Iowa's 1st Five Healthy Mental Development Initiative

The 1st Five Healthy Mental Development Initiative assists health care providers in implementing standardized, research-based tools to better identify the full range of family needs during well-child visits. When developmental or behavioral concerns, family stress, or caregiver depression are identified, the provider sends a referral to the local 1st Five care coordinator, who then assists in linking the family to appropriate services. The care coordinator follows up with the family on a regular basis to ensure they are receiving the services they need and keeps the referring physician informed of the patient’s status. 1st Five targets all children birth to five and their families, with the goal of universal surveillance and screening.

Research shows that parents view their children’s doctors as credible sources of information and expect to receive guidance on behavior and development during routine office visits. Because 1st Five is a public-private partnership bridging primary care and public services in Iowa, 1st Five care coordinators can provide education and ongoing support to participating practices to help them implement the model. Survey data show that 1st Five is having a significant impact on physicians’ behavior. Prior to 1st Five involvement, 33% of medical providers reported universal surveillance activities; afterward, that number rose to 92%. This increase in screening is resulting in many more children and families receiving the services they need.

Between 2007 and 2018, nearly 18,000 children have been supported by 1st Five for the early identification of and intervention for social-emotional and developmental concerns. The number one reason for an initial health provider referral is either a speech, hearing, development, or other health-related concern, with family stress and resource needs as a close second. Over 42,000 connections to local resources have been made for these families. Connections to resources such as food, housing, energy assistance, child care and preschool, employment assistance, and transportation are most common, with health-related referrals, such as immunizations, lead screening, vision testing, and specialty care, second.

1st Five grew out of Iowa’s Assuring Better Child Health and Development II (ABCD II) grant. The Iowa Department of Public Health selected four community-based child health centers as lead agencies for the demonstration and gave planning grants to three others. Since then, 1st Five’s budget has grown and has expanded its capacity to serve more children statewide. Currently, 1st Five works with local child health agencies operating in 88 Iowa counties with participating medical practices, impacting over 136,000 children from birth to 5.

Revised July 2019