A Modified Healthy Steps Model to Improve Resident Training in Behavioral and Developmental Care

Objective: To assess whether implementing a modified Healthy Steps (HS) for young children program in residency clinics could improve resident education and their perception of the quality of care provided for common behavioral and developmental (B/D) issues. Methods: Residents and faculty blinded to study intent were surveyed to assess perceptions of resident preparedness and the quality of behavioral and developmental (B/D) care at 4 pediatric residency training sites in North Carolina. Initially, Program 1 (with an established HS program) was compared with 3 sites without established programs at baseline (Programs 2, 3, and 4), and then the results before and after implementation at Programs 2 to 4 were compared. Results: Initially, subjects at Program 1 were more likely than those at Programs 2 to 4 to rate residents as "well" or "very well" prepared to provide B/D care (63% vs 20% respectively, 95% confidence interval of the difference, 25-61%) and more likely to rate the overall quality of B/D care at their clinic as "high" or "extremely high" (94% and 47% respectively, 95% confidence interval for the difference, 34-59%). After implementation of HS at Programs 2 to 4, the mean percentage of subjects rating residents as "well" or "very well" prepared and the ratings of the care provided increased dramatically. Conclusion: A modified HS model focusing on resident B/D education substantially increased attending and resident ratings of residents' preparedness to deliver B/D care and increased the ratings of the quality of B/D care provided.