Hawaii's Healthy Start Program (HSP) has two components: a population-based screening and assessment of families of newborns to identify those at risk for child abuse and neglect and home visiting of at-risk families. Home visitors, who are trained paraprofessionals working under professional supervision, establish a trusting relationship with parents by using empathetic, nonjudgmental listening and assisting parents in addressing crises. Once immediate crises are resolved, home visitors work to help families build on their strengths to improve family functioning. Home visitors promote child health and development by providing parenting education, modeling effective parent-child interaction, and ensuring that each child has a medical home. From November 1994 through December 1995, the program identified 1,803 families as at risk for child abuse. Of these, 643 families agreed to participate in both the program and the evaluation for a period of 3 years. By design the HSP intended to work directly with fathers in addressing violence and substance use and promote their role in parenting. Data for this study were collected through annual interviews with the mother, HSP record reviews, and annual surveys of the home visitors. The evaluation measured fathers' participation in home visiting and the program's impact on fathers' role in parenting, on the parents' relationship, on fathers' violence, and on outcomes in families with heavy drinking by fathers. Overall, the program apparently had no impact on fathers; however, it did have a positive impact for one subgroup, i.e., nonviolent fathers in families where the parents lived together at baseline. For this group, the program was accompanied by mothers' increased satisfaction with the father's involvement. For another subgroup, however, the program apparently had a negative impact. For violent fathers not living with the family, family contact increased, but the violent behavior remained. The findings suggest that a home visitation model designed to promote healthy families must take into account variation between families and between parents within families. Research is required to develop and test the effectiveness of alternative strategies for promoting family health and reducing child abuse and neglect by intervening with both parents. 5 tables and 48 references