The study results provided little indication that Healthy Families Alaska enrollment had substantial positive impact on child maltreatment. Nevertheless, physical abuse referrals among enrolled children decreased 42 per 1,000 child-years of followup from 1996-1998 to 2000-2002; all of this decrease occurred among children who received 20 or more home visitations. Healthy Families Alaska screening criteria successfully identified families at high risk of experiencing child abuse or neglect. However, a similar 38-percent decrease in physical abuse referral rates among unenrolled children born to unmarried women reporting prenatal alcohol use may indicate that the decrease in abuse referrals among enrolled children did not result from the Healthy Families Alaska Program, but rather from unmeasured events occurring in the study communities as a whole. Although Healthy Families Alaska screening criteria successfully identified families at high risk of experiencing child abuse or neglect, the screening criteria were no more successful at identifying high risk children than risk factors easily identifiable from the birth certificate. The most promising finding among enrolled children was a 42-percent decrease in physical abuse referral rates over time. This occurred despite no change among study communities in overall referral rates or among high risk infants; the likelihood is that the children enrolled in Healthy Families Alaska received more scrutiny for potential abuse than other children, and never changed or evaluated demographic risk factors over time. Numerous problems with the design and implementation of Healthy Families Alaska may have led to lack of effectiveness. Given the absence of a successful comparison model, it is not clear which components of the program, if any, presented the achievement of reductions in child maltreatments. Data were collected from the existing public health databases housed within the Alaska Department of Health and Social Services. Tables, figures, references