Practice-based interventions enhance quality of care

December 16, 2003

Adding behavior and development services to the pediatric health care practice dramatically improved the quality of care of young children and the parenting practices of families, according to a scientific evaluation of the Healthy Steps for Young Children Program conducted by researchers from the Johns Hopkins Bloomberg School of Public Health. The findings are published in the December 17, 2003, edition of the Journal of the American Medical Association (JAMA).

The Healthy Steps for Young Children Program was designed 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, which is sponsored by the Commonwealth Fund, places trained behavioral specialists in the pediatric practice to provide enhanced behavior and development services during the first three years of a child's life. The enhanced services provided by Healthy Steps were available to all children, regardless of socioeconomic status. They included home visits from developmental specialists, a telephone help line, educational materials and support groups to aid parents with developmental concerns.

"Our evaluation found that participation in the Healthy Steps Program significantly improved the effectiveness, patient-centeredness, timeliness and efficiency of care provided to children," said Cynthia Minkovitz, MD, MPP, lead author of the study and associate professor with the School's Department of Population and Family Health Sciences. "These improvements included marked parental satisfaction with the Healthy Steps Program; timelier preventive care, including timely immunizations; and the receipt of more developmentally-oriented services."

For the evaluation, Dr. Minkovitz and her colleagues followed 5,565 children from 15 Healthy Steps sites across the United States. The participants were monitored from birth to age three. All of the children received standard pediatric care. Some families received additional enhanced behavioral and developmental services provided as part of the Healthy Steps Program, while others did not.

According to the study, families who participated in the Healthy Steps Program were more likely to receive Healthy Steps-related services compared to families who did not receive enhanced services. These services included office visits about child's development, telephone line for non emergent concerns, written materials and special health booklets. Families who received enhanced services were more likely to discuss problems and issues with their care providers and were more satisfied with their care than families who did not. In addition, families who received enhanced care were less like to use severe disciplinary tactics with their children, such as slapping the face or spanking with an object, compared to parents who did not receive additional services.

"There is a growing concern in this country regarding the quality of health care for children, particularly in the area of early childhood behavior and development," said co-author Bernard Guyer, MD, MPH, Zanvyl Krieger Professor of Children's Health and chair of the Department of Population and Family Health Sciences at the School of Public Health. "Our evaluation shows that universally applied behavioral and developmental services, like those provided by the Healthy Steps Program, can dramatically improve the quality of care for children."
"A Practice-Based Intervention to Enhance Quality of Care in the First 3 Years of Life: The Healthy Steps for Young Children Program" was written by Cynthia Minkovitz, MD, MPP; Nancy Hughart, BSN, MPH; Donna Strobino, PhD; Dan Scharfstein, ScD; Holly Grason, MA; William Hou, MS; Tess Miller, DrPH; David Bishai, MD, PhD; Marilyn Augustyn, MD; Kathryn Taaffe McLearn, PhD; and Bernard Guyer, MD, MPH.

The evaluation was funded by the Commonwealth Fund.

News releases from the Johns Hopkins Bloomberg School of Public Health are available online at

Johns Hopkins University Bloomberg School of Public Health

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