Evaluation of a rural Healthy Families America (HFA) program: The importance of context

This paper describes sociodemographics, program involvement, and outcomes for 115 families involved in a rural HFA program. HFA-involved families fared well in concrete areas, yet demonstrated fewer positive changes in abstract goals. Subgroup analyses revealed relationships between mothers' sociodemographic characturistics and outcomes. HFA programs must allow for variability in implementation based on context. The effectiveness of persistent outreach in a geographically-dispersed area with families who do not engage with home visitors merits reexamination. While the riskiest families should always be given the opportunity to participate, we suggest that rural implementation may be most effective when utilized as part of a triage case management model which better integrates child welfare, mental and physical health care systems.