Fall 2007

Public-Private Partnerships Maximize
Healthy Mental Development
in Early Childhood

Sonni Vierling, Program Coordinator, 1^st Five Healthy Mental Development Initiative

Iowa is currently implementing a system to maximize the benefits of well-child care through the adoption of surveillance and screening standards to promote healthy mental development in a child’s first five years. As part of this process, checklists of age-appropriate child development milestones, called the Iowa Child Health and Development Records (Iowa CHDR), are now available for use in well-child exams.

In addition, this system emphasizes a public-private partnership to assist health care providers in making referrals and providing families with assistance to carry out the referrals. Simply stated, the system provides a bridge between two systems of care, the public and the private. Its success depends on collaboration between the two.

In Iowa, 90.7% of families
take their children for
a health care visit
during a child’s
first 5 years.

In Iowa, 90.7% of families take their children for a health care visit during a child’s first 5 years. Parents look to their child’s health care provider for expert advice on growth, development, and parenting. Yet when a provider encounters a developmental red flag, family stress, or parental depression, that provider may not know what local resources are available to assist the child or family. The provider may wonder, “How can I help this family get the services they need? Will I ever know the results of my referral?”

On the public health side, similar questions about referrals arise. Care coordinators from community-based child health centers are responsible for linking families to services. When a coordinator suspects a child may have or be at risk for developmental delay, it may be clear that screening and identification from a health care professional is needed. However, the coordinator may not know whether the delay arises from a specific medical condition or is related to the child’s home environment, information that is key to determining the kind of referral that would be most effective.

Private and public systems of care have a mutual interest in helping children and families succeed, and yet too often each operates independently of the other.

1^st Five Healthy Mental Development Initiative – focusing on the first five years

Iowa’s 1^st Five Healthy Mental Development Initiative focuses on a child’s first five years. It recognizes the critical roles played by public and private providers. 1^st Five works to create partnerships between private health care practices and public service providers to develop a structure for assessing the social-emotional and developmental skills of young children. 1^st Five is building on the success of the previous ABCD II project in Iowa, which demonstrated that when providers use standardized surveillance tools, the percent of effective screens and referrals increases.

Tips for implementing an effective public-private partnership for children have been drawn from 1^st Five pilot sites, which were located in three different, community-based child health centers. Over the last year, these pilot sites worked with private health care providers, local community-based agencies, and referral resources.

Together, they developed a streamlined referral and follow-up process for medical referrals that begins when a health care provider identifies a child who has a developmental or behavioral concern. The provider makes a referral to the child health center care coordinator, who then assists in linking the family to appropriate services. Once the family is connected to services, the care coordinator follows-up with the referring health care provider about the status of the referral. Public and private providers work together to design a process for assessment, referral, and follow-up that effectively and efficiently assures children receive needed services.

Nearly 30 medical practices are currently implementing this model. It is estimated that 39 additional practices will begin implementation in the next year. For this public-private partnership to work effectively, each participant must be committed to supporting the other.
 

Strategies for primary care providers 

• Staff of private health care providers and medical practices can use the strategies below to partner more effectively with public health agencies and child health centers: 

• Be sure everyone on your staff understands the concept of healthy mental development in young children and the four key assessment areas: Social, emotional, and behavioral development; parental depression; family stress; autism

• Involve all office staff in training

• Ensure that staff at all levels are aware of and involved in developing and implementing practice changes

• Identify and tap the skills of a medical office “champion” who is interested in coordinating the project with the local public health agency

• Get staff input about effective standardized surveillance and screening tools such as the Iowa CHDR

• Use these tools in every well-child exam for children birth to age 5

• Develop a referral process within the medical practice that streamlines referrals to the child health center care coordinator

• Refer children who need further screening to your local EPSDT Care for Kids Coordinator (see page 6 for contact information)

• Invite your local child health center care coordinator to one of your staff meetings to explain their services to families

• Primary care providers screen for social, emotional, and behavioral development, family stress, and parental depression.

• If a condition is identified, the provider makes a referral to the local child health agency care coordinator (see page 6).

• Care coordinator links the child and family to intervention services.

• Care coordinator follows up with provider regarding the status of the referral.

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