Healthy Steps improves health care for small children and their families By Kathryn Monroe
Ten-minute doctor visits often don't cut it for parents overwhelmed with questions about their newborns and infants. Parents want more-more answers, more time, more help.
Amy Keller says she was frustrated with short doctor visits herself and couldn't imagine facing that with a new baby.
So she and her husband Jac Charlier sought out a physician that would offer her more, and found Healthy Steps, a six-year-old program, incorporated into the pediatric practice they use at Luthern General Hospital.
"There are so many questions that have nothing to do with whether the child is healthy or not," says Charlier. "The other 23 hours of the day are just about parenting- how to handle temper tantrums, how to put on socks."
Healthy Steps, which is co-sponsored by the American Academy of Pediatrics, is a program designed to expand pediatrics to meet families' changing needs. The program is based on the philosophy that for a truly health child, a doctor needs to go beyond medical concerns and address family concerns.
It also goes against years of get-'em-in-get-'em-out for-profit medicine, by suggesting that time and longterm prevention are keys to a healthy family. The program varies according to what the individual health care facility can fund. Some simply train doctors and nurses, while others have on staff a full-time specialist in child development.
"Without Healthy Steps, I'd be a lot more timid about asking the genuine concerns on my mind. When you have a healthy child, you don't feel like you deserve to ask a physician," Keller says.
Charlier took a 12-week paternity leave last year with their first child, Jean-Luc, and again this spring with their newborn daughter Nina. Faced with the day-to-day anxieties and concerns of new parents, he says having the Healthy Steps staff available has "made us calmer, more patient."
Offering families more Healthy Steps emphasizes the importance of a child's first three years of life, considers the entire family's needs, including the parents' emotional health, their interaction with the child and the child's environment. It also attends to a child's behavioral, intellectual, emotional and developmental needs.
"This program gives parents tools to do their best at parenting," says Anita Berry, the Healthy Steps director at Advocate Health Care, and the leader of all of the Chicago-area programs.
"My kids have never, ever been afraid of the doctor's office and I think that [Healthy Steps] was part of it. It was nurturing; it wasn't hurried," says Sarah Katula, a Healthy Steps parent and mother of two.
"I'm very thankful that we're able to access Healthy Steps for our peace of mind and for our kids," Charlier says.
About 50 Chicago-area sites use the Healthy Steps approach, including pediatric and family practices as well as several daycare centers. Nine of these sites have a part- or full-time, on-staff Healthy Steps specialist. Also, more than 300 pediatricians, nurse practitioners, nurses and child development specialists in the Chicago area have been trained in the Healthy Steps approach. Nine sites added or expanded the program this summer.
In addition to regular office visits, some Healthy Steps sites offer home visits, parent groups, well childcare, and information and resources for parents.
Changing society, medicine Parents today are more concerned with "social factors such as child abuse, domestic violence, depression, divorce, poverty, homelessness, single parent families, working parents, child care issues-instead of disease," Berry says.
And Healthy Steps was born from that need.
The Commonwealth Fund in New York City, a foundation dedicated to improving health care, designed Healthy Steps in 1994. According to Berry, the idea was based on research done in other health care projects as well as surveys of parents with young children who were asked what they wanted from a doctor.
The Commonwealth Fund put the research into practice with a developmental specialist, thereby giving parents the attention and information they needed. Chicago was the one of the first sites where training began in 1997. The program has since spread to hospitals, clinics and residency programs throughout the city and surrounding areas.
Diana Wright, a pediatric nurse practitioner, says, "We've gone from dealing with contagious illnesses to social illnesses. This program and clinic are part of the now changing approach to children and pediatric medicine."
Teaching by showing The developmental approach to pediatrics makes this program stand out.
"It helps parents to reframe the way they look at their baby and understand its behavior. It lays a great foundation for the child's entire life," Berry says.
"You can't measure prevention, but we see it. We see these families thrive. I see what a great start they've got," says Patty Mack, a Healthy Steps specialist at Advocate Health Care's Touhy Support Center. "I know these families are gonna have less problems down the road."
Doctors and nurses trained in the program look for teachable moments during their time with families to show parents their child's developmental milestones.
If an infant lifts its head off the table during a visit, Brian Dumais, a second-year pediatric resident involved in Healthy Steps points out the importance of putting a baby on its stomach to explore.
"I can tell parents all day long about the important things going on with the children, but if they're a part of it and can see it, they can ask appropriate questions," Dumais says. "It gets the message across better."
Or, if your baby starts throwing toys or repeatedly dropping things and laughing, this doesn't mean you have a bad seed. Instead, your child is discovering that objects don't disappear when he or she lets go of them.
"When you learn why kids do things, it's fascinating," Keller says. "It's just normalized parenting for us."
It has changed Dumais' approach.
"I think it prepares me to offer something different to patients and their families," he says. "It allows me to appreciate the physician-patient-family interaction from a different perspective."
To learn more about the Healthy Steps program, visit www.healthysteps.org. In addition, Advocate Health Care offers free parenting classes in the Chicago area. For more information and to register, call (800) 3Advocate.
Healthy Steps works here
"They have everything you need here. You don't have to go anywhere else," says Esperanza Covaleda, a 35-year-old new mother in Chicago. "Every service fits me as an immigrant, as a woman, as a parent, as a wife. "Families in the Healthy Steps program at the Infant Welfare Society say the facility is convenient, with multiple programs in one place.
Currently at 1931 N. Halsted in the Lincoln Park neighborhood, the Infant Welfare Society has 142 families enrolled in Healthy Steps, with 10 to 20 new families added each month. Their goal is to have 300 families in the program at all times.
Families gush over the warmth and patience of the people who work there, as well as their resolve to find solutions. The staff, in turn, says they work hard to develop relationships with their patients to ensure families return for the care they need. And these families have extra needs. Infant Welfare caters mainly to non-English speaking Hispanic families that are uninsured or underinsured.
"Families we work with have fewer resources. They are struggling to survive financially," says Ellen Talsky, the Healthy Steps program director. "Many of them are immigrants and struggling to adapt to a new place, a new culture, struggling to succeed."
Covaleda, who came from Colombia two years ago, says everything is different in America, especially with a new baby. It makes her miss her home and mother in Colombia. Luckily, Infant Welfare gives her a support system. The staff prepared her and took care of her during her pregnancy. They continue to look after her and her daughter today.
"Everybody says hi, everybody's asking about my baby and her health. They care," she says. Covaleda has used the nutritionist, therapist, gynecologist, dentist and Healthy Steps program.
"The parents are like sponges. They just soak up all the information you give them," says Dr. Dennis Vickers, the organization's medical director.
And everything is in one convenient location, which adds to family's comfort. "There are more people interested in [the mother's] care that she knows here. It's easy for her to come and talk about other issues," Talsky says.
"The team sees the family regularly, and patients don't have to go elsewhere,"says Anita Berry, who trained the Infant Welfare staff and oversees Chicago area Healthy Steps programs. "More moms will follow up because of their comfort level in knowing the social worker, the convenience of using someone in the same place and the level of trust that's built."
The clinic's well-rounded approach improves the relationships between families and health care professionals. "It's satisfying as providers and instills a sense of validity among patients" to develop these relationships, Vickers says. "It's very encouraging to see the involvement."
Infant Welfare's Healthy Steps team also emphasizes fathers. "Part of what we do is to reach out to fathers and say come, learn and be a part of this. The dads respond really well," Talsky says.
For information, call (312) 751-2800 or visit www.infantwelfare.com.
Out of the mouths of experts
In some ways, Healthy Steps is just common sense. Everything about a baby's life-the parents health, the home environment and all aspects of the baby-affect the child's health and well-being. But just to be sure, here's some advice from Healthy Steps specialists:
• You are the expert. "One of the things that's a really important part of the program is this idea of empowering parents to quarterback their child's medical care," says Ellen Talsky, Healthy Steps program director at the Infant Welfare Society.
• Ask, ask, ask. Dr. Olga Silva-Zletz, a Healthy Steps specialist says: "I would be a little more proactive when I'm with a provider. We tell parents to be assertive. Do you have any concerns? We tell parents to ask questions. We even tell parents to bring a piece of paper, write out questions, because sometimes they become intimidated with a provider and forget what they had to ask."
• Learn the milestones. "I would suggest to parents that they somehow get information about where the baby is because every age has specific milestones," Silva-Zletz says. For example, at 2 months a baby isn't ready to play with toys, but wants to be held. By 4 months, a baby does want to play, hold things and explore on the floor, she says.
• Be a role model. Talsky says: "Get down on the floor and play with them when they're little so you're not only interacting with your kids in a meaningful way, but also modeling for the children the developmental steps necessary to be able to turn over, crawl, scootch along and start walking."
• Consider your needs. The Healthy Steps program also emphasizes the emotional well-being of the parents. Parents should speak with other parents, whether family or friends, about the pressures and concerns of parenting. They can also attend classes or group sessions. "All parents need support, especially with newborns and infants," Silva-Zletz says.
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