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 Public Health (IDPH), a cabinet level agency, as the administrator for Title V and Maternal, Child, and Adolescent Health (MCAH) services through the Bureau of Family Health (BFH). The legislature directs IDPH 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 3.1 million people according to United States Census Bureau. In 2017, there were around 580,000 women of reproductive age (15-44 years) and 38,000 births. Of the 733,000 children under 18 years of age, about 128,000 were CYSHCN. Of Iowa’s population, 18% is covered by Medicaid and/or Hawki. Iowa is becoming more diverse. Although in 2017, 90.6% identified as white, the Hispanic population increased from 2.8% in 2000 to 5.7% in 2017. Live births to Hispanic women made up 10.9% of all births in 2017.

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 uses the Standards for Systems of Care for CYSHCN 2.0 document as a framework for program planning, reporting, and evaluation. 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 and described below.

Access to care for the MCH population

NPM 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year

Ensure all Title V Maternal Health clients receive a postpartum follow up appointment. Within this structure include education on continuing health care coverage. Continue to collaborate with Iowa Medicaid to improve the post-partum visit rate and quality of visits for members.

SPM 2: A) Percent of children 0-21 served by Title V who meet Iowa's Title V criteria as having a medical home B) Percent of women served by Title V who meet Iowa's Title V criteria as having a medical home

Assist families with health insurance literacy to increase awareness of what is provided within their health insurance and how to access the services covered. Meet with Iowa Medicaid Enterprise and Medicaid Managed Care Organizations to discuss medical home, EPSDT services, and population health strategies. Continue to collaborate with CHSC regarding the promotion of medical home within the children and youth with special health care needs population.

Dental delivery strategies for MCH 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 3: Percent of children with a payment source for dental care

Continue 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.

Breastfeeding support

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.

Adolescent health systems coordination

NPM 9: Percent of adolescents, ages 12 through 17, who are bullied or who bully others

Develop a multi-sector group with organizations and individuals who have an interest in bullying prevention. Research and implement evidence-based program implementation models and/or curriculum. Obtain information about current bullying prevention efforts being implemented in the state through schools and community-based organizations.

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.

Access to quality child care

SPM 4: 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.

Physical activity for MCH population

SPM 5: Percent of adults aged 18-24 who report being physically active

Collaborate with the Healthiest State Initiative to promote wellness activities. Participate on Iowa’s 5-2-1-0 Advisory Committee/Leadership Team. Address physical activity within the IDPH Adolescent Health Collaborative. Screen clients within maternal, child, and adolescent health agencies for physical activity; provide education materials when needed.

Developmental screening and surveillance

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.

Care Coordination for CYSHCN through a Medical/Health Home

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

NPM 11 ties closely to SPM2, which also focuses on medical home but for other populations. Strategies for improving access to medical home for CYSHCN includes: 1) providing access for CYSHCN and their families to a health team approach to care coordination and service provision; 2) supporting primary care providers in their efforts to increase capacity to treat CYSHCN with mild to moderate mental health needs within their medical home; 3) continuing to develop workforce programs to educate health care providers about the principles of family-centered decision making; and 4) continuing to collaborate with Iowa’s programs that support the use of evidence-based preventive health assessments and screening tools.

Transition Planning for YSHCN

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

Iowa’s effort to improve transition to adult care for YSHCN includes: 1) assuring that transition is addressed at each visit that includes a youth or young adult ages 12-21 years; 2) monitoring the distribution of the DCCH Transition to Adult Health Care Quick Guide; 3) Evaluating parent engagement and satisfaction with DCCH transition programs, and; 4) exploring youth engagement models to develop a program that better incorporates youth into transition planning processes. 

Integration of Services for CYSHCN

SPM 6: Percent of CYSHCN with parents who are very satisfied with the communication among doctors and other health care providers.

The Integration of Services priority area focuses on 1) assuring that family goals are collected at each visit; 2) tracking documentation of family goal; 3) providing opportunities for families to increase family leadership and advocacy skills; 4) exploring opportunities to increase family leadership and advocacy skills that are culturally diverse, and; 5) continuing to build access to pediatric specialty services through telehealth for Iowa CYSHCN.

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 Engagement Program Manager who works to build the workforce, and assures that the family perspective is represented at all levels of decision‐making. Iowa’s Title V CYSHCN program includes a Family Advisory Council to provide meaningful input with planning, development, and evaluation of programs and policies. Each of Iowa’s 14 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. 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 IDPH and the Iowa Department of Human Services (DHS) ‐ 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.

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 Departments of Education, Public Health, and Human Services, DCCH and CHSC, 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, consistent with IDEA, Part C.

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. In order to be a recipient of 1st Five funding the agency must be the contract holder for providing Title V services.

Mobile Regional Child Health Specialty Clinics

DCCH, including CHSC, blends resources from several state allocations to complement Title V resources for CYSHCN. The Iowa Department of Public Health (IDPH) Bureau of Family Health 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 IDPH to provide a comprehensive System of Care for children and youth with Autism Spectrum Disorder (ASD) and their families.