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Caughy, M. O., Huang, K., Miller, T., & Genevro, J. L. (2004). The effects of Healthy Steps for Young Children Program: Results from observations of parenting and child development. Early Childhood Research Quarterly, 19(4), 611–630.

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
Moderate Randomized controlled trial High Established on race/ethnicity and SES (i.e., maternal education and Medicaid coverage). Equivalence on baseline measures is not feasible. None None


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The standard errors in Caughy et al. (2004) are adjusted for making multiple comparisons.

Study characteristics
Study participants The sample included 378 mothers with children ages 16 to 18 months 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. Most mothers had a high school degree (86%) and one in five also had a college degree. Study participants tended to be either white (62%) or African American (25%). The most common maternal age groups were 20-29 (57%) and over 30 (25%). Two in three mothers were married.
Setting The study used two of the six randomly assigned pediatric care sites that were part of the national evaluation of Healthy Steps (Amarillo, TX, and Florence, SC). One site was in the southeast and one site was in the southwest. Both sites served economically and racially/ethnically diverse populations.
Intervention services Healthy Steps Specialists provided well-child care, home visits, 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 program offered families nine standard pediatric office visits and six home visits by the time the children were age 3. Healthy Steps families received, on average, two home visits.
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 Funder(s) not listed.
Author affiliation None of the study authors are developers of this model.

Findings details

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Attachment Q-sort scale
FavorableUnfavorable or ambiguousNo Effect
2 of the 6 RCT national evaluation sites 16-18 mo. 378 children Mean = 0.37 Mean = 0.36 Mean difference = 0.01 Not available Not statistically significant, p ≥ 0.05

Outcome measure summary

Child development and school readiness
Outcome measure Description of measure Data collection method Properties of measure

Attachment Q-Sort scale

The Attachment Q-Sort assesses security of attachment and dependency in young children. Each of the 90 items is a description of a specific behavior. Items are sorted by the mother/caregiver into nine piles of 10 cards each based on how likely or unlikely the item matches the behavior of her child. Parent/caregiver report with the assistance of a trained interviewer

Not reported by author

Positive parenting practices
Outcome measure Description of measure Data collection method Properties of measure

NCAST: Total score

The NCAST assesses the quality of teaching interaction between caregivers and young children. The assessment is based on binary items scored from direct observation of mother and child during an age-appropriate, parent-selected teaching task lasting about 3 to 6 minutes. Videotaped observation

ICC = 0.78

P/CIS: General, Appropriateness

The P/CIS is a behavioral rating scale of caregivers based on observations of the mother during 15 minutes of free play with her child. The scale is divided into 11 types of behaviors and then into three different aspects of those behaviors: amount, quality, and appropriateness. There are five global assessments that assess overall parent involvement. The researchers constructed three subscales—amount, quality, and appropriateness—by calculating the mean score for the 11 behaviors and created a general impression score based on the mean of the five global measures. Videotaped observation

ICC = 0.77

HOME: Total score, Positive involvement, Lack of negativity, Cognitive stimulation

The HOME assesses parenting practices and aspects of the home environment. The scale consisted of 45 items. In addition to using the total score, the researchers constructed three factor scores: (1) Positive Involvement, (2) Lack of Negativity, and (3) Cognitive Stimulation. Parent/caregiver interview and videotaped observational assessment

Cronbach’s α = 0.67 (Total score)ICC= 0.40 (Positive involvement) ICC= 0.77 ( Lack of negativity) ICC = 0.52 (Cognitive stimulation)