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Cynthia Minkovitz, MD, MPP; Donna Strobino, PhD; Nancy Hughart, RN, MPH; Daniel Scharfstein, ScD; Bernard Guyer, MD, MPH; and the Healthy Steps Evaluation Team

Arch Pediatr Adolesc Med. 2001;155:470-479.

Objective  The Healthy Steps for Young Children Program (HS) incorporates early child development specialists and enhanced developmental services into routine pediatric care. An evaluation of HS is being conducted at 6 randomization and 9 quasi-experimental sites. Services received, satisfaction with services, and parent practices were assessed when infants were aged 2 to 4 months.

Methods  Telephone interviews with mothers were conducted for 2631 intervention (response rate, 89%) and 2265 control (response rate, 87%) families. Analyses were conducted separately for randomization and quasi-experimental sites and adjusted for baseline differences between intervention and control groups. Hierarchical linear models assessed overall adjusted effects, while accounting for within-site correlation of outcomes.

Results  Intervention families were considerably more likely than controls to report receiving 4 or more developmental services and home visits and discussing 5 infant development topics. They also were more likely to be satisfied and less likely to be dissatisfied with care from their pediatric provider and were less likely to place babies in the prone sleep position or feed them water. The program did not affect breastfeeding continuation. Differences in the percentage of parents who showed picture books to their infants, fed them cereal, followed routines, and played with them daily were found only at the quasi-experimental sites and may reflect factors unrelated to HS.

Conclusions  Intervention families received more developmental services during the first 2 to 4 months of their child's life and were happier with care received than were control families. Future surveys and medical record reviews will address whether these findings persist and translate into improved language development, better utilization of well-child care, and an effect on costs.

From the Women's and Children's Health Policy Center, Department of Population and Family Health Sciences, The Johns Hopkins University School of Hygiene and Public Health; Baltimore, Md. Presented in part at the Pediatric Academic Societies Annual Meeting, Boston, Mass, May 13, 2000.

Corresponding author and reprints: Cynthia Minkovitz, MD, MPP, Department of Population and Family Health Sciences, The Johns Hopkins University School of Hygiene and Public Health, 624 N Broadway, Baltimore, MD 21205.

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