1st Five

Step 1: The primary care provider performs surveillance and standardized screening for development, social/emotional development, and family stress.

Step 2: If a concern is identified, the child is referred to their local 1st Five agency through a one-step referral process.

Step 3: The 1st Five Development Support Specialist contacts the parent/caregiver to link them to appropriate intervention services and remains in contact until services are established. 

Step 4: The 1st Five Developmental Support Specialist follows up with the provider by sharing updates on the status of the referral and intervention services. 

If you answer "yes" to any of these, 1st Five may be able to help your patient. 

Considered adding developmental screening to your well-child visits but aren’t sure how to get started, when to screen, or what tools to consider using?

Been concerned about a child’s development, but not been able to screen them for developmental delay due to lack of time, competing healthcare priorities, or access to standardized screening tools?

Wanted to make a referral for a patient but didn’t have the time, or staff resources, and weren’t sure what resources were available to identify a best fit service?

Made a referral but wasn’t sure if the client was actually connected to the service, and/or were unaware of the referral outcome or progress?

Been concerned that parental stress may be negatively impacting the current and future social and emotional development of a child you are seeing?

1st Five is administered by Iowa HHS with the goal of improving rates of developmental screening in primary healthcare and to provide linkages to early intervention services and community resources for referred children. 

1st Five provides technical assistance to local 1st Five contractors and their engaged primary care practices and providers to meet these shared goals. 

Technical support includes access to peer consultation support through:

 local subcontracts with practicing 1st Five engaged primary care providers, and

a contract with the University of Iowa Division of Child and Community Health 

For more information about how to access peer consultation supports to reach universal screening goals and referral to 1st Five contact your local 1st Five Site Coordinator. 

Virtual, hybrid, and on-site presentations to primary care providers on a variety of topics including:

Integrating Developmental Screening into Practice

Adverse Childhood Experiences

Autism Spectrum Disorder: Information for Primary Care Providers

1st Five offers certified medical education credits (CMEs) through webinar opportunities related to:

Integrating developmental screening into primary care practices, and

Topics related to supporting healthy mental development of children birth to 5 (ACE’s, and referral to 1st Five)

Recordings of past 1st Five webinars

List of 1st Five participating primary care practices.

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.

A significant portion of young children are not receiving adequate developmental surveillance and screening.  

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. 

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.

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.

Surveillance and screening are two different processes, and are both equally important in the beginning steps toward identification of developmental delay in children. 

Surveillance is an important way for clinicians to identify children at risk for developmental delay and should occur during every health supervision visit. During these visits, clinicians should address developmental progress, concerns, and promotion. Examples of surveillance tools include Bright Futures, and Iowa’s Child Health Development Record (CHDR).

The American Academy of Pediatrics (AAP) recommends that every well-child visit include developmental surveillance that assesses social-emotional development,  as well as cognitive, communicative, and physical development.  This is also an excellent opportunity to assess for family risk factors, like family stress or caregiver depression. The AAP also recommends that all children receive developmental screening with a standardized tool at the 9, 18, and 30 (or 24) month well-child visits or whenever a concern is raised by parents or health care professionals.  An autism-specific screening tool should be administered at the 18 and 24 month well-child visits or whenever a parent raises a concern.

Screening supplements and strengthens ongoing developmental surveillance to identify subtle risks for developmental delays that parents and pediatricians may not recognize during routine interactions. Examples of screening tools include the Ages and Stages Questionnaire, (ASQ) and the Ages and Stages Social Emotional Questionnaire (ASQ:SE).

Without use of a standardized screening tool, only 20% of young children with mental health problems and 30% of children with developmental delays are identified.  By using a standardized screening tool, physicians are able to identify 80-90% of children with mental health problems and 70-80% of children with developmental disabilities. Research indicates that parents want and expect support from their child’s physician on child development.

Early identification and intervention with developmental concerns and family risk factors lead to improved outcomes for the individual child and family, as well as considerable savings to society over the long term, with the biggest savings from decreased criminality in adulthood. Several national studies have demonstrated that every dollar invested in early childhood yields between $3-$17 in return. The RAND group estimated a government savings of $18,611 per child who underwent early intervention in the Elmira Prenatal / Early Infant Project, and a savings of $13,289 per child for individuals receiving intervention in the Perry Preschool Project (figures in 1996 dollars). For further information on the economic return from early childhood investments, see First Years First.

In Iowa, nearly all children ages birth to five are seen by a primary care provider, giving them the unique opportunity to play an important role in early identification of developmental concerns and family risk factors.

1st Five can help providers by finding resources for families who continually miss appointments due to family stress or transportation challenges.

1st Five can help providers implement surveillance and screening tools that will assist them in talking with parents about issues that may be negatively impacting their child’s development.

1st Five will follow up with all children and families referred by physicians to ensure that they get connected to all beneficial community resources and public service providers available. 1st Five will then follow up with referring physicians on the outcome of each of their referrals.

Supporting the population of children birth to age five (up to a child’s fifth birthday).

Increasing use of surveillance and standardized developmental screening by partnering with (engaging) primary care providers.

Providing a one-step referral resource for primary care providers.

Connecting referred children (and their parents/caregivers) to existing services in their local communities.

Keeping primary care providers informed about children’s progress.

Supporting healthy social, emotional and cognitive development of children birth to 5.

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2020