Kansas Title V is focused on assuring that infants and families have support from strong community systems to optimize infant health and wellbeing. The Kansas Perinatal Community Collaboratives (KPCCs), described in the Women/Maternal narratives, provides a framework for an evidence-based community model that helps make connections before, during and after pregnancy and coordination across and within those community systems to advance health and well-being for Kansas babies. The objectives within this priority are focused on the reduction of maternal and infant mortality, supporting healthy development practices – like breastfeeding, safe sleep habits, and supporting mom and baby with information, resources, and referrals. Success in these areas is likely due to the community connections found within KPCC’s and MCH universal home visiting programs. The measures associated with this priority are:

 

NPM 5:  Safe Sleep (Percent of infants placed to sleep; (A) on their backs; (B) on separate sleep surface; and (C) without soft objects and loose bedding)

ESM:  Percent of Kansas Perinatal Community Collaboratives (KPCC) participants who placed their infants to sleep (A) on their backs; (B) in a crib/bassinet or portable crib

 

SPM 2:  Breastfeeding (Percent of infants breastfed exclusively through 6 months)

ESM: Percent of WIC non‐Hispanic black infants breastfed exclusively through six months

 

National Performance Measure 5: Safe Sleep

 

Among Kansas residents with a recent live birth in 2021,

• 82.2% reported that their infants were placed to sleep on their backs most often – rather than on their sides, stomachs, or a combination of positions. There was not enough evidence to show that this was significantly different from the prevalence in 2020 (82.3%).
• less than half (47.7%) reported that their infants “always” or “often” slept alone, usually in a crib, bassinet, or pack and play, and not usually in a standard bed, couch, sofa, armchair, car seat, or swing in the past two weeks. There was not enough evidence to show that the 2021 estimate for Kansas was significantly different from the Kansas estimate for 2020 (46.1%).
• 61.1% reported that their infants did not usually sleep with blankets, toys, cushions, pillows, or crib bumper pads in the past two weeks. This was significantly higher than the prevalence in 2020 (54.8%).

 

* Indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha = 0.05 level.

Source: Kansas Department of Health and Environment, Kansas Pregnancy Risk Assessment Monitoring System (PRAMS), 2017-2021

 

In 2021, Kansas birth certificate data showed that breastfeeding was initiated for 89.4% of resident live-born infants (95% confidence interval [CI]: 89.1%-89.7%). This was comparable to the estimate reported for 2020 births (89.3%; 95% CI: 88.9%-89.6%). During the five-year period of 2017 to 2021, Kansas’ breastfeeding initiation rate increased significantly by 0.3% per year (95% CI: 0.2%-0.3%).

 

* Indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha = 0.05 level.

Note: Missing/unknown breastfeeding status and infants that died shortly after birth were excluded.

Source: KDHE Bureau of Epidemiology and Public Health Informatics, Kansas birth certificate data (Resident)

 

From the three-year period of 2016-2018, to the three-year period of 2019-2021, breastfeeding initiation rates increased significantly for two racial and ethnic groups: births among non-Hispanic Black persons (from 79.2% to 82.6%) and births among non-Hispanic White persons (from 89.5% to 90.5%) (Table 1). Births among non-Hispanic persons of other race/multiple races also experienced an increase (from 85.8% to 87.2%), but there was not enough evidence to show that the difference was statistically significant. Births to all other racial and ethnic groups experienced a decrease, including persons of Hispanic ethnicity (statistically significant decrease from 87.5% to 86.8%), non-Hispanic Asian persons (non-significant decrease from 94.1% to 93.6%), non-Hispanic American Indian or Alaska Native persons (non-significant decrease from 81.6% to 78.3%), and non-Hispanic Native Hawaiian and Other Pacific Islander persons (non-significant decrease from 80.5% to 73.9%).

 

Table 1. Breastfeeding initiation by maternal race and ethnicity, Kansas, 2019-2021 vs. 2016-2018

Maternal race/ethnicity	Initiated breastfeeding	Resident live births	2019-2021 % (95% CI)	Direction of Difference	2016-2018 % (95% CI)
Asian, non-Hispanic	3,056	3,265	93.6 (92.8-94.4)		94.1 (93.3-94.9)
White, non-Hispanic	64,786	71,582	90.5 (90.3-90.7)	*	89.5 (89.3-89.7)
Hispanic	15,688	18,083	86.8 (86.3-87.2)	*	87.5 (87.0-88.0)
Other race or multiple races, non-Hispanic	2,786	3,195	87.2 (86.0-88.4)		85.8 (84.6-86.9)
Black, non-Hispanic	5,797	7,021	82.6 (81.7-83.5)	*	79.2 (78.3-80.1)
American Indian or Alaska Native, non-Hispanic	379	484	78.3 (74.6-82.0)		81.6 (78.1-85.0)
Native Hawaiian or Other Pacific Islander, non-Hispanic	156	211	73.9 (68.0-79.9)		80.5 (74.8-86.2)
Total	92,783	104,010	89.2 (89.0-89.4)	*	88.4 (88.3-88.6)

*Statistically significant difference between the percentages for 2016-2018 and 2019-2021 (p<0.05)

CI=confidence interval

Note: Missing/unknown breastfeeding status and infants that died shortly after birth were excluded.

Source: KDHE Bureau of Epidemiology and Public Health Informatics, Kansas birth certificate data (Resident)

 

Breastfeeding initiation rates varied widely based on county of residence at the time of the birth (Figure 2). Counties with significantly higher breastfeeding initiation rates in 2019-2021 compared to 2016-2018 were:

 

Anderson	84.7% in 2016-2018, to 92.0% in 2019-2021
Atchison	77.1% to 82.3%
Franklin	83.1% to 87.6%
Hamilton	81.4% to 90.7%
Johnson	94.9% to 96.0%
Leavenworth	90.2% to 93.2%
Miami	88.6% to 91.6%
Mitchell	82.8% to 91.5%
Sedgwick	90.0% to 91.3%
Shawnee	82.5% to 84.2%
Wyandotte	86.3% to 87.6%

 

Counties with significantly lower breastfeeding initiation rates in 2019-2021 than in 2016-2018 were:

 

Bourbon	90.1% in 2016-2018, to 78.1% in 2019-2021
Lyon	85.5% to 77.5%
Republic	93.2% to 85.9%
Seward	80.8% to 74.8%

 

 

     Figure 2. Breastfeeding initiation by county of residence, Kansas, 2019-2021

 

Note: Missing/unknown breastfeeding status and infants that died shortly after birth were excluded.

Source: KDHE Bureau of Epidemiology and Public Health Informatics, Kansas birth certificate data (Resident)

 

Eleven Kansas hospitals are currently recognized as ‘Baby-Friendly Designated Facilities’ through the Baby-Friendly Hospital Initiative.1 The Citizens Medical Center in Thomas County most recently received the designation, in December 2022. Prior to this, the Northwestern region of the state did not have a Baby-Friendly Designated Facility.

 

According to the most recent National Immunization Survey (NIS), for infants born in Kansas, in 2019, 87.1% were reported as ever breastfeeding, 59.9% were reported as breastfeeding at six months, and 29.2% were reported as exclusively breastfeeding at six months.2 From birth years 2016 to 2019, there was not enough evidence to show any statistically significant change in breastfeeding exclusivity at six months of age (Figure 3). More work is needed to meet the Healthy People 2030 goal of 42.4%.3

 

Breastfeeding is linked to a reduced risk for many illnesses in children and mothers. The U.S. Dietary Guidelines for Americans and the American Academy of Pediatrics recommend exclusive breastfeeding for about 6 months, and then continuing breastfeeding while introducing complementary foods until the child is 12 months old or older. Preventative health through exclusive breastfeeding can save health care dollars through reduction in acute illnesses and chronic disease.2,3 One of the factors contributing to stopping breastfeeding earlier than 6 months may include lack of accessible breastfeeding support especially for those returning to work or school soon after birth. Breastfeeding support programs including Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Breastfeeding Peer Counselors, lactation consultants, workplace policies, and supportive communities can help address these barriers.

 

The Centers for Disease Control and Prevention (CDC) invites biennially all hospitals across the country to complete the Maternity Practices in Infant Nutrition and Care Survey (mPINC).4 The survey measures maternal care practices and policies that impact newborn feeding, feeding education, staff skills and discharge support. A Total mPINC score indicates its overall level of maternity care practices and policies that support optimal infant feeding. Subscores further categorize maternity care practice subdomains: Immediate Postpartum Care, Rooming-In, Feeding Practices, Feeding Education & Support, Discharge Support, Institutional Management. Responses are scored using an algorithm that denotes the evidence and best practices to promote optimal infant feeding within the maternity care setting. Possible scores range from 0 to100, with higher scores indicating better maternity care practices and policies. The mPINC survey results provide feedback to encourage hospitals to make improvements that better support breastfeeding. In the most recent 2020 mPINC survey, 44 of 57 eligible Kansas hospitals (77%) that deliver babies participated. Kansas scored 83/100, which was higher than the national average (81/100).5 Kansas scored higher than three out of four neighboring states - Nebraska 73%, Missouri and Oklahoma 79%, Colorado 85%.5 Kansas hospitals are doing well in the domains related to Feeding Practices, Feeding Education & Support and Discharge Support, which positively impact early initiation. However, improvement could be made in the domain of Institutional Management.

 

*The mPINC survey was redesigned in 2018. Results from the mPINC surveys 2018 or later cannot be compared with results from 2007-2015 mPINC surveys.

 

Local MCH Reach: Based on SFY2023 MCH Aid-to-Local applications received: 54 of 61 grantees selected to work on Perinatal/Infant Health objectives. Some of the grantees who reached their goals are highlighted in this report. Those who didn’t reach their goals, cited the following barriers:

• Hesitancy among clients to accept home visits because of the stigma of having a professional come to the home.
• Staff vacancies/shortages were a chronic challenge, particularly for grantees who employ RNs or social workers in a home visitor role.

 

Breastfeeding Initiatives

Objective 2.1: Promote and support cross-sector breastfeeding policies, practices, and environments to increase exclusive breastfeeding rates at 6 months.

 

Kansas Breastfeeding Infrastructure: According to the 2022 Breastfeeding Report Card from the Centers for Disease Control and Prevention (CDC), Kansas breastfeeding initiation rates are at 87.1% which exceeds the national average. Breastfeeding duration and exclusivity rates in Kansas are ahead of the national rates but far below the Healthy People 2030 goals. 

 

Continued investment and support for a cross-sector approach to increasing access to culturally affirming breastfeeding education, support, and practices are essential to improving the health and prosperity of all Kansans. Collaboration with local and state partners such as the Kansas Breastfeeding Coalition (KBC) and Kansas Perinatal Community Collaborative sites have strengthened the impact of policies, systems, and environmental changes initiated to create a culture of support for breastfeeding statewide. Kansas has also continued its commitment to addressing racial and ethnic disparities and incorporating behavioral health considerations into the promotion, protection, and support of breastfeeding.

 

The KBC continues to nurture a strong relationship with Title V to maintain effective and sustainable initiatives such as the Kansas Business Case for Breastfeeding and the Breastfeeding Welcome Here program. The KBC strives to use an equity lens to inform and guide their external work and also an “equity mirror” to examine internal structures, culture, and policies which aligns with Title V’s mission to support optimal breastfeeding practices among Black families. Several strategies have been deployed to make progress towards this goal in FY2022.

• Increasing access to lactation support by African American providers such as breastfeeding peer counselors, doulas, International Board‐Certified Lactation Consultants (IBCLC), and mid-level lactation providers that represent high-risk populations to provide culturally congruent support for women of color to initiate and maintain breastfeeding. Eight educational stipends funded by Title V and the United Methodist Health Ministry Fund (UMHMF) were awarded to individuals who self-identified as Latinx (4), Black (3), and Indigenous (1) to support the achievement of mid-level or higher lactation credentials. Title V is funding the KBC’s Color-Filled Breastfeeding: Clinical Lactation Training Program to increase the number of IBCLCs of color across Kansas. The KBC has secured four clinical sites for student placement in Wichita, Topeka, and Kansas City (2).
• Supporting the implementation of community‐centered, culturally relevant mother‐to‐mother, father, and grandparent breastfeeding support clubs for African Americans (e.g., Black Breastfeeding Clubs, Brown Baby Brigade, BSTARS, Reach our Brothers Everywhere, Fathers Uplift, Grandmothers Tea Project) in order to build capacity and develop sustainable communities of support for breastfeeding families of color. Title V funding supported three stipends to support Chocolate Milk Café facilitators in Wichita, Topeka, and Kansas City. Additional culturally congruent breastfeeding support resources for Black, Hispanic, and Indigenous families are maintained on the KBC Resources page.
• Broadening the establishment of breastfeeding coalitions for African Americans that connect health care providers and the community to local information and resources (e.g., African American Breastfeeding Coalition of Wyandotte County) to foster a culture of change within communities. Title V funding supported five stipends to local leaders of Black Breastfeeding Coalitions in Topeka, Wichita, and Kansas City; a Latinx Breastfeeding Coalition in Southwest Kansas; and an Indigenous Breastfeeding Coalition in Kansas.

 

Title V continues to work with a variety of partners and programs to enhance the protection, promotion, and support of breastfeeding in Kansas.

 

Communities Supporting Breastfeeding (CSB): Title V has continued to support the KBC’s work to establish CSB. The Kansas CSB program has received state and national attention and was selected as an Emerging Practice for AMCHP’s Innovation Station (2016) and was featured in AMCHP’s NPM 4 toolkit (2019). The CSB is also included in the Kansas Health Matters database of promising practices. CSB is a designation from the KBC that recognizes communities that are building a culture of supporting breastfeeding utilizing a collaborative multi-sector approach by engaging stakeholders from public health, hospitals, early childhood development, and businesses through partnerships with local breastfeeding coalitions. The goal of a CSB community is to improve exclusive breastfeeding rates for infants at six months of age by cultivating systems of breastfeeding support.  As of October 2022, 28 communities had achieved the CSB designation with support from KDHE, KBC, Kansas Health Foundation, UMHMF, and Prime Health Foundation. Several established CSB communities are in the process of meeting the criteria to reach the new Community Supporting Breastfeeding Plus (CSB Plus) designation. This designation expands upon the CSB foundation to include addressing diversity and new systems of support including physician offices; emergency preparedness; city and/or county governments; faith-based organizations; schools, colleges, and universities; correctional facilities, food pantries; doulas; and local health departments. The KBC hosted monthly “Office Hours” in FY 2022 to provide technical assistance to communities working toward the CSB Plus designation. The KBC also created a toolkit with resources to help guide communities as they develop strategies for implementation in their local MCH programs.

 

Local Breastfeeding Coalitions: One of the six required CSB criteria is having an active local breastfeeding coalition. Over the past 10 years, the number of local breastfeeding coalitions has increased from eight to 27 county coalitions, five regional coalitions, and five cultural coalitions covering 71 counties or 68% of the state.

 

KBC’s Local Breastfeeding Coalition Section supports local coalitions by providing networking, learning opportunities, technical assistance and fostering the formation of new coalitions. In FY 2022, the KBC’s Local Breastfeeding Coalition Section:

• Held bi-monthly meetings for local coalition leaders and advocates interested in forming a coalition to provide an opportunity for sharing and networking for 220 members.
• Hosted presentations from guest speakers with specialized knowledge in coalition building, strategic planning, and fiscal management.
• Featured success stories from local coalitions across the state and highlighted unique partnerships established by local leaders.
• Facilitated discussions on strengthening organizational viability and sustainability.

 

In addition to the Local Breastfeeding Coalition Section, the KBC supports local coalitions through:

• Additional education of training needs identified through the review of 36 Aid-to-Local grant applications that selected “Objective 2.1 Breastfeeding.” Findings were compiled for a presentation in September 2022 to Aid-to-Local grantees including resources and strategies to strengthen applications.
• Four statewide general meetings each year featuring speakers who are experts on topics of interest to local coalitions.
• Hosting the 2022 Kansas Breastfeeding Coalitions Conference drawing 194 attendees with 14 hours of education from national experts in lactation.
• Maintaining and updating the Tools for Coalitions webpage with resources such as sample coalition documents, community needs assessment templates, project ideas for local coalitions, community engagement strategies, and tools for local coalitions.

 

Activities from local breastfeeding coalitions:

• Topeka Area Breastfeeding Coalition moved their meetings online during the COVID-19 pandemic. KBC provided technical support and hosted the meetings on their business platform. As a result, a KBC Co-Executive Director was able to regularly participate in meetings and offer guidance to increase the sustainability of the local coalition.
• Ford County Breastfeeding Coalition transitioned to an online breastfeeding support group to maintain the CSB criteria as COVID-19 shut down in-person meetings. The “Dodge City Area Breastfeeding Support Group” is moderated by several local leaders holding lactation credentials and offers peer support through its membership. The group currently has 575 members which benefits from materials and resources provided by the KBC’s Local Coalitions Toolkit.

 

Addressing Breastfeeding Disparities: MCH and KBC continue to focus on disparities in breastfeeding. The KBC translated materials into Spanish including the Feeding Tips for Breastfed Babies card, Breastfeeding 911 card, Breast Pump Bag Tag, and the Kansas Public Breastfeeding Law card which are available to order for free through the KBC Online Supply Order Form.

 

Child Care Provider Training: To support breastfeeding families using evidenced-based practices, partnerships between Title V, KBC, Child Care Licensing and Kansas Child Care Training Opportunities (KCCTO) provide an online course for childcare providers at no cost each month. During the reporting period, 410 childcare providers completed the online 2-hour course “How to Support the Breastfeeding Mother & Family.” This course was translated into Spanish with support from Child Care Aware of Kansas. The KBC provides a Spanish speaking instructor for the course and eight (8) people have completed the Spanish language course in FY 2022. Over 5,100 childcare providers have completed the training since its launch in June 2013, most through an online course hosted by KCCTO and taught by the KBC. During the reporting period, the KBC Child Care Section met bi-monthly and includes 94 members. The Breastfeeding Friendly Child Care Provider toolkit was reviewed and updated.

 

The Business Case for Breastfeeding assists employers in providing worksite support for breastfeeding employees and creating a breastfeeding friendly worksite through education and resources. As of October 2022, 362 employers across Kansas had received the “Breastfeeding Employee Support Award” which recognizes employers in Kansas that provide levels of support for breastfeeding employees: Gold, Silver, and Bronze. Four Gold level awards were given to employers in FY 2022.

 

COVID-19 Breastfeeding Guidance: Throughout the pandemic the Title V Perinatal/Infant Clinical Consultant has created and published public guidance on breastfeeding for providers and mothers and can be found on the KDHE COVID-19 Resource Center. The guidance is updated regularly based on the latest recommendations from the American College of Obstetricians and Gynecologists, and the CDC among others. The KBC continues to maintain their “COVID & Breastfeeding” webpage with information about COVID-19. The KBC also launched the “Protect Yourself, Protect Your Baby” campaign funded by an Increase the Reach grant through the CDC of the U.S. Department of Health and Human Services (HHS) to support safe learning environments for breastfeeding families to engage local health providers in open discussions to explore COVID-19 vaccine hesitancy.

 

KBC Partnership Activities: Title V collaborated with the KBC, UMHMF, and WIC to expand the High 5 for Mom and Baby program (funded and administered by the UMHMF) by increasing the number of hospitals trained and implementing the program. A total of 41 Kansas birthing facilities demonstrated their commitment to supporting breastfeeding success by participating in High 5 activities. A total of 19 hospitals have achieved High 5 for Mom & Baby program recognition. In addition, 22 hospitals have achieved High 5 for Mom & Baby Premier designation. The KBC also continues to host bi-monthly Hospital Section meetings for 114 members working in the hospital setting to provide peer support and technical assistance to those working towards implementing best practices for breastfeeding support.

 

Breastfeeding Education & MCH Workforce: The KBC provides ongoing education to communities, including the MCH workforce. An overview of key presentations offered throughout the reporting period are depicted below.

 

 

The following are other activities supported through expanded capacity funded by MCH that took place during the reporting period.

• Issued the 2022 State of Breastfeeding in Kansas Report.
• Updated the Breastfeeding Support by Kansas County database.
• Exhibited at:
  • Heartland Equity Conference and Kansas Birth Equity Summit
  • Heartland Labor and Employment Law Conference
  • Kansas Community Health Worker Symposium
  • Kansas Association of Infant Mental Health Conference
  • Kansas American Academy of Pediatrics Spring CME Meeting
  • Governor’s Public Health Conference
  • Kansas Society for Human Resource Management Conference
  • League of Kansas Municipalities Annual Conference
• Co-presented with the Kansas WIC State Breastfeeding Coordinator at the 2022 National WIC Association Conference. The session was Synergy in Kansas: The Story of a Relationship between a State WIC Agency & a State Breastfeeding Coalition.
• Sponsored Dr. Joan Meek, lead author of the AAP’s Policy Statement “Breastfeeding and the Use of Human Milk”, to host Grand Rounds at Wesley in Wichita and facilitated her speaking at the Kansas AAP CME meeting.
• Facilitated and hosted USDA’s Breastfeeding Training for all Kansas WIC staff.
• Facilitated workgroups/Sections to advance breastfeeding in childcare, local breastfeeding coalitions, hospitals, and public health.

 

KBC also maintained a statewide Local Resources Directory to allow families and other breastfeeding advocates in communities to find local breastfeeding support by entering their zip code. A Google map is populated with breastfeeding resources from a wide variety of sources to include health departments, hospitals, private practice lactation consultants, peer breastfeeding support groups and walk-in clinics. The range of the search can be enlarged to encompass a larger area if the family is willing to travel. This resource is promoted through a business card with a QR code, a tote bag with a QR code, and full URL to the page. Thousands of these cards and tote bags have been distributed to community level partners.

 

MCH-WIC-KBC-Becoming a Mom® (BaM) Program Collaboration: Working together collaboratively across WIC, MCH, and BaM, as well as with community partners such as local hospitals and birthing centers, breastfeeding coalitions, and La Leche League groups, along with support from KBC, much progress is being made to improve breastfeeding initiation and continuation rates in Kansas. MCH Home Visitors are working alongside WIC Breastfeeding Peer Counselors (BFPC) and BaM facilitators to provide breastfeeding support to individuals in their homes and in group and clinic settings in both the prenatal and postpartum periods. The State WIC Director continues to promote and support local WIC staff to collaborate as BaM session facilitators, while also allowing local WIC budgets to include BaM incentives that support good nutrition and breastfeeding practices. This collaboration continues to be an integral component to local BaM program implementation and supports easy access and dual enrollment in both programs.

 

KBC reviews and updates the BaM Infant Feeding session curriculum annually. The 2022 revisions included the updated AAP’s recommendation for continued breastfeeding through two years of age or longer as mutually desired, which aligns with the World Health Organization’s recommendations. Alignment with the Kansas Baby-Friendly Hospital efforts continues to occur, assuring the curriculum meets Baby-Friendly Hospital requirements. Work was completed in early 2019 to produce a recorded training webinar for the Breastfeeding Integration Toolkit that is provided as part of the online resources for local program sites through the BaM private website. This addition reduced reliance on in-person training, thereby promoting greater long-term sustainability of efforts, and prove to be vital as local programs face significant staff turnover due to the pandemic. BaM resources continue to be made available to WIC and MCH programs in counties across the state where KPCC/BaM sites are not in place.

 

According to the 2021 BaM State Aggregate Report, initiation rates were 93.4% (higher than the 89.4% state rate, according to Kansas Birth Certificate data, 2021), which we feel is reflective of efforts by KPCC partners to provide extensive education and support around this priority. See data below reflecting the significant improvement in confidence of BaM participants in their ability to breastfeed and their knowledge of available breastfeeding support resources pre to post intervention, two significant variables effecting breastfeeding initiation and continuation rates.

 

 

 

 

Additionally, data consistently show the BaM Infant Feeding session as one of the highest ranking in “helpfulness of the session”, with 94% rating it between very (36.5%) and extremely (57.7%) helpful. Although breastfeeding initiation rates across the state have improved steadily in recent years, there is continued work to be done to improve continuation and exclusivity rates at six months. KPCC partners around the state have acknowledged a lack of a structured follow-up process for the offering of support at targeted points following the initial postpartum home visit and lack of a system for data collection related to tracking continuation rates. In response, the P/I Health Consultants have requested KBC partners to present on “building a continuum of care” specific to breastfeeding support, to set the stage for ongoing conversation and presentations during the KPCC Conference scheduled for November 2022.

 

Local MCH Agencies:

• The Geary County Breastfeeding Coalition hosted a community gathering in honor of World Breastfeeding Week.

 

 

• The Topeka Area Breastfeeding Coalition hosted an educational session titled “Trauma & Breastfeeding” for health care providers, lactation support providers, and breastfeeding advocates. This educational session was supported by a KBC mini grant.

 

 

• The Ford County Breastfeeding Coalition hosted their 6th annual Baby Expo in July 2022 as their first in-person event since the COVID-19 pandemic. The event was attended by over 125 families and hosted over 30 vendors including community partners and small local businesses. The Baby Expo continued its tradition of a “Latch On at High Noon” photo to promote public breastfeeding. Many coalition members who supported the Baby Expos are Ford County WIC and Ford County Health Department staff whose time is supported by KDHE.

 

 

 

• Delivering Change (TPTCM agency) reported that Navigators talked with all their clients about services available to them, including BaM prenatal education classes, hosted by Delivering Change. Each client was offered enrollment into BaM during this initial conversation, and during subsequent monthly meetings. The Navigator talked about the importance of these classes and how they would be beneficial to clients regarding understanding prenatal care, along with parenting education. The agency offered BaM both in person and virtually, due to the ongoing pandemic. During prenatal visits with clients, Navigators also provided education about Safe Sleep, including why safe sleep is important to practice, how to practice safe sleep, along with identifying a safe sleep environment. Navigators ensured that clients understand the ABCs of safe sleep and have a safe sleep environment prior to delivering. Furthermore, each TPTCM client was invited to attend Luke’s Community Baby Shower, a virtual event hosted by Delivering Change in November 2021, where participants learned about safe sleep, practicing safe sleep, benefits of breastfeeding and smoking cessation as it relates to SIDS reduction.

 

The MCH Universal Home Visiting program provides education and support related to breastfeeding initiation, exclusivity, and duration. MCH state staff have explored a collaborative effort with WIC state staff to increase the number of MCH Home Visitors who are also Breastfeeding Peer Counselors. Several communities in the state hosted community baby showers to promote breastfeeding, safe sleep, and to connect pregnant women and their support persons with community resources. KBC Co-Executive Director exhibited at the Gray County Community Baby Shower. The KBC also provided breastfeeding resources and materials to local breastfeeding coalitions to exhibit at the Hodgeman County and Topeka Community Baby Showers.

 

Safe Sleep Initiatives

Objective 2.2: Promote and support safe sleep practices and cross-sector initiatives to reduce the sudden unexplained infant death (SUID) rate.

 

KIDS Network Infrastructure & Family Support: Title V continues to focus on reducing Sudden Unexpected Infant Death (SUID) rates through safe sleep education and professional trainings/resources offered to local MCH agencies, home visiting programs, hospitals, childcare facilities, and other providers to support safe sleep practices and accurate, consistent safe sleep messages across all sectors in a community. Consistent and current safe sleep education and messaging is critical as we strive to eradicate unsafe sleep practices. Title V has maintained a contractual partnership with the Kansas Infant Death and SIDS (KIDS) Network to reduce infant mortality, specifically with a focus on continued implementation of a comprehensive statewide safe sleep approach.

 

Safe Sleep Network Infrastructure: Title V provides organizational infrastructure support for the KIDS Network Executive Director and support staff. Safe sleep education and promotion is the predominant focus of the Network’s outreach activities, including Safe Sleep Community Baby Showers, Safe Sleep Instructor (SSI) certification trainings, Crib Clinics, dissemination of Safe Sleep education materials and tools (such as, safety approved cribs and wearable blankets), and other health and childcare provider education/training opportunities.

 

In FY2022, the KIDS Network, in collaboration with their certified SSIs and other partners, assisted 33 Kansas counties in implementing their “Safe Sleep Strategy” to reduce infant mortality. This includes: 49 Safe Sleep Instructor Certifications, 23 Community Baby Showers, 97 Crib Clinics, Safe Sleep Trainings to 67 Parent/Caregivers and 56 Professionals (through Safe Sleep Hospital Certification, Provider Safe Sleep Star Program, and the Provider Outpatient Toolkit trainings). These initiatives are instrumental in providing shared safe sleep messaging and education across the state.

 

 

 

A total of 27,601 individuals were trained on safe sleep and bereavement through presentations at hospitals, universities, online education system (KS Train), conferences, and outreach activities including professional meetings, community events, social media and KIDS Network events (e.g., Susan E. Bredehoft Candle Lighting, Haley's SIDS Scramble, Step Up for KIDS). Due to continuing health concerns related to COVID-19, health and safety restrictions remained in place to limit transmission of the virus; thus, trainings were held in-person (n=94, 76%) and virtually (n=29, 24%).

 

Safe Sleep Instructor (SSI) Program: Each year, the KIDS Network hosts two SSI Certification Trainings to certify professionals and caregivers as educators on safe sleep best practices. The curriculum was developed based on the updated 2022 American Academy of Pediatrics (AAP) recommendations and updated annually based on current research and recommendations. Topics discussed in this training include diagnosis and disparity of sleep-related deaths, including sudden infant death syndrome (SIDS), Accidental Suffocation and Strangulation in Bed and undetermined causes of infant death. Training planning with SSI faculty began in the summer of 2022, with monthly meetings. The updated AAP Safe Sleep Recommendations were released in July 2022. Materials including presentations, handouts, the workbook, and evaluation tools were updated to reflect the most recent AAP recommendations. Changes included but were not limited to recommendation for non-inclined sleep surface; utilization of inclusive language (e.g., breast or chest feeding); expansion of “why” behind recommendations; and risks of bedsharing based on infant/parent characteristics. Topics addressed included diagnosis of sleep-related deaths, including SIDS; data trends and disparities in sleep-related infant deaths; safe sleep location, surface, environment, and position; risks of smoking and protective quality of breastfeeding; recommended practices related to temperature regulation and pacifiers; messaging strategies; maternal mental health; and details on the 2022 recommendation changes compared to the 2016 recommendations. Attendees learned to provide a 1-hour safe sleep training, a Safe Sleep Crib Demonstration, and host a Safe Sleep Community Baby Shower or Crib Clinic. Instruction was also provided on data collection, data entry, and grant writing. Following training, SSIs are certified (three levels – Gold, Silver, Bronze) to educate parents/caregivers, childcare providers, health care providers and other members of their communities about safe sleep practices.

 

 

KIDS Network continues to provide technical assistance to SSIs to ensure consistent messaging and continuity of existing supports. FY22 SSI certification trainings were provided in-person to assure the continuation of efforts as pandemic precautions ensued training faculty continue to implement the following COVID-19 safety guidelines: Recommended mask wearing; assigned seating, with 6 ft. between individual seating locations; hand sanitizer; prepacked lunch and snacks; routine cleaning of the training area. Enrollment was reduced to 50% usual capacity to allow for adequate social distancing. The smaller cohort also allows SSI faculty to better facilitate small group discussions and hands on activities.

 

In addition to updating all SSI certification training materials, the KIDS Network also updated the SSI web portal, videos, posters, crib cards, postcards, and social media pages. The executive director presented at numerous conferences and workshops updating state agencies, public health entities, hospitals, early childhood programs and child abuse prevention programs across the state on the updated safe sleep recommendations.

 

Community Baby Shower (CBS) Model: This model goes beyond the traditional health fair by providing education, service access and data to measure the effectiveness of the strategy. A memorandum of understanding was established by the BFH, KIDS Network, KBC, and the Bureau of Health Promotion/KS Quitline to collaboratively support the CBS model statewide through staffing, education, and the provision of resources and referrals. This brings together key lead agencies to help provide consistent safe sleep messaging and comprehensive services to a greater reach of perinatal people and their support individuals. This multi-agency approach also supports cross-sharing of accurate and reliable information related to safe sleep, breastfeeding, mental health, and tobacco cessation. Goals established for each of these priority areas include:

• Safe Sleep: increase education and adherence of safe sleep practices (e.g., back position only, safe location, no unsafe items in bed)
• Tobacco Cessation: identify three or more ways to avoid secondhand smoke; identify at least three tobacco cessation resources
• Breastfeeding: increase confidence in ability to breastfeed for at least 6-months; identify at least three resources for breastfeeding support
• Maternal Mental Health: increase understanding of perinatal mood and anxiety disorders (PMADs) as a potential complication of pregnancy and the postpartum period; identify strategies for reducing PMAD symptoms; identify at least three external resources for PMAD support

 

A total of 968 individuals attended these CBS events. Of those, 675 pregnant or postpartum people were educated about safe sleep, breastfeeding, maternal mental health and tobacco cessation through demonstrations at KIDS Network Safe Sleep CBS/Crib Clinics. Kansas Pregnancy Risk Assessment Monitoring System (PRAMS) data shows improvement of infants being placed to sleep “mostly on the back” from 80.2% in 2017 to 82.2% in 2021, suggesting that the years of safe sleep collaboration and work is resulting in positive change. During the pandemic, many communities began offering local CBS events virtually. KIDS has provided support and technical assistance to local SSIs on adapting this model to a virtual format. Review of evaluation results from this format was completed to determine its effectiveness and practicality for continuation beyond the pandemic. Although in both event formats most participants reported being more confident regarding safe sleep practices, avoiding secondhand smoke, breastfeeding, their ability to follow safe sleep recommendations even when receiving conflicting advice, and recognizing the signs and symptoms of perinatal depression or anxiety, the data showed less posttest response from those attending virtual crib clinics. Further interpretation of results indicate that virtual events may also further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated have been addressed through in-home visits for delivery of the safety-approved crib and wearable blanket. QR codes have also been designed to ease the completion of both pre and post-tests.

 

The SSI training is also being evaluated using the RE-AIM framework. Reach, effectiveness (R-E) and maintenance (M) are evaluated at SSI certification trainings and recertification webinars. Outcomes related to adoption and implementation (A-I) are assessed following the trainings. To enhance the success of future SSI Trainings, the following action steps have been

implemented:

 

Hospital Safe Sleep Certification Program: The Safe Sleep Hospital Certification initiative was developed by Cribs for Kids to identify and recognize hospitals that demonstrate a commitment to community leadership for best practices and education on infant sleep safety. SSIs who complete all training requirements can participate in the Safe Sleep Hospital Certification Program to promote safe sleep education in hospitals and hospital systems.

 

 

Safe Sleep Star Outpatient Toolkit – SSIs who complete all training requirements can participate in the Safe Sleep Star Program to promote safe sleep education in outpatient clinics (e.g., obstetrics, pediatrics, family medicine).

 

The Safe Sleep Star Outpatient Toolkit was launched in FY18 to address infant mortality by providing implementation strategies to help outpatient maternal and infant healthcare providers improve safe sleep promotion utilizing evidence-based/informed practices, including the Safe Sleep Toolkit targeted to health care providers. To maintain the earned stars, practices must continue to report compliance on an annual basis. Practices may upgrade their status at any time a higher level is reached. The certification program identifies three designations: bronze, silver, and gold. These are explained in the following image.

 

Limitations associated with the pandemic slowed progress with the certification program. Many clinics halted or slowed the process due to restrictions on visitors being allowed to present non-mandatory trainings. These barriers have been assessed and contact has been made with 19 clinics in 13 counties. The executive director is working with a pediatric consultant and local SSIs to increase implementation across the state.

 

Examples of impact of the above strategies and initiatives, from the FY22 Instructor-Led Training Annual Report (published July 2022) produced by the Center for Research for Infant Birth and Survival (CRIBS), KIDS Network evaluator, highlight the following changes pre-to-post education intervention evaluation:

 

 

Additional examples, from the FY22 Safe Sleep Community Baby Shower and Crib Clinic Report (published July 2022) produced by the Center for Research for Infant Birth and Survival (CRIBS), KIDS Network evaluator, highlight the following changes pre-to-post education intervention evaluation:

 

 

Kansas Perinatal Community Collaboratives / Becoming a Mom®: Training on the SIDS/Safe Sleep integration component is recorded and available online for new KPCCs preparing to implement the BaM curriculum, as well as new BaM facilitators. Annual review and updates to the safe sleep content in the BaM curriculum and associated implementation resources are made in partnership with the KIDS Network. Updates during this reporting period focused on updated guidance from the AAP, more information on the updates can be found in the Safe Sleep Instructor (SSI) Program section above. Updates to Safe Sleep posters and magnets are underway, as well as translation and creation of equivalent resources in Spanish. Printing is hoped to be completed by the end of calendar year 2022, for early 2023 distribution to KPCC sites, local Title V supported programs and partnering WIC, Title X, MICEHV, TPTCM and PMI programs. To support messaging within the BaM curriculum, program incentives align with recommendations and guidelines. Every site includes the pack-n-play crib distribution as part of the incentive-based program, which provides a safety-approved crib for expectant mothers with limited resources.

 

2021 BaM outcome data showed significant improvement in knowledge and intentions for safe sleep position (87.2% “On his/her back ONLY” to 94.3%) and location (91.0% “In a crib/basinet or portable crib ONLY” to 97.3%) following the provided education (Figures 39 and 40).

 

 

In 2020, in an effort to determine if parents/caregivers were following through with intentions expressed during their pregnancy, KDHE began gathering data on actual sleep position through participant feedback following their infant’s birth via the BaM Birth Outcome Card. This evaluation data, included in the 2021 BaM State Aggregate Report, showed even greater improvement in knowledge and intended behavior among those who initially reported an intended sleep position and location that was not recommended as safe (Figures 41 and 42).

 

 

 

 

 

Local MCH Agencies:

• Barton County Health Department’s DAISEY reports show 337 instances of Safe Sleep education provided in the reporting period. They met their goal of holding two CBS during the year. They held one at the beginning of the year and one at the end and saw increased attendance at the second event, due in part to earlier and increased promotion on social media. They partnered with the local fire department’s safe sleep instructor to provide education at the events. They also received a grant to purchase cribs and smoke detectors for baby shower participants. They educated individual clients during their 3rd trimester and gave them the book "Sleep Baby Safe and Snug". Barton County Health Department met with their local hospital to assist them with becoming a safe sleep certified facility.
• Kearny County Hospital’s DAISEY reports show 822 instances of Safe Sleep education provided in the reporting period. Education was provided during prenatal classes and one-on-one prior to discharge from the hospital. They saw an increase in patients from Eastern Colorado due to Lamar’s Hospital closing their OB unit. They are the closest delivering facility for much of Eastern Colorado within a 2-hour radius.
• Leavenworth County Health Department’s DAISEY reports show 88 instances of Safe Sleep education provided in the reporting period. There is not a hospital in Leavenworth County that provides OB care. 100% of clients were provided with Safe Sleep information during their prenatal care, which was consistent with their baseline. Education was provided both verbally and in the form of information sheets.
• Rooks County Health Department’s DAISEY reports show 9 instances of Safe Sleep education provided in the reporting period. They provided the community education on Safe Sleep through social media posts, during home visits, and during well infant appointments. They were also able to provide sleep sacks to home visiting clients. One client had moved to the area from Dallas, TX and was a new, first-time mom. She didn’t have any family around or support from the baby’s father. Health department staff helped her obtain a cell phone so she could communicate with them any time she needed assistance. She called the health department once a week to ask questions and gain reassurance.
• Sedgwick County Health Department’s DAISEY reports show 376 instances of Safe Sleep education provided in the reporting period. Their Healthy Babies home visiting program completed a safe sleep assessment with each family. Families who scored negative for a safe sleep environment were provided a pack and play, education, and a referral to meet with a Safe Sleep Instructor.
• Saline County Health Department’s DAISEY reports show 275 instances of Safe Sleep education provided in the reporting period. All clients served by MCH/BaM programs received safe sleep education to include risk factors such as smoking, drinking, illegal drug use, positioning of the infant, items in the crib, and examples of unsafe sleep environments. They presented a program on infant mortality and safe sleep on KSAL radio in October. 1:1 safe sleep crib clinics/demonstrations were provided to five mothers during this reporting period.

• Crawford County Health Department (TPTCM Agency) reports 100% of clients were offered the In Joy Videos titled "Positive Discipline" Volumes 1-3, as well as the Safe Sleep video in SFY2022. Educational material was printed and distributed to clients. The case manager provided handouts at visits on topics such as prenatal care, postpartum depression/anxiety, infant care and post maternal warning signs to name a few. The agency also ensured all clients of TPTCM had initiated first trimester prenatal visits according to ACOG guidelines.

 

Kansas Perinatal Quality Collaborative

Objective 2.3: Implement at least two quality cross-sector initiatives focused on improving maternal, perinatal, and infant health in partnership with the Kansas Perinatal Quality Collaborative (KPQC).

 

Role of State MMRCs & PQCs: State Perinatal Quality Collaboratives (PQCs) and Maternal Mortality Review Committees (MMRCs) function to improve maternal and perinatal health and believe that investing in the mother’s health leads to healthier birth/pregnancy outcomes. Roles are different but complementary.

• PQCs: Focus on efforts during the maternal and perinatal periods intended to improve birth outcomes and strengthen perinatal systems of care for mothers and infants
• MMRCs: Focus on reviewing maternal and pregnancy-associated deaths (pregnancy through one year after delivery) to identify gaps in health services and make actionable recommendations to prevent future deaths, improving maternal and perinatal health

 

 

As convener of the Kansas PQC and MMRC, KDHE Title V brings together the work of both entities to translate findings and recommendations to action, in partnership with other state organizations, such as American College of Obstetricians and Gynecologists (ACOG), March of Dimes, Kansas Hospital Association (KHA), and others. As the KMMRC focuses on identifying gaps in health services and making actionable recommendations to prevent future deaths, the KPQC focuses on acting on these recommendations by using data-driven, evidence-based practice and quality improvement processes (e.g., Patient Safety Bundles). This is intended to improve birth outcomes and strengthen perinatal systems of care for mothers and infants.

 

The Title V State Action Plan aligns with collaborative efforts underway for the Kansas Perinatal Quality Collaborative (KPQC). The KPQC is a panel of experts working to improve the quality of care for mothers and infants, affecting measurable improvements in statewide health care and health outcomes.

 

KPQC, KMMRC, KPCC & KCC Collaborative Efforts – Data to Action: Data from KDHE Vital Statistics and the KMMRC indicated that targeted interventions during the postpartum period should be the primary focus in order to improve maternal health outcomes. The KMMRC recommended that all providers thoroughly screen, provide brief interventions and make appropriate referrals based on screening results. Additional recommendations included improving communication and collaboration between providers, and dramatically increasing patient education and empowerment. Fall of 2020, the KPQC launched the Fourth Trimester Initiative (FTI) aimed at decreasing maternal morbidity and mortality in Kansas. The FTI focuses on quality care and provider communication and collaboration related to the transition from pregnancy through the postpartum period. As of July 2022, there are 28 birth hospitals and 2 birth centers enrolled in the FTI project, representing over 80% of births in Kansas.

 

FTI was designed to be a cutting-edge approach to study and improve the experience of mothers and families in Kansas. FTI focuses on chronic disease, behavioral health (mental health and substance use), breastfeeding, health equity, and access to care. Implementation of the FTI initiative positioned Kansas to enroll in the Alliance for Innovation on Maternal Health (AIM) in October 2021, for the Postpartum Discharge Transition AIM bundle, the only state to date to select this bundle. AIM is a national, data-driven initiative based on proven implementation approaches to improving maternal safety and outcomes in the country. AIM works through state teams and health systems to align national, state, and hospital level efforts to improve maternal and perinatal health outcomes. States that enroll in AIM receive access to 8 Core AIM “Patient Safety Bundles;” patient safety tools; and the “AIM Community of States.” This bundle will help to guide Kansas in implementation of FTI, including tracking progress measures and data collection, and leverage existing MCH investments around the KPCC model.

 

The KMMRC’s work and recommendations continuously guide the KPQC and MCH activities and initiatives. Title V has continued to advocate for policy changes, develop action alerts/bulletins, and identify and develop public and patient education initiatives for statewide implementation in response to data/findings. 2016-2020 findings indicate the majority of “pregnancy-related deaths” are related to chronic pre-existing conditions exacerbated by the pregnancy, or conditions of pregnancy that worsen in the postpartum period, where symptoms are not recognized as emergent or life threatening, and appropriate treatment is not sought/provided quickly enough – 79.3% were found to be preventable.

 

 

In response, the KPQC, in partnership with the KDHE Title V led Maternal Warning Signs Initiative (MWS), is finishing implementation of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Post-Birth Warning Signs (PBWS) Education Program. Training seats were purchased and initially made available for local Title V and MICEHV grantees, KPCC sites and partnering birthing facilities, and facilities enrolled in the FTI. Title V included resources from multiple other national campaigns such as CDC’s Hear Her Campaign and NIH’s Mom’s Mental Health Matters. State-developed and modified tools and resources targeting families and support persons are included. Additionally, there is a focus to address the specific needs of racially and ethnically disparate and low-literacy populations. The intent and purpose of this comprehensive statewide initiative is to provide consistent and repeat messaging across all health care sectors in Kansas. Phase II implementation, launched September 2022, has included providing AWHONN PBWS training seats and MWS resources to Title X, WIC and Community Health Worker programs. As of September 30, 2022, 209 individuals representing 45 local programs have completed the training. Work is also underway on the development of a Perinatal Hypertension Patient Education Guide as a supplemental component to the MWS Initiative and will include home blood pressure monitoring pilots through MIECHV and BaM/KPCC programs in 2023.

 

During 2016-2020, there were 105 pregnancy-associated deaths, which translated to a pregnancy-associated mortality ratio of 56 deaths per every 100,000 live births occurring in Kansas (KMMRC Infographic). Most pregnancy-associated Kansas deaths have been the result of motor vehicle accidents (20.9%), homicide (10.5%), and cardiovascular conditions (10.5%). The combination of the underlying cause of death determined by the KMMRC and underlying cause filed on the death certificate were used to categorize the type of pregnancy-associated death. Results indicate nearly one-third (27.7%) were caused by homicide, suicide, mental health conditions, or unintentional poisoning/overdose. Further, KMMRC determinations on circumstances surrounding death were obesity (contributed to 23.8%), mental health conditions other than substance use disorder (contributed to 22.9%) and substance use disorder (contributed to 26.7%). KPQC/KMMRC is promoting and incorporating universal education, and a universal screening, brief intervention, and referral to treatment (SBIRT) approach to identifying health risks across MCH programming and all perinatal service providers. The SBIRT process was used as the comprehensive, integrated, public health approach for the early identification and intervention of MCH patients exhibiting health risk behaviors.

KPQC FTI/Kansas Connecting Communities (KCC) Integration: Given KMMRC findings and overall prevalence and impact of untreated PMADs, KPQC FTI and Kansas’ Perinatal Psychiatric Access Program, KCC, a HRSA-funded Maternal Depression and Related Behavioral Disorders (MDRBD) program partnered to develop an intervention strategy. 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 (more information is available in the Woman/Maternal and Cross-Cutting Reports). KPQC and KCC launched a FTI Mental Health Technical Assistance cohort in September 2021. During this project, participating clinics received individualized implementation technical assistance from a team of perinatal behavioral health experts to develop and implement a maternal mental health screening policy, including identifying and providing needed staff training and ensuring workflows and resources are available to facilitate connections to a variety of effective treatment options. Participants shared their experiences with other FTI Enrollees to support replication. Fourteen FTI Centers applied and eight were selected to participate in the first cohort.

 

In addition to site-specific technical assistance provided, FTI Centers had the opportunity to participate in a 5-session peer learning series from April-June 2022.

 

 

The participating FTI Centers were asked to submit screening data each quarter as well as annually, in aggregate form, to measure implementation progress and refine practices. Requested data will include: (1) Number of perinatal women seen during the reporting period; (2) Number of perinatal women in the immediate postpartum setting who received at least one screening for depression, anxiety, and/or substance use using a standardized validated tool; (3) Number of perinatal women in the immediate postpartum setting who screened positive for a mental health condition and were referred or treated; (4) Demographic data, where available. The following graph reflects perinatal depression, anxiety, and substance use screening as well as referrals initiated based on “positive” screening results; for clarify, “Y3 Q4” is time period 7/1/2021-9/30/2021, “Y4 Q1” is time period 10/1/2021-12/31/2021, “Y4 Q2” is 1/1/2022-3/31/2022, and “Y4 Q3” is 4/1/2022-6/30/2022.

 

 

Data “dashboards” were also created for each participating FTI Center using their quarterly screening data. The “dashboard” was created in Microsoft PowerPoint and outlined each center’s quarterly screening data overview noting improvements and opportunities for improvements based on screening practices that were previously reported, a referral practices overview, screening data trends over time, comparison of the center’s screening data trends compared to the combined FTI Mental Health Technical Assistance cohort’s trends, and included training opportunities, resources, and contact information for further technical assistance and support offered by the KCC Team. This offered opportunity to reflect on screening practices, identify opportunities for improvement, and work with the KCC Team to make enhancements.

 

Birth Defects Surveillance Education: Since January 1, 2022, the program has successfully verified 128 core, 517 recommended, and 33 extended diagnosed birth defects. Starting September 19, 2022, core defects have been referred to internal and external partner groups: Kansas Special Healthcare Needs and Critical Congenital Heart Disease. These partners have ensured families and children affected by birth defects received proper education, outreach, and service navigation to effectively care for themselves.

 

Education material relevant to core, recommended, and extended birth defects is being created by the Kansas Birth Defects Coordinator in collaboration with the Education and Outreach Coordinator. These materials are not yet ready for distribution to families upon verification of the birth defect via traditional mail.

 

The Kansas Administrative Regulations (K.A.R. 28-4-520, 28-4-521) were approved and effective on October 7, 2022. Changes to those regulations included Neonatal Abstinence Syndrome (NAS) as a reportable condition. This change allowed both mothers and infants to get adequate follow-up care and intervention.

 

MCH Universal Home Visiting Initiatives

Objective 2.4: Increase the proportion of pregnant and postpartum women receiving MCH Universal Home Visiting services.

 

Title V staff coordinated a session on COVID-19 Innovative Strategies which included a panel of MCH home visitors sharing the strategies they developed and incorporated into their ongoing service delivery. Over 40 MCH grantees participated.

 

In August 2022, the MCH Program Consultant held an informational call for potential Universal Home Visiting Expansion Project (UHVEP) applicants to review the Request for Applications (RFA) and grant requirements. A total of 23 MCH grantees joined the call to learn about this opportunity.

 

Home Visiting Staff Training: Home visiting staff is required to complete online training through the Institute for the Advancement of Family Support Professionals which is a national home visiting competency training platform with existing content for use by anyone at no cost. A checklist of required trainings was provided to aid grantees in tracking progress.

 

MCH Intensive Home Visiting Pilot Project: In August 2022, Title V staff reconvened the partner organizations on this project after several positions turned over at KDHE. Title V staff from the Bureau of Family Health, KDHE Overdose Data 2 Action staff in the Bureau of Health Promotion, and staff from University of Kansas Lifting Young Families to Excellence (KU LYFTE) met monthly to discuss progress toward recruiting families for home visiting services when the infant has Neonatal Abstinence Syndrome (NAS). KU LYFTE navigators reported challenges with getting referrals from hospitals and birthing centers, so the group brainstormed other community organizations that serve families and infants with NAS. Nine LYFTE clients received intensive home visiting support.

 

Local MCH Agencies:

• Reno County Health Department provided home visiting services to 64 clients. Fewer community outreach events were held, than previous years due to COVID-19 but internal referrals from WIC increased to connect the clients with the service they need. Other sources of referrals included Hutchinson Regional Medical Center, Hutchinson Clinic OB/GYN and pediatric clinics. A nurse makes rounds to all new moms at the hospital and holds standing meetings with the other partners to work through any snags in the referral process or clients’ barriers to care.
• Riley County Health Department served 126 clients with home visits. They received an increased number of referrals from Women’s Health Group (WHG) due to a more streamlined referral process. Among those referrals, they observed an increase in the proportion of women in their first trimester. Riley County’s MCH nurse created informational packets about home visiting for WHG to share with their clients at the 10-week, 28-week, and postpartum visits. She also partnered with WIC dieticians on Ft. Riley to include MCH information with the WIC information that a person receives with they deliver at Irwin Army Community Hospital. A Riley County Health Department bilingual navigator/MCH home visitor assisted Title V staff in interviewing an MCH home visiting client about her experience with the program.
• Saline County Health Department provided home visiting services to 346 clients through an expansion of their home visiting service area to include McPherson County. They received the Universal Home Visiting Expansion Project grant to obtain the resources necessary to expand and enhance their home visiting service. They promoted their expanded availability directly to the community through television appearances and podcasts, and to providers during community partner meetings and mailed letters/brochures.
• Southeast Kansas Multi-County Health Department served 161 clients with home visits. The MCH Home Visitor for Allen and Anderson County worked with the Southeast Kansas Community Action Program, Early Head Start, Healthy Families America, Kansas Children’s Service League, and Community Health Center of Southeast Kansas (CHC-SEK) to foster bi-directional referrals based on a client’s needs at any given time. The Bourbon and Woodson County Home Visitor reached out to Ascension Via Christi Clinic in Ft. Scott and CHC-SEK's Pregnant Woman Clinic to establish a referral process for families who can benefit from MCH home visiting services. They also attended several community events to meet potential clients, including a Mommy & Me support group, health fairs and community baby showers. Several southeast Kansas home visiting clients expressed their gratitude to the home visitors, especially for the time they spent providing breastfeeding support during the formula shortage. Clients also expressed gratitude for the supplies and education they received at the community baby shower.
• Sedgwick County Health Department served 119 clients with home visits through their Health Babies program. They expanded outreach to Hunter Health Clinic which is a federally qualified health center in Wichita that was created to offer care to Native Americans, and today serves all people. Sedgwick County Health Department sets up a table at Hunter Health on Fridays when they have OBGYN walk-in hours for clients. It has helped build relationships with Hunter Health clients, so they become more comfortable and receptive to home-based services. Healthy Babies staff also visits the WIC clinic at their health department to facilitate a warm handoff from the WIC Coordinator to the Healthy Babies home visitor.
• Shawnee County Health Department served 72 home visiting clients. They continued to receive referrals from the hospital and WIC. They followed up on 439 postpartum referrals by phone or letter but must maintain a balance of the number of clients served to people on staff. Multiple home visitor positions have been vacant for an extended time. Their MCH RN completed Car Seat Safety Technician training and offered installation and assessment to families interested in a home visit.
• Seward County Health Department served 195 clients with home visits. They continued to receive internal referrals from WIC and the health department clinic. They started promoting home visiting services to one of the largest churches in Liberal and at the Liberal Area Coalition for Families.

 

Other Perinatal/Infant Health Initiatives

 

Pregnancy Risk Assessment Monitoring System (PRAMS): KS PRAMS continued data collection, including questions from supplements. Supplements for 2022 births included Opioid and Social Determinants of Health (SDoH) Supplements. 2022 birth data collection is on-going, and data will not be finalized until end of 2023.  PRAMS also continued to integrate strategies for promoting the survey/questionnaire to hard-to-reach populations (such as low-income minority mothers). Finally, KS PRAMS worked to strengthen their ties with MCH partners across the state to ensure that they have the data they need to improve the health of mothers and babies in Kansas.

 

Title V staff meet with the PRAMS coordinator and data manager regularly to review and discuss data. Title V staff collaborated with the PRAMS coordinator and data manager to make revisions to the Phase 9 PRAMS Questionnaire, scheduled to commence April 2023. The Kansas MCH Council meetings often involve PRAMS updates, sharing of data and stories/input from mothers, and requests for more information. The Women/Maternal and Perinatal/Infant workgroups from the Council will continue to serve in an advisory capacity for PRAMS. Perinatal/Infant Health Consultants will continue to work closely with the PRAMS/MCH Epidemiologist to incorporate PRAMS data into Action Alerts related to applicable Awareness Month and Health Equity topics that are shared with local MCH grantees and partner networks for promotion widely across the state.

 

Infant Mental Health/Social-Emotional Development/Early Childhood Literacy: Title V continued providing the Cuddle board book to home visitors and other MCH providers to encourage parents and caregivers to read and hold/interact with their infants. The board books were provided to the PRAMS Team for dissemination with PRAMS survey respondents. After receiving positive responses and requests to make more books available, Title V purchased several additional books and created a Materials Request Form for MCH ATL grantees to use to request materials, such as these books.