The low-cost HealthySteps model is replicable in many settings—from small pediatric practices to large health systems in both urban and rural areas.
CONSIDERATIONS FOR IMPLEMENTING HEALTHYSTEPS IN RURAL AREAS
HealthySteps can be implemented in practices where the birth-to-3-panel size may not necessitate the hiring of a full-time HealthySteps Specialist or a practice cannot hire a full-time HealthySteps Specialist due to workforce shortages. The strategies below require new practices to attend the mandatory HealthySteps Institute and complete implementation planning with the HealthySteps National Office to support successful model implementation.
STRATEGIES FOR IMPLEMENTING HEALTHYSTEPS IN RURAL AREAS/ SMALL PRACTICES
- Deploy flexible scheduling: This approach allows HealthySteps Specialists to split their time between two sites (due to the important work of integrating fully into the practice, the National Office does not recommend splitting time across more than two sites). Flexible scheduling requires participating sites to attempt to schedule well-child visits for children birth to 3 on certain days of the week (or potentially less difficult, only scheduling visits for families needing Tier 3 services on certain days of the week) and the ability for HealthySteps Specialists to split time between sites that are in geographic proximity. This will also require office administrative staff to understand the HealthySteps Specialist’s schedule and how to book visits.
- Expand HealthySteps Specialist role: This approach requires that the role of the HealthySteps Specialist expand to accommodate a full-time position and maintain cost-effectiveness. This may include a HealthySteps Specialist seeing children older than 3 and/ or performing additional services beyond HealthySteps’ Core Components (e.g., autism assessments, lactation consults, etc.) with a focus on reimbursable activities. Multiple sites in rural areas of Arizona, Colorado and South Carolina have HealthySteps Specialists that also serve as lactation consultants. Small urban sites in New York offer autism assessments alongside the usual three Tiers of Service.
- Repurpose current staff: Another approach is to retrain an existing staff member who is already performing many of the core services of the HealthySteps model (e.g., social worker) to dedicate a portion of time to serving children birth to 3 and their families. This allows the practice to leverage existing resources and does not require hiring a new staff member.
- Use telehealth: This approach relies on using telehealth solutions to provide access to HealthySteps Specialists located at other sites. Telehealth equipment and space are required, as well as staff training on using equipment, two-way booking capability for sites and identification of willing HealthySteps Specialists with the capacity to provide telehealth consults.
The HealthySteps National Office continues to work with our national network to explore these strategies in greater detail and share lessons learned with interested practices.