Expanding Healthy Steps, an Effective Program that Augments and Improves Pediatric Care

Healthy Steps for Young Children (Healthy Steps), managed by ICF International (formerly ICF Incorporated), was a national initiative, started with funding from the Commonwealth Fund in 1994, to augment pediatric care in order to enhance the growth and development of young children. Participating families received standard pediatric care along with seven other services, including up to six home visits in the first three years, a telephone line for non-emergency developmental concerns and developmental assessments.

From 1997 to 2003, RWJF provided funding to support operational and technical assistance to two affiliate sites of the Healthy Steps program: Advocate Health Care-Ravenswood Hospital (Chicago) and Residents Primary Care Group at Texas Children's Hospital (Houston).

Key Results

The RWJF funding also supported an evaluation of these two sites along with four other affiliate sites, by researchers from Johns Hopkins University Bloomberg School of Public Health. Affiliate sites fully participated in the Healthy Steps program; however, they did not qualify for a comprehensive national evaluation also conducted by researchers at Johns Hopkins since they had no matched control groups.

The affiliate programs demonstrated the value of Healthy Steps in large medical centers/systems such as Advocate Health Care-Ravenswood Hospital (Chicago) and Texas Children's Hospital (Houston).

The evaluation of the six affiliate sites showed that they Increased the amount of preventive health services children received, they improved clinicians' and families' satisfaction with pediatric care, and they added value to the pediatric practices and enriched the relationship between families and the practice.

Evaluation Findings

In 2006, with funding from the Commonwealth Fund and the Agency for Healthcare Quality and Research, researchers from Johns Hopkins University Bloomberg School of Public Health completed the evaluation of the Healthy Steps projects with matched control groups to determine whether benefits from the program were sustained two years after participation ended.

As reported in an article entitled "Healthy Steps for Young Children Sustained Results at 5.5 Years," (Pediatrics, 120(3): e658–e668, 2007):

  • Compared to families in the control group, intervention families were more satisfied with the care they received and more likely to receive needed anticipatory guidance on a wide range of topics, from use of car seats to assigning chores.
  • Intervention families were less likely to report ever using severe discipline, such as spanking, and more likely to report that they often or almost always negotiated with their child.
  • Intervention families reported more favorable practices with respect to encouraging reading.

These results suggested that Healthy Steps had the potential to enhance parenting outcomes that are critical to positive child development and that the benefits of participation in Healthy Steps could be sustained beyond the intervention period.