Healthy Families America: ruminations on implementing a home visitation program to prevent child maltreatment.

Following a 1990 federal report forecasting a national child abuse and neglect epidemic, Prevent Child Abuse America (PCA America) promoted a home visitation program known as Healthy Families America (HFA). HFA achieved rapid adoption and implementation across the nation going from 25 sites in 1992 to 430 in a decade. In this article, the authors describe PCA America's approach to develop, promote, oversee, and evaluate a national home visitation program. Despite its promising growth, HFA has been criticized for failing to achieve the goal of preventing child maltreatment. HFA's past and present are critiqued based on theory and implementation practice of home visitation and its future projected from the perspective of insiders. Developing a better understanding of HFA's history will advance existing models of home visitation and add to the emerging knowledge base of child maltreatment prevention.