Healthy Steps (National Evaluation 1996 Protocol) Meets HHS Criteria

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

Model overview

Theoretical approach

Healthy Steps was a universal parenting intervention implemented between 1996 and 2001. The HomVEE review is based on Healthy Steps as implemented in the 1996 national evaluation, and referred to as Healthy Steps (national evaluation 1996 protocol), or HS (national evaluation). Sites enrolled in the national evaluation followed a protocol that incorporated home visits. However, home visiting is not the primary method of service delivery in the current model guidelines, and implementation of the HS (national evaluation) is no longer supported.

HS (national evaluation) was designed to enhance pediatric primary care for children from birth to age 3 and their families by incorporating preventive developmental and behavioral services into routine practice. The model strived to enhance the knowledge and confidence of caregivers as a means of promoting children’s well-being. It focused on aspects of the caregiving environment amenable to change. Infancy is a suitable period for intervention because it is a time of rapid child development and high stress for parents, and parents are likely to be open to new ideas. The model was designed to be universal, with services offered to all families in participating practices, in recognition that all parents have concerns and questions about their children’s health, behavior, and development. Operating through pediatric practices allowed the program to periodically reach children and parents during the developmentally critical first few years of children’s lives.

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Model services

The HS (national evaluation) had seven major elements. Parents were offered:

  • Home visits from HS specialists, timed to reach parents at children’s key developmental junctures during the first three years. For example, a home visit conducted in a newborn’s first few weeks of life encouraged continued breastfeeding and supported parents as they established their caregiving patterns. A home visit when a baby was about 9 months old and becoming mobile focused on safety hazards and childproofing.
  • Enhanced well-child care appointments before, after, or during well-child appointments, during which HS specialists answered questions about child development and encouraged early reading to children.
  • Child development telephone information line, staffed by HS specialists, for parents to ask questions about day-to-day worries and developmental concerns.
  • Child development and family health check-ups, to detect developmental or behavioral problems and identify family health risks.
  • Written materials that emphasized prevention and health promotion on medical, developmental, and practical topics. For example, parents received a Child Health and Development Record that chronicled immunizations, physical growth, developmental milestones, and parental concerns through age 18.
  • Parent group meetings, facilitated by the HS specialists, for social support and opportunities for interactive learning.
  • Linkages to community resources, consisting primarily of a list of community resources compiled by HS specialists.

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.

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Intended population

HS (national evaluation) was designed for parents with children from birth through age 2. For the evaluation, enrollment was limited to families with newborns less than 4 weeks old. Any such family served by a practice that participated in the national evaluation could enroll in the program, except for families that (1) planned to move or change pediatric practices within six months, (2) did not speak fluent English or Spanish, (3) planned to put their child up for adoption or in foster care, or (4) had a child who was too ill for an office visit within the first four weeks of life.

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Where to find out more

Healthy Steps (national evaluation 1996 protocol) is no longer supported. For information about the current Healthy Steps model, contact:

Margot Kaplan-Sanoff
Healthy Steps National Network Director
ZERO TO THREE
1255 23rd Street, NW
Suite 350
Washington, DC 20037

Telephone: 202-857-2283
Toll-free line: 1-844-464-9811
Email: mkaplan-sanoff@zerotothree.org
Website: http://www.healthysteps.org

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Effects shown in research

Child health

Findings rated high

Healthy Steps (National Evaluation 1996 Protocol)
Show findings details
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 HomVEE 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 HomVEE 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 HomVEE calculated = 0.37 Statistically significant,
p < 0.05
Healthy Steps (National Evaluation 1996 Protocol)
Show findings details
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 HomVEE 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 HomVEE 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 HomVEE calculated = -0.14 Statistically significant,
p < 0.05
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show findings details
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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE calculated = 0.02 Statistically significant,
p < 0.05
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show findings details
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 HomVEE 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 HomVEE calculated = -0.01 Not statistically significant, p ≥ 0.05

Findings rated moderate

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 HomVEE calculated = -0.02 Not statistically significant, p ≥ 0.05
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Positive parenting practices

Findings rated high

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
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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE calculated = -0.17 Statistically significant,
p < 0.05
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
Covers on electrical outlets
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 232 mothers Mean = 0.95 Mean = 0.91 OR = 1.06 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE calculated = 0.18 Statistically significant,
p < 0.05
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
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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE calculated = 0.01 Not statistically significant, p ≥ 0.05

Findings rated moderate

Healthy Steps (National Evaluation 1996 Protocol)
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 HomVEE 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 HomVEE calculated = 0.18 Not statistically significant, p ≥ 0.05
Healthy Steps (National Evaluation 1996 Protocol)
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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE 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 HomVEE calculated = -0.15 Not statistically significant, p ≥ 0.05
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Maternal health

Findings rated high

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
Mother resumed smoking
FavorableUnfavorable or ambiguousNo Effect
2-4 months The 6 RCT national evaluation sites 1987 mothers Not reported Not reported OR = 1.20 HomVEE calculated = -0.02 Not statistically significant, p ≥ 0.05
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
CES-D scale
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 239 mothers Mean = 4.74 Mean = 3.80 Mean difference = 0.55 Not available Statistically significant,
p < 0.05
Any illicit drug use in past year
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 239 mothers Mean = 0.07 Mean = 0.05 OR = 1.02 HomVEE calculated = 0.01 Not statistically significant, p ≥ 0.05
Clinically significant depressive symptoms
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 239 mothers Mean = 0.10 Mean = 0.07 OR = 0.93 HomVEE calculated = -0.04 Not statistically significant, p ≥ 0.05
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance
CES-D score above clinical cutoff
FavorableUnfavorable or ambiguousNo Effect
3 months Healthy Steps sample 275 mothers Mean = 0.06 Mean = 0.07 OR = 0.65 HomVEE calculated = -0.26 Not statistically significant, p ≥ 0.05
Any CES-D mental health symptoms
FavorableUnfavorable or ambiguousNo Effect
3 months Healthy Steps sample 275 mothers Mean = 0.14 Mean = 0.01 OR = 0.95 HomVEE calculated = -0.03 Not statistically significant, p ≥ 0.05
Household drug/alcohol concern
FavorableUnfavorable or ambiguousNo Effect
3 months Healthy Steps sample 275 mothers Mean = 0.10 Mean = 0.05 OR = 1.62 HomVEE calculated = 0.29 Not statistically significant, p ≥ 0.05
Modified CES-D scale
FavorableUnfavorable or ambiguousNo Effect
3 months Healthy Steps sample 275 mothers Mean = 4.18 Mean = 3.56 Mean difference = 0.33 Not available Not statistically significant, p ≥ 0.05
Psychosocial profile (Daily Hassles) score
FavorableUnfavorable or ambiguousNo Effect
3 months Healthy Steps sample 275 mothers Mean = 15.85 Mean = 15.21 Mean difference = 0.38 Not available Not statistically significant, p ≥ 0.05
Support Behavior Inventory – Family
FavorableUnfavorable or ambiguousNo Effect
3 months Healthy Steps sample 275 mothers Mean = 60.38 Mean = 60.43 Mean difference = 0.30 Not available Not statistically significant, p ≥ 0.05
Support Behavior Inventory – Partner
FavorableUnfavorable or ambiguousNo Effect
3 months Healthy Steps sample 275 mothers Mean = 58.71 Mean = 60.25 Mean difference = 0.30 Not available Not statistically significant, p ≥ 0.05
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Reductions in child maltreatment

Findings rated moderate

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
Used emergency department in past year for injury
FavorableUnfavorable or ambiguousNo Effect
5.5 years The 6 RCT national evaluation sites 1308 children Mean = 0.09 Mean = 0.10 OR = 0.96 HomVEE calculated = -0.02 Not statistically significant, p ≥ 0.05
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Reductions in juvenile delinquency, family violence, and crime

Findings rated high

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
Domestic violence in past year
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 239 mothers Mean = 0.03 Mean = 0.01 OR = 2.09 HomVEE calculated = 0.44 Not statistically significant, p ≥ 0.05
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Child development and school readiness

Findings rated high

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
MCDI combines two or more words (sometimes/often versus not yet)
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 219 children Mean = 0.93 Mean = 0.89 OR = 1.05 HomVEE calculated = 0.03 Statistically significant,
p < 0.05
MCDI use of two-word endings (three or more versus less than three)
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 219 children Mean = 0.55 Mean = 0.55 OR = 1.09 HomVEE calculated = 0.05 Not statistically significant, p ≥ 0.05
MCDI vocabulary checklist
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 219 children Mean = 54.40 Mean = 52.30 Mean difference = 4.08 Not available Statistically significant,
p < 0.05
MCDI word length of child’s 3 longest phrases
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 219 children Mean = 4.29 Mean = 4.57 Mean difference = -0.22 Not available Not statistically significant, p ≥ 0.05
Child Behavior Checklist: Aggressive behavior subscale
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 239 children Mean = 8.01 Mean = 7.46 Mean difference = 0.54 Not available Not statistically significant, p ≥ 0.05
Child Behavior Checklist: Anxious or depressed mood subscale
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 239 children Mean = 4.12 Mean = 3.71 Mean difference = 0.40 Not available Statistically significant,
p < 0.05
Child Behavior Checklist: Sleep problems subscale
FavorableUnfavorable or ambiguousNo Effect
30 months Healthy Steps sample 239 children Mean = 3.35 Mean = 2.88 Mean difference = 0.39 Not available Not statistically significant, p ≥ 0.05

Findings rated moderate

Healthy Steps (National Evaluation 1996 Protocol)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance
Attachment Q-sort scale
FavorableUnfavorable or ambiguousNo Effect
16-18 mo. 2 of the 6 RCT national evaluation sites 378 children Mean = 0.37 Mean = 0.36 Mean difference = 0.01 Not available Not statistically significant, p ≥ 0.05
Healthy Steps (National Evaluation 1996 Protocol)
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance
Clinical or borderline concern about child behavior
FavorableUnfavorable or ambiguousNo Effect
5.5 years The 6 RCT national evaluation sites 1308 children Mean = 0.20 Mean = 0.17 OR = 1.26 HomVEE calculated = 0.14 Not statistically significant, p ≥ 0.05
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In brief

Evidence of model effectiveness

Title General population Tribal population Domains with favorable effects
Healthy Steps (National Evaluation 1996 Protocol) Yes, Meets HHS Criteria Meets HHS criteria Does not meet HHS criteria for tribal population because the model has not been evaluated with a tribal population.
  • Child health,
  • Positive parenting practices,

Model description

Healthy Steps (national evaluation 1996 protocol) was a universal parenting intervention implemented between 1996 and 2001 for parents of children from birth to age 3. The HomVEE review is based on Healthy Steps as implemented in the 1996 national evaluation, and referred to as Healthy Steps (national evaluation 1996 protocol), or HS (national evaluation). HS (national evaluation) was designed to promote (1) the clinical capacity and effectiveness of pediatric primary care to better meet the needs of families with young children; (2) the knowledge, skills, and confidence of parents in their child-rearing abilities; and (3) the health and development of young children. The program added a child development specialist to the pediatric care team. HS specialists delivered a minimum of six home visits, attended well-child care appointments, staffed a telephone line parents could call with any questions, conducted child development and family health assessments, led parent group meetings, disseminated written materials to parents, and connected parents to community resources. Home visits and other components focused on educating families about their children’s health, behavior, and development.

This report also includes a review of an enhancement to Healthy Steps, called PrePare. PrePare was designed for sites that provide prenatal assistance only. PrePare has been studied as a supplement to Healthy Steps that added an average of three prenatal home visits by the HS specialist. Home visitors covered general topics on the transition to parenthood, as well as dealing with family-specific risk factors.

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Extent of evidence

Healthy Steps (National Evaluation 1996 Protocol)
Results of search and review
Number of manuscripts
At least one finding was eligible for review…
7
  …and at least one finding rated high
2
  …and at least one finding rated moderate (but none rated high)
3
  …and all findings that were eligible for review rated low or indeterminate2
2
  …but manuscript is additional source3
0
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Results of search and review
Number of manuscripts
At least one finding was eligible for review…
2
  …and at least one finding rated high
2
  …and at least one finding rated moderate
0
  …and all findings that were eligible for review rated low or indeterminate2
0
  …but manuscript is additional source3
0

For more information, see the research database. For more information on the criteria used to rate research, please see details of HomVEE’s methods and standards.

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Summary of findings

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Criteria established by the U.S. Department of Health and Human Services

Information based on comprehensive review of all high- and moderate-rated manuscripts
Healthy Steps (National Evaluation 1996 Protocol)
CriterionCriterion descriptionCriterion met?
1High- or moderate-quality impact study?Yes
2Across high- or moderate-quality studies, favorable impacts in at least two outcome domains within one sample OR the same domain for at least two non-overlapping samples?Yes
3Favorable impacts on full sample?Yes
4Any favorable impacts on outcome measures sustained at least 12 months after model enrollment?
Reported for all research but only required for RCTs.
Yes
5One or more favorable, statistically significant impact reported in a peer-reviewed journal?
Reported for all research but only required for RCTs.
Yes
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