Building Healthy Children (BHC)

MODEL
EFFECTIVENESS

Not an evidence-based model
More information below

Not MIECHV eligible

6
Manuscripts

Released in 2005 through 2024

2
Manuscripts

Impact studies rated high or moderate quality

Services intended at ages
Prenatal
0-6 months
7-11 months
12-23 months
24-35 months
Favorable results from well-designed research
Child health

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Building Healthy Children (BHC) is a preventive intervention that works to promote healthy child development and encourage strong, positive relationships between parents and their children. BHC enrolls families with adolescent mothers that are pregnant or before their child is 12 months old, with a focus on socioeconomically disadvantaged families with limited access to support and services, and serves them until their child turns 3 years old. BHC uses a team-based approach that partners families with a trained therapist with a master’s degree and a paraprofessional community health worker. Together, this team works with a family to identify and address mental and behavioral health and social needs. Through weekly home visits, BHC tailors and integrates services from three different interventions: Interpersonal Psychotherapy for Adolescents, Child-Parent Psychotherapy, and Parents as Teachers. BHC also partners with pediatric and family medical practices to coordinate health care and social services provided to families.

Where to find out more

Effectiveness

This model does not meet criteria established by the U.S. Department of Health and Human Services for an evidence-based home visiting model because findings from high- or moderate-rated effectiveness studies of the model do not demonstrate favorable (statistically significant) impacts in at least two outcome domains within one sample OR the same domain for at least two non-overlapping samples.

Does not meet criteria for an evidence-based home visiting model for Indigenous peoples and communities.

Extent of Evidence

For more information about manuscripts, search the research database.

For more information on the criteria used to rate research, please see details of HomVEEʼs methods and standards.

6
Manuscripts

Released in 2005 through 2024

2
Manuscripts

Eligible for review

2
Manuscripts

Impact studies rated high or moderate quality

When an individual manuscript reports findings from multiple studies, HomVEE reviews each study as a distinct manuscript. In these rare instances, HomVEE counts that manuscript multiple times in this table, once for each study identified, screened, and reviewed by HomVEE.

Summary of Findings

To see details on each manuscript HomVEE reviewed in well-designed research, click on the manuscript counts in the table.

Favorable:
A finding showing a statistically significant impact on an outcome measure in a direction that is beneficial for children and parents.

No effect:
Findings are not statistically significant.

Unfavorable:
A finding showing a statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents.

Ambiguous findings are excluded from this table. An ambiguous finding is a statistically significant impact on an outcome measure in a direction that is not clearly beneficial for or potentially harmful to children and/or parents.

Outcomes Manuscripts Favorable Findings No Effects Findings Unfavorable Findings
Child Development and School Readiness Not measured - - -
Child Health View 1 Manuscript 1 2 0
Family Economic Self-Sufficiency Not measured - - -
Linkages and Referrals Not measured - - -
Maternal Health Not measured - - -
Positive Parenting Practices Not measured - - -
Reductions In Child Maltreatment View 2 Manuscripts 0 3 0
Reductions in Juvenile Delinquency, Family Violence, and Crime Not measured - - -

Research Characteristics

Well-designed impact studies about this model included participants with the following characteristics. The evidence for effectiveness for the model may include additional studies that did not report this participant information.

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Black or African American
67%
Hispanic or Latino
19%
White
21%
Some other race
1%
Two or more races
9%

Maternal Education

Less than a high school diploma
45%
High school diploma or GED
42%
Unknown
14%

Other Characteristics

Data not available

Well-designed impact studies about this model were conducted in the following locations:

  • New York

Implementation

In this section:

Overview

Theoretical approach, intended population, and targeted outcomes.

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Support Availability

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Service Delivery

Model services, adaptions and enhancements, model intensity and length.

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Requirements

Staffing and organizational requirements.

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Overview

Theoretical approach

Started in 2007, BHC is a prevention program that builds on family strengths. It uses a trauma-informed, and culturally sensitive approach to support positive parenting, strengthen family relationships, and promote child development and school readiness. The program is grounded in developmental psychopathology—a science that studies mental health challenges in children and teens. The BHC approach also draws from attachment theory—a theory that emphasizes strong parent-child bonds—and focuses on relationships as a way to understand and treat mothers experiencing depression. 

BHC is affiliated with the University of Rochester and the Mt. Hope Family Center. BHC also partners with community medical providers in pediatrics, family medicine, and obstetrics.

Intended population

BHC serves families who face socioeconomic disadvantages and are at high risk for child maltreatment and poor child developmental outcomes. The intended population is adolescent and young mothers (up to 24 years old) and their children, with support offered to fathers and other family members as appropriate. Families can enroll during the 2nd or 3rd trimester of pregnancy or following the birth of the child and can be enrolled until their child turns 3 years old. Eligible families must have no more than three children, and the oldest child must be under 5 years old.

Intended outcomes

BHC intends to promote healthy child development and encourage strong, positive relationships between parents and their children by focusing on: 

  • Child development
  • Child health
  • Economic self-sufficiency
  • Maternal health, including maternal mental health
  • Positive parenting practices

Highlights

Populations intended
Families with a history of child abuse or neglect, or interactions with child welfare services
Families with low-income
Families with pregnant women under age 21
Services intended at ages
Prenatal
0-6 months
7-11 months
12-23 months
24-35 months

Support Availability

Implementation support availability

BHC was developed by staff at Mt. Hope Family Center at the University of Rochester. Staff from Mt. Hope Family Center are available to provide implementation support and training for agencies interested in implementing BHC.

Highlights

Locations where model has been implemented
Within the U.S.

Service Delivery

Model services

BHC services focus on mental health needs and nonmedical factors that impact a family’s health with an emphasis on promoting positive parent-child relationships and healthy child development. In addition, the model partners with the families’ medical homes to coordinate care and ensure timely well-child and immunization support, as well as other medical needs that the children may have.

Home visiting services can help children and parents by addressing their mental health needs and identifying and supporting other family needs, such as:

  • health care,
  • safe and stable housing,
  • sufficient food, and
  • reliable transportation.

Home visiting services may also identify and support families in reducing:

  • ongoing and excessive stress that may be harmful to health and development, and
  • intimate partner violence.

BHC relies on a team-based approach to home visits that partners each family with a team of two providers, a paraprofessional community health worker (CHW) and a trained therapist with a master’s degree. The therapist and CHW work with families during individual home visits that take place in the family’s home, or a location preferred by participants. Therapists focus on mental and behavioral health.

During home visits, therapists deliver services based on three established interventions: Interpersonal Psychotherapy for Adolescents (IPT-A), Child-Parent Psychotherapy (CPP), and Parents as Teachers (PAT). After a needs assessment, therapists determine which interventions are appropriate. Parents demonstrating symptoms of depression are eligible for IPT-A. CPP is offered to families at high risk for child maltreatment and parents with a history of childhood trauma or challenging relationships with their parents. All other families receive services guided by the PAT curriculum.

BHC therapists are trained to deliver each intervention individually and in combination. This gives them flexibility to tailor the services to address family needs and pivot between interventions as a family’s goals and needs evolve. CHWs focus on a family’s social needs, including linking them to resources for concrete needs (such as housing, food, or clothing), and offering support with accessing social services, managing daily life, and supporting goals around employment and education. CHWs may also identify the need for additional intervention or services beyond BHC.

In addition to home visits, BHC coordinates directly with a family’s primary care providers to incorporate behavioral health and social needs into the family’s health care. BHC staff have access to a family’s electronic medical records and enter notes about progress toward BHC goals, with a goal of communicating with the family’s clinical providers and centralizing information about a family’s needs, referrals, and care in one place. CHWs track upcoming appointments and may provide transportation and/or attend appointments with families as appropriate. CHWs attend initial appointments with families.

BHC also offers monthly group events to allow BHC families to connect with each other and their children.

Model intensity and length

Home visiting requirements: 

Families receive weekly hour-long home visits. IPT-A is delivered in 12–14 visits, CPP is delivered weekly for 10–12 months, and PAT is delivered weekly for up to three years. Therapists determine when and how each intervention is delivered and may pivot in response to emerging family needs. Families that do not need CPP or IPT begin with PAT. In addition to these weekly visits with the therapist, CHWs meet with families regularly, as needed, and at least once a month. 

Additional requirements: 

All participants are screened for concerns about domestic violence. Additionally, when issues are raised outside of the scope of BHC, families can be referred to local agencies. Examples could include referrals for chemical dependency treatment, inpatient mental health or substance abuse treatment, or legal consultation. 

Service duration: 

Families can be enrolled in BHC from the time the mother is in the second or third trimester of pregnancy until the child is 12 months old. Services can have a duration of one to three years. The timing of concluding services is determined by achievement of goals set with the family, family choice, or supporting the family as they transition to preschool services when the child reaches 3 years old. Most families are enrolled for at least two years.

Tailored services and enhanced models

As part of the BHC model, therapists provide tailored services to participants as needed, including (1) education, support, and referrals for issues related to domestic violence and (2) counseling and referrals to repair and strengthen family relationships. For more information about tailored services, please contact the model developer.

Implementation with Indigenous peoples and communities

BHC has not been implemented with Indigenous peoples and communities. However, the model could be adapted with active partnerships with those communities.

Highlights

Program is available in other language(s)
Spanish
Maximum program duration
Program duration varies
Visit frequency
Weekly
Delivery method supported
Supports hybrid in-person and virtual service delivery
Implementation with Indigenous communities
Designed for implementation in Indigenous communities or allows for tailoring for Indigenous communities

Requirements

Staffing requirements

Education and supervisory requirements: 

Staff. The BHC model has four staff positions. Home visits are delivered by therapists and CHWs. BHC also requires a program director and a pediatric social worker. The number of staff could vary based on the number of families the program intends to serve.

Education and experience

  • Therapists must have a master’s degree. The model recommends that therapists also have a minimum of two to three years of experience working with families who have young children and limited access to support and services. Licensure is also recommended, or the therapist could work under the supervision of a licensed provider.
  • CHWs must have at least a GED, an understanding of community resources, and experience working with families that have limited access to support and services. CHWs must also have experience as a parent. Ideally, CHWs have backgrounds and experiences similar to those of the families BHC serves.
  • The pediatric social worker who supervises the CHWs must be a licensed master’s level social worker with experience working in a pediatric healthcare setting.
  • The program director must be a master’s or doctoral level professional. The model recommends that program directors have three to five years of experience working with families at high risk for child maltreatment and poor child developmental outcomes and those with limited access to support and services; experience in implementing evidence-based therapy with families; and experience in providing supervision.

Supervision

  • CHWs are supervised by the pediatric social worker. They meet for bi-weekly individual supervision meetings and monthly group supervision meetings.
  • Therapists are supervised by the program director. They meet weekly for individual and group reflective supervision.
  • Program directors are supervised by the Mt. Hope Family Center’s Clinical Director, and pediatric social workers are supervised by the University of Rochester’s Medical Center’s Director of Social Work. They meet bi-weekly for individual supervision meetings and weekly with one another for peer support meetings. This may vary by agency.

Training and professional development:

Pre-service training. The model requires therapists and CHWs to participate in pre-service training before working with families. Therapists are trained separately in IPT-A, CPP, and PAT and in how all three are integrated as BHC. CHWs are oriented and trained by their supervisor, a pediatric social worker. Please contact the model developer for additional information about the pre-service training requirements.

Ongoing professional development. Quarterly BHC team meetings offer professional development opportunities for continued learning and training. Therapists complete continuing education units according to the regulations of their state and professional discipline.

Organizational requirements

To implement BHC, organizations should have the capacity to implement evidence-based mental health treatment, pre-existing connections with the community to be served, the ability to conduct home visits, small caseloads that facilitate intensive service delivery, and partnerships with pediatric and obstetric services. 

The model requires home visitors to meet a set of ongoing fidelity guidelines. Please contact the model developer for additional information about the guidelines.

Highlights

Minimum education requirement
Unknown

HomVEE requests input and feedback from the model developers on their profiles. The information in this implementation profile reflects feedback, if provided, from this model’s developer. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model here may differ from how the model was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Model developers are encouraged to notify HomVEE of any changes to their contact information on this page.