Iowa’s Title V MCH program guides priorities and provides foundational support for community based agencies and state-level public health programs. The Iowa Legislature designates the Iowa Department of Health and Human Services as the administrator for Title V and Maternal, Child, and Adolescent Health (MCAH) services through the Family Health Bureau (FHB). The legislature directs the department to contract with Child Health Specialty Clinics (CHSC) within the University of Iowa Stead Family Department of Pediatrics, Division of Child and Community Health (DCCH) for the administration of the Children and Youth with Special Health Care Needs (CYSHCN) program.

The State of Iowa is primarily rural, with approximately 3.2 million people according to United States Census Bureau. The state of Iowa is located in the upper Midwest region of the United States. Iowa is home to 606,327 women of reproductive age (Access to Obstetrical Care in Iowa: A Report to the Iowa State Legislature, 2023). The racial and ethnic makeup of Iowa is primarily White, non-Hispanic. The full racial and ethnic makeup is described below: 

(U.S. Census Bureau, 2022)

Between the years 2000 and 2020, the percent of Iowa’s population that identifies as Hispanic or African American has increased. Hispanics now compose 6.8% of the population compared to 2.8% in 2000. African Americans represent 4.1% of the population compared to 2.1% in 2000. Likewise, these changes are reflected in births to Iowans. Statewide in 2021, 7.3% of birthing people were African American and 11.1% of birthing people were Hispanic. (Source: Bureau of Health Statistics - Certificate of Live Birth)

In 2022, the total number of deliveries in the state totaled 34,001, a decrease from 36,137 in 2021. Of the 737,601 children under 18 years of age, about 143,000 were CYSHCN.

Assessment of needs, program planning, and performance reporting

Iowa’s Title V program monitors MCH needs through input from family-led organizations, the MCH Advisory Council and organizational leadership. Data from state, national, local, and program-specific sources inform planning and evaluation activities. The SSDI Minimum-Core Dataset Indicator Workbook is a valuable asset for evaluation and performance reporting. The MCH state action plan priorities and measures were built on foundational logic models, and correspond to the Title V Pyramid levels. Contracts with community-based local agencies are designed to build local activities to meet state action plan goals. All activities within Iowa’s MCH Title V program, both locally and statewide, must connect to state action plan measures and/or the interagency agreement with Iowa Medicaid. The Iowa Title V CYSHCN program currently uses the Standards for Systems of Care for CYSHCN 2.0 document as a framework for program planning, reporting, and evaluation, and is working toward incorporating programmatic activities into the national Blueprint for Change framework. Title V CYSHCN program activities align with DCCH’s strategic plan and these standards.

Population needs and Title V priorities

The 5-year needs assessment cycle guides the development of activities, monitoring, and evaluation. These needs are listed below with descriptions of the NPMs and SPMs that were

Infusing Health Equity within the Title V System

SPM 6: Percent of Title V contractors with a plan to identify and address health equity in the populations they serve

Ensure that all Title V NPMs and SPMs work towards addressing health inequities and disparities within the state and local system. Develop and implement a data analysis plan to assess distribution of Title V resources and services through a health equity lens. Develop partnerships with organizations, agencies or programs and/or those specifically designed to serve priority populations, including communities of color.

Access to care for the MCH population

NPM 4: A) Percent of infants who are ever breastfed B) Percent of infants breastfed exclusively through 6 months

Provide education to maternal health clients on the benefits and methods of breastfeeding. Ensure maternal health nursing staff have the education and ability to provide breastfeeding education to clients. Establish links among birthing hospitals and community breastfeeding support networks. Develop partnerships and training opportunities for businesses on the topic of breastfeeding policies and best practices.

NPM 6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year

Promote parent and caregiver awareness of developmental screening. Continue to work with provider champions in associations of health professionals to promote developmental screenings within clinical settings. Facilitate collaboration between Title V, early care and education settings, and home visiting providers on the provision of developmental screenings.

NPM 10: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year

Work with local primary care practitioners and other providers serving adolescents to increase the numbers served and enhance the quality of adolescent well visits. Collaborate and share resources with school nurses and adolescent serving organizations across the state to promote adolescent well visits.

MCAH Systems Coordination

NPM 14: A) Percent of women who smoke during pregnancy B) Percent of children, ages 0 through 17, who live in households where someone smokes

MH staff will collaborate with staff from the Division of Tobacco Use and Prevention (DTUP). Title V will support staff in the DTUP in implementing an incentive program for pregnant women who smoke to participate in the Quitline maternal tobacco use program. All local MH agencies providing direct services to pregnant women in Iowa will provide individualized health education, in a culturally and linguistically appropriate manner, on the importance of tobacco use cessation and refer interested clients to the Quitline.

SPM 1: Number of pregnancy-related deaths for every 100,000 live births

Title V staff will provide local agencies training and communication related to the most recent Maternal Mortality Review Committee (MMRC) findings and recommendations. Local Title V MH agencies provide screenings and education on topics specific to preventing maternal mortality. MH agencies are required to conduct screenings for depression, substance abuse, domestic violence, and tobacco all MH clients receiving direct services. Clients also receive health education which includes specific topics related to recommendations from the MMRC recommendations such as the importance of chronic disease management, nutrition, and physical activity.

SPM 4: Percent of adolescents who report that during the past 12 months they have felt so sad or hopeless almost every day for 2 weeks or more in a row that they stopped doing some usual activities

Explore and research the use of psychosocial assessments provided to adolescents in primary care settings across the state. If gaps in services are identified, Iowa will partner with the Iowa Medicaid Enterprise (IME) to identify billing codes that local Title V agencies can pursue under their purview of their child screening center designation. Title V staff will continue to be involved in the development and implementation of the newly codified Iowa’s Children’s Behavioral Health System State Board.

Dental Delivery Structure of the MCAH Population

NPM 13.1: Percent of women who had a preventive dental visit during pregnancy

NPM 13.2: Percent of children, ages 1 through 17, who had a preventive dental visit in the past year

SPM 5: Percent of children 0-35 Months who have had fluoride varnish during a well visit with Physician/health care provider

Outreach with medical and dental providers to educate on the need for integration. Inform, educate and disseminate scientific evidence on the importance of prenatal dental screening and treatment. Continue to advocate for dental providers to increase the acceptance of new Medicaid covered patients. Assure statewide care coordination network that includes dental home referral, tracking, and follow-up for children. Continue to expand preventive school-based sealant programs such as I-Smile@School.

Safe and Healthy Environments

NPM 5: A) Percent of infants placed to sleep on their backs B) Percent of infants placed to sleep on a separate approved sleep surface C) Percent of infants placed to sleep without soft objects or loose bedding

Women who are receiving Title V direct care services will receive safe sleep education based on the mother’s needs, taking into account any personal or cultural beliefs the mom or family express, on the following topics: back to sleep, safe sleep environment (crib), no co-sleeping, no extra items in the crib and other recommendations from the AAP and the report from the Child Death review team.

SPM 2: Percent of children ages 1 and 2, with a blood lead test in the past year

Local Title V agencies will coordinate blood lead screening with primary care providers, local public health agencies, local Childhood Lead Poisoning Prevention Programs (CLPPPs) and others providing blood lead testing in the community. Educate parents on the importance of blood lead testing at appropriate intervals. Contractors are encouraged to partner with an agency or group serving one of the priority populations to promote blood lead testing in more culturally targeted ways.

SPM 3: Percent of early care and education programs that receive Child Care Nurse Consultant services

Outreach to local early care and education programs regarding the participation in CCNC services. Promote the utilization of CCNCs to provide Health and Safety pre-service/orientation training for child care providers to meet the requirement within the Child Care Development Block Grant.

Access to services, pediatric specialty providers, and care coordination

NPM 11: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home

DCCH Regional Centers will continue to provide access to specialty care for CYSHCN and their families, utilizing its existing telehealth infrastructure to increase the number and types of pediatric specialty providers available. Primary care capacity to treat children with complex and/or mental health needs and developmental and intellectual disabilities will be prioritized through provider education opportunities.

Support for making transitions to adulthood

NPM 12: Percent of children with and without special health care needs who receive services necessary to make transitions to adult health care

Regional Centers will continue to provide gap-filling services to youth with special health care needs. Transition to adulthood resources will be regularly reviewed to ensure that best practices are followed. Transition resources will be enhanced to directly address issues for YSHCN from underrepresented backgrounds.

Support for parenting CYSHCN

SPM 7: Percent of caregivers of CYSHCN who report overall satisfaction with support services received through Title V

DCCH will continue to provide support services to Iowa families of CYSHCN, including those with diverse needs. Priority areas will include workforce recruitment and continuing education for staff on culturally responsive approaches to reduce barriers to family participation in health care. Trainings for families will focus on the development of leadership and advocacy skills among parents of CYSHCN at the individual, community, and policy levels.

Family centered services

Iowa’s Title V program works to ensure all services provided are coordinated and family‐centered. Services are provided through a medical home model, a family‐centered approach to comprehensive primary care that values the whole person, communication with patients and families, and coordination of care.

Iowa’s CYSHCN program leadership includes a full‐time Family Partnership Program Manager who works to build the family leadership workforce and assures that the family perspective is represented at all levels of decision‐making. Iowa’s Title V CYSHCN program includes DCCH’s Family Advisory Council that meets regularly to provide meaningful input to the planning, development, and evaluation of DCCH programs and policies. The CYSHCN program started a Youth Advisory Council in FFY 2021 with emphasis on building youth leadership skills and providing input to the Transition to Adulthood priority area. Each of Iowa’s 13 community-based Regional Centers includes at least one member from Iowa’s statewide Family Navigator Network to promote the development of family-professional partnerships, provide family support, and assure that the family voice is heard. In addition, family navigators partner with families in Regional Center Satellite locations serving underserved communities. Family Navigators are paid staff members and primary caregivers of a CYSHCN.

Established partnerships

Title XIX

Iowa’s Title V MCH program and Iowa Medicaid have had a mutually beneficial relationship for nearly three decades. The foundation for this relationship is the contract established each year between the Legacy Departments of Public Health and Human Services specifically, Iowa Medicaid Enterprise (IME). This agreement is for six years and renewed annually through an amendment to address program updates. This contract, known as the Omnibus Agreement, does not include services for CYSHCN. With the merger of the two departments it will be determined how this agreement will be carried out.

Early ACCESS

Early ACCESS (IDEA, Part C) is an integrated system of early intervention services for infants and toddlers with disabilities and/or at risk for developmental delays and their families. Early ACCESS is a partnership between families with infants and toddlers, the Iowa Departments of Education, Public Health, and Human Services, DCCH, and other community partners. The commitments of the four signatory agencies provide the vision, leadership and resources needed to have a coordinated, interagency, family centered system of services.

1st Five Healthy Mental Development

1st Five is a state funded public‐private partnership bridging primary care and public health services in Iowa. 1st Five supports health providers in the earlier detection of social‐emotional and developmental delays and family risk‐related factors in children 0‐5 years and coordinates referrals, interventions and follow‐up. Currently, 1st Five covers 88 of the 99 counties in Iowa. 1st Five collaborates with local Title V contractors to decrease duplication of developmental screenings and for referrals.

Mobile Regional Child Health Specialty Clinics

DCCH, which includes Child Health Specialty Clinics (CHSC), blends resources from several state allocations to complement Title V resources for CYSHCN. The FHB awards state appropriations funding to DCCH through a contract called Mobile Regional Child Health Specialty Clinics to assure community‐based, family centered and comprehensive services for CYSHCN.

The Regional Autism Assistance Program (RAP)

The Iowa Department of Education (DE) has contracted with DCCH for over 30 years to support the statewide Regional Autism Assistance Program (RAP). RAP aligns with authorizing legislation, Iowa Code 256.35, to “coordinate educational, medical, and other human services for persons with autism, their parents, and providers of services to persons with autism.” DCCH combines Title V resources with support from DE and HHS to provide a comprehensive System of Care for children and youth with Autism Spectrum Disorder (ASD) and their families.