Integrating Infant & Early Childhood Mental Health in Pediatric Primary Care
TBF's Child Well-Being pathway centers that physical, mental, and behavioral health must be addressed together, not just for the children but also the adults who care for them. TBF began investing in HealthySteps as part of our goal to integrate behavioral and mental health into pediatric care. The evidence spoke for itself: When families experience consistent, trust-based care, the outcomes for both children and adults improve. But we also knew that evidence alone wouldn’t change systems. To help HealthySteps take root and flourish in our state, we needed to aim for both program expansion and policy change.
by Danubia Camargos Silva, Senior Program Officer, Child Well-Being
December 12, 2025
What Is HealthySteps and Why It Matters
HealthySteps is a national program developed by ZERO TO THREE that integrates child development and behavioral health support into pediatric primary care. Each site includes a HealthySteps (HS) Specialist, a child development and behavioral health professional, who partners with families during and between well-child visits as part of the care team.
HS Specialists help address both common and complex challenges that physicians often don’t have time to explore in depth, such as behavior, sleep, attachment, perinatal depression, social determinants of health, and the transition to life with a baby or young child. They provide tailored parenting guidance, ongoing support between visits, referrals, and care coordination based on each family’s needs.
Most importantly, HealthySteps supports not only the child but the entire family. Because more than 90 percent of children attend well-child visits during infancy, pediatric care is a powerful touchpoint—for vaccinations and growth monitoring, of course, but also for supporting mental and emotional health for child and caregivers alike. For example, mothers report they are more likely to complete depression screenings in pediatric settings than during their own wellness visits.
Note from the Author
This is a story about children and caregivers, but it’s also a story about systems — and about how partnerships, funding strategies, and policy alignment can shape the way we support families. At the Boston Foundation, our work in the Child Well-Being pathway centers on the idea that physical, mental, and behavioral health must be addressed together, not just for the children but also the adults who care for them.
My academic and professional development and my intuition, informed by my lived experience, lead me to believe that if the adults in the village are well, the children will be just fine. And one of the clearest, most compelling examples of that idea in action is our investment in Behavioral and Mental Health Integration. Over the past six years, we have invested in three organizations — HealthySteps, a program from ZERO TO THREE, Health Care For All, and MGH - Chelsea — all as part of a multifaceted plan to make mental health in pediatric care a reality through programmatic, policy, and systems-change work.
- Danubia Camargos Silva, Senior Program Officer, Child Well-Being
In just 5 years, HealthySteps in MA has expanded from 1 site to 13. This means 21,000 children and their families now have access to comprehensive, family-based care at their pediatrician’s office.
HealthySteps Expansion in Massachusetts
TBF began investing in HealthySteps as part of our goal to integrate behavioral and mental health into pediatric care. The evidence spoke for itself: When families experience consistent, trust-based care, the outcomes for both children and adults improve. But we also knew that evidence alone wouldn’t change systems. To help HealthySteps take root and flourish in our state, we needed to aim for both program expansion and policy change.
The expansion of HealthySteps began at pediatric sites serving children covered by public insurance, including MGH Chelsea, MGH Charlestown, the MGH Main Campus, Boston Children’s Hospital, and others. These are places where pediatric care is already a trusted part of family life, especially in the earliest years of a child’s development.
“The tremendous support we have from HealthySteps is absolutely invaluable. I always worry when a mother and baby leave my exam room because I know the overwhelming pressures they face in their lives. With HealthySteps, we have a specialist who keeps track of them and offers support between visits. It’s incredibly reassuring for our patients—and for me as their pediatrician.”
- Alexy Arauz Boudreau, Associate Chief of Pediatrics for Primary Care at MGH Chelsea, medical director for population health management at Mass General Brigham for Children and assistant professor of pediatrics at Harvard Medical School
This fiscal year, despite financial challenges faced by MGH and its affiliates, none of the HealthySteps specialists were laid off. In fact, the program has transitioned from being philanthropically supported to becoming a fully integrated part of the clinic.
The results speak for themselves. In just five years, HealthySteps in Massachusetts has expanded from one site to 13. This means 21,000 children and their families now have access to comprehensive, family-based care at their pediatrician’s office. Due to ongoing momentum, local support, and growing demand, Massachusetts also received an investment from HealthySteps’ national funder, Blue Meridian Partners, which has committed $46.5 million to help double HealthySteps’ reach to over 1 million children annually.
Marrying Program Expansion with Policy Advocacy
As we learned in the early 2010s, program growth can’t rely on philanthropy alone. MGH Chelsea ran a pilot HealthySteps program from 2012 to 2015 but had to shut it down when federal funding guidelines shifted. To help avoid the same fate, TBF partnered with the Klarman Family Foundation and the Richard & Susan Smith Family Foundation to advance policy solutions to the long-term sustainability of these practices. We collectively invested in Health Care For All, a local nonprofit advocacy organization, to help us pursue public and commercial insurance coverage as a more durable solution.
Health Care For All’s work was integral to ensuring a number of crucial policy wins. A change to MassHealth local regulations now allows reimbursement of up to six preventative mental and behavioral health visits without a diagnosis. Through its Section 1115 Waiver, MassHealth increased its investment in primary care, which helps support integrated behavioral health services like HealthySteps. And the passage of the state Mental Health ABC Act 2.0 in 2022 mandated coverage for annual mental health wellness exams comparable to annual physical exams. Today, HealthySteps is part of the base clinical budget at MGH Chelsea. It is not a side project; it is a core part of how care is delivered there. That is systems change.
This transformation did not happen overnight. It took intensive collaboration across actors in philanthropy, clinical care, and public advocacy, as well as families themselves. It took persistence, shared vision, and a commitment to what we know works: meeting families where they are, supporting caregivers as well as children, and treating mental health as essential health.
Looking Ahead
Even as economic and political shifts threaten to slow further expansion, the model we’ve built in Massachusetts shows what’s possible. Integrating mental and behavioral health into pediatric care is no longer just an aspiration—it’s a reality. And it’s worth protecting.
We continue our due diligence to ensure that recent policy wins truly support the kind of care every child and family deserves. As Suzanne Curry, Director of Policy Initiatives at Health Care For All, notes, “We should hold the line on the progress we’ve made in the face of massive federal funding and policy changes. And as we work to protect that progress, we must also ensure that commercial insurance covers preventive behavioral health services.”
ZERO TO THREE Growth Manager Lisa Powell agrees that, despite the current uncertainty surrounding potential reductions in Medicaid funding, interest in HealthySteps remains strong, and she expects continued growth next year. Some health systems that have already implemented HealthySteps in pediatrics are now looking to expand into other departments—such as family medicine. Others are seeking to launch the model to better support young children and their parents as they face increasing stress, one of the greatest threats to children’s health and well-being.
HealthySteps has shown that when philanthropy, health systems, and policy align, meaningful systems change is possible. Massachusetts now has a proven model for integrating behavioral and mental health into pediatric care—one that other states can learn from and build upon. But sustaining this progress will require continued advocacy, long-term funding solutions, and collaboration across sectors to ensure that integrated care becomes the standard, not the exception.
When I think about the families behind this work – the parents navigating daily pressures, the pediatricians who refuse to give up, the policymakers who listen and act – I am reminded why this matters. Integrating mental and behavioral health into pediatric care is not just good policy; it’s an act of love, care, and justice. Our journey in Massachusetts proves that transformation happens when we believe every child – and every caregiver – deserves to be seen, supported, and healthy.