Addressing the needs of the child population, Kansas Title V strives to assure that children and families have access to and utilize developmentally appropriate services and supports, specifically through collaborative and integrated communities. This priority crosses various complex systems, such as early childhood and school-aged systems. There is a strong focus on developmental screening and comprehensive annual preventive service visits for the full child population. It’s known that once kids enter school, they are seen less frequently for preventive care services as many of the earlier well-child visits are aligned with recommended immunization schedules. In addition to screening and preventive services, Kansas strives to assure that our school-aged children (those ages 6 to 11) are accessing programs and activities that help them grow, learn, and be healthy. Work within this domain was affected by staff related changes. The Child and Adolescent Health Consultant position was officially filled in May of 2023 and further strategies to update and implement work in this domain is anticipated for the upcoming grant year.

 

NPM 6:  Developmental Screening (Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year)

ESM:  Percent of children who received a parent‐completed developmental screen during an infant or child visit provided by a participating program

 

National Performance Measure 6: Developmental Screening

 

The American Academy of Pediatrics recommends that all children should be screened for developmental delays during their regular well-check visits at 9, 18, and 24 or 30 months. According to the 2020-2021 National Survey of Children’s Health (two years of data combined), 40.2% (95% confidence interval [CI]: 31.1%-50.0%) of Kansas children, ages 9 through 35 months, received standardized developmental, behavioral and social screening using a parent-reported, standardized screening tool or instrument, compared to 34.8% nationally (95% CI: 32.9%-36.7%). However, the difference was not statistically significant. Subgroup information is not available for this indicator, due to small sample size. From 2016-2017 to 2020-2021 (two-year estimates), no statistically significant changes were observed in this indicator.

 

 

Weighted Percent of Children, Ages 9 through 35 Months, Who Received a Developmental Screening Using a Parent-completed Screening Tool in the Past Year, Kansas, 2016-2021†

* The estimates for 2016-2017, 2017-2018, 2018-2019, and 2019-2020 each have a confidence interval width >20% points, >1.2 times the estimate, or that is inestimable and should be interpreted with caution.

† Note: After 2016, state-level estimates were produced using two-year combined data.

The Annual Percent Change (APC) was not found to be significantly different from zero at the alpha = 0.05 level.

Source: U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), National Survey of Children’s Health (NSCH)

 

Based on the preliminary Annual Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Report from the Kansas Medical Assistant program, for the federal fiscal year 2022 (10/01/2021-09/30/2022), 37,383 (82.2%) of the 45,475 eligible children who should receive at least one initial or periodic screen, under 1 through 2 years old, received at least one initial or periodic screen.

 

Local MCH Reach: Based on SFY2023 MCH Aid-to-Local applications received: 43 of 61 grantees selected to work on Child 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: 

• The agencies that children with developmental delays are referred to had limited staff or no staff to accept the referral in a timely manner.

 

Developmental Screening Initiatives

Objective 3.1: Increase the proportion of children aged 1 month to kindergarten entry statewide who receive a parent-completed developmental screening by 5% annually through 2025.

 

Becoming a Mom (BaM): The Title V supported BaM program has integrated education and promotion of developmental screening. While developmental milestone related content has been an ongoing component of Session 5 on Infant Care, it has also recently been incorporated into the new Session 7, which convenes in the postpartum period. Postcards promoting the CDC Milestone Tracker App and website resources are provided to participants during the session. Guidance and resources were provided to BaM sites during the November 2022 in-person TA session for a January 2023 launch of Session 7.

 

Development Milestone Cards & Passports: Title V continued to disseminate the Developmental Milestone and Activity Postcards and Developmental Screening Passports previously created through the Early Childhood Comprehensive Service (ECCS) grant for MCH programs’ use with families. The 21 Developmental Milestone Postcards contain developmental milestones provided by the CDC and age-appropriate activities promoted by Vroom. The cards are shared with families to start a conversation about a child’s development and to encourage a fun learning experience at home. The Developmental Screening Passports are helpful tools for families in tracking the number of developmental screenings their child received. These resources can be downloaded from the Kansas Help Me Grow website.

 

Title V and the Kansas Early Childhood Developmental Services (Part C) Program is collaborating to update the Milestone Cards to align with CDC’s updated milestone by age checklist. Title V is also using the CDC’s handouts, especially the promotional flyer for the Milestone Tracker App, while resource updates are made.

 

The Children and Families Section Director and MCH Program Consultant developed and distributed an order form containing several different educational materials available at no cost to Aid-to-Local grantees from several programs including Family Planning, Pregnancy Maintenance Initiative, Teen Pregnancy Targeted Case Management, and Maternal Infant Early Childhood Home Visiting. The materials assist the grantees in providing screening and educational services to their clients. Developmental milestone cards and child development screening passports were included on the form. Several copies were mailed to grantees upon request.

 

Developmental Milestone Cards and Passports are used regularly by the KS-SHCN and Bridges care coordinators to help families with ideas for engaging with their young children and to monitor their developmental screening scores and screening timelines.

 

Healthy Child Development Programs: Title V continued promotion of early literacy programs such as the American Academy of Pediatrics’ Turn a Page, Touch a Mind; the Dolly Parton Imagination Library; and other interactive activities recommended by Learn the Signs, Act Early Campaign, with local MCH programs, home visiting programs, and healthcare providers. Title V continued to encourage other partners across the state to incorporate more early literacy and age-appropriate activities that help children develop healthy habits into their services. Through successful promotion, the Kansas Children’s Cabinet and Trust Fund has included information about Dolly Parton’s Imagination Library and 1-800-CHILDREN at the top of the main page on their website.

 

Utilizing Statewide ASQ Data: Title V, in partnership with other state agencies, entered into an agreement with Brookes Publishing to establish a statewide ASQ Enterprise for alignment of statewide data. This agreement now consolidates multisector development screens into one statewide hub account. Below is an image of the multi-sector structure that will be in place.

Technical assistance is provided to local MCH agencies on how to access the statewide ASQ Enterprise and guidance for documentation of developmental screenings and referrals into the shared data measurement system, DAISEY.

 

Local MCH Agencies:

• Barton County Health Department provided education and referrals for developmental screening in conjunction with lead screening appointments for 73 clients. They distributed the Developmental Screening Passports and Milestone cards provided by KDHE.
• Lawrence-Douglas County Health Department met their goal of engaging 75% of families in Kansas Early Childhood Developmental Services when developmental screening revealed the need for support. 100% (10/10) of children with an identified delay were referred to services (5 were referred to Kansas Early Childhood Developmental Services, 1 was referred to Head Start since the child was over the age of 3 years, and 2 were referred to their pediatrician for continued follow up). Additionally, all 10 children were still engaged with support services at the time of this report.
• Leavenworth County Health Department completed 72 well-child visits which included an ASQ-3 completed by the caregiver. MCH staff used the ASQ-3 to discuss concerns and make referrals for any children with delays. In addition, 146 other developmental screenings were completed.
• Marshall County Health Department completed 46 Kan-Be-Healthy physicals which encompassed 138 procedures, including 34 ASQ-3s, blood lead, hemoglobin, vision and hearing screenings.
• Rooks County Health Department provided developmental screenings to 67% of children receiving a well child exam. This was a 4% increase from their baseline of 63%. 64 children ages 1-11, were screened at a well child exam using Bright Futures guidelines (Pre-visit Questionnaire, Parent Handout, and Nutrition Questionnaire), Denver Development and/or Ages and Stages tools with appropriate referrals made at time of visit. MCH staff members gave families information on OneCare Kansas in order to improve outcomes for the families. All families were given a community resource list at their visit. Prior to each MCH visit or immunization visit, the clerk or RN check the child's status for immunizations, KanBeHealthy /well child/preventative care, and insurance coverage.

 

Healthy Activities for School-Aged Children

Objective 3.2: Increase the proportion of children, 6 through 11 years, with access to activities and programs that support their interests, healthy development, and learning by 10% by 2025.

 

Clinical School Health Consultant: Amidst the COVID-19 pandemic, Title V invested in a Clinical School Health Consultant to work closely with Title V, Kansas State Department of Education (KSDE), local school districts, and communities on health screenings, referrals, and other school health initiatives, such as school-based health centers. A Consultant was hired in February 2021 and predominately focused on coordinating COVID-19 guidance to schools and school districts across the state and updating information and resources as part of the School Nurse Toolkit. Due to personal reasons, the Consultant resigned from the position in August 2021. Title V attempted to recruit another qualified candidate, identifying a couple applicants who would have been excellent in the role, but state salary limitations prevented efforts from being successful. During this report period, Title V determined they would not fill the role, and the position was transferred to another function within the agency. Title V plans to continue partnering with local school districts, the Bureau of Health Promotion, KSDE, and the Kansas School Nurses Organization to align statewide messaging around child health initiatives. Local communities will receive guidance on healthy campaigns (e.g., Move Your Way, Let’s Move; Turn a Page-Touch a Mind; Dolly Parton’s Imagination Library), farmer’s market resources, and other food programs that are available. With the Child and Adolescent Health Consultant position vacancy, the Consultant Unit Director has supported planning and coordination for the 2023 Annual Kansas School Nurses Conference.

 

Inclusive School and Community Playgrounds: A call for investment to assist with funding for inclusive playgrounds was originally planned but due to staff and funding shortages, this was not able to be offered in 2022. This is still something the Title V team wants to offer when funding allows. This would be open to a variety of agencies (e.g., communities, schools, childcare facilities) who would like to make their playgrounds more inclusive for those with disabilities. Matching funds would be required for all applicants. Read more about this in the CYSHCN Plan.

 

Well-Child Preventive Services

Objective 3.3: Increase the proportion of MCH program participants, 1 through 11 years, receiving a quality, comprehensive annual preventive services by 10% annually through 2025.

 

KanBeHealthy Trainings & Bright FuturesTM: According to the 2020 National Survey of Children’s Health (NSCH) 78.3% of children visited a doctor, nurse, or other health care professional for a preventative check-up. This shows an improvement of 5.7% compared to the 2018 NSCH data for Kansas of 72.6%. KanBeHealthy (KBH) is the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit that provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, developmental, and specialty services. Kansas Medicaid utilizes Bright FuturesTM as the EPSDT/KBH standard of care, so all services are expected to be provided in accordance.

 

Title V received feedback from local health agencies indicating a need to re-train clinical professionals on conducting KBH visits. MCH funds were used to purchase a statewide license in 2019 for the most current edition of the Bright Futures Toolkit, eliminating cost as a barrier of conducting a complete and quality visit. The Child and Adolescent Health Consultant was the point of contact for this training for the state. The Consultant position has been vacant since November 2021, and the MCH Program Manager has filled in as capacity allowed to support local MCH programs and respond to questions or requests for technical assistance related to the use of the Bright Futures toolkit and materials. 31 local MCH staff completed the online training on the Bright Futures Tool and Resources Kit 2nd Edition. Upon completion of training, attendees were given access to online toolkit resources through a KDHE organizational account. This exceeds the number (12) who completed training in SFY 2021. The Bright Futures Resources and Toolkit training and access is promoted through email from KDHE and in the MCH Services Manual. Due to the Child and Adolescent Health Consultant vacancy, additional targeted technical assistance was not offered to local MCH programs during this report period.

 

The KS-SCHN program has continued to address the need for annual preventative care for their uninsured program participants by covering an annual well child visit, vision and dental exam, which mirrors the EPSDT benefit, through the Medical Services Direct Assistance Program (DAP-MS). Additionally, the importance of this yearly visit is reiterated to all families on the program, as this can be lost amongst the specialist and therapy visits their child requires. Some families have shared that they use their child’s specialist, for example the pediatric pulmonologist, for their child’s primary care in lieu of a pediatrician or family practice physician. These families are encouraged by care coordination staff to find a primary care physician in their area and are assisted in this search, upon request.

 

Title V and KDHE’s Local Public Health Program (LPHP) continued to utilize the Regional Public Health meetings and other communication venues for local public health administrators as an avenue for communicating updated changes on KBH visits and exams/EPSDT and other important issues related to child health.

 

Social and Emotional Development Milestones: An Age-By-Age Guide: The Bureau of Family Health has developed Social and Emotional Development Milestones: An Age-By-Age Guide to be used in conjunction with the Developmental Milestone & Activity Postcards. Since behavioral health was one of the most addressed concerns in the MCH Needs Assessment, capacity-building of the MCH workforce to address behavioral health concerns has become a top priority. The Guide is a resource that the MCH workforce can provide to families for their use, gain knowledge of healthy social-emotional development, and identify strategies to address concerns they may have. This approach will further increase early identification of social and emotional development delays, thus allowing interventions to occur earlier and families to be healthier. The Guide offers information on developmental milestones, guidance for talking to children about their mental wellbeing, and other tips for furthering a child’s development. There are 12 age groups, ranging from newborn to 18 years, in which Title V plans to partner with community organizations leading efforts on social-emotional health to provide programs with these resources/tools that support the encouragement and empowerment to build healthy relationships with parents/caregivers, teachers, mentors, health care providers, and peers. With the release of revised developmental milestones and tips to support early child development in February 2022, printing and promotion of the Social and Emotional Developmental Milestones resource was put on hold. In collaboration with the Kansas Early Childhood Developmental Services (Part C) Program, Title V is exploring options for creating a new Kansas specific Developmental Milestone resource that aligns with CDC’s updated milestone by age checklist. In the interim, Title V is using the CDC’s handouts, especially the promotional flyer for the Milestone Tracker App, for outreach/promotion with providers, programs, and communities.

 

Other Child Activities

 

Early Childhood Systems Building: The Preschool Development Grant Birth through Five (PDG B-5) funding provided through the Department of Health and Human Services (HHS) Administration for Children and Families (ACF) Every Student Succeeds Act (ESSA), was awarded to the Kanas State Department of Education in early 2020. The KCCTF, DCF, and BFH leveraged these funds to complete a statewide early childhood needs assessment and develop an early care and education system strategic plan. The initiative has been branded, All in for Kansas Kids, Ensuring Every Child Thrives.

 

The All in for Kansas Kids strategic plan provides equitable, high-quality care and education to all Kansas families regardless of where they live. The aim is to strengthen local systems by empowering communities with the flexibility they need to deliver connected, high-quality services. The plan is grounded in data to ensure that resources are strategically directed, and the work focused to achieve the greatest impact.

 

As one of four state agencies involved in the early childhood systems building initiative, KDHE serves as the lead agency to carry out certain work under the plan. There have been opportunities through several of these projects to provide support for families facing challenges around Adverse Childhood Experiences (ACEs), including education, screening, referral, and follow-up. These programs are:

• Bridges: Helping families navigate systems after early intervention and bridging transition gaps identified by the needs assessment
• Holistic Care Coordination: Establishing models of holistic, coordinated care in primary care settings across the state to support child development and growth
• Family Engagement and Leadership: Strengthening family voices in leadership through development and learning, program and policy advisory roles, and engagement.
• Peer to Peer Supports: Expanding peer to peer support and information sharing opportunities for families in Kansas.
• Child Care Systems Improvement: Increasing capacity of the childcare system and assuring equitable access to high-quality early childhood care and education programs.

 

Reports on these initiatives can be found in the Cross-Cutting Domain.

 

System Level Improvement Work: Ensuring a well-functioning system of care for all children is a goal of Title V. Work has been happening to improve coordination and referrals among children services including the following initiatives/activities.

Help Me Grow: In 2017, the Kansas Title V team worked with the National Help Me Grow (HMG) organization for Kansas to become an affiliate state. When Kansas was awarded the Preschool Development Grant (PDG) in 2019, the HMG work was move to the University of Kansas Center for Public Partnerships and Research (KU CPPR). During that time progress focused on the 1-800-CHILDREN call line, mobile app and a searchable website, along with a focus on strengthening work around Ages and Stages Questionnaires (ASQ). With the PDG award ending in April of 2023, HMG work will no longer be contracted out to our partners with KU-CPPR and began to transition back to the Title V team in FY’23. Monthly transition meetings between KU CPPR and the Title V leadership helped to form the HMG vision for the future.

The four core components to a strong HMG structure are: (1) Centralized Access Point: 1-800-CHILDREN was designed to assist families and professionals in connecting children and families to community resources; (2) Family & Community Outreach assists parents/caregivers and providers in understanding healthy child development and linkages to supportive services within their communities; (3) Child Health Care Provider Outreach supports early detection and intervention efforts while supporting providers in connecting families to appropriate community resources in their area. Providers are supported and encouraged to screen children birth through five using the Ages and Stages Questionaries' (ASQ), so any child showing a delay can immediately be referred to the right community resource for assistance; (4) Data Collection & Analysis is to assist with ensuring all other components are working effectively, help to identify gaps or barriers, and guide quality improvement work. These four components work cooperatively and interdependently with each other to form the HMG system.

Improving Connections to Services Through Referrals, a KSKidsMAP IRIS Project: Improving connections between primary care physicians, behavioral health clinicians, and community-based service providers is critical to supporting the holistic needs of children, adolescents, and families. As such, KSKidsMAP, Kansas’ Pediatric Mental Health Care Access, a HRSA-funded program, offered an Improving Connections to Services Through Referrals project. In partnership with the University of Kansas Center for Public Partnerships and Research (KU-CPPR), the Project supported pediatric primary care clinics in adopting use of the tool IRIS. The Integrated Referral and Intake System (IRIS), is a web-based communication and referral application used to support warm handoffs for families and improve communication among partnering service agencies. IRIS streamlines referral processes, closes communication loops, and gives physicians and clinicians a reliable measure of partners’ capacity.

 

Four clinics applied and were selected to participate in the project. Clinics planned their referral workflow, participated in IRIS training, and onboarded into the IRIS system over a four-month period (January – April 2022). Clinics provided feedback about their experiences and lessons learned during individual, semi-structured interviews in April 2022. Interview feedback themes include:

• Workflow and Planning: Clinics reported that designing their workflow and completing the onboarding process took approximately 2-6 hours of active planning time over the course of 1-2 months. Clinics with more staff reported more time needed to communicate the vision and workflow changes with all necessary staff. Challenges encountered during the onboarding process included: competing with other staffing and process changes within the clinic; effectively communicating with all staff to ensure they were prepared for workflow changes; and implementing a consent process that is easy for staff as well as sufficient for patient privacy for referrals from behavioral health. Three of four clinics designed a workflow that allowed for both incoming and outgoing referrals; one is making outgoing referrals only at this time.
• Clinic Impact: At the time of interviews, two of the four clinics had used IRIS to make and/or receive referrals. Key impacts reported by these clinics included: 1) Improved services for patients. Patients can be directly connected to services and perceive providers are responsive to their needs. 2) Increase in staff time required to gather consent prior to making a referral; decrease in referral coordination and follow-up time. 3) Increased interest in using IRIS to make better connections to early intervention services. 4) Recognition of need to better understand the available services in the community and need to initiate conversations with patients about their holistic needs.
• Lessons learned: All clinics indicated they intend to continue using IRIS and will evaluate the impact for their clinic over time. Based on experience with workflow planning, onboarding, and initial use, clinics shared the following lessons learned and tips: 1) Involve different parts of the clinic in the process. Get input from all staff. Keep them in the loop. Don’t discredit any staff, assume they don’t have input, or won’t be the person that makes a connection with families. 2) Have the workflow and consent process in place with all staff before you need it. 3) Start by looking at partners who are involved and what services they offer. Introduce the tool to the whole practice. Use your existing referral process. If you have a workflow in place, the tool can slide into place easily. 4) Connection with community partners and relationship building is key. Connect with partners in the network and participate in community meetings.

 

More information about KSKidsMAP can be found in the Cross-Cutting Report.

 

Systems Navigation Training for Families (SNTF): Parent/guardian education is provided through the SNTF. These one-day trainings presented by parents who have children with special needs, for parents who have children with special needs. When presenters are able to share their personal story, it opens the dialog for others to feel comfortable in sharing their personal journey without judgement. The SNTF provides a holistic approach in navigating all the various systems of care not just the medical but understanding that for a child to live a good life all the different systems need to work together. Information is shared during these trainings on the value of completing developmental screening on their child/children per the recommended screening guidelines. Read more in the CYSHCN Report section. 

 

KS-SHCN and Bridges: The KS-SHCN and Bridges programs provide parent/guardian education routinely as part of the holistic care coordination (HCC) model that both programs follow. Through HCC, children and families are closely followed and provided education as identified through the assessment process. Goals and objectives are collaboratively developed by the parents/guardians and their care coordinator and added to the Action Plan. As part of the HCC work families whose children are not currently receiving services for a developmental delay are encouraged and guided by the care coordinators on where they can complete a developmental screening for their child per the recommended time frames. If concerns are noted the care coordinators help guide them in next steps. Read more in the CYSHCN Report section.

 

KS-SHCN: The KS-SHCN program has continued to strengthen the referral process with other Bureau of Family Health Programs (e.g., Genetic/metabolic hearing, heart, newborn screenings and birth defects). The referral process has moved to a postcard first contact structure since many families do not answer unknow phone numbers. This was impeding the contact process. Now they are notified via a secure postcard that their child medically qualifies for the KS-SHCN program and that someone from the program will be call in a couple of days to answer questions and explain the benefit of the program. If no contact is made, follow up postcards are sent and an application. All data is tracking in a spread sheet that all programs staff making and receiving refers can access. Read more in the CYSHCN report.