Healthy Families Arizona
Evaluation Report
2005

Prepared by:
LeCroy & Milligan Associates, Inc.
620 N. Country Club Road
Tucson, Arizona 85716
(520) 326-5154
www.lecroymilligan.com

Prepared for:
The Arizona Department of Economic Security
Division of Children, Youth and Families
Office of Prevention and Family Support
1789 W. Jefferson, Site Code 940A
Phoenix, Arizona 85007

Acknowledgements
This evaluation report represents the efforts of many individuals and many
collaborating organizations.
The evaluation team for Healthy Families Arizona that contributed to this year’s report
includes evaluators Craig W. LeCroy, Ph.D., Kerry Milligan, MSSW, Cindy Jones, BSMIS ; Judy Krysik, Ph.D., Pat Beauchamp, MSW, Allison Titcomb, Ph.D., Olga
Valenzuela, BA, Allyson LaBrue, BA; and data management staff, Veronica Urcadez,
Delcia Cardenas, and Elizabeth Carmargo.
We are grateful to Rachel Whyte, Coordinator for the Child Abuse Prevention Fund and
Healthy Families Arizona for her guidance and support. Valerie Roberson, Manager for
the Office of Prevention and Family Support, continues to provide leadership and
vision for the program. The Healthy Families Quality Assurance and Training Team
deserves many kudos for their hard work during expansion—providing training in data
collection and helping the sites collect data and make use of findings for program
improvement. Thank you to Kate Whitaker, TA/QA Coordinator, Pauline HaasVaughn, Barbara Griffin, Kathy Van Meter, Ellie Jimenez, Danielle Gagnier, TA/QA
Program Specialists, and Penny Swenson, Administrative Manager. Thank you to the
program managers and supervisors who have worked so hard getting new sites up and
running and ensuring data is collected and submitted. Family Assessment Workers,
Family Support Specialists and support staff at the sites have dutifully collected the
data, and have participated in focus groups and interviews—all of which help to tell an
accurate story about Healthy Families Arizona. Lastly, we acknowledge the families
who have received Healthy Families Arizona services.
Suggested Citation:
LeCroy & Milligan Associates, Inc. (2005). Healthy Families Arizona Evaluation Report
2005. Tucson, AZ: LeCroy & Milligan Associates, Inc.

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Healthy Families Arizona Evaluation Report 2005

Healthy Families Arizona
2005 Evaluation Report Highlights
Program Growth







Program expanded from 23 sites to 51 sites
Prenatal program component initiated to serve pregnant women and their families
Families with prior CPS history are now eligible for services

Program participants
Postnatal component

Prenatal component

•

69% single mothers

•

69% single mothers

•

88% families on AHCCCS

•

84% families on AHCCCS

•

62% of mothers have less than high
school education

•

67% of mothers have less than high school
education

•

17% infants born <37 weeks gestation

•

20% infants born <37 weeks gestation

•

13% infants had low birth weight

•

11% infants had low birth weight

•

34% of mothers received late or no
prenatal care

•

32% of mothers received late or no
prenatal care

Service Delivery









3,655 families were served
85% (3,096) families engaged with the program (4 or more home visits)
2735 families entered after the birth of their child and 361 entered prenatally
66% remained in the program 1 year or longer

Outcomes












Overall, 98.2% of all families had no substantiated child abuse or neglect incidences
Parents improved on 7 of 10 subscales of Healthy Families Parenting Inventory,
indicating increased parenting competence, improved problem-solving and parentchild interaction, and decreased depression
Percent of infants with all 2 year immunizations was 89% (state percent 77%)
97% of children were linked to a medical doctor
11.5% of mothers had subsequent pregnancies (28% 18years old or younger)

Recommendations







Continue to enhance use of evidence-based practice and logic model
Improve data collection
Enhance services to prenatal families and families with older children

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Healthy Families Arizona Evaluation Report 2005

Table of Contents
Acknowledgements ..................................................................................................................... i
Healthy Families Arizona 2005 Evaluation Report Highlights..........................................ii
List of Exhibits............................................................................................................................. v
Executive Summary ................................................................................................................. vii
Introduction ................................................................................................................................. 1
Healthy Families Arizona Expansion ................................................................................... 3
Program evaluation and research evolve as program matures ........................................ 5
Longitudinal study underway ............................................................................................... 6
In this Report ............................................................................................................................... 7
Program implementation and expansion............................................................................. 7
Prenatal program implementation ........................................................................................ 7
Program outcomes and service delivery .............................................................................. 7
Program and Policy Updates..................................................................................................... 8
Implementation of the Healthy Families Prenatal Component....................................... 11
Recruitment............................................................................................................................. 12
Challenges with Recruitment and Participation ............................................................... 13
Prenatal Service Delivery...................................................................................................... 14
Staff training and resource needs ........................................................................................ 15
Healthy Families Arizona Program Services ....................................................................... 17
Program Participants ................................................................................................................ 17
Infant Characteristics ............................................................................................................... 23
Service Delivery ........................................................................................................................ 25
Participant Satisfaction ............................................................................................................ 28
Program Outcomes.................................................................................................................... 30
Program Logic Model............................................................................................................ 30
Child and Family Health and Parenting Outcomes ........................................................... 33
Development and Implementation of the Healthy Families Parenting Inventory
(HFPI)....................................................................................................................................... 33
Child Abuse and Neglect ........................................................................................................ 35
All Families ............................................................................................................................. 35
Safety Practices ....................................................................................................................... 36
Child Development................................................................................................................ 38
Mother’s Health, Education and Employment.................................................................. 40
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Healthy Families Arizona Evaluation Report 2005

Substance Abuse Screening .................................................................................................. 42
Decision- Making Study........................................................................................................ 43
Themes..................................................................................................................................... 43
Common Questions of Home Visitors................................................................................ 43
Recommendations..................................................................................................................... 47
References................................................................................................................................... 50
Appendix A: Site Level Data .................................................................................................. 51
Appendix B: Family Stress Checklist.................................................................................... 74
Appendix C: Healthy Families Parenting Inventory ......................................................... 75
Appendix D: Selected Risk Factors at Intake All Families –2005.................................... 76
Appendix E. Healthy Families Prenatal Logic Model....................................................... 77
Appendix F. Healthy Families Postnatal Logic Model ..................................................... 78

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Healthy Families Arizona Evaluation Report 2005

List of Exhibits
Exhibit 1. Healthy Families Arizona Evaluation Components ............................................ 6
Exhibit 2: Developments in the Healthy Families Arizona program in 2004-2005 ............ 8
Exhibit 3. Healthy Families Arizona Prenatal Component Objectives .............................. 11
Exhibit 4. Healthy Families Prenatal Services........................................................................ 15
Exhibit 5. Healthy Families Arizona Participants Enrolled and Actively Engaged........ 18
Exhibit 6. Selected Risk Factors for Mothers at Intake--2005............................................... 19
Exhibit 7. Ethnicity of Mothers Enrolled Prenatally (N=356)............................................. 20
Exhibit 8. Ethnicity of Mothers Enrolled Postnatally (N=2704) ......................................... 20
Exhibit 9. Father Ethnicity-- Prenatal Families (N=320)..................................................... 21
Exhibit 10. Father Ethnicity-- Postnatal Families (N=2440) ................................................ 21
Exhibit 11. Percentage of Parents Rated Severe on the Family Stress Checklist Items
PRENATAL................................................................................................................................. 22
Exhibit 12. Percentage of Parents Rated Severe on the Family Stress Checklist Items
POSTNATAL .............................................................................................................................. 22
Exhibit 13. Risk Factors for Infants at Intake--2005............................................................... 24
Exhibit 14. Types of Healthy Families referrals at six, twelve and eighteen months ..... 27
Exhibit 15. Responses to “I understand when the home visitor explained the family
service plan to me.” ................................................................................................................... 28
Exhibit 16. Responses to “I was satisfied with information provided on child
development and parenting.” .................................................................................................. 29
Exhibit 17. Participants’ perception of usefulness and responsiveness of Healthy
Families services......................................................................................................................... 29
Exhibit 18. Program Objectives and Data Sources ................................................................ 31
Exhibit 19. Healthy Families Parenting Inventory ............................................................... 34
Exhibit 20. Percent of families showing NO child abuse and neglect incidences ........... 35
Exhibit 21. Percent of families implementing safety practices ........................................... 36
Exhibit 22. Immunization Rate of Healthy Families Arizona Children............................. 37
Exhibit 23. Percentage of Children Linked to a Medical Doctor......................................... 37
Exhibit 24. ASQ Screening ........................................................................................................ 39
Exhibit 25. ASQ Referral Status—2005 ................................................................................... 40
Exhibit 26. Length Of Time To Subsequent Pregnancy........................................................ 41
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Healthy Families Arizona Evaluation Report 2005

Exhibit 27. Percent of Mothers enrolled in school................................................................. 41
Exhibit 28. Mother’s employment status ................................................................................ 41
Exhibit 29. Concerns that affect home visitor intervention decisions ............................... 43

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Executive Summary
Introduction
Healthy Families Arizona is part of the growing trend towards evidence-based practice.
The evaluation and quality assurance aspects of the program draw on practice and
policy-related research findings in assessing program implementation and program
outcomes. Many of the evidence-based aspects of Healthy Families Arizona are
described in this report.

The Healthy Families Arizona Program
The Healthy Families Arizona program is a voluntary program that reaches out to
families experiencing multiple stressors. These stressors are often avenues for poor
child health and development as well as child abuse and neglect. Families identified as
at-risk for multiple stressors and child abuse and neglect are assessed shortly after the
birth of a child through a two-stage screening and assessment process. Families who
are identified to benefit from services are offered a home visitation program. Home
visitation staff provide a wide continuum of services such as emotional support,
informal teaching, modeling of parent-child interaction, information and referral,
transportation, and encouragement with parenting. The overall goals of the program
are 1) promote positive parent/child interaction, 2) improve child health and
development, and 3) prevent child abuse and neglect.

Program Implementation
Healthy Families Arizona is experiencing an exciting period of program expansion that
began in the fall of 2004, as increased funding became available to expand from 23 to 51
program sites. New challenges in quality assurance and program monitoring and
evaluation have emerged as the program experiences rapid and challenging growth.
The program also launched new services for pregnant women and their families.
Finally, the program began serving families with substantiated child abuse and neglect
reports—for several years the program could not provide services to these families.

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Healthy Families Arizona Evaluation Report 2005

Program Outcomes
Child Health, Development, and Safety
Child health and development indicators show positive results for the program. For
example, there was a reported 89% immunization rate for postnatal participants in the
program. This is in comparison to a 77% immunization rate for 2-year-olds in Arizona.
A large percentage of families were linked to a medical doctor (97.1% at 12 months).
The program also screens for developmental delays and provides referrals for further
services. Assessment of home safety practices such as use of car seats, poisons locked,
and smoke alarms installed show a large percentage of participants using safety
practices (all over 90% at a 24 month assessment).
Healthy Parenting Behavior
The Healthy Families Parenting Inventory (HFPI) is a primary measure of program
outcome and revealed statistically significant improvement on 7 of 10 subscales and the
total score of the HFPI. The scales that showed improvement include: increased
problem solving, decreased depression, increased use of resources, improved parent
child behavior, improved home environment, increased parenting competence, and
increased parenting efficacy. These results suggest that program participants are
reducing risk factors that are related to child abuse and neglect. While this data is
limited without a comparison group, it does confirm that participants are reporting
improvements in healthy parenting behavior.
Child Abuse and Neglect
Child abuse and neglect incidents (substantiated) were examined for program
participants. The results reveal that child abuse and neglect rates continue to be low
(1.8%) and meet the program goal of having no higher than a 5% rate of child abuse and
neglect.
Maternal Life Course Outcomes
An additional outcome of the Healthy Families Arizona program is a positive influence
on the mother’s life course. Specifically, many of the participants enroll in school,
obtain their GEDs or seek gainful employment. For example, data show that 39% of
mothers were employed at 12 months and 19% are enrolled in school.

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Participant Satisfaction
Healthy Families is a voluntary program and therefore, depends on participants
obtaining personally meaningful benefits from the program. An annual assessment of
participant satisfaction is conducted. Of those participants who complete and return
surveys the results show they are very satisfied with the program services they receive.
For example, in response to the questions, “I was satisfied with information provided
on child development and parenting” 96% responded always or a lot; “I received the
services I wanted and needed” 95.8% responded always or a lot.

Conclusions
The value of Healthy Families Arizona as a prevention program is the potential of
having a positive impact on multiple goals. Positive changes across multiple indicators
point to the deep benefits of the Healthy Families Arizona program. This is because the
program allows for the delivery of multiple services to families in need. This program
represents a strategy for delivering services that can have broad impacts. While the
outcome evaluation in this report is limited without the benefit of a comparison group,
past studies have also found positive effects. Furthermore, the addition of a
longitudinal randomized control trial, which began this year, will provide the program
with an opportunity to demonstrate long-term outcomes in the context of a rigorous
research design.

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Healthy Families Arizona Evaluation Report 2005

Introduction
Legislators, policy makers, academics and program directors are all calling for
“evidence-based” practice to guide our investment in social programs. The growing
popularity of evidence-based practice is found at over 25 federal web sites. A Medline
internet search on “evidence based treatment or practice will generate over 5,000
citations. The ongoing focus of home visitation programs like the Healthy Families
Arizona program is smack in the middle of the evidence-based revolution.
The Healthy Families Arizona program is well positioned with regard to “evidencebased practice”. Since 1991, before an emphasis on evidence-based practice had even
begun, the Healthy Families Arizona program set out to collect ongoing data and
examine program effectiveness—a center point for evidence-based practice. What is
evidence-based practice? Evidence-based practice is an effort to draw on practice and
policy related research findings as well as an evolving technology for integrating
evidentiary, ethical, and practical issues (Gambrill, 2003). Integrating program
evaluation with the program service delivery efforts puts “evidence” at the center of
decision-making concerning all facets of the Healthy Families program.
The philosophy of evidence-based practice involves breaking down the division
between research and practice. As Sackett et al. (2000) note it is: “the integration of the
best research evidence with clinical expertise and client values.” Too often, evidencebased practice is misunderstood as simply basing decisions on evidence—it is much
more than this. An important aspect of evidence-based practice is encouraging an open
review of a program and this annual report is part of that process. All Healthy Families
Arizona data are made public for anyone to review and critique. Indeed, the goal is
sharing responsibility for decision-making in a context of recognized uncertainty (in
other words, when we don’t have all the answers).
Perhaps most important for our purposes, is to understand evidence-based practice as a
systemic approach to improving the quality of services (Gray, 2001; Sackett et al., 2000),
including:
1. Working with program directors, program administrators, supervisors, and
direct care home visitors to learn about evidence-based processes.
2. Involving participants of home visitation services as informed participants.
3. Reviewing Healthy Families Arizona management and administrative practices
and policies that influence practice.
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Healthy Families Arizona Evaluation Report 2005

4. Addressing implementation challenges including the implications of scarce
resources.
These broader aspects of evidence-based practice acknowledge that achieving evidencebased practice is a complex enterprise and not as simple as just administering a
program with “good evidence”. For example, poor morale or high turnover of home
visitors could easily undermine the “effectiveness” of an evidence-based practice
program.
How is evidence-based practice a part of the Healthy Families Arizona program? There
are multiple ways that the Healthy Families Arizona program endeavors to be an
evidence-based program, for example:
1. Examining practice decisions of home visitors and translating those decisions
into research questions.
2. Finding the best available research to answer those questions (brokering
knowledge for program directors and service staff).
3. Critically appraising the existing evidence of the home visitation program.
4. Using this analysis to inform ongoing practice and policy decisions.
5. Discovering and applying ways to retrieve relevant information and research.
6. Evaluating the process for improving the program and seeking ways to improve.

This report highlights many of the evidence-based aspects of the Healthy Families
program, in the report the following examples show how:
 The annual report encourages greater shared decision making about what the
program has achieved and can be a starting point for discussions of new
directions the program should take.
 The discussion of the longitudinal study is an example of seeking a more
rigorous test of the programs outcomes and investigating the potential long-term
benefits of the program. The longitudinal study also will share its outcomes with
the research community and promote critical discussion of findings.
 The newsletter, Building Bridges, was created to enhance knowledge use by
program directors, supervisors, and home visitors. In this quarterly publication
new research is reviewed that has direct relevance to administering home
visitation services. For example, articles on preventing accidental injuries and
new research findings on birth spacing.
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Healthy Families Arizona Evaluation Report 2005

 Sub-studies continue to be conducted in order to answer specific questions
generated by program and evaluation staff to shed new perspectives on program
implementation. Studies of what situations are considered most “difficult” for
home visitors have been conducted and current efforts are addressing how home
visitors are using training and best practices to respond to difficult situations.
 Improved outcome assessment was the goal in creating the Healthy Families
Parenting Inventory (HFPI), which can improve the quality of data received from
families and better direct how home visitors can help them.
Healthy Families Arizona Expansion
Healthy Families Arizona (HFAz) is experiencing an exciting period of program
expansion that began in the fall of 2004, as increased funding became available to
expand from 23 to 51 program sites by the summer of 2005. Program quality assurance
and program evaluation take on increased importance as mechanisms to provide
meaningful information for program planning, program enhancement and program
monitoring during a time of rapid and challenging growth.
The impact of program expansion with a statewide initiative of this size brings
opportunities and challenges in program evaluation and quality assurance. The
Healthy Families Arizona expansion has provided opportunities to clarify a wellcrafted program logic model and theory of change that can guide all Healthy Families
staff in their daily work. This year brought opportunities to create new training
approaches to bring new sites up to speed, implement improved outcome measures,
and initiate a longitudinal outcome study. Rapid growth presents a challenge for
program staff to maintain quality in program start-up. In particular, new programs
have been challenged to recruit and hire talented new staff in a limited job market,
provide training and supervision to new home visitors and new program directors,
insure quality data collection among expanding and new sites, and maintain a shared
and meaningful vision among newcomers and seasoned staff alike.
Since July 2004, several new sites have come “on board” each month and existing sites
have expanded in the numbers of families they serve. This has required site and
operations development, staff hiring, and training for new staff (CORE Training for
home visitors and family assessment workers, Supervisor Training, data collection
training, and prenatal program implementation training). In addition, beginning in
August 2004, program policy began to support provision of services to families during
the prenatal period. This has required training for existing and new sites in policies and
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Healthy Families Arizona Evaluation Report 2005

protocols, extensive community networking to establish referral and recruitment
processes, training for home visitors and supervisors in the prenatal program
components, and development of new and revised data collection instruments. Also in
August 2004, program policy was changed so that Healthy Families Arizona can serve
families who have been involved with child protective services.
In summary, during this program year an amazing effort has been undertaken to get 28
new sites up and running, while also expanding some of the existing 23 sites. This
expansion has increased the availability of Healthy Families Arizona services to families
in previously unserved regions of Arizona, and expanded services in the highest need
areas. The map below highlights the fifty-one program sites throughout Arizona.

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Healthy Families Arizona Evaluation Report 2005

Program evaluation and research evolve as program matures
The evaluation of HFAz has, until 2004, focused on an annual review of selected
implementation issues, services provided and participant outcomes, a review of current
research in home visitation, an examination of the program’s adoption of commonly
accepted practice principles, and a review of the program’s adherence to the Healthy
Families America Critical Elements. In addition, the annual evaluation effort has
focused on providing information for program improvement and quality assurance.
For example, site-level evaluation reports provide immediate feedback to ensure that
processes not working well and outcomes that are less than expected receive immediate
attention. Quality Assurance and Training Specialists conduct at least two visits to each
site per year to provide follow-up on concerns and technical assistance. Other
contributions of the annual evaluation are to evaluate the outcomes relative to the
requirements of the legislation authorizing the program and to provide information to
guide strategic planning and growth since the program’s inception in 1992. The annual
evaluation has relied on two primary methods to evaluate program outcomes. One is
an assessment of changes in specified outcomes from intake to specified time intervals
thereafter. The second method is the use of a comparison group to evaluate program
effectiveness. Positive program impacts have been found in many areas using these
evaluation methods, e.g., fewer incidences of substantiated abuse and neglect, higher
rates of immunization compared to the state, and decreased parental stress. These
annual evaluation components continue to provide relevant information on the
program’s annual performance and trends across years.
With additional funding available in 2004, the evaluation team designed and initiated a
five-year longitudinal study. The longitudinal evaluation of HFAz differs from the
ongoing evaluation in three essential ways. First, as it’s name implies it is long-term – it
follows the same 190 families for five years. Secondly, it uses a randomized control
group as opposed to a comparison group as a means to determine program
effectiveness. Third, it employs additional measures to test a full-range of potential
outcomes. For instance, it measures domestic violence, substance abuse, mental health,
and discipline on an on-going basis. Participants in the longitudinal study will be
assessed at least once each year from their enrollment in the study until their child’s
fifth birthday. By age five, the children will be approaching elementary school, allowing
for an assessment of school readiness. Zero to five is the period in which children are
the most vulnerable to child abuse and neglect, and thus the most relevant for the
study. Exhibit 1 on the following page illustrates the evaluation components of Healthy
Families Arizona.
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Healthy Families Arizona Evaluation Report 2005

Exhibit 1. Healthy Families Arizona Evaluation Components

Longitudinal study underway
The approach to the HFAz Longitudinal Study can be described as a layered-study
approach, wherein one study creates a foundation for the next. It consists of seven substudies; the first four were designed to prepare the program for the longitudinal
evaluation and to provide information for the annual evaluation. Briefly, the first four
substudies include: (1) a statement of program theory - how does the program plan to
affect change through home visitation; (2) a retrospective study of 13 years of data
collected on all HFAz participants to determine the factors related to substantiated child
abuse and neglect; (3) the refinement of a program structure and logic model, and (4) an
exploratory study of long-term outcomes in the HFAz program. Work on the first four
substudies has been completed and the results will be reported in the First Annual
Longitudinal Evaluation Report. The final three substudies: the Outcome, Process and
Cost studies form the basis for examining the long-term impacts of the Healthy Families
Arizona program. These parts of the study are now underway.
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Healthy Families Arizona Evaluation Report 2005

In this Report
Program implementation and expansion
The report begins with a review of major changes and challenges in the statewide
Healthy Families Arizona (HFAz) program implementation and policy over the last
year as the statewide effort has expanded from 23 to 51 program sites. A brief
description of the new home visitation research/practice newsletter, Building Bridges, is
also provided.
In later sections of this report, information from focus groups with HFAz home visitors
and supervisors is provided in order to examine ongoing issues in program
implementation.
Prenatal program implementation
During this program year, Healthy Families Arizona began to deliver services during
the prenatal period. Information will be presented regarding the progress and
challenges in implementing services to families before the birth of their child.
Program outcomes and service delivery
This report focuses on aggregate data that is summarized across all sites that make up
the Healthy Families Arizona program. Data is presented regarding service delivery,
participant characteristics and selected outcomes for participants who received HFAz
services between the period of July 1, 2004 – June 30, 2005. This includes all families
who received services at any time during the study period regardless of when they
entered the program. Information will be provided about two new target groups,
families who enter prenatally and families who have been previously involved with
child protective services. Separate site reports are produced quarterly and provided to
each site for quality management purposes. Site level data can also be obtained in the
Appendices. In addition, this year’s report provides the initial data gathered from the
first year of implementation of the Healthy Families Parenting Inventory.

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Healthy Families Arizona Evaluation Report 2005

Program and Policy Updates
Exhibit 2 depicts some of the key program and policy changes that have occurred in the
past year.
Exhibit 2: Developments in the Healthy Families Arizona program in 2004-2005
Expansion from 23 to 51 Program Sites
The Legislature and the Governor increased Healthy Families Arizona funding
beginning in July 2004 that enabled the program to expand from 23 to 51 program sites.
The expansion was completed in three phases. Phase 1 began July 2004, Phase 2 began
October 2004, and Phase 3 began January 2005. The Phoenix area received the largest
expansion (from 7 to 22 sites) because the highest number of births in the state occurs in
Maricopa County. The Tucson area programs expanded from 4 sites to 8 total sites.
New programs were developed for the Safford, Winslow, Globe, and Bullhead
City/Kingman areas. Flagstaff, Verde Valley, Prescott and Pinal County also increased
their capacity.
Expansion of Services for Pregnant Women and their Families
Beginning July 2004, Healthy Families Arizona was able to enroll pregnant women into
the program. The sites developed arrangements with County Health Departments,
Women, Infant & Children (WIC) nutrition support programs, local obstetricians, and
prenatal clinics across the state to encourage a systematic referral system. Healthy
Families and Health Start initiated collaboration meetings both at the state and local
levels. It is anticipated that each year will demonstrate an increase in the number of
prenatal referrals received by program sites.
The Healthy Families Arizona training team members were certified as state trainers for
the prenatal curriculum, “Great Beginnings Start Before Birth” developed by Healthy
Families America in partnership with Ronald McDonald House Charities. This training
was provided to all HFAz staff beginning in August 2004 and has become an integral
component of on-going training. The prenatal training is also available to Health Start
staff beginning July 2005.
Expansion of Services for Families with CPS History
In July 1998, the Legislature added a clause to the Healthy Families law that prevented
Healthy Families Arizona from serving families with substantiated child abuse and
neglect reports. Effective August 2004, that clause was removed from the law allowing
services to be delivered to families with a history of Child Protective Services (CPS)
involvement. Healthy Families Arizona staff developed policy regarding service
coordination with CPS and guidelines for appropriate referrals. Inclusion of families
who are involved with child protective services has increased the need for additional
training and support.
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Healthy Families Arizona Evaluation Report 2005

Specialty Training to Address Challenging Issues
To assist home visiting staff with addressing difficult issues such as substance abuse,
domestic violence, mental health and other complicated lifestyle challenges, a multidisciplinary task force was convened to review the Healthy Families Arizona state
system. This task force made eight recommendations to increase the program’s ability
to both assess and address the complex issues affecting families. Three of these
recommendations included training and clinical support. As such, the Healthy Families
State Training team was awarded specialty-training units that provide additional
training to staff on “facilitating change,” substance abuse, domestic violence and mental
health. Additionally, these specialty-training units allow for each site to contract with a
clinical consultant that will participate in monthly team meetings and offer clinical
support to staff working with families. With this type of clinical support, staff will be
better able to address the multitude of challenges experienced by families in Healthy
Families Arizona.
Additionally, the Healthy Families Arizona Excellence Committee, a multi-disciplinary
committee charged to increase the quality of services across a broad spectrum of issues,
developed an advanced Individual Family Support Plan training for home visiting staff.
This training integrates the work of AzEIP (Arizona Early Intervention Program) and
Healthy Families in the process of developing family goal plans that are family-centered
and meaningful within the change process.
One of the new program functions added to the Healthy Families law is to “offer
participants education on successful marriage.” In October 2004, all staff received
training in “Successful Relationships.” The content of this training includes the benefits
of a healthy relationship for children, promoting positive communication between
partners, learning to deal with conflicts, exploring expectations about the ideal
relationship, learning to parent together, and identifying domestic violence patterns.
This training was added to the prenatal training so that all new staff will be trained.
Additionally, staff provided pamphlets to families provided by the state about healthy
marriages.
The Healthy Families Web Portal
Healthy Families Arizona launched its Web Portal in June 2005. The Technical
Assistance/Quality Assurance team recognized the administrative benefits of a web
portal versus a web site. A web site is simply a listing of information and is noninteractive. It has no record keeping capacity or ability to flag areas of non-adherence to
best practice standards. By moving from a web site to a web portal, HFAz is able to set
up a system where staff can enter the information on their training logs on-line, access
committee work and discussion boards within those committees to provide input,
register for the training offered throughout the state on-line, access distance learning
coursework and interact with each other online, post useful documents and web links
so other staff have access, and maintain administrative records regarding contract and
credentialing compliance and support. The HFAz Web Portal can be accessed by going
to http://www.healthyfamiliesarizona.org.
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Healthy Families Arizona Evaluation Report 2005

Building Bridges: Linking Research and Practice in Home Visitation Newsletter
This year the evaluation team began publishing a newsletter, Building Bridges, in order
to forge stronger connections between what is happening in the field and what
knowledge is available from the scientific community. Our mission in creating this
newsletter is simply to provide up-to-date information and analysis regarding new and
exciting advances in research and practice on home visitation, family support, and other
child and family programs. The information will be highly accessible with a focus on
ideas and information that is readily useable by the reader. The newsletter seeks to
build bridges across research, practice, training, and policy.
Each newsletter is organized around a theme.
We felt this was the best way to communicate
critical knowledge on a number of different
topics and do so in a way that would be most
beneficial. The theme of the first issue was
discipline and child maltreatment. We selected
this theme because child abuse and neglect
prevention is one of the key goals of home
visitation and discipline has a direct
relationship to child maltreatment.
The cover of this issue shows our goal—to
create an interesting and readable newsletter.
Additional themes in future issues will include:
school readiness, maternal and child health,
fatherhood, and depression.

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Healthy Families Arizona Evaluation Report 2005

Implementation of the Healthy Families Prenatal Component
The Prenatal Component of Healthy Families Arizona provides voluntary services
targeted to expectant mothers and fathers identified at-risk for child abuse and neglect
through a two-stage screening and assessment process. Family Support Specialists
provide support and referral assistance in the home on a weekly and biweekly basis,
and education based on the curriculum Great Beginnings Start Before Birth. The program
strives to assist each expectant parent to develop empathy for his or her unborn child, to
strengthen family and individual functioning, and to maximize the likelihood of fullterm delivery with minimal complications. The goal is to provide Arizona children with
the best possible start in a safe, stimulating, and abuse and neglect free environment.
The amount of impact program services can have is dependent upon the stage of
pregnancy when the parents enter the program. Late entry will still facilitate early
access once the baby is born and the possibility to educate parents on the special care
newborns require including information on SIDS, shaken-baby syndrome and how to
calm a crying baby. It also offers an opportunity to screen for postpartum depression, a
major factor in the commission of child abuse and neglect. Following birth, the family
can receive Healthy Families Arizona program services for up to five years.
During this program year, the evaluation team developed and published a program
logic model for the prenatal component. Information for the logic model was gathered
from focus groups and interviews with key stakeholders, e.g., home visitors, program
managers, supervisors, and the QA/TA team. The logic model identifies the five
program outcomes, nine key program objectives leading to those outcomes, critical
strategies and activities, and evaluation tools and resources for the program. Exhibit 3
identifies the nine key prenatal program objectives, and the full logic model is in
Appendix E.
Exhibit 3. Healthy Families Arizona Prenatal Component Objectives
• Increase the family’s support network
• Improve mother’s mental health
• Increase parents’ health behaviors
• Increase the family members’ problem solving skills
• Improve nutrition
• Increase empathy for the unborn baby
• Increase father involvement
• Increase the safety of the home environment
• Increase the delivery of healthy babies, free from birth complications
11
Healthy Families Arizona Evaluation Report 2005

Program staff hold a long-term goal of having all families who want Healthy Families
services enter the program during the prenatal period. The prenatal component of
Healthy Families Arizona represents a significant effort to design and implement
training, curricula, services and protocols for the program.
The evaluation team conducted interviews with Healthy Families program staff from
two urban and three rural areas in 5 counties in Arizona to gather perspectives about
recruitment, initial service delivery strategies and challenges, and training and
resources needed to effectively implement the prenatal program. Perspectives from
those interviews are summarized below.
Recruitment
Recruiting families into Healthy Families poses unique challenges during the prenatal
period, and program staff are experimenting with many strategies to determine what is
most effective. Staff felt the keys to successful recruitment are to 1) develop strong
relationships and support from key individuals, and 2) insure consistent, systematic
screening takes place. There was some concern that because Healthy Families is
known to serve families at risk for child abuse and neglect, referral agents might have a
tendency to informally screen out families felt to be not at risk. Program staff are
working with referral sources to insure that all families are screened and offered
services in a systematic way.
Primary referral sources include:
•
•
•
•
•
•
•
•
•
•

Prenatal clinics
School counselors
Teen parent programs
Hospitals
WIC offices
Child Protective Services
Health Department Reproductive Health Clinics
Midwives
Current families receiving Healthy Families services (word of mouth)
Healthy Families staff

12
Healthy Families Arizona Evaluation Report 2005

Referral strategies have included:
•
•
•

•
•

Presentations and outreach
Networking with local organizations (formal and informal connections)
Establishing an intake process that coincides with hospital or clinic-based
prenatal classes, birth preparation classes, obstetrical tours, or pre-admission
processes
Establishing a consistent, identifiable space for systematic screening in a hospital
or clinic
Developing and nurturing individual contacts in referral sources.

Challenges with Recruitment and Participation
Challenges to program implementation varied across the rural and urban communities.
The most obvious example of these differences was the availability of medical
providers. For more remote areas, the lack of a hospital or doctors who can care for
prenatal women meant that families had to travel out-of-county for services. This in
turn limited the number of sources for referrals to the Healthy Families prenatal
program in that area.
All sites noted that in general families are hard to reach. Even when hospitals are
utilized, the complexity (e.g., bureaucracy) of their systems sometimes delayed or
prevented straightforward access to the prenatal families they serve. The smaller
hospitals might not have space available for a Family Assessment Worker (FAW) to
meet with the mothers in order to complete the assessment process.
Several staff who were interviewed mentioned challenges for the prenatal program
start-up that can be described as “perceptual” in nature. For example, it was sometimes
difficult to obtain a clear understanding of the benefits of participation in the Healthy
Families prenatal services among staff at referral sites or the families themselves. Most
of the staff interviewed said that the mothers seemed to clearly understand the benefits
of Healthy Families after the birth of their babies, but were unclear about what a home
visitor could do for them before they had their babies. A typical question from
prospective mothers would be, “What will you do with me before the baby’s born?” It
was not an uncommon experience for a mom to refuse the program prenatally, but then
call and ask for it after the baby’s birth. One possible source of confusion might be the
information handed out about the program. The broader Healthy Families postnatal
services are described fully in program materials and the program does not as clearly
describe prenatal services and expectations in a concrete, fun way.
13
Healthy Families Arizona Evaluation Report 2005

Another challenge came from a few community providers who felt that the Healthy
Families pre-natal program might be viewed as competing or overlapping with other
services offered to mothers. This leads to some confusion both for providers and for
families when they’re unsure about the most appropriate services for the families.
Finally, there are times when a lack of “buy-in,” time, or familiarity with the program
among new referral sources seems to be a barrier. In some cases, a few individuals do
not make referrals to the program because they believe that nurse visits better serve the
prenatal families. Despite an initial enthusiasm and interest among referral providers,
Healthy Families staff report that, “They forget about us.” It is not a question of
approval or interest in the program, but of maintaining the original high level of
enthusiasm and support through meetings and contacts.
The most useful and successful strategies described by the staff revolved around
positive relationships and clear understanding of the level of effort needed to do
referrals and screening. Several said that “you have to know someone” at the hospital
or other site where most prenatal women are contacted, and offer the screening and
clear program information at that time. For agencies that offer to do the screening for
the Healthy Families program, “you have to make sure they’re prepared to do the extra
work” and consistent follow-up to encourage referrals is critical. Informing the social
workers at the hospital can be a key to success. In short, staff emphasized the need to
invest the time to make and maintain the connections with referral resources and
families to keep the program services visible and accessible.
Prenatal Service Delivery
According to staff, the services most frequently offered to prenatal parents included
nutrition and health information and referrals, information about the baby’s
development, and stress reduction. Other services included encouraging doctor’s
appointments, getting the mother to the doctor (e.g., transportation), encouraging
exercise, completing a birth plan, coaching on the importance of being ready for the
birth, providing crisis services and resource referral, and using the Great Beginnings
Start Before Birth curriculum with families. Exhibit 4 lists the most common prenatal
services offered to families.

14
Healthy Families Arizona Evaluation Report 2005

Exhibit 4. Healthy Families Prenatal Services
•
•
•
•
•
•
•
•

Nutrition and Health Information
Referrals to health and nutrition services
Information on fetal development and maternal health
Stress reduction information and skills
Transportation to prenatal doctor appointments
Completion of a birth plan
Coaching on birth process
Crisis intervention and referral

The utility of the Great Beginnings Start Before Birth curriculum was explored through
the interviews with staff. Overall, staff seemed pleased with the curriculum noting that
it provided innovative ideas, explicit information about birth plans, and “fun” activities.
Some staff found it very helpful and useful, but others felt the need to supplement it
with information from other sources such as the internet and magazines (e.g., tips and
lists from American Baby, Lamaze sites, etc.). However, at the time of interviews, not
all of the sites had the curriculum yet due to program startup, and so their views are not
included.
Staff training and resource needs
Interviews with staff regarding additional training or resources that could help with the
implementation of the prenatal component centered on two main themes: more
information and more “advertising.” The staff suggested that they could benefit from
more detailed information on:
•
•
•
•
•
•
•

the birthing process (e.g., videos)
the development of the baby
instructions for parents regarding the birth process
expectations for first-time mothers
how to deal with male doctors
recognizing potential problem births (“We know about routine pregnancies--but what about the problem pregnancies?”)
more training on how to use the curriculum.

15
Healthy Families Arizona Evaluation Report 2005

Several staff also lamented the lack of adequate mental health services and the need for
help with drug rehabilitation for the prenatal families. One requested more resources
for other types of mental health issues beyond depression, e.g., the need for an
assessment or screening tool for other issues.
The second constellation of suggestions revolved around the need for clearer
understanding and communication about the benefits of the Healthy Families prenatal
program. “We need help to get the word out.” Suggestions included the need for
assistance with redoing brochures and producing flyers and other methods to raise
awareness about the program (e.g., billboards, TV commercials). Staff also wanted
training on how to describe the program to make it more interesting and enticing to
potential clients. One person even suggested the possibility of offering pregnancy tests
as a way to get potential mothers in the program.
In summary, although outcome data for the prenatal component is limited during this
startup year, Healthy Families Arizona has established the staff training, recruitment
and referral processes, and initial home visiting services needed to bring families into
the program during the prenatal period. A continued focus on recruitment and
engagement into the prenatal program is needed that identifies specific strategies to
make the program attractive to pregnant women. In addition, more training and
materials in prenatal issues would likely build the confidence and skills among home
visitors in dealing effectively with families who enter Healthy Families during the
prenatal period.

16
Healthy Families Arizona Evaluation Report 2005

Healthy Families Arizona Program Services
Healthy Families Arizona is a home visitation program designed to provide supportive
services and education to parents of newborns and to expectant parents who might
benefit from support to strengthen their families at this crucial time. The overarching
goals of the program include:


To promote positive parent/child interaction



To improve child health and development



To prevent child abuse and neglect

Families are selected via a screening process that begins in the hospital or community
organization serving families in the prenatal period. If the parent experiences multiple
risks (based on factors known to be associated with child abuse and neglect), the family
is offered program services. The program is voluntary, and the families may remain in
the program for up to five years. In 2004-2005, two changes in policy expanded the
program to serve two new target groups—expectant families and families with prior
histories of child abuse or neglect.
Healthy Families Arizona has built its program model to incorporate the critical
elements identified by Healthy Families America (HFA) as well as the mandated
services established by Arizona legislation.

Program Participants
During the period of July 2004 through June 2005, a total of 3,655 families were enrolled
in the Healthy Families Arizona program. Of these, 3,096 families became actively
engaged in the program, 1 with 2,735 enrolling after the birth of their child and 361
enrolling during the prenatal period. Twenty-six families who enrolled in the program
had histories of child abuse and/or neglect (23 postnatal and 3 prenatal).
During 2004-2005, Healthy Families expanded steadily throughout the year to a total of
51 sites. Exhibit 5 shows the number of participants served by each site during 20042005. The number of participants varies widely during start-up as sites came on board
at different times.

1

Actively engaged families are defined as those who participate in four or more visits.

17
Healthy Families Arizona Evaluation Report 2005

Exhibit 5. Healthy Families Arizona Participants Enrolled and Actively Engaged,
by Site July 2004 - June 2005
County
Cochise
Coconino

Gila
Graham
Maricopa

Mohave

Navajo
Pima

Pinal

Santa Cruz
Yavapai
Yuma

Site
Douglas/Bisbee
Sierra Vista
Flagstaff (La Plaza Vieja)
Page
Tuba City
Williams (Kinlani)
Globe/Miami
Safford
Central Phoenix
Deer Valley
East Mesa
East Valley Phoenix
El Mirage/Surprise
Gilbert
Glendale
Kyrene
Maryvale
Mesa
Metro Phoenix
Scottsdale
South Mountain
South Phoenix
Southeast Phoenix
Sunnyslope
Tempe
Tolleson/Avondale
Bullhead City
Kingman
Lake Havasu City
Winslow
Blake Foundation
Casa de los Niños
Child & Family Resources
CODAC
East/SE Tucson
La Frontera
Marana
Pascua Yaqui
Southwest Tucson
Apache Junction
Gila River
Pinal County
Stanfield
Nogales
Prescott
Verde Valley
Yuma

Prenatal
3
14
18
3
7
20
3
6
8
3
15
8
5
9
5
3
6
9
9
4
7
9
4
3
3
2
2
4
9
5
6
4
0
8
3
6
2
21
2
24
13
11
7
6
10
28
4

Postnatal
89
70
65
43
40
35
21
16
108
17
42
82
54
54
43
39
74
137
63
36
25
71
95
106
24
37
19
30
100
10
73
102
11
115
12
138
28
57
29
21
4
94
9
106
135
76
80

Prenatal Total
All Sites = 361
Postnatal Total
All Sites = 2,735
*Italicized sites are new
sites started between
July 2004-June 2005

18
Healthy Families Arizona Evaluation Report 2005

The families that participate in the Healthy Families Arizona program enter the
program because they have many stresses in their lives. The stressors constitute risk
factors that have been associated with increased risk for child abuse and neglect, as well
as poor child health and developmental outcomes (LeCroy & Milligan Associates, 2001).
Exhibit 6 highlights the risk factor data for both the prenatal and postnatal program
participants in the Fiscal Year 2005, as compared to the general Arizona population.
Exhibit 6. Selected Risk Factors for Mothers at Intake--2005
Risk Factors of Mothers

Prenatal
Families

Postnatal
Families

Arizona—2003

Teen Births (19 years or less)

28.6 %

28%

13%*

Births to Single Parents

68.7%

69.3%

41%*

Less Than High School
Education

67.1%

62.5%

30%*

No data

83.7%

NA

No Health Insurance

7.3 %

2.1%

NA

Receives AHCCCS

84.2%

88.5%

50.4%*

Late or No Prenatal Care

32.1 %

34.4%

22.9%*

Median Yearly Income

$10,560

$9,600

$42,590**

Not Employed

*Source: 2003 data from the Arizona Department of Health Services Vital Statistics records. Percent does not
include “unknown”.
**U.S. Census Bureau Population survey 2002-2004. Three Year Average median family income for
families with related children at home
Note: Percentages for the combined total for Prenatal and postnatal families can be found in Appendix F.

These data illustrate that the screening process is recruiting the population targeted by
Healthy Families Arizona—those with multiple risk factors. Both the prenatal and
postnatal programs are successful in reaching single, teen mothers with less than a high
school education. Healthy Families participants consistently show notably higher rates
of these risk factors than the overall rates for Arizona families. Overall, data revealed
that the prenatal mothers were younger (average age 22.6 years) than the postnatal
mothers (average age 24 years), indicating that recruitment is successfully recruiting
younger mothers. In general, the characteristics of mothers served this year are quite
similar to previous years. With median incomes between $9,000-$10,000 it is clear that
economic stress and poverty continue to pervade families’ lives.

19
Healthy Families Arizona Evaluation Report 2005

Analysis of the twenty-three families in this year’s cohort who came into the postnatal
program with histories of substantiated child abuse and neglect revealed even higher
rates of risk factors among this group. Among these mothers, nearly half (43.5%) had
no or inadequate prenatal care; 75% had not graduated high school; and their annual
median income was much lower--$3990. Other risk factors were very similar to the
other groups.
Healthy Families Arizona continues to serve a culturally diverse population. The ethnic
makeup of the families who entered prenatally and postnatally in 2005 are shown
below in Exhibits 7 and 8.
Exhibit 7. Ethnicity of Mothers Enrolled Prenatally (N=356)

Other/Mixed
8%

Native American
15%

White/Caucasian
30%

African American
7%
Hispanic
40%

Exhibit 8. Ethnicity of Mothers Enrolled Postnatally (N=2704)

Native American
8%

Other/Mixed
3%

African American
6%

White/Caucasian
27%

Asian American
1%
Hispanic
55%

20
Healthy Families Arizona Evaluation Report 2005

Healthy Families Arizona continues to put effort into encouraging and supporting
father involvement. During this year, ethnicity data was gathered on 320 prenatal
fathers and 2440 postnatal fathers. The ethnic breakdown of fathers is displayed below.
Exhibit 9. Father Ethnicity-- Prenatal Families (N=320)

Native American
14%

Other/Mixed
6%

White/Caucasian
26%

African American
10%

Asian American
0.3%
Hispanic
44%

Exhibit 10. Father Ethnicity-- Postnatal Families (N=2440)

Native American
7%

Other/Mixed
3%

White/Caucasian
23%
Asian American
0.4%

African American
8%

Hispanic
58%

In addition to collecting basic demographic information during the screening process,
families (mothers, and fathers when they are involved) are assessed using the Family
Stress Checklist. During the 2005 program year, the Family Stress Checklist was
revised and renamed the Parent Survey to impart a more strengths-based perspective
with staff and families; however the rating scale remains the same. At intake, the Family
Assessment Worker evaluates each parent’s level of stress in 10 domains. The
percentages of parents scoring severe on each of the scales are presented in Exhibit 11.
21
Healthy Families Arizona Evaluation Report 2005

Exhibit 11. Percentage of Parents Rated Severe on the Family Stress Checklist Items
PRENATAL (N= 361 mothers; N= 361 fathers)
Childhood Abuse
Crime, Substance Abuse, Mental Illness
Self-esteem, Isolation
CPS Involvement
Current Life Stresses
Violence Potential
Expectations of Infant
Discipline Attitudes

Mom

Difficult Child

Dad

Parental Attachment
0

10

20

30

40

50

60

70

80

90

100

Exhibit 12. Percentage of Parents Rated Severe on the Family Stress Checklist Items
POSTNATAL (N=2734 mothers; N=2735 fathers)
Childhood Abuse
Crime, Substance Abuse, Mental Illness
Self-esteem, Isolation
CPS Involvement
Current Life Stresses
Violence Potential
Expectations of Infant

Mom

Discipline Attitudes
Difficult Child

Dad

Parental Attachment
0

10

20

30

40

50

60

70

80

90

100

22
Healthy Families Arizona Evaluation Report 2005

As in previous years, the most significant stressors are coping with a history of child
abuse, having low self-esteem, feeling isolated, and dealing with current life stress,
including low income, poor housing, and relationship difficulties. In addition, many
families enter the program with risks related to crime, substance abuse and mental
illness. Although the kinds of stressors affecting parents who enter prenatally are
similar to those who enter the program after the birth of their babies, overall the
percentage of severe stress scores is slightly higher for the prenatal families, indicating
that the program is reaching the mothers that might most benefit from the earlier
services by reducing stressors before the new baby arrives.
Not surprisingly, for those families who entered the postnatal program with histories of
prior child abuse and neglect incidences, the same pattern of more severe stress scores
is evident. These mothers scored higher on stressors such as childhood abuse, histories
of crime, substance abuse and mental health issues, and problems with isolation and
self-esteem.
As the Healthy Families Arizona program has matured, more and more training
emphasis is being placed on increasing home visitors’ knowledge and skills in
addressing these most difficult risk factors with families.

Infant Characteristics
During the Healthy Families screening process (or following the birth of the baby for
prenatal families), program staff assess the risk factor characteristics of the newborns.
Having an infant with health problems increases the potential for child abuse and
neglect in families. The challenges to new parents can be overwhelming. Infants who
are born weighing less than 2,500 grams are at a greater risk for many problems
including death within the first month of life, developmental disabilities and a myriad
of health problems throughout their lives such as chronic lung disease, adult-onset
diabetes, coronary heart disease, high blood pressure, intellectual, physical and sensory
disabilities, and psychological and emotional distress. Babies born to mothers who
have abused alcohol and other drugs during pregnancy face similar health problems.
The costs to the parents of having a drug-affected, premature or low birth weight baby
can be huge—not only financially but emotionally as well. Seeing their baby struggling
for life or not being able to take their baby home from neonatal intensive care is
extremely stressful to new parents.
23
Healthy Families Arizona Evaluation Report 2005

The Healthy Families prenatal component aims to deter some of these risk factors by
assuring good prenatal care, and the postnatal program supports parents during these
difficult times. Exhibit 13 displays the high-risk characteristics of the newborns among
families who entered prenatally and postnatally.
Exhibit 13. Risk Factors for Infants at Intake--2005
Risk Factors for Infants

Prenatal Families

Postnatal Families

Arizona State
percent

Born < 37 weeks gestation

20.2%

16.6%

11%*

Birth Defects

1.6%

1%

1%*

Low Birth Weight

10.7%

12.7%

7.1%*

Positive Alcohol/Drug
Screen

3.1%

1.9%

NA

*2003 data from the Arizona Department of Health Services Vital Statistics records

The percentage of Healthy Families Arizona infants born early (less than 37 weeks
gestation) has increased from the 2004 percentage (13.9%) of Healthy Families
participants, and it is nearly twice as high as the state rate. The percentage of low birth
weight infants in the program is about the same as previous years, but again remains
high in comparison to the state rates. It is apparent that Healthy Families is reaching
parents and babies who have greater risks leading to child abuse and neglect and other
unhealthy outcomes. As the prenatal component of the program grows, the Healthy
Families Arizona home visitors have a great opportunity to help mothers prevent
having pre-term or low birth weight babies by encouraging parents to attend regular
prenatal visits and adopt healthy behaviors such as good nutrition habits and stopping
alcohol, drug and tobacco use.

24
Healthy Families Arizona Evaluation Report 2005

Service Delivery
In examining service delivery, participant retention and participant satisfaction, it is
helpful to focus on the context of program growth this year. With the initiation of the
prenatal component of Healthy Families, new services were developed and
implemented. As new sites started up, they faced the challenge of hiring and training
staff in the program service model, and insuring documentation of services and
activities. The development of the program logic model was an additional tool to help
staff focus on the most important strategies for each component. New quality
assurance forms have been developed and implemented to better track service delivery.
To reach the overall goals of reducing child abuse and neglect, success will be more
likely when the program ensures that families stay engaged in the program, receive the
services they need, and are satisfied with the program. Each of these aspects of the
program will be reviewed in the following section.
During the study year the total number of families served by the program was 3,655.
However, not all families who initially enroll become actively engaged in the program.
Successful program engagement is defined as those families who complete 4 home
visits. A breakdown of the total families enrolled in Healthy Families Arizona reveals
that:
•
•
•
•

2,735 postnatal families became actively engaged, with 23 of these families
having a prior CPS history
469 postnatal families terminated before 4 visits (none had a prior CPS history)
361 prenatal families became actively engaged
87 prenatal families terminated prior to 4 home visits, with three of these families
having prior CPS history.

This year marked the first year that families with a CPS history were served because of
the change in the Healthy Families legislation. Because the families exhibited increased
risk factors, staff thought they might be more difficult to engage in the program, but
data shows that all the families were successfully engaged. Overall the engagement
rate among families who entered postnatally is 85.3 percent. This is lower than the rate
from the previous year (90.7%), but still represents a significant engagement rate. Part
of the explanation for the lower rate may stem from the challenges associated with
program startup in many of the new sites.

25
Healthy Families Arizona Evaluation Report 2005

For prenatal families, the engagement rate is lower—80.6 percent. Some of the
challenges in recruitment were described earlier in this report and it will be important
to examine engagement of prenatal families more fully next year when the program
model is more mature.
Families who terminated from the program prior to completing 4 home visits, when
compared to engaged families are:
•
•
•

More likely to be single (postnatal)
More likely to have a criminal history, be involved with illegal substances, or
suffer from some form of mental illness (prenatal and postnatal)
More likely to suffer from current life stresses (prenatal and postnatal).

The length of time families stay in the program continues to increase. Only data on the
postnatal families are reported because so few prenatal families had left at the time of
this report. For the group (N= 662) that terminated during the past year, 66% had been
in the program over 12 months, compared to 63% last year. This rate of retention points
to the continued emphasis given by Family Support Specialists to building a solid
relationship with each family.
The most frequently given reasons for terminating from the program include:
1)
2)
3)
4)
5)
6)

moved away (23.5%)
unable to contact (15.9%)
did not respond to outreach (14.7%)
completed program (12.7%)
reported self-sufficiency (10%)
declined worker change (7.3%).

An important aspect of the Healthy Families program model is linking families with
needed community resources. While much of the home visitor’s activity is provided in
the home in terms of child development education, coaching and modeling bonding,
and so on, equally important is the home visitor’s efforts to connect the family to other
resources in the community. While some Healthy Families sites exist in communities
with adequate resources, others are in communities with very limited support resources
for families. A common problem noted among more rural sites is that there are not
enough options for families who need help, or transportation is a significant barrier as
they have to travel to other communities to access resources.
26
Healthy Families Arizona Evaluation Report 2005

During this program year, the Healthy Families program made several changes in the
types of data collected regarding service delivery, as program staff wanted to better
track the types of external resource referrals made by home visitors and the outcomes of
those referrals in terms of services actually received. Data is limited for this year due to
changes in data collection forms and new sites starting up at different times. Exhibit 14
below illustrates the types of referrals made by Family Support Specialists for those
families who are served at the 6, 12, and 18-month intervals. The largest percentage of
the referrals fall into the “Other “ category, indicating the data collection tool may not
be capturing the types of service referrals that are commonly made.
Exhibit 14. Types of Healthy Families referrals at six, twelve and eighteen months
Types of referrals
at 6-months
(N=836)

Types of referrals
at 12-months
(N=371)

Types of referrals
at 18-months
(N=154)

Health Care

13%

13%

12%

Nutrition Services

6%

6%

2%

Public Assistance

17%

13%

14%

Family and Social
support

13%

13%

16%

Employment,
Training and
Education

15%

10%

12%

Counseling and
support services

7%

10%

5%

Other

30%

34%

38%

Service referrals

27
Healthy Families Arizona Evaluation Report 2005

Participant Satisfaction
One aspect of program implementation, especially with a voluntary program like
Healthy Families, is the satisfaction family members express about their participation.
Healthy Families program sites distribute a satisfaction survey to participants during a
two-month time period each year. For this program year, 517 surveys were returned
from 23 sites. This is a large number of families, but they cannot be considered
representative of all families served by the program; nonetheless it provides important
information about the program. A separate Satisfaction Report (LeCroy & Milligan
Associates, 2005) was completed for program staff about a variety of satisfaction
questions, and that analysis revealed high satisfaction in all areas of the program. For
this report, only several critical areas are highlighted below.
Two key components of the Healthy Families model are 1) the use of the Individual
Family Support Plan (IFSP) to set concrete goals with participants and 2) the teaching of
child development and parenting skills. Exhibit 15 and 16 show that participants feel
quite satisfied with the child development materials and understand the service plan
(IFSP).
Exhibit 15. Responses to “I understand when the home visitor explained the family
service plan to me.”
Sometimes
3%

A little
1%

Never
0%

A lot
30%

Alw ays
66%

28
Healthy Families Arizona Evaluation Report 2005

Exhibit 16. Responses to “I was satisfied with information provided on child
development and parenting.”

A lot
23%

Sometimes
3%

A little
1%

Never
0%

Always
73%

A large percentage of HFAz participants speak or use Spanish as their primary
language. It is critical that home visitors speak the families’ language and program
materials are translated appropriately and in a culturally respectful manner.
Participant responses regarding the relevance of program materials are shown below in
Exhibit 17.
Exhibit 17. Participants’ perception of usefulness and responsiveness of Healthy
Families services (For questions 3 and 4, on a five point scale, percentages shown are “a lot”
and “always” combined)
Did home visitor speak your language?

96.6%

Were program materials in your language?

95.6%

Home visitor was respectful of my cultural
beliefs.

97.5%

I received the services I wanted and needed.

95.8%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

In summary, all of the participant satisfaction data suggest the program is well received
by the participants. This is particularly important for a voluntary program.
Furthermore, program satisfaction is a first step in producing program outcomes.
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Healthy Families Arizona Evaluation Report 2005

Program Outcomes
One of the consistent criticisms of home visitation programs has been that there is
insufficient data regarding the specific outcomes related to the program model. The
development of the Healthy Families logic models and the Healthy Families Parenting
Inventory (HFPI) are helping HFAz better measure specific outcomes by clearly linking
measures to known risk factors and indicators of child abuse and neglect. These
indicators include program impact on child abuse and neglect, parental stress and
competence, health risk behaviors, parental depression, parent-child bonding, safety
practices, medical and social service use, employment, education attainment, and
others.
Program Logic Model
Over the last year, two logic models were developed for the Healthy Families Arizona
program—one for the postnatal services and one for prenatal Services. Both logic
models are included in Appendix E & F. The logic model process brought together
stakeholders to work together to clarify the underlying rationale for the programs, the
most important outcomes for prenatal and postnatal families, the activities and
processes that will lead to these outcomes, and ways to measure the outcomes.
Through this process, gaps in assumptions about outcomes, program activities and
evaluation measures were revealed, resulting in changes and refinements in program
services and evaluation measures. The process of developing and sharing the program
logic models serves to build a common understanding of the logical connections
between the program components—that is, how program activities will lead to the
accomplishment of objectives and goals. In addition, the logic model includes the
measures that will be used to determine if the activities were carried out as planned
(process measures), and if the program’s goals were met (outcome measures).
The following Exhibit identifies the primary objectives of the prenatal and postnatal
logic models and the data source for measuring outcomes related to each objective.
Some tools are still being developed or refined.

30
Healthy Families Arizona Evaluation Report 2005

Exhibit 18. Program Objectives and Data Sources
Objective
Increased Social Support Network
Improved Mental Health

Increased Parents’ Health Behaviors
Increased Problem Solving Skills
Improved Family Stability
Increased Parental Competence
Increased Positive Parent/Child
Interaction
Improved Child Health

Optimized Child Development
Prevention of child abuse and neglect
Increase empathy for the unborn child
(prenatal)
Increase father involvement
Increase safety in the home
environment
Increase the delivery of healthy babies,
free from birth complications
Improve nutrition

Data Source
HFPI* Social Support Scale
HFPI Depression Scale
HFPI Personal Care Scale
FSS-23** Services received
FSS-23-Link to Medical Doctor
Substance Abuse Screen (CRAFFT)
HFPI Problem Solving Scale
FSS-23—Employment, Education
HFPI Mobilizing Resources Scale
HFPI Parental Competence Scale
HFPI Parenting Efficacy Scale
HFPI Parent/Child Behavior Scale
FSS-23 --Immunizations
Link to Medical Doctor
Safety Checklist
HFPI—Parent child Interaction
ASQ Screening
CHILDS Registry Check
Total HFPI score
HFPI-prenatal
HFPI—Commitment to Parent Role
Father Involvement levels
HFPI—Home environment
Safety Checklist
FSS-20P; FSS-23
In development

*Healthy Families Parenting Inventory
**FSS-23 is a Healthy Families Arizona tool developed to collect process and outcome
data every six months.

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Healthy Families Arizona Evaluation Report 2005

In the last year, Healthy Families Arizona made some significant changes in the way it
collects program process and outcome data. For example, the Parenting Stress Index
has been replaced by the Healthy Families Parenting Inventory (HFPI). A review of
other tools resulted in changes to the FSS-23 data collection form in order to collect
information that will more accurately measure both process and outcomes related to the
program objectives listed above. For example, as mentioned earlier, the program has
begun to collect data on referrals made/recommended for the families in the program.
As a result of the new forms and recent introduction of these data collection efforts, and
the inexperience of the new personnel associated with expansion, some of the data is
limited.
For 2005, the following outcomes were examined:
•
•
•
•

Parent outcomes, e.g., parental stress, (Healthy Families Parenting Inventory)
Child and Maternal health outcomes
Safety in the home environment
Child Abuse and Neglect.

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Healthy Families Arizona Evaluation Report 2005

Child and Family Health and Parenting Outcomes
Development and Implementation of the Healthy Families Parenting Inventory
(HFPI)
Last year the evaluation team initiated the development of a new outcome instrument,
the Healthy Families Parenting Inventory (HFPI) in place of the Parenting Stress Index.
While various instruments have been used in past research and evaluation of home
visitation programs, most are ill equipped to capture the actual changes made by
participants. This is because many of the existing instruments were not designed as
outcome instruments but rather instruments that measure concepts, like family stress. By
focusing on outcomes and designing an instrument specifically for the Healthy Families
program we believe better outcome data can be generated for the evaluation.
The development of the HFPI was guided by several principles: the actual practice as
conducted by home visitors in the Healthy Families Arizona program; data gathered
directly from home visitors, supervisors, and experts; information obtained from
previous studies of the Healthy Families program; and examination of other similar
measures. The process included focus groups with home visitors, the development of a
logic model, and an extensive review of relevant literature. The final instrument
includes 10 scales that were tested for reliability. The final result is an inventory that is
specific to Healthy Families, captures change initiated by the program, and has good
reliability data. The average reliability across the ten subscales is .83. (See Appendix C
for specific reliability data).
Although the use of the HFPI is new, there is enough data on participants to report the
results of changes from the two month (N=974) and six month (N=638) administration
of the instrument. Exhibit 19 presents each subscale and the results of the statistical
analysis of changes in parents from two months to six months.

33
Healthy Families Arizona Evaluation Report 2005

Exhibit 19. Healthy Families Parenting Inventory
Scale

Significant
Improvement
Baseline to 6
months

Social Support

Significance

.232

Problem Solving

U

.013*

Depression

U

.036*

Personal Care
Mobilizing Resources

.348
U

Commitment to Parent Role

.001*
.106

Parent/Child Behavior

U

.002*

Home Environment

U

.001*

Parenting Competence

U

.000*

Parenting Efficacy

U

.008*

Total Scale

U

.001*

*Indicates a significant difference at the .05 level. (Statistical significance indicates the results of
the analysis could only be due to chance in 5 out of 100 cases.)
As Exhibit 19 shows, seven of the ten scales, plus the overall scale, showed a statistically
significant difference in the families between the two month and six month
administration of the instrument. Families are showing significant improvement on
most of the scales that indicate healthy parenting. Because some of the scales measure
new aspects of the program’s outcome, it is encouraging to see these positive outcomes.

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Healthy Families Arizona Evaluation Report 2005

Child Abuse and Neglect
The following exhibit presents data for families who were active in Healthy Families
during the period of July 1, 2004 to June 30, 2005 and who had been in the program at
least six months. The percent of families having a substantiated incidence of child
abuse or neglect since entering the program is compared with the previous two years’
rates. In addition, analysis was conducted to determine if the new policy of accepting
families with prior histories of substantiated reports may have had an impact on the
rate.
For the total families served by Healthy Families in 2005, 98.2 percent had no
substantiated reports of child abuse or neglect. The data show that if families with prior
CPS histories are removed from the analysis, the percent of families without
substantiated reports is 98.3 percent—essentially the same as last year. For those
engaged families with a prior CPS history, 92.3 percent had no further reports.
Exhibit 20. Percent of families showing NO child abuse and neglect incidences
Percent without
substantiated
report
2003

Percent without
substantiated report
2004

Percent without
substantiated
report
2005 (N=1814)

All Families

99.0

98.4

98.2

Families without
prior CPS history

99.0

98.4

98.3

Families with a
prior CPS history

Not served

Not served

92.3

Group

As more families with previous CPS histories are accepted into the program in future
years there may be a negative impact on the rate of child abuse and neglect since many
of these families are at higher risk for abuse and neglect. As stated in previous years,
the CPS match data should be treated with caution. Child abuse and neglect rates may
not be good measures of short-term program impact for several reasons, including:
•
•
•

Child abuse and neglect are low occurring events, and small changes in short
periods of time may not be representative of long term effects;
Many incidents of child abuse and neglect go unreported, which calls into
question the reliability of the data;
Families in the program may be under increased surveillance, and this may
result in increased reporting.
35

Healthy Families Arizona Evaluation Report 2005

Safety Practices
Both the prenatal and postnatal program components seek to help families develop and
maintain a safe home environment for their children. The area of program emphasis
can be one of the most instrumental ways of assuring reduced injuries due to neglect in
the home and car. Home visitors continue to administer the home safety checklist at a
high rate during the families’ tenure with the program. The following exhibit shows the
data for postnatal families in critical areas of safety as the child grows.
Exhibit 21. Percent of families implementing safety practices
2
Month

6
Month

12
Month

18
month

24
month

Outlets
Covered

47.8%

65.5%

75.6%

80.9%

82.9%

Poisons
Locked

83.9%

90.0%

93.2%

93.6%

93.1%

Smoke Alarms

84.5%

89.5%

87.1%

84.7%

90.0%

Car seats

99.4%

99.4%

97.0%

97.0%

98.0%

The numbers of families implementing the various safety practices when the child is
very young remains very similar to previous years. Continued attention to safety
practices during the infant years is needed, particularly with smoke alarms, electrical
outlets and poisons.
The program excels in assuring infants and children are secured in car safety seats.
However, as the child begins talking and resisting (a common problem at three years),
home visitors need to coach parents on maintaining car seat use through much of
elementary school. The data also show clearly that as the child becomes more mobile at
12-24 months, appropriate safety practices increase steadily. Additional data shows
that by the age of three, 98% of families display emergency phone stickers, 98% of
families supervise their children during play, and 98.9% insure pool safety.

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Healthy Families Arizona Evaluation Report 2005

Promoting family members health behaviors and child health are key objectives of
both the prenatal and postnatal components of Healthy Families Arizona. The
immunization rate for the children is one of the indicators used to measure this
objective. Exhibit 22 shows the rate for the infants of Healthy Families participants for
2005 and 2004. This year’s data shows that there has been a slight decrease in
immunizations at each period. It is unknown whether this is a data collection problem
due to new site startup or whether families are not getting the immunizations. Healthy
Families supervisors and staff should maintain high expectations for immunization
completion. Overall, Healthy Families Arizona families continue to have their children
immunized at a rate greater than the Arizona percentages.
Exhibit 22. Immunization Rate of Healthy Families Arizona Children
Percent
Immunized
Postnatal 2005

Percent
Immunized
Postnatal
-2004

2 month

92.7%

96.7%

4 month

90.2%

94.3%

6 month

82.3%

87.1%

12 month

92.1%

95.9%

Received all 4 in
the series by 2
years old.

89.1%

94.0%

Immunization
Period

Immunization Rate for
2-year-olds in Arizona
(2004)*

77.0%

*Source: 2004 data from the Arizona Department of Health Services

A second way to look at the goal of ensuring the families receive adequate medical care
is to look at the percentage of children linked to a medical doctor. The data reveal a
substantial number of the children linked to a medical doctor.
Exhibit 23. Percentage of Children Linked to a Medical Doctor

Percent of children with
medical home

6 months

12 months

18 months

24 months

98.6%

97.1%

98.7%

96%

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Healthy Families Arizona Evaluation Report 2005

Equally important to the need for quality care of the child is the need to ensure the
parent receives appropriate health care. Health care for parents can contribute to better
family planning and early identification of problems such as depression or domestic
violence—all problems that affect the health and well-being of the entire family. This
year, more than 80 percent of the parents report they have a primary care physician
after they’ve been in the program eighteen months.
One of the keys to achieving the high rate of success in both immunizations and linkage
to physicians is continued emphasis by supervisors and regular feedback to the sites.
Data regarding the immunization rates and the linkage to a doctor are reported
regularly to the sites via the Healthy Families Arizona Quarterly Family Data Report,
which is used by the sites as an on-going quality assurance tool. The quarterly reports
provide timely information about which families need support in medical and health
care.
Child Development
The program uses the Ages and Stages Questionnaire (ASQ) as a screening tool for
developmental delays. Approximately three quarters of all children are screened for
developmental delays. There has been a slight decrease in the numbers who receive the
ASQ from the previous year, and this is likely due to program expansion as new
workers have much to focus on during their first year and data collection is new to
them. However, a primary objective of Healthy Families is to promote child
development and this is an area for increased attention. The data show a similar
pattern to the previous year in that the percentage of children screening as delayed
increases with age.

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Healthy Families Arizona Evaluation Report 2005

Exhibit 24. ASQ Screening
Percent of children

Percent of

Percent screened

Interval ASQ

screened with

children screened

as delayed 2005

Administered

ASQ

with ASQ

2004

2005

6-Month

81.0 %

72.4 %

5.6 %

12-Month

80.6 %

78.8 %

4.6 %

18-Month

73.3 %

72.0 %

19.9 %

24-Month

76.1 %

72.3 %

22.1 %

30-Month

75.1 %

71.6%

16.5 %

36-Month

NA

73.3%

20.9%

48-month

NA

66.7%

31.4%

If the ASQ indicates a potential delay, it is important to ensure further assessment is
made to determine the proper course of action. Continued assessment often indicates
no delay is evident. Approximately one-fourth to one-fifth of the children who initially
screen delayed with the ASQ are determined to be “not delayed” when referred for
further assessment.
In other cases, further assessment indicates that additional intervention is needed, and
appropriate referrals need to be made or the Family Support Specialist needs to focus
on appropriate development interventions with the child and family. The pattern of
services received is similar to last year with referral to the Arizona Early Intervention
Program (AzEIP) being the most common external resource used. It is notable that as
potential delays are identified when the child gets to be three to four years old, a more
common intervention choice becomes the Family Support Specialist providing a
developmental intervention at home with the parent and child (61% at 36 months and
72% at 48 months report providing this service). This may indicate an appropriate use
of child development curricula in the Healthy Families program model, as the home
visitor becomes more familiar with the child and family over the course of service.
Further exploration into this aspect of the program model may illuminate how these
professional choices are made. Exhibit 25 illustrates the types of referrals and services
received by families with children exhibiting delays.

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Healthy Families Arizona Evaluation Report 2005

Exhibit 25. ASQ Referral Status—2005
Continued
assessment
shows “no
“Delay”

Referred to
AzEIP

Referred to
other Early
Intervention

Provided
Developmental
Intervention

Referred
to
Therapy

Parent
Declined
Referral

% (N)

% (N)

% ( N)

% (N)

% (N)

% (N)

6month
Screen

27% (7)

19% (5)

19% (5)

38% (10)

4% (1)

4% (1)

12month
Screen

18% (3)

18% (3)

18% (3)

53% (9)

0% (0)

0% (0)

18month
Screen

39%(16)

24% (10)

10% (4)

37% (15)

2% (1)

5% (2)

24month
Screen

21% (7)

44% (15)

9% (3)

35% (3)

6% (2)

0% (0)

36month
Screen

17% (2)

35% (8)

17% (4)

61% (14)

4% (1)

0% (0)

48month
Screen

19%(6)

16%(5)

3%(1)

72%(23)

0%(0)

3%(1)

Note: percents do not equal 100% as multiple referrals can happen for a single child

Mother’s Health, Education and Employment
The Healthy Families Arizona program focuses on the health and well-being of the
parents as well as children. Each year, the evaluation examines the health and wellbeing of participating mothers in outcomes such as subsequent pregnancies, education,
and employment.
During the study period, 11.5 percent of the mothers who entered postnatally reported
subsequent pregnancies, compared to 15% in 2004. Of these, 27.9 percent were 18 years
or younger, compared to 29% in 2004. Exhibit 26 shows the length of time to
subsequent pregnancy for active families during each year.

40
Healthy Families Arizona Evaluation Report 2005

Exhibit 26. Length Of Time To Subsequent Pregnancy
Length of Time to
Subsequent Pregnancy

2005
Percent of mothers

2004
Percent of mothers

1 to 12 mos.

33.3%

31.6 %

13 to 24 mos.

42.3%

42.3 %

Over 24 mos.

24.4%

26.1 %

Parents who participate in Healthy Families Arizona may desire to complete or further
their education. Home visitors provide links and support to finish GED programs, or
enroll in vocational or college education programs. Exhibit 27 displays the percentage
of mothers enrolled in school full or part-time at different intervals.
Exhibit 27. Percent of Mothers enrolled in school
6 month (N=437)
12 month (N=345)
24month (N=162)
36 month(N=141)

Percent enrolled part-time
4.6%
6.3%
5.0%
6.3%

Percent enrolled fulltime
9.3%
12.7%
7.8%
8.4%

Exhibit 28 shows the employment status of mothers actively engaged in the program at
various points in the program as compared to 2004. While the mothers employed at
baseline is the same as 2004, those employed at six and twelve months show slight
increases over 2004, with 35% employed full or part-time at 6 months, and 39%
employed at 12 months.
Exhibit 28. Mother’s employment status

Percent Employed

100.0%
2004

80.0%

2005

60.0%
40.0%
20.0%
0.0%
Baseline

6 months

12 months

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Healthy Families Arizona Evaluation Report 2005

Substance Abuse Screening
Alcohol and other substance abuse is a significant risk factor for child abuse and
neglect. As illustrated in the program logic model, the primary roles of the home visitor
are to help identify and assess when alcohol or other drug abuse may be affecting the
family, educate about risky and healthy choices and make referrals for support or
treatment services if appropriate. In the past years the CAGE assessment instrument
was used, but was not well received by home visitors. After an evaluation review, the
CRAFFT screening tool was chosen this year as a replacement, in hopes that it would
screen effectively for substance abuse problems while at the same time promoting
communications. The brief alcohol and drug-screening test is known by a mnemonic,
CRAFFT, based on the first letter of keywords in the 6 easy-to-remember questions.
It is a widely used assessment instrument and has acceptable reliability and validity
data. It is particularly intended for young adults and adolescents. It consists of a series
of questions that are intended to allow the home visitor and parent to have a
conversation about substance use and abuse. While a positive screen doesn’t
necessarily indicate a substance abuse problem or alcoholism, it may be an important
signal to Healthy Families staff about the need for further discussion or referral.
Routine use of an appropriate screen may reduce the stigma associated with asking
questions about substance use and in turn, help families seek help more readily.
The data indicate that only 25-33% of the families are screened using the CRAFFT
depending on the interval examined (6 months, 12 months, etc). Of those, none were
identified as having a positive screen. Again, because this is a new instrument
introduced within a year of rapid expansion, it has not been fully implemented. This
represents a significant issue for the program, given the recent emphasis on substance
abuse issues. In response to the need for further training in this area, in 2004-2005 the
program developed and began implementing training workshops in motivational
interviewing and facilitating change to increase the skills and comfort of the Family
Support Specialists and supervisors in addressing these difficult issues.
To explore substance abuse and other difficult family issues, the evaluation team has
examined the ways in which home visitors decide how to address significant issues
with families. A summary of this year’s process study follows.

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Healthy Families Arizona Evaluation Report 2005

Decision- Making Study
Over the years, the HFAz evaluation effort has conducted several special process
studies in order to better understand program implementation. For example, the
“problematic situations” study (LeCroy & Whitaker, 2005) sought to identify very
specific problematic situations for home visitors. It was designed to shed additional
understanding on what situations were difficult and provide a framework for
improving supervision and training to respond to those difficult situations.
Many of the families in HFAz present difficult and challenging problems. Over the past
several years there has been a focus on three critical risk factors: mental health,
domestic violence, and substance abuse. All of these factors pose substantial risk for
child abuse and have been found to mitigate the positive effects of home visitation
services. While home visitors receive ongoing training on many of these issues it is
unclear how the training influences decision making and ultimately what is done to
address such critical issues.
To begin an exploration of these decision-making processes, the evaluation team
conducted a focus group with home visitors from southern Arizona program sites to
examine how home visitors make decisions about what to do with families when
dealing with families who have significant risk factors and problems. The intent of the
study was to obtain information about what drives home visitor decisions about what
problem to address, how to approach the family, and whether there are any “best
methods” for “solving challenging problems.” The following Exhibit lists the questions
that home visitors said that they must answer for themselves as they make decisions
regarding how to address a difficult family problem or concern, grouped according to
themes.
Exhibit 29. Concerns that affect home visitor intervention decisions
Themes
Common Questions of Home Visitors
Safety

Am I safe? Is the family safe? Are the children safe?
Should I call the police?

Timing

How will the mom or dad react? Should I bring this
up now or later? When is the best time to approach
this with them?

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Healthy Families Arizona Evaluation Report 2005

Uncertainty

Is this just a suspicion? Did families admit to an
issue? Are families aware of the issue? Is there clear
evidence of the difficulty?

Fear

Will this lead the family to refuse services? Am I
doing the right thing in bringing this issue up? How
will my relationship with the family be impacted?

Obtaining needed services

Will the family be able to get the additional help they
need? Are there agencies in the community that can
provide this assistance?

The focus group brought forth a valuable discussion concerning how home visitors
attempt to deal with critical risk factors in families. Insight may be gained by examining the
home visitors’ words in describing how they approach families who have significant
problems or risk factors:
•
•
•
•
•
•
•
•

•

“You need to be non-judgmental, have an open attitude.”
“You need to hang in there with them—getting past the “shock value” can build
trust. They want to see if you’re going to run like everyone else in their lives.”
“You need to ask neutral/open-ended questions to gently probe on issues.”
“You need to deal with your own issues.” (i.e., to be effective with families)
“Sharing, and listening helps lift the family’s burden.” (i.e., the Home visitor’s
role is to listen, not counsel)
Uncertainty is typical—“Prepare yourself for a roller-coaster ride.”
“I try to provide ongoing encouragement and emotional support.”
“I help them deal with their other crises.” (e.g., “When their baby is in the NICU,
parents are overwhelmed but when they get home they think the hospital took
care of everything--- preemies are really hard.”)
“We need to focus on parenting skills.”

The most appropriate and helpful role of the supervisor was explored, and the program staff
outlined the types of supervision efforts that are found to be most helpful, including:
•
•
•

Debriefing after the home visit
Processing and reflecting the experience with the Family Support Specialist (FSS)
Knowing legal ramifications of family issues and home visitor choices

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Healthy Families Arizona Evaluation Report 2005

•

•

Helping to focus the home visitors on their critical roles and understand that
they can’t “fix” the big issues; i.e. they can help the family with parenting skills
and improving their relationship with their baby
Connecting the FSS to other resources

The focus group also examined how confident home visitors were in addressing difficult
issues such as substance abuse, mental illness or domestic violence. They responded by
saying they are very confident in their overall knowledge and experience but worry
about the application of their knowledge in the specific situation. In particular, the
home visitors noted:
•
•

•
•
•

•

•
•

Bringing up the subject is hard--- when something sensitive needs to be
discussed.
Without an admission or concrete evidence of a problem (e.g., marijuana on the
coffee table), it’s hard to discuss the issue. (for example, a family member might
say that they used drugs in the past, but not anymore. “If they’re denying it,
what can you do?”)
The FSS needs a good relationship with the family to be able to discuss issues.
They needed more coaching on how to suggest an evaluation for mental health.
Despite the home visitors’ overall length of experience and knowledge of
emergency procedures, there is still fear and concern. The staff emphasized the
importance of the supervisor relationship where the FSS can discuss how they
handled the situation and what else could have been done with the family.
Home visitors struggle with the feeling that they may have failed the family
somehow; that they have a lost opportunity when the family drops out of the
program.
The assessment process can bring awareness that serves as an important step in
understanding what the most difficult risk factors may be for a family.
You need to trust your intuition despite the anxiety at the back of your mind.

They were also asked where they learned how to respond, how they think through the
family situation and choices for intervention. Most of the home visitors indicated that
they obtained on-the-job training. They learned from experience, the Healthy Families
training institutes, agency-level training, and specialty trainings. They also indicated
that staff meetings, discussions with their supervisor and case reviews were helpful.

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Healthy Families Arizona Evaluation Report 2005

Final comments shared by home visitors regarding the key ingredients for effectively
making decisions reflected the importance of experience combined with training. The
respondents offered these points:
•
•
•

•

There are certain things you can’t train. You need to hire “good raw material”,
(i.e. a talented employee) .
You need to be able to “think on your feet” and know how to recognize when the
family is ready for a counselor, for example.
There is a big difference between book knowledge and experience. Even the
extensive trainings are “just book knowledge.” Experience is the best way to put
everything together. Perhaps an apprentice model would be best. Other ways
to get more “hands on” include observation, learning from each other.
Other suggestions included having “advanced” core training (even a whole day
on one risk factor area) for experienced workers who’ve already completed core
training-- instead of the same trainings and same handouts that they’ve seen
many times.

In summary, it is clear that home visitors are continually identifying and assessing
choices about how they work with families on a daily basis. A number of
considerations must be juggled at once—personal safety, readiness among family
members, how to broach or initiate discussion of a difficult issue, the repercussions of
addressing an issue with the family, and how to follow-up with the family. The home
visitors value the supervisory relationship and on-going professional development to
sharpen their skills and knowledge in critical areas. The need for on-the-job learning
and reflective supervision seems vitally important to strengthening and sustaining the
home visitors in their challenging work.

46
Healthy Families Arizona Evaluation Report 2005

Recommendations
The Healthy Families Arizona program exhibits aspects of both a mature and a newly
developing program. For example, while much of the Healthy Families Arizona
structure has become solid over the years, new sites bring the opportunities and
challenges inherent in growth. The review of data over this year, combined with
previous years, provides an opportunity to reflect on the needs of the program as it
expands. The following recommendations are made to support program expansion.

Enhance the evidence-based structure of the Healthy Families program. Using evidence-based
practice is at the heart of Healthy Families Arizona. Program effectiveness can be
enhanced even more with a stronger, formalized mechanism for using research
information for decision-making. In this way, the program can better apply evidence to
delivery of program services and program staff become more involved in the evaluation
process. An identified mechanism for sharing knowledge will build a stronger link
between program staff and the evaluation process, and promote greater collaboration in
building research and evidence into the program development process. The Excellence
Committee could invite an annual evaluation review and feedback session that would
result in recommended program changes based on evaluation and research findings.
The annual review would also be a time to generate new evaluation questions for the
evaluation team to investigate.

Develop standards for sites that set expectations for collecting and submitting data so that
quarterly evaluation feedback reports are meaningful. The quality assurance and evaluation
components of Healthy Families Arizona should develop new policies for following up
with sites when they fall below standards for quality data collection. This will insure
that the management information system provides accurate feedback for ongoing
program quality assurance processes.

The program needs to improve the administration of several of the evaluation instruments, in
particular, the Safety Checklist and the Ages and Stages Questionnaire. In addition, a reevaluation of the substance abuse screening tool (CRAFFT) needs to be conducted in
terms of implementation and the tool’s ability to identify substance abuse problems.
Program staff should give special attention to insuring appropriate referrals are given to
families when a concern is identified.
47
Healthy Families Arizona Evaluation Report 2005

Recruitment and retention in the program remains an ongoing concern. Specific recruitment
and retention strategies should be developed. All home visitation programs work to create
and sustain a mutually satisfying match between the family’s needs and what the
program has to offer. The Healthy Families Arizona program should be recognized for
having obtained a better retention than many Healthy Families programs throughout
the nation, and over time retention has increased. Nonetheless, exploration of how the
program might continue to address retention is warranted particularly with the influx
of new families and program expansion. A sub-study that compares two different
approaches to retention could provide some insight. Further, new service delivery
strategies might continue some form of engagement sufficient to reap benefits (e.g.,
would parents who might terminate continue if a telephone support program was in
place?). Specific approaches need to be tailored for rural and urban areas. Special
efforts should be made to retain families with a CPS history, to recruit prenatal families
into the program, and engage postnatal families in program delivery. There are
important differences between prenatal families, postnatal families, and families with
histories of CPS reports. Program protocols should be tailored for each of these groups.

The program should identify specific strategies to meet the needs of families who have prior
histories of child abuse and neglect. These families are at higher risk for subsequent abuse
or neglect and may need more clinical services or community resources to strengthen
their parenting skills. Recruitment and retention of these families is also critical and
may require focused strategies and increased resources, such as more intensive home
visits, clinical consultation or more intensive follow-up on referrals.

Continued program development is needed in delivering services to parents with multiple
children at various ages and with families when the child is age 2 or older. When children get
older the program goals need to shift to increased emphasis on parent child interaction
and positive discipline strategies. As children get older and become more active many
parents are prompted to use unhealthy discipline strategies. Staff must assess how to
deliver effective services with limited contact (by age 2 most families graduate to a level
that reduces the amount of home visitations). This requires reviewing program design
(e.g. videotape modeling) and/or forging stronger links with additional community
resources to provide support and education for child management skills.

48
Healthy Families Arizona Evaluation Report 2005

The recruitment materials for the prenatal component of Healthy Families Arizona could be
strengthened by development of attractive materials that clarify the services, goals and benefits of
enrolling in Healthy Families during the prenatal period. This will help referral sources
understand and communicate the services to pregnant women and help motivate
families to participate.

Linking families to needed resources is a key strategy in the Healthy Families model, but data
collection forms do not seem to be capturing the types of referrals being made. The evaluation
and training teams should review the instrument and make revisions to capture a more
accurate picture of the types of referrals that are made the most.

Staff training and development is an important focus during this time of program expansion
and staff are indicating a desire for relevant training. The program staff and Quality
Assurance and Training Team should continue to track the number and types of staff
training completed during the year, and assess the usefulness and satisfaction with staff
training.

The revised HFAz logic model presents a framework for reviewing program activities and
assuring the home visitors are engaging in activities that address each of the 10 objectives. The
use of the program logic model is important because programs can experience
“program drift” which often leads to a slow but significant change in the coherent
direction of the program. The program staff should revisit how the program activities
are being administered as the program expands and maintain supervision guidelines
for addressing each objective. This will keep the program focused and directed to the
identified goals and objectives of the program. The Evaluation team, in collaboration
with the Healthy Families Steering Committee should periodically review and refine
the program logic model to insure it reflects any changes in the goals, objectives,
activities and resources of the program.

49
Healthy Families Arizona Evaluation Report 2005

References
Chaffin, Mark (2004). Is it time to rethink Healthy Start/Healthy Families? Child Abuse
and Neglect, 28, 589-595.
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 and Neglect, 28, 597-622.
Explaining the 2001-02 Infant Mortality Increase: Data From the Linked Birth/Infant
Death Data Set. NVSR Volume 53, Number 12. 23 pp. (PHS) 2005-1120.
Gambrill, E. (2003). Evidence-based practice: Sea changes or the emperor’s new clothes?
Journal of Social Work Education, 39, 3-23.
Gray, J. A. M. (2001). The origin of evidence-based practice. In A. Edwards & G. Elwyn
(Eds.), Evidence-informed client choice (pp. 19-33). New York: Oxford University Press.
LeCroy, C.W. & Whitaker, K. (2005). Improving the quality of home visitation: An
exploratory study of difficult situations. Child Abuse and Neglect, 29, 1003-1013.
LeCroy & Milligan Associates, Inc. (2005). Healthy Families Arizona Participant
Satisfaction Survey FY 2005 Results. LeCroy & Milligan Associates, Inc. Tucson, AZ.
Sackett, D. L., Strauss, S. E., Richardson, W. C., Rosenberg, W., & Haynes, R. (2000).
Evidence-based medicine: How to practice and teach EBM. New York: Churchill
Livingstone.

50
Healthy Families Arizona Evaluation Report 2005

Appendix A: Site Level Data



Age of Child at Entry ...................................................................................51



Days to Termination.....................................................................................53



Reason for Termination ...............................................................................55



Health Insurance at Intake............................................................................57



Late or No Prenatal Care or Poor Compliance at Intake..............................59



Ethnicity of Mother ......................................................................................61



Gestational Age............................................................................................65



Low Birth Weight ........................................................................................67



Yearly Income..............................................................................................69



Family Stress Checklist Score......................................................................71

51
Healthy Families Arizona Evaluation Report 2005

Age of Child at Entry by Site - 2005
(Age in days)
Mean
(Age in Days)

Number

Standard
Deviation

Douglas

16.57

87

16.54

Central Phoenix

24.80

105

21.96

Maryvale (Phoenix)

23.17

72

22.82

South Phoenix

22.21

71

19.80

East Valley (Phoenix)

21.86

79

18.91

Nogales

14.55

105

21.07

Page

24.07

43

16.45

Casa de los Niños (Tucson)

25.82

100

21.85

CODAC (Tucson)

29.40

114

25.13

La Frontera (Tucson)

23.61

137

23.04

Child & Family Resources
(Tucson)

23.73

11

21.42

Sierra Vista

12.90

68

15.27

Tuba City

22.00

38

23.32

Verde Valley

12.29

75

17.92

Yuma

19.62

79

19.12

Pascua Yaqui

29.32

56

24.42

Lake Havasu City

26.23

99

20.72

Flagstaff

22.60

63

24.87

Sunnyslope (Phoenix)

24.92

103

20.55

Prescott

23.97

134

22.26

Pinal County

17.45

92

22.48

Mesa

26.35

136

20.38

Southeast Phoenix

22.32

93

18.23

El Mirage (Maricopa)

26.08

50

23.24

Blake Foundation (Pima)

33.17

71

24.28

Marana

37.82

28

22.79

Site

52
Healthy Families Arizona Evaluation Report 2005

Mean
(Age in Days)

Number

Standard
Deviation

Safford

28.81

16

36.77

Stanfield (Pinal)

25.33

9

31.52

Apache Junction

34.67

18

30.12

Gila River

33.67

3

13.58

Winslow

51.43

7

23.99

Kingman

19.89

28

15.76

Globe/Miami

31.57

14

32.31

Kyrene (Maricopa)

33.76

33

31.87

Metro Phoenix

27.95

63

25.28

Tolleson (Maricopa)

21.94

36

19.52

South Mountain (Maricopa)

27.70

23

22.67

Glendale (Maricopa)

17.63

41

17.99

Deer Valley (Maricopa)

29.00

17

24.26

East/SE Tucson

36.92

12

23.87

SW Tucson

26.43

28

16.66

Bullhead City

20.80

15

7.54

Tempe (Maricopa)

16.33

24

17.10

Gilbert (Maricopa)

23.00

52

21.72

Scottsdale (Maricopa)

23.69

36

21.29

East Mesa (Maricopa)

28.94

35

25.91

Kinlani-Flagstaff

15.46

35

22.61

Total

23.51

2654*

22.24

Site

*Note: total does not include missing data for 81 participant files.

53
Healthy Families Arizona Evaluation Report 2005

Days to Termination by Site - 2005
(For terminated families)
POSTNATAL Only *
Site

Mean
(Days to termination)

Standard Deviation

Number

Douglas

1204.83

539.51

18

Central Phoenix

798.60

618.19

25

Maryvale (Phoenix)

1214.58

648.44

24

South Phoenix

493.81

367.28

21

East Valley (Phoenix)

791.82

476.46

17

Nogales

1142.50

678.00

18

Page

812.61

634.82

18

Casa de los Niños (Tucson)

852.12

635.83

50

CODAC (Tucson)

742.61

471.04

31

La Frontera (Tucson)

827.53

587.12

45

Child & Family Resources (Tucson)

923.78

618.54

9

Sierra Vista

561.72

402.47

32

Tuba City

1031.00

645.54

7

Verde Valley

802.97

613.62

29

Yuma

539.48

396.64

21

Pascua Yaqui

765.33

582.87

9

Lake Havasu City

710.54

570.24

35

Flagstaff

592.77

422.89

22

Sunnyslope (Phoenix)

663.60

497.27

35

Prescott

640.80

488.03

40

Pinal County

1059.06

663.16

31

Mesa

664.66

483.15

38

Southeast Phoenix

773.67

448.71

33

El Mirage (Maricopa)

1122.75

807.57

4

Blake Foundation (Pima)

410.50

278.03

20

Marana

165.50

58.69

2

Safford

NO DATA

NO DATA

N/D

Stanfield (Pinal)

NO DATA

NO DATA

N/D

Apache Junction

186.00

0

1

NO DATA

NO DATA

N/D

209.00

NO DATA

1

Gila River
Winslow

54
Healthy Families Arizona Evaluation Report 2005

POSTNATAL Only *
Site

Mean
(Days to termination)

Standard Deviation

Number

Kingman

NO DATA

NO DATA

N/D

Globe/Miami

NO DATA

NO DATA

N/D

Kyrene (Maricopa)

485.00

490.68

4

Metro Phoenix

1067.00

624.26

3

Tolleson (Maricopa)

213.00

0

1

South Mountain (Maricopa)

622.67

434.01

3

NO DATA

NO DATA

N/D

Deer Valley (Maricopa)

110.50

21.92

2

East/SE Tucson

907.00

944.69

2

SW Tucson

853.00

0

1

Bullhead City

NO DATA

NO DATA

N/D

Tempe (Maricopa)

NO DATA

NO DATA

N/D

Gilbert (Maricopa)

1177.50

638.52

2

Scottsdale (Maricopa)

439.40

420.57

5

East Mesa (Maricopa)

658.00

0

1

Kinlani-Flagstaff

354.50

84.15

2

Total

766.68

563.68

662

Glendale (Maricopa)

*There were only 2 prenatal families who terminated during this data collection period.

55
Healthy Families Arizona Evaluation Report 2005

Top Three Reasons for Termination by Site - 2005
Percent and number ( ) within Site
POSTNATAL*
Moved
Away

Unable to
contact

Did Not Respond to
Outreach Efforts

27.8% (5)

5.6% (1)

16.7% (3)

16% (4)

16% (4)

24% (6)

Maryvale (Phoenix)

13.6% (3)

9.1% (2)

9.1% (2)

South Phoenix

4.8% (1)

23.8% (5)

28.6% (6)

East Valley (Phoenix)

15.4% (2)

15.4% (2)

15.4% (2)

Nogales

35.3% (6)

0

17.6% (3)

Page

16.7% (3)

38.9% (7)

5.6% (1)

Casa de los Niños (Tucson)

24% (12)

12% (6)

14% (7)

CODAC (Tucson)

19.4% (6)

35.5% (11)

19.4% (6)

La Frontera (Tucson)

30.2% (13)

11.6% (5)

0

Child & Family Resources (Tucson)

22.2% (2)

0

0

Sierra Vista

28.1% (9)

9.4% (3)

18.8% (6)

Tuba City

42.9% (3)

0

14.3% (1)

Verde Valley

39.3% (11)

10.7% (3)

0

Yuma

28.6% (6)

14.3% (3)

14.3% (3)

Pascua Yaqui

11.1% (1)

55.6% (5)

11.1% (1)

Lake Havasu City

34.3% (12)

14.3% (5)

8.6% (3)

Flagstaff

9.1% (2)

18.2% (4)

13.6% (3)

Sunnyslope (Phoenix)

6.1% (2)

12.1% (4)

18.2% (6)

Prescott

47.5% (19)

17.5% (7)

7.5% (3)

Pinal County

16.1% (5)

19.4% (6)

19.4% (6)

Mesa

24.3% (9)

21.6% (8)

13.5% (5)

Southeast Phoenix

12.1% (4)

27.3% (9)

33.3% (11)

0

0

0

20% (4)

15% (3)

10% (2)

Marana

0

0

0

Safford

No data

No data

No data

Stanfield (Pinal)

No data

No data

No data

Apache Junction

0

0

0

Site
Douglas
Central Phoenix

El Mirage (Maricopa)
Blake Foundation (Pima)

56
Healthy Families Arizona Evaluation Report 2005

POSTNATAL*
Moved
Away

Unable to
contact

Did Not Respond to
Outreach Efforts

No data

No data

No data

Winslow

0

0

0

Kingman

No data

No data

No data

Globe/Miami

No data

No data

No data

Kyrene (Maricopa)

50% (2)

0

25% (1)

Metro Phoenix

100% (3)

0

0

Tolleson (Maricopa)

100% (1)

0

0

0

0

33.3% (1)

No data

No data

No data

Deer Valley (Maricopa)

0

0

0

East/SE Tucson

0

0

50 % (1)

SW Tucson

0

0

100% (1)

Bullhead City

No data

No data

No data

Tempe (Maricopa)

No data

No data

No data

Gilbert (Maricopa)

0

0

100% (2)

Scottsdale (Maricopa)

20% (1)

0

40% (2)

East Mesa (Maricopa)

0

0

0

50% (1)

0

50% (1)

23.5% (152)

15.9% (103)

14.7% (95)

Site
Gila River

South Mountain (Maricopa)
Glendale (Maricopa)

Kinlani-Flagstaff
Total

*There were only 2 prenatal families who terminated during this data collection period.

57
Healthy Families Arizona Evaluation Report 2005

Health Insurance by Site at Intake - 2005
Percent and number ( ) within Site
PRENATAL

Site

POSTNATAL

None

AHCCCS

Private

None

AHCCCS

Private

0

100% (3)

0

2.2% (2)

92.1% (82)

5.6% (5)

12.5% (1)

75% (6)

12.5% (1)

1.9% (2)

86% (92)

9.3% (10)

0

80% (4)

0

4.1% (3)

86.3% (63)

8.2% (6)

11.1% (1)

66.7% (6)

11.1% (1)

1.4% (1)

87.3% (62)

7.0% (5)

East Valley (Phoenix)

0

87.5% (7)

12.5% (1)

2.5% (2)

81.5% (66)

14.8% (12)

Nogales

0

100% (6)

0

1.9% (2)

93.3% (97)

3.8% (4)

Page

0

100% (3)

0

0

95.3% (41)

4.7% (2)

Casa de los Niños (Tucson)

0

100% (4)

0

1.0% (1)

88.2% (90)

9.8% (10)

CODAC (Tucson)

0

87.5% (7)

0

0

94.7% (107)

3.5% (4)

La Frontera (Tucson)

0

80% (4)

20% (1)

2.9% (4)

90.5% (124)

5.8% (8)

No data

No data

No data

0

90.9% (10)

9.1% (1)

Sierra Vista

0

71.4% (10)

28.6% (4)

1.5% (1)

78.5% (51)

15.4% (10)

Tuba City

0

100% (7)

0

2.5% (1)

90% (36)

5% (2)

7.1% (2)

85.7% (24)

7.1% (2)

1.4% (1)

86.3% (63)

12.3% (9)

Yuma

0

100% (4)

0

3.8% (3)

94.9% (75)

0

Pascua Yaqui

0

85% (17)

0

0

94.7% (54)

0

Lake Havasu City

0

88.9% (8)

11.1% (1)

3% (3)

87% (87)

9% (9)

29.4% (5)

64.7% (11)

0

4.6% (3)

83.1% (54)

10.8% (7)

0

100% (3)

0

2.9% (3)

86.7% (91)

7.6% (8)

10% (1)

90% (9)

0

1.5% (2)

85.8% (115)

7.5% (10)

Pinal County

18.2% (2)

72.7% (8)

9.1% (1)

1.1% (1)

91.4% (85)

7.4% (7)

Mesa

11.1% (1)

77.8% (7)

11.1% (1)

1.5% (2)

87.2% (116)

7.5% (10)

Southeast Phoenix

0

100% (4)

0

4.3% (4)

84% (79)

9.6% (9)

El Mirage (Maricopa)

0

100% (5)

0

3.8% (2)

73.1% (38)

17.3% (9)

16.7% (1)

66.7% (4)

0

2.8% (2)

88.9% (64)

8.3% (6)

Marana

0

100% (2)

0

7.1% (2)

85.7% (24)

7.1% (2)

Safford

0

80% (4)

0

0

93.8% (15)

6.3% (1)

71.4% (5)

28.6% (2)

0

0

100% (9)

0

Douglas
Central Phoenix
Maryvale (Phoenix)
South Phoenix

Child & Family Resources
(Tucson)

Verde Valley

Flagstaff
Sunnyslope (Phoenix)
Prescott

Blake Foundation (Pima)

Stanfield (Pinal)

58
Healthy Families Arizona Evaluation Report 2005

PRENATAL

Site

POSTNATAL

None

AHCCCS

Private

None

AHCCCS

Private

4.2% (1)

91.7% (22)

4.2% (1)

0

90.5% (19)

4.8% (1)

Gila River

0

92.3% (12)

7.7% (1)

0

100% (4)

0

Winslow

0

80% (4)

20% (1)

0

100% (10)

0

Kingman

0

100% (4)

0

10% (3)

76.7% (23)

13.3% (4)

Globe/Miami

0

100% (3)

0

0

100% (21)

0

Kyrene (Maricopa)

33.3% (1)

66.7% (2)

0

0

76.9% (30)

23.1% (9)

Metro Phoenix

11.1% (1)

88.9% (8)

0

1.6% (1)

98.4% (61)

0

Tolleson (Maricopa)

0

100% (1)

0

2.7% (1)

86.5% (32)

8.1% (3)

South Mountain (Maricopa)

0

85.7% (6)

14.3% (1)

0

100% (25)

0

Glendale (Maricopa)

0

100% (5)

0

0

88.4% (38)

9.3% (4)

33.3% (1)

66.7% (2)

0

0

76.5% (13)

17.6% (3)

0

66.7% (2)

33.3% (1)

0

91.7% (11)

8.3% (1)

50% (1)

50% (1)

0

6.9% (2)

86.2% (25)

6.9% (2)

Bullhead City

0

100% (2)

0

0

100% (19)

0

Tempe (Maricopa)

0

100% (3)

0

0

95.7% (22)

4.3% (1)

Gilbert (Maricopa)

0

77.8% (7)

11.1% (1)

1.9% (1)

90.6% (48)

7.5% (4)

Scottsdale (Maricopa)

0

100% (4)

0

2.8% (1)

88.9% (32)

8.3% (3)

East Mesa (Maricopa)

0

100% (14)

0

0

92.9% (39)

4.8% (2)

10% (2)

85% (17)

0

0

88.6% (31)

8.6% (3)

7.3%
(26)

84.2%
(298)

5.4%
(19)

2.1%
(56)

88.5%
(2393)

7.6% (206)

Apache Junction

Deer Valley (Maricopa)
East/SE Tucson
SW Tucson

Kinlani-Flagstaff
Total

59
Healthy Families Arizona Evaluation Report 2005

Late or No Prenatal Care or Poor Compliance at Intake – 2005 by Site
Percent and number ( ) within Site
PRENATAL

Site

POSTNATAL

True

False

Unknown

True

False

Unknown

33.3% (1)

66.7% (2)

0

42.7% (38)

55.1% (49)

2.2% (2)

50% (4)

50% (4)

0

29% (31)

68.2% (73)

2.8% (3)

Maryvale (Phoenix)

16.7% (1)

93.3% (5)

0

28.8% (21)

67.1% (49)

4.1% (3)

South Phoenix

22.2% (2)

66.7% (6)

11.1% (1)

29.6% (21)

70.4% (50)

0

East Valley (Phoenix)

37.5% (3)

62.5% (5)

0

40.2% (33)

57.3% (47)

2.4% (2)

Nogales

0

100% (6)

0

49.1% (52)

45.3% (48)

5.7% (6)

Page

0

100% (3)

0

30.2% (13)

69.8% (30)

0

Casa de los Niños
(Tucson)

50% (2)

50% (2)

0

24.5% (25)

65.7% (67)

9.8% (10)

CODAC (Tucson)

12.5% (1)

87.5% (7)

0

31.0% (35)

66.4% (75)

2.7% (3)

La Frontera (Tucson)

16.7% (1)

83.5% (5)

0

30.4% (42)

63.8% (88)

5.8% (8)

No data

No data

No data

54.5% (6)

45.5% (5)

0

21.4% (3)

78.6% (11)

0

22.9% (16)

72.9% (51)

4.3% (3)

0

100% (7)

0

42.5% (17)

55% (22)

2.5% (1)

Verde Valley

7.1% (2)

82.1% (23)

10.7% (3)

48% (36)

50.7% (38)

1.3% (1)

Yuma

25% (1)

75% (3)

0

53.8% (43)

45% (36)

1.3% (1)

Pascua Yaqui

14.3% (3)

85.7% (18)

0

12.3% (7)

87.7% (50)

0

Lake Havasu City

22.2% (2)

66.7% (6)

11.1% (1)

25.3% (25)

70.7% (70)

4% (4)

Flagstaff

33.3% (6)

55.6% (10)

11.1% (2)

26.6% (17)

71.9% (46)

1.6% (1)

0

100% (3)

0

24.8% (26)

74.3% (78)

1% (1)

50% (5)

50% (5)

0

45.2% (61)

53.3% (72)

1.5% (2)

Pinal County

63.6% (7)

36.4% (4)

0

37.2% (35)

62.8% (59)

0

Mesa

22.2% (2)

66.7% (6)

11.1% (1)

32.1% (44)

62.8% (86)

5.1% (7)

Southeast Phoenix

25% (1)

75% (3)

0

40% (38)

57.9% (55)

2.1% (2)

El Mirage (Maricopa)

60% (3)

40% (2)

0

27.8% (15)

64.8% (35)

7.4% (4)

83.3% (5)

16.7% (1)

0

23.6% (17)

75% (17)

1.4% (1)

Marana

50% (1)

50% (1)

0

42.9% (12)

53.6% (15)

3.6% (1)

Safford

0

100% (6)

0

13.3% (2)

86.7% (13)

0

Douglas
Central Phoenix

Child & Family
Resources (Tucson)
Sierra Vista
Tuba City

Sunnyslope (Phoenix)
Prescott

Blake Foundation
(Pima)

60
Healthy Families Arizona Evaluation Report 2005

PRENATAL

Site

POSTNATAL

True

False

Unknown

True

False

Unknown

Stanfield (Pinal)

85.7% (6)

14.3% (1)

0

44.4% (4)

55.6% (5)

0

Apache Junction

45.8% (11)

54.2% (13)

0

28.6% (6)

71.4% (15)

0

Gila River

41.7% (5)

58.3% (7)

0

0

100% (4)

0

Winslow

25% (1)

75% (3)

0

11.1% (1)

88.9% (8)

0

Kingman

25% (1)

75% (3)

0

20.7% (6)

58.6% (17)

20.7% (6)

0

100% (3)

0

42.9% (9)

52.4% (11)

4.8% (1)

Kyrene (Maricopa)

66.7% (2)

33.3% (1)

0

46.2% (18)

48.7% (19)

5.1% (2)

Metro Phoenix

44.4% (4)

55.6% (5)

0

36.5% (23)

61.9% (39)

1.6% (1)

50% (1)

50% (1)

0

35.1% (13)

62.2% (23)

2.7% (1)

28.6% (2)

71.4% (5)

0

48% (12)

48% (12)

4% (1)

0

100% (5)

0

41.9% (18)

58.1% (25)

0

Deer Valley (Maricopa)

100% (3)

0

0

35.3% (6)

64.7% (11)

0

East/SE Tucson

66.7% (2)

33.3% (1)

0

25% (3)

75% (9)

0

SW Tucson

100% (2)

0

0

37.9% (11)

62.1% (18)

0

Bullhead City

50% (1)

50% (1)

0

31.6% (6)

63.2% (12)

5.3% (1)

Tempe (Maricopa)

33.3% (1)

66.7% (2)

0

43.5% (10)

52.2% (12)

4.3% (1)

Gilbert (Maricopa)

37.5% (3)

62.5% (5)

0

42.6% (23)

55.6% (30)

1.9% (1)

Scottsdale (Maricopa)

25% (1)

75% (3)

0

28.6% (10)

71.4% (24)

0

East Mesa (Maricopa)

40% (6)

53.3% (8)

6.7% (1)

45% (18)

45% (18)

10% (4)

Kinlani-Flagstaff

35% (7)

65% (13)

0

31.4% (11)

68.6% (24)

0

32.1% (115)

65.4%
(234)

2.5% (9)

34.4%
(936)

62.4% (1698)

3.1% (85)

Globe/Miami

Tolleson (Maricopa)
South Mountain
(Maricopa)
Glendale (Maricopa)

Total

61
Healthy Families Arizona Evaluation Report 2005

PRENATAL Ethnicity of Mother by Site - 2005
Percent and number ( ) within Site
Mixed/Other

Caucasian/
White

Hispanic

African
American

Asian
American

Native
American

0

0

66.7% (2)

0

0

33.3% (1)

Central Phoenix

12.5% (1)

25% (2)

62.5% (5)

0

0

0

Maryvale (Phoenix)

20% (1)

0

60% (3)

20% (1)

0

0

South Phoenix

11.1% (1)

11.1% (1)

33.3% (3)

44.4% (4)

0

0

East Valley
(Phoenix)

0

37.5% (3)

37.5% (3)

25% (2)

0

0

Nogales

0

0

100% (5)

0

0

0

Page

0

0

0

0

0

100% (2)

Casa de los Niños
(Tucson)

0

50% (2)

50% (2)

0

0

0

CODAC (Tucson)

50% (4)

0

37.5% (3)

12.5% (1)

0

0

0

16.7% (1)

83.3% (5)

0

0

0

No data

No data

No data

No data

No data

No data

Sierra Vista

0

71.4% (10)

14.3% (2)

14.3% (2)

0

0

Tuba City

0

0

0

0

0

100% (7)

3.6% (1)

57.1% (16)

28.6% (8)

0

0

10.7% (3)

0

0

100% (4)

0

0

0

19% (4)

0

14.3% (3)

0

0

66.7% (14)

Lake Havasu City

11.1% (1)

66.7% (6)

11.1 (1)

0

0

11.1% (1)

Flagstaff

16.7% (3)

22.2% (4)

55.6% (10)

5.6% (1)

0

0

0

0

66.7% (2)

33.3% (1)

0

0

Prescott

10% (1)

80% (8)

10% (1)

0

0

0

Pinal County

9.1% (1)

18.2% (2)

63.6% (7)

9.1% (1)

0

0

Mesa

0

44.4% (4)

55.6% (5)

0

0

0

Southeast Phoenix

0

0

100% (4)

0

0

0

40% (2)

20% (1)

40% (2)

0

0

0

Blake Foundation
(Pima)

0

16.7% (1)

83.3% (5)

0

0

0

Marana

0

50% (1)

0

50% (1)

0

0

Safford

0

50% (3)

50% (3)

0

0

0

Site
Douglas

La Frontera
(Tucson)
Child & Family
Resources (Tucson)

Verde Valley
Yuma
Pascua Yaqui

Sunnyslope
(Phoenix)

El Mirage
(Maricopa)

62
Healthy Families Arizona Evaluation Report 2005

Mixed/Other

Caucasian/
White

Hispanic

African
American

Asian
American

Native
American

Stanfield (Pinal)

0

33.3% (2)

33.3% (2)

0

0

33.3% (2)

Apache Junction

0

69.6% (16)

26.1% (6)

4.3% (1)

0

0

Gila River

0

0

0

0

0

100% (13)

Winslow

20% (1)

0

20% (1)

0

0

60% (3)

Kingman

25% (1)

75% (3)

0

0

0

0

Globe/Miami

0

0

100% (3)

0

0

0

Kyrene (Maricopa)

0

0

100% (3)

0

0

0

Metro Phoenix

0

11.1% (1)

66.7% (6)

0

0

22.2% (2)

Tolleson (Maricopa)

0

0

100% (2)

0

0

0

South Mountain
(Maricopa)

0

0

42.9% (3)

57.1% (4)

0

0

Glendale
(Maricopa)

20% (1)

20% (1)

60% (3)

0

0

0

Deer Valley
(Maricopa)

0

33.3% (1)

66.7% (2)

0

0

0

East/SE Tucson

0

33.3% (1)

33.3% (1)

33.3% (1)

0

0

SW Tucson

0

0

100% (2)

0

0

0

Bullhead City

0

50% (1)

50% (1)

0

0

0

Tempe (Maricopa)

33.3% (1)

0

33.3% (1)

33.3% (1)

0

0

Gilbert (Maricopa)

11.1% (1)

44.4% (4)

0

33.3% (3)

0

11.1% (1)

Scottsdale
(Maricopa)

0

0

100% (4)

0

0

0

East Mesa
(Maricopa)

6.7% (1)

46.7% (7)

40% (6)

6.7% (1)

0

0

5% (1)

20% (4)

40% (8)

5% (1)

0

30% (6)

2.8% (10)

29.8% (106)

39.9% (142)

7.3% (26)

0

15.4% (55)

Site

Kinlani-Flagstaff
Total

63
Healthy Families Arizona Evaluation Report 2005

POSTNATAL Ethnicity of Mother by Site - 2005
(Percent and number within Site)
Mixed/Other

White/
Caucasian

Hispanic

African
American

Asian
American

Native
American

0

11.2% (10)

88.8% (79)

0

0

0

Central Phoenix

2.8% (3)

23.4% (25)

59.8% (64)

11.2% (12)

1.9% (2)

0.9% (1)

Maryvale (Phoenix)

2.8% (2)

17.8% (13)

67.1% (49)

8.2% (6)

0

4.1% (3)

South Phoenix

2.8% (2)

8.5% (6)

64.8% (46)

22.5% (16)

0

1.4% (1)

East Valley
(Phoenix)

3.9% (3)

24.1% (19)

54.4% (43)

12.7% (10)

1.3% (1)

3.8% (3)

Nogales

0

0

100% (105)

0

0

0

Page

0

0

2.3% (1)

2.3% (1)

0

95.3% (41)

Casa de los Niños
(Tucson)

3% (1)

27.5% (28)

65.7% (67)

1% (1)

1% (1)

2% (2)

CODAC (Tucson)

3.5% (4)

17.5% (20)

71.1% (81)

4.4% (5)

0

3.5% (4)

La Frontera
(Tucson)

2.2% (3)

13% (18)

76.8% (106)

3.6% (5)

0.7% (1)

3.6% (5)

0

18.2% (2)

81.8% (9)

0

0

0

Sierra Vista

8.6% (6)

38.6% (27)

45.7% (32)

5.7% (4)

0

1.4% (1)

Tuba City

2.5% (1)

0

0

0

0

97.5% (39)

Verde Valley

2.6% (2)

57.9% (44)

32.9% (25)

0

0

6.6% (5)

0

6.9% (5)

91.7% (66)

0

0

1.4% (1)

23.6% (13)

3.6% (2)

12.7% (7)

1.8% (1)

0

58.2% (32)

1% (1)

50.5% (50)

42.4% (42)

1% (1)

2% (2)

3% (3)

Flagstaff

1.5% (1)

26.2% (17)

35.4% (23)

1.5% (1)

1.5% (1)

33.8% (22)

Sunnyslope
(Phoenix)

3.9% (4)

48.6% (51)

33.3% (35)

10.5% (11)

1% (1)

2.9% (3)

Prescott

0.7% (1)

58.5% (79)

38.5% (52)

0

0.7% (1)

1.5% (2)

Pinal County

2.2% (2)

23.9% (22)

56.5% (52)

8.7% (8)

0

8.7% (8)

Mesa

4.4% (6)

39.4% (54)

44.5% (61)

7.3% (10)

0

4.4% (6)

Southeast Phoenix

4.3% (4)

12.8% (12)

67% (63)

12.8% (12)

0

3.2% (3)

El Mirage
(Maricopa)

3.8% (2)

32.1% (17)

56.6% (30)

7.5% (4)

0

0

Blake Foundation
(Pima)

2.7% (2)

19.2% (14)

67.1% (49)

8.2% (6)

0

2.7% (2)

Marana

7.1% (2)

53.6% (15)

35.7% (10)

0

3.6% (1)

0

Safford

0

50% (8)

43.8% (7)

6.3% (1)

0

0

Site
Douglas

Child & Family
Resources (Tucson)

Yuma
Pascua Yaqui
Lake Havasu City

64
Healthy Families Arizona Evaluation Report 2005

Mixed/Other

White/
Caucasian

Hispanic

African
American

Asian
American

Native
American

Stanfield (Pinal)

0

33.3% (3)

33.3% (3)

0

0

33.3% (3)

Apache Junction

0

80% (16)

15% (3)

0

0

5% (1)

Gila River

0

0

0

0

0

100% (4)

Winslow

10% (1)

20% (2)

10% (1)

20% (2)

0

40% (4)

Kingman

10% (3)

73.3% (22)

13.3% (4)

0

3.3% (1)

0

Globe/Miami

5.9% (1)

5.9% (1)

17.6% (3)

0

0

70.6% (12)

Kyrene (Maricopa)

2.6% (1)

35.9% (14)

46.2% (18)

10.3% (4)

0

5.1% (2)

Metro Phoenix

4.8% (3)

9.5% (6)

74.6% (47)

9.5% (6)

0

1.6% (1)

0

16.2% (6)

73% (27)

10.8% (4)

0

0

8% (2)

20% (5)

44% (11)

28% (7)

0

0

Glendale
(Maricopa)

2.4% (1)

9.5% (4)

78.6% (33)

9.5% (4)

0

0

Deer Valley
(Maricopa)

0

35.3% (6)

58.8% (10)

5.9% (1)

0

0

8.3% (1)

50% (6)

33.3% (4)

0

8.3% (1)

0

0

20.7% (6)

75.9% (22)

0

3.4% (1)

0

Bullhead City

15.8% (3)

63.2% (12)

21.1% (4)

0

0

0

Tempe (Maricopa)

8.4% (2)

4.2% (1)

83.3% (20)

4.2% (1)

0

0

Gilbert (Maricopa)

0

54.7% (29)

32.1% (17)

11.3% (6)

0

1.9% (1)

Scottsdale
(Maricopa)

2.9% (1)

17.1% (6)

71.4% (25)

8.6% (3)

0

0

East Mesa
(Maricopa)

7.2% (3)

19% (8)

61.9% (26)

9.5% (4)

0

2.4% (1)

Kinlani-Flagstaff

5.8% (2)

28.6% (10)

42.9% (15)

8.6% (3)

0

14.3% (5)

Total

3.3% (91)

26.7% (721)

55.4% (1497)

5.9% (160)

0.5% (14)

8.2% (221)

Site

Tolleson (Maricopa)
South Mountain
(Maricopa)

East/SE Tucson
SW Tucson

65
Healthy Families Arizona Evaluation Report 2005

Gestational Age by Site - 2005
(Number and Percent within Site)
Was the gestational age less than 37 weeks?
PRENATAL

POSTNATAL

Site
No

Yes

No

Yes

No data

No data

85.5% (65)

14.5% (11)

100% (1)

0

74.4% (61)

25.6% (21)

No data

No data

81.5% (44)

18.5% (10)

South Phoenix

100% (4)

0

81.8% (45)

18.2% (10)

East Valley (Phoenix)

50% (1)

50% (1)

78.3% (54)

21.7% (15)

Nogales

100% (1)

0

86.5% (83)

13.5% (13)

No data

No data

92.5% (37)

7.5% (3)

Casa de los Niños (Tucson)

100% (2)

0

78.5% (73)

21.5% (20)

CODAC (Tucson)

100% (4)

0

90% (90)

10% (10)

0

100% (1)

82.4% (103)

17.6% (22)

Child & Family Resources
(Tucson)

No data

No data

90.9% (10)

9.1% (1)

Sierra Vista

75% (6)

25% (2)

93.1% (54)

6.9% (4)

Tuba City

50% (1)

50% (1)

93.5% (29)

6.5% (2)

Verde Valley

80% (8)

20% (2)

90.1% (64)

9.9% (7)

Yuma

100% (3)

0

90.4% (66)

9.6% (7)

Pascua Yaqui

100% (1)

0

95.5% (42)

4.5% (2)

Lake Havasu City

100% (2)

0

92.1% (82)

7.9% (7)

Flagstaff

87.5% (7)

12.5% (1)

81.6% (40)

18.4% (9)

Sunnyslope (Phoenix)

100% (1)

0

79.8% (71)

20.2% (18)

Prescott

100% (4)

0

89.7% (113)

10.3% (13)

Pinal County

83.3% (5)

16.7% (1)

90% (72)

10% (8)

Mesa

0

100% (1)

68.6% (81)

31.4% (37)

Southeast Phoenix

0

100% (1)

80.2% (65)

19.8% (16)

El Mirage (Maricopa)

100% (2)

0

78.9% (30)

21.1% (8)

Blake Foundation (Pima)

100% (3)

0

83.1% (54)

16.9% (11)

Marana

0

100% (1)

76% (19)

24% (6)

Safford

100% (1)

0

100% (1)

0

Douglas
Central Phoenix
Maryvale (Phoenix)

Page

La Frontera (Tucson)

66
Healthy Families Arizona Evaluation Report 2005

PRENATAL

POSTNATAL

Site
No

Yes

No

Yes

Stanfield (Pinal)

100% (1)

0

75% (3)

25% (1)

Apache Junction

No data

No data

100% (3)

0

83.3% (5)

16.7% (1)

100% (2)

0

Winslow

No data

No data

70% (7)

30% (3)

Kingman

50% (1)

50% (1)

88.2% (15)

11.8% (2)

Globe/Miami

100% (1)

0

88.9% (8)

11.1% (1)

Kyrene (Maricopa)

100% (2)

0

57.7% (15)

42.3% (11)

Metro Phoenix

100% (3)

0

70.3% (26)

29.7% (11)

Tolleson (Maricopa)

No data

No data

85% (17)

15% (3)

South Mountain (Maricopa)

No data

No data

78.9% (15)

21.1% (4)

100% (3)

0

88.5% (23)

11.5% (3)

0

100% (1)

91.7% (11)

8.3% (1)

100% (1)

0

88.9% (8)

11.1% (1)

SW Tucson

No data

No data

89.3% (25)

10.7% (3)

Bullhead City

No data

No data

33.3% (1)

66.7% (2)

Tempe (Maricopa)

100% (1)

0

80% (12)

20% (3)

Gilbert (Maricopa)

50% (4)

50% (4)

76.2% (32)

23.8% (10)

Scottsdale (Maricopa)

100% (1)

0

80% (16)

20% (4)

East Mesa (Maricopa)

No data

No data

70.4% (19)

29.6% (8)

Kinlani-Flagstaff

70% (7)

30% (3)

90.5% (19)

9.5% (2)

79.8%
(87)

20.2%
(22)

83.4%
(1825)

16.6%
(364)

Gila River

Glendale (Maricopa)
Deer Valley (Maricopa)
East/SE Tucson

Total

67
Healthy Families Arizona Evaluation Report 2005

Low Birth Weight by Site - 2005
(Number and Percent within Site)
Did the child have low birth weight (less than 2500 grams or 88 ounces)?
PRENATAL

Site

POSTNATAL

No

Yes

No

Yes

Douglas

100% (1)

0

85.2% (75)

14.8% (13)

Central Phoenix

100% (1)

0

84.9% (90)

15.1% (16)

Maryvale (Phoenix)

100% (1)

0

78.1% (57)

21.9% (16)

South Phoenix

100% (4)

0

84.5% (60)

15.5% (11)

East Valley (Phoenix)

100% (2)

0

83.3% (65)

16.7% (13)

Nogales

100% (2)

0

90.6% (96)

9.4% (10)

No data

No data

97.7% (42)

2.3% (1)

Casa de los Niños (Tucson)

100% (3)

0

88.1% (89)

11.9% (12)

CODAC (Tucson)

100% (5)

0

93% (107)

7% (8)

0

100% (1)

85.4% (117)

14.6% (20)

No data

No data

81.8% (9)

18.2% (2)

Sierra Vista

88.9% (8)

11.1% (1)

94.3% (66)

5.7% (4)

Tuba City

100% (1)

0

97.5% (39)

2.5% (1)

Verde Valley

100% (11)

0

90.4% (66)

9.6% (7)

Yuma

100% (3)

0

93.7% (74)

6.3% (5)

Pascua Yaqui

100% (2)

0

96.4% (54)

3.6% (2)

Lake Havasu City

100% (3)

0

89.9% (89)

10.1% (10)

Flagstaff

87.5% (7)

12.5% (1)

73% (46)

27% (17)

Sunnyslope (Phoenix)

100% (1)

0

82.9% (87)

17.1% (18)

Prescott

100% (4)

0

90.4% (122)

9.6% (13)

Pinal County

100% (5)

0

93.5% (87)

6.5% (6)

Mesa

66.7% (2)

33.3% (1)

78.8% (104)

21.2% (28)

Southeast Phoenix

100% (2)

0

85.9% (79)

14.1% (13)

El Mirage (Maricopa)

100% (4)

0

88.2% (45)

11.8% (6)

Blake Foundation (Pima)

100% (3)

0

89% (65)

11% (8)

Marana

0

100% (1)

82.1% (23)

17.9% (5)

Safford

50% (1)

50% (1)

87.5% (14)

12.5% (2)

Stanfield (Pinal)

100% (1)

0

55.6% (5)

44.4% (4)

Apache Junction

100% (1)

0

85% (17)

15% (3)

Page

La Frontera (Tucson)
Child & Family Resources (Tucson)

68
Healthy Families Arizona Evaluation Report 2005

PRENATAL

Site

POSTNATAL

No

Yes

No

Yes

66.7% (4)

33.3% (2)

100% (4)

0

Winslow

No data

No data

90% (9)

10% (1)

Kingman

100% (3)

0

79.3% (23)

20.7% (6)

Globe/Miami

100% (2)

0

94.1% (16)

5.9% (1)

Kyrene (Maricopa)

100% (2)

0

83.8% (31)

16.2% (6)

Metro Phoenix

100% (5)

0

87.1% (54)

12.9% (8)

Tolleson (Maricopa)

No data

No data

88.9% (32)

11.1% (4)

South Mountain (Maricopa)

50% (1)

50% (1)

72% (18)

28% (7)

Glendale (Maricopa)

100% (3)

0

88.1% (37)

0

100% (1)

100% (16)

0

100% (2)

0

66.7% (8)

33.3% (4)

SW Tucson

No data

No data

86.2% (25)

13.8% (4)

Bullhead City

No data

No data

94.7% (18)

5.3% (1)

Tempe (Maricopa)

100% (1)

0

81.8% (18)

18.2% (4)

Gilbert (Maricopa)

50% (4)

50% (4)

88.5% (46)

11.5% (6)

Scottsdale (Maricopa)

100% (1)

0

94.1% (32)

5.9% (2)

East Mesa (Maricopa)

No data

No data

83.8% (31)

16.2% (6)

100% (11)

0

94.1% (32)

5.9% (2)

89.3% (117)

10.7% (14)

87.3% (2339)

12.7% (341)

Gila River

Deer Valley (Maricopa)
East/SE Tucson

Kinlani-Flagstaff
Total

11.9% (5)

69
Healthy Families Arizona Evaluation Report 2005

Yearly Income by Site - 2005
PRENATAL
Site

POSTNATAL

Median
Yearly Income

Number

Median
Yearly Income

Number

Douglas

$7,296

3

$8,400

87

Central Phoenix

$5,004

2

$7,700

73

Maryvale (Phoenix)

$9,000

4

$10,800

55

South Phoenix

$10,128

4

$6,000

45

East Valley (Phoenix)

$4,992

4

$10,800

55

Nogales

$8,280

6

$9,600

98

Page

$10,800

3

$6,720

43

Casa de los Niños (Tucson)

$7,200

3

$9,600

79

CODAC (Tucson)

$8,400

5

$10,800

95

La Frontera (Tucson)

$11,100

6

$8,400

111

Child & Family Resources
(Tucson)

No data

No data

$13,800

10

Sierra Vista

$16,281

13

$2,880

63

Tuba City

$19,800

4

$9,300

27

Verde Valley

$10,080

24

$8,400

69

Yuma

$10,800

3

$8,400

69

Pascua Yaqui

$10,800

20

$6,870

54

Lake Havasu City

$19,711

9

$12,000

97

Flagstaff

$12,000

17

$9,600

58

Sunnyslope (Phoenix)

$11,070

2

$6,600

73

Prescott

$15,000

3

$10,100

36

Pinal County

$4,161

3

$9,000

49

Mesa

$12,000

7

$6,084

101

Southeast Phoenix

$22,020

2

$7,800

69

El Mirage (Maricopa)

$49,000

2

$14,400

35

Blake Foundation (Pima)

$6,850

4

$7,800

62

Marana

$18,000

1

$9,600

25

Safford

$10,800

6

$10,104

14

Stanfield (Pinal)

$7,800

4

$17,772

4

Apache Junction

$12,282

22

$17,400

18

70
Healthy Families Arizona Evaluation Report 2005

PRENATAL
Site

POSTNATAL

Median
Yearly Income

Number

Median
Yearly Income

Number

Gila River

$13,200

7

No data

No data

Winslow

$3,450

4

$9,600

8

Kingman

$7,800

3

$12,000

27

Globe/Miami

$72,000

1

$16,800

6

Kyrene (Maricopa)

$10,560

2

$15,600

25

Metro Phoenix

$6,090

6

$12,000

41

Tolleson (Maricopa)

No data

No data

$12,600

28

South Mountain (Maricopa)

$1,536

5

$6,168

16

Glendale (Maricopa)

$6,624

2

$14,400

31

Deer Valley (Maricopa)

$12,000

3

$14,400

11

East/SE Tucson

$19,200

3

$14,400

9

SW Tucson

$3,312

2

$13,700

24

Bullhead City

$5,000

1

$12,000

15

Tempe (Maricopa)

$15,600

2

$12,000

17

Gilbert (Maricopa)

$5,016

9

$14,000

24

Scottsdale (Maricopa)

$24,000

3

$12,000

25

East Mesa (Maricopa)

$10,200

6

$14,400

29

Kinlani-Flagstaff

$5,400

17

$7,200

34

Total

$10,560

262

$9,600

2044

71
Healthy Families Arizona Evaluation Report 2005

Family Stress Checklist Score by Site - 2005
PRENATAL

POSTNATAL

Mean
Score

Percent of
mothers
whose FSC
score was
greater than
40

Number of
mothers
whose FSC
score was
greater than
40

Mean
Score

Percent of
mothers
whose FSC
score was
greater than
40

Number of
mothers
whose FSC
score was
greater than
40

Douglas

41.67

100%

3

37.70

48.3%

43

Central Phoenix

44.38

62.5%

5

39.35

45.4%

49

Maryvale (Phoenix)

44.17

83.3%

5

37.70

48.6%

36

South Phoenix

45.56

66.7%

6

39.65

53.5%

38

East Valley (Phoenix)

40.63

62.5%

5

40.12

58.5%

48

Nogales

33.33

16.7%

1

34.39

32.1%

34

Page

41.67

66.7%

2

33.60

25.6%

11

Casa de los Niños
(Tucson)

42.50

50%

2

37.21

46.1%

47

CODAC (Tucson)

50.63

87.5%

7

39.39

52.2%

60

La Frontera (Tucson)

50.83

100%

6

38.15

49.3%

68

Child & Family
Resources (Tucson)

No
data

No data

No data

36.82

36.4%

4

Sierra Vista

40.36

35.7%

5

36.07

35.7%

25

Tuba City

27.86

28.6%

2

30.50

12.5%

5

Verde Valley

37.32

50%

14

34.54

31.6%

24

Yuma

26.25

25%

1

34.06

32.5%

26

Pascua Yaqui

31.90

23.8%

5

31.75

24.6%

14

Lake Havasu City

47.78

66.7%

6

39.10

48%

48

Flagstaff

36.67

38.9%

7

39.31

46.2%

30

Sunnyslope (Phoenix)

30.00

33.3%

1

39.29

50%

53

Prescott

45.50

70%

7

40.67

54.8%

74

Pinal County

36.82

45.5%

5

33.14

33%

31

Mesa

42.22

55.6%

5

39.04

51.1%

70

Southeast Phoenix

26.25

25%

1

37.58

50.5%

48

El Mirage (Maricopa)

35.00

40%

2

36.57

44.4%

24

Blake Foundation
(Pima)

42.50

50%

3

41.30

49.3%

36

Site

72
Healthy Families Arizona Evaluation Report 2005

PRENATAL

POSTNATAL

Mean
Score

Percent of
mothers
whose FSC
score was
greater than
40

Number of
mothers
whose FSC
score was
greater than
40

Mean
Score

Percent of
mothers
whose FSC
score was
greater than
40

Number of
mothers
whose FSC
score was
greater than
40

Marana

45.00

100%

2

28.04

42.9%

12

Safford

25.83

0

0

22.50

6.3%

1

Stanfield (Pinal)

41.43

57.1%

4

35.56

33.3%

3

Apache Junction

46.25

62.5%

15

43.81

71.4%

15

Gila River

41.54

53.8%

7

31.25

25%

1

Winslow

41.00

60%

3

21.00

20%

2

Kingman

46.25

75%

3

38.50

46.7%

14

Globe/Miami

35.00

33.3%

1

27.86

33.3%

7

Kyrene (Maricopa)

31.67

33.3%

1

40.00

59%

23

Metro Phoenix

39.44

55.6%

5

40.56

49.2%

31

Tolleson (Maricopa)

35.00

50%

1

35.41

35.1%

13

South Mountain
(Maricopa)

40.00

57.1%

4

42.20

56%

14

Glendale (Maricopa)

45.00

100%

5

34.65

41.9%

18

Deer Valley (Maricopa)

38.33

66.7%

2

34.12

41.2%

7

East/SE Tucson

30.00

33.3%

1

40.83

75%

9

SW Tucson

42.50

50%

1

35.17

34.5%

10

Bullhead City

45.00

50%

1

33.68

36.8%

7

Tempe (Maricopa)

51.67

66.7%

2

40.42

62.5%

15

Gilbert (Maricopa)

50.56

77.8%

7

41.30

59.3%

32

Scottsdale (Maricopa)

38.75

50%

2

41.11

52.8%

19

East Mesa (Maricopa)

52.00

93.3%

14

41.90

59.5%

25

Kinlani-Flagstaff

41.00

60%

12

41.86

60%

21

Total

40.64

55.1%

199

37.55

45.5%

1245

Site

73
Healthy Families Arizona Evaluation Report 2005

Appendix B: Family Stress Checklist
Family Stress Checklist Problem Areas and Interpretation (Mother & Father)
Problem Areas
I. Childhood history of
physical abuse and
deprivation.

Range
0, 5, or 10

Interpretation/ Administration
The FSC is a 10 item rating scale. A
score of 0 represents normal, 5
represents a mild degree of the

II. Substance abuse, mental
illness, or criminal history.

problem, and a 10 represents severe,
0, 5, or 10

III. Previous or current CPS
involvement.

Family Stress Checklist items. The
FSC is an assessment tool and is

IV. Self-esteem, available
lifelines, possible depression.

0, 5, or 10

V. Stresses, concerns.

0, 5, or 10

VIII. Discipline of infant,
toddler, and child.

administered to the mother through
an interview by a Family Assessment
Worker from the Healthy Families
Arizona Program. The interview

VI. Potential for violence.
VII. Expectations of infants’
milestones, behaviors.

on both the Mother and Father

takes place shortly after birth, or as
0, 5, or 10

near to that time as possible.

0, 5, or 10
0, 5, or 10

IX. Perception of new infant.
X. Bonding, attachment
issues.

0, 5, or 10

0, 5, or 10
0, 5, or 10
A score over 25 is considered

Total Score

medium risk for child abuse and
0 - 100

neglect, and a score over 40 is
considered high-risk for child abuse.

74
Healthy Families Arizona Evaluation Report 2005

Appendix C: Healthy Families Parenting Inventory
Healthy Families Parenting Inventory Alpha Scores

Subscale

Alpha*

Social support

r=.87

Problem solving

r=.92

Depression

r=.79

Personal care

r=.69

Mobilizing resources

r=.83

Accepting the parent role

r=.72

Parent child behavior

r=.87

Home environment

r=.84

Parent competence

r=.86

Parenting efficacy

r=.89

*Alpha score represents the correlation of items on a scale, and is an indication of how
well the items in a subscale relate to each other.

75
Healthy Families Arizona Evaluation Report 2005

Appendix D: Selected Risk Factors at Intake
All Families –2005
Selected Risk Factors for Mothers at Intake--2005
Risk Factors of Mothers

All Families (prenatal and postnatal
combined)

Teen Births (19 years or less)

28.8%

Births to Single Parents

69.3%

Less Than High School
Education

62.9%

Not Employed

83.7%

No Health Insurance

2.7%

Receives AHCCCS

87.9%

Late or No Prenatal Care

34.2%

76
Healthy Families Arizona Evaluation Report 2005

Appendix E. Healthy Families Prenatal Logic Model

77
Healthy Families Arizona Evaluation Report 2005

Appendix F. Healthy Families Postnatal Logic Model

78
Healthy Families Arizona Evaluation Report 2005