Exceptional Care for Diverse Populations
HealthySteps (HS) is an evidence-based integrated model designed to provide enhanced primary care services to young children and families. This article describes the strategies HS specialists use, adapt, and innovate while maintaining fidelity to the model to meet the unique needs of diverse settings, circumstances, and communities. The authors illustrate various strategies used to support adolescent parents, children with medical complexity, children in foster care, families with unstable housing, children being parented by grandparents, and children in rural communities. In each case, exceptional care is provided to meet families’ unique needs. The authors include recommendations for practice.
Young children and their families present in primary care clinics earlier and more often than any other professional setting. Integrating prevention and health promotion strategies into these systems, especially for families most in need, is a critical strategy for ensuring that young children receive the highest quality care available. HealthySteps (HS), a program of ZERO TO THREE, is an evidence-based, integrated model designed to enhance primary care services for young children from birth through 3 years old and their families. The model consists of eight core components that define a service delivery strategy to comprehensively care for all young children and their families within a primary care clinic. When HS is implemented with full fidelity, both children and their caregivers experience positive outcomes (HealthySteps National Office, 2023).
Clinics implementing this evidence-based model serve a diverse group of patients and families, some of whom have unique characteristics or circumstances, such as children being cared for by grandparents or living with families without stable housing. There are also clinics that exclusively serve specific populations such as children with medical complexity or children in the foster care system. Finally, there are clinics across the country implementing this model in rural communities where unique considerations and opportunities for innovation exist.
Early childhood integrated behavioral health (ECIBH) strategies, such as HS, are especially important and impactful in each of these contexts. There are ample opportunities for creative implementation of evidence-based models that meet the unique needs of these diverse populations while adhering to model fidelity. The following examples highlight a handful of clinics and circumstances where HS and ECIBH have been implemented creatively and play an important role in providing comprehensive care to young children most in need. When case vignettes are discussed, identifying details have been changed to protect patient confidentiality.
Buchholz, M., Ashby, B., Ehmer, A., Serrano, V., Kenny, J., Fried, E., Gleason, E., Sandoval, C., & Yuen, J. (2023). Exceptional care for diverse populations. ZERO TO THREE Journal, 43(4), 5-12.
Children’s Bureau. (2023). Child maltreatment 2021. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families. www.acf.hhs.gov/cb/report/child-maltreatment-2021
Cohn, L. N., Pechlivanoglou, P., Lee, Y., Mahant, S., Orkin, J., Marson, A., & Cohen, E. (2020). Health outcomes of parents of children with chronic illness: A systematic review and meta-analysis. The Journal of Pediatrics, 218, 166–177.e2. https://doi.org/10.1016/j.jpeds.2019.10.068. https://www.jpeds.com/article/S0022-3476(19)31479-9/fulltext
Corsi, M., Orsini, A., Pedrinelli, V., Santangelo, A., Bertelloni, C. A., Carli, N., Buselli, R., Peroni, D., Striano, P., Dell’Osso, L., & Carmassi, C. (2021). PTSD in parents of children with severe diseases: A systematic review to face Covid-19 impact. Italian Journal of Pediatrics, 47(1). https://doi.org/10.1186/s13052-021-00957-1. https://ijponline.biomedcentral.com/articles/10.1186/s13052-021-00957-1
Garner, A., & Yogman, M., Committee on Psychosocial Aspects of Child and Family Health, Section on Developmental and Behavioral and Behavioral Pediatrics, Council on Early Childhood. (2021). Preventing childhood toxic stress: Partnering with families and communities to promote relational health. Pediatrics, 148(2), e2021052582.
HealthySteps National Office. (2023). HealthySteps outcomes summary. www.healthysteps.org/resource/healthysteps-outcomes-summary
Johnson-Motoyama, M., Moses, M., Conrad-Hiebner, A., & Mariscal, E. S. (2016). Development, CAPTA part C referral and services among young children in the U.S. child welfare system: Implications for Latino children. Child Maltreatment, 21(3), 186–197. https://doi.org/10.1177/1077559516630831. https://journals.sagepub.com/doi/10.1177/1077559516630831
National Conference of State Legislatures. (2021). Disproportionality and race equity in child welfare. www.ncsl.org/human-services/disproportionality-and-race-equity-in-child-welfare