Johnston Brian D, Huebner Colleen E, Anderson Melissa L, Tyll Lynda T, Thompson Robert S
Department of Pediatrics and Maternal and Child Health Program, University of Washington, Seattle, WA 98104, USA.
Arch Pediatr Adolesc Med. 2006 Aug;160(8):793-800. doi: 10.1001/archpedi.160.8.793.
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.
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.
Five primary care clinics in an integrated delivery system in the Pacific Northwest.
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.
Assessed by telephone interview in the 3 domains of child health and development, parenting practices, and parental well-being.
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.
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.
测试“幼儿健康成长计划”（HS）（该计划支持家长应对孩子的发育和行为问题）有无产前部分对儿童健康与发育、养育方式及家长幸福感的影响。
采用诊所层面随机分配至干预组或常规护理组的同期对照研究。在干预组中进行嵌套式随机试验，比较有产前部分和无产前部分的HS计划。
太平洋西北部一个综合医疗服务体系中的五家初级保健诊所。
连续招募了439名孕妇（占符合条件者的80%）。当孩子30个月大时，获得了78%参与者的随访数据。干预措施：干预诊所的家庭接受HS服务，包括发育和行为咨询以及风险因素筛查。此外，随机分配到产前服务组的孕妇在孕期接受3次家访。
通过电话访谈在儿童健康与发育、养育方式及家长幸福感这三个领域进行评估。
干预与及时的儿童健康护理、免疫接种率、母乳喂养、看电视、预防伤害及管教策略等方面的积极结果相关。产前开始服务与24个月大时更大的表达性词汇量相关。接受干预的母亲报告有更多抑郁症状，但临床显著抑郁的比例没有增加。
对于综合医疗服务体系的成员，HS干预对儿童健康和养育方式有积极影响。几乎没有证据表明产前启动HS服务有任何额外益处。
