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Am Fam Physician. 2006;74(12):2112

The Healthy Steps for Young Children program is a practice-based intervention that was developed to support families of young children. It includes risk-reduction activities, developmental screening, anticipatory guidance, and follow-up services. Program goals include improvement of parental practices and use of health care and the promotion of childhood development. A pre-natal program, PrePare, also was developed. This provided three prenatal visits from a Healthy Steps specialist aimed at helping the parents prepare for the arrival of the newborn and educating them about fetal and infant development. Johnston and colleagues evaluated the impact of these programs on child health and development, parenting practices, and parental well-being.

The study was performed in five clinics within an integrated health care delivery system. Two of the sites were used as comparison clinics and continued usual care. At the other three sites, participants were randomly assigned to receive prenatal and postnatal Healthy Steps services or postnatal services alone. Postnatal services included home visits by a Healthy Steps specialist, developmental advice, parent-initiated telephone support, developmental assessments in addition to scheduled well-child care, a literacy program, risk-based screening services, and parenting classes. Those assigned to the prenatal group received three prenatal visits from a Healthy Steps specialist who assisted them in transitioning to new family roles and creating a safe home environment. The main outcome measures were findings in three domains: child health and development, parenting practices, and parental well-being when children were 30 months of age.

A total of 343 women who were enrolled during their pregnancy completed the study: 122 received the postnatal and prenatal services, 117 received the postnatal intervention alone, and 104 received usual care. Those who received the Healthy Steps services were more likely to be timely in their well-child care and had higher immunization rates than those who received usual care. They also were more likely to breastfeed, allow less television viewing time, and develop more injury prevention interventions; and they were less likely to use extreme disciplinary strategies. The children of parents who participated in the prenatal program had a larger expressive vocabulary at 24 months of age compared with the other two groups. Parental well-being outcomes were similar among the three groups except with regard to depressive symptoms. The intervention groups had slightly higher depressive symptom scores than the usual care group, but there was no difference between the two groups with regard to clinically significant depression.

The authors conclude that the Healthy Steps program had a positive impact on children’s health and on parenting practices, but that the prenatal program provided only minor benefits. They speculate that the increase in depression in the intervention group could reflect an increased accuracy of identification and willingness to report symptoms.

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Copyright © 2006 by the American Academy of Family Physicians.

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