Healthy Steps: A Systematic Review of a Preventive Practice-Based Model of Pediatric Care

Abstract

The preventive role of anticipatory guidance in pediatric practice has gained increasing importance over the last two decades, resulting in the development of competing models of practice-based care. Our goal was to systematically evaluate and summarize the literature pertaining to the Healthy Steps Program for Young Children, a widely cited and utilized preventive model of care and anticipatory guidance, Medline and the bibliographies of review articles for relevant studies were searched using the keywords: Healthy Steps, preventive care, pediatric practice and others. Other sources included references of retrieved publications, review articles, and books; government documents; and Internet sources. Relevant sources were selected on the basis of their empirical evaluation of some component of care (e.g., child outcomes, parent outcomes, quality of care). From 21 identified articles, 13 met the inclusion criteria of empirical evaluation. These evaluations were summarized and compared. Results indicated that the Healthy Steps program has been rigorously evaluated and shown to be effective in preventing negative child and parent outcomes and enhancing positive outcomes. Despite limited information concerning cost effectiveness, the Healthy Steps Program provides clear benefit through early screening, family-centered care, and evidence-based anticipatory guidance. It is recommended that the Healthy Steps program be more widely disseminated to relevant stakeholders, and further enhanced by improved linguistic and cultural sensitivity and long term evaluation of cost effectiveness.

Well-Child Care Clinical Practice Redesign for Young Children: A Systematic Review of Strategies and Tools

“…Eleven articles were identified through a reference search of accepted articles. Thirty-three articles were accepted; these included 13 articles primarily on alternative formats for WCC, 16,25-36 2 articles primarily on nonclinical locations for WCC, 37,38 17 articles primarily on nonphysicians/ non-NPs added to enhance WCC, 17,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] and 1 miscellaneous article. 55 Of 13 WCC format articles, 5 were on non-face-to-face formats, [25][26][27][28]36 and 8 were on group visit formats.…”

“…In 2009, Piotrowski et al published a systematic review of the literature evaluating HS. 51 There were 13 articles included in this review, from 1999 to 2007; we have summarized them in Table 5. Among the 13 articles, 8 analyzed data from a large, national 3-year prospective, randomized controlled and quasi-experimental trial at 15 US sites that evaluated the program with 5565 newborns.…”

Early Childhood Home Visiting

“…Although not approved for MIECHV funding, Healthy Steps for Young Children is a comprehensive primary-care model that may include on the treatment team a home visitor who supports positive parenting, provides in-home developmental assessment, and links the family more strongly to the medical home. 68 The example of Healthy Steps illustrates the significant potential benefits from improved collaboration between the medical home and community home-visiting programs. These include common documentation, centralized intake services, strengthbased assessments, colocation of home visitors in the pediatric practice, and multidisciplinary team meetings convened by the practice.…”

Primary Care–Based Interventions to Promote Positive Parenting Behaviors: A Meta-analysis

“…One systematic review has evaluated HS, but includes nonexperimental studies and prenatal components that are out of scope for this review. 52 The 3 studies included in our review assigned newborns either randomly or via enrollment at quasi-experimental (QE) sites (ie, consecutively enrolled at intervention sites and matched with control sites). 20,32,33 Between ages 8 and 18 weeks, a greater percentage of parents who received HS self-reported showing picture books at least once a day to their infant.…”