Minkovitz C, Strobino D, Hughart N, Scharfstein D, Guyer B
Department of Population and Family Health Sciences, The Johns Hopkins University School of Hygiene and Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
Arch Pediatr Adolesc Med. 2001 Apr;155(4):470-9. doi: 10.1001/archpedi.155.4.470.
The Healthy Steps for Young Children Program (HS) incorporates early child development specialists and enhanced developmental services into routine pediatric care. An evaluation of HS is being conducted at 6 randomization and 9 quasi-experimental sites. Services received, satisfaction with services, and parent practices were assessed when infants were aged 2 to 4 months.
Telephone interviews with mothers were conducted for 2631 intervention (response rate, 89%) and 2265 control (response rate, 87%) families. Analyses were conducted separately for randomization and quasi-experimental sites and adjusted for baseline differences between intervention and control groups. Hierarchical linear models assessed overall adjusted effects, while accounting for within-site correlation of outcomes.
Intervention families were considerably more likely than controls to report receiving 4 or more developmental services and home visits and discussing 5 infant development topics. They also were more likely to be satisfied and less likely to be dissatisfied with care from their pediatric provider and were less likely to place babies in the prone sleep position or feed them water. The program did not affect breastfeeding continuation. Differences in the percentage of parents who showed picture books to their infants, fed them cereal, followed routines, and played with them daily were found only at the quasi-experimental sites and may reflect factors unrelated to HS.
Intervention families received more developmental services during the first 2 to 4 months of their child's life and were happier with care received than were control families. Future surveys and medical record reviews will address whether these findings persist and translate into improved language development, better utilization of well-child care, and an effect on costs.
幼儿健康成长计划（HS）将幼儿发育专家和强化发育服务纳入常规儿科护理中。目前正在6个随机化试验点和9个准试验点对HS进行评估。在婴儿2至4个月大时，评估了其接受的服务、对服务的满意度以及家长的做法。
对2631个干预组家庭（回复率89%）和2265个对照组家庭（回复率87%）的母亲进行了电话访谈。分别在随机化试验点和准试验点进行分析，并对干预组和对照组之间的基线差异进行了调整。分层线性模型评估了总体调整效应，同时考虑了各试验点内结果的相关性。
与对照组相比，干预组家庭更有可能报告接受了4项或更多的发育服务和家访，并讨论了5个婴儿发育话题。他们也更有可能对儿科服务提供者的护理感到满意，而不太可能不满意，并且不太可能让婴儿俯卧睡眠或喂他们喝水。该计划对母乳喂养的持续时间没有影响。仅在准试验点发现了在给婴儿看图画书、喂他们吃谷物、遵循日常作息以及每天与他们玩耍的家长比例方面存在差异，这可能反映了与HS无关的因素。
干预组家庭在孩子出生后的头2至4个月接受了更多的发育服务，并且比对照组家庭对所接受的护理更满意。未来的调查和病历审查将探讨这些发现是否持续存在，并转化为语言发育的改善、对儿童健康护理的更好利用以及对成本的影响。
