Healthy Steps (National Evaluation 1996 Protocol)
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.
Model effectiveness research report last updated: 2011
Effects shown in research & outcome measure details
Positive parenting practices
Findings rated high
Show findings details
| Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
|---|---|---|---|---|---|---|---|---|---|
| Car seat in back seat | FavorableUnfavorable or ambiguousNo Effect |
2-4 mo. | The 6 RCT national evaluation sites | 1987 mothers | Mean = 0.90 | Mean = 0.90 | OR = 1.08 | HomeVEE calculated = 0.05 | Not statistically significant, p ≥ 0.05 |
| Followed at least 2 routines | FavorableUnfavorable or ambiguousNo Effect |
2-4 mo. | The 6 RCT national evaluation sites | 1987 mothers | Mean = 0.94 | Mean = 0.93 | OR = 1.27 | HomeVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 |
| Lowered water temperature | FavorableUnfavorable or ambiguousNo Effect |
2-4 mo. | The 6 RCT national evaluation sites | 1987 mothers | Mean = 0.31 | Mean = 0.33 | OR = 0.93 | HomeVEE calculated = -0.04 | Not statistically significant, p ≥ 0.05 |
| Played with baby daily | FavorableUnfavorable or ambiguousNo Effect |
2-4 mo. | The 6 RCT national evaluation sites | 1987 mothers | Mean = 0.93 | Mean = 0.93 | OR = 1.02 | HomeVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 |
| Showed picture books daily | FavorableUnfavorable or ambiguousNo Effect |
2-4 mo. | The 6 RCT national evaluation sites | 1987 mothers | Mean = 0.28 | Mean = 0.27 | OR = 1.08 | HomeVEE calculated = 0.05 | Not statistically significant, p ≥ 0.05 |
| Used wrong sleep position | FavorableUnfavorable or ambiguousNo Effect |
2-4 mo. | The 6 RCT national evaluation sites | 1987 mothers | Mean = 0.11 | Mean = 0.14 | OR = 0.76 | HomeVEE calculated = -0.17 | Statistically significant, p < 0.05 |
Show outcome measure summary
| Outcome measure | Outcome measure description | Collection method | Properties |
|---|---|---|---|
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 |
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 |
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 |
Played with baby daily |
Percentage of mothers who played with their child at least once daily | Parent/caregiver report during telephone interview | Not applicable |
Showed picture books daily |
Percentage of mothers who showed their child picture books daily | Parent/caregiver report during telephone interview | Not applicable |
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 |
Show findings details
| Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
|---|---|---|---|---|---|---|---|---|---|
| Covers on electrical outlets | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.95 | Mean = 0.91 | OR = 1.06 | HomeVEE calculated = 0.03 | Statistically significant, p < 0.05 |
| Discipline by ever slapping face or spanking with object | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.01 | Mean = 0.03 | OR = 0.20 | HomeVEE calculated = -0.98 | Not statistically significant, p ≥ 0.05 |
| Environment with tobacco smoke | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 239 mothers | Mean = 0.10 | Mean = 0.07 | OR = 1.05 | HomeVEE calculated = 0.03 | Not statistically significant, p ≥ 0.05 |
| Followed 3 routines, 2 if no nap | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.80 | Mean = 0.91 | OR = 1.02 | HomeVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 |
| Has access to poison control center telephone number | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.96 | Mean = 0.96 | OR = 1.01 | HomeVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 |
| Health care self-efficacy | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 239 mothers | Mean = 17.00 | Mean = 17.00 | Mean difference = -0.14 | Not available | Not statistically significant, p ≥ 0.05 |
| Injury prevention index | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 239 mothers | Mean = 4.86 | Mean = 4.81 | Mean difference = -0.02 | Not available | Not statistically significant, p ≥ 0.05 |
| Parenting Behavior Checklist: Nurturing subscale | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 239 mothers | Mean = 58.70 | Mean = 60.20 | Mean difference = -1.35 | Not available | Not statistically significant, p ≥ 0.05 |
| Parenting sense of competence | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 239 mothers | Mean = 47.10 | Mean = 47.60 | Mean difference = -0.69 | Not available | Not statistically significant, p ≥ 0.05 |
| Play with child at least daily | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.97 | Mean = 0.99 | OR = 0.98 | HomeVEE calculated = -0.01 | Not statistically significant, p ≥ 0.05 |
| Read to child at least daily | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.88 | Mean = 0.95 | OR = 0.92 | HomeVEE calculated = -0.05 | Statistically significant, p < 0.05 |
| Safety latches on cabinets | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.63 | Mean = 0.71 | OR = 0.87 | HomeVEE calculated = -0.08 | Statistically significant, p < 0.05 |
| Use stair gate | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.32 | Mean = 0.34 | OR = 0.99 | HomeVEE calculated = -0.01 | Not statistically significant, p ≥ 0.05 |
| Watch television more than one hr. per day | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.39 | Mean = 0.28 | OR = 1.35 | HomeVEE calculated = 0.18 | Statistically significant, p < 0.05 |
Show outcome measure summary
| Outcome measure | Outcome measure description | Collection method | Properties |
|---|---|---|---|
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 |
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 |
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 |
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 |
Environment with tobacco smoke |
Percentage of households with current smokers |
Parent/caregiver report |
Not applicable |
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 |
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 |
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 |
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 |
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 |
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 |
Uses stair gate |
The proportion of parents who used a stair gate in the home |
Parent/caregiver report during telephone interview |
Not applicable |
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 |
Show findings details
| Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
|---|---|---|---|---|---|---|---|---|---|
| KIDI score | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 0.82 | Mean = 0.83 | Mean difference = 0.00 | Not available | Not statistically significant, p ≥ 0.05 |
| Endorsed appropriate discipline | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 0.90 | Mean = 0.90 | OR = 1.01 | HomeVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 |
| Home Safety Index | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 6.29 | Mean = 6.27 | Mean difference = 0.03 | Not available | Not statistically significant, p ≥ 0.05 |
| Knowledge of sleep positions | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 0.97 | Mean = 0.98 | OR = 0.60 | HomeVEE calculated = -0.31 | Not statistically significant, p ≥ 0.05 |
| Parenting sense of competence | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 47.30 | Mean = 48.05 | Mean difference = -0.70 | Not available | Not statistically significant, p ≥ 0.05 |
| Read with infant in past week | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 0.78 | Mean = 0.80 | OR = 0.98 | HomeVEE calculated = -0.01 | Not statistically significant, p ≥ 0.05 |
| Role satisfaction | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 0.98 | Mean = 0.98 | OR = 1.01 | HomeVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 |
| Safe-sleep practices | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 0.81 | Mean = 0.78 | OR = 1.05 | HomeVEE calculated = 0.03 | Not statistically significant, p |
| Self-efficacy (health care specific) | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 16.54 | Mean = 16.73 | Mean difference = -0.17 | Not available | Not statistically significant, p ≥ 0.05 |
| Tobacco-free household | FavorableUnfavorable or ambiguousNo Effect |
3 months | Healthy Steps sample | 275 mothers | Mean = 0.90 | Mean = 0.91 | OR = 1.01 | HomeVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 |
Show outcome measure summary
| Outcome measure | Outcome measure description | Collection method | Properties |
|---|---|---|---|
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 |
PSOC |
A Likert scale ranging from 16 to 64 that measured parenting self-efficacy |
Parent/caregiver report during telephone interview |
Cronbach’s α = .80 |
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 |
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 |
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 |
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 |
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 |
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 |
Self-efficacy (health care specific) |
This scale measures parents’ self-efficacy in addressing child health problems. |
Parent/caregiver report |
Cronbach’s α = .82 |
Tobacco-free household |
Percentage of households without smokers |
Parent/caregiver report |
Not applicable |
Findings rated moderate
Show findings details
| Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
|---|---|---|---|---|---|---|---|---|---|
| Use of inductive/authoritative discipline | FavorableUnfavorable or ambiguousNo Effect |
16-18 mo. | 2 of the 6 RCT national evaluation sites | 378 mothers | Mean = 0.10 | Mean = -0.12 | Mean difference = 0.22 | HomeVEE calculated = 0.21 | Statistically significant, p < 0.05 |
| Use of punitive/“high power” discipline | FavorableUnfavorable or ambiguousNo Effect |
16-18 mo. | 2 of the 6 RCT national evaluation sites | 378 mothers | Mean = -0.06 | Mean = 0.13 | Mean difference = -0.19 | HomeVEE calculated = 0.18 | Not statistically significant, p ≥ 0.05 |
Show outcome measure summary
| Outcome measure | Outcome measure description | Collection method | Properties |
|---|---|---|---|
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 |
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 |
Show findings details
| Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
|---|---|---|---|---|---|---|---|---|---|
| Ever slap in face/spank with object | FavorableUnfavorable or ambiguousNo Effect |
5.5 yrs | The 6 RCT national evaluation sites | 1308 mothers | Mean = 0.11 | Mean = 0.13 | OR = 0.85 | HomeVEE calculated = -0.10 | Not statistically significant, p ≥ 0.05 |
| Looked at/read books in past week | FavorableUnfavorable or ambiguousNo Effect |
5.5 yrs | The 6 RCT national evaluation sites | 1308 mothers | Mean = 0.59 | Mean = 0.57 | OR = 1.07 | HomeVEE calculated = 0.04 | Not statistically significant, p ≥ 0.05 |
| Often/almost always ignore misbehavior | FavorableUnfavorable or ambiguousNo Effect |
5.5 yrs | The 6 RCT national evaluation sites | 1308 mothers | Mean = 0.09 | Mean = 0.09 | OR = 1.07 | HomeVEE calculated = 0.04 | Not statistically significant, p ≥ 0.05 |
| Often/almost always negotiate | FavorableUnfavorable or ambiguousNo Effect |
5.5 yrs | The 6 RCT national evaluation sites | 1308 mothers | Mean = 0.59 | Mean = 0.54 | OR = 1.25 | HomeVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 |
| Routine/regular bedtime | FavorableUnfavorable or ambiguousNo Effect |
5.5 yrs | The 6 RCT national evaluation sites | 1308 mothers | Mean = 0.85 | Mean = 0.88 | OR = 0.76 | HomeVEE calculated = -0.17 | Not statistically significant, p ≥ 0.05 |
| Use harsh discipline | FavorableUnfavorable or ambiguousNo Effect |
5.5 yrs | The 6 RCT national evaluation sites | 1308 mothers | Mean = 0.05 | Mean = 0.07 | OR = 0.78 | HomeVEE calculated = -0.15 | Not statistically significant, p ≥ 0.05 |
Show outcome measure summary
| Outcome measure | Outcome measure description | Collection method | Properties |
|---|---|---|---|
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 |
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 |
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 |
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 |
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 |
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 |