Healthy Steps: Transforming Pediatric Care by Embedding Child Development and Infant Mental Health Services Into Primary Care
By: Martha Edwards, Ph.D.
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Enter the HealthySteps Specialist (HSS). Parents bringing their children in for well-baby visits (usually 10-12 visits during the first three years of a child’s life) can meet with the HSS – either jointly with the pediatrician or in a separate session -- to address concerns, e.g., child behavioral challenges, parent mental health, food insecurity, domestic violence, etc. In addition, the HSS: conducts developmental screenings and screenings for family risk and protective factors, provides support through a telephone support line, distributes written evidence-based child development materials, links the family to community resources, and provides targeted therapeutic services.
Elaine’s case presentation illustrated the critical role that the therapeutic relationship with the HSS plays in ensuring the health and well-being of both children and their parents. Over the course of five years, she worked with a mother and her two children, guiding them through dealing with two incidents of domestic violence (safety planning, order of protection, legal services, preventive services) and helping to secure EI services and day care vouchers for the children and mental health services for the mother. She provided ongoing developmental and parenting information and was a stable and supportive figure to whom the mother could reach out to address a variety of needs.
HealthySteps started with two sites in 1995. There have been two national evaluations which documented the significant effect HealthySteps has had on parenting practices and child outcomes. Today, there are 232 sites across 24 states and one in Germany. The final takeaway lessons learned were:
Parents are thirsty for developmental and behavioral information. They look forward to their appointments and bring lots of questions.
Pediatric clinicians, in collaboration with the HSS, are uniquely poised to effectively provide information and support to families to help them do the best job they can.
Establishing an ongoing dialogue with parents about their child’s development opens the door to earlier identification of developmental and behavioral difficulties. The trusting relationship with the pediatric team, established at the beginning of a child’s life, is the foundation for being able to provide whatever support the families might need.
It is always good to learn more about programs that are built on relational principles.