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Assessing the effects of prenatal enrollment into HealthySteps on dyadic health outcomes
Jaya Mishra1, Ronald Sanchez2, Hannah Brody2
1Heilbrunn Department of Population and Family Health, Columbia University, Mailman School of Public Health.
Insights
Extending the HealthySteps (HS) intervention to prenatal care improved maternal and child health outcomes. Prenatal enrollment in HS reduced social drivers of health risks and increased breastfeeding rates and pediatric visit completion.
Area of Science:
- Pediatric Behavioral Health
- Maternal and Child Health
- Public Health Interventions
Background:
- The HealthySteps (HS) model is an evidence-based pediatric behavioral health intervention.
- HS aims to enhance mental and psychosocial care for young children in underserved communities.
- This study investigated extending HS into the prenatal period within obstetric settings.
Purpose of the Study:
- To evaluate the impact of integrating the HealthySteps intervention into prenatal care.
- To compare outcomes between families enrolled prenatally versus postnatally.
- To assess effects on maternal depression, social drivers of health (SDOH), breastfeeding, and pediatric visit adherence.
Main Methods:
- A comparative study of 611 families, with 120 in the prenatal (extended) group and 491 in the postnatal (traditional) group.
- Data collected on maternal depression, SDOH, breastfeeding, pediatric well visits, and HS engagement over 15 months.
- Statistical analyses, including regression, compared outcomes between the two enrollment groups.
Main Results:
- Prenatal enrollment significantly reduced SDOH risk scores (20% vs. 7%, p=0.003).
- Higher breastfeeding rates were observed in the prenatal group (83% vs. 46%, p<0.001).
- Prenatally enrolled high-risk families showed improved pediatric appointment adherence (91% vs. 78%, p=0.011).
Conclusions:
- Expanding the HealthySteps intervention into obstetric care demonstrates potential for improved maternal and child well-being.
- Prenatal integration of HS is linked to better SDOH, breastfeeding, and pediatric care utilization.
- This extended model shows promise for enhancing early childhood health outcomes in marginalized populations.
Introduction:
HealthySteps (HS) is a national evidence-based, pediatric behavioral health model designed to improve comprehensive mental and psychosocial health care during early childhood in marginalized communities. Our study sought to examine the effects of extending the HS intervention to the prenatal period, embedded within outpatient obstetric care from 2020 to 2022.
Method:
A sample of 611 families was included; 120 families enrolled prenatally (extended model) and 491 families enrolled postnatally (traditional model). Baseline, follow-up (over a 15-month period), and change in rates of maternal depression, social drivers of health (SDOH), breastfeeding practices, pediatric well visit completion, and HS engagement were compared between prenatally and postnatally enrolled groups.
Results:
Families in the prenatally enrolled group had a 20% decrease in SDOH risk score compared with 7% in the postnatally enrolled group (p = 0.003). A higher percentage of prenatally enrolled families (83%) reported breastfeeding compared with 46% of postnatal families (p < 0.001), and specifically at their infant's 2-4-month visit (66% compared with 38% in postnatal group, p = 0.004). Furthermore, subanalysis of Tier 3 (high-risk) families revealed greater follow-up with scheduled pediatric appointments for prenatal families (91% compared with 78%, p = 0.011). After controlling for covariates, regression analyses revealed that prenatal enrollment resulted in greater odds of reduced SDOH risk (p = 0.003), reported breastfeeding practices (p < 0.001), and completed pediatric visits for Tier 3 families (p = 0.021).
Discussion:
These results provide some evidence that expanding the HS intervention into obstetric care is linked to improved outcomes for young children and their caregivers. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
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