1. Introduction/Definitions

1. Introduction/Definitions


The mission of the Bureau of Maternal and Child Health (BMCH) is to:

  • Reduce the incidence of infant mortality, premature births and low birth weight;
  • Promote optimal growth and development of infants; and
  • Promote healthy habits and medical follow-up care to high-risk infants and pregnant women.

BMCH implements several programs throughout the State in partnership with Local Public Health Departments, FQHCs and CBOs throughout the state to provide services at a local level to achieve this mission.

This document establishes minimum procedures for all Community Service Provider Agreements with the Illinois Department of Human Services, Division of Family and Community Services - Bureau of Maternal and Child Health (BMCH) and is used in conjunction with specific program policy and procedure manuals when applicable.


The BMCH oversees provision of the following programs as defined below:

i. Family Case Management (FCM)

Family Case Management (FCM) is a statewide program that provides comprehensive service coordination to improve the health, social, educational, and developmental needs of pregnant women, and infants (0 - 12 months) from low-income families in the communities of Illinois (410 ILCS 212/15). Family Case Management (FCM) aims to "assess current needs within the State and provide goals and objectives for improving the health of mothers, children, and for reducing infant mortality" (77 Ill. Adm Code 630.20).

ii. High Risk Infant Follow-Up / HealthWorks

The IDHS BMCH aims to facilitate case management services to high risk infants and children statewide with the goal of reducing infant mortality and morbidity rates at both the state and local level. Assistance is provided in obtaining services which promote healthy growth and development to high-risk families as mandated in the Illinois Family Case Management Act through High Risk Infant Follow-Up, and HealthWorks. The Grantee will provide services under the program(s) identified in Exhibit G of the contract.

a) High Risk Infant Follow-Up

Infants and children (ages 0 - 2 years old) are referred to the high-risk infant follow up program either through the IDPH Adverse Pregnancy Outcomes Reporting System (APORS) or based on assessments done in the Family Case Management program which determine: that the infant has been diagnosed with a serious medical condition after newborn discharge; when maternal alcohol or drug addiction has been diagnosed; or when child abuse or neglect has been indicated based on investigation by the Illinois Department of Children and Family Services (See 410 ILCS 525/3 and 77 Ill. Adm. Code 840.210). The primary goals of HRIF are to:

  • Minimize disability in high-risk infants by early identification of possible conditions requiring further evaluation, diagnosis, and treatment
  • Promote optimal growth and development of infants
  • Teach family care of the high-risk infant
  • Decrease the stress and potential for abuse in the family setting of the high-risk infant.

b) HealthWorks of Illinois (HWIL)

Clients are referred to HWIL from DCFS Lead Agencies after the initial 45 days the child is in care. Grantees are expected to provide follow-up services and communicate regularly back to the Lead Agencies regarding issues pertaining to these cases and to maintain complete medical records for the child.

The primary goals of HWIL are to:

  • Ensure that each child receives preventive health care services
  • Ensure that each child is connected with a Primary Care Provider (PCP)
  • Develop health care plans to each child's overall DCFS service plan.

iii. Better Birth Outcomes (BBO)

High-risk pregnant women in areas of the state with higher than average Medicaid costs associated with poor birth outcomes and with higher than average numbers of Medicaid women delivering premature infants are enrolled in the Better Birth Outcomes (BBO) program.

BBO offers standardized prenatal case management services that emphasize the importance of regular prenatal medical care visits, home visits each trimester active in the program, monthly engagement with the BBO case manager for continued prenatal education and care coordination with the client's prenatal medical provider. The program's emphasis on reproductive life planning and health benefits associated with the delay of subsequent pregnancy impacts Illinois' infant mortality rate and rates of prematurity in Medicaid-eligible pregnant women. Women are enrolled in BBO through the duration of pregnancy up to six weeks postpartum. Because the pregnant women that are the target population for these services are not women who typically tend to seek out early prenatal medical care or other needed services, BBO programs are expected to develop an annual outreach plan.

iv. Perinatal Depression

The Perinatal Depression Treatment program provides the following client services in the Chicago area:

  • Perinatal depression screening
  • Assessments
  • Treatment
  • Psychiatric care to women referred by the Family Case Management (FCM) and Healthy Families Illinois (HFI) programs

v. Illinois Perinatal Quality Collaborative (ILPQC)

The ILPQC assesses current trends and issues related to negative maternal/infant outcomes and through its collaborative identifies strategies to address them. A partnership between BMCH and ILPQC enhances Case Management services by allowing for training and implementation of these strategies statewide though the FCM provider networks.

The ILPQC operates targeted collaborative learning opportunities designed to reduce maternal morbidity in Illinois.

vi. Special Projects

Special Project contracts provide services to Illinois citizens with special needs. Identified programs are negotiated individually, services may be restricted to target population, specified communities, or geographic areas.


  • APORS - Adverse Pregnancy Outcomes Reporting System
  • BBO - Better Birth Outcomes
  • BMCH - Bureau of Maternal and Child Health
  • CBO - Community Based Organization
  • CDC - Centers for Disease Control
  • DCFS - Department of Children and Family Services
  • DHS - Department of Human Services
  • FCM - Family Case Management
  • FQHC - Federally Qualified Health Center
  • GATA - Grants Accountability & Transparency Act
  • HFS - Healthcare and Family Services
  • HRIF - High Risk Infant Follow-up
  • HWIL - HealthWorks of Illinois
  • IDPH - Illinois Department of Public Health
  • ILPQC - Illinois Perinatal Quality Collaborative
  • LHD - Local Health Department
  • NICU - Neo-Natal Intensive Care Unit
  • PCP - Primary Care Provider
  • PFR - Periodic Financial Report
  • SSBG - Social Services Block Grant Title 20
  • WIC - Special Supplemental Nutrition Program for Women, Infants & Children