The Evidence Portal

First Steps

About the program

The First Steps program is a primary prevention strategy that aims to promote child health and development by improving the quality of parenting behaviour. It achieves this by building parenting capacity and supports, specifically the protective factors of parenting knowledge and social support.

The program model has two main components:

  • a required in-person initial visit with the mother in their hospital room
  • optional telephone or mail follow-up contacts.

Mothers are provided with both an information packet and a brief discussion with a healthcare professional on various topics around infant development.

Who does it work for?

The First Steps program is designed for mothers who have just given birth (within 2 days).

The First Steps program has only been evaluated in the USA (O’Neill et al. 2018).

A randomised control trial was conducted with 558 people (278 people were in the intervention group and 280 people were in the control group). On average, parents were 27 years old. Almost 60% of families were African American and more than 50% were employed.

The program has not been evaluated in Australia, or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

  • Parenting knowledge: mothers have higher overall parenting knowledge on infant development when receiving the program, such as better understanding reasons for infants crying.

Negative outcomes:

  • No negative effects were found.

How effective is it?

The First Steps program has positive effects on client outcomes.

How strong is the evidence?

Promising research evidence:

  • At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
  • Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND

No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

The First Steps program consists of an in-person hospital room visit, and optional additional telephone contact. On average, visits are 18 minutes.

Hospital room visit: First Steps providers give families a packet of parenting information and a guide to community resources during the initial visit. They typically review these materials with the mother, provide information about needed community resources and answer any questions the mother has.

Content covered in the information packet includes:

  • maternal, newborn and child health
  • home and child safety
  • community and family safety
  • family economic self-sufficiency
  • school readiness

Content of visits include:

  1. infant development
  2. infant feeding
  3. infant sleep
  4. infant crying
  5. immunisations
  6. postpartum depression.

How much does it cost?

Not reported

What else should I consider?

First Steps providers spent the greatest amount of time talking about infant crying, a topic area in which mothers were not particularly interested, but in which they showed the greatest gains in knowledge.

Mothers contributed more to the conversation when providers used statements of support, reassurance and partnership building. Mothers talked less when providers merely gave information.

In the RCT completed by O’Neill et al. (2018) only 25% of families received additional telephone support.

Where does the evidence come from?

One RCT conducted in the USA, with 558 participants (O’Neill et al. 2018).

Further resources

O’Neill et al. (2018), Impact of a child abuse primary prevention strategy for new mothers. Prevention Science, Vol. 21, pp. 4-14.

Last updated:

16 Feb 2023

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