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Healthy Steps (National Evaluation 1996 Protocol)

Meets DHHS criteria for an evidenced based model

Last Updated: July 2011

Effects Shown in Research & Outcome Measure Details for Child Health Outcomes

Impact Studies Rated High


Guyer, B., Barth, M., Bishai, D., Caughy, M., Clark, B., Burkom, D., Tang, C. (2003). The Healthy Steps for Young Children Program National Evaluation. Baltimore: Women’s and Children’s Health Policy Center, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
DTP1 vaccination Favorable The 6 RCT national evaluation sites 2 months 1,950 mothers 0.916 0.882 OR = 1.50 Statistically significant,
p < 0.05
HomVEE = 0.25 Primary
Hospitalization since birth No Effect The 6 RCT national evaluation sites 2-4 months 1,987 mothers Not reported Not reported OR = 0.71 Not statistically significant,
p > 0.05
HomVEE = -0.21 Secondary
One-month well-child care visit Favorable The 6 RCT national evaluation sites 1 month 2,086 mothers 0.972 0.951 OR = 1.85 Statistically significant,
p < 0.05
HomVEE = 0.37 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
DTP1 vaccination Percentage of children who had received the DTP1 vaccination between 42 and 92 days postpartum Review of medical records Not applicable Primary
Hospitalization since birth Number of child hospitalizations Parent/caregiver report Not applicable Secondary
One-month well-child care visit Percentage of children who had attended a well-child care visit within 41 days of birth Review of medical records Not applicable Primary

Johnston, B. D., Huebner, C. E., Anderson, M. L., Tyll, L. T., & Thompson, R. S. (2006). Healthy Steps in an integrated delivery system: Child and parent outcomes at 30 months. Archives of Pediatrics & Adolescent Medicine, 160(8), 793–800.
Results for women receiving Healthy Steps plus PrePare.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
10-month well-child care visit No Effect Healthy Steps sample 30 months 239 children Mean = 0.94 Mean = 0.93 OR = 1.01 Not statistically significant,
p > 0.05
HomVEE = 0.01 Primary
15-month well-child care visit No Effect Healthy Steps sample 30 months 239 children Mean = 0.88 Mean = 0.89 OR = 0.99 Not statistically significant,
p > 0.05
HomVEE = -0.01 Primary
2-month well-child care visit No Effect Healthy Steps sample 30 months 239 children Mean = 0.93 Mean = 0.96 OR = 0.97 Not statistically significant,
p > 0.05
HomVEE = -0.02 Primary
24-month well-child care visit Favorable Healthy Steps sample 30 months 239 children Mean = 0.87 Mean = 0.76 OR = 1.17 Statistically significant,
p < 0.05
HomVEE = 0.10 Primary
4-month well-child care visit No Effect Healthy Steps sample 30 months 239 children Mean = 0.96 Mean = 0.98 OR = 0.97 Not statistically significant,
p > 0.05
HomVEE = -0.02 Primary
6-month well-child care visit No Effect Healthy Steps sample 30 months 239 children Mean = 0.94 Mean = 0.94 OR = 1.01 Not statistically significant,
p > 0.05
HomVEE = 0.01 Primary
Breastfeeding duration (mo.) Unfavorable Healthy Steps sample 30 months 232 mothers Mean = 13.0
SD = 8.9
Mean = 13.9
SD = 8.7
MD = -0.64 Statistically significant,
p < 0.05
Not available Secondary
Ever breastfed Unfavorable Healthy Steps sample 30 months 232 mothers Mean = 0.95 Mean = 0.99 OR = 0.96 Statistically significant,
p < 0.05
HomVEE = -0.03 Secondary
Immunization status up-to-date at 24 mo. Favorable Healthy Steps sample 30 months 239 children Mean = 0.92 Mean = 0.88 OR = 1.03 Statistically significant,
p < 0.05
HomVEE = 0.02 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Breastfeeding duration Number of months the mother breasted her child Parent/caregiver report Not applicable Secondary
Ever breastfed Percentage of mothers who had ever breastfed their child Parent/caregiver report Not applicable Secondary
Immunization status up-to-date at 24 months Percentage of children who had up-to-date immunizations for their age Review of the health plan’s standard Health Plan Employer Data and Information Set. Not applicable Primary
Well-child care visits at 2, 4, 6, 10, 15, 24 months of age. Percentage of children who had a well-child visit at the reference month of age Review of health plan records Not applicable Primary

Johnston, B. D., Huebner, C. E., Tyll, L. T., Barlow, W. E., & Thompson, R. S. (2004). Expanding developmental and behavioral services for newborns in primary care: Effects on parental well-being, practice, and satisfaction. American Journal of Preventative Medicine, 26(4), 356–366.
Results for women receiving Healthy Steps plus PrePare.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Breastfeeding at 3 months No Effect Healthy Steps sample 3 months 275 mothers Mean = 0.89 Mean = 0.92 OR = 0.98 Not statistically significant,
p > 0.05
HomVEE = -0.01 Secondary
Feels strongly supported to breastfeed No Effect Healthy Steps sample 3 months 275 mothers Mean = 0.73 Mean = 0.77 OR = 0.98 Not statistically significant,
p > 0.05
HomVEE = -0.01 Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Breastfeeding at 3 months Percentage of mothers who had been breastfeeding at the child’s 3rd month of age Parent/caregiver report Not applicable Secondary
Feels strongly supported to breastfeed Percentage of mothers who felt supported by their partner and extended family to breastfeed their child Parent/caregiver report Not applicable Secondary

Minkovitz, C., Strobino, D., Hughart, N., Scharfstein, D., Guyer, B., & Healthy Steps Evaluation Team (2001). Early effects of the Healthy Steps for Young Children Program. Archives of Pediatrics & Adolescent Medicine, 155(4), 470–479.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Continuing to breastfeed No Effect The 6 RCT national evaluation sites 2-4 mo. 1,987 mothers Mean = 0.56 Mean = 0.54 OR = 1.15 Not statistically significant,
p > 0.05
HomVEE = 0.08 Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Continuing to breastfeed Percentage of mothers who were breastfeeding, including those that continued to breastfeed, among women who had initiated breastfeeding Parent/caregiver report Not applicable Secondary
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Impact Studies Rated Moderate


Minkovitz, C. S., Strobino, D., Mistry, K. B., Scharfstein, D. O., Grason, H., Hou, W., Guyer, B. (2007). Healthy Steps for Young Children: Sustained results at 5.5 years. Pediatrics, 120(3), 658–668.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
Child hospitalized in past year No Effect The 6 RCT national evaluation sites 5.5 years 1,308 children Mean = 0.03 Mean = 0.04 OR = 0.96 Not statistically significant,
p > 0.05
HomVEE = -0.02 Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Child hospitalized in past year Percentage of children who had been hospitalized during the previous year Parent/caregiver report Not applicable Secondary
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