Healthy Families Arizona Annual Evaluation Report FY2014 FINAL July 2013 – June 2014 Prepared by: LeCroy & Milligan Associates, Inc. 2020 N. Forbes Blvd., Suite 104 Tucson, Arizona 85745 (520) 326-5154 www.lecroymilligan.com Prepared for: The Arizona Department of Child Safety Office of Prevention and Family Support 3443 N. Central Ave., Suite 1206 Phoenix, Arizona 85012 Acknowledgements This evaluation report represents the efforts of many individuals and many collaborating organizations. The evaluation team for Healthy Families Arizona (HFAz) that contributed to this year’s report includes evaluators Darlene Lopez, Ph.Dc., Nicole Huggett, MSW, Craig W. LeCroy, Ph.D., Michel Lahti, Ph.D., Kerry Milligan, MSSW, Olga Valenzuela, B.A, and data management staff, Veronica Urcadez, Eloina Cardenas, and Frankie Valenzuela. We extend appreciation to Jenna Shroyer, Manager, and Esthela Navarro, HFAz Statewide Program Coordinator, in the Office of Prevention and Family Support, for their guidance and support. The members of the Healthy Families Arizona Advisory Board are thanked for their long term commitment, enthusiasm and leadership in Arizona (a list of members is included in the appendices). Thank you to the Healthy Families Arizona program managers and supervisors, who have worked diligently to ensure data are collected, submitted, and shared with staff for program improvement. Family Assessment Workers, Family Support Specialists and support staff at the sites have dutifully collected the data, and have participated in the evaluation process--all of whom help to tell an accurate story about Healthy Families Arizona. Lastly, we acknowledge the families who have received Healthy Families Arizona services. Suggested Citation: LeCroy & Milligan Associates, Inc. (2014). Healthy Families Arizona Annual Evaluation Report 2014. Tucson, AZ: LeCroy & Milligan Associates, Inc. Healthy Families Arizona Annual Evaluation Report 2014 1 Table of Contents Table of Contents .................................................................................................................................. 2 List of Exhibits....................................................................................................................................... 3 Executive Summary.............................................................................................................................. 4 Introduction ........................................................................................................................................... 8 Healthy Families Arizona Statewide System ............................................................................ 8 In this Report ....................................................................................................................................... 10 Evaluation Methodology ........................................................................................................... 10 Review of Current Literature .................................................................................................... 12 Program Updates ................................................................................................................................ 16 Training and Professional Development ................................................................................. 16 Program Affiliation in Yavapai County – Verde Valley ........................................................ 17 MIECHV Grant ............................................................................................................................ 17 Quality Assurance and Training Assistance ........................................................................... 18 Collaboration between First Things First and Arizona Department of Health Services .. 18 Healthy Families Arizona Participant Characteristics .................................................................. 19 Length of Time in Program and Reasons for Termination.................................................... 21 Maternal Risk Factors ................................................................................................................. 22 Infant Characteristics .................................................................................................................. 23 Race and Ethnicity ...................................................................................................................... 24 Assessment of Risk Factors ........................................................................................................ 26 Summary ...................................................................................................................................... 27 Key Healthy Families Arizona Services .......................................................................................... 28 Developmental Screens and Referrals for Children ............................................................... 28 Outcomes for Families ....................................................................................................................... 30 Parent outcomes .......................................................................................................................... 30 Healthy Families Parenting Inventory Reveals Positive Parent Change ........................ 31 Healthy Families Parent Inventory (HFPI) Subscales ........................................................ 32 Total Change Score on the HFPI ........................................................................................... 32 Child Abuse and Neglect ........................................................................................................... 33 Collaboration with the Department of Child Safety .............................................................. 35 Child Development and Wellness ............................................................................................ 35 Immunizations ........................................................................................................................ 35 Safety Practices in the Home ................................................................................................. 37 Mothers’ Health, Education, and Employment ...................................................................... 38 Subsequent Pregnancies and Birth Spacing ........................................................................ 38 School, Educational Enrollment, and Employment ........................................................... 39 Substance Abuse Screening ....................................................................................................... 41 2013 Participant Satisfaction Survey ........................................................................................ 42 Conclusions and Recommendations ................................................................................................ 44 References ............................................................................................................................................ 46 Appendix A. Team Level Data ......................................................................................................... 48 Appendix B. Healthy Families Arizona Steering Committee Members ..................................... 63 Appendix C. Parent Survey............................................................................................................... 64 Appendix D. Healthy Families Arizona Prenatal Logic Model ................................................... 65 Appendix E. Healthy Families Arizona Postnatal Logic Model .................................................. 66 Healthy Families Arizona Annual Evaluation Report 2014 2 List of Exhibits Exhibit 1. Healthy Families Arizona Program Sites in State Fiscal Year 2014 ..................... 9 Exhibit 2. Participants Included in the Evaluation for State Fiscal Year 2014 ................... 20 Exhibit 3. Families’ Length of Time in the Program for State Fiscal Year 2014 .................. 21 Exhibit 4. Most Frequent Reasons for Termination State Fiscal Year 2014 ......................... 22 Exhibit 5. Selected Risk Factors for Mothers at Intake State Fiscal Year 2014 .................... 23 Exhibit 6. Risk Factors for Infants - State Fiscal Year 2014 ................................................... 24 Exhibit 7. Parent’s Ethnicity State Fiscal Year 2014 ............................................................... 25 Exhibit 8. Mother’s Race* State Fiscal Year 2014.................................................................... 25 Exhibit 9. Father’s Race* State Fiscal Year 2014 ..................................................................... 25 Exhibit 10. Percentage of Parents Rated Severe on Parent Survey Items PRENATAL .... 26 Exhibit 11. Percentage of Parents Rated Severe on Parent Survey Items POSTNATAL . 27 Exhibit 12. ASQ-3 Screening State Fiscal Year 2014 ............................................................... 29 Exhibit 13. ASQ-3 Follow-up Services State Fiscal Year 2014 ............................................... 30 Exhibit 14. Change in Subscales of the HFPI .......................................................................... 32 Exhibit 15. Overall Change in Healthy Families Parenting Inventory Outcomes ............. 33 Exhibit 16. Percent of Families Showing No Child Abuse and Neglect Incidences .......... 34 Exhibit 17. Immunization Rate of Healthy Families Arizona Children .............................. 37 Exhibit 18. Percent of all Families Implementing Safety Practices ....................................... 38 Exhibit 19. Percentage of Mothers who Reported Subsequent Pregnancies State Fiscal Year 2014....................................................................................................................................... 39 Exhibit 20. Length of Time to Subsequent Pregnancy for Those Families with Subsequent Births ........................................................................................................................ 39 Exhibit 21. Percent of Mothers Enrolled in School – State Fiscal Year 2014........................ 40 Exhibit 22. Mother’s Employment Status ................................................................................ 40 Exhibit 23. Percent Screened and Assessed Positive on the CRAFFT.................................. 41 Exhibit 24. Percent Who Strongly Agreed on Satisfaction Survey Statements 2014 .......... 43 Healthy Families Arizona Annual Evaluation Report 2014 3 Executive Summary The Healthy Families program model is designed to help expectant and new parents get their children off to a healthy start. Families are screened according to specific criteria and participate voluntarily in the program. Families that choose to participate receive home visits and referrals from trained staff. The Healthy Families Arizona program serves families with multiple stressors and risk factors that can increase the likelihood that their children may suffer from abuse, neglect, or other poor outcomes. By providing services to under-resourced, stressed, and overburdened families, the Healthy Families Arizona program fits into a continuum of services provided to Arizona families. Recent research shows that home visitation programs tend to have wide-ranging and significant outcomes. Studies conducted on Healthy Families programs in several states show that these programs can impact infant health, positive parenting practices, safety practices, parenting stress, parental knowledge, and even in some cases incidences of abusive and neglectful behaviors. However, more research is needed regarding program fidelity, implementation, and program effects with specific populations. Image courtesy of www.socialmediamom.com The Healthy Families Arizona Program Healthy Families Arizona is in its twenty-third year, and is modeled after and accredited with the Healthy Families America initiative under the auspices of Prevent Child Abuse America. In State Fiscal Year 2014, with combined funding from the Arizona Department of Child Safety (DCS), First Things First (FTF), and the Department of Health Services (DHS) funding, Healthy Families Arizona provided services to families in 13 counties through 12 sites and 39 teams. Who Does Healthy Families Arizona Serve? A total of 4,761 families had data submitted for evaluation purposes during the current study year from July 1, 2013 through June 30, 2014. The evaluation of the Healthy Families Arizona Annual Evaluation Report 2014 4 statewide Healthy Families Arizona system covers only families with children that are 24 months old or younger (n=4,096) The remaining 665 families’ children were between 24 and 60 months, so were not included in the evaluation. In order to have a meaningful evaluation of the program effects, only the families that receive at least a minimal amount of program exposure are included. This further restricts our dataset to 3,197 families that have received at least four home visits. Slightly less than one fourth of the families enter in the prenatal period and the average length of time in the program is just under 12 months. Healthy Families Arizona program families have a significant number of maternal and infant risk factors at entry into the program compared to the overall state rates. The mothers enrolled into Healthy Families Arizona are more likely to be single parents, unemployed, undereducated, living in poverty, and receiving AHCCCS. The infants are also more likely to suffer from birth defects, be of low birth weight, be born preterm, and have positive alcohol or drug screens at birth than for Arizona as a whole as reported in state and federal data. Risk Factors of Mothers Teen Births (19 years or less) Births to Single Parents Less Than High School Education Not Employed No Health Insurance Receives AHCCCS Late or No Prenatal Care Median Yearly Income Risk Factors for Infants Born < 37 weeks gestation Birth Defects Low Birth Weight Positive Alcohol/Drug Screen Prenatal Families 20.9% 67.8% 39.6% 74.7% 4.7% 87.2% 27.5% $10,000 Prenatal Families 12.1% 1.1% 6.9% 0.5% Postnatal Families 16.4% 66.3% 38.6% 78.7% 6.9% 82.5% 35.6% $11,640 Postnatal Families 15.6% 0.9% 13.2% 9.4% Arizona State Rates 8.5% 45.1% 19.7% 45.8% 3.6% 53.8% 18.7% $48,510 Arizona State Rates 10.2% 1.7% 8.2% 1.4% Sources: 2012 and 2013 data from the Arizona Department of Health Services Vital Statistics records, and the U.S. Census Bureau, American Community Survey, 2013 Outcomes for Families and Children Participating in Healthy Families The Healthy Families Parenting Inventory (HFPI) revealed statistically significant improvement on all subscales at 6 and 12 months except social support. This indicated that Healthy Families Arizona participants are continuing to see reductions in their risk factors related to child abuse and neglect. Healthy Families Arizona Annual Evaluation Report 2014 5 Parents in Healthy Families report significant changes in:         Increased problem solving Increased personal care Improved mobilization of resources Increased parenting role satisfaction Improved parent/child interaction Improved home environment Improved parenting efficacy Decreased depression Child Development and Wellness Timely immunizations remain an important component for positive child health and development outcomes. The immunization rate for the children of Healthy Families Arizona participants by 24 months was 71.4% compared to a 70.3% immunization rate for 2 year-olds in the state of Arizona as a whole. Healthy Families Arizona also educates families on home safety practices. Results indicate that for families who have been in the program for 12 months: 99.8% of participants are using car seats, 97% have poisons locked, and 89.9% have working smoke alarms. Developmental delays are screened for at regular intervals in the Healthy Families Arizona program to assure that children who need further services are referred appropriately. The program was just short of meeting the statewide performance measure goal of 90% of two year-old children screened for developmental delays; 84.9% of 2-year olds in the program were Image courtesy of www.sheknows.com screened for developmental delays. Child Abuse and Neglect Records of child abuse and neglect incidents (substantiated) were examined for program participants who had received services for at least six months. The statewide program performance measure goal is for 99.7% of families to have no substantiated reports to child protective services. This year the percent of families with no child abuse or neglect incidences was 96%, and did not meet the performance measure goal. A total of 94 Healthy Families Arizona families had a substantiated case of child abuse and/or neglect out of 2,360 families that had participated in the program for at least 6 months. Healthy Families Arizona teams also provided home visitation services to 681 families that were involved with Child Protective Services. Healthy Families Arizona Annual Evaluation Report 2014 6 Mothers’ Health, Education, and Employment Healthy Families Arizona also seeks to improve the health, education, and employment outcomes among mothers so that they are better equipped to meet their families’ needs. Research shows that spacing pregnancies at least 24 months apart has positive health benefits for the mother. This year 1.2% of mothers with a subsequent pregnancy waited over 24 months before they got pregnant with their next child. The number of mothers enrolled in school has continued to decrease in recent years, with 13.9% enrolled at 1 year of program participation, and 11.2% at 2 years. The home visitors also complete screenings and provide referrals for substance abuse problems. Substance abuse continues to be a difficult problem for families. Approximately 44% of the participants were screened as having a history of substance abuse problems at intake, with nearly 12% continuing to have problems after six months in the program. Healthy Families Arizona Annual Evaluation Report 2014 7 Introduction Healthy Families Arizona was established in 1991 by the Arizona Department of Economic Security (now known as the Arizona Department of Child Safety) as a home visitation service for at-risk families, and is now in its 23rd year. The Healthy Families Arizona program is accredited by Prevent Child Abuse America and is modeled after the Healthy Families America initiative. Healthy Families America began under the auspices of Prevent Child Abuse America (formerly known as the National Committee to Prevent Child Abuse) in partnership with the Ronald McDonald House Charities. Healthy Families America was designed to promote positive parenting, enhance child health and development, and prevent child abuse and neglect. Healthy Families America has nearly 600 affiliated program sites in 40 States, the District of Columbia, all five US territories, and Canada. Healthy Families America is approved as an “evidence-based early childhood home visiting service delivery model” by the US Department of Health and Human Services. The program model of Healthy Families is designed to help expectant and new parents get their children off to a healthy start. Families are screened according to specific criteria and participate voluntarily in the program. Trained staff provide home visits and referrals to families that choose to participate. By providing services to under-resourced, stressed, and overburdened families, the Healthy Families Arizona program fits into a continuum of services provided to Arizona families. Healthy Families Arizona Statewide System Healthy Families Arizona is a multi-site statewide system. The Office of Prevention and Family Support under the Arizona Department of Child Safety is designated as the Central Administration for all accredited Healthy Families Arizona sites. The variety of functions performed by Central Administration is designed to support the multi-site system and include quality assurance, evaluation, training and technical assistance, system-wide policy development, and administration. Each of these functions covers a set of activities and tasks that guide operations at the Central Administration level as well as at program level. The funding structure for the Healthy Families Arizona Program is supported by three state agencies: the Arizona Department of Child Safety (DCS), First Things First (FTF), and the Arizona Department of Health Services (DHS). The DCS Central Administration supports collaboration with the three state agencies in a fully integrated system to enhance the quality of Healthy Families Services. Healthy Families Arizona Annual Evaluation Report 2014 8 In State Fiscal Year 2014, funding for the statewide system included $6,598,343 from DCS, $6,076,237 from FTF, and $3,676,072 from DHS. This represents a $2.17 million increase in funding from the previous year. The combined funding of $16,350,651 from DCS, FTF, and DHS allows the Healthy Families Arizona sites and teams to provide services to families living in 13 counties and 233 zip code areas around Arizona. For the 2014 state fiscal year, there were 12 sites and 39 home visitor teams (11 DCS funded, 9 FTF funded, 7 MIECHV funded, and 12 receiving funding from more than one source). See Exhibit 1 for a list of teams funded in fiscal year 2014. Exhibit 1. Healthy Families Arizona Program Sites in State Fiscal Year 2014 Site Number of Teams Cochise/Santa Cruz County 2 Coconino County 2 Graham/Greenlee County 1 Lake Havasu (Mohave and La Paz Counties) 1 Maricopa County 17 Mohave County 2 Navajo County 1 Pima County 6 Pinal County 3 Verde Valley (in Yavapai County) 1 Yavapai County 1 Yuma County 2 Healthy Families Arizona Annual Evaluation Report 2014 9 In this Report The purpose of this report is to provide information on families’ outcomes, program performance measures, process and implementation information, and evaluation information that can be used to guide program improvement. This report covers the state fiscal year 2014 from July 1, 2013 to June 30, 2014. Additionally, this report also reviews recently published literature related to Healthy Families and home visitation program. The evaluation of Healthy Families Arizona includes both process and outcome evaluation. The process evaluation includes an update of statewide implementation, describes the characteristics of families participating in the program, and provides general satisfaction of families participating in the program. The outcome evaluation examines program outcomes and looks at the program’s impact across a number of measures, with comparisons to previous years when appropriate and available. Detailed appendices provide specific site data on process and outcome variables. The description of evaluation methodology outlines the methods used for each part of the report. The 2014 Annual Evaluation Report has been designed to provide vital information and reporting of yearly data for basic accountability and credentialing. The data analyzed are limited to only those families within 24 months of the birth of the infant. Currently, the Healthy Families Arizona evaluation also includes the creation and distribution of quarterly cumulative performance reports for ongoing program monitoring. These reports are used during quality assurance and technical assistance site visits to review and assess progress on key program activities, including administration rates for developmental screenings and parenting skills inventories, attainment of immunization data, and substance abuse screening. Evaluation Methodology The Healthy Families Arizona evaluation includes both a process evaluation component and an outcome evaluation component. The primary questions for the process evaluation include: Who participates in the program and what are the services provided? The primary question for the outcome evaluation is: What are the short and long term outcomes for families in the program? Healthy Families Arizona Annual Evaluation Report 2014 10 In order to answer the process evaluation question, participants of the Healthy Families Arizona program are described and the services they receive are documented. In the process evaluation, the program “inputs” such as numbers served, participant characteristics, and services received are described. Also, information relative to Critical Elements and expected standards from Healthy Families America is provided as a benchmark for assessing some aspects of the implementation. The primary data for the process evaluation comes from the management information system developed to process data for Healthy Families Arizona. Sites are required to submit data that captures enrollment statistics, number of home visits, administration of assessment and outcome forms, descriptions of program participants, types of services provided, and other relevant information. The overall aim for the outcome study is to examine program effects and outputs, at both the parent and child level on a number of different outcomes. During the course of the evaluation, the evaluation team has worked together with program staff to develop and select key program measures that are used to provide feedback and to measure the program’s ability to achieve specific outcomes. The primary activities of the outcome evaluation are to: examine the extent to which the program is achieving its overarching goals, examine the program’s effect on short term goals, and examine the extent to which participant characteristics, program characteristics, or community characteristics moderate the attainment of the program’s outcomes. For most of the outcome measures, Healthy Families home visitors collect baseline (pretest) data and follow-up data at different time points of program participation: 6 months, 12 months, 18 months, and 24 months. The outcome evaluation also includes examination of substantiated cases of child abuse and neglect obtained through the Department of Economic Security’s CHILDS database. The process and outcome components of the evaluation were developed and guided by the logic models for both the prenatal and postnatal programs. Logic models for the prenatal and postnatal components of Healthy Families Arizona are presented in the Appendices. Healthy Families Arizona Annual Evaluation Report 2014 11 Review of Current Literature Home visitation research remains on the forefront as policy makers look to evidence for programs they FAMILY BENEFITS AT A GLANCE believe are worthy of investment. Furthermore, the outcomes associated with home visitation are wide ranging and significant. Home visitation programs expect outcomes across many domains: child maltreatment rates, positive and nurturing parenting behaviors, prenatal and child health, child development and school readiness, and educational and employment success. Estimates of the annual costs of home visitation programs range from 250 million to 1 billion dollars (Stolzfus & Lynch, 2009), and additional federal funds will add another 1.5 billion over the next several years. The infusion of significant dollars from the Maternal, Infant, and Early Childhood Home Visiting program (MIECHV), the Children’s Bureau, and various states accentuates the need for new research and lessons that can influence future implementation and build more effective practice models. In spite of new findings reviewers continue to characterize home visitation programs as having uncertain impact. “Despite their growing popularity, there is considerable uncertainty regarding the efficacy of home visitation programs to produce meaningful and lasting outcomes for the children and families they serve (Azzi-Lessing, 2013, p. 377).” Therefore, it is critical that ongoing documentation of outcomes -- beyond child maltreatment -- be presented and published. In a comprehensive review Kahn & Moore (2010) report only six home visitation programs had any impact on child maltreatment; one of the six was the Healthy Families New York program. In particular, Healthy Families New York had some positive outcomes on Studies of various Healthy Families programs (including New York, Massachusetts, Arizona, and in American Indian communities) show that participants benefit in many ways, including:  Reduced abusive and neglectful parenting practices  Reduced risk of low birth weight  Improvements on measures of harsh discipline  Increased parent knowledge  Increased maternal involvement  Decreased parenting stress  Increased use of safety practices  Improved parenting attitudes  Parents reading more often with their children  Increased access to resources  Reduced alcohol use  Increased schooling and training for parents cases of physical abuse, but did not have positive Healthy Families Arizona Annual Evaluation Report 2014 12 outcomes on cases of neglect. The Healthy Families Massachusetts study examined child maltreatment rates and found no significant differences between treatment and control groups on state-reported child maltreatment and self-reported child maltreatment. A recent study of the Nurse Family Partnership program found that program participants had higher rates of injury visits at the 2-year period than children in a matched comparison group. Researchers (See Howard & Brooks-Gunn, 2009; Olds et al., 2009; Mitchell-Herzfeld, Izzo, Green, Lee, & Lowenfels, 2005) continue to suggest that using child abuse rates as an outcome is an unrealistic standard of effectiveness because of problems due to surveillance bias. There are five recent experimental studies that have examined the effectiveness of the Healthy Families program model using a variety of outcome measures. A series of studies in New York (DuMont et al., 2008) found positive results showing reductions in several types of abusive and neglectful parenting practices and positive results in reducing the risk of a low birth weight baby (Lee, et al., 2009). A further analysis (DuMont et al., 2010) found more positive outcomes on measures of harsh discipline for first-time, prenatally enrolled mothers when compared with the control participants. One study (Barlow, et al., 2006), less recent but often not cited, is of a Healthy Families program that examined program outcomes with an American Indian population. This is one of the few studies looking at program impacts within a minority population. This small randomized trial was conducted with one Apache and three Navajo communities where paraprofessionals delivered the program prenatally. Program participants showed positive impacts on measures of parent knowledge and maternal involvement. The Massachusetts study (Easterbrooks et al., 2012) found that mothers enrolled in the Healthy Families program reported less parenting stress than control mothers. There were no program differences between the two groups on measures of selfreported child maltreatment, and in one analysis there was a significant difference of reported cases of child maltreatment in the Healthy Families group. Healthy Families Arizona Annual Evaluation Report 2014 13 The Arizona study (LeCroy & Krysik, 2011) found positive results on reductions of harsh discipline similar to the New York study. Using multiple outcome measures the Arizona study also found positive results, in comparison to the control condition, on use of safety practices, parenting attitudes (e.g., CRITICAL PROGRAM ELEMENTS AT A GLANCE inappropriate expectations), reading to children, use of resources, reduced alcohol use, and greater school and training. Families see more benefits with increased frequency and intensity of services. The most recent published study (Green et al., in press) reported results from a randomized trial and found positive outcomes showing Healthy Families mothers read more frequently to their children, provided more developmentally supported activities, and had less parenting stress than the control group. The areas of focus that continue to direct research attention in home visitation include: quality of service delivery and implementation, timing of service initiation--prenatal or post natal enrollment or services limited to first time moms or multiparous mothers, and families with high risk factors such as depression, violence, substance abuse. Research continues to stress the importance of program implementation and fidelity. Research studies have found that families that receive more home visits and the highest dosage are more effective (Howard & Brooks-Gunn, 2009). More recently, studies (See Kahn& Moore, 2010) found that program intensity, that is, the number of home visits within a time period, had the greatest impact. In particular, programs that achieved more than four home visits per month over a Families receiving more than 4 visits each month benefitted more than those families receiving fewer visits. Two visits per month is a critical threshold for showing impact in families receiving services. The quality of implementation and program fidelity, along with caseload size, continue to be challenges for home visiting programs. Future research should focus on implementation, fidelity, and examining outcomes for various special populations. one year period had more positive outcomes than did programs with fewer visits (Kahn & Moore, 2010). Nievar (2010) found that two visits per month was a critical threshold for showing impact. Green et al. (in press, p. 6) summarize the issue: “the quality of program implementation, and in particular the dosage, frequency, and content of home visits is a near-universal challenge for home visiting programs and associated research.” Healthy Families Arizona Annual Evaluation Report 2014 14 The recent report by Boller, et al., 2014, Making Replication Work, examined program implementation across the sites funded by the Evidence Based Home Visiting to prevent child maltreatment (EBHV) initiative. The study found that all home visitation programs struggled to maintain caseloads and deliver service at the intended intensity, fidelity of implementation was partly a function of “model factors”, and that high risk families were more likely to leave the program early. Research continues to examine whether first-time mothers benefit more from program effects than multiparous mothers. Based on the early findings of Olds’ work, some have suggested that program effects are likely to be stronger when services are restricted to first-time mothers. The New York study examined impacts with first time prenatal mothers and found more positive outcomes. Huntington & Galano (2013) compared outcomes between first time mothers and multiparous mothers and found no difference in program impacts. Green et al. (in press) compared outcomes for prenatal and postnatal enrolled families and found no significant differences in outcomes. Overall levels of risk and, in particular, maternal depression have been studied a great deal in recent home visitation research. Depression has been strongly linked to poor parenting and associated with child maltreatment (See, e.g., Duggan et al., 2007; Ammerman, et al, 2010; Conron et al., 2009). The research question most often examined is, what impact does maternal depression have on program outcomes? Ammerman et al. (2010) have focused research on depressed mothers and in their initial study they found that depressed mothers were less likely to benefit from home visitation services. Other researchers have also found non-depressed mothers obtained better outcomes (Easterbrooks, et al., 2013; Michhell-Herzfeld, et al., 2005; Green et al., in press). Stevens, et al. (2002) report that maternal depression was present for 30% of the Healthy Families participants and disrupts service delivery. Also, Duggan et al. report that program outcomes for depressed mothers can be negatively impacted by attachment style. Research studies are also investigating whether level of risk (defined in various ways) is related to different program outcomes. At present, studies report inconsistent results of the relationship between level of risk and program outcomes (Olds, 2002; Green, in press, Peterson et al., 2013). In sum, further research is needed that can explore how outcomes might vary across different parents, family constellations, and environments (Azzi-Lessing, 2011; Ammerman et al., 2010). Although families are treated similarly within home Healthy Families Arizona Annual Evaluation Report 2014 15 visitation programs, they can be dramatically different—teen moms, single moms with 3 or more children, low income intact families, refugee families, families within racial minority communities—and it is likely that the outcomes for all of these different service participants will vary depending on the outcomes being used. For example, increasing reading time for a single mom with one child is vastly different from increasing reading time for a mom with three or more children. Further complicating the picture is that home visitation occurs in a socio-environmental context; local and community factors are likely to be key in refining program adaptations and improving effectiveness. Program Updates Training and Professional Development Throughout the state fiscal year 2014, Healthy Families Arizona staff participated in a variety of professional development opportunities.  On September 24-25, 2013, DCS Central Administration staff and several program Supervisors, Family Assessment Workers, and Family Support Specialists participate in the Second Arizona Home Visitors Conference in Phoenix, Arizona. The conference was sponsored by the U.S. Department of Health and Human Services through the MIECHV grant. The conference provided attendees with a variety of home visiting related topics in the areas of prevention and intervention.  On November 6-7, 2013, DCS Central Administration staff and three Program Managers from different regions of the state attended the First Healthy Families America National Leadership Conference in Jacksonville, FL. The conference offered various workshops on leadership related topics; it was intended to support Healthy Families America state leaders with information regarding Healthy Families America model implementation and help build connections throughout the Network.  On January 29-30, 2014, DCS Central Administration staff and three Family Assessment Workers participated on the Fourth National Summit on Quality in Home Visiting Programs in Washington, DC. The focus of the conference was in innovations, policies, and research related to home visiting.  On April 29- May 1, 2014, DCS Central Administration staff and three Program Supervisors attended the Nineteenth National Conference on Prevent Child Abuse and Neglect held in New Orleans, Louisiana. The Healthy Families Arizona Annual Evaluation Report 2014 16 conference gathered professionals from across the nation to strengthen the connections that help energize and build new knowledge, skills and abilities.  On May 18-21, 2014, DSC Central Administration staff and five Family Support Specialists attended the Healthy Families National Conference presented by Prevent Child Abuse America. The conference provided lectures from world-renowned experts such as Dr. Bruce D. Perry, Robin Karr-Morse, and like-minded professionals. Program Affiliation in Yavapai County – Verde Valley On July 8, 2014, The DCS Central Administration Office of the Healthy Families Arizona Program granted official affiliation to Healthy Families Yavapai NE to the State system. As an affiliated program, the Yavapai NE site became an active participant in all aspects of the Healthy Families Arizona multi-site system to satisfy all of the requirements of Healthy Families America accreditation process. MIECHV Grant The program continued expanding services in state fiscal year 2014 thanks to the MIECHV grant. Expansion of services occurred to communities within the designated MIECHV Community Health Analysis Areas (CHAA). Training on data collection, data forms, and technical assistance were provided to sites and staff to support integration and building of new caseloads. Healthy Families Arizona was recommended by Healthy Families America to be considered for participation in the Maternal and Infant Home Visiting Program Evaluation - MIHOPE-Strong Start study. The MIHOPE is a multi-state study of home visiting programs that will inform the federal government about the effectiveness of home visiting programs to improve birth outcomes and maternal and infant health. The study is sponsored by the Centers for Medicaid and Medicare Services in partnership with the Office of Planning Research and Evaluation and Human Resources and Services Administration. With 12 participating states, the MIHOPE-Strong Start will:  Focus on building evidence about the effects of home visiting on preventing adverse birth outcomes and improving maternal and infant health Healthy Families Arizona Annual Evaluation Report 2014 17    Bring national recognition to states and their home visiting programs to support future funding and policy decisions, such as Medicaid reimbursement practices Provide financial support and technical assistance to participating home visiting programs on outreach and study participation Enroll 15,000 expectant women enrolled on Medicaid and give them small payments for completing one 20 minute survey and a welcome baby card. During state fiscal year 2014, DCS Central Administration collaborated with the MIHOPE study team to discuss the research design, reach agreement on roles and responsibilities, project timeline, and facilitate communication with identified potential Healthy Families Arizona sites for participation. Quality Assurance and Training Assistance During the third quarter of state fiscal year 2014, the Quality Assurance and Training Assistance (QA/TA) team experienced staff changes. Three QA/TA Statewide Coordinators left their positions to either retire and/or move to other divisions within the Arizona State System. Provisions and general adjustments were made to support continuation of quality assurance annual site visits, technical assistance, and oversee of various program administrative components. The DCS, Central Administration Manager continues efforts to bring the QA/TA team to full staff capacity. The DCS Central Administration in collaboration with the Policy and Procedures (P&P) Taskforce led major revision of the P&P to ensure the manual's content and presentation is consistent with the various guiding tools that shape the HFAz program including DCS Scope of Work, Arizona State Legislature, and the new Healthy Families America Best Practice Standards. The DCS Central Administration and the P&P Taskforce will review any needed P&P changes on an annual basis. On January, 2014 the final updated version of the HFAz Policies and Procedures Manual was released to the HFAz network. Programs are expected to fully transition to new policies and practices effective July 1, 2014. Collaboration between First Things First and Arizona Department of Health Services DCS Central Administration continues to be the hub for the coordination and collaboration efforts with First Things First (FTF) and the Arizona Department of Health Services (ADHS). DCS Central Administration focuses on maintaining healthy working relationships with FTF and ADHS to support model fidelity and Healthy Families Arizona Annual Evaluation Report 2014 18 consistency across the program's statewide evaluation, training, quality assurance, technical assistance, program development, administration, and other program related activity. Healthy Families Arizona Participant Characteristics Data were submitted for a total of 4,761 families for evaluation purposes during the current study year from July 1, 2013 through June 30, 2014. A total of 2,053 were funded through the Department of Child Safety; 1,536 through First Things First; and 1,172 through MIECHV. The evaluation of the statewide Healthy Families Arizona system includes only families with children that are 24 months old or younger (n=4,096). The remaining 665 families’ children were between 24 and 60 months, so were not included in the evaluation. In order to have a meaningful evaluation of the program effects only the families that receive at least a minimal amount of program exposure are included. This further restricts the dataset to include only those families with full data showing that they have received at least four home visits. A total of 3,197 families are included in this report. Thus, the data for this report focuses on families who were within the first 24 months after the birth of the infant and “actively engaged” (received four or more home visits) in the Healthy Families program regardless of when they entered the program. Just under a quarter (23.9%) of the families enter the program in the prenatal period (prenatal participants) and about three quarters (76.1%) of the families enter the program after the birth of the child (postnatal participants). For the July 2013 to June 2014 evaluation cohort, there were 764 prenatal and 2,433 postnatal families. Exhibit 2 presents the total numbers of prenatal and postnatal families actively engaged from July 2013 to June 2014. Image courtesy of www.jachip.org Healthy Families Arizona Annual Evaluation Report 2014 19 Exhibit 2. Participants Included in the Evaluation for State Fiscal Year 2014 County Site Prenatal Postnatal Cochise Team # 12 Douglas/ Sierra Vista 10 49 Coconino Team # 18 Flagstaff 44 35 Team # 13 Tuba City 19 45 Graham/ Team # 28 Safford 35 69 Greenlee Maricopa Team # 2 Central Phoenix 18 78 Team # 3 Maryvale 13 89 Team # 5 East Valley 27 55 Team # 19 Sunnyslope 22 70 Team # 23 Mesa 23 99 Team # 48 West Phoenix 17 68 Team # 61 Central Phoenix 29 65 Team # 62 Central Phoenix 25 82 Team #64 SE/NE Maricopa 33 86 Team # 65 Combination Phoenix 22 83 Team # 68 Southeast Maricopa 27 56 Team # 71 South Scottsdale 1 4 Team # 80 MIECHV Phoenix 21 70 Team # 83 MIECHV Maryvale 23 82 Team # 84 MIECHV N Mountain 33 77 Team # 88 MIECHV S Mountain 5 66 Team # 89 MIEVHV Mesa 10 59 Mohave Team # 43 Bullhead City 25 40 Team # 33 Kingman 54 32 Team # 17 Lake Havasu City 21 76 Navajo Team # 32 Winslow 20 45 Pima Team # 8 Pima 15 68 Team # 9 Pima 17 83 Team # 10 Pima 16 50 Team # 11 Pima 10 48 Team # 27 Pima 16 53 Team # 81 MIECHV Pima 16 62 Pinal Team # 82 Casa Grande/Coolidge 9 73 Team # 85 Pinal – FTF San Tan/Florence 9 41 Team # 86 MIECHV Apache Junction 8 46 Santa Cruz Team # 6 Nogales 30 83 Yavapai Team # 21 Prescott 8 81 Team # 87 Verde Valley 15 18 Yuma Team # 15 Yuma 14 77 Team # 70 Yuma 4 70 Total 764 2433 Healthy Families Arizona Annual Evaluation Report 2014 Total 59 79 64 104 96 102 82 92 122 85 94 107 119 105 83 5 91 105 110 71 69 65 86 97 65 83 100 66 58 69 78 82 50 54 115 89 33 91 74 3197 20 Length of Time in Program and Reasons for Termination In State Fiscal Year 2014, a total of 1,097 families closed. Approximately the same percentage of families closed this year (34.3%) compared to last year (34.2% in fiscal year 2013). The length of time in the program for closed families was lower than last year. For all families (N=1,097) who closed in State Fiscal Year 2014:  The median number of days in the program was 246 days (as compared to 263 in 2013, 290 in 2012, and 257 in 2011);  The average length of time in the program was 320 days (as compared to 346 in 2013, 352 in 2012, and 317 in 2011); and  Thirty-three percent of families were in the program one year or longer (as compared to 37% in 2013, 38% in 2012, and 30% in 2011). Exhibit 3 shows the distribution of length of time that families stayed in the program for all families who closed in 2014. The majority of families (35%) who closed in 2014 were in the program between 6 and 12 months. Exhibit 3. Families’ Length of Time in the Program for State Fiscal Year 2014 35% 23% 16% 10% 10% 7% Less than 3 months 3 to less than 6 months 6 to less than 12 months 12 to less than 18 months Healthy Families Arizona Annual Evaluation Report 2014 18 to less than 24 months 24 months or more 21 Exhibit 4 shows the most frequent reasons families left the program during this year (5% or more). The most common reason a family’s case was closed was due to the family refusing further services. A breakout by site is presented in Appendix A. Exhibit 4. Most Frequent Reasons for Termination State Fiscal Year 2014 Reason Family refused further services Did not respond to outreach efforts Moved away Self-sufficiency Unable to contact No longer has custody Refused worker change Prenatal Postnatal Overall 26.5% 16.4% 20.7% 8.7% 8.7% 8.4% 3.6% 27.5% 18.4% 15.9% 13.7% 7.8% 6.4% 6.8% 27.3% 17.9% 17.1% 12.5% 8.0% 6.9% 6.0% Maternal Risk Factors Upon enrollment into Healthy Families Arizona, both prenatal and postnatal mothers have certain risk factors that are higher than the average rates for all mothers in the State of Arizona. The percentage of Healthy Families Arizona mothers who are teenagers is considerably higher than last year. In 2014, 20.9% of prenatal mothers and 16.4% of postnatal mothers enrolled are teens compared to 16.5% and 11.7% respectively in 2013. Two-thirds (66.7%) of all mothers are single parents at enrollment. Mothers enrolled in Healthy Families Arizona are twice as likely to have less than a high school education (38.9%) compared to all mothers in the State (19.7%). More than three quarters (77.8%) of Healthy Families Arizona mothers are unemployed and 83.6% are receiving AHCCCS at enrollment. The HEALTHY FAMILIES ARIZONA MOTHERS AT A GLANCE     median income is below the poverty level indicating that many participants are living in  poverty. In relation to the state and national rates, these data confirm that Healthy Families  In 2014 a higher percentage of mothers were teen mothers than in 2013 Two-thirds of all mothers were single parents at enrollment Twice as many Healthy Families Arizona mothers have less than a high school education compared to all mothers in the state More than ¾ of enrolled mothers are unemployed About four out of five mothers received AHCCCS Participant median income is well below poverty level Arizona participants do represent an “at-risk” group of mothers and that the program has been Healthy Families Arizona Annual Evaluation Report 2014 22 successful in recruiting families with multiple risk factors associated with child abuse and neglect and poor child health and developmental outcomes. Exhibit 5 presents selected risk factors for both prenatal and postnatal mothers at intake compared with state rates. Exhibit 5. Selected Risk Factors for Mothers at Intake State Fiscal Year 2014 Prenatal Postnatal Arizona state Risk Factors of Mothers Families Families Rates Teen Births (19 years or less) 20.9% 16.4% 8.5%* Births to Single Parents 67.8% 66.3% 45.1%* Less Than High School Education 39.6% 38.6% 19.7%** Not Employed 74.7% 78.7% 45.8%*** No Health Insurance 4.7% 6.9% 3.6%* Receives AHCCCS 87.2% 82.5% 53.8%* Late or No Prenatal Care 27.5% 35.6% 18.7%* Median Yearly Income $10,000 $11,640 $48,510 *** Percent does not include “unknown.” *Source: 2013 data from the Arizona Department of Health Services Vital Statistics records. **Source: 2012 data from the Arizona Department of Health Services Vital Statistics records. ***U.S. Census Bureau, American Community Survey, 2013 Note: Percentages for the combined total for prenatal and postnatal families can be found in Appendix A. Infant Characteristics In addition to mother risk factors, information about infant risk factors is collected at intake for postnatal families and at birth for prenatal families. This information gives an indication of the level of need of the families served by the program. The overall risk factors for infants in 2014 are similar to prior years. The percentage of postnatal Healthy Families Arizona program infants born early (less than 37 weeks gestation) remains higher than the overall state rate, suggesting that the families being identified for service have a significant level of need. The percentage of low birth weight infants in the program also remains high in Image courtesy of www.liebenfels.com comparison to the state rate. Healthy Families Arizona Annual Evaluation Report 2014 23 Exhibit 6 below shows the prenatal, postnatal, and Arizona state rates for a set of infant characteristics that are considered in the field to be risk factors for child maltreatment. Exhibit 6. Risk Factors for Infants - State Fiscal Year 2014 Prenatal* 10.2% 15.6% 12.1%*** Born <37 Weeks Gestation Postnatal** Arizona State Rate 1.7% 0.9% 1.1%*** Birth Defects 8.2% Low Birth Weight 13.2% 6.9%*** 1.4% Positive Alcohol/Drug Screen 0.5%*** 0% 5% 9.4% 10% 15% 20% *The Family Support Specialist collects this information either from the family or from a CPS referral form for prenatal families. **Family Assessment Workers collect this information from hospital records for postnatal families. ***2012 and 2013 data from the Arizona Department of Health Services Vital Statistics records. Race and Ethnicity The Healthy Families Arizona program serves a culturally diverse population. In the following exhibits, ethnicity and race are examined for all mothers and fathers based on information gathered at enrollment. Similar to 2013, more than half of mothers (53.1%) and fathers (43.1%) enrolled in the program are Hispanic (see Exhibit 7). Exhibits 8 and 9 display mothers’ and fathers’ race. Site level data for race and ethnicity are available in Appendix A. Healthy Families Arizona Annual Evaluation Report 2014 24 Exhibit 7. Parent’s Ethnicity State Fiscal Year 2014 100% 80% 60% 40% 20% NonHispanic, 46.9% NonHispanic, 56.9% Hispanic, 53.1% Hispanic, 43.1% 0% Mothers Fathers Exhibit 8. Mother’s Race* State Fiscal Year 2014 African American 5.9% Native American 7.8% Other/Mixed 9.1% Asian American 1.1% White/Caucasian 76.1% *This includes all mothers who entered the program either prenatally or postnatally. Exhibit 9. Father’s Race* State Fiscal Year 2014 African American 7.0% Native American 6.4% Other/Mixed 9.6% Asian American 0.8% White/Caucasian 76.2% *This includes all fathers who entered the program either prenatally or postnatally. Healthy Families Arizona Annual Evaluation Report 2014 25 Assessment of Risk Factors Both mothers and fathers are assessed at intake using an interview with the Parent Survey1. The Parent Survey helps the program learn about the family’s circumstances and life events that place them at risk for child maltreatment and other adverse outcomes. During the intake process, the Family Assessment Worker evaluates each family across the 10 domains of the Parent Survey. The survey is administered in an interview format and the items are then rated by the worker according to level of severity. The percentage of parents scoring severe on each of the scales is presented for prenatal mothers and fathers and for postnatal mothers and fathers in Exhibits 10 and 11. Exhibit 10. Percentage of Parents Rated Severe on Parent Survey Items PRENATAL Mother Father Parental Attachment Difficult Child Discipline Attitudes Expectations of Infant Violence Potential Current Life Stresses Social Support, Isolation CPS Involvement Crime, Substance Abuse, Mental Illness Parent Childhood Abuse 0 10 20 30 40 50 60 70 80 90 100 Previously known as The Family Stress Checklist, it was renamed the Parent Survey based on revisions to focus on a more strength based perspective; however, the rating scale remains unchanged. More information on this instrument is provided in Appendix C. 1 Healthy Families Arizona Annual Evaluation Report 2014 26 Exhibit 11. Percentage of Parents Rated Severe on Parent Survey Items POSTNATAL Mother Father Parental Attachment Difficult Child Discipline Attitudes Expectations of Infant Violence Potential Current Life Stresses Social Support, Isolation CPS Involvement Crime, Substance Abuse, Mental Illness Parent Childhood Abuse 0 10 20 30 40 50 60 70 80 90 100 The four factors rated most severe by both mothers and fathers remain consistent with previous years’ data. These include: history of childhood abuse (for the parent); current life stressors; social support and isolation; and a history of crime, substance abuse, or mental illness. A higher percentage of prenatal mothers had severe scores on history of childhood abuse (79.2%) and current life stresses (73.7%) than postnatal mothers at 70.4% and 67.4% respectively. Summary The process evaluation for fiscal year 2014 suggests that the Healthy Families Arizona program continues to effectively reach parents and infants with high risks for child maltreatment and other unhealthy outcomes. The population that Healthy Families Arizona is serving has greater risks than the state or national population as a whole. Overall, the Healthy Families Arizona program is reaching families that are impoverished, stressed, socially disadvantaged, and lacking in resources to manage the demands of parenting. Families that enter during the prenatal period have slightly higher risks than families that enter after birth. However, the risk factors of low birth weight babies, preterm birth, and substance exposed newborns are lower for those families participating in Healthy Families Arizona prenatally than for those that enter in the postnatal period. This suggests that these high risk families benefit from the early support that is offered in the home visitation program. Healthy Families Arizona Annual Evaluation Report 2014 27 Key Healthy Families Arizona Services The primary goals of reducing child abuse and neglect and improving child wellbeing are only attainable when families stay engaged in the program and receive the services and supports they need. One important aspect of the Healthy Families program model is linking families with needed community resources. Home visitors provide not only assistance and guidance in the home, but they also connect families with education, employment, and training resources, counseling and support services, public assistance, and health care services. Developmental Screens and Referrals for Children Developmental screens are used to measure a child’s developmental progress and to identify potential developmental delays requiring specialist intervention. The primary screening tool used by home visitors is the Ages and Stages Questionnaire, Third Edition (ASQ-3). This tool helps parents assess the Image courtesy of www.livestrong.com developmental status of their child across five areas: communication, gross motor, fine motor, problem solving, and personalsocial. The Healthy Families Arizona program administers the ASQ-3 at 4, 6, 9, and 12 months in the first year of the infant’s life, every six months until the child is three years of age, and then yearly at age 4 and 5. The statewide program performance goal for screening in year two is to screen at least 90% of the children in the program. As Exhibit 12 shows, the number of children receiving the ASQ-3 at each interval is exceeding 90% in the time periods up to 18 months, and the 24-month ASQ-3 rate fell this year to 84.9% (from 89.1% in 2013), just short of the statewide performance goal. More children ages 9 months through 24 months continue to be identified as delayed through the screenings. This may be due to improved screening, or other factors that should be further examined by program staff. Healthy Families Arizona Annual Evaluation Report 2014 28 Exhibit 12. ASQ-3 Screening State Fiscal Year 2014 Interval Percent of children ASQ-3 Screening Screened with ASQ-3 4-month 96.1% 6-month 93.1% 9-month 96.8% 12-month 91.4% 18-month 91.5% 24-month 84.9% Percent screened as delayed 2.8% 2.8% 4.8% 5.1% 6.1% 8.3% Healthy Families Arizona works to ensure that children who may have developmental delays obtain needed interventions. Program data tracks what happens after a family’s ASQ-3 is scored as follows: 1) the child is screened as having no delays, 2) the child is referred for further assessment and is determined to have no delays upon a more extensive assessment, 3) families are referred to different services such as the Arizona Early Intervention Program (AzEIP) or other early intervention or therapy, or 4) the home visitor may provide developmental intervention or education to the family. Although approximately 3% to 8% of children (depending on their age) are initially screened as delayed in their development, up to 7.1% of the children who initially screen as delayed on the ASQ-3 in the early months of their life are determined to not have delays upon further assessment (see Exhibit 13 below). For example, of the children at 4 months who screened as delayed on the ASQ-3 and were referred for more assessment, 3 children showed no delay, 21 were referred to the AzEIP, 3 were referred to some other early intervention program, 51 received developmental interventions, 5 were referred to specialized therapy, and 12 families declined further referral. The ASQ-3 screening provides a valuable service to families because it enables them to access appropriate services to meet their child’s particular needs. This practice is consistent with the American Academy of Pediatrics strategic plan to promote developmental screening and establish a medical home when needed (Tait, 2009). There is a national effort to increase early developmental screening after studies found that up to 70% of developmental problems were not identified until school entry (e.g., see Glascoe & Dworkin, 1993). The following exhibit shows the outcome of these follow-up assessments that are completed with families at the different time intervals. Healthy Families Arizona Annual Evaluation Report 2014 29 Exhibit 13. ASQ-3 Follow-up Services State Fiscal Year 2014 Screening Interval 4-month 6-month 9-month 12-month 18-month 24-month Continued Assessment shows “no delay” % (n) 4.8% (3) 1.8% (1) 1.6% (1) 6.6% (4) 4.8% (2) 7.1% (2) Referred to AzEIP % (n) Referred to other Early Intervention % (n) Provided Developmental Intervention % (n) Referred to Therapy % (n) Parent Declined Referral % (n) 33.9% (21) 32.7% (18) 46.0% (29) 41.0% (25) 40.5% (17) 50.0% (14) 4.8% (3) 10.9% (6) 9.5% (6) 9.8% (6) 14.8% (9) 0 82.3% (51) 74.5% (41) 81.0% (51) 70.5% (43) 4.8% (2) 64.3% (18) 8.1% (5) 7.3% (4) 4.8% (3) 9.8% (6) 7.1% (3) 3.6% (1) 19.4% (12) 14.5% (8) 19.0% (12) 14.8% (9) 14.3% (6) 7.1% (2) Note: Percentages do not equal 100% as multiple referrals can happen for a single child. Outcomes for Families The Healthy Families Arizona program focuses the outcomes evaluation on the following primary indicators:  Parent outcomes  Child development and wellness  Mother’s health, education, and employment  Child abuse and neglect Parent outcomes One of the primary intermediate goals of the Healthy Families Arizona program is to have a positive influence on parenting attitudes and behaviors. While reducing child abuse and neglect is the ultimate outcome, intermediate objectives, such as changes in parenting behaviors, can inform us about progress toward the ultimate goal. The intermediate goals of the Healthy Families program revolve around a few key factors known to be critical in protecting children from maltreatment (Jacobs, 2005):  providing support for the family;  having a positive influence on parent-child interactions;  improving parenting skills and abilities and sense of confidence; and  promoting the parents’ healthy functioning. Research from a randomized clinical trial of the Healthy Families Arizona program (LeCroy & Krysik, 2011) supports the finding that the program can produce positive change favoring the experimental group in contrast to the control group across multiple outcome domains such as parenting support, parenting attitudes and practices, violent parenting behavior, mental health and coping, and maternal outcomes. Healthy Families Arizona Annual Evaluation Report 2014 30 Healthy Families Parenting Inventory Reveals Positive Parent Change In order to better evaluate critical goals of the Healthy Families program, the evaluation team developed the Healthy Families Parenting Inventory (HFPI) in 2004 (LeCroy, Krysik, & Milligan, 2007). This instrument was developed, in part, because of measurement difficulties identified in the literature (See LeCroy & Krysik, 2010). The development of the HFPI was guided by several perspectives and sources: the experience of the home visitors in the Healthy Families Arizona program; data gathered directly from home visitors, supervisors, and experts; information obtained from previous studies of the Healthy Families program; and examination of other similar measures. The process included focus groups with home visitors, the development of a logic model, and a review of relevant literature. In an initial validation study the pattern of inter-item and item-to-subscale correlations, as well as an exploratory factor analysis and sensitivity to change analysis, supported the ninefactor model of the HFPI. This work was published in the journal Infant Mental Health (Krysik & LeCroy, 2012). The final instrument includes 9 scales: Social Support, Problem-solving, Depression, Personal Care, Mobilizing Resources, Role Satisfaction, Parent/Child Interaction, Home Environment and Parenting Efficacy. The following section describes the results obtained for each subscale of the HFPI. The level of significance is reported along with the effect size. An effect size gives a sense of how large the change or improvement is from baseline to 6 months or 12 months. Effect sizes below 0.20 are considered small changes, and those between 0.20 and 0.50 are considered small to medium changes. These findings are based on data reported from the sites and represent participants who completed both instruments at the baseline and 6 month intervals (n=1636) and participants who also had matched instruments at the 12 month interval (n=987). Healthy Families Arizona Annual Evaluation Report 2014 31 Healthy Families Parent Inventory (HFPI) Subscales Exhibit 14. Change in Subscales of the HFPI Significant Significant improvement improvement Effect Sub- scale from Significance from Significance size baseline to baseline to 6 months 12 months Social .178 (0.03) .794 None None Support Problem.000 (0.16) .000   solving Depression .000 (0.09) .000   Personal care .000 (0.22) .000   Mobilizing .000 (0.30) .000   resources Commitment To Parent .000 (0.12) .000   Role Parent/Child .000 (0.27) .000   Behavior Home .000 (0.41) .000   Environment Parenting .000 (0.18) .000   Efficacy Effect size (-0.007) (0.21) (0.15) (0.16) (0.37) (0.12) (0.22) (0.50) (0.14) From baseline to 6 months, there were statistically significant changes in all subscales except social support, which was also not significant at 12 months. The largest improvements (as shown by the effect sizes) at 6 months after entering the program are in the categories of home environment (0.41), mobilizing resources (0.30), parent/child behavior (0.27), and personal care (0.22) scales. At 12 months the largest improvements are in home environment (0.50), mobilizing resources (0.37), problem solving (0.21), and parent/child behavior (0.22). This indicates that the Healthy Families Arizona sites are effective at connecting parents to resources, improving the atmosphere of the home, improving parents’ problem solving skills, and emphasizing the importance of good self-care. Total Change Score on the HFPI In order to provide a more comprehensive understanding of outcomes in parenting observed during participation in the Healthy Families program, it is also useful to examine the total score on the Healthy Families Parenting Inventory and overall significance of change. As Exhibit 15 below shows, there were significant changes Healthy Families Arizona Annual Evaluation Report 2014 32 from baseline to 6 months and from baseline to 12 months on the HFPI total scale. This finding supports the conclusion that program participants changed during the course of the program. Overall, approximately 65% of parents had positive changes on the total score from baseline to 6 months (64.9%) and from baseline to 12 months (65.5%). Exhibit 15. Overall Change in Healthy Families Parenting Inventory Outcomes Significant Significant Sub- improvement Effect improvement Effect Significance Significance scale from baseline size from baseline size to 6 months to 12 months Total  .000 (0.28)  .000 (0.32) Scale Child Abuse and Neglect One of the main goals of Healthy Families Arizona is to reduce the incidence of child maltreatment and abuse. In order to look at child abuse and neglect directly, data from CHILDS, the Arizona Department of Child Safety Child Protective Services data system is used to determine the rates of child abuse and neglect for Healthy Families Arizona participants. It is important to acknowledge that using official child abuse data as an indicator of program success is complex and is unlikely to fully answer the question about the effectiveness of Healthy Families Arizona in preventing child abuse. The shortcomings in using official child abuse rates to assess the effectiveness of home visiting programs have been discussed in numerous journal articles (see for example, The Future of Children, 2009). There are several reasons the use of child abuse data is believed to have limitations. First, child abuse is an event that occurs infrequently and, therefore, changes are difficult to detect with statistical methods. Second, using official incidents of child abuse and neglect does not necessarily reflect actual behavior—there are many Research continues to support using outcomes other than incidence of child abuse and neglect to measure program success. variations in what constitutes abuse and neglect and using only reported and substantiated incidents of abuse captures incidents that rise to that level of severity. Some incidents of child abuse or neglect are undetected or may not meet some definitional standard minimizing the accuracy Healthy Families Arizona Annual Evaluation Report 2014 33 of the count. Third, using official data requires a process whereby cases are “matched” on available information such as mother’s name, social security number, and date of child’s birth. When any of this information is missing, the accuracy of the match decreases. Finally, because home visitors are trained in the warning signs of abuse and neglect and are required to report abuse or neglect when it is observed, there is a “surveillance” effect—what might have gone unreported had there been no home visitor shows up in the official data. In order to best represent families that have received a significant impact from the Healthy Families Arizona program, only families that have been in the program for at least six months are analyzed to determine if they have a substantiated report of child abuse or neglect. This year, 96% of the Healthy Families Arizona eligible families (2,266 out of 2,360) were without a substantiated report, as can be seen in Exhibit 16. This is short of achieving the performance measure goal of 99.7%. A total of 94 cases were determined to be substantiated reports. A substantiated finding means that “Child Protective Services has concluded that the evidence supports that an incident of abuse or neglect occurred based upon a probable cause standard” (see DCS substantiation guidelines for further detail). The increase in substantiated cases this year may be due to the additional efforts to investigate all open cases during the latter part of the state fiscal year. Exhibit 16. Percent of Families Showing No Child Abuse and Neglect Incidences Of all families with at least 6 months in the program in 2014, 96% had no substantiated child abuse or neglect incidences. This is a decrease from 2013 (97.1%) and 2012 (97.9%).                                                   Healthy Families Arizona Annual Evaluation Report 2014                                                   34 Collaboration with the Department of Child Safety Healthy Families Arizona provides supportive services for families involved with the Department of Child Safety (DCS, formerly Child Protective Services). In state fiscal year 2014, 681 (20.8%) Healthy Families Arizona families had some level of involvement with DCS. Healthy Families Arizona supportive services included:  acceptance of referrals from DCS;  providing screening and assessment for parent(s) if the parent(s) wished to determine eligibility to receive program services;  attending DCS staffing;  utilizing best practices and a family-centered approach when working with families; and  coordinating with DCS staff to identify service needs and development of family and child goals. It is hoped that the collaboration between Healthy Families Arizona and the Department of Child Safety will assist those families that may be at highest risk for child maltreatment. Child Development and Wellness While it is challenging to find ways to accurately measure child abuse and neglect, researchers do point to the benefits and impact that home visitors and home visiting can have on promoting optimal child growth and development in the families served. Home visitors are in a strategic position to help families obtain access to health resources and promote wellness. Immunizations and safety practices in the home are two indicators of child development and wellness reported this year. Immunizations The Healthy People 2020 goal is to have at least 90% of all children immunized with 4 doses of DTaP; 3 doses of IPV; one dose of MMR; 3 or more doses of Hib; 3 or more doses of Hep B vaccine; and 1 dose of Varicella vaccine by 2 years of age. This is referred to as the 4:3:1:3:3:1 immunization standard. For calendar year 2013, the Arizona immunization rate for 24 month olds was 70.3%, and the U.S. rate was 77.7% (www.cdc.gov). Healthy Families Arizona Annual Evaluation Report 2014 35 The Healthy Families Arizona program supports children obtaining all their necessary immunizations as a key step in preventing debilitating diseases. The home visitors encourage the families to follow through on completing their child’s immunizations and ask to check the family’s immunization booklet to record the dates of immunizations and assess completion. However, recently some families do not have booklets and say it is only recorded electronically. Due to this, some families may not know the immunization status of their child and assume that they are up to date when they may not be. Some families with a regular primary care doctor may receive electronic printouts from their doctor regarding timelines for immunizations. However, due to the fact that few doctors are providing a printout of electronic records, and many families are receiving immunization at clinics this is not a reliable method of educating families on when immunizations are due. Exhibit 17 presents full immunization data at 12 months and 24 months, based on the recommended schedule of immunizations to meet Arizona state compliance of the 4:3:1:3:3:1 standard. Healthy Families Arizona families are slightly higher than the state immunization rate for 2-year olds and lower than the national immunization rate for 2-year olds. The national immunization rate increased substantially from 68.1% in 2012 to 77.7% in 2013. The immunization rates for both 1-year olds and 2year olds in Healthy Families Arizona are higher than in previous years. This may be due to increased efforts at collecting immunization data or may reflect an increase in parent’s following through with completing the immunizations on schedule. It may be beneficial for Healthy Families Arizona program staff to systematically investigate factors that lead to families not being in compliance with the recommended immunization schedule. Healthy Families Arizona Annual Evaluation Report 2014 36 Exhibit 17. Immunization Rate of Healthy Families Arizona Children 100% 80% 89.1% 77.7% 71.4% 70.3% HFAz 2 year Arizona 2 year 60% 40% 20% 0% HFAz 1 year U.S. 2 year *Source: 2013 data from the CDC National Immunization Survey. Safety Practices in the Home A study released by the Centers for Disease Control and Prevention (MMWR 2012) states that even though injury death for children have decreased from 15.5 to 11.0 per 100,000 population from 2000 to 2009, they continue to be the leading cause of death for children over the age of 1. Unintentional injuries are also the fifth leading cause of death for newborns and infants under the age of 1. A report in 2004, Home visiting and childhood injuries, concluded that home visits can reduce the risk of accidental injuries in the home by approximately 26 percent. The Healthy Families Arizona home visitors both assess and promote safe environments for children. The home visitors provide education about safety practices and monitor safety in the home through the completion of the safety checklist with the family. Exhibit 18 reports the use of four key safety practices across five time points for postnatal participants. Families that continue to participate in Healthy Families Arizona see increased safety practices and reach high rates. The National Highway Traffic Safety Administration in 2009 estimated the rate of child seat use for children under the age of 1 as 98%. The national rate for children between the ages of 1 to 3 however is estimated to be 96%. The families participating in Healthy Families Arizona maintain their high use of car seats over time (99% or Healthy Families Arizona Annual Evaluation Report 2014 37 more), indicating that the message of child safety in cars has been well received. The National Fire Protection Association reports that smoke detectors were present in only 72% of all reported home fires and operated in only 51% of home fires. Healthy Families Arizona households with working smoke alarms range from approximately 87% to 90%, improving the safety of the household environment for these families. Families also obtain relatively high rates of covered outlets and poisons locked adding to the overall safety being maintained. Exhibit 18. Percent of all Families Implementing Safety Practices 2-Month 6-Month 12-Month 18-Month Outlets 39.2% 52.9% 73.1% 75.4% Covered Poisons 85.0% 92.7% 97.0% 98.0% Locked Smoke 86.9% 89.0% 89.9% 89.5% Alarms Car Seats 99.7% 100% 99.8% 100% 24-Month 74.0% 97.7% 88.0% 100% Mothers’ Health, Education, and Employment The Healthy Families Arizona program also attempts to influence maternal life course outcomes. The home visitors encourage families to seek new educational opportunities, complete their high school education, obtain greater economic selfsufficiency, and obtain better paying and better quality jobs. Information is also provided to mothers regarding the positive health impacts of delaying subsequent pregnancies to at least 24 months. Subsequent Pregnancies and Birth Spacing Multiple births for some families can lead to increased stress and parenting difficulties, especially if the birth is unwanted or unplanned. Mothers with greater birth spacing have fewer pregnancy complications and are less likely to give birth to low birth weight or premature babies (Kallan, 1997). The home visitors emphasize the benefits of delaying repeat pregnancies and promote longer birth spacing for the mothers in the program. Exhibit 19 shows that the percent of Healthy Families Arizona mothers who reported subsequent pregnancies has decreased in 2014 (6.0%) from the 2013 of 7.6%. Healthy Families Arizona Annual Evaluation Report 2014 38 Exhibit 19. Percentage of Mothers who Reported Subsequent Pregnancies State Fiscal Year 2014 Percent of mothers with subsequent pregnancies 2011 2012 2013 2014 4.9% 7.9% 7.6% 6.0% For mothers in the Healthy Families Arizona program who have a subsequent pregnancy, there is a small percentage of women waiting at least two years. The Healthy People 2020 goal is to reduce the proportion of pregnancies conceived within 18 months of a previous birth down to 29.8%. Exhibit 20 below shows the length of time to subsequent pregnancy for those mothers who do have subsequent births. The low percentage of mothers that wait at least 2 years between subsequent births indicates that the message of delaying subsequent pregnancies is either not being received or embraced. It would be beneficial for program staff to follow-up with families regarding the short birth spacing. Exhibit 20. Length of Time to Subsequent Pregnancy for Those Families with Subsequent Births Length of Time to Subsequent Pregnancy 1 to 12 mos. 13 to 24 mos. Over 24 mos. 2011 Percent of Mothers 65.1% 31.0% 3.9% 2012 Percent of Mothers 59.9% 37.4% 2.7% 2013 Percent of Mothers 59.4% 40.1% 0.5% 2014 Percent of Mothers 67.7% 31.1% 1.2% School, Educational Enrollment, and Employment Continued educational obtainment and increased employment are also important to consider when examining the program’s potential impact on maternal life course outcomes. Increased education is associated with better overall well-being and greater family stability. Exhibit 21 shows that education enrollment remained steady until the 24 month time point. In fiscal year 2014, 11-14% of the mothers are enrolled in school either full- or part-time, which is fairly steady as compared to 12-15% in fiscal year 2013 and lower than the 15-17% enrolled in school in fiscal year 2012. Although there are signs that the US economy is improving, the economy in Arizona has been slower to recover, maintaining higher than average unemployment rates and slower wage growth compared to US rates (US Bureau of Labor Statistics). Parents may have additional challenges in accessing or affording childcare, affording school, or having the time available away from work (or seeking employment) to attend school. Healthy Families Arizona Annual Evaluation Report 2014 39 Exhibit 21. Percent of Mothers Enrolled in School – State Fiscal Year 2014 Percent Percent Percent Percent enrolled enrolled enrolled enrolled part-time (2013 full-time (2013 part-time (2014) full-time (2014) prior report) prior report) 6 month 5.1% 9.6% 5.8% 7.4% 12 month 6.4% 8.0% 5.4% 8.5% 18 month 5.0% 7.3% 5.7% 7.6% 24 month 6.5% 6.3% 4.6% 6.6% Maternal employment shows an increasing rate over time. Thirty-nine percent of Healthy Families Arizona mothers are employed at 12 months, and approximately 45% at 24 months. According to the most recent Bureau of Labor Statistics report for 2013, 57.3% of mothers with children less than 1 year of age, and 61.1% of mothers with children less than 3 years of age participate in the labor force. While increasing employment and income is fundamental for family well-being, there are complex realities facing families as they begin to increase their earnings. The importance of home visitors working with families in obtaining quality child care is critical given the limited child care options currently available for families with low incomes. Exhibit 22. Mother’s Employment Status 100% Full-time Part-time 80% 60% 40% 20% 0% 20.6% 22.9% 25.1% 24.6% 10.9% 9.0% 13.7% 16.5% 17.5% 20.5% Baseline 6 months 12 months 18 months 24 months Healthy Families Arizona Annual Evaluation Report 2014 40 Substance Abuse Screening The relationship between substance abuse and the potential for child maltreatment is strong and well known (Pan, et al., 1994; Windom, 1992; Wolfe, 1998). When parents or caretakers are abusing substances, children may not be adequately cared for or supervised. While successful substance abuse treatment often requires intensive inpatient or outpatient treatment and counseling, home visitors can still play a critical role in screening for substance abuse, educating families about the effects of substance abuse on their health and the health of their children, and in making referrals for treatment services. Healthy Families Arizona uses the CRAFFT as a method of screening for substance use and abuse. The CRAFFT is a short screening tool for adults and adolescents to assess high risk drug and alcohol use disorders developed by the Center for Adolescent Substance Abuse Research (CeASAR), at the Children’s Hospital of Boston. A positive screen occurs if there are two or more “yes” answers out of six questions and indicates that further assessment and or referrals are recommended. Exhibit 23 presents data on the percent of families screened with the CRAFFT substance abuse screening tool and the percent of those families who screened positive for drug use. Nearly 44% of families screened at intake assessed positive for a history of substance use putting them at potential risk. The number of families with positive substance abuse screens drops dramatically at 6 months (11.6%) and continues to drop at 12 months (8.2%). Exhibit 23. Percent Screened and Assessed Positive on the CRAFFT Percent Percent Assessed Time at assessment Screened Positive 2 months (lifetime) 96.2% 43.9% 6 months 92.8% 11.6% 12 months 92.3% 8.2% Note: The 2 month screen asks lifetime substance use; later screens cover the past 6 months. Healthy Families Arizona Annual Evaluation Report 2014 41 2013 Participant Satisfaction Survey The Healthy Families Arizona participant satisfaction survey provides valuable information for program staff and an opportunity for participants to reflect on their experiences. If participants are satisfied with the program and the work of the home visitor, they are more likely to benefit from the program. The following data summarizes the responses of participants who took the Healthy Families Arizona participant satisfaction survey in spring 2014. The survey is distributed to all current participants in the program and returned by mail. A total of 1,815 surveys were returned. The ethnic breakdown of these participants was similar to past years and is representative of the populations served by Healthy Families Arizona, with 57% Hispanic, 25% White, 7% American Indian, 4% African American, 5% Two or More Races, 1% Asian, less than 1% Hawaiian/Pacific Islander, and less than 1% Other. Exhibit 24 below shows key highlights from participant satisfaction survey responses. The exhibit presents the items which received the highest percent of strongly agree responses from participants and the items receiving the lowest percent of strongly agree. Based on the results of the survey it appears that participants feel they have good communication with their home visitors. Fewer Healthy Families Arizona participants (75.1%) agree strongly that finding services was easy compared to the responses for other questions. For the remaining statements in the satisfaction survey, more than 80% of the respondents strongly agreed. This is similar to the 2013 survey results and indicates a strong satisfaction level with the program. Healthy Families Arizona Annual Evaluation Report 2014 42 Exhibit 24. Percent Who Strongly Agreed on Satisfaction Survey Statements 2014 Finding Healthy Families services was Finding Healthy Families services was easy. easy. 75.1% HealthyFamilies Familiesservices servicesare are scheduled scheduled at Healthy convenient times. convenient times. The fitsmy my TheHealthy HealthyFamilies Families program program fits family's beliefs, culture,and and values. family beliefs, cultures, values. Myfamily’s family'soverall overall experience experience with My withthe the Healthy Families program is good. Healthy Families program is good. The Healthy Families program provides The Healthy Families program provides the the support my family needs. support my family needs. 83.5% 81.2% 86.4% 83.4% I Ireceive receivehigh high quality quality services services from frommy my Healthy Families home visitor. Healthy Families home visitor. 86.0% feltcomfortable comfortable discussing discussing my I Ifelt my concerns concerns with my Healthy with Healthy Families Familieshome homevisitor. visitor. 86.3% TheHealthy HealthyFamilies Families program program staff The addresses my concerns. addresses my concerns. 84.7% MyHealthy HealthyFamilies Families home home visitor does My does aa good jobjob explaining things to me. good explaining things to me. I am satisfied with the information I I am satisfied with the information I receive. receive. As a result of the Healthy Families As a result of the Healthy Families program, I program, I feel supported in growing as a feel supported parent. in growing as a parent. recommend the Healthy Families I recommend Ithe Healthy Families program to program to others. others. My Healthy FamiliesFamilies home visitor refers me to My Healthy home visitor refers helpful community services. me to helpful community services. The Healthy Families materials and The Healthy Families materials and activities activities are respectful of my culture and are respectful of my culture and language. language. Healthy Families Arizona Annual Evaluation Report 2014 88.6% 85.3% 86.7% 85.5% 83.9% 86.2% 43 Conclusions and Recommendations The 2014 state fiscal year has been productive for Healthy Families Arizona. The combined funding from the Department of Child Safety (DCS), First Things First (FTF), and the Department of Health Services (DHS) has increased the number of families receiving services throughout the state. The Healthy Families Arizona evaluation report focuses on the following primary outcome indicators: parent outcomes, child health and wellness, and child abuse and neglect. The results from the Healthy Families Parenting Inventory, participant tracking data sheets, safety checklists, screening tools, child abuse and neglect rates, and immunization rates all suggest that the Healthy Families Arizona program continues to address and reach most of its goals. The Healthy Families Arizona program uses evidence-based methods to guide the practice of home visitation. In order to continue to see successful outcomes and to improve other outcomes, the Healthy Families Arizona program needs to rigorously evaluate the program at least annually and use evidence for program improvement. Recommendations for this year are focused on ways the program can continue to emphasize quality programming, provide the most critical services to the highest risk families, and improve parent and child outcomes.  Develop or enforce strategies to increase retention. The average length of stay in the program is less than a year with only 33% of families remaining in the program for more than a year. This has been a downward trend in recent years and remains a priority for improvement. While nothing can be done to retain families that move into areas not served by Healthy Families Arizona, other reasons for termination such as family refusal of services, declining a new home visitor, and not responding to outreach should be reviewed. The home visitors and their supervisors should use this information to develop creative retention strategies for families in their programs.  Review and update the program logic models to align with the Healthy Families America Best Practice Standards. The new Best Practice Standards from Healthy Families America went into effect in July 2014. Healthy Families Arizona has updated their Policies and Procedures Manual and the data collection forms to meet these new best practice standards. Healthy Families Arizona can use these to review and revise the program logic models to match Healthy Families Arizona Annual Evaluation Report 2014 44 the new critical elements outlined in the Best Practice Standards. Although many of the critical elements remain unchanged or similar, it would be useful to reexamine if the logic models are depicting the program as currently implemented. These logic models can be distributed and used by all program staff to maintain focus on key aspects of the intervention model. Training for program staff can support the use of the logic model to maintain sharp focus on fidelity to the model.  Reinforce the importance of developmental screening with home visitors and families. Healthy Families Arizona nearly met the target of 90% of 2-year old children screened for developmental delays using the ASQ 3. Reinforcing the importance of continued screening with home visitors and families, in addition to exploring barriers to completion of developmental screening, may increase the rate of screening even further.  Continued emphasis on alternative methods of collecting immunization data and educating families on the importance of timely and full immunization. This year, the increased emphasis by supervisors and home visitor teams on obtaining immunization data through electronic records greatly decreased the amount of missing information. The change away from immunization booklets to electronic records has impacted the ability of home visitors to verify the immunization dates for a child at the time of a home visit. Continued efforts by Central Administration and the sites to develop alternative methods of obtaining immunization data will help to improve the accuracy of immunization data even more. The home visitors may also need to place more emphasis on the importance of immunizations for families who are late in receiving immunizations, explore barriers to the child receiving timely immunizations, and may need to make additional referrals to local immunization clinics or other support services. Healthy Families Arizona Annual Evaluation Report 2014 45 References Ammerman, R. T., Putnam, F. W., Bosse, N. R., Teeters, A. R., & Van Ginkel, J. B. (2010). Maternal depression in home visitation: A systematic review. Aggression and Violent Behavior, 15, 191–200. Barlow, A., Varipatis-Baker, E., Speakman, K., Ginsburg, G., Friberg, I., Goklish, N., Cowboy, B., Pields, P., Hastings, R., Pan, W. Reid, R., Santosham, M., & Walkup, J. (2006). Home-visiting intervention to improve child care among American Indian adolescent mothers. Arch Pediatric Medicine, 160, 1101-1107. Boller, Kimberly, Deborah Daro, Patricia Del Grosso, Russell Cole, Diane Paulsell, Bonnie Hart, Brandon Coffee-Borden,Debra Strong, Heather Zaveri, and Margaret Hargreaves. “Making Replication Work: Building Infrastructure to Implement, Scale-up, and Sustain Evidence-Based Early Childhood Home Visiting Programs with Fidelity.” Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services. June 2014. Contract No.: GS-10F-0050L/ HHSP233201200516G. Conron, K. J., Beardslee, W., Koenen, K. C., Buka, S. L., & Gortmaker, S. L. (2009). A longitudinal study of maternal depression and child maltreatment in a national sample of families investigated by child protective services. Archives of Pediatric and Adolescent Medicine, 63(10), 922–930. Duggan, A., Caldera, D., Rodriguez, K., Burrell, L., & Crowne, S. S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31, 801-827. Duggan, A., McFarlane, E., Fuddy, L., Burrell, L., Higman, S. M., Windham, A. & Sia, C. (2004). Randomized trial of a statewide home visiting program: Impact in preventing child abuse and neglect. Child Abuse & Neglect, 28, 597–622. DuMont, K. Kirkland, K., Mitchell-Herzfeld, S., Ehrhard-Dietzel, S., Rodriguez, M. L., Lee, E.,…& Greene, R. (2011). A randomized trial of Healthy Families New York (HFNY): Does home visiting prevent child maltreatment? Retrieved from https://www.ncjrs.gov/pdffiles1/nij/grants/232945.pdf. Easterbrooks, M. A., Jacobs, F. H., Bartlett, J. D., Golderg, J., Contreras, M. M., Kotake, C., Raskin, M., & Chaudhuri, J. H. (no date). Initial findings from a randomized, controlled trial of Healthy Families Massachusetts: Early program impacts on young mothers’ parenting. Healthy Families Arizona Annual Evaluation Report 2014 46 Fergusson, D.M., Grant, H., Horwood, J., & Ridder, E.M. (2005). Randomized trial of the Early Start Program of Home Visitation. Pediatrics, 116(6), 803–809. Howard, K. S., & Brooks-Gunn, J. (2009). The role of home-visiting programs in preventing child abuse and neglect. Future of Children, 19(2), 119–146. Kahn, J., & Moore, K. A. (2010). What works for home visiting programs: Lessons from experimental evaluations of programs and interventions. (No. #2010– 17). Washington, DC: Child Trends. Lee, E., Mitchell-Herzfeld, S. D., Lowenfels, A. A., Greene, R., Dorabawila, V., & DuMont, K.A. (2009). Reducing low birth weight through home visitation: a randomized controlled trial. American Journal of Preventive Medicine, 36(2), 154160. Mitchell-Herzfeld, S., Izzo, C., Greene, R., Lee, E., & Lowenfels, A. (2005). Evaluation of Healthy Families New York (HFNY): First year program impacts. Renselaer, NY: New York State Office of Children & Family Services. Nievar, M. A., Van Egern, L.A., & Pollard, S. (2010). A meta-analysis of home visiting programs: Moderators of improvements in maternal behavior. Infant Mental Health Journal, 31(5), 499–520. Olds, D. L., Eckenrode, J., Henderson, C., Kitzman, H., Cole, R., Luckey, D.,…Baca, P. (2009). Preventing child abuse and neglect with home visiting by nurses. In K. A. Dodge, & D. L., Coleman (Eds.), Preventing child maltreatment: Community approaches. New York: Guilford. Peterson, C. A., Roggman, L. A., Green, B., Chazan-Cohen, R., Korfmacher, J., McKelvey, L. … Atwater, J. B. (2013). Home Visiting Processes: Relations with Family Characteristics and Outcomes. Zero to Three, 33(3), 39-44. Stevens, J., Ammerman, R.T., Putnam, F.G., & Van Ginkel, J.B. (2002). Depression and trauma history in first-time mothers receiving home visitation. Journal of Community Psychology, 30, 551–564. Stoltzfus, E., & Lynch, K. (2009). Home visitation for families with young children. Washington, DC: Congressional Research Service. Healthy Families Arizona Annual Evaluation Report 2014 47 Appendix A. Team Level Data  Age of Child at Entry by Team .................................................................................. 49  Days  Top to Program Exit by Team.................................................................................. 50 Four Reasons for Program Exit by Team ......................................................... 51  Health Insurance at Intake by Team ......................................................................... 52  Late or No Prenatal Care or Poor Compliance at Intake by Team ....................... 53  Race of Mother by Team Prenatal ............................................................................. 54  Race of Mother by Team Postnatal ........................................................................... 55  Hispanic Ethnicity of Mother by Team .................................................................... 56  Gestational  Low Age by Team ........................................................................................... 57 Birth Weight by Team ........................................................................................ 58  Yearly Income by Team .............................................................................................. 59  Mother’s Parent Survey Score by Team ................................................................... 60  Trimester  Engaged of Enrollment into Prenatal Program by Team ..................................... 61 Prenatal Families that Exited before Baby’s Birth by Team .................. 62 Healthy Families Arizona Annual Evaluation Report 2014 48 Age of Child at Entry by Team– 2014 (Age in Days) Mean Standard Number (Age in Days) Deviation Team 2 - Central Phoenix 39.40 85 22.21 Team 3 - Maryvale 41.45 94 24.80 Team 5 - East Valley 50.00 58 99.96 Team 6 - Nogales 13.81 83 15.05 Team 8 – Pima 25.74 69 20.79 Team 9 - Pima 21.62 85 15.89 Team 10 - Pima 29.27 55 26.80 Team 11 - Pima 24.24 49 21.93 Team 12 - Douglas / Sierra Vista 18.22 50 16.74 Team 13 - Tuba City 13.30 46 18.13 Team 15 - Yuma 17.13 78 14.60 Team 17 - Lake Havasu 16.58 76 14.34 Team 18 - Flagstaff 38.13 38 29.12 Team 19 - Sunnyslope 48.63 75 27.26 Team 21 - Prescott 24.52 82 21.11 Team 23 - Mesa 45.83 104 27.09 Team 27 - Pima 24.07 54 25.11 Team 28 - Safford 20.67 70 19.69 Team 32 - Winslow 21.24 45 26.01 Team 33 - Kingman 28.59 32 15.39 Team 43 - Bullhead City 25.44 41 25.20 Team 48 - West Phoenix 36.70 70 22.80 Team 61 - Central Phoenix #1 33.50 66 22.10 Team 62 - Central Phoenix #2 32.89 82 22.66 Team 64 - SE/NE Maricopa 37.08 89 21.83 Team 65 - Combo Phoenix 35.10 84 23.72 Team 68 – Queen Creek 35.91 56 21.58 Team 70 - Yuma 18.91 70 23.59 Team 71 - South Scottsdale 28.40 5 25.19 Team 80 – CHAA Phoenix 37.03 70 23.90 Team 81 – CHAA Tucson 19.16 62 20.41 Team 82 – CHAA Casa Grande 12.07 75 22.57 Team 83 – CHAA Maryvale 34.51 83 24.53 Team 84 - CHAA N. Mountain 45.36 78 26.34 Team 85 – San Tan/Florence 12.33 43 19.27 Team 86 – CHAA Apache Junction 22.39 46 11.68 Team 87 - CHAA Verde Valley 19.17 18 13.95 Team 88 - CHAA South Mountain 35.27 67 26.38 Team 89 - CHAA Mesa 34.22 59 25.28 Total 29.67 2,492 28.65 Note: Total does not include data for families that enrolled in the prenatal period including those that did not receive prenatal services. Team Healthy Families Arizona Annual Evaluation Report 2014 49 Days to Program Exit by Team – 2014 (For families who left the program) Team Median 791.00 161.00 466.00 Prenatal Mean St. Dev. 652.00 402.97 254.29 228.89 435.46 231.90 Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales 214.00 347.63 353.25 Team 8 – Pima 281.50 357.17 283.08 Team 9 - Pima 252.00 433.40 341.12 Team 10 - Pima 366.00 485.43 332.47 Team 11 - Pima 254.00 314.33 177.37 Team 12 - Douglas / Sierra Vista 331.00 374.14 218.92 Team 13 - Tuba City 466.00 615.60 357.77 Team 15 - Yuma 644.00 579.00 402.55 Team 17 - Lake Havasu 215.00 321.00 274.73 Team 18 - Flagstaff 245.00 233.54 90.54 Team 19 - Sunnyslope 421.00 452.60 248.89 Team 21 - Prescott 63.00 319.67 461.99 Team 23 - Mesa 224.00 343.60 276.99 Team 27 - Pima 295.50 352.13 226.21 Team 28 - Safford 365.00 347.63 171.82 Team 32 - Winslow 358.00 444.25 309.78 Team 33 - Kingman 219.00 339.10 258.09 Team 43 - Bullhead City 239.50 363.86 291.60 Team 48 - West Phoenix 170.50 175.50 76.36 Team 61 - Central Phoenix #1 227.00 292.89 177.38 Team 62 - Central Phoenix #2 193.50 286.43 212.68 Team 64 - SE/NE Maricopa 327.00 319.31 208.09 Team 65 - Combo Phoenix 459.00 449.14 329.64 Team 68 – Queen Creek 327.00 364.00 270.20 Team 70 - Yuma 283.00 283.00 291.33 Team 71 - South Scottsdale 149.00 149.00 Team 80 – CHAA Phoenix 478.00 461.20 113.40 Team 81 – CHAA Tucson 404.00 395.17 203.90 Team 82 – CHAA Casa Grande 340.50 340.50 143.54 Team 83 – CHAA Maryvale 234.50 255.25 78.25 Team 84 - CHAA N. Mountain 202.00 212.33 97.37 Team 85 – San Tan/Florence 89.00 85.25 46.69 Team 86 – CHAA Apache Junction 269.50 269.50 228.40 Team 87 - CHAA Verde Valley 245.00 245.00 21.21 Team 88 - CHAA South Mountain 206.50 206.50 2.12 Team 89 - CHAA Mesa 208.00 175.67 63.96 Total 263.00 345.99 249.62 Note: St. Dev = Standard Deviation, # = Number of Families Healthy Families Arizona Annual Evaluation Report 2014 # 5 7 13 Median 480.00 238.00 353.00 8 6 5 7 3 7 5 5 4 13 5 3 10 8 8 8 20 14 4 18 14 13 7 7 2 1 5 6 2 4 15 4 2 2 2 3 275 302.00 335.50 275.00 331.00 223.00 195.00 223.00 185.00 262.00 321.50 179.50 442.00 230.00 232.00 287.00 349.50 144.00 369.00 261.00 253.00 255.50 198.00 304.50 258.50 314.00 168.00 361.00 206.00 261.00 255.50 187.00 155.00 145.50 174.00 164.00 106.00 240.50 Postnatal Mean St. Dev. 474.41 277.09 314.56 223.84 404.29 241.12 # 34 41 17 369.53 379.64 340.11 334.87 291.47 274.73 227.25 331.36 304.33 398.50 249.67 437.56 306.47 320.48 324.11 389.22 209.00 387.73 318.53 288.68 325.97 267.64 381.90 328.07 343.33 264.00 344.29 252.33 294.48 272.47 234.80 185.68 145.33 174.00 147.05 122.94 311.38 17 22 27 15 15 15 12 11 27 8 30 32 47 25 27 18 5 15 15 19 30 28 30 14 12 4 24 15 31 36 35 19 12 1 19 18 822 230.45 219.16 212.51 193.16 227.67 239.94 105.14 280.49 209.37 229.41 203.88 279.82 230.86 192.16 213.66 201.29 130.24 264.39 195.29 142.47 217.86 217.84 249.68 237.34 229.16 255.79 204.24 129.75 131.43 117.74 147.99 122.81 53.21 58.77 69.35 214.62 50 Top Four Reasons for Program Exit by Team – 2014 Percent and Number within Team Overall (Prenatal and Postnatal Combined) Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total #1 Family Refused Further Services % 7.7 41.7 16.7 28.0 14.3 21.9 9.1 16.7 18.2 23.5 18.8 35.5 19.0 11.4 14.3 33.3 15.2 37.1 11.5 24.0 10.3 31.6 37.8 29.5 26.8 5.4 33.3 35.7 80.0 37.9 23.8 33.3 37.5 56.0 47.8 21.4 66.7 38.1 38.1 27.3 n 3 20 5 7 4 7 2 3 4 4 3 11 4 4 5 19 5 13 3 6 3 6 14 13 11 2 7 5 4 11 5 11 15 28 11 3 2 8 8 299 #2 Did Not Respond to Outreach Efforts % 15.4 22.9 20.0 8.0 32.1 34.4 9.1 16.7 4.5 5.9 25.0 6.5 4.8 22.9 14.3 8.8 42.4 14.3 3.8 16.0 24.1 31.6 24.3 22.7 22.0 21.6 14.3 7.1 0.0 10.3 23.8 27.3 17.5 12.0 17.4 42.9 0.0 9.5 0.0 17.9 Healthy Families Arizona Annual Evaluation Report 2014 n 6 11 6 2 9 11 2 3 1 1 4 2 1 8 5 5 14 5 1 4 7 6 9 10 9 8 3 1 0 3 5 9 7 6 4 6 0 2 0 196 #3 Moved Away % 15.4 2.1 16.7 20.0 14.3 12.5 9.1 16.6 36.4 41.2 31.3 29.0 38.1 5.7 17.1 8.8 15.2 28.6 42.3 28.0 34.5 5.3 5.4 11.4 22.0 8.1 14.3 42.9 0.0 17.2 19.0 12.1 7.5 6.0 8.7 28.6 33.3 14.3 33.3 17.1 n 6 1 5 5 4 4 2 3 8 7 5 9 8 2 6 5 5 10 11 7 10 1 2 5 9 3 3 6 0 5 4 4 3 3 2 4 1 3 7 188 #4 Self Sufficiency % 30.8 4.2 13.3 0.0 7.1 0.0 45.5 11.1 13.6 0.0 12.5 0.0 0.0 40.0 11.4 8.8 9.1 0.0 19.2 8.0 17.2 15.8 8.1 9.1 17.1 43.2 23.8 7.1 20.0 6.9 9.5 0.0 17.5 4.0 4.3 0.0 0.0 33.3 4.8 12.5 n 12 2 4 0 2 0 10 2 3 0 2 0 0 14 4 5 3 0 5 2 5 3 3 4 7 16 5 1 1 2 2 0 7 2 1 0 0 7 1 137 51 Health Insurance at Intake by Team – 2014 Percent and number within Team * Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total None % n 11.1 2 0.0 0 3.7 1 6.7 2 0.0 0 5.9 1 0.0 0 10.0 1 PRENATAL AHCCCS % n 88.9 16 92.3 12 88.9 24 90.0 27 100 15 64.7 11 87.5 14 90.0 9 Private % n 0.0 0 7.7 1 3.7 1 0.0 0 0.0 0 23.5 4 12.5 2 0.0 0 None % n 11.5 9 7.9 7 5.5 3 3.6 3 1.5 1 6.3 5 4.1 2 0.0 0 POSTNATAL AHCCCS % n 80.8 63 85.4 76 92.7 51 89.2 74 83.1 54 75.0 60 87.8 43 72.9 35 Private % n 7.7 6 6.7 6 1.8 1 7.2 6 10.8 7 18.8 15 8.2 4 27.1 13 0.0 0 100 10 0.0 0 2.0 1 81.6 40 10.2 5 0.0 7.1 0.0 9.1 0.0 12.5 0.0 0.0 2.9 15.0 3.7 16.7 0.0 6.9 8.0 9.1 0.0 7.4 0.0 100 4.8 6.3 0.0 4.3 0.0 0.0 0 1 0 4 0 1 0 0 1 3 2 4 0 2 2 3 0 2 0 1 1 1 0 1 0 0 93.3 78.6 100 81.8 95.5 87.5 91.3 93.8 65.7 75.0 79.6 75.0 100 89.7 84.0 87.9 90.9 88.9 75.0 0.0 95.2 93.8 100 91.3 90.9 75.0 14 11 21 36 21 7 21 15 23 15 43 18 17 26 21 29 20 24 3 0 20 15 9 21 30 6 0.0 7.1 0.0 9.1 4.5 0.0 8.7 6.3 31.4 5.0 16.7 8.3 0.0 0.0 8.0 3.0 4.5 3.7 25.0 0.0 0.0 0.0 0.0 4.3 9.1 25.0 0 1 0 4 1 0 2 1 11 1 9 2 0 0 2 1 1 1 1 0 0 0 0 1 3 2 0.0 2.6 4.1 8.8 4.3 6.2 13.1 3.8 2.9 2.2 0.0 5.0 14.9 9.2 15.0 8.1 7.4 10.7 4.3 0.0 15.7 1.6 5.6 12.2 9.1 5.0 0 2 3 3 3 5 13 2 2 1 0 2 10 6 12 7 6 6 3 0 11 1 4 10 7 2 100 85.5 84.9 85.3 77.1 82.7 76.8 86.8 66.7 91.1 87.1 90.0 64.2 84.6 81.3 84.9 86.4 78.6 84.3 75.0 75.7 87.1 88.9 79.3 87.0 82.5 44 65 62 29 54 67 76 46 46 41 27 36 43 55 65 73 70 44 59 3 53 54 64 65 67 33 0.0 10.5 11.0 5.9 17.1 11.1 10.1 7.5 30.4 4.4 12.9 5.0 20.9 6.2 2.5 7.0 4.9 10.7 11.4 25.0 8.6 11.3 5.6 8.5 3.9 12.5 0 8 8 2 12 9 10 4 21 2 4 2 14 4 2 6 4 6 8 1 6 7 4 7 3 5 0.0 0 100 8 0.0 0 6.5 3 76.1 35 17.4 8 0.0 0 93.3 14 6.7 1 0.0 0 100 18 0.0 0 0.0 0 100 5 0.0 0 7.6 5 78.8 52 13.6 9 0.0 4.7 0 36 100 87.2 10 661 0.0 7.0 0 53 10.2 6.9 6 166 79.7 82.5 47 1,989 10.2 10.2 6 245 *”Other” insurance percentages are not listed in this table but can be estimated by subtracting the sum of the other insurance categories from 100. Healthy Families Arizona Annual Evaluation Report 2014 52 Late or No Prenatal Care or Poor Compliance at Intake - 2014 by Site Percent and number ( ) within Team Did the mother have late or no prenatal care or poor compliance with prenatal care? Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA S. Mountain Team 89 - CHAA Mesa Total Yes 38.9% (7) 23.1% (3) 37.0% (10) 26.7% (8) 20.0% (3) 29.4% (5) 31.3% (5) 50.0% (5) 50.0% (5) 26.3% (5) 50.0% (7) 28.6% (6) 30.2% (13) 27.3% (6) 37.5% (3) 34.8% (8) 12.5% (2) 20.6% (7) 15.0% (3) 14.8% (8) 29.2% (7) 35.3% (6) 20.7% (6) 44.0% (11) 27.3% (9) 33.3% (7) 44.4% (12) 25.0% (1) 0.0% (0) 14.3% (3) 25.0% (4) 22.2% (2) 30.4% (7) 27.3% (9) 11.1% (1) PRENATAL No Unknown 61.1% (11) 0.0% (0) 76.9% (10) 0.0% (0) 63.0% (17) 0.0% (0) 73.3% (22) 0.0% (0) 80.0% (12) 0.0% (0) 70.6% (12) 0.0% (0) 68.8% (11) 0.0% (0) 50.0% (5) 0.0% (0) 50.0% (5) 0.0% (0) 68.4% (13) 5.3% (1) 50.0% (7) 0.0% (0) 71.4% (15) 0.0% (0) 69.8% (30) 0.0% (0) 72.7% (16) 0.0% (0) 62.5% (5) 0.0% (0) 65.2% (15) 0.0% (0) 87.5% (14) 0.0% (0) 79.4% (27) 0.0% (0) 85.0% (17) 0.0% (0) 85.2% (46) 0.0% (0) 70.8% (70) 0.0% (0) 64.7% (11) 0.0% (0) 79.3% (23) 0.0% (0) 56.0% (14) 0.0% (0) 72.7% (24) 0.0% (0) 66.7% (14) 0.0% (0) 51.9% (14) 3.7% (1) 75.0% (3) 0.0% (0) 100% (1) 0.0% (0) 85.7% (18) 0.0% (0) 75.0% (12) 0.0% (0) 77.8% (7) 0.0% (0) 69.6% (16) 0.0% (0) 69.7% (23) 3.0% (1) 88.9% (8) 0.0% (0) Yes 46.2% (36) 46.6% (41) 45.5% (25) 42.2% (35) 23.9% (16) 26.8% (22) 16.0% (8) 33.3% (16) 32.7% (16) 22.2% (10) 41.6% (32) 19.7% (15) 11.8% (4) 48.6% (34) 42.5% (34) 39.3% (39) 20.8% (11) 17.6% (12) 26.7% (12) 31.3% (10) 50.0% (19) 39.7% (27) 44.6% (29) 53.7% (44) 38.4% (33) 34.9% (29) 39.3% (22) 28.6% (20) 0.0% (0) 34.3% (24) 25.8% (16) 23.9% (17) 35.4% (29) 41.6% (32) 36.6% (15) POSTNATAL No Unknown 53.8% (42) 0.0% (0) 53.4% (47) 0.0% (0) 54.5% (30) 0.0% (0) 54.2% (45) 3.6% (3) 76.1% (51) 0.0% (0) 73.2% (60) 0.0% (0) 84.0% (42) 0.0% (0) 66.7% (32) 0.0% (0) 65.3% (32) 2.0% (1) 75.6% (35) 2.2% (1) 58.4% (45) 0.0% (0) 75.0% (57) 5.3% (4) 88.2% (30) 0.0% (0) 51.4% (36) 0.0% (0) 53.8% (43) 3.8% (3) 59.6% (59) 1.0% (1) 79.2% (42) 0.0% (0) 79.4% (54) 2.9% (2) 71.1% (32) 2.2% (1) 68.8% (22) 0.0% (0) 47.4% (18) 2.6% (1) 60.3% (41) 0.0% (0) 55.4% (36) 0.0% (0) 46.3% (38) 0.0% (0) 61.6% (53) 0.0% (0) 63.9% (53) 1.2% (1) 60.7% (34) 0.0% (0) 71.4% (50) 0.0% (0) 100% (4) 0.0% (0) 65.7% (46) 0.0% (0) 72.6% (45) 1.6% (1) 76.1% (54) 0.0% (0) 64.6% (53) 0.0% (0) 57.1% (44) 1.3% (1) 63.4% (26) 0.0% (0) 0.0% (0) 100% (8) 0.0% (0) 37.8% (17) 60.0% (27) 2.2% (1) 6.7% (1) 0.0% (0) 40.0% (4) 27.5% (209) 80.0% (12) 100% (5) 60.0% (6) 71.8% (546) 13.3% (2) 0.0% (0) 0.0% (0) 0.7% (5) 33.3% (6) 51.5% (34) 37.3% (22) 35.6% (863) 44.4% (8) 48.5% (32) 62.7% (37) 63.3% (1,534) 22.2% (4) 0.0% (0) 0.0% (0) 1.0% (25) Healthy Families Arizona Annual Evaluation Report 2014 53 Race of Mother by Site PRENATAL – 2014 Percent and number within Team Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total Caucasian % 88.9 84.6 96.3 100 93.3 88.2 81.3 70.0 80.0 0.0 35.7 81.0 40.9 81.8 87.5 77.3 75.0 88.6 20.0 84.9 80.0 100 75.9 80.0 84.8 59.1 81.5 50.0 0.0 76.2 68.8 62.5 82.6 66.7 66.7 87.5 93.3 80.0 80.0 75.0 n 16 11 26 30 14 15 13 7 8 0 5 17 18 18 7 17 12 31 4 45 20 17 22 20 28 13 22 2 0 16 11 5 19 22 6 7 14 4 8 570 African American % n 5.6 1 7.7 1 3.7 1 0.0 0 6.7 1 5.9 1 0.0 0 20.0 2 0.0 0 0.0 0 7.1 1 4.8 1 0.0 0 4.5 1 0.0 0 18.2 4 0.0 0 0.0 0 5.0 1 0.0 0 4.0 1 0.0 0 13.8 4 12.0 3 3.0 1 36.4 8 0.0 0 0.0 0 0.0 0 9.5 2 18.8 3 12.5 1 17.4 4 27.3 9 0.0 0 12.5 1 0.0 0 20.0 1 0.0 0 7.0 53 Healthy Families Arizona Annual Evaluation Report 2014 Asian American % n 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 10.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 4.0 1 0.0 0 0.0 0 4.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 3.0 1 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.5 4 Native American % N 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 6.3 1 0.0 0 0.0 0 94.7 18 7.1 1 9.5 2 50.0 22 4.5 1 12.5 1 0.0 0 6.3 1 8.6 3 65.0 13 0.0 0 0.0 0 0.0 0 3.4 1 0.0 0 0.0 0 0.0 0 11.1 3 0.0 0 0.0 0 4.8 1 12.5 2 12.5 1 0.0 0 0.0 0 11.1 1 0.0 0 0.0 0 0.0 0 10.0 1 9.6 73 Mixed/ Other % n 5.6 1 7.7 1 0.0 0 0.0 0 0.0 0 5.9 1 12.5 2 0.0 0 20.0 2 5.3 1 50.0 7 4.8 1 9.1 4 9.1 2 0.0 0 4.5 1 18.8 3 2.9 1 10.0 2 15.1 8 12.0 3 0.0 0 6.9 2 4.0 1 12.1 4 4.5 1 7.4 2 50.0 2 0.0 0 9.5 2 0.0 0 12.5 1 0.0 0 3.0 1 22.2 2 0.0 0 6.7 1 0.0 0 10.0 1 7.9 60 54 Race of Mother by Site POSTNATAL – 2014 Percent and number within Team Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total Caucasian % 88.5 93.3 87.0 97.6 83.8 62.5 84.0 76.1 68.1 0.0 45.5 72.4 34.3 84.3 86.4 77.6 79.2 92.8 17.8 93.3 86.5 85.1 80.0 85.4 87.1 80.2 89.3 30.0 50.0 81.4 86.7 66.2 89.0 85.7 51.2 80.5 93.3 80.3 89.8 76.4 n 69 83 47 81 57 50 42 35 32 0 35 55 12 59 70 76 42 64 8 28 32 57 52 70 74 65 50 21 2 57 52 47 73 66 21 33 14 53 53 1,837 African American % n 7.7 6 2.2 2 3.7 2 0.0 0 2.9 2 6.3 5 4.0 2 8.7 4 2.1 1 0.0 0 1.3 1 1.3 1 2.9 1 5.7 4 3.7 3 10.2 10 5.7 3 2.9 2 0.0 0 0.0 0 2.7 1 9.0 6 9.2 6 9.8 8 8.2 7 6.2 5 7.1 4 1.4 1 25.0 1 12.9 9 5.0 3 4.2 3 7.3 6 11.7 9 9.8 4 2.4 1 0.0 0 13.6 9 5.1 3 5.6 135 Healthy Families Arizona Annual Evaluation Report 2014 Asian American % n 0.0 0 1.1 1 0.0 0 0.0 0 4.4 3 5.0 4 0.0 0 6.5 3 4.3 2 0.0 0 0.0 0 0.0 0 2.9 1 1.4 1 0.0 0 1.0 1 1.9 1 0.0 0 0.0 0 0.0 0 0.0 0 3.0 2 0.0 0 1.2 1 1.2 1 2.5 2 0.0 0 1.4 1 25.0 1 0.0 0 5.0 3 1.4 1 0.0 0 0.0 0 0.0 0 2.4 1 0.0 0 0.0 0 0.0 0 1.2 30 Native American % n 2.6 2 0.0 0 9.3 5 1.2 1 0.0 0 8.8 7 2.0 1 4.3 2 2.1 1 95.6 43 1.3 1 14.5 11 34.3 12 4.3 3 1.2 1 7.1 7 5.7 3 2.9 2 71.1 32 3.3 1 2.7 1 0.0 0 3.1 2 3.7 3 2.4 2 4.9 4 0.0 0 0.0 0 0.0 0 1.4 1 1.7 1 14.1 10 2.4 2 0.0 0 12.2 5 0.0 0 6.7 1 4.5 3 5.1 3 7.2 173 Mixed/ Other % n 1.3 1 3.4 3 0.0 0 1.2 1 8.8 6 17.5 4 10.0 5 4.3 2 23.4 11 4.4 2 51.9 40 11.8 9 25.7 9 4.3 3 8.6 7 4.1 4 7.5 4 1.4 1 11.1 5 3.3 1 8.1 3 3.0 2 7.7 5 0.0 0 1.2 1 6.2 5 3.6 2 67.1 47 0.0 0 4.3 3 1.7 1 14.1 10 1.2 1 2.6 2 26.8 11 14.6 6 0.0 0 1.5 1 0.0 0 9.5 228 55 Hispanic Ethnicity of Mother by Team– 2014 Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total Percent Hispanic Prenatal 27.8 61.5 25.9 90.0 46.7 41.2 56.3 20.0 20.0 5.3 57.1 23.8 18.2 27.3 0.0 60.9 68.8 34.3 20.0 18.5 20.0 64.7 65.5 56.0 39.4 22.7 37.0 50.0 0.0 66.7 56.3 66.7 78.3 45.5 77.8 25.0 60.0 60.0 60.0 42.0 Healthy Families Arizona Annual Evaluation Report 2014 Percent Hispanic Postnatal 37.2 53.9 27.3 88.0 61.8 42.2 66.0 39.6 34.7 8.9 53.2 25.0 25.7 31.4 7.4 47.5 54.7 52.2 15.6 6.3 25.0 63.2 69.2 61.0 40.7 51.8 42.9 62.9 25.0 57.1 48.4 68.5 80.5 54.5 63.4 30.4 72.2 65.2 45.8 48.5 Percent Hispanic Total 35.4 54.9 26.8 88.5 59.0 42.0 63.6 36.2 32.2 7.8 53.8 24.7 21.5 30.4 6.7 50.0 58.0 46.2 16.9 14.0 23.1 63.5 68.1 59.8 40.3 45.7 41.0 62.2 20.0 59.3 50.0 68.3 80.0 51.8 66.0 29.6 66.7 64.8 47.8 46.9 56 Gestational Age by Team – 2014 (Number and Percent within Team) Was the gestational age less than 37 weeks? PRENATAL No Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total % 100 88.9 92.6 96.0 75.0 92.9 100 71.4 66.7 100 75.0 100 91.9 90.0 80.0 88.2 100 96.4 100 86.5 90.9 93.3 88.5 85.0 89.3 86.7 95.5 66.7 100 88.2 66.7 75.0 81.8 88.0 83.3 100 100 100 100 89.8 Yes n 11 8 25 24 9 13 11 5 6 10 9 18 34 18 4 15 10 27 11 32 20 14 23 17 25 13 21 2 1 15 8 3 9 22 5 5 9 3 6 521 % 0.0 11.1 7.4 4.0 25.0 7.1 0.0 28.6 33.3 0.0 25.0 0.0 8.1 10.0 20.0 11.8 0.0 3.6 0.0 13.5 9.1 6.7 11.5 15.0 10.7 13.3 4.5 33.3 0.0 11.8 33.3 25.0 18.2 12.0 16.7 0.0 0.0 0.0 0.0 10.2 Healthy Families Arizona Annual Evaluation Report 2014 n 0 1 2 1 3 1 0 2 3 0 3 0 3 2 1 2 0 1 0 5 2 1 3 3 3 2 1 1 0 2 4 1 2 3 1 0 0 0 0 59 POSTNATAL No Yes % n % n 78.6 66 21.4 18 73.1 68 26.9 25 78.9 45 21.1 12 94.0 78 6.0 5 81.2 56 18.8 13 94.0 79 6.0 5 78.2 43 21.8 12 85.1 40 14.9 7 91.8 45 8.2 4 90.9 40 9.1 4 92.3 72 7.7 6 90.7 68 9.3 7 75.0 27 25.0 9 79.7 59 20.3 15 89.0 73 11.0 9 74.8 77 25.2 26 87.0 47 13.0 7 91.3 63 8.7 6 93.3 42 6.7 3 86.2 25 13.8 4 89.7 35 10.3 4 74.3 52 25.7 18 84.8 56 15.2 10 84.0 68 16.0 13 76.1 67 23.9 21 81.9 68 18.1 15 83.3 45 16.7 9 89.9 62 10.1 7 80.0 4 20.0 1 82.9 58 17.1 12 91.9 57 8.1 5 87.8 65 12.2 9 80.5 66 19.5 16 78.2 61 21.8 17 82.9 34 17.1 7 91.3 42 8.7 4 100 12 0.0 0 81.8 54 18.2 12 88.1 52 11.9 7 84.4 2,071 15.6 384 57 Low Birth Weight by Team – 2014 (Number and Percent within Team) Did the child have low birth weight? (less than 2500 grams, 88 ounces, or 5.5 pounds) Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total PRENATAL No Yes % n % n 100 100 91.3 100 75.0 100 100 75.0 100 90.9 90.9 100 86.2 100 75.0 86.7 66.7 96.2 90.9 84.4 90.0 100 100 92.9 96.2 92.9 90.0 100 100 100 75.0 80.0 60.0 87.5 100 80.0 100 100 100 91.8 11 9 21 16 9 9 12 6 3 10 10 16 25 17 3 13 4 25 10 27 18 14 22 13 25 13 18 3 1 16 6 4 3 14 6 4 5 2 5 448 0.0 0.0 8.7 0.0 25.0 0.0 0.0 25.0 0.0 9.1 9.1 0.0 13.8 0.0 25.0 13.3 33.3 3.8 9.1 15.6 10.0 0.0 0.0 7.1 3.8 7.1 1.0 0.0 0.0 0.0 25.0 20.0 40.0 12.5 0.0 20.0 0.0 0.0 0.0 8.2 Healthy Families Arizona Annual Evaluation Report 2014 0 0 2 0 3 0 0 2 0 1 1 0 4 0 1 2 2 1 1 5 2 0 0 1 1 1 2 0 0 0 2 1 2 2 0 1 0 0 0 40 POSTNATAL No Yes % n % n 76.5 78.0 80.0 96.2 83.9 91.1 84.3 91.7 91.5 95.2 94.3 93.0 74.3 78.6 88.8 77.8 86.5 93.8 90.9 96.9 95.0 76.9 89.3 92.4 75.3 89.0 86.3 93.8 80.0 88.1 92.9 90.0 83.8 80.8 80.5 90.7 94.4 90.5 91.2 86.8 62 71 44 75 52 72 43 44 43 40 66 66 26 55 71 77 45 61 40 31 38 50 50 73 64 73 44 60 4 59 52 63 62 59 33 39 17 57 52 2,033 23.5 22.0 20.0 3.8 16.1 8.9 15.7 8.3 8.5 4.8 5.7 7.0 25.7 21.4 11.3 22.2 13.5 6.2 9.1 3.1 5.0 23.1 10.7 7.6 24.7 11.0 13.7 6.3 20.0 11.9 7.1 10.0 16.2 19.2 19.5 9.3 5.6 9.5 8.8 13.2 19 20 11 3 10 7 8 4 4 2 4 5 9 15 9 22 7 4 4 1 2 15 6 6 21 9 7 4 1 8 4 7 12 14 8 4 1 6 5 308 58 Yearly Income by Team – 2014 Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total PRENATAL Median Number Yearly Income 8,880 12,000 456 8,970 3,600 14,400 8,520 4,800 11,250 10,800 2,600 5,760 12,500 9,660 0 16,640 6,800 18,000 4,356 13,800 13,200 19,200 12,000 7,920 7,800 6,840 8,400 1,200 30,960 12,000 7,836 10,800 13,620 14,400 8,520 10,920 15,000 9,156 8,460 10,000 Healthy Families Arizona Annual Evaluation Report 2014 18 13 27 30 15 17 16 10 10 19 14 21 44 22 8 23 16 35 20 54 25 17 29 25 33 22 27 4 1 21 16 9 23 33 9 8 15 5 10 764 POSTNATAL Median Number Yearly Income 14,400 12,000 10,000 10,000 10,600 10,500 11,280 12,360 12,000 6,000 8,340 17,040 12,000 10,308 0 12,000 9,600 12,000 6,768 12,000 12,000 13,100 12,000 10,020 10,620 11,112 10,600 11,880 12,540 10,764 8,388 9,100 12,000 14,400 3,420 20,280 14,400 13,200 14,400 11,640 78 89 55 83 68 82 50 48 49 45 77 76 35 70 81 99 53 69 45 32 40 68 65 82 86 83 56 70 4 70 62 73 82 77 41 46 18 66 59 2,432 59 Mother’s Parent Survey Score by Team – 2014 Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total 0 – 20 5.6% 0.0% 0.0% 10.0% 0.0% 0.0% 12.5% 0.0% PRENATAL 25 – 40 45 – 65 11.1% 72.2% 23.1% 61.5% 26.9% 63.0% 73.3% 16.7% 46.7% 53.3% 64.7% 35.3% 43.8% 25.0% 30.0% 70.0% 11.1% 15.4% 7.4% 0.0% 0.0% 0.0% 18.8% 0.0% 0 – 20 0.0% 1.1% 0.0% 10.8% 5.9% 7.2% 4.0% 4.2% POSTNATAL 25 – 40 45 – 65 30.8% 61.5% 29.2% 61.8% 16.4% 69.1% 83.1% 6.0% 64.7% 27.9% 47.0% 43.4% 68.0% 28.0% 68.8% 27.1% 70+ 70+ 7.7% 7.9% 14.5% 0.0% 1.5% 2.4% 0.0% 0.0% 0.0% 0.0% 100% 0.0% 0.0% 61.2% 34.7% 4.1% 5.3% 14.3% 4.8% 2.3% 0.0% 0.0% 8.7% 0.0% 2.9% 0.0% 1.9% 8.0% 0.0% 3.4% 4.0% 0.0% 0.0% 0.0% 25.0% 0.0% 0.0% 0.0% 47.4% 35.7% 66.7% 40.9% 31.8% 37.5% 34.8% 37.5% 62.9% 30.0% 22.2% 40.0% 47.1% 27.6% 28.0% 21.2% 36.4% 11.1% 50.0% 0.0% 14.3% 25.0% 47.4% 42.9% 23.8% 54.5% 59.1% 62.5% 47.8% 56.3% 34.3% 55.0% 61.1% 48.0% 41.2% 55.2% 60.0% 72.7% 54.5% 81.5% 25.0% 100% 61.9% 75.0% 0.0% 7.1% 4.8% 2.3% 9.1% 0.0%. 8.7% 6.3% 0.0% 15.0% 14.8% 4.0% 11.8% 13.8% 8.0% 6.1% 9.1% 7.4% 0.0% 0.0% 23.8% 0.0% 2.2% 13.0% 0.0% 0.0% 0.0% 2.5% 1.0% 1.9% 7.2% 4.4% 3.1% 0.0% 0.0% 1.5% 1.2% 2.3% 1.2% 0.0% 14.3% 0.0% 0.0% 9.7% 55.6% 63.6% 71.1% 57.1% 14.3% 59.3% 21.2% 54.7% 65.2% 37.8% 34.4% 37.5% 33.8% 32.3% 25.6% 26.7% 32.5% 33.9% 58.6% 25.0% 27.1% 54.8% 42.2% 22.1% 27.6% 37.1% 68.6% 35.8% 65.7% 41.5% 24.6% 51.1% 43.8% 60.0% 54.4% 56.9% 68.3% 52.3% 53.0% 60.7% 27.1% 75.0% 60.0% 35.5% 0.0% 1.3% 1.3% 5.7% 17.1% 2.5% 12.1% 1.9% 2.9% 6.7% 18.8% 2.5% 11.8% 9.2% 4.9% 18.6% 13.3% 5.4% 0.0% 0.0% 12.9% 0.0% 0.0% 33.3% 55.6% 11.1% 2.7% 52.1% 45.2% 0.0% 0.0% 39.1% 52.2% 8.7% 2.4% 31.7% 57.3% 8.5% 0.0% 36.4% 54.5% 9.1% 5.2% 18.2% 61.0% 15.6% 11.1% 66.7% 22.2% 0.0% 9.8% 46.3% 43.9% 0.0% 0.0% 50.0% 50.0% 0.0% 0.0% 76.1% 23.9% 0.0% 0.0% 73.3% 26.7% 0.0% 11.1% 66.7% 22.2% 0.0% 0.0% 0.0% 80.0% 20.0% 1.5% 28.8% 57.6% 12.1% 0.0% 2.7% 10% 36.5% 90% 53.5% 0.0% 7.2% 0.0% 3.4% 20.3% 43.4% 72.9% 46.7% 6.8% 6.5% Healthy Families Arizona Annual Evaluation Report 2014 60 Trimester of Enrollment into Prenatal Program by Team - 2014 Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total 1st Trimester 2nd Trimester # % 6 33.3 8 61.5 7 25.9 9 30.0 2 13.2 7 41.2 3 18.8 6 60.0 3 30.0 10 52.6 7 50.0 6 28.6 16 36.4 8 36.4 3 37.5 6 26.1 4 25.0 13 37.1 12 60.0 20 37.0 7 28.0 5 29.4 9 31.0 14 56.0 9 27.3 10 45.5 5 18.5 1 25.0 0 0.0 10 47.6 6 37.5 2 22.2 9 39.1 14 42.4 1 11.1 3rd Trimester # % 10 55.6 4 30.8 18 66.7 14 46.7 8 53.3 9 52.9 10 62.5 4 40.0 6 60.0 6 31.6 7 50.0 14 66.7 22 50.0 9 40.9 3 37.5 15 65.2 8 50.0 14 40.0 4 20.0 11 20.4 14 56.0 10 58.8 15 51.7 8 32.0 20 60.6 11 50.0 16 59.3 2 50.0 1 100 11 52.4 9 56.3 4 44.4 9 39.1 13 39.4 7 77.8 Other / Unknown # % 0 0.0 0 0.0 1 3.7 1 3.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 4.8 2 4.5 1 4.5 0 0.0 1 4.3 1 6.3 0 0.0 0 0.0 0 0.0 1 4.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 3.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 3.0 0 0.0 Total # 2 1 1 6 5 1 3 0 1 3 0 0 4 4 2 1 3 8 4 23 3 2 5 3 4 1 5 1 0 0 1 3 5 5 1 % 11.1 7.7 3.7 20.0 33.3 5.9 18.8 0.0 10.0 15.8 0.0 0.0 9.1 18.2 25.0 4.3 18.8 22.9 20.0 42.6 12.0 11.8 17.2 12.0 12.1 4.5 18.5 25.0 0.0 0.0 6.3 33.3 21.7 15.2 11.1 0 0.0 1 12.5 7 87.5 0 0.0 8 1 0 3 115 6.7 0.0 30.0 15.1 3 2 2 266 20.0 40.0 20.0 34.8 11 2 5 371 73.3 40.0 50.0 48.6 0 1 0 12 0.0 20.0 0.0 1.6 15 5 10 764 Healthy Families Arizona Annual Evaluation Report 2014 # 18 13 27 30 15 17 16 10 10 19 14 21 44 22 8 23 16 35 20 54 25 17 29 25 33 22 27 4 1 21 16 9 23 33 9 61 Engaged Prenatal Families that Exited Before Baby’s Birth By Team – 2014 Team Team 2 - Central Phoenix Team 3 - Maryvale Team 5 - East Valley Team 6 - Nogales Team 8 – Pima Team 9 - Pima Team 10 - Pima Team 11 - Pima Team 12 - Douglas / Sierra Vista Team 13 - Tuba City Team 15 - Yuma Team 17 - Lake Havasu Team 18 - Flagstaff Team 19 - Sunnyslope Team 21 - Prescott Team 23 - Mesa Team 27 - Pima Team 28 - Safford Team 32 - Winslow Team 33 - Kingman Team 43 - Bullhead City Team 48 - West Phoenix Team 61 - Central Phoenix #1 Team 62 - Central Phoenix #2 Team 64 - SE/NE Maricopa Team 65 - Combo Phoenix Team 68 – Queen Creek Team 70 - Yuma Team 71 - South Scottsdale Team 80 – CHAA Phoenix Team 81 – CHAA Tucson Team 82 – CHAA Casa Grande Team 83 – CHAA Maryvale Team 84 - CHAA N. Mountain Team 85 – San Tan/Florence Team 86 – CHAA Apache Junction Team 87 - CHAA Verde Valley Team 88 - CHAA South Mountain Team 89 - CHAA Mesa Total Total Families 18 13 27 30 15 17 16 10 10 19 14 21 44 22 8 23 16 35 20 54 25 17 29 25 33 22 27 4 1 21 16 9 23 33 9 8 15 5 10 764 Healthy Families Arizona Annual Evaluation Report 2014 # Closed Before birth 1 3 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 4 0 1 1 1 2 1 0 0 0 0 0 0 1 2 1 0 0 0 2 22 % Closed Before birth 5.6 23.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.3 0.0 12.5 0.0 0.0 0.0 0.0 7.4 0.0 5.9 3.4 4.0 6.1 4.5 0.0 0.0 0.0 0.0 0.0 0.0 4.3 6.1 11.1 0.0 0.0 0.0 20.0 2.9 62 Appendix B. Healthy Families Arizona Steering Committee Members Jenna Shroyer Esthela Navarro Department of Child Safety, Healthy Families Arizona Central Administration Julie Rosen Parenting Arizona Becky Ruffner Prevent Child Abuse Arizona Committee Chairperson Mary Warren Prevent Child Abuse Arizona Kerry Milligan Michel Lahti Darlene Lopez LeCroy & Milligan Associates Ginger Ward Suzanne Schunk Southwest Human Development Eric Schindler Ellie Jimenez Child and Family Resources Samantha Martin Wellington Consulting Beth Rosenberg Children’s Action Alliance Judy Krysik Arizona State University Joanne M. Karolzak Casa de los Niños Jessica Stewart Department of Health Service, Bureau of Women’s and Children’s Health Healthy Families Arizona Annual Evaluation Report 2014 63 Appendix C. Parent Survey Parent Survey* Problem Areas and Interpretation (Mother & Father) Areas (Scales) 1. Parent Childhood Experiences (e.g., Childhood history of physical abuse and deprivation) 2. Lifestyle, Behaviors and Mental Health (e.g., substance abuse, mental illness, or criminal history) Range Interpretation/ Administration The Parent Survey comprises a 10-item rating 0, 5, or 10 scale. A score of 0 represents normal, 5 represents a mild degree of the problem and a 10 represents severe for both the Mother 0, 5, or 10 and Father Parent Survey Checklist items. The Parent Survey is an assessment tool and 3. Parenting Experiences (e.g., Previous or current CPS involvement) 0, 5, or 10 4. Coping Skills and Support Systems (e.g., Selfesteem, available lifelines, possible depression) 0, 5, or 10 5. Stresses (e.g., Stresses, concerns, domestic violence) is administered to the mother and father Family Assessment Worker from the Healthy 0, 5, or 10 Families Arizona program if either parent scores 25 or higher. 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 10. Bonding/Attachment Issues Families Arizona Program. A family is considered eligible to receive the Healthy 6. Anger Management Skills (e.g., Potential for violence) 9. Perception of New Infant prior to enrollment through an interview by a 0, 5, or 10 0, 5, or 10 A score over 25 is considered medium risk for child abuse and neglect, and a score over 40 Total Score 0 - 100 is considered high-risk for child abuse. * Modified from the Family Stress Checklist Healthy Families Arizona Annual Evaluation Report 2014 64 Appendix D. Healthy Families Arizona Prenatal Logic Model Long Term Outcomes Program Resources  Reduced child abuse and neglect  Increased child wellness and development 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  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 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 Explore father’s feelings, childhood experiences, expectations, hopes and fears about baby and goals for fatherhood Assess, encourage and guide family in making needed safety arrangements, e.g. crib safety, car seat, pets, SIDS, child care, feeding Connect mother to prenatal care and encourage compliance with visits Program Activities and Strategies Assess family’s support systems Model relationship skills Foster connections to positive support sources Identify signs and history of depression, abuse, mental illness, substance abuse Review history of birthing Encourage medical assessment, referral and treatment if needed Encourage exercise, personal care, rest Educate on post partum depression 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 Teach stress reduction Educate and provide materials on nutrition during pregnancy, buying and choosing healthy foods, and requirements for healthy fetal development Provide referrals to WIC, other resources Encourage healthy celebrations Explore and assess issues around pregnancy, relationships, hopes, fears Discuss and educate about changes in body, sexuality during pregnancy Educate about changes in intimacy, ways father can support mother Share developmental information about stages of development of fetus Encourage supportive relationships for father Encourage prebirth bonding and stimulation exercises (reading, touch, etc) Educate on father’s legal rights and responsibilities Educate on baby temperaments, how to calm baby, Shaken Baby Syndrome, medical concerns 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 InventoryPrenatal (HFPIP); FSS-23 HFPIP; FSS-23 HFPIP; FSS23; CRAFFT HFPIP; FSS-23 Healthy Families Arizona Annual Evaluation Report 2014 HFPIP; FSS-23 HFPIP; FSS-23; father involvement scale HFPIP; FSS-23 65 HFPIP; FSS-23; Safety checklist HFPIP; FSS-23; FSS20P Appendix E. Healthy Families Arizona Postnatal Logic Model Long Term Outcomes Program Resources  Reduced child abuse and neglect  Increased child wellness and development  Strengthened family relations  Enhanced family unity 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 abuse of drugs and alcohol Postnatal Program Objectives Increase the family’s support network Improve mother’s mental health Increase parents’ health behaviors Assess family’s support systems Identify signs and history of depression, abuse, mental illness, substance abuse Assess personal risk behaviors; Educate on dangers of specific risk behaviors Address issues of grief and loss Support family in making lifestyle changes and adopting healthy behaviors Increase the family members’ problem solving skills Improve family stability Increase parental competence Increase positive parent-child interaction Improve child health and Optimize child development Prevent child abuse and neglect Program Activities and Strategies Model relationship skills Foster connections to positive support sources Educate on communication skills Encourage medical assessment, referral and treatment if needed Encourage/coa ch on exercise, personal care, rest Educate on community resources Explore domestic violence, create safety plan Educate on post- partum depression Identify major life stressors 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 about effect of stress on child Assess basic living skills and needs; help family access housing, education, job, and budget management services. Coach parent to set and evaluate goals; teach basic living skills Promote use of community resources for self sufficiency 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 Promote and teach developmentally appropriate stimulation activities Educate about rhythm and reciprocity, reading baby’s cues Promote reading, bonding during feeding Educate about importance of routines and rules Encourage family activities, celebrations Refer to parenting groups and classes Coach on father involvement Complete developmental assessments and make referrals Address medical screenings, support well child checks, immunizations, and good nutrition habits Promote play, reading; provide links to early childhood programs Assess risk of child abuse and neglect Coach and guide in choices for child care Educate about consequences of child abuse and neglect 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 Healthy Families Arizona Annual Evaluation Report 2014 HFPI; FSS-23 HFPI; FSS-23; father involvement scale HFPI; FSS-23 66 HFPI; FSS-23; Safety checklist; ASQ HFPI; FSS-23; FSS20