HealthySteps
Category
Child & Family Health
Child's Age
0-1 years, 1-2 years, 2-3 years
Participant
Parents/Guardian
Languages
English, Spanish
Brief Description
HealthySteps integrates a child development and behavioral health promotion and prevention expert (HealthySteps Specialist) into the primary care team to promote healthy relationships, promote positive parenting, strengthen early social and emotional development, and ensure access to services that address both child and family needs, with a particular emphasis on families in low-wealth communities.
Expected Impact
- Increase in children receiving timely vaccinations and attending well-child visits
- Increase in parent knowledge (safe sleep, safe feeding, television time, child safety & development)
- Increase in positive parenting practices
- Decreased likelihood of parents using severe/negative discipline techniques
- Increased likelihood of parents using nonphysical discipline techniques
- Increased likelihood of families receiving developmental services and discussing developmental topics with providers
Core Components for Model Fidelity
HealthySteps Specialists work with families in the primary care setting based on 3 tiers of service. For more information, visit Healthy Steps Components webpage.
- Tier 1: Universal Services– For All Families with Children Ages 0-3
- Core Component 1: Child Development, Social-Emotional & Behavioral Screening
- Core Component 2: Screening for Family Needs
- Core Component 3: Family Support Line
- Tier 2: Short Term Supports – For Families with Mild Concerns
All components of Tier 1
- Core Component 4: Child Development & Behavior Consults
- Core Component 5: Care Coordination & Systems Navigation
- Core Component 6: Positive Parenting Guidance & Information
- Core Component 7: Early Learning Resources
- Tier 3: Comprehensive Services
- All components of Tiers 1 and 2
- Core Component 8: Ongoing, Preventive Team-Based Well-Child Visits
Languages Materials are Available in
English, Spanish
Delivery Mode
- Tiers 1-3: Virtual helpline available to parents/caregivers.
- Tiers 2-3: As needed, in-person visits with HealthySteps Specialist and/or primary care provider and follow-up telephone conversations with caregivers between routine well-child visits.
- Tier 3: In-person team-based well-child visit with primary care provider and HealthySteps Specialist.
Dosage
Tier 1: Services are universal and provided to all patients who enter the clinic during their regularly scheduled well-child visits.
Tier 2: HealthySteps Specialists provide 1-3 short-term consultations to families to address specific concerns about a child’s development and/or behavior or a parental concern (e.g., depression, substance misuse, etc.). Families receiving Tier 2 services continue to receive services from Tier 1.
Tier 3: For families with more significant risk factors and/or concerns, the HealthySteps Specialist and pediatric primary care provider jointly see the family at well-child visits. Families receiving Tier 3 services continue to receive services from Tiers 1 and 2.
Infrastructure for Implementation
Space: There must be a designated space within the pediatric suite for the Specialist to meet privately with families.
Shared Service: Sites can share a Specialist between multiple practices (2-3) depending on size, location, and with National Office approval. Some smaller practices may combine their Specialist’s services with home visiting models.
Staffing Requirements
HealthySteps Specialist: One fully-time HealthySteps Specialist allows a practice to provide the Tier 1 universal components of the model to up to 2,000 children birth to age 3 annually, at an average cost per child of $50-$80/year. From that population of 2,000, HealthySteps Specialists can provide short-term child development and behavior consults and care coordination (Tier 2) to up to 300 children annually, and the most comprehensive services (i.e., ongoing, preventive team-based well-child visits, or Tier 3) to up to an additional 300 children annually. For more information, please visit How to Pay for HealthySteps - HealthySteps. HealthySteps Specialists are typically Master’s level professionals in related fields with the additional HealthySteps training completed through ZERO to THREE. Some clinics hire and train community health workers to become HS Specialists.
Physician Champion: Pediatrician or primary care team.
NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Prevent Child Abuse North Carolina | PCANC (preventchildabusenc.org) or National Family Support Network for more information, training and certification.
Training for Model Fidelity
Training is provided through the Virtual HealthySteps Institute, which uses a blended approach to deliver content. Participants complete online courses independently and attend Zoom calls for live practice and application opportunities. Team members complete specific courses and Zoom calls depending on their role. Prior to attending the Institute training, teams complete practice activities, such as data readiness and implementation planning calls. After the Institute, teams receive Technical Assistance calls to support model fidelity in implementation.
Contact Information
https://www.healthysteps.org/
Natalie Tackitt, MSA, MED: North Carolina Coordinator; 202-864-2949, ntackitt@zerotothree.org
Cost Estimates
The cost of implementation includes the Virtual HealthySteps Institute (VHSI) that supports the training and implementation, in addition to the HealthySteps Specialists salaries which vary depending on several factors such as local needs and Specialists' credentialing.
The standard rate for VHSI of $25,000 applies to practices implementing HealthySteps at a single site/practice and includes:
- Practice Assessment
- Contracting
- Implementation Planning
- Data consultation and Welly
- Virtual HealthySteps Institute
- 6 Technical Assistance Calls during 1st year of implementation
For a single health system implementing HealthySteps at multiple sites/practices:
- $25,000 for first site plus $5,000/site for 2 additional sites (each training serves a maximum of 3 sites)
- The training rate includes the items listed above plus 1 additional TA call/site.
This rate is good through September 30, 2024. Please contact Natalie Tackitt for the most current pricing.
Purpose Service Code (PSC)
5410 - Quality Child Health Services
Program Identifier (PID)
HealthySteps
Minimal Outputs for NCPC Reporting
FY 23-24:
- Number of medical practices participating
- Number of children in participating practices
FY 24-25
- Number of medical practices participating
- Number of children in participating practices
Minimal Outcomes for NCPC Reporting
FY 23-24:
- Increase in developmental screenings or assessments, referrals, and child use of services
FY 24-25
- Increase in developmental screenings or assessments, referrals, and child use of services
Minimal Measures for NCPC Reporting
FY 23-24:
- Child Screenings, Referrals, and Use of Services Calculation
FY 24-25:
- Child Screenings, Referrals, and Use of Services Calculation
NCPC Evidence Categorization
Evidence Based- 3 publications. Of these, 1 national evaluation used randomized and quasi-experimental study sites and 1 study used comparison groups.
Research Summary
Relevant publications include a national evaluation that used randomized and quasi-experimental study sites and multiple comparison studies. Overall results of Buchholz and Talmi (2012)1 and Johnston et al. (2006)2 reported that Healthy Steps children attended well child visits/received immunizations in a timelier manner. Buchholz and Talmi (2012) also found that HS families discussed more developmental topics with their providers. Johnston et al. (2006) results indicated an increase in positive parenting practices and positive breastfeeding outcomes, whereas Minkovitz et al. (2001)3 only found improvements in parenting practices and no significant differences in breastfeeding practices. However, Minkovitz et al. (2001) also found that HS families received more developmental services and discussed a greater number of developmental topics with providers, similar to Buchholz and Talmi (2012). The national evaluation found that the Healthy Steps clinics reported significant increases in clinic effectiveness, patient-centeredness, and the timeliness/efficiency of the care provided. These improvements increased satisfaction, well-timed preventative care, and on-time immunizations. Families that participated in Healthy Steps reported using more positive discipline techniques at home and documented an increase in mothers noting behavioral changes in their children and discussing them with a provider (Minkovitz, et al., 2003).4
- ^ See Buchholz and Talmi (2012). This study was conducted in Colorado at an urban primary care clinic, connected to the children’s hospital. The sample was heavily Hispanic, followed by Black, White, and Multiracial and the families had children between 2 and 18 months old. Researchers retrospectively compared medical records of children in HealthySteps and those who received standard pediatric care. Data was collected through medical records and a developmental topics checklist.
- ^ See Johnston et al. (2006). Authors conducted a two-part investigation using concurrent comparison groups and a randomized trial within the HealthySteps sites. Pregnant women and their later born children participated. The women were from diverse socioeconomic backgrounds. Data was collected using sub scales from the Child Behavior Checklist, the Parenting Behavior Checklist, Parenting Sense of Competence, and they developed a self-care scale and an injury prevention index.
- ^ This early study used data from the national evaluation of HealthySteps (HS) where the authors collected data from 15 randomized and quasi-experimental sites around the United States (see Minkovitz, et al., 2003). Data was collected through phone interviews with participating parents of children between 2 and 4 months old.
- ^ See Minkovitz et al. (2003). This article is based on the findings from the National Evaluation of the HealthySteps program. Authors collected data from 15 sites that were either randomized or quasi-experimental. The study population included children that were enrolled at birth and participated in HealthySteps until they reached 30-33 months (3years). The children’s parent or guardian completed phone interviews and well-child visit and immunization information was collected from their medical records for analysis.
Researched Population
- Families/Parents/Caregivers with child ages 0-3 years
- Families/Parents/Caregivers with various levels of education
- Multi-lingual populations
- Racially/ethnically diverse caregivers
Buchholz, M., & Talmi, A. (2012). What we talked about at the pediatrician’s office: Exploring the differences between healthy steps and traditional pediatric primary care visits. Infant Mental Health Journal, 33(4). 430-436. https://doi.org/10.1002/imhj.21319
Johnston, B. D., Heubner, C. E., Anderson, M. L., Tyll, L, T., & Thompson, R. S. (2006). Healthy Steps in an integrated delivery system: Child and parent outcomes at 30 months. Archives of Pediatrics and Adolescent Medicine, 160. 793-800. https://doi.org/10.1001/ARCHPEDI.160.8.793
Minkovitz, C. S., Hughart, N., Strobino, D., Scharfstein, D., Grazon, H., Hou, W., Miller, T., Bishai, D., Augustyn, M., McLearn, K. T., & Guyer, B. (2003). A practice-based intervention to enhance quality of care in the first 3 years of life: The healthy Steps for young children program. JAMA, 290(23). 3081-3091. https://www.doi.org/10.1001/jama.290.23.3081
Minkovitz, C., Strobino, D., Hughart, N., Scharfstein, D., Guyer, B., & Healthy Steps Evaluation Team. (2001). Early effects of the healthy steps for young children program. Archives of Pediatrics and Adolescent Medicine, 155. 470-479. https://www.doi.org/10.1001/archpedi.155.4.470
Local Partnerships Currently Implementing
Local Partnerships in purple have adopted HealthySteps. Local Partnership contact information can be found here.