Iowa's 1st Five Healthy Mental Development Initiative

The initiative assists health care providers in implementing a standardized, research-based tool to better identify the full range of family needs during well-child visits. The Iowa Child Health and Development Record is a one-page, age-specific form that helps physicians assess developmental milestones and identify risk factors in a child’s life related to family stress, caregiver depression, and social/emotional concerns. 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.

Iowa made the decision to target pediatricians and other primary care physicians to deliver screening since they see over 90% of children under age five in the state. Furthermore, 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. 1st Five care coordinators 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 2016, over 200 medical practices representing more than 600 health care providers have participated in 1st Five, impacting over 136,971 children. In that time, more than 12,000 children and families have been referred by health providers to 1st Five for support and connections to community resources. A speech, hearing, developmental, or another health-related concern is the number one reason for an initial health provider referral, with family stress and resource needs a close second. Over 26,000 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. In 2006, the state legislature allocated $325,000 per year for three years for a demonstration project. 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. An additional $200,000 was allocated by the General Assembly the following year to extend the program to additional communities. The Iowa legislature allocated an additional $1 million for the initiative in 2013. Since then, 1st Five has grown in its budget and expanded its capacity to serve more children statewide. In state fiscal year 2017, 1st Five had a total budget of $4,374,471, through a combination of state funds ($3,27,059) and federal Medicaid funds ($1,099,412). There are now 18 coordinating sites serving 88 counties in the state.