HealthySteps: Transforming the Promise of Pediatric Care and Tackling Evaluation Questions of the Future

• In Event: 2-155 - Leveraging Healthcare for Population-Level Prevention of Disparities in Child Development: Linking Across Services and Platforms

Integrative Statement

HealthySteps is an evidence-based, interdisciplinary pediatric primary care program designed to promote nurturing parenting and healthy child development through the integration of a child development professional (HealthySteps Specialist) into the primary care team. HealthySteps Specialists are trained to provide families with parenting guidance, support between visits, referrals, and care coordination, all tailored to the family’s needs. Previous research has provided a strong evidence base for HealthySteps, indicating improved parenting practices (e.g., back to sleep, not introducing solids early) and increased adherence to well-child visit and vaccination schedules. This paper will discuss research focused on linking families to community and other resources through traditional implementations and the addition of community health workers to the team.

Originally, HealthySteps implementation was examined in a 15-site National Evaluation clinical trial. A total of 5565 children were enrolled at birth and followed through 5.5 years. Healthy Steps was evaluated at 6 randomization and 9 quasi-experimental sites. Computer-assisted telephone interviews were conducted with mothers when Healthy Steps children were 5.5 years of age. Outcomes included experiences seeking care, parent response to child misbehavior, perception of child’s behavior, and parenting practices to promote development and safety. To expand on the HealthySteps model via the addition of community health workers (CHWs) to the team, an ongoing study at a large urban hospital serving a mainly low-income population is being conducted. Preliminary data on numbers of referrals to various services was collected through medical records.

Over a 9 month period, 101 families were referred to two CHWs. The most common reason for referral was housing, which was three times higher than the next highest categories of education, childcare, and food insecurity. Findings from both the National Evaluation and the smaller implementation indicate that HealthySteps successfully linked families to tailored resources outside of the pediatric clinic. Nationally, HealthySteps families were 4 times more likely to receive information on community resources, compared to families in clinics without HealthySteps. They were also more likely to discuss age-appropriate topics with their healthcare provider and to receive a developmental assessment for their child. The current study continues to examine the referrals made by the CHWs, and how they compare to referrals made within HealthySteps without CHWs.

These results indicate the potential power of pediatric primary care as a platform for linking parents to resources both within the clinic as well as in their community. Not only were HealthySteps families provided with more referrals, but they indicated more knowledge of child development in their conversations with health care providers and were more likely to receive services (e.g., developmental assessments) for their children. Further, the resource-efficient, risk-stratified approach of HealthySteps, especially when adding community health workers to the team, suggest that large-scale implementation is possible. These positive impacts on children and families also provide opportunities for long-term evaluation, as well as partnerships with other models to amplify these effects.

Authors

• Rahil Briggs, Zero to Three
  Presenting Author

• Trenna Valado, Zero to Three
  Non-Presenting Author

• Brandon Aylward, Zero to Three
  Non-Presenting Author

• Miguelina German, Albert Einstein College of Medicine, Montefiore Medical Center
  Non-Presenting Author