Published online September 1, 2004
PEDIATRICS Vol. 114 No. 3 September 2004, pp. 820-826 (doi:10.1542/peds.2003-0999-L)
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SPECIAL ARTICLE

Healthy Steps: A Case Study of Innovation in Pediatric Practice

Barry Zuckerman, MD*, Steven Parker, MD*, Margot Kaplan-Sanoff, EdD*, Marilyn Augustyn, MD* and Michael C. Barth, PhD{ddagger}

* Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
{ddagger} ICF Consulting, Fairfax, Virginia

Healthy Steps (HS) represents a significant innovation in the way pediatric primary care can be delivered. Based on the standards and principles of Bright Futures and the American Academy of Pediatrics Health Supervision Guidelines, HS enhances and expands traditional pediatric care by including a child development specialist (Healthy Steps specialist) as part of the pediatric practice team. Services offered by this person, typically a nurse, early childhood educator, or social worker, include more time to spend discussing preventive issues during well-child visits, home visits, a telephone information line exclusively addressing developmental and behavioral concerns, new written materials, and more seamless linkages to community resources and parent support groups.

The original HS cohort consisted of 15 pediatric practices in a variety of settings (private practices, health centers, pediatric training programs). Evaluated for the effects of HS on their family were 3737 intervention and comparison families. HS families received significantly more preventive and developmental services, compared to families in the control group. HS families were also less likely to be dissatisfied with their pediatric primary care. Additionally, HS had a positive impact on parenting in many areas including adherence to health visits, nutritional practices, developmental stimulation, appropriate disciplinary techniques, and correct sleeping position. Other outcome measures (such as initiation or duration of breastfeeding, child development knowledge, sense of competence, and reports of child language development at 2 years of age) did not differ between intervention and comparison group.

Compared to other early childhood intervention efforts, HS offers a comparable positive impact on parenting at a relatively inexpensive cost: an estimated $400 per family per year (compared to $4500 from Early Head Start). Approximately 3 years after the evaluation of HS ended, 10 of the original 24 sites are still in operation, and an additional 24 sites have started up. Although funding and reimbursement remain an important barrier, continued growth of HS suggests an abiding interest in this approach to expand and enhance preventive and developmental care in pediatric primary care.

Key Words: pediatric prevention • developmental services • parenting

Abbreviations: HSS, Healthy Steps specialist

Accepted Mar 15, 2004.




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