You are viewing historical content. Access the latest data.

2023 Yearbook

Healthy Families America

Healthy Families America (HFA) works with pregnant and parenting families of children prenatally up to age 5. The model is grounded in an infant mental health framework and aims to cultivate and strengthen nurturing parent-child relationships, promote healthy childhood growth and development, and enhance family functioning by reducing risk and building protective factors.

What is the model’s approach to providing home visiting services?

All families receive an initial assessment of risks, resilience, and opportunities for growth, which is used to tailor services to meet their specific needs. All families are offered weekly home visits at the start of services. Family progress criteria are then used to determine a family’s readiness to move to less frequent visits—from weekly to every other week, then monthly, and finally, quarterly.

Services are offered for a minimum of 3 years and up to 5 years. HFA recommends that services start prenatally, if possible, but allows for families to enroll after the child is born. Programs are required to enroll at least 80 percent of families by the time the child is 3 months old. One exception is families referred from child welfare, whose children can be up to 24 months old at intake. Local programs have the flexibility to define their service populations based on community needs data.

Who is implementing the model?

Home Visitors

HFA was implemented by 3,677.1 full-time equivalent (FTE) home visitors in 2020. The model requires a minimum of a high school diploma or equivalent for home visitors. The average caseload size for a full-time home visitor is 15–20 families.


HFA was implemented by 686.9 FTE supervisors in 2020. HFA requires a master’s degree or bachelor’s degree plus 3 years of experience for supervisors.

Where is the model implemented?

HFA operated in 586 local agencies across 38 states and the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands in 2020. HFA also operated outside the United States and its territories in Israel in 2020.


US map with Healthy Families America service area highlighted

Families Served Through Evidence-Based Home Visiting in 2020

home visits provided
including 490,449 virtual visits
families served
children served

Child age

43% <1 year

39% 1-2 years

17% 3-6 years

Caregiver age

26% ≤21 years

43% 22-29 years

30% 30-44 years

1% ≥45 years

Child insurance status

91% Public

7% Private

2% None

Primary language

77% English

18% Spanish

5% Another language

Caregiver education

31% No HS diploma

47% HS diploma or GED

18% Some college or training

5% Bachelor's degree or higher

Percentages may not add to 100 due to rounding.