Healthy Steps for Young Children: Integrating Behavioral Health into Primary Care for Young Children and their Families

  • Margot Kaplan-Sanoff
  • Rahil D. Briggs


Pediatric clinicians have been tasked by the American Academy of Pediatrics with increasing their attention to the psychosocial determinants of health for early childhood, including the prevention and treatment of toxic stress. To help practices as they struggle to design a comprehensive response to this call, this chapter presents the Healthy Steps program, a flexible model of integrated primary pediatric care that has been adapting to change in healthcare and reimbursement practices and policies since its inception in 1994. Currently operating in over 80 sites nationwide, Healthy Steps expands the model of a solo pediatric clinician to include a new member of the healthcare team—the Healthy Steps Specialist—who enhances the information and services available to parents by providing specific information about the child’s behavior and development, by discussing the family’s adjustment to caring for their new baby, and by conducting screening and intervention related to the additional psychosocial needs of the child and/or family.


Healthy Steps Pediatric care Behavioral health 


  1. Briggs, R. D., Germán, M., & Schrag, R. D. A. (2013). Breaking down silos with a butter knife: Lessons learned from integrated pediatric behavioral health. New York State Psychologist, 25(4), 31–34.Google Scholar
  2. Coker, T. R., Chung, P. J., Cowgill, B. O., Chen, L., & Rodriguez, M. A. (2009). Low-income parents’ views on the redesign of well-child care. Pediatrics, 124(1), 194–204.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Felitti, V. J., Anda, R. F, Nordenberg, D., Williamson, D. F, Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14:245–258.Google Scholar
  4. Garner, A. S., & Shonkoff, J. P., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental and Behavioral Pediatrics. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 129(1). Retrieved from
  5. Gilkerson, L., & Gray, L. (2014). Fussy babies: Early challenges in regulation, impact on the dyad and family, and longer-term implications. In K. Brandt, B. Perry, S. Seligman, & E. Tronick (Eds.), Infant and early childhood mental health (pp. 195–208). Alexandria, VA: American Psychiatric.Google Scholar
  6. Gilkerson, L, Hofherr, J., Steir, A., Cook, A., Arbel, A., Heffron, M., … Paul, J. (2012) Implementing fussy baby network approach. Zero to Three Journal, 33(2), 59–65.Google Scholar
  7. Kaplan-Sanoff, M. (2006). Infusing mental health support and services into pediatric primary care. In D. F. Perry, R. K. Kaufmann, & J. Knitzer (Eds.), Social and emotional health in early childhood. Baltimore, MD: Brookes.Google Scholar
  8. Kaplan-Sanoff, M. (2013). Healthy Steps for Young Children: Supporting young children and their families using primary care as a vehicle for service delivery. In “North American Models.” In Glascoe FP, Marks KP, Poon JK, Macias MM (Eds.). Identifying and Addressing Developmental-Behavioral Problems: A Practical Guide for Medical and Non-medical Professionals, Trainees, Researchers and Advocates. Nolensville, TN:, LLCGoogle Scholar
  9. Kaplan-Sanoff, M., Lerner, C., & Bernard, A. (2000). New roles for developmental specialists in pediatric primary care. Zero to Three, 18(2), 17–23.Google Scholar
  10. Kaplan-Sanoff, M., Talmi, A., & Augustyn, M. (2013). Infusing mental health services into primary care for very young children and their families. Zero-to-Three Journal, 33(2), 73–77.Google Scholar
  11. McLearn, K., Zuckerman, B., Parker, S., Yelowitz, M., & Kaplan-Sanoff, M. (1998). Child development and pediatrics for the 21st century: The healthy steps approach. Journal of Urban Health, 75(4), 704–723.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Minkovitz, C.S., Hughart, N., Strobin, D., Scharfstein, D., Grason, H., Hou, M., … Guyer, B. (2003) A practice-based intervention to enhance quality of care in the first three years of life: Results from the healthy steps for young children program. Journal of the American Medical Association, 290(23), 3081–3091.Google Scholar
  13. Minkovitz, C. S., Strobino, D., Mistry, K. B., Scharfstein, D. O., Grason, H., Hou, W., & Guyer, B. (2007). Healthy steps for young children: Sustained results at 5.5 years. Pediatrics, 120(3), 658–668.Google Scholar
  14. Parker, S., & Zuckerman, B. (2004). Teachable moments in primary care. In S. Parker, B. Zuckerman, & M. Augustyn (Eds.), Handbook of developmental and behavioral pediatrics: A handbook for primary care (2nd ed.). Boston, MA: Lippincott, Williams & Wilkins.Google Scholar
  15. Robins, D. L., Fein, D., & Barton, M. (2009). The modified checklist for autism in toddlers. Revised (M-CHAT-R). Self-published.Google Scholar
  16. Satcher, D. (2001). Surgeon General’s Report on Youth Violence. US Dept of Health and Human Services Office of the Surgeon General, Public Health Service, United States of America.Google Scholar
  17. Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246.CrossRefPubMedGoogle Scholar
  18. Squires, J., & Bricker, D. (2009). Ages and stages questionnaires, third edition (ASQ-3). Baltimore, MD: Paul H. Brookes.Google Scholar
  19. Squires, J., Bricker, D., & Twombly, E. (2002). Ages and stages questionnaire: Social-emotional (ASQ:SE). Baltimore, MD: Paul H. Brookes.Google Scholar
  20. Zuckerman, B., Kaplan-Sanoff, M., Parker, S., & Young, K. (1997). The healthy steps for young children program. Zero-to-Three, 17(6), 20–25.Google Scholar
  21. Zuckerman, B., Parker, S., Kaplan-Sanoff, M., Augustyn, A., & Barth, M. (2004). Healthy steps: A case study of innovation in pediatric practice. Pediatrics, 114(3), 820–826.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Healthy Steps, Zero to ThreeWashingtonUSA
  2. 2.Montefiore Health SystemBronxUSA

Personalised recommendations