Information in this section was extracted from 15 studies, including 7 RCTs/QEDs with a moderate or high rating (of these 7 studies, 2 are studies of PrePare, a program supplement) and 8 implementation studies. (Please see Studies for Implementation Experiences for a list of the studies and to link to the characteristics of the samples examined in the effectiveness studies.)
Implementing Healthy Steps (National Evaluation 1996 Protocol)
This report focuses on Healthy Steps as implemented in the 1996 evaluation. HHS has determined that home visiting is not the primary service delivery strategy and the model does not meet current requirements for MIECHV program implementation.
Last updated: July 2011
This report summarizes information on how a given model was implemented in the studies reviewed. The report includes only information provided in (1) implementation studies and (2) effectiveness studies that rate moderate or high. These studies vary in the level of detail they provide about implementation features. Thus, the report does not provide an exhaustive picture of how the model was implemented across the programs studied. HomVEE notes, in the text or in parentheses, the number of studies that reported information on a given implementation feature.
Characteristics of model participants
One study reported on the average age of the children participating in Healthy Steps. In this study, the average age of the children was 21 months.
Of the eight studies that reported the gender of the program participants, nearly all adult participants were female (seven studies reported that 100 percent were female, and one study reported that 99 percent were female).
Eight studies reported on the race and ethnicity of the program participants. Across these studies, 6 to 25 percent of program participants were African American, and 62 to 77 percent of participants were white. In one of the studies, 17 percent of program participants identified themselves as of other or multiple races.
Across four studies that reported on the educational attainment of program participants, 85 to 97 percent had at least a high school degree, and between 20 and 79 percent of participants had a college degree.
Three studies reported on marital status. In these studies, 66 percent of program participants reported that they were married.
Four studies described the average income of program participants. Two reported that between 17 and 80 percent of families had an annual income of $40,000 or less. Two studies reported that one in three families made more than $75,000.
Twelve studies reported that participation in the Healthy Steps program was voluntary.
Location and setting
Across all the studies, sites were located in rural, urban, and suburban communities.
In the studies reviewed, Healthy Steps was implemented in a variety of settings, including group pediatric practices, primary care clinics in academic medical centers, and managed care networks.
Staffing and supervision
Five studies reported on the qualifications of the Healthy Steps Specialists. In four studies, Healthy Steps Specialists had a background in child development, early intervention, special education, or social work. One study reported that the Healthy Steps Specialist had a master’s-level degree.
The training provided to staff was reported in seven studies. Four studies reported that training was led by a pediatric team from Boston University School of Medicine. In these studies, the Healthy Steps Specialists received five days of training, while other direct-service staff (physicians, supervisors, and administrators) received three days of training.
None of the studies reviewed described how Healthy Steps Specialists were supervised.
Two studies reported that Healthy Steps Specialists had a caseload of between 100 and 125 families.
All the studies reviewed described Healthy Steps as including (1) home visits offered soon after a newborn was discharged from the hospital and at key developmental stages; (2) child development and family health checkups (including formal developmental screens); (3) a child development telephone information line; and (4) written materials for parents on topics such as toilet training, discipline, and nutrition. In addition, participating practices could offer one or more of the following services: well-child visits with a clinician and Healthy Steps specialist, age-appropriate books for mothers and fathers to read to their children, parent support groups, and/or referrals for children (such as to speech or hearing specialists) and parents (such as to maternal depression counseling).
Two studies reported on the specific screenings and assessments offered to participating families. These included (1) an informal developmental checkup that was conducted every six months, (2) a temperament scale, (3) the Brazelton Neonatal Behavioral Assessment Scale, (4) the Denver II Developmental Screening Test, (5) the BABES Behavior Checklist, and (6) the MacArthur Communicative Development Inventory.
One study reported that the local programs used protocols and other program materials provided by Healthy Steps.
One study reported that the information that was handed out to parents was printed in both English and Spanish.
Model adaptations or enhancements
- Sites that experienced smoother implementation typically had (1) strong consistent leadership to assure the structural changes needed to accommodate the program, (2) thorough orientation and buy-in from staff, and (3) a well-developed training program for staff.
- Healthy Steps Specialists recommended providing information to families about breast-feeding prenatally, because by the time they met with families (soon after mothers were released from the hospital), the families had typically decided whether or not to breast-feed.
- Sites reported that families needed additional education about the number of well-child visits a child needs during the first year of life to assure that the families bring the children in at the age-appropriate times.
- Sites recommended adding information to the Healthy Steps model about vaccinations, as well as using the opportunity to learn from families why they chose not to vaccinate their children.