Healthy Steps (National Evaluation 1996 Protocol)

Model Effectiveness

Evidence Based Model

Manuscripts

Released in 1979 through 2011

Manuscripts

Impact studies rated high or moderate quality

Services intended at ages

0-6 months

7-11 months

12-23 months

24-35 months

Favorable results from well-defined research

Child health

Positive parenting practices

Skip to: Effectiveness Implementation

This report focuses on Healthy Steps as implemented in the 1996 evaluation. HHS has determined that home visiting is not the primary service delivery strategy and the model does not meet current requirements for MIECHV program implementation.

Healthy Steps (national evaluation 1996 protocol) was a universal parenting intervention implemented between 1996 and 2001 for parents of children from birth to age 3. The HomVEE review is based on Healthy Steps as implemented in the 1996 national evaluation, and referred to as Healthy Steps (national evaluation 1996 protocol), or HS (national evaluation). HS (national evaluation) was designed to promote (1) the clinical capacity and effectiveness of pediatric primary care to better meet the needs of families with young children; (2) the knowledge, skills, and confidence of parents in their child-rearing abilities; and (3) the health and development of young children. The program added a child development specialist to the pediatric care team. HS specialists delivered a minimum of six home visits, attended well-child care appointments, staffed a telephone line parents could call with any questions, conducted child development and family health assessments, led parent group meetings, disseminated written materials to parents, and connected parents to community resources. Home visits and other components focused on educating families about their children’s health, behavior, and development.

This report also includes a review of an enhancement to Healthy Steps, called PrePare. PrePare was designed for sites that provide prenatal assistance only. PrePare has been studied as a supplement to Healthy Steps that added an average of three prenatal home visits by the HS specialist. Home visitors covered general topics on the transition to parenthood, as well as dealing with family-specific risk factors.

Related Models:

Effectiveness

This model meets criteria established by the U.S. Department of Health and Human Services for an evidence-based home visiting model.

Does not meet criteria for an evidence-based home visiting model for Indigenous peoples and communities.

Extent of Evidence

For more information about manuscripts, search the research database.

For more information on the criteria used to rate research, please see details of HomVEEʼs methods and standards.

Manuscripts

Released in 1979 through 2011

Manuscripts

Eligible for review

Manuscripts

Impact studies rated high or moderate quality

Summary of Findings

To see details on each manuscript HomVEE reviewed in well-designed research, click on the manuscript counts in the table.

Favorable:
A finding showing a statistically significant impact on an outcome measure in a direction that is beneficial for children and parents.

No effect:
Findings are not statistically significant.

Unfavorable:
A finding showing a statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents.

Outcomes	Manuscripts	Favorable Findings	No Effects Findings	Unfavorable Findings
Child development and school readiness	View 2 Manuscripts	0	2	0
Child health	View 3 Manuscripts	3	4	0
Family economic self-sufficiency	Not measured	-	-	-
Linkages and referrals	Not measured	-	-	-
Maternal health	View 1 Manuscript	0	1	0
Positive parenting practices	View 4 Manuscripts	2	12	0
Reductions in child maltreatment	View 1 Manuscript	0	1	0
Reductions in juvenile delinquency, family violence, and crime	Not measured	-	-	-

Research Characteristics

Well-designed impact studies about this model included participants with the following characteristics. The evidence for effectiveness for the model may include additional studies that did not report this participant information.

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Black or African American

23.83%

Hispanic or Latino

17.92%

White

62.69%

Unknown

11.91%

Maternal Education

Less than a high school diploma

14.90%

High school diploma or GED

29.83%

Some college or Associate's degree

30.96%

Bachelor's degree or higher

24.32%

Unknown

0.00%

Other Characteristics

This data is only reported if known for at least 50 percent of participants in well-designed impact studies of the model.

Enrollment in means-tested programs

37.77%

Implementation

In this section:

Overview

Theoretical approach, intended population, and targeted outcomes.

Support Availability

Service Delivery

Model services, adaptions and enhancements, model intensity and length.

Requirements

Staffing and organizational requirements.

Overview

Theoretical approach

Healthy Steps was a universal parenting intervention implemented between 1996 and 2001. The HomVEE review is based on Healthy Steps as implemented in the 1996 national evaluation, and referred to as Healthy Steps (national evaluation 1996 protocol), or HS (national evaluation). Sites enrolled in the national evaluation followed a protocol that incorporated home visits. However, home visiting is not the primary method of service delivery in the current model guidelines, and implementation of the HS (national evaluation) is no longer supported.

HS (national evaluation) was designed to enhance pediatric primary care for children from birth to age 3 and their families by incorporating preventive developmental and behavioral services into routine practice. The model strived to enhance the knowledge and confidence of caregivers as a means of promoting children’s well-being. It focused on aspects of the caregiving environment amenable to change. Infancy is a suitable period for intervention because it is a time of rapid child development and high stress for parents, and parents are likely to be open to new ideas. The model was designed to be universal, with services offered to all families in participating practices, in recognition that all parents have concerns and questions about their children’s health, behavior, and development. Operating through pediatric practices allowed the program to periodically reach children and parents during the developmentally critical first few years of children’s lives.

Intended population

HS (national evaluation) was designed for parents with children from birth through age 2. For the evaluation, enrollment was limited to families with newborns less than 4 weeks old. Any such family served by a practice that participated in the national evaluation could enroll in the program, except for families that (1) planned to move or change pediatric practices within six months, (2) did not speak fluent English or Spanish, (3) planned to put their child up for adoption or in foster care, or (4) had a child who was too ill for an office visit within the first four weeks of life.

Targeted outcomes

The national evaluation model was designed to promote (1) the clinical capacity and effectiveness of pediatric primary care to better meet the needs of families with young children; (2) the knowledge, skills, and confidence of mothers and fathers in their child-rearing abilities; and (3) the health and development of young children.

Highlights

Services intended at ages

0-6 months

7-11 months

12-23 months

24-35 months

Support Availability

Implementation support availability

The Commonwealth Fund, a foundation that aims to improve the health care system for vulnerable populations, developed the program’s vision and provided financial support and direction. A team from Boston University School of Medicine, Department of Pediatrics, designed the program, trained site staff, and provided technical assistance to the sites in the national evaluation. The Healthy Steps National Program Office (NPO) created additional program materials and supported implementation during visits to monitor fidelity. ICF Consulting directed and coordinated implementation. As of 2015, Zero to Three, a national organization that focuses on the health and development of infants and toddlers, operates Healthy Steps.

HS specialists participated in biweekly technical assistance teleconference sessions with key training staff from the Boston University training team. Teleconferences provided a forum for answering questions, reinforcing training, and troubleshooting implementation issues. Teleconferences continued throughout the demonstration program period, but, over time, decreased in frequency and focused more on clinical concerns and less on implementation issues.

Service Delivery

Model services

The HS (national evaluation) had seven major elements. Parents were offered:

Home visits from HS specialists, timed to reach parents at children’s key developmental junctures during the first three years. For example, a home visit conducted in a newborn’s first few weeks of life encouraged continued breastfeeding and supported parents as they established their caregiving patterns. A home visit when a baby was about 9 months old and becoming mobile focused on safety hazards and childproofing.
Enhanced well-child care appointments before, after, or during well-child appointments, during which HS specialists answered questions about child development and encouraged early reading to children.
Child development telephone information line, staffed by HS specialists, for parents to ask questions about day-to-day worries and developmental concerns.
Child development and family health check-ups, to detect developmental or behavioral problems and identify family health risks.
Written materials that emphasized prevention and health promotion on medical, developmental, and practical topics. For example, parents received a Child Health and Development Record that chronicled immunizations, physical growth, developmental milestones, and parental concerns through age 18.
Parent group meetings, facilitated by the HS specialists, for social support and opportunities for interactive learning.
Linkages to community resources, consisting primarily of a list of community resources compiled by HS specialists.

Sites in the HS (national evaluation) followed protocols and other guidance in the training and operations materials. These materials guided specialists and other clinicians on relaying child development, safety, and other recommendations to parents.

Model intensity and length

HS specialists were expected to offer a minimum of six home visits to each family by the child’s third birthday. Home visits occurred at key developmental junctures, including the first few weeks after birth, and as children became mobile at about 9 months of age.

Well-child visits followed standard pediatric guidelines, which called for nine visits during the first three years.

Adaptations and enhancements

The HS (national evaluation) did not allow for site adaptation. HS has continued to be implemented in sites not in the national evaluation, however. In one adaptation, sites that provide prenatal assistance only offer families a supplement called PrePare. PrePare adds an average of three prenatal home visits. Home visitors cover general topics on the transition to parenthood and overcoming family-specific risk factors.

Related Models:

Requirements

Staffing requirements

HS used a team approach to primary health care for young children. The team included (1) the HS specialist, who conducted home visits, staffed the telephone line, attended well-child care appointments, and facilitated parent group meetings and (2) the pediatric or family medicine clinicians, who served HS families during well-child care appointments.

HS specialists were professionals with training in early childhood development, nursing, or social work.

HS specialists were supervised by physicians or administrators in the pediatric or family practice where they worked.

The model required home visitors to participate in pre-service training. Key personnel from each site participated in an initial HS training institute in Boston, Massachusetts. Key personnel who attended the training were expected to orient all staff in their practice to the program.

The model also required home visitors and other site staff to participate in ongoing professional development. Key personnel participated in two additional annual training institutes after the initial training institute.

Organizational requirements

HS (national evaluation) was implemented by pediatric and family medicine practices, including group practices and clinics within a hospital or health maintenance organization.

HS sites in the national evaluation followed written protocols and guidelines that described key model elements and the role of the HS specialist.

Highlights

Professional certification required for home visitors

HomVEE requests input and feedback from the model developers on their profiles. The information in this implementation profile reflects feedback, if provided, from this model’s developer as of the above date. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Model developers are encouraged to notify HomVEE of any changes to their contact information on this page.