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, KS Title V strives 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

 

Annual routine medical checkups are important for preventive care. The American College of Obstetricians and Gynecologists recommends that the well-women visit specifically include “screening, evaluation and counseling, and immunizations based on age and risk factors.”1 In 2022, according to the Behavioral Risk Factor Surveillance System, an estimated 74.0% of Kansas women aged 18-44 years reported having a routine medical checkup within the past year (95% confidence interval [CI]: 71.1%-76.8%). This was slightly higher, though not significantly, than the U.S. estimate of 72.5% (95% CI: 71.8%-73.1%).

 

In 2022, the percentage of Kansas women receiving a preventive medical checkup within the past year was significantly higher among:

• Those with a college degree (79.8%; 95% CI: 75.8%-83.4%), compared to those with less than high school education* (61.8%; 95% CI: 45.1%-76.1%), only a High School Diploma or GED (71.4%; 95% CI: 64.8%-77.2%), or some college but no degree (73.4%; 95% CI: 68.6%-77.7%).
• Those with a household income of $50,000 to $74,999 (79.7%; 95% CI: 71.6%-85.9%), $75,000 to $99,999 (79.3%; 95% CI: 72.0%-85.0%), or $100,000 to $149,999 (80.1%; 95% CI: 72.5%-85.9%), compared to those with a household income of less than $25,000* (65.8%; 95% CI: 54.9%-75.3%) or $25,000 to $49,999 (70.3%; 95% CI: 64.5%-75.5%).
• Those who were married (77.6%; 95% CI: 73.8%-81.0%), compared to those who were not married (71.3%; 95% CI: 66.8%-75.4%).
• Those who had any health care coverage (77.8%; 95% CI: 74.9%-80.4%), compared to those who did not* (45.3; 95% CI: 34.6%-56.5%).
• Those who had one health care provider (78.6%; 95% CI: 74.9%-81.8%) or more than one (82.2%; 95% CI: 77.2%-86.2%) that they considered as their personal doctor(s), compared to those who did not have a health care provider that they considered as their personal doctor (44.5%; 95% CI: 35.8%-53.5%).

 

* Indicator has a confidence interval width >20% points or >1.2 times the estimate and should be interpreted with caution.

 

There was not enough information to show that the percentage of women receiving a routine medical checkup differed significantly by race and ethnicity, age group, or urban/rural residence, respectively.

 

The estimated percentage of Kansas women aged 18-44 years who reported having a routine medical checkup in the past year increased significantly from 2018 to 2022, as calculated from Joinpoint regression software, with an estimated annual percent change (APC) of 0.8% (95% CI: 0.1%-1.5%).

 

1.  ACOG Committee Opinion No. 755: Well-Woman Visit. Obstet Gynecol. 2018;132(4):e181-e186. doi:10.1097/AOG.0000000000002897

 

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)

 

Perinatal depression, including postpartum depression, can affect maternal and family well-being. Perinatal depression may endanger maternal or infant safety, impair maternal bonding with children, hinder utilization of health care, or result in delays in infant development.1 Due to the risks of perinatal depression, the American College of Obstetricians and Gynecologists recommends screening for perinatal depression at least once using a validated screening tool, and conducting a “full assessment of mood and emotional well-being (including screening for postpartum depression and anxiety with a validated instrument) during the comprehensive postpartum visit.”2 Efforts to increase screening and referral for perinatal mood and anxiety disorders can be guided, in part, through ongoing surveillance of the impact of postpartum depression in Kansas.

Data on postpartum depression have been collected through the Pregnancy Risk Assessment Monitoring System (PRAMS). Kansas-specific PRAMS data have been collected by the Kansas Department of Health and Environment since 2017, in partnership with the Centers for Disease Control and Prevention. Through PRAMS, Kansas residents who have recently given birth in Kansas to a live infant are asked about their health and experiences before, during, and in the months following pregnancy. Respondents are indicated as having postpartum depressive symptoms if they answer that since the birth, they “often” or “always” either felt down, depressed, or hopeless, or had little interest or little pleasure in things they usually enjoyed.

Among Kansas residents with a recent live birth in 2022, more than one in nine (11.9%) were indicated as having postpartum depressive symptoms. There was not enough evidence to show that this was significantly different from the prevalence for 2021, despite a slight decrease (15.1%).

From 2018 to 2022, no statistically significant change was observed in the prevalence of postpartum depressive symptoms, despite a decreasing trend.

Among Kansas residents with a recent live birth in 2022, whose deliveries were indicated on the birth certificate as being paid for by Medicaid, 18.3% were indicated as having postpartum depressive symptoms. This was significantly higher than among those with a non-Medicaid payment source for the delivery (8.8%).

 

Some Kansas residents with a recent live birth in 2021-2022 (two years combined) had a significantly higher prevalence of postpartum depressive symptoms, including:

• Those who were under 20 years old* (29.4%*) or 20-24 years old (20.7%), compared to those who were 25-34 years old (11.3%) or 35 years old or older (9.1%)
• Those with only a High School Diploma/GED (19.6%), compared to those with at least some college credit (10.9%)
• Those who received WIC food during pregnancy (20.9%), compared to those who did not (11.4%)
• Those whose birth was indicated on the birth certificate as being paid for by Medicaid (22.3%), compared to those whose births were paid for by all other payment sources (9.6%)
• Those who had not intended to become pregnant 1 month before pregnancy (16.8%), or were unsure what they wanted (18.0%), compared to those who had intended to become pregnant (11.1%)
• Those who had not gone for a postpartum checkup for themselves since the birth (25.2%), compared to those who had (12.4%)

 

* Note: Indicator has a confidence interval width >20% points or >1.2 times the estimate or a Relative Standard Error > 30% or a denominator < 60 respondents and should be interpreted with caution.

 

There was not enough evidence to show that the prevalence of self-reported postpartum depressive symptoms differed significantly between racial and ethnic groups.

1. Rafferty J, Mattson G, Earls MF, Yogman MW; COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH. Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice. Pediatrics. 2019;143(1):e20183260. doi:10.1542/peds.2018-3260

ACOG Committee Opinion No. 757: Screening for Perinatal Depression. Obstet Gynecol. 2018;132(5):e208-e212. doi:10.1097/AOG.0000000000

 

Local MCH Reach: Based on SFY2024 MCH Aid-to-Local applications received: 50 of 56 grantees selected to work on Women/Maternal Health objectives. Some of the grantees who reached their goals are highlighted in this report.

• Butler County Health Department continued to conduct maternal mental health screenings virtually the first half of the year, which inhibited rapport and engagement with community members. They transitioned back to completing them in person in the second half of the year. 
• Community Health Center of Southeast Kansas observed an increasingly transient clientele that experiences higher rates of food insecurity and unreliable transportation while local social service agencies that have historically been reliable have become strained. 
• Delivering Change in Geary County went through a large transition, as Stormont Vail Health bought out Geary Community Hospital. The change brought many questions and needs from patients regarding their healthcare. Patients needed additional support and education about moving forward with a new hospital, how to access services for themselves, their child(ren) and their families, along with education about continuing to attend their prenatal, postpartum and well child visits as scheduled. Delivering Change lost access to the EHR which resulted in a heavier patient navigation workload.  

 

MCH ATL grantees who didn’t reach their goals, cited the following barriers:  

• Staffing challenges related to MCH nurse and home visitor positions. 
  • Nurse wages that aren’t competitive
  • Vacancies and continued COVID-19 duties overburdening the existing staff.
• Rural communities losing their obstetricians and challenges with developing relationships with the remaining obstetricians in the region.
• Lower participation in Becoming a Mom (BaM) at some sites due to change in leadership at referring sites, transportation barriers, and difficultly getting paperwork when classes are attended virtually.

 

Well-Woman Visit Initiatives 

Objective 1.1: Increase the proportion of women program participants receiving a high-quality, comprehensive preventive medical visit. 

 

Well-Woman Visit Integration Toolkits: Published in December of 2020, the KDHE Well-Woman Visit Integration Toolkits for Healthcare Professionals and Communities intends for these resources to help ensure every woman in Kansas has access to, and receives, comprehensive, integrated care every year. Research indicates most women view their OB/GYN as their primary care provider. However, primary care physicians were found to be 2.5x more likely to address multiple co-occurring conditions during preventative wellness visits, such as mental health concerns, metabolic conditions, circulatory, respiratory, digestive and skin diseases[1].  

 

Following guidance from The Women’s Preventative Service Institute (WPSI) 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 healthcare professionals. Supplemental training and technical assistance opportunities, including collaborative approach to connection to local partners and experts were an ongoing theme for the domain.  

• Comprehensive screening:  

 

Substance Use	Tobacco Use	Mental Health	Pregnancy Intention	Social Determinants of Health	Intimate Partner Violence
Substance Use, Alcohol, Smoking and Substance Use Involvement Screening Test (ASSIST)	ASSIST	PHQ-9  GAD-7  EPDS	Client Centered Reproductive Counseling and PATH Tool from the Reproductive Health National Training Center (RHNTC)	AAFP Social Determinants of Health Screener	CUES: Evidence-Based Intervention

 

Updates to the Well-Woman Toolkit and associated programmatic work are currently in progress to reflect the ongoing needs of local communities. Despite ongoing website changes and barriers to data collection available, MCH Toolkits had a known 1,018 webpage views between October 2022 – September 2023.  

  

• Violence prevention: Futures Without Violence subject matter expert, Rebecca Levinson provided multiple recorded trainings on violence prevention and healthy relationships for community-based professionals and birth-setting based professionals. These trainings are available on an on-going bases through MAVIS funding. Assistance to all state healthcare professionals who see perinatal populations, including pre-conception, are eligible for free training and technical assistance on CUES through the Kansas Perinatal Psychiatric Access Line.  
   
• Partnerships: The toolkit relies on continued collaboration and partnership between programs. To better support women throughout the state, collaboration between MCH and Title X Family Planning provided training and guidance on RHNTC’s Client-Centered Reproductive Counseling and PATH Tool. These collaborative efforts resulted in quality engagement with locals through learning webinars and national recognition from the RHNTC as a Grantee Spotlight.  

  

MCH-led promotional efforts around awareness months and weeks incorporate messaging related to the importance of the well-woman visit. Promotional materials and social media kits developed were 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. 

 

Universal Screening Practices: Screening guidance for the Women/Maternal Domain emphasizes holistic and preventative evidence-based practices. Throughout FY23, the Women/Maternal Health Consultant continued to promote the Well-Woman Toolkit. Title V continued to promote the Women’s Preventive Services Initiative Recommendations for Well-Woman Visits including all recommended screenings.

 

Behavioral Health Integration: 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 incorporates behavioral health screening forms to our shared data management system, DAISEY, to increase availability of evidence-based screenings to local MCH agencies.

  

Guidance on screenings is available to local programs. The guidance includes a 1-page overview of each of the screening tools and scripts for introducing the tool to a client, administering the screening, and details on scoring the screen, determining risk-level and appropriate interventions. Additionally, a Plan of Action form will be populated in DAISEY for moderate or high-risk screening results. This form allows for local MCH staff to document that a brief intervention was conducted, the type of brief intervention provided, indicate referral(s) made, and summarize any emergency or support services initiated for a client experiencing a crisis.  

 

Through funding and support of the MAVIS initiative and collaboration with Kansas Connecting Communities, a series of videos have been developed to help providers and clinics implement screening and brief interventions. These role play videos were created with the guidance of KCC’s clinical consultant team to offer guidance and shared language, specifically for behavioral health concerns with perinatal patients. Videos can be used individually to build skills or integrated into organizational policy for ongoing training of staff. Additional information on implementing perinatal behavioral health screenings can also be found in the toolkits or by reaching out to the Provider Consultation Line. 

 

Utilizing DAISEY Data: The Family Planning Program Manager and MCH Program Manager presented to about 50 attendees on how to get the most use out of DAISEY data at the Governor’s Public Health Conference in March 2023. DAISEY report tables were shared and discussed regarding what the data tells us, why it is telling us that, and what actions to take as a result. Well-visit services were used as an example.  

 

In April, the Family Planning Program Manager, MCH Program Manager, and PMI/TPTCM Program Manager followed up with a webinar specific to current Aid-to-Local grantees titled Using DAISEY to Monitor Reproductive Health/Well Woman Goals.  

 

Perinatal Mood and Anxiety Disorders Initiatives 

Objective 1.2: Objective 1.2: Increase the proportion of women receiving education or screening about perinatal mood and anxiety disorders (PMADs) during pregnancy and the postpartum period. 

 

Kansas Connecting Communities (KCC): Managed by the MCH Behavioral Health Director and funded by the HRSA Maternal Mental Health and Substance Use Disorder (MMHSUD) (originally awarded in October 2018, re-awarded in October 2023), 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. KCC provided statewide access to training and technical assistance for screening, assessment, and treatment for maternal depression, anxiety, and substance use disorders at no cost to Kansas healthcare professionals who treat perinatal populations in their program or practice.   

  

The KCC work encourages the development of provider knowledge on assessing and treating perinatal behavioral health conditions through facilitating partnerships between FTI sites and KCC training and technical assistance staff, including provider-provider consultation with access to a perinatal psychiatrist and a perinatal mental health – certified (PMH-C) OB/GYN. Through this program all healthcare professionals can access resource and referral support and receive trainings tailored to their programs by submitting a request through an online form or calling a 1-800 number.  

 

For MCH programs, this is a continuation of the 2020-2021 Perinatal Behavioral Health Community Collaborative. By aligning with KCC, there is an increase in trainer capacity to assist more local programs. The components that were developed as a guide to Perinatal Behavioral Health Community Collaborative participants were incorporated into KCC’s training plans and serve as guidance for local agencies to enhance their programs. These components include establishing an agency screening policy, executing a MOA/MOU with a mental health or substance use treatment professional/organization to increase access to timely care, and starting a support group. Additionally, several training opportunities were made available in the reporting period: 

• PMAD Components of Care Training: This virtual, 2-day training follows an evidence-based curriculum designed for nurses, physicians, social workers, mental health providers, childbirth professionals, social support providers, or anyone interested in learning skills and knowledge for assessment and treatment of PMADs.  
• PSI Advanced Psychotherapy Training: With the onset of the MDS Medicaid policy and increase in screening practices, an increased demand in perinatal mental health treatment services is anticipated. This evidence-based, advanced, curriculum (6-hour virtual training) is designed for mental health and psychotherapy providers and covers differential diagnosis, evidence-based psychotherapeutic approaches, and advanced therapeutic issues. It combines expert presentation with case studies, group discussion, and practical examples of treatment approaches. KCC is collaborating with the Association of Community Mental Health Centers of Kansas (ACMHCK) to ensure mental health clinicians employed by Community Mental Health Centers, Kansas’ community-based public mental health services safety net, can participate.  
• Kansas Moms in Mind (KMIM): Family physicians and OB practitioners play a critical role in the identification and treatment of PMADs. The KMIM project is a closed virtual rounds format where a multidisciplinary team look at real cases in didactic form where live questions on the treatment and follow-up for real cases is explored.  

 

Kansas’ Pediatric providers continue to be the largest group of professionals billing Medicaid for Maternal Depression Screenings. This year, efforts continued in the evaluation of billing utilization and reimbursement education. Through partnerships and outreach the KCC program presented to ACOG, Community Mental Health Centers, KS Office of Primary and Rural Healthcare, as well as to local programs including Parent and Teacher groups and other less traditional perinatal health professionals. Based on PRAMS data and other key indicators of mental health treatment access, KCC and the program experts are under-utilized. Through a series of provider interviews and feedback, the Behavioral Health Consultant was able to consolidate KCC and KSKidsMap under one umbrella and continues to work to re-brand the programs to simplify the process and increase access for all prescribers throughout the state.

 

Maternal Mental Health Treatment Pilot Project: To further increase the identification of postpartum women experiencing perinatal mood and anxiety disorders 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. 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 perinatal mood and anxiety disorders in postpartum populations 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 addressing maternal mental health conditions through early childhood systems. 

 

RCDC employs two licensed master’s social worker’s (LMSW) who accept referrals for treatment from RCDC staff, local healthcare, social services, and other providers screening for risk of PMADs. Maternal mental health therapy services were 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 allowed infants and toddlers (0-3) and their caregivers to receive therapeutic services from one organization. While reducing barriers in accessing care, the pilot also increased local capacity by expanding the mental health professional network and subject-matter expertise in a mental health professional shortage area. This grant year both LMSW’s received Perinatal Mental Health – Certification through Postpartum Support International. On-site interactive training was provided to the entirety of the staff at RCDC where best practices and prevalence were presented, and the referral process was refined in a collaborative all-staff meeting with guidance from MCH staff and KCC facilitators. To support sustainability, RCDC has established a Medicaid billing process for screening and referral treatment and intends to apply for 2024 MCH aid-to-local funding. The RCDC team reports positive experience in engagement and treatment but has experienced challenges in the billing and reimbursement process. These challenges have been largely clerical, with rejected claims resulting in troubleshooting for billing identification.  

 

Local MCH Agencies: The following are examples of how some of the local MCH grantee agencies have made progress toward Objective 1.2 during the reporting period.  

• Barton County Health Department screened 204 clients using the Edinburgh Postnatal Depression Scale (EPDS). They provided maternal mental health education to the community at a Mental Health Awareness event. They also worked to increase partnerships with mental health providers by inviting two to attend the community baby shower and inviting another to join the IRIS referral network. They were successful in getting staff from The Center to provide education at the community baby shower.  
• Coffeyville Regional Medical Center completed 34 EPDS during infant immunization appointments. This was an increase from 23 the previous year. They attributed the increase to increased availability of interpreters post-COVID restrictions.  
• Lawrence-Douglas County Health Department met their goal of screening 80% of prenatal Healthy Families Douglas County clients for maternal mental health concerns. Clients were screened during the third trimester of pregnancy, six weeks postpartum, and again six months postpartum with referrals being made and more frequent screening when a score indicated need for additional support and monitoring.  
• University of Kansas’s Becoming a Mom program, known locally as Baby Talk, had 91% of participants complete maternal mental health screening. Of those, 101 (27%) screened positive with a score of 10+ or indication of self-harm. They provided education on maternal mental health during Session 6 which is taught by labor and delivery nurses at partner sites.  

 

Prenatal Education and Support Services Initiatives 

Objective 1.3: Increase the proportion of high-risk pregnant women receiving prenatal education and support services through perinatal community collaboratives. 

 

Prenatal Education (BaM/Cb) Program Support for Growth and Sustainability: With proven success, Kansas MCH remains committed to infrastructure development that supports implementation and sustainability of the Becoming a Mom® (BaM) / Comenzando bien® (Cb) prenatal education program. KDHE’s Title V commitment to this program is greater than just increasing the number of BaM programs across the state. Rather it is our desire to support the model through continuous improvements that ease the burden of local implementation as well as improving reach and relevance for all populations, especially those at most risk of poor health outcomes. Continual growth and sustainability are priority.

 

Much work has been done throughout this reporting period to help reinvigorate local efforts that suffered greatly during the pandemic. Fallout from the pandemic not only left local coalitions/collaboratives struggling to reengage partners, but it also left many BaM programs unstaffed and in mere survival mode, as well as several programs that did not survive. P/I Consultants have had to work to stabilize and rally existing programs, which has continued to be the focus throughout 2023. This work included a two-month tour across the state visiting twenty local programs/sites during August – October 2023. These visits were warmly welcomed by locals, and deemed a tremendous success, with passion and energy for the work reignited on both sides (KDHE and local). Common themes, key take-aways and actionable items were compiled following the visits and shared with our Children and Families Section. Input gleaned during these visits is also helping to shape the focus of training and technical assistance opportunities being planned for 2024, as well as BaM curriculum adaptation efforts and evaluation form updates that have been kicked off since the fall visits.  

 

New training and implementation resources were added to the existing KPCC partner-only website during FFY2023. Upon release of the 2021 updated BaM curriculum by March of Dimes (MOD) in Spring of 2022, all curriculum handouts were reviewed, and updates were made to Kansas supplemental handouts, including updated MOD, Maternal Warning Signs (MWS) and COVID-19 handouts. These handouts were posted to the website in July 2022 with mass printing of the updated curriculum for all Kansas program sites occurring in the fall. The updated curriculum was distributed to sites in November 2022, with full implementation occurring by January 2023. Work has also been in progress to fully align English and Spanish curriculum resources to assure equivalent supplemental resources are available in Spanish. P/I Consultants have been working with local programs serving a high number of Spanish speaking participants to glean input on these adaptations. Updated session PowerPoints, lesson plans and activity plans were posted to the website for implementation January 1, 2023, following addition of content and resources requested by local sites during the August 2022 site visits. Annual updates to these implementation resources are again underway for a planned January 1, 2024 implementation date. 

 

KPCC Model Support and Expansion: 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, as well as offering additional services and mechanisms to support the work of communities who’ve been historically disenfranchised and marginalized. KDHE’s Title V commitment to this model is greater than just increasing the number of KPCCs across the state; rather we support the model by strengthening the perinatal collaborations within local communities, as well as growing the programs and initiatives they implement in response to their local data, direct experience, and identifying areas of focus. Much work was done throughout this reporting period to help reinvigorate collaborative efforts that suffered greatly during the pandemic. Fallout from the pandemic left local coalitions/collaboratives struggling to survive. Efforts in the past year focused on learning more about each community’s systems, programs, efforts, and challenges, and as needed, assisting with the reengagement and commitment of collaborative partners. 

 

Compilation and development of resources for regional and statewide implementation of KPCCs continues, which ensures 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, with the full website redesign and expansion under development. The KPCC infographic, accessed from the KPCC website, was developed to aid communication and recruitment for new communities. 

 

Each community is unique in its population, services, and challenges. Furthermore, development of the KPCC model seeks to create individualized support melded with a group-setting focused conversation that facilitates connection to, and/or development of, programs, services, resources, and technical assistance. As well, strategic education about, and connection to, alternative community care providers, such as community-based doulas and Community Health Workers, is integrated into the model, as these providers serve as the arms and legs of a community, often having a trusted connection to the families they serve, often resulting in more positive health outcomes when their support is involved. 

 

Addressing Disparities in Access to Prenatal Care and Education: 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 5.6 in 2018-2022. The Saline County infant mortality rate has decreased from 9.0 infant deaths per 1,000 live births in 2005-2009, to 7.0 in 2018-2022. 

Data from the 2022 BaM Aggregate State Report highlights the program’s reach of disparity populations (see BaM Infographic), which is a target of Kansas Title V services. 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 all Kansas mothers but are particularly targeted at disparity populations. Interestingly, with implementation of virtual sessions during and since the pandemic, the number of higher educated and privately insured participants has grown drastically, contributing to a bit of a shift in the demographics of the population served. 

  

While virtual prenatal education became a necessary option during the COVID-19 pandemic, evaluation efforts and anecdotal evidence has supported its continuation as a mainstay option in most communities due to it improving program access. While resources and guidance documents for virtual implementation, including online data collection and guidance for virtual screening for perinatal mental health, were developed and disseminated during 2021, resources continue to be built upon, including a SMS text version of evaluation forms that will be piloted with BaM programs starting January 1, 2024. These infrastructure components are continuing to be improved, supported, and grown, to reach populations where programming and services are not currently available locally. As part of these efforts, during FFY2023, the Sedgwick County BaM program (locally branded as “Baby Talk”) began a partnership with Aetna, a managed care organization, to begin offering the BaM program virtually to any pregnant Medicaid member who resides outside an existing BaM service area in the state. Since this is a new partnership, more will be reported on in the next reporting period. Additionally, this local grantee has continued to partner with the Wichita Black Nurse Association to increase Baby Talk’s reach and relevance in Wichita’s Black communities.  

  

To help facilitate greater utilization and ease of access to BaM programs across the state, an online referral form has been created. To view this online referral form as well as a map of existing sites and local contact information, visit the KPCC Participating Communities webpage. 

 

Additional efforts to address disparities in access to prenatal care and education are described in the Cross-Cutting Report under the Social Determinants of Health Initiatives section. In this location, you can learn about curriculum adaptations/ development for use across other ATL program models, service settings and with special populations (I.e. virtual format, low-literacy and non-English speaking immigrant populations, etc.) through our BaM Health Equity Opportunity Projects (HEOP) that kicked off in July 2023. 

 

Local MCH Agencies: The following are examples of how some of the local MCH grantee agencies have made progress toward Objective 1.3 during the reporting period.    

• Finney County Health Department provided one-on-one prenatal education to 82 clients at the time of positive pregnancy test and at a community baby shower. 
• Northeast Kansas Multi-County Health Department provided prenatal support and education at 313 visits.  
• Riley County Health Department met or exceeded multiple goals related to their Becoming a Mom program.
  • All Spanish speaking clients on the Riley County Perinatal Grant attended BaM classes. The Riley County Perinatal Grant provides prenatal care for those in the community who are pregnant, do not have access to health insurance and meet income criteria. The grant will pay for all or a portion of the cost for prenatal care (1 time use). 
  • BaM classes were offered in a hybrid format (virtual/in-person) and 120 participants attended 36 classes.
    • The number of BaM participants increased from the previous year.
    • The proportion of clients referred by Women’s Health Group that enrolled for services and received care coordination was 21.4% which is a success when compared to only getting 2 or 3 referrals a year prior.  

• Saline County Health Department recruited the Salina Regional Health Center Birth Unit Director to facilitate session 3 of BaM. This aligns with Kansas Perinatal Community Collaborative model of service delivery. They also presented a service delivery plan to Republic County Hospital as a step toward providing BaM to Republic County residents.  

 

Pregnancy Intention Screening Initiatives 

Objective 1.4: Increase the proportion of women receiving pregnancy intention screening as part of preconception and interconception services. 

 

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 our state in both clinical and non-clinical settings. The workbook was designed with the intention of using the tool in a variety of settings where providers have varying degrees of opportunity to work through the workbook with a woman. For example, a case management or home visitation service provider can be revisited 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 a variety of settings including physician offices, safety net clinics, home visiting with parent educators, 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. In the coming year, the workbook, along with the Well-Woman Visit Toolkit, Preconception Guide (Prenatal Syphilis Screening, Staging, Treatment, and Monitoring for Congenital Syphilis) will be key components for training related to the well-woman visit. Materials will be integrated into promotional efforts for National Women’s Health Month, Black Maternal Health Week, the KPQC Fourth Trimester Initiative (FTI) as well as applicable webinars and trainings for MCH and Title X providers.

 

LARC Toolkit:  Title V continued its collaboration with Title X and other state partners to increase access to LARCs for women, including continued implementation of the LARC Integration Toolkit. However, barriers to accessibility of LARC have been identified including gaps in areas where LARC’s or LARC providers are available, and attitudes towards LARC by women and prescribers throughout the state. More work needs to be done in the assessment and implementation of contraception counseling and pregnancy intention throughout the state at consumer and prescriber levels. 

 

Local MCH Agencies: The following are examples of how some of the local MCH grantee agencies have made progress toward Objective 1.4 during the reporting period. 

• The Jefferson County Health Department home visiting nurse attended training on pregnancy intention screening and has increased the recorded instances of women receiving education on Preconception/Interconception Health and Reproductive Health from 0 instances in 2022 to 58 and 59 instances in 2023.  
• Lawrence-Douglas County met their goal of having 75% of all subsequent births to enrolled program participants occur at least 24 months after the parent’s previous birth. Upon enrollment into the program, pregnancy intention screening was used to guide conversation that encourages intentional family planning. The conversations included education on maternal health, birth spacing, and contraception methods. Of the 45 families enrolled in the home visiting program, only one had experienced a subsequent pregnancy and the children were born 20 months apart.  
• Riley County Health Department achieved the following progress on their goals: 
  • Posted social media messages to increase awareness of post-birth warning signs and pregnancy intention.  
  • Provided 256 instances of preconception/interconception health education during multiple appointments before, during and after pregnancy, an increase from 214 in 2022. 
  • Reviewed and discussed the Reproductive Life Plan with 308 clients at the postpartum visit. 651 instances of reproductive health education were provided in 2023, an increase from 484 in 2022. 
• Shawnee County Health Department staff assessed for pregnancy intention at all postpartum visits (n=95). 

 

Other Women/Maternal Initiatives 

 

Count the Kicks® (CTK) Stillbirth Prevention Initiative: Title V began the fifth year of formal partnership with Healthy Birth Day to continue the Count the Kicks (CTK) campaign to prevent stillbirth through provider and patient education around monitoring fetal movements during the 3rd trimester of pregnancy. CTK educates providers and patients about monitoring fetal movements during the 3rd trimester of pregnancy and teaches mothers the importance contacting their provider right away if they notice a change in patterns. We continue to promote and utilize the KS-specific version of the CTK app with four follow-up questions that connect mothers directly with resources in Kansas (1-800-CHILDREN) based on expressed needs and concerns.  

 

The CTK campaign provided 120 toolkits across the state at no cost to maternal care providers, and provided access to videos and educational materials, including posters, brochures, and magnets in English and Spanish. Toolkits contained low literacy materials and Kick Counting wristbands for individuals who may not have internet/data to access the Count the Kicks App, and were distributed to home visitors, WIC offices, maternal care providers, and faith leaders across the state.  

 

Compared to the previous year, the number of Count the Kicks materials ordered increased by 37%. Count the Kicks fulfilled 182 orders throughout the span of the work, and 38,385 materials in the last year. Kansans completed 776 app downloads and made 10,516 visits to the Count the Kicks website. Additionally, Google Ad displays engaged 15.8K clicks, social media reach engaged 2,217 clicks reaching 71,246 users and making 400,155 impressions. 
 
Kansas Baby Save Press Release:

 

 

Every year in the U.S. an average of 21,745 babies are stillborn according to the CDC. The CDC also reports an average of 190 babies are stillborn each year in Kansas. Through this collaboration, the organizations hope to reduce the stillbirth rate in Kansas by 30% as they have seen in Iowa, which would save approximately 61 babies in the state each year[2].

 

Black Maternal Health Statewide Interviews: Title V awarded a contract to Wichita State University to solicit feedback from Black mothers about their pregnancy, delivery, and postpartum experiences to better identify barriers to care and gaps in services to inform policies and programs. The goal of these interviews was to facilitate conversations and record the perspectives of Non-Hispanic Black mothers in Kansas regarding the following: 

• 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 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

 

The interviews began in early summer of 2021 and the final report and subsequent presentation of the findings was to conclude by May 2022. However, because the scope of the project was smaller than anticipated (limited interviews were held in lieu of focus groups due to difficulties in recruitment) Kansas Title V staff was not able to release the report and has instead continued to connect with Black-led maternal health organizations across the state to identify areas for collaboration. 

 

Blood Pressure Monitoring: Based off data from the Kansas Maternal Mortality Review Committee (KMMRC) hypertensive conditions in pregnancy and the postpartum period are a significant contributing factor to maternal morbidity and mortality in Kansas.  In response, Title V had planned to collaborate with home visiting and Kansas Perinatal Community Collaboratives across the state to implement a pilot blood pressure cuff project to provide eligible pregnant persons access to blood pressure cuffs to be utilized in the home setting at little to no cost. However, Title V was waiting on the release of the statement on screening for hypertensive disorders of pregnancy from the U.S. Preventive Services Task Force before proceeding. This statement was released in September 2023 and the Title V team will revisit the potential of this project in the coming year.   

 

Maternal Anti-Violence and Information Sharing (MAVIS): KDHE continues work on the federally funded competitive Maternal Anti-Violence Innovation and Sharing (MAVIS) grant with the specific goal to reduce violent maternal deaths (homicide, suicide, poisoning/overdose). This grant funding has supported the Maternal Mortality Review Committee through epidemiology, expert consultation, and state-wide collaborative training. The CDC maternal mortality review process is such that robust case-reviews are somewhat stipulated by pregnancy-relatedness and manner of death. MAVIS funding enables the sub-committee to fully review violent deaths irrespective of the pregnancy-relatedness. The information garnered through the subcommittee has informed ongoing adjustments to programmatic work, including education and awareness on the proliferation of fentanyl, healthy relationships, and social determinants of health. This year, MAVIS funded expert training for community-based professionals and birth-setting based professionals. The recorded trainings that occurred during this grant year will be available on an ongoing basis and CME’s/CEU’s will be made available for attendees to support sustainability on this important topic. Promotional information is as follows:  
 

• From ACEs to Promoting Positive Experiences: Training for Home Visitors Audience: home visitors, social workers, and community health workers only. In this virtual session, trainer Rebecca Levenson guided attendees through the impact of ACEs on health and introduce new frameworks for mitigating harm. Attendees learned more about the Healthy Outcomes from Positive Experiences (HOPE) framework and how it can be used by home visitors in their work with parents and children.
• Impacts of Intimate Partner Violence (IPV) on Maternal Health and Pregnancy: Training for Birth Centers. Audience: nurses (APRN, RN, LPN), physicians, physician assistants, and other health professionals working with patients in maternal and reproductive health only. In this virtual session, trainer Rebecca Levenson described how intimate partner violence can affect maternal health and pregnancy. Attendees become familiar with new strategies for addressing IPV with patients. The significance of partnership and collaboration on this important topic cannot be understated. Collaboration between multiple programs and grants have provided educational opportunities across the state. Challenges in the critical piece of relationship building between partner organizations independent of MCH facilitation has been difficult. In August of 2023 the Kansas Coalition of Sexual and Domestic Violence hired a MAVIS Coordinator with extensive experience as a birth doula. KDHE is anticipating robust and collaborative work in the upcoming grant year. The MAVIS Coordinator initiated efforts to offer the Future’s Without Violence recorded trainings for CME’s /CEU’s on a recurring basis and in a few short months has been an active participant in taking steps to reduce harm, including the introduction of fentanyl test strips, Narcan and medication lock boxes across the state at advocacy shelters.

 

Maternal Health Innovation Grant: In FFY23, the Maternal Health Innovation Grant funding opportunity was released. Interested in increasing work and capacity in this area of maternal health, Kansas Title V took leadership on applying for this opportunity. Building on existing partnerships and the work of the Kansas Maternal Mortality Review Committee (KMMRC) and Kansas Perinatal Quality Collaborative (KPQC), the Title V Team proposed the following goals: 

• By Sept. 29, 2024, the Maternal Health Task Force (MHTF) will have developed a draft strategic plan to improve maternal health, including addressing identified health disparities and other gaps and incorporating activities outlined in the State Title V needs assessment. 
• By September 29, 2024, annual maternal health data will be used to report on and implement culturally and linguistically appropriate and innovative approaches to address identified needs and disparities. 
• By September 29, 2024, an annual report will be submitted to HRSA that documents and reports on maternal health indicators and outcomes disaggregated by maternal race/ethnicity, age, level of education, health insurance coverage, and geographic location (urban/rural).  
• By September 29, 2025, the established MHTF will update and finalize the Maternal Health Strategic Plan by increasing the number of actionable recommendations based on state-level maternal health data and will submit a final strategic plan to HRSA. 
• By September 29, 2028, the number of innovative approaches for replication and scale-up to improve maternal health will be increased. 
• By September 29, 2028, innovations focused on addressing existing maternal health disparities within the state will be evaluated and supported. 

 

Proposed grant activities included surveys, strategic planning, training, education, and outreach for providers and partners on the continuum of maternal health services, family engagement, and other activities deemed necessary by data from the KMMRC reviews and review of SMM data. These activities were proposed to be identified and lead by the KS MHTF with partnership from the KMMRC and Kansas Title V. Kansas received a notice of award for this grant and has begun the process of launching these activities.

[1] Cohen, D., & Coco, A. (2014, January 1). Do physicians address other medical problems during preventive gynecologic visits?. American Board of Family Medicine. https://www.jabfm.org/content/27/1/13.long.

[2] Number based on 5-year average stillbirth rate (201-2021), multiplied by the 32% reduction seen in Iowa. Stillbirth data is from CDC Wonder. Note stillbirth rate is calculated by: Fetal Deaths/Total of Live Births  + Fetal Deaths*1,000.