Guyer, B., Barth, M., Bishai, D., Caughy, M., Clark, B., Burkom, D., Tang, C. (2003). The Healthy Steps for Young Children Program National Evaluation. Baltimore: Women’s and Children’s Health Policy Center, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health.
Model(s) Reviewed:
Healthy Steps (National Evaluation 1996 Protocol)
| 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., maternal education, employment status, and Medicaid coverage). Equivalence on baseline measures is not feasible. | None | None | Not assessed in manuscripts reviewed before 2021 |
| Study participants | The sample presented here included 1,987 mothers with children ages 2 to 4 months at assessment. (This report also includes a sample of mothers followed up when the child was 30-33 months of age. That analysis received a low rating, however. See Study Ratings for details.) All women enrolled in Healthy Steps within four weeks of the child’s birth. Study enrollment occurred between September 1996 and November 1998. One in four mothers had a college degree and 35% were enrolled in Medicaid during pregnancy. Most study participants were white (63%) or African American (24%). The most common maternal age groups were 20-29 (51%) and over 30 (33%). |
|---|---|
| Setting | The six sites—Allentown, PA, Amarillo, TX, Florence, SC, Iowa City, IA, Pittsburgh, PA, and San Diego, CA—were randomly assigned as part of the national evaluation. (There were nine other sites that used quasi-experimental comparisons. These comparisons received a low rating, however. Sites were group practices, hospital-based clinics, or pediatric practices in health maintenance organizations. |
| Intervention services | Healthy Steps Specialists provided well-child care, up to six home visits in the first three years, a child development telephone information line, child development and family health checkups, written materials for parents that emphasize prevention, parent group meetings, and links to community resources. The first home visit occurred in the first few weeks after birth, with the second scheduled for when the child was 9 months old. Note: The Healthy Steps national office now allows sites greater flexibility when selecting the intensity of service delivery. The program intensity and length described in the program overview reflects current recommendations from the Healthy Steps Intensity Chart (see http://www.healthysteps.org/healthysteps/homepage.nsf/All/intensity%20l…, retrieved January 19, 2010). |
| Comparison conditions | Children in the control group received routine pediatric care but had no exposure to the Healthy Steps Specialist or to Healthy Steps materials. |
| 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). • Maternal age (less than 20 years or 20 or older) • Parity (primiparous or multiparous) • Household income (less than $20,000 annually or $20,000 or more) |
| Funding sources | The Commonwealth Fund and local funders. |
| 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 | DTP1 vaccination | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2 months | 1,950 mothers | = 0.92 | = 0.88 | OR = 1.50 | HomVEE calculated = 0.25 | Statistically significant, p < 0.05 |
|
| High | Hospitalization since birth | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 months | 1,987 mothers | Not reported | Not reported | OR = 0.71 | HomVEE calculated = -0.21 | Not statistically significant, p ≥ 0.05 | |
| High | One-month well-child care visit | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 1 month | 2,086 mothers | = 0.97 | = 0.95 | OR = 1.85 | HomVEE calculated = 0.37 | 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 | Mother resumed smoking | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 months | 1,987 mothers | Not reported | Not reported | OR = 1.20 | HomVEE calculated = -0.02 | Not statistically significant, p ≥ 0.05 |