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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.

Manuscript screening details
Screening decision Screening conclusion HomVEE procedures and standards version
Passes screens Eligible for review Version 1
Study design details
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:

footnote73

Submitted by user on Fri, 03/15/2019 - 14:29

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 characteristics
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 details

Child development and school readiness
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 HomeVEE 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 HomeVEE 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
Child health
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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE calculated = 0.02 Statistically significant,
p < 0.05
Maternal health
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 HomeVEE 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 HomeVEE calculated = -0.04 Not statistically significant, p ≥ 0.05
Positive parenting practices
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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE 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 HomeVEE calculated = 0.18 Statistically significant,
p < 0.05
Reductions in juvenile delinquency, family violence, and crime
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 HomeVEE calculated = 0.44 Not statistically significant, p ≥ 0.05