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.

Last updated: July 2011

Model Overview

Theoretical Model

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. View Revisions

Model Components

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.
View Revisions

Target Population

HS (national evaluation) was designed for parents with children from birth to age 3. 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. View Revisions

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 for Healthy Steps: 1-844-464-9811
Email: mkaplan-sanoff@zerotothree.org
Website: http://www.healthysteps.org exit disclaimer

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Effects Shown in Research & Outcome Measure Details

Summary of Findings

Please read Describing Effects for more information on these categories. Only results from studies that meet the standards for the high or moderate ratings are included above.

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Child Health

Outcomes Rated High

Healthy Steps (National Evaluation 1996 Protocol)
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
DTP1 vaccination
FavorableUnfavorableNo 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
Primary
Hospitalization since birth
FavorableUnfavorableNo 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
Secondary
One-month well-child care visit
FavorableUnfavorableNo 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
Primary
Show Study Outcome Measure Summary
Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

DTP1 vaccination

Percentage of children who had received the DTP1 vaccination between 42 and 92 days postpartum Review of medical records

Not applicable

Primary

Hospitalization since birth

Number of child hospitalizations Parent/caregiver report

Not applicable

Secondary

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

Primary
Healthy Steps (National Evaluation 1996 Protocol)
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Continuing to breastfeed
FavorableUnfavorableNo 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
Secondary
Show Study Outcome Measure Summary
Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

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

Secondary
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
10-month well-child care visit
FavorableUnfavorableNo 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
Primary
15-month well-child care visit
FavorableUnfavorableNo 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
Primary
2-month well-child care visit
FavorableUnfavorableNo 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
Primary
24-month well-child care visit
FavorableUnfavorableNo 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
Primary
4-month well-child care visit
FavorableUnfavorableNo 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
Primary
6-month well-child care visit
FavorableUnfavorableNo 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
Primary
Breastfeeding duration (mo.)
FavorableUnfavorableNo 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
Secondary
Ever breastfed
FavorableUnfavorableNo 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
Secondary
Immunization status up-to-date at 24 mo.
FavorableUnfavorableNo 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
Primary
Show Study Outcome Measure Summary
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Breastfeeding at 3 months
FavorableUnfavorableNo 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
Secondary
Feels strongly supported to breastfeed
FavorableUnfavorableNo 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
Secondary
Show Study Outcome Measure Summary

Outcomes Rated Moderate

Healthy Steps (National Evaluation 1996 Protocol)
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Child hospitalized in past year
FavorableUnfavorableNo 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
Secondary
Show Study Outcome Measure Summary
Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

Child hospitalized in past year

Percentage of children who had been hospitalized during the previous year Parent/caregiver report

Not applicable

Secondary
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Positive Parenting Practices

Outcomes Rated High

Healthy Steps (National Evaluation 1996 Protocol)
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Car seat in back seat
FavorableUnfavorableNo 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
Secondary
Followed at least 2 routines
FavorableUnfavorableNo 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
Secondary
Gave baby cereal
FavorableUnfavorableNo 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
Secondary
Gave baby water
FavorableUnfavorableNo 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
Secondary
Lowered water temperature
FavorableUnfavorableNo 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
Secondary
Played with baby daily
FavorableUnfavorableNo 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
Secondary
Showed picture books daily
FavorableUnfavorableNo 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
Secondary
Used wrong sleep position
FavorableUnfavorableNo 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
Secondary
Show Study Outcome Measure Summary
Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

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

Secondary

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

Secondary

Gave baby cereal

Percentage of mothers who fed their infant cereal Parent/caregiver report during telephone interview

Not applicable

Secondary

Gave baby water

Percentage of mothers who fed their infant water Parent/caregiver report during telephone interview

Not applicable

Secondary

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

Secondary

Played with baby daily

Percentage of mothers who played with their child at least once daily Parent/caregiver report during telephone interview

Not applicable

Secondary

Showed picture books daily

Percentage of mothers who showed their child picture books daily Parent/caregiver report during telephone interview

Not applicable

Secondary

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

Secondary
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Covers on electrical outlets
FavorableUnfavorableNo 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
Secondary
Discipline by ever slapping face or spanking with object
FavorableUnfavorableNo 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
Secondary
Environment with tobacco smoke
FavorableUnfavorableNo 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
Secondary
Followed 3 routines, 2 if no nap
FavorableUnfavorableNo 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
Secondary
Has access to poison control center telephone number
FavorableUnfavorableNo 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
Secondary
Health care self-efficacy
FavorableUnfavorableNo 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 Secondary
Injury prevention index
FavorableUnfavorableNo 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
Secondary
Parenting Behavior Checklist: Nurturing subscale
FavorableUnfavorableNo 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
Secondary
Parenting sense of competence
FavorableUnfavorableNo 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
Secondary
Play with child at least daily
FavorableUnfavorableNo 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
Secondary
Read to child at least daily
FavorableUnfavorableNo 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
Secondary
Safety latches on cabinets
FavorableUnfavorableNo 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
Secondary
Use stair gate
FavorableUnfavorableNo 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
Secondary
Watch television more than one hr. per day
FavorableUnfavorableNo 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
Secondary
Show Study Outcome Measure Summary
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
KIDI score
FavorableUnfavorableNo 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
Secondary
Endorsed appropriate discipline
FavorableUnfavorableNo 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
Secondary
Home Safety Index
FavorableUnfavorableNo 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
Secondary
Knowledge of sleep positions
FavorableUnfavorableNo 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
Secondary
Parenting sense of competence
FavorableUnfavorableNo 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
Secondary
Read with infant in past week
FavorableUnfavorableNo 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
Secondary
Role satisfaction
FavorableUnfavorableNo 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
Secondary
Safe-sleep practices
FavorableUnfavorableNo 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
Secondary
Self-efficacy (health care specific)
FavorableUnfavorableNo 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 Secondary
Tobacco-free household
FavorableUnfavorableNo 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
Secondary
Show Study Outcome Measure Summary

Outcomes Rated Moderate

Healthy Steps (National Evaluation 1996 Protocol)
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Use of inductive/authoritative discipline
FavorableUnfavorableNo 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
Secondary
Use of punitive/“high power” discipline
FavorableUnfavorableNo 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
Secondary
Show Study Outcome Measure Summary
Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

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

Secondary

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

Secondary
Healthy Steps (National Evaluation 1996 Protocol)
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Ever slap in face/spank with object
FavorableUnfavorableNo 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
Secondary
Looked at/read books in past week
FavorableUnfavorableNo 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
Secondary
Often/almost always ignore misbehavior
FavorableUnfavorableNo 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
Secondary
Often/almost always negotiate
FavorableUnfavorableNo 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
Secondary
Routine/regular bedtime
FavorableUnfavorableNo 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
Secondary
Use harsh discipline
FavorableUnfavorableNo 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
Secondary
Show Study Outcome Measure Summary
Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

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

Secondary

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

Secondary

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

Secondary

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

Secondary

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

Secondary

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

Secondary
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Maternal Health

Outcomes Rated High

Healthy Steps (National Evaluation 1996 Protocol)
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Mother resumed smoking
FavorableUnfavorableNo Effect
2-4 months The 6 RCT national evaluation sites 1987 mothers Not reported Not reported OR = 1.20 HomeVEE calculated = -0.02 Not statistically significant, p > 0.05 Secondary
Show Study Outcome Measure Summary
Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

Mother resumed smoking

Percentage of mothers who resumed smoking after the birth of their child Parent/caregiver report

Not reported by author

Secondary
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
CES-D scale
FavorableUnfavorableNo 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
Secondary
Any illicit drug use in past year
FavorableUnfavorableNo Effect
30 months Healthy Steps sample 239 mothers Mean = 0.07 Mean = 0.05 OR = 1.02 HomeVEE calculated = 0.01 Not statistically significant,
p > 0.05
Secondary
Clinically significant depressive symptoms
FavorableUnfavorableNo Effect
30 months Healthy Steps sample 239 mothers Mean = 0.10 Mean = 0.07 OR = 0.93 HomeVEE calculated = -0.04 Not statistically significant,
p > 0.05
Secondary
Show Study Outcome Measure Summary
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
CES-D score above clinical cutoff
FavorableUnfavorableNo Effect
3 months Healthy Steps sample 275 mothers Mean = 0.06 Mean = 0.07 OR = 0.65 HomeVEE calculated = -0.26 Not statistically significant,
p > 0.05
Secondary
Any CES-D mental health symptoms
FavorableUnfavorableNo Effect
3 months Healthy Steps sample 275 mothers Mean = 0.14 Mean = 0.01 OR = 0.95 HomeVEE calculated = -0.03 Not statistically significant,
p > 0.05
Secondary
Household drug/alcohol concern
FavorableUnfavorableNo Effect
3 months Healthy Steps sample 275 mothers Mean = 0.10 Mean = 0.05 OR = 1.62 HomeVEE calculated = 0.29 Not statistically significant,
p > 0.05
Secondary
Modified CES-D scale
FavorableUnfavorableNo 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
Secondary
Psychosocial profile (Daily Hassles) score
FavorableUnfavorableNo 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
Secondary
Support Behavior Inventory – Family
FavorableUnfavorableNo 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
Secondary
Support Behavior Inventory – Partner
FavorableUnfavorableNo 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
Secondary
Show Study Outcome Measure Summary
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Reductions in Child Maltreatment

Outcomes Rated Moderate

Healthy Steps (National Evaluation 1996 Protocol)
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Used emergency department in past year for injury
FavorableUnfavorableNo Effect
5.5 years The 6 RCT national evaluation sites 1308 children Mean = 0.09 Mean = 0.10 OR = 0.96 HomeVEE calculated = -0.02 Not statistically significant,
p > 0.05
Secondary
Show Study Outcome Measure Summary
Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

Used emergency department in the past year for injury

Percentage of parents who reported using the emergency department in the past year for a child injury Parent/caregiver report

Not applicable

Secondary
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Reductions in Juvenile Delinquency, Family Violence, and Crime

Outcomes Rated High

Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Domestic violence in past year
FavorableUnfavorableNo Effect
30 months Healthy Steps sample 239 mothers Mean = 0.03 Mean = 0.01 OR = 2.09 HomeVEE calculated = 0.44 Not statistically significant,
p > 0.05
Primary
Show Study Outcome Measure Summary
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In Brief

Evidence of Model Effectiveness

This model meets the criteria established by the Department of Health and Human Services (HHS) for an “evidence-based early childhood home visiting service delivery model” for the general population, but does not meet the criteria for tribal populations.

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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. For more information, please read the Model Overview.

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 Research and Review
Number of studies
Eligible for review
7
Rated high
2
Rated moderate
3
Rated low
2
Additional source1
0
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
Results of Research and Review
Number of studies
Eligible for review
2
Rated high
2
Rated moderate
0
Rated low
0
Additional source1
0

For more information, see the study database. For more information on the criteria used to determine the study ratings, please read Producing Study Ratings.

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Summary of Findings

Please read Describing Effects for more information on these categories. Only results from studies that meet the standards for the high or moderate ratings are included above.

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Criteria Established by the Department of Health and Human Services

Information Based on Comprehensive Review of All High- and Moderate-Impact Studies for this Model
Healthy Steps (National Evaluation 1996 Protocol)
High- or moderate-quality impact study?
Yes
Across 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
Favorable impacts on full sample?
Yes
Any favorable impacts on outcome measures sustained at least 12 months after model enrollment?1
Yes
One or more favorable, statistically significant impact reported in a peer-reviewed journal?1
Yes
Healthy Steps - PrePare supplement relative to Healthy Steps only subgroup
High- or moderate-quality impact study?
Yes
Across 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
Favorable impacts on full sample?
Yes
Any favorable impacts on outcome measures sustained at least 12 months after model enrollment?1
Yes
One or more favorable, statistically significant impact reported in a peer-reviewed journal?1
Yes

Please read the HHS Criteria for Evidence-Based Models for more information.

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