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Healthy Families America

Public Health & Prevention: Home- or Family-based
Benefit-cost methods last updated December 2023.  Literature review updated July 2017.
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Healthy Families America (http://www.healthyfamiliesamerica.org) is a network of programs that grew out of the Hawaii Healthy Start program. Healthy Families America programs aim to reduce child maltreatment and promote positive parent-child relationships. At-risk families are identified and enrolled either during pregnancy or shortly after the birth of a child. The intervention involves home visits by trained paraprofessionals who provide information on parenting and child development, parenting classes, and case management. Participants typically receive weekly home visits in the first six months after a child’s birth and may continue to receive periodic home visits until the child is three years old. Among programs included in the meta-analysis, participants typically received 29–43 home visits over a period of about 16 months.
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $7,062 Benefits minus costs $4,837
Participants $3,733 Benefit to cost ratio $1.81
Others $93 Chance the program will produce
Indirect ($68) benefits greater than the costs 62%
Total benefits $10,819
Net program cost ($5,982)
Benefits minus cost $4,837

^WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Substance use^
Nonspecified substance use (i.e., alcohol, cannabis, or illicit drugs) that does not rise to the level of "disordered."
 22 Primary 1 373 0.021 0.163 25 n/a n/a n/a 0.021 0.895
Major depressive disorder
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 22 Primary 4 1080 -0.057 0.051 25 -0.029 0.063 27 -0.057 0.269
Employment
Any employment, including part-time work.
22 Primary 2 462 0.077 0.091 25 0.000 0.000 26 0.077 0.397
Public assistance
Any form of welfare assistance, such as Temporary Assistance for Needy Families (TANF) or Assistance for Families with Dependent Children (AFDC).
22 Primary 3 2226 0.006 0.031 25 0.006 0.031 25 0.006 0.838
Problem alcohol use
Alcohol use reflecting problem behaviors (e.g., high frequency drinking, binge drinking, or drinking that has a high impact on daily life) for individuals who do not have an alcohol use disorder.
 22 Primary 1 373 -0.166 0.172 25 -0.166 0.172 35 -0.166 0.335
Food assistance
Receipt of food assistance, such as from the Supplemental Nutrition Assistance Program (SNAP).
 22 Primary 3 2226 0.033 0.031 25 0.033 0.031 25 0.033 0.286
Repeat birth^
A birth that occurs within two years of a prior birth for the same mother.  
 22 Primary 1 263 0.041 0.187 21 n/a n/a n/a 0.041 0.827
Emergency department visits
Whether someone visited the emergency department, or the number of times they visited the emergency department.
22 Primary 1 263 0.006 0.146 25 0.000 0.000 26 0.006 0.967
K-12 grade repetition
Repeating a grade. This is sometimes called "grade retention."
 1 Secondary 1 452 -0.012 0.122 8 -0.012 0.122 8 -0.012 0.920
K-12 special education
Placement into special education services.
1 Secondary 1 452 -0.216 0.116 8 -0.216 0.116 8 -0.216 0.062
Preschool test scores^
Measures of cognition in young children on standardized scales.
 1 Secondary 2 321 0.145 0.085 3 n/a n/a n/a 0.145 0.089
Externalizing behavior symptoms
Symptoms of externalizing behavior (e.g., aggressive, hostile, or disruptive behavior) measured on a validated scale.
 1 Secondary 2 578 -0.081 0.115 6 -0.044 0.072 9 -0.081 0.482
Internalizing symptoms
Symptoms of internalizing behavior (e.g., sadness, anxiety, or withdrawal) measured on a validated scale.
 1 Secondary 2 720 -0.151 0.161 6 -0.151 0.161 8 -0.151 0.348
Child abuse and neglect
Substantiated or founded reports to child protective services.
 1 Secondary 9 5003 -0.026 0.060 3 -0.026 0.060 17 -0.026 0.663
Out-of-home placement
The removal of a child from parental care, most often to foster care.
 1 Secondary 2 2006 0.180 0.164 6 0.180 0.164 6 0.180 0.274
Emergency department visits
Whether someone visited the emergency department, or the number of times they visited the emergency department.
1 Secondary 1 263 0.190 0.099 7 0.000 0.000 8 0.190 0.055
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1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Public assistance Public assistance ($93) $34 $0 ($46) ($105)
Employment Labor market earnings $1,062 $2,503 $0 $0 $3,565
Major depressive disorder Health care associated with major depression $100 $28 $103 $50 $281
Problem alcohol use Criminal justice system $0 $0 $19 $0 $19
Property loss associated with problem alcohol use $0 $9 $17 $0 $27
Mortality associated with problem alcohol $3 $6 $0 $98 $107
Emergency department visits Health care associated with emergency department visits ($3) ($1) ($5) ($2) ($10)
Food assistance Food assistance ($180) $159 $0 ($90) ($111)
Subtotals $889 $2,739 $135 $10 $3,773
From secondary participant
Child abuse and neglect Criminal justice system $35 $0 $69 $18 $121
Child abuse and neglect $15 $162 $0 $7 $184
Property loss associated with alcohol abuse or dependence $0 $0 $0 $0 $0
Labor market earnings associated with child abuse & neglect $356 $837 $0 $0 $1,193
Mortality associated with child abuse and neglect $0 $1 $0 $4 $5
K-12 grade repetition K-12 grade repetition $19 $0 $0 $10 $29
K-12 special education K-12 special education $6,016 $0 $0 $3,008 $9,025
Out-of-home placement Out-of-home placement ($240) $0 $0 ($120) ($359)
Externalizing behavior symptoms Health care associated with externalizing behavior symptoms $157 $44 $162 $79 $442
Emergency department visits Health care associated with emergency department visits ($186) ($50) ($273) ($93) ($603)
Subtotals $6,173 $994 ($42) $2,913 $10,038
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($2,991) ($2,991)
Totals $7,062 $3,733 $93 ($68) $10,819
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $5,071 2016 Present value of net program costs (in 2022 dollars) ($5,982)
Comparison costs $0 2016 Cost range (+ or -) 10%
Treatment cost estimates for this program reflect costs beyond treatment as usual. The per-participant cost is based on an average annual cost per family and the weighted average length of time in the program for included studies, which was 16.4 months. The average annual cost per family was $3,718 (provided by Kathryn Harding at Prevent Child Abuse America, August 2017).
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Citations Used in the Meta-Analysis

Anisfeld, E., Sandy, J. (with Guterman, N. B., & Rauh, V.). (2004). Best Beginnings: A randomized controlled trial of a paraprofessional home visiting program (Technical Report). Email from E. Anisfeld on February 2, 2011.

Caldera, D., Burrell, L., Rodriguez, K., Crowne, S. S., Rohde, C., & Duggan, A. (2007). Impact of a statewide home visiting program on parenting and on child health and development. Child Abuse & Neglect, 31(8), 829-852.

Center on Child Abuse Prevention Research. (1996). Intensive home visitation: A randomized trial, follow-up and risk assessment study of Hawaii's Healthy Start program (Final Report). Chicago: Prevent Child Abuse America.

Chambliss, J. W., & Emshoff, J. G. (1999). The evaluation of Georgia's Healthy Families Program: Results of phase 1 and 2. Atlanta, GA: EMSTAR Research. Unpublished manuscript.

Duggan, A., McFarlane, E., Fuddy, L., Burrell, L., Higman, S. M., Windham, A., & Sia, C. (2004). Randomized trial of a statewide home visiting program: Impact in preventing child abuse and neglect. Child Abuse & Neglect, 28(6), 597-622.

Duggan, A., Fuddy, L., Burrell, L., Higman, S. M., McFarlane, E., Windham, A., & Sia, C. (2004). Randomized trial of a statewide home visiting program to prevent child abuse: Impact in reducing parental risk factors. Child Abuse and Neglect, 28(6), 625-645.

Duggan, A., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crowne, S. S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31(8), 801-827.

DuMont, K., Kirkland, K., Mitchell-Herzfeld, S., Ehrhard-Dietzel, S., Rodriguez, M. L., Lee, E., . . . Greene, R. (2010). Final report: A randomized trial of Healthy Families New York (HFNY): Does home visiting prevent child maltreatment? Renssalaer, NY: New York State Office of Children and Family Services.

Earle, R.B. (1995). Helping to prevent child abuse and future criminal consequences: Hawai'i Healthy Start. Washington, DC: National Institute of Justice. (ERIC Document Reproduction Service No. ED 394651).

Easterbrooks, A., Chaudhuri, J., & Fauth, R. (2017). The Massachusetts Healthy Families Evaluation phase 2: Early childhood (MHFE-2EC): Final report to Massachusetts Department of Public Health, Children's Trust of Massachusetts. Medford, MA: Tufts Interdisciplinary Evaluation Research (TIER), Eliot-Pearson Department of Child Study and Human Development, Department of Urban and Environmental Planning, Tufts University.

Galano, J., & Huntington, L. (1999). Year VI evaluation of the Hampton, Virginia Healthy Families Partnership: 1992-1998. Hampton, VA: Virginia Healthy Families Partnership.

Green, B.L., Sanders, M.B., & Tarte, J. (2017). Using administrative data to evaluate the effectiveness of the Healthy Families Oregon home visiting program: 2-year impacts on child maltreatment & service utilization. Children and Youth Services Review, 75, 77-86.

Landsverk, J., Carrilio, T., Connelly, C.D., Ganger, W.C., Slymen, D.J., Newton, R.R., . . . Jones, C. (2002). Healthy Families San Diego clinical trial: Technical report. San Diego, CA: The Stuart Foundation.