positive, child-centered nurturing environments. The positive home environments suggest
the Program has been successful in creating positive parent-child bonds that may reduce
the likelihood of child abuse and neglect. Although Healthy Families services appear to
have a positive effect on parent-child relationships, they have no measurable impact on
the families’ adaptability, cohesiveness, or overall family functioning. The lack of
apparent impact may be partly attributable to services focusing primarily on the
parent-child relationships rather than the entire family. Staff should continue to focus
on improving parent-child relationships. However, since family functioning is not a goal
of the national model, and since Healthy Families staff lack the skill level to provide
intensive family counseling, the Program may not be able to strengthen overall family
relations and improve overall family unity. We suggest the Legislature consider rewording
the Program’s statutory goals to more closely reflect the Program’s emphasis on
parent-child relationships.
Healthy Families Improves Children’s
Health Care and Development
(See pages 21 through 26)
Healthy Families is effective in improving the medical care and healthy
development of participating children. Immunization rates for children in the Program are
higher than community rates. Also, while most children in the Program are developing
normally, the Program’s family support specialists are referring families with
potentially developmentally delayed children to medical and social services for further
assessment and services.
Additionally, family support specialists have made referrals to doctors
for almost two-thirds of program participants. The referrals may have increased the
likelihood that Healthy Families children had medical "homes" (a medical
provider such as a physician, health clinic, or other place of health care where an
individual regularly and routinely seeks care). Almost all of the Healthy Families
participants have a medical "home" to which they regularly turn for medical care
and well-baby check-ups.
Healthy Families Participants
Rely Less on Public Assistance
(See pages 27 to 30)
Program participants are less likely to rely on public assistance
programs. They show a lower participation rate for public assistance than is found for a
comparison group of families. Additionally, Healthy Families participants are not on AFDC,
food stamps, and AHCCCS as long as the comparison families. The shortened time on benefits
for Healthy Families participants in contrast to the comparison families occurs whether
the program participants were already on the programs at the time they entered Healthy
Families, or enrolled after entering Healthy Families.
The findings indicate that by helping families increase
self-sufficiency through direct services and referrals, the Program may be an effective
method for decreasing the length of time families need to rely on public assistance and
may help them to move off programs before their time limits expire.
Statutory Annual Evaluation Components
(See pages 31 through 44)
Pursuant to Laws 1994, Ninth S.S., Ch. 1, §9, the Office of the
Auditor General is required to make recommendations regarding program expansion and to
estimate savings from the Program.
A cost-benefit analysis for the Healthy Families Pilot Program was
contracted to the Early Intervention Institute at Utah State University. Long-term
benefits could not be calculated due to the short time covered by the Program and the
evaluation. This short time period makes it impossible to measure any long-term effects
that could be derived from reductions in children being placed in special education,
juvenile delinquency, drug and alcohol abuse, or adult crime. Potential benefits such as
higher productivity, school completion, and wages and tax revenues were also impossible to
measure.
Short-term, two-year benefits were estimated by the contractor.
Overall, the contractors found that a short-term, two-year cost of the Program was
$2,701,309 for families served through 1996. The two-year cost of the Program is based on
the Program costs less the benefits from improved immunizations, decreased reliance on
social welfare programs by Program families, and from reduced costs of Child Protective
Services. There are short-term costs and benefits that have not been included in the
short-term estimates. For example, costs of services provided by staff other than Healthy
Families are not included. Additionally, benefits from reduced medical care for injuries
caused by abuse are not included and some benefits, such as those from improved home
environments, could not be calculated in dollars. However, such benefits are important and
should be taken into account when considering the Program’s value.
Short-term dollar savings are not the only factor in determining
program continuation. In recommending continuation or expansion of Healthy Families, the
Program’s value to participants should be weighed against the Program’s costs
for the short period of time the Program has been operating. If the perceived value of the
potential long-term benefits coupled with the short-term benefits of reducing the numbers
of children abused and neglected and improving the health of these children exceeds the
negative net dollar benefit, the Program should be continued and expanded. If the Program
is expanded or continued, the administrative, program delivery recommendations made in
this report should help to increase the benefits derived from it. However, if the Program
is expected to pay for itself in reduced costs to taxpayers, in the short term, the
Program should not be continued or expanded.
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