Healthy Families Arizona evaluation report

              Healthy Families Arizona
Evaluation Report 2002
Prepared by: Prepared for:
LeCroy & Milligan Associates, Inc. The Department of Economic Security
620 N. Country Club Road, Suite B Division of Children, Youth & Families
Tucson, Arizona 85712 Office of Prevention and Family Support
(520) 326-5154 1789 W. Jefferson, Site Code 940A
FAX 326-5155 Phoenix, Arizona 85007
www.lecroymilligan.com
December 2002
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 1
Table of Contents
List of Exhibits...............................................................................................................2
Acknowledgements ........................................................................................................ 3
Executive Summary....................................................................................................... 4
Introduction...................................................................................................................8
In this Report .................................................................................................................9
The Healthy Families Arizona Program....................................................................... 9
Converging Evidence: A Summary of Evaluation Results ........................................ 10
Implementation Update 2002......................................................................................14
Program Participants................................................................................................... 15
Service Delivery ........................................................................................................... 17
Program Outcomes for 2002 ........................................................................................19
Child Abuse and Neglect Outcomes....................................................................... 20
Maternal Life Course Outcomes ............................................................................ 24
Participant Satisfaction............................................................................................... 25
Recommendations ........................................................................................................ 26
References ....................................................................................................................28
Appendix A – List of Healthy Families Arizona Reports ........................................... 29
Appendix B – Parenting Stress Index Information.................................................... 30
Appendix C – Family Stress Checklist........................................................................ 34
Appendix D – Site Level Data ..................................................................................... 35
Age of Child at Entry ........................................................................................ 36
Days to Termination ......................................................................................... 37
Reason for Termination .................................................................................... 38
Mothers’ Education ........................................................................................... 39
Fathers’ Education ............................................................................................ 40
Health Insurance at Intake .............................................................................. 41
Late or No Prenatal Care or Poor Compliance at Intake ................................ 42
Ethnicity of Mother ........................................................................................... 43
Gestational Age ................................................................................................. 44
Low Birth Weight.............................................................................................. 45
Yearly Income.................................................................................................... 46
Family Stress Checklist Score ..........................................................................47
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 2
List of Exhibits
Exhibit 1. Selected risk factors for Healthy Families mothers at intake.............................. 15
Exhibit 2. Ethnicity of Healthy Families Mothers ................................................................. 15
Exhibit 3. Percentage of Mothers and Fathers Rated Severe on the
Family Stress Checklist Items.......................................................................... 16
Exhibit 4. Percentage of infants with high-risk characteristics ............................................ 16
Exhibit 5. Number of participants served by county, by site................................................. 17
Exhibit 6. Length of time in the program at termination for engaged families ................... 18
Exhibit 7. Major reasons for termination from the program................................................. 18
Exhibit 8. Parenting Stress Index Findings ........................................................................... 20
Exhibit 9. Percent of child abuse and neglect cases in treatment and comparison groups . 21
Exhibit 10. Percent of safety practices implemented............................................................. 21
Exhibit 11. Rate of immunization by Healthy Families participants ................................... 22
Exhibit 12. Percentage of children linked to a medical doctor at 6 months, 12 months,
and 24 months ................................................................................................... 22
Exhibit 13. Percent of Healthy Families participants who make appropriate
use of the emergency room................................................................................ 23
Exhibit 14. Developmental delay from 4 to 36 months.......................................................... 23
Exhibit 15. Percentage of families who screened positive for alcohol and drug problems... 24
Exhibit 16. Mother’s employment status across three time periods ..................................... 24
Exhibit 17. School enrollment status of mothers at 6 months .............................................. 24
Exhibit 18. Responses to “The Healthy Families staff who offered me program services
treated me with respect and dignity.” .............................................................. 25
Exhibit 19. Responses to: “How did you feel about the program so far?”.............................. 25
Exhibit 20. How would you describe the Healthy Families worker who first offered
you program services? ............................................................................... 25
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 3
Acknowledgements
This evaluation report represents the efforts of many individuals and many collaborating
agencies.
Craig LeCroy, Ph.D. was the primary author of this report. The evaluation team was
instrumental in the creation of this report. Cindy Jones conducted statistical analyses. Melanie
Ruiz, Olga Urcadez, Veronica Urcadez and Vanessa Batt perform data entry and data cleaning.
Allyson LaBrue helped with editing and formatting of the report.
We are grateful to Rachel Whyte, Coordinator for the Child Abuse Prevention Fund and Healthy
Families Arizona. Valerie Roberson continues to provide leadership and vision for the program.
Kate Whitaker, Pauline Haas-Vaughn and Barbara Griffin provide quality assurance and
training and help the sites to collect valid information. Jennifer Lopez and Bob Hoekstra
provided administrative assistance for quality assurance for all the sites. Thank you to the
program managers who have spent their time collecting and sending data. Staff at the sites have
dutifully collected the data and answered endless questions to increase the accuracy of the data.
Lastly, we acknowledge the families who have received Healthy Families Arizona services.
Suggested Citation:
LeCroy & Milligan Associates, Inc. (2002). Healthy Families Arizona Evaluation Report 2002.
Tucson, AZ: LeCroy & Milligan Associates, Inc.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 4
Imagine a community that exists at the top of
a steep mountain. It is a thriving community
where people have created a productive and
satisfying life. There is only one problem in
this community. Occasionally, the children
fall off the steep mountain and slide down
the hill becoming hurt and sometimes even
die. The community came up with a
practical solution. They built a hospital at
the bottom of the mountain. The hospital
was able to help care for the hurt children. A
few leaders in the community protested that
this was not a good enough solution to the
problem. They got together and built a fence
around the top of the steep mountain.
Healthy Families Arizona is a child abuse
prevention program that attempts to be part
of the fence at the top of the steep
mountain—before children fall off. As Neil
Gutterman (2001, p.3) notes in his recent
book, Stopping child maltreatment before it
starts, “early intervention research have re-ignited
the hope of stopping child abuse
before it starts...Selected interventions
under careful study and specific conditions
have shown that the onset of child
maltreatment can be averted.” Indeed, the
early childhood years may provide a “window
of opportunity” for early intervention that
can impact critical and long lasting changes
in parents and families. Major social and
health organizations now advocate for home
visitation services because of the belief in the
potential it has to offer families. For
example, Zero to Three, the National
Research Council, American Academy of
Pediatrics, the Freddie Mac Foundation, and
Ronald McDonald Charities are only some of
the groups that have supported the effort to
promote home visitation.
The Healthy Families Arizona
Program
Healthy Families Arizona is a home
visitation program designed to provide
supportive services and education to parents
of newborns who might benefit from support
to strengthen their families at this crucial
time. The goals of the program include:
􀂃􈌠 Promote positive parent/child
interaction
􀂃􈌠 Improve child health and development
􀂃􈌠 Prevent child abuse and neglect
All services are voluntary and assistance is
typically provided for 12 to 18 months but
may be provided for up to five years.
Families enter the program based on a two
level screening and assessment process. In
the hospital after a child’s birth, the family
can consent to an initial screening, which
identifies family, parental, child and
community risk factors associated with child
abuse and neglect. If the screening is
assessed as positive (indicating potential
increased needs) the family is referred to a
Family Assessment Worker who conducts a
more detailed interview and assessment
with the family. If the assessment is
positive (family may be in need based on
risk), the family is offered intensive home
visiting services through the Healthy
Families Arizona program. Any family who
has had or receives a substantiated report of
child abuse and/or neglect from Child
Protective Services in Arizona will be
excluded from the program, as required by
law. Since the program is voluntary, the
family can withdraw from the program at
any time.
After the family is referred to the program
and accepts home visitation services, a
Family Support Specialist visits the family
in their home on a regular basis to provide
supportive services and education. The
Family Support Specialist seeks to develop a
Executive Summary
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 5
trusting, open and constructive relationship
with the family to meet their individual
needs. The core Healthy Families Arizona
services are:
􀂃􈌠 emotional support
􀂃􈌠 assistance in developing positive
parenting skills
􀂃􈌠 education on child development and
nutrition
􀂃􈌠 education and assistance in problem
solving and coping skills
􀂃􈌠 education on preventive health care
(immunizations, links to medical
doctor)
􀂃􈌠 linkages to preschool resources
􀂃􈌠 referrals related to education,
employment, and mental health and
substance abuse services.
This report focuses on aggregate data that is
summarized across the 23 sites that make
up the Healthy Families Arizona program.
This report presents the evaluation data for
the cohort of participants who received
services in the Healthy Families Arizona
program between the period of July 1, 2001
and June 30, 2002. This includes all families
who received services at any time during the
study period regardless of when they entered
the program. Separate site reports are
produced quarterly and provided to each site.
In this year’s report, more extensive site
level data can be obtained in the Appendices.
Converging Evidence: A summary of
Evaluation Results
In this year’s report an examination of the
converging evidence was provided to
summarize what has been learned to date
and reassess the overall impact of Healthy
Families.
The converging evidence for Healthy
Families Arizona suggests that the program
is effective. This conclusion is supported by
the following findings: replicated evaluations
showing improvement from baseline to post
assessment periods, positive results when
using a comparison group on the Parenting
Stress Index, replication of positive gains and
positive results from a comparison group
using the Child Abuse Potential Inventory,
findings showing the comparison group
getting worse on most measures while the
Healthy Families participants were showing
improvements, findings showing
immunization rates higher than the
statewide average, and findings that
consistently show the Healthy Families
participants had lower rates of child abuse
and neglect when contrasted to a comparison
group not receiving the program. Other
outcomes that add to the cumulative
evidence include the qualitative study that
documented the perceived value the families
report from being involved in the program
and twelve years of experience in working
toward program improvement showing gains
in program implementation such as
increased immunization and retention rates
over time. Assessing program effectiveness
is always a complex process, which requires
a balance of good methodology, measures,
and program implementation. In the end, a
question of effectiveness requires a judgment
be made based on an assessment of the data.
Program Outcomes for 2002
The evaluation has assessed program
outcomes in the following areas: health and
development indicators, parenting
effectiveness and competence, child safety,
child abuse and neglect, and maternal life
course indicators. The outcomes for families
served in FY2002 are summarized
graphically.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 6
Health Outcomes for Participants
There was a 92.7% immunization rate for
participants in the program at the 2-month
assessment and at the 6-month assessment
97.3% of families were linked to a medical
doctor. In terms of having received all 4
immunizations in the series, 83.9% obtained
this compared with the state immunization
rate for 2 year olds of 78%.
Child Safety
Enhanced quality of the home environment
can be assessed by examination of child
safety practices. At a 12-month assessment,
almost all families practice many of the
recommended child safety procedures. The
results for two safety procedures are shown.
Parenting Stress & Competence
Overall parenting effectiveness and
competence is evaluated using a
standardized parenting stress index.
Assessment of participants from baseline to
a 6 month, 1 year and 18 month follow up
show statistically significant changes on all
measures at each assessment period except
distractibility which did not have adequate
reliability to be used as a reliable measure.
Child Abuse and Neglect
Child abuse and neglect incidents were
examined for program participants and a
small comparison group. As in previous
years, child abuse and neglect rates continue
to be low. In FY2002, 0.7% of program
families had subsequent substantiated
incidents of child abuse and neglect, meeting
the program goal of having no higher than a
5% rate of child abuse and neglect. The
comparison group rate of child abuse and
neglect was 0.84%.
Results on the Parenting Stress Index
Scale Improvement
Sense of Competence Significant
Parental Attachment Significant
Feeling restricted in role Significant
Depression Significant
Isolation Significant
Mood Significant
Total Stress Significant
92.8%
72.8%
0.0% 50.0% 100.0%
Percent of Participants at 12
months
Poisons
Locked
Outlets
Covered
97.3%
92.7%
0.0% 50.0% 100.0%
Percent of Participants
Link to
Medical
Doctor
Immunizations
at 2 months
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 7
Maternal Life Course
The Healthy Families Arizona program has
also been shown to positively influence
mothers’ life goals and actions. Specifically,
many of the participants enroll in school,
obtain their GED or seek gainful
employment. Mothers’ employment
outcomes at baseline, 6 and 12 months are
shown to the right. Additionally, 17.3% of
the mothers were enrolled full-time in school
and 5.5% were enrolled part time in school.
Participant Satisfaction
Overall, program participants are very
satisfied with the program services they
receive. For example, 98.4% agreed or
strongly agreed that they were treated with
dignity and respect and 94.2% were
somewhat satisfied or very satisfied with the
program at a 2-month assessment.
Overall, results from multiple outcome indicators suggest the program is
providing valuable services and improving the quality of life for participants.
Positive changes in multiple outcome
indicators point to the success of the Healthy
Families Arizona home visitation program.
Many social programs hope to impact only
one model goal; Healthy Families Arizona
demonstrates positive outcomes across
multiple goals: child health and
development, quality of home life, reduction
in parental stress, low rates of child abuse
and neglect and increases in child safety
practices.
40.8%
31.3%
15.9%
0.0% 25.0% 50.0% 75.0% 100.0%
Percent of Participants Employed
12 Months
6 Months
Baseline
94.2%
98.4%
0.0% 50.0% 100.0%
Percent of Participants
Satisfaction
with the
Program
Treated me
with dignity
and respect
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 8
Imagine a community that exists at the top of
a steep mountain. It is a thriving community
where people have created a productive and
satisfying life. There is only one problem in
this community. Occasionally, the children
fall off the steep mountain and slide down
the hill becoming hurt and sometimes even
die. The community came up with a
practical solution. They built a hospital at
the bottom of the mountain. The hospital
was able to help care for the hurt children. A
few leaders in the community protested that
this was not a good enough solution to the
problem. They got together and built a fence
around the top of the steep mountain.
Healthy Families Arizona is a child abuse
prevention program that attempts to be part
of the fence at the top of the steep
mountain—before children fall off. As Neil
Gutterman (2001, p.3) notes in his recent
book, Stopping child maltreatment before it
starts, “early intervention research have re-ignited
the hope of stopping child abuse
before it starts...Selected interventions
under careful study and specific conditions
have shown that the onset of child
maltreatment can be averted.” Indeed, the
early childhood years may provide a “window
of opportunity” for early intervention that
can impact critical and long lasting changes
in parents and families.
Support for a national effort that suggests
we can stop child abuse before it starts is
converging from many sources. An early
push came from the United States Advisory
Board on Child Abuse and Neglect in 1991,
which recommended a nationwide neonatal
home visitation program. In 1992 Prevent
Child Abuse America launched the Healthy
Families America initiative to promote the
expansion of home visitation services. Major
social and health organizations now advocate
for home visitation services because of the
belief in the potential it has to offer families.
For example, Zero to Three, the National
Research Council, American Academy of
Pediatrics, the Freddie Mac Foundation, and
Ronald McDonald Charities are only some of
the groups that have supported the effort to
promote home visitation.
In line with the current emphasis at the
Federal and state levels, “best practices” and
science-based principles have been an
important part of the Healthy Families
effort. These principles are implemented
through the assessment of “critical elements”
believed essential for producing the best
program outcomes. As the Healthy Families
initiative evolved, the critical elements
became a way to offer certification to
programs that were adhering to practices
that were the most likely to lead to positive
outcomes. Arizona became the first
statewide system to obtain the certification
from Prevent Child Abuse America
documenting adherence to “best practice”
principles. This approach is recommended
by Gutterman (2001, p.10) in his careful
review of research literature on home
visitation:
“For application purposes, emphasizing best
practice principles rather than whole
program models enhances flexibility for
programmatic adoption while minimizing
overly prescriptive information that might
constrain adaptation to specific needs and
contexts.”
This is a sound approach to building a
scientific-based program. However, others
have argued for the “model approach” which
endorses strict adherence to specific
intervention models rather than using
research-based conclusions to inform best
practice principles. For community-based
programs, the best practice model allows for
the inclusion of new scientific discoveries
and becomes a more dynamic application of
knowledge.
Introduction
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 9
In this Report
The Healthy Families Arizona Program
The Healthy Families Arizona program has
been evaluated since 1991 by LeCroy &
Milligan Associates, Inc. and several
separate reports have been written (See
Appendix A for a list of reports). This year’s
report attempts to examine and summarize
the cumulative evidence of the effectiveness
of Healthy Families Arizona. Increasing
emphasis is being placed on providing site-level
data for program improvement and
quality as the program evolves into a mature
and established program.
This report focuses on aggregate data that is
summarized across the 23 sites that make
up the Healthy Families Arizona program.
Evaluation data are presented for the cohort
of participants who received services in the
Healthy Families Arizona program between
the period of July 1, 2001 and June 30, 2002.
This includes all families who received
services at any time during the study period
regardless of when they entered the
program. Separate site reports are produced
quarterly and provided to each site. In this
year’s report, more extensive site level data
can be obtained in the Appendices.
Healthy Families Arizona is a home
visitation program designed to provide
supportive services and education to parents
of newborns who might benefit from support
to strengthen their families at this crucial
time. The goals of the program include:
􀂃􈌠 Promote positive parent/child
interaction
􀂃􈌠 Improve child health and development
􀂃􈌠 Prevent child abuse and neglect
All services are voluntary and assistance is
typically provided for 12 to 18 months but
may be provided for up to five years.
Families enter the program based on a two
level screening and assessment process. In
the hospital after a child’s birth, the family
can consent to an initial screening, which
identifies family, parental, child and
community risk factors associated with child
abuse and neglect. If the screening is
assessed as positive (indicating potential
increased needs) the family is referred to a
Family Assessment Worker who conducts a
more detailed interview and assessment
with the family. If the assessment is
positive (family may be in need based on
risk), the family is offered intensive home
visiting services through the Healthy
Families Arizona program. Any family who
has had or receives a substantiated report of
child abuse and/or neglect from Child
Protective Services in Arizona will be
excluded from the program, as required by
law. Since the program is voluntary, the
family can withdraw from the program at
any time.
After the family is referred to the program
and accepts home visitation services, a
Family Support Specialist visits the family
in their home on a regular basis to provide
supportive services and education. The
Family Support Specialist seeks to develop a
trusting, open and constructive relationship
with the family to meet their individual
needs. The core Healthy Families Arizona
services are:
􀂃􈌠 emotional support
􀂃􈌠 assistance in developing positive
parenting skills
􀂃􈌠 education on child development and
nutrition
􀂃􈌠 education and assistance in problem
solving and coping skills
􀂃􈌠 education on preventive health care
(immunizations, links to medical doctor)
􀂃􈌠 linkages to preschool resources
􀂃􈌠 referrals related to education,
employment, and mental health and
substance abuse services.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 10
Converging Evidence: A Summary of Evaluation Results
Each year an evaluation report is written that summarizes the service and demographic data for
the program. This information is used extensively for purposes of program improvement.
However, increasingly, policy makers and program staff want to know whether the program
works or what the program outcomes are. This year’s report provides additional information
about program outcomes by examining the converging evidence that can be summarized from
past evaluation reports of the program.
1992-1993 Evaluation Report
Methodology: descriptive analysis of
program participants, screening and
assessment data, pretest/posttest data on
Parenting Stress Index, the HOME
observation scale and child abuse and neglect
rates.
Results: Parenting Stress Index; Three of 9
subscales were significant at .05 level
showing positive change, all of the subscales
were significant at the .10 level. HOME
scale; 2 of the 3 scales significant at the .05
level, one at the .10 level. Child abuse and
neglect substantiated rates were 3% covering
the years 1992-1993.
Conclusions: Program is targeting at-risk
families with a high percentage of past
childhood abuse and neglect. Some
promising results were obtained in the first
year of implementation. This included
significant pretest/posttest changes and
attaining the program goal of child abuse
and neglect rates below 5%. Low numbers
affected the ability to document some
outcomes.
1992-1994 Evaluation Report
Methodology: descriptive analysis of
program participants, screening and
assessment data, pretest/posttest data on
Parenting Stress Index, the HOME
observation scale and child abuse and neglect
rates. Design was strengthened with the
addition of a comparison group for the
Parenting Stress Index and child abuse and
neglect reports.
Results: Parenting Stress Index scores from
baseline to 6 months found 10 out of 11
subscales showed significant positive change.
More importantly, when comparisons were
made between the treatment and a
comparison group, 5 of the 11 scales found
significant positive differences favoring the
Healthy Families participants. In fact, on all
but one scale the comparison group got worse
and the Healthy Families group got better.
On the HOME measure, results found
significant change from pretest to posttest on
3 of the 6 subscales and on the total score.
Immunization data found that most
immunization shots were up to date for over
50% of the Healthy Families group. The
immunization rate for Arizona in 1993 was
46%. Substantiated child abuse and neglect
reports were 2.8% for the treatment group
and 3.7% for the comparison group which
also included one child death.
Conclusions: Results improved in that
more Parenting Stress Index and HOME
subscales were found to show significant
pretest to posttest changes. A major
methodological improvement was the
addition of a comparison group that found
significant improvement for the treatment
group in contrast to the comparison group on
some measures. The immunization rates
were low for program participants and
targeted as an important area for
improvement. Child abuse and neglect rates
were lower for the treatment group than the
comparison group and met the stated
program goal of less than 5 percent.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 11
1992-1996 Evaluation Report
Methodology: includes the same
methodology as previous report. An addition
is the use of the Child Abuse Potential
Inventory and continued use of a matched
comparison group for assessing outcomes in
child abuse and neglect rates.
Results: The Child Abuse Potential
Inventory is primarily a screening tool for
assessing child physical abuse. Results from
this study found a statistically significant
decrease in the average score from baseline
to 12 months, indicating a reduced potential
for physical abuse. Reductions in three
subscales accounted for this change: parental
distress, rigidity, and problems with others.
Two subscales did not show significant
change: problems with families of origin and
problems with child and self. Positive
results were also found with the Parenting
Stress Index in that the total score and most
of the subscales (e.g., parental attachment,
sense of competence) showed significant
improvements when assessed from baseline
to 6 month and 18 month time periods.
Similar to the last evaluation, positive
changes were found on the HOME scale
showing improvement in the total score from
baseline to post assessment periods.
Immunization data found that most
immunization shots were up to date for over
90 to 99% of families enrolled at different
time periods. Substantiated child abuse and
neglect reports were studied for two groups,
the original three sites (referred to as CAP
sites) and the expansion sites (referred to as
DES sites). For the CAP sites, the child
abuse and neglect rate was 4.5% for the
treatment group and 8.5% for a comparison
group that did not receive services. This
result favors the Healthy Families group at a
statistically significant level of p <.10. For
the DES sites, the child abuse and neglect
rate was 0.7% for the Healthy Families
participants and 2.0% for the comparison
participants, a non-significant result. Given
important methodological considerations
(greater surveillance in treatment group,
greater likelihood of being tracked in the
system) these results can be interpreted as
positive. Although the numbers are small, a
further study into the type of abuse that
occurred revealed that physical abuse was
more frequent for the comparison group than
the Healthy Families group.
Conclusions: Greater convergence of
effectiveness data emerges from this
evaluation. The Parenting Stress Index
results of previous years is replicated but the
additional finding from the Child Abuse
Potential Inventory adds further evidence
that program participants make
improvements while in the program.
Program implementation appears to improve
as immunization rates increase considerably
from last years’ assessment. Child abuse
and neglect rates show significant decreases
for the Healthy Families group when
contrasted with a comparison group. The
overall evaluation begins an increased focus
on cross-site comparisons allowing enhanced
quality assurance as data was more easily
examined for each site. The report finds
improvement in retention rates but there
remains a need to continue improvements in
retention.
1997 Qualitative Interview Study
Methodology: A stratified random sample
of 46 mothers was interviewed about their
experiences in the program in order to
understand program experience from the
participants.
Results: Participants reported that the
program was seen as: helpful in addressing
immediate family needs such as housing and
food, providing emotional support with the
multiple challenges parents face, and
providing useful information about child
health and development. Participants were
also asked about their experiences with the
screening process and it was found that
participants perceive the screening as
voluntary. Finally, participants reported a
strong commitment to the program and
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 12
believe the program dramatically affected
how they feel about themselves as mothers,
feelings about their own sense of self, and
their relationships with their children.
Conclusions: This study provided
additional data suggesting the participants
benefited from what the program has to
offer. Consistent with program theory, the
participants reported value in the
participant-worker relationship. This
relationship appears to be the primary
mechanism for achieving positive client
outcomes.
1992-1998 Evaluation Report
Methodology: descriptive analysis of
program participants, screening and
assessment data, pretest/posttest data on the
Parenting Stress Index, the Child Abuse
Potential Inventory and the HOME
observation scale. Evaluation design is
strengthened with the addition of a
comparison group for the Child Abuse
Potential Inventory. Because of a state-level
change to the computerized CHILDS system
of data collection, this report did not include
an analysis of child abuse and neglect rates.
Results: Assessment using the Child Abuse
Potential Inventory showed some positive
outcomes. In particular, baseline to post test
at 12 months showed significant
improvement in 4 of the 7 subscales: abuse,
distress, rigidity, and problems with others.
More importantly, an analysis was
conducted to compare the change in scores
between the Healthy Families participants
and a comparison group of individuals who
did not receive treatment. The Healthy
Families group reduced their potential for
abuse significantly more than the
comparison group. Noteworthy was the
finding that the comparison subjects actually
increased their abuse potential as shown by
an increase rather than a decrease on the
abuse subscale. The Parenting Stress Index
findings replicated the earlier reports
showing 10 of 11 subscales had significant
gains for the participants. This cohort was
also compared with the earlier comparison
group using the Parenting Stress Index.
Results found significance between group
differences favoring the Healthy Families
participants. The results for the HOME
scale also found significant gains for
participants at 12 month and 2 year
assessments for the total score and most of
the subscales. Immunization rates assessed
at three time periods were again higher than
what has been typically reported for
statewide immunization rates.
Conclusions: This report added to the
evidence of effectiveness by finding
improvements with the Child Abuse
Potential Inventory. Especially significant
was the greater between group differences in
the Healthy Families group on abuse
potential when compared to a no-treatment
group. Also important was the replication of
positive findings from the Parenting Stress
Index. Critical program changes included
the beginning efforts to systematically assess
and intervene with families that have
substance abuse problems. The program
also showed improvement in the retention of
families and that has been a major
implementation issue. New efforts were also
initiated to include fathers and expand
outreach to strengthen the family focus of
the program and the program began to
collect participant satisfaction data.
Healthy Families Evaluation
Reports 2000 and 2001
Methodology: The last two reports from
years 2000 and 2001 are combined because
their methodology and results are quite
similar. In these reports, the focus shifted
from an extensive examination of outcomes
to an examination on program improvement
based on site-level data. After extensive
analysis of multiple measures and outcomes,
the program evaluation was refined using a
smaller set of measures consisting primarily
of the Parenting Stress Index, child safety in
the home, and immunization rates. The
program continues to monitor participant
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 13
data based on the screening tool, child
development and referral for delays, links to
medical doctors, maternal life outcomes such
as employment and education and parent
satisfaction with the program. These data
are used primarily for program
improvement.
Results: Data from both years replicate the
earlier findings from the Parenting Stress
Index showing improvement from baseline to
6, 12 and 18-month assessments. Data on
child safety show increases from baseline to
assessment but increases are small because
most parents are practicing safety habits
prior to assessment. Immunization rates
have remained stable and are consistently
higher than comparable statewide data. In
both years the rate of child abuse and
neglect remained very low. For example, in
2001 the child abuse and neglect rate was
0.8% for the Healthy Families group and
1.7% for the comparison group.
Conclusions: Program results continue to
be documented by the gains shown in the
Parenting Stress Index, increases in
immunization rates (and higher rates than
statewide averages), small increases in child
safety practices in the home, and low child
abuse and neglect rates.
What is the evidence for program
effectiveness based on the
evaluation studies completed?
The converging evidence for Healthy
Families Arizona suggests that the program
is effective. This conclusion is supported by
the following findings: replicated evaluations
showing improvement from baseline to post
assessment periods, positive results when
using a comparison group on the Parenting
Stress Index, replication of positive gains and
positive results from a comparison group
using the Child Abuse Potential Inventory,
findings showing the comparison group
getting worse on most measures while the
Healthy Families participants were showing
improvements, findings showing
immunization rates higher than the
statewide average, and findings that
consistently show the Healthy Families
participants had lower rates of child abuse
and neglect when contrasted to a comparison
group not receiving the program. Other
outcomes that add to the cumulative
evidence include the qualitative study that
documented the perceived value the families
report from being involved in the program,
the cost benefit study which found that cost
savings can be documented, and twelve
years of experience in working toward
program improvement showing gains in
program implementation such as increased
immunization and retention rates over time.
Assessing program effectiveness is always a
complex process, which requires a balance of
good methodology, measures, and program
implementation. In the end, a question of
effectiveness requires a judgment be made
based on an assessment of the data.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 14
Implementation Update 2002
There have been no new requirements added
to the program during the last three years.
However, the Healthy Families state system
has developed new implementation
strategies. First, a series of small focus
groups was held to discover the barriers and
challenges that hinder home visitors from
focusing on parent-child relationships and
child development. From these focus groups,
a staff situational questionnaire was
developed, implemented and analyzed
identifying which situations occur the most
frequently and are the most difficult to
address. Training is being developed around
each of these issues and will be implemented
through the Training Institutes. Support for
staff in dealing with these issues will be
systemic and all aspects of the state system
are being analyzed.
Training efforts have been focused on
developing the skills of the supervisors and
program managers across the state.
Advanced supervision training has been
scheduled each quarter. Consultants have
been included in the training to provide
regional interim support monthly as
supervisors integrate new supervisory skills
into practice. Reflective, responsive
supervision is seen as key to successful
program outcomes.
Thirdly, in an effort to reach out and include
fathers in service delivery, a state
Fatherhood Involvement Committee has
been established. This committee defined
active father/male involvement, methods
staff could use to reach out to fathers, and
training content to be included during the
Training Institute and on site visits. Initial
data were gathered to determine father/male
involvement as a baseline and will be
reviewed on a regular basis.
In order to integrate early intervention
services for children with special needs,
Healthy Families Arizona developed policies
and procedures that were reviewed and
agreed to by the Arizona Early Intervention
Program (AzEIP). These procedures will
facilitate the referral process to therapy and
other services for children with special
needs. Additionally, semi-annual training
has been institutionalized for staff
administering the Ages and Stages
Questionnaire, a child developmental screen.
Finally, in August 2002, Healthy Families
Arizona applied for and was awarded the
Western Regional Resource Center of
Excellence. This center will provide training
and technical assistance to the western
states in all areas of Healthy Families
program implementation. Arizona is one of
two regions awarded the contract due to the
quality of our statewide system.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 15
Program Participants
What risk factors are associated with Healthy Families Arizona program
participants?
The graph shows that the kinds of families
recruited to participate in the Healthy
Families Arizona program are participants
with clearly identifiable risk factors. These
risk factors are associated with poor child
development outcomes and child abuse and
neglect. Important to any prevention
program is the ability to target an at-risk
population to deliver services. In examining
the Healthy Families Arizona screening
process, it is evident that the program is
identifying a proper target population for
services.
Exhibit 1. Selected risk factors for
Healthy Families mothers at intake
Risk Factors Number
Teen Births (<19 years old) 38.5%
Births to single parents 70.8%
Less than high school education 62.9%
Not employed 17%
No health insurance 4.8%
Late or no prenatal care 38%
Median yearly income $9,600
What is the ethnicity of the mothers served by the Healthy Families Arizona
program?
The Healthy Families Arizona program
seeks to serve a culturally diverse number of
participants in the state. Each site (see site
level data in the Appendices) does an
analysis of its community and ensures that
staff are representative of the ethnic groups
in the community. Staff are also trained in
cultural competency.
Exhibit 2. Ethnicity of Healthy Families
Mothers
                  
                               
                  
                               
                  
                               
                  
                               
                  
                               
                  
                               
                  
                               
                  
                               
                  
                               
                  
                               
                                                 
                                                                                                         Caucasian
21%
Hispanic
59%
Other
4%
Native
American
8%
Asian
American
1%
African
American
7%
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 16
What percentage of mothers and fathers obtain a rating of severe on the Family
Stress Checklist items?
Exhibit 3. Percentage of Mothers and Fathers Rated Severe on the Family Stress
Checklist Items
                     
                     
   
   
          
         
                           
                           
                                                                                                          
                                                                                                          
   
                                                                                            
                                     
                                     
                                                                                                                
                                                                                                                
0 10 20 30 40 50 60 70
Parental Attachment
Difficult Child
Discipline Attitudes
Expectations of Infant
Violence Potential
Current Life Stresses
CPS Involvement
Self-esteem, isolation
Crime, substance abuse, mental illness
Childhood Abuse
Percent with Severe Rating
      
       Male Female
During the initial assessment period, mothers and fathers are rated using the Family Stress
Checklist. The above graph shows the three greatest stressors in families’ lives: coping with a
history of child abuse, feeling low and isolated, and difficulty in coping with major stresses such
as low income, poor housing, and relationship difficulties.
What percentage of infants has high-risk characteristics?
Exhibit 4. Percentage of infants with
high-risk characteristics
Risk Factor Percent
Born <37 weeks gestation 15.1%
Birth defects 1.1%
Low birth weight 14.2%
Positive alcohol screen 0.4%
The initial screening and assessment process
identifies the risk characteristics of infants
entering the program. Many of these risk
characteristics are associated with increased
risk for child abuse and neglect. The
screening process helps workers provide
tailored services to help families that have
infants who may need special attention.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 17
Service Delivery
What number of participants does each county and site serve?
Exhibit 5. Number of participants served by county, by site
Site and Participants Served Site and Participants Served
Cochise County
Douglas/Bisbee 112
Sierra Vista 111
Coconino County
Flagstaff 82
Page 50
Tuba City 60
Mohave County
Lake Havasu City 129
Maricopa County
Central Phoenix 95
East Valley Phoenix 79
Maryvale 89
Mesa 110
South Phoenix 78
Southeast Phoenix 120
Sunnyslope 119
Pima County
Casa de los Niños 129
CODAC 120
Devereux 121
La Frontera 138
Pascua Yaqui 42
Pinal County
Pinal County Department
Of Public Health 110
Santa Cruz County
Nogales 122
Yuma County
Yuma 104
Yavapai County
Prescott 142
Verde Valley 85
TOTAL ALL SITES = 2,347
The number of participants served across all
sites for the study time period (July 1, 2001
– June 30, 2002) totals 2,347. Sites serve
different numbers of families depending on
their funding level and number of Family
Support Specialists at the site. Enrollment
and participation in the program remains a
program strength in that services are
delivered to meet a broad range of needs
such as child safety in the home,
immunizations, and parenting skills to a
large number of families. In spite of the
volunteer nature of the program,
recruitment and participation remains high
(over 90% of the families who are offered the
program, accept services).
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 18
What is the length of time in the program at termination for engaged families?
In the home visitation field, a factor that has
taken on increasing importance is the
process of actively engaging families in the
services. Families may enroll in the program
but are not actively engaged until four home
visits have been completed. In this year’s
study, the percentage of families who were
actively engaged was 89.4%, therefore only
about 10% terminated the program prior to
the four home visits. Exhibit 6 describes the
actual length of time that families
participated in the program before
termination. Only 4% terminated the
program at 3 months, which is a vast
improvement over last year when 11.1%
terminated at 3 months. Over half of the
families participate for a year or longer. The
average length of days in the program
increased from 498 days in last year’s study
to 595 days in this year’s study. In
summary, Healthy Families Arizona has
documented 3 years of steady improvement
in the engagement and retention of families.
Exhibit 6. Length of time in the
program at termination for engaged
families
             
                             
             
                             
             
                             
             
                             
             
                             
                             
                             
                             
                             
                             
                                          
                           
                           
                           
                           
                           
                                                                                              7-9
months
16%
1 year
and
beyond
10-12 56%
months
10%
3-6
months
14%
Up to 3
months
4%
Exhibit 7. Major reasons for termination from the program
5.1%
6.0%
8.3%
10.5%
10.6%
29.3%
30.2%
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
Achieved self-sufficiency
Refused a change in worker
All other reasons
Completed program
Family refused further services
Unable to contact
Moved away
Percent of Families
In order to better understand how
participants move in and out of the program,
Healthy Families Arizona collects data on
the reasons for termination in the program.
Exhibit 7 presents this information. As can
be seen, the main reasons for termination
are being unable to contact the family and
family moved away. Noteworthy is that in
last year’s study 5.7% had completed the
program as a reason for termination and this
year the percentage is up to 10.5%.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 19
How do families who do not engage differ from those that do?
This is an important question because it
provides information about which families
may need extra attention and help to stay
engaged in the program. Several factors
were examined to see if differences between
the engaged and non-engaged families were
present. The results reveal that most factors
did not show a difference such as: age of the
mother, Family Stress Checklist score,
ethnicity of the mother, low birth weight of
the infant, and household size. Only two
factors could be considered to be
meaningfully different: about 5% more early
terminators where single parents and 5% of
the early terminators were more likely to
have had only a chart screen as opposed to a
verbal screen at initial intake. Overall, it
does not appear that any one set of risk
factors are more likely to lead to early
termination from the program.
Program Outcomes for 2002
Healthy Families Arizona has continued to collect outcome data to examine program
effectiveness. This section reports on multiple outcome indicators to study the overall impact of
the program on parental stress and competence, child abuse and neglect, safety practices in the
home, medical and social service use, and employment and educational attainment.
Do Healthy Families Arizona participants show reductions in stress after
participating in the program?
One of the primary outcome indicators for
the success of the Healthy Families Arizona
program has been a measure of parental
stress. This is because parental stress is
related to increases in child abuse and
neglect. The Parenting Stress Index (Abdin,
1995) is a reliable and valid measure used
extensively in research and evaluation
studies. This index provides data on the
total amount of stress and information on
seven subscales: sense of competence,
parental attachment, feeling restricted in
one’s role, depression, isolation,
distractibility, and mood. As the exhibit
shows, significant pretest to posttest changes
occurred for every subscale at 6 months and
all but one subscale at 12 and 18 months.
Furthermore, the total parenting stress score
shows significant change across all time
periods.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 20
Exhibit 8. Parenting Stress Index Findings
Time Period
Subscale Baseline to 6
months
Baseline to 12
months
Baseline to 18
months
Sense of Competence Significant
Improvement
t=9.28, p<.000
Significant
Improvement
t=7.07, p<.000
Significant
Improvement
t=3.25, p<.001
Parental Attachment Significant
Improvement
t=5.83, p<.000
Significant
Improvement
t=4.26, p<.000
Significant
Improvement
t=2.97, p<.003
Feeling restricted in role Significant
Improvement
t=3.60, p<.000
Significant
Improvement
t=4.46, p<.000
Significant
Improvement
t=3.57, p<.000
Depression Significant
Improvement
t=4.85, p<.000
Significant
Improvement
t=5.05, p<.000
Significant
Improvement
t=3.93, p<.000
Isolation Significant
Improvement
t=4.57, p<.000
Significant
Improvement
t=4.47, p<.000
Significant
Improvement
t=3.20, p<.002
Distractibility Significant
Improvement
t=2.66, p<.000
No Significant
Improvement
t=0.10, p>0.05
No Significant
Improvement
t=0.10, p>0.05
Mood Significant
Improvement
t=11.88, p<.000
Significant
Improvement
t=6.90, p<.000
Significant
Improvement
t=3.06, p<.002
Total Stress Score Significant
Improvement
t=9.63, p<.000
Significant
Improvement
t=6.82, p<.000
Significant
Improvement
t=4.48, p<.000
Note: See Appendix B for statistical details. Most reliabilities for the subscales were adequate, distractibility has an alpha
of .47 which may explain why results were not significant for this scale. Definitions of each subscale can be found in
Appendix B.
Child Abuse and Neglect Outcomes
Is there a difference in the rate of child
abuse and neglect when comparing
treatment and comparison groups?
A common expectation of program impact is
examination of the incidence of child abuse
and neglect reports from the families who
participate in the program. These data are
presented in Exhibit 9, although reports of
child abuse and neglect are unlikely to be a
good measure of program impact. This is
because of several factors: child abuse and
neglect are low occurring events, many
incidents (perhaps up to one third) of child
abuse and neglect go unreported, and
increased community involvement with the
family (e.g., mandatory reporting by
physicians) may lead to increased reporting
which can suggest the misleading conclusion
that the program has no impact.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 21
Exhibit 9. Percent of child abuse and neglect cases in treatment and comparison
groups
Group CPS Match Rate
Healthy Families Participants 0.76%
Comparison Group Participants 0.84%
Exhibit 9 summarizes the percent of child
abuse and neglect reports from two groups:
the Healthy Families treatment group and a
comparison group. The treatment group
consists of families who have had at least
four or more home visits (sufficient time to
expect a program impact) and the
comparison group consists of families who
dropped out and did not complete at least
four visits. The results are based on all
families who entered the program during the
study period of July 1, 2001 to June 30,
2002. Both groups had a very small
percentage of matches when compared with
the CHILDS registry. There were no
significant differences between the groups
and it is difficult to detect such differences
when the rates are so small.
Do Healthy Families Arizona participants show increases in child safety after
participating in the program?
Exhibit 10. Percent of safety practices implemented
Since home visitors are in the parent’s
home environment, they are in an
excellent position to improve the safety
of the family’s home. Data obtained
from a child safety checklist show that
most homes follow safety procedures
and that on some indicators, child
safety increases over time.
This exhibit shows that on two safety
measures, outlets covered and poisons
being locked, increases can be detected
from the 2 month, 6 month and 12
month assessment. Other safety
indicators are also assessed including:
smoke alarms, car seats, scissors and
knives, lighters and matches, water
safety, emergency phone numbers,
outside supervision, and food storage.
At the 2-month assessment, these other
safety practices were all being actively
used with over 90% of the participants.
     
    
    
    
    
    
    
    
    
    
    
          
          
          
          
          
          
          
          
          
          
         46.7%
82.2%
 
   
 
   
 
   
 
   
 
   
 
   
 
   
 
   
 
   
   
   
   
   
                                                                                           
          
          
          
60.7%
89.7%
 
    
 
    
 
    
 
    
 
    
 
    
 
    
 
    
 
    
 
    
 
    
 
    
 
    
 
    
 
    
 
    
                                                                                                                                                72.8%92.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Percent
2 months 6 months 12 months
    
     Outlets Covered
Poisons Locked
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 22
Do Healthy Families Arizona child participants show increased levels of
immunization after participating in the program?
One goal of the Healthy Families program is
to ensure that all families receive
appropriate medical care. An assessment of
this can be conducted by looking at the rate
of immunizations that the children receive.
Exhibit 11 shows the percentage of
immunizations at different time periods.
Overall, program children do receive the
required immunizations and, when
compared with ADHS (2001) data, Healthy
Families Arizona children do fairly well.
This is especially noteworthy when
considering that the program participants
represent a high-risk group (less likely to get
immunizations) and the state rate for
immunization of 2 year olds is 78%
(including both high-risk and low-risk
groups).
Exhibit 11. Rate of immunization by
Healthy Families participants
Immunization
period
Percent
immunized
Immunization
rate for 2-
year-olds in
Arizona
(OAG, 1999)
2 month 92.7%
4 month 86.9%
6 month 76.6%
12 month 86.6%
Received all 4
in the series 83.9% 78%
What percent of Healthy Families program children get linked to a medical
doctor?
Exhibit 12 shows the percentage of families that are linked to a medical doctor, a critical goal of
the program.
Exhibit 12. Percentage of children linked to a medical
doctor at 6, 12, and 24 months
94.8%
96.2%
97.3%
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
24 months
12 months
6 months
Percentage of Children Linked to Medical Doctor
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 23
What percent of Healthy Families participants make appropriate use of the
emergency room?
Data were also collected on emergency room
use. A concern from health providers has
been the inappropriate use of the emergency
room for routine health care. Exhibit 13
shows a trend for an increasing number of
participants who use the emergency room
only when having obtained a doctors’
referral.
Exhibit 13. Percent of Healthy Families participants who make
appropriate use of the emergency room
0 10 20 30 40 50 60 70 80 90 100
60 months
54 months
48 months
42 months
36 months
30 months
24 months
12 months
6 months
Percent Using Emergency Room Appropriately
What percent of families are detected to have children with developmental
delays?
The Healthy Families program seeks to
monitor and promote healthy child
development. Families that are in the
program are offered developmental screening
to assess their child’s developmental status.
Both the parents and the home visitors are
learning ways to encourage proper
stimulation for growth and development and
can then use this information. Home visitors
attempt to administer the Ages and Stages
Questionnaire to all their families. At the 4-
month time period, 55.8% of families had
been administered the questionnaire, at the
6-month time period, 60.2% of the families
had been administered the questionnaire.
Exhibit 14. Developmental delay from 4
to 36 months
Developmental delay at 4 months 11.3%
Developmental delay at 12 months 4.2%
Developmental delay at 24 months 13.8%
Developmental delay at 36 months 7.5%
Infants whose development is delayed are
referred to early intervention services.
Another major service that the program offers
parents is early detection of such problems.
Exhibit 14 shows the percent of developmental
delays detected across four time periods. In
almost all cases, children who were detected
for delays were referred to appropriate follow-up
services such as early intervention, AzEIP,
or an intervention program.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 24
What percent of families have
alcohol and drug problems?
High-risk families can have serious
difficulties with alcohol and drug problems.
The Healthy Families program is able to
provide screening and referral for families
who need to seek alcohol and drug
treatment. Exhibit 15 shows the percentage
of families who screened positive for alcohol
and drug problems across four time periods.
Exhibit 15. Percentage of families who
screened positive for alcohol and drug
problems
2 months (N=35) 6.8%
6 months (N=16) 3.7%
12 months (N=22) 5.7%
18 months (N=12) 4.5%
While only a small number of participants
are identified, those who are identified are
referred to treatment. Given the strong
connection between substance abuse and
child abuse and neglect, getting even a few
families into treatment could have a
significant impact.
Maternal Life Course Outcomes
Although the Healthy Families program
focuses on parent-child interaction as a
primary goal, it can also bring benefits with
regard to maternal life course outcomes such
as subsequent pregnancies, education and
employment.
What percentage of mothers have
subsequent pregnancies?
Subsequent pregnancies were reported by
12.1% (N=254) of the participants while
involved in the program. Of these mothers,
36% were 18 years or younger. In terms of
how quickly they got pregnant, 36.1% did so
within one year, the majority (43.4%) did so
within 1-2 years.
Do Healthy Families Arizona
participants show increases in
employment after participating in
the program?
Exhibit 16 shows the percent change in
employment status for mothers actively
engaged in the program at baseline, 6
months and 12 months.
Exhibit 16. Mother’s employment status
across three time periods
15.9%
31.3%
40.8%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Percent
Baseline 6 months 12 months
What percentages of Healthy Families
Arizona participants become enrolled
in school while participating in the
program?
Exhibit 17 shows small but consistent
involvement in educational programs while
participants are involved in the program.
Exhibit 17. School enrollment status of
mothers at 6 months
1%
6%
12%
17%
0% 20% 40% 60% 80% 100%
College Degree Obtained
High school/GED Obtained
Enrolled part-time
Enrolled full-time
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 25
Participant Satisfaction
One aspect of program implementation,
especially with a voluntary program like
Healthy Families, is the satisfaction family
members express about their participation. All
Healthy Families program sites undertake an
evaluation of both the program and staff after
approximately 2 months of program
involvement. Exhibit 18 shows that 98% of all
participants returning a survey (N=557) agreed
or strongly agreed that they had been treated
with respect and dignity. In terms of program
involvement, Exhibit 19 shows that 94% of the
families were somewhat satisfied or very
satisfied with the program.
Exhibit 18. Responses to “The Healthy
Families staff who offered me program
services treated me with respect and
dignity.”
                           
                          
                           
                          
                           
                          
                           
                          
                           
                          
                                                     
                                                     
                                                     
                                                     
Strongly
Agree
78%
Neutral
1%
Strongly
Disagree
Agree 1%
20%
Exhibit 19. Responses to “How did you
feel about the program so far?”
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                                                      
                                                      
                                                      
                                                      
Very
Satisfied
81%
Neutral
5%
Very
Unsatisfied
1%
Somewhat
Satisfied
13%
Finally, Exhibit 20 describes various worker characteristics, such as polite or friendly, and the
data show that almost 100% of workers are rated in a positive manner.
Exhibit 20. How would you describe the Healthy Families worker who first offered
you program services? (On a five point scale, shown are the two highest options for each
characteristic)
Characteristics
99.3%
98.8%
98.8%
93.7%
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
Friendly to Very Friendly
Somewhat Patient to Patient
Somewhat Concerned to Concerned
Somewhat Polite to Very Polite
Percent of Participants
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 26
Recommendations
In order to continue to focus Healthy
Families programming on factors that are
likely to lead to the greatest outcomes, this
year’s recommendations are based on an
assessment of practice principles recently
established by Neil Gutterman (2001) in his
extensive review of home visitation research.
Practice principle 1: To effectively serve
families in their homes, workers must
structure their work to clarify their focus
with families.
This practice principle concerns the
implementation of the home visitation
services. Because the evaluation has had a
primary focus on outcome evaluation, not
much attention has been paid in several
years to the process of doing home visitation.
However, an ongoing issue in
implementation of services has always been
clarifying the role of the home visitor.
Therefore, a recommendation is to continue
efforts at role clarification to help re-focus
home visitors on their key functions with
families. An additional assessment may be
helpful in identifying any further issues
around how to structure and clarify roles
with families.
Practice principle 2: Early home visitation
programs should adapt and/or adopt
parenting educational curricula with clear
objectives, structured protocols that directly
address those objectives and do so in ways
that are compatible with and respectful of the
families’ own cultural and individual
contexts.
It is encouraging to note that ongoing work
has been done in the implementation of the
Healthy Families Arizona program to refine
and examine the use of curricula. In fact, a
recent analysis of data attempted to examine
the impacts of using the Growing Great Kids,
Portage, and other varied curriculum. This
practice principle suggests a further need to
assess the use of existing curricula in each
site. Furthermore, whatever curricula are
used should be evaluated for clear objectives
and accompanying protocols for
implementation. In areas where the
curricula do not have clear protocols, they
should be developed. Also, the recent study
of difficult situations for home visitors in the
Healthy Families Arizona program could be
used as a starting point for developing
clearer protocols to respond to those
situations.
Practice principle 4: Programs do not
appear to increase their advantage by
deploying multidisciplinary teams, either
with regard to outcomes related to child
maltreatment or with regard to cost
efficiency.
Healthy Families Arizona does not employ a
multidisciplinary team by design so this
practice principle is already in place.
Practice principle 5: Programs that
deliver, in practice, at least moderately
intensive services–biweekly or more
frequently–are linked with more favorable
family participation and child maltreatment-related
outcomes than those providing less
intensive services. This trend holds for the
frequency of services usually delivered, not
for the frequency planned to be delivered.
The Healthy Families Arizona program has
continued to work on and has improved the
engagement and retention rate of families.
More intensive models of limited duration
appear to hold greater promise for positive
outcomes, where families are more likely to
be engaged and involved in services, in
comparison to approaches with less intensive
services and longer service horizons. This
practice principle suggests more effort might
be made in ensuring an intensely delivered
service. Since this is deemed an important
practice principle, supervisors should
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 27
consider program intensity when addressing
how workers can respond to families with
greater needs.
This practice principle also directs attention
to prenatal initiated services that are
associated with more favorable engagement
and retention rates and reported outcomes.
Furthermore, services initiated at the
prenatal stage hold the opportunity to
address significant problems that shape the
in-uterus environment and that later
heighten risk for both maltreatment and for
a host of poor developmental outcomes.
Currently, prenatal initiated services by
Healthy Families Arizona are legislatively
restricted.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 28
References
Abdin, R. L. (1995). The parenting stress index. Odessa, FL: Psychological Assessment
Resources.
Gutterman, N. (2001). Stopping child maltreatment before it starts. Thousand Oaks,
CA: SAGE Publications.
Office of the Auditor General Report (1999). Department of Health Services: Bureau of
Epidemiology and Disease Control Services.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 29
Appendix A.
List of Healthy Families Arizona Reports Prepared by
LeCroy & Milligan Associates, Inc. (formerly LAM & Associates)
1) Implementation Study: Arizona Healthy Start/Families – (published 1993)
2) Arizona Healthy Families Outcome Evaluation Report for 1992-1993 Families –
(published 1993)
3) Arizona Healthy Families: First Year Outcome Evaluation Report – (published
1994)
4) Healthy Families Arizona Evaluation Report for Tucson, Prescott and Casa
Grande Sites 1992-1994 – (published 1996)
5) Qualitative Interview Study of Healthy Families Arizona – (published 1997)
6) Healthy Families Arizona Evaluation Report 1992-1996 (all sites) – (published
1997)
7) Healthy Families Arizona Evaluation Report, 1992-1998 (all sites) – (published
1999)
8) Healthy Families Arizona Evaluation Report, 2000 (published 2000)
9) Healthy Families Arizona Evaluation Report, 2001 (published 2001)
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 30
Appendix B
Parenting Stress Index Information
Reliabilities for Current Study
Subscale Alpha
Competence .73
Attachment .62
Restricted Role .72
Depression .78
Isolation .73
Distractability .48
Mood .69
Change in Parenting Stress Index Subscales Scores from baseline to 6 months
Baseline 6 months Significance
Subscale Mean SD Mean SD t
Competence 31.6 6.2 29.6 6.1 9.28
Attachment 12.9 3.8 12.19 3.5 5.83
Restricted role 19.97 4.9 19.25 5.2 3.60
Depression 20.56 6.0 19.52 6.1 4.85
Isolation 14.58 4.5 13.82 4.6 4.57
Mood 10.65 3.2 9.15 2.9 11.88
Note: * p<.01, ** p<.001, *** p<.000, dependent t-tests, SD=Standard Deviation. Test
are significant when applying a Bonferroni correction. N’s vary from 689 to 696.
Change in Total Parenting Index Scores from baseline to 6 months
Baseline 6 months Significance
Subscale Mean SD Mean SD t
Total Stress Score
(N=684) 136.4 24.0 128.90 25.1
6.82
*** p<.000
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 31
Appendix B Continued:
Change in Parenting Stress Index from baseline to 12 months
Baseline 12 months Significance
Subscale Mean SD Mean SD t
Competence 31.58 6.2 29.4 5.9 7.07
Attachment 13.04 3.9 12.30 3.7 4.26
Restricted role 19.98 5.0 18.77 5.6 4.46
Depression 20.82 6.3 19.38 6.2 5.05
Isolation 14.66 4.7 13.61 4.8 4.47
Mood 10.68 3.3 9.52 2.9 6.90
Note: * p<.01, ** p<.001, *** p<.000, dependent t-tests, SD=Standard Deviation. Test
are significant when applying a Bonferroni correction. N’s range from 454-461.
Change in Total Parenting Index Scores from baseline to 12 months.
Baseline 12 months Significance
Subscale Mean SD Mean SD t
Total Stress Score
(N=453) 136.44 24.0 128.9 25.1
6.82
*** p<.000
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 32
Appendix B Continued:
Change in Parenting Stress Index from baseline to 18 months
Baseline 18 months Significance
Subscale Mean SD Mean SD t
Competence 31.08 6.2 29.66 6.2 3.25
Attachment 13.02 3.9 12.26 3.2 2.97
Restricted role 20.14 5.0 18.69 5.7 3.59
Depression 20.70 6.0 19.0 5.8 3.93
Isolation 14.4 4.5 13.34 4.6 3.20
Mood 10.62 3.3 9.72 3.2 3.06
Note: * p<.01, ** p<.001, *** p<.000, dependent t-tests, SD=Standard Deviation. Test
are significant when applying a Bonferroni correction. N’s range from 239-242
Change in Total Parenting Index Scores from baseline to 18 months.
Baseline 18 months Significance
Subscale Mean SD Mean SD t
Total Stress Score
(N=239) 136.76 127.78 25.47
4.48
*** p<.000
Range and Reliability of the Parenting Stress Index (PSI) (Selected subscales
for original reliabilities analysis)
Subscales
Rangea
Alpha
Coefficient
Administration
Sense of Competence 13 - 65 .77
Parental Attachment 7 - 35 .64
Role Restriction 7 - 35
.74
Depression 9 - 45 .75
Social Isolation 6 - 30 .69
Mood 5 - 25 .70
Distractibility 9 - 45 .82
Total Scoreb 78-390 .85
Administered
at 3 weeks, 6
months, and 18
months
a A higher score on each of the subscales represents a higher degree of stress in that
area.
b The total score on the Parenting Stress Index is computed by summing all of the
subscales, with a higher score indicating more stress.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 33
Appendix B Continued:
Description of Parenting Stress Index Subscales
Sense of Competence Subscale: Assesses the parent’s sense of competence in relation to his or her
role as parent. It relates to knowledge of how to manage the child’s behavior and comfort in making
decisions such as when and how to discipline the child.
Parental Attachment Subscale: Assesses the intrinsic investment the parent has in the role of
parent. This subscale was expected to determine the parent’s motivation level to fulfill the role of
parent.
Restrictive Role Subscale: Assesses the negative impact, losses, and sense of resentment associated
with the parent’s perceptions of loss of important life roles.
Depression Subscale: Assesses the extent to which the parent’s emotional availability to the child is
impaired and the extent to which the parent’s emotional and physical energy is compromised.
Isolation Subscale: Examines the parent’s social isolation and the availability of social support for
the role of parent.
Distractibility Subscale: Assesses the degree to which the child displays many of the behaviors
associated with Attention Deficit Disorder with Hyperactivity and other behaviors which result in a
continuous drain on the parents’ energy, which requires not only active parental management but
also sustained high states of vigilance.
Mood Subscale: Assesses child characteristics related to excessive crying, withdrawal, and
depression. The parent usually experiences these behaviors as anxiety or anger provoking.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 34
Appendix C
Family Stress Checklist
Family Stress Checklist Problem Areas and Interpretation (Mother & Father)
Problem Areas
Range
Interpretation/
Administration
I. Childhood history of
physical abuse and
deprivation.
II. Substance abuse,
mental illness, or criminal
history.
III. Previous or current
CPS involvement.
IV. Self-esteem, available
lifelines, possible
depression.
V. Stresses, concerns.
VI. Potential for violence.
VII. Expectations of
infants milestones,
behaviors.
VIII. Discipline of infant,
toddler, and child.
IX. Perception of new
infant.
X. Bonding, attachment
issues.
0, 5, or 10
0, 5, or 10
0, 5, or 10
0, 5, or 10
0, 5, or 10
0, 5, or 10
0, 5, or 10
0, 5, or 10
0, 5, or 10
0, 5, or 10
The FSC is a 10 item
rating scale. A score of 0
represents normal, 5
represents a mild degree of
the problem, and a 10
represents severe, on both
the Mother and Father
Family Stress Checklist
items. The FSC is an
assessment tool and is
administered to the mother
through an interview by a
Family Assessment Worker
from the Healthy Families
Arizona Program. The
interview takes place
shortly after birth, or as
near to that time as
possible.
Total Score
0 - 100
A score over 25 is
considered medium risk for
child abuse and neglect,
and a score over 40 is
considered high-risk for
child abuse.
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 35
Appendix D
Site Level Data
Age of Child at Entry
Days to Termination
Reason for Termination
Mothers’ Education
Fathers’ Education
Health Insurance at Intake
Late or No Prenatal Care or Poor Compliance at Intake
Ethnicity of Mother
Gestational Age
Low Birth Weight
Yearly Income
Family Stress Checklist Score
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 36
Age of Child at Entry by Site
(Age in days)
Site Mean
(Age in Days)
Standard
Deviation Number
Douglas/Bisbee 17.88 17.81 104
Central Phoenix 27.10 21.58 88
Maryvale (Phoenix) 21.23 15.57 82
South Phoenix 21.95 21.21 73
East Valley (Phoenix) 21.75 18.16 64
Nogales 12.21 15.76 104
Page 21.18 19.41 49
Casa de los Niños (Tucson) 20.82 15.16 119
CODAC (Tucson) 17.90 20.12 105
La Frontera (Tucson) 17.04 14.23 131
Devereux (Tucson) 17.96 20.86 117
Sierra Vista 13.48 17.57 94
Tuba City 11.71 14.19 55
Verde Valley 10.17 10.74 75
Yuma 16.63 14.95 93
Pascua Yaqui 43.65 30.58 40
Lake Havasu City 25.06 19.14 120
Flagstaff 14.51 20.50 74
Sunnyslope (Phoenix) 24.79 19.82 94
Prescott 20.89 19.62 119
Casa Grande 18.82 19.97 93
Mesa 20.29 14.96 93
Southeast Phoenix 19.25 14.27 105
Total 19.37 18.75 2091
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 37
Days to Termination by Site
(For terminated clients)
Site Mean
(Days to termination)
Standard
Deviation Number
Douglas/Bisbee 873.82 664.61 28
Central Phoenix 809.92 649.34 25
Maryvale (Phoenix) 555.08 497.03 25
South Phoenix 618.25 536.53 28
East Valley (Phoenix) 592.55 413.04 31
Nogales 909.23 655.79 26
Page 615.44 540.98 16
Casa de los Niños (Tucson) 585.84 431.97 49
CODAC (Tucson) 781.02 547.03 43
La Frontera (Tucson) 767.28 623.66 32
Devereux (Tucson) 662.39 457.02 28
Sierra Vista 378.48 289.30 50
Tuba City 607.54 553.26 13
Verde Valley 638.72 588.75 29
Yuma 765.89 540.81 27
Pascua Yaqui 310.71 477.37 7
Lake Havasu City 487.19 507.02 36
Flagstaff 421.91 345.67 23
Sunnyslope (Phoenix) 507.57 520.38 30
Prescott 328.11 285.15 27
Casa Grande 455.14 285.68 36
Mesa 401.64 350.81 28
Southeast Phoenix 346.34 200.03 32
Total 595.50 508.88 669
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 38
Reason for Termination by Site
(Number and Percent within Site)
Site Moved Away Unable to
contact
Family refused
further services
Douglas/Bisbee 39.3% (11) 3.6% (1) 7.1% (2)
Central Phoenix 44% (11) 20% (5) 0
Maryvale (Phoenix) 28% (7) 28% (7) 12% (3)
South Phoenix 18.6% (8) 53.6% (15) 3.6% (1)
East Valley (Phoenix) 12.9% (4) 41.9% (13) 6.5% (2)
Nogales 38.5% (10) 11.5% (3) 26.9% (7)
Page 43.8% (7) 18.8% (3) 18.8% (3)
Casa de los Niños (Tucson) 26.5% (13) 36.7% (18) 2% (1)
CODAC (Tucson) 16.3% (7) 30.2% (13) 11.6% (5)
La Frontera (Tucson) 28.1% (9) 21.9% (7) 9.4% (3)
Devereux (Tucson) 17.9% (5) 25% (7) 7.1% (2)
Sierra Vista 36% (18) 42% (21) 6% (3)
Tuba City 30.8% (4) 7.7% (1) 15.4% (2)
Verde Valley 41.4% (12) 24.1% (7) 3.4% (1)
Yuma 37% (10) 22.2% (6) 7.4% (2)
Pascua Yaqui 14.3% (1) 0 0
Lake Havasu City 41.7% (15) 16.7% (6) 13.9% (5)
Flagstaff 34.8% (8) 30.4% (7) 21.7% (5)
Sunnyslope (Phoenix) 26.7% (8) 30% (9) 16.7% (5)
Prescott 33.3% (9) 44.4% (12) 7.4% (2)
Casa Grande 41.7% (15) 25% (9) 11.1% (4)
Mesa 21.4% (6) 25% (7) 21.4% (6)
Southeast Phoenix 12.5% (4) 59.4% (19) 21.9% (7)
Total 30.2% (202) 29.3% (196) 10.6% (71)
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 39
Mothers’ Education by Site
(Number and Percent within Site)
Site
Middle
School (less
than 9th)
Some High
School
High School
Graduate
Post High
School
Douglas/Bisbee 23.1% (24) 46.2% (48) 22.1% (23) 8.7% (9)
Central Phoenix 29.5% (23) 42.3% (33) 19.2% (15) 9% (7)
Maryvale (Phoenix) 24% (18) 38.7% (29) 34.7% (26) 2.7% (2)
South Phoenix 20.6% (14) 50% (34) 23.5% (16) 5.9% (4)
East Valley (Phoenix) 7.3% (4) 50.9% (28) 23.6% (13) 18.2% (10)
Nogales 25.3% (20) 57% (45) 16.5% (13) 1.3% (1)
Page 13.3% (4) 56.7% (17) 23.3% (7) 6.7% (2)
Casa de los Niños
(Tucson)
9.7% (10) 46.6% (48) 33% (34) 10.7% (11)
CODAC (Tucson) 19.8% (20) 39.6% (40) 33.7% (34) 6.9% (7)
La Frontera (Tucson) 23.4% (30) 46.9% (60) 24.2% (31) 5.5% (7)
Devereux (Tucson) 18.2% (20) 37.3% (41) 36.4% (40) 8.2% (9)
Sierra Vista 12.2% (11) 45.6% (41) 41.1% (37) 1.1% (1)
Tuba City 1.8% (1) 39.3% (22) 41.1% (23) 17.9% (10)
Verde Valley 17.4% (12) 43.5% (30) 27.5% (19) 11.6% (8)
Yuma 27.6% (24) 35.6% (31) 27.6% (24) 9.2% (8)
Pascua Yaqui 28.6% (10) 48.6% (17) 20% (7) 2.9% (1)
Lake Havasu City 17.1% (18) 35.2% (37) 41.9% (44) 5.7% (6)
Flagstaff 21% (13) 33.9% (21) 33.9% (21) 11.3% (7)
Sunnyslope (Phoenix) 15.3% (13) 40% (34) 35.3% (30) 9.4% (8)
Prescott 15.7% (13) 50.6% (42) 21.7% (18) 12% (10)
Casa Grande 20.7% (19) 54.3% (50) 23.9% (22) 1.1% (1)
Mesa 6.3% (5) 45% (36) 26.3% (21) 22.5% (18)
Southeast Phoenix 13.5% (13) 55.2% (53) 24% (23) 7.3% (7)
Total 18.1% (339) 44.7% (837) 28.9% (541) 8.2% (154)
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 40
Fathers’ Education by Site
(Number and Percent within Site)
Site
Middle
School (less
than 9th)
Some High
School
High School
Graduate
Post High
School
Douglas/Bisbee 7.3% (6) 47.6% (39) 36.6% (30) 8.5% (7)
Central Phoenix 19.3% (11) 42.1% (24) 35.1% (20) 3.5% (2)
Maryvale (Phoenix) 8.6% (5) 56.9% (33) 31% (18) 3.4% (2)
South Phoenix 29.1% (16) 38.2% (21) 30.9% (17) 1.8% (1)
East Valley (Phoenix) 2.4% (1) 47.6% (20) 33.3% (14) 16.7% (7)
Nogales 20.6% (14) 54.4% (37) 19.1% (13) 5.9% (4)
Page 4.2% (1) 54.2% (13) 37.5% (9) 4.2% (1)
Casa de los Niños
(Tucson)
12.8% (11) 39.5% (34) 40.7% (35) 7% (6)
CODAC (Tucson) 18.2% (14) 40.3% (31) 37.7% (29) 3.9% (3)
La Frontera (Tucson) 18.2% (20) 43.6% (48) 33.6% (37) 4.5% (5)
Devereux (Tucson) 8.7% (8) 46.7% (43) 38% (29) 6.5% (6)
Sierra Vista 7% (4) 38.6% (21) 50.9% (37) 5.3% (3)
Tuba City 2% (1) 43.1% (22) 49% (25) 5.9% (3)
Verde Valley 12.3% (7) 38.6% (22) 40.4% (23) 8.8% (5)
Yuma 20% (15) 44% (33) 21.3% (16) 14.7% (11)
Pascua Yaqui 16.7% (4) 62.5% (15) 20.8% (5) 0
Lake Havasu City 17.2% (16) 36.6% (34) 44.1% (41) 2.2% (2)
Flagstaff 26.7% (12) 37.8% (17) 26.7% (12) 8.9% (4)
Sunnyslope (Phoenix) 12.7% (8) 36.5% (23) 44.4% (28) 6.3% (4)
Prescott 10.2% (6) 52.5% (31) 15.3% (9) 22% (13)
Casa Grande 16.4% (12) 45.2% (33) 38.4% (28) 0
Mesa 0 44.6% (25) 35.7% (20) 19.6% (11)
Southeast Phoenix 6.9% (4) 51.7% (30) 39.7% (23) 1.7% (1)
Total 13.4% (196) 44.4% (649) 35.3% (516) 6.9% (101)
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 41
Health Insurance by Site at Intake
(Number and Percent within Site)
Site None AHCCCS Private
Douglas/Bisbee 2.9% (3) 92.2% (95) 4.9% (5)
Central Phoenix 4.5% (4) 83% (73) 11.4% (10)
Maryvale (Phoenix) 3.7% (3) 84.1% (69) 9.8% (8)
South Phoenix 0 64% (87.7) 9.6% (7)
East Valley (Phoenix) 4.6% (3) 80% (52) 15.4% (10)
Nogales 15.2% (16) 81% (85) 1% (1)
Page 6.1% (3) 91.8% (45) 2% (1)
Casa de los Niños (Tucson) 1.7% (2) 74.8% (89) 18.5% (22)
CODAC (Tucson) 2.9% (3) 83.3% (85) 11.8% (12)
La Frontera (Tucson) 5.4% (7) 82.3% (107) 10.8% (14)
Devereux (Tucson) 1.7% (2) 78.6% (92) 13.7% (16)
Sierra Vista 2.1% (2) 76.8% (73) 16.8% (16)
Tuba City 25% (14) 71.4% (40) 3.6% (2)
Verde Valley 0 94.7% (71) 5.3% (4)
Yuma 7.5% (7) 86% (80) 2.2% (2)
Pascua Yaqui 0 76.9% (30) 7.7% (3)
Lake Havasu City 3.3% (4) 85% (102) 10.8% (13)
Flagstaff 6.8% (5) 89.2% (66) 4.1% (3)
Sunnyslope (Phoenix) 6.3% (6) 75.8% (72) 16.8% (16)
Prescott 5% (6) 79.8% (95) 7.6% (9)
Casa Grande 2.1% (2) 83% (78) 14.9% (14)
Mesa 4.3% (4) 75.3% (70) 16.1% (15)
Southeast Phoenix 4.8% (5) 83.7% (87) 11.5% (12)
Total 4.8% (101) 82.3% (1720) 10.3% (215)
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 42
Late or No Prenatal Care or Poor Compliance at Intake
by Site
(Number and Percent within Site)
The participant received no or late prenatal care
or showed poor compliance with prenatal care
Site True False Unknown
Douglas/Bisbee 41.3% (43) 54.8% (57) 3.8% (4)
Central Phoenix 39.1% (34) 57.5% (50) 3.4% (3)
Maryvale (Phoenix) 33.7% (28) 63.9% (53) 2.4% (2)
South Phoenix 35.6% (26) 61.6% (45) 2.7% (2)
East Valley (Phoenix) 23.4% (15) 68.8% (44) 7.8% (5)
Nogales 61% (64) 33.3% (35) 5.7% (6)
Page 43.8% (21) 56.3% (27) 0
Casa de los Niños (Tucson) 29.2% (35) 58.3% (70) 12.5% (15)
CODAC (Tucson) 38.1% (40) 56.2% (59) 5.7% (6)
La Frontera (Tucson) 38.9% (51) 58% (76) 3.1% (4)
Devereux (Tucson) 30.2% (35) 62.1% (72) 7.8% (9)
Sierra Vista 41.5% (39) 57.4% (54) 1.1% (1)
Tuba City 46.4% (26) 51.8% (29) 1.8% (1)
Verde Valley 47.3% (35) 52.7% (39) 0
Yuma 41.3% (38) 58.7% (54) 0
Pascua Yaqui 21.1% (8) 76.3% (29) 2.6% (1)
Lake Havasu City 32.5% (39) 67.5% (81) 0
Flagstaff 38.4% (28) 60.3% (44) 1.4% (1)
Sunnyslope (Phoenix) 40% (38) 56.8% (54) 3.2% (3)
Prescott 42% (50) 54.6% (65) 3.4% (4)
Casa Grande 35.5% (33) 63.4% (59) 1.1% (1)
Mesa 33.7% (31) 60.9% (56) 5.4% (5)
Southeast Phoenix 34.3% (36) 62.9% (66) 2.9% (3)
Total 38% (793) 58.4% (1218) 3.6% (76)
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 43
Ethnicity of Mother by Site
(Number and Percent within Site)
Site Caucasian Hispanic African
American
Asian
American
Native
American Other
Douglas/Bisbee 14.4% (15) 85.6% (89) 0 0 0 0
Central Phoenix 18.4% (16) 59.8% (52) 8% (7) 0 2.3% (2) 11.5% (10)
Maryvale (Phoenix) 31.7% (26) 58.5% (48) 6.1% (5) 0 0 3.7% (3)
South Phoenix 11% (8) 65.8% (48) 16.4% (12) 1.4% (1) 4.1% (3) 1.4% (1)
East Valley (Phoenix) 50.8% (33) 35.4% (23) 4.6% (3) 1.5% (1) 0 7.7% (5)
Nogales 0 100% (105) 0 0 0 0
Page 6.1% (3) 4.1% (2) 0 2% (1) 85.7% (42) 2% (1)
Casa de los Niños
(Tucson)
25.4% (30) 61% (72) 4.2% (5) 0.8% (1) 6.8% (8) 1.7% (2)
CODAC (Tucson) 6.7% (7) 80% (84) 7.6% (8) 0 0 5.7% (6)
La Frontera (Tucson) 12.2% (16) 78.6%
(103)
3.8% (5) 0.8% (1) 3.1% (4) 1.5% (2)
Devereux (Tucson) 24.8% (29) 64.1% (75) 2.6% (3) 1.7% (2) 3.4% (4) 3.4% (4)
Sierra Vista 52.7% (49) 31.2% (29) 10.8% (10) 0 0 5.4% (5)
Tuba City 1.8% (1) 0 0 0 98.2% (55) 0
Verde Valley 65.3% (49) 25.3% (19) 0 0 9.3% (7) 0
Yuma 8.8% (8) 87.9% (80) 2.2% (2) 0 1.1% (1) 0
Pascua Yaqui 0 10.5% (4) 2.6% (1) 0 55.3% (21) 31.6% (38)
Lake Havasu City 55% (66) 40.8% (49) 0.8% (1) 0 0.8% (1) 2.5% (3)
Flagstaff 20.5% (15) 43.8% (32) 1.4% 91) 0 32.9% (24) 1.4% (1)
Sunnyslope (Phoenix) 44.2% (42) 41.1% (39) 9.5% (9) 1.1% (1) 2.1% (2) 2.1% (2)
Prescott 73.1% (87) 26.9% (32) 0 0 0 0
Casa Grande 27.7% (26) 56.4% (53) 8.5% (8) 0 3.2% (3) 4.3% (4)
Mesa 57% (53) 24.7% (23) 5.4% (5) 0 5.4% (5) 7.5% (7)
Southeast Phoenix 16.2% (17) 51.4% (54) 24.8% (26) 0 1% (1) 6.7% (7)
Total 28.5%
(596)
53.4%
(1115)
5.3%
(111)
0.4%
(8)
8.8%
(183)
3.6%
(75)
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 44
Gestational Age by Site
(Number and Percent within Site)
Was the gestational age less than 37 weeks?
Site No Yes
Douglas/Bisbee 89.2% (91) 10.8% (11)
Central Phoenix 67.1% (57) 32.9% (28)
Maryvale (Phoenix) 78.8% (63) 21.3% (17)
South Phoenix 92.4% (61) 7.6% (5)
East Valley (Phoenix) 79.7% (51) 20.3% (13)
Nogales 92.3% (96) 7.7% (8)
Page 87.2% (41) 12.8% (6)
Casa de los Niños (Tucson) 80.4% (86) 19.6% (21)
CODAC (Tucson) 88.8% (79) 11.2% (10)
La Frontera (Tucson) 81.3% (100) 18.7% (23)
Devereux (Tucson) 82.1% (87) 17.9% (19)
Sierra Vista 91.8% (78) 8.2% (7)
Tuba City 80.9% (38) 19.1% (9)
Verde Valley 93.3% (70) 6.7% (5)
Yuma 87.8% (79) 12.2% (11)
Pascua Yaqui 97.1% (33) 2.9% (1)
Lake Havasu City 85.9% (79) 14.1% (13)
Flagstaff 84.6% (55) 15.4% (10)
Sunnyslope (Phoenix) 83% (73) 17% (15)
Prescott 91.5% (107) 8.5% (10)
Casa Grande 81.5 % (75) 18.5% (17)
Mesa 78% (71) 22% (20)
Southeast Phoenix 85.6% (83) 14.4% (14)
Total 84.9% (1653) 15.1% (293)
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 45
Low Birth Weight by Site
(Number and Percent within Site)
Did the child have low birth weight (less than
2500 grams or 88 ounces)?
Site No Yes
Douglas/Bisbee 82.7% (86) 17.3% (18)
Central Phoenix 69.3% (61) 30.7% (27)
Maryvale (Phoenix) 80.5% (66) 19.5% (16)
South Phoenix 84.7% (61) 15.3% (11)
East Valley (Phoenix) 76.9% (50) 23.1% (15)
Nogales 91.4% (96) 8.6% (9)
Page 85.7% (42) 14.3% (7)
Casa de los Niños (Tucson) 85.7% (102) 14.3% (17)
CODAC (Tucson) 84.8% (89) 15.2% (16)
La Frontera (Tucson) 85.3% (110) 14.75 (19)
Devereux (Tucson) 87.2% (102) 12.8% (15)
Sierra Vista 87.4% (83) 12.6% (12)
Tuba City 90.9% (50) 9.1% (5)
Verde Valley 94.7% (71) 5.3% (4)
Yuma 92.4% (85) 7.6% (7)
Pascua Yaqui 97.5% (39) 2.5% (1)
Lake Havasu City 87.4% (104) 12.6% (15)
Flagstaff 79.5% (58) 20.5% (15)
Sunnyslope (Phoenix) 83% (78) 17% (16)
Prescott 95.7% (112) 4.3% (5)
Casa Grande 87.2% (82) 12.8% (12)
Mesa 75.3% (70) 24.7% (23)
Southeast Phoenix 89.5% (94) 10.5% (11)
Total 85.8% (1791) 14.2% (296)
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 46
Yearly Income by Site
Site Mean
Yearly Income
Standard
Deviation Number
Douglas/Bisbee $9325.25 7438.07 93
Central Phoenix $11171.36 10529.50 56
Maryvale (Phoenix) $10534.60 8256.56 67
South Phoenix $9363.40 8103.32 60
East Valley (Phoenix) $18329.49 20597.03 41
Nogales $11250.45 8422.57 103
Page $8121.00 7492.00 44
Casa de los Niños (Tucson) $14422.49 11405.28 97
CODAC (Tucson) $13172.14 12958.05 79
La Frontera (Tucson) $10964.46 6514.70 96
Devereux (Tucson) $10814.11 7378.44 93
Sierra Vista $7242.98 14329.18 86
Tuba City $13602.98 18804.42 49
Verde Valley $8969.52 6440.61 66
Yuma $8079.90 5431.36 80
Pascua Yaqui $8618.50 6609.40 36
Lake Havasu City $13227.62 8987.39 105
Flagstaff $10672.45 11549.97 66
Sunnyslope (Phoenix) $12342.25 13631.41 71
Prescott $15080.18 10798.91 44
Casa Grande $10374.22 7951.74 54
Mesa $13320.76 12374.59 62
Southeast Phoenix $10911.32 11061.71 59
Total $11217.82 10749.18 1607
Healthy Families Arizona Evaluation Report
LeCroy & Milligan Associates, Inc. December 2002 47
Family Stress Checklist Score by Site
Site Mean Score
Percent of
mothers whose
FSC score was
greater than 40
Number of
mothers whose
FSC score was
greater than 40
Douglas/Bisbee 39.13 54.8% 57
Central Phoenix 36.21 38.6% 34
Maryvale (Phoenix) 38.86 56.6% 47
South Phoenix 37.95 47.9% 35
East Valley (Phoenix) 35.62 38.5% 25
Nogales 33.24 24.8% 26
Page 35.20 38.8% 19
Casa de los Niños (Tucson) 38.82 48.3% 58
CODAC (Tucson) 35.48 35.2% 37
La Frontera (Tucson) 37.25 44.3% 58
Devereux (Tucson) 39.36 53.8% 63
Sierra Vista 40.63 52.6% 50
Tuba City 30.71 12.5% 7
Verde Valley 35.60 34.7% 26
Yuma 38.28 43% 40
Pascua Yaqui 34.38 30% 12
Lake Havasu City 35.25 32.5% 39
Flagstaff 38.38 44.6% 33
Sunnyslope (Phoenix) 38.74 49.5% 47
Prescott 43.74 58.8% 70
Casa Grande 33.56 34% 32
Mesa 33.68 38.7% 36
Southeast Phoenix 37.10 45.7% 48
Total 37.15 42.8% 899