First Steps
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First Steps

Revised July 14, 2009

Purpose: This category describes the First Steps Program which is designed to provide additional medical care, enhanced services and case management to Medicaid eligible women and infants.

GUIDELINES

The 1989 Maternity Care Access Act, implemented as First Steps, seeks to reduce 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 jointly administered by the Department of Social and Health Services, Health and Recovery Services Administration with assistance from Department of Health, Maternal and Infant Health program.

First Steps services include:

  • Maternity Support Services (MSS)
  • Infant Case Management (ICM)

Maternity Support Services (MSS)

Maternity Support Services (MSS) provides assistance to pregnant women to promote their health and the health of infants.

The MSS team consists of community health nurses, certified registered dietitians, behavioral health specialists and in some cases community health workers. The team coordinates with health care providers and staff from other agencies who are also working with the client. Services may be provided in both the home and office.

MSS facilitates access to health care for pregnant women, including prenatal care as early in pregnancy as possible, and infants into pediatric care. Members of the team provide screening, assessment, health education, and interventions related to targeted risk factors impacting low birth weight MSS referrals and linkages include but are not limited to:

  • Prenatal Medical Care
  • WIC
  • Pediatric Care
  • Family Planning
  • Childbirth Education
  • Lactation Consultation
  • Family Health Hotline toll free phone number operated by WithinReach (formally Healthy Mothers Healthy Babies).
  • Childcare
  • 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, childcare, 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. The ICM services eligibility period is from the infant's third month of life through the end of the month of the child's first birthday.

ICM eligibility criteria includes:

  1. The infant must reside with a parent(s).
  2. The parent(s) must need assistance in accessing services.
  3. The family/infant must have at least one of the following:
    • Low Birth Weight: Infant weighed less than 5lbs. 8oz. at birth.
    • Premature Birth: Infant was born at less than 37 weeks gestation.
    • Failure to Thrive: Weight less than 3 rd percentile on standard growth chart, a weight that is less than 80% expected weight for age or a deceleration of growth velocity across two major percentiles.
    • Significant Birth/Health Problem: As determined by the infant's medical provider.
    • Alcohol and/or Substance Abuse Within the Past Year: Abuse of alcohol and/or illicit drugs and/or non prescription use of prescription drugs.
    • Current Child Protective Services Involvement with Parent(s) of infant or other child(ren) of parent(s): This can be in Washington State or elsewhere
    • Parental Rights Terminated in the Past: This can be in Washington State or elsewhere
    • Homelessness: Homelessness is unstable shelter, i.e.; living in a car, on the street or in a shelter. Homelessness may also be “couch surfing” which is moving from relative to relative or friend to friend.
    • Current Domestic/Family Violence: Domestic or family violence includes not only physical violence, but also the use of power and control over a victim. The physical and emotional effects of abuse may prevent a victim from meeting the basic needs of themselves and/or their infant.
    • Current Mental Health Diagnosis: The diagnosis must be made by a qualified medical provider, psychiatrist, psychologist, behavioral health specialist or other qualified health professional staff.
    • Parent's Limitation/Disability: In two parent households, the limitation of one parent must be a limitation that prevents both of the parents from accessing necessary services. Limitations may be physical, cognitive or developmental in nature.
    • 17 Year Old Parent(s) or Younger: The parent(s) must be age 17 or younger when ICM eligibility begins. This parent(s) will not age out of eligibility.
    • Social Isolation: A low level of contact with family, friends, neighbors, community and social sources. Social Isolation can be caused by geographic, physical, economic, personal and social barriers.

      For additional information about the First Steps program and available services visit the First Steps website at http://fortress.wa.gov/dshs/maa/firststeps.

WORKER RESPONSIBILITIES

The Community Service Office (CSO) plays a critical role in First Steps. Eligibility for Medicaid coverage is determined at the CSO and serves as an entry point for First Steps services. All Medicaid-eligible pregnant women must be offered these 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 First Steps.


NOTE: As part of the ongoing First Steps provider network, the CSO works with the group to establish the referral process in the local community.

  1. Minimum service level: Pregnant women must be offered First Steps services as soon as they are 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 Step services. Arrange for First Steps services and other services if needed, i.e., shelter, food, clothing. Obtain any needed release from the client and share the assessment with the partners providing services (MSS, ICM, Pregnancy to Employment worker). Follow-up to ensure the client has connected with the needed services including CSO Family Planning staff.

NOTE: Maternity Support Services and Infant Case Management agencies have already signed Confidentiality Agreements with DSHS and are held to the highest standards for client protection during regular program monitoring by First Steps State Staff.

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 CSD1stSteps@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 CSD1stSteps@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 CSD1stSteps@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 CSD1stSteps@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.

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Modification Date: July 14, 2009
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