Healthy Families America: using research to enhance practice.

The Healthy Families America (HFA) initiative seeks to expand the availability of high-quality, intensive home visitation services and to create communitywide commitments to these services and others that promote a supportive atmosphere for all new parents. This article briefly describes HFA's theoretical framework, its history, and its current status. The HFA Research Network, a partnership among researchers who are engaged in evaluating HFA programs around the country, is also highlighted. Preliminary findings of the research partners suggest that HFA programs may have the most success at improving parent-child interactions, with more limited or mixed success in the areas of health care status and utilization, the prevention of child abuse and neglect, and improved maternal life course outcomes. HFA programs so far have not demonstrated significant improvements in children's development or maternal social support. The authors report variability in both outcomes and attrition rates across subgroups of families in these studies, but there are no consistent patterns to identify who is most likely to stay enrolled in an HFA program or who is most likely to benefit from that enrollment. The authors conclude that these and several other areas require additional research. They further recommend that researchers and practitioners move beyond a singular focus on individualized interventions and work to create a communitywide and national context in which support for all new parents is the norm.