title: Expanding developmental and behavioral services for newborns in primary care; Effects on parental well-being, practice, and satisfaction.
abstract: BACKGROUND
  Healthy Steps (HS) was designed to address, prospectively, behavioral and developmental support needs of young families in pediatric clinical care settings. PrePare (PP) initiates these services prenatally, whereas HS begins services in the postnatal period. Both interventions have universal and risk-directed components. Intervention effects in the first 3 months after birth are reported here.
  
  
  METHODS
  A quasi-experimental design was used to allocate 439 participants to intervention or usual care conditions. Within the intervention group, enrollees were randomly assigned to receive HS or PP+HS services. Early outcomes were assessed by telephone survey at 1 week and 3 months postpartum.
  
  
  RESULTS
  Mothers in either intervention condition were less likely to report depressive symptoms and more likely to describe themselves as pleased in their role as parents. Intervention families were more likely to continue breastfeeding and more likely to read to their 3-month-old. Knowledge of infant development and recognition of appropriate discipline was greater among intervention recipients. Satisfaction with pediatric care was higher among intervention recipients and the rate of health plan disenrollment was 75% lower at 3 months among those enrolled in the prenatal intervention. No other outcome difference emerged between HS and PP+HS enrollees.
  
  
  CONCLUSIONS
  Receipt of either intervention was associated with positive effects on health, safety, and developmentally appropriate parenting, as assessed in early infancy. There were positive effects on health plan disenrollment. No additional benefit could be ascribed to prenatal institution of services. A combination of universal and risk-based support for new parents is recommended, rather than the provision of risk-based services alone.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Johnston
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Huebner
authors.forename: Lynda T
authors.initials: LT
authors.lastname: Tyll
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
authors.forename: Robert S
authors.initials: RS
authors.lastname: Thompson
mesh_terms: D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000523:psychology*; D017060:Patient Satisfaction; D016012:Poisson Distribution; D011181:Postnatal Care / Q000458:organization & administration*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D014861:Washington