title: Healthy steps in an integrated delivery system: child and parent outcomes at 30 months.
abstract: OBJECTIVE
  To test the effects of the Healthy Steps for Young Children program (HS) (which supports parents managing children's developmental and behavioral issues)-with and without a prenatal component-on child health and development, parenting practices, and parental well-being.
  
  
  METHODS
  A concurrent comparison with clinic-level assignment to intervention or usual care status. Nested in the intervention arm, a randomized trial compared HS with and without a prenatal component.
  
  
  METHODS
  Five primary care clinics in an integrated delivery system in the Pacific Northwest.
  
  
  METHODS
  A consecutive sample of 439 pregnant women (80% of eligible) were enrolled. Follow-up data were obtained for 78% when the child was 30 months old. Intervention Families in intervention clinics received HS services, including developmental and behavioral advice and risk factor screening. In addition, those randomized to prenatal services received 3 home visits during pregnancy.
  
  
  METHODS
  Assessed by telephone interview in the 3 domains of child health and development, parenting practices, and parental well-being.
  
  
  RESULTS
  Intervention was associated with positive outcomes in timely well-child care, immunization rates, breastfeeding, television viewing, injury prevention, and discipline strategies. Prenatal initiation of services was associated with larger expressive vocabularies at age 24 months. Mothers who received the intervention reported more depressive symptoms, but there was no increase in the proportion with clinically significant depression.
  
  
  CONCLUSIONS
  For members of an integrated delivery system, the HS intervention was associated with positive effects on children's health and parenting practices. There was little evidence of any additional benefit of HS services initiated during the prenatal period.
authors.affiliation: Department of Pediatrics and Maternal and Child Health Program, University of Washington, Seattle, WA 98104, USA. bdj@u.washington.edu
authors.forename: Brian D
authors.initials: BD
authors.lastname: Johnston
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Huebner
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Anderson
authors.forename: Lynda T
authors.initials: LT
authors.lastname: Tyll
authors.forename: Robert S
authors.initials: RS
authors.lastname: Thompson
mesh_terms: D000056:Accident Prevention; D000328:Adult; D001942:Breast Feeding; D002657:Child Development; D002662:Child Health Services / Q000458:organization & administration*; D002668:Child Rearing; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D007804:Language Development; D010043:Outcome and Process Assessment, Health Care; D016487:Parenting / Q000523:psychology; D011247:Pregnancy; D011295:Prenatal Care; D011314:Preventive Health Services / Q000458:organization & administration*; D017751:Safety Management