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Healthy Steps (National Evaluation 1996 Protocol)

Meets DHHS criteria for an evidenced based model

Last Updated: July 2011

In Brief for Positive Parenting Practices Outcomes

Impact Studies Rated High


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
Covers on electrical outlets Favorable Healthy Steps sample 30 months 232 mothers Mean = 0.95 Mean = 0.91 OR = 1.06 Statistically significant,
p < 0.05
HomVEE = 0.03 Secondary
Discipline by ever slapping face or spanking with object No Effect Healthy Steps sample 30 months 232 mothers Mean = 0.01 Mean = 0.03 OR = 0.20 Not statistically significant,
p > 0.05
HomVEE = -0.98 Secondary
Environment with tobacco smoke No Effect Healthy Steps sample 30 months 239 mothers Mean = 0.10 Mean = 0.07 OR = 1.05 Not statistically significant,
p > 0.05
HomVEE = 0.03 Secondary
Followed 3 routines, 2 if no nap No Effect Healthy Steps sample 30 months 232 mothers Mean = 0.80 Mean = 0.91 OR = 1.02 Not statistically significant,
p > 0.05
HomVEE = 0.01 Secondary
Has access to poison control center telephone number No Effect Healthy Steps sample 30 months 232 mothers Mean = 0.96 Mean = 0.96 OR = 1.01 Not statistically significant,
p > 0.05
HomVEE = 0.01 Secondary
Health care self-efficacy No Effect Healthy Steps sample 30 months 239 mothers Mean = 17.0
SD = 2.0
Mean = 17.0
SD = 1.9
MD = -0.14 Not statistically significant, p > 0.05 Not available Secondary
Injury prevention index No Effect Healthy Steps sample 30 months 239 mothers Mean = 4.86
SD = 0.41
Mean = 4.81
SD = 0.45
MD = -0.02 Not statistically significant,
p > 0.05
Not available Secondary
Parenting Behavior Checklist: Nurturing subscale No Effect Healthy Steps sample 30 months 239 mothers Mean = 58.7
SD = 7.3
Mean = 60.2
SD = 5.6
MD = -1.35 Not statistically significant,
p > 0.05
Not available Secondary
Parenting sense of competence No Effect Healthy Steps sample 30 months 239 mothers Mean = 47.1
SD = 4.6
Mean = 47.6
SD = 4.9
MD = -0.69 Not statistically significant,
p > 0.05
Not available Secondary
Play with child at least daily No Effect Healthy Steps sample 30 months 232 mothers Mean = 0.97 Mean = 0.99 OR = 0.98 Not statistically significant,
p > 0.05
HomVEE = -0.01 Secondary
Read to child at least daily Unfavorable Healthy Steps sample 30 months 232 mothers Mean = 0.88 Mean = 0.95 OR = 0.92 Statistically significant,
p < 0.05
HomVEE = -0.05 Secondary
Safety latches on cabinets Unfavorable Healthy Steps sample 30 months 232 mothers Mean = 0.63 Mean = 0.71 OR = 0.87 Statistically significant,
p < 0.05
HomVEE = -0.08 Secondary
Use stair gate No Effect Healthy Steps sample 30 months 232 mothers Mean = 0.32 Mean = 0.34 OR = 0.99 Not statistically significant,
p > 0.05
HomVEE = -0.01 Secondary
Watch television more than one hr. per day Unfavorable Healthy Steps sample 30 months 232 mothers Mean = 0.39 Mean = 0.28 OR = 1.35 Statistically significant,
p < 0.05
HomVEE = 0.18 Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Covers on electrical outlets The proportion of parents who placed covers on electrical outlets in the home Parent/caregiver report during telephone interview Not applicable Secondary
Disciplined by ever slapping face or spanking with object The proportion of parents who had ever disciplined their child by slapping them in the face or spanking them with an object Parent/caregiver report during telephone interview Not applicable Secondary
Followed three routines (two if no nap) The proportion of parents who followed at least three routines at mealtime or sleep time Parent/caregiver report during telephone interview Not applicable Secondary
Has access to poison control center telephone number The proportion of parents who reported they had access to the poison control center telephone number Parent/caregiver report during telephone interview Not applicable Secondary
Injury prevention index A 5-item assessment developed for the study to access injury prevention practices. The assessment is scored by summing binary items for a score of 0 to 5. Parent/caregiver report during telephone interview Not reported by author Secondary
PBC: Nurturing subscale The PBC examines how parents raise their child. This outcome is an 18-item subscale of the PBC ranging from 18 to 72. Parent/caregiver report during telephone interview Cronbach’s α = .79 Secondary
Played with child at least daily The proportion of parents who played with their child at least once daily Parent/caregiver report during telephone interview Not applicable Secondary
PSOC A 16-item assessment scored from 16 to 64 that examined parenting self-efficacy and competence Parent/caregiver report during telephone interview Cronbach’s α = .79 Secondary
Read to child at least daily The proportion of parents who read to their child at least once daily Parent/caregiver report during telephone interview Not applicable Secondary
Safety latches on cabinets The proportion of parents who placed safety latches on cabinets in the home Parent/caregiver report during telephone interview Not applicable Secondary
Uses stair gate The proportion of parents who used a stair gate in the home Parent/caregiver report during telephone interview Not applicable Secondary
Watched television more than one hour per day The proportion of parents whose children watched television for more than one hour per day Parent/caregiver report during telephone interview Not applicable Secondary

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
Endorsed appropriate discipline No Effect Healthy Steps sample 3 months 275 mothers Mean = 0.90 Mean = 0.90 OR = 1.01 Not statistically significant,
p > 0.05
HomVEE = 0.01 Secondary
Home Safety Index No Effect Healthy Steps sample 3 months 275 mothers Mean = 6.29
SD = 0.85
Mean = 6.27
SD = 0.92
MD = 0.03 Not statistically significant,
p > 0.05
Not available Secondary
KIDI score No Effect Healthy Steps sample 3 months 275 mothers Mean = 0.82
SD = 0.09
Mean = 0.83
SD = 0.08
MD = 0.00 Not statistically significant,
p > 0.05
Not available Secondary
Knowledge of sleep positions No Effect Healthy Steps sample 3 months 275 mothers Mean = 0.97 Mean = 0.98 OR = 0.60 Not statistically significant,
p < 0.05
HomVEE = -0.31 Secondary
Parenting sense of competence No Effect Healthy Steps sample 3 months 275 mothers Mean = 47.30
SD = 4.66
Mean = 48.05
SD = 5.28
MD = -0.70 Not statistically significant,
p > 0.05
Not available Secondary
Read with infant in past week No Effect Healthy Steps sample 3 months 275 mothers Mean = 0.78 Mean = 0.80 OR = 0.98 Not statistically significant,
p > 0.05
HomVEE = -0.01 Secondary
Role satisfaction No Effect Healthy Steps sample 3 months 275 mothers Mean = 0.98 Mean = 0.98 OR = 1.01 Not statistically significant,
p > 0.05
HomVEE = 0.01 Secondary
Safe-sleep practices No Effect Healthy Steps sample 3 months 275 mothers Mean = 0.81 Mean = 0.78 OR = 1.05 Not statistically significant,
p
HomVEE = 0.03 Secondary
Self-efficacy (health care specific) No Effect Healthy Steps sample 3 months 275 mothers Mean = 16.54
SD = 1.89
Mean = 16.73
SD = 1.91
MD = -0.17 Not statistically significant, p > 0.05 Not available Secondary
Tobacco-free household No Effect Healthy Steps sample 3 months 275 mothers Mean = 0.90 Mean = 0.91 OR = 1.01 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
Endorsed appropriate discipline Proportion of correctly answered age-appropriate questions about appropriate discipline, for undesirable infant behavior extracted from the KIDI Parent/caregiver report during telephone interview Not reported by author Secondary
Home Safety Index A Home Safety Index was constructed using a 7-item count score comprised of answers, for questions about appropriate car seat use, safe storage of firearms, functioning smoke detector, scald prevention activities, and safe infant sleep practices. Parent/caregiver report during telephone interview Not reported by author Secondary
KIDI The KIDI measures the parent’s knowledge of childrearing practices and developmental processes. The researchers analyzed the proportion of correct responses on the KIDI. Parent/caregiver report during telephone interview Not reported by author Secondary
Knowledge of sleep positions Proportion of correctly answered age-appropriate questions about sleeping and bedding extracted from the KIDI Parent/caregiver report during telephone interview Not reported by author Secondary
PSOC A Likert scale ranging from 16 to 64 that measured parenting self-efficacy Parent/caregiver report during telephone interview Cronbach’s α = .80 Secondary
Read with infant in past week The proportion of parents who read to their child at least once in the previous week Parent/caregiver report during telephone interview Not applicable Secondary
Role satisfaction The proportion of parents who were “pleased” or “delighted” with their role as a parent Parent/caregiver report during telephone interview Not applicable Secondary
Safe-sleep practices Proportion of parents reporting that their child was always put to sleep in the supine position without thick or very soft bedding Parent/caregiver report during telephone interview Not applicable Secondary
Self-efficacy (health care specific) This scale measures parents’ self-efficacy in addressing child health problems. Parent/caregiver report Cronbach’s α = .82 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
Car seat in back seat No Effect The 6 RCT national evaluation sites 2-4 mo. 1,987 mothers Mean = 0.90 Mean = 0.90 OR = 1.08 Not statistically significant,
p > 0.05
HomVEE = 0.05 Secondary
Followed at least 2 routines No Effect The 6 RCT national evaluation sites 2-4 mo. 1,987 mothers Mean = 0.94 Mean = 0.93 OR = 1.27 Not statistically significant,
p > 0.05
HomVEE = 0.14 Secondary
Gave baby cereal No Effect The 6 RCT national evaluation sites 2-4 mo. 1,987 mothers Mean = 0.30 Mean = 0.32 OR = 0.88 Not statistically significant,
p > 0.05
HomVEE = -0.08 Secondary
Gave baby water Favorable The 6 RCT national evaluation sites 2-4 mo. 1,987 mothers Mean = 0.38 Mean = 0.41 OR = 0.80 Statistically significant,
p < 0.05
HomVEE = -0.14 Secondary
Lowered water temperature No Effect The 6 RCT national evaluation sites 2-4 mo. 1,987 mothers Mean = 0.31 Mean = 0.33 OR = 0.93 Not statistically significant,
p > 0.05
HomVEE = -0.04 Secondary
Played with baby daily No Effect The 6 RCT national evaluation sites 2-4 mo. 1,987 mothers Mean = 0.93 Mean = 0.93 OR = 1.02 Not statistically significant,
p > 0.05
HomVEE = 0.01 Secondary
Showed picture books daily No Effect The 6 RCT national evaluation sites 2-4 mo. 1,987 mothers Mean = 0.28 Mean = 0.27 OR = 1.08 Not statistically significant,
p > 0.05
HomVEE = 0.05 Secondary
Used wrong sleep position Favorable The 6 RCT national evaluation sites 2-4 mo. 1,987 mothers Mean = 0.11 Mean = 0.14 OR = 0.76 Statistically significant,
p < 0.05
HomVEE = -0.17 Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Car seat in back seat Percentage of mothers who placed the child’s car seat in the back seat Parent/caregiver report during telephone interview Not applicable Secondary
Followed at least two routines Percentage of mothers who followed at least two routines at bedtime, naptime, or mealtime Parent/caregiver report during telephone interview Not applicable Secondary
Gave baby cereal Percentage of mothers who fed their infant cereal Parent/caregiver report during telephone interview Not applicable Secondary
Gave baby water Percentage of mothers who fed their infant water Parent/caregiver report during telephone interview Not applicable Secondary
Lowered water temperature Percentage of mothers who lowered the temperature of the hot water heater at home Parent/caregiver report during telephone interview Not applicable Secondary
Played with baby daily Percentage of mothers who played with their child at least once daily Parent/caregiver report during telephone interview Not applicable Secondary
Showed picture books daily Percentage of mothers who showed their child picture books daily Parent/caregiver report during telephone interview Not applicable Secondary
Used wrong sleep position Percentage of mothers who used the wrong sleep position at both nap and bedtime Parent/caregiver report during telephone interview Not applicable Secondary
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Impact Studies Rated Moderate


Caughy, M. O., Huang, K., Miller, T., & Genevro, J. L. (2004). The effects of Healthy Steps for Young Children Program: Results from observations of parenting and child development. Early Childhood Research Quarterly, 19(4), 611–630.
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

NCAST total score

P/CIS general

P/CIS appropriateness

HOME total score

HOME positive involvement

HOME lack of negativity

HOME cognitive stimulation

No Effect 2 of the 6 RCT national evaluation sites 16-18 mo. 378 mothers

NCAST Total Score Mean = 47.61 (SE = 0.42)

P/CIS general mean = 3.71 (SE = 0.05)

P/CIS appropriateness mean = 3.47 (SE = 0.03)

HOME total score mean = 39.07 (SE = 0.26)

HOME positive involvement mean = 5.69 (SE = 0.05)

HOME lack of negativity mean = 4.88 (SE = 0.12)

HOME cognitive stimulation mean = 6.78

NCAST Total Score mean = 48.58 (SE = 0.47)

P/CIS general mean = 3.85 (SE = 0.05)

P/CIS appropriateness mean = 3.59 (SE = 0.03)

HOME total score mean = 39.65 (SE = 0.29)

HOME positive involvement mean = 5.70 (SE = 0.05)

HOME lack of negativity mean = 5.03 (SE = 0.13)

HOME cognitive stimulation mean = 6.72 (SE = 0.10)

NCAST Total Score MD = -0.97

P/CIS general MD = -0.14

P/CIS appropriateness MD = -0.12

HOME total score MD = -0.58

HOME positive involvement MD = -0.01

HOME lack of negativity MD = -0.15

HOME cognitive stimulation MD = 0.06

Not statistically significant,
p > 0.05, Significance test performed jointly
Not available Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
HOME: Total score, Positive involvement, Lack of negativity, Cognitive stimulation The HOME assesses parenting practices and aspects of the home environment. The scale consisted of 45 items. In addition to using the total score, the researchers constructed three factor scores: (1) Positive Involvement, (2) Lack of Negativity, and (3) Cognitive Stimulation. Parent/caregiver interview and videotaped observational assessment Cronbach’s α = 0.67 (Total score)
ICC= 0.40 (Positive involvement)
ICC= 0.77 ( Lack of negativity)
ICC = 0.52 (Cognitive stimulation)
Primary
NCAST: Total score The NCAST assesses the quality of teaching interaction between caregivers and young children. The assessment is based on binary items scored from direct observation of mother and child during an age-appropriate, parent-selected teaching task lasting about 3 to 6 minutes. Videotaped observation ICC = 0.78 Primary
P/CIS: General, Appropriateness The P/CIS is a behavioral rating scale of caregivers based on observations of the mother during 15 minutes of free play with her child. The scale is divided into 11 types of behaviors and then into three different aspects of those behaviors: amount, quality, and appropriateness. There are five global assessments that assess overall parent involvement. The researchers constructed three subscales—amount, quality, and appropriateness—by calculating the mean score for the 11 behaviors and created a general impression score based on the mean of the five global measures. Videotaped observation ICC = 0.77 Primary

Caughy, M. O., Miller, T., Genevro, J. L., Huang, K., & Nautiyal, C. (2003). The effects of Healthy Steps on discipline strategies of parents of young children. Journal of Applied Developmental Psychology, 24(5), 517–534.
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
Use of inductive/authoritative discipline Favorable 2 of the 6 RCT national evaluation sites 16-18 mo. 378 mothers Mean = 0.10
SE = 0.07
Mean = -0.12
SE = 0.08
MD = 0.22 Statistically significant,
p < 0.05
HomVEE = 0.21 Secondary
Use of punitive/“high power” discipline No Effect 2 of the 6 RCT national evaluation sites 16-18 mo. 378 mothers Mean = -0.06
SE = 0.07
Mean = 0.13
SE = 0.08
MD = -0.19 Not statistically significant,
p > 0.05
HomVEE = 0.18 Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Use of inductive/authoritative discipline A modified version of the Parental Responses to Child Misbehavior was administered to parents who were asked to report how frequently in an average week in the previous month they used 12 discipline strategies. Authors conducted confirmatory factor analysis on a two-factor model: inductive/authoritative behavior and punitive/high-power behavior. Parent/caregiver report Not reported by author Secondary
Use of punitive/“high-power” discipline A modified version of the Parental Responses to Child Misbehavior was administered to parents who were asked to report how frequently in an average week in the previous month they used 12 discipline strategies. Authors conducted confirmatory factor analysis on a two-factor model: inductive/authoritative behavior and punitive/high-power behavior. Parent/caregiver report Not reported by author Secondary

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
Ever slap in face/spank with object No Effect The 6 RCT national evaluation sites 5.5 yrs 1,308 mothers Mean = 0.11 Mean = 0.13 OR = 0.85 Not statistically significant,
p > 0.05
HomVEE = -0.10 Secondary
Looked at/read books in past week No Effect The 6 RCT national evaluation sites 5.5 yrs 1,308 mothers Mean = 0.59 Mean = 0.57 OR = 1.07 Not statistically significant,
p > 0.05
HomVEE = 0.04 Secondary
Often/almost always ignore misbehavior No Effect The 6 RCT national evaluation sites 5.5 yrs 1,308 mothers Mean = 0.09 Mean = 0.09 OR = 1.07 Not statistically significant,
p > 0.05
HomVEE = 0.04 Secondary
Often/almost always negotiate No Effect The 6 RCT national evaluation sites 5.5 yrs 1,308 mothers Mean = 0.59 Mean = 0.54 OR = 1.25 Not statistically significant,
p > 0.05
HomVEE = 0.14 Secondary
Routine/regular bedtime No Effect The 6 RCT national evaluation sites 5.5 yrs 1,308 mothers Mean = 0.85 Mean = 0.88 OR = 0.76 Not statistically significant,
p > 0.05
HomVEE = -0.17 Secondary
Use harsh discipline No Effect The 6 RCT national evaluation sites 5.5 yrs 1,308 mothers Mean = 0.05 Mean = 0.07 OR = 0.78 Not statistically significant,
p > 0.05
HomVEE = -0.15 Secondary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Ever slapped in face/spanked with object Percentage of mothers who had ever slapped their child in the face or spanked their child with an object during the last 12 months Parent/caregiver report during telephone interview Not applicable Secondary
Looked at/read books in past week Percentage of mothers whose child looked at or read books outside of school in the past week once or twice per week or more Parent/caregiver report during telephone interview Not applicable Secondary
Often/almost always ignored misbehavior Percentage of mothers who often or almost always ignored their child in response to their child’s misbehavior during the last 12 months Parent/caregiver report during telephone interview Not applicable Secondary
Often/almost always negotiated Percentage of mothers who often or almost always used negotiation as a response to their child’s misbehavior during the last 12 months Parent/caregiver report during telephone interview Not applicable Secondary
Routine/regular bedtime Percentage of mothers whose child usually went to bed at about the same time each night on weeknights during the school year Parent/caregiver report during telephone interview Not applicable Secondary
Used harsh discipline A dichotomous variable indicating harsh discipline was formed from a constructed scale that included responses to misbehavior such as yelling in anger or threatening during the last 12 months. The respondent’s total score on the scale was summed and divided by the number of items and was interpreted in relation to the response categories for the items. Parent/caregiver report during telephone interview Cronbach’s α = 0.59 Secondary
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