Program

Jan 16, 2013

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.

KEYWORDS: Child
Care, Early Childhood (0-5), Parenting, Home Visiting, Clinic/Provider-Based,
Parent or Family Component, Physical Health.

Program information last updated on
4/3/08.

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