application) Parental practices have been identified as key factors contributing to child health and development. Numerous interventions attempt to enhance parental attitudes, knowledge, beliefs, and practices with the expectation those children's outcomes ultimately will be enhanced. Unfortunately, methodologically flawed evaluations of such programs have contributed to our limited knowledge of how best to promote parenting practices among diverse families. The proposed project is a follow up of the National Evaluation of the Healthy Steps for Young Children Program. Healthy Steps is a new model of pediatric practice that incorporates child development specialists and enhanced developmental services into routine pediatric care for all families of young children from birth to age 3 years. The Program is designed to strengthen parents' knowledge, attitudes, and behaviors in ways that promote their child's health and development. The proposed project is the second phase of what is currently planned as a three phase longitudinal cohort study. The primary objective of the proposed project is to assess whether enhanced delivery of behavioral and developmental services in the first 3 years of life changes parental attitudes and practices related to their child's health, behavior, and development when their children reach 5 years of age.
Study aims i nclude: (1) to describe parents' health care seeking for their children at approximately 5 years of age, particularly with regard to behavior and development, and to explore parents' health promotion activities for their children and their expectations for and experiences with pediatric health care; and (2) To assess whether enhanced delivery of pediatric care regarding behavior and development in the first 3 years of life leads to positive effects on parents' health care seeking and health promotion activities for their children beyond the life of the intervention, with special emphasis on these activities in relation to their child's behavior and development. Specific hypotheses, under the second aim, will test whether parents in the Healthy Steps intervention group are more likely than parents in the comparison group to: a) seek care appropriately for their children; b) engage in positive health promotion activities for their children; and c) be positively affected in their expectations for pediatric care, each with regard to their child's behavior and development. The proposed study follows Healthy Steps families when their children are 5 years of age using a parent interview. Data collected will be analyzed with data from interviews conducted at 2-4 and 30-32 months using hierarchical regression models to generate overall estimates of the effect of Healthy Steps and account for within site correlation of outcomes and possible covariates. This study will inform policy and practice regarding whether or not a parenting intervention, highly targeted to child development and behavior when children are 0-3, has effects when children are 5 years of age.
