Minkovitz, C. S., Strobino, D., Mistry, K. B., Scharfstein, D. O., Grason, H., Hou, W., Guyer, B. (2007). Healthy Steps for Young Children: Sustained results at 5.5 years. Pediatrics, 120(3), 658–668.
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) |
|---|---|---|---|---|---|---|
| Moderate | Randomized controlled trial | High | Established on race/ethnicity and SES (i.e., family income). Equivalence on baseline measures is not feasible. | 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).
| Study participants | The sample included 1,308 mothers with children about 5.5 years old at assessment. All women enrolled in Healthy Steps within four weeks of the child’s birth. Study enrollment occurred between September 1996 and November 1998. Just over one in three parents had a college degree, and 40% had incomes above $50,000 at baseline. Most study participants were white (65%) or African American (21%). The most common maternal age groups were 20-29 (48%) and over 30 (42%). |
|---|---|
| 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. See Study Ratings for details.) 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. Families actually received fewer than two visits, on average, during the child’s first 2.5 years. |
| 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). Subgroups are not listed for manuscripts reviewed before 2021. |
| Funding sources | The Commonwealth Fund (grant 20010683) and the Agency for Healthcare Quality and Research (grant R01HS13086). |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Clinical or borderline concern about child behavior | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 years | 1,308 children | Mean = 0.20 | Mean = 0.17 | OR = 1.26 | HomVEE calculated = 0.14 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Child hospitalized in past year | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 years | 1,308 children | Mean = 0.03 | Mean = 0.04 | OR = 0.96 | HomVEE calculated = -0.02 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Ever slap in face/spank with object | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.11 | Mean = 0.13 | OR = 0.85 | HomVEE calculated = -0.10 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Looked at/read books in past week | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.59 | Mean = 0.57 | OR = 1.07 | HomVEE calculated = 0.04 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Often/almost always ignore misbehavior | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.09 | Mean = 0.09 | OR = 1.07 | HomVEE calculated = 0.04 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Often/almost always negotiate | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.59 | Mean = 0.54 | OR = 1.25 | HomVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Routine/regular bedtime | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.85 | Mean = 0.88 | OR = 0.76 | HomVEE calculated = -0.17 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Use harsh discipline | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 yrs | 1,308 mothers | Mean = 0.05 | Mean = 0.07 | OR = 0.78 | HomVEE calculated = -0.15 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Used emergency department in past year for injury | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 5.5 years | 1,308 children | Mean = 0.09 | Mean = 0.10 | OR = 0.96 | HomVEE calculated = -0.02 | Not statistically significant, p ≥ 0.05 |