Healthy Steps for Young Children

OVERVIEW

Healthy Steps for Young Children was designed to increase the amount and quality of care received by newborns and their mothers.  In a random assignment study, 2,235 newborns at pediatric practices were assigned to receive the Healthy Steps intervention or their standard practice’s care.  Intervention families were more likely than control families to see increases in effectiveness, efficiency, patient-centeredness, and timeliness of care.  There were no differences in the groups among parenting, except for the intervention groups’ increased likelihood to use covers on electrical outlets.

DESCRIPTION OF PROGRAM

Target population: Newborns

Parents receive Healthy Steps care at their pediatric practice site, as well as home visiting and care from a Healthy Steps specialist, written materials, parent support groups, and links and referrals to community resources.  Questions and concerns about child’s and mother’s health are addressed and parent-child interaction is emphasized.

EVALUATION(S) OF PROGRAM

Minkovitz, C. S., Hughart, N., Strobino, D., Scharfstein, D., Grason, H., Hou, W., Miller, T., Bishai, D., MAugustyn, M., McLearn, K. T., & Guyer, B. (2003). A practice-based intervention to enhance quality of care in the first 3 years of life. Journal of the American Medical Association, 290(23), 3081-3091.

Evaluated population: A total of 2235 newborns at six pediatric practice sites across six states served as the study sample.

Approach: Newborns at each of the six randomization sites were randomly assigned to intervention or control groups of approximately 200 newborns each.  Newborns were deemed ineligible for the program if they were to be adopted or placed in foster care, too ill to make an office visit by 4 weeks, the mother did not speak English or Spanish, or the family intended to leave the practice within six months.

Families in both groups received standard pediatric care from the practice and care from the clinicians.  The intervention group also received the Healthy Steps program and were in contact with a Healthy Steps specialist.  The specialists were nurses, nurse practitioners, early childhood educators, and social workers with training and experience.  Each site had two specialists with caseloads of 100 families each.  Site personnel participated in three annual training sessions, with a focus on knowledge in child development, parenting and practical clinical strategies, importance of relationships, team building and implementation of Healthy Steps.  Due to changes in ownership, administration and staff, one practice was forced to close prior to study completion.

Healthy Steps provided six home visits in the first three years, a direct phone line to the Healthy Steps specialist, developmental assessments, written materials emphasizing prevention and health promotion, parent support groups, and links and referrals to community resources.  The Healthy Steps program also provided enhanced well-child care, in which parents’ questions and concerns about child development and behavior are addressed with a focus on positive parent-child interactions.  Mother’s health was also emphasized.

Parenting outcomes evaluated included response to child misbehavior, parenting practices, and mother’s depressive symptoms.  Quality of care received was also evaluated.

Results: Intervention families were significantly more likely than control families to see increased effectiveness of pediatric service, e.g. receiving four or more services, receiving home visits, discussing more than six topics, and becoming informed about community resources.  Intervention families were also significantly more likely than control families to report that someone in the practice went out their way for them.  Intervention families were significantly more likely than control families to receive age-appropriate vaccinations and age-appropriate care at visits at 1, 2, 6, 12, and 24 months.

Among parenting outcomes, the intervention families were only significantly more likely than control families to use covers on electrical outlets.  All other outcomes concerning parent responses to child misbehavior, perceptions of child behavior, and promotion of child development and safety showed no significant differences between groups.

Note: Additional sites employed a quasi-experimental design, but results for these quasi-experimental sites are not reported here.

SOURCES FOR MORE INFORMATION

More information on Healthy Steps available at:

http://www.healthysteps.org/

References:

Minkovitz, C. S., Hughart, N., Strobino, D., Scharfstein, D., Grason, H., Hou, W., Miller, T., Bishai, D., MAugustyn, M., McLearn, K. T., & Guyer, B. (2003). A practice-based intervention to enhance quality of care in the first 3 years of life. Journal of the American Medical Association, 290(23), 3081-3091.

Program categorized in this guide according to the following:

Program age ranges in the guide: Early childhood

Program components: Clinic/provider-based, parent or family, home visiting

Measured outcomes: Physical Health

Program information last updated on 4/3/08.