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Implementing Healthy Steps (National Evaluation 1996 Protocol)

Meets DHHS criteria for an evidenced based model

This report focuses on Healthy Steps as implemented in the 1996 evaluation. HHS has determined that home visiting is not the primary service delivery strategy and the model does not meet current requirements for MIECHV program implementation.

Materials and Forms to Support Implementation

Last Updated

August 2015


Operations Manuals

HS sites in the national evaluation followed written protocols and guidelines that described key program elements and the role of the HS specialist. Another program manual, Strategies for Change: Child Development in Primary Care for Young Children, guided pediatric clinicians in the HS approach. This manual instructed clinicians on how to individualize care, focus on the whole child and whole family, and build a relationship with families; included information on child safety in the home, breastfeeding, smoking, and maternal depression; and included strategies for creating teachable moments. A third set of HS program manuals and other written materials helped to guide site operations and finances, including recommendations for orienting HS specialists to the practice, and example press releases and fact sheets directed toward families. Sites also received a training manual.


Service Delivery Forms

HS specialists logged detailed information on their contact with families, including the services delivered and topics discussed.

Parents received several written materials to inform them about their child’s development and involve them in their child’s care. These materials included, but were not limited to:

  • Child Health and Development Record. This was provided to parents at the beginning of the program and used to record the child’s growth and development, immunizations, and illnesses. It also contained information on developmental milestones and safety.
  • Linkletters. This was a newsletter with information on well-child appointments, mailed to parents before their well-child visit.
  • Parent prompt sheets. These contained questions parents could ask their clinicians.


Assessment Tools

HS specialists periodically assessed each child’s development, either at the home visit or at an office visit, using several standardized tools. Specialists used portions of the Brazelton Neonatal Assessment instrument at the earliest visit, the MacArthur Communicative Development Inventory as language began to emerge, and the Denver Developmental Screening Test on a periodic basis.



Sites in the HS (national evaluation) followed protocols and other guidance in the training and operations materials. These materials guided specialists and other clinicians on relaying child development, safety, and other recommendations to parents.


Available Languages

All written materials for parents were available in both English and Spanish.


Fidelity Measurement

To ensure sites in the national evaluation followed the written protocols and guidelines consistently, the NPO, along with representatives from the implementation team and The Commonwealth Fund, visited sites twice: between 6 and 9 months after operations began, and approximately 18 months after startup. In addition to site visits, NPO staff obtained information on fidelity through formal and informal telephone calls with sites, and through documentation of technical assistance.


Fidelity Standards

All sites were required to adhere to the protocols developed for the national evaluation.



The information contained on this page was last updated in August 2015.