Starting in January 1994, the Johns Hopkins University School of Medicine conducted a three-year evaluation of Hawaii's Healthy Start Program (HSP).

HSP provides early intervention family support services to young children from birth to age 5 who are at risk for maltreatment. This evaluation sought to determine:

• How closely the HSP implementation mirrored its design.
• How effectively the program achieved its intended benefits for children and families.
• How the fidelity of program implementation influenced program impact.
• And how program benefits compared with program costs.

Key Findings:

• Early identification staff determined risk status for 84 percent of target families.
• Families with higher risk scores, young mothers with limited schooling and families with infants at biologic risk were more likely to enroll in home visiting.
• Only half of those who enrolled were active at one year with an average of 22 visits.
• After two years of service provision to families, HSP was successful in linking families with pediatric medical care.
• Most families enrolled for home visits were linked with a primary care provider, but linkage rates for other community resources varied widely by type of service.
• Although HSP visits improved family wellness according to several measures, no overall positive program impact emerged after two years in terms of child maltreatment, adequacy of well-child health care, or pediatric health care use for illness or injury.

Conclusions:

• The researchers conclude in The Future of Children that "home visiting programs and evaluations should monitor program implementation for faithfulness to the program model, and should employ comparison groups to determine program impact."