Johnston, B. D., Huebner, C. E., Anderson, M. L., Tyll, L. T., & Thompson, R. S. (2006). Healthy Steps in an integrated delivery system: Child and parent outcomes at 30 months. Archives of Pediatrics & Adolescent Medicine, 160(8), 793–800.
Model(s) Reviewed:
PrePare supplement relative to Healthy Steps only subgroup
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Established on race/ethnicity and SES (i.e., family income). Controls for baseline scores of outcomes collected at baseline. | None | None | Not assessed in manuscripts reviewed before 2021 |
Notes:
Study presents unadjusted program and comparison group means (columns 5 and 6). Tests of statistical significance apply to adjusted results in column 7 (means difference or odds ratio). The standard errors in Johnston et al. (2006) are adjusted for clustering within clinic.
| Study participants | The sample included 239 mothers with children age 30 months at assessment. All women were receiving Healthy Steps services and had enrolled before 22 weeks of gestation. Study enrollment occurred between July 1998 and September 2000. Most mothers had some college experience (>90%), with over one in three also having graduate-level training. Study participants were predominately white (>75%). Over 80% of mothers had family incomes above $40,000, with over one in three family incomes exceeding $75,000. |
|---|---|
| Setting | Three primary care clinics that are part of the Group Home Cooperative in the Pacific Northwest. |
| Intervention services | The study randomly assigned mothers to receive either Healthy Steps only or Healthy Steps plus the PrePare supplement. Those in the Healthy Steps plus PrePare group received three prenatal home visits in addition to standard Healthy Steps program services following the child’s birth. Healthy Steps Specialists provided prenatal home visiting services to help parents prepare for their newborn. Specialists also screened and provided interventions for smoking, depression, and domestic violence. Following birth, Healthy Steps Specialists provided home visits, developmental and behavioral advice, a child development telephone information line, and links to community resources. The typical frequency of home visits by three months after birth is five in the standard implementation and eight with PrePare supplemental visits included. |
| Comparison conditions | Women in the comparison group received the standard Healthy Steps program. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). Subgroups are not listed for manuscripts reviewed before 2021. |
| Funding sources | The Kaiser Foundation Health Plan; the Group Health Community Foundation; the Nesholm Family Foundation; and the Group Health Administration Employees Community Fund of Boeing, Puget Sound. |
| Author affiliation | None of the study authors are developers of this model. |
| Peer reviewed | Peer reviewed status is not listed for manuscripts reviewed before 2021. |
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | MCDI combines two or more words (sometimes/often versus not yet) | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 219 children | Mean = 0.93 | Mean = 0.89 | OR = 1.05 | HomVEE calculated = 0.03 | Statistically significant, p < 0.05 |
|
| High | MCDI use of two-word endings (three or more versus less than three) | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 219 children | Mean = 0.55 | Mean = 0.55 | OR = 1.09 | HomVEE calculated = 0.05 | Not statistically significant, p ≥ 0.05 | |
| High | MCDI vocabulary checklist | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 219 children | Mean = 54.40 | Mean = 52.30 | Mean difference = 4.08 | Not available | Statistically significant, p < 0.05 |
|
| High | MCDI word length of child’s 3 longest phrases | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 219 children | Mean = 4.29 | Mean = 4.57 | Mean difference = -0.22 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Child Behavior Checklist: Aggressive behavior subscale | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 8.01 | Mean = 7.46 | Mean difference = 0.54 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Child Behavior Checklist: Anxious or depressed mood subscale | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 4.12 | Mean = 3.71 | Mean difference = 0.40 | Not available | Statistically significant, p < 0.05 |
|
| High | Child Behavior Checklist: Sleep problems subscale | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 3.35 | Mean = 2.88 | Mean difference = 0.39 | Not available | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | 10-month well-child care visit | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 0.94 | Mean = 0.93 | OR = 1.01 | HomVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 | |
| High | 15-month well-child care visit | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 0.88 | Mean = 0.89 | OR = 0.99 | HomVEE calculated = -0.01 | Not statistically significant, p ≥ 0.05 | |
| High | 2-month well-child care visit | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 0.93 | Mean = 0.96 | OR = 0.97 | HomVEE calculated = -0.02 | Not statistically significant, p ≥ 0.05 | |
| High | 24-month well-child care visit | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 0.87 | Mean = 0.76 | OR = 1.17 | HomVEE calculated = 0.10 | Statistically significant, p < 0.05 |
|
| High | 4-month well-child care visit | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 0.96 | Mean = 0.98 | OR = 0.97 | HomVEE calculated = -0.02 | Not statistically significant, p ≥ 0.05 | |
| High | 6-month well-child care visit | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 0.94 | Mean = 0.94 | OR = 1.01 | HomVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 | |
| High | Breastfeeding duration (mo.) | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 13.00 | Mean = 13.90 | Mean difference = -0.64 | Not available | Statistically significant, p < 0.05 |
|
| High | Ever breastfed | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.95 | Mean = 0.99 | OR = 0.96 | HomVEE calculated = -0.03 | Statistically significant, p < 0.05 |
|
| High | Immunization status up-to-date at 24 mo. | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 children | Mean = 0.92 | Mean = 0.88 | OR = 1.03 | HomVEE calculated = 0.02 | Statistically significant, p < 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | CES-D scale | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 mothers | Mean = 4.74 | Mean = 3.80 | Mean difference = 0.55 | Not available | Statistically significant, p < 0.05 |
|
| High | Any illicit drug use in past year | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 mothers | Mean = 0.07 | Mean = 0.05 | OR = 1.02 | HomVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 | |
| High | Clinically significant depressive symptoms | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 mothers | Mean = 0.10 | Mean = 0.07 | OR = 0.93 | HomVEE calculated = -0.04 | Not statistically significant, p ≥ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Covers on electrical outlets | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.95 | Mean = 0.91 | OR = 1.06 | HomVEE calculated = 0.03 | Statistically significant, p < 0.05 |
|
| High | Discipline by ever slapping face or spanking with object | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.01 | Mean = 0.03 | OR = 0.20 | HomVEE calculated = -0.98 | Not statistically significant, p ≥ 0.05 | |
| High | Environment with tobacco smoke | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 mothers | Mean = 0.10 | Mean = 0.07 | OR = 1.05 | HomVEE calculated = 0.03 | Not statistically significant, p ≥ 0.05 | |
| High | Followed 3 routines, 2 if no nap | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.80 | Mean = 0.91 | OR = 1.02 | HomVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 | |
| High | Has access to poison control center telephone number | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.96 | Mean = 0.96 | OR = 1.01 | HomVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 | |
| High | Health care self-efficacy | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 mothers | Mean = 17.00 | Mean = 17.00 | Mean difference = -0.14 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Injury prevention index | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 mothers | Mean = 4.86 | Mean = 4.81 | Mean difference = -0.02 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Parenting Behavior Checklist: Nurturing subscale | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 mothers | Mean = 58.70 | Mean = 60.20 | Mean difference = -1.35 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Parenting sense of competence | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 mothers | Mean = 47.10 | Mean = 47.60 | Mean difference = -0.69 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Play with child at least daily | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.97 | Mean = 0.99 | OR = 0.98 | HomVEE calculated = -0.01 | Not statistically significant, p ≥ 0.05 | |
| High | Read to child at least daily | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.88 | Mean = 0.95 | OR = 0.92 | HomVEE calculated = -0.05 | Statistically significant, p < 0.05 |
|
| High | Safety latches on cabinets | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.63 | Mean = 0.71 | OR = 0.87 | HomVEE calculated = -0.08 | Statistically significant, p < 0.05 |
|
| High | Use stair gate | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.32 | Mean = 0.34 | OR = 0.99 | HomVEE calculated = -0.01 | Not statistically significant, p ≥ 0.05 | |
| High | Watch television more than one hr. per day | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 232 mothers | Mean = 0.39 | Mean = 0.28 | OR = 1.35 | HomVEE calculated = 0.18 | Statistically significant, p < 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Domestic violence in past year | FavorableUnfavorable or ambiguousNo Effect |
Healthy Steps sample | 30 months | 239 mothers | Mean = 0.03 | Mean = 0.01 | OR = 2.09 | HomVEE calculated = 0.44 | Not statistically significant, p ≥ 0.05 |