Independent Health Foundation

The first three years of a child’s life is a crucial period for ensuring long-term cognitive, physical, social, and emotional development.

But children living in poverty begin life at a disadvantage and are often deprived of essential needs for healthy early development. Within Erie County, Buffalo has the second-highest rate of childhood poverty for cities of comparable size, the majority of whom are children of color living at or below the poverty line. Pediatric primary care is an excellent opportunity to intervene, but pediatric primary care practices may lack the resources to identify families’ full social and emotional needs and to coordinate care for these children and families. The Growing Up Strong initiative is a regional pilot that uses HealthySteps, a national evidence-based model for pediatric care coordination, to help children from birth to age three thrive. In 2021, NYHealth awarded the Independent Health Foundation (IHF) a grant to pilot Growing Up Strong at pediatric primary care practices in Erie County.

Under this grant, IHF collaborated with participating primary care practices to restructure well-child visits to place greater emphasis on whole-child wellbeing and caregiver wellness. Universal screening tools were used to assess both child and family needs, so children identified to be at the highest risk received the appropriate interventions and referral coordination. A trained HealthySteps child specialist was embedded in each practice to join the care team and build strong relationships with families and providers. The specialist implemented the universal screenings, as well as provided prevention interventions, referrals, and ongoing follow-up for children and their families. Practices adoptec new workflows and processes to fully integrate the HealthySteps model at their sites. IHF also served as the connection between practices and the HealthySteps national coordinating office to support scale and sustainability of the program, including potential reimbursement structures with New York State.