Land use changes and channelization of streams in the deep loess region of western Iowa have led to stream channel incision, altered flow regimes, increased sediment inputs, decreased habitat diversity and reduced lateral connectivity of streams and floodplains. Grade control structures (GCSs) are built in streams to prevent further erosion, protect infrastructure and reduce sediment loads. However, GCS can have a detrimental impact on fisheries and biological communities. We review three complementary biological and hydraulic studies on the effects of GCS in these streams. GCS with steep (≥1:4 rise : run) downstream slopes severely limited fish passage, but GCS with gentle slopes (≤1:15) allowed greater passage. Fish assemblages were dominated by species tolerant of degradation, and Index of Biotic Integrity (IBI) scores were indicative of fair or poor biotic integrity. More than 50% of fish species had truncated distributions. After modification of GCS to reduce slopes and permit increased passage, IBI scores increased and several species were detected further upstream than before modification. Total macroinvertebrate density, biomass and taxonomic diversity and abundance of ecologically sensitive taxa were greater at GCS than in reaches immediately upstream, downstream or ≥1 km from GCS. A hydraulic study confirmed results from fish passage studies; minimum depths and maximum current velocities at GCS with gentle slopes (≤1:15) were more likely to meet minimum criteria for catfish passage than GCS with steeper slopes. Multidisciplinary approaches such as ours will increase understanding of GCS-associated factors influencing fish passage, biological assemblage structure and other ecological relationships in streams.