What it is

HealthySteps, a program of ZERO TO THREE, is a pediatric primary care program designed to address inequities in child and family outcomes. HealthySteps provides integrated early childhood development support to families where they are most likely to access it – the pediatric primary care office. Ninety percent of all babies and toddlers regularly see a pediatric primary care provider, and new parents and caregivers attend 12-13 well-child visits during a child’s first three years – that’s at least 12 opportunities to change a child’s future.

HealthySteps transforms pediatric practices by promoting nurturing parenting, identifying children and families most at risk for adverse outcomes, and intervening early to set them on a better life path. The model embeds early childhood development experts in pediatric primary care teams. HealthySteps Specialists help to identify developmental concerns, address challenges early while preventing others, strengthen parent-child relationships, and connect families to community support. They work alongside pediatricians and influence the entire practice. Specifically, HealthySteps Specialists:

• Build strong and trusted relationships between families and pediatric practices by spending additional time with families, listening to their experiences, and providing and connecting them with resources to improve parenting practices.
• Ensure universal developmental screening of all children ages 0-3 to identify individual child and family needs.
• Provide appropriate interventions, consultations, referrals, and follow-ups when an issue arises from a developmental screening.
• Link families to a wide range of targeted community resources such as additional providers (e.g., dental and vision), programs that address unmet social needs (e.g., food, housing, and employment), and resources to promote academic readiness (e.g., early literacy).

The HealthySteps model is tiered according to children’s needs. All children ages 0-3 in the practice and their families receive a core set of screenings to identify concerns in a timely and equitable manner, as well as access to a Family Support Line to address non-urgent, non-medical questions on a variety of topics such as child development, parenting, and behavior. Based on identified needs, a subset of children and families receive a range of additional services.

The problem it addresses

Ninety percent of a child’s brain develops by age five, a process that is shaped by the quality of a child’s early experiences – positive or negative – that profoundly impact lifelong trajectories. However, millions of babies and toddlers fail to receive the necessary screenings, resources, and information to ensure positive early experiences and mitigate any potential problems from taking root.

Fortunately, identifying and addressing developmental concerns early – through a two-generation program that supports young children and their caregivers through well-child visits and tailored services – is a powerful way to prevent problems from taking root, reshape trajectories, and advance equity.

Why we believe in it

A national evaluation and multiple site-level evaluations of HealthySteps demonstrate positive outcomes for children, families, and the providers that serve them. 

Child Impacts

HealthySteps improves child health and well-being by supporting perceptual, motor, and physical development, strengthening early social-emotional development, and promoting timely care. More specifically, results include:

• Children were 8x more likely to receive a developmental screening.
• Children were more likely to attend all of the first 10 recommended well-child visits and were twice as likely to attend specific visits.
• Children were 1.4x more likely to be up to date on vaccinations by age two.
• Children whose mothers reported childhood trauma scored better on a social-emotional screening after receiving HealthySteps than comparable children.

Family Impacts 

HealthySteps improves family health and supports a child’s early learning and overall well-being. More specific results include:

• Mothers with depressive symptoms reported significantly fewer symptoms. Maternal depression can have powerful negative effects on child outcomes, from school readiness and early cognitive development to long-term well-being.
• Families were significantly more likely to notice behavioral cues and provide age-appropriate nurturing.

Practice and Provider Impacts 

HealthySteps supports pediatric primary care practices to improve their patients’ experience and provider satisfaction while lowering health care costs. More specific results include:

• Physicians report high satisfaction with HealthySteps and that they felt emotionally supported by the HealthySteps Specialist. 
• Families rated their provider as more competent and caring and were more likely to report that practice staff went out of the way for them.

For more information, see the HealthySteps evidence summary.