• Brian D Johnston, Colleen E Huebner, Melissa L Anderson, Lynda T Tyll, and Robert S Thompson.
• Department of Pediatrics and Maternal and Child Health Program, University of Washington, Seattle, WA 98104, USA. bdj@u.washington.edu
• Arch Pediat Adol Med. 2006 Aug 1;160(8):793-800.

ObjectiveTo 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.DesignA 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.SettingFive primary care clinics in an integrated delivery system in the Pacific Northwest.ParticipantsA 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.Main Outcome MeasuresAssessed by telephone interview in the 3 domains of child health and development, parenting practices, and parental well-being.ResultsIntervention 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.ConclusionsFor 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.

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