The Iowa Department of Public Health's 1st Five Healthy Mental Development Initiative is bridging public and private health care systems to improve early detection of social–emotional delays and prevention of mental health problems among young children and their families. Key features of the 1st Five model include: user-friendly mental and developmental health screening and referral forms; ongoing education and support for medical office staff on healthy development and use of screening and referral tools; specially trained care coordinators to identify and address a wide range of children's and families' needs; relationships with community resources that provide early intervention; and timely notification of outcomes to the referring physician offices. With an evaluation under way, early 1st Five experience indicates that families identified through the program have a range of unmet needs: each physician referral results in an average of three to five follow-up referrals for services.