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Healthy Families

What was Healthy Families?

The Healthy Families model, which is based on the Healthy Families America program, was tested in five sites across Canada: three sites in Edmonton (Norwood Child and Family Resource Centre, Bent Arrow Traditional Healing Society, and Terra Association), the Kwanlin Dun First Nation Healthy Families Program in Whitehorse, Yukon, and Best Start Healthy Families in Charlottetown, Prince Edward Island.

The Healthy Families projects were funded under the Crime Prevention Investment Fund of the National Crime Prevention Strategy. Each site targeted parents with children aged 0-6 who were considered at high risk for future criminal behaviour and victimization. The Yukon site focused primarily on Aboriginal children.

The projects utilized an intensive family home visitation program to provide parents with the support they need to get their children off to a healthy start in life. The home visits were tailored to the needs of each family and were conducted by family support workers. They often incorporated the modeling of good parenting practices and the setting and monitoring of goals with the purpose of increasing the capacity of families. The aim was to reduce the multiple risk factors associated with anti-social behaviour, delinquency and criminal behaviour, including child abuse and neglect, poor parenting skills, exposure to domestic violence and parental criminality.

What was the Healthy Families’ evaluation methodology?

The Canadian Research Institute for Law and the Family, an independent third party evaluator, conducted the evaluation of the five Healthy Families sites. A process and outcome evaluation was completed for each of the sites. Standardized instruments used during the evaluation included: the Family Assessment Device (FAD), Maternal Social Support Index (MSSI), Adult-Adolescent Parenting Inventory-2 (AAPI-2), Child Development Inventory (CDI), Center for Epidemiological Studies Depression Scale (CES-D), Denver Developmental Screening Test II (DDS-II), Carey Infant Temperament Scale (CITS) and the Home Observation for Measurement of Environment Scale (HOME). All were administered at three time periods over a 32-month span in order to obtain pre/post-test scores for participants.

Only the Best Start -- Prince Edward Island site could employ a quasi-experimental design incorporating a non-treatment comparison group. Overall, outcome data was collected across the five sites from 370 clients from July 1999 to December 2001. The following summary of findings comes from the Canadian Research Institute for Law and the Family’s Final Evaluation Report.

What were the project’s key findings?

Process evaluation findings

The Healthy Families model was successfully implemented at all five sites. All components of the model were used and there was little variance from the original Healthy Families model. At all program sites, over 70% of time was spent on client-focussed activities.

The client activities that took place usually involved scheduling home visits and discussions about: child development issues, family functioning issues, health issues and community resources and referrals. Findings indicated that the Healthy Families model worked best with younger, first-time parents. Evaluation findings suggest that the Aboriginal population in Kwanlin Dun was particularly hard to reach.

Although the caseload for the Yukon site was smaller than anticipated, the degree and intensity of risk experienced by Aboriginal families in the program was greater than expected, with the result that family support workers had to devote many extra hours to their cases. This was because half of the families were, at some time, in a state of chronic or acute crisis.

Also, the evaluation found a history of strained relations between First Nation communities and Family and Children’s Services Branch of the Government, which had an impact on the amount of effort family support workers needed to devote to each case.

Outcome evaluation findings

Evaluation results in Prince Edward Island’s Best Start Healthy Families site showed very high satisfaction rates among participants, although standardized instruments failed to show significant differences between the participant and the comparison groups. As the other four sites were unable to locate candidates for a no-treatment comparison group, it cannot be said with certainty that the changes observed on the standardized measures resulted from the intervention.

Nonetheless, since some results were replicated across many sites, it seems that some degree of confidence can be placed in the findings. According to the Family Assessment Device (FAD), four out of the five sites (Bent Arrow, Terra, Best Start and Kwanlin Dun) demonstrated improvements in family functioning; also, the Adult-Adolescent Parenting Inventory-2 (AAPI-2) revealed that parents’ expectations of their children, their levels of empathy and beliefs about punishment, changed to an extent across all programs.

Participants’ experiences of the program were also favourable in all five sites. They felt that the best parts of the program were: learning about child development and parenting, obtaining knowledge of and access to the community and its specific services, and their relationship with the family support worker.

Although not shown with statistical significance, parents did feel that the program provided social support, helped them to become more child-focused, strengthened their ability to cope and aided them in building relationships with others. One specific finding that stood out from the Best Start evaluation was the 30% difference in child welfare involvement between participant families and comparison group families (35% of the comparison group reported child welfare involvement, compared to only 5% of Best Start clients). Overall, the evaluators concluded that Healthy Families programs were successful at achieving some, but not all of their stated objectives.

What are the implications of the findings?

More rigorous evaluations of the Canadian Healthy Families model must be conducted before any firm conclusions can be drawn about its general effectiveness. Evaluators have noted that there is a need to expand the program’s ability to address the needs of Aboriginal communities effectively.

What were the key lessons learned from this evaluation?

Many lessons were learned from this project including:

• Involving a broad range of individuals with a variety of perspectives and expertise can help connect the program to other programs, agencies and infrastructures;
• there is a very high rate of potential clients who qualify for the program but refuse to participate. Attrition rates are also high. Policy-makers and program administrators should develop strategies to provide appropriate services that address the needs of these hard-to-reach groups;
• barriers are often raised when trying to provide services within Aboriginal communities, and effort must be made to incorporate Aboriginal values and principles within the Healthy Families programs;
• new measuring instruments that are more sensitive to the developmental pathways of families with older children must be chosen/developed;
• new procedures are needed to track families’ contact and involvement with their community’s resources and activities. This would increase the information about social support that is already being gathered;
• client families who receive the Healthy Families programs are a very heterogeneous group. Although all are characterized as “families at risk,” individual families’ specific strengths and weaknesses are unique, making it difficult to provide services and evaluate the program and its outcomes; and
• high staff turnover can negatively influence a family’s progress through the Healthy Families project. Participants found it difficult to accept a new family support worker after having worked closely with another one.

For more information or to receive a copy of the final evaluation report please contact the National Crime Prevention Centre at 1-877-302-6272.