Caughy, M. O., Miller, T., Genevro, J. L., Huang, K., & Nautiyal, C. (2003). The effects of Healthy Steps on discipline strategies of parents of young children. Journal of Applied Developmental Psychology, 24(5), 517–534.
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., maternal education and Medicaid coverage). Equivalence on baseline measures is not feasible. | None | None |
Notes:
Information on baseline equivalence for race/ethnicity was obtained from Caughy et al. (2004). In addition to the outcomes assessed at the 16-18 month follow-up period, outcomes were assessed at a 34-37 month follow-up period. The outcomes assessed at 34-37 months received a low rating because they had high attrition and baseline equivalence was not established on SES.
| 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. Most study participants were either white (62%) or African American (25%). The most common maternal age groups were 20-29 (57%) and over 30 (25%). Two-thirds of 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). 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 | William T. Grant Foundation; The Amarillo Area Foundation; The Duke Endowment; The Hogg Foundation; and The McLeod Foundation. |
| 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 | Use of inductive/authoritative discipline | FavorableUnfavorable or ambiguousNo Effect |
2 of the 6 RCT national evaluation sites | 16-18 mo. | 378 mothers | Mean = 0.10 | Mean = -0.12 | Mean difference = 0.22 | HomeVEE calculated = 0.21 | Statistically significant, p < 0.05 |
|
| Moderate | Use of punitive/“high power” discipline | FavorableUnfavorable or ambiguousNo Effect |
2 of the 6 RCT national evaluation sites | 16-18 mo. | 378 mothers | Mean = -0.06 | Mean = 0.13 | Mean difference = -0.19 | HomeVEE calculated = 0.18 | Not statistically significant, p ≥ 0.05 |
Outcome measure summary
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Use of inductive/authoritative discipline |
A modified version of the Parental Responses to Child Misbehavior was administered to parents who were asked to report how frequently in an average week in the previous month they used 12 discipline strategies. Authors conducted confirmatory factor analysis on a two-factor model: inductive/authoritative behavior and punitive/high-power behavior. | Parent/caregiver report | Not reported by author |
Use of punitive/“high-power” discipline |
A modified version of the Parental Responses to Child Misbehavior was administered to parents who were asked to report how frequently in an average week in the previous month they used 12 discipline strategies. Authors conducted confirmatory factor analysis on a two-factor model: inductive/authoritative behavior and punitive/high-power behavior. | Parent/caregiver report | Not reported by author |