Implementing Healthy Steps (National Evaluation 1996 Protocol)
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.
Model implementation summary last updated: 2015
The information in this implementation report reflects feedback, if provided, from this model’s developer as of the above date. 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. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.
Healthy Steps (national evaluation 1996 protocol) 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.
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.
- 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.
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.