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: 2011

Effects shown in research & outcome measure details

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 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
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Outcome measure Outcome measure description Collection method Properties 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

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

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 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
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Outcome measure Outcome measure description Collection method Properties Operations links

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

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
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
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Outcome measure Outcome measure description Collection method Properties Operations links

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

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 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 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

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

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 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 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

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

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