Assessing HSC Health Pediatric Clinic Adherence and Barriers to HealthySteps Screenings

Purpose: HealthySteps is a program created to provide developmental support to patients aged up to three years old and their families. Children are monitored to make sure they are reaching developmental milestones. Implementation and adherence to the HealthySteps competencies are monitored yearly per clinic. Each clinic can self-assess through a Fidelity Implementation Checklist, where each indicator is graded as either: did not begin, does not meet fidelity, approaching fidelity, meets basic fidelity, or meets optimal fidelity. When the optimal goals of HealthySteps are followed, the program had nationwide significant benefits for the patients, parents, and pediatric care team. Methods: The UNT Health Science Center Pediatric Clinic was analyzed for its implementation and fidelity to HealthySteps developmental and autism screening competencies. Data was collected from Jan. 2017 – July 2022 beginning when HealthySteps was implemented at the clinic and analyzed yearly. The number of patients receiving at least one developmental screening a year and one autism screening by 28 months were calculated from the total number of patients 0 – 3 years of age. Results: Developmental screenings have improved from "Approached Fidelity” to "Meets Basic Fidelity,” while autism screenings have gone from "Approaching Fidelity” to "Does Not Meet Fidelity.” Conclusions: Barriers to patient screenings could include the following: patients coming late to appointments leading to a rushed visit, tablet technology failure, data entry issues from patient check-in to EHR, EMR content access, new staff not being aware of the HealthySteps program and its benefits, and staff forgetting to administer the screenings. To begin reaching for the "Meets Optimal Fidelity” target, the most attainable goal is to establish better communication between the clinic and HealthySteps specialists with more consistent scheduled meetings.