Manuscript Detail | Home Visiting Evidence of Effectiveness

Guyer, B., Barth, M., Bishai, D., Caughy, M., Clark, B., Burkom, D., Tang, C. (2003). The Healthy Steps for Young Children Program National Evaluation. Baltimore: Women’s and Children’s Health Policy Center, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health.

Model(s) Reviewed: Healthy Steps (National Evaluation 1996 Protocol)

Manuscript screening details
Screening decision	Screening conclusion
Passes screens	Eligible for review

Study design details
Rating	Design	Attrition	Baseline equivalence	Reassignment	Confounding factors
High	Randomized controlled trial	Low	Established on race/ethnicity and SES (i.e., maternal education, employment status, and Medicaid coverage). Equivalence on baseline measures is not feasible.	None	None

Study characteristics
Study participants	The sample presented here included 1,987 mothers with children ages 2 to 4 months at assessment. (This report also includes a sample of mothers followed up when the child was 30-33 months of age. That analysis received a low rating, however. See Study Ratings for details.) All women enrolled in Healthy Steps within four weeks of the child’s birth. Study enrollment occurred between September 1996 and November 1998. One in four mothers had a college degree and 35% were enrolled in Medicaid during pregnancy. Most study participants were white (63%) or African American (24%). The most common maternal age groups were 20-29 (51%) and over 30 (33%).
Setting	The six sites—Allentown, PA, Amarillo, TX, Florence, SC, Iowa City, IA, Pittsburgh, PA, and San Diego, CA—were randomly assigned as part of the national evaluation. (There were nine other sites that used quasi-experimental comparisons. These comparisons received a low rating, however. Sites were group practices, hospital-based clinics, or pediatric practices in health maintenance organizations.
Intervention services	Healthy Steps Specialists provided well-child care, up to six home visits in the first three years, a child development telephone information line, child development and family health checkups, written materials for parents that emphasize prevention, parent group meetings, and links to community resources. The first home visit occurred in the first few weeks after birth, with the second scheduled for when the child was 9 months old. Note: The Healthy Steps national office now allows sites greater flexibility when selecting the intensity of service delivery. The program intensity and length described in the program overview reflects current recommendations from the Healthy Steps Intensity Chart (see http://www.healthysteps.org/healthysteps/homepage.nsf/All/intensity%20levels.pdf/$file/intensity%20levels.pdf, retrieved January 19, 2010).
Comparison conditions	Children in the control group received routine pediatric care but had no exposure to the Healthy Steps Specialist or to Healthy Steps materials.
Staff characteristics and training	Specialists were early childhood educators, nurses, nurse practitioners, social workers, or professionals with other relevant expertise. Each attended annual trainings conducted by the Boston University Healthy Steps team and administered services in cooperation with pediatricians and pediatric nurse practitioners. Sites also received program and training manuals and technical assistance through biweekly teleconferences. Implementation of written protocols was monitored by the Healthy Steps national program office. The Healthy Steps Specialists ranged in age from 25 to 55, and all but one was female. Two in three had master’s degrees and another 25% had bachelor’s degrees.
Funding sources	The Commonwealth Fund and local funders.
Author affiliation	None of the study authors are developers of this model.

Findings details

Child health
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	DTP1 vaccination	FavorableUnfavorable or ambiguousNo Effect	The 6 RCT national evaluation sites	2 months	1,950 mothers	= 0.92	= 0.88	OR = 1.50	HomeVEE calculated = 0.25	Statistically significant, p < 0.05
High	Hospitalization since birth	FavorableUnfavorable or ambiguousNo Effect	The 6 RCT national evaluation sites	2-4 months	1,987 mothers	Not reported	Not reported	OR = 0.71	HomeVEE calculated = -0.21	Not statistically significant, p ≥ 0.05
High	One-month well-child care visit	FavorableUnfavorable or ambiguousNo Effect	The 6 RCT national evaluation sites	1 month	2,086 mothers	= 0.97	= 0.95	OR = 1.85	HomeVEE calculated = 0.37	Statistically significant, p < 0.05

Maternal health
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Mother resumed smoking	FavorableUnfavorable or ambiguousNo Effect	The 6 RCT national evaluation sites	2-4 months	1,987 mothers	Not reported	Not reported	OR = 1.20	HomeVEE calculated = -0.02	Not statistically significant, p ≥ 0.05

Outcome measure summary

Child health
Outcome measure	Description of measure	Data collection method	Properties of measure
DTP1 vaccination	Percentage of children who had received the DTP1 vaccination between 42 and 92 days postpartum	Review of medical records	Not applicable
Hospitalization since birth	Number of child hospitalizations	Parent/caregiver report	Not applicable
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

Maternal health
Outcome measure	Description of measure	Data collection method	Properties of measure
Mother resumed smoking	Percentage of mothers who resumed smoking after the birth of their child	Parent/caregiver report	Not reported by author