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.
Citation Year
Used in Implementation Reports
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%).
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.
Home Visiting 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.
Author Affiliation
None of the study authors are developers of this model.
Funding Sources
The Commonwealth Fund and local funders.
Citation short
Guyer, B., Barth, M., Bishai, D., Caughy, M., Clark, B., Burkom, D., Tang, C. (2003)
Confounding Factors
Baseline Equivalence
Established on race/ethnicity and SES (i.e., maternal education, employment status, and Medicaid coverage). Equivalence on baseline measures is not feasible.
This study used a quasi-experimental design that did not establish baseline equivalence for the program and comparison groups.
Screening Decision
Passes screens
Design Detail
RCT (2-4 months)