Healthy Families Arizona Evaluation Report FY2007 (July 1, 2006-June 30, 2007) Prepared by: LeCroy & Milligan Associates, Inc. 4911 E. Broadway, Suite 100 Tucson, Arizona 85711 (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 annual evaluation report represents the efforts of many individuals and collaborating organizations. First, we want to acknowledge the participating families and the staff who work with them. Program managers and supervisors provide guidance and support for ensuring evaluation and program forms are collected and submitted. Family Assessment Workers, Family Support Specialists, and support staff at the sites collected data and provided feedback and success stories—all of which help the annual evaluation of Healthy Families Arizona. We are grateful to Amy Jo Filas and Mark R. (Randy) Grover, coordinators for the Child Abuse Prevention Fund and Healthy Families Arizona, for their guidance and support. Valerie Roberson, Manager for the Office of Prevention and Family Support, provided leadership and vision for the program. Last, but certainly not least, the Healthy Families Arizona Quality Assurance and Training Team has worked hard to be a bridge and conduit for communication of expectations and needs by providing training in data collection, helping the sites to collect data, and to use the findings for program improvement. Special thanks to Kate Whitaker, TA/QA Coordinator, Pauline Haas-Vaughn, Barbara Griffin, Kathy Van Meter, Ellie Jimenez, Danielle Gagnier, Esthela Navarro, and Lee Zinsky, TA/QA Program Specialists, Maritza Noriega and Penny Swenson, Administrative Managers, and Claudia Garcia and Joan Duggan, Administrative Assistants. The evaluation team for Healthy Families Arizona that contributed to this year’s report includes evaluators Allison Titcomb, Ph.D., Craig W. LeCroy, Ph.D., Kerry Milligan, MSSW, Cindy Jones, BSBA, BSPA, Judy Krysik, Ph.D., Jen Kozik, MPH, Olga Valenzuela, BA, Allyson Baehr, BA, Darcy Richardson, BA; and data management staff KristaLyn Santiago, BA, Veronica Urcadez, Delcia Cardenas, and Rosalita Campos. Suggested Citation: LeCroy & Milligan Associates, Inc. (2007). Healthy Families Arizona Evaluation Report 2007. Tucson, AZ: LeCroy & Milligan Associates, Inc. i Healthy Families Arizona Evaluation Report 2007 Table of Contents Acknowledgements ..............................................................................................................i Healthy Families Arizona 2007 Evaluation Report Highlights................................... vi Executive Summary.......................................................................................................... vii Introduction ..........................................................................................................................2 In this Report ........................................................................................................................6 Who Does Healthy Families Arizona Serve? ...................................................................8 Program Participants—Risk Factors and Enrollment.................................................8 Infant Characteristics.....................................................................................................14 What Services Does Healthy Families Arizona Provide? ............................................16 Child Development Screening .....................................................................................20 Fatherhood/Male Involvement Data..........................................................................24 Participant Satisfaction..................................................................................................26 What Difference Does the Program Make with Families?...........................................29 Parent Outcomes ............................................................................................................29 Healthy Families Parenting Inventory (HFPI)...........................................................29 Child Abuse and Neglect..............................................................................................32 Child Development and Wellness ...............................................................................33 Safety Practices and Healthy Behaviors .....................................................................34 Immunizations and Medical Homes...........................................................................35 Mothers’ Health, Education, and Employment.........................................................37 Substance Abuse Screening ..........................................................................................39 Information for Program Learning..................................................................................41 Program and Policy Updates .......................................................................................41 Building Bridges Newsletter ........................................................................................44 Ongoing Evaluation Communications .......................................................................44 Home Visitor Retention ................................................................................................46 Average age ....................................................................................................................50 Highest level of education ............................................................................................50 Limitations and Notes ...................................................................................................56 Conclusions and Findings on Staff Retention............................................................56 ii Healthy Families Arizona Evaluation Report 2007 Conclusions and Recommendations ...............................................................................58 References ...........................................................................................................................62 Appendix A: Parent Survey..............................................................................................64 Appendix B: Site Level Data.............................................................................................65 Appendix C. Program Objectives and Data Sources ...................................................92 Appendix D: Healthy Families Parenting Inventory....................................................93 Appendix E: Selected Risk Factors at Intake All Families 2007 ..................................94 Appendix F. Regression Coefficients for Workforce Survey.......................................95 Appendix G. Healthy Families Arizona Prenatal Logic Model .................................96 Appendix H. Healthy Families Arizona Postnatal Logic Model ...............................97 iii Healthy Families Arizona Evaluation Report 2007 List of Exhibits Exhibit 1. Healthy Families Arizona Map .....................................................................................2 Exhibit 2. Participants Enrolled and Actively Engaged July 2006- June 2007 ..........................9 Exhibit 3. Selected Risk Factors for Mothers at Intake—2007...................................................10 Exhibit 4. Ethnicity of Mothers Engaged Prenatally .................................................................11 Exhibit 5. Ethnicity of Mothers Engaged Postnatally ...............................................................11 Exhibit 6. Father Ethnicity-- Prenatal Families ..........................................................................12 Exhibit 7. Father Ethnicity-- Postnatal Families .........................................................................12 Exhibit 8. Percentage of Parents Rated Severe on the Parent Survey Items PRENATAL ....13 Exhibit 9. Percentage of Parents Rated Severe on the Parent Survey Items POSTNATAL..13 Exhibit 10. Risk Factors for Infants –2007 ....................................................................................15 Exhibit 11. Types of Healthy Families referrals at six, twelve, eighteen and twenty-four months .........................................................................................................................18 Exhibit 12. Trimester of Enrollment*............................................................................................19 Exhibit 13. ASQ Screening .............................................................................................................21 Exhibit 14. ASQ Referral Status—2007 (All families).................................................................22 Exhibit 15. ASQ-SE (All families)..................................................................................................23 Exhibit 16. Male Involvement Across All Categories at 6 and 12 months* ............................25 Exhibit 17. Male Involvement at 6 and 12 Months.....................................................................25 Exhibit 18. Participant Satisfaction Survey Results (n=1259)...................................................27 Exhibit 19. Participants’ Perception of Language Barriers........................................................28 Exhibit 20. Healthy Families Parenting Inventory .....................................................................30 Exhibit 21. Percent of families showing no child abuse and neglect incidences....................33 Exhibit 22. Percent of all families implementing safety practices ............................................34 iv Healthy Families Arizona Evaluation Report 2007 Exhibit 24. Immunization Rate of Healthy Families Arizona Children ..................................36 Exhibit 25. Percentage of Children Linked to a Medical Doctor ..............................................36 Exhibit 26. Length Of Time To Subsequent Pregnancy for Those Families with Subsequent Births.......................................................................................................37 Exhibit 27. Percent of all mothers enrolled in school.................................................................38 Exhibit 28. Mother’s employment status .....................................................................................38 Exhibit 29. Developments in the Healthy Families Arizona Program in 2006-2007..............41 Exhibit 30. 2006 Workforce survey domains and sample items...............................................47 Exhibit 31. Comparison of home visitors retained and those who were not retained..........50 Exhibit 32. Factors from the Workforce Survey Predictive of Home Visitor Attrition .........51 Exhibit 33. 2006 Recommendations and Key Results from 2007..............................................59 v Healthy Families Arizona Evaluation Report 2007 Healthy Families Arizona 2007 Evaluation Report Highlights Who Does Healthy Families Arizona Serve?  The number of sites increased from 51 to 58 sites in FY2007. The expansion included increased numbers of new families, new staff, and the services to meet their needs.  5,869 families were served by the program from July 1, 2006, to June 30, 2007.  86% of the families engaged with the program (4 or more home visits) and 56% of the families remained in the program 1 year or longer. The average length of stay in the program was just over one year.  3,910 of these engaged families entered after the birth of their child and 1,116 entered during the prenatal phase. This represented a 50% increase in prenatal families served (e.g., in 2006 the program served 3,185 postnatal and 772 prenatal families).  Healthy Families Arizona screens and assesses families at intake to determine the level of risk factors they experience. The results showed that the families screened into the program did exhibit the type of stressors that made them appropriate for program services. What Difference Does Healthy Families Arizona Make for Families and Children?  Parents improved in areas such as mobilizing resources, social support, increased parenting competence, improved problem-solving, improved parent-child interactions, and decreased depression as shown by increases on 9 of 10 subscales of the Healthy Families Parenting Inventory.  Healthy behaviors improved. For example, immunization rates were high and exceeded the statewide and AHCCCS rates. The percent of eighteen-month olds with all immunizations was 88% (vs. state average of 79% for 2 year olds and 82% for AHCCCS), 95% of children were linked to a medical doctor and 90% of families did not use an emergency room visit without a doctor’s referral.  Safety practices (e.g., car seats, pool safety) improved and in some cases were higher than national averages.  10.4% of postnatal, engaged mothers had subsequent pregnancies (28.6% of these were 18 years old or younger). vi Healthy Families Arizona Evaluation Report 2007 Executive Summary The Healthy Families Arizona Program Healthy Families Arizona serves families experiencing multiple stressors that can put their children at risk for child abuse and neglect. The program has operated in Arizona since 1991 and follows the national Healthy Families America® model. Healthy Families Arizona continued program expansion activities, which began in fall 2004 (23 sites). As a result of this work, program sites increased in number from 51 to 58 in FY2007. The program also continues to enhance its expansion of prenatal services for pregnant women and their families, including collaboration with the Women, Infants and Children program (WIC) to provide early referrals. The program has also increased its professional development support for staff by updating web-based orientation training and providing specialty training in substance abuse. Who Does Healthy Families Arizona Serve?   5,869 families were served by the program from July 1, 2006 to June 30, 2007, with 86% of the families engaging with the program (4 or more home visits) and 56% of the families remaining in the program 1 year or longer. 3,910 of the engaged families entered service after the birth of their child and 1,116 entered during the prenatal phase. Program participants report a significant number of risk factors at entry into program (prenatal & postnatal percentages respectively), such as: • • • 79% and 77% were single mothers 84% and 87% of the families utilized AHCCCS 68% and 63% of mothers had not finished high school. In particular, postnatal families presented with the following risk factors at intake: • • • 20% of the infants were born at less than 37 weeks gestation 15% of the infants had low birth weight (less than 5.5 pounds) 36% of the mothers received late (after 3 months) or no prenatal care. vii Healthy Families Arizona Evaluation Report 2007 What Difference Does Healthy Families Arizona Make for Families and Children? Healthy Parenting Behavior Areas of parental improvement included the following: • increased problem solving • decreased depression • increased use of resources • improved parent child behavior • improved home environment • increased parenting competence • increased parenting efficacy. The Healthy Families Parenting Inventory (HFPI) also revealed statistically significant improvement on 9 of 10 subscales and on the total HFPI score, suggesting that program participants reduced risk factors related to child abuse and neglect. Furthermore, the effects of the program seemed to increase with time as revealed by the moderate levels of “effect sizes”1 for the 12month measures. These results, even stronger than last year’s, continue to be considered promising for a home visitation program. Although the evaluation lacks a comparison group to study program effects, these findings continue to show that participants consistently report improvements in healthy parenting behavior. Furthermore, the Longitudinal Evaluation, a separate 5-year study using an experimental design, will be able to provide definitive results regarding program effectiveness. Child Health, Development, and Safety Child health and development indicators show positive results for the program. For example, there was a reported 88% immunization rate for the children of Healthy Families Arizona participants at 18 months. This is in comparison to a 79% immunization rate for 2-year-olds in Arizona and 82% for those on Arizona Health Care Cost Containment System (AHCCCS) coverage. A large percentage (95%) of families reported having a consistent medical doctor and only 10% visited an emergency room without a doctor’s 1 Effect size is a descriptive statistic that measures the magnitude of the difference between two scores. In this report, Cohen’s d, i.e., the standardized difference between two means, is used to report effect sizes. viii Healthy Families Arizona Evaluation Report 2007 referral. Assessment of home safety practices shows over 90% of participants are reducing risks at the 24 month assessment (e.g., use of car seats, poisons locked, and smoke alarms installed). This compares favorably with national trends (e.g., national estimates of 90% car seat usage and 75% “working” smoke detectors). The program also screens for developmental delays and provides referrals for further services. Child Abuse and Neglect Child abuse and neglect incidents (substantiated) were examined for program participants. The results estimate that child abuse and neglect rates were low (<1%) and met the program goal of having no higher than a 5% rate of child abuse and neglect. Program Learning and Special Studies A follow-up special study looked at staff retention because of its vital role for family engagement and participant retention. The study used results from a survey administered in 2006 to predict actual staff attrition in 2007 to further explore the relationship between job satisfaction and employment expectations. Results showed predictors of staff attrition include personal/professional fit, professional efficacy, feelings of belonging and value, and perception of workload. Time employed and intent to leave were also significant predictors of actual attrition from the program. The Building Bridges newsletter continued to provide information on key topics such as domestic violence, working with teen mothers, quality child care, and positive child development. The purpose of the newsletter is to provide examples of the link between practice and research for home visitation. The newsletter is distributed to over a 1000 individuals and is available to others on the web. Conclusions and Recommendations The program reached nearly 700 more families and provided additional services to families and staff in the FY2007 program year than in past years. Parent outcome measures including parenting behaviors and health outcomes showed significant gains at 6-month and 12-month intervals. ii Healthy Families Arizona Evaluation Report 2007 Recommendations include increasing enrollment of prenatal families, refining the definition of prenatal families, investigating the phases of engagement (e.g., reviewing “creative outreach” families), reviewing the utility of measures such as the substance abuse screening tool, emphasizing the importance of greater spacing between subsequent pregnancies, and using a collaborative approach to prioritize special studies that can address these recommendations. iii Healthy Families Arizona Evaluation Report 2007 Introduction Healthy Families Arizona (HFAz) is a nationally credentialed, communitybased voluntary home visitation program designed to promote positive parenting, child development and wellness, and to prevent child abuse and neglect. The program was established in Arizona in 1991 and has since expanded statewide to serve pregnant women and families who have risk factors that may result in abuse and neglect of their children. In 2006, the program services increased to 55 program sites and 3 intake sites (58 total sites) serving over 150 communities (see Exhibit 1). Exhibit 1. Healthy Families Arizona Map 2 Healthy Families Arizona Evaluation Report 2007 The program model of Healthy Families Arizona incorporates critical elements identified by Healthy Families America® (HFA) as well as the mandated services established by Arizona legislation. The overarching goals of the program include the following:  To promote positive parent/child interaction  To improve child health and development  To prevent child abuse and neglect. Highlights of the critical elements of HFA include the following:        Services initiated prenatally or at birth Use of a standardized assessment tool to systematically identify families most in need of services (e.g., assessment of risk factors such as social isolation, substance abuse, parental history of abuse in childhood, etc.) Services offered voluntarily and use of positive outreach efforts to build family trust Culturally competent services Comprehensive services focused on supporting parents, parent-child interactions, and child development All families should be linked to a medical provider and may be referred to additional services Service providers receive basic training and ongoing, effective supervision so that they are able to develop realistic and effective plans to empower families to meet their objectives; to understand why a family may not be making progress and how to work with the family more effectively. Following this model, Healthy Families Arizona’s home visitors 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. 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 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. 3 Healthy Families Arizona Evaluation Report 2007 This year’s evaluation report includes information on the continued expansion of these services. The annual evaluation serves to assist the program in learning and decision making as it expands to new areas and refines its approach. This annual report summarizes key results relevant for legislative and program goals and objectives and provides accountability for program services. Special substudies provide additional information on special “topics” to further assist in program learning and to build knowledge among program providers and funders. For example, this year’s report includes a section on staff retention. Research Update A separate research study that incorporates a randomized-control design to track long-term impact of Healthy Families Arizona completed its second of five study years in 2007. In addition to the annual evaluation results reported here, this five-year longitudinal study, initiated in 2004, will be able to definitively describe the effectiveness of the program. Key features of the longitudinal study include the following: It follows the same 190 families for five years and uses additional measures to test a full-range of potential outcomes. For instance, domestic violence, substance abuse, mental health, and discipline are assessed on a regular and ongoing basis for both the treatment (Healthy Families Arizona participants) and control group. Participants in the longitudinal study are 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 years of age is the period in which children are the most vulnerable to child abuse and neglect, and thus the most relevant for the study. Readers are encouraged to refer to the separate longitudinal evaluation report for details on the progress of the study (see the Healthy Families Arizona Longitudinal Reports for 2006 and 2007, LeCroy & Milligan Associates, Inc.). A special volume of the Journal of Prevention and Intervention in the Community summarized results and lessons learned about the Healthy Families America model by focusing on successful evaluation results from programs around the country. Healthy Families Arizona was featured in several of the articles and its results were described as “…exciting because it is grounded in theory and 4 Healthy Families Arizona Evaluation Report 2007 research but also recognizes the practical constraints and complexities of conducting action-oriented evaluation research in a real-world setting” (Galano, 2007, p. 6). Furthermore, Friedman & Schreiber (2007) noted that Healthy Families Arizona has exhibited a shared vision considered critical for successful program implementation. They also indicated that Healthy Families is an important piece of prevention in the continuum of child welfare services. Finally, an entire article devoted to Healthy Families Arizona (Krysik & LeCroy, 2007) featured the five-year evaluation results and described the collaborative relationship among the evaluation team, quality assurance/technical assistance staff, and the state coordinators in the Department of Economic Security’s Division of Children, Youth and Families Office of Prevention and Family Support. 5 Healthy Families Arizona Evaluation Report 2007 In this Report Program Participant Characteristics, Program Services, and Outcomes The main sections of this report focus on data related to participant characteristics, service delivery, and outcomes for participants who received HFAz services between the period of July 1, 2006 – June 30, 2007. This includes all families who received services at any time during the study period regardless of when they entered the program. Information about families who enter prenatally are presented separately when the results were different for those families compared to families entering the program after the birth of their baby (postnatal). Unless otherwise noted, the results presented include all families regardless of program entry date. The main sections include aggregate data that is summarized across all sites that make up the Healthy Families Arizona program. Separate site reports are produced quarterly and provided to each site for quality management purposes. Site level data are provided in Appendix B. The service delivery section is followed by the outcome results (e.g., Healthy Families Parenting Inventory results, child abuse and neglect data, safety behaviors, etc.). Information for Program Improvement and Learning A main function of the annual evaluation is to facilitate program learning by sharing data and information that helps program planning, implementation, and decision making. The final sections of the report provide updates on program changes and information on special studies that were conducted in the previous year. A program and policy update reviews major changes and challenges in the Healthy Families Arizona (HFAz) program implementation and policy over the last year as the statewide effort has continued its expansion of sites and new training curricula. One of the program implementation special studies looks at the relationship between staff perceptions of their work and staff turnover. This study is a follow-up to a “workforce survey” conducted in April 2006. Last year’s report discussed “intent to leave” among program staff. This year’s report describes factors that may contribute to actual decisions to leave among program staff. 6 Healthy Families Arizona Evaluation Report 2007 Recommendations The final section of the report describes recommendations for continued program improvement as well as potential evaluation topics for the next program year. 7 Healthy Families Arizona Evaluation Report 2007 Who Does Healthy Families Arizona Serve? Families who participate in Healthy Families Arizona voluntarily enter the program via a screening process that begins in the hospital or community organization serving families in the prenatal period or at birth (See Appendix A for screening question categories). Services are offered to those who experience multiple risks for child abuse and neglect. Parents can receive home visitation and support services for up to five years. This section describes the characteristics of families at intake and the following section reports on the services received by the families. Program Participants—Risk Factors and Enrollment During the period of July 2006 through June 2007, a total of 5,869 families (4,590 as postnatal and 1,279 prenatal) were served in the Healthy Families Arizona program. Of these, 5,026 families became actively engaged in the program, 2 with 3,910 engaging after the birth of their child and 1,116 engaging during the prenatal period. This represented an overall 86% engagement rate. During FY2007, Healthy Families Arizona expanded the numbers of families served in its 55 program sites. More than 800 additional families were actively engaged than last year. Exhibit 2 shows the number of participants served by each site during FY2007. The number of participants continued to vary widely as some sites initiated start-up and some continued their implementation progress. The program sites, covering a statewide area, also served different urban and rural area needs. 2 Actively engaged families are defined as those who participate in four or more visits. 8 Healthy Families Arizona Evaluation Report 2007 Exhibit 2. Participants Enrolled and Actively Engaged July 2006- June 2007 County Cochise Coconino Gila Graham Maricopa Mohave Navajo Pima Pinal Santa Cruz Yavapai Yuma Site* Douglas/Bisbee Sierra Vista Sierra Vista Blake Flagstaff (La Plaza Vieja) Page Tuba City Wellspring Williams (Kinlani) Globe/Miami Safford Central Phoenix Deer Valley East Mesa East Valley Phoenix El Mirage/Surprise Gilbert Glendale Kyrene Maryvale Mesa Metro Phoenix Northwest Phoenix Peoria Scottsdale South Mountain South Phoenix Southeast Phoenix Southwest Phoenix Sunnyslope Tempe Tolleson/Avondale West Phoenix Bullhead City Kingman Lake Havasu City Winslow Blake Foundation Casa de los Niños Casa Family First CODAC East/SE Tucson La Frontera Marana Metro Tucson Pascua Yaqui Southwest Tucson Apache Junction Gila River Coolidge Stanfield Nogales Prescott Verde Valley Primero Los Niños Yuma TOTAL Prenatal 20 18 15 37 8 18 28 33 13 20 18 10 29 18 14 36 10 27 17 22 8 9 20 18 23 15 15 4 23 12 16 15 15 19 35 11 24 34 13 23 25 37 15 13 47 17 31 13 9 11 23 24 73 6 9 1116 Postnatal 82 69 31 34 37 42 40 37 23 28 91 98 82 109 92 95 102 71 88 114 69 70 71 104 124 99 91 60 75 48 92 90 47 53 83 28 108 100 32 94 62 100 83 59 50 82 75 8 82 11 106 122 51 49 67 3910 *Italicized names are new sites. In 2006-2007, there were 55 Healthy Families Arizona sites with Family Support Specialists (home visitors) and 3 sites with Family Assessment Workers for a total of 58 sites. 9 Healthy Families Arizona Evaluation Report 2007 Families who participate in the Healthy Families Arizona program completed assessments for 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 3 highlights the risk factor data for both the prenatal and postnatal 2007 program participants when they began the program and show comparison data for the general Arizona population. Exhibit 3. Selected Risk Factors for Mothers at Intake—2007 Prenatal Families Postnatal Families Arizona state rates—2006 Teen Births (19 years or less) 32.1% 24.5% 12.6%* Births to Single Parents 79.4% 77.0% 44.0%* Less Than High School Education 68.2% 63.4% 29.1%* Not Employed 81.3% 77.8% NA No Health Insurance 8.5% 2.8% NA Receives AHCCCS 83.8% 87.0% 52.0%* Late or No Prenatal Care (or Poor Compliance) 33.2% 36.1% 23.5%* $12,000 $13,000 $45,279** Risk Factors of Mothers Median Yearly Income *Source: 2006 data from the Arizona Department of Health Services Vital Statistics records. Percent does not include “unknown.” **U.S. Census Bureau Population survey 2004-2005 median income. Note: Percentages for the combined total for Prenatal and postnatal families can be found in Appendix B. Based on these results, Healthy Families Arizona was successful in recruiting families with multiple risk factors as indicated by program and legislative goals. The prenatal services reached over 300 more families compared to last year. Both the prenatal and postnatal programs were successful in reaching single, teen mothers with less than a high school education. As in past years, Healthy Families Arizona participants consistently showed higher rates of these risk factors than the overall rates for Arizona families. Overall, data 10 Healthy Families Arizona Evaluation Report 2007 revealed that the prenatal mothers were slightly younger (average age 23 years) than the postnatal mothers (average age 25 years). In general, the characteristics of mothers served this year are quite similar to previous years. With median incomes around $13,000 or less, it is clear that economic stress and poverty continue to pervade families’ lives. Healthy Families Arizona continues this year to serve a culturally diverse population. The ethnic background of the families who entered prenatally and postnatally in 2007 are shown below in Exhibits 4 and 5. Exhibit 4. Ethnicity of Mothers Engaged Prenatally (N=1,116) Native American 11.5% Other/Mixed 5.8% White/Caucasian 31.6% African American 5.3% Hispanic 45.2% Asian American 0.6% Exhibit 5. Ethnicity of Mothers Engaged Postnatally (N=3,910) Native American 6.9% Other/Mixed 4.4% African American 5.1% White/Caucasian 27.3% Asian American 0.7% Hispanic 55.6% Healthy Families Arizona continued to encourage and support father involvement. During this year, ethnicity data was gathered on 1,116 prenatal fathers and 3,910 postnatal fathers. The ethnicity of fathers is displayed below. 11 Healthy Families Arizona Evaluation Report 2007 Exhibit 6. Father Ethnicity-- Prenatal Families (N=1,116) Native American 9% Other/Mixed 6% African American 6% White/Caucasian 28% Hispanic 51% Asian American 0% Exhibit 7. Father Ethnicity-- Postnatal Families (N=3,910) Native American 6% Other/Mixed 4% African American 7% White/Caucasian 25% Asian American 0% Hispanic 58% Mothers, and fathers when they are involved, are assessed during the screening process with the Parent Survey, a modified version of the Family Stress Checklist.3 During the intake process, a Family Assessment Worker evaluates each parent’s level of stress across 10 domains. The percentages of parents scoring severe on each of the scales are presented in Exhibits 8 and 9. A description of the scales is included in Appendix A. 3 During the 2005 program year, the Family Stress Checklist was revised by the original developer of the rating scale and renamed the Parent Survey to impart a more strengths-based perspective with staff and families; however the rating scale remains the same. 12 Healthy Families Arizona Evaluation Report 2007 Exhibit 8. Percentage of Parents Rated Severe on the Parent Survey Items PRENATAL (n~ 801) 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 9. Percentage of Parents Rated Severe on the Parent Survey Items POSTNATAL (n~ 2,674. Note: Approximately 500 moms and 400 dads were assessed using an older version of the Parent Survey. These families are not included in this figure.) 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 13 Healthy Families Arizona Evaluation Report 2007 The most significant stressors for families as they enter the Healthy Families Arizona program include the following: 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. Additionally, 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 who might most benefit from the earlier services by reducing stressors before the new baby arrives. These risk factors were similar to results from past years. Infant Characteristics In addition to family risk factors, information about infant risk factors is also collected at intake for postnatal families or at birth for prenatal families. This information can be seen as indicators of the level of need of the families served by the program. These risks factors, such as premature birth, low birth weight and drug exposed newborns, can have long-term financial and emotional impacts on families and children. For example, children can be subject to greater risk for many problems including death within the first month of life, developmental disabilities and a myriad of health problems such as chronic lung disease, adult-onset diabetes, coronary heart disease, high blood pressure, intellectual, physical and sensory disabilities, and psychological and emotional distress. Exhibit 10 displays the high-risk characteristics of the newborns among families who entered prenatally and postnatally. 14 Healthy Families Arizona Evaluation Report 2007 Exhibit 10. Risk Factors for Infants –2007 Risk Factors for Infants Prenatal Families* Postnatal Arizona State Families** percent*** 16.9% (Overall) Born < 37 weeks gestation 12.0% (1st Trimester Enrollment) 19.7% 10.7% 18.0% (3rd Trimester Enrollment) Birth Defects 0.7% 1.4% <1% Low Birth Weight 12.1% 15.0% 7.1% Positive Alcohol/Drug Screen 2.0% 3.5% NA *The Family Support Specialist collects this information either from the family or a CPS referral for prenatal families. **Family Assessment Workers collect this information from hospital records for postnatal families. ***2006 data from the Arizona Department of Health Services Vital Statistics records. The percentage of postnatal Healthy Families Arizona program infants born early (less than 37 weeks gestation) was slightly higher than in past years (e.g., the 2005 percentage was 16.6%) and it was nearly twice as high as the state rate. Some of the risk factors for those entering prenatally are slightly lower than those entering postnatally, and the percent of infants born early are slightly lower than last year’s percentages. It should be noted that results comparing those enrolling during the 1st trimester of pregnancy had slightly lower percentages of early births than those enrolling in the 3rd trimester. This suggests that the program may have some success in serving prenatal mothers when the staff have time to work with them. The percentage of low birth weight infants in the program remains high in comparison to the state rate. It is apparent that Healthy Families Arizona 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 continues to grow, 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. 15 Healthy Families Arizona Evaluation Report 2007 What Services Does Healthy Families Arizona Provide? During the current study year the total number of families served by the program was 5,869. Not all families who 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 the following: • • • • 3,910 postnatal families became actively engaged 680 postnatal families left the program before 4 visits 1,116 prenatal families became actively engaged 163 prenatal families left the program prior to 4 home visits. Overall the engagement rate among families who entered postnatally was 85.2% percent. For prenatal families, the 87.3% engagement rate is slightly higher than for the postnatal families. The length of time families stayed in the program decreased again slightly this year. For all the families (both postnatal and prenatal) who closed (1,551), the median number of days in the program was 384 (just over 1 year). The most frequently given reasons for leaving the program include: 1) 2) 3) 4) 5) 6) 7) did not respond to outreach (37.0%) moved away (18.3%) family refused further services (14.3%) completed program (6.2%) unable to locate (6.0%) reported self-sufficiency (5.1%) refused worker change (3.3%) A critical element of the national HFA model followed by Healthy Families Arizona called “outreach” occurs when families have not outright rejected services. The purpose of these efforts is to intensify the process for retaining parents and is typically used when a family appears to be disengaging (e.g., cancelled visits, etc.). In 2007, the evaluation team analyzed results to answer staff questions related to this outreach. These preliminary results are presented below. 16 Healthy Families Arizona Evaluation Report 2007 How many families were on outreach? At the 6-month interval, approximately 756 families were reported to be on outreach. The length of time families were on outreach varied:     103 one month (23.3%) 103 two months (23.3%) 307 three months (44.0%) 66 greater than three months (9.4%) If families were on outreach, did they re-engage with the program? Over 80% of these families (585) did not re-engage with the program (i.e., they “closed” and were no longer considered to be enrolled in the program). If a family was on outreach at the 6-month interval, did they close from the program on outreach? Ninety-three percent (416) did close on outreach. As noted above, the number one reason for closure was lack of responsiveness to these outreach efforts. The Healthy Families program model includes resource referral as an important link between families and needed community resources. Home visitors provide information on child development education, as well as modeling and coaching mothers in bonding with their child. However, equally important are the home visitor’s efforts to connect the family to other resources in the community. Just over half of the families for whom referral information was available received at least one referral in the past year (e.g., 869 of 1654 or 53% at 6-months; 675 of 1,308 or 52% at 12-months). For those families receiving referrals, Exhibit 11 below illustrates the numbers and types of referrals made by Family Support Specialists at the 6, 12, 18 and 24-month intervals. The percentage of families accessing the referred service is also included. Two-thirds to less than one-half of the referred families accessed the service. Possible reasons for these rates include lack of accessibility of services, availability of the services, and the time it can take to access a referral for services. Some Healthy Families Arizona sites exist in communities with adequate resources and others occur in communities where limited support resources are available for families. Some families did not access services because of a shortage of available services and were placed on “pending status” or wait lists. When interpreting the information provided below, it is important to note that a common concern among more rural sites is that there are not enough options for families who need help. Furthermore, 17 Healthy Families Arizona Evaluation Report 2007 transportation can be a significant barrier as families travel to other communities to access resources. Exhibit 11. Types of Healthy Families Arizona referrals at six, twelve, eighteen and twenty-four months* Number of Families Who Received Referrals at 6-months & Percent of Those Who Accessed the Referral (n=1,654) Number of Families Who Received Referrals at 12-months & Percent of Those Who Accessed Referral (n=1,308) Number of Families Who Received Referrals at 18-months & Percent of Those Who Accessed Referral (n=1,001) Number of Families Who Received Referrals at 24-months & Percent of Those Who Accessed the Referral (n=577) Number % Number % Number % Number % Received Accessed Received Accessed Received Accessed Received Accessed Health Care 296 50.0% 244 61.1% 195 61.5% 113 55.8% Nutrition Services 246 63.8% 175 65.3% 132 71.2% 84 54.8% Public Assistance 290 52.4% 236 54.0% 162 59.9% 83 53.0% Family and Social Support 318 40.6% 204 43.6% 169 47.9% 90 44.4% Employment, Training and Education 249 43.0% 154 43.5% 117 48.7% 61 52.5% Counseling and Support Services 237 40.1% 175 34.9% 121 33.1% 59 30.5% Child Development 142 52.8% 127 59.8% 106 62.3% 88 55.7% Other 288 51.7% 244 51.6% 200 54.5% 102 50.0% *The total number of referrals for each time period does not add up to the total number of families because some families may not have received any referrals or may have received multiple referrals. 18 Healthy Families Arizona Evaluation Report 2007 Healthy Families Arizona added services for prenatal families in 2005. They continued this past year to try to reach mothers as early as possible. Exhibit 12 shows the trimester of enrollment for all families entering the program prenatally. Healthy Families Arizona staff continued to strive to reach families in the first trimester of pregnancy. The majority of the families do not enter until the third trimester, although more families in the 1st and 2nd trimester were reached this past year. This represents a continuing challenge for the program to reach more families even earlier. It also indicates a need to review definitions of prenatal enrollment (e.g., “prenatal” could be limited to those families who enroll prior to 24 weeks gestational age) to better target and track the effects of early involvement in HFAz visits. Exhibit 12. Trimester of Enrollment* Trimester of Enrollment into Prenatal Program Families Enrolling from July 2006 through June 2007 100 percent 80 60 47.8 34.1 40 20 0 11.7 6.3 1st trimester 2nd trimester 3rd trimester post-birth percent 11.7 34.1 47.8 6.3 number 131 381 534 70 (assumption - trimesters equal 280 days divided into three equal parts) *Families who are referred to the program prior to birth of the baby are considered to be in this prenatal category. However, not all of the families enter and receive services early enough to have potentially improved birth outcomes. Also, some families were screened just prior to birth and final acceptance of enrollment did not occur until after the baby was born. Therefore, some (about 6%) of the “prenatal” families were considered for this analysis as enrolled post-birth. As noted in past years, recruitment and retention strategies that seem to be effective, according to the staff interviewed, included (1) having the hospital social worker conduct initial screens for new participants and (2) having home 19 Healthy Families Arizona Evaluation Report 2007 visitors with a strong ability to offer concrete types of assistance to meet the mother’s immediate needs. Program staff can review these ideas and consider additional assessment of the effectiveness of them in reaching families as early as possible during prenatal development. Recruitment is challenging, but early enrollment is important for the program to have the best chance to positively influence birth outcomes and subsequent parenting and child development outcomes. Child Development Screening One of the important services provided by Healthy Families Arizona is monitoring, screening, and assessment of child development. The program uses the Ages and Stages Questionnaire (ASQ) as a screening tool to assess for developmental delays. One of the main advantages of the tool is that it is considered very “parent friendly” and usable. One of the primary goals set by Healthy Families Arizona sets is to administer the Ages and Stages questionnaire with 80% of the children in families served by the program. In 2006, just under 66% of all children were screened for developmental delays. This number increased in 2007 to between 71% and just over 80%, depending on the time interval. This represented an increase compared to previous years. It also is consistent and in some cases higher than the 75% average across Healthy Families sites nationally (Harding, et. al., 2007). Based on file reviews during site visits, there continued to be some indication that the lower rates may be more of an issue of data collection than actual ASQ administration. However, a primary objective of the program is to administer the ASQ as a monitoring function so this is an area that deserves continued attention. The data show a similar pattern to the previous year in that the percentage of children screening as delayed increases with age. Furthermore, an estimate of the numbers of families on “outreach,” and therefore perhaps not receiving ASQ administration, would account for a maximum of ten percent of the amount of children reported as having no ASQ scores. Therefore, there remained some room for improvement and ongoing commitment to the program goal of screening 80% of the children. 20 Healthy Families Arizona Evaluation Report 2007 Exhibit 13. ASQ Screening Interval ASQ Percent of children Percent screened as delayed Administered screened with ASQ 2007 2007 6-Month 71.0% 5.4% 12-Month 74.9% 9.0% 18-Month 73.3% 24.7% 24-Month 79.5% 20.2% 30-Month 76.7% 14.2% 36-Month 78.9% 19.6% 48-month 84.8% 19.1% Program guidelines suggest that when an ASQ score falls into the “cutoff category” that indicates a potential delay, further assessment is required to determine whether the child needs additional intervention services. Continued assessment sometimes indicates no delay is in fact evident. Approximately one-fourth to one-fifth of the Healthy Families Arizona children who initially screen delayed with the ASQ are determined to be “not delayed” when referred for further assessment. In other cases, assessment suggested additional intervention is needed, and appropriate referrals need to be made. The Family Support Specialist may also provide appropriate development interventions with the child and family. The table below describes the pattern of these services that are generally similar to previous years with referral to the Arizona Early Intervention Program (AzEIP) being the most common external resource used for children 18 months and older. Multiple intervention referrals occur and are often used. As in past years, when potential delays have been identified, the most common intervention choice continued to be developmental interventions offered by the Family Support Specialist at home with the parent and child (74% at 36 months and 71% at 48 months of the families received this type of service). This may reflect the program’s emphasis on providing appropriate support for parents and follow-up to discussions with the families about the results of the ASQ. It may also indicate an appropriate use of child 21 Healthy Families Arizona Evaluation Report 2007 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 needs to be conducted in order to illuminate exactly how these professional choices occur. Exhibit 14 illustrates the types of referrals and services received by families with children exhibiting delays. Exhibit 14. ASQ Referral Status—2007 (All families) Continued assessment shows “no Delay” % (n) Referred to AzEIP % (n) Referred to other Early Intervention % (n) Provided Developmental Intervention % (n) Referred to Therapy % (n) Parent Declined Referral % (n) 6month Screen 18% (8) 34% (17) 18% (9) 62% (31) 6% (3) 2% (1) 12month Screen 29% (20) 25% (17) 18% (12) 63% (43) 6% (4) 6% (4) 18month Screen 21% (31) 24% (36) 11% (17) 73% (110) 4% (6) 4% (6) 20% (15) 29% (22) 26% (20) 72% (55) 1% (1) 5% (4) 30month Screen 21% (6) 10% (3) 24% (7) 69% (20) 7% (2) 10% (3) 36month Screen 4% (1) 11% (3) 15% (4) 74% (20) 11% (3) 11% (3) 48month Screen 24% (4) 0% (0) 24% (4) 71% (12) 12% (2) 0% (0) 24month Screen Note: percents do not equal 100% as multiple referrals can happen for a single child 22 Healthy Families Arizona Evaluation Report 2007 ASQ-SE In 2004 the Healthy Families Arizona program decided to add a socialemotional development screening tool to provide additional insight in child development of families served by the program. The Ages and Stages Questionnaire-Social Emotional (ASQ-SE) primarily assists parents and early intervention and early childhood personnel to identify “children with responses or patterns of responses that indicate possible future social or emotional difficulties” (Squires, Bricker and Twombly, 2002, p. 8). Similarly to the ASQ, the ASQ-SE serves as an aid to identify potential developmental delays and to help parents deepen their understanding of child development and their own child’s needs. Because the administrative timing for the ASQSE is not as narrow as with the ASQ (e.g., there is a six-month time frame for completion of the ASQ-SE), actual rates of administration are not included in this report. However, Exhibit 15 reports a summary of the ASQ-SE results (median and mean scores) obtained for postnatal families served by the program. For comparison, the cut-off scores (i.e., the score above which a recommendation for further assessment is made) are also listed. Exhibit 15. ASQ-SE (All families) Interval ASQ-SE Mean ASQ- Median ASQ- ASQ-SE Cutoff Administered SE Score SE Score Score* 6-Month (386) 14.92 10.00 45 12-Month (381) 16.34 15.00 48 18-Month (252) 22.06 15.00 55 24-Month (145) 25.52 20.00 50 30-Month (79) 28.61 20.00 57 (N) *Scores above the cutoff score indicate need for additional assessment. Similar to the results from FY2006, these families report relatively low averages for their children. One possible explanation for this could be the nature of the Social-Emotional scale--- it may be more subject to a “social” bias than the ASQ because the “socially acceptable” response is more obvious than 23 Healthy Families Arizona Evaluation Report 2007 with the items on the ASQ. Another possible explanation is that the families served by the program may not feel they have any concerns about the social and emotional aspects of their child’s development. Fatherhood/Male Involvement Data Healthy Families Arizona created a staff committee, called Men Involved in the Lives of their Children (MILC) in 2002 to identify strategies to increase father involvement. The committee has created training curricula and added resources related to male involvement to the web portal. The program evaluation added questions related to male involvement in January 2005. In 2007 the program renamed the effort: Men Are Nurturers (MAN) committee. The goal of the working group is to increase fatherhood involvement throughout the state’s Healthy Families programming. Their strategies this past year have focused on increasing awareness, identification, and sharing of strategies for increasing father involvement and helping other staff improve the measurement and tracking of this involvement. The male involvement section of the FSS-20 form asked questions about the following categories: shared responsibility of the child through both basic care (feeding, bathing, etc.) and extended care (transportation, appointments, etc.), financial support, residence in the child’s home, and male participation in HFAz activities. These questions are asked of male involvement of the father, partner, grandfather, and other male figures. There is also a ‘none’ option for every question, which indicates lack of male involvement. These questions are completed during the same times as the FSS-20 form (6 months, 12 months, 18 months, etc.). From January 2006 to June 2007, 1,658 families at the 6-month interval were eligible to answer the male involvement questions. During this time, approximately 1,528 (92%) of the families had data recorded in this area. At the 12-month interval, 1,192 of 1,316 (91%) reported on male involvement. In general, just over half of the families reported some sort of male involvement. Of those families where information was available, fathers were the most frequently involved, followed by grandfathers, partners, and the other categories. The following table shows the percentage of male involvement across time. 24 Healthy Families Arizona Evaluation Report 2007 Exhibit 16. Male Involvement Across All Categories at 6 and 12 months* Male Figure 6 months 56.0% (average n = 936) 8.5% (average n = 141) 1.4% (average n = 23) Father Grandfather Partner 12 months 55.0% (average n =728) 8.8% (average n = 116) 10.0% (average n = 36) Exhibit 17. Male Involvement at 6 and 12 Months Number & Percent of Families Reporting Number & Percent of Families Reporting Male Involvement at 6 Months Male Involvement at 12 Months Total # of Families Enrolled at Total Number of Families Enrolled at 6 months=1,658 12 Months=1,316 Father Shares Grandfather Partner Other None Father Grandfather Partner Other None 963 151 27 55 332 759 127 37 36 233 58.1% 9.1% 1.6% 3.3% 20.0% 57.7% 9.7% 2.8% 2.7% 17.7% Helps with 950 128 25 53 348 726 111 39 35 265 Basic Care 57.3% 7.7% 1.5% 3.2% 21.0% 55.2% 8.4% 3.0% 2.7% 20.1% Helps with 886 117 21 41 420 693 107 33 29 310 53.4% 7.1% 1.3% 2.5% 25.3% 52.7% 8.1% 2.5% 2.2% 23.6% 988 144 22 43 313 766 104 35 24 240 59.6% 8.7% 1.3% 2.6% 18.9% 58.2% 7.9% 2.7% 1.8% 18.2% 894 165 18 79 349 698 130 37 56 256 53.9% 10.0% 1.1% 4.8% 21.0% 53.0% 9.9% 2.8% 4.3% 19.5% 598 28 13 15 758 483 37 22 11 551 Child Care Responsibilities Extended Care Provides Financial Support Currently Resides in Same Home as Target Child Participates in H.F. Activities 36.1% 1.7% 0.8% 0.9% 45.7% 36.7% 2.8% 1.7% 0.8% 41.9% *Numbers reflect how many families indicated whether a male figure was involved with each activity with the target child at each time interval. More than one male figure could have been chosen for each activity. 25 Healthy Families Arizona Evaluation Report 2007 Across the categories, approximately 58% (963) of fathers were involved in the child’s life, although a few more contribute by providing financial support. Grandfather involvement was the next most frequent category. Fathers were least frequently reported as being involved in Healthy Families Arizona activities (36%). There can be several reasons for this, including that many visits occur when fathers are working and not at home. The program staff have been interested in reaching out to fathers. Despite improvements in data collection, father involvement cannot be fully assessed using these limited measures. Nevertheless, the program staff intend to increase the involvement of fathers; therefore, the results can help shape the expectations around these intentions. For example, approximately two-thirds of the families in the program reported any involvement by a male figure. Of these, approximately half or less of the male figures are involved with the home visitation activities. Therefore, increased involvement could reasonably be expected for approximately a few hundred more families. Participant Satisfaction Satisfaction with the program is an aspect of program implementation that may help families to stay involved in a program. Asking for feedback from families can also help them feel valued. Healthy Families Arizona program sites distribute a satisfaction survey to participants during a two-month time period each year. For this program year, 1332 surveys were returned from 54 sites. This is a large number of families, but may not be representative of every family served by the program. For example, this survey is not used as an exit survey for the program so families that have dropped out may not be included in the sample. Regardless, the results can provide important feedback for the program. A separate report was completed for sites that included 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. For most of the categories, over 97% of the families agreed or strongly agreed with the statements. Fully 94% of the families agreed or strongly agreed with the statement “As a result of Healthy Families, I feel I am a better parent.” 26 Healthy Families Arizona Evaluation Report 2007 Exhibit 18. Participant Satisfaction Survey Results (n=1259) Sample Items from HFAZ Neither Strongly Strongly Participant Satisfaction Disagree Agree nor Agree Disagree Agree Surveys Disagree I felt I received the help and services I wanted 0.7% 0.6% 1.0% 25.1% 72.5% and needed. I felt the home visitor was respectful of my 0.7% 0.1% 0.8% 16.7% 81.7% cultural beliefs and practices. My home visitor helped me to establish goals that I understand, that I 1.0% 0.0% 1.2% 21.8% 76.1% am interested in pursuing, and that are important to me. I was satisfied with the information provided 0.7% 0.0% 0.6% 20.6% 78.0% on child development and parenting. I felt I received high 0.8% 0.2% 1.4% 21.7% 75.9% quality services in Healthy Families. As a result of Healthy 0.7% 0.2% 5.3% 26.3% 67.4% Families, I feel I am a better parent. As in prior years, 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 19. 27 Healthy Families Arizona Evaluation Report 2007 Exhibit 19. Participants’ Perception of Language Barriers Do you speak another language other than English? Were the program materials provided to you in a language that you read and understand? Did your home visitor speak a language you understand? Language the survey was completed in: Yes 30.9% No 69.1% 98.3% 1.7% 98.2% 1.8% 70% 30% English Spanish In summary, and consistent with prior years, participant satisfaction results suggested that 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. 28 Healthy Families Arizona Evaluation Report 2007 What Difference Does the Program Make with Families? For FY2007, the following outcomes were examined: • • • • Parent outcomes, e.g., parental stress, (i.e., results of the Healthy Families Parenting Inventory) Child Abuse and Neglect Child and Maternal health outcomes Safety in the home environment. The outcome indicators reported annually 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. These outcomes are described in more detail in two logic models created in collaboration with program staff in 2005. The models (included in the Appendix) continued to provide guidance in thinking about the program, in organizing results and in identifying areas for development. In addition, the list of the measures used to determine whether the activities were carried out as planned (process measures), and whether program goals were met (outcome measures) is also included in Appendix C. Parent Outcomes Healthy Families Parenting Inventory (HFPI) Three years ago, the evaluation team and program staff created a new outcome instrument, the Healthy Families Parenting Inventory (HFPI). Various instruments have been used with other home visitation program evaluations that have been shown to be inadequate to capture the actual changes made by program participants. Many of these instruments were not designed as outcome instruments, but rather as measures of concepts, e.g., family stress. By focusing on outcomes (i.e., changes) and by designing an instrument specifically for the Healthy Families program, more relevant outcomes can be assessed to describe program effectiveness. 29 Healthy Families Arizona Evaluation Report 2007 The HFPI includes 10 sub-scales that have been tested for reliability. The survey represents an inventory specific to Healthy Families that has shown its ability to capture change initiated by the program; furthermore, the inventory has good reliability data (See Appendix D for specific details on the more recent reliability estimates). Results from participant data on the HFPI revealed significant improvements from the two-month and six-month as well as two-month and twelve-month administration of the instrument. Exhibit 20 presents each subscale and the results of the statistical analysis of changes in parents from two months to six months and two to twelve months. Exhibit 20. Healthy Families Parenting Inventory Scale Significant Improvement Significance* Baseline to 6 (Effect Size**) months Social Support Significant Improvement Baseline to 12 months Significance* (Effect Size**) .105 (.05) U .000* (.23) Problem Solving U .000* (.23) U .000* (.34) Depression U .001* (.11) U .000* (.32) Personal Care U .004* (.10) U .000* (.24) Mobilizing Resources U .000* (.25) U .000* (.48) Commitment to Parent Role U .004* (.10) U .000* (.20) Parent/Child Behavior U .000* (.17) U .038* (.11) Home Environment U .000* (.27) U .000* (.28) Parenting Competence U .000* (.24) U .000* (.35) Parenting Efficacy U .000* (.19) Total Scale U .000* (.27) .141 (.08) U .000* (.37) *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. **Effect size was computed using Cohen’s d. Effect size estimates the magnitude of the change. As Exhibit 20 shows, nine of the ten scales, plus the overall scale, showed a statistically significant difference in the families between the two month 30 Healthy Families Arizona Evaluation Report 2007 (baseline) and six month and between baseline and 12 month administration of the instrument. Families showed significant improvement on all but one of the scales; these results are indicators of improvements in healthy parenting. Overall, 68.5% of families showed positive change between baseline to twelve months. To further describe and estimate the amount of change shown by the families, a statistic called the “effect size” was calculated. Most social service programs produce effects that are considered “moderate” and these are roughly in the 0.1 to 0.2 range of effect size calculations (e.g., Gomby, 2005)4. The effect sizes in the HFPI results indicated modest effects and that the program’s influence increased over time (i.e., the effect sizes are higher for the 12-month administration of the HFPI). The largest effect size occurred with mobilizing resources (i.e., 0.48), a result that supports the value placed by the program on serving as support for families in connecting and using resources. Other moderate effects are seen in the parenting competence, problem solving, home environment, and depression scales. Smaller but consistent effects are reflected in improvements in social support, commitment to parent role and personal care. An additional set of analyses5 was used to examine factors that might predict the total score of the HFPI. Included in the analyses were mother’s age, ethnicity, marital status, history of childhood abuse, and number of children (i.e., first time mother or had at least one child). The results indicated that none of these characteristics predicted large differences on the HFPI. Ethnicity and number of children showed some small differences (e.g., Hispanic mothers and mothers with more than one child scored lower on the HFPI). These results should be reviewed with program staff to assess whether additional analyses about these groups of mothers might provide insight into their special needs. However, these results should also not be over interpreted, More stringent interpretations of effect sizes consider 0.2 as “small” and 0.5 as “medium” effects. Cohen, J. (1988). 4 Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: LEA 5 A linear regression model was used to analyze a set of variables as they relate to an outcome (in this case, total HFPI score) of interest. The final model was significant and explained six percent of the relationship between the HFPI score and the included variables (R2 = .058, p<0.001). This analysis is preliminary and will be assessed for potential use in the future. 31 Healthy Families Arizona Evaluation Report 2007 as they are preliminary in nature but can provide hints for potential extra attention from the home visitors to particular types of mothers. Child Abuse and Neglect The following exhibit presents data for families who were active in Healthy Families during the period of July 1, 2006, to June 30, 2007, 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 years’ rates. For the total families served by Healthy Families Arizona in FY2007, 99.7% had no substantiated reports of child abuse or neglect. The comparison group, families who dropped out of the program before four home visits, showed a slightly higher (98.6%) rate. Healthy Families Arizona is required to report these statistics because the goal is included in the HFAz statute. However, several reasons exist for using caution in their interpretation. Child abuse and neglect rates may not be the best measures to describe short-term program impact because of the following: 1) The rates reflect low-occurring events where small changes may not be representative of long-term effects; 2) Incidents of child abuse and neglect often go unreported; 3) These rates involved a process that requires a “match” on available information on the families such as mother’s name, social security number, and date of birth. When details for the match are missing or the legal name is not available, the accuracy of the match can decrease. A final explanation for finding lower numbers of substantiated reports in the short run is that the recording of “substantiated” is often delayed in the CPS system due to the time it takes to complete investigations and to go through appeals processes. 32 Healthy Families Arizona Evaluation Report 2007 Exhibit 21. Percent of families showing no child abuse and neglect incidences Percent without substantiated report 2004 (n=1,568) Percent without substantiated report 2005 (n=1,814) Percent without substantiated report 2006 (n=2,780) Percent without substantiated report 2007 (n=3,301) All Families 98.4 98.2 99.2 99.7 Comparison Group* 98.6 97.3 99.1 98.6 Group *Families who dropped out of the program before 4 home visits. In 2007, there were 827 families in the comparison group. These data represent a one-year snapshot of information. Long-term patterns of substantiated reports may vary somewhat from what is reported here due to lag time in the final assignment of “substantiated” categories. This challenge to the interpretation of the child abuse and neglect results further supports the need for results from the longitudinal study that will provide more definite answers about ultimate outcomes as mentioned previously in this report. Child Development and Wellness Healthy Families Arizona maintains a process goal of completing administration of the Ages and Stages Questionnaire screening instrument with 80% of the children in families served by the program. The ranges of those results varied by time interval and most were within ten percentage points of the goal (e.g., 71%-84%). These results are significantly better than last year. For those children that were screened and had scores within the cutoff range, the majority received appropriate referrals and support. For more detailed information, refer to the service delivery section of this report. 33 Healthy Families Arizona Evaluation Report 2007 Safety Practices and Healthy Behaviors Healthy Families Arizona assesses and promotes safe environments for children through education about important safety practices and monitoring the use of that information through completion of a safety checklist. These practices play an important role in accident and injury prevention in homes and cars. The home visitors successfully administered the safety checklist with more than 80% of the families in the program. The following exhibit reports the results in four critical areas of child safety. The results showed some increases from prior years. Exhibit 22. Percent of all families implementing safety practices 2-Month 6-Month (n=1,535) (n=1,658) 12-Month (n=1,316) 18-Month (n=1,001) 24-Month (n=580) Outlets Covered 46.0% 59.9% 75.2% 82.2% 84.5% Poisons Locked 84.2% 90.3% 94.5% 95.5% 95.2% Smoke Alarms 84.4% 86.7% 89.3% 92.1% 90.9% Car seats 99.5% 99.1% 98.7% 98.4% 98.4% The program continues to excel in car safety seat use. For example, car seat use for a similar age group has been estimated to be 90% (Glassbrenner and Ye, 2007). As in past years, appropriate safety practices increased steadily as the child becomes more mobile at 12-24 months. Additional data showed that as the child ages, more attention to safety is shown, e.g., 99.2% of families ensure pool safety at the 24-month interval. These results compare favorably with national estimates. A national study of households revealed that although 96% of households have a smoke alarm, when asked if they have a “working smoke alarm,” only three-fourths of U.S. households response in the affirmative (Ahrens, 2007). The Healthy Families safety checklist refers to working alarms. Therefore, the program results appear to be better than those of average homes in the U.S. with regard to use of car seats and smoke alarms. 34 Healthy Families Arizona Evaluation Report 2007 In addition to household safety practices, a separate checklist related to healthy behaviors was administered to prenatal families. The following exhibit summarizes some of the key results of this assessment and shows fairly high, positive ratings. Exhibit 23. Percent of prenatal families implementing prenatal safety practices 78.6 Follows nutritional guidelines 97.3 Avoids alcohol and drugs 84.7 Avoids contact with cigarette smoke 78.1 Avoids stress Attends all prenatal care visits 91.5 Calls doctor with concerns 91.5 Consults medical doctor about use of medications 93.1 Has been tested for STDs 94.1 0 10 20 30 40 50 60 70 80 90 100 Percent Immunizations and Medical Homes Promoting positive health behaviors encompass key objectives of Healthy Families Arizona. A common indicator for prevention programs is the immunization rate for the children. Exhibit 24 shows the rate for the infants of Healthy Families Arizona participants for 2007, 2006, and 2005. The results indicate even higher levels for children in the program than last year. Overall, Healthy Families Arizona families continue to have their children immunized at a rate greater than the Arizona percentages and are higher than estimates for children with the state insurance, Arizona Health Care Cost Containment System (AHCCCS). Nevertheless, Healthy Families Arizona supervisors and staff should continue to maintain high expectations and to encourage immunization completion and data submission. 35 Healthy Families Arizona Evaluation Report 2007 Exhibit 24. Immunization Rate of Healthy Families Arizona Children Percent Percent Percent Immunization Immunized Immunized Immunized Period Immunization 2005 2006 2007 Immunization Rate for 2Rate for 22 month 92.7% 86.4% 91.3% year-olds on year-olds in AHCCS in Arizona 4 month 90.2% 83.9% 88.4% Arizona (2006)* (2006)** 6 month 82.3% 69.5% 77.7% 12 month 92.1% 87.4% 89.3% Received all 4 in the series by 18 months of age. 89.1% 83.5% 87.5% 79.0% 82.0% *Source: 2006 data from the Arizona Department of Health Services. **Source: 2007 report to Arizona Early Childhood Development and Health Board. Another indicator for the goal of ensuring the families receive adequate medical care is the percentage of children linked to a medical doctor. The data revealed a substantial number of the children linked to a medical doctor. Furthermore, the levels were consistent with the 94% average noted across other Healthy Families programs (Harding et al., 2007) . Emergency room use without a doctors referral was estimated at around 10%; approximately 90% of the families did not report emergency room visits without a doctor’s referral. Exhibit 25. Percentage of Children Linked to a Medical Doctor 6 12 months months 18 months AHCCCS 24 Children 12-24 months months Percent of children with medical home 2006* 97.5% 97.1% 96.4% 97.8% 80.5% Percent of children with medical home 2007** 96.0% 94.1% 92.4% 94.7% NA *Postnatal only and **Prenatal and postnatal. 36 Healthy Families Arizona Evaluation Report 2007 Mothers’ Health, Education, and Employment The following results report on the health and well-being of participating mothers in outcomes such as subsequent pregnancies, education, and employment. During the study period, 10.4% of the mothers who entered postnatally reported subsequent pregnancies, compared to 15% in 2004 and 11.8% in 2006. Therefore the total rate of repeated pregnancies has decreased slightly. Of these, 28.6% were 19 years or younger . Exhibit 26 shows the length of time to subsequent pregnancy for active families during each year. In examining the past four years, the number of mothers having another child within 12 months of their child has again increased. The results should be reviewed with program staff and discussion about reasons and strategic planning around steps to affect this trend should be identified. Staff need to continue to place increased emphasis on the risks and challenges associated with closely spaced pregnancies and the benefits of increased spacing. Exhibit 26. Length Of Time To Subsequent Pregnancy for Those Families with Subsequent Births Length of Time to Subsequent Pregnancy 2004 Percent of mothers 2005 Percent of mothers 2006 Percent of mothers 2007 Percent of mothers 1 to 12 mos. 31.6 % 33.3% 37.7% 42.1% 13 to 24 mos. 42.3 % 42.3% 38.1% 39.3% Over 24 mos. 26.1 % 24.4% 24.2% 18.6% Home visitors can provide links and support mothers to finish GED programs, or enroll in vocational or college education programs for those interested in furthering their education. Exhibit 27 displays the percentage of mothers enrolled in school full or part-time at different intervals. The results are slightly lower than reported in the past year for fulltime enrollment and slightly higher for part-time enrollment in school. 37 Healthy Families Arizona Evaluation Report 2007 Exhibit 27. Percent of all mothers enrolled in school 6 month 12 month 24month 36 month Percent enrolled part-time 2005 4.4% 6.3% 5.0% 6.3% Percent enrolled part-time 2006 3.3% 4.8% 3.5% 5.8% Percent enrolled part-time 2007 4.5% 6.5% 4.2% 5.8% Percent Percent Percent enrolled enrolled enrolled fulltime fulltime fulltime 2005 2006 2007* 9.4% 9.3% 8.9% 12.9% 8.0% 9.8% 7.8% 8.8% 4.6% 8.4% 2.9% 5.8% * For 2007, data was available for 1454 mothers at 6 months, 1131 at 12 months, 524 at 24 months and 173 at 36 months Exhibit 28 shows the employment status of mothers actively engaged in the program at various points in the program as compared to 2004, 2005 and 2006. The results have been relatively stable over the past several years. They also showed a pattern of increased employment over time that indicated approximately 40% of the mothers in Healthy Families Arizona are working approximately 12 months after their baby was born. This may be a partial explanation for length of time in the program that is, on average, approximately 13 months. National estimates of employment rates of mothers with young children tend to be in the mid-fifty percent range. These results may also imply greater need for referral and support for helping mothers find quality child care. Exhibit 28. Mother’s employment status Percent Employed 100% 2004 2005 2006 2007 80% 60% 40% 20% 0% Baseline 6 months 12 months 38 Healthy Families Arizona Evaluation Report 2007 Substance Abuse Screening One of the primary roles of the home visitor is the identification and assessment of the possible influence of alcohol or other drug abuse on the family. Alcohol and other substance abuse is a significant risk factor for child abuse and neglect. Home visitors provide education to the families about risky and healthy choices and can make referrals for support or treatment services if appropriate and available. Screening tools can help home visitors identify families most in need of such referrals. The CRAFFT screening tool was chosen three years ago by program staff with expectations that it would effectively screen for substance abuse problems, and also promote communication between the home visitor and family member. However, its continued use for the Healthy Families program has been under review because alternative, brief, reliable, and valid measures about substance abuse are difficult to identify. The brief alcohol and drugscreening test is known by a mnemonic, CRAFFT, based on the first letter of keywords in the 6 easy-to-remember questions. The CRAFFT is a widely-used assessment instrument with acceptable reliability and validity; it was created for particular use with young adults and adolescents. Its series of questions should allow the home visitor and parent to have a conversation about substance use and abuse. Although a positive screen may not necessarily indicate a substance abuse problem or alcoholism, it could serve as a signal to Healthy Families staff about the need for further discussion or referral. The data from the past year indicated that 67-99% of the families were screened using the CRAFFT, depending on the interval examined (6 months, 12 months, etc). These rates showed a large increase from the 25-33% reported in 2005 and the 52-68% reported in 2006 year. Furthermore, of those who received the screen, 430 (26%) were screened as positive for drug use at 2 months, but none received a positive screen at other intervals. In 2007, the program implemented newly designed specialty trainings in substance abuse for Family Support Specialists and this could have contributed to increased awareness and comfort in administering the CRAFFT or at least addressing substance abuse issues with families. 39 Healthy Families Arizona Evaluation Report 2007 However, anecdotal feedback from staff have indicated continued dissatisfaction with the implementation of the CRAFFT and question the relevance for use with these families. Therefore, its use continues to be under review and a possible alternative measure may be suggested. 40 Healthy Families Arizona Evaluation Report 2007 Information for Program Learning This section of the report focuses on special studies and ongoing evaluation support for program learning and decision making. First, a summary of programming and policy updates is provided, followed by a brief description of the past year’s activities highlighting efforts to effectively communicate about the links between research and practice through the Building Bridges newsletter and evaluation presentations. Finally, information and results from the home visitor retention study is presented. Program and Policy Updates Exhibit 29 depicts some of the key program and policy developments that have occurred in the past year. Exhibit 29. Developments in the Healthy Families Arizona Program in 20062007 The Healthy Families Arizona Web Portal Provides New Opportunities for Distance Learning to the Program Sites Healthy Families Arizona launched its Web Portal in June 2005. The Web Portal has been programmed to handle a number of administrative functions including new staff enrollment, registration for all required HFAz trainings, maintenance of on-line training logs, HFAz committee activities, and chat rooms. In 2007, HFAz developed two new orientation trainings specific to the roles of supervisors and family assessment worker staff. In the past, the online orientation training was focused primarily on the home visitors’ role. Supervisor and family assessment orientation was only available through written training modules. These new on-line trainings were developed to ensure that newly hired supervisors and family assessment workers would have a high quality training regarding orientation to their role in the program including confidentiality, the strength-based philosophy, child abuse and neglect reporting and policy review. The format of all distance learning projects involves a “tell me, show me, let me try” approach so that staff feel successful and enthusiastic about their new job. The Web Portal has also served as a means for parents in HFA programs from other states to contact 41 Healthy Families Arizona Evaluation Report 2007 HFAz central administration for potential transfers. The HFAz Web Portal can be accessed by going to http://www.healthyfamiliesarizona.org. Revised Accreditation Standards Implementation In 2007, Prevent Child Abuse America revised the Healthy Families America Accreditation standards. The process for credentialing has been streamlined with a more process and outcome based approach to quality assurance. In addition, several standards were identified as being key to the safety of families and the quality of work. These “safety” and “sentinel” standards must be met in order to receive a credential. Safety standards include background checks and child abuse and neglect reporting processes. Sentinel standards include supervision, developmental screening, confidentiality practices and informed consent. Seasoned Program Specialist staff have participated in peer refresher training and are certified peers reviewers in the 2007 accreditation process. All site visits conducted this year utilized the new credentialing and quality assurance format to assist program sites in preparing for credentialing. HFAz State System Analyses and Plans for Improvement In preparation for HFAz credentialing in 2009, the HFAz Credentialing Committee has developed a timeline and plan for implementation of the analyses required by accreditation. HFAz sites must measure, monitor, and analyze program acceptance, family retention, staff retention, cultural sensitivity, and progress towards accomplishment of program goals. These five analyses are required once every two years. Since family retention has been an improvement recommendation for the program for several years, the family retention analysis became the starting point for the credentialing process. Demographic, programmatic, social, and community factors are considered as part of the analysis. In partnership with the evaluation team, the Credentialing Committee has trained program supervisors and is in the process of reviewing each site’s family retention analysis and plan for improvement. 42 Healthy Families Arizona Evaluation Report 2007 Prenatal Referral Collaboration with WIC Healthy Families Arizona staff continue to seek stronger partnerships for enrolling families earlier during the prenatal period. In order to have more positive birth outcomes, it is important to recruit families during the first trimester of pregnancy. In partnership with the Department of Economic Security, HFAz is in the process of working out a systematic referral system with WIC statewide that will allow for earlier access to pregnant woman and their families. Father Involvement and Parent Leadership The HFAz Father Involvement Committee was revitalized in 2007 as a statewide committee. The Men Are Nurturers (MAN) Committee goals are to increase the number of fathers actively involved in the lives of their children, to provide additional training for staff on father involvement, and to develop materials designed to recruit fathers as leaders. This Committee moves its meetings throughout the state in an effort to recruit and increase each program’s involvement in reaching out to fathers. Expanded Specialty Training for Substance Abuse In 2006, the Training team initiated specialty training that supports staff in working more effectively with the ever-increasing needs of the families served by the program. Through the use of specialty training funds, most program sites have been able to contract with a clinical consultant who participates in monthly to bi-monthly team meetings and offers 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 participating in Healthy Families Arizona. The Program Specialist team developed a series of trainings that specifically address how to “facilitate change” through the use of motivational interviewing techniques that are integrated within the Healthy Families Arizona approach. 43 Healthy Families Arizona Evaluation Report 2007 To maximize the use of these specialty training funds, and to ensure that new skills are used in interactions with families, the Program Specialist team has developed the first of three trainings that are based on the concepts of “facilitating change” in families that anchor experience and practice. A twoday Substance Abuse training was launched in 2007. In 2008, HFAz will launch domestic violence and mental health training. The primary focus of the substance abuse training includes the following topics and is specifically designed for HFAz home visitors: The effects of the use of psycho-active substances on individual users and their families; the nature of the connection between substance abuse and the person who uses; the continuum of intervention resources available for those engaged in harmful substance abuse; how the home visitor fits into the continuum of intervention; risk factors, identification of the risks in the families served, how to talk with families about substance abuse, relapse factors, interventions when families are in denial, what to do when families won’t stop, and staying safe. Building Bridges Newsletter In 2005, a newsletter was created to link practice and research on home visitation. The 2006-2007 issues of the newsletter, Building Bridges, were distributed to approximately 1000 people each quarter and were made available on the web. Topics included domestic violence, quality child care, working with teen mothers, and positive child development. The purpose of the newsletter fits well with recent research articles that point to the value of sharing explicit connections between research and practice (Galano, 2007). Ongoing Evaluation Communications Evaluation team members regularly attend and participate in statewide committee meetings and bi-annual staff institute trainings. With the high number of program staff with relatively short tenure, there is a continual need to educate and update staff on evaluation methods and results. Ongoing efforts to share data, results, and lessons learned can help build capacity and motivation to engage in evaluation and provide opportunities for evaluation 44 Healthy Families Arizona Evaluation Report 2007 staff to gather feedback and suggestions from Healthy Families stakeholders. Presentations at the institutes included results from the 2006 report as well as feedback on examples of “what works” for the sites to track and monitor administration dates of program forms (e.g., ASQ). In addition, a session on “Why evaluate?” using resources such as Healthy Families America® Site Development and Critical Elements documents was conducted to help all program staff discover and guide meaningful uses for evaluation data. For example, the following reasons to evaluate are noted by HFA:             Provide direction for staff Identify training needs Improve programs Support annual and long-range planning Guide budgets and justify resource allocation Suggest target outcomes Recruit talented staff and volunteers Promote the program to potential participants and referral sources Identify partners for collaboration Enhance the program’s public image Support the program’s advocacy agenda and Retain and increase funding. Furthermore, HFA notes, “It is critical that home visiting programs share their stories, their triumphs and shortfalls with their colleagues in this field. The only way we can learn and improve upon the work we do is to share…Evaluation data can lead to the creation of new policies, better programs and the allocation of new resources.” 45 Healthy Families Arizona Evaluation Report 2007 Home Visitor Retention In April 2006, a workforce survey was administered to all Healthy Families Arizona staff attending the spring institute training in order to gather information relevant to staff retention. Home visitor retention is important for the following reasons: 1. It influences participant retention. Ninety-four families dropped out of Healthy Families Arizona during the three-year period from 2004 through 2006 due to “refusal of worker change.” 2. It protects a substantial investment in training. In the first year of employment, each Healthy Families Arizona home visitor receives between 140 and 180 hours of dedicated training, including orientation training, core training, and the biannual institute. 3. It protects against a loss of productivity that occurs when experienced home visitors leave and new home visitors are interviewed, hired, trained, and garner the experience necessary to carry a full caseload. In Healthy Families Arizona, new workers are typically assigned no more than two-to-three new families per week. Generally it takes two-to-three months following the completion of core training for new workers to build-up a full caseload. According to Michaud (2000), the Department of Labor estimates that it costs one-third of a new employee’s salary to replace a worker, and for a professional position the cost is estimated as high as 100%. A total of 271 individuals completed the workforce survey in April 2006 (88% response rate). These staff responses represented the perspectives of family support specialists (home visitors), family assessment workers, supervisors, administrative support staff, program managers, and program specialists. The survey included questions relating to 13 domains, each identified in the literature as important to workforce satisfaction and retention. Exhibit 30 lists the 13 domains included in the workforce survey and a sample item from each domain. The full results of the workforce survey are reported in the 2006 Healthy Families Arizona Annual Report (LeCroy & Milligan Associates, 2006). 46 Healthy Families Arizona Evaluation Report 2007 Exhibit 30. 2006 Workforce survey domains and sample items Domains 1. Realistic expectations at entry Example Statements Those who interviewed me for this job gave me an accurate picture of the work. 2. Personal/professional fit The work I am doing suits me. 3. Professional efficacy I am generally effective in working with families. 4. Perception of workload The size of my workload is too big. 5. Quality supervision My supervisor provides the expert help I need to do my job. 6. Opportunity for meaningful input I have the support to make work-related decisions when appropriate. 7. Leadership encouraged My employing agency shares leadership roles with staff. 8. Location attachment I consider the community where I live “home.” 9. Perceived employing agency I feel good about what my employing agency performance does for children and families. 10. Non-salary reward My Healthy Families supervisor shows approval when I succeed. 11. Adequacy of salary I am satisfied with the salary I receive from my employing agency. 12. Opportunity for advancement This agency provides support for those working towards a degree or certificate. 13. Perceived community sanction Other professionals respect Healthy Families staff. Overall, the 177 home visitors responding to the workforce survey had a relatively short tenure with the program. Seventy-eight percent of the 177 home visitors had been employed with Healthy Families Arizona for only two years or less. 47 Healthy Families Arizona Evaluation Report 2007 A majority (58%) of these home visitors indicated an ethnicity other than white. Maintaining a diverse workforce that reflects the population of families served by Healthy Families Arizona is considered important. The 2006 Annual Healthy Families Report identified that 69% of mothers engaging in the prenatal period, and 73% of mothers engaging in the postnatal period identified as other than white or Caucasian. In terms of intent to remain employed with Healthy Families Arizona, 66% percent of the 177 home visitors surveyed reported that it was unlikely that they would make an effort to find a new job within the next six months, 73% reported that they were not actively seeking other employment, and 54% reported that they intended to work with Healthy Families Arizona as a longterm career. An analysis that examined factors related to home visitors’ intentions to work with Healthy Families Arizona as a long-term career found three statistically significant predictors: -1- encouragement of leadership -2- location attachment, and -3- age. The greater the home visitor’s attachment to the local area, such as considering the community “home,” having a spouse or immediate family members attached to the area, and not considering moving away, the more likely the individual was to indicate an intent to remain employed with Healthy Families Arizona. Greater perceived encouragement of leadership in the employing agency was also related to intent to remain employed with Healthy Families Arizona. And finally, age was also related to intent to remain with Healthy Families Arizona, with older home visitors more likely to report their intent to remain employed than younger home visitors. The following analysis examines factors related to the actual retention of home visitors in the one-year period following the administration of the workforce survey in April 2006. During the 1-year period from April 2006 to April 2007, 35 of 177 Healthy Families Arizona home visitors terminated their employment (19.8%), and 142 (80.2%) were retained. 48 Healthy Families Arizona Evaluation Report 2007 Characteristics Related to Home Visitor Retention and Attrition Exhibit 31 provides a comparison of the 142 home visitors who were retained during the study period and the 35 home visitors who ended their employment. As seen by the summary statistics presented in Exhibit 31, the home visitors who were retained by Healthy Families Arizona were slightly older than those who left, averaging 34 years of age for the former compared to an average of 32 years for the latter. Those who moved on tended to do so earlier in their careers. The average length of employment for those whose employment with HFAz ended was almost 2 years; however, some left as early as 72 days after initial hiring. Among the 35 home visitors who left their employment, 22.9% (8) did so within their first year of employment, and an additional 34% (12) discontinued their position between one and two-years of service. A total of 88.6% of the 35 home visitors leaving their employment during the study period had been employed in Healthy Families Arizona less than three years. There were no statistically significant differences in age, ethnicity, and education between those home visitors who were retained and those who discontinued. There were, however, statistically significant group differences in average length of employment, with those home visitors who were retained being employed longer on average than those who were not retained. Also, those who left were significantly more likely to indicate on the April 2006 workforce survey that they did not view Healthy Families Arizona as a long-term career, and that they were likely to seek alternative employment within the next six months. 49 Healthy Families Arizona Evaluation Report 2007 Exhibit 31. Comparison of home visitors retained and those who were not retained Retained (n = 142) Not Retained (n = 35) 34 years 32 years 3 years, 82 days 1 year, 343 days 41.6% 38.0% 8.8% 12.0% 48.6% 38.4% -11.6% 10.6% 14.2% 15.6% 52.5% 2.1% 5.0% 22.9% 2.9% 5.7% 62.9% 2.9% 2.9% 70.4% 29.6% 40.0% 60.0% 78.2% 21.8% 48.6% 51.4% Home Visitor Characteristics Average age Average length of employment as of termination or 04/30/07 * Ethnicity White, not Hispanic (n = 74) Hispanic (n = 66) American Indian (n = 12) All other (n = 20) Highest level of education High School (n = 23) Some college (n = 21) AA degree (n = 24) BA/BS (n = 96) MA/MS (n = 4) BSW/MSW (n = 8) Intent to make HF long-term career in April 2006** Yes No, don’t know Unlikely to seek employment in next 6 months as of April 2006** Yes No, don’t know * p. < .01 - denotes a statistically significant difference between the groups of retained and terminated. ** p. < .001, 50 Healthy Families Arizona Evaluation Report 2007 Predictors of Home Visitor Attrition A multivariate logistic regression analysis6 was performed to determine the best predictors of attrition among Healthy Families Arizona home visitors. The outcome of interest was whether or not the home visitor had ended employment with Healthy Families Arizona in the one-year period between the date the survey was administered in April 2006, and one full-year of follow-up on April 30, 2007. Logistic regression was conducted to determine which variables were statistically significant predictors of home visitor attrition. Regression results using a simultaneous entry method indicate that a model of five predictors was statistically reliable in distinguishing between those home visitors who terminate and those who are retained (See Exhibit 32). The best fitting regression model correctly classified 85% of the cases based on information from six statistically significant predictor variables: professional fit, professional efficacy, non-salary reward, workload, actively seeking alternative employment, and time employed. For additional details on the regression analysis see Appendix F. Exhibit 32. Factors from the Workforce Survey Predictive of Home Visitor Attrition Variables Entered into the Regression Equation Statistically Significant Predictor of Attrition  = no Realistic expectations at entry  = yes  Personal/professional fit  Professional efficacy  Perception of workload  Quality supervision  Opportunity for meaningful input  Leadership encouraged  Location attachment  Perceived employing agency performance   Non-salary reward Adequacy of salary 6  Logistic regression analysis is a statistical procedure that determines whether a set of variables has a unique predictive relationship to an outcome of interest. 51 Healthy Families Arizona Evaluation Report 2007 Variables Entered into the Regression Equation Statistically Significant Predictor of Attrition  = no Opportunity for advancement  Perceived community sanction   = yes  Actively seeking alternative employment  Education Time employed  Professional/personal fit Three items are included in professional/personal fit. These include the following: • • • There is a good match between the duties of this job and my skills. There is a good match between the duties of this job and my interests. The work I am doing suits me. As expected, those home visitors who scored lower on professional/personal fit were more likely to terminate their employment with Healthy Families Arizona. The following quote by a home visitor illustrates the enthusiasm that is present when the professional/personal fit exists. This job is a perfect match for me. I feel like it was created just for me, a great fit! I love working for Healthy Families. Professional efficacy Six items are included in the professional efficacy subscale: • • • • • • I remain motivated to help families overcome obstacles. I rebound and persist after setbacks in order to accomplish work goals. I am generally effective in working with families. I am proud of my work. I am confident in my ability to perform this job. I feel a sense of personal accomplishment through my work. 52 Healthy Families Arizona Evaluation Report 2007 Those who scored higher on professional efficacy were more likely to end their employment with Healthy Families Arizona. While this may seem counter intuitive, some of the narrative comments home visitors wrote on the workforce survey adds some insight on this phenomenon. It appears that home visitors with a strong sense of professional efficacy are driven to other employment because, in the absence of a masters degree, there are limited opportunities for advancement within some of the Healthy Families Arizona sites. Twelve home visitors wrote comments on the survey related to this concern. The following quote illustrates this point: I would like to become a supervisor, but I'm hesitant about obtaining my Master's due to having busy family life with young children. I believe experience should weigh higher than education in advancement. Some home visitors who have an associates or bachelors degree perceive that they face a ceiling in Healthy Families Arizona in terms of advancement and salary. Healthy Families Arizona is therefore considered a stepping-stone for employment outside of the program. This sentiment is reflected in the following verbatim comments from home visitors. HF is a beautiful program. I love the type of work I do but I do feel like I don't get paid enough for having a college education. This would be the only reason why I would seek new employment in the future. More financial support for continuing graduate education would be very helpful! Also, I know we'll probably always be underpaid but it would be very nice not to have to have a second job just so I can afford to have the job I want (that would be this job). This program was a perfect fit directly out of college because there was a lot of support and training. It was a good transition. I recommend it to new graduates. It would be nice if there were more funding for employees to get more college education. 53 Healthy Families Arizona Evaluation Report 2007 Non-salary reward Six items are included in the non-salary reward subscale. Non-salary reward includes a variety of aspects of the job that encourage feelings of belonging and value. Examples of statements included in the survey that fall into this category include the following: • • • • • • My supervisor cares about me as a person. My supervisor shows approval when I succeed. I am satisfied with the level of flexibility in my work schedule. There are clear job expectations for my work. Overall, I receive sufficient recognition for my work. I feel a sense of personal accomplishment through my work. Home visitors who scored lower on non-salary reward, for instance, those who did not feel as much approval and recognition, were more likely to be lost to attrition. The following quotes from home visitors are reflective of the different types of non-salary rewards that are part of the program. I like the fact that we go to different conferences, the information is helpful. I wish there was more funding to support FSS to continue their education. I like the agency & I love to learn! I've enjoyed working for HFAZ- I have a wonderful supervisor & great team. I'm content where I am and welcome all training & any continuing experience. I absolutely love my employing agency & the administrators above me. I feel valued & trusted by my program manager. Perception of Workload Two items are considered for perception of workload. These include statements about the amount of end-of-month paperwork and documentation paperwork (e.g., home visit notes, etc.) being manageable. 54 Healthy Families Arizona Evaluation Report 2007 Home visitors who disagreed with these two statements on workload were more likely to be lost to attrition. Fourteen home visitors wrote comments on the workforce survey pertaining to workload. All but two of the comments offered by home visitors in this area pertained to paperwork, rather than issues with caseload. The specific aspects of paperwork mentioned are home visitation notes, evaluation tools, and the family plan. It is important to note that the comments were written prior to implementation of the revised Healthy Families Parenting Inventory (HFPI). I'm not happy with salaries-I wish something could be done about it and also paperwork for FSS. Smaller caseload would give more effective time with families. Extensive amount of paperwork required, 24/7 responsibility and not enough time for personal welfare. I love working with Healthy Families. I feel that it really helps the families that I work with. I strongly feel that there is way too much paperwork involved. The home visit note takes too long to effectively fill out. I feel that when I hit a burnout it's because of the paperwork. HF is a great program. I don't think the pay is good considering I have a college degree. I don't think everything in the home visit notes is necessary. Time Employed and Intent to Terminate The longer the home visitor’s employment in Healthy Families Arizona, the less likely the home visitor was lost to attrition. The item “I am actively seeking other employment” was the single, strongest predictor of actual attrition. 55 Healthy Families Arizona Evaluation Report 2007 Limitations and Notes It is important to note when interpreting the data presented in this section of the report that the attrition of home visitors presumably includes both preventable as well as non-preventable turnover. In addition, some level of turnover is desirable; for instance, where there is a poorly performing home visitor, or a home visitor is promoted within the organization. There was no indicator in the data to distinguish between preventable and non-preventable forms of attrition. For instance, there was no way to identify those home visitors who retired, moved out of state, were fired, or left due to dependent care-taking responsibilities. Given that the age of the oldest worker who ended employment was 55 years of age, retirement is not likely to be an issue in home visitor attrition in this study. Promotion or change to another position within Healthy Families Arizona was captured in the data and therefore was not counted as attrition. Conclusions and Findings on Staff Retention Stability in the home visitation workforce is critical to child abuse and neglect prevention in Arizona. Research has consistently shown that continuity in home visitor is important for participant retention, and participant retention is important for the achievement of desirable participant-related outcomes. Although home visitor experience and continuity are important, many home visitors have been on the job for a relatively short period of time. At the time of the workforce survey, 49.7%of home visitors had been employed less than one- year, 77.4% less than two-years, and 83.6% less than 3 years. There is no one answer to address home visitor retention. Rather, the analysis of the workforce survey and retention study point to a combination of factors that could be addressed to improve retention. 1. Healthy Families Arizona, because of its clarity in purpose and expectations, quality training and supervision, is an excellent training ground for college and university graduates with a bachelors or associates degree. Due to the salary, however, some home visitors who want to remain employed with the organization perceive that they are required to either return to school for a masters-level education, or seek employment in another 56 Healthy Families Arizona Evaluation Report 2007 agency where the same ceiling for advancement does not apply. This is a significant drain on experience and workers who have a strong sense of professional efficacy. 2. Paperwork is perceived as a workload detriment as opposed to something that is useful in regard to supervision and practice. The case plan and home visit notes, and some of the tools used in the evaluation are particularly perceived as problematic. There appears to be sufficient impetus to review the information being collected in order to reduce the paperwork burden, highlight the practice, policy, and evaluation relevance of what paperwork is necessary, and to maintain the focus of home visitation on the child and family. 3. Professional/personal fit is important to retention. Individuals seeking employment as home visitors with Healthy Families Arizona should have to answer “What is it that I really want to do.” Employing agencies should evaluate whether or not the answer includes working with families as well as working with babies and children. Experienced workers, videos, and other materials can be used to give prospective workers a true sense of the position. These types of materials could be developed out of current best practices among the sites. 4. Organizational factors that can positively influence retention and that are within the employing organization’s control include non-salary reward. The relationship with the supervisor is viewed as very important by the home visitor. Home visitors reportedly appreciate supervisors who are grounded in the practice of home visitation, and who they feel can help them succeed with families. Again, best practices in terms of non-salary reward could be surveyed among the sites and shared. If home visitor retention is to be positively impacted, agency administrators should ask whether or not the agency provides the necessary supports – supervisory, career ladder, workload support, and learning environment that will attract home visitors and keep them at the agency. 57 Healthy Families Arizona Evaluation Report 2007 Conclusions and Recommendations A variety of key stakeholders with interest in Healthy Families Arizona necessitates multiple ways of communicating accountable results. Some of these stakeholders include the participating families, Healthy Families Arizona staff, Arizona Department of Economic Security staff, state legislators, Healthy Families America, and other home visitation programs. This annual report describes results in the main program goal areas. Based on the results from such measures as the Healthy Families Parenting Inventory, participant satisfaction surveys, safety checklists and screening tools, Healthy Families Arizona continues to address and reach most of its goals, particularly in the areas of child and maternal healthy outcomes as well as child abuse and neglect rates. To capitalize on the potential for learning from the extensive and ongoing data collection efforts, the evaluation should continuously seek to better understand the relationship between Healthy Families Arizona processes or activities and participant outcomes. The program theory (logic model) identifies the important concepts that facilitate change in the desired outcomes. For instance, increasing a parent’s knowledge of child development should lead to more developmentally appropriate expectations of the child and improvements in parent child interaction. In the longer term, quality parent child interaction that is developmentally appropriate should produce children who are ready to learn in the longer term as they approach school age. It is important to examine the nature of relationships such as these, and to identify whether or not these relationships hold true for parents and children in general, and also for parents and children with diverse characteristics. By posing and answering questions related to the logic model, and to prior research findings on home visitation, the evaluation can help to inform practice. In sum, the Healthy Families Arizona program reached even more families in FY2007 than in past years and increased its ability to reach families before the birth of their babies. The program continued to help parents make significant changes in their parenting outcomes and home safety. The annual evaluation activities will continue in the next year to provide information throughout the year to assist in program improvement and decision making. 58 Healthy Families Arizona Evaluation Report 2007 The Healthy Families Arizona program showed increased service and improved outcomes in FY2007. Additional expansion in the previous year has brought on new sites with continued opportunities and challenges inherent in growth. The following table lists recommendations from the 2006 report that were suggested to help support program expansion and progress made during the 2007 program year. Exhibit 33. 2006 Recommendations and Key Results from 2007 2006 Recommendations Key Results from 2007 Attention to review of data collection training and follow-up support to improve data collection. Sites, QA/TA staff, DES and the evaluation team redoubled efforts to ensure that data was gathered and submitted by the sites; additional processes for feedback and accountability were defined and implemented; results included an increase in the quantity and quality of data submitted. Sub-studies that address “outreach” Discussions about key questions and and ASQ and ASQ-SE administration data analysis occurred between the evaluation and QA/TA staff; results were included in the FY2007 report; continued questions about this topic will be addressed in 2007-2008. Consider ways to involve more FSSs in leadership roles; discuss with sites strategies for describing or increasing promotion opportunities A staff committee was formed to review evaluation plan; QA/TA encouraged sites to consider options to increase leadership roles; QA/TA staff conducted specific training and follow-up to increase knowledge about credentialing (e.g., standards and HF process); QA/TA team revised the annual staff satisfaction survey to include this topic. 59 Healthy Families Arizona Evaluation Report 2007 Explore ways to measure parentchild interactions and review the best ways to record child development progress Excellence Committee is in the process of identifying possible strategies to use on a small scale with a limited number of sites. Program focus on dosage, engagement in program, frequency of visits, and retention in program for both families and workers. More emphasis has been placed on the logic model during staff training and technical assistance; improved specialty training (to be rolled out over time) as noted in program update section of this report; staff note that some of the external influences over program goals are not able to be altered from within the program. 2007 Recommendations Recommendations based on 2007 evaluation activities include the following: • Further the development of Healthy Families Arizona as a “ learning organization” by scheduling regular communication updates with evaluation staff, QA/TA staff, program sites, DES staff, and others in areas such as development of evaluation plans, evaluation training, and data collection systems. • Reconsider the format of evaluation report deliverables and identify alternative formats for timely feedback on issues important for program planning and decision making. • Conduct a review of the clinical, administrative, and evaluation paperwork requirements as they pertain to FAW, FSS and Supervisor workloads to recommend ways to streamline the process. Incorporate into the process recommendations for alternative measures when appropriate. 60 Healthy Families Arizona Evaluation Report 2007 • Use a collaborative approach to prioritize possible sub-studies that could include the following: clinical use of HFPI and ASQ-SE; staff operational definitions and use of “outreach”; child development outcomes that could reasonably and practically be assessed as part of an annual evaluation; and empirical outcomes predicted by the logic model, such as the relationship between quality parent/child interactions and readiness to learn. • Continue support for QA/TA site visits and credentialing process by providing available data to address critical elements. • Consider exploring site recommendations for best practices around non-salary rewards, supervisory strategies, career ladders, workload support, and learning environments that can attract and retain home visitors. • Review the criteria and use of “outreach” when families remain in the program but are not receiving home visits. Explore the phases of reengagement especially as it relates to “creative outreach” families. • Strategize and implement program approaches to increase families’ understanding of the benefits of greater spacing between subsequent pregnancies. • Discuss ways to increase the number and early enrollment of prenatal families. Review and set program standards around the categorization of “prenatal” enrollment (e.g., define prenatal to be enrollment prior to 24 weeks gestational age). • Continue to review the use of the substance abuse screening tool and identify a short list of alternative measures. Decide whether to continue using the CRAFFT or a different screening tool. 61 Healthy Families Arizona Evaluation Report 2007 References Ahrens, M. (2007). U.S. Experience with smoke alarms and other fire detection/alarm equipment. National Fire Protection Association. Retrieved 10-24-07 from www.nfp.org. Friedman, L. & Schreiber, L. (2007). Healthy Families America® state systems development: An emerging practice to ensure program growth and sustainability. Journal of Prevention & Intervention in the Community, 24 (1/2), 67-87. Harding, K., Galano, J., Martin, J., Huntington, L. & Schellenbach, C. (2007). Healthy Families America® Effectiveness: A comprehensive review of outcomes. Journal of Prevention & Intervention in the Community, 24 (1/2), 149-179. Galano, J. (2007). The challenge of integrating research into practice. Journal of Prevention & Intervention in the Community, 24 (1/2), 1-11. Glassbrenner, D. & Ye, Te Jianqiang. (2007). Child restraint safety used in 2006: Demographic Results. Traffic Safety Facts Research Note DDT HS 801 797. National Highway Traffic Safety Commission. Retrieved 10-24-07 from www.nhtsa.gov. Gomby, D. (2005). Home Visitation in 2005: Outcomes for Children and Parents. Invest in Kids Working Paper No. 7. Committee for Economic Development, Invest in Kids Working Group. Washington D.C. Krysik, J. & LeCroy, C. (2007). The evaluation of Healthy Families Arizona: A multisite home visitation program. Journal of Prevention & Intervention in the Community, 24, (1/2), 109-127. LeCroy & Milligan Associates, Inc. (2006). Healthy Families Arizona Evaluation Report 2006. Tucson, Arizona: LeCroy & Milligan Associates, Inc. LeCroy & Milligan Associates, Inc. (2006). Healthy Families Arizona Longitudinal Evaluation: 2nd Annual Report November 2006. Tucson, Arizona: LeCroy & Milligan Associates, Inc. 62 Healthy Families Arizona Evaluation Report 2007 Michaud, L. (2000). Turn the tables on employee turnover: Five keys to maximum employee retention. Retrieved October 10, 2007. http://www.frogpond.com/articles/docs/lmichaud07.doc Olds, D., Eckenrode, J., Henderson, C. R., Jr., Kitzman, H., Powers, J., Cole, R., Sidora, K., Morris, P., Pettitt, L., & Luckey, D. (1997). Long-term effects of home visitation on maternal life course, child abuse and neglect and children’s arrests: Fifteen-year follow-up of a randomized trial. Journal of the American Medical Association, 278(8), 637-643. Squires, J., Bricker, D. & Twombly, E. (2002). The ASQ-SE User’s Guide. Baltimore, MD: Paul H. Brookes Publishing. Squires, J, Potter, L, & Bricker, D. (1999). The ASQ User’s Guide (2nd Edition). Baltimore, MD: Paul H. Brookes Publishing. 63 Healthy Families Arizona Evaluation Report 2007 Appendix A: Parent Survey* Problem Areas and Interpretation (Mother & Father) Areas (Scales) Range 1. Parent Childhood Experiences (e.g., Childhood history of physical abuse and deprivation) 0, 5, or 10 2. Lifestyle, Behaviors and Mental Health (e.g., substance abuse, mental illness, or criminal history) Interpretation/ Administration The Parent Survey comprises a 10item rating scale. A score of 0 represents normal, 5 represents a mild degree of the problem, and a 10 0, 5, or 10 represents severe for both the Mother and Father Parent Survey Checklist 3. Parenting Experiences (e.g., Previous or current CPS involvement) 0, 5, or 10 items. The Parent Survey is an 4. Coping Skills and Support Systems (e.g., Self-esteem, available lifelines, possible depression) to the mother and father prior to 5. Stresses (e.g., Stresses, concerns, domestic violence) 0, 5, or 10 assessment tool and is administered enrollment through an interview by a Family Assessment Worker from the Healthy Families Arizona Program. 0, 5, or 10 A family is considered eligible to receive the Healthy Families Arizona 6. Anger Management Skills (e.g., Potential for violence) 0, 5, or 10 7. Expectations of Infant’s Developmental Milestones and Behaviors 0, 5, or 10 8. Plans for Discipline (e.g., infant, toddler, and child) 0, 5, or 10 9. Perception of New Infant 10. Bonding/Attachment Issues program if either parent scores 25 or higher. 0, 5, or 10 0, 5, or 10 A score over 25 is considered medium risk for child abuse and Total Score 0 - 100 neglect, and a score over 40 is considered high-risk for child abuse. * Modified from the Family Stress Checklist 64 Healthy Families Arizona Evaluation Report 2007 Appendix B: Site Level Data  Age of Child at Entry....................................................................................66  Days to Program Exit....................................................................................68  Top Four Reasons for Exit............................................................................70  Health Insurance at Intake...........................................................................72  Late or No Prenatal Care or Poor Compliance at Intake.........................74  Ethnicity of Mother.......................................................................................76  Gestational Age .............................................................................................80  Low Birth Weight..........................................................................................82  Yearly Income................................................................................................84  Parent Survey Score......................................................................................86  Trimester of Enrollment into Prenatal Program.......................................88  Engaged Prenatal Families that Exited before Baby’s Birth ...................90 65 Healthy Families Arizona Evaluation Report 2007 Age of Child at Entry by Site - 2007 (Age in days) Mean (Age in Days) Number Standard Deviation Douglas 16.25 80 13.75 Central Phoenix 29.01 90 23.65 Maryvale 23.60 87 24.17 South Phoenix 28.69 97 23.74 East Valley 29.49 103 20.82 Nogales 15.83 101 19.08 Page 28.30 37 22.53 Casa de los Niños 31.98 97 24.63 CODAC 34.55 94 25.48 La Frontera 34.90 98 29.22 Sierra Vista 15.81 68 15.13 Tuba City 29.95 39 24.67 Verde Valley 17.37 51 22.44 Yuma 16.40 67 15.63 Pascua Yaqui 29.90 48 23.91 Lake Havasu City 25.38 81 18.86 Flagstaff 24.73 30 28.04 Sunnyslope 25.69 74 21.97 Prescott 31.09 121 26.23 Coolidge 20.73 80 28.37 Mesa 32.52 111 22.51 Southeast Phoenix 28.37 89 25.26 El Mirage 34.43 92 30.86 Blake Foundation 33.62 103 26.55 Marana 35.29 82 23.79 Safford 29.46 28 32.87 Stanfield 24.90 10 20.31 Apache Junction 26.92 75 21.43 Site 66 Healthy Families Arizona Evaluation Report 2007 Mean (Age in Days) Number Standard Deviation Gila River 35.00 7 13.33 Winslow 31.50 22 22.89 Kingman 30.84 50 24.96 Globe/Miami 32.40 20 28.86 Kyrene 30.04 71 19.71 Metro Phoenix 27.20 69 26.21 Tolleson 27.39 88 24.05 South Mountain 26.33 120 24.48 Glendale 26.78 101 21.37 Deer Valley 28.24 96 24.02 East/SE Tucson 34.95 60 23.86 SW Tucson 33.36 80 25.02 Bullhead City 24.80 45 22.78 Northwest Phoenix 24.77 69 24.65 Tempe 38.50 48 23.76 Gilbert 32.53 94 24.06 Scottsdale 29.82 100 23.44 West Phoenix 27.14 88 24.97 East Mesa 35.61 79 24.39 Kinlani-Flagstaff 18.97 37 26.74 Southwest Phoenix 21.56 59 21.79 Peoria 35.13 70 33.48 Metro Tucson 26.74 58 20.24 Casa Family First 30.45 31 19.78 Wellspring 16.82 38 24.36 Primero Los Niños 14.46 46 13.72 Sierra Vista Blake 15.13 30 17.40 Total 27.89 3809 24.39 Site *Note: total does not include missing data for 101 participant files. 67 Healthy Families Arizona Evaluation Report 2007 Days to Program Exit by Site - 2007 (For families who left the program) Prenatal Sites Postnatal Median Mean Standard Deviation Number Median Mean Standard Deviation Number Douglas 340.50 354.00 125.49 6 603.00 789.85 645.13 27 Central Phoenix 176.00 219.00 131.64 5 408.00 549.23 417.10 31 Maryvale 365.00 381.33 172.39 6 500.00 552.75 390.44 24 South Phoenix 475.00 483.60 199.69 5 354.00 420.41 261.56 41 East Valley 500.00 510.50 226.78 6 357.50 578.35 507.51 40 Nogales 273.00 260.20 73.09 5 1185.00 1111.52 723.15 25 Page 254.00 354.33 220.36 3 867.00 861.33 689.61 9 Casa de los Niños 184.00 219.00 93.76 9 392.00 596.46 535.69 39 CODAC 263.50 276.00 143.52 4 457.00 612.23 519.86 30 La Frontera 354.00 363.70 173.08 10 739.50 884.81 617.46 42 Sierra Vista 436.00 457.86 183.68 7 377.00 605.69 558.84 34 Tuba City 554.00 391.67 281.17 3 380.00 586.22 543.29 9 Verde Valley 441.00 422.10 171.09 31 563.00 746.86 580.09 21 263.00 599.09 571.17 22 Yuma None Pascua Yaqui 389.00 428.30 196.13 10 1780.00 1382.43 591.45 21 Lake Havasu City 377.00 430.50 293.15 12 819.50 871.23 579.61 30 Flagstaff 479.50 463.50 217.89 10 720.00 831.75 655.08 8 Sunnyslope 240.00 282.33 168.54 3 594.00 773.18 660.87 17 Prescott 535.00 526.55 145.90 11 764.00 912.70 596.00 43 Coolidge 441.00 453.33 200.78 3 362.00 564.58 490.95 26 Mesa 201.50 262.33 129.65 6 369.00 458.39 289.58 28 Southeast Phoenix 258.00 258.00 1.41 2 360.50 560.25 552.65 24 El Mirage/ Surprise 379.00 431.63 177.58 8 413.00 541.31 382.93 29 Blake Foundation 309.50 338.90 92.46 10 439.00 490.22 377.20 36 Marana 228.00 228.00 137.18 2 395.00 380.14 160.98 22 Safford 631.00 498.67 361.17 3 442.00 489.60 251.40 5 Stanfield 285.00 252.40 106.39 5 201.00 201.00 0 1 Apache Junction 221.00 315.80 208.29 10 249.00 250.55 158.09 22 Gila River 767.00 715.60 129.91 5 190.50 190.50 88.39 2 68 Healthy Families Arizona Evaluation Report 2007 Prenatal Sites Postnatal Median Mean Standard Deviation Number Median Mean Standard Deviation Number Winslow 266.50 265.00 54.84 4 437.00 444.31 249.45 13 Kingman 123.00 187.00 151.50 3 310.00 344.57 192.97 23 Globe/Miami 484.00 411.75 165.29 4 564.00 560.73 273.73 11 Kyrene 366.00 414.13 201.38 8 384.00 510.88 384.14 25 Metro Phoenix 626.00 602.33 170.74 3 474.00 503.87 382.66 23 Tolleson/Avondale 376.00 410.75 169.71 8 476.00 523.26 425.75 34 South Mountain 488.00 470.67 239.18 9 307.00 420.65 331.80 51 Glendale 391.50 391.25 170.15 4 435.00 461.81 320.68 31 Deer Valley 643.50 611.50 213.42 4 444.00 485.10 313.67 31 East/SE Tucson 317.00 248.75 145.98 4 230.00 287.21 151.06 14 SW Tucson 207.00 302.71 227.49 7 526.00 531.61 359.06 23 Bullhead City 287.00 254.00 157.12 3 405.00 414.80 201.26 15 N.W. Phoenix 288.50 288.50 91.22 2 382.00 514.63 543.49 8 Tempe 268.00 239.00 74.84 3 231.00 379.57 381.66 7 Gilbert 311.00 335.38 181.39 8 336.00 380.39 295.06 44 Scottsdale 188.50 327.50 317.39 6 184.00 247.59 193.62 37 West Phoenix 338.00 405.71 233.18 7 243.00 357.77 239.70 31 East Mesa 493.00 479.25 99.46 8 395.00 384.40 164.18 21 Kinlani-Flagstaff 725.00 669.25 241.22 8 1338.00 1181.92 722.37 12 114.00 135.05 97.62 19 Southwest Phoenix None Peoria 500.00 46.71 164.93 7 395.00 532.79 528.99 19 Metro Tucson 239.50 239.50 106.77 2 239.50 501.58 517.44 12 Casa Family First Wellspring None 878.00 878.00 Primero Los Niños None 181.02 2 None 491.00 592.88 531.47 8 174.50 202.83 124.40 12 Sierra Vista Blake 217.00 217.00 0 1 129.00 120.33 28.02 3 Total 358.00 399.80 206.98 315 393.00 561.97 491.94 1235 69 Healthy Families Arizona Evaluation Report 2007 Top Four Reasons for Exit by Site - 2007 Percent and number within Site Overall (Prenatal and Postnatal Combined) Site #1 Did Not Respond to Outreach Efforts #2 Moved Away #3 Family Refused Further Services #4 Completed Program % n % n % n % n Douglas 33.3% 11 21.2% 7 3.0% 1 12.1% 4 Central Phoenix 44.4% 16 8.3% 3 22.2% 8 0 0 Maryvale 30.0% 9 26.7% 8 13.3% 4 3.3% 1 South Phoenix 55.3% 26 17.0% 8 4.3% 2 0 0 East Valley 34.8% 16 21.7% 10 19.6% 9 2.2% 1 Nogales 40.0% 12 23.3% 7 0 0 26.7% 8 Page 41.7% 5 8.3% 1 16.7% 2 8.3% 1 Casa de los Niños 45.8% 22 12.5% 6 16.7% 8 10.4% 5 CODAC 32.4% 11 14.7% 5 5.9% 2 14.7% 5 La Frontera 17.3% 9 23.1% 12 1.9% 1 23.1% 12 Sierra Vista 29.3% 12 31.7% 13 7.3% 3 9.8% 4 Tuba City 45.5% 5 9.1% 1 18.2% 2 18.2% 2 Verde Valley 28.8% 15 28.8% 15 11.5% 6 5.8% 3 Yuma 13.6% 3 27.3% 6 13.6% 3 0 0 Pascua Yaqui 25.8% 8 19.4% 6 0 0 32.3% 10 Lake Havasu City 21.4% 9 21.4% 9 31.0% 13 11.9% 5 Flagstaff 22.2% 4 27.8% 5 16.7% 3 11.1% 2 Sunnyslope 30.0% 6 5.0% 1 30.0% 6 15.0% 3 Prescott 48.1% 26 18.5% 10 3.7% 2 16.7% 9 Coolidge 17.2% 5 10.3% 3 10.3% 3 6.9% 2 Mesa 37.1% 13 31.4% 11 11.4% 4 0 0 Southeast Phoenix 46.2% 12 15.4% 4 15.4% 4 7.7% 2 El Mirage 51.4% 19 16.2% 6 0 0 2.7% 1 Blake Foundation 26.1% 12 10.9% 5 19.6% 9 4.3% 2 Marana 25.0% 6 16.7% 4 16.7% 4 0 0 Safford 37.5% 3 0 0 37.5% 3 0 0 Stanfield (Pinal) 33.3% 2 50.0% 3 16.7% 1 0 0 70 Healthy Families Arizona Evaluation Report 2007 Overall (Prenatal and Postnatal Combined) Site #1 Did Not Respond to Outreach Efforts #2 Moved Away #3 Family Refused Further Services #4 Completed Program % n % n % n % n Apache Junction 28.1% 9 28.1% 9 21.9% 7 0 0 Gila River 28.6% 2 0 0 42.9% 3 0 0 Winslow 52.9% 9 5.9% 1 23.5% 4 0 0 Kingman 42.3% 11 11.5% 3 19.2% 5 0 0 Globe/Miami 60.0% 9 33.3% 5 6.7% 1 0 0 Kyrene 37.5% 12 12.5% 4 28.1% 9 3.1% 1 Metro Phoenix 23.1% 6 11.5% 3 23.1% 6 0 0 Tolleson 37.5% 15 7.5% 3 10.0% 4 5.0% 2 South Mountain 57.6% 34 6.8% 4 13.6% 8 1.7% 1 Glendale 42.9% 15 20.0% 7 11.4% 4 2.9% 1 Deer Valley 41.2% 14 23.5% 8 14.7% 5 0 0 East/SE Tucson 22.2% 4 22.2% 4 22.2% 4 0 0 SW Tucson 26.7% 8 30.0% 9 10.0% 3 3.3% 1 Bullhead City 55.6% 10 33.3% 6 11.1% 2 0 0 Northwest Phoenix 30.0% 3 20.0% 2 20.0% 2 0 0 Tempe 33.3% 3 11.1% 1 22.2% 2 0 0 Gilbert 34.6% 18 7.7% 4 32.7% 17 0 0 Scottsdale 39.5% 17 14.0% 6 9.3% 4 0 0 West Phoenix 59.5% 22 13.5% 5 2.7% 1 0 0 East Mesa 62.1% 18 24.1% 7 10.3% 3 0 0 Kinlani-Flagstaff 5.0% 1 40.0% 8 10.0% 2 20.0% 4 Southwest Phoenix 10.5% 2 5.3% 1 84.2% 16 0 0 Peoria 73.1% 19 7.7% 2 3.8% 1 7.7% 2 Metro Tucson 35.7% 5 14.3% 2 7.1% 1 0 0 Casa Family First NO DATA Wellspring 30.0% 3 0 0 30.0% 3 10.0% 1 Primero Los Niños 41.7% 5 50.0% 6 0 0 0 0 Sierra Vista Blake 0 0 75.0% 3 25.0% 1 0 0 37% 571 18.3% 282 14.3% 221 6.2% 95 Total 71 Healthy Families Arizona Evaluation Report 2007 Health Insurance by Site at Intake - 2007 Percent and number within Site* PRENATAL Site None AHCCCS POSTNATAL Private None AHCCCS Private % n % n % n % n % n % n Douglas 15.0% 3 80.0% 16 0 0 1.2% 1 96.3% 79 2.4% 2 Central Phoenix 5.6% 1 83.3% 15 11.1% 2 4.5% 4 86.4% 76 8% 7 Maryvale 6.7% 1 73.3% 11 13.3% 2 4.7% 4 88.4% 76 7% 6 South Phoenix 6.7% 1 86.7% 13 6.7% 1 3.1% 3 91.8% 90 5.1% 5 East Valley 11.8% 2 76.5% 13 5.9% 1 1.9% 2 86.9% 93 11.2% 12 Nogales 28.6% 6 66.7% 14 4.8% 1 5.0% 5 80.1% 91 4.0% 4 Page 12.5% 1 87.5% 7 0 0 0 0 100% 37 0 0 Casa de los Niños 3.0% 1 97.0% 32 0 0 2.0% 2 91.9% 91 3.0% 3 CODAC 4.8% 1 81.0% 17 9.5% 2 5.4% 5 87% 80 4.3% 4 La Frontera 2.9% 1 91.4% 32 2.9% 1 3% 3 91% 91 5% 5 Sierra Vista 0 0 85.7% 12 14.3% 2 3.6% 2 83.6% 46 7.3% 4 Tuba City 0 0 94.4% 17 0 0 4.8% 2 92.9% 39 0 0 Verde Valley 8.2% 6 79.5% 58 12.3% 9 2% 1 90% 45 8% 4 Yuma 12.5% 1 87.5% 7 0 0 3.1% 2 93.8% 61 3.1% 2 0 0 95.5% 42 0 0 0 0 95.9% 47 2% 1 Lake Havasu City 5.9% 2 76.5% 26 14.7% 5 2.4% 2 92.8% 77 4.8% 4 Flagstaff 11.1% 4 80.6% 29 2.8% 1 0 0 77.4% 24 22.6% 7 Sunnyslope 13.6% 3 86.4% 19 0 0 2.7% 2 83.8% 62 12.2% 9 Prescott 8.3% 2 83.3% 20 8.3% 2 0 0 88.5% 100 8% 9 Coolidge 12.5% 1 87.5% 7 0 0 1.2% 1 88.9% 72 9.9% 8 Mesa 9.5% 2 76.2% 16 9.5% 2 3.6% 4 85.7% 96 9.8% 11 Southeast Phoenix 14.3% 2 85.7% 12 0 0 4.4% 4 86.7% 78 8.9% 8 El Mirage 21.4% 3 78.6% 11 0 0 2.2% 2 72.8% 67 22.8% 21 Blake Foundation 8.7% 2 82.6% 19 8.7% 2 3.7% 4 88% 95 7.4% 8 Marana 0 0 80.0% 12 13.3% 2 0 0 89% 73 6.1% 5 Safford 0 0 87.5% 14 6.3% 1 0 0 92% 23 8% 2 Stanfield 10.0% 1 80.0% 8 10.0% 1 10% 1 90% 9 0 0 Apache Junction 9.7% 3 80.6% 25 9.7% 3 2.7% 2 78.7% 59 16.0% 12 Pascua Yaqui 72 Healthy Families Arizona Evaluation Report 2007 PRENATAL Site None AHCCCS POSTNATAL Private None AHCCCS Private % n % n % n % n % n % n Gila River 0 0 100% 13 0 0 0 0 100% 8 0 0 Winslow 0 0 100% 10 0 0 0 0 100% 28 0 0 Kingman 10.5% 2 84.2% 16 5.3% 1 1.9% 1 88.5% 46 9.6% 5 0 0 100% 13 0 0 0 0 86.4% 19 13.6% 3 Kyrene 11.1% 3 81.5% 22 7.4% 2 0 0 73.9% 51 24.6% 17 Metro Phoenix 25.0% 2 75.0% 6 0 0 4.4% 3 92.6% 63 2.9% 2 Tolleson 12.5% 2 81.3% 136 0 0 6.6% 6 80.2% 73 13.2% 12 South Mountain 9.1% 2 81.8% 18 9.1% 2 3.2% 4 87.1% 108 8.1% 10 Glendale 20.0% 2 70.0% 7 10.0% 1 1.0% 1 86.3% 88 10.8% 11 Deer Valley 20.0% 2 60.0% 6 20.0% 2 4.1% 4 83.7% 82 12.2% 12 East/SE Tucson 4.2% 1 87.5% 21 4.2% 1 1.6% 1 88.7% 55 8.1% 5 SW Tucson 11.8% 2 88.2% 15 0 0 6.1% 5 90.2% 74 3.7% 3 Bullhead City 0 0 93.3% 14 6.7% 1 6.5% 3 82.6% 38 10.9% 5 Northwest Phoenix 0 0 44.4% 4 55.6% 5 2.9% 2 85.7% 60 10.0% 7 Tempe 16.7% 2 83.3% 10 0 0 2.1% 1 89.4% 42 8.5% 4 Gilbert 0 0 97.0% 32 3.0% 1 1.1% 1 75.8% 72 20.0% 19 Scottsdale 0 0 83.3% 15 16.7% 3 1.0% 1 77.7% 80 21.4% 22 West Phoenix 6.7% 1 80.0% 12 13.3% 2 2.3% 2 88.6% 78 9.1% 8 East Mesa 7.4% 2 92.6% 25 0 0 1.2% 1 92.6% 75 4.9% 4 Kinlani-Flagstaff 6.5% 2 93.5% 29 0 0 0 0 80.6% 29 16.7% 6 0 0 100% 4 0 0 8.5% 5 84.7% 20 6.8% 4 5.0% 1 90.0% 18 1.0% 5 0 0 81.7% 58 16.9% 12 0 0 100% 13 0 0 5.3% 3 86.0% 48 7.0% 4 Casa Family First 25.0% 3 58.3% 7 8.3% 1 0 0 90.6% 29 9.4% 3 Wellspring 34.6% 9 61.5% 16 3.8% 1 2.6% 1 94.7% 36 2.6% 1 Primero Los Niños 40.0% 2 60.0% 3 0 0 6.3% 3 93.8% 45 0 0 Sierra Vista Blake 9.1% 1 81.8% 9 9.1% 1 7.7% 2 80.8% 21 11.5% 3 Total 8.5% 91 83.8% 895 6.1% 65 2.8% 108 87.0% 3334 9.0% 345 Globe/Miami Southwest Phoenix Peoria Metro Tucson *”Other” insurance percentages are not listed in this table but can be estimated by subtracting the sum of the other insurance categories from 100. 73 Healthy Families Arizona Evaluation Report 2007 Late or No Prenatal Care or Poor Compliance at Intake 2007 by Site Percent and number ( ) within Site Did the mother have late or no prenatal care or poor compliance with prenatal care? PRENATAL Site POSTNATAL Yes No Unknown Yes No Unknown Douglas 35.0% (7) 65.0% (13) 0 39.0% (32) 56.1% (46) 4.9% (4) Central Phoenix 16.7% (3) 83.3% (15) 0 40.7% (37) 57.1% (52) 2.2% (2) Maryvale 35.3% (6) 58.8% (10) 5.9% (1) 31.0% (27) 69.0% (60) 0 South Phoenix 26.7% (4) 60.0% (9) 13.3% (2) 40.4% (40) 56.6% (56) 3.0% (3) East Valley 33.3% (6) 66.7% (12) 0 45.9% (50) 47.7% (52) 6.4% (7) Nogales 36.4% (8) 59.1% (13) 4.5% (1) 51.9% (55) 43.4% (46) 4.7% (5) 0 100% (8) 0 24.3% (9) 75.7% (28) 0 Casa de los Niños 30.3% (10) 69.7% (23) 0 31.0% (31) 67.0% (67) 2.0% (2) CODAC 39.1% (9) 60.9% (14) 0 36.2% (34) 63.8% (60) 0 La Frontera 45.9% (17) 54.1% (20) 0 38.0% (38) 60.0% (60) 2.0% (2) Sierra Vista 38.9% (7) 61.1% (11) 0 33.8% (23) 63.2% (43) 2.9% (2) Tuba City 27.8% (5) 72.2% (13) 0 42.9% (18) 52.4% (22) 4.8% (2) Verde Valley 13.7% (10) 83.6% (61) 2.7% (2) 36.7% (18) 63.3% (31) 0 Yuma 66.7% (6) 33.3% (3) 0 34.8% (23) 65.2% (43) 0 Pascua Yaqui 14.9% (7) 85.1% (40) 0 10.0% (5) 90.0% (4) 0 Lake Havasu City 22.9% (8) 74.3% (26) 2.9% (1) 34.1% (28) 57.3% (47) 8.5% (7) Flagstaff 27.8% (10) 69.4% (25) 2.8% (1) 14.7% (5) 85.3% (29) 0 Sunnyslope 34.8% (8) 60.9% (14) 4.3% (1) 31.1% (23) 67.6% (50) 1.4% (1) Prescott 50.0% (12) 45.8% (11) 4.2% (1) 50.4% (61) 47.1% (57) 2.5% (3) Coolidge 33.3% (3) 66.7% (6) 0 51.2% (42) 48.8% (40) 0 Mesa 31.8% (7) 63.6% (14) 4.5% (1) 31.9% (36) 64.6% (73) 3.5% (4) Southeast Phoenix 42.9% (6) 57.1% (8) 0 41.8% (38) 58.2% (53) 0 El Mirage 50.0% (7) 42.9% (6) 7.1% (1) 27.2% (25) 68.5% (63) 4.3% (4) Blake Foundation 29.2% (7) 70.8% (17) 0 34.9% (37) 60.4% (64) 4.7% (5) Marana 13.3% (2) 86.7% (13) 0 30.1% (25) 67.5% (56) 2.4% (2) Safford 10.0% (2) 90.0% (18) 0 10.7% (3) 89.3% (5) 0 Stanfield 40.4% (4) 60.0% (6) 0 54.5% (6) 45.5% (5) 0 Page 74 Healthy Families Arizona Evaluation Report 2007 PRENATAL Site POSTNATAL Yes No Unknown Yes No Unknown Apache Junction 38.7% (12) 58.1% (18) 3.2% (1) 48.0% (36) 50.7% (38) 1.3% (1) Gila River 53.8% (7) 46.2% (6) 0 37.5% (3) 62.5% (5) 0 Winslow 45.5% (5) 54.5% (6) 0 42.9% (12) 57.1% (16) 0 Kingman 52.6% (10) 47.4% (9) 0 15.7% (8) 64.7% (33) 19.6% (10) Globe/Miami 38.5% (5) 61.5% (8) 0 26.1% (6) 65.2% (15) 8.7% (2) Kyrene 48.1% (13) 48.1% (13) 3.7% (1) 35.2% (25) 57.7% (41) 7.0% (5) Metro Phoenix 25.0% (2) 62.5% (5) 12.5% (1) 33.3% (23) 63.8% (44) 2.9% (2) Tolleson 40.0% (6) 60.0% (9) 0 39.1% (36) 56.5% (52) 4.3% (4) South Mountain 52.2% (12) 43.5% (10) 4.3% (1) 37.9% (47) 62.1% (77) 0 Glendale 40.0% (4) 50.0% (5) 10.0% (1) 29.4% (30) 69.6% (71) 1.0% (1) Deer Valley 30.0% (3) 60.0% (6) 10.0% (1) 27.8% (27) 68.0% (66) 4.1% (4) East/SE Tucson 20.0% (5) 80.0% (20) 0 30.6% (19) 67.7% (42) 1.6% (1) SW Tucson 52.9% (9) 47.1% (8) 0 39.0% (32) 61.0% (50) 0 Bullhead City 26.7% (4) 73.3% (11) 0 27.7% (13) 68.1% (32) 4.3% (2) Northwest Phoenix 33.3% (3) 55.6% (5) 11.1% (1) 45.7% (32) 51.4% (36) 2.9% (2) Tempe 41.7% (5) 58.3% (7) 0 35.4% (17) 58.3% (28) 6.3% (3) Gilbert 33.3% (12) 63.9% (23) 2.8% (1) 33.7% (31) 62.0% (57) 4.3% (4) Scottsdale 22.2% (4) 72.2% (13) 5.6% (1) 36.5% (38) 57.7% (60) 5.8% (6) West Phoenix 33.3% (5) 60.0% (9) 6.7% (1) 32.2% (29) 65.6% (59) 2.2% (2) East Mesa 51.7% (15) 44.8% (13) 3.4% (1) 50.0% (41) 41.5% (34) 8.5% (7) Kinlani-Flagstaff 27.3% (9) 72.7% (24) 0 24.3% (9) 75.7% (28) 0 Southwest Phoenix 25.0% (1) 75.0% (3) 0 45.0% (27) 51.7% (31) 3.3% (2) Peoria 45.0% (9) 55.0% (11) 0 27.1% (19) 70.0% (49) 2.9% (2) Metro Tucson 23.1% (3) 76.9% (10) 0 27.1% (16) 72.9% (43) 0 Casa Family First 30.8% (4) 69.2% (9) 0 37.5% (12) 62.5% (20) 0 Wellspring 35.7% (10) 57.1% (16) 7.1% (2) 35.0% (14) 65.0% (26) 0 Primero Los Niños 66.7% (4) 33.3% (2) 0 43.8% (21) 56.3% (27) 0 Sierra Vista Blake 46.7% (7) 40.0% (6) 13.3% (2) 38.7% (12) 54.8% (17) 6.5% (2) 32.0% (245) 65.6% (502) 2.4% (18) 35.9% (1135) 60.86% (1924) 3.3% (104) Total 75 Healthy Families Arizona Evaluation Report 2007 PRENATAL Ethnicity of Mother by Site - 2007 Percent and number ( ) within Site Site Mixed/Other Caucasian/ White Hispanic African American Asian American Native American % n % n % n % n % n % n Douglas 5.0% 1 10.0% 2 80.0% 16 0 0 0 0 5.0% 1 Central Phoenix 5.6% 1 38.9% 7 44.4% 8 11.1% 2 0 0 0 0 Maryvale 5.9% 1 23.5% 4 70.6% 12 0 0 0 0 0 0 South Phoenix 6.7% 1 20.0% 3 46.7% 7 26.7% 4 0 0 0 0 East Valley 0 0 33.6% 6 50.0% 9 16.7% 3 0 0 0 0 Nogales 0 0 8.7% 2 82.6% 19 8.7% 2 0 0 0 0 Page 0 0 16.7% 1 0 0 0 0 0 0 83.5% 5 Casa de los Niños 8.8% 3 11.8% 4 70.6% 24 8.8% 3 0 0 0 0 CODAC 13.6% 3 18.2% 4 63.6% 14 4.5% 1 0 0 0 0 La Frontera 0 0 16.2% 6 70.3% 26 10.8% 4 0 0 2.7% 1 Sierra Vista 0 0 44.4% 8 44.4% 8 11.1% 2 0 0 0 0 Tuba City 5.6% 1 0 0 0 0 11.1% 2 0 0 83.3% 15 Verde Valley 2.7% 2 63.0% 46 31.5% 23 0 0 0 0 2.7% 2 0 0 12.5% 1 75.0% 6 12.5% 1 0 0 0 0 Pascua Yaqui 13.3% 6 0 0 4.4% 2 0 0 2.2% 1 80.0% 36 Lake Havasu City 5.7% 2 71.4% 25 20.0% 7 0 0 0 0 2.9% 1 Flagstaff 2.7% 1 37.8% 14 27.0% 10 5.4% 2 0 0 27.0% 10 Sunnyslope 13.6% 3 31.8% 7 50.0% 11 4.5% 1 0 0 0 0 Prescott 4.2% 1 62.5% 15 33.3% 8 0 0 0 0 0 0 Coolidge 11.1% 1 22.2% 2 66.7% 6 0 0 0 0 0 0 0 0 36.4% 8 59.1% 13 0 0 0 0 4.5% 1 Southeast Phoenix 13.3% 2 6.7% 1 53.8% 8 20.0% 3 0 0 6.7% 1 El Mirage 14.3% 2 7.1% 1 71.4% 10 7.1% 1 0 0 0 0 Blake Foundation 8.3% 2 4.2% 1 70.8% 17 8.3% 2 4.2% 1 4.2% 1 Marana 20.0% 3 33.3% 5 46.7% 7 0 0 0 0 0 0 Safford 5.0% 1 45.0% 9 45.0% 9 5.0% 1 0 0 0 0 Stanfield 9.1% 1 36.4% 4 18.2% 2 18.2% 2 0 0 18.2% 2 Apache Junction 3.2% 1 71.0% 22 19.4% 6 3.2% 1 3.2% 1 0 0 0 0 0 0 0 0 0 0 0 0 100% 13 18.2% 2 27.3% 3 36.4% 4 0 0 0 0 18.2% 2 Yuma Mesa Gila River Winslow 76 Healthy Families Arizona Evaluation Report 2007 Site Mixed/Other Caucasian/ White Hispanic African American Asian American Native American % n % n % n % n % n % n 5.3% 1 84.2% 16 5.3% 1 0 0 0 0 5.3% 1 Globe/Miami 0 0 33.3% 4 33.3% 4 0 0 0 0 33.3% 4 Kyrene 0 0 14.8% 4 63% 17 0 0 0 0 22.2% 6 12.5% 1 25.0% 2 62.5% 5 0 0 0 0 0 0 0 0 6.3% 1 87.5% 14 0 0 0 0 6.3% 1 8.7% 2 8.7% 2 82.6% 19 0 0 0 0 0 0 0 0 40.0% 4 20.0% 2 40.0% 4 0 0 0 0 Deer Valley 10.0% 1 40.0% 4 50.0% 5 0 0 0 0 0 0 East/SE Tucson 4.0% 1 36.0% 9 24.0% 6 20.0% 5 4.0% 1 12.0% 3 SW Tucson 5.9% 1 5.9% 2 88.2% 15 0 0 0 0 0 0 Bullhead City 7.1% 1 78.6% 11 7.1% 1 7.1% 1 0 0 0 0 Northwest Phoenix 33.3% 3 33.3% 3 22.2% 2 11.1% 1 0 0 0 0 Tempe 33.3% 4 33.3% 4 16.7% 2 16.7% 2 0 0 0 0 Gilbert 11.1% 4 63.9% 23 16.7% 6 2.8% 1 0 0 5.6% 2 Scottsdale 0 0 38.9% 7 33.3% 6 11.1% 2 5.6% 1 11.1% 2 West Phoenix 0 0 20.0% 3 73.3% 11 6.7% 1 0 0 0 0 3.4% 1 31.0% 9 65.5% 19 0 0 0 0 0 0 0 0 21.2% 7 48.5% 16 0 0 0 0 30.3% 10 Southwest Phoenix 25.0% 1 0 0 75.0% 3 0 0 0 0 0 0 Peoria 5.0% 1 15.0% 3 60.0% 12 15.0% 3 5.0% 1 0 0 Metro Tucson 0 0 15.4% 2 84.6% 11 0 0 0 0 0 0 Casa Family First 0 0 25.0% 3 75.0% 9 0 0 0 0 0 0 3.6% 1 14.3% 4 53.6% 15 3.6% 1 0 0 25.0% 7 Primero Los Niños 0 0 16.7% 1 83.3% 5 0 0 0 0 0 0 Sierra Vista Blake 0 0 73.3% 11 13.3% 2 6.7% 1 6.7% 1 0 0 5.8% 64 31.6% 349 45.2% 500 5.3% 59 0.6% 7 11.5% 127 Kingman Metro Phoenix Tolleson South Mountain Glendale East Mesa Kinlani-Flagstaff Wellspring Total 77 Healthy Families Arizona Evaluation Report 2007 POSTNATAL Ethnicity of Mother by Site - 2007 (Percent and number within Site) Site Mixed/Other Caucasian/ White Hispanic African American Asian American Native American % n % n % n % n % n % n Douglas 1.2% 1 11.0% 9 85.4% 70 1.2% 1 1.2% 1 0 0 Central Phoenix 3.3% 3 15.4% 14 72.5% 66 5.5% 5 0 0 3.3% 3 0 0 13.6% 12 75.0% 66 6.8% 6 1.1% 1 3.4% 3 South Phoenix 7.1% 7 15.3% 15 66.3% 65 7.1% 7 0 0 4.1% 4 East Valley 0.9% 1 33.3% 36 53.7% 58 8.3% 9 0.9% 1 2.8% 3 0 0 0.9% 1 98.1% 104 0 0 0 0 0.9% 1 Page 2.9% 1 2.9% 1 0 0 0 0 0 0 94.3% 33 Casa de los Niños 3.1% 3 18.6% 18 70.1% 68 4.1% 4 1.0% 1 3.1% 3 CODAC 6.4% 6 18.1% 17 71.3% 67 2.1% 2 0 0 2.1% 2 La Frontera 9.0% 9 16.0% 16 66.0% 66 6.0% 6 0 0 3.0% 3 Sierra Vista 7.2% 5 55.1% 38 33.3% 23 4.3% 3 0 0 0 0 Tuba City 2.4% 1 0 0 0 0 0 0 0 0 97.6% 41 0 0 52.0% 26 40.0% 20 2.0% 1 0 0 6.0% 3 Yuma 1.9% 1 5.7% 3 86.8% 46 3.8% 2 1.9% 1 0 0 Pascua Yaqui 24.0% 12 2.0% 1 8.0% 4 2.0% 1 2.0% 1 62.0% 31 Lake Havasu City 6.0% 5 44.6% 37 43.4% 36 1.2% 1 0 0 4.8% 4 Flagstaff 6.1% 2 36.4% 12 30.3% 10 3.0% 1 0 0 24.2% 8 Sunnyslope 8.1% 6 32.4% 24 51.1% 40 4.1% 3 0 0 1.4% 1 Prescott 0.8% 1 43.0% 52 52.1% 63 0.8% 1 1.7% 2 1.7% 2 Coolidge 0 0 30.4% 24 57.0% 45 6.3% 5 0 0 6.3% 5 Mesa 5.3% 6 33.6% 38 55.8% 63 2.7% 3 0.9% 1 1.8% 2 Southeast Phoenix 1.1% 1 13.5% 12 73.0% 65 9.0% 8 1.1% 1 2.2% 2 El Mirage 11.0% 10 36.3% 33 42.9% 39 8.8% 8 1.1% 1 0 0 Blake Foundation 4.8% 5 23.8% 25 62.9% 66 6.7% 7 0 0 1.9% 2 Marana 8.4% 7 34.9% 29 49.4% 41 4.8% 4 1.2% 1 1.2% 1 Safford 0 0 73.1% 19 19.2% 5 7.7% 2 0 0 0 0 Stanfield 0 0 10.0% 1 50.0% 5 20.0% 2 0 0 20.0% 2 1.4% 1 66.2% 47 26.8% 19 4.2% 3 0 0 1.4% 1 0 0 0 0 0 0 0 0 0 0 100% 8 7.1% 2 7.1% 2 17.9% 5 7.1% 2 0 0 60.7% 17 Maryvale Nogales Verde Valley Apache Junction Gila River Winslow 78 Healthy Families Arizona Evaluation Report 2007 Site Mixed/Other Caucasian/ White Hispanic African American Asian American Native American % n % n % n % n % n % n Kingman 11.1% 5 75.6% 34 11.1% 5 0 0 2.2% 1 0 0 Globe/Miami 5.0% 1 55.0% 11 10.0% 2 0 0 0 0 30.0% 6 Kyrene 2.8% 2 21.1% 15 63.4% 45 4.2% 3 1.4% 1 7.0% 5 Metro Phoenix 4.3% 3 18.8% 13 62.3% 43 13.0% 9 0 0 1.4% 1 Tolleson 3.3% 3 13.0% 12 67.4% 62 7.6% 7 0 0 8.7% 8 South Mountain 2.4% 3 12.1% 15 79.0% 98 4.8% 6 0.8% 1 0.8% 1 Glendale 7.0% 7 29.0% 29 50.0% 50 11.0% 11 1.0% 1 2.0% 2 Deer Valley 6.2% 6 36.1% 35 48.5% 47 4.1% 4 1.0% 1 4.1% 4 East/SE Tucson 9.8% 6 41.0% 25 42.6% 26 6.6% 4 0 0 0 0 SW Tucson 2.5% 2 8.9% 7 84.8% 67 2.5% 2 0 0 1.3% 1 Bullhead City 2.2% 1 68.9% 31 24.4% 11 4.4% 2 0 0 0 0 Northwest Phoenix 2.9% 2 41.4% 29 44.3% 31 5.7% 4 0 0 5.7% 4 Tempe 8.5% 4 25.5% 12 51.1% 24 12.8% 6 0 0 2.1% 1 Gilbert 9.5% 9 53.7% 51 26.3% 25 3.2% 3 2.1% 2 5.3% 5 Scottsdale 5.8% 6 47.1% 49 34.6% 36 5.8% 6 1.0% 1 5.8% 6 West Phoenix 5.6% 5 10.1% 9 74.2% 66 9.0% 8 0 0 1.1% 1 0 0 20.7% 17 75.6% 62 1.2% 1 0 0 2.4% 2 Kinlani-Flagstaff 2.7% 1 18.9% 7 32.4% 12 2.7% 1 0 0 43.2% 16 Southwest Phoenix 1.7% 1 13.3% 8 71.7% 43 10.0% 6 0 0 3.3% 2 Peoria 4.3% 3 34.3% 24 50.0% 35 7.1% 5 0 0 4.3% 3 Metro Tucson 5.2% 3 25.9% 15 56.9% 33 8.6% 5 3.4% 2 0 0 Casa Family First 9.4% 3 12.5% 4 65.6% 21 6.3% 2 3.1% 1 3.1% 1 Wellspring 0 0 33.3% 13 41.0% 16 0 0 2.6% 1 23.1% 9 Primero Los Niños 0 0 0 0 97.2% 35 0 0 2.8% 1 0 0 Sierra Vista Blake 3.2% 1 54.8% 17 29.0% 9 12.9% 4 0 0 0 0 Total 5.3% 203 27.3% 1044 55.6% 2129 5.1% 196 0.7% 25 6.9% 263 East Mesa 79 Healthy Families Arizona Evaluation Report 2007 Gestational Age by Site - 2007 (Number and Percent within Site) Was the gestational age less than 37 weeks? PRENATAL No Site POSTNATAL Yes No Yes % n % n % n % n Douglas 100% 1 0 0 83.3% 25 16.7% 5 Central Phoenix 100% 6 0 0 77.0% 57 23.0% 17 Maryvale 60.0% 6 40.0% 4 72.7% 48 27.3% 18 South Phoenix 75.0% 3 25.0% 1 76.8% 63 23.2% 19 East Valley 100% 4 0 0 74.2% 66 25.8% 23 Nogales 100% 10 0 0 80.4% 45 19.6% 11 Page 100% 4 0 0 100% 35 0 0 Casa de los Niños 93.3% 14 6.7% 1 84.4% 65 15.6% 12 CODAC 83.3% 10 16.7% 2 87.0% 60 13.0% 9 La Frontera 95.0% 19 5.0% 1 82.8% 72 17.2% 15 Sierra Vista 80.0% 4 20.0% 1 90.6% 48 9.4% 5 Tuba City 90.9% 10 9.1% 1 82.9% 29 17.1% 6 Verde Valley 89.4% 42 10.6% 5 87.8% 43 12.2% 6 Yuma 66.7% 2 33.3% 1 95.8% 46 4.2% 2 Pascua Yaqui 80.0% 4 20.0% 1 91.4% 32 8.6% 3 Lake Havasu City 93.3% 14 6.7% 1 87.3% 69 12.7% 10 Flagstaff 88.2% 15 11.8% 2 59.1% 13 40.9% 9 Sunnyslope 50.0% 3 50.0% 3 67.7% 44 32.3% 21 Prescott 83.3% 15 16.7% 3 88.9% 96 11.1% 12 Coolidge 100% 3 0 0 86.4% 51 13.6% 8 Mesa 75.0% 9 25.0% 3 68.4% 65 31.6% 30 Southeast Phoenix 85.7% 6 14.3% 1 77.3% 58 22.7% 17 El Mirage 100% 4 0 0 79.7% 59 20.3% 15 Blake Foundation 86.7% 13 13.3% 2 83.5% 71 16.5% 14 Marana 83.3% 5 16.7% 1 74.6% 50 25.4% 17 Safford 85.7% 6 14.3% 1 100% 7 0 0 Stanfield 100% 6 0 0 80.0% 8 20.0% 2 80 Healthy Families Arizona Evaluation Report 2007 PRENATAL No Site POSTNATAL Yes No Yes % n % n % n % n Apache Junction 81.8% 9 18.2% 2 80.7% 46 19.3% 11 Gila River 88.9% 8 11.1% 1 100% 7 0 0 Winslow 100% 4 0 0 86.4% 19 13.6% 3 Kingman 100% 2 0 0 90.3% 28 9.7% 3 Globe/Miami 50.0% 2 50.0% 2 76.5% 13 23.5% 4 Kyrene 81.8% 9 18.2% 2 72.7% 40 27.3% 15 Metro Phoenix 100% 2 0 0 75.5% 40 24.5% 13 Tolleson 57.1% 4 42.9% 3 83.1% 59 16.9% 12 South Mountain 90.9% 10 9.1% 1 83.8% 88 16.2% 17 Glendale 60.0% 3 40.0% 2 74.3% 55 25.7% 19 Deer Valley 100% 3 0 0 78.6% 55 21.4% 15 East/SE Tucson 58.3% 7 41.7% 5 75.0% 30 25.0% 10 SW Tucson 60.0% 3 40.0% 2 90.1% 64 9.9% 7 Bullhead City 100% 1 0 0 84.6% 22 15.4% 4 Northwest Phoenix 40.0% 2 60.0% 3 69.5% 41 30.5% 18 Tempe 100% 2 0 0 81.0% 34 19.0% 8 Gilbert 74.1% 20 25.9% 7 65.8% 52 34.2% 27 Scottsdale 60.0% 3 40.0% 2 77.4% 65 22.6% 19 West Phoenix 91.7% 11 8.3% 1 75.0% 51 25.0% 17 East Mesa 78.6% 11 21.4% 3 66.2% 45 33.8% 23 Kinlani-Flagstaff 75.0% 12 25.0% 4 100% 24 0 0 Southwest Phoenix 50.0% 1 50.0% 1 84.3% 43 15.7% 8 Peoria 80.0% 4 20.0% 1 71.4% 45 28.6% 18 Metro Tucson 50.0% 3 50.0% 3 86.0% 43 14.0% 7 Casa Family First 100% 1 0 0 75.0% 21 25.0% 7 Wellspring 93.8% 15 6.3% 1 95.2% 20 4.8% 1 Primero Los Niños 100% 3 0 0 94.3% 33 5.7% 2 Sierra Vista Blake 100% 6 0 0 89.7% 26 10.3% 3 Total 83.1% 399 16.9% 81 80.3% 2434 19.7% 597 81 Healthy Families Arizona Evaluation Report 2007 Low Birth Weight by Site - 2007 (Number and Percent within Site) Did the child have low birth weight? (less than 2500 grams, 88 ounces or 5.5 pounds) PRENATAL No POSTNATAL Yes No Yes % n % n % n % n Douglas 100% 2 0 0 90.0% 72 10.0% 8 Central Phoenix 100% 6 0 0 80.0% 72 20.0% 18 Maryvale 81.8% 9 18.2% 2 79.5% 70 20.5% 18 South Phoenix 80.0% 4 20.0% 1 77.6% 76 22.4% 22 East Valley 100% 3 0 0 81.9% 86 18.1% 19 Nogales 85.7% 12 14.3% 2 92.4% 97 7.6% 8 Page 60.0% 3 40.0% 2 94.6% 35 5.4% 2 Casa de los Niños 87.5% 14 12.5% 2 90.6% 87 9.4% 9 CODAC 87.5% 14 12.5% 2 91.1% 82 8.9% 8 La Frontera 95.5% 21 4.5% 1 85.9% 85 14.1% 14 Sierra Vista 92.9% 13 7.1% 1 88.4% 61 11.6% 8 Tuba City 80.0% 12 20.0% 3 90.2% 37 9.8% 4 Verde Valley 97.9% 46 2.1% 1 82.0% 41 18.0% 9 Yuma 100% 5 0 0 96.9% 63 3.1% 2 Pascua Yaqui 81.8% 9 18.2% 2 93.8% 45 6.3% 3 Lake Havasu City 95.8% 23 4.2% 1 91.6% 76 8.4% 7 Flagstaff 93.3% 14 6.7% 1 66.7% 22 33.3% 11 Sunnyslope 71.4% 5 28.6% 2 79.5% 58 20.5% 15 Prescott 81.0% 17 19.0% 4 88.5% 108 11.5% 14 Coolidge 100% 5 0 0 90.0% 72 10.0% 8 Mesa 75.0% 9 25.0% 3 80.5% 91 19.5% 22 Southeast Phoenix 100% 9 0 0 83.0% 73 17.0% 15 El Mirage 100% 8 0 0 86.8% 79 13.2% 12 Blake Foundation 87.5% 14 12.5% 2 85.6% 898 14.4% 15 Marana 57.1% 4 42.9% 3 89.0% 73 11.0% 9 Safford 75.0% 9 25.0% 3 82.1% 23 17.9% 5 82 Healthy Families Arizona Evaluation Report 2007 PRENATAL No POSTNATAL Yes No Yes Stanfield 100% 6 0 0 90.0% 9 10.0% 1 Apache Junction 100% 13 0 0 86.7% 65 13.3% 10 Gila River 90.9% 10 9.1% 1 100% 8 0 0 Winslow 100% 4 0 0 92.9% 26 7.1% 2 Kingman 100% 4 0 0 91.5% 43 8.5% 4 Globe/Miami 80.0% 4 20.0% 1 90.0% 18 10.0% 2 Kyrene 93.8% 15 6.3% 1 84.3% 59 15.7% 11 Metro Phoenix 100% 3 0 0 79.7% 55 20.3% 14 Tolleson 71.4% 5 28.6% 2 82.4% 75 17.6% 16 South Mountain 90.9% 10 9.1% 1 83.7% 103 16.3% 20 Glendale 60.0% 3 40.0% 2 82.0% 82 18.0% 18 Deer Valley 100% 3 0 0 81.4% 79 18.6% 18 East/SE Tucson 84.6% 11 15.4% 2 81.0% 47 19.0% 11 SW Tucson 80.0% 8 20.0% 2 88.9% 72 11.1% 9 Bullhead City 100% 6 0 0 84.2% 32 15.8% 6 Northwest Phoenix 80.0% 4 20.0% 1 75.7% 53 24.3% 17 Tempe 75.0% 3 25.0% 1 85.4% 41 14.6% 1 Gilbert 70.4% 19 29.6% 8 79.8% 75 20.2% 19 Scottsdale 77.8% 7 22.2% 2 82.4% 84 17.6% 18 West Phoenix 84.6% 11 15.4% 2 81.8% 72 18.2% 16 East Mesa 85.7% 12 14.3% 2 70.5% 55 29.5% 23 Kinlani-Flagstaff 100% 20 0 0 91.7% 33 8.3% 3 Southwest Phoenix 66.7% 2 33.3% 1 90.0% 54 10.0% 6 Peoria 100% 7 0 0 76.8% 53 23.2% 16 Metro Tucson 66.7% 4 33.3% 2 94.6% 53 5.4% 3 Casa Family First 100% 3 0 0 77.4% 24 22.6% 7 Wellspring 88.9% 16 11.1% 2 82.5% 33 17.5% 7 Primero Los Niños 100% 3 0 0 95.8% 46 4.2% 2 Sierra Vista Blake 100% 8 0 0 90.3% 28 9.7% 3 Total 87.9% 514 12.1% 71 85.0% 3250 15.0% 574 83 Healthy Families Arizona Evaluation Report 2007 Yearly Income by Site – 2007 PRENATAL Site POSTNATAL Median Yearly Income Number Median Yearly Income Number Douglas $3,600 17 $8,220 73 Central Phoenix $9,288 11 $12,000 62 Maryvale $16,040 12 $13,782 48 South Phoenix $9,600 8 $13,920 56 East Valley $14,400 13 $14,400 63 Nogales $10,400 17 $10,800 90 Page $4,320 7 $10,800 33 Casa de los Niños $14,400 25 $12,000 79 CODAC $5,892 15 $12,000 80 La Frontera $12,760 32 $10,068 83 Sierra Vista $7,044 15 $5,070 58 Tuba City $12,000 9 $9,300 21 Verde Valley $12,000 63 $12,000 46 Yuma $5,200 6 $8,400 53 Pascua Yaqui $8,400 36 $6,870 48 Lake Havasu City $21,855 32 $19,200 75 Flagstaff $12,000 35 $16,200 32 Sunnyslope $10,000 16 $14,400 49 Prescott $16,800 11 $18,000 33 Coolidge $4,164 1 $7,680 45 Mesa $20,800 16 $12,600 70 Southeast Phoenix $15,270 10 $11,592 55 El Mirage $20,400 4 $18,000 60 Blake Foundation $13,200 19 $13,100 84 Marana $19,200 11 $14,400 60 Safford $12,600 14 $11,400 24 Stanfield $16,800 5 $6,600 6 84 Healthy Families Arizona Evaluation Report 2007 PRENATAL Site POSTNATAL Median Yearly Income Number Median Yearly Income Number Apache Junction $13,200 24 $16,116 63 Gila River $13,200 7 $3,240 3 Winslow $9,600 10 $7,920 25 Kingman $16,800 7 $14,400 27 Globe/Miami $10,800 9 $6,700 12 Kyrene $19,200 17 $16,800 41 Metro Phoenix $22,800 4 $10,200 44 Tolleson $10,800 11 $15,600 65 South Mountain $15,000 16 $13,000 75 Glendale $7,800 5 $15,600 65 Deer Valley $17,780 8 $14,400 61 East/SE Tucson $14,300 50 $18,576 48 SW Tucson $9,600 16 $13,100 68 Bullhead City $12,000 7 $12,000 25 Northwest Phoenix $18,720 3 $15,600 41 Tempe $4,980 7 $14,400 29 Gilbert $6,148 14 $12,900 50 Scottsdale $15,000 10 $15,300 44 West Phoenix $21,600 13 $16,720 56 East Mesa $11,400 20 $16,000 55 Kinlani-Flagstaff $9,000 29 $14,400 34 Southwest Phoenix $5,082 4 $14,400 38 Peoria $14,400 11 $20,400 50 Metro Tucson $14,400 11 $11,400 50 Casa Family First $14,850 10 $13,200 21 Wellspring $12,000 23 $8,400 35 Primero Los Niños $9,000 2 $9,600 35 Sierra Vista Blake $5,748 12 $11,000 27 Total $12,000 789 $13,000 2673 85 Healthy Families Arizona Evaluation Report 2007 Parent Survey Score by Site – 2007 PRENATAL POSTNATAL Mean Score Percent of mothers whose score was greater than 40 Number of mothers whose score was greater than 40 Mean Score Percent of mothers whose score was greater than 40 Number of mothers whose score was greater than 40 Douglas 38.75 55.0% 11 37.38 43.9% 36 Central Phoenix 55.28 88.9% 16 43.85 70.3% 64 Maryvale 49.12 82.4% 14 43.92 59.1% 52 South Phoenix 57.00 86.7% 13 44.95 69.7% 69 East Valley 48.06 72.2% 13 41.70 61.5% 67 Nogales 36.96 30.4% 7 35.75 38.7% 41 Page 40.00 62.5% 5 31.08 18.9% 7 Casa de los Niños 41.62 55.9% 19 39.10 48.0% 48 CODAC 42.61 60.9% 14 39.95 62.8% 59 La Frontera 43.24 62.2% 23 40.00 53.0% 53 Sierra Vista 42.78 61.1% 11 38.31 44.9% 31 Tuba City 41.39 66.7% 12 30.36 33.3% 14 Verde Valley 38.49 46.6% 34 35.59 37.3% 19 Yuma 38.33 44.4% 4 32.69 25.4% 17 Pascua Yaqui 32.66 29.8% 14 33.10 28.0% 14 Lake Havasu City 49.57 71.4% 25 38.61 47.0% 39 Flagstaff 41.08 51.4% 19 39.41 52.9% 18 Sunnyslope 45.22 52.2% 12 41.67 60.0% 45 Prescott 45.42 70.8% 17 39.63 50.8% 62 Coolidge 39.44 44.4% 4 36.28 41.5% 34 Mesa 47.73 72.7% 16 42.63 57.9% 66 Southeast Phoenix 38.33 46.7% 7 43.13 59.3% 54 El Mirage 43.93 71.4% 10 39.35 54.3% 50 Blake Foundation 42.29 58.3% 14 40.42 48.1% 52 Marana 41.00 53.3% 8 37.47 48.2% 40 Safford 31.25 30.0% 6 20.89 14.3% 4 Stanfield 38.18 54.5% 6 34.55 18.2% 2 Apache Junction 50.16 80.6% 24 51.13 77.3% 58 Site 86 Healthy Families Arizona Evaluation Report 2007 PRENATAL POSTNATAL Mean Score Percent of mothers whose score was greater than 40 Number of mothers whose score was greater than 40 Mean Score Percent of mothers whose score was greater than 40 Number of mothers whose score was greater than 40 Gila River 40.00 46.2% 6 32.50 25.0% 2 Winslow 34.55 45.5% 5 34.82 46.4% 13 Kingman 53.68 73.7% 14 42.55 60.4% 32 Globe/Miami 32.31 53.8% 7 31.43 39.1% 9 Kyrene 39.07 48.1% 13 40.77 59.2% 42 Metro Phoenix 41.25 62.5% 5 45.43 62.3% 43 Tolleson 39.06 50.0% 8 40.43 48.9% 45 South Mountain 38.91 56.5% 13 44.72 68.5% 85 Glendale 56.50 90.0% 9 43.33 59.8% 61 Deer Valley 44.00 70.0% 7 41.30 58.2% 57 East/SE Tucson 43.00 60.0% 15 43.55 58.1% 36 SW Tucson 36.18 47.1% 8 37.07 46.3% 38 Bullhead City 53.00 93.3% 14 42.55 48.9% 23 Northwest Phoenix 43.89 55.6% 5 46.93 68.6% 48 Tempe 54.58 83.3% 10 46.56 72.9% 35 Gilbert 56.11 88.9% 32 43.26 67.4% 64 Scottsdale 51.39 77.8% 14 47.55 75.0% 78 West Phoenix 44.67 60.0% 9 41.33 54.4% 49 East Mesa 49.66 75.9% 22 43.35 58.5% 48 Kinlani-Flagstaff 46.52 72.7% 24 39.86 51.4% 19 Southwest Phoenix 57.50 100% 4 49.33 83.3% 50 Peoria 41.25 50.0% 10 44.51 67.6% 48 Metro Tucson 41.54 53.8% 7 42.80 61.0% 36 Casa Family First 45.00 69.2% 9 37.81 46.9% 15 Wellspring 38.04 53.6% 15 42.38 57.5% 23 Primero Los Niños 41.67 50.0% 3 34.90 30.6% 15 Sierra Vista Blake 45.67 73.3% 11 35.65 41.9% 13 Total 43.42 60.8% 678 40.84 54.8% 2142 Site 87 Healthy Families Arizona Evaluation Report 2007 Trimester of Enrollment into Prenatal Program July 2006 to June 2007 (includes all families, even those that did not engage) Site 1st Trimester # 2nd Trimester % # % 3rd Trimester # % Post-birth # Total % # Douglas 5 25.0% 8 40.0% 7 35.0% 0 0 20 Central Phoenix 1 5.6% 5 27.8% 12 66.7% 0 0 18 Maryvale 1 5.9% 8 47.1% 8 47.1% 0 0 17 South Phoenix 1 6.7% 7 46.7% 6 40.0% 1 6.7% 15 East Valley 2 11.1% 8 44.4% 8 44.4% 0 0 18 Nogales 2 8.7% 7 30.4% 11 47.8% 3 13.0% 23 Page 2 25.0% 4 50.0% 2 25.0% 0 0 8 Casa de los Niños 5 14.7% 14 41.2% 13 38.2% 2 5.9% 34 CODAC 0 0 9 39.1% 13 56.5% 1 4.3% 23 La Frontera 0 0 14 37.8% 19 51.4% 4 10.8% 37 Sierra Vista 3 16.7% 7 38.9% 6 33.3% 2 11.1% 18 Tuba City 0 0 6 33.3% 12 66.7% 0 0 18 Verde Valley 6 8.2% 19 26.0% 46 63.0% 2 2.7% 73 Yuma 0 0 2 22.2% 6 66.7% 1 11.1% 9 Pascua Yaqui 9 19.1% 17 36.2% 21 44.7% 0 0 47 10 28.6% 10 28.6% 15 42.9% 0 0 35 Flagstaff 5 13.5% 7 18.9% 25 67.6% 0 0 37 Sunnyslope 2 8.7% 7 30.4% 12 52.2% 2 8.7% 23 Prescott 3 12.5% 8 33.3% 13 54.2% 0 0 24 Coolidge 0 0 3 33.3% 6 66.7% 0 0 9 Mesa 2 9.1% 8 36.4% 12 54.5% 0 0 22 Southeast Phoenix 1 6.7% 7 46.7% 8 33.3% 2 13.3% 15 El Mirage 1 7.1% 6 42.9% 6 42.9% 1 7.1% 14 Blake Foundation 4 16.7% 5 20.8% 14 58.3% 1 4.2% 24 Marana 4 26.7% 7 46.7% 1 6.7% 3 20.0% 15 Safford 2 10.0% 3 15.0% 14 70.0% 1 5.0% 20 Stanfield 4 36.4% 4 36.4% 3 27.3% 0 0 11 Apache Junction 6 19.4% 13 41.9% 10 32.3% 2 6.5% 31 Gila River 2 15.4% 4 30.8% 5 38.5% 2 15.4% 13 Winslow 1 9.1% 4 36.4% 6 54.5% 0 0 11 Kingman 4 21.1% 7 36.8% 6 31.6% 2 10.5% 19 Lake Havasu City 88 Healthy Families Arizona Evaluation Report 2007 Site 1st Trimester # 2nd Trimester % # 3rd Trimester % # % Post-birth # Total % # Globe/Miami 0 0 7 53.8% 5 38.5% 1 7.7% 13 Kyrene 6 22.2% 5 18.5% 15 55.6% 1 3.7% 27 Metro Phoenix 1 12.5% 5 62.5% 2 25.0% 0 0 8 Tolleson 0 0 8 50.0% 6 37.5% 2 12.5% 16 South Mountain 2 8.7% 8 34.8% 10 43.5% 3 13.0% 23 Glendale 1 10.0% 2 20.0% 6 60.0% 1 10.0% 10 Deer Valley 0 0 2 20.0% 7 70.0% 1 10.0% 10 East/SE Tucson 2 8.0% 9 36.0% 12 48.0% 2 8.0% 25 SW Tucson 1 5.9% 9 52.9% 5 29.4% 2 11.8% 17 Bullhead City 2 13.3% 9 60.0% 2 13.3% 2 13.3% 15 Northwest Phoenix 1 11.1% 1 11.1% 7 77.8% 0 0 9 Tempe 0 0 5 41.7% 5 41.7% 2 16.7% 12 Gilbert 0 0 12 33.3% 50 55.6% 4 11.1% 36 Scottsdale 3 16.7% 4 22.2% 7 38.9% 4 22.2% 18 West Phoenix 1 6.7% 7 46.7% 7 46.7% 0 0 15 East Mesa 3 10.3% 14 48.3% 10 34.5% 2 6.9% 29 Kinlani-Flagstaff 5 15.2% 6 18.2% 20 60.6% 2 6.1% 33 Southwest Phoenix 0 0 3 75.0% 1 25.0% 0 0 4 Peoria 2 10.0% 6 30.0% 11 55.0% 1 5.0% 20 Metro Tucson 0 0 5 38.5% 6 46.2% 2 15.4% 13 Casa Family First 1 7.7% 7 53.8% 4 30.8% 1 7.7% 13 10 35.7% 5 17.9% 13 46.4% 0 0 28 Primero Los Niños 0 0 0 0 3 50.0% 3 50.0% 6 Sierra Vista Blake 2 13.3% 4 26.7% 7 46.7% 2 13.3% 15 131 11.7% 381 34.1% 534 47.8% 70 6.3% 1113 Wellspring Total 89 Healthy Families Arizona Evaluation Report 2007 Engaged Prenatal Families that Exited before Baby's Birth By Site - July 2006 through June 2007 Site Total Families # Closed % Closed before before birth birth Douglas 20 0 0% Central Phoenix 18 0 0% Maryvale 17 0 0% South Phoenix 15 0 0% East Valley 18 0 0% Nogales 23 0 0% Page 8 0 0% Casa de los Niños 34 1 3% CODAC 23 0 0% La Frontera 37 1 3% Sierra Vista 18 0 0% Tuba City 18 1 6% Verde Valley 73 0 0% Yuma 9 0 0% Pascua Yaqui 47 0 0% Lake Havasu City 35 2 6% Flagstaff 37 0 0% Sunnyslope 23 1 4% Prescott 24 0 0% Coolidge 9 0 0% Mesa 22 0 0% Southeast Phoenix 15 0 0% El Mirage 14 0 0% Blake Foundation 24 0 0% Marana 15 0 0% Safford 20 0 0% Stanfield 11 1 9% Apache Junction 31 1 3% Gila River 13 0 0% Winslow 11 0 0% Kingman 19 1 5% 90 Healthy Families Arizona Evaluation Report 2007 Site Total Families # Closed % Closed before before birth birth Globe/Miami 13 0 0% Kyrene 27 0 0% Metro Phoenix 8 0 0% Tolleson 16 0 0% South Mountain 23 0 0% Glendale 10 0 0% Deer Valley 10 0 0% East/SE Tucson 25 1 4% SW Tucson 17 0 0% Bullhead City 15 1 7% Northwest Phoenix 9 0 0% Tempe 12 0 0% Gilbert 36 0 0% Scottsdale 18 0 0% West Phoenix 15 0 0% East Mesa 29 0 0% Kinlani-Flagstaff 33 0 0% Southwest Phoenix 4 0 0% Peoria 20 0 0% Metro Tucson 13 0 0% Casa Family First 13 0 0% Wellspring 28 0 0% Primero Los Niños 6 0 0% Sierra Vista Blake 15 0 0% 1116 11 1% Total 91 Healthy Families Arizona Evaluation Report 2007 Appendix C. 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. 92 Healthy Families Arizona Evaluation Report 2007 Appendix D: Healthy Families Parenting Inventory Healthy Families Parenting Inventory Cronbach’s Alpha Scores Subscale Alpha* 2month r=.84 Alpha* 6month r=.86 Alpha* 12month r=.87 Problem solving r=.79 r=.69 r=.85 Depression r=.72 r=.73 r=.72 Personal care r=.80 r=.83 r=.85 Mobilizing resources r=.78 r=.82 r=.82 Accepting the parent role r=.77 r=.79 r=.82 Parent Child behaviors r=.79 r=.79 r=.82 Home environment r=.79 r=.81 r=.83 Parenting efficacy r=.84 r=.87 r=.88 Social support *Alpha scores represent the correlation of items on a scale, and indicate how well the items in a subscale relate to each other. 93 Healthy Families Arizona Evaluation Report 2007 Appendix E: Selected Risk Factors at Intake All Families 2007 Selected Risk Factors for Mothers at Intake*--2007 Risk Factors of Mothers All Families (prenatal and postnatal combined) Teen Births (19 years or less) 24.7% Births to Single Parents 70.2% Less Than High School Education 63.1% Not Employed 80.0% No Health Insurance 4.7% Receives AHCCCS 85.1% Late or No Prenatal Care 35.0% 94 Healthy Families Arizona Evaluation Report 2007 Appendix F. Regression Coefficients for Workforce Survey Professional/personal fit Professional efficacy Perceptions of workload Non-salary reward Time employed Actively seeking employment B Wald df p -.621 .334 -.351 -.265 -.001 8.786 5.343 5.325 4.831 8.652 1 1 1 1 1 .003 .021 .021 .028 .003 Odds Ratio .537 1.397 .704 .767 .9999 .843 12.385 1 .000 2.323 This regression model was selected because it balanced maintaining the most cases in relation to missing data, and maximized the proportion of variance explained. This particular model explained 38% of the variance in attrition. 95 Healthy Families Arizona Evaluation Report 2007 Appendix G. Healthy Families Arizona Prenatal Logic Model Long Term Outcomes Î Ï Ð Ñ Ò Program Resources Family Support Specialists; Family Assessment Workers; Clinical consultants; Quality Assurance/Training/Evaluation; Funding; Community based services, e.g., prenatal support & education programs, hospital programs, nutrition services, translation & transportation services, mental health, domestic violence, substance abuse services Reduced child abuse and neglect Increased child wellness and development Strengthened family relations Enhanced family unity Reduced abuse of drugs and alcohol Prenatal Program Objectives Increase the family’s support network Improve mother’s mental health Increase parents’ health behaviors Increase the family members’ problem solving skills Identify signs and history of depression, abuse, mental illness, substance abuse Assess personal risk behaviors Identify major life stressors Improve nutrition Increase empathy for the unborn baby Increase father involvement Increase safety in the home environment Increase the delivery of healthy babies, free from birth complications Program Activities and Strategies Assess family’s support systems Model relationship skills Foster connections to positive support sources Review history of birthing Encourage medical assessment, referral and treatment if needed Encourage exercise, personal care, rest Educate on risk behaviors, lifestyle choices, community resources, affect of drugs, medicines on fetus Explore domestic violence, form safety plan Encourage help seeking and adoption of healthy behaviors Educate on problem-solving, goal setting. Use IFSP to review progress Educate on access to community resources, how to reach out Make referrals as needed for anger and stress management Educate and provide materials on nutrition during pregnancy, buying and choosing healthy foods, and requirements for healthy fetal development Explore and assess issues around pregnancy, relationships, hopes, fears Provide referrals to WIC, other resources Share developmental information about stages of development of fetus Encourage healthy celebrations Teach stress reduction Educate on post partum depression Discuss and educate about changes in body, sexuality during pregnancy Encourage prebirth bonding and stimulation exercises (reading, touch, etc) Explore father’s feelings, childhood experiences, expectations, hopes and fears about baby and goals for fatherhood Educate about changes in intimacy, ways father can support mother Encourage supportive relationships for father Educate on father’s legal rights and responsibilities Assess, encourage and guide family in making needed safety arrangements, e.g. crib safety, car seat, pets, SIDS, child care, feeding Educate on baby temperaments, how to calm baby, Shaken Baby Syndrome, medical concerns Connect mother to prenatal care and encourage compliance with visits Encourage STD testing Educate on symptoms requiring medical attention Promote breastfeeding and refer to resources Refer to parenting workshops Explore cultural beliefs about discipline Outcome Evaluation Measures H.F. Parenting Inventory-Prenatal (HFPIP); FSS-23 HFPIP; FSS-23 HFPIP; FSS23; CRAFFT HFPIP; FSS-23 HFPIP; FSS-23 HFPIP; FSS-23 HFPIP; FSS-23; father involvement scale 96 Healthy Families Arizona Evaluation Report 2007 HFPIP; FSS-23; Safety checklist HFPIP; FSS-23; FSS20P Appendix H. Healthy Families Arizona Postnatal Logic Model Long Term Outcomes Î Ï Ð Ñ Ò Program Resources Family Support Specialists; Family Assessment Workers; Clinical consultants; Quality Assurance/Training/Evaluation; Funding; Community based services, e.g., parenting support & education programs, nutrition services, translation & transportation services, mental health, domestic violence, substance abuse services Reduced child abuse and neglect Increased child wellness and development Strengthened family relations Enhanced family unity Reduced abuse of drugs and alcohol Postnatal Program Objectives Increase the family’s support network Improve mother’s mental health Increase parents’ health behaviors Increase the family members’ problem solving skills Improve family stability Increase parental competence Increase positive parentchild interaction Improve child health and Optimize child development Prevent child abuse and neglect Program Activities and Strategies Assess family’s support systems Model relationship skills Foster connections to positive support sources Educate on communication skills Identify signs and history of depression, abuse, mental illness, substance abuse Address issues of grief and loss Encourage medical assessment, referral and treatment if needed Encourage/coach on exercise, personal care, rest Educate on postpartum depression Assess personal risk behaviors; Educate on dangers of specific risk behaviors Support family in making lifestyle changes and adopting healthy behaviors Educate on community resources Explore domestic violence, create safety plan Identify major life stressors Educate on problem-solving, goal setting. Use IFSP to review progress Assess basic living skills and needs; help family access housing, education, job, and budget management services. Educate on access to community resources, how to reach out Coach parent to set and evaluate goals; teach basic living skills Make referrals as needed for anger and stress management Promote use of community resources for self sufficiency Educate about effect of stress on child Explore family planning decisions Provide empathy and support to parent in parenting role Teach child development, early brain development, temperament Address parental expectations of child Educate about importance of routines and rules Refer to parenting groups and classes Promote and teach developmentally appropriate stimulation activities Educate about rhythm and reciprocity, reading baby’s cues Promote reading, bonding during feeding Encourage family activities, celebrations Coach on father involvement Complete developmental assessments and make referrals Address medical screenings, support well child checks, immunizations, and good nutrition habits Assess risk of child abuse and neglect Coach and guide in choices for child care Educate about consequences of child abuse and neglect Promote play, reading; provide links to early childhood programs Assess and Guide family in making safety arrangements, e.g., home and car safety Outcome Evaluation Measures Healthy Families Parenting Inventory (HFPI); FSS-23 HFPI; FSS-23 HFPI; FSS-23; CRAFFT HFPI; FSS-23 HFPI; FSS-23 HFPI; FSS-23 HFPI; FSS-23; father involvement scale 97 Healthy Families Arizona Evaluation Report 2007 HFPI; FSS-23; Safety checklist; ASQ HFPI; FSS-23; FSS20