In this article, Trenna Valado, Jennifer Tracey, Jonathan Goldfinger, and Rahil Briggs highlight the potential to expand the promise of pediatric care to encompass the full array of child and family needs that can affect the long-term wellbeing of infants and toddlers.
Pediatric care is not stigmatized, nearly universally accessed, and oriented toward prevention. The American Academy of Pediatrics already urges pediatricians to screen for adverse childhood experiences, maternal depression, behavioral and developmental risk, and even the effects of poverty on children. Most pediatricians would like to extend their narrow health care mandate to broader social-emotional and behavioral care and education, but they're often constrained by issues of time, training, and reimbursement.
Valado and her colleagues offer a solution to those constraints: HealthySteps, a risk-stratified, population health model that integrates a skilled child development professional—called a HealthySteps specialist—into the pediatric care team. The model comprises eight core components that can be divided into three tiers of service, beginning with universal screening that allows practices to identify children and families at higher risk of negative outcomes. These families are then offered the more intensive service tiers, in which they receive customized support based on their needs.
The evidence supporting HealthySteps comes from a large multi-site evaluation conducted by Johns Hopkins University, which included a randomized controlled trial component, as well as several site-level research studies. Results from this research indicate that HealthySteps had an array of positive impacts on practices that adopted the program and clients they served, including increased physician and caregiver satisfaction, improved continuity of care, greater adherence to recommended well-child visits and vaccinations, and increased rates of developmental screening and other services. There were also positive impacts on children and parents over time, though many of these impacts were modest. The HealthySteps National Office is continuing to evaluate implementation, training, impact, and cost as the program spreads across the nation. Questions that remain to be answered include how such a model should be financed and how health insurance could pay for it.