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Study Detail

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.

Program(s) Reviewed: Healthy Steps (National Evaluation 1996 Protocol)

Study Screening Details

Screening DecisionScreening Conclusion
Study Passes ScreensEligible for Review

Study Design Details

RatingDesignAttritionBaseline EquivalenceReassignmentConfounding Factors
HighRCT (2-4 months)LowEstablished on race/ethnicity and SES (i.e., maternal education and Medicaid coverage). Equivalence on baseline measures is not feasible.NoneNone
LowQED (2-4 months)NANot established on race/ethnicity or SES (i.e., maternal education).NANone

Study Characteristics

Study Participants The sample included 1,987 mothers with children ages 2 to 4 months at assessment. All women enrolled in Healthy Steps within four weeks of the child’s birth. Study enrollment occurred between September 1996 and November 1998. Most mothers had a high school degree (~85%) and one in four also had a college degree. Most study participants were white (~62%) or African American (~24%). The most common maternal age groups were 20-29 (~51%) and over 30 (~33%). Nearly two-thirds of mothers were married.
Setting The six sites—Allentown, PA, Amarillo, TX, Florence, SC, Iowa City, IA, Pittsburgh, PA, and San Diego, CA—were randomly assigned as part of the national evaluation. (There were nine other sites that used quasi-experimental comparisons. These comparisons received a low rating, however. See Study Ratings for details.) Sites were group practices, hospital-based clinics, or pediatric practices in health maintenance organizations.
Home Visiting Services Healthy Steps Specialists provided well-child care, home visits, a child development telephone information line, child development and family health checkups, written materials for parents that emphasize prevention, parent group meetings, and links to community resources. Home visits typically occurred at least once during the first month after birth and a total of six times by the time the children were age 3. Three in four mothers in the intervention group had received a home visit by the two- to four-month follow-up.
Comparison Condition Children in the control group received routine pediatric care but had no exposure to the Healthy Steps Specialist or to Healthy Steps materials.
Staff Characteristics and Training Specialists were early childhood educators, nurses, nurse practitioners, social workers, or professionals with other relevant expertise. Each attended annual trainings conducted by the Boston University Healthy Steps team and administered services in cooperation with pediatricians and pediatric nurse practitioners. Sites also received program and training manuals and technical assistance through biweekly teleconferences. Implementation of written protocols was monitored by the Healthy Steps national program office. See Guyer et al. (2003) for more details.
Funding Source The Commonwealth Fund and local funders.
Author Affiliation None of the study authors are developers of this program model.

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