Providers & Payers Resource

HealthySteps Evidence

HealthySteps (HS) has positive outcomes for children, their families, and the physicians and practices that serve them.

That was the conclusion, published in 2003, of a National Evaluation of HealthySteps conducted by the Johns Hopkins Bloomberg School of Public Health Women’s and Children’s Health Policy Center. The evaluation, which studied 15 private and public pediatric practices serving more than 5,500 children and their families across the country and the economic spectrum, included both a randomized controlled trial (RCT) and a quasi-experimental comparison study. An accompanying Affiliate Evaluation at six sites showed that HS could be effectively delivered to low-income and high-risk families. RCT findings showed that HS children were:

  • 1.5 to 2.4 times more likely to receive age-appropriate well-child visits on time than children in the control group;
  • 1.4 to 1.6 times more likely to receive age-appropriate vaccinations on time, and 1.4 times more likely to be up-to-date on their vaccinations by 2 years old;
  • 8 times more likely to receive a developmental assessment at 30-33 months; and
  • 23% less likely to visit the emergency room for injury-related causes in a 1-year period. HS parents were:
  • 10 times more likely than those in the control group to discuss six or more age-appropriate topics with clinic professionals;
  • 27% less likely to use severe physical discipline such as a slap in the face or spanking with an object;
  • 4 times more likely to receive information on community resources;
  • more likely to be satisfied with their pediatric care; and
  • almost twice as likely to remain with the same practice until their child was at least 20 months old. The evaluations also found that HS families were more likely to:
  • discuss important concerns, including nutrition, discipline, language development, child temperament, and maternal depression and anxiety;
  • show picture books to and play with their infants daily;
  • interact sensitively with their infants by reading their cues; and
  • ensure that newborns slept on their backs to prevent Sudden Infant Death Syndrome(SIDS).

Overall, HS significantly reduced income disparities by ensuring access to preventive services.

HS also enhanced the experiences of providers. Physicians were highly satisfied with the program and thought it:

  • helped the families they served,
  • improved their own listening skills,
  • improved teamwork,
  • strengthened their relationships with families, and
  • empowered their staff to support child development. In 2007, the continuing National Evaluation published findings showing sustained treatment effects when HS children were 5.5 years old.

Other research has demonstrated additional outcomes:

  • A randomized treatment study with results published in 2004 found that HS children showed more secure attachment to their mothers and fewer externalizing behavior problems such as aggression.
  • A clinical trial published in 2006 found that HS improved rates of breastfeeding and injury prevention, and reduced television viewing—three American Academy of Pediatrics recommendations.
  • A quasi-experimental, longitudinal study published in 2014 in Clinical Practice in Pediatric Psychology found that HS may help moderate the deleterious effects that maternal childhood trauma can have on the social-emotional development of their own children.

FUTURE EVALUATION PLANS A 2015–2017 implementation study by James Bell Associates, MDRC, and the Johns Hopkins Bloomberg School of Public Health Women’s and Children’s Health Policy Center documented how HS sites are providing services and identified various program innovations taking place throughout the nationwide network. It also convened an evaluation advisory group that included one of the original Johns Hopkins researchers. Results from the implementation study are being used to codify the essential elements of the model and to position HS for additional rigorous evaluation in the near future.

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