Implementing 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 implementation summary last updated: 2015

The information in this implementation report reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

Training to support implementation

Requirements for program certification

The Commonwealth Fund and its partners actively recruited sites to participate in the HS national evaluation. To be considered for the national evaluation, sites were required to have a client base of 200 or more newborns within a six- to nine-month period, strong interest from the lead pediatrician and support from senior leadership at the site, a commitment of three years from the practice and a local funder, and the potential to support random assignment or help develop a comparison group.
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Pre-service staff training

Key personnel from each site participated in three annual HS training institutes in Boston, Massachusetts. The training institutes had four goals:

  1. Translate new knowledge in child development, parenting, and women’s health into practical clinical strategies for clinicians
  2. Emphasize the importance of relationships between parent and child, and parent and professional
  3. Create multidisciplinary teams of pediatric clinicians and HS specialists
  4. Help participants transform their pediatric practices into HS practices

Training institutes typically included three to five sites, with two physicians, two HS specialists, and an administrator from each site. Training topics included early brain development, breastfeeding, newborn and child development assessment, maternal depression, early learning and reading, family health behaviors, and systems change in pediatric settings. Participants were trained to take advantage of teachable moments, or occasions when the clinician or HS specialist could explain to parents what they observe about a child’s behavior, development, or temperament.

Key personnel who attended the training were expected to orient all staff in their practice to the program.

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In-service staff training

Key personnel, plus other site staff, participated in two additional annual training institutes after the initial training institute. In addition to topics covered during the first training, these trainings covered team processes and preschool development and clinical problems in the toddler years.
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Training materials

Participants at the training institutes received a training manual that described the program in detail and reviewed, reinforced, and supplemented information presented in training sessions.
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Qualified trainers

An interdisciplinary pediatric team from Boston University School of Medicine, Department of Pediatrics, trained site staff.
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Technical assistance

HS specialists participated in biweekly technical assistance teleconference sessions with key training staff from the Boston University training team. Teleconferences provided a forum for answering questions, reinforcing training, and troubleshooting implementation issues. Teleconferences continued throughout the demonstration program period, but, over time, decreased in frequency and focused more on clinical concerns and less on implementation issues.
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Implementation notes

The information contained on this page was last updated in August 2015.

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