There are several requirements to become a HealthySteps (HS) site:
- A Physician Champion (a nurse practitioner may be acceptable but should be discussed with the National Office) in a pediatric primary care practice who actively supports the program’s implementation and growth.
- Ability to have most clinic team members attend the HealthySteps Institute training.
- Adequate funds to implement and cover ongoing HS program costs which are primarily driven by the salary and benefits of the HS Specialist.
- Commitment to deliver all eight Core Components and the capacity to offer team-based, interdisciplinary health care, with parents and family members viewed as integral members of the health care team.
HS Specialists are frequently social workers with mental health training, psychologists, early childhood educators, and/or nurses with experience in early childhood development (the minimum requirement is a bachelor’s degree, although a master’s degree is preferred).
We highly recommend that a practice hire a candidate with a mental health background (ideally infant and early childhood mental health or infant and early childhood development). Mental health professionals are well-suited for the position due to their clinical training, skills related to reflective practice, and the ability to provide consultation and care coordination.
You can consult with us prior to recruitment for this position to help clarify what professional background would best meet the needs of your practice and families, while also potentially maximizing your site’s ability to bill for HS services. Our team can also provide a sample job description.
Please review Chart Your Path: Becoming a HealthySteps site for an overview of the process. Interested pediatric and family practices should then complete our interest form. A member of our team will reach out and schedule a call to answer any additional questions and discuss the next steps. Once sites have secured funding and have signed contracts, we will schedule your training, HealthySteps Institute (HSI), for your practice, and the practice will begin implementation planning and participate in pre- and post-implementation technical assistance.
Funders, health systems, or regional entities interested in adopting the HealthySteps model are also encouraged to complete the interest form.
The HS model includes eight Core Components. All HS sites implement these components into their practice.
- Child Developmental, Social-Emotional & Behavioral Screenings
- Screenings for Family Needs (i.e., maternal depression, social determinants of health, other risk factors)
- Child Development Support Line (e.g., phone, text, email, online portal)
- Child Development & Behavior Consults
- Care Coordination & Systems Navigation
- Positive Parenting Guidance & Information
- Early Learning Resources
- Ongoing, Preventive Team-Based Well-Child Visits
While implementing each of the HS eight Core Components is essential to delivering the model successfully, we do not expect practices to provide all components immediately following training. We provide six technical assistance calls following the HealthySteps Training Institute to assist sites with successfully implementing the components and resolving implementation challenges. New HS sites have three years to deliver model components to fidelity.
Children and families receive Core Components based on a tiered-model approach. Families with higher needs receive more intensive services. If funding is abundant or patient populations are relatively small, practices may choose to provide all eight Core Components for all families in the practice.
HS visits can vary significantly in response to the level of family concerns, availability of the primary care provider (PCP), and scheduled screenings during a visit. That said, a typical visit usually includes many of the following:
- The HS Specialist ensures the administration of recommended screenings, either in the waiting room or in the exam room.
- If the HS Specialist is meeting with the family first, they greet the family and inquire how they are doing. Caregivers and the HS Specialist observe the baby or child and notice developmental changes since their last visit.
- The HS Specialist explores any family concerns, discusses typical behavior and development, and collaborates with parents on potential solutions.
- The PCP joins the visit to conduct the well-child check-up and any previous discussion is summarized and shared by the HS Specialist. Screening results are reviewed, and potential referrals are discussed if appropriate.
- The HS Specialist reviews anticipatory guidance for the next weeks or months, provides referrals and handouts regarding positive parenting and/or early learning, and encourages caregivers to reach out as needed prior to their next visit.
We have a recommended screening schedule to help sites determine which screening tools to use and how often to administer them. At a minimum, all sites are required to meet screening fidelity requirements by their third year of implementation. Required screens are based on the American Academy of Pediatrics’ Bright Futures recommendations and include developmental, social-emotional, maternal depression, and other family needs screenings.
HS Specialists work closely with medical students and residents both during and in-between well-child visits. This provides an optimal, timely opportunity for HS Specialists to teach residents and medical students about child development, positive parenting, and social determinants of health. HS Specialists may also provide more structured training to residents and students during their ambulatory rotations, through lectures, presentations, and shadowing opportunities. At some HS sites, Graduate Medical Education (GME) funding helps to support the HS budget.
We encourage sites to add enhancements and innovations if they do not detract from providing the eight Core Components. For example, some sites provide optional home visits and parenting groups. We recommend that sites focus first on achieving fidelity to the eight Core Components before adding new enhancements or innovations.
HS Specialists typically meet with a family before, during, or after a routine well-child visit with a pediatrician or family practitioner. Each HS site determines the timing and workflow that work best for the practice. HS Specialists must be flexible as their workflows change in response to family needs, patient schedules, provider availability, and volume. During the HS training for new sites, our trainers will address the “how-to” of team-based care and help teams plan for implementation.
The cost to implement HS varies based on several factors, which include: HS Specialist credentials; the number of children served; the geographic location of the site; any site-specific adaptions, enhancements, or innovations to the model; and funder-specific requirements. Typically, the program’s cost per child receiving the most comprehensive (Tier 3) services ranges between $450 and $900 annually. The primary costs of launching and sustaining HS are HS Specialist salaries and employee benefits (ongoing) and initial HS site training (a one-time fee). Other ongoing costs may include dedicated office space for HS Specialists, information technology, and other equipment and materials. Sites may also want to provide site-specific professional development (e.g., budget to travel and attend the ZERO TO THREE Annual Conference) and/or implement site-specific model enhancements (e.g., parent groups that may require food or other supplies, or home visits that may necessitate mileage costs, etc.). Creating a budget for a new HS program is one of the first steps in preparing to adopt the model.
Given the model’s intentional flexibility and varying locations and approaches, no two sites fund their HS programs in identical ways; that said, many sites look to similar funding sources to provide ongoing support for their programs. These sources often include public or philanthropic grant funding (particularly during the launch and start-up phase); reimbursement for HS services from health care payers; and the reinvestment of other practice/system revenue to support HS costs (in recognition of its value for children, families, and the practice/system itself). Overall, it is very important that sites move toward and prioritize ongoing, sustainable funding pathways whenever possible. While one-time and time-limited funding can be very beneficial, these resources are not sustainable in the long term as the primary or sole funding mechanisms for HS.
Our policy and finance team is dedicated to supporting new and existing sites in achieving a sustainable funding model. All new sites will receive sustainability resources and support from us. We facilitate site-to-site learning and networking around HS funding opportunities. For an additional fee, our policy and finance experts are available to provide premium, customized support.
HealthySteps has demonstrated positive outcomes for children, families, and the practices that serve. A national randomized control trial, a 15-site national evaluation, and several subsequent site-level research studies demonstrate that HealthySteps have positive outcomes for the families and providers. Explore HealthySteps’ evidence of impact.
Each year in July, we require that all sites in the HS network report on key metrics regarding program implementation and the children and families they serve. Reporting is always done in aggregate and via a secure online portal.