The Title V program strives to assure that women have access to and utilize integrated, holistic, patient-centered care before during and after pregnancy. Within the context of this priority, we strive for integrated care and alignment and coordination among systems and providers serving women, such as between Title V/MCH and Title X/Family Planning services, public health/primary care/OB-GYN, physical and behavioral health, and others. Title V is also focused on holistic care through assuring access to preventive services, screenings for early identification/intervention, addressing disparities and social determinants of health, and connecting to collaborative communities to address all needs of the women served, while meeting them where they are and with what they need. The measures associated with this priority are:

 

NPM 1:  Well-woman visit (Percent of women, ages 18-44, with a past year preventive visit)

ESM:  Percent of women program participants (18‐44 years) with a preventive medical visit in the past year

 

SPM 1: Postpartum depression (Percent of women who have recently given birth who reported experiencing postpartum depression following a live birth)

ESM:  Percent of MCH program participants screened for depression and anxiety during pregnancy and/or the postpartum period using the Edinburgh Postnatal Depression Scale (EPDS)

ESM:  Percent of pregnant/postpartum MCH program participants who received a referral in response to a positive screen for depression or anxiety through the Edinburgh Postnatal Depression Scale (EPDS)

 

National Performance Measure 1: Well-Woman Visits

 

Annual routine medical checkups are important for preventive care. The American College of Obstetricians and Gynecologists (ACOG) recommends that well-women visits include “screening, evaluation and counseling, and immunizations based on age and risk factors.” In 2020, an estimated 72.2% of Kansas women aged 18-44 years reported having a routine medical checkup within the past year (95% confidence interval [CI]: 69.4%-74.8%). This was not significantly different from the U.S. estimate of 71.2% (95% CI: 70.4%-72.0%).

 

Utilization of a routine medical checkup within the past year varied by household income and health insurance status. A significantly higher percentage of women in households with an income of $75,000 or more reported having a routine checkup within the past year (77.6%; 95% CI: 73.0%-81.7%), compared to women in households earning $25,000 to $49,999 (67.5%; 95% CI: 61.1%-73.2%). A significantly lower percentage of women without health insurance coverage (45.1%; 95% CI: 37.0%-53.5%) reported having had a routine checkup within the past year compared to those with health insurance coverage (76.6%; 95% CI: 73.8%-79.2%). The estimated percentage of Kansas women aged 18-44 years who reported having a routine medical checkup in the past year did not change significantly from 2018 to 2020.

 

State Performance Measure 1: PMADs

 

According to the Kansas Pregnancy Risk Assessment Monitoring System (PRAMS), among Kansas residents with a recent live birth in 2020, about one in seven (14.3%) were indicated as having postpartum depressive symptoms (95% confidence interval [CI]: 11.9%-17.0%). From 2017 to 2020, no statistically significant change was observed in the prevalence of postpartum depressive symptoms, despite an increasing trend.

 

Among those who gave birth in 2019-2020 (two years combined), some subpopulations were more commonly indicated as having postpartum depressive symptoms, including:

• Under 25 years old (20.6%), compared to 25-34 (12.0%) or 35 years or older (9.2%)
• Highest level of education of high school diploma/GED (21.6%), compared to some college education (10.3%)
• Receiving WIC food during pregnancy (19.4%), compared to those who did not (12.1%)
• Medicaid deliveries as indicated on the birth certificate (20.4%), compared to those with non-Medicaid payment sources for the delivery (11.2%)

 

 

Among Kansas residents with a recent live birth in 2020 who went for prenatal care, 82.3% reported being asked by a health care worker if they were feeling down or depressed during a prenatal care visit (95% CI: 79.4%-84.9%). Among those who went for a postpartum checkup for themselves, 91.1% reported that a health care worker asked if they were feeling down or depressed during that visit (95% CI: 88.7%-93.0%). For both types of visits, the prevalence of being asked about feeling down or depressed improved from 2017 to 2020. The postpartum checkup experienced the most improvement, with a statistically significant annual percent change of 3.7% (95% CI: 2.1%-5.4%). For prenatal care visits, the prevalence also increased significantly, with an annual percent change of 2.7% (95% CI: 1.4%-4.0%).

 

Among those with a recent live birth in 2020, there was not enough evidence to show the prevalence of being asked about feeling down or depressed varied by whether Medicaid was indicated as the payment source for the delivery on the birth certificate, for either the postpartum checkup or for prenatal care visits. Those whose births were indicated as having a Non-Medicaid payment source for the delivery experienced a significant increase in being asked about feeling down or depressed during prenatal care visits, between 2017 and 2020. The annual percent change was 3.2% (95% CI: 0.8%-5.6%). Although those with Medicaid-covered births also experienced an increase, it was non-significant. From 2017 to 2020, those whose births were indicated as having a Non-Medicaid payment source for the delivery also experienced significant improvement in being asked about feeling down or depressed during a postpartum checkup. The annual percent change was 4.8% (95% CI: 3.9%-5.7%). Those with Medicaid-covered births did not experience a statistically significant change.

 

 

Local MCH Reach: During SFY2021, 58 of 67 grantees (87%) provided services to the Women & Maternal population.

 

 

Well-Woman Visit Initiatives (Objective 1.1)

 

Title V strives to increase the proportion of women who received their preventive well-woman visit – specifically a high-quality, comprehensive visit. This includes integration of health screenings as part of the visit, as opposed to only pap smears or breast and pelvic exams. Strategies include providing resources and tools to our local MCH programs to help educate women on the importance of their preventive visits, increase insurance coverage before, during, and after pregnancy, and raise awareness in the community. Additionally, Title V plays a key role in supporting and advancing policy changes that assure services for women.

 

Well-Woman Visit Integration Toolkits: In December of 2020, Title V published the Well-Woman Visit Integration Toolkits for Providers and Communities, resources to ensure every woman in Kansas has access to, and receives, comprehensive, integrated care every year. There are three main areas covered in each toolkit: recommended components of a well woman visit; barriers faced by women that prevent them from receiving annual preventive care and recommendations to address these barriers; and resources for communities and providers. The toolkit’s success relies on partnerships with allied professionals and community agencies. The Community Provider Toolkit focuses on educating partner programs about the importance of the well-woman visit. Title V provides webinars with key programs, specifically targeting MCH-serving programs (Title X, WIC, PMI, TPTCM, MIECHV, KPCC). In addition, the Well-Woman Toolkits and the Reproductive Life Plan (RLP) are components of the Kansas Perinatal Quality Collaborative (KPQC) Fourth Trimester Initiative (FTI). Participating FTI birthing facilities are required to ask patients to schedule their postpartum follow-up visit as well as their annual exam prior to discharge in an effort to ensure all new mothers receive this important preventive care.

 

Addressing Disparities in Women’s Health Care Access: MCH-led promotional efforts around awareness months and weeks (e.g., National Women’s Health Week, Minority Health Month, Black Maternal Health Week) have incorporated messaging related to the importance of the well-woman visit. Action Alerts & Infographics and corresponding social media kits were developed and shared with all Title V and Title X partners as well as other key partners such as the Kansas Maternal and Child Health and Family Advisory Councils.

 

In an effort to better serve all Kansas women and connect with communities across the state around preventive care, the KMCHC held a listening session during the April 2021 meeting on the state of preventive and maternal health services for Hispanic/Latina women in Kansas. A panel of presenters that are a part of, and serve, Hispanic women across the state shared insights and recommendations related to what both KDHE and local partners can be doing to better engage and serve this population. Panelists included a doula, FQHC administrator and former MCH provider. As a result of this session, the BFH determined that all public-facing documents with patients as the intended audience must be available in English and Spanish and that program staff will be intentional when seeking translation services to ensure the dialect accurately reflects the Spanish-speaking populations in various communities across the state.

 

In support of best practice recommendations, Title V strives to assure women are screened for anxiety, depression, and substance use annually, along with the well-woman visit. Title V added behavioral health screening forms to our shared data management system, DAISEY, to increase availability of evidence-based screenings to local MCH agencies. More information about the Universal Screening Practices can be found in the Cross-Cutting narratives.

 

Medicaid Policy Improvements: The Medicaid Maternal Depression Screening (MDS) policy became effective January 1, 2021 to reimburse for up to three screenings during the prenatal period under the mother’s Medicaid ID and for up to five screenings during the 12-month postpartum period under the child’s Medicaid ID. The policy also allows for reimbursement to occur when non-licensed professionals, like home visitors and community health workers, administer screenings under supervision of a licensed professional. MCH developed MDS Medicaid Policy Guidance to aid in these efforts. The guidance was added to the Perinatal Mental Health Toolkit, which is available to all Kansas perinatal providers on the KDHE Integration Toolkits website. KS Title V also facilitated a virtual Q&A session for local MCH and Infant, Toddler Service programs related to the MDS policy. The session focused on how to bill for MDS, documentation requirements, and available resources to assist with screening administration, care coordination practices, and billing questions.

 

Approval of this policy further supports the BFH’s guidance to local health agencies to follow American Academy of Pediatrics (AAP)/Bright Futures Guidelines, which includes MDS during well-child visits. Through the BFH’s Kansas Connecting Communities (KCC) initiative, BFH contracted with the AAP-KS Chapter to develop guidance for pediatric primary care physicians. The Clinical Guidelines for Implementing Universal Postpartum Depression Screening in Well-Child Checks is also published in the Perinatal Mental Health Integration Toolkit and is promoted for use by BFH and AAP-KS Chapter. This partnership and resource development likely contributed to the initial success of the MDS policy and reimbursement utilization by pediatric physicians administering screens as part of the well-infant/child health benefit.

 

The Title V Behavioral Health Consultant is monitoring the implementation, awareness, and utilization of MDS as a billable service. Preliminary Medicaid claims data suggests that in the first 12-months of MDS becoming a reimbursable service:

• Over 8,500 women were screening for perinatal depression
• On average, each woman was screened twice, which follows screening frequency recommendations
• Most women (91.4%) were screened under the infant’s Medicaid ID as part of a comprehensive infant/child health benefit (caregiver risk assessment)
• Most screenings (85.8%) were administered by general pediatricians

 

Local MCH Agencies: Local MCH grantee agencies have proposed community-specific approaches to promoting well-woman visits. Some examples include:

• Community Health Center of Southeast Kansas: Staff work with all MCO incentive programs to maximize the services available, while also working with local foundations to offer incentives for women to access preventive care. The well-woman exam is incorporated into each participant’s individual goals, but available at no “out of pocket” cost and includes transportation to the appointment.
• Pawnee County: Education was provided on the importance of regular well woman exams, types of birth control available, STDs as well as mental health, nutrition, healthy relationships, alcohol, tobacco and other drugs.
• Wyandotte County: Provides comprehensive care during annual well-woman exams. All staff trained on the ACOG annual well-woman examination guidelines. Staff are trained on implementing the evidence-based Smoking Cessation and Reduction in Pregnancy Treatment Program, which has also been implemented into the STI clinic and into all prenatal care and well-woman exams.
• Delivering Change: Teen Pregnancy Targeted Case Management (TPTCM) staff regularly educate clients about the importance of following up their post-delivery visits around their 34-37 week appointment. Maternal education is provided at this time regarding the importance of waiting at least 18 months between pregnancies and staff facilitate discussion around making a RLP prior to delivery. Case managers also meet with clients before discharge from the hospital to go over contraceptive methods, including LARC, and re-enforce the importance of birth spacing.

 

Perinatal Mood and Anxiety Disorders Initiatives (Objective 1.2)

 

Title V has expanded focus on behavioral and mental health for all populations over the past few years. This objective focused on support for more education and screening around perinatal mood and anxiety disorders (PMADs). As such, a heavy focus is on integration within our existing service delivery systems (such as local health departments, family planning clinics, and perinatal collaboratives). Integration toolkits for well-woman visits and perinatal community collaboratives have already been completed, which will be updated and expanded on as time goes on. In the past year, we were able to get a new Medicaid policy that allows maternal depression screening to be conducted during well-child visits, however there is more work to be done, as that policy allows for reimbursement for the screening, but not necessarily for coverage for all the necessary referral and treatment services.

 

Maternal Mental Health Treatment Pilot Project: To further increase the identification of postpartum women experiencing perinatal mood and anxiety disorders (PMADs) and improve access to mental health treatment (counseling/therapy), Title V partnered with Russell Child Development Center (RCDC) on a Maternal Mental Health Treatment Pilot Project. RCDC is a Part C, Infant Toddler Services program, that provides early childhood services in 19 rural/frontier counties in Southwest Kansas. All 19 counties are designated Mental Health Provider Shortage Areas, and timely access to quality perinatal mental health treatment is limited.

 

Launched in July 2021, the aim of the pilot is to increase the availability, accessibility, and affordability of evidence-based maternal mental health treatment services by:

• Increasing timely detection, assessment, and treatment of PMADs in postpartum women using evidence-based practices;
• Increasing RCDC staff capacity to provide maternal mental health specialty treatment services to caregivers of children participating in RCDC services; and
• Supporting infrastructure development and create a replicable and sustainable model for treating maternal mental health conditions that can be replicated through early childhood systems.

 

RCDC staff participated in a Maternal Mental Health 101/Screening Implementation Training offered by KCC. Staff administer the Edinburgh Postnatal Depression Scale (EPDS) with pregnant and postpartum mothers and submit referrals to the Finding the Light program, when indicated. The program lead is a licensed master’s social worker (LMSW) who is actively pursuing her clinical license following the Kansas Behavioral Sciences Regulatory Board guidelines, which includes clinical supervision and continuing education requirements. The LMSW reviews the screening and referral information, meets with the mother and completes a psychiatric assessment, when indicated. Based on findings and the mother’s interest/willingness to engage in treatment or support services, the LMSW coordinates care. Maternal mental health therapy services are made available in-person and by telehealth and in collaboration the individuals’ healthcare providers to coordinate comprehensive care for the caregiver and the family.

 

The pilot allows infants and toddlers (0-3) and their caregivers to receive therapeutic services from one organization. While reducing barriers in accessing care, the pilot also increases local capacity by expanding the mental health professional network and subject-matter expertise in a mental health professional shortage area. Title V provides instruction and technical assistance to RCDC, including coordination with Kansas Medicaid, to ensure services will be sustained beyond the pilot project period and can be replicated by other early child development centers.

 

Kansas Connecting Communities (KCC): Managed by the Title V Behavioral Health Consultant as funded by the HRSA Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program Cooperative Agreement (awarded in October 2018), KCC strives to increase health care providers’ capacity to screen, assess, treat, and refer pregnant and postpartum women for depression, anxiety, and substance use disorders. To achieve this, KCC offers perinatal behavioral health trainings, technical assistance, resource and referral support and psychiatric case consultations via established Perinatal Provider Consultation Line.

 

To bring awareness and utilization of KCC capacity-building trainings, a Perinatal Behavioral Health Practice Survey was developed for programs and clinics currently implementing or seeking to implement mental health and/or substance use screening during the perinatal period. The survey serves as a self-assessment, focusing on universal screening administration:

• Use of a validated screening tool for depression, anxiety, and substance use
• Adoption of a universal mental health and/or substance use screening policy that includes 1) name of the screening tool(s) used, 2) frequency in which screenings should be administered, and 3) response protocol for positive screens and crisis intervention
• Use of data to guide quality improvement, including compliance to the screening policy practices
• Referral mechanisms
• Staff knowledge, skills, and comfort to detect, address, provide appropriate resources, and conducting follow-up activities
• Awareness and promotion of available resources, including KanCare Maternal Depression Screening Policy Guidance, Perinatal Provider Consultation Line, Perinatal Mental Health Toolkit, and Perinatal Substance Use Toolkit.

 

KCC piloted the survey with KPCC sites in Summer 2021. Responses were used to develop a KPCC Perinatal Behavioral Health Training and Technical Assistance Plan that was implemented Fall 2021.

 

Local MCH Agencies: Many local MCH agencies provide PMAD screenings during visits with pregnant and/or postpartum women using the EPDS. Case managers from the PMI and TPTCM programs screen clients using the EPDS to help identify woman experiencing or at-risk of experiencing PMADs. Several MCH agencies are taking advantage of technical assistance to create innovative ways to screen more women by implementing screenings during infant immunization appointments. Examples of local MCH agencies activities:

• Coffey County: Provides the EPDS on all 2, 4, 6, & 12-month immunization appointments and make referrals as needed. They continue meeting with the Mental Health Collaborative Resource Team to improve access to care. MCH staff meet with local primary care providers to discuss postnatal depression and the screening tool.
• Dickinson County: Prenatal education clients are screened for PMADs using the EPDS during sessions three and six as well as postpartum. All clients with positive screens are referred to a community mental health center (CMHC) and/or their primary care physician for further evaluation and care.
• Hamilton County: The MCH Home Visitor uses the EPDS at every home/clinic visit for both prenatal and postpartum women. The home visitor provides educational materials that address substance use during pregnancy and within the household. MCH staff provide clients with educational materials that address nutrition, good health hygiene, dental care, sleep practices, and having a medical home.
• Nemaha County: Has a PMAD Screening Policy that assures the MCH nurse universally screens every pregnant and postpartum woman (through one-year post-delivery) using the EPDS. Repeat screening is administered according to the policy, as the client remains engaged in MCH Services, WIC, and/or the Breastfeeding Clinic. A referral is made to the client's primary health care provider or CMHC. The MCH nurse follows up by phone to the client and if needed, the health care provider. MCH staff work with providers and agencies across the community to ensure an adequate system of care is in place. Staff also provide educational resources on PMAD and information on available mental health services to every pregnant and postpartum woman served by the agency.
• Wichita Children’s Home: Provides residential maternity care to pregnant and parenting teens to give them and their babies a healthy start and screen PMI/TPTCM clients for mental health and substance use. Program staff are trained in trauma informed care to provide trauma sensitive direct care services. A biopsychosocial assessment is completed for each client and referrals are made according to identified needs.

 

Perinatal Community Collaboratives Initiative (Objective 1.3)

 

A strong focus of Title V in the last decade, the Kansas Perinatal Community Collaboratives (KPCCs) efforts have shifted to assuring a focus on birth outcome disparities and expanded connections across public health education and coordinated clinical care. This includes developing innovative approaches to meet the needs of urban and rural communities. A strong focus of the PCC’s is on the connection between public health education and clinical services during the prenatal period. Recent efforts to integrate the postpartum period through implementation of initiatives such as maternal warning signs (MWS) and FTI have really enhanced this model. Collectively, these efforts will continue to support our goals to increase

the proportion of high-risk pregnant women receiving prenatal education and support services through KPCCs.

 

KPCC/Becoming a Mom® (BaM): With proven success, Kansas MCH remains committed to supporting the expansion and sustainability of the KPCC initiative, providing training and technical assistance on community collaborative development and MCH program integration targeted at reaching a greater disparity population, and integrating additional services and support mechanisms for populations at greatest risk. View a map of existing sites and implementation progress on the Participating Communities website.

 

Data from the 2019 BaM Aggregate State Report highlights disparities (see BaM Infographic) that Title V is working to address. According to the Report, mothers receiving education through the BaM prenatal education program were more likely than other mothers giving birth in the state to be racial/ethnic minorities; younger; lower education level; enrolled in WIC; and covered by non-private insurance. The education sessions and associated activities are aimed at improving pregnancy health and infant health outcomes for disparity populations.

 

Since inception in 2010, KPCCs have been a driving force behind improving birth outcomes in Kansas. In two of the longest running sites, infant mortality has decreased from pre-implementation to post-implementation. The Geary County infant mortality rate has decreased significantly from 11.9 infant deaths per 1,000 live births in 2005-2009, to 5.1 in 2016-2020. The Saline County infant mortality rate has decreased from 9.0 infant deaths per 1,000 live births in 2005-2009, to 6.4 in 2016-2020.

 

KPCC/BaM Website: Resources for regional and statewide implementation of KPCCs have been under development over the past several years to ensure both growth and sustainability of the initiative. The KPCC website serves as an access point to introductory information about the initiative. Updates to the site were made during this reporting period, however the full website redesign and expansion is still under development. KPCC and BaM infographics were also developed to aid communication and recruitment for new communities while showcasing the impact of the KPCC model and BaM programming in existing communities.

 

New training and resources were also added to the existing KPCC partner-only website. Local program coordinators and group facilitators can now access the new integration toolkits and initiatives that were implemented during this reporting period (e.g., MWS toolkit and FTI). Additionally, the COVID-19 pandemic has heightened the need for a virtual prenatal education option. Resources and guidance documents for virtual implementation, including online data collection and guidance for virtual screening for PMADs, were developed and disseminated. This infrastructure component will continue to be improved and supported.

 

Pregnancy Intention Screening (Objective 1.4)

 

Supporting the upstream approach to address pregnancy and birth outcomes prior to conception, Title V focused on raising awareness of pregnancy intention screening, such as One Key Question and partnership with Title X/Family Planning. These efforts help to promote reproductive life planning and increase the proportion of women receiving these services as part of their preconception and inter-conception services.

 

One Key Question (OKQ): Kansas Local MCH agencies utilize the OKQ algorithm to screen for pregnancy intention and provide resources and referrals based on client responses. Local MCH agencies capture this information regarding pregnancy intention (No – do not want to become pregnant, Yes – would like to become pregnant, Unsure if they would like to become pregnant, or ‘OK either way’) into the DAISEY system. Based on these responses clients are provided comprehensive education and referrals to help them achieve their goals including, but not limited to, information on preconception health, family planning resources, and tobacco cessation referrals. The below table shows unduplicated counts of women screened for pregnancy intention.

 

 

Reproductive Life Plan (RLP) Workbook: Released in December 2020, the RLP Workbook was developed for use across agencies and sectors of the health care system in Kansas in both clinical and non-clinical settings. The workbook was designed to be used in a variety of settings. For example, a case manager or home visitor can revisit the workbook over the course of several visits for completion, reflection, and progress monitoring, whereas only targeted sections of the workbook might be completed by a provider in a medical or Title X clinic. Use of the workbook can be customized by each type of service provider but does provide standardized tools and a consistent approach for encouraging women of reproductive age to set life and health goals during a well-woman visit on an annual basis.

 

The workbook has been tested in physician offices, safety net clinics, home visiting programs, health department clinics, peer to peer conversations, and a barber shop. The responses were overwhelmingly positive, with an appreciation of the contraceptive devices and effective rates, space to plan/think/take notes, and the reflections on health. The workbook is available in English and Spanish and as both a printable document and a fillable PDF form. The workbook and other resources (e.g., Well-Woman Visit Toolkit, Preconception Guide) are key components for training related to the well-woman visit. Materials were integrated into promotional efforts for National Women’s Health Month, Black Maternal Health Week, the KPQC FTI as well as applicable webinars and trainings for MCH and Title X providers.

 

Long Acting Reversible Contraceptives (LARC): Title V continued to collaboration with Title X and other state partners to increase access to LARCs for women, including continued implementation of the LARC Integration Toolkit. During FY21, activities included:

• LARC Preceptor Network: A peer to peer learning model to allow trained physicians to serve as preceptors for newly trained providers that need experience.
• Lunch and Learn Webinars: Title V continued the LARC “lunch and learn” online events where organizations can call in for a short didactic session about a specific LARC topic (e.g., LARC myths, educating about LARCs, Intimate Partner Violence Considerations, LARC Service Delivery) followed by a Q&A session where participants can discuss LARC cases and get expert and peer advice.

 

Local MCH Agencies: MCH staff and case managers assured clients have access to holistic services and supports through coordinated and comprehensive care, including preconception and interconception care. Local program staff utilize external partnerships and internal agency programs to help clients access any service that promotes healthy, full-term pregnancies. One of the common goals among PMI/TPTCM grantees is to help clients increase self-sufficiency and reduce negative outcomes. Participants receive assistance to set personal and professional goals according to the eight life domains: empowerment, key relationships, health, daily living, financial, parenting, education/training, and employment. All PMI/TPTCM participants received RLP education, to support family stability through completion of basic education, vocational, and health goals prior to subsequent pregnancies.

• Barton County: Provided annual training on OKQ to their staff and refer TPTCM clients to contraception services provided by family planning programs, OB-GYNs, or other health care providers. OKQ was implemented and discussed with each intake and reviewed semi-annually for each TPTCM participant.
• Wyandotte County: Case managers utilize OKQ to track pregnancy intent of all TPTCM enrolled clients. Each client completes a birth plan. Medically accurate education is used by providing and counseling clients with the contraception handout from Reproductive Access. A contraception kit is used as a hands-on tool to demonstrate each method to clients.

 

Other Women/Maternal Activities

 

Count the Kicks® (CTK) Stillbirth Prevention Initiative: The Kansas stillbirth rate increased from 4.4 per 1,000 live births and stillbirths in 2007 to 5.4 per 1,000 live births and stillbirths in 2018. Vital Statistics reports that 196 stillbirths occurred in 2018 which was up from 184 stillbirths in 2017. In 2018, Title V launched a partnership with a nonprofit lead for an intervention known as the CTK campaign to prevent stillbirth through provider and patient education that emphasizes the critical importance of monitoring fetal movements during the 3rd trimester of pregnancy. Thanks to this investment from Title V, Kansas maternal providers have free, full access to videos and educational materials (including posters, brochures, magnets, and appointment cards in English and Spanish) for use in their practices. Mothers everywhere can download the free app, which is available in the Google Play and iTunes online stores. The app, available in English and Spanish, allows expectant mothers to monitor their baby’s movement, record the history, set a daily reminder, and count for single babies and twins. Additionally, a KS-specific version of the app with four follow-up questions that connect mothers directly with resources in Kansas based on expressed needs and concerns, was developed.

 

From the time of launch in August 2018 to October 2021, over 385 orders for free materials were placed by providers from all corners of the state, equating to 115,460 pieces of education being distributed. Over 6,700 Kansans have visited the CTK website seeking more information about kick counting, and more than 2,400 expectant parents have downloaded the free app to track their baby’s movements.

 

During FY21, professional development opportunities regarding stillbirth prevention utilizing CTK were offered to the MCH workforce. More than 50 health professionals attended “Using Technology to Kick Off a Healthy Birth”, a joint presentation given by Title V staff and the CTK Program Manager at the Governor’s Public Health Conference in March. In total, over 150 healthcare professionals and maternal health workers were trained and over 1,000 individuals were mailed educational information about the KDHE/CTK partnership.

 

In 2020, there were 167 stillbirths reported for Kansas residents, a decrease of 14.8% from 2018. While it is impossible to tell if this decrease is related to the CTKs initiative we continue to track stillbirth data for impact. The introduction of CTK has the potential to save 60 babies every year if the stillbirth rate decreases by 26%, which is the result of the campaign in neighboring Iowa.

 

Black Maternal Health Key Informant Interviews: In partnership with Title V and the Governor’s Office, Wichita State University collected qualitative data from Black mothers to better identify barriers to care and gaps in services. The goal of this research is to better understand the following from Black mothers and families:

• Views on importance of overall health and the functionality of the current health care system
• Health priorities and biggest needs
• Availability of health care services for them and their children
• Services and supports they feel were lacking during the perinatal period III and neonatal periods related to physical health, emotional wellbeing, and mental health
• Barriers faced when seeking whole health services, including prenatal and postpartum care
• Tools they find helpful, or would find helpful, when navigating the health care system

 

Due to a scope of work change with WSU, a shift from focus groups to key informant interviews was made. Unfortunately, there was a very limited response to requests for interviews and only four interviews were able to be completed. A preliminary report was prepared and distributed internally, however Title V believes further conversations are needed to present findings or recommendation for action.

MCH Universal Home Visiting (UHV): The MCH UHV program includes protocol and utilization of standard tools for smoking/tobacco, alcohol, substance abuse, and mental health, including perinatal depression. Home visitors make every effort to ensure that prenatal and postpartum mothers and their infants receive screening assessments with persons that are trained and qualified to conduct them. Based on data collected in DAISEY, during SFY21, MCH UHV programs provided a total of 3,040 visits, reaching 1,556 women (16% inter-conception; 36% pregnant; 48% postpartum) and provided verbal and written education to the prenatal and postpartum mother on a variety of topics, such as breastfeeding, safe sleep, infant care, immunizations. More informaitona bout these services can be found in the Perinatal/Infant narratives.

 

In partnership with the MCH UHV team, MIECHV local programs also provided educational information, referrals, and support addressing multiple areas affecting maternal health including prenatal and postpartum care. Screenings of substance use, maternal depression, and domestic violence using standardized tools were conducted and tracked to identify and address needs for additional information, support, and referrals as well as completed referrals.