Practice-based Interventions Enhance Quality of
Pediatric Care
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 Dec. 17,
2003, edition of the Journal of the American Medical
Association.
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, between 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, 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, 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 3. All 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 that participated in the
Healthy Steps Program were more likely to receive Healthy
Stepsrelated services compared with families that did
not receive enhanced services. These services included
office visits about child's development, a telephone line
for nonemergent 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 likely to use severe disciplinary
tactics with their children, such as slapping the face or
spanking with an object, compared with 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, 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.
— Tim Parsons
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