HealthySteps®, a program of ZERO TO THREE®, is an evidence-based, early childhood integrated behavioral health model embedded in primary care settings. It is designed to enhance pediatric primary care for children ages birth through three and their families, addressing common and complex issues in early childhood.
The program focuses on promoting health, prevention and early identification of challenges, supporting families with concerns like tantrums, toilet training, feeding difficulties, parental mental health and social determinants of health. HealthySteps provides universal services to all children ages birth through three in primary care clinics, using a tiered approach to offer additional care to families needing extra support.
Why primary care settings?
Primary care settings are trusted environments where over 90% of children and families receive regular well child visits. With up to thirteen well child visits recommended in the first three years of life, this frequent interaction creates opportunities for HealthySteps to ensure high-quality, comprehensive care for young children and their families.
HealthySteps in Colorado
HealthySteps is a national model implemented in over 300 clinics across the country, including 32 clinics in Colorado. Several more are scheduled to launch in 2025. These clinics span urban, rural, suburban and frontier areas, ensuring widespread access to services for young children and families across the state. Clinics are located from Fort Morgan to La Junta, Grand Junction to Denver, and many more communities, and collectively serve over 38,000 children from 32 different counties.
ABCD, in collaboration with the National Office, provides each HealthySteps site in Colorado with support achieving and maintaining fidelity to the evidence-based model, developing sustainability strategies, and providing professional development for clinic staff. ABCD also works with local communities to cultivate and establish new sites, and advocate for statewide expansion and sustainability. At ABCD, we believe that every young child deserves the best care possible, and every primary care provider deserves the resources and support to deliver it.
Overcoming two key barriers to widescale expansion
ABCD’s goal is that HealthySteps is available in every community across Colorado. Accomplishing this goal will require addressing two critical challenges: financial sustainability and workforce development.
The HealthySteps model has seen tremendous growth in Colorado over the last twelve years of intentional scaling. Primary care settings and health systems have been innovative with strategies to implement and sustain the model long-term. Each clinic or health system has developed a unique strategy for sustaining the model including using Medicaid and/or insurance billing, philanthropic investments, and health system re-investments. While it is commendable that so many primary care clinics have been able to piece together effective sustainability strategies, these approaches can be quite challenging and exacerbate provider and clinic burden and burn-out. To ensure long-term sustainability in the context of primary care, clearer state and federal funding pathways are needed – not only for the clinics, but also for the essential technical assistance, practice transformation, professional development, and advocacy work provided by ABCD in its role as the State Intermediary.
A second challenge that is essential to consider is workforce development. Scaling this model and ensuring its effective implementation statewide hinges on developing a robust workforce to deliver these crucial services to young children and families. Currently, there is a shortage of infant and early childhood mental health professionals, especially those trained to work in primary care settings. It is essential for us to be innovative in our approach to addressing this shortage.
Solutions include:
Recruiting students and young professionals into this niche field.
Supporting each member of the provider team with working at the top of their scope
Integrating roles such as community health workers, family navigators, etc. into health settings to address family needs and free up medical and mental health providers to focus on complex cases
Team-based care is essential to successful scale and implementation.
The vision of HealthySteps in every Colorado community
Over the past twelve years, HealthySteps has grown from a small program implemented in a handful of clinics in Colorado, to a well-known and respected model currently serving tens of thousands of young children in nearly half of the counties in our state. At ABCD we are confident and committed to the vision that every community in Colorado will have access to this transformational model and are so grateful to our many partners who have helped get this program to where it is today. The journey to statewide implementation continues, and we’re ready to take the next steps. Are you?
To learn more about HealthSteps and get involved, visit: https://www.coloradoabcd.org/our-work/healthysteps