PRIORITY: Developmentally appropriate care and services are provided across the lifespan

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)
NPM 7: Child Injury (Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9)
SPM 2: Physical Activity (Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day)

 

 

Local MCH Reach: During SFY2019, 59 of 71 grantees (83%) provided services to the Child population.

 

 

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)

 

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

 

Kansas has made strides in its ability to provide developmental screenings to the child population. According to the 2017-2018 National Survey of Children’s Health (2 years combined), 34.6% (95% confidence interval [CI], 23.3% - 48.0%) of Kansas parents reported they completed a standardized screening tool during a health care visit, compared to 33.5% (95% CI, 31.1% - 36.0%) nationally. However, the difference was not significant. In fiscal year 2019 (10/01/2018-09/30/2019), according to the Kansas Medical Assistance Program Annual EPSDT Report, 45,101 (91.3%) of the 49,417 eligible children, under 1 through 2 years old, received at least one initial or periodic screen. This data only reflects a portion of the children Kansas is targeting (e.g., activities are focused on all children birth to 5 years, rather than only on 9 through 35 months).

 

Help Me Grow Kansas: Kansans recognize the need for early identification of children at risk for developmental and/or behavioral challenges and for improved linkages between families and the services and supports they need. Help Me Grow (HMG) is a national framework that promotes integrated, cross-sector collaboration to build efficient and effective early childhood systems that mitigate the impact of adversity and support protective factors among families. HMG is a comprehensive approach to early childhood systems building. Successful implementation of HMG leverages existing community resources, maximizes opportunities, and advances partnerships working collaboratively through the implementation and cooperation of four core components: family and community outreach, provider outreach, a centralized access point, and data collection and analysis, as shown in the image to the right.

 

Title V initiated HMG efforts in February 2017 by convening a Core Leadership Team comprised of key program staff and partners from early childhood agencies to discuss how HMG fit into the existing early childhood vision for Kansas. In December 2018, Kansas became a HMG national affiliate state. The Kansas HMG mission states, “Kansas families have informed and equitable access to seamless, comprehensive supports and services that ensure the well-being and lifelong success of all children.” The HMG vision is “Connected Families Connected Communities: Every Child Thrives.” This has been the foundational framework for much of the early childhood systems building work (described later in this report). The Kansas effort is not exclusively about health care or developmental screening alone, even though developmental screening is a key component; rather it is focused on forging partnerships to collectively address issues families face in the context of their communities. The areas of focus for this project include access to quality care and services, social determinants of health, enhanced education and training, sustainability and accountability, and vulnerable populations. Community and state MCH and early childhood partners identified the need for resources around children’s developmental health and screening among three audiences: families, communities, and providers.

 

The Screen Early Start Strong website, originally developed through the KIDOS 1.0 project, was redesigned and integrated into Kansas Help Me Grow website (screenshot below) updated to reflect the interests and needs of these three groups. This site also contains information about the HMG Framework and pilot communities, information on how to contact the statewide centralized access point, the Parent Helpline (1-800-CHILDREN), and family and provider resources.

 

MCH/Early Childhood Comprehensive Systems Partnership: Kansas is one of 12 states that received an Early Childhood Comprehensive Systems (ECCS) Impact grant and is in Year 4 of a 5-year grant cycle. The Title V priority and measures for child health are directly aligned with the ECCS Impact project work. This alignment has allowed for focus and expansion on communities beyond the two primary target areas under the grant. Furthermore, Title V provides the overall “umbrella” vision for this work. Due to this broad, systems level thinking and view, critical systems improvements have been realized (HMG framework, integrated referral and intake system, state early childhood systems building, and more).

 

The ECCS Impact project, also known as the Kansas Initiative to Develop and Optimize Systems for early childhood (KIDOS 2.0), expands upon existing efforts and infrastructure to effectively coordinate, improve, and promote developmental health for infants and toddlers across a variety of health and early childhood support systems. The overall aim for the grant is to show a 25% relative increase in children birth through age 3 that are achieving age appropriate developmental health in all five developmental domains by July 31, 2021.This grant aligns perfectly with Title V National Performance Measure 6, Developmental screening, as well as ESM 6.1 – Percentage of children who received a parent-completed developmental screening tool during an infant or child visit provided by a participating program (9-35 months).

 

The ECCS/KIDOS work is focused in two place-based communities: Montgomery and Geary counties. In these communities, efforts are underway to build, pilot, and strengthen systems and coordination for developmental screenings and referrals across sectors in ways that meet the needs of both families and programs. Partners in both communities drive the Collaborative Improvement and Innovation Network (CoIIN) work that is central to ECCS Impact. As part of this CoIIN work and continuous quality improvement effort, community partners carry out Plan-Do-Study-Act (PDSA) cycles - rapid-cycle, small-scales tests of change ideas - to learn if these changes will bring about improvement. This community work is being done in tandem with a state advisory team, which utilizes the place-based communities’ findings to scale these efforts statewide. The number of developmental screenings reported in 2019 increased from 2018 in the areas where ECCS work takes place (576 in 2018 to 1,075 in 2019). Highlights of the reporting period activities in the communities and across the state thanks to Title V capacity and investments/resources are below.

 

The distribution and spread of best practice resources including the Developmental Screening Passports, Developmental Milestone Activity Cards, and the newly created “Implementation Tips for Developmental Activity Cards and Passports” to reach statewide.

 

 

These resources are used as appointment reminders for upcoming screenings/well child visits and for parent engagement opportunities (e.g., community health fairs, baby shower events). Geary County Hospital provided approximately 200 - 2-month developmental milestone postcards in the “new mom” packets. Early childhood programs, also in Geary County, gave out up to 40 passports each month during developmental screening events. As part of the 2019 KS Parent Leadership Conference held on November 15-16, Title V and other KDHE programs hosted breakout sessions about family self-care. During the session, families walked away with a bundle of developmental milestone postcards and a passport for each child. Approximately 200 passports and 100 bundles of postcards were given out. Feedback from the attendees were positive, indicating they would use the passports and loved the activities listed on the postcards and what to look for in their child’s development. The Developmental Screening Passports and Developmental Milestone Activity Cards were translated into Spanish to increase outreach to our Spanish-speaking population.

 

Title V is building from ECCS to impact the broader MCH work around developmental screening. The below table describes the distribution of ECCS materials with more than 1,527 pieces of developmental screening materials distributed through local and state level activity. Title V staff continue to receive requests from MCH Home Visitors and grantees for more materials, therefore the materials have been made available for free download on the HMG website.

 

 

ASQ Trainings & ASQ Screening Data: ASQ Screening data shows that through the KIDOS 2.0 project 1,075 screening assessments were completed during this project year. Of these screenings, 41 were conducted on infants (˂ 1 year) and 1,034 were children between the ages of 1 year through 5 years old. A total of 57.5% were Caucasian, 9.3% were Black or African American, 1.3% were Asian, and 15.5% reported more than one race.

 

Building on past work of KIDOS 1.0, to increase the number of health and early childhood practitioners trained on administering ASQ screenings, KIDOS 2.0, with support from the United Methodist Health Ministry Fund and partnership with the University of Kansas, provided ongoing ASQ trainings for any professional from a community agency that works with parents and young children under age 6, such as home visitors, public health professionals, clinical health providers, and early childhood educators. MCH local agencies are strongly encouraged to attend the training when offered.

 

During this program year, ECCS made great strides in building relationships with local medical professionals. With patience and the efforts of the local health provider champions, more medical facilities are being trained on the ASQ-3 and ASQ:SE tools. ECCS staff have also provided on-site technical assistance on how to incorporate development screening into policies and practices in these facilities. Between August 1, 2018 and July 31, 2019, 103 professionals attended an ASQ training. The following table outlines the impact of the trainings during the reporting period.

 

 

For years, funding from KDHE and the Children’s Cabinet has made it possible for programs and individuals across the state to enter ASQ screening results into the ASQ Enterprise, a secure online database for tracking ASQ screenings. Building from KIDOS 2.0 and HMG initiatives, Title V has been engaged in conversations among key state partners and backbone support from KU-CPPR, with Brooke’s Publishing regarding using the ASQ Enterprise to expand data entry into the existing system by bringing data together into a data warehouse, or “hub.” This would allow Kansas ASQ data to be available across all online/pro/enterprise accounts and moves the state forward in the development of an Early Childhood Integrated Data System (ECIDS), rather than increase the number of accounts across the state. While this is not a new goal for KS early childhood partners, current programming and leadership have brought about a renewed focus (specifically the alignment work and collaboration brought about with the work around HMG and the Preschool Development Grant activities). The broader vision is to inform services, connect parents to resources, and move the needle towards wide spread screening for all kids and earlier interventions. More information about the State wide ASQ Enterprise can be found in the Child Plan.

 

Developmental Screening Environmental Scan: Title V partnered with the Early Childhood Comprehensive Systems (ECCS) project to complete an environmental scan of developmental screening in the state in order to identify what entities offer screenings, the tools being used, and barriers preventing regular screening practices. Between November 2018 to April 2019, data from the developmental screening environmental scan was collected using the Qualtrics survey tool. A total of 550 unduplicated surveys were analyzed by early childhood partners representing all six regions of the state. A total of 491 respondents identified what provider settings across the state were utilized to complete developmental screenings.

 

 

The table below shows the developmental screening tools used by respondents. Results show most respondents utilize validated developmental screening tools. Title V staff are working on locating partners that are not using evidence-based tools to provide technical assistance and resources related to obtaining validated screening products for practice implementation.

 

The Medicaid Early Periodic Screening, Diagnostic, and Treatment (EPSDT), also referred to as KanBehealthy (KBH), guidelines recommend developmental screening at regular intervals including at 9, 18, and 30 months. The table below shows when respondents administer developmental screenings.

 

 

Aligning Developmental Screening Efforts: KIDOS 2.0 continued to align with Delivering Change and Lifting Young Families Towards Excellence (LYFTE) project (administered by the Bureau of Family Health) in Geary County. and with the MIECHV, LYFTE and Kansas Connecting Community (KCC) work in Montgomery County. As part of the efforts to strengthen early childhood systems, both communities are piloting the Help Me Grow (HMG) framework. The Montgomery County IRIS community expanded to include Crawford County which has resulted in 50 programs and 21 organizations. KIDOS 2.0 project staff attend and provide project updates at monthly meetings of the Montgomery County Coalition for Children, Families, and Communities, a group including all partners. By identifying overlapping activities and aims, KIDOS 2.0 has been able to capitalize on and expand existing work, further strengthen relationships with partners, and broaden reach across these communities. LYFTE in SEK aims to improve the lives of young families, parents and children, through an integrated approach to life-skills development, focusing on health, education, and employment. KIDOS 2.0 staff work with LYFTE navigators to ensure that information about children’s development is provided to parents in this program. Recently the state was awarded a maternal screening grant called Kansas Connecting Communities (KCC). KCC is being implemented initially in SEK (Montgomery, Labette, and Crawford Co.). KCC aims to improve the mental health and well-being of pregnant and postpartum women through increased screening, referral, treatment and recovery support services. KCC increases statewide access (with a regional approach) to screening, assessment, and treatment for maternal depression and substance abuse disorders. KIDOS 2.0 staff worked with KCC staff to integrate depression and substance abuse screening into the care coordination of SEK families.

 

Resource and Referral System – IRIS: The Integrated Referral and Intake System (IRIS) is a web-based communication tool, developed by KU-CPPR and supported in part by Title V. IRIS enables service providers in a community to make, receive, and track referral, essentially helping organizations connect families to providers, services, and supports in their community. IRIS empowers communities to build a family-centered network supported by common expectations. In addition to closing the referral loop, IRIS allows communities to collect and track data related to coordination and referral. This allows communities to identify where connections are not being made and where there are gaps in services or no services at all.

 

IRIS implementation in Kansas began with a MIECHV pilot and then spread to the Healthy Start project, with the two ECCS Impact and MCH communities, to support best practices in social service referral and coordination. Community conversations brought partners together to agree upon a common referral form and a set of community standards around IRIS use. Ongoing training and technical assistance are provided to organizations to ensure that IRIS is successfully incorporated into staff workflow. Data available for two IRIS communities follows.

• Southeast Kansas includes 75 programs offered by 30 organizations. There were 1,848 referrals between February 2017 (launch) and September 2019.
• Geary County includes 32 programs offered by 14 organizations. There were 1,403 referrals between February 2018 (launch) and September 2019. The Title V program continues to promote and support the use of IRIS at the community level. Several Local MCH agencies are a part of an IRIS community and MCH funds are used in some areas to support ongoing use and expansion. Below is the most current map of communities.

 

 

IRIS has helped align systems and increase coordination between public health and social services. Fourteen multi-sector IRIS networks currently span 20 rural and urban counties, and local public health programs have been early and enthusiastic adopters in nearly all of them. Public health organizations have initiated implementation n in half of all IRIS networks, identifying and engaging multi-sector referral partners and providing ongoing leadership to sustain and expand their local network. Referrals involving a public health program or partner have increased from 48% in 2018 to 62% in 2019. Key connections include WIC program referrals to dental providers, MCH referrals to early childhood programs, and health care providers to WIC. These referrals reflect network partners’ view of public health programs as critical access points to a holistic range of programs and supports. Local health departments also use IRIS to coordinate internal referrals, streamlining and easing patients’ experience accessing programs located under the same roof. The impact of IRIS across all community-based networks continues to grow. Total referrals doubled from 2018 to 2019 and, to date, 6,148 families have received 8,950 referrals, 42% of which resulted in the family engaging in services and supports.

 

Learn more about IRIS at: http://connectwithiris.org/what-is-iris/. Read more about the future IRIS work in the Child Plan. NOTE: MCH took a lead role in expanding IRIS to the behavioral health system during the reporting period in partnership with the KDHE Bureau of Health Promotion related to the CDC opioid response funding.

 

Local MCH Agencies: Local agencies provided developmental screenings to children served, birth to age 6 years. Many agencies use the Ages and Stages Questionnaire (ASQ-3; ASQ-SE/ASQ-SE2) for developmental screenings for ages 2-60 months old. For ages above 60 months, agencies use the Bright Futures Pediatric Symptoms Checklist (PSC). Local MCH agencies provided health screenings in accordance with the KanBeHealthy (KBH)/EPSDT guidelines during well visits/screenings. Developmental screening is a vital component to the continuum of care for children. The ASQ parent-completed questionnaire is intended to screen children for developmental delays in the areas of communication, gross motor, fine motor, problem solving and personal-social skills. Educational materials are provided to parents regarding developmental milestones during the visit.

 

A review of local MCH agencies revealed that six health departments were found to be conducting developmental screenings using tools not recommended by Kansas MCH (e.g., Denver products). MCH staff contacted these health departments to advise on utilizing the ASQ starter kit, training, and Enterprise. A few MCH local agencies using the ASQ are highlighted.

• Hays Area Children’s Center MCH home visitors completed 20 ASQ questionnaires with families with children less than one year of age. Information about the importance of annual developmental screenings was covered with 27 clients, resulting in one referral to the local Part C program.
• Pawnee County Health Department uses Ages and Stages parent completed questionnaires for developmental screening and Pediatric Symptom checklists for older children. Parents and youth are given safety information based on Ages and Stages guidelines, physical activity, and decreased screen time.
• Saline County Health Department provides ASQ-3 and KIPS (Keys to Interactive Parenting Skills) developmental screens to program participants. KIPS is a structured observation tool to assess parent-child interaction during play.
• Wabaunsee County Health Department staff have parents of infants complete the ASQ-3 developmental screening and counsel on the growth and development expectations for the next six months. Parent are provided with written and verbal health information and education.

 

Local agencies use an outline and multiple screening assessment tools to determine the needs of the child through direct services and indirectly through making referrals. Data is captured in DAISEY related to child development education provided during an MCH visit as well as referrals for developmental screening and/or early childhood intervention services that are appropriate to the needs of the child. Child development education and referrals are also provided to clients receiving MCH home visiting services.

 

Feedback from local agencies emphasized their need to receive additional training on KBH visits and the Bright Futures guidelines. In response to this need, a taskforce was formed to update the current KBH training to include up-to-date information, and more helpful tools and resources, see more about this training in the Adolescent Report.

 

MCH home visitors provide child development and child social-emotional development screenings for families they serve. Universal MCH home visitors provided developmental screening for participants who have continued to receive services and are not eligible for other community-based home visiting programs. Technical assistance and training were provided to local agencies regarding the protocol and expectations for incorporating the developmental screening (parent completed tool) into child well visits. Distinctions between the intent, purpose, and use of Bright Futures and the ASQ were provided to ensure local agencies were not using one or the other, but both per intent and standards related to monitoring and improving child health. Read more about the MCH Universal Home Visiting Program online at: http://kshomevisiting.org (click on Resources – Universal Home Visiting).

 

Beyond the Developmental Screen Project ECHO: Title V partnered with the University of Kansas Medical Center Project ECHO (Extension for Community Healthcare Outcomes) team to conduct a four-part ECHO series entitled, “Beyond the Developmental Screen.” The series was designed to assist providers (medical, educational and community) to understand what to do after a developmental screening indicates a potential delay or that a child might need additional help. Waiting for an appointment with a developmental pediatrician is not always the answer, there are many things that can be done more timely or that may not even necessitate an appointment with a specialist. The goal was to increase the system’s capacity to provide additional developmental evaluations and meet the needs of children with developmental delays, including providing access to services or diagnostic evaluations.

 

 

The ECHO team consisted of a developmental pediatrician, two social workers, a parent of a child with special health care needs, a nurse, and an ASQ screening expert. Each member of the team had experience with CSHCN and provided a valuable resource to all EHCO participants. This ECHO series occurred weekly throughout June 2019. Designed and led by Title V CSHCN, the objectives of the four sessions were: to raise awareness of the benefits of early screening, assessment and referral; provide an overview of screening implementation and the importance of working across systems to reduce duplication and assure screenings occur; help providers gain culturally competent communication strategies to help families better understand screening results; and share resources, referral points (specialty care, medical services, or community supports), and next steps when a developmental delay or concern is noted. Each session included didactic education, a case study, and allowed time for participants to ask questions and discuss.

 

The flyer for this event is located in the Supporting Documents included as part of this application.

 

Early Childhood Systems Building: Kansas received the Preschool Development Birth to Five Planning Grant (PDG B-5) in early 2019 to support the development of a comprehensive Needs Assessment and Strategic Plan for early childhood in Kansas. The Kansas Children’s Cabinet and Trust Fund, Kansas Department for Children and Families, Kansas Department of Health and Environment, Kansas State Department of Education, and other early childhood stakeholders partnered with Kansas communities to carry out this important work. Throughout the process, young children ages birth through five and their families were at the core of the work. The collective vision of Kansas being “the best place to raise a child” served as the foundation of the efforts, echoed in the aspirations of thousands of Kansans who contributed to our shared understanding of early childhood in our state. Yet the reality for many Kansas families does not match this vision.

 

To this end, the Needs Assessment for the Preschool Development Grant Birth to Five (PDG) began in January 2019, consisting of five core components:

• Review and analysis of existing needs assessments
• Collection and analysis of additional data
• Story collection (SenseMaker®) and community sensemaking
• Community Engagement Sessions
• Synthesis

 

A large focus of the Needs Assessment was widespread community engagement and creating a mixed-delivery system that is coordinated, collaborative, and supportive to family needs. While these efforts provided extensive data around the struggles families face throughout the state, it also included many stories of resilience and community commitment to supporting families. This launched Kansas onto a journey in which children and families thrive in caring and connected communities, high-quality early childhood care and education services are equitably accessible and available, the early childhood workforce is valued and respected, and our resources and investments align with our vision.

 

Over 6,000 Kansans contributed to the data collection process, ranging from personal stories and online insights, to over 100 in-person community conversations with parents and caregivers, business leaders and elected officials, educators and health care providers, and a wide variety of early childhood care and education professionals and champions. In addition to the voices of Kansans, the Needs Assessment also includes an analysis of 45 existing needs assessment reports, and data collected from three new surveys on the early childhood care and education workforce, facilities, and pre-k services.

 

Building on the Children’s Cabinet Blueprint for Early Childhood, promoting Healthy Development, Strong Families, and Early Learning, the new early childhood strategic plan was built from the analysis of thousands of data points, which resulted in two central messages:

• The experiences of families with young children in Kansas are shaped by where they live, both across the regions of the state and within their communities.
• Young children are growing up in families where basic needs are not being met.

 

Kansas Family Engagement and Partnership Standards for Early Childhood: Title V continues to be heavily invested and drive to streamline services and supports, improve early screening and identification, and assure needed services begin early in a child’s life. As part of early childhood systems alignment work, Kansas Family Engagement and Partnership Standards for Early Childhood was reviewed and updated to better align with all early childhood systems across the state. The KS-SHCN Program Manager participated in both the original development team and the revision team.

 

The standards focus on families as: Foundation, Communicators, Advocates, Partners, and Community Members. The goal of this project was to identify and implement evidence-based practices for each standard and to make sure the standards are reflective of all early childhood systems in Kansas. The Standards are:

 

 

Objective: Provide annual training for child care providers to increase knowledge and promote screening to support healthy social-emotional development of children.

 

Child Care Licensing Partnership: In partnership with the Child Care Licensing program, the MCH Child and Adolescent Health reviewed the components of the Screen Early Start Strong/Help Me Grow resources for those that were most appropriate for child care providers. As part of the KIDOS 2.0 initiative aimed to improve early identification of children with autism and other developmental disabilities, so children and families can get the services and support they need, the importance of assuring this information is accessible, available, and valuable for child care providers. An inquiry was also sent to CDC to gain access to the GroupSpaces site to begin customization of the materials to tailor them to Kansas. The Track Your Child’s Developmental Milestones brochure was printed in English and Spanish.

 

Approximately 4,700 licensed facilities serving 90,000 children between the ages of 0 and 4 years of age received the Milestones brochure with child care facility renewal licenses. The brochures were also provided to child care licensing surveyors to be distributed to applicants during orientation.

 

In addition to the child care licensing program participating in the ECCS/KIDOS 2.0 initiative with a focus on typical development and developmental screening, including social emotional health, the program has partnered with training organizations in the state to ensure training tailored for child care providers is made available. Hours do apply toward annual in-service training requirements. Title V partners with Child Care Licensing, Child Care Aware of Kansas, and Kansas Children’s Service League to ensure that up-to-date quality training opportunities are provide for child care professionals across the state both in-person and online. Examples of courses are listed below.

• Behavior & Guidance (ways to encourage positive behavior in young children)
• FLIP IT! (steps to help young children identify their feelings, learn healthy self-control, and reduce challenging behavior-feelings, limits, inquiry, and prompts)
• Understanding Temperaments of Young Children
• Supporting Relationships through Engaging Environments
• Play: Problems and Interventions
• Infant and Toddler Social-Emotional Development Series (three courses)
  • Social Emotional Development within Relationships
  • Responsive Routines, Environments and Targeted Strategies to Support Social Emotional Development
  • Individualized Intervention: Determining the Meaning of Behavior and Appropriate Responses

 

PDG Environmental and Workforce Survey: A total of 805 early childhood educators representing 84 Kansas counties took part in a statewide workforce survey. Professional voices representing early childhood convened to identify opportunities related to strengthening the early childhood workforce across the state.

 

 

According to the survey, 41% of the current workforce travels more than 25 miles for professional development trainings. Most respondents (81%) report accessing online training. Professionals are primarily focused on completing only the required trainings for licensing purposes due to the constraints of travel and cost. The survey also revealed that 78% of respondents have 15+ years of experience in the field and are looking for more intermediate or advanced training options (building on knowledge). However, there is still a need for more entry-level training options on trauma-informed care, infant-toddler care, and early learning standards. A summary of the workforce survey is available online here: https://kschildrenscabinet.org/wp-content/uploads/2019/08/NewSurveys_Summary.pdf.

 

 

 

NPM 7: Child Injury (0 to 9 years)

 

In 2017, rates of non-fatal injuries were highest among infants less than a year old (204.9 per 100,000), followed by children ages one to four (148.3 per 100,000), and children ages five to nine (80.1 per 100,000). Non-Hispanic black children had the highest rate of non-fatal injury hospitalizations at 190.4 per 100,000, which was nearly double the rates among non-Hispanic white (116.1 per 100,000) and Hispanic (88.7 per 100,000) children. Male children are more likely than female children to sustain non-fatal injuries (134.5 per 100,000, versus 102.5 per 100,000, respectively). Children in small/medium metro areas (155.4 per 100,000) had significantly higher non-fatal injury rates than children in large metro areas (93.9 per 100,000). Rate in non-metro areas was 112.8 per 100,000.

 

Objective: Increase by 10% the number of children through age 8 riding in age and size appropriate car seats per best practice recommendations by 2020.

 

State & Local Partnerships: Title V has a close partnership with Safe Kids Kansas, a network of partners and local coalitions across the state dedicated to preventing childhood injury. The Safe Kids Kansas Director sits on the KMCHC and provides technical assistance to local MCH agencies on activities such as coalition development and building a car seat program (including training for potential car seat technicians). There are 13 local MCH agencies (City-Cowley County, Dickinson County, Doniphan County, Elk County, Geary County, Johnson County, Marshall County, Mitchell County, Montgomery County, Morris County, Pottawatomie County, Republic County, Riley County) that serve as members of their communities Safe Kids coalition, have trained car seat technicians on staff, and/or assist in the community at car seat check and education events. Title V continues to work with Safe Kids to uncover where there are gaps in coverage of Safe Kids Coalitions.

 

 

Title V uses curricula from the Kansas Traffic Safety Resource Office (KTSRO) for car seat safety education at the local level. Data from the KTSRO 2019 Kansas Child Seat Belt Survey revealed both successes and potential areas where MCH can target over the next year to increase seatbelt use. Of the 20 counties completing the survey, 12 saw increased use of seat belts from the previous year. Wyandotte and Harvey counties reported the highest increase of seatbelt use for children ages 0-4 years (3.66% and 3.45%). Five counties showed an increase of 5% or above in seatbelt use for children ages 5-9 years (Harvey 13.87%, Reno 11.57%, Lyon 7.25%, Labette 6.19%, Seward 5.25%). Seatbelt usage is below average in many counties.

 

Local MCH Agencies: Many local MCH agencies provide education on car seat installation and safety, several agencies also have staff that are Child Passenger Safety Technicians. During the report period, 3,437 car seat safety/installations were provided to families served through MCH local agencies. One local agency, Morris County Health Department continues to have a strong Safe Kids Coalition in their community. Morris County MCH staff provide education and equipment/devices recommended by Safe Kids. They also have a Certified Car Seat Technician that installs and checks car seats during community outreach activities. Children are weighed and measured by the certified car seat technician and advised what type of car seat is recommended for each child. Certified car seat technicians with the Saline County Health Department provide training to clients on car seat safety during prenatal visits. The Cowley County Health Department MCH Home Visitor is trained as a Car Seat Technician and provides safety education on car seats, bicycle helmets, and carbon monoxide detectors to families in partnership with their Safe Kids Coalition. Kearny County Hospital staff participated in a Child Passenger Safety Technician training to assist parents with correctly installing child car seats. They have eight certified car seat technicians on staff. They hosted two free car seat check-up events with a local trooper. Car seats and booster seats were also available for children without proper seats.

 

Objective: Increase the proportion of families receiving education and risk assessment for home safety and injury prevention by 2020.

 

Safe Kids Kansas Collaboration: Title V staff continue to work closely with the Bureau of Health Promotion, Injury Prevention Program and Safe Kids to implement strategies in partnership with MCH grantees across the state. As part of the “shared work” across the MCH Action Plan and Safe Kids Strategic Plan, Title V staff work to increase the number of MCH grantees that lead or partner with local Safe Kids Coalitions. Local MCH agencies provided child injury education and information based on age and development of the child. Child injury education and installation of car seats is provided during developmental screenings, immunizations and home visits. Local MCH agencies collaborate with Safe Kids for injury prevention and program guidance on topics including water safety, sun safety, poison control, car seat safety, choking, fire, carbon monoxide, and prevention falls. Local agencies collaborate with local school districts to provide presentation to students regarding injury prevention. Safe Kids staff presented during a MCH Technical Assistance webinar to all MCH local agencies to educate about Safe Kids, discuss additional partnerships at the local level, where local Safe Kid coalitions are located and how to become a coalition in their community.

 

Poison Control Resources: Title V staff continued to promote poison control resources, including the Poison Diaper Bag (available in English and Spanish http://www.kumed.com/medical-services/poison-control/info-for-families). Home visitors are encouraged to increase awareness of the Poison Control Center Helpline (1-800-222-1222), Poison Control Center services and distribute poison control center resources such as “Congratulations on your New Baby” postcard with a Poison Help magnet attached and a “Medication Safety” postcard with metric medicine dosing syringes with the Poison Control Center Helpline number.

 

Smoke and Carbon Monoxide Detectors for Families of CSHCN: In partnership with Safe Kids the KS-SHCN program offered free smoke and carbon monoxide detectors to any family served by the program. Families are asked if they have these devices in their home. If not, KS-SHCN arranges for free detectors and installation. When a custom installation is required, due to the child’s health needs, KS-SHCN covers the installation expense through the Special Bequest fund. Smoke and carbon monoxide detectors are covered by Safe Kids. All families who request a detector complete a safety survey at the time the request is made and a second survey during the care coordination follow up call after installation has occurred. Additional collaboration has occurred between the two programs to secure appropriate car seats for children. Information is shared with families on where they can go to have car seats installed safely. Both programs are committed to working together to keep all Kansas children safe and healthy and to developing additional partnership projects in the future.

 

The KS-SHCN care coordinators share the Safe Kids safety tips with families and other information they learn with CSHCN families, and if appropriate, add child injury prevention goals to the child’s Action Plans.

 

 

SPM 2: Physical Activity (children 6 through 11)

 

Objective: Increase the percent of children participating in at least 60 minutes of daily physical activity per CDC recommendations to decrease risk of obesity by 2020.

 

The 2018 Physical Activity Guidelines for Americans recommend that children and adolescents ages 6-17 get 60 minutes or more of physical activity daily with most of the 60 minutes being either moderate- or vigorous intensity aerobic physical activity. The overall finding from the 2016*-2017 combined National Survey of Children’s Health, based on parent-reported data, was that 26.7% of Kansas children ages 6-11 were physically active for at least 60 minutes seven days a week. There were no significant disparities by gender, race/ethnicity, special health care needs, parental educational attainment, health insurance, household income-poverty ratio, household structure, or nativity.

 

Physical Activity Guidelines in Kansas Schools: Members of the KMCHC Child Work Group created an action plan to address the lack of physical activity in school-aged children in July 2019. Since this population spends most of their time in a school environment, the group reviewed resources on recommended recess policies based on Children Mercy Hospital’s “Creating Healthy Schools” program and created action alerts to support adoption of these policies.

 

The three main policies consisted of: providing at least one 20-minute elementary recess daily, providing 3- to 5-minute physical activity breaks during classroom time, and not using or withholding physical activity as a punishment. Letters in support of these policies were created for school superintendents, physical education teachers, and health department staff to discuss with parents during child well visit appointments. Dissemination of letters and resources are planned during the next grant reporting year.

 

 

Local MCH Agencies: Local agencies worked on initiatives to increase children’s physical activity. Local MCH agencies provided and distributed information on the importance of daily physical activity to clients regarding the American Academy of Pediatrics’ (AAP) Healthy Habits. Local MCH agencies promoted and encouraged physical activity among children and youth through counseling during developmental screenings, well child visits, home visits, immunization and WIC appointments. Families were educated at each visit about physical activity the entire family can focus on. Families were encouraged for children and adolescents to have at least 60 minutes of physical activity daily. Some local MCH agencies provided presentations to students in elementary and middle schools regarding physical activity. Other examples of local agency activities are below.

• Morris County Health Department collaborated with the Morris County CORE Coalition to promote the Walk KS Kids offered to children in elementary schools in the county. The agency annually offers a SAFE Kids Day featuring bicycle safety education to all 3rd grade students in their community. The mission of the Morris County CORE Coalition focuses on health and wellness, including drug and alcohol prevention.
• Sedgwick County Health Department home visiting staff work with families on developmental and physical activities to implement into their daily lives while interacting with their children. Home visiting staff use the developmental/physical activities provided by Ages and Stages Questionnaire to create action items for families.
• Wilson County Health Department partnered with the Cultivate Fredonia Healthy Living Action Team (HLAT) to engage community business and partners to conduct their Every Child Deserves a Bike program for the third year. During 2019, new bicycles and helmets were offered to all 2nd graders after a safety demonstration from local law enforcement.

 

Child Care Licensing: Child Care Licensing collaborated with the Bureau of Health Promotion to update a Physical Activity training available to early care professionals. The training included all ages and was developed using CDC standards and the Let’s Move! Child Care model (a national, web-based initiative that support child care providers to help kids get off to a healthy start). Participating child care providers who meet all 5 Let’s Move! Child Care goals can earn recognition. This training focuses on increasing children’s physical activity. Children ages 3-5 years should have two or more hours of active play time throughout the day. Children ages 1-2 years should have at least one hour of active play time throughout the day. Non-crawling infants should have short periods of “tummy time” every day. Training is offered to child care providers at no cost. The training was completed by 39 child care center staff and 25 in-home early care professionals from April 2019 through April 2020.

 

Objective: Implement collaborative oral health initiatives to expand oral health screening, education, and referral by 2020.

 

Kansas Perinatal Community Collaboratives (KPCC)/Becoming a Mom® (BaM) Program: The handout “Tips for Good Oral Health During Pregnancy” by the National Maternal and Child Oral Health Resource Center has been added as a supplemental handout to the BaM curriculum, as part of the “relaunch” of the BaM curriculum by KPCC. The partnership with Oral Health Kansas has led to the production of PowerPoint slides, video, and activity, all focused on the importance of good oral health in pregnancy, to be integrated into session one. Sites were encouraged to bring a partnering dental hygienist from their local community, who will serve as a guest presenter of the session content as available.

 

Child Care Licensing: Child Care Licensing continued collaboration with KCCTO to offer online trainings to support the health and wellbeing of children while in out-of-home care, specifically around oral health needs.

• Whole Tooth and Nothing but the Tooth: This introductory course assists early care professionals in understanding the importance of good oral health. Specifically, participants learn the benefits of keeping children cavity-free, strategies for the prevention of bacterial transmission, healthy snacking tips, and how to keep teeth clean and strong as well as information on group tooth brushing. Additionally, participants are provided with numerous resources to assist them in promoting oral health in the child care setting and home setting for families. Six training sessions were offered between April 1, 2019, through April 30, 2020. The training was completed by 93 child care providers from 38 of 105 counties.

• How Teething, Weaning and Oral Habits Impact Oral Health: This introductory course addresses three events that can have a significant impact on a child’s oral health. Topics included: what to expect during the teething process, how to properly wean infants and toddlers, the advantages and disadvantages of non-nutritive sucking, as well as ideas for discontinuation of oral habits such as thumb sucking and pacifier use. Eight training sessions were offered between April 1, 2019, through April 30, 2020. The training was completed by 160 child care providers from 49 of 105 counties.