Black or African American
25%
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
Navigate to model page for more information about the home visiting model.
Funding Sources
The Commonwealth Fund and local funders.
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| 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 |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
Findings that rate moderate or high in this manuscript
Maternal health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Mother resumed smoking | 2-4 months | High | 0.02 | Not statistically significant, p ≥ 0.05 | 1987 mothers | The 6 RCT national evaluation sites |
Child health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| One-month well-child care visit | 1 month | High | 0.37 | Statistically significant,p < 0.05 | 2086 mothers | The 6 RCT national evaluation sites | ||
| DTP1 vaccination | 2 months | High | 0.25 | Statistically significant,p < 0.05 | 1950 mothers | The 6 RCT national evaluation sites | ||
| Hospitalization since birth | 2-4 months | High | 0.21 | Not statistically significant, p ≥ 0.05 | 1987 mothers | The 6 RCT national evaluation sites |
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.
Home Visiting 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).
Model(s) Reviewed
Navigate to model page for more information about the home visiting model.
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
• 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)
This study included participants from the following locations:
- California
- Iowa
- Pennsylvania
- South Carolina
- Texas