A paediatric primary care program designed to improve the health, wellbeing and school readiness of young children in low-income families.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
Australian Study
Risk of Bias
Cost
Target Age Group
About
HealthySteps partners with paediatric primary care providers to support parents and improve the health and wellbeing of children up to age 3 so they are prepared for school and life. HealthySteps specialists are child development experts, who join the paediatric primary care team to ensure early preventive services and universal screening and provide successful interventions, referrals and follow up to the whole family.
Aims
- Build strong family relationships
- Foster healthy child development and lifelong wellbeing
- Promote child social-emotional development
- Promote parenting skills
- Connect families to community resources.
Impact
The evidence is mixed for health service use and parenting skills. There was no effect found for improving child's mental health/behaviour related to aggressive behaviour, anxiety and depression and problems sleeping.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Health service use | Yes | Yes | Yes |
| Child | Mental health/behaviour | Not found | Yes | Not found |
| Parent/caregiver | Parenting skills | Yes | Yes | Yes |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
HealthySteps has an evidence rating of Well-supported+.
This means that HealthySteps has evidence from at least 2 randomised controlled trials (RCT) and/or quasi-experiments (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on 2 research outputs from one RCT and one QE. Another RCT (van der Put et al., 2018) was identified but did not count towards the evidence due to concerns with study quality. HealthySteps has not received a Very well-supported rating as a rigorous systematic review with meta-analysis has not been conducted.
| Study design | Number of research outputs included (Note: Can include research outputs from the same study) |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 1 |
| Quasi-experiment | 1 |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of evidence from the included studies.
The studies were conducted in the United States and do not include Aboriginal children and families.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- Both studies were conducted in the United States.
Sample characteristics
- The RCT included 658 families (337 intervention, 321 control) across 2 sites; and the QE included 3,330 participants (1830 intervention, 1500 control) across 9 sites.
- Participating families had newborns 0 to 4 months old.
- Across both studies, families who identified as White made up slightly more than half of the cohort, with the others identifying as African Americans, Hispanic and others (including Asians and Native Americans).
Implementation
Delivery model and mode
- HealthySteps is delivered in-person and over the internet/phone, to the parent only, child only or both the parent and child separately or together.
Target cohort
- Parents from low-income backgrounds
- Children up to age 3.
Program delivery
- HealthySteps is a package of services comprising of 3 tiers of services.
- By design, during the first 3 years, HealthySteps families receive 9 office visits, 6 telephone calls, 2 home visits, 2 other contacts from the HealthySteps Specialist and up to one parent group.
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Description of services provided at each tier Tier Target group Description of services Tier 1: Universal Services All families with children up to age 3 - Routine child development, social-emotional and behavioural screening
- Annual screening for family needs
- Access to a child development support line.
Tier 2: Short Term Supports Families with mild concerns - Tier one services
- Short-term consultations to address specific concerns about a child’s development and/or behaviour or a parental concern
- Referral to both in-house and community resources based on identified needs
- Positive parenting guidance and information
- Early learning resources such as concrete strategies, activities and tools, designed to support child’s early learning.
Tier 3: Comprehensive Services Families with more significant risk factors and/or concerns - Tier one and 2 services
- Ongoing, preventive team-based well-child visits with the HealthySteps Specialist and paediatric primary care provider.
Manuals and guides
- There is an implementation guide to support the delivery of HealthySteps.
- There is a fidelity self-assessment based on implementation science to inform quality delivery of the HealthySteps model.
Additional information
- The HealthySteps website has more information about the model.
Staffing
- At a minimum, HealthySteps Specialists must have a bachelor’s degree in early childhood or a related field; a master or doctoral level degree and mental health background is preferred.
Training
- Key staff participate in an initial in-person training and multiple technical assistance calls with the HealthySteps National Office.
- HealthySteps Specialists receive reflective supervision at least once a month in addition to logistical supervision.
To our knowledge, HealthySteps is not available and has not been implemented in Australia.
Cost
According to the HealthySteps website, the typical program cost per child receiving the most comprehensive (Tier 3) services ranges between $450 to $900 annually. The cost to implement HealthySteps varies based on several factors, such as credentials, the number of children served, the geographic location of the site, any site-specific adaptions or innovations to the model and funder-specific requirements.
The primary costs of launching and sustaining HealthySteps are salaries, employee benefits and initial HealthySteps site training (a one-time fee). Other ongoing costs may include dedicated offices, information technology and other equipment and materials.
References
Studies identified and included in the review
- Caughy MOB, Huang K-Y, Miller T & Genevro JL (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.
- Minkovitz CS, Hughart N, Strobino D, Scharfstein D, Grason H, Hou W, Miller T, Bishai D, Augustyn M, McLearn KT & 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. Journal of the American Medical Association, 290(23):3081-3091.
Studies identified but not counted towards the evidence rating due to study quality
- van der Put CE, Assink M, Gubbels J & Boekhout van Solinge NF (2018). Identifying effective components of child maltreatment interventions: A meta-analysis. Clinical Child and Family Psychology Review, 21(2):171-202.