First Steps

Revised June 26, 2012

GUIDELINES

The 1989 Maternity Care Access Act, implemented as First Steps, seeks to reduce poor birth outcomes, maternal and infant illness and death as well as increase access to maternity and infant care for low-income families. The First Steps program is administered by the Department of Social and Health Services, and Health Care Authority (HCA).

First Steps includes:

Medical Services:

·         Prenatal care,

·         Delivery,

·         Post pregnancy follow-up, including family planning

Enhanced Services:    

·         Maternity Support Services (MSS)

·         Infant Case Management (ICM)

·         Childbirth Education (CBE)

Expedited Alcohol and Drug Assessment and Treatment Services.

Ancillary Services:

·         Expedited eligibility determination,

·         Case finding,

·         Outreach,

·         Transportation and

·         Interpreter services

Family Planning

MATERNITY SUPPORT SERVICES (MSS) and INFANT CASE MANAGEMENT (ICM)

• Participation in MSS and/or ICM is voluntary.  Clients choosing to participate in MSS or ICM are free to choose which First Steps provider to see. 
• Transportation to and from all MSS and ICM appointments is available and interpreter services are also available. 
• Appointments may take place in the client’s home, an office or other safe place. 

Maternity Support Services (MSS)

MSS is available to eligible women on Medicaid from the time they are pregnant and continues through the end of the month in which the 60^th day post pregnancy occurs.  The MSS provider facilitates access to health care for pregnant women, including prenatal care, as early in pregnancy as possible, and infants into pediatric care. 

MSS is provided to eligible women by an interdisciplinary team of nurses, dietitians, behavior health specialists and community health workers. Members of the interdisciplinary team provide screening, professional assessments, health education, care coordination, case management and interventions related to targeted risk factors known to influence poor birth outcomes.  The team coordinates care with health care providers and staff from other agencies and organizations who is or could be working with the client and/or her infant to meet their needs.

MSS care coordination may include, but is not limited to:

• Prenatal medical care
• WIC
• Dental and vision care
• Pediatric care
• Family Planning
• Childbirth Education
• Lactation Consultation
• Family Health Hotline toll free phone number operated by WithinReach (formerly Healthy Mothers Healthy Babies)
• Local community resources specific to individual needs, e.g. Domestic Violence hotline, educational resources, Crisis Clinic, mental health resources, car seats, food bank, CPR training resources,  transportation, interpreter services, disability services, and the Tobacco quit line.
• Referral for Division of Alcohol and Substance Abuse (DASA) services.

Infant Case Management (ICM)

The purpose of ICM is to improve the welfare of infants by providing their parent(s) with information and assistance in order to access needed medical, social, educational, and other services.  Clients who meet certain risk criteria and need help in accessing resources to meet their needs are eligible for ICM.

To be eligible for ICM, the infant must:

1.    Receive Medicaid,

2.    Reside with a parent(s), and

3.    Be within the ICM eligibility period which is the day after MSS ends through the end of the month of the infant’s first birthday. 

Infants meeting the above eligibility criteria are screened by an Infant Case Manager for a variety of risk factors that may impact the infant’s welfare, health, and/or safety.  

An infant Case Manager must be a qualified person who is employed by an agency or entity approved as an MSS/ICM provider by MPA.

WORKER RESPONSIBILITIES

The Community Services Office (CSO) plays a critical role in assisting clients to access First Steps services. Eligibility for Medicaid coverage is determined at the CSO and serves as an entry point for First Steps services. All pregnant women on Medicaid must be offered a referral to a local provider for First Steps services.

A Bar Code report, generated at least weekly, of all newly eligible pregnant women in the CSO can be used to refer the clients to local First Steps providers.

1.    Minimum service level: Pregnant women must be offered a referral to First Steps services as soon as she is found eligible for Medicaid coverage. This includes women whose eligibility is determined by a call-center or on-line application. 

2.   Best Practice service level: Conduct an assessment to determine the woman's needs for First Steps services. Arrange for First Steps services and other services if needed, i.e., shelter, food and clothing. Obtain any needed release from the client and share the assessment with the partners providing services (i.e.: MSS, ICM). Follow-up to ensure the client has connected with the needed services.

RESOURCES

For additional information about the First Steps program and available services visit:

• DSHS First Steps Website  
• ParentHelp123

CHILDREN’S ADMINISTRATION (CA) - Prenatal Substance Abuse "Screen Out" Intakes

GUIDELINES

On all Child Protective Service (CPS) "screen-out" intakes involving pregnant women allegedly abusing substances, CA will determine Medicaid status. CA will send the intake to Community Services Division (CSD) headquarters OR directly to the First Steps provider depending upon the Medicaid status. If there are multiple First Steps providers serving one area, CA will email the intake to the CSD First Steps Service Delivery program manager..

For additional information about the CA Prenatal Substance Abuse policy visit: http://www.dshs.wa.gov/ca/pubs/mnl_pnpg/chapter2_2500.asp#2551

WORKER RESPONSIBILITIES

Children's Administration:

1. On all "Screen Out" intakes involving a pregnant woman allegedly abusing substances, intake staff will identify whether she is receiving Medicaid.
   1. If the woman is not on Medicaid, intake staff will email a copy of the intake to ESA at CSDFirstSteps@dshs.wa.gov.
   2. If the woman is on Medicaid, intake staff will send a copy of the intake by email, mail or fax to the First Steps provider whenever possible. If there are multiple First Steps providers serving one community, intake staff will send to ESA HQ at CSDFirstSteps@dshs.wa.gov.
2. When the referrer is ESA or a First Steps provider, intake staff will not need to send an intake.

Community Services Division:

1. For current recipients of Medicaid, where there are multiple First Steps providers, the CSD First Steps Service Delivery program manager will receive the Children's Administration (CA) intake at CSDFirstSteps@dshs.wa.gov email address.
   1. After receiving the First Steps referral the CSD First Steps Service Delivery program manager identifies the client's catchment office and default First Steps worker.
   2. The First Steps Service Delivery program manager will create a First Steps tickler assignment in Barcode.
      1. The First Steps Service Delivery manager note type as First Steps Provider Referral Needed, copies client information into the subject box and sends the tickle to the default First Steps worker in Barcode.
   3. The First Steps worker receives an assignment via DMS tickles.
   4. When the First Steps worker completes the referral to the First Steps provider they will mark the tickle complete.
   
   
   
2. For women not receiving Medicaid, the CSD First Steps Service Delivery program manager receives the CA intake referral at CSDFirstSteps@dshs.wa.gov email address.
   1. After receiving the First Steps referral the CSD First Steps Service Delivery manager identifies the client's catchment office and default First Steps Worker.
   2. The First Steps Service Delivery program manager creates a First Steps tickler in Barcode.
      1. The First Steps worker notes type as First Steps Application request, copies client information into the subject box and sends the tickle to the default First Steps worker in Barcode.
   3. The First Steps worker receives an assignment via DMS tickles.
   4. The First Steps worker sends an introduction letter and Medical application to the client at the address listed.