Hawaii Healthy Start Program

Hawaii Healthy Start Program

By Loretta J. Fuddy, A.C.S.W., M.P.H.
Chief, Family Health Services Division
State of Hawaii
Department of Health

Cindy Hirai, MSW
Healthy Start Program Manager

Helene Kaiwi, MSW
Community & Family Support Section Supervisor 


The Hawaii Healthy Start (HHS) home visiting program is administered through the State Department of Health’s Title V program within the Family Health Services Division, (FHSD), Maternal and Child Health Branch (MCHB). HHS began as a demonstration project in 1985 and expanded statewide in 2001. The program included universal screenings and assessments for at risk families in all civilian birthing hospitals. Throughout its 25 year history, HHS has conducted rigorous program evaluations and has made several revisions to the program design to improve child and family outcomes.  

HHS home visitors are trained paraprofessionals working with a team which includes a clinical supervisor, clinical specialist, and child development specialist. Home visiting services include screenings for developmental delays and referrals for early intervention services; teaching the care giver about child development; positive parenting skills and problem solving techniques; linking to community resources; and, when necessary, referring for substance abuse, maternal depression and domestic violence services. 

Regrettably, today the program is limited to two sites because of severe budgetary restrictions. Statewide screening and assessment services and inclusion in the Individuals with Disabilities Education Act Part C services for care coordination have been eliminated.

The Title V/MCH Role in Hawaii’s Healthy Start Program

MCHB/FHSD has been the departmental lead for home visitation since 1987. Originally purely a child abuse prevention program, the program was restructured to broaden its intervention to address outcome measures embraced by Title V (e.g. medical home, immunization, age appropriate child development rates). MCHB led the development of the client tracking data system and partnered with Johns Hopkins University to evaluate program effectiveness.  

All violence prevention efforts including child abuse, domestic violence, and sex assault are administered within MCHB and are supported by its statewide network of prevention partners. As part of the current Title V Needs Assessment process, child abuse and neglect (CAN) was ranked as one of Hawaii’s state priority areas.


Program Impact and Success
Rigorous evaluation is crucial to program improvement; as such HHS has contributed to the body of knowledge on home visitation. Research highlights include: strategies to prevent child abuse and neglect; and discrete interventions which impact program quality, dosage, assessment, and training issues. Annual variance data indicates consistently that 98 percent of families enrolled in HHS for at least 12 months have no confirmed CAN report. Virtually all the enrolled children have a medical home; and receive timely immunization and developmental assessments.  

In response to research findings, professional clinical support for paraprofessional home visitors was added to the model with the inclusion of Clinical and Child Development Specialist positions. HHS has collaborated closely with the author of the evidence–informed “Nurturing Parenting” curriculum to adapt its assessment tools to be culturally responsive to Hawaii’s unique populations.  

Through support from the Evidenced Based Home Visitation federal grant, HHS continues its tradition of evaluation and program improvement. Enhancements to its data management system to address continuous quality improvement and the development of program fidelity activities to ensure valid and compelling positive program outcomes are the program’s current priorities.  

Due entirely to the community’s overwhelming support for home visitation services, the State Legislature recently increased the appropriation for HHS. This bodes well for the future reinstatement of a statewide home visitation program when the economy recovers. A community voice recognizing the value of early intervention for families is perhaps our proudest organizational achievement. This we believe is a testament to the successful partnership and collaboration between our Title V program, the network of partnering agencies, the consumer and the community.