footnote33
Study presents unadjusted program and comparison group means (columns 5 and 6). Tests of statistical significance apply to adjusted results in column 7 (means difference or odds ratio).
Manuscript Detail
Model(s) Reviewed: Healthy Steps (National Evaluation 1996 Protocol)
| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
|---|---|---|---|---|---|
| Moderate | Randomized controlled trial | High | Established on race/ethnicity and SES (i.e., family income). Equivalence on baseline measures is not feasible. | None | None |
Notes:
| Study participants | The sample included 1,308 mothers with children about 5.5 years old at assessment. All women enrolled in Healthy Steps within four weeks of the child’s birth. Study enrollment occurred between September 1996 and November 1998. Just over one in three parents had a college degree, and 40% had incomes above $50,000 at baseline. Most study participants were white (65%) or African American (21%). The most common maternal age groups were 20-29 (48%) and over 30 (42%). |
|---|---|
| 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. See Study Ratings for details.) 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. Families actually received fewer than two visits, on average, during the child’s first 2.5 years. |
| 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. See Guyer et al. (2003) for more details. |
| Funding sources | The Commonwealth Fund (grant 20010683) and the Agency for Healthcare Quality and Research (grant R01HS13086). |
| Author affiliation | None of the study authors are developers of this model. |
Findings details
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Clinical or borderline concern about child behavior | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 years | 1,308 children | Mean = 0.20 | Mean = 0.17 | OR = 1.26 | HomeVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Child hospitalized in past year | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 years | 1,308 children | Mean = 0.03 | Mean = 0.04 | OR = 0.96 | HomeVEE calculated = -0.02 | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Ever slap in face/spank with object | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.11 | Mean = 0.13 | OR = 0.85 | HomeVEE calculated = -0.10 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Looked at/read books in past week | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.59 | Mean = 0.57 | OR = 1.07 | HomeVEE calculated = 0.04 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Often/almost always ignore misbehavior | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.09 | Mean = 0.09 | OR = 1.07 | HomeVEE calculated = 0.04 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Often/almost always negotiate | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.59 | Mean = 0.54 | OR = 1.25 | HomeVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Routine/regular bedtime | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.85 | Mean = 0.88 | OR = 0.76 | HomeVEE calculated = -0.17 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Use harsh discipline | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.05 | Mean = 0.07 | OR = 0.78 | HomeVEE calculated = -0.15 | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Used emergency department in past year for injury | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 years | 1,308 children | Mean = 0.09 | Mean = 0.10 | OR = 0.96 | HomeVEE calculated = -0.02 | Not statistically significant, p ≥ 0.05 |
Outcome measure summary
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
CBCL: Clinical or borderline concern about child behavior |
The CBCL is a questionnaire that assesses behavioral problems in young children. | Parent/caregiver report | Not reported by author |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Child hospitalized in past year |
Percentage of children who had been hospitalized during the previous year | Parent/caregiver report | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
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 |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Used emergency department in the past year for injury |
Percentage of parents who reported using the emergency department in the past year for a child injury | Parent/caregiver report | Not applicable |