The Hawaii Healthy Start program (Enhanced with Cognitive Appraisal) (HSP-Enhanced) is a home visitation program designed to promote the well-being of children by providing services to parents and parents-to-be at risk of child abuse. The program is an enhanced version of the original Hawaii Healthy Start program, which is designed to improve family functioning, prevent child abuse and promote child health development.
HSP-Enhanced includes the original HSP components plus an additional cognitive appraisal component.
HSP-Enhanced is designed specifically to assist parents in becoming competent and independent problem solvers, a skill that is underdeveloped among abusive parents and that may be expected to endure following participation in the program. The goal of the enhanced program is to give parents repeated experience in finding new ways (directed away from self- or child-blame) of explaining problems and in finding new ways of resolving those problems.
HSP-Enhanced is designed for all families expecting the birth of a child (or having recently given birth to a child) who are identified as at moderate risk to become abusive.
The program has only been evaluated in the USA (Bugental et al. 2002; Bugental & Schwartz 2009).
One randomised control trial was conducted with 73 people (the numbers of people in the intervention group and control group was not reported). On average, parents were 25 years old. Most parents were Latino and 50% had been physically abused as children (Bugental et al. 2002).
Another randomised control trial was conducted with 102 people (45 people were in the intervention group and 57 people were in the control group). On average, parents were 27 years old and most were Latino (Bugental & Schwartz 2009).
The program has not been tested in Australia or with Aboriginal Australians.
Overall, HSP-Enhanced has a positive effect on client outcomes.
Supported research outcomes:
The HSP-enhanced program consists of a series of home visitations.
The visits last for one year, with about 17-20 visits in total.
The original HSP provided regular home visits to assist with:
HSP-Enhanced combined all features of the original program, but also includes an additional cognitive appraisal component. This consists of:
At the start of each visit, parents are asked for examples of recent caregiving problems. They are then asked about
(a) the potential causes of those problems (with repeated inquiry until a benign or non–blame-oriented cause was generated by the parent)
(b) potential ways of solving problems (to be tried out during the next period and discussed at the following visit).
Not reported
Two RCTs:
16 Feb 2023
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