Practice-based Intervention Has Sustained Benefits For Children And Families

The sustained benefits from participation in Healthy Steps included greater satisfaction among parents with their child's health care, greater odds that parent's will report a child's serious behavioral issue to the pediatrician and greater odds of children reading books. Parents also were less likely to use severe discipline such as spanking with an object or slapping in the face.

"Incorporating developmental specialists into pediatric practices seems to be an effective strategy to meet families' needs regarding their children's behavior and development," said Cynthia Minkovitz, MD, MPP, lead author of the study and associate professor with the School's Department of Population, Family and Reproductive Health. Minkovitz noted that this universal practice-based intervention had favorable, sustained effects on "experiences seeking health care and other parenting behaviors that are critical to children's development."

Healthy Steps for Young Children was initially designed by Boston University and The Commonwealth Fund to meet the early development and behavior needs of young children by enhancing the relationships between parents and children, families and the pediatric practice, and among physicians and staff.

The program placed trained developmental specialists in pediatric practices to provide enhanced behavior and development services during the first three years of a child's life. Healthy Steps services included enhanced well-child care, home visits from developmental specialists, a telephone help line, developmental assessments, educational materials, support groups to aid parents with developmental concerns and linkages to community resources.

To determine whether Healthy Steps had any sustained effect, Minkovitz and her colleagues conducted follow-up phone interviews with 3,165 families enrolled in a national evaluation. Some families received the additional enhanced services provided as part of Healthy Steps, while others did not. The interviews were conducted when the children reached 5.5 years of age, which was 2.5 years after intervention services were discontinued.

Previous studies by Minkovitz and her colleagues found that families who participated in Healthy Steps received higher quality of care and had more favorable parenting practices. This study shows sustained treatment effects even after the intervention ended.

The findings are published in the September 2007 edition of Pediatrics.

Additional authors include Donna Strobino, PhD; Kamila B. Mistry, MPH; Daniel O. Scharfstein, ScD; Holly Grason, MA; William Hou, MS; Nicholas Ialongo, PhD; and Bernard Guyer, MD, MPH.

The research was funded by grants from the Commonwealth Fund and the Agency for Healthcare Quality and Research.