1st Five works with local child health agencies operating in 88 Iowa counties with participating medical practices, impacting approximately 136,971 children from birth to 5 who are seen for well-child exams at these practices. Pending funding, the intent of the 1st Five Initiative is to continue to expand throughout Iowa. For more information about 1st Five, contact the 1st Five State Coordinator at 1-800-383-3826. 

Why Are the First 5 Years So Important?

The foundations of mental health are set in the first five years of life. During these years, children rapidly develop social and emotional capacities that prepare them to be self-confident, trusting, empathetic, intellectually inquisitive, competent in using language to communicate and capable of relating well to others. These emotional skills form the foundation of a child's "healthy mental development" - to develop the ability to regulate and express emotions, form close personal relationships with other children and adults, and explore and learn from their environment. This social-emotional foundation also plays a key role in determining a child's school readiness.

Research tells us that a significant portion of young children are not receiving adequate developmental surveillance and screening.  Current brain research indicates that social and emotional development in young children is as important as physical, cognitive, and language development.

  • Nationally, 63% of pediatricians use only observation of development to screen children; however, this method identifies only 30% of young children with developmental concerns.
  • Only 1 in 6 children with a developmental concern are identified before starting school, leaving teachers to identify and handle most developmental and behavioral problems in the classroom. These unidentified concerns affect all children in a classroom since teachers must regularly attend to a disruptive child. It is to the benefit of all children to identify and intervene with developmental concerns early.
  • When young children do not achieve the milestones linked to healthy mental development, they are at risk to do poorly in the early school years, putting them at increased risk for school failure, juvenile delinquency, and other problems.

When developmental concerns are not identified, then it is less likely families will get linked to community-based intervention services. Additionally, many providers are not aware of available resources to refer families to, even when a concern is identified.  1st Five provides the necessary links to up-to-date community-based resources that match the needs of the family and child. Read more from the Center on the Developing Child, from Harvard University.

What Does the 1st Five Program Do?

Iowa's 1st Five Healthy Mental Development Initiative builds partnerships between physician practices and public service providers to enhance high quality well-child care. 1st Five promotes the use of developmental tools that support healthy mental development for young children during the first five years. By using a tool for all children that includes social-emotional development and family risk factors, providers are able to identify children at risk for developmental concerns that, if left untreated, would play out later in life.

How Does 1st Five Work?

  • Step 1 The primary care provider performs standardized surveillance for social/emotional development, family stress and parental depression.
  • Step 2 When a medical provider discovers a concern, the provider makes a referral to a 1st Five office.
  • Step 3 Shortly after receiving the referral, the Developmental Support Specialist (DSS) contacts the family to discuss available resources that will meet the family’s needs. Often other issues come to light during these discussions and additional referrals are made. For every one medical provider referral to 1st Five, 2-3 additional referrals are identified when the DSS contacts the family. The DSS works extensively with families to assure follow-up and access to services.   
  • Step 4 The DSS then provides feedback to the referring provider on the status of the referral.  Overall improved patient care results from this comprehensive, family-centered model.

Annual Evaluation Summary

1st Five is administered by Iowa HHS and contracts with the University of Iowa Division of Child and Community Health to work with local 1st Five Developmental Support Specialist (DSS) related to primary care provider consultation services. Contact the State Coordinator at 515-954-6087 or your local DSS with questions.