Healthy Steps (National Evaluation 1996 Protocol)
This report focuses on Healthy Steps as implemented in the 1996 evaluation. HHS has determined that home visiting is not the primary service delivery strategy and the model does not meet current requirements for MIECHV program implementation.
Model effectiveness research report last updated: 2011
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.
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.
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.
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
Effects shown in research
Child health
Findings rated high
Show findings details
Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
---|---|---|---|---|---|---|---|---|---|
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 |
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 |
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 |
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
Show findings details
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 |
Positive parenting practices
Findings rated high
Show findings details
Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
---|---|---|---|---|---|---|---|---|---|
Car seat in back seat | FavorableUnfavorable or ambiguousNo Effect |
2-4 mo. | The 6 RCT national evaluation sites | 1987 mothers | Mean = 0.90 | Mean = 0.90 | OR = 1.08 | 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 |
Show findings details
Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
---|---|---|---|---|---|---|---|---|---|
Covers on electrical outlets | FavorableUnfavorable or ambiguousNo Effect |
30 months | Healthy Steps sample | 232 mothers | Mean = 0.95 | Mean = 0.91 | OR = 1.06 | 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 |
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 | 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
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 |
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 |
Maternal health
Findings rated high
Show findings details
Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
---|---|---|---|---|---|---|---|---|---|
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 |
Show findings details
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 |
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 |
Reductions in child maltreatment
Findings rated moderate
Show findings details
Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
---|---|---|---|---|---|---|---|---|---|
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 |
Reductions in juvenile delinquency, family violence, and crime
Findings rated high
Show findings details
Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
---|---|---|---|---|---|---|---|---|---|
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 |
Child development and school readiness
Findings rated high
Show findings details
Outcome measure | Effect | Follow-up timing | Sample | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance |
---|---|---|---|---|---|---|---|---|---|
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
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 |
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 |
In brief
Evidence of model effectiveness
Title | General population | Tribal population | Domains with favorable effects |
---|---|---|---|
Healthy Steps (National Evaluation 1996 Protocol) | Meets HHS criteria | Does not meet HHS criteria for tribal population because the model has not been evaluated with a tribal population. |
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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.
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.
Extent of evidence
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.