Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e658-e668 (doi:10.1542/peds.2006-1205)
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ARTICLE

Healthy Steps for Young Children: Sustained Results at 5.5 Years

Cynthia S. Minkovitz, MD, MPPa, Donna Strobino, PhDa, Kamila B. Mistry, MPHa, Daniel O. Scharfstein, ScDb, Holly Grason, MAa, William Hou, MSa, Nicholas Ialongo, PhDc and Bernard Guyer, MD, MPHa

a Departments of Population, Family, and Reproductive Health
b Biostatistics
c Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

OBJECTIVE. 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.

METHODS. Healthy Steps was a clinical trial that incorporated developmental specialists and enhanced developmental services into pediatric care in the first 3 years of life. A total of 5565 children were enrolled at birth and followed through 5.5 years. Healthy Steps was evaluated at 6 randomization and 9 quasi-experimental sites. Computer-assisted telephone interviews were conducted with mothers when Healthy Steps children were 5.5 years of age. Outcomes included 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.

RESULTS. A total of 3165 (56.9%) families responded to interviews (usual care: n = 1441; Healthy Steps: n = 1724). Families that had received Healthy Steps services were more satisfied with care (agreed that pediatrician/nurse practitioner provided support, 82.0% vs 79.0%; odds ratio: 1.25 [95% confidence interval: 1.02–1.53]) and more likely to receive needed anticipatory guidance (54.9% vs 49.2%; odds ratio: 1.33 [95% confidence interval: 1.13–1.57]) (all P < .05). They also had increased odds of remaining at the original practice (65.1% vs 61.4%; odds ratio: 1.19 [95% confidence interval: 1.01–1.39]). Healthy Steps families reported reduced odds of using severe discipline (slap in face/spank with object, 10.1% vs 14.1%; odds ratio: 0.68 [95% confidence interval: 0.54–0.86]) and increased odds of often/almost always negotiating with their child (59.8% vs 56.3%; odds ratio: 1.20 [95% confidence interval: 1.03–1.39]). They had greater odds of reporting a clinical or borderline concern regarding their child's behavior (18.1% vs 14.8%; odds ratio: 1.35 [95% confidence interval: 1.10–1.64]) and their child reading books (59.4% vs 53.6%; odds ratio: 1.16 [95% confidence interval: 1.00–1.35]). There were no effects on safety practices.

CONCLUSIONS. 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.

Key Words: randomized prospective trial • child development • parenting

Abbreviations: HS—Healthy Steps for Young Children • OR—odds ratio • CI—confidence interval

Accepted Feb 1, 2007.


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