Raising children, especially during their early years, can be challenging.
With behaviors that parents might be unfamiliar with, or unique health concerns, sometimes a family needs an extra person – outside of their pediatrician – to rely on for support.
HealthySteps, is a national program that aims to support family health and a child’s early learning and well-being by connecting with them in a pediatric setting. The program is in 231 different locations across the U.S., with one in Minneapolis and another in St. Cloud.
“About 90% of families take their child to the pediatrician, so it’s really the only system in those first few critical years that reaches almost every single family in the country,” said Samantha Prior, the communications manager for HealthySteps.
The program connects with families through well-child visits, which happen pretty regularly, up to 12 times, between ages zero and three.
“That’s a lot of opportunity to connect with families and ensure that they’re getting the help that they need,” said Prior.
Children’s Minnesota’s Minneapolis primary care clinic is one of the locations with a HealthySteps program. Kim Zack started as the specialist in July 2022. From September 2022 to June 2023, she’s met with 228 families – 80 of them who have had recurring visits.
What does she do?
Zack is a licensed clinical professional counselor with a background in children’s mental health, having previously worked with school-based mental health programs. While a pediatrician will see a child during regular checkups, look at weight, growth and answer medical questions a family may have, many times, families have other needs.
“(HealthySteps) really is around child development, parenting, healthy and happy families equaling healthy and happy babies, and decreasing some of those social determinants of health that we know have a big impact on our kids as they grow,” Zack said. “Families are also here to talk about how their kids are growing and developing. And sometimes that falls outside of the pediatrician’s area of expertise. Sometimes the pediatrician is just so booked in their day that they don’t have the time that they want to dedicate to talking with a family about their child’s development or their social situations.”
Referrals to the program can be made by a pediatrician and other times, screening forms will indicate that Zack could help out.
Dr. Ethan Nemmers is a parent, and pediatrician himself at Children’s Minnesota. He’s referred many people to the program – and when he became a parent, his family met with Zack to discuss the challenges they had getting their four-month old daughter to sleep.
“Pretty much no matter what we tried, doing all sorts of things like changing of her feeding schedule before bed, working on different routines, all sorts of things. … It was getting to the point that we were getting less than five hours of sleep at night and then trying to work and do all this stuff during the day,” Nemmers said.
During one of their visits to a pediatrician, their doctor recommended they speak with Zack.
“Whenever we have families who have either developmental concerns or behavioral concerns or simple as things as, ‘how do I deal with tantrums? How do I deal with picky eating?’” Nemmers said. “She’s (Zack) a really great resource for our families.”
She told Nemmers and his wife to try having the baby in her own room, which could help her sleep. So they tried that and found it worked. Even with a background in pediatrics, he found her input helpful.
“As a part of pediatrics training, you learn about different ways to troubleshoot, how sleep is going or how eating is going. But it’s nice to have Kim there, who’s has dedicated focuses,” Nemmers said.
Zack also works with families who get referred for maternal mental health needs, behavioral needs, those struggling with their child’s eating and sleeping, and also sometimes, babies who have experienced neonatal abstinence syndrome – being exposed to chemicals in utero, she said.
Early childhood assistance
HealthySteps is part of a larger program Zero to Three, which focuses on early childhood development. In 2022, 361,009 children across the U.S. were in the HealthySteps program.
“The core of the model is that period from birth to age three,” said Prior. “What evidence tells us research tells us is perhaps (that’s) the most critical developmental window for a child. So babies and toddlers, their brains are growing faster during that period than any other period. They’re like sponges. They soak up all of the good but also all of the bad around them.”
A larger part of addressing health for children at that age is supporting the people around them.
“We’re really talking about reaching their parents and caregivers to ensure that they have the resources and the skills that they need to provide those positive conditions,” Prior said. “It goes beyond key components of health and safety for the baby. But there are also things of early learning or, ‘Are you reading to your child, are you spending the kind of engaging time,’ what we call really relational health with your child; all those key building blocks that go beyond just like the pure medical health of a child. A lot of families don’t have access to the resources they need, whether it be basic nutritional, safe housing, or even the knowledge of what these best practices are.”
Much of Zack’s work involves connecting families with various resources – which she does through Community Connect – a program of Children’s Minnesota.
“Sometimes it’s as simple as me saying, ‘Oh, I have a colleague who can help with housing supports or getting you connected with the county for that’ and bringing them and connecting them with that team. Sometimes it might be me sitting in the room and helping the family to fill out a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) application or talking through what other services they might qualify for and how they might go about accessing those,” Zack said.
Nationally, HealthySteps has had various successes, including one location showing that mothers indicated feeling more supported to breastfeed and having higher rates of continued breastfeeding. Another location found that children in the program were more likely to attend all of the first 10 recommended well-child visits and were twice as likely to attend specific visits. Three of the sites found reduced disparities between well-child visit attendance and insurance coverage, meaning that attendance rates for visits for children with Medicaid were on par for children with commercial insurance.