In 1995, The Commonwealth Fund launched a program called Healthy Steps for Young Children, a model of preventive pediatric care for infants and toddlers up to age 3. The model relies on Healthy Steps Specialists, midlevel professionals with expertise in child development. In 1996, the Fund launched an evaluation of Healthy Steps implementation in 15 pediatric practice sites that had a specialist and staff trained in the model; the results showed excellent clinical outcomes for children in the program. Following the evaluation, many pediatric care facilities began offering Healthy Steps, with a peak of over 60 active sites in 2006, and 50 sites currently. While the specialist's salary has been the primary obstacle in maintaining Healthy Steps, the program can serve as a model of the patient-centered care that recent health care reform was intended to encourage.
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