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.

Last updated: 2011

Effects shown in research & outcome measure details

Child health

Findings rated high

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.

Healthy Steps (National Evaluation 1996 Protocol)

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Continuing to breastfeed	FavorableUnfavorable or ambiguousNo Effect	2-4 mo.	The 6 RCT national evaluation sites	1987 mothers	Mean = 0.56	Mean = 0.54	OR = 1.15	HomeVEE calculated = 0.08	Not statistically significant, p ≥ 0.05
Gave baby cereal	FavorableUnfavorable or ambiguousNo Effect	2-4 mo.	The 6 RCT national evaluation sites	1987 mothers	Mean = 0.30	Mean = 0.32	OR = 0.88	HomeVEE calculated = -0.08	Not statistically significant, p ≥ 0.05
Gave baby water	FavorableUnfavorable or ambiguousNo Effect	2-4 mo.	The 6 RCT national evaluation sites	1987 mothers	Mean = 0.38	Mean = 0.41	OR = 0.80	HomeVEE calculated = -0.14	Statistically significant, p < 0.05

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Outcome measure	Outcome measure description	Collection method	Properties
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
Gave baby cereal	Percentage of mothers who fed their infant cereal	Parent/caregiver report during telephone interview	Not applicable
Gave baby water	Percentage of mothers who fed their infant water	Parent/caregiver report during telephone interview	Not applicable

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.

Healthy Steps (National Evaluation 1996 Protocol)

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
DTP1 vaccination	FavorableUnfavorable or ambiguousNo Effect	2 months	The 6 RCT national evaluation sites	1950 mothers	= 0.92	= 0.88	OR = 1.50	HomeVEE calculated = 0.25	Statistically significant, p < 0.05
Hospitalization since birth	FavorableUnfavorable or ambiguousNo Effect	2-4 months	The 6 RCT national evaluation sites	1987 mothers	Not reported	Not reported	OR = 0.71	HomeVEE calculated = -0.21	Not statistically significant, p ≥ 0.05
One-month well-child care visit	FavorableUnfavorable or ambiguousNo Effect	1 month	The 6 RCT national evaluation sites	2086 mothers	= 0.97	= 0.95	OR = 1.85	HomeVEE calculated = 0.37	Statistically significant, p < 0.05

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Outcome measure	Outcome measure description	Collection method	Properties
DTP1 vaccination	Percentage of children who had received the DTP1 vaccination between 42 and 92 days postpartum	Review of medical records	Not applicable
Hospitalization since birth	Number of child hospitalizations	Parent/caregiver report	Not applicable
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

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.

Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
10-month well-child care visit	FavorableUnfavorable or ambiguousNo Effect	30 months	Healthy Steps sample	239 children	Mean = 0.94	Mean = 0.93	OR = 1.01	HomeVEE calculated = 0.01	Not statistically significant, p ≥ 0.05
15-month well-child care visit	FavorableUnfavorable or ambiguousNo Effect	30 months	Healthy Steps sample	239 children	Mean = 0.88	Mean = 0.89	OR = 0.99	HomeVEE calculated = -0.01	Not statistically significant, p ≥ 0.05
2-month well-child care visit	FavorableUnfavorable or ambiguousNo Effect	30 months	Healthy Steps sample	239 children	Mean = 0.93	Mean = 0.96	OR = 0.97	HomeVEE calculated = -0.02	Not statistically significant, p ≥ 0.05
24-month well-child care visit	FavorableUnfavorable or ambiguousNo Effect	30 months	Healthy Steps sample	239 children	Mean = 0.87	Mean = 0.76	OR = 1.17	HomeVEE calculated = 0.10	Statistically significant, p < 0.05
4-month well-child care visit	FavorableUnfavorable or ambiguousNo Effect	30 months	Healthy Steps sample	239 children	Mean = 0.96	Mean = 0.98	OR = 0.97	HomeVEE calculated = -0.02	Not statistically significant, p ≥ 0.05
6-month well-child care visit	FavorableUnfavorable or ambiguousNo Effect	30 months	Healthy Steps sample	239 children	Mean = 0.94	Mean = 0.94	OR = 1.01	HomeVEE calculated = 0.01	Not statistically significant, p ≥ 0.05
Breastfeeding duration (mo.)	FavorableUnfavorable or ambiguousNo Effect	30 months	Healthy Steps sample	232 mothers	Mean = 13.00	Mean = 13.90	Mean difference = -0.64	Not available	Statistically significant, p < 0.05
Ever breastfed	FavorableUnfavorable or ambiguousNo Effect	30 months	Healthy Steps sample	232 mothers	Mean = 0.95	Mean = 0.99	OR = 0.96	HomeVEE calculated = -0.03	Statistically significant, p < 0.05
Immunization status up-to-date at 24 mo.	FavorableUnfavorable or ambiguousNo Effect	30 months	Healthy Steps sample	239 children	Mean = 0.92	Mean = 0.88	OR = 1.03	HomeVEE calculated = 0.02	Statistically significant, p < 0.05

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Outcome measure	Outcome measure description	Collection method	Properties
Breastfeeding duration	Number of months the mother breasted her child	Parent/caregiver report	Not applicable
Ever breastfed	Percentage of mothers who had ever breastfed their child	Parent/caregiver report	Not applicable
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
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

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.

Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Breastfeeding at 3 months	FavorableUnfavorable or ambiguousNo Effect	3 months	Healthy Steps sample	275 mothers	Mean = 0.89	Mean = 0.92	OR = 0.98	HomeVEE calculated = -0.01	Not statistically significant, p ≥ 0.05
Feels strongly supported to breastfeed	FavorableUnfavorable or ambiguousNo Effect	3 months	Healthy Steps sample	275 mothers	Mean = 0.73	Mean = 0.77	OR = 0.98	HomeVEE calculated = -0.01	Not statistically significant, p ≥ 0.05

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Outcome measure	Outcome measure description	Collection method	Properties	Operations links
Breastfeeding at 3 months	Percentage of mothers who had been breastfeeding at the child’s 3rd month of age	Parent/caregiver report	Not applicable
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

Findings 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.

Healthy Steps (National Evaluation 1996 Protocol)

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Child hospitalized in past year	FavorableUnfavorable or ambiguousNo Effect	5.5 years	The 6 RCT national evaluation sites	1308 children	Mean = 0.03	Mean = 0.04	OR = 0.96	HomeVEE calculated = -0.02	Not statistically significant, p ≥ 0.05

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Outcome measure	Outcome measure description	Collection method	Properties	Operations links
Child hospitalized in past year	Percentage of children who had been hospitalized during the previous year	Parent/caregiver report	Not applicable

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