Providers & Payers Resource

National and Site-Level Evaluations

Learn more about findings from past evaluations of HealthySteps.

Original National Evaluation

HealthySteps’ (HS) effectiveness was studied through a 15-site national evaluation conducted by Johns Hopkins Bloomberg School of Public Health Women’s and Children’s Health Policy Center. The evaluation design included a randomized controlled trial at six sites and a quasi-experimental nonequivalent control group design at nine sites. A diverse sample of 5,565 infants from 15 sites across the country were enrolled at birth and followed for 3 years. The study also included follow-up with children at 5½ years old. Evaluation findings indicated that HS successfully redesigned primary health care to refocus attention on preventive services, child development, and effective parenting practices. The HS model was shown to have significant benefits for children, families, and pediatric care in the United States. The full National Evaluation report is available to download below.

The following are a few articles highlighting key findings:

  • Caughy , M. O., Huang, K., Miller, T., & Genevro, J. L. (2004). The effects of the Healthy Steps for Young Children program: Results from observations of parenting and child development. Early Childhood Research Quarterly, 19(4), 611–630.

    Abbreviated Abstract: The Healthy Steps for Young Children Program (HS) is designed to provide support for new parents through the pediatrician’s office. We present findings of the effect of HS on the quality of mother–child interaction, security of attachment, and child behavior using observational data from two of the HS sites that utilized a randomized treatment design. Results from longitudinal analysis (which included families who participated in the home observations at both Time 1 and Time 2) indicated that Healthy Steps participation was associated with greater security of attachment and fewer child behavior problems.

  • Minkovitz , C. S., Hughart, N., Strobino, D., Scharfstein, D., Grason, H., Hou, W., Miller, T., Bishai, D., Augustyn, M., McLearn, K. T., & Guyer, B. (2003). A practice-based intervention to enhance quality of care in the first 3 years of life: The Healthy Steps for Young Children program. JAMA, 290(23), 3081–3091.

    Abbreviated Abstract: Providing quality pediatric care for young children involves matching the needs and expectations of families with the organizational structure and clinical practices of pediatric providers. There is growing evidence of deficiencies in the quality of health care for children, including low rates of preventive services, persistent disparities in health status, and lack of a usual source of care among ethnic and racial minorities and children in low-income families. This article presents results from the national evaluation of Healthy Steps, the first large clinical trial of an intervention in pediatric practices to improve delivery of developmental and behavioral services. In this article, we report whether Healthy Steps increased quality of care related to developmental and behavioral services and affected parenting practices regarding discipline, perceptions of their children’s behavior, and promotion of development when children were ages 30 to 33 months.

  • Minkovitz , C. S., Strobino, D., Mistry, K. B., Scharfstein, D. O., Grason, H., Hou, W., Ialongo, N., & Guyer, B. (2007). Healthy Steps for Young Children: Sustained results at 5.5 years. Pediatrics, 120(3), e658–e668.

    Abbreviated Abstract: We sought to determine whether Healthy Steps for Young Children has sustained treatment effects at 5.5 years, given early findings demonstrating enhanced quality of care and improvements in selected parenting practices. Outcomes studied include experiences seeking care, parent response to child misbehavior, perception of child’s behavior, and parenting practices to promote development and safety. Logistic regression was used to estimate overall effects of Healthy Steps, adjusting for site and baseline demographic characteristics. Sustained treatment effects, albeit modest, are consistent with early findings. Universal, practice-based interventions can enhance quality of care for families with young children and can improve selected parenting practices beyond the duration of the intervention.

  • Piotrowski , C. C., Talavera, G. A., & Mayer, J. A. (2009). Healthy Steps: A systematic review of a preventive practice-based model of pediatric care. Journal of Developmental & Behavioral Pediatrics, 30(1), 91–103.

    Abbreviated Abstract: The preventive role of anticipatory guidance in pediatric practice has gained increasing importance over the last two decades, resulting in the development of competing models of practice-based care. Our goal was to systematically evaluate and summarize the literature pertaining to the Healthy Steps Program for Young Children, a widely cited and utilized preventive model of care and anticipatory guidance. Results indicated that the Healthy Steps program has been rigorously evaluated and shown to be effective in preventing negative child and parent outcomes and enhancing positive outcomes.

Site-Level Evaluations

All of our HealthySteps sites are committed to data collection and program monitoring. Several have conducted studies on the implementation of HealthySteps at their sites. The following are a few examples of site-level evaluations that add to the broader evidence base for HealthySteps.

  • Briggs, R. D., Silver, E. J., Krug, L. M., Mason, Z. S., Schrag, R. D. A., Chinitz, S., & Racine, A. D. (2014). Healthy Steps as a moderator: The impact of maternal trauma on child social-emotional development. Clinical Practice in Pediatric Psychology, 2(2), 166–175.

    Abbreviated Abstract: Caregiver experiences of childhood trauma (a.k.a., adverse childhood experiences) are related to deficits in social-emotional development in their 3-year-old children. HealthySteps, with a focus on caregiver trauma and child social-emotional development, may serve as a moderator of this association.

  • Briggs, R. D., Stettler, E. M., Silver, E. J., Schrag, R. D., Nayak, M., Chinitz, S., & Racine, A. D. (2012). Social-emotional screening for infants and toddlers in primary care. Pediatrics, 129(2), e377–384.

    Abbreviated Abstract: This article describes a program designed to identify the social-emotional status of young children in the pediatric setting and to assess the effect of interventions by a co-located HealthySteps Specialist who is a psychologist over time. The study found that universal social-emotional screening can identify significant percentages of children as being at risk for social-emotional problems, and co-location of a psychologist promotes the ability to effectively address young children’s social-emotional development within their medical home.

  • Gross, R. S., Briggs, R. D., Hershberg, R. S., Silver, E. J., Velazco, N. K., Hauser, N. R., & Racine, A. D. (2015). Early child social-emotional problems and child obesity: Exploring the protective role of a primary care-based general parenting intervention. Journal of Developmental & Behavioral Pediatrics, 36(8), 594-604.

    Abbreviated Abstract: Children determined to be “at risk” for social-emotional challenges were categorized into two groups—receiving HealthySteps (HS) vs. not receiving HS—and retrospectively compared to children who were “not at risk.” Children “at risk” who received HS did not demonstrate differences in weight status compared with children “not at risk.” In contrast, children “at risk” who did not receive HS were more likely to be obese at age 5, and their mothers were less likely to do two recommended feeding practices (restriction and limit setting) and more likely to pressure their child to eat. These results suggest that early social-emotional problems, unmitigated by intervention, were related to several feeding styles and to obesity at age 5 years. Further study is needed to understand how HealthySteps may be protective against obesity.

  • Huebner, C. E., PhD, MPH, Barlow, W. E., PhD, Tyll, L. T., MS, Johnston, B. D., MD, MPH, & Thompson, R. S., MD. (2004). Expanding developmental and behavioral services for newborns in primary care: Program design, delivery, and evaluation framework. American Journal of Preventive Medicine, 26(4), 344-355.

    Abbreviated Abstract: The study examined the benefit of beginning the HealthySteps services during pregnancy. The intervention was delivered with fidelity and with minimal disruption to the practice styles of pregnancy providers, most of whom considered the program valuable to their patients. Relative to families in the comparison group, families in the intervention group received more usual care services and more intervention-specific services.

  • Johnston, B. D., MD, MPH, Huebner, C. E., PhD, MPH, Tyll, L. T., MA, Barlow, W. E., PhD, & Thompson, R. S., MD. (2004). Expanding developmental and behavioral services for newborns in primary care: Effects on parental well-being, practice and satisfaction. American Journal of Preventative Medicine, 26(4), 356-366.

    Abbreviated Abstract: The study compared usual care with two interventions: HealthySteps (HS) delivered postnatally, and HS with an added prenatal component (PrePare). Mothers in either intervention were less likely to report depressive symptoms and more likely to describe themselves as pleased in their role as parents. Intervention families were more likely to continue breastfeeding and more likely to read to their 3-month-old. Knowledge of infant development and recognition of appropriate discipline was greater among intervention recipients. Satisfaction with pediatric care was higher among intervention recipients and the rate of health plan disenrollment was 75% lower at 3 months among those enrolled in the prenatal intervention. Receipt of either intervention was associated with positive effects on health, safety, and developmentally appropriate parenting.

  • 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.

    Abbreviated Abstract: The study examined the effects of HealthySteps with and without a prenatal component, as compared to usual care. Both interventions were associated with positive effects on children’s health and parenting practices, including positive outcomes in timely well-child care, immunization rates, breastfeeding, television viewing, injury prevention, and discipline strategies. Prenatal initiation of services was associated with larger expressive vocabularies at age 24 months. Mothers who received the intervention reported more depressive symptoms, but there was no increase in the proportion with clinically significant depression.

  • Niederman, L. G., Schwartz, A., Connell, K. J., & Silverman, K. (2007). Healthy Steps for Young Children Program in pediatric residency training: Impact on primary care outcomes. Pediatrics, 120(3), e596–e603.

    Abbreviated Abstract: This study examined the impact of integrating HealthySteps (HS) into residency training, finding potential benefits in multiple health service outcomes. Most important, continuity of care in residents’ practices significantly improved, as did the residents’ documentation of psychosocial issues in children.

Ongoing Evaluation Efforts

HealthySteps recently completed a third-party implementation study that documented various innovations taking place throughout the nationwide network. The study helped inform the codification of the HealthySteps model to reflect recent research and emerging best practices. HealthySteps also plans to initiate an outcome evaluation focused on several areas that currently have promising evidence. Check back regularly for more updates!

HealthySteps ongoing evaluation efforts are informed by an evaluation advisory group comprised of diverse experts.

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